70例原发性阴道癌治疗的临床报告

为了探讨原发性阴道癌的预后因素及治疗方法,对１９６３ 年１０ 月至１９９３ 年１ 月间收治的７０ 例阴道癌病例进行回顾性分析。鳞癌５４ 例,腺癌１６ 例,放疗者５７ 例,手术者１３ 例,根据病灶部位不同采取不同治疗方法。各期的５ ａ 生存率为：Ⅰ期６１．１％ （１１／１８） ,Ⅱ期４２ ．３％ （１１／２６）,Ⅲ期２８．６ ％（４／１４）,Ⅳ期１６．７％（２／１２）,Ｐ＜ ０．０５;鳞癌及腺癌的５ ａ 生存率分别为４８．１ ％ 及１２．５％ ,Ｐ＜０ ．０１;不同病理分级的５ ａ 生存率为：Ⅰ级５８ ．３ ％ ,Ⅱ级４４．４ ％ ,Ⅲ级２２．７％ ,Ｐ＞ ０．０５;不同阴道受侵长度的５ ａ 生存率为：１／３ 受侵者５２．５ ％ ,２／３ 受侵者２５．０ ％ ,２／３ 受侵者１６．７ ％ ,Ｐ＜ ０．０１;总的５ ａ 生存率为４０ ．０％ （２８／７０） 。结果表明,临床期别、病理类型、阴道受侵长度与预后相关,病理分级与预后无关;阴道癌治疗首选放疗,早发现,早治疗,合理的放疗剂量分布及适合的剂量是提高生存率的关键。     

甲状腺滤泡状癌的诊断与治疗（附16例报告）

甲状腺滤泡状癌的诊断与治疗（附１６例报告）德州市肿瘤医院外科杜宪武，王山城，阎汝萍我院１９８５年４月至１９９５年６月收治甲状腺滤泡状癌１６例，占同期甲状腺癌的１３．４％（１６／１１９），现报告如下。临床资料一、一般资料：本组男２例，女１４例。年龄１６...     

涎腺腺样囊性癌的放射治疗──附75例分析

１９７５年至１９８７年我院收治腺样囊性癌７５例。腮腺１２例，颌下腺１４例，舌下腺１例和小涎腺４８例。综合治疗５４例（７２％），单纯放疗１６例和单纯手术５例。５年随访率８７．９％，３、５和１０年生存率分别为７７．３％（５８／７５），６５．５％（３８／５８）和４５．２％（１４／３１）。单纯放疗、单纯手术和综合治疗５年生存率分别为３８．５％（５／１３），５０％（２／４）和７５．６％（３１／４１）（Ｐ＜０．０１），Ⅰ～Ⅳ期５年生存率分别为８１．３％（１３／１６）、７０％（１４／２０）、５３．３％（８／１５）和４２．９％（３／７）（Ｐ＜０．０５）。     

同时性食管贲门重复癌34例报告

１９７６年１月至１９９４年１２月，我们收治同时性食管贲门重复癌３４例，占同期食管、贲门癌病人的０．７％（３４／５０４０）。全组食管病变全部为鳞癌，贲门病变中腺癌３２例、恶性纤维组织细胞瘤和平滑肌肉瘤各１例。术前诊断率７０．６％（２４／３４），手术切除率７９．４％（２７／３４），术后１、３、５年生存率分别为８７．５％（２１／２４）、４５．０％（９／２０）和１８．８％（３／１６）。作者认为：注意各项检查的相互配合及仔细的上消化道全面检查能提高诊断率，早期手术并扩大手术范围可提高手术疗效。     

甲状腺乳头状癌雌激素受体的检测

目的：探讨甲状腺乳头状癌雌激素受体阳性表达的临床病理意义。方法：应用免疫组化ＳＰ法对８０太腺乳头状癌,３０例滤泡状癌及５０例癌旁正常甲状腺组织雌激素受体（ＥＲ）进行测定。结果：甲状腺乳头状癌、滤咆状癌及正常组织ＥＲ阳性率分别为６７．５０％（５４／８０）、２３．３３％（７／３０）、６％（３／５０）,乳头状癌ＥＲ阳性率显著滤泡状癌及正常组织,乳头状癌中原发癌ＥＲ阳性率显著高于复发癌,无淋巴结转移者ＥＲ     

原发性食管小细胞未分化癌5例报告及文献综合分析

原发性食管小细胞未分化癌少见。本文对从国内文献收集的１３７例加上本院的５例共１４２例进行分析。发病年龄以５０～６０岁多见，男女之～为３．７９：ｌ，肿瘤长径范围为１．２～１５ｃｍ，平均５．６ｃｍ。病变发生于食管上１／３者１０例（７．５％）、中１／３８６例（６４．２％）、下１／３３８例（２８．３％）。髓质型５０例（４１％）、蕈伞型２６例（２１．３％）、溃疡型２４例（１９．７％）、腔内型１６例（１３．１％）、缩窄型６例（４．９％）。统计国内文献各该组发病率为０．７％～５．１％，本院组为０．１％。本病预后主，在可评价疗效的１３１例中，中位生存期和１年生存率：全组为７．６个月和２９％；单纯手术６．３个月和１８．４％；单纯放疗１１．８个月和３６．６％；放疗加化疗１２．３个月和５０％；手术加化疗１２．２个月和３９．３％。单纯化疗和手术加放疗中位生存期分别为５．５个月和５个月，无１年生存者。根据资料，作者认为使用放疗或根治性手术加用化疗可以提高本病的疗效。     

38例子宫内膜间质肉瘤的诊断和治疗

目的：研究子宫内膜间质肉瘤的诊断和治疗方法。方法：对３８例子宫内膜间质肉瘤进行回顾性分析,其中Ⅰ期１３例,Ⅱ期１４全,Ⅲ期７例,Ⅳ期４例,３８例均经手术治疗。１０例术后补充放疗,１１例补充化疗,７例补充放疗加化疗。结果：本组病例总的３年及５年生存率分别为５４．３％（１９／３５）及４５．５％（１５／３３）,Ⅰ期病例３年及５年生存率分别为７６．９％（１０／１３）及６１．５％（８／１３）,Ⅱ期为５０．０％（７／１４）及４６．２％（６／１３）。结论：子宫内膜间质肉瘤的预后和组织类型、临床分期、治疗方法密切有关,综合运用手术、放疗、化疗及孕激素治疗能减少阴道及盆腔复发,提高生存率。     

甲状腺透明细胞癌四例

甲状腺透明细胞癌四例郭大庆戴梦华石胜军张希春甲状腺透明细胞癌临床少见。我们１９９５年经治４例，现结合文献复习，就其诊治问题作一初步探讨。临床资料本组病例全部为女性，年龄４１．６１岁平均４８岁。病史５个月～１８年，平均８．３年，皆以颈部肿块和（或）甲状...     

PCMF与CAF联合化疗治疗晚期乳腺癌疗效观察

我院从１９９４年到１９９５年１２月，用ＰＣＭＦ和ＣＡＦ联合化职方案治疗晚期乳腺癌４８例，效果满意，ＰＣＭＦ方案的有效率为６６．７％（１６／２４），其中ＣＲ为２９．２％（７／２４），ＰＲ为３７．５％（９／２４），ＣＡＦ方案的有效率为５８．３％（１４／２４），其中ＣＲ为２０．８％（５／２４），ＰＲ主３７．５％（９／２４），两种方案疗效无显著差别（Ｐ〉０．０５）。中位缓解期分别为７和８个月，两种方案相近     

年青人原发性肺癌的临床研究

收集我院１９６４～１９９１年间资料较完整的２７３例４０岁以下原发性肺癌患者进行临床分析，其中男性１９３例（７０．７％），女性８０例（２９．３％）；腺癌占４１．０％（１１２／２７３），鳞癌占４０．７％（１１１／２７３），小细胞未分化癌占１６．５％（４５／２７３）。非手术治疗的１５０例中，生存＜１年者达１１６例（７７．３％），＞５年者仅６例（４％）。而手术治疗的１２３例中，９０例进行了肺叶或全肺切除，     

甲状腺癌的再次手术治疗

目的：探讨甲状腺癌再次手术的必要性及其手术方式，分析再次手术的原因。方法：回顾性分析我科于1999年2月～2002年10月，45例甲状腺癌再次手术的临床资料。结果：首次行甲状腺肿块切除术的有43例，行甲状腺患叶 峡部切除术的2例。首次手术后的病理类型：乳头状腺癌32例，滤泡性腺癌12例，髓质样癌l例。根据外院手术治疗资料及我院术前彩色多普勒超声检查或CT检查结果，均再次行手术治疗，其中再次行甲状腺残叶 峡部切除术的28例，行甲状腺残叶 峡部 同侧功能性颈清扫的17例。再次手术后病理检查证实癌残留的29例(67．4％)，颈部淋巴结有转移癌的有12例(70．6％)，随访至今均生存。结论：甲状腺癌行局部切除术，残癌率高，再次手术是必要的。     

桥本病合并甲状腺肿瘤的外科治疗和临床特征分析

背景与目的:桥本病(Hashimoto's disease,HD)并存甲状腺癌(thyroid careinoma,TO的发病率在0.5%～38.0%之间,近年来呈显著上升趋势.基于上述原因,本研究旨在探讨HD合并甲状腺肿瘤的临床特征和外科诊治经验.方法:对本院1985年1月-2007年12月收治的因甲状腺结节行外科手术后经病理证实为HD的417例患者(包括93例HD合并TC患者)的临床资料进行分析.结果:与HD并存TC患者共93例,占22.3%;1995年以前HD与TC并存患者6例,占同期手术治疗HD病例的9.2%(6/65);1995年以后HD与TC并存患者87例,占同期手术治疗HD病例的24.7%(87/352),差异有显著性(P<0.05).并存TC病例中乳头状癌66例,滤泡状癌15例,混合性癌9例,黏膜相关淋巴瘤3例;全组中微灶癌43例,占并存TC病例的46.2%(43/93).手术方式包括一侧或双侧甲状腺全切除或次全切除、部分切除和活检术.结论:HD并存甲状腺结节的病例中TC的发病率近年来有明显增高趋势,临床上应警惕并存TC特别是微灶癌的可能性.     

The prognostic value of serum thyroid‐stimulating hormone level post‐lobectomy in low‐ and intermediate‐risk papillary thyroid carcinoma

Background: This study was undertaken to determine the optimal thyroid‐stimulating hormone (TSH) value associated with structural recurrence in patients with low‐risk or intermediate‐risk papillary thyroid carcinoma (PTC) who underwent thyroid lobectomy. Methods: Patients with PTC (n = 1047) who received thyroid lobectomy and central compartment node dissection were included in the study. Results: Structural recurrence occurred in 42 of the patients (4.0%), and no patient died of PTC. Multivariate analysis showed a primary tumor size (with a cut‐off of 0.85 cm) and serum TSH level measured 1 year after the initial surgery (cut‐off 1.85 mU/L) independently predicted structural recurrence. Conclusions: TSH levels during the early postoperative period need to be monitored and maintained in the lower normal range even in patients with low‐ or intermediate‐risk PTC undergoing thyroid lobectomy.     

Clinical outcome of anaplastic thyroid carcinoma treated with radiotherapy of once- and twice-daily fractionation regimens

BACKGROUND: The purpose was to assess local control, survival, and toxicity after radiotherapy in patients with anaplastic thyroid carcinoma, and to compare clinical outcomes between once-daily and twice-daily fractionation regimens. METHODS: A retrospective review of patients with anaplastic thyroid carcinoma (n = 47) who underwent external beam radiotherapy from 1983 to 2004 was conducted. Twenty-three patients underwent radical radiotherapy with a radiation dose > 40 Gy, and 24 patients underwent palliative radiotherapy with a dose < or = 40 Gy. Of radical radiotherapy, radiation was given with once-daily (14 patients) or twice-daily fractionation (9 patients; 1.5 Gy per fraction) to a total dose of 45-66 Gy. Most patients (37 patients; 78.7%) were followed to death. RESULTS: The 6-month local progression-free rate in patients who underwent radical radiotherapy was 94.1%, significantly higher compared with palliative radiotherapy (64.6%; P = .02). The median actuarial overall survival was greater in patients with radical radiotherapy (11.1 months) compared with palliative radiotherapy (3.2 months; P < .0001). The median overall survival in patients with twice-daily fractionation (13.6 months) was 3.3 months longer than patients treated with once-daily fractionation (10.3 months), but the difference was not statistically significant (P = .3). For patients treated with twice-daily fractionation, 3 patients had Grade 3 acute skin toxicity, and no patient had Grade 3 or higher esophageal toxicity. CONCLUSIONS: Radiotherapy can result in local control of anaplastic thyroid carcinoma. A twice-daily fractionation regimen is well tolerated and has a trend to longer survival, which deserves a larger study.     

Clinical Features and Prognosis of Patients with Benign ThyroidDisease Accompanied by an Incidental Papillary Carcinoma

Purpose: To investigate the clinical features and prognosis of papillary thyroid carcinoma (PTC) with abackground of benign disease. Method: A total of 709 patients with papillary thyroid carcinoma undergoingsurgical resection were analyzed retrospectively. In 147 patients who underwent surgery for benign thyroiddisease, incidental PTC (IPC group) were identified by intraoperative or postoperative pathological examinationof surgical specimens but were not detected by preoperative imaging studies. In the other group, according tothe pathological examination with or without co-existing benign thyroid disease, 253 cases were clarified asconcomitant PTC and 309 cases were clarified as dominant PTC. Results: Incidental PTC was more commonin women, about 85.7%, the mean age was 47.6±11.3 years old. Average tumor diameter was 4.4±2.2 mm,multiple lesions accounted for 12.9% (19/147), and the cervical lymph node metastasis rate was 6.1% (9/147).After radical resection 8 cases recurred, the median time of recurrence was about 12 months (0.5 to 162), therewas no tumor-related death. The tumor-free survival rates were 97.3%, 95.9%, 91.5%, and 79.3% in 1, 5, 10and 14 year respectively. Conclusion: Incidental PTC with a background of benign lesions is common, and thegenerally good prognosis can be attributed to tumor early detection and early treatment. On the intraoperativefinding of incidental PTC, lobectomy (unilateral) or total thyroidectomy (bilateral) should be the first choice, butwith a postoperative pathologic finding of incidental PTC, further treatment, such as completion thyroidectomyor immediate lymph dissection is not necessary. Central lymph node dissection is also not needed unlesslymphadenectasis is present.     

老年甲状腺癌的临床诊治（附58例）

目的:分析老年人甲状腺癌的临床病理特征。方法:选择新疆医科大学第五附属医院2001年至2015年间的58例老年甲状腺癌病例进行回顾性分析。结果:58例甲状腺癌中,乳头状癌75.9%（44/58）、滤泡性腺癌5.2%（3/58）、髓样癌15.5%（9/58）、未分化癌3.4%（2/58）。甲状腺癌扩大根治术复发率51.4%（18/35）,甲状腺全切术+患侧颈淋巴结清扫术复发率23.8%（5/21）。两组手术之间的复发率,差异有统计学意义（P<0.05）。5年生存率67.2%（39/58）。结论:老年甲状腺癌病人预后不良,年龄越大甲状腺癌恶性度越高,甲状腺癌全切术+患侧颈淋巴结清扫术优于甲状腺癌扩大切除术。     

Patterns of care for patients with primary differentiated carcinoma of the thyroid gland treated in Germany during 1996. U.S. and German Thyroid Cancer Group

BACKGROUND: To determine current patterns of care and disease characteristics for patients with thyroid carcinoma, a Patient Care Evaluation Study was initiated in 1996 in the U.S. and Germany. This project addresses ongoing concerns with respect to the diagnostic evaluation and treatment of patients diagnosed with thyroid carcinoma and raises questions concerning how physicians are interpreting current standards and acting on the basis of these recommendations. METHODS: Patients with primary thyroid carcinoma were entered into a prospective multicenter observational study with free choice of treatment (no control group) between January 1, 1996 and December 31, 1996 in Germany. This resulted in a total of 2537 cases under observation and analysis; 1685 patients had papillary carcinoma (66.4%), 691 had follicular carcinoma (27.2%), 70 had medullary carcinoma (2.8%), and 91 had anaplastic carcinoma (3.6%). The 2376 patients with carcinoma of either papillary or follicular histology were included in the current analysis. RESULTS: The major symptoms reported for patients with papillary and follicular thyroid carcinoma was neck mass (reported in 76% and 79%, respectively) followed by dysphagia (reported in 25% and 27%, respectively), stridor (reported in 9% and 14%, respectively), and neck pain (reported in 7% and 8%, respectively). Greater than 50% of the patients with papillary thyroid carcinoma were reported to have American Joint Committee on Cancer/International Union Against Cancer Stage I disease. Between 37-39% of the follicular carcinoma patients had Stage I and Stage II disease. Only slight differences in the diagnostic approach to patients with papillary or follicular carcinoma were noted. The majority of patients underwent an ultrasound of the thyroid region (78.1%), which was suggestive of carcinoma in only 39% of the cases. A thyroid scan was performed on 76.6% of patients, and the results were suggestive of carcinoma in 44.8% of the individuals. In contrast, fine-needle aspiration biopsy of the thyroid is highly recommended in the current Clinical Practice Guidelines (CPG) but results were obtained in only 27.4% of the patients. Total thyroidectomy without lymph node dissection was the most commonly used surgical procedure in the treatment of patients with papillary and follicular thyroid carcinoma. Only approximately 2% of patients at low risk in the group with Stage I disease were treated with a lobectomy. In 80% of the patients with Stage I papillary thyroid carcinoma and approximately 90% of those patients diagnosed with Stage II, III, and IV disease treating physicians chose to utilize radioiodine as adjuvant treatment after disease-directed surgery. External beam radiation was added to the treatment regimen for many patients diagnosed with Stage III and IV disease (30% in patients with papillary thyroid carcinoma and 33% in patients with follicular thyroid carcinoma). CONCLUSIONS: To the authors' knowledge no single effective diagnostic test for thyroid carcinoma currently is available and in the majority of cases a combination of ultrasound, thyroid scan, or fine-needle aspiration biopsy together with the clinical findings (e.g., thyroid mass) led to a diagnosis of carcinoma. The authors suspect that the high prevalence of concomitant pathologic findings such as goiter, even in the healthy population in Germany, reduces the accuracy of all diagnostic test methods and may account for the frequent use of imaging techniques. The majority of patients underwent a total or near-total thyroidectomy. Total thyroidectomy with radical lymph node dissection was used very frequently in those patients with papillary thyroid carcinoma (22%). German physicians tend to surgically treat early stage thyroid carcinoma somewhat more radically than recommended in the CPG. With respect to other treatment options employed as part of the first course of treatment, radioiodine appears to play the most important role. [See commentary o     

cN0甲状腺乳头状癌74例治疗分析

背景与目的:临床颈淋巴结阴性(cN0)甲状腺乳头状癌是否行颈部淋巴结清扫术、清扫范围以及清扫时机等是国内外学者长期争论的焦点.本研究通过对cN0甲状腺乳头状癌手术治疗结果分析,评价中央区淋巴结清扫的安全性和有效性,探讨cN0甲状腺乳头状癌患者清扫侧颈区淋巴结的必要性.方法:回顾性分析1999年1月-2006年12月间74例cN0甲状腺乳头状癌患者的手术治疗疗效.结果:74例患者均行中央区淋巴结清扫(Ⅵ区),其中32例阳性.32例中央区淋巴结阳性患者同期或分期行侧颈区淋巴结清扫(Ⅱ-Ⅴ区),其中19例阳性.中央区淋巴结转移与原发病灶大小、患者年龄无关,侧颈区淋巴结转移与原发病灶大小有关(χ2=5.96,P<0.05)、与患者年龄无关.当中央区淋巴结转移≥2枚时,侧颈区淋巴结转移率85.71%(χ2=4.61,P<0.05).结论:对cN0甲状腺乳头状癌建议行患侧腺叶和峡部切除加中央区淋巴结清扫术;对中央区淋巴结阳性(≥2枚)的患者可考虑行侧颈区清扫术.     

The incidence of hyperthyroidism in patients with thyroid cancer in an area of iodine deficiency

BACKGROUND: The incidence of hyperthyroidism among thyroid malignancy varies greatly depending on the geographical area and iodine intake. The aim of the study was to evaluate the association of hyperthyroidism and thyroid cancer (TC) in an iodine deficient area. PATIENTS AND METHODS: Medical records of 422 patients who underwent operation for TC between 1992 and 2000 in Ankara Oncology Hospital were reviewed. The characteristics of TC patients with hyperthyroidism were analyzed in respect to gender, age, histopathological type, thyroid function status, tumor size, extrathyroidal invasion, local recurrences, distant metastasis, AMES and MACIS scoring. RESULTS: In the present patient series, among 422 patients with TC, hyperthyroidism was found in 12 patients (2.8%). None of the patients had Graves' disease. Of 12 patients with hyperthyroidism, 9 patients had papillary carcinoma, 1 patient had follicular carcinoma and 2 patients had follicular variant of papillary carcinoma. The tumor was in the active nodule in 5 patients. CONCLUSION: The existence of hyperthyroidism among patients with differentiated TC is a clinical entity. Patients with hyperthyroidism and nodules require a careful approach in order to establish or exclude the possibility of TC especially in formerly iodine deficient areas.     

甲状腺乳头状癌手术方式的选择(附76例临床分析)

目的:探讨甲状腺乳头状癌的手术方式。方法:回顾分析我科1995年2月~2005年5月甲状腺乳头状癌76例病人的临床资料。结果:37例患者施行甲状腺腺叶切除,30例行腺叶加峡部切除术,全甲状腺切除术9例。,获随访62例,术后随访3月~10年全部存活,局部复发1例,颈淋巴结复发2例,无发生远处转移。结论:根据不同情况选择适宜的手术方法,可取得满意疗效。