产甲胎蛋白胃癌1例报告

甲胎蛋白(alpha-fetoproteins,AFP)是卵黄囊瘤、畸胎瘤、肝细胞癌等多种肿瘤的重要肿瘤标志物。自从1970年Bour-reillee等^[1]报道第一例产AFP胃癌(alpha-fetoproteins-produc-ing gastric cancer,AFPGC)以来,陆续发现一些胃肠道肿瘤可产生AFP,其中以胃癌报道最多,占全部胃癌的1%~6%^[2],但总的来说国内外报道较少,其中血清AFP阴性的产AFP胃癌更为罕见,本文报告1例如下。     

产甲胎蛋白胃癌2例报道及文献复习

目的:旨在加深对产甲胎蛋白胃癌(alpha-fetoprotein-producing gastric carcinoma,AFPGC)的诊断、治疗及预后的认识.方法:回顾性复习2001年11月～2002年6月87例血清甲胎蛋白(AFP)升高的住院患者病历资料,对其中诊断为胃癌患者的手术标本进行苏木精-伊红 (HE)染色及免疫组化染色.总结有关资料并复习相关文献.结果:血清AFP高于正常水平的患者中,2例病理诊断为胃肝样腺癌.AFP、癌胚抗原(CEA)、α1-抗胰蛋白酶(α1-AT)、α1-抗胰糜蛋白酶(α1-ACT)等免疫表型均呈阳性.常规化疗不能控制疾病进展,2者均出现肝转移.结论:AFPGC具有高度侵袭性,易出现肝转移,预后差.治疗首选胃癌根治术,术后推荐使用以丝裂霉素、伊立替康等为主的方案行辅助化疗,但仍有待发现更新的AFPGC综合治疗模式.     

Waist cancer: report of two cases

Saree is a type of female costume unique to Indian subcontinent. This includes a superficial cloth and a skirt underneath which is fastened securely to the waist by a cord. Persistent and long-term wearing of this costume has resulted in waist dermatoses. This waist dermatoses giving rise to malignancy is being reported here and 'saree cancer' is the term used to this entity of waist cancer. Here two cases of waist cancer are reported.     

Long-term survival after gastric cancer with liver metastasis: a report of two cases

We have experienced two cases of long-term survival after surgery for gastric cancer case with liver metastasis. One case was of a 66-year-old male patient diagnosed as having type 1 advanced gastric cancer located in the posterior wall of the lower body with liver metastasis. The stage of this case was P0H1N1T2M0 stage IV. This patient underwent distal gastrectomy with D2 lymph node resection, partial hepatectomy of the S3 region including the metastatic liver tumor and coagulation of metastatic liver tumors in the S6 and S7 regions. This patient was treated by intra-hepatic arterial infusion of 5-FU, CDDP and peroral administration of UFT after surgery. This patient has died at 3 years and 7 months after surgery. The other case was of a 55-year-old male patient diagnosed as having type 2 advanced gastric cancer located in the lesser curvature of the cardia with liver metastasis. The stage of this case was P0H1N1T3 M0 stage IV. This patient underwent total gastrectomy with D2 lymph node dissection, wedge resection of the S8 region including the metastatic liver tumor and coagulation of a metastatic liver tumor in the S4 region. This patient was treated by obstruction of the hepatic artery using coils, peroral administration of UFT, lentinan, MMC, and continuous low-dosage 5-FU and CDDP after surgery. This patient has died at 3 years and 6 months after surgery. These results suggest that for long-term survival in cases of gastric cancer with liver metastasis, hepatectomy or coagulation of the metastatic tumor with postoperative chemotherapy are indicated in cases that have no non-curative factors and only a few metastatic tumors.     

Unresectable advanced gastric cancer effectively treated by combined chemo-immunotherapy: a report of two cases

We have experienced two cases of unresectable advanced gastric cancer effectively treated by chemo-immunotherapy. One case was of a 68-year-old male patient diagnosed as having inoperable advanced gastric cancer with liver and lung metastasis. This patient was treated by combined chemo-immunotherapy of MMC 10 mg/M, 5'-DFUR 800 mg/day and OK-432 5 KE/2W. At 6 months later, a computed tomography (CT) scan and upper gastrointestinal (GI) series revealed that the metastatic liver tumors and stomach lesion were remarkably decreased in size, and endoscopic biopsy confirmed no cancer cells in the stomach lesion. Moreover, the metastatic lung tumor had disappeared on chest X-ray. The other case was of a 68-year-old female patient with unresectable advanced gastric cancer treated by combined administration of MMC 10 mg/M, 5-FU 200 mg/day and OK-432 5 KE/2W. At 2 months after commencing the treatment, there was a reduction in the serum carcinoembryonal antigen (CEA) level. At 6 months later, the CEA had decreased to normal, the primary and metastatic sites had completely disappeared on CT, and endoscopic biopsy confirmed no cancer cells in the stomach lesion. This patient has survived to date for 5 years and 6 months after commencing the treatment. These results suggested that combined chemo-immunotherapy of MMC, antimetabolite, and OK-432 was an effective treatment for unresectable advanced gastric cancer.     

Intracranial metastasis of prostate cancer: report of two cases

Metastases from prostate cancer to the brain are very unusual and are seldom reported in the clinical literature. We report 2 cases of advanced stage prostate cancer with intracranial metastasis. One patient developed intracranial metastasis 5 years after step-up treatment. He had hormone refractory prostate cancer with a high level of prostate specific antigen (PSA). Unfortunately, he died of sepsis 3 weeks after craniotomy. The other patient with various neurologic symptoms and a normal PSA level responded to hormone therapy well. He had an uneventful postoperative course and has survived for more than 21 months after surgery. We also reviewed the literature and suggest that aggressive treatment, including neurosurgery, could improve the survival of certain patients with advanced prostate cancer with intracranial metastasis.     

86例早期胃癌预后因素分析

目的：探讨分析对早期胃癌预后影响的因素。方法：回顾性分析1997年1月-2007年1月我院收治86例早期胃癌患者的临床资料及术后随访资料,统计分析早期胃癌影响预后的因素。结果：本组早期胃癌病例5年生存率为90．9％,其预后主要与肿瘤大小、淋巴结转移相关,肿瘤直径〈2cm、2～4cm、〉4cm以上5年生存率分别为100．0％、71．6％,50．5％,有淋巴结转移者5年生存率（73．4％）明显低于无淋巴结转移者（91．3％）。相关性分析表明年龄、性别、病理分型与预后因素问无明显相关性。结论：毕I或毕Ⅱ式根治术后患者,淋巴结转移、肿瘤大小是早期胃癌重要的预后因素,对肿瘤直径大、淋巴结转移广泛的早期胃癌患者应采用以根治术为主的综合治疗方案,对指导早期胃癌预后及手术选择有实际应用价值。     

早期胃癌51例临床诊治分析

目的 探讨早期胃癌的治疗效果。方法 对1989年2月至2000年8月间早期胃癌患者51例的临床资料及生存预后的情况进行回顾性分析。结果 早期胃癌大体类型以凹陷型多见，其次为浅表型，全组淋巴结转移率为13．73％，早期胃癌最常见症状是上腹不适或隐痛，3年和5年生存率为98．04％和92．15％，全组术后复发率为11．7％。复发均发生于D1术式。结论 早期诊断、早期治疗是提高生存率的关键，建议对早期胃癌尤其是癌细胞分化差侵犯黏膜下层者行D2术式。     

残胃癌32例临床诊治分析

[目的]研究广义残胃癌(gastric stump cancer,GSC)的预后情况和影响预后的相关因素.[方法]回顾性分析1999-2009年期间收治的32例GSC患者临床资料,所有病例全部经胃镜和CT确诊.发病距前次手术时间平均(375.75±131.47)月,其中消化性溃疡(411.56±109.47)月,胃癌(...     

早期胃癌93例临床与病理分析

目的探讨早期胃癌的临床与病理特点,提高早期胃癌的检出率,为进一步防治早期胃癌提供依据。方法收集93例早期胃癌患者的临床和病理资料,观察发病部位、组织学分型、浸润深度以及淋巴结转移程度等相关病理学指标。结果早期胃癌好发部位以胃窦居多,组织学分型多见于中分化和高分化,多为黏膜内层癌,早期胃癌淋巴结转移率为7.53%。结论浸润深度、伴随疾病、淋巴结转移等是早期胃癌组织病理学诊断的重要指标。     

早期胃癌的诊治(附15例临床分析)

目的：总结15例早期胃癌临床特点，诊治经验，探讨治疗新进展。方法：对15例早期胃癌诊治进行回顾性总结。结果：早期误诊率达66．7％，15例手术，术后存活5年以上13例（86．7％）。结论：早期胃癌缺乏特异症状，早期误诊率高，内镜下平坦型胃癌最易误诊，作认为D2术应为根治EGC的标准术式，内镜下粘膜切除术（EMR），保留迷走神经胃段切除术有利于保护患术后生存质量。     

56例早期胃癌临床病理分析

胃癌是我国最常见的恶性肿瘤 ,早期诊断和手术治疗是改善胃癌预后的关键。早期胃癌术后平均 5年生存率为 95 .2 % 〔1〕。作者对本院 1989～1998年经手术切除并病理证实的 5 6例早期胃癌进行回顾分析 ,旨在总结经验、掌握早期胃癌临床病理特点及提高检出水平。临床资料1.性别与年龄 :5 6例中 ,男 34例 ,女 2 2例 ,男女比为 1.5 5∶1。年龄 31～76岁 ,平均 5 4.6岁。发病年龄以 31～6 0岁者居多 ,占 73.2 %。2 .临床表现 :本组所有患者术前均有数月至 2 0余年不等的胃病史 ,主诉上腹隐痛不适 (包括胀满感 ) 5 0例 ,黑便 14例 ,泛酸 7例 ,食欲…     

Infantile hepatic hemangioendothelioma presenting as early heart failure: report of two cases

Hepatic hemangioendothelioma is rare. We report on hepatic hemangioendotheliomas in 2 young infants, with initial manifestations of respiratory distress and congestive heart failure. Serum alpha-fetoprotein (alphaFP) level was as high as 26,343 microg/l at 14 days old in 1 case, but was only 18 microg/l in the other case. The 2 patients were treated with prednisolone and hepatic artery ligation, respectively, with no residual sequelae after 12 months of follow-up. In this article, the clinical courses of these 2 young infants are reviewed, and the management of infantile hepatic hemangioendothelioma complicated with heart failure is discussed. In our experience, early heart failure caused by infantile hepatic hemangioendothelioma can be well controlled, especially with prednisolone therapy or by hepatic artery ligation. Spontaneous regression has been reported. However, without early recognition and therapeutic intervention, progression to decompensated heart failure may lead to death. Furthermore, it is necessary to differentiate infantile hepatic hemangioendothelioma (IHH) from hepatic malignancies.     

纤维胃镜诊断早期胃癌的几点体会(附五例报告)

通过对5例早期胃癌的临床观察和分析,认为注意胃癌早期症状及时进行内镜检查,熟识早期胃癌内镜下的表现,了解早期胃癌的好发部位而作重点观察、熟练内镜操作技术、密切注意胃凹陷性病变、胃腔的活动度及胃壁的柔软度、准确活检等,是提高内镜对早期胃癌检出率必需注意的几个重要问题,并对预防漏诊问题提出了看法。     

Massive gastric distension in acute pancreatitis--a report of two cases.

Massive gastric distension was diagnosed in 2 patients with acute pancreatitis. Both showed signs of severe peripheral circulatory failure, and responded well to intravenous fluid replacement and nasogastric aspiration. A review of the literature revealed only 2 previously reported cases. The possible mechanisms linking the pathogenesis of these 2 conditions are discussed.     

早期直肠癌局部切除26例疗效分析

目的：探讨早期直肠癌局部切除的远期疗效。方法：对26例早期直肠癌患者术前施行1周的5-Fu乳剂保留灌肠治疗，行直肠癌经肛门局部切除术，术后随访5-15年。结果：术后局部复发2例（7．6％），肝转移1例。全部患者5年生存率为88．5％（23／26）。结论：严格选择早期直肠癌局部切除术的适应证，能获得较好的远期疗效。     

Ectopic pancreas with gastric outlet obstruction: report of two cases and literature review

Ectopic pancreas is a rare entity and is usually an incidental finding in clinical practice. Most patients with an ectopic pancreas are asymptomatic, and if present, symptoms are non-specific according to the site of the lesion and different complications encountered. The most-common site is the stomach, accounting for 25%-38.2% of all patients. An asymptomatic ectopic pancreas is usually of no clinical importance, and there is no surgical indication in such a situation. However if there are complications caused by an ectopic pancreas, a variety of actions becomes necessary. We report 2 cases of ectopic pancreas with gastric outlet obstruction. The first case was a 41-year-old man who suffered from epigastric fullness and dyspepsia for 3 years. Endoscopic examination revealed a submucosal tumor measuring 2.5 cm in diameter in the prepyloric area. The second case was a 53-year-old man, who initially underwent a craniotomy to remove a pituitary adenoma, and laparotomy and duodenorrhaphy due to a perforated peptic ulcer. The postoperative course was not uneventful, and an upper gastrointestinal series showed a 2-cm intramural mass with a mucosal ulcer at the distal antrum. Both cases had symptoms and signs of gastric outlet obstruction, and both cases accepted subtotal gastrectomy with Billroth II anastomosis. A review of the literature revealed few cases of ectopic pancreas with gastric outlet obstruction. An ectopic pancreas must be considered in the differential diagnosis of gastric outlet obstruction.     

胃癌急性穿孔的治疗:附40例分析

目的 探讨胃癌急性穿孔的临床特点,以指导临床诊治和提高其疗效.方法 对镇平县第二人民医院收治的40例胃癌急性穿孔患者采用不同形式的治疗方法:10例行单纯穿孔修补术;21例行姑息性胃大部切除术(其中6例于术后3周行腹腔淋巴结清扫术),5例行胃癌根治术,2例行胃造瘘或空肠营养性造瘘术,1例行单纯腹腔引流、灌洗术,1例非手术治疗.结果 本组死亡4例.术后1,2,3年生存率分别为86.1% (31/36)、55.6% (20/36)、36.1%(15/36).分期手术疗效最佳.结沦早期诊断,采取手术切除加综合治疗是治疗胃癌穿孔患者的最佳方案,可改善其预后.     

腹腔镜辅助下胃癌根治术22例报告

目的探讨腹腔镜辅助下胃癌根治术的手术方法及效果。方法回顾分析22例腹腔镜胃癌根治术的临床资料,近端胃大部切除术3例,远端胃大部切除术19例。结果22例病人均顺利完成腹腔镜手术,无中转开腹。平均手术时间195 min（180～250 min）,平均出血量130 ml（85～170 ml）,平均下床活动时间52 h（41～61 h）,平均排气时间75 h（58～92 h）,平均住院时间9天（7～17天）。术后并发症3例,均经保守治疗治愈。结论腹腔镜辅助下胃癌根治术,在保留腹腔镜手术微创优点的同时减少了腔镜下的操作步骤,降低了腹腔镜胃癌根治术的手术难度,具有较好的临床应用价值。