原发性肺腺癌及其外科疗效（附115例报告）

１９８３年６月至１９９１年１２月，手术治疗原发性肺腺癌１１５例，占同期肺癌手术２７．３％。术后１、３、５年生存率分别为６７．０％、３５．４％、２１．８％，无手术死亡。本病发生率日趋上升，误诊率高达６７．８％；根治性手术是重要治疗手段，但不能控制潜在性微转移灶。作者就其独特临床特点、影响疗效因素、Ｎ_２淋巴结清除以及全身综合治疗等有关问题进行讨论。     

Frozen-Section Diagnosis of Small Adenocarcinoma of the Lung for Intentional Limited Surgery

Purpose To determine if Noguchi's classification can be evaluated accurately by frozen-section diagnosis before limited surgery. Methods We performed frozen-section diagnosis in 31 of 343 patients who underwent excision of primary lung cancer at our hospital between 1993 and 2004. All 31 patients had pulmonary adenocarcinoma, with a tumor diameter of ≦20 mm. There were 20 men and 11 women, ranging in age from 42 to 79 years (mean, 63.2 years). We assessed the rate of correct Noguchi's classification by categorizing all lesions into the following three groups on the basis of tumor diameter: ≤10 mm, 11–15 mm, and 16–20 mm. Results The overall rate of correct frozen-section diagnosis during surgery was 67.7%; being 100%, 41.7%, and 70% in the ≦10 mm, 11–15 mm, and 16–20 mm groups, respectively. Conclusion Limited surgery for primary lung cancer can be performed when the tumor diameter is ≦10 mm, by confirming it as either type A or B according to Noguchi's classification, using frozen-section diagnosis. Thus, examination of frozen sections might be an important diagnostic procedure before intentional limited surgery for lung cancer.     

Maxillary Verrucous Carcinoma Coincident With Cervical Lymph Node Metastasis of Colon Adenocarcinoma

Cervical lymph node metastasis is an extremely rare event in oral verrucous carcinoma. Isolated cervical lymph node metastasis of colon cancer is also rare. This article describes a case of maxillary verrucous carcinoma accompanied by colon adenocarcinoma that metastasized to a cervical lymph node in a 69-year-old Japanese woman. During preoperative evaluation for maxillary verrucous carcinoma, enlarged cervical lymph nodes and colon cancer were suspected by positron emission tomography. Colonoscopy with biopsies confirmed primary colon adenocarcinoma. Left radical neck dissection, partial maxillectomy, and full-thickness skin graft to the mucosa of the upper lip were performed before treatment of colon adenocarcinoma. Cervical lymph nodes showed metastasis from colon adenocarcinoma, and right hemicolectomy was performed. This is the first case report of synchronous oral verrucous carcinoma and colon adenocarcinoma with cervical lymph node metastasis.     

膀胱腺癌(附26例报告)

目的 提高膀胱腺癌的诊治水平。方法 回顾分析１９８０年１月至１９９８年１月收治的２６例膀胱腺癌资料。其中脐尿管腺癌１２例,原发性膀胱腺癌１４例。结果 ２６例中膀胱部分切除术８例,全膀胱切除＋尿流改道术１３例,根治性全膀胱切除＋尿流改道术２例,姑息性尿流改道术３例。随访１年生存率５２％,５年生存率２０％。结论 较局限的脐尿管腺癌可行广泛性部分膀胱切除术,原 性膀胱腺癌应行根治性全膀胱切除。     

膀胱腺癌（附31例报告）

１９６０年１月～１９９３年１月收治膀胱腺癌３１例，经病理证实原发性膀胱腺癌２５例，脐尿管腺癌６例。就临床表现、膀胱镜检查及膀胱造影等特点，结合文献分析讨论组织起源、早期诊断、及时正确治疗的重要性。手术治疗主张广泛膀胱部分切除术及根治性膀胱全切术，联合放疗，化疗。本组５年生存率２２．６％。     

电视胸腔镜辅助小切口肺叶切除治疗周围型肺癌

目的探讨电视胸腔镜辅助小切口（video-assisted mini-thoracotomy,VAMT）肺叶切除术在周围型肺癌治疗中的应用价值。方法2004年1月～2007年12月对56例周围型肺癌全麻下施行VAMT肺叶切除术,其中右肺上叶5例,右肺中叶2例,右肺下叶19例,左肺上叶8例,左肺下叶22例。双腔气管插管单肺通气,于第4或第5肋间做长6.0～8.0cm辅助小切口进胸,第6肋间隙腋中线1.5cm切口,置入胸腔镜。切除肺叶从小切口取出。常规清扫区域肿大淋巴结。结果术中未延长切口,纵隔淋巴结清扫平均14枚/例（9～31枚/例）。手术时间120～220min,（145±35）min。术中出血量100～450ml,（210±48）ml。术后住院5～11d,平均7d。7例出现并发症（7/56,12.5%）,包括胸腔积液5例,肺膨胀不全2例。56例随访1年,3例死亡,1年生存率94.6%（53/56）。结论VAMT肺叶切除术对周围型肺癌是一种安全可行的手术方法。     

肺移植手术中供肺保存液的研究现状

肺移植手术是治疗终末期肺部疾病的惟一有效方法，但仍然有许多相关问题须待解决。除了供肺严重缺乏外，因缺血-再灌注损伤导致的移植肺功能异常是肺移植手术患者最常见的早期死亡原因之一。保存移植肺的最佳状态对减轻肺移植术后缺血器官功能障碍至关重要。因此，寻找一种高度可靠的肺保存液，对减轻移植肺的缺血-再灌注损伤、提高肺移植术后肺功能有着十分重要的意义。现就供肺保存液的种类、灌注方式、灌注条件及其改良措施的研究现状进行综述。     

Synchronous Primary Lung Cancer Presenting with Small Cell Carcinoma and Adenocarcinoma

Multiple synchronous primary lung cancers presenting with different histologic types are uncommon. Among reported cases with different histologic findings, only a few had small cell lung cancer (SCLC) and adenocarcinoma. This unusual combination of lung cancers has not been well reported. In this report, we describe two cases of synchronous primary lung cancer presenting with lymph node metastasis of SCLC and early-stage adenocarcinoma. Epidermal growth factor receptor (EGFR) mutation was not detected in either SCLC or adenocarcinoma in the two cases.     

膀胱腺癌的诊治(附22例报告)

目的：探讨膀胱腺癌的诊治效果。方法：回顾性分析22例膀胱腺癌的临床资料，其中原发性膀胱腺癌19例，脐尿管癌3例。结果：22例有8例次行根治性膀胱全切术，4例行次膀胱全切术，2例次行扩大膀胱部分切除术，3例次行膀胱部分切除术，5例次行经尿道膀胱肿瘤切除术。术后随访1－5年，其2年生存率为55.5%，5年生存率为33.3%。结论：扩大性膀胱部分切除术是脐尿管癌的主要手术方式，原发性膀胱腺癌多行根治性膀胱全切术，总体疗效需进一步提高。     

Successful Bilateral Lung Transplantation for Lymphangiomatosis

Lymphangiomatosis is a rare disease of lymphatic proliferation for which no adequate treatment is known. We report the first successful case of bilateral lung transplantation for the treatment of end-stage pulmonary lymphangiomatosis. A successful outcome was achieved with continued survival beyond 4 years posttransplant and stable lung function. The primary obstacles to significant gains in pulmonary function were thoracic, skeletal and abdominal lymphangiomatosis, which led to pulmonary restriction. Our report demonstrates that pulmonary lymphangiomatosis should be included among those diseases for which lung transplantation is considered potentially beneficial treatment but also emphasizes the importance of screening patients carefully for chest wall and abdominal lymphangiomas that may impede recovery.     

Objective definition and measurement method of ground-glass opacity for planning limited resection in patients with clinical stage IA adenocarcinoma of the lung

Objective: The standard operation for patients with stage IA lung adenocarcinoma is considered to be a lobectomy. Recently, some researchers have reported that patients with tumors showing greater proportions of ground-glass opacity (GGO) at computed tomography (CT) could be candidates for limited resection, because of its less aggressive nature. However, the lack of a precise definition or standard measuring method of GGO prevents its general use as an index for planning limited resection. Therefore, we attempted to define GGO based on CT number and measured it more objectively. Methods: Between 1998 and 2001, 90 patients with clinical stage IA adenocarcinoma, who underwent standard or intentional limited resection and whose images of chest high-resolution CT were preserved in Digital Imaging and Communications in Medicine (DICOM) format, constituted the study population. The tumor shadow seen on the solid window (WL, −160 HU; WW, 2 HU) was regarded as the central solid area of the tumor seen on the lung window, and GGO was defined as the whole tumor area with the exception of the central solid area. Each area was measured using Scion Image (Scion Corp., Frederick, MD). We analyzed the relationship between the proportion of GGO and both of pathologic findings and recurrence. Results: Among the 90 tumors, 31 (34.4%) were calculated to have a GGO area greater than or equal to 50%. Of these, 27 (87%) tumors were bronchioloalveolar carcinoma. Lymphatic and vascular invasions, or nodal involvement were found only in patients with a smaller proportion of GGO (<50%) (P<0.05). During the follow-up period (median 36 months), recurrences occurred in eight patients who were diagnosed as having tumors showing smaller proportion of GGO (<50%). Conclusions: Tumors with a greater proportion of GGO measured by our method are thought to have a less invasive nature. Our objective measuring method of GGO could be useful for future multicenter trials to elucidate the value of limited resection for clinical stage IA adenocarcinoma based on the proportion of GGO.     

肺癌切除术后生存10年以上80例病人分析

１９７０年１月至１９８３年５月，手术切除原发性支气管肺癌２９２例，术后生存１０年以上者８０例，术后１０年生存率为２７．４％。分析影响手术后长期生存的因素后，认为病理分期、组织类型、肺瘤部位、手术方式和综合治疗等是影响切除术后长期生存的重要因素。作者强调提高早期肺癌的发现率和以外科手术为主的综合治疗是改善术后远期疗效的关键。     

Multifocal Primary Prostate Cancer Exhibits High Degree of Genomic Heterogeneity

Background

Most primary prostate cancers are multifocal with individual tumors harboring different aggressiveness; however, the genomic heterogeneity among these tumors is poorly understood.

Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has become an attractive surgical procedure, but several issues remain to be resolved. Prognosis after VATS lobectomy is important to evaluate the adequacy of VATS lobectomy as a cancer operation. Interestingly, several investigators, including us, have reported that prognosis after VATS lobectomy was superior to that after open lobectomy in early non-small-cell lung cancer (NSCLC). One of the possible reasons is the low invasiveness of VATS lobectomy. But we considered that patient bias might have some influence favoring VATS lobectomy. To evaluate our hypothesis, we reviewed medical records of stage I NSCLC patients undergoing operation between 1993 and 2002. We compared and evaluated the relationship between patient characteristics and prognosis after VATS and open lobectomy. We focused particularly on histological type, classifying it into four subgroups; (1) bronchioloalveolar carcinoma (BAC), (2) mixed BAC + papillary adenocarcinoma (BAC + Pap), (3) other adenocarcinoma (Other adeno), (4) squamous cell carcinoma + others (Sq + others). RESULTS: A total of 165 patients underwent VATS lobectomy, and 123 patients underwent open lobectomy. The 5-year survival rate of the VATS lobectomy group was 94.5% and that of the open lobectomy group was 81.5%. Univariate Cox regression of survival revealed that male, CEA > 5, Other adeno, Sq + others, open lobectomy, and tumor size > 3 cm were significant negative prognostic variables. Multivariate Cox regression of survival revealed that histological subtype and tumor size were independent prognostic factors, but surgical procedure was not an independent prognostic factor. COMMENTS: Prognosis after VATS lobectomy was superior to that after open lobectomy, but patient bias influenced the prognosis in favor of VATS lobectomy, and the surgical procedure itself was not a prognostic factor.