纤维支气管镜检查中央型肺癌246例分析

对２４６例中央型肺癌行纤支镜检查，结果显示：肿瘤均位于段及段以上支气管。右肺６１％，左肺３９％，两肺上叶４６．３％，两肺下叶２８％。病理类型为鳞癌５６．１％，小细胞癌２８％，腺癌１４．６％。纤支镜下主要特征为：鳞癌以管内增殖型改变（７１％）为主，表现为肿物向腔内生长，常伴管腔阻塞；小细胞癌和腺癌以浸润型改变和间接征象明显，小细胞癌常表现为局部粘膜增厚，管腔不同程度狭窄，组织脆，易出血等；腺癌多为息肉型，阻塞管腔。１２例胸片及ＣＴ阴性者，仅见局部粘膜色泽异常或粘膜粗糙。复检纤支镜可提高早期肺癌诊断率。     

纤维支气管镜对肺门影增大诊断价值的探讨

纤维支气管镜对肺门影增大诊断价值的探讨谭杰，庄淑华广州铁路中心医院呼吸内科（广州５１００８０）肺门影增大是较为常见的Ｘ线表现，在临床上较易漏诊。本文对６３例胸片示肺门影增大患者的纤支镜检查结果进行分析：发现镜下见腔内肿物２９例（４６％），管腔狭窄２１...     

非小细胞肺癌根治术后残端复发的放射治疗

目的评价和分析非小细胞肺癌根治术后残端复发的放射治疗疗效及预后因素。材料与方法从１９７０年２月至１９９３年初，３９例肺癌根治术后残端复发的病人入组分析。中位年龄５９岁，术后至复发时间３～５０月，始发复发症状至确诊时间０～２０月。伴有淋巴结转移者１８例，残端复发有组织学诊断２８例。８例加腔内放疗８～３０Ｇｙ／１～３次，２例加化疗，６例单纯腔内放疗１２～３０Ｇｙ／２～３次。单纯外照射剂量为４５～７０Ｇｙ，加腔内放疗者为２０～６０Ｇｙ。结果症状缓解率达９０％左右，５年生存率２３．０±７．５％。单纯残端复发者５年生存率３８．１±１１．０％，而伴有淋巴结转移者无３年存活（Ｐ＜０．００３）。始发复发症状至确诊时间＜２月与≥２月者，５年生存率分别为３３．７±１２．０％与１２．６±８．２％（Ｐ＞０．１０４５）。在６例行单纯腔内放疗中，２例长期生存。Ｃｏｘ回归分析仅残端复发是否伴有淋巴结转移为影响预后的重要因素。结论放射治疗是治疗非小细胞肺癌根治术后残端复发的重要手段，尤其单纯残端复发者可取得满意结果     

切割式活检针经皮肺活检对肺周围型肿块诊断的应用

肺周围型肿块，症状体征较少，X线和CT征象没有一个具有绝对的特异性，不能定性诊断；痰细胞学及纤支镜检查阳性率低；传统的经皮肺抽吸活检的标本只能做细胞学检查；经支气管肺活检及切割式活检针经皮肺活检的标本能同时做细胞学和病理检查，阳性率有所提高，但前者操作复杂。1994年4月－1996年10月作者用Trucut针经皮肺活检对肺周围性肿块检查，确诊率83．3％（5／6）。对于直径≥3cm的肺周围型肿块，在痰细胞学和纤支镜检查阴性时，应首选X线电视导弓吓切割式活检针经皮肺活检术。能提高确诊率。材料与方法6例男性病人。年龄55-70岁，…     

纤维支气管镜检查对老年肺不张的病因诊断

目的　探讨老年肺不张的病因及纤支镜检查在明确病因诊断中的作用。方法　经胸部Ｘ线或ＣＴ证实为肺不张的老年患者２４３ 例，行纤支镜检查并取活检，刷检及抗酸杆菌检查。结果　肺癌１５８ 例（６５．０％ ） ，其中鳞癌１２１ 例，未分化癌２１ 例，腺癌１６ 例，慢性炎症６２ 例（２６．７％ ），支气管内膜结核１５ 例（６．２ ％ ） ，纵隔淋巴瘤３ 例（１．２ ％ ） ，支气管扩张并血块阻塞２ 例（０．８％ ）。结论　老年肺不张多由肿瘤所致，纤支镜检查是明确病因诊断的重要方法。老年肺不张一旦发现，应尽快行纤支镜检查。     

纤支镜刷检、活检、冲洗、检后痰对非典型肺癌的诊断价值

纤支镜刷检、活检、冲洗、检后痰对非典型肺癌的诊断价值王琳主治医师曹培根解放军８５医院（２００２３３）据报道，肺癌病人的纤支镜检查（ＦＢ）阳性率，刷检８５％，活检９４％～９７％，总细胞学阳性率８５％，而纤支镜检查对胸部Ｘ线未显示明显增生性块影的非典型肺...     

175例肺癌阴影患者的纤支镜检查分析

目的：了解纤维支气管镜（纤支镜）检查对肺部阴影性病变的诊断价值，以及支气管肺癌（肺癌）的检出率。方法：采用纤支镜、病理组织学、细胞学及X线胸部摄片等方法，对175例患者进行检查分析。结果：X线胸片肺部阴影175例经纤支镜和病理学检查，112例有明确的病理结果，诊断率64％，确诊为肺癌者92例（52．6％）。临床诊断可疑肺癌124例经纤支镜检查和病理学检查，确诊为肺癌92例（74．2％）。结论：纤支镜检查是明确肺部阴影性质必不可少的手段，凡患者有可疑肺癌的临床指征或X线征象，均应及时进行纤支镜检查。     

补充性全肺切除术对残肺病变的治疗价值

目的：评估补充性全肺切除术的适应证、危险性和结果。方法：回顾性分析６８例年龄在１５￣７１岁的残肺良恶性病变的患者的补充性全肺切除术，其中第二肺癌１７例，肺复发癌３２例，良性肺及胸膜疾患１９例。再次手术间隔期为恶性者２９个月，良性为２１７个月。结果：７例患者死亡（１０．４％），２例死于术中，５例死于术后，癌性患者死亡率（１１．６％）高于良性患者（５．９％）。全部病例５年生存率为４８％，癌症患者３３％     

气管,支气管成形,肺切除支气管无残端成形术治疗肺癌

作者报告70例气管、支气管恶性肿瘤及原发性支气管肺癌的手术治疗。A：气管、支气管成形术25例：术式包括：1）气管袖式切除成形术。2）支气管袖式切除成形术。3）支气管、肺动脉双成形术。B：肺叶切除支气管无残端成形术40例：本式包括：1）中叶式舌段支气管无残端成形术。2）中下叶切除上叶支气管无残端成形术。C：全肺切除气管、支气管无残端成形术5例。术后随访1、3、5年生存率，A：83．3％（20／24），57．9％（11／19），40％（2／5）。B：80％（32／40），65．4％（17／26），43．8％（7／16）。C：80％（4／5），50％（2／4），33％（1／3）。本类术式的开展既可完全切除肿瘤，又最大限度地保留正常肺组织，又可避免支气管胸膜瘘的发生，提高了术后生存质量。     

食管癌术前大剂量短程放疗的临床研究

１９９３年２月至１９９４年１２月对８７例食管癌患者进行大剂量短程术前放疗，８６例做了食管癌切除颈部Ｇａｍｂｅｅ＇ｓ吻合术，１例单纯探查（Ⅰ组）。同期食管癌患者９９例，行单纯手术治疗（Ⅱ组），作为对照组。放疗方法：２０～２５ＧＹ／４～５次／４～５天，放疗后１～７天行手术治疗。结果：全部患者均可耐受大剂量放疗。术中见肿瘤变软、缩小；手术出血量、手术时间、术后并发症与对照组相比无明显差异。手术切除率：Ⅰ组９９％（８６／８７），Ⅱ组８９％（８８／９９），Ｐ＜０．０５。手术死亡率：Ⅰ组０，Ⅱ组２％（２／９９）。术后生存率：１年Ⅰ组６８．６％（５９／８６），Ⅱ组６４．８％（５７／８８）；２年Ⅰ组５０．０％（４３／８６），Ⅱ组４６．６％（４１／８８）；３年Ⅰ组４６．９％（１５／３２），Ⅱ组３７．５％（１２／３２）。     

胃癌术后内镜检查74例分析

我院子１９８４年６月至１９９０年１月，因胃癌术后行内镜检查７４例。从内镜检查中发现残胃有多种病变，尤以残胃再发癌，吻合口炎和吻合口溃疡为多，分别占２５．３８％、７０．５７％及６．７６％。根据残胃再发癌发病早、发病率高以及在临床上与吻合口炎和溃疡等易混淆的特点，建议于术后２年内每３－６个月进行内镜复查一次，２年以后每年复查一次。本文就如何提高残胃再发癌的内镜检查技术进行详细讨论，以便能得到早期诊断及为再次手术切除提供更多的依据。     

Treatment of recurrent cervical cancer

The questionnaire about recurrent cervical cancer of uterus were taken in 57 hospitals and treatments to 370 recurrent cases in National Institute of Radiological Science were studied. Our results were as follows. 1) About 50% of recurrent cases were detected within one year after primary treatments. Local recurrents were superior in cases of surgery as initial treatment, distant metastasis in cases of radiation. 2) Five Y.S.R. of 370 cases was 17.3% that of 105 operation cases as initial treatment was 26.7%. 3) Five Y.S.R. according to the sites of recurrence were 26.5% in vaginal stump, 6.7% in intrapelvis, 2.2% in lung metastasis, 5.5% in bone metastasis. 4) Five Y.S.R. according to the secondary treatments were 30% in operation, 16.4% in radiation, 6.9% in chemotherapy. 5) The principals of combined therapy to recurrent cervical cancer were presented.     

上叶肺癌术后支气管切缘癌残留相关因素分析

目的　探讨肺癌术后支气管切缘癌残留的相关形成因素 ,确立避免和减少切缘癌发生的策略和方法。方法　分析1994年至 2 0 0 2年经手术治疗的 60例上叶肺癌 ,在不同肿瘤分期、病理类型、手术适应证与扩大的手术适应证、术前纤维支气管镜所见、不同手术方式、支气管残端不同缝合方法及术中是否行残端快速冷冻病理检查等诸因素 ,对术后支气管残端癌残留形成的影响。结果　在 60例中手术后出现残端癌残留 10例 ,残端癌发生率 16.7% ,术前纤维支气管镜检查 ,能够在支气管腔内观察到肿瘤的 19例为中心型肺癌 ,其中残端癌残留 7例 ,阳性率高达 3 6.8% ,术前支气管镜检查阴性 41例为周围型 ,其中出现残端残留 3例 ,支气管残端癌发生率在中心型肺癌比周围型高 (P <0 .0 5 ) ;手术中未做残端冷冻病理检查的 5 6例 ,术后残端癌残留阳性 10例 ,其中 6例肺叶切除术后残端阳性者 ,分析其为支气管袖状肺叶切除术的手术适应证 ;在肺叶切除术中通过冷冻病理检查发现支气管残端阳性 2例 ,术式改变为支气管袖状肺叶切除术。结论　严格掌握肺癌手术的适应证并选择合理术式 ,术中支气管残端快速冷冻病理检查应作为肺癌外科的手术常规     

Surgical management of primary lung cancer in an elderly patient with preoperative empyema

A 74-year-old man with primary lung cancer developed preoperative empyema but was successfully managed surgically. The patient was given a diagnosis of c-T2N1M0, stage IIB, moderately differentiated squamous cell carcinoma, but before surgery pneumothorax and empyema developed, resulting from rupture of the carcinoma. Thoracic drainage, lavage and systemic administration of antibiotics improved his empyema. As there were no malignant cells in the drainage fluid, right middle-lower bilobectomy, empyemal cavity resection and lymph node dissection were performed. The bronchial stump was covered with an intercostal muscle flap. Thoracic drainage, lavage and systemic administration of antibiotics were performed for 6 days following the operation. The patient was discharged on the 27th postoperative day without any complications having developed. The pathological diagnosis of the tumor was p-T4N2(#7)M0, stage IIIB, br(-), ly(+), v(+), p3(pleura), pm1 and d0. He died of recurrence at home 18 months after the operation. We believe the following to be the minimum requirements for surgical management of such patients: (1) immediate thoracic cavity drainage and lavage with systemic antibiotic therapy, aiming at infection control before surgery; (2) prophylactic lavage of the thoracic cavity during and after surgery and (3) coverage of the bronchial stump with an adequate flap. Six reported cases of primary lung cancer with preoperative empyema are also discussed.     

胃癌二次手术经验分析

目的：探讨胃癌再手术的适应证和再手术效果及其手术后复发因素。方法：回顾性分析1995～2005年胃癌术后复发病人进行再次手术治疗50例的临床资料,并对手术方法、术后并发症、病死率及术后生存情况进行了分析。结果：术后生存5年以上6例,3年以上10例,2年以上12例,1年以上6例,1年内死亡者14例。手术死亡1例,死于其他疾病1例。单纯探查空肠造瘘者9例分别于3～11个月内死亡。结论：对胃癌术后复发者,再手术能争取一定的生存率和生存质量,凡证实吻合口或残胃复发者,即使侵及邻近脏器,无远处转移,均应再次手术。     

External beam radiation therapy for bronchial stump recurrence of non-small-cell lung cancer after complete resection.

BACKGROUND AND PURPOSE: External beam radiation therapy (EBRT) is occasionally used in the treatment of bronchial stump recurrences after complete surgical resection in patients with non-small-cell lung cancer (NSCLC), but no prospective study exists, so far. The objective of this review is to determine effectiveness of high-dose EBRT in this disease.METHODS: A systematic review was undertaken using electronic databases, reference lists and hand searching of journals to identify potentially eligible studies. Selection criteria included studies that provided outcome after high-dose EBRT in this disease. Six retrospective studies were reviewed, including a total of 54 patients.RESULTS AND CONCLUSION: High-dose EBRT appears to be an effective treatment modality for recurrent NSCLC confined to the bronchial stump after curative resection with a median survival time of approximately 30 months and 5-year survival of approximately 30%. Although small patient numbers and unclear indications for radical versus palliative EBRT may obscure the overall conclusions, among patients with intrathoracic recurrence those with bronchial stump recurrence only do better than those with non-stump recurrence. It seems there is a dose-response effect in this patient population and a predominantly local pattern of failure, both observations having an implication for future studies. The optimal dose/fractionation pattern or treatment fields must be further investigated in the future. Identification of an unfavourable subset of patients may help optimize treatment in the future by omitting high-dose, curative RT in those patients who may be best treated with palliative RT. Prospective studies on EBRT in both bronchial stump and other post-surgical recurrences are urgently needed.     

复发转移性结直肠癌的外科治疗及预后分析

背景与目的:结直肠癌是常见恶性肿瘤之一,其发病率有逐渐增高的趋势.其主要的治疗方法是根治性手术,手术后的复发及转移是导致患者死亡的主要原因.目前复发性结直肠癌的再手术是提高患者生存率和生存质量的主要方法.本文探讨结直肠癌术后复发的原因、诊断和外科治疗方法.方法:回顾性分析2003-2006年35例复发与转移性结直肠癌的外科治疗及预后.结果:手术后1年内复发者9例 (26%),3年内复发者26例(74 %).本组35例复发或转移性结直肠癌均行再次手术,7例复发性直肠癌再切除4例,造瘘3例,28例复发性结肠癌中,根治性切除8例(包括5例肝转移灶切除),姑息性切除10例,盲肠或横结肠造瘘10例.总切除率为63 %(22/35),其中根治性切除率为55%(12/22),姑息性切除45%(10/22).术后随访6～36个月,2例失访,12例根治性切除组中,9例无瘤生存,1例肺转移,2例肝转移;23例姑息治疗组中,5例死亡,4例肝转移,其余14例带瘤生存.结论:结肠癌的手术治疗,应根据其生物学特点,采取规范的手术方式、彻底清除原发灶、转移的肠系膜及淋巴结,术中注意无瘤操作,术后酌情辅以化疗或放疗,定期随访,是预防结直肠癌术后复发的主要措施.而对复发和转移病例,应根据其部位、临床特征,选择以手术为主的综合治疗方案,酌情达到根治或姑息治疗的目的.     

肺癌全肺切除术后支气管胸膜瘘的原因分析和处理

]目的：探讨全肺切除术后支气管胸膜痿(BPF)的发生原因和早期处理原则。方法：回顾分析1995～2000年我院全肺切除820例发生支气管胸膜痿16例的的临床资料。BPF发生于右全肺切除(13／320)多于左全肺切除(3／500)；支气管切端癌残留(10／41)多于无癌残留(6／779)，术前化疗(5／110)多于未化疗(11／710)，70例自体组织覆盖残端未发生BPF。16例早期处理为胸腔穿刺和抗菌素冲洗，证实胸腔感染或支气管胸膜痿后均给予闭式引流。引流不畅者必要时行胸腔开放引流(5例)。结果：2例痊愈出院(1例早期用5％碳酸氢钠和尿激酶反复冲洗，1例3天后行肌瓣痿口修补)。8例带闭式引流管出院，4例开放引流后出院，长期换药，1例开放引流后痿口长期未愈合，1例因全身功能衰竭死亡。结论：BPF的发生同残端的处理和残留癌密切相关，支气管残端用自体组织覆盖，是降低BPF发生的有效手段，对于右全肺切除和术前实施化疗或放疗者，更为重要。BPF的处理原则：早期的反复胸腔穿刺并用5％碳酸氢钠和尿激酶冲洗和留置胸腔，及时的闭式引流是取得治疗脓胸和支气管胸膜瘘良好疗效的有效方法。     

宫颈癌手术治疗后阴道残端复发灶的放射治疗

目的：研究３８例狗颈癌术后阴道残端复发放疗的疗效及预后的有关因素。方法：３８例患者中,２５例为单纯阴道残端复发,１３例为阴道残端合并盆腔复发。根据阴道残端肿瘤大小分为３组,Ａ组：肿瘤直径≥３ｃｍ,Ｂ组：肿瘤直径〈３ｃｍ,Ｃ组：肿瘤结节不明显。采用阴道高剂量率后装加盆腔外照射治疗。结果：１７例患者治疗后存活期超过５年,五年生存率为４４．７％;其中Ａ组五年生存率２３．１％（３／１３）,Ｂ组五年生存率３     

Should patients with post-resection locoregional recurrence of lung cancer receive aggressive therapy?

The outcome of thirty-seven patients with a post-resection locoregional recurrence of non-small cell lung cancer treated with radiation therapy alone between 1979 and 1989 was compared to that of 759 patients with unresected non-small cell lung cancer also treated with standard radiation during the same period. Each patient's locoregional recurrence was staged using the current American Joint Committee on Cancer staging system. Comparison of pretreatment characteristics between the two groups, including age, sex, extent of weight loss, performance status, stage, and histologic subtype revealed fewer patients with greater than 5% weight loss (35 vs. 47%, p = 0.04) and more cases with squamous histology (54 vs. 28%, p = 0.01) among the patients with locoregional recurrences than those with newly diagnosed lesions. Over 80% of both groups had clinical stage III lesions. The median radiation doses were 56 and 59 Gy for recurrent and newly diagnosed cases (p = NS). For the patients with locoregional recurrences, the median time from resection to recurrence was 13 months (range: 3-118 months), and the recurrences were predominantly nodal in 25 cases, chest wall/pleural in four and at the bronchial stump in eight. When measured from the date of documented recurrence, the median survival time and 2-year actuarial survival rate of the patients with recurrent lesions were 12 months and 22%, as compared to 12 months and 26% for the newly diagnosed patients (p = NS). Freedom from documented locoregional tumor progression at 2 years was 30% for both groups. Patients with bronchial stump lesions had superior survival to those with nodal or chest wall recurrences, with a median survival time of 36 versus 9 months. A therapeutic approach to selected patients with post-resection locoregional recurrence of non-small cell lung cancer equally aggressive to that for newly diagnosed lung cancer patients is justified by these results, especially for patients with bronchial stump recurrences.