原发性肝癌术后放疗21例报告

１９８６年１月至１９９２年１月，２１例原发性肝癌行肝叶切除术，切除肿瘤者８例，手术切除有残留者１２例，探查后未能切除者１例，术后用肝移动条技术或局部野进行放疗，对术后有残留者给组织量６０Ｇ对有亚临床灶者给４０Ｇｙ左右，其１、３、５年生存率分别为９５．５％，４７．６％和３３．３％，本组病例虽少，但似乎也可以看出肝癌术后放疗可以延长患者生存期。     

116例乳腺癌病人术后生存分析

作者统计了手术治疗的１１６例乳腺癌病人，随访期为术后的０．１～５年，平均３．７年。随访结束时生存９２例，死亡２４例。采用Ｋａｐｌａｎ－Ｍｅｉｅｒ方法计算的术后１年、３年、５年生存率分别为９８．２１％、８３．８１％、７４．２０％。单因素分析结果表明原发肿瘤＞５ｃｍ、腋下淋巴结转移、ＴＮＭ分期晚、术后无辅助治疗者，其５年生存率明显降低。     

肝门部胆管癌35例分析

目的 探讨肝门部胆管癌多种术式对患者预后的影响。方法 回顾性分析我院１９９２年１２月～１９９９年５月收治的３５例经手术和病理证实的肝门部胆管癌病人手术方式和随访结果。结果 本组手术切除１３例,胆管内引流５例,外引流１１例,仅剖腹探查６例。有随访资料的２３例,随访率６５．７％。手术后生存最短２８ｄ,最长３０个月。切除术（根治切除和姑息切除）１３例存活７～３０个月,中位生存期１５个月,１、２年生存率为７６．９％、３０．８％。引流组存活２．５～２４个月,中位生存期８个月,１、２年生存率为２０．６％、１４．３％。单纯剖腹探查术多于术后３个月内死亡。至今生存５例,生存期分别为１２、１３、１３、１５和２１个月。结论 根治性切除和扩大切除范围是肝门部胆管癌最佳治疗方法。不放弃手术探查机会,对不能切除的病例,争取胆道内、外引流     

心包内处理肺血管全肺切除治疗晚期肺癌的疗效

报告５０例晚期肺癌采用心包内处理肺血管的肺切除术。术后随访５年生存率１４．３％。有胞膜侵犯，胸水或肋骨破坏１２例中，１例存活１年，余均在１年内死亡，平均生存３．７个月。     

116例乳腺癌病人术后生存分析

作者统计了手术治疗的１１６例乳腺癌病人，随访期为术后的０．１－５年，平均３．７年。随访结果时生存９２例，死亡２４例。采用Ｋａｐｌａｎ－Ｍｅｉｅｒ方法的术后１年、３年、５年生存率分别为９８．２１％、８３．８１％、７４．２０％。     

胰腺癌的诊断与治疗

本文报告胰腺癌８０例，其中胰头癌５３例，胰体尾部癌８例，全胰癌１９例。手术切除１２例（１５％），计胰头十二指肠切除１０例，全胰及脾切除１例，胰体尾切除１例。本组切除病例，肿瘤直径平均３．９ｃｍ，未切除病例平均７．１ｃｍ，两者有明显差异，说明早期诊断对手术切除具有重要性。切除组术后平均生存时间２３．２月，未切除组平均生存时间６．６月。本组５年生存率为６．３％。     

老年人肝癌66例手术治疗分析

目的 进一步探讨老年人肝癌的诊断和外科手术治疗的疗效。方法 回顾分析１９９０年５月至１９９７年６月收治的６６例６０岁以上肝癌患者的临床特点、诊断、外科治疗方法和疗效。结果 本组合并肝外疾病发生率为８４．８％。以肝外临床表现首诊占３０．３％（２０／６６），６６例经局部或肝叶切除，无１例死亡，术后并发症发生率为３１．８％（２１／６６），均经及时处理痊愈出院，随访３２例，术后１、２、３年生存率为１００％     

118例食管癌和贲门癌的外科治疗

１９８０ 年１ 月～１９９８ 年１２ 月经外科治疗食管癌和贲门癌１１８ 例，手术切除８５ 例（７２ ％ ） ，术后并发症１０ 例（８ ．５ ％ ） ，死亡２ 例（１ ．７ ％ ） 。３ 年和５ 年生存率分别为２１ ．２ ％ 和２ ．５ ％ 。通过分析认为：①早期诊断、早期治疗是提高手术及远期疗效的前提。②完善术前准备、正确选择术式、熟练掌握吻合技术及术后良好的监护治疗是减少并发症的关键     

非小细胞肺癌中的DNA相对含量预后意义的研究

目的：进一步探讨图像分析术测定ＤＮＡ相对含量在肺癌中的预后意义。方法：随访８５例原发性非小细胞肺癌（ＮＳＣＬＣ）术后病例，图像分析术测定经Ｆｅｕｌｇｅｎ染色的肿瘤细胞核涂片的ＤＮＡ相对含量。Ｋａｐｌａｎ－Ｍｅｉｅｒ乘积限法用于生存分析。结果：本组病例中位随访时间为４７个月，３年、５年总体生存率分别为６６％和６１％；全部病例均为非整倍体，５ＣＥＲ均值为４５．９％±２３．６％，ＤＩ均值为３．０６±０．６３，５ＣＥＲ与ＤＩ之间有密切的相关性（ｒ＝０．８６，Ｐ＜０．００１），ＤＩ＜２．７９组和ＤＩ≥２．７９组病人的５年生存率分别为８０％和４３％，两者之间有显著差别（χ２＝１３．１，Ｐ＝０．００３）。讨论：图象分析术测定ＤＮＡ相对含量可作为判断ＮＳＣＬＣ预后的辅助指标。     

卵巢无性细胞瘤（附24例临床分析）

对我院收治的２４例卵巢无性细胞瘤的临床资料进行分析。结果：本组病例占同期收治的原发性卵巢恶性肿瘤的６．５％（２４／３６９），发病年龄中位数为２５岁，全宫及附件切除１９例，单纯肿瘤切除５例，２３例术后均辅以放疗或／和化疗，１例未补充治疗，有２例有正常生育。２４例患者出院后均随访９～２１年，五年存活率为９０．９％。术后复发率为２５．０％，经补充治疗后效果良好。并对手术治疗、放疗及化疗等问题进行了讨论。     

肝门部胆管癌25例外科治疗的选择

目的：探讨肝门部胆管癌的手术方式及手术要点。方法：回顾性分析经手术和病理证实的25例肝门部胆管癌临床特点，手术方式和随访结果。结果：本组手术切除11例，余14例均行胆汁内，外引流术，其中胆肠内引流术9例，外引流术5例。随访手术切除病人1．0，1．5，2．0年生存率分别为54．6％（6／11），45．4％（5／11），18．1％（2／11），最长存活11年；引流组病人1年生存率仅35．7％（5／14），结论：肝门部胆管癌应力争根治性切除，不能切除者应行内引流术，但对于医疗条件较差的医院，则可行外引流术，延长病人生命，提高生存质量。     

松果体区肿瘤显微手术治疗

19例松果体区肿瘤采用幕下小脑上入路行显微手术治疗,10例获全切,另9例获大部分切除。术后1月内无1例死亡。随访表明存活1年以上无肿瘤复发者15例,占78.9％。认为,松果体区肿瘤的显微直视手术有其必要性;幕下小脑上入路为该区肿瘤显微切除的最佳手术入路之一;肿瘤能否全切与肿瘤的性质、大小以及肿瘤与周围结构的关系有关。术后及时对脑积水等并发症妥善处理是提高手术疗效的重要因素。     

SURGICAL TREATMENT OF MALIGNANTESOPHAGEAL TUMORS IN PUMC HOSPITAL

To study how to prolong the postoperative survival time of the patients with malignant esophageal tumors. The clinical data of 1098 patients with malignant esophageal tumors from 1961 to 1992 were retrospectively analyzed.The deletion of fragile histnmine triplet (FHIT) gene (a tumor suppressor gene) in 30 fresh esophageal samples obtained in 1996 was detected with PCR and RT-PCR method. The resectability was raised gradually and the operatire morbidity and mortality decreased year by year, but there was no significant improvement on the postoperative 5-year survival rate. Delayed diagnosis and irradical resection influenced the long-term survival. The deletion of cDNA of FHIT gene was 64. 2% in esophageal cancer and 20% in the resected margin of the cancer. We believe that high-grade atypical hyperphsia in esophageal epithelium and deletion of FHIT gene in esophageal cancer and its resected margin are pathological and molecular markers for early diagnosis of esophageal cancer respectively,and the latter may be one of the molecular markers for the resection. Early diagnosis and treatment, radical.resection, and postoperative nutritional support are very important for the improvement of the postoperative survival time of the patients.     

腹腔镜和开腹全直肠系膜切除术治疗165例直肠癌患者短期疗效的比较

目的 比较腹腔镜全直肠系膜切除术(total mesorectal excision, TME)和开腹TME治疗直肠癌的手术切除范围和短期疗效.方法 在2002年8月至2005年12月期间收治了165例直肠癌患者,由患者自由选择上述手术方式,比较两组病例手术标本的长度、直肠远切端距肿瘤下缘的距离、清扫的淋巴结数目、局部复发率、远处转移发生率和2年生存率.两组病例的平均随访时间均为26.9个月(6～46个月).结果 两组病例的一般情况和Dukes分期相似.腹腔镜组和开腹手术组手术标本的长度分别是24.4 cm和25.2 cm;直肠远切端距肿瘤下缘的距离分别是2.9 cm和2.7 cm;清扫的淋巴结数目分别是11.5枚和10.6枚;局部复发率分别是9.6%和11%;远处转移发生率分别是11.5%和14.6%;2年生存率分别是85.7%和78.8%;2年无瘤生存率分别是76.2%和69.7%.两组病例以上参数均无显著差异.结论 腹腔镜TME和开腹TME治疗直肠癌的手术切除范围和短期疗效相同.     

Clinical and pathological characteristics of primary intraspinal hemangiopericytoma and choice of treatment

Background  Primary intraspinal hemangiopericytoma is a rare malignant mesenchymal tumor with high rates of recurrence and metastasis. Surgery is the main therapeutic procedure for this lesion. This clinical research was undertaken to analyze the pathological characteristics, clinical course, and the choice of treatment for this lesion.
Methods  Twenty-three patients with primary intraspinal hemangiopericytomas were treated from 1987 to 2004. The clinical and imaging features, pathological findings, therapeutic procedures, and prognosis were analyzed retrospectively.
Results  Primary intraspinal hemangiopericytoma is more likely to attack middle-aged persons. The tumor mainly manifests as muscle weakness and sensor abnormalities. Microscopic examination showed slit-like vascular spaces and oral- or spindle-shaped cells with slightly acidic cytoplasm and oral nuclei. Tumors were subtotally resected in 11 patients, subtotally resected with postoperative radiotherapy in 4, totally resected in 5, and totally resected with postoperative radiotherapy in 3. Two patients were given spinal stabilization after total resection. Recurrence and metastatic rates were 50% and 0 in intradural patients. They were 73% and 27% in extradural patients, respectively.
Conclusions  The tumor should be resected en bloc with the neighboring dural mater to reduce recurrence and metastasis. Patients with subtotal resection need adjuvant radiotherapy. Patients with evident spinal involvement may benefit from spinal stabilization. The prognosis of the lesion arising from the dural mater is better.

     

胃肠道间质瘤原发灶大小与预后的关系

目的　探讨胃肠道间质瘤 (gastrointestinalstromaltumor,GIST)原发肿瘤大小与预后的关系。方法　对92例能完全切除的GIST患者的临床资料和病理切片 (含免疫组织化学检查 )重新复核并进行随访 ,分析原发肿瘤大小与预后的关系。结果　中位生存时间为 5 9 1个月 ,术后 2 ,5年生存率分别为 89 38%和 6 7 4 5 %。原发灶肿瘤完全切除术患者的生存率与其性别、肿瘤部位和大小、肿瘤性质、核分裂及复发转移有关 ;但多因素的Cox回归分析显示 ,术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关 (P <0 0 5 )。以 2cm为界比较生存率有统计学意义 (P <0 0 5 ) ,5cm为界比较生存率无统计学意义 (P >0 0 5 )。结论　GIST仍以外科治疗为主 ,胃肠道间质瘤原发灶大小是影响预后的独立高危因素 ,肿瘤直径≥ 2cm的患者应加强随诊     

非小细胞肺癌的预后因素及多变量分析

寻找非小细胞肺癌（ＮＳＣＬＣ）独立的预后因素，识别手术后复发和死亡的高危险性病人，以指导临床治疗。方法随访ＮＳＣＬＣ病人８５例。采用组织学观察、免疫组织化学及聚合酶链反应－单链构象多态性（ＰＣＲ－ＳＳＣＰ）方法和ＤＮＡ图象分析技术，采用Ｃｏｘ回归模型，多变量分析了临床、病理及主要生物学等１３项因素。结果本组病例中位随访时间为４７个月；３年、５年总体生存率分别为６６％和６１％。Ｃｏｘ回归显示，早期复发和死亡的单变量预后因素（Ｐ＜０．０５）为：淋巴结状况、ｐＴＮＭ分期、瘤栓形成、微血管数目、Ｋｉ－６７抗原标记率、ＤＮＡ相对含量以及ｐ５３基因突变；其中微血管数目和ｐＴＮＭ分期（均Ｐ＜０．０１）为ＮＳＣＬＣ独立的预后因素，并由此建立了ＮＳＣＬＣ的复发和死亡预测模型，得出了预后指数（ＰＩ）。结论ＰＩ可能是临床评价病人预后、识别ＮＳＣＬＣ手术后复发的高危险性病人很有实用价值的指标。     

原发性肝癌合并门静脉高压症的外科治疗

目的 探讨原发性肝癌合并门脉高压症的外科治疗方法与疗效。方法 回顾分析1992-2002年经手术治疗的肝癌合并门脉高压症患者87例。重点是加强围手术期处理,术中先结扎脾动脉,再根据肿瘤大小及部位选择手术方法。在切除肝癌病灶的同时行脾切除+门奇断流术26例,切除癌灶同时作脾切除术19例,42例只行肝癌切除。结果 术后死亡2例,分别死于肝功能衰竭及腹腔出血。术后1、3、5年生存率分别为90.8％、61.3％、29.2％。死亡原因依次为肝癌复发、上消化道出血及肝功能衰竭。结论 原发性肝癌合并门静永高压症病人重视加强围手术期的处理,根据肿瘤的大小及部位选择手术方案,一期手术治疗是安全可行的。     

Esophageal invasion by an upper gastric cancer: retrospective evaluation and prognosis

From 1975 to 1984, 894 patients with gastric cancer were operated on in the Department of Surgery at Kurume University School of Medicine. Of these, 86 (10%) had upper gastric cancer invading the esophagus. The 86 resected tumors were divided into two groups according to the surgical approach, thoraco-abdominal or abdominal. Twenty-three (27%) were resected through the abdominal approach and 63 (73%) were resected by the thoraco-abdominal approach. The overall positive mediastinal lymphnode metastasis rates for the 55 patients who underwent mediastinal lymphnode dissection by the thoraco-abdominal approach were 22% for differentiated type and 37% for undifferentiated type. The positive mediastinal lymphnode metastasis and the correlation to the extent of esophageal cancer invasion were observed at a minimal 7 mm distance from the esophago-gastric (E-G) junction for the undifferentiated type, and 2.2 cm for the differentiated type. Sixteen patients with cancer invading the esophagus were radically resected by the abdominal approach with an overall survival rate of 39%, while 48 were resected by the thoraco-abdominal approach with a 5 year survival rate of 40%. The 86 resected tumors were further subdivided into two groups according to the year of surgery. From 1975 to 1979, the abdominal approach was employed in 36% and the thoraco-abdominal approach in 64% of the surgeries, with an overall curative resection rate of 47%. However, from 1980 to 1984, the abdominal approach was employed in only 17% and the thoraco-abdominal approach in 83% of the surgeries and the curative resection rate increased to 59%.(ABSTRACT TRUNCATED AT 250 WORDS)     

北京协和医院食管恶生肿瘤的外科治疗

目的：探讨如何延长食管恶性肿瘤患者术后生存期。方法：回顾性分析１９６１￣１９９２年我院１０９８例食管恶性肿瘤患者的临床资料,并采用ＰＣＲ及ＲＴ－ＰＣＲ方法检测１９９６年３０例信管癌新鲜标本的抑癌出因脆性组氨酸三联体（ＦＨＩＴ）的缺失情况。结果：食管恶性肿瘤手术切除率不断提高,手术并发症和手术死亡率不断降低,但术后５年生存率无明显改变,延误诊断及非根治性切除影响了术后长期生存。ＦＨＩＴ基因的ｃＤＮＡ缺失在食管癌组织为６４．２％,在癌旁组织为２０％。结论：食管上皮高度不典型增生和ＦＨＩＴ基因在食管及其癌旁组织的缺失分别是早期食管癌诊断的病理学及分子生物学指标,后者也可作为食管癌切除范围的指标之一。早期诊断和治疗、根治性切除及术后营养支持对延长术后生存期十分重要。