原发性食管恶性黑色素瘤的外科诊治

目的探讨原发性食管恶性黑色素瘤的临床病理特征、诊断、鉴别诊断和外科治疗。方法回顾我院6例外科手术切除和病理学确诊原发性食管恶性黑色素瘤的相关临床资料,并分析相关文献。结果6例患者中男5例,女1例,年龄48～66岁,平均55.8岁,临床症状主要为吞咽困难和胸骨后疼痛,均经钡餐检查提示食管肿瘤性病变,食管中段4例,下段2例,术前2例误诊为食管癌,4例胃镜刷咬切片检查提示食管恶性黑色素瘤,均行食管切除和胃代食管吻合术。术后病理诊断为原发性食管恶性黑色素瘤,组织学特征与其他部位恶性黑色素瘤相似,免疫组化表达HMB45、S-100、Vimentin,不表达CgA。结论原发性食管恶性黑色素瘤临床罕见,易误诊,诊断依据临床病理特征、影像学检查,内镜刷片检查有利术前诊断,治疗原则为以外科手术切除为主的综合治疗。     

原发性肺恶性黑色素瘤的外科诊治

目的探讨原发性肺恶性黑色素瘤的临床病理特征、诊断和鉴别诊断以及外科治疗。方法分析我院1980至2008年间5例原发性肺恶性黑色素瘤患者的相关临床治疗,并结合文献复习。结果5例患者中男2例,女3例;年龄41-72岁,平均51.6岁;左上叶2例,右上、中和下叶各1例;症状包括咳嗽、咳痰、胸痛和胸闷不适。术后病理诊断为原发性肺恶性黑色素瘤。无手术和术后住院期死亡。结论原发性肺恶性黑色素瘤临床罕见,诊断主要依据影像学检查和病理检查,治疗首选外科手术完整切除。     

原发性肝脏恶性黑色素瘤的诊治进展

恶性黑色素瘤是由皮肤等器官黑色素细胞产生的肿瘤,该病多见于中老年人,其常见发生部位为皮肤、眼部、肛周等,少数可发生于鼻腔、鼻窦、口腔、喉部、脑脊膜、胆囊、消化道、骨、肺、肾上腺等,原发于肝脏的恶性黑色素瘤临床极为罕见。原发性黑色素瘤主要临床表现为肝大、黄疸、消瘦、肝区叩击痛等,表现特异性不强,其诊断需借助于病理学及免疫组织化学染色支持,并结合临床排除其他部位恶性黑色素瘤生长可能。在治疗方面,目前国内外肝脏原发性恶性黑色素瘤无特效的治疗方法。对于单发或肿瘤体积相对较小的个体可考虑积极手术治疗,多发及体积较大者可行放射及化学治疗、免疫调节治疗。但一般情况下,原发性黑色素瘤预后相对较差。     

重组全人源抗程序性死亡受体1单克隆抗体治疗肺原发性恶性黑色素瘤1例

恶性黑色素瘤是一种起源于神经鞘的黑色素细胞的恶性肿瘤,多分布于皮肤、黏膜、眼部和神经系统,恶性程度高,易转移、复发,预后较差。肺原发恶性黑色素瘤临床罕见。本文报道1例经病理确诊的肺原发恶性黑色素瘤患者资料,应用重组全人源抗程序性死亡受体1单克隆抗体（PD-1）抑制剂治疗效果良好。     

直肠肛管恶性黑色素瘤1例报道并文献复习

正直肠肛管恶性黑色素瘤是一种恶性程度高、预后差、病死率高的疾病,其发病率在恶性黑色素瘤中低于皮肤、眼内~([1]),由于本病缺乏特异性临床表现,因此诊断时多已为疾病晚期。临床中需重视结肠镜检查的重要性,早期诊断和治疗可延长患者生存期,提高临床疗效。本文报道1例经病理及影像学检查证实的直肠肛管恶性黑色素瘤(anorectal malignant melanoma,AMM),希望借此病例提高医师对此病的认识。     

胰腺原发性恶性黑色素瘤的诊断和治疗

消化道恶性黑色素瘤是一种少见性肿瘤,而原发性胰腺黑色素瘤极为罕见,发病隐匿,临床上对此认识不深.我们结合近期手术治疗的一例胰腺黑色素瘤,对该病的诊断和治疗进行了回顾分析.     

内镜诊断恶性黑色素瘤胃转移一例

恶性黑色素瘤胃转移临床罕见，本文介绍1例以消化道不适就诊于我院消化内科的患者，该患者既往有黑色素瘤病史，结合病理、内镜、临床等检查，最终确诊为恶性黑色素瘤胃转移。     

结膜恶性黑色素瘤1例

恶性黑色素瘤是来源于黑色素细胞的一种高度恶性的肿瘤,其中结膜恶性黑色素瘤是一种罕见的单侧性恶性肿瘤,尤其结膜表面光滑、结节孤立者更为罕见,因其对视力影响小,不易引起注意。本文分析收治的1例结膜恶性黑色素瘤患者的临床资料。     

老年手部恶性黑色素瘤患者13例

恶性黑色素瘤恶性程度极高,病程进展快,在手外科临床少见,临床上容易误诊。只有临床重视,早发现,早诊断,早治疗才能有好的预后。1资料与方法1.1一般资料2001年1月至2010年2月我院共收治13例恶性黑色素瘤患者,其中男11例,女2例,年龄64～79〔平均(69±6.7)〕岁。病程:最短5个月,最长8年。发病部位:右手     

原发性食管恶性黑色素瘤1例报道

原发性食管恶性黑色素瘤罕见,大多数患者就诊时临床症状与食管癌类似。现报道1例经胃镜确诊的原发性食管恶性黑色素瘤患者。     

上消化道间叶源性肿瘤的内镜超声与病理诊断的对照研究

,特异性达93.8%.结论 上消化道GIMTs在胃以间质瘤为多见,EUS显示多起源于固有肌层;在食管以平滑肌瘤为多见,EUS显示多起源于黏膜肌层.根据EUS声像图特征判断上消化道间质瘤良恶性具有较高的敏感性和特异性.对GIMTs 临床处置具有重要的指导作用.     

Presumed primary malignant melanoma of the liver: a case report

A 55-year-old woman was hospitalized with a palpable and painful mass in her upper abdomen. Abdominal computed tomography revealed a 10 × 7-cm tumor extending into the abdominal cavity from the left hepatic lobe and multiple metastatic lesions in the right hepatic lobe. A left hepatic lobectomy was performed for debulking and palliative resection. Histopathological examination of the resected specimen diagnosed the large hepatic tumor in the left hepatic lobe as a malignant melanoma. Physical and radiological examinations were performed on dermatological, ophthalmic, gynecological, and central nervous system areas, and endoscopic examinations were performed on the upper digestive tract and colon. No other lesions were disclosed as possible primary tumors for the disease. This result suggested that the tumor might arise from the left hepatic lobe.     

上消化道溃疡急性穿孔96例保守治疗的体会

目的总结上消化道溃疡急性穿孔保守治疗的体会。方法对2008-01～2009-12接受保守治疗的上消化道溃疡急性穿孔患者96例的临床资料进行回顾性分析。结果全组96例上消化道溃疡急性穿孔患者全部治愈,无出现腹腔脓肿、再穿孔和死亡病例。随访半年,预后良好84例,复发10例,死亡2例。结论对于上消化道溃疡急性穿孔的治疗,在严格掌握适应证的前提下对患者采取保守治疗,可以取得满意效果。     

老年人消化道瘘38例临床分析

目的 探讨老年人术后消化道瘘发生的病因,寻找诊断及治疗方法。方法 以老年人术后消化道瘘３８例,对其发生率、发生时间、临床表现及原因进行分析。结果 发生率占同期老年人消化系手术的０．６５％,术后娄的时间平均５．２ｄ。５７．８％是由医源性损伤所造成的,再次手术１４例,占３６．８％,全组死亡１４例,死亡率３６．８％。良性疾病及恶性肿瘤术后消化道瘘的死亡率分别为１９．０％和５９．８％,老年人术后消化道瘘发     

善得定治疗癌性上消化道出血临床观察

目的为观察善得定治疗恶性肿瘤所致上消化道出血的疗效及副作用方法选用恶性肿瘤所致上消化道出血６６例，随机分为善得定治疗组和垂体后叶素对照组，治疗组病人先用善得定０１ｍｇ＋０．９％ＮＳ２０ｍｌ静推，后用善得定以每小时２５微克滴速静滴维持２４～４８小时，对照组用垂体后叶素以每小时２～５Ｕ滴速静滴维持２４～４８小时，同时给硝酸甘油０．５ｍｇ吞下含服。结果治疗组总有效率为８８２３％（３０／３４），对照组总有效率为６２５０％（２０／３２），两组差异有显著意义（Ｐ＜００５），治疗组每例平均输血量为７００８０±３２７１８ｍｌ，对照组输血量平均每例为１１７６００±３２４１２ｍｌ，两组差异显著（Ｐ＜０００１）。两组均无严重副作用。结论癌性上消化道出血是晚期肿瘤常见并发症及致死原因之一，善得定较传统的垂体后叶素治疗具有止血快、止血率高，副作用少等优点，且可减少输血量，值得临床广泛推广使用。     

Small bowel intussusception due to metastatic malignant melanoma. A case report

Small bowel metastatic deposits attributed to malignant melanoma are found in 2-5% of patients with malignant melanoma of the skin. Ileo-ileo intussusception caused by metastatic melanoma is a very rare condition. The prognosis of metastatic melanoma is poor. We report a case of a cutaneous malignant melanoma which metastasised to the small bowel causing enteroenteric intussusception. This case refers to a 66-year-old male patient who underwent surgery for suspected enteric intussusception. This diagnosis was suggested by computer tomography scan. The patient had had previous surgery for a primary malignant melanoma in the eyelid of the right eye. Segmental intestinal resection with regional lymph node dissection and ileo-ileo anastomosis was performed. Metastatic melanoma in the gastrointestinal tract should be suspected in patients with history of melanoma of the skin and acute gastrointestinal symptoms. Immediate laparotomy and excision of the affected bowel segment is the appropriate treatment.     

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstruction of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs. METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger's technique. RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group. CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.     

内镜超声检查在上消化道隆起性病灶诊断中的应用--附322例诊断分析

目的：探讨内镜超声检查在上消化道隆起性病灶诊断中的价值。方法：应用OLYMPUS EU-M30，GF-UM200，7.5/12MHz超声内镜对322例内镜提示上消化道隆起性病灶，部分甚至结合活检仍无法确诊进行内镜超声检查，并分析检查结果。结果：322例上消化道隆起性病灶中，以胃的隆起性病灶最多（198），其他依次为食道（95例）、十二指肠（23例）和贲门（6例）。病变性质以良性病变为主，共检出平滑肌瘤121例（位于固有肌层83例、黏膜肌层38例），其它依次为恶性肿瘤53例、外压性病变50例（其中胃底20例、脾脏外压14例）、未发现病变23例、异位胰腺20例（胃窦15例）、血管性病变16例、息肉11例、炎症9例、消化道壁增厚8例、囊肿与脂肪瘤各5例、纤维瘤1例。恶性病变及部分良性病变获组织学证实。结论：内镜超声检查能贴近病变部位进行扫描，能清楚地显示消化道壁的层次结构，对上消化道隆起性病灶具有准确的定位作用，并能较好地提示病变的性质。对明确上消化道隆起性病灶的诊断及指导治疗，具有较高的价值。但在肌瘤的良恶性判断上存在着一定困难。     

垂体后叶素单用及与硝酸甘油联用治疗老年人肝硬化上消化道出血作用比较

以垂体后叶素（PT）单用及与硝酸甘渍（NG）联用治疗老年肝硬化上消化道出血，两组12小时止血率分别为25％和56．2％（P＝0．0383），各种副作用发生率分别为79．2％和25％（P＝0．0009），因严重副作用而需中止治疗者分别占45．8％和12．5％）P＝0．0249）。提示老年人肝硬化上消化道出血不宜单用PT而应联用NG等扩血管药。药物以静脉途径给予为好。     

Endoscopic Diagnosis of Metastatic Disease of the Stomach and Duodenum

Endoscopic diagnosis of metastatic disease of the stomach and duodenum. G. P. Coughlin, A. J. Bourne and A. Kerr Grant, Aust. N.Z. J. Med., 1 977, 7 , pp. 52–55. The commonest tumours which metastasise to the upper gastrointestinal tract are from malignant melanoma, carcinoma of the breast and lung. Over a period of 12 months, three persons with known malignant disease were submitted to endoscopy by reason of upper gastrointestinal symptoms which could have been due to associated non-malignant disease. Two patients had known malignant melanoma and one a carcinoma of the breast. In each instance, endoscopy and biopsy demonstrated evidence of metastatic disease.