原发性肝癌伴胆管癌栓致阻塞性黄疸的外科治疗

目的探讨原发性肝癌伴胆管癌栓致阻塞性黄疸的外科手术治疗及其治疗效果。方法回顾性对15例原发性肝癌伴胆管癌栓致阻塞性黄疸行外科手术治疗的总结和分析。结果行左半肝切除 胆总管切开取癌栓术5例,行肿瘤切除 胆总管切开取癌栓术7例,行胆总管切开取癌栓 肝总动脉结扎3例,术后随访2年,平均生存时间为14.5个月,最长存活23个月。结论外科治疗明显提高了患者生活质量,延长了生存时间。     

原发性肝癌伴胆管癌栓的外科处理

目的 探讨原发性肝癌合并胆管癌栓的外科治疗及其疗效。方法 对浙江省台州市中心医院1995年1月至2007年10月收治的13例原发性肝癌合并胆管癌栓的治疗情况进行回顾性总结和分析。结果 肝癌切除加胆管癌栓清除术10例,单纯胆管切开取栓术3例。7例获得随访,3例1年内死亡,3例存活1到4年,1例至今存活6年。结论 原发性肝癌伴胆管癌栓行外科治疗是一种积极有效的治疗方法。     

原发性肝癌伴胆管癌栓11例的治疗体会

目的 原发性肝癌伴胆管癌栓的外科手术治疗及其治疗效果。方法 回顾性总结原发性肝癌伴胆管癌栓１１例行胆管切开癌栓清除术,其中加做肝癌局部切除术７例。结果 手术死亡２例,术后随访１年,除１例至今仍存活１１个月外,余８例生存期分别为１１,１０,９,８．５,４．５,３,３个月。平均生存时间为６个月。结论肝癌局部切除加胆管切开癌栓清除术术不失为原发性肝癌伴胆管癌栓患者的一种姑息治疗方法。     

原发性肝癌伴胆管癌栓的外科治疗

目的　探讨伴胆管癌栓的原发性肝癌 (HCC)外科治疗方式的选择及对预后的影响。方法　回顾性分析 1994～ 2 0 0 1年 15例HCC伴胆管癌栓的外科治疗情况。　结果　肝癌切除加胆管癌栓清除术 7例 ,肝癌切除加肝外胆管切除术 4例 ,单纯胆总管切开取栓术 3例 ,背驮式肝移植 1例。术后 1年生存率为 73 3%,3年生存率为 40 %,其中有 2例生存已超过 5年。门静脉侵犯者的生存率显著低于未侵犯者 (P <0 0 5 )。　结论　原发性肝癌伴胆管癌栓行外科治疗是一种积极有效的治疗方法。复发后选择适当病例再次手术 ,仍可取得较好疗效。肝移植作为一种崭新的手术方式值得探讨。     

原发性肝癌合并胆管内癌栓12例临床分析

目的探讨原发性肝癌继发胆管癌栓的临床特点和诊治要点。方法回顾性分析1990～2003年12例HCC伴癌栓的外科治疗情况。结果本组原发性肝癌合并胆管内癌栓的发生率为4．69％(12／256)．术前确诊牢为25％(3／12)．肝癌切除加胆管癌栓清除术8例,肝癌切除加肝外胆管切除．胆肠内引流1例．单纯胆总管切开取栓术3例。术后1年生存率66．7％(8／12)．3年生存率25％(3／12),其中1例生存已超过5年。结论原发性肝癌伴胆管内癌栓十分少见．术前易误诊．手术治疗不失为一种积极有效的治疗方法。     

原发性肝癌伴胆管癌栓的诊治

目的　探讨原发性肝癌伴胆管癌栓的诊治方法。方法　回顾性分析 8年间收治的 2 1例原发性肝癌伴胆管癌栓的临床资料。结果　临床表现为肝癌及梗阻性黄疸症状 ;术前正确诊断率76.2 %,B超 ,CT ,MRI ,ERCP和PTC的正确诊断率分别为 14 .3 %,9.5 %,14 . 3 %,71.4%和10 0 %。行肝癌切除加胆管癌栓清除术 10例 ,肝癌切除加肝外胆管切除术 5例 ,单纯胆总管切开取栓加肝动脉化疗栓塞 (TACE ) 3例 ,胆管癌栓清除加肝动脉灌注 (HIA ) 3例。术后 3年生存率 44 .4%,5年生存率 2 8.6%。结论　原发性肝癌伴胆道癌栓的诊断应选择多种检查手段 ,综合分析 ;以外科为主的综合治疗是积极有效的治疗方法。     

原发性肝细胞癌合并胆管癌栓的外科诊治分析

目的探讨原发性肝细胞癌合并胆管癌栓的诊断及外科治疗效果。方法回顾性总结和分析20例原发性肝细胞癌合并胆管癌栓的外科诊治情况。采用肝叶切除及癌栓取出术7例、单纯胆管癌栓取出3例;肝动脉化疗栓塞术(transcatheter hepatic arterial chemoembolization,TACE)后肝切除加癌栓取出术10例。术后均行胆管引流及TACE。结果术前行TACE的10例患者,术中胆道出血(45.2±12.5)ml,明显少于未行TACE者(90.5±10.5)ml,差异显著(P0.05)。全部病例均获随访,平均时间22(2～54)个月。肝叶切除及癌栓取出7例,平均生存(21.5±2.8)个月;术前TACE、2周后行肝叶切除加癌栓取出10例,平均生存(28.5±3.1)个月;单纯癌栓取出3例,平均生存(4.1±0.5)个月,术前行TACE组生存时间明显长于其余两组(P0.05)。结论对原发性肝细胞癌合并胆管癌栓早期诊断、积极切除肿瘤并清除胆管癌栓,配合术前术后TACE术,是改善预后的有效治疗方法。     

原发性肝癌并发胆管癌栓的手术治疗：附13例报告

笔者回顾性分析14年间手术治疗的13例原发性肝癌伴有胆管癌栓患者的临床资料。全组病例术前均有黄疸，总胆红素水平在54～574 mol/L，平均251 mol/L。B超术前确诊肝癌伴有胆管癌栓7例，CT术前确诊肝癌伴有胆管癌栓9例。 13例均行手术治疗，其中11例行肝切除+胆管癌栓取除，包括右半肝切除2例，右半肝不规则切除2例，左半肝切除3例，左外叶切除2例，肝方叶切除1例，肝中叶切除1例;2例仅行胆总管切开取癌栓，T管引流。术后1年内死亡2例。行肝切除者，术后生存时间为6个月~5年9个月。中位生存时间为15个月;未切肝者2例，分别生存11个月和17个月。提示对原发性肝癌伴胆管癌栓者应积极手术治疗，仍有可能获得较好的效果。     

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目的 探讨不同类型原发性肝癌伴梗阻性黄疸的原因及其治疗方法。方法 分析原发性肝癌伴梗阻性黄疸的病人15例。其中肝癌引起胆管癌栓7例。肝癌压迫或侵犯肝门部胆管8例。其中手术10例，清除肝癌原发灶，解除胆管梗阻，非手术5例，先行减轻黄疸处理，然后行TAE，PEI等综合治疗。结果 手术切除病灶，延长生存期，而非手术处理组也明显改善症状，疗效显著，随访1-24个月（平均9个月）3例死亡，12例仍存活。结论 临床上有必要对原发性肝癌伴梗阻性黄疸进行积极治疗，以改善生活质量，延长生存期。     

Diagnosis and treatment of primary hepatocellular cancer with bile duct tumor thrombi

目的 探讨原发性肝癌合并胆管癌栓的诊断方法和治疗方式的选择.方法 通过回顾分析41例原发性肝癌合并胆管癌栓的诊断方法、误诊原因及综合治疗效果.结果 34例行手术切除肿瘤+胆管取癌栓,6例仅行胆管切开取癌栓.术后随访至今,其中肿瘤切除+胆管取癌栓患者平均生存时间超过2年,最长生存时间已超过10年,仅行胆管切开取癌栓平均生存时间18个月.结论 对于肝癌合并胆管癌栓,早期诊断并积极选择合适的手术方式可以获得症状的缓解和长期的生存,甚至获得根治.     

THE COMBINED APPROACH TO CANCER THERAPY IN CANCER CENTRES

In the complex field of cancer therapy the cancer centre approach may be seen more clearly by division of its structure into vertical and horizontal components. Vertically, there are numerous special consultative clinics in types of cancer usually associated with a body region (lung, breast, melanoma, etc.). Horizontally, there are teams of specialists (surgeons, radiotherapists, solid tumour chemotherapists), in some clinics supplemented by hæmatologists, immunologists, and endocrinologists, providing a wide therapeutic spectrum. Working together in a particular consultative team, the specialists are clinical oncologists, but without the summed wisdom and expertise of the group, the members are more accurately designated individually as specialists in the field from which they spring, for example, thoracic surgeon, hæmatologist, radiotherapist, and so on. The team approach lends itself to full exploitation of all the centralized sophisticated cancer machinery, be it in the form of equipment like celltrifuges and linear accelerators, a range and depth of cancer monitoring aids, or a medical record system aligned to a computer, with consequent immediate and long-term therapeutic gain to patients. For the State there is greater efficiency and hence economy. In teaching, the aggregation of all matters relating to cancer therapy presents enhanced opportunities for training of technicians and scientists and nurses as well as doctors, for postgraduate instruction, and for continuing education. For progress in understanding cancer, it is clear that clinical research in conjunction with the combined approach in cancer centres can be conducted with sufficient numbers of patients to give statistical credence to clinical trials.     

EARLY GASTRIC CANCER

Thirty patients with early gastric cancer were studied as part of a consecutive series of 308 gastric cancers, giving a proportion of 9.7%. Twenty-eight of the early gastric cancer patients were symptomatic, pain being the most common symptom. Endoscopy proved more effective than barium studies as a first investigation but the diagnosis rate at first examination was still only 69%. Seven patients with early gastric cancer had lymph node spread at the time of presentation. Five patients eventually died of cancer metastases. There was a high incidence of benign peptic ulceration (50%) and this with lymph node metastasis was an unfavourable prognostic feature. Only four of the 26 patients submitted to standard surgical resections died of cancer. This study supports the concept that early gastric cancer does indeed occur in Westem man and the five year survival rate (65%) is much higher than for late gastric cancer (13%). The high incidence of metastasis at the time of presentation may account for the difference between our survival rate for early gastric cancer, and that reported from Japan.     

隐匿性乳腺癌

本文报告隐匿性乳腺癌7例,均以腋下肿块为首发症状。探讨了误诊原因,强调了以腋下肿块为首发症状的女性病人,应考虑到隐匿性乳腺癌;对乳腺各种检查无阳性发现者不能排除本病。确定性诊断需行腋下肿块活检。作者认为本病应行根治术或改良根治术并辅以放疗、化疗。     

EARLY GASTRIC CANCER

Eighteen cases of ‘early gastric cancer’have been managed over a 14-year period. This represents only 3.5% of all patients diagnosed as having adenocarcinoma of the stomach. The symptoms of early gastric cancer are similar to those of benign peptic ulcer disease and differ from those of invasive disease. The pathology of the lesions is described and the morphology shown to be similar to that seen in Japan. The overall 5-year survival rate is 82% but no patient has developed recurrence within 5 years of surgery, confirming the biological behaviour of the lesion to be identical to that noted by Japanese researchers.     

FAMILIAL BLADDER CANCER IN THE NATIONAL SWEDISH FAMILY CANCER DATABASE

PURPOSE: We analyzed the risk of bladder cancer in offspring according to parental and sibling cancer using the national Swedish Family Cancer Database. MATERIALS AND METHODS: Cancer data were obtained from the Swedish Cancer Registry for 1958 to 1996, including 2,105 cases of bladder cancer in offspring. The standardized incidence ratio was used to measure cancer risk in offspring according to familial cancer status. RESULTS: The incidence ratio of bladder cancer increased in Sweden from 1958 to 1996 and it was 3 to 4-fold higher in males than in females. We identified 65 families in which the parents and offspring had bladder cancer with a familial risk of 1.35 (95% confidence interval [CI] 0.97 to 1.79) in sons and 2.29 (95% CI 1.46 to 3.29) in daughters. Discordant cancer sites associated with bladder cancer in the 2 generations were the kidney and thyroid with a standardized incidence ratio of 1.58 (95% CI 1.18 to 2.05) and 1.89 (95% CI 1.00 to 3.05), respectively. Sibling risk was higher compared with offspring risk with a standardized incidence ratio of 2.96 (95% CI 1.41 to 5.08) and in males there was a statistically significant ratio of sibling-to-offspring risk of 2.66 (95% CI 1.29 to 5.45). Patient age at onset modified the familial risk. The highest familial risk of 7.26 (95% CI 2.61 to 14.24) was observed in the brothers of bladder cancer probands diagnosed before age 45 years. CONCLUSIONS: The relatively high ratio of sibling-to-offspring risk as well as observed gender specific effects in bladder cancer may reflect an X linked susceptibility gene.     

PARANASAL SINUS CANCER

This is a review of 65 patients with paranasal sinus malignancies who were treated by radical surgery. Most patients received either pre- or postoperative radiotherapy. Twenty-nine tumours arose in the maxillary antrum, seventeen in the ethmoid labyrinth and the remainder from the vestibule, nasal septum, lateral nasal wall and vault. There were 58 epithelial cancers. The 5-year survival rate for patients with adenocarcinoma was 78%, and 70% for antral squamous cell cancer and esthesioneuroblastoma. None of the melanoma patients survived free of disease for 5 years. The 5-year survival rate for the 21 patients undergoing orbital exenteration was 50%, compared with 70% when the eye was spared. Twelve free flap revascularized tissue transfer flaps were used to reconstruct large cranial and sino-orbital defects.