女性原发性尿道癌8例临床分析

目的探讨女性原发性尿道癌的临床特点、治疗及预后。方法回顾性分析2000年1月至2013年12月期间的8例女性原发性尿道癌患者资料并进行随访,了解其转移、复发和生存情况。采用Kaplan-Meier法进行生存分析。结果 8例尿道癌患者以老年女性为主,平均64岁。常见的临床表现为尿道外口肿物、排尿困难及肉眼血尿。尿路上皮癌为其主要病理类型。8例患者均行手术治疗,6例患者行术后辅助化疗。中位随访25.5个月,4例患者死亡,2例患者发生远处转移,2例患者无瘤生存。中位生存期31个月,1年生存率为75.0%,3年生存率为41.7%。结论女性原发性尿道癌是一种罕见且预后较差的恶性肿瘤,治疗方案以手术切除为主,对于晚期肿瘤多建议采取手术治疗、放化疗相结合的综合治疗方案。     

原发性气管癌44例临床分析

比较原发性气管癌手术与非手术治疗的疗效，探讨影响本病预后的因素。回顾性分析经组织学证实的４４例原发性气管癌病人的临床与随访资料。手术切除１８例；非手术治疗２６例（放疗采用钴６０或高能Ｘ线，靶区剂量为６０～７０Ｇｙ；化疗采用ＣＯＭＦ或ＡＭＦＰ方案４～６个疗程）。结果采用ＫａｐｌａｎＭｅｉｅｒ法计算其１、３、５年生存率，手术切除者分别为８３．３％、６６．７％和３３．３％，非手术治疗者分别为７３．１％、４２．３％和１５．４％。ｌｏｇｒａｎｋ检验显示无统计学意义，Ｐ＞０．０５。气管上段腺样囊性癌预后相对较好，治疗后５年内约有７７．３％病人死于肿瘤末控、复发或转移。结论：原发性气管癌手术与非手术者的预后似乎无明显差异，影响本病预后的因素主要为其发病部位和病理类型     

胃食管结合部癌514例外科治疗结果及其预后分析

目的 探讨影响胃食管结合部癌患者预后的临床病理因素.方法 回顾性分析1995年9月至2007年1月接受外科手术治疗的514例胃食管结合部癌患者的临床资料,统计分析患者临床病理因素和治疗措施对预后的影响.结果 全组514例患者,男性424例,女性90例,中位年龄63岁.全组1、3、5年生存率分别为74.8%、42.1%和29.1%.Kaplan-Meier法单因素分析显示,患者的性别、年龄与生存无明显相关性,而肿瘤大体分型、组织学类型、TNM分期、有无脉管癌栓及是否接受根治手术是影响患者预后的因素.经腹与经胸手术相比,两组患者的生存曲线未见显著差异(P＞0.05);对于分期≥Ⅱ期的患者,近端胃大部切除和全胃切除亦未显示生存差异(P＞0.05);而对于Ⅱ、Ⅲ期患者,术前化疗患者的预后要优于术前无化疗者(P＜0.05).采用Cox模型进行多因素分析显示,TNM分期和有无脉管癌栓是影响患者预后的独立因素.结论 TNM分期和有无脉管癌栓是影响患者预后的独立因素,对于Ⅱ、Ⅲ期患者,术前新辅助化疗可改善患者预后.手术应尽可能做到根治,并根据肿瘤的位置、大小、分期等因素选择合适的手术路径和切除范围.     

Acinar cell carcinoma of the pancreas: is resection justified even in limited metastatic disease?

Background

Acinar cell carcinoma (ACC) of the pancreas is characterized by better long-term survival compared with the more common ductal adenocarcinoma, and prognosis is better in resected compared with nonresected patients. The aim of the present study was to investigate the role of surgery in ACC with limited metastatic disease.

Methods

All patients with histologically confirmed ACC treated at the investigators' institution between October 2001 and September 2009 were identified from a prospective database. Clinicopathologic details, perioperative results, and follow-up results were analyzed.

Results

Seventeen patients with nonmetastatic and metastatic ACC were identified. Initially, localized, locoregional, and metastatic disease was present in 5, 7, and 5 patients, respectively. Pancreatic resections were performed in 15 patients. In limited metastatic disease, additional liver resection was performed in 3 patients and omentectomy in 1 patient. In 2 patients, metachronous liver metastases were resected. With a median follow-up period of 36.5 months, overall 1-year, 2-year, and 3-year survival rates were 88%, 65%, and 47%, respectively. Survival of resected patients with metastatic and nonmetastatic disease showed no differences between the 2 groups.

Conclusions

ACC of the pancreas is a relatively rare tumor entity for which resection may result in long-term survival even in limited metastatic disease.     

Prim?re Trachealtumoren in Hals und Mediastinum

Primary tumors of the trachea account for less than 0.1% of all tumors. They are malignant in more than 90% of cases with squamous cell carcinoma and adenoidcystic carcinoma accounting for 2/3 of all tracheal tumors. Since they are often misdiagnosed as asthma or chronic lung disease, diagnosis can be delayed for years. Once the diagnosis has been established, surgical resection being the only curative treatment should be considered first. Modern techniques for tracheal surgery such as laryngotracheal, tracheal or carinal resection and different tracheal mobilisation maneuvers such as laryngeal and hilar release allow for resection of more than 50% of the trachea and anastomosis without excessive tension. Results in patients with complete tumor resection are good with 5-year and 10-year survival between 39% and 79% and between 18% and 51%, respectively. However, careful patient evaluation, preservation of tracheal blood supply and accepting the limits of resectability are mandatory to avoid major complications that accompany tracheal resections in more than 20% of cases depending on the type of resection.     

A clinical study of surgical treatment of patients with carcinoma of the cervical esophagus extending to the thoracic esophagus.

OBJECTIVE: We studied optimum surgery for carcinoma of the cervical esophagus extending to the thoracic esophagus (Ce-Ut carcinoma). METHODS: Subjects were 13 patients diagnosed with Ce-Ut carcinoma treated at our institute from January 1989 to December 1998. Clinicopathologic information such as surgical procedures, pathologic findings, and postoperative complications were analyzed. RESULTS: In 10, laryngoesophagectomy was conducted due to tracheal invasion by the tumor. In 7, mediastinal tracheostomy was done because of the extended resection of the proximal trachea. In 3, the larynx was preserved and, in 2, cricopharyngeal myotomy was added. Lymph node metastasis was found only in the neck and the upper mediastinum at surgery and recurrences were all lung metastasis. The incidence of postoperative complications was very high (76.9%), and 1 patient died due to widespread tracheal necrosis. The cumulative 5-year survival rate for the group was 33.3% and that for the 9 curative cases was 50%, but most of the cases who underwent noncurative resection and/or who received preoperative therapy for widespread invasion to surrounding organs died within a year. CONCLUSION: The prognosis of patients who undergoing curative extended resection of the proximal trachea and suitable lymph node dissection in the neck and upper mediastinum may improve, and larynx-preserving surgery is recommended for patients without tracheal invasion. Despite preoperative chemoradiotherapy, the prognosis of patients with widespread invasion to surrounding organs was very poor, and clinical studies on new therapeutic strategies for these advanced cases are needed to improve the prognosis of Ce-Ut carcinoma patients.     

原发性胃淋巴瘤的诊断与治疗

目的 探讨原发性胃淋巴瘤的临床特点和治疗方法.方法 回顾性分析23例经病理证实为原发性胃淋巴瘤患者的临床资料.23例均行手术治疗,其中胃大部切除16例(D1 9例,D2 7例),全胃切除3例,姑息性切除术2例,剖腹探查术2例.术后21例患者接受辅助化疗.结果 本组总体5年生存率为80%.低度恶性14例,其巾病史5年以上有10例,生存期超过5年9例;高度恶性9例,病史5年以上有7例(失访2例),生存期超过5年2例.Ⅰ期13例,病史5年以上有10例,生存期超过5年9例;Ⅱ期7例,病史5年以上有5例(失访2例),生存期超过5年2例;Ⅲ～Ⅳ期3例,5年生存0例.根治性手术19例中病史5年以上有14例(失访1例),生存期超过5年12例;非根治性手术4例(失访2例),5年生存0例.低度恶性、早期并获得根治性切除的原发性胃淋巴瘤预后较好.结论 原发性胃淋巴瘤的术前诊断和分期主要依靠胃镜和CT检查.手术和术后辅助治疗是治疗早期原发性胃淋巴瘤的重要手段,非手术疗法是治疗晚期原发性胃淋巴瘤的主要方法.     

Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina

Background

Tracheal resection for primary carcinoma may extend survival. We evaluated survival after surgical resection or palliative therapy to identify prognostic factors.

Methods

We conducted a retrospective study of patients diagnosed with primary adenoid cystic carcinoma (ACC) or squamous cell carcinoma (SCC) of the trachea between 1962 and 2002. Laryngotracheal, tracheal, or carinal resection was performed when distant metastasis and invasion of adjacent mediastinal structures were absent and tumor length permitted. Radiotherapy was administered after operation (54 Gy), except in superficial tumors, or as palliation (60 Gy).

Results

Of 270 patients with ACC or SCC (135 each), 191 (71%) were resected. Seventy-nine were not resected due to tumor length (67%), regional extent (24%), distant metastasis (7%), or other reasons (2%). Overall operative mortality was 7.3% (14/191) and improved each decade from 21% to 3%. Tumor in airway margins was present in 40% (17/191) of resected patients (ACC 59% versus SCC 18%) and lymph node metastasis in 19.4% (37/191). Overall 5- and 10-year survival in resected ACC was 52% and 29% (unresectable 33% and 10%) and in resected SCC 39% and 18% (unresectable 7.3% and 4.9%). Multivariate analysis of long-term survival found statistically significant associations with complete resection (p < 0.05), negative airway margins (p < 0.05), and adenoid cystic histology (p < 0.001), but not with tumor length, lymph node status, or type of resection.

Conclusions

Locoregional, not distant, disease determines resectability in primary tracheal carcinoma. Resection of trachea or carina is associated with long-term survival superior to palliative therapy, particularly for patients with complete resection, negative airway margins, and ACC.     

The management of locally advanced (pT4) esophageal carcinoma

Summary Background: The dismal prognosis of patients with an esophageal carcinoma can only be improved by R0 resection. However, this condition is very difficult to be achieved in cases with locally advanced (pT4)-tumors. Methods: This paper reviews the results of diagnostic and neoadjuvant therapeutic modalities in patients with esophageal carcinoma that invades adjacent organs. Results: Endosonography (7,5 and 12 MHz frequencies) is with an accuracy rate of approximately 86% actually the most accurate method for staging esophageal carcinoma. Randomized clinical trials indicate that neoadjuvant radiotherapy does not increase the resection rate or prolong survival (5-year survival rate 9.5 to 16%) compared to surgical resection alone. Data from several series suggest that preoperative cisplatin-based chemotherapy is effective, but it is associated with a high perioperative morbidity (>45%) and mortality (>15%) rate. Neoadjuvant radio-chemotherapy appears to improve the prognosis only in those patients with objective clinical or histopathologic response. Due to a high postoperative mortality, combined resection of the tracheobronchial tree and aorta is considered too invasive and therapeutically not worthwhile. When patients are appropriately selected, a combined pulmonary (including lobectomy), pericard and esophageal resection is a relatively safe procedure. The survival curve seems to be better in these patient groups. Conclusions: Patients with locally advanced esophageal carcinoma should undergo neoadjuvant treatment. This should be performed on appropriately selected cases and in experienced centers within the context of clinical trials. The available data on the role of neoadjuvant radio-chemotherapy are not conclusive and a recommendation can not yet be given. Multivisceral resection should be performed only if complete tumor resection can be anticipated and only in those patients who respond to neoadjuvant treatment modalities.      

成人肾上腺皮质癌的诊断和治疗（附25例报告）

目的：探讨成人肾上腺皮质癌（ACC）的诊断及治疗方法。方法：对1986年～2012年期间我科收治的25例成人肾上腺皮质癌患者的临床资料进行回顾性分析,结合文献就其临床表现、影像学特征、诊断及鉴别诊断、治疗等问题进行讨论。本组25例术前均行B超、IVP、CT、MRI等影像检查。结果：14例行手术治疗并经术后病理证实。术后平均生存10．2个月,3年生存率为14．3％（2／14）,5年生存率为0。结论：肾上腺皮质癌恶性程度高、浸润性强,早期诊断和治疗是改善预后的关键,手术根治性切除仍是目前治疗的最佳方法。     

Evaluation of malignancy and the prognosis of esophageal cancer based on an immunohistochemical study (p53, E-cadherin, epidermal growth factor receptor)

The subjects in this study consisted of 40 preoperative untreated esophageal squamous cell carcinoma patients. While p53 did not significantly correlate with the clinicopathological factors, E-cadherin significantly correlated with lymphatic invasion, vascular invasion, the depth of invasion, the degree of lymph node metastasis, the histological stage, and the number of lymph node metastases. Epidermal growth factor receptor (EGFR) significantly correlated with age, the depth of invasion, and the number of lymph node metastases. The 5-year cumulative survival rate was 45.7% in the p53-positive cases and 61.9% in the p53-negative cases, with no significant difference, and 87.8% in the E-cadherinpositive cases and 19.1% in the-negative cases, and the difference was significnat. The prognosis was significantly poor in EGFR-positive subjects: the 5-year survival rate was 38.6% in EGFR-positive cases and 68% in-negative cases. The 5-year survival rate in E-cadherin-negative, EGFR-positive cases was 0%, while it was 91.7% in the reverse pattern, and this difference was significant. These findings suggest that both E-cadherin and EGFR are important prognostic factors, and a more precise prognosis can thus be obtained by combining them. Such a combined technique may be very useful as an indicator for grading the biological malignancy of esophageal cancer.     

原发性乳腺恶性淋巴瘤的发病特征和诊疗分析

目的 探讨原发性乳腺恶性淋巴瘤(PBL)的发病率、高发年龄和发病趋势、影像学特点、转移规律及不同治疗方法对预后的影响.方法 总结1960年1月至2007年8月收治的49例PBL患者的资料,收集性别、年龄、病理类型、乳腺钼靶X线及B超检查、转移部位等资料并分析治疗与预后的相关性.结果 1960年至2007年间天津市平均人121数中PBL的发病率为59/1000万,高发年龄30～59岁;自1960年至2007年每10年间该病的发病率分别为2/1000万、3/1000万、0、13/1000万和32/1000万,非霍奇金淋巴瘤占绝大部分(48例),乳腺钼靶X线、B超、冰冻病理检查不典型,随访显示脏器受累以骨髓(9/49)、肺(7/49)、脑膜(4/49)和卵巢(4/49)多见,5年总体生存率仅为6.1%.根治术+化疗组患者预后均优于单纯肿物切除术+化疗组和全乳或区段切除术+化疗组(5年存活率分别为21.4%、0、0).结论 PBL是一组罕见的结外淋巴瘤,发病率逐年增加,临床及影像学表现不典型,易累及骨髓、肺、脑膜、卵巢,治疗方案以根治术联合化疗及局部放疗为佳,但预后不良.     

Bronchoplastic procedures for lung cancer

Bronchoplastic procedures for patients with lung cancer are designed to achieve radical cure with preservation of functioning lung parenchyma. The operative results of 139 cases of lung cancer who underwent bronchoplasty between 1963 through 2007 were reviewed. The mean age of the patients was 62.5 years (range, 20 to 78 years). Sleeve lobectomy (SL) was performed in 119 cases, wedge lobectomy (WL) in 10 cases, sleeve segmentectomy (SS) in 5 cases, wedge segmentectomy (WS) in 2 cases, sleeve resection (SR) in 2 cases, and wedge resection (WR) in 1 case. Squamous cell carcinoma was the most frequently encountered histological type of disease (78%), followed by adenocarcinoma (12%) and other histological types (10%). The tumor was central in 125 patients (90%) and peripheral with nodal involvement in 14 patients (10%). Vascular resection and reconstruction was performed in 16 patients. Early major bronchial anastomotic complications occurred in 6 patients (4.3%). The 5-year survival rate in the patients with squamous cell carcinoma was 63.2%, and in patients with adenocarcinoma was 26.3%. SS for patients with early-stage squamous cell carcinoma of the segmental bronchus is a curative operation with preservation of the pulmonary function. Bronchoplasty without lung resection (SR, WR) is a reliable method for patients with low-grade malignant polypoid tumors arising from the bronchus. Patients with adenocarcinoma, N2 disease or major bronchial anastomotic complication show a worse prognosis.     

Adenoid cystic carcinoma of the trachea: a long-term problem

Adenoid cystic carcinoma of the trachea, although rare, is the second most common primary tumour of the trachea. It is a slow-growing tumour found in younger patients than the more common squamous cell carcinoma and is relatively resistant to treatment, but metastasizes late in the course of disease and even in unresectable cases can be palliated successfully for many years. We present a retrospective 20-year series of this condition from a single institute encompassing 13 patients of whom 6 were resected and 7 treated by palliative methods. A review of hospital records was carried out over the period 1984-2003. Details collected included symptoms before diagnosis, length of time from onset of the first symptom to diagnosis, resection details, survival statistics and accessory procedures tried before and after consideration of resection. The overall 5-year survival was 38.5%, but the mean survival in resected patients was 66 months as against 36 months for unresectable patients. Although most patients presented with dyspnoea, this was initially often attributed to other factors. The mean time of diagnosis from the onset of symptoms was 16 months. Although complete resection remains the management of choice if feasible, modern techniques of maintaining the airway in unresectable patients can give useful palliation for years.     

腹腔镜胆囊切除意外胆囊癌的处理策略

目的：探讨不同处理方式对腹腔镜胆囊切除术（laparoscopic cholecystectonay, LC）后意外胆囊癌（incidental gall—bladder cancer,IGBCA）预后的影响。方法：回顾分析LC术后22例IGBCA患者的临床资料。结果：根治性手术患者15例,3年生存率46．67％,5年生存率26．67％;姑息性手术患者7例,3年生存率14．29％,5年生存率为0。根治性手术患者生存时间明显长于姑息性手术患者,平均生存时间（56．19±6．61）个月vs．（26．20±5．19）个月（χ^2=5．290,P=0．021）。结论：LC术前应警惕IGBCA的发生,根治手术患者的预后明显优于姑息性单纯胆囊切除的患者,经过合理的再次根治手术,LC并不影响IGBCA患者的预后。     

Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma

Background

The outcomes after repeat pulmonary resection for colorectal cancer (CRC) and the factors associated with the prognosis of these patients remain uncharacterized.

Methods

Data on 156 patients who underwent curative resection of pulmonary metastasis from CRC were reviewed. Repeat pulmonary resection was performed in 25 patients; the present study examined the outcomes and factors associated with prognosis after repeat pulmonary resection.

Results

The 5-year survival rate after the first pulmonary resection was 56.2%. A multivariate analysis identified a histological type other than well-differentiated adenocarcinoma, a high prethoracotomy serum carcinoembryonic antigen (CEA) level, and the presence of hilar or mediastinal lymph node metastasis as poor prognostic factors for the first pulmonary resection. The 5-year survival rate after repeat pulmonary resection was 42.1%. Hilar or mediastinal lymph node metastasis at the time of the repeat resection was significantly associated with poor survival.

Conclusions

Repeat pulmonary resection for metastatic CRC provides satisfactory outcomes. Hilar or mediastinal lymph node involvement is consistently associated with a poor prognosis after the first and repeat pulmonary resections.     

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目的 总结和分析残胃癌的临床诊治特点。方法 回顾性分析1996年2月至2003年11月收治的14例残胃癌病人。结果 手术切除率为78．6％，根治切除率57．1％，5年生存率21．4％；根治性切除者的2年生存率达87．5％。结论 根治性外科治疗及病期是决定残胃癌预后的关键。     

原发性肝癌合并门静脉癌栓86例治疗体会

目的探讨肝癌合并门静脉癌栓(PVTT)的有效治疗方法。方法 86例肝癌合并门静脉癌栓患者行肝切除+门静脉取栓+肝动脉、门静脉双灌注化疗栓塞及生物靶向治疗。结果 1年生存率为90%,2年生存率为85%,3年生存率为35%;结论肝切除+门静脉取癌栓+肝动脉、门静脉双灌注化疗栓塞+生物靶向治疗是治疗肝癌合并门静脉癌栓的有效治疗方法。     

96例胆囊癌的外科治疗与预后因素分析

目的 研究影响胆囊癌预后的因素.方法 回顾性分析中国医科大学附属第一医院1993-2003年收治的96例胆囊癌临床资料并进行预后多因素Cox回归模型分析.结果 胆囊癌的总体5年生存率为6.32%,胆囊癌根治切除组的1、3、5年生存率分别为78.36%、48.54%和23.87%,与姑息手术组、剖腹探查组、非手术组间之间的差异有统计学意义;Cox模型多因素分析表明手术方式和肿瘤的浸润深度与胆囊癌的预后显著相关,其中手术方式为保护性因素.结论 早期诊断并予根治是胆囊癌病人长期生存的保证,适宜的围手术期处理有助于改善生存率.     

原发性胃肠道间质瘤73例的外科治疗

目的 探讨原发性胃肠道间质瘤(GIST)的外科治疗方法及预后.方法 回顾性分析1997年4月至2007年12月手术切除治疗的73例原发性GIST的临床病理资料和治疗方法,并对其预后进行评价.结果 73例GIST施行肿瘤完全切除者68例(其中12例在腹腔镜下完成肿瘤切除术),行肿瘤不完全切除仅取活检者5例,两组生存率差异有统计学意义(P=0.000).66例获随访的患者1、3、5年总体生存率分别为91.0%、78.2%、74.1%,根据肿瘤直径和核分裂象计数分级的肿瘤恶性程度风险分级与术后生存率密切相关(P=0.002),极低度及低度风险组与高度风险组间生存率差异有统计学意义(P<0.05).结论 应高度重视原发性GIST的初次手术治疗,积极行肿瘤完全切除以提高疗效,对肿瘤恶性程度风险较高者需扩大切除范围,应强调腹腔镜下GIST切除术适应证的选择和肿瘤完全切除.