急性肾后性肾功能不全的原因及综合处理（附6例报告）

目的：探讨急性肾后性肾功能不全的原因及临床处理。方法：回顾性分析2003～2008年6例肾后性肾功能不全患者的临床资料,总结治疗方法。结果：上尿路梗阻原因5例,其中盆腔肿瘤3例,子宫颈癌2例,子宫内膜癌1例;孤立肾、输尿管结石1例;乙状结肠癌根治术后造成双侧输尿管下段压迫1例。下尿路梗阻原因1例,为BPH并发尿潴留。急诊行输尿管逆行双J管置入术3例,其中双侧置管1例,单侧置管2例;血液透析后行ESWL1例;B超引导下肾穿刺造瘘术1例;留置尿管肾功能恢复后行TURP术1例。6例患者梗阻解除后,3～10天肾功能有不同程度恢复。结论：导致急性肾后性肾功能不全的原因众多,以肿瘤、结石、前列腺增生进行性尿潴留为主。急诊处理原则为解除梗阻,改善肾功能。待患者肾功能恢复后,针对不同病因进行治疗。     

输尿管癌误诊的原因与防范措施

目的:探讨输尿管癌误诊的原因和防范措施.方法:报告6例误漏诊断输尿管癌的临床资料.误诊为输尿管结石2例,尿路结核1例,尿路感染1例,漏诊2例(只诊断治疗并发的膀胱癌).其中3例输尿管癌已侵犯到输尿管周围组织或邻近器官,1例已有远处转移.按照国际TNM分类法:T2期2例,T3期3例,T4期1例.结果:T2期2例,术后已分别存活了12年和9年;T3期3例,其中1例联合肾、输尿管膀胱及精囊切除术,术后3年尚未见复发;其余2例分别于术后26个月和5个月复发盆腔肿瘤.T4期1例化疗无效,生存6个月.结论:输尿管癌临床表现缺乏特异性,影像学检查应使输尿管全程显影,可疑病例及时作输尿管镜检查,或开放性手术探查.     

Nd-YAG laser therapy of tracheobronchial lesions by malignant tumor]

Thirty-seven patients with tracheobronchial lesions by malignant tumor were treated with Nd-YAG laser. Thirty-seven patients were twenty-three males and fourteen females and ages ranged from 34 to 79 years. Diseases included were primary tracheal tumor in 3 cases, lung cancer in 16 (8 squamous cell carcinoma, 5 adenocarcinoma, 2 large cell carcinoma, 1 small cell carcinoma), cancer of adjacent organs in 9 (5 thyroid cancers, 4 esophageal cancers), and metastatic cancer to the lung or mediastinal lymph nodes in 9 (4 renal cell carcinoma, 2 thyroid cancer, one patient respectively, colon cancer and breast cancer). Intermittent irradiation of YAG laser was done for 0.5 second at 30-40 Watt through flexible bronchoscope under local anesthesia. It was repeated 1 to 41 times (mean 4.1 times) and energy amount was 148 Joules to 18,513 Joules (mean 3,305 J). The result was; stenosis disappeared in 22 cases (59.4%), improved in 14 (37.8%), and in one case YAG laser therapy discontinued due to intractable bleeding. The Nd-YAG laser therapy for tracheobronchial lesions by malignant tumor is very useful to improve dyspnea or atelectasis.     

肾和肾上腺恶性肿瘤合并下腔静脉瘤栓的外科治疗

目的 提高肾和肾上腺恶性肿瘤伴下腔静脉瘤栓的治疗效果.方法 1985年1月至2008年4月收治肾和肾上腺恶性肿瘤合并下腔静脉瘤栓患者29例,均经彩色多普勒超声、CT及MRI检查确诊.瘤栓分型:I型7例、Ⅱ型10例、Ⅲ型8例、Ⅳ型4例.其中肾上腺肿瘤4例,肾肿瘤25例.TNM分期:T2NoMo 23例,T2N1Mo 1例,T2N1M1 1例,T3N.Mo 1例,T3N1M1 2例,T3N2Mo 1例.肿瘤平均直径8.7(4.O～16.0)cm.瘤栓平均长度:I型3.2(2.5～4.O)cm,Ⅱ型5.3(4.5～6.O)cm,Ⅲ型8.2(6.5～9.0)cm,IV型15.1(12.O～18.5)cm.29例均在全麻下行肾或肾上腺肿瘤根治性切除加下腔静脉瘤栓切除术.结果 29例手术均获成功.术后病理报告:肾透明细胞癌18例、肾肉瘤样癌3例、肾乳头腺癌2例、肾细胞癌(未分化型)1例、肾颗粒细胞癌1例、肾上腺皮质癌3例、肾上腺转移性恶性黑色索瘤1例.失访3例,余26例平均随访35(0～62)个月,患者3年生存率58%(15/26),5年生存率42%(11/26).T2、T3患者3年生存率分别为64%(14/22)、25%(1/4),5年生存率分别为45%(10/22)、25%(1/4).I、II、Ⅲ和Ⅳ型瘤栓患者3年生存率分别为4/6、5/8、5/8和1/4,5年生存率分别为3/6、4/8、3/8和1/4.膈肌以下瘤栓患者3、5年生存率分别为64%(14/22)、45%(10/22),膈肌以上瘤栓患者分别为1/4、1/4.肾和肾上腺恶性肿瘤伴下腔静脉瘤栓无转移患者的3、5年生存率为12/18、9/18,有转移患者分别为3/8、2/8.3例术前出现转移患者生存时间分别为6、10、22个月.结论 根治性肿瘤切除和下腔静脉取栓治疗无淋巴和远处转移的肾和肾上腺恶性肿瘤合并下腔静脉瘤栓效果良好;即使存在远处转移,外科手术仍可以提高患者生活质量,延长患者生存期.     

原发性膀胱小细胞癌诊治体会

目的 探讨膀胱小细胞癌的临床及病理特点.方法 回顾性分析9例膀胱小细胞癌的基本资料.男6例,女3例.年龄45～79岁,平均62岁.临床表现为肉眼血尿7例,排尿困难及下腹部疼痛2例.肿瘤直径0.5～7.0 cm,平均2.0 cm;多发2例,单发5例,全膀胱弥漫性生长2例.7例行尿脱落细胞学检查,阳性4例.9例均行手术治疗,其中4例术前诊断为浅表性者行TURBt,术后均定期行吡柔比星膀胱灌注,1例化疗3个周期;膀胱部分切除2例,均定期行吡柔比星膀胱灌注,1例化疗2个周期;根治性膀胱全切3例,静脉化疗2例.结果 术后病理检查:肿瘤细胞体积小,呈圆形,胞质稀少,核浓染,缺乏巢状结构.免疫组化染色:嗜铬素A(+)、神经元特异性烯醇化酶(+).诊断为小细胞癌,其中1例含移行细胞癌成分,1例合并前列腺癌.1例术前检查显示高血钙(3.15 mmol/L)和低血磷(0.61 mmol/L),术后1个月血钙及血磷恢复正常.保留膀胱者随访4例,3例分别于术后4、9、25个月死于转移,1例术后化疗者随访24个月未见复发及转移.膀胱全切3例中2例分别于术后2、28个月死亡,1例术后随访32个月未见肿瘤复发及转移.结论膀胱小细胞癌恶性程度高,预后差,根治性膀胱全切加全身化疗是主要的治疗方法,保留膀胱的手术应配合全身化疗.决定预后的是肿瘤的临床分期及治疗方法.

Abstract：

Objective To investigate the clinical and pathological features of small cell carcinoma of the urinary bladder. Methods The pathological and clinical data of 9 cases of small cell carcinoma were analyzed retrospectively. There were 6 males and 3 females, ages 45 to 79 years (mean age, 62 years). Clinical manifestations of 7 cases included gross hematuria and dysuria, the other 2 cases experienced lower abdominal pain. The mean tumor size was 2.0 cm (ranged, 0.5 to 7.0 cm). Two cases had multiple tumors and 5 cases had single tumors. The growth pattern in 2 cases was diffuse growth in the whole bladder. In 4 cases tumor cells were found in urine cytology. All 9 patients underwent surgical treatment, including TURBt. Four patients were diagnosed as superficial tumors before operation. All the patients underwent regular theprubicine irrigation in the bladder. One case underwent additional intravenous chemotherapy for 3 cycles. Partial cystectomy was performed in 2 cases, with regular theprubicine irrigation in bladder and 1 case underwent intravenous chemotherapy for 2 cycles. Radical cystectomy was performed in 3 cases, with 2 cases undergoing intravenous chemotherapy after operation. Results Pathological findings showed that tumor cells were small and round in shape. These hyperchromatic nuclei showed limited cytoplasm with lack of nesting characters. CgA and NSE were positive in immunohistochemistry. The final diagnosis was small cell carcinoma, with 1 case accompanied with transitional cell carcinoma and 1 case accompanied with prostate cancer. One case showed high preoperative serum calcium (3.15 mmol/L) and low serum phosphate (0.61 mmol/L), which returned to normal 1 month after operation. Four cases who′s bladder was preserved were followed up, 3 cases were alive for 4, 9 and 25 months after operation. The 1 case who underwent intravenous chemotherapy was followed up for 24 months and there was no sign of relapse or metastasis. In all the 3 cases with radical cystectomy, 2 cases died 2 and 28 months postoperativly. Another case with adjuvant chemotherapy was followed up for 24 months without recurrence or metastasis. Conclusions Small cell carcinoma of the urinary bladder is highly malignant with poor prognosis. Radical cystectomy in combination with systemic chemotherapy has better efficacy. Retained bladder surgery with systemic chemotherapy is an alternative choice. The most important factors which influence the prognosis of the tumor are clinical stage and therapeutic methods.     

上尿路结石合并气肿性肾盂肾炎五例报告并文献复习

目的探讨上尿路结石合并气肿性肾盂肾炎的临床表现和诊治方法。方法回顾性分析2012年7月至2019年12月北京大学人民医院收治的5例上尿路结石合并气肿性肾盂肾炎患者的病例资料,并结合既往文献进行总结。本组5例,男2例,女3例。年龄40~67岁。1例既往有糖尿病史且血糖控制较差。5例入院时均有发热表现,体温分别为38.7℃、38.8℃、37.5℃、38.6℃、40.0℃,血常规白细胞计数分别为17.2×10^9/L、14.9×10^9/L、11.2×10^9/L、15.1×10^9/L、13.3×10^9/L,中性粒细胞分别为0.90、0.89、0.85、0.87、0.88,均高于正常。尿常规白细胞均>200/μl。C反应蛋白分别为68 mg/L、253 mg/L、9 mg/L、8 mg/L、67 mg/L,其中例1、例2和例5升高较明显。3例有肾功能不全。5例中肾鹿角形结石2例,肾多发结石3例,均伴中重度肾积水。CT检查均提示肾、集合系统和/或肾周有气肿性表现,明确诊断为上尿路结石合并气肿性肾盂肾炎。例3、例4经单纯抗感染治疗,例5行肾穿刺引流术配合抗感染治疗后,体温恢复正常,血常规检查示白细胞降至10×10^9/L以下,中性粒细胞降至0.80以下,尿常规白细胞降至50/μl以下。另2例感染控制不佳,例1接受肾周脓肿穿刺引流术及经皮肾穿刺引流术并配合抗感染治疗3 d后,体温恢复正常,但血常规白细胞始终为(11~12)×10^9/L,多次复查CT提示各肾盏及肾周积脓积气情况无改善;例2留置输尿管支架及经皮肾穿刺引流术并配合抗感染治疗后,仍有间断发热,尿细菌培养为热带假丝酵母菌,加用氟康唑治疗后,体温恢复正常,但血常规白细胞仍为12×10^9/L左右,复查CT提示肾盏及肾周积脓积气情况略有加重。结果3例感染得到控制者行经皮肾镜碎石取石术,例4术后出现发热,抗感染治疗后缓解,未发生其他并发症。2例感染控制不佳者行肾切除术,术后恢复顺利,术后病理检查均提示肾小球萎缩、硬化,肾小管扩张,炎性肉芽组织形成。5例随访1~84个月,血常规、肌酐、CT影像与出院时相比均无明显变化,未出现结石梗阻导致的感染。结论上尿路结石合并气肿性肾盂肾炎少见,但病情进展迅速,治疗难度大,应早期行CT检查以明确诊断,及时留置双J管或行穿刺引流,并配合广谱抗菌药物控制感染,以改善患者预后。     

胸、腹腔镜联合全喉切除治疗颈段食管癌

目的探讨胸、腹腔镜联合全喉切除治疗颈段食管的可行性和疗效。方法2009年1月一2014年7月胸、腹腔镜联合全喉切除治疗33例颈段食管癌。胸腔镜下分离食管、腹腔镜下管胃成形、全喉切除、气管永久造口、胃咽吻合术。结果胸部手术时间40～66min,平均53min;腹部手术时间35～51min,平均44rain;颈部手术时间128～150min,平均139min。术中出血量130～270ml,平均150ml。术后住院时间8～14d,平均12d。病理均为鳞状细胞癌,其中高分化2例,中分化19例,中一低分化7例,低分化5例。切缘病理学检查无癌组织残留。31例淋巴结转移。并发症：吻合口漏2例,喉返神经损伤3例,肺部感染6例,胃排空障碍2例,吻合口狭窄1例,无死亡病例。33例随访1个月～5年,术后1、3、5年生存率分别为87．9％、54．5％、45．5％。结论颈段食管癌应采取积极的手术治疗,胃咽吻合术是颈段食管癌切除后较为理想的修复手段。     

Multiple primary cancers in surgically resected lung cancer patients

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Total cystectomy for urinary bladder cancer: clinicopathological study of 95 cases

Total cystectomy was performed on 95 patients with primary urinary bladder cancer between 1973 and 1983. Histopathological and prognostic studies were reviewed according to the general rules for clinical and pathological studies on bladder cancer. The cancer histological type were transitional cell carcinoma in 87 cases, squamous cell carcinoma in 5 cases, adenocarcinoma in 2 cases, and undifferentiated carcinoma in 1 case. The overall 5-year actuarial survival rate was 36.0%. As for the growth pattern of the bladder cancer, the 5-year survival rates for the patients with papillary non-invasive type (PNT), papillary invasive type (PIT), and non-papillary invasive type (NIT) were 100%, 25.8% and 34.8% respectively. As for the stage, the 5-year survival rates for the patients with pTa, pT1, pT2, pT3a, pT3b, and pT4 were 81.8%, 64.7%, 40.1%, 30.5%, 22.6% and 6.7% respectively. Of 87 patients with transitional cell carcinoma, the 5-year survival rates for the patients with grade 1, grade 2 and grade 3 were 100%, 43.0% and 32.1% respectively. Intramural lymphatic invasion and vascular invasion and intramural histopathological mode of spread were significant indicators of prognosis.     

Sarcomatoid carcinoma of the prostate: a study of 42 cases

Sarcomatoid carcinoma of the prostate is a rare type of prostatic cancer. With the exception of 1 study, the morphologic features and patient outcomes have been reported only in relatively small case series and individual reports. We examined transurethral resection, needle biopsy, and radical prostatectomy specimens from 42 patients with sarcomatoid carcinoma of the prostate, all of which were received in consultation. Clinical information on 32 patients was obtainable. Five patients were lost to follow-up and information on the 5 remaining patients could not be obtained. Prior prostatic adenocarcinoma: The majority of patients (n=21; 66%) had a prior history of acinar adenocarcinoma of the prostate. Of the 14 men with available data, reported Gleason scores were 6 (n=7), 8 (n=4), and 10 (n=3). Of the remaining patients for whom this information was known, 11 patients presented with de novo sarcomatoid carcinoma. The time between the original diagnosis of acinar adenocarcinoma and diagnosis of sarcomatoid carcinoma ranged from 6 months to 16 years (mean 6.8 y). Concurrent adenocarcinoma: The majority of patients demonstrated a concurrent high grade acinar carcinoma of Gleason score 7 (n=3), 8 (n=9), 9 (n=10), and 10 (n=10). A subset of patients contained an admixed ductal adenocarcinoma (n=4), small cell carcinoma (n=3), squamous cell carcinoma (n=3), or other unusual pattern of prostate carcinoma (n=3). In 1 case, the diagnosis was based on immunohistochemical evidence of epithelial differentiation along with the history of prior adenocarcinoma. Morphology of the sarcomatoid component: The percentage of sarcomatoid growth ranged from 5% to 99% (mean 65%). Bizarre atypia with giant cells was present in 55% of cases. Admixed heterologous elements were identified in 10 cases (29%), including osteosarcomatous (n=7), chondrosarcomatous (n=5), and rhabdomyosarcomatous (n=2) elements. Of the 12 cases with received immunostains of the sarcomatoid component, 5/7 cases were at least focally positive for cytokeratin, 1/1 case was focally positive for Cam5.2, and 3/6 cases were focally positive for prostate acid phosphatase. The sarcomatoid component did not demonstrate immunoreactivity for prostate-specific antigen in 8 cases. Prognosis: approximately half of all patients developed metastatic disease either at time of presentation or subsequently. Of patients with meaningful follow-up, 6/7 died within 1 year of the diagnosis of sarcomatoid carcinoma; 20 were alive yet with very short follow-up (median 1 y; mean 2.3 y). Kaplan-Meier analysis revealed that the actuarial risk of death at 1 year after diagnosis of sarcomatoid carcinoma was 20%. No correlation was identified between patient survival and morphologic features, before radiation or hormone therapy, or concurrent high-grade prostate cancer. Sarcomatoid carcinoma demonstrates diverse spindle and epithelial cell morphologies. The sarcomatoid component often has heterologous elements and, in 1 case, no epithelial component was seen on hematoxylin and eosin-stained sections. The epithelial component is typically high-grade acinar adenocarcinoma, yet other aggressive tumor subtypes such as ductal adenocarcinoma and small cell carcinoma may also be seen. Sarcomatoid carcinoma is an aggressive form of prostate cancer, the prognosis of which is dismal regardless of other histologic or clinical findings.     

多原发大肠癌37例临床分析

目的 探讨多原发大肠癌的临床特点、诊断治疗及预后。方法 对1974-1998年37例多原发大肠癌进行回顾性分析。结果 37例占同期收治原发大肠癌的2．74％(37／1348)，其中同时多原发大肠癌15例，异时多原发大肠癌22例，癌灶部位以右半结肠和直肠为多，异时多原发大肠癌55％(12／22)在3年内发生，41％(9／22)在8年后发生，全部癌灶除1例外均得到根治性切除，同时多原发大肠癌5年生存率为5／9，异时多原发大肠癌5年生存率为15／21，二次癌术后5年生存率为7／18。结论 提高对多原发大肠癌的警惕性，术前全面检查，术中仔细探查，术后定期复查，争取早期发现，积极手术治疗，以提高生存率。     

乳腔镜辅助乳腺癌腺体切除假体植入一期成形17例报告

目的探讨在乳腔镜辅助下行皮下腺体切除、假体植入一期成形术治疗乳腺癌的手术方法、可行性及疗效。方法 2009年3月～2012年5月乳腺癌患者17例,均在乳腔镜辅助下行皮下腺体切除及腋窝淋巴结清扫,一期将假体植入胸大肌后方间隙。结果 17例乳腔镜辅助单侧乳腺腺体皮下切除、假体植入一期成形术均获成功。切除腺体组织切缘未见癌残留。按TNM分期:T1N0M0期5例,T1N1M0期1例,T2N0M0期9例,T2N1M0期2例。术后病理证实16例为浸润性导管癌,1例为小叶癌。腋窝淋巴结病理发现1例有1枚淋巴结阳性,2例3枚淋巴结阳性。17例均无皮下气肿、乳头及皮肤局部坏死情况。均在术后7～10 d拔除引流管,4例出现腋窝少量积液,穿刺抽吸加压包扎后好转,无其他并发症发生。17例均获随访,随访时间3～41个月,中位时间18个月,均无局部复发及远处转移,无患侧上肢水肿及功能障碍。术后外观评价:优9例,良6例,尚可1例;优良率达94.1%。结论乳腔镜辅助下行皮下腺体切除、假体植入一期成形术治疗乳腺癌,可减少手术创伤,安全可行,美容效果好。     

Die Zystektomie aus anderer Indikation als dem Blasenkarzinom

A cystectomy for indications other than transitional cell cancer of the bladder or general bladder cancer is frequently performed in cooperation with other surgical specialties such as general surgery or gynecology. In these cases the urological procedure as well as the oncological and surgical concepts of other specialties have to be combined. We studied our cystectomy patients who had undergone such a combined procedure for a non-urothelial indication concerning perioperative and postoperative complications.A total of 204 cystectomies were performed by the Department of Urology at the University of Hamburg, Germany between 1995 and 2003. Bladder cancer was the indication for cystectomy in 162 patients, but 42 patients had a non-urothelial indication for this procedure. These patients included 12 cases of advanced rectal cancer, 9 cases of advanced cervical cancer, 6 cases of advanced sigmoid cancer, 4 cases of advanced prostate cancer, 1 case of prostate sarcoma, 5 cases of complex vesicointestinal fistulae, 2 cases of urachal cancer, 1 leiomyosarcoma, 1 rhabdomyoma, and 1 rhabdomyosarcoma, respectively. Perioperative and postoperative complications of those patients were compared to patients who underwent cystectomy for transitional cell cancer of the bladder.Those 42 patients who underwent cystectomy for non-urothelial indications included 14 male and 28 female patients. The mean age was 58.2 years with a range of 3-78 years. For urinary diversion 30 ileum conduits, 4 sigma conduits, and 8 ileum neobladders were used. The mean operative time was 6.25 h. The mean blood loss was 2200 ml. An average of four red blood cell concentrates (RBC) had to be given. Postoperative hydronephrosis had to be treated in three (7%) patients unilaterally and in two (5%) patients bilaterally with a temporary nephrostomy. Postoperative urinary leakage lasting more than 30 days was found in two (5%) patients. A deep vein thrombosis as well as an ileus was found in five (12%) patients each, respectively. There was no perioperative mortality in this study. When comparing the complications of those patients with the 162 patients who underwent cystectomy for bladder cancer, the only significant difference ( p=0.033, chi-square test) was a higher ileus rate in the patients with cystectomy for a non-urothelial indication.Complications with cystectomy for non-urothelial indications are in large comparable to those for transitional cell carcinoma of the bladder. The higher ileus rate in non-urothelial patients can be explained by the more radical procedures in this group of patients. Even though the group of patients undergoing cystectomy for indications other than bladder cancer was small in this trial, the procedure is standardized in combination with other specialties. Larger patient numbers and a longer follow-up will lead to more data in this special group of patients.     

伴有呼吸道梗阻的晚期甲状腺恶性肿瘤的多学科协同处理

目的探讨多学科协同诊疗模式（MDT）在伴有呼吸道梗阻的局部晚期甲状腺恶性肿瘤治疗中的应用。 方法回顾性分析四川省肿瘤医院2015年10月至2017年7月收治的31例局部晚期甲状腺恶性肿瘤患者临床资料,其中伴有明显呼吸道梗阻症状（Shin分级Ⅳ级）13例。术前支气管镜及CT检查均明确诊断为肿瘤压迫或侵犯气管伴严重狭窄,所有患者术前经MDT讨论制定治疗方案,后期9例手术治疗,4例非手术治疗。 结果乳头状癌7例,乳头状癌合并鳞癌1例,低分化癌3例,未分化癌1例,淋巴瘤1例。根据2017年AJCC第8版临床肿瘤分期：Ⅲ期4例,Ⅳa期7例,Ⅳb期1例,淋巴瘤为Ⅳ期。患者呼吸困难症状均在急症气管支架置入后明显改善,9例限期完成手术,其中8例行甲状腺癌联合根治术及气管袖状切除一期气管重建,1例行甲状腺癌联合根治术及全喉、颈段及部分胸段气管切除、气管-胸骨柄低位造瘘。除1例患者术后第7天死于心肺功能衰竭外,7例气管切除端-端吻合重建者均一期愈合,无气管瘘发生。气管-胸骨柄低位造瘘者术后19 d出院。所有患者术后予以¹³¹I治疗和TSH抑制治疗。随访时间4~22个月,均无瘤生存。4例未手术治疗者中2例后期行局部放射治疗,生存期分别为1年及9个月;1例甲状腺淋巴瘤行化疗;1例未分化癌仅姑息对症治疗,生存期3个月。 结论晚期甲状腺恶性肿瘤侵犯气管导致的气道梗阻直接危及患者生命,MDT并拟定个体化诊疗方案具有显著优势。对于需要手术的患者,MDT模式的开展能显著减低围术期风险,提高生存率;对于无手术指征的患者,MDT可详细评估病情,制定对应的合理治疗方案,为患者姑息治疗提供机会,延长患者生命。     

Sequential combination chemotherapy consisting of vincristine, peplomycin, methotrexate, cis-diamminedichloroplatinum (II), cytosine arabinoside and 5-fluorouracil, for advanced urothelial cancer

Two VPM-CisCF chemotherapy regimens (vincristine (VCR), peplomycin (PEP), methotrexate (MTX), cis-diamminedichloroplatinum (II) (CDDP), cytosine arabinoside (Ara-C) and 5-fluorouracil (5-FU), established using human bladder cancer xenografts in nude mice were applied for advanced urothelial cancer. VPM-CisCF (I) consisted of 0.4 mg/m2 VCR on days 1 and 4, 2 mg/m2 PEP on days 1-7, 2 mg/m2 MTX on days 2, 3, 5 and 6, 20 mg/m2 CDDP on days 8, 20 mg/m2 Ara-C on days 8 and 13, and 150 mg/m2 5-FU on days 10-12. VPM-CisCF (II) consisted of 0.6 mg/m2 VCR on days 1 and 3, 3 mg/m2 PEP on days 1-4, 3 mg/m2 MTX on days 2 and 3, 35 mg/m2 CDDP on day 4, 20 mg/m2 Ara-C on days 4 and 7, and 200 mg/m2 5-FU on days 5 and 6. These doses were adjusted for each case: the above mentioned dose x [(80/(40 + Age))2 + (Karnofsky's performance status/100)2]. VPM-CisCF (I) was administered to 6 patients (bladder cancer and transitional cell carcinoma), intra-arterially in two cases. One patient showed a complete response and survived for 7 months, three partial response (PR) surviving for 13, 8 and 37 (arterial-infused case) months, one showed minor response (MR) surviving for 4 months, and one had no change (NC) surviving for 5 months. VPM-CisCF (II) was administered to 11 patients (1 ureteral cancer, 1 renal pelvic cancer, 9 bladder cancer, and 10 transitional cell carcinoma except a case of mixed type of transitional cell carcinoma and squamous cell carcinoma). Four of the patients who had PR survived for 9, 8, 8 and 7 (alive) months, two who had MR survived for 8 and 4 months, three who had NC survived for 6, 4 and 4 months, and who two had progressive disease survived for 8 and 6 months. The major toxicities were myelosuppression and gastrointestinal symptoms, especially nausea and vomiting, but the treatment was well-tolerated.     

电视纵隔镜手术128例

目的探讨电视纵隔镜检查术（video-mediastinoscopy，VM）在肺癌术前分期、纵隔肿物诊断和恶性胸腔积液诊治中的价值。方法采用全麻单腔螺纹气管插管，48例行颈部纵隔镜术，33例行胸骨旁纵隔镜检查术，47例行经肋间纵隔镜术。结果125例经电视纵隔镜术后确诊：肺腺癌38例，肺转移性低分化鳞癌33例，结核9例，淋巴结炎症8例，肺小细胞癌7例，胸腺鳞状细胞癌6例，非霍奇金淋巴瘤5例，纵隔神经母细胞瘤4例，胸腺瘤4例，胸膜间皮瘤3例，霍奇金淋巴瘤2例，后纵隔神经鞘瘤2例，结节病1例，胸腺增生1例，类癌1例，中纵隔原始神经外胚叶肿瘤1例。1例电视纵隔镜检查纵隔淋巴结为反应性增生，行左下肺叶切除，病理为鳞癌。2例术前纤维支气管镜病理确诊左下肺鳞癌，电视纵隔镜检查右气管旁淋巴结转移。术中发生气胸1例、出血1例、喉返神经麻痹和切口感染各2例。结论电视纵隔镜术不但是肺癌术前病理分期、纵隔疾病的重要检查方法，而且也是诊治恶性胸腔积液的简便方法。     

肾上腺转移癌(附11例报告)

目的　探讨肾上腺转移癌的临床特点与诊治方法。　方法　回顾分析 1993年 12月至2 0 0 3年 3月肾上腺转移癌患者 11例的诊治结果。原发灶为肺癌 4例 ,肝癌 5例 ,胆管癌 1例 ,肾癌 1例。临床表现腰背部胀痛 3例 ,乏力、消瘦 3例 ,血尿 1例 ,无症状者 4例。 11例行B超及CT检查 ,2例行正电子发射断层扫描 (PET)检查。 11例均行手术治疗 ,肿瘤完整切除 9例 ,姑息性切除 1例 ,双侧转移者仅行左侧切除 1例。　结果　完整切除转移癌 9例中 5例生存 6～ 6 3个月 ,平均 34个月 ;2例已分别存活 2及 16个月 ,仍在随访中 ;2例失访。 1例行姑息性切除者生存 3个月 ,1例双侧肾上腺转移癌仅行左侧切除者生存 4个月。　结论　B超及CT是诊断肾上腺转移癌的重要检查方法 ,PET对诊断肾上腺转移癌有较高的临床价值。手术切除转移灶是延长患者生存期的最有效方法。     

多原发性大肠癌14例报告

目的:总结多原发性大肠癌诊治经验，提高多原发性大肠癌诊治水平。方法:回顾性分析23年来多原发性大肠癌14例临床资料。结果:14例中同时癌9例，异时癌5例。14例共37个癌灶，分布部位：乙状结肠8个，脾曲6个，横结肠6个，肝曲5个，升结肠3个，降结肠2个，直肠4个，盲肠3个。病理类型：腺癌19个，管状腺癌7个，黏液腺癌7个，乳头状腺癌2个，未分化癌1个，息肉恶变1个。Dukes分期：B期26个，C期10个，D期1个。14例中21例次手术，半结肠切除11例次，扩大左半结肠切除5例次，结肠次全切除2例次，全结肠切除2例次，姑息性切除1例次；无手术死亡。14例均随访1~19年，3例死于脑出血或自然死亡，11例至今生存4~17年。结论:多原发性大肠癌，只要及早发现，积极手术，预后好，异时癌比同时癌效果好。术式选择以半结肠或扩大半结肠切除为主，必要时才考虑全结肠切除。术后应定期结肠镜随访。     

脐尿管癌的诊断和治疗(附9例报告)

目的探讨脐尿管癌的诊断和治疗方法及其疗效。方法回顾性分析广西医科大学附属肿瘤医院1999年7月至2009年12月收治的9例脐尿管癌患者的临床资料和随访结果,其中黏液腺癌6例、肠型腺癌1例、尿路上皮癌2例。结果本组患者最常见的临床症状为血尿和膀胱刺激症状,膀胱镜检查主要表现为膀胱顶部宽基底肿物,影像学检查常见膀胱顶前壁与腹壁之间软组织肿块影,多浸润膀胱壁。2例(Ⅲ期)膀胱部分切除者分别于术后7、9个月局部复发,并于1年内死亡。1例(Ⅳ期)晚期未切除者行化疗,无进展生存6个月,化疗后13个月死亡。6例行扩大性膀胱部分切除术,患者中1例(Ⅳ期)术后18个月因肺转移死亡,2例(Ⅲ期)术后32个月及41个月死亡,3例(Ⅲ期)分别为术后22、58和62个月,仍在随访中。结论脐尿管癌发病位置隐匿,术前诊断较为困难。治疗方法主要是行扩大性膀胱部分切除术,首次手术彻底切除肿瘤及对晚期及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。本病的预后很差,临床分期与预后密切相关。     

Ultrasonically guided percutaneous nephrostomy.

Ultrasonically guided percutaneous nephrostomy was planned in 98 patients with a total of 128 nephrostomies. The success rate was over 90%. The catheters were maintained from a 1/2 day to 150 days with a median duration of 13 days. 26% of the patients had the catheter replaced, mainly because of displacement. Two major complications were seen, one perforation of the gallbladder and one case of major haemorrhage resulting in a nephrectomy. Two of the 26 patients infected at the puncture died from sepsis. Among cases with low ureteral obstruction untreated prostatic carcinoma and ureteral tumors were the two only categories in which a palliative nephrostomy was beneficial.