肝门部胆管癌的诊断与治疗

肝门部胆管癌也称上段胆管癌。其位置较深在 ,局部解剖关系较复杂 ,因此 ,多数患者发现时已属晚期而不能根治。肝门部胆管癌可分为四类 :即息肉样或乳头状癌 ,结节状癌 ,硬化型癌及浸润型癌。前两种类型的胆管癌分化程度高 ,手术效果较好 ;后两种类型的胆管癌由于有浸润和扩展 ,且肝内外胆管组织受广泛侵犯 ,故手术切除率很低。临床分型 (Ｂｉｓ ｍｕｔｈ四型分型法 ) :①Ⅰ型 :胆总管上段癌 ;②Ⅱ型 :胆管分叉部癌 ;③Ⅲ型 :起始于左侧或右侧肝管的癌 ;④Ⅳ型 :广泛的肝外胆管癌。Ⅰ型、Ⅱ型早期可出现阻塞性黄疸 ,而Ⅲ型早期无黄疸 ,故一…     

27例肝门部胆管癌的手术治疗体会

目的探讨肝门部胆管癌的手术治疗方式。方法回顾性分析27例手术治疗的肝门部胆管癌患者的临床资料。结果27例中根治性切除者10例平均生存时间为23．7个月,8例肝肠内引流术者平均生存时间为7．5个月,剖腹探查取活检术者16例,平均生存时间为75d,无手术死亡。结论肝门部胆管癌的手术疗效与术式密切相关,做好术前评估、选择合适手术方式,可提高切除率及疗效。     

肝门部胆管癌的治疗研究进展

肝门部胆管癌（HC）在肝外胆管癌中发病率较高,可达75％。由于其发现时已处于中、晚期,故手术切除率低、预后差。虽然手术切除有一定疗效,但仍不能仅限于行局部切除或根治性切除术,还需要术前引流及术后与其他治疗相结合的综合治疗方法,以提高患者的生存率及生活质量。本文就其治疗进展作一综述。     

老年肝门部胆管癌24例外科诊治分析

目的总结老年肝门部胆管癌的外科诊治经验。方法回顾性分析我院1999~2004年收治的24例老年肝门部胆管癌的临床资料和随访。结果24例中手术切除15例,切除率为62.5%(15/24),其中根治性切除6例、姑息性切除9例。体内引流3例、体外引流4例、探查手术2例。术后并发症7例、1例死于肝肾功能衰竭。根治性切除1、2、3年生存率分别为83.3%、50.0%、16.6%;姑息性切除1、2年生存率分别为37.5%、12.5%;非切除引流者1年生存率为16.6%;探查性手术者生存期均<3个月。结论根治性切除优于姑息性切除,非根治性切除优于引流和探查。术前正确评价病情、术中选择适宜术式、术后并发症的合理治疗是提高疗效的关键。     

老年肝门部胆管癌的诊治特点

目的探讨老年肝门部胆管癌的诊治特点。方法回顾性分析111例60岁以上肝门部胆管癌的临床资料及随访情况。结果43例行肿瘤根治性切除,10例行肿瘤姑息性切除,20例行手术胆道引流,38例行内镜置管或PTCD引流。行根治性或姑息性肿瘤切除的患者,减黄效果、生活质量改善及术后生存时间均明显优于其他方法。结论对老年肝门部胆管癌的手术治疗应持积极态度。     

肝门部胆管癌行肝移植术7例

目的:报道7例不可手术切除的肝门部胆管癌患者行肝移植术,结合文献对其临床预后因素、临床结果进行分析.方法:回顾性调查研究分析2000-03/2010-12中国人民解放军海军总医院7例肝门部胆管癌行肝移植患者的临床资料,分析总结其临床病理特征、术后生存时间、肿瘤复发以及预后因素.结果:7例患者术前评估均不能达到根治性切除,均行肝移植术,术后病理诊断明确,无围手术期死亡,淋巴结转移者为57.1%(4/7),2例术前CA19-9100 KU/L.随访时间为7-108 mo,7例均死亡,肿瘤特异性死亡者5例,其中淋巴结阴性者[国际抗癌联盟(Union for International Cancer Control,UICC)分期均为2期]生存时间分别为108、37 mo,淋巴结阳性者(UICC分期,2例3b期,1例4a期)则分别为11、26、7 mo;而肿瘤非特异性死亡者2例,生存时间分别为18、34 mo.结论:对于不能外科手术切除且无淋巴结转移的肝门部胆管癌患者行肝移植术是一种有效的治疗手段.     

手术与介入治疗中晚期肝门部胆管癌的临床疗效对比

目前对于中晚期肝门部胆管癌患者首选根治性手术切除治疗,而对于已错过最佳手术时机或无法耐受手术的患者,则会选择介入治疗作为一种姑息手段〔1〕。本文拟对比分析手术与介入治疗中晚期肝门部胆管癌的临床效果。     

肝门胆管癌31例临床分析

肝门胆管癌因其位于肝门部,易侵犯肝动脉、门静脉,早期诊断困难,故其切除率低,预后差。自１９９２年以来,我院手术治疗肝门胆管癌３１例,取得了满意疗效。现报告如下。 一般资料：本组男２３例,女８例;年龄３０～７５岁,平均５４岁。３１例均表现为进行性加重的黄疸,其中２６例为无痛（或隐痛）性、无热性,另５例则有疼痛、发热。多数患者先以黄疸就诊传染科,后转外科。全部患者均为Ｂ（彩）超首诊,１８例后经ＣＴ、ＭＲＩ确诊。按Ｂｉｓｍｕｔｈ法分型,Ⅰ型（侵犯肝总管）Ⅱ例。Ⅱ型（位于左右肝管汇合部）６例。Ⅲａ型（侵…     

胆道支架放置术治疗肝门部胆管癌的体会

对１１例无法手术切除的肝门部胆管癌患者在行狭窄胆管扩张的基础上经引流管或ＰＴＣＤ窦道放置自制Ｚ形胆道支架和记忆金属网状支架，效果较满意，未发现严重并发症。认为术前了解病变部位及范围，选择合适的支架，术中根据病变部位安排支架放置顺序是手术成功的关键     

Pleiotrophin promotes perineural invasion in pancreatic cancer

Perineural invasion(PNI)in pancreatic cancer is an important cause of local recurrence,but little is known about its mechanism.Pleiotrophin(PTN)is an important neurotrophic factor.It is of interest that our recent experimental data showed its involvement in PNI of pancreatic cancer.PTN strongly presents in the cytoplasm of pancreatic cancer cells,and high expression of PTN and its receptor may contribute to the high PNI of pancreatic cancer.Correspondingly,PNI is prone to happen in PTN-positive tumors.We thus hypothesize that,as a neurite growth-promoting factor,PTN may promote PNI in pancreatic cancer.PTN is released at the time of tumor cell necrosis,and binds with its highaffinity receptor,N-syndecan on pancreatic nerves,to promote neural growth in pancreatic cancer.Furthermore,neural destruction leads to a distorted neural homeostasis.Neurons and Schwann cells produce more N-syndecan in an effort to repair the pancreatic nerves.However,the abundance of N-syndecan attracts further PTN-positive cancer cells to the site of injury,creating a vicious cycle.Ultimately,increased PTN and N-syndecan levels,due to the continuous nerve injury,may promote cancer invasion and propagation along the neural structures.Therefore,it is meaningful to discuss the relationship between PTN/N-syndecan signaling and PNI in pancreatic cancer,which may lead to a better understanding of the mechanism of PNI in pancreatic cancer.     

Midkine promotes perineural invasion in human pancreatic cancer

AIM:To investigate midkine(MK)and syndecan-3protein expression in pancreatic cancer by immunohistochemistry,and to analyze their correlation with clinicopathological features,perineural invasion,and prognosis.METHODS:Pancreatic cancer tissues(including adequately sized tumor tissue samples and tissue samples taken from areas less than 2.0 cm around the tumor)were taken from 42 patients who were undergoing a partial duodenopancreatectomy.MK and syndecan-3proteins were detected by immunohistochemistry using a standardized streptavidin-peroxidase method,and analyzed for their correlation with clinicopathological features,perineural invasion,and prognosis.Associations of neural invasion with aggressive characteristics of pancreatic cancer and the presence of perineural invasion were assessed by two independent observers blinded to the patient status.RESULTS:MK and syndecan-3 were found in 26(61.9%)and 24(57.1%)specimens,respectively.MK and syndecan-3 expression was associated with perineural invasion(P=0.018 and 0.031,respectively).High MK expression was closely associated with advanced tumor,node and metastasis stage(P=0.008),lymph node metastasis(P=0.042),and decreased postoperative survival at 3years(51.0%vs 21.8%,P=0.001).Syndecan-3 levels were correlated with tumor size(P=0.028).Patients who were syndecan-3 negative had a higher cumulative survival rate than those who were positive,but the difference was not significant(44.0%vs 23.0%,P>0.05).CONCLUSION:MK and syndecan-3 are frequently expressed in pancreatic cancer and associated with perineural invasion.High expression of MK and syndecan-3may contribute to the highly perineural invasion and poor prognosis of human pancreatic cancer.     

胰腺癌神经浸润体外模型的构建与观察

目的 构建胰腺癌神经浸润的体外模型,并对胰腺癌细胞的神经浸润现象进行初步观察.方法 将胰腺癌Capan-2细胞与大鼠背根神经节(DRG)置于Matrigel基质胶中共培养,分别建立以观察细胞集落面积(模型1)和观察细胞迁移距离(模型2)为主的两种模型.倒置显微镜下观察神经突及细胞生长情况,利用图像分析软件Image pro plus对图片进行分析.结果 共培养对神经突起生长无显著影响,无论是共培养还是单培养,DRG神经突均向四周呈放射状生长.培养模型中,Capan-2细胞朝向DRG方向生长迁移,接着包绕神经突呈纺锤状,并继续向DRG爬行.在模型1的共培养组,Capan-2细胞第5天时细胞集落面积为(309.28±19.11) μm2,显著大于单培养模型的(208.57±7.94)μm2(P＜0.01).在模型2的共培养组,Capan-2细胞第5天时向DRG方向迁移了(284.1±12.9)μm,而空白基质胶一侧,细胞迁移距离＜150 μm,二者差异具有统计学意义(P＜0.01).结论 本实验成功构建了胰腺癌神经浸润体外模型,为后续研究打下了良好的实验基础.     

胰腺癌伴神经浸润动物模型的建立

目的 建立胰腺癌伴神经浸润的动物模型.方法 32只裸鼠分为4组,每组8只.将人胰腺癌细胞SW1990、CAPAN-2、PANC1分别注射于裸鼠的坐骨神经周围,以不做任何处理的裸鼠作为对照组.观察术后裸鼠体质量变化、成瘤情况、成瘤时间、造模成功率等指标.结果 对照组裸鼠体质量增加,各癌细胞注射组裸鼠成瘤后体质量明显下降,甚至呈现恶液质,成瘤侧肢体活动受限.CAPAN-2注射组及SW1990注射组的8只裸鼠最终均成瘤,PANC1注射组只有5只成瘤.以肿瘤最长径长至约0.8 cm为时间截点,CAPAN-2注射组、PANC1注射组、SW1990注射组裸鼠的成瘤时间分别为（49.8±5.0）、（56.6±2.4）、（25.4±3.0）d.SW1990注射组成瘤时间最短,PANC1注射组成瘤时间最长,3组间成瘤时间的差异具有统计学意义（F=73.51,P＜0.01）.CAPAN-2注射组、PANC1注射组、SW1990注射组裸鼠神经浸润造模成功率分别为87.5％ （7/8）、20.0％（1/5）、50.0％ （4/8）.结论 成功建立了胰腺癌伴神经浸润动物模型,但不同的胰腺癌细胞系建立的动物模型具有不同的特点.     

Vascular invasion, perineural invasion, and tumour budding: predictors of outcome in colorectal cancer

Tumour stage reflected by the AJCC/UICC TNM system is currently regarded as the most powerful prognostic parameter in patients with colorectal cancer. However, additional histopathological markers are required to improve clinical decision-making with respect to follow-up scheduling and administration of adjuvant therapy. In this review we summarize the available literature regarding the prognostic impact of venous and lymphatic invasion, perineural invasion and tumour budding in colorectal cancer. Special emphasis was placed on patients with AJCC/UICC stage II disease, the risk of lymph node metastasis in early cancer and the prediction of local recurrence in rectal cancer. For each of the markers, the different methods of evaluation, implications resulting from different definitions used in previous studies as well as future perspectives are discussed in detail.     

The complementary role of lymphovascular invasion and perineural invasion in the TNM staging process of rectal cancer

The aim of this study is to clarify the association between lymphovascular invasion (LVI) and/or perineural invasion (PNI) and the clinical characteristics and prognostic importance of rectal cancer, to provide a basis for early adjuvant treatment of rectal cancer. We retrospectively analyzed patients diagnosed with rectal cancer. This study involved rectal cancer tissue samples were obtained by surgical methods. Data on histological form, tumor classification, tumor size, gross growth pattern, blood and lymphatic vessel invasion, and PNI of the slice by HE staining were obtained from pathological examination. Immunohistochemical analysis of tissue samples was performed to determine p53 and EGFR expressions. There were 330 rectal cancer patients included in the study. LVI and/or PNI can be used as a high-risk factor for the prognosis of rectal cancer, predict prognostic survival, and guide adjuvant therapy. The detection rates of LVI and PNI were 32.1% and 16.1%. Differentiation grade, Union for International Cancer Control staging, tumor-lymph node-metastasis staging are significantly related to LVI or PNI. Multivariate logistic regression analysis shows that poor differentiation and N ≥ 1 can be used as independent risk factors and predictive factors for LVI. At the same time, poor differentiation and T > 3 is an independent risk factor for PNI. Only poor differentiation is the risk factor for poor prognosis in Cox risk regression analysis. In addition, the simultaneous occurrence of LVI and PNI is an independent prognostic factor.     

胰腺癌513例神经浸润的病理分析

目的 探讨胰腺癌神经浸润的特征及其与其他临床病理参数之间的关系.方法 光镜下观察491例胰腺导管腺癌、22例其他胰腺恶性肿瘤、41例胰腺良性病变和21例慢性胰腺炎组织中的神经浸润状况,分析其与其他病理学指标的相关性.结果 胰腺导管腺癌的神经浸润率为74%,显著高于其他类型恶性肿瘤的23%(P＜0.01).导管腺癌癌细胞通常穿越外周神经中膜到达内部的神经纤维束,有的甚至横断整根神经纤维.但神经浸润与导管腺癌的分化程度无关.52%的胰腺导管腺癌癌旁组织呈慢性炎症改变,且程度严重,远高于其他类型胰腺癌(14%)及胰腺良性病变(15%)的慢性炎症发生率(P＜0.01).胰腺导管腺癌淋巴细胞浸润神经的发生率为65%,远高于其他恶性肿瘤的36%和胰腺良性病变的22%(P＜0.01).胰腺导管腺癌的神经浸润与癌旁慢性胰腺炎症以及淋巴细胞浸润神经均相关,但与淋巴结转移无关.结论 神经浸润是胰腺导管腺癌特征性的生物学行为之一.