老年进展期胃癌的外科治疗

胃癌是我国死亡率最高的恶性肿瘤之一,随着人口老龄化,老年患者逐渐增多。根治性手术是治愈进展期胃癌的唯一手段:D2胃癌根治术作为治疗进展期胃癌的标准术式已被普遍接受。几项临床试验已证实与D2根治术相比,扩大手术范围并未使患者术后生存率有更多的获益。为改善进展期胃癌患者的预后,必须强调开展术前TNM分期,以便临床医师根据肿瘤的状况选择合适的治疗方案。微创外科技术在进展期胃癌中的应用仍有争议,需要进一步研究。胃癌术后消化道重建方式是决定术后生活质量的关键因素,理想的重建方式仍有争议。     

复发性胃癌56例的外科治疗

目的探讨胃癌手术后复发因素及其再手术的适应证。方法回顾性分析1997年1月至2004年4月胃癌术后复发行再次手术治疗56例的临床资料,对复发原因、手术方法、术后并发症、病死率进行分析。结果术后生存5年以上10例,3年以上15例,1年以上13例,1年以内死亡12例。单纯探查者6例分别于术后3~6个月内死亡。结论胃癌术后复发者再手术能否切除病灶主要取决于复发形式。     

胃穿孔手术治疗分析

目的探讨胃穿孔的特点和手术治疗的方法。方法对电白县电城中心卫生院2008年1月至2011年1月收治的62例胃穿孔患者的临床资料进行回顾性分析。结果患者中胃溃疡穿孔55例,胃癌穿孔4例,外伤性穿孔3例。患者全部进行手术治疗,行胃穿孔单纯修补术48例,行胃大部分切除术10例,行穿孔修补术后胃癌Ⅱ期根治术4例。治愈60例,死亡2例,1例死于胃癌复发,1例死于感染性休克伴多脏器功能衰竭。结论消化性溃疡是胃穿孔的主要病因,早期诊断、及时处理是治疗成功的关键。     

残胃食管癌再手术治疗

目的探讨胃大部切除术后食管癌,残胃贲门癌的手术方式及效果。方法回顾分析手术治疗38例胃大部切除术后食管癌及残胃贲门癌的临床资料。结果全组无手术死亡,除2例切口感染外,余均一期痊愈出院。术后生存1年以上28例(73.7%),3年以上16例(42.1%),5年以上10例(26.3%)。结论胃大部切除术后食管癌、残胃贲门癌的手术治疗需根据病变部位选择手术方式:中上段食管癌宜用结肠代食管,残胃癌、残胃贲门宜用空肠代食管。     

多模式综合治疗胃癌

胃癌在全球恶性肿瘤致死原因中排名第二位。尽管完整外科手术切除是治愈早期胃癌的唯一方法,但是,对于进展期胃癌,单纯手术长期生存者仅占30%。为了提高现状,必须进行包括化疗、放疗及外科治疗的多模式综合治疗。最近的临床试验已经证明,联合不同的新辅助或辅助治疗方案生存获益优于单纯手术。此外,实施化疗联合新的靶向药物治疗在进展期胃癌多模式综合治疗中起至关重要的作用。本文重点讨论胃癌多模式综合治疗的方法及提高疗效的未来策略。     

隐匿性乳腺癌外科治疗

目的 探讨隐匿性乳腺癌的外科治疗方法.方法 对11例隐匿性乳腺癌患者的临床资料进行回顾性分析.结果11例均为女性,年龄44～70岁,中位年龄55岁.首发症状均为腋窝肿物,左侧4例,右侧7例.合并锁骨上淋巴结转移2例.行改良根治术4例,保留乳房仅行腋窝淋巴清扫术3例,腋窝肿物切除术2例,锁骨上淋巴结活检2例.术后按乳腺癌治疗规范行放、化疗和内分泌治疗.随访8个月至9年6个月,死亡3例,5年生存率54.5%(6/11).结论 隐匿性乳腺癌应根据乳腺癌治疗规范进行综合治疗.手术可行改良根治术或根治性保乳术,对于乳腺无原发癌证据者可保留乳房仅行腋窝淋巴清扫术.     

Surgical treatment of pancreatic cancer.

The problems encountered in the surgical treatment of pancreatic cancer are outlined on the basis of a review of the literature published in the last 15 years and the authors' experience with 157 patients over the period 1970 to 1977. The overwhelming evidence favors resection as opposed to any palliative procedure. Although the number of patients eligible for 5-year follow-up is small, the data suggest that total pancreatectomy with regional lymphadenectomy may be the most appropriate operation.     

Surgical treatment of nonmelanoma skin cancer

Nonmelanoma skin cancer is the most common human malignancy. An estimated 2.75 million patients worldwide are diagnosed with skin cancer each year, with more than one million in the United States alone. Treatment for skin cancer includes methods such as cryosurgery, curettage and electrodessication, local excision, and Mohs micrographic surgery. Regardless of the method used, the goal is to provide the patient with the safest, most cost-effective and curative treatment.     

原发中叶肺癌的外科治疗

目的探讨原发中叶肺癌的临床特点、诊断及外科治疗特点。方法对1987年1月～2006年12月经外科手术治疗的43例原发中叶肺癌的临床资料进行回顾性分析。结果本组原发中叶肺癌43例,占同期肺癌手术病例的3.7%,年龄≥50岁的占79.1%,男性多见。手术方式:单纯中叶切除16例,姑息切除10例,中上叶切除或中下叶切除术6例,剖胸探查4例,楔形切除3例,根治术4例。全组病例中除1例术后发生纵隔气肿再次剖胸修补肺断面漏气外,其余均无并发症,均痊愈出院。术后1年生存率67.44%,3年生存率25.58%,5年生存率9.3%。1年内死亡病例均为姑息切除和剖胸探查的患者。结论本组病例发现时多已是中晚期,病变常侵及心包、胸壁及膈肌,累及上叶或下叶,中叶支气管旁及纵隔淋巴结转移常见,手术效果欠理想。临床医生应提高对中叶肺癌的认识,提高早期确诊率,避免错过手术时机。术前掌握患者的肺功能及远处转移情况,制定合适的手术方案,尽可能行根治性切除,单纯中叶切除适合于肿瘤局限,无扩散或转移的病例。如肿瘤跨叶,可行双肺叶切除、袖式肺叶切除或全肺切除。如肿瘤已扩散或转移,可行局部姑息切除,但复发率高,远期效果差。     

Surgical treatment of gastric outlet obstruction due to gastroduodenal tuberculosis

Gastroduodenal tuberculosis is a very rare location of abdominal tuberculosis; it is usually secondary to pulmonary tuberculosis and is often associated with HIV infection. We report a case of a 45-year-old woman with no HIV infection and no evidence of pulmonary tuberculosis, with a history of duodenal ulcer treated for several months, who presented at the emergency department with severe gastric outlet obstruction of recent onset caused by ulcerohypertrophic antroduodenal tuberculosis. The lesion was misdiagnosed at endoscopy as a malignancy, although histological examination of biopsies showed only chronic inflammation. The diagnosis was established at surgery, when a frozen section of an enlarged lymph node showed the presence of giant cells and caseating granuloma. The treatment was gastric resection with Roux-en-Y gastrojejunal anastomosis. In this patient the rare gastroduodenal location of tuberculosis occurred as primary disease in the absence of other organ involvement.     

Oncology today: ovarian cancer

While researchers work to improve treatment and come up with an accurate way to detect the disease early on, ovarian cancer will kill 14,000 women in the United States this year. Here's an update on this particularly insidious form of cancer: how it's managed today and treatment options for the future.