肾母细胞瘤综合治疗模式分析

目的 探讨肾母细胞瘤的综合治疗模式,提高肾母细胞瘤的疗效. 方法 回顾性分析1981年7月至2010年6月55例肾母细胞瘤患者资料.术前超声引导下细针穿刺活检确诊18例,术后病理确诊53例.其中Ⅰ期7例,Ⅱ期19例,Ⅲ期21例,Ⅳ期6例,Ⅴ期2例;35例有组织学分型,其中预后良好型30例,预后不良型5例.55例患者中,行肾脏肿物切除术48例,局部扩大切除术2例,双肾肿瘤剜除术1例,肾肿物切除术加肺转移灶切除术2例,2例未行手术治疗;术前化疗18例,术后化疗40例,术后放疗12例.根据年龄、分期、组织分型、治疗方式、治疗时间段及是否放疗分组,应用Kaplan-Meier法比较各组3年和5年总生存率、2年无病生存率及1年无复发生存率,分析各分组因素与肾母细胞瘤预后的关系. 结果 55例患者治疗后3年和5年总生存率及2年无病生存率分别为77.6％、69.0％和52.4％,不同分期对总生存率(P=0.006)、单纯手术与综合治疗对无病生存率(P =0.004)、是否放疗对无病生存率(P=0.03)影响有统计学意义(P＜0.05). 结论 规范的多学科协作的综合治疗模式可以显著提高肾母细胞瘤疗效.     

脐尿管癌的临床特点及疗效观察

目的：探讨脐尿管癌的临床特点及疗效,提高对该病的诊疗水平。方法回顾性分析2002年1月至2013年12月15例脐尿管癌患者的临床资料、治疗方案和随访结果。结果病理证实黏液腺癌7例,腺癌6例,黏液腺癌伴尿路上皮细胞癌1例,小细胞内分泌癌1例。依据 Sheldon分期标准,Ⅱ期1例,ⅢA 期9例,ⅢB 期4例,ⅢC 期1例。行扩大性膀胱部分切除术14例,其中同时行双侧盆腔淋巴结清扫1例,行膀胱部分切除术1例。12例获随访,失访3例,随访时间3~67个月,中位随访时间36个月。1例小细胞内分泌癌患者接受 MEP 方案化疗,于术后3个月死于全身骨转移;1例术后1年复发,行经尿道肿瘤电切术并接受联合化疗及盆腔放疗,于术后1.5年死于远处转移;1例术后15个月和2年复发,行经尿道肿瘤电切术,于术后3年死于盆腔转移;2例分别于术后8个月和术后3年死于远处转移;7例随访至今,未出现复发及转移。1年生存率为83.3%(10/12),5年生存率为37.5%(3/8)。结论脐尿管癌是一种少见的高恶性肿瘤,发病率低,临床表现隐匿,预后极差。扩大性膀胱部分切除术为治疗脐尿管癌的主要术式。进行盆腔淋巴结清扫对肿瘤预后判断及辅助治疗选择有一定临床意义。根据病理及复发情况,可行化疗或积极补救性手术,以期延长患者生存期。     

脐尿管癌诊治的临床分析(附13例报告)

目的探讨脐尿管癌的临床特征、诊断与及治疗,以提高其疗效。方法回顾性分析13例脐尿管癌患者的临床资料。结果男11例,女2例,平均年龄48岁。Sheldon分期Ⅱ期1例,ⅢA期8例,ⅢC期2例,ⅣA期1例,ⅣB期1例。13例患者均获手术治疗,10例行膀胱扩大部分切除术1例因术后复发并远处转移于术后1年死亡,1例术后2年出现局部复发转移,予以MVAC方案化疗,化疗后未见缓解,半年内死亡。其余8例随访3个月至10年。中位随访时间为48个月,均未见复发。3例患者行根治性膀胱切除术,其中两例分别于术后3个月、半年内死于并发症,1例随访四年未见复发。术后1年、3年、5年生存率分别为83.1%、50%、25%。结论扩大膀胱部分切除术可作为治疗脐尿管癌的首选术式,首次手术彻底切除肿瘤以及对晚期和术后复发转移患者积极的综合治疗是提高脐尿管癌疗效的关键。     

不同治疗方式对巴塞罗那分期B期HCC患者疗效及预后影响因素

目的探讨肝切除手术与经肝动脉导管化疗栓塞(TACE)治疗巴塞罗那分期(BCLC)B期肝细胞癌(HCC)患者的疗效及影响患者预后的危险因素。方法选取168例BCLC B期HCC患者为研究对象,根据患者治疗方式分为手术组86例以及TACE组82例,对比分析两组治疗效果。术后对两组患者随访5年,应单因素及Logistic多因素分析影响BCLC B期HCC患者预后的危险因素。结果肝切除术组术后1、3、5年总生存率及无复发生存率分别为90.70%、48.84%、37.21%及32.56%,TACE组术后1、3、5年总生存率及无复发生存率分别为75.61%、29.77%、12.19%及2.44%。经Cox风险模型分析可知,TACE术、肿瘤直径、肿瘤数目是影响BCLC B期HCC患者生存率的危险因素,而无复发是BCLC B期HCC患者生存率的保护因素。结论肝切除术治疗BCLC B期HCC患者疗效较TACE显著,可有效提高后患者总生存率及无复发生存率。     

气管、隆突成形术14例临床分析

目的 探讨气管隆突成形术的临床效果。方法 气管下段癌行袖式切除及癌灶旷置、右支气管胸壁造口术各1例;双侧隆突切除术7例,单侧隆突切除术5例,其中保留术侧部分肺叶3例,切除术侧全肺9例。结果 无术中死亡,术后围手术期死亡1例,1年内死亡4例;生存1年9例,生存3年4例,生存5年1例。1例死于术中麻醉管理有关,5例死于心脑血管意外及肺功能衰竭,6例死于肿瘤复发或转移。结论 气管隆突手术创伤大、难度高,并发症和复发率高、生存率低,因而正确掌握适应证,简化手术操作,术中麻醉师与手术医师密切配合,术后积极防治并发症,辅以有效的放疗、化疗是提高此手术效果的重要措施。     

脐尿管癌的临床诊断及治疗

目的 探讨脐尿管癌的临床诊断及治疗方法.方法 回顾性分析北京友谊医院泌尿外科及北京市房山区第一医院泌尿外科1990-2011年收治的13例脐尿管癌患者的临床资料,并结合文献讨论其临床诊断与治疗方法.结果 13例患者中12例出现无痛性肉眼血尿,B超及CT均提示膀胱顶壁或前壁外囊性或囊实性肿物.9例患者行扩大性膀胱部分切除术,3例行膀胱全切术;3例术后行化疗,1例单纯行化疗.随访2个月～11年,9例单纯行手术治疗的患者中,6例2年内死于肿瘤复发转移,1例术后30个月死于肿瘤复发并远处转移,2例术后分别随访至今3年及6年肿瘤无复发;3例行手术加化疗患者中1例术后,1年复发转移死亡,2例术后分别随访至今4年及6年肿瘤无复发;1例单纯化疗患者2个月后死于肿瘤进展.结论 脐尿管癌首发症状多为无痛性肉眼血尿,手术方法以扩大性膀胱部分切除为主,术后应积极辅助化疗.     

小儿肝肿瘤的外科治疗

目的 探讨儿童肝肿瘤的临床诊断与治疗。方法 本组肝肿瘤患儿共23例，21例行手术切除。结果 术后病理：良性肿瘤10例，恶性肿瘤11例。随访0．5～3年，死亡2例。1例肝母细胞瘤死于肿瘤复发，腹腔淋巴结广泛转移、肺转移；另1例肝血管内皮肉瘤行肝移植术，术后1年肿瘤复发，再次行肿瘤切除术，术后1．5年复发，死亡。其余均存活。良性肿瘤术后3年生存率100％（10／10），生长发育良好；恶性肿瘤1年生存率100％，3年82％（9／11）。结论 儿童肝肿瘤多为先天性。恶性肿瘤体积大、生长快，需手术与化疗结合治疗，可以改善预后；良性肿瘤可完整切除，术后效果满意。     

成人肾母细胞瘤的诊断与治疗（附12例报告）

目的探讨成人肾母细胞瘤的诊断和治疗方法。方法回顾性分析12例成人肾母细胞瘤患者的临床资料。结果本组患者年龄16-63岁,表现为肉眼血尿2例,腰腹痛6例,4例为体检发现;术前诊断为肾肿瘤9例,肾盂肿瘤3例。12例均行手术治疗,术后病理均诊断为肾母细胞瘤。按照美国国家肾母细胞瘤研究组（NWTS）分期标准,本组分别为Ⅰ期5例、Ⅱ期3例、Ⅲ期3例、Ⅳ期1例。术后辅以放疗和化疗,平均随访41个月,3年生存率为48%。结论成人肾母细胞瘤是一种比较少见的恶性肿瘤,术前确诊困难,手术治疗并辅以放疗、化疗是其主要的治疗方法。     

成人肾母细胞瘤的诊断与治疗(附9例报告及文献复习)

目的探讨成人肾母细胞瘤的诊断和治疗方法。方法回顾性分析9例成人肾母细胞瘤的临床表现、分期、治疗及预后。结果9例患者按照美国国家肾母细胞瘤研究组（National Wilms Tumor Study,NWTS）分期：Ⅰ期3例,Ⅱ期3例,Ⅲ期2例,Ⅳ期1例。9例均行肾切除术,其中术前分别辅以化疗1例、放疗1例、肾动脉介入栓塞化疗2例。9例术后辅以放疗和化疗。8例获得随访,随访1-6年,7例生存。结论成人肾母细胞瘤是一种比较少见的恶性肿瘤,早期诊断、手术治疗、辅以放疗和化疗等可明显提高治愈率并改善其预后。     

50岁以下前列腺癌的治疗观点

作者对20例50岁以下前列腺癌的临床症状分期、分级和治疗结果进行了回顾性研究。65%患者被发现有包膜外扩散(C期和D期);治疗或采用根治性前列腺切除术、放疗和激素疗法中的任意一种,或采用三种联合疗法。6例B期患者中的5例及6例C期患者中的3例采用放疗,其余B期和C期患者采用根治性前列腺切除术。采用放疗的5例B期患者治疗均失败,肿瘤复发平均时间为3.2年。接受放疗的     

鼻内镜下切除鼻窦低分化神经内分泌癌5例报告

目的探讨鼻内镜下切除鼻窦低分化神经内分泌癌（ poorly differentiated neuroendocrine carcinoma, PNEC ）的疗效。方法2004年8月-2011年9月采用鼻内镜手术联合术后放化疗治疗鼻窦PNEC5例,术中根据肿瘤累及范围,开放相应的鼻窦,去除肿瘤及周围破坏的骨质。术中行颅底修补1例。结果手术时间40-180min,平均105min;术中出血量150—400ml,平均240ml。术后颅内感染1例,应用大剂量抗生素静点及椎管内注射后感染控制。5例随访4～34个月,平均20．8月,1例蝶窦肿瘤术后3个月侧颅底及颅内复发,术后4个月死亡,余4例无复发。结论鼻内镜下切除联合术后放化疗治疗鼻窦PNEC疗效确切。     

Endoscopic-assisted cranionasal resection of olfactory neuroblastoma

BACKGROUND: Cranionasal resection was first described in 1997 for the surgical resection of olfactory neuroblastoma. The endoscopic transnasal approach is used in cranionasal resection to replace the more invasive craniofacial resection. It has the advantages of avoiding the facial wound and its associated pain, swelling, and scar. The authors have routinely practiced cranionasal resection since 1996 for resection of all anterior skull base tumors in which the resultant skull base bony defect is limited to the nasal and sinus roof. The aim of this study was to review the results of cranionasal resection for olfactory neuroblastoma. METHODS: The results of cranionasal resection for olfactory neuroblastoma in six patients from 1996 to 2003 were reviewed. RESULTS: The Kadesh stages were 3A, 2B, and 1C. None of the patients had postoperative complications. Postoperative radiotherapy was given only to the patient with Kadesh stage C disease. There were no local recurrences. Two patients died of lung metastasis. CONCLUSIONS: Cranionasal resection is a safe and adequate procedure. Postoperative radiotherapy is not necessary after clear resection of Kadesh A and B tumors.     

鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术

目的探讨鼻内镜下经鼻腔直接入路行蝶窦及中颅窝手术的方法. 方法鼻内镜下经较宽大一侧鼻腔将中鼻甲向外推移,鼻腔扩张器扩大视野,直达并开放蝶窦前壁, 鼻内镜与显微镜联合切除病变. 结果 10例孤立性蝶窦炎术后症状消失.6例蝶窦囊肿、脑膜瘤均一次手术切除.32例垂体腺瘤17例全切除,12例次全切除,3例大部分切除,术后补充X刀治疗.48例术后随访6个月～3.5年,平均2.5年,蝶窦囊肿、蝶窦炎、脑膜瘤无复发,3例垂体腺瘤复发,无颅内感染并发症,无鼻腔粘连、鼻出血等鼻腔并发症. 结论鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术损伤小、出血少、手术时间短、效果好.     

枕颈融合联合鼻内镜治疗枢椎肿瘤

目的探讨枕颈融合联合鼻内镜技术行颈椎重建和肿瘤切除治疗枢椎肿瘤的疗效及其预后。方法2005年7月以来,共收治5例枢椎肿瘤,采取后路枕颈融合联合前路鼻内镜肿瘤切除术治疗。结果5例患者术后颈椎稳定性均得到满意重建,肿瘤切除充分。其中2例瘫痪患者术后JOA评分较术前明显增加。结论枕颈融合联合鼻内镜技术治疗枢椎肿瘤,肿瘤切除率高,并发症低,为高颈段肿瘤的治疗提供了新的临床思路。     

内镜经鼻蝶入路切除垂体肿瘤62例分析

目的探讨内镜经鼻蝶入路治疗垂体肿瘤的手术技巧及效果。方法对62例垂体肿瘤患者实施神经内窥镜经鼻蝶手术切除。结果肿瘤全切除45例,近全切除12例,大部切除5例。术后所有患者症状均有不同程度改善,有6例出现一过性脑脊液漏,9例出现尿崩症,其中1例需长期口服弥凝。无严重并发症发生。结论内镜技术经鼻蝶手术治疗鞍区肿瘤,具有对鼻腔正常结构损伤小、暴露清楚等特点,能提高肿瘤的全切率及手术的安全性。     

A Modified Combined Transseptal/Transnasal Binostril Approach for Pituitary Lesions in Patients with a Narrow Nasal Space: Technical Note

We describe a modification of the combined transseptal/transnasal binostril approach using a two-surgeon, four-handed technique (modified Stamm''s approach) for pituitary lesions in patients with narrow nasal spaces. This approach comprises of a transseptal route through one nostril and a transnasal route without harvesting a pedicled nasoseptal flap (NSF) through the other. On the transseptal side, the nasal septum was removed using an endoscopic septoplasty technique. On the transnasal side, the mucosa containing the septal branch of the sphenopalatine artery over the face of the sphenoid and nasal septum was preserved for harvesting the NSF if an intraoperative cerebrospinal fluid leak was encountered. This approach was performed in six patients with pituitary lesions, including four nonfunctioning macroadenomas, one growth hormone-producing macroadenoma, and one Rathke''s cleft cyst, all of which were associated with a severe deviation of the nasal septum and/or narrow nasal space. The meticulous and comfortable manipulation of an endoscope and instruments were achieved in all six patients without surgical complications. Our findings, although obtained in a limited number of cases, suggest that the modified Stamm''s approach may be useful for selected patients, particularly those with a severe deviation of the nasal septum, without considerable damage to the nasal passages.     

Olfactory neuroblastoma with spinal metastasis: case report

Olfactory neuroblastoma is a rare tumor of the nasal cavity. It is a locally aggressive tumor with local recurrence, and distant metastasis occurs in 22-40% of patients. We report a case of olfactory neuroblastoma with cauda equina metastases. A 49-year old male had undergone surgery twice previously; the first for olfactory neuroblastoma in October, 1990, and the second for its intracranial and orbital metastasis in September, 1999. He complained of lumbago in autumn, 2005 and MRI showed two enhanced lesions in the cauda equina. The mass was partially removed and histologically diagnosed as olfactory neuroblastoma metastasis. Whole-spine irradiation of 32 Gy and lumber-spine irradiation of 10 Gy were performed. The mass at L2/3 was disappeared after the irradiation although the mass at L4/5 was not changed in size. The patient was discharged without neurological deficit and is now kept under observation as an outpatient. Olfactory neuroblastoma with spinal metastasis is rare and only 11 cases have been reported in the literature. A very poor prognosis was observed in the patients of olfactory neuroblastoma with spinal metastasis. Olfactory neuroblastoma is a radiosensitive tumor, and radiotherapy for spinal metastasis was reported to be effective. However, effectiveness of chemotherapy was still uncertain. The patient with olfactory neuroblastoma should be observed carefully even though no local recurrence had been detected over 10 years. Radiotherapy and further treatment including chemotherapy should be considered in case of spinal metastasis.     

全麻支撑喉镜联合鼻内窥镜与单纯支撑喉镜下治疗声带息肉的疗效比较

目的对全麻支撑喉镜联合鼻内窥镜与单纯支撑喉镜下治疗声带息肉的疗效进行比较,探讨两种方法治疗声带息肉的优劣,为基层医院临床治疗寻求更好的治疗手段。方法选取2009-2013年我院收治的声带息肉患者60例,随机分成治疗组和对照组。治疗组在静脉复合麻醉下采用支撑喉镜联合鼻内窥镜行声带息肉摘除术,对照组则单纯采用支撑喉镜下行声带息肉摘除术,对两组患者手术结果进行评估。结果术后1个月随访,对鼻内窥镜复查结果结合患者的主观声嘶等症状改善情况进行比较,治疗组治愈率达93.3%,明显高于对照组73.3%,两组比较差异有统计学意义（x2=4.320,P〈0.05）。两组手术成功患者术后2-6个月随访均无复发。结论全麻支撑喉镜联合鼻内窥镜治疗声带息肉疗效确切,值得基层临床推广使用。     

Only used unilateral transnasal approach applied endoscopic sinus surgery for pituitary adenomas

Endoscope-assisted transnasal approach (TNA) for pituitary adenoma is a new alternative for Hardy's surgery (TSS). We performed TNA using only an endoscope through unilateral nostril. In our approach to sphenoid sinus, we apply method of endoscopic sinus surgery (ESS-TNA). We enter the sphenoid sinus directly through the natural ostium and do not brake the nasal septum nor vomer bone. Since September 2004 we had operated on 12 patients by endoscopic TNA. Six were non-functioning adenomas, and 6 were functioning adenomas. We are first to open the ethomoid sinus to make the space for middle concha to be displaced laterally. Secondary, we widen the natural ostium of the sphenoid sinus, retracting the middle concha laterally. The results were compared with those in 10 cases by TSS operated in our institute. Adenoma removal more than 80% was achieved in 58% by endoscopic TNA whereas in 50% by TSS. We had no case with postsurgical infection. Transient DI occurred in 4 cases and 1 case showed permanent. CSF rhinorrhea was seen in the case having small empty sellae in front of adenoma. For this case, we packed the fat tissue at the floor of the sella with endoscope under local anesthesia to close the fistula.Three cases that had hemianopsia before surgery showed the recovery postoperatively. In 6 functional adenoma, postoperative endocrinological examinations showed normalization in 3 cases and improvements in 3 cases. Postsurgical hospitalization days were 11.4 by endoscopic TNA whereas 15.4 by TSS. Our method showed same or better results than TSS in the removal rate and complication rate whereas the postoperative duration of nasal packing and hospitalization days were shorter than TSS.     

Olfactory neuroblastoma (esthesioneuroblastoma): report of six cases treated by a novel combination of endoscopic surgery and radiosurgery.

Microsurgical techniques have considerably improved the results of surgical treatment for esthesioneuroblastoma (olfactory neuroblastoma). Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and radiosurgery (gamma knife) is presented here. Six patients (3 males, 3 females) aged between 27 and 75 years (median 38 years) were treated between August 1993 and July 1999. Following paranasal and nasal endoscopic sinus surgery, marginal irradiation doses ranging from 16 to 34 Gy were applied radiosurgically involving up to 7 isocentres. At present, the median follow-up period is 57 months (range: 9 - 79 months). Without mortality, tumour control was achieved in all patients. One patient, who had to undergo additional craniotomy because of extensive neoplastic infiltration, developed postoperative liquorrhea. In another case the clinical course was complicated by a bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. However, a preoperative Karnovsky Index ranging from 80 to 100 % remained stable in four patients whereas an improvement was observed in two patients. Based on the favourable results observed so far, the combination of endoscopic sinus surgery and radiosurgery can be considered as promising new option for the treatment of esthesioneuroblastoma that merits further investigation.