大肠类癌31例诊治分析

目的:研究大肠类癌的临床特点及个体化治疗策略。方法:回顾性分析31例大肠类癌患者的临床资料,分析肿瘤大小与生存率及病理分期的关系。结果:31例中30例获得随访,死亡7例,生存期6～40个月,中位生存期15月,5年生存率87.5%(21/24)。类癌直径1cm、1～2cm、2cm肿瘤患者的5年生存率分别为100%、85.7%、20.0%,直径2cm组与另外两组差异有统计学意义(P0.05)。按TNM病理分期,直径1cm、1～2cm、2cm3组肿瘤的T分期与N分期存在差异(P0.05),肿瘤直径越大T及N分期越晚。结论:肿瘤大小及术前完善检查、准确分期对于大肠类癌的个体化治疗有重要意义。     

直肠类癌预后影响因素分析

目的探讨直肠类癌的临床病理特点及影响预后的因素。方法回顾性分析31例直肠类癌患者的临床资料,所有病例均经手术和病理检查证实。将其按肿瘤直径大小和肌层是否有浸润分别分组,比较不同肿瘤直径各组和肌层是否浸润各组的手术治疗效果。结果本组31例直肠类癌患者的中位年龄49岁(22～83岁),中位随访时间36个月(15～86个月),随访率为80.6%(25/31)。随访期内,肿瘤直径≤l.0 cm的15例手术切除肿瘤后无复发,直径1.0～2.0 cm的7例中复发1例,直径>2.0 cm的3例中2例因类癌肝转移死亡。直肠类癌是否浸润肌层或全层以及是否有转移均与肿瘤大小有关(P<0.05);肿瘤的浸润深度与转移有关(P<0.05)。随着直肠类癌直径的增大,肿瘤浸润深度加深,转移发生率增高。结论直肠类癌的大小和肌层浸润可能是影响患者生存的重要因素,是选择手术方式时需参考的重要依据。     

大肠类癌的诊断与治疗

目的探讨结直肠类癌的预后因素及外科治疗方法的选择.方法回顾性分析1990～1999年经我院治疗的46例结直肠类癌的临床资料.结果大肠类癌男女之比为1.4∶1.直肠类癌发病率高(83%,38/46),肿瘤体积小(直径<2*!cm者占82%,31/38),预后较好.肿瘤直径大于2*!cm的直肠类癌转移率为71%(5/7),平均生存时间25个月.结肠类癌发现晚,转移发生早,转移率为83%(5/6),大于2*!cm结肠类癌平均生存时间18个月.结论结直肠类癌的大小,有无浸润及远处转移,是判断结直肠类癌良恶性、决定手术方式和预后的主要依据.     

影响直肠类癌治疗及预后因素的分析(附46例报告)

目的分析直肠类癌的临床及预后影响因素,探寻有参考价值的治疗方式的指标。方法回顾性分析我院自1999~2011年间收治的46例直肠类癌患者的临床资料,其中43例经手术治疗和病理证实。按肿瘤直径大小肌层是否有浸润和分别分组,比较不同肿瘤直径各组和肌层是否浸润各组的手术治疗效果,并随访术后的生存状况。结果本组46例直肠类癌患者中位年龄46.5岁(19~83岁),随访6~60个月,随访率84.7%。其中,肿瘤直径≤2cm的随访时间(47.2±19.8)个月,无复发病例。3例肿瘤直径2cm的随访中,1例术后3个月腹腔广泛转移,1例于28个月后死于肝转移,1例吻合口复发,再次手术,目前仍存活。直肠类癌是否浸润肌层或全层与肿瘤的大小有关(P0.05),3例放弃治疗的患者均为肿瘤局部侵犯和广泛转移。结论直肠类癌直径和浸润深度是影响患者生存的重要因素,提示外科医师应慎重考虑选择合适的手术方式。     

直肠类癌33例的诊治分析

目的探讨直肠类癌的临床、病理及预后影响因素.方法回顾性分析33例直肠类癌的临床病理资料,并进行随访,将其按直径大小和肌层是否有浸润分别分组,比较各组手术治疗效果及其生存率的区别.结果直肠类癌以大便习惯改变(17/33,52%)、便血(14/33,42%)和体检发现直肠肿块(14/33,42%)为主要临床表现.直肠类癌一般发现较早,肿瘤直径>2*!cm或浸润肌层者分别占12%(4/33).电灼术、局切术和扩大局切术共占79%(26/33),根治性手术仅占18%(6/33).所有病例(n=29)总的10年生存率为84%,肿瘤直径<2*!cm组(n=26)10年生存率为94%,而>2*!cm组(n=3)无1例活过5年,两者差别非常显著(P=1.0×10-9);未浸润肌层者(n=25)10年生存率为94%,而浸润肌层者(n=4)仅1例活过5年,两者差异非常显著(P=1.2×10-5).结论直肠类癌一般能早期发现,局部切除效果好.     

直肠类癌29例的外科治疗

目的 探讨直肠类癌的临床、病理及影响预后的因素.方法 回顾性分析两家医院29例直肠类癌患者的临床资料.所有病例均经手术和病理证实,其中内镜黏膜下切除5例,经肛门局部切除14例、局部扩大切除4例,经骶尾直肠部分切除2例,根治性切除4例.结果 本组29例直肠类癌患者的年龄32～71(54±11)岁,随访时间3至136个月,平均(61±4)个月,随访率为76%.随访期内,直径小于1 cm的13例手术切除后无复发,直径1～2 cm的5例复发1例,直径大于2 cm的4例中3例因类癌肝转移死亡.5年、10年肿瘤相关生存率为87%、80%.结论 手术治疗是直肠类癌的最佳治疗方法,手术切除范围取决于原发肿瘤的大小、浸润程度、淋巴结受累及是否存在肝脏转移等情况.     

术前结直肠炎症对于结直肠癌局部进展的预测意义

目的研究术前结直肠非特异性炎症对结直肠肿瘤局部进展及预后的影响。方法本研究为回顾性队列研究,通过回顾中山大学附属第六医院2007年至2010年的结直肠癌患者。所有具备该中心术前肠镜资料或手术病理证实肠炎的患者纳入研究,分为炎症组(肠镜下肠炎及手术病理肠炎)及对照组;比较肿瘤分期、淋巴结转移、癌结节转移、其他手术病理资料及生存预后等指标;比较总体生存及肿瘤复发等随访情况,随访时间3年。结果回顾病例907例,纳入研究346例;其中炎症组患者共70例,包括镜下远处肠炎39例(20.2%)、镜下肿瘤原位肠炎16例(22.9%)手术病理肠炎15例(21.4%),对照组276例(78.8%)。炎症组进展期肿瘤发生率74.3%(P0.001),淋巴结转移率62.3%(P0.001),癌结节转移率40.2%(P=0.001)均高于对照组。经logistic回归分析,手术病理肠炎是进展期肿瘤(P=0.016)、淋巴结转移(P=0.017)及癌结节转移(P=0.017)的独立危险预后因素;镜下远处肠炎是进展期肿瘤(P=0.003)、淋巴结转移(P=0.017)的独立危险预后因素。结论手术前结直肠非特异性炎症与肿瘤的分期存在明确的相关性,此类病例可用于结直肠炎症与恶性肿瘤关系研究。     

直肠类癌的病理特点及预后分析

为探讨直肠类癌的临床病理特点及影响预后的相关因素,回顾分析83例直肠类癌患者的临床病理资料及随访情况。结果显示,淋巴结转移情况与肿瘤大小有关,χ2=11．91,P〈0．05;5年生存率与肿瘤大小、浸润深度及淋巴结转移情况有关,P〈0．05。结果表明,肿瘤大小、浸润深度及淋巴结转移情况是影响直肠类癌5年生存率的重要因素,且肿瘤大小与淋巴结是否转移也相关。     

癌结节对胃癌患者预后及淋巴结分期的影响及其意义

目的探讨癌结节对胃癌患者预后及淋巴结分期的影响及其意义。方法回顾性分析2016年1至12月河北医科大学第四医院收治907例胃癌患者的临床病理资料, 根据病理诊断将患者分为癌结节阳性组(121例)和癌结节阴性组(786例), 分析癌结节与胃癌患者的临床病理特征及预后的关系。结果本组907例患者中有癌结节121例。单因素分析显示, 癌结节与pT分期、pN分期、pTNM分期、肿瘤直径、神经受侵、脉管受侵均有关(均P<0.05);多因素分析显示, pT分期(P<0.001)、pN分期(P=0.002)、pTNM分期(P=0.001)、肿瘤直径(P=0.033)、神经受侵(P=0.017)、脉管受侵(P=0.011)是癌结节阳性的独立危险因素。癌结节阳性胃癌患者的预后显著差于癌结节阴性患者(χ2=77.869, P<0.001)。单因素分析显示, 年龄、肿瘤位置、肿瘤直径、pT分期、pN分期、pTNM分期、脉管癌栓、神经受侵、有无癌结节及癌结节数量均影响患者预后(均P<0.05)。多因素分析显示, 年龄、pT分期、pN分期、pTNM分期、神经受侵、脉管受侵、癌结节数量是影...     

大肠类癌7例分析(摘要)

自1993年3月至1998年6月,我科收治了大肠类癌7例,占同期大肠恶性肿瘤的0.74%。其中女5例,占71%,男2例,占29%。年龄16~62岁,平均38.7岁。肿瘤直径:<1cm4例,>1cm3例。肿瘤部位:直肠4例,占57.1%,乙状结肠2例,占28.5%,阑尾1例,占14.4%。术前确诊6例,占85.7%,误诊1例,占14.3%,在术前确诊6例中,3例经肠镜活检确诊,2例经肠镜行肠息肉电切,切下的息肉标本送病理确诊,另有1例在院外误诊为急性阑尾炎,行阑尾切除,将切除的阑尾标本送病理确诊为阑尾类癌后上送我院,另1例误诊是术前活检诊断为直肠增生性息肉,术中快速冰冻切片证实为直肠类癌。本文对直肠、结肠、阑尾类痛的治疗进行了重点讨论。     

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??Clinical and pathalogical characteristic of colorectal carcinoid and prognosis WANG DA-quan??FU CHUAN-gang??MENG RONG-gui??et al.Department of Anus & Intestine Surgery??Changhai Hospital, Second Military Medical University,Shanghai 200433,China. Corresponding author: FU CHUAN-gang, E-mail??fugang416@126.com Abstract Objective To study clinical and pathalogical characteristic of colorectal carcinoid and its treatment.Methods Clinical data of 121 patients with colorectal carcinoid were analyzed retrospectively. Results The Male??female ratio was 1.42/1??The average age was (49.3±13.0)years old. 111 cases of which was located in rectum, 6 cases in appendix, 4 cases in colon. 5-year cumulative survival rate of total patients was 83.5%.Patients with rectal carcinoid whose tumor <2cm had a significantly longer survival than those with tumor ≥2cm (P <0.001).Patients whose lesions were in different intestinal wall had a different survival too(P<0.001).NSE expression and tumor diameter was related (P <0.01). Conclusion Incidence of colorectal is high, and it has been an upward trend. Colorectal carcinoid isnot specific performance. The pathological diagnosis has an important role in choosing treatment options and predicting prognosis. Surgery should be implemented in accordance with individual treatment.     

Prognostic analysis for carcinoid tumours of the rectum: a single institutional analysis of 106 patients

Aim Rectal carcinoid is a rare rectal tumour with a good prognosis. The aim of this study was to assess its clinicopathological characteristics and prognostic factors in a single institution. Method Clinical and pathological information was retrospectively collected in a single institution, and patients’ outcomes were determined. Multivariate analyses were performed to find independent prognostic factors attributed to overall survival. Results A total of 106 patients with rectal carcinoid were included. In all, 66% of the patients underwent transanal local excision and 34% had transabdominal surgery. The 5‐year survival rate was 87%. Muscularis invasion was the only independent prognostic factor for predicting 5‐year survival (P = 0.00046). Tumour size was found to be significantly associated with muscular invasion (P = 0.00003). The area under the curve of tumour size in the receiver operating characteristic curve for predicting muscular invasion was 0.92. Conclusion Patients with rectal carcinoid have a good prognosis. Muscular invasion is an independent risk factor of survival.     

消化道类癌的诊治和预后

目的:探讨消化道类癌的诊断、治疗和预后。方法:回顾性分析122例消化道类癌的临床资料。结果:消化道类癌临床表现不典型。54.1％的病例类癌浸及肌层,18％的类癌有区域淋巴结转移。随访3年以上的89例类癌其3年、5年和10年生存率分别为81.7％、66.7％和44.4％。结论:肿瘤直径<2cm者应行局部广泛切除术,>2cm者行根治术。结肠及胃部类癌切除范围应相对较大,而阑尾及空回肠类癌手术范围应相对较小。消化道癌早期手术预后较好。     

Carcinoid tumor of the common bile duct in children: a case report

Carcinoid tumors of common bile duct (CBD) are rare, with fewer than 60 cases reported worldwide. Typically, jaundice is the most common presenting symptom. Preoperative diagnosis is difficult because methods for obtaining adequate specimens for histologic analysis are limited. Surgery is the primary treatment for CBD carcinoids to have disease-free survival. This is a case report concerning a 10-year-old boy with a carcinoid tumor of the CBD. An overview of the clinical presentation, diagnosis, radiologic workup, surgical treatment, histologic features, and prognosis of carcinoid tumor is provided.     

Gastrointestinal carcinoids. Prognosis and survival

BACKGROUND: Gastrointestinal carcinoid tumors are rare and little is known about factors related to prognosis in patients with carcinoid disease. Aim of this study is to determine the impact of clinical presentation variables on the management and survival. METHODS: We have evaluated 31 consecutive patients with gastrointestinal carcinoid tu-mours who underwent surgical intervention at the I Department of Surgery of Milano-Bicocca University over 15 years (1985-1999). Tumor distribution, hormone production, prognostic factors and survival were analysed. RESULTS: Carcinoid syndrome was the only clinical pattern diagnostic of carcinoid tumour. Most common symptoms were abdominal pain (64%), nausea and vomiting (48%). High levels of urinary 5-hydroxyindolacetic acid were significantly associated with carcinoid syndrome and metastatic disease. Tumor size, depth and gender were significant predictors of metastases. Age, gender, tumor size, metastatic spread and location were statistically significant predictors of death. CONCLUSIONS: Clinical presentation was non specific except for those patients affected by carcinoid syndrome. Ten years overall survival was 43%, with 52% metastatic spread incidence. The extent of surgical resection should be modulated on patient related risk factors. Poor prognostic factors affecting survival were: age, gender, metastatic disease, depth of invasion and tumour size.     

原发性结直肠上皮样肉瘤的临床特征分析

目的了解原发性结直肠上皮样肉瘤的临床特点。方法回顾性分析我院收治及文献个案报道的共32例原发性结直肠上皮样肉瘤的临床资料。结果男女发病比例均等,平均发病年龄64岁;首发症状以下腹疼痛为最常见,其次为便血和大便性状改变,偶见便秘、体重下降等。肿瘤好发于结肠;肿瘤直径2~24cm;同时性和异时性转移,均以肝转移最常见,腹腔淋巴结转移其次;手术治疗以根治术为主;中位生存时间11.4个月。结论原发性结直肠上皮样肉瘤无特征性表现,恶性程度较高,首选手术治疗,预后效果不佳。