原发性肝癌伴胆道癌栓的诊治

目的 总结原发性肝癌伴胆道癌栓的诊断和治疗方法。方法 回顾性分析16例患者的临床资料及影响预后的相关因素。结果 原发灶未切除仅T管引流2例,术后生存时间为2．5个月和4．5个月。14例原发灶切除者．术后生存1年、1.5～2年、2～2.5年、2.5～3年分别为12例、9例、6例和3例,其中1例存活4．5年。结论 提高对原发性肝癌伴胆道癌栓的认识,及早诊断并积极手术治疗是改善预后的关键。     

原发性肝癌伴胆管癌栓的诊治

目的　探讨原发性肝癌伴胆管癌栓的诊治方法。方法　回顾性分析 8年间收治的 2 1例原发性肝癌伴胆管癌栓的临床资料。结果　临床表现为肝癌及梗阻性黄疸症状 ;术前正确诊断率76.2 %,B超 ,CT ,MRI ,ERCP和PTC的正确诊断率分别为 14 .3 %,9.5 %,14 . 3 %,71.4%和10 0 %。行肝癌切除加胆管癌栓清除术 10例 ,肝癌切除加肝外胆管切除术 5例 ,单纯胆总管切开取栓加肝动脉化疗栓塞 (TACE ) 3例 ,胆管癌栓清除加肝动脉灌注 (HIA ) 3例。术后 3年生存率 44 .4%,5年生存率 2 8.6%。结论　原发性肝癌伴胆道癌栓的诊断应选择多种检查手段 ,综合分析 ;以外科为主的综合治疗是积极有效的治疗方法。     

原发性肝癌合并胆管内癌栓12例临床分析

目的探讨原发性肝癌继发胆管癌栓的临床特点和诊治要点。方法回顾性分析1990～2003年12例HCC伴癌栓的外科治疗情况。结果本组原发性肝癌合并胆管内癌栓的发生率为4．69％(12／256)．术前确诊牢为25％(3／12)．肝癌切除加胆管癌栓清除术8例,肝癌切除加肝外胆管切除．胆肠内引流1例．单纯胆总管切开取栓术3例。术后1年生存率66．7％(8／12)．3年生存率25％(3／12),其中1例生存已超过5年。结论原发性肝癌伴胆管内癌栓十分少见．术前易误诊．手术治疗不失为一种积极有效的治疗方法。     

原发性肝癌伴胆管癌栓导致阻塞性黄疸的诊治

目的；探讨原发性肝癌继发胆管癌栓引起阻塞性黄疸（阻黄）的临床表现，诊断，治疗及手术方式与预后的关系。方法：回顾分析我院收治的11例阻黄患者的临床资料。结果：患者的临床症状不典型，入院后按常规均行化验及B超，CT、ERCP，MRCP，PTC等检查，并分别行肝原发癌灶切除，胆管癌栓清除，T管引流，肝动脉插管埋泵等手术治疗，术前诊断符合率为45.5%。术后对症化疗，患者预后与术式有关，行切除肝内原发肿瘤 胆道癌栓清除术者预后较好，行单纯癌栓清除术者预后较差。结论：原发性肝癌继发胆管癌栓引起阻黄术前不易诊断，应选择多种检查手段。包括术中B超，纤维胆道镜等检查，力求确诊，尽可能切除原发性肝内癌灶以提高疗效。     

原发性肝癌并发胆管癌栓的手术治疗：附13例报告

笔者回顾性分析14年间手术治疗的13例原发性肝癌伴有胆管癌栓患者的临床资料。全组病例术前均有黄疸，总胆红素水平在54～574 mol/L，平均251 mol/L。B超术前确诊肝癌伴有胆管癌栓7例，CT术前确诊肝癌伴有胆管癌栓9例。 13例均行手术治疗，其中11例行肝切除+胆管癌栓取除，包括右半肝切除2例，右半肝不规则切除2例，左半肝切除3例，左外叶切除2例，肝方叶切除1例，肝中叶切除1例;2例仅行胆总管切开取癌栓，T管引流。术后1年内死亡2例。行肝切除者，术后生存时间为6个月~5年9个月。中位生存时间为15个月;未切肝者2例，分别生存11个月和17个月。提示对原发性肝癌伴胆管癌栓者应积极手术治疗，仍有可能获得较好的效果。     

原发性肝癌伴胆管癌栓的手术方法

目的　提高临床医师对肝癌合并胆管癌栓患者手术方法的技巧。方法　术前确切检查及特殊检查 ,术中间歇阻断肝门 ,切除原发病灶 ,肝断面肝管取癌栓 ,清除肝门胆管内癌栓 ,肝断面胆管与肝门胆管“会师” ,胆总管置T管引流。结果　切除原发病灶 ,取出癌栓 ,使患者生存质量改善 ,为化疗、生物治疗提供了条件 ,延长了患者生存期。结论　原发性肝癌伴胆管癌栓的手术方法可行 ,较姑息手术或单纯手术生存时间延长 ,解除胆道高压 ,缓解症状 ,为后续治疗创造了有利条件。     

原发性肝癌伴门静脉癌栓的治疗

目的探讨原发性肝癌(PHC)伴门静脉癌栓的有效治疗方法.方法回顾性分析23例原发性肝癌伴门静脉癌栓患者的临床资料.结果23例均行手术切除肿瘤,并尽可能切除有癌栓的门静脉及从肝断面门静脉内取栓.术后分别采用化疗泵和微量泵化疗,并观察疗效.门静脉主干癌栓8例,死亡2例,6个月内复发4例;门静脉第1级分支癌栓11例,6个月内复发2例,6～12个月内复发6例;小分支癌栓4例,6～12个内复发1例(P<0.01).化疗泵化疗12例,6个月内复发5例,6～12个月内复发4例;微量泵化疗9例,6个月内复发1例,6～12个月内复发3例(P<0.01).结论手术治疗原发性肝癌伴门静脉癌栓有效;术后首选微量泵持续灌注化疗;癌栓部位会影响疗效.     

原发性肝癌伴胆管癌栓11例的治疗体会

目的 原发性肝癌伴胆管癌栓的外科手术治疗及其治疗效果。方法 回顾性总结原发性肝癌伴胆管癌栓１１例行胆管切开癌栓清除术,其中加做肝癌局部切除术７例。结果 手术死亡２例,术后随访１年,除１例至今仍存活１１个月外,余８例生存期分别为１１,１０,９,８．５,４．５,３,３个月。平均生存时间为６个月。结论肝癌局部切除加胆管切开癌栓清除术术不失为原发性肝癌伴胆管癌栓患者的一种姑息治疗方法。     

肝癌并门静脉癌栓的外科治疗

目的:探讨术中连续门静脉灌注化疗治疗原发性肝癌并门静脉癌栓的治疗效果。方法:将38例肝癌并门静脉癌栓患者随机分为治疗组19例和对照组19例，治疗组术中实施连续门静脉灌注化疗+肝癌切除+癌栓取除术，对照组术中仅行肝癌切除+癌栓取除术。术后两组均行门静脉和/或肝动脉置管化疗。结果:A组与B组术后7 d和30 d的AFP阴性率间明显高于B组(P>0.05)，A组1，3年复发率显著低于B组(P<0.05)，1，3年生存率明显高于B组(P<0.05)。结论:术中连续门静脉灌注化疗+肝癌切除+癌栓取出术+术后门静脉和/或肝动脉置管化疗是治疗肝癌伴门静脉癌栓的一种效果较满意的方法。     

伴有胆道内癌栓的原发性肝癌

我院自1988．9～1991．10．3年间手术治疗原发性肝癌81例，其中9例于胆道内发现癌栓。肝脏肿瘤及胆道内癌栓均经组织学检查确诊。现报道伴胆道内癌栓的原发性肝癌的临床特点，诊治情况井结合文献予以探讨。     

PERITONECTOMY AND INTRAPERITONEAL CHEMOTHERAPY IN APPENDICEAL AND COLORECTAL CANCER

Background : Peritoneal spread of gastrointestinal malignancies has been regarded as an incurable disease, and treatment has been aimed at short-term palliation. The use of cytoreductive surgery, including peritonectomy procedures and intraperitoneal chemotherapy, has been proposed with the intention of prolonging survival, and perhaps curing patients with peritoneal carcinomatosis from appendiceal and possibly colon cancers. A series of eight patients who have undergone this procedure at St George Hospital is presented, and the results obtained by other groups are reviewed. Method : Eight patients fitted the criteria for peritoneal carcinomatosis between January 1996 and November 1998. In seven patients this was secondary to appendiceal or colon cancer, and one patient had signet ring cancer of the uterus. The surgical treatment involved removing all macroscopic evidence of disease, and this was followed by early postoperative intraperitoneal chemotherapy. Results : The eight patients (seven female, one male) ranged in age from 25 to 67 years. There were seven complications, including two patients with pelvic abscesses, and one patient who developed Tenchkoff catheter occlusion. There were three deaths, one due to pelvic sepsis after 30 days, and the other two were due to metastatic disease. Of the remaining five patients, two have developed recurrence and three remain disease-free. Conclusion : The results of peritonectomy and intraperitoneal chemotherapy for appendiceal tumours are encouraging. The role in colorectal cancer is less clear, although there are some reports that suggest a benefit.     

GROWTH FACTORS AND CANCER

Recent advances in protein chemistry and genetic engineering have revealed new information about the molecular lesions involved in the induction and maintenance of cancer cells. It is now known that a single base change in the DNA of human cells leads to cancer. The normal pathway of proliferation and differentiation is perturbed by changes to molecules involved in the intracellular biochemical pathways controlled by growth factors. Some cancer cells appear to produce their own growth factor, others have higher concentrations of growth factor receptors on their surface and others have mutated versions of the intracellular proteins linked to the growth factor receptors. This increased understanding of growth control in normal and neoplastic cell populations is gradually providing a foundation for new approaches to cancer therapy.     

性激素与原发性肝癌

运用ＲＩＡ法对７６例男性肝癌及１０例女性肝癌患者血清睾丸酮（Ｔ）、雌二醇（Ｅ２）及孕酮（Ｐ）水平进行测定。结果：男性肝癌手术组及非手术组血清Ｔ水平显著高于肝良性病变组及正常对照组，Ｅ２水平则显著低于后两组；雄／雌激素比例（Ｔ／Ｅ２）显著高于后两组；肝癌切除后Ｔ水平下降，Ｅ２水平升高，Ｔ／Ｅ２比值下降，与肝良性病变组及正常对照组比较无显著差异。女性肝癌组Ｔ、Ｅ２水平与肝良性病变组及正常对照组比较无显著差异，但Ｔ／Ｅ２比例明显高于正常对照组。男、女肝癌组的Ｐ水平均未见明显改变。本组资料结果提示：高Ｔ水平及低Ｅ２水平与肝癌有关，性激素比例失调在肝癌的发生和发展中起了重要作用     

CELL ADHESION MOLECULES AND COLON CANCER

There is a general consensus that cell-cell and cell-matrix interactions determine. at least in part. the behaviour of colon cancer. The biological mediators responsible for these interactions are cell adhesion molecules belonging to several major receptor families called integrins, cadherins, the immunoglobulin superfamily, hyaluronate receptors and mucins. Emerging data indicate that certain patterns of adhesion receptor expression are associated with more aggressive disease. The present review examines the role of each of the receptor families in the development and progression of large bowel cancer.     

A COMPARISON BETWEEN PRIMARY AND SECONDARY LIVER CANCER

Two groups of patients have been compared, one with primary liver cancer, the other with liver secondaries. The groups did not demonstrate major differences in age, sex, ethnic background or treatment methods. Although patients with secondaries showed some survival advantage during the first 612 months, any difference had disappeared by 24 months. Patients with potentially ‘curable’ lesions having hepatic resection fared significantly better than all other patients, whether their tumours were primary or secondary in the liver. For practical purposes, the two groups can be considered as having problems of comparable biological significance.     

乳腺癌基质金属蛋白酶的表达及其意义

目的 研究基质金属蛋白酶（ＭＭＰｓ）与乳腺癌的关系。方法 采用文献回顾的方法对基质金属蛋白酶在乳腺癌中的表达及其意义加以综述。结果 正常状态下，人体内基质金属蛋白酶与其组织抑制剂保持一种平衡状态，而在体外及体内的多项研究中发现，在乳腺癌中多种基质金属蛋白酶有增强的表达。结论 乳腺癌的生长，浸润及转移与基质金属蛋白酶的表达及其抑制剂的关系密切。基质金属蛋白酶可能为一个新的有价值的乳腺癌预后指标，基质     

1,25-DIHYDROXYVITAMIN D3 AND BREAST CANCER*

Studies by this laboratory have demonstrated the presence of specific, high affinity 1,25-dihydroxyvitamin D3 (1,25-(OH)2, D3) receptors both in surgical specimens of human breast cancer and in breast cancer cells in culture. We report here that 1,25-(OH)2D3 receptors were found in 54% of 230 human primary breast cancers. Although receptor levels are lower than those of oestrogen receptors, using a modified and more sensitive assay method, the apparent receptor concentration is increased without altering the receptor positivity rate. Also in preliminary studies on lymph node metastases and their primary tumours, the receptor positivity rate is higher in the lymph nodes. These findings suggest that metastatic cells may be selected for the presence of 1,25-(OH)2D3 receptors. These data, taken with the evidence that 1,25-(OH)2D3 and several of its metabolites inhibit the growth of human breast cancer cells in culture, exactly analogously with the effects of oestrogens on cancer cell growth in vitro and in vivo, indicate that 1,25-(OH)2D3 or its metabolites could have a role in the ‘hormonal’ therapy of metastatic human breast cancer.     

金属硫蛋白与乳腺癌预后的关系

为探讨金属硫蛋白与乳腺癌转移和预后的关系,应用免疫组织化学ＳＡＢＣ法检测了乳腺癌及乳腺纤维腺瘤中ＭＴ的表达。结果;ＭＴ在乳腺癌,乳腺纤维腺瘤中的表达阳性率分别为７３．８％和１５．０％,两者的差异有显著性意义。ＭＴ在乳腺癌中的表达随临床分期的升高而增加。ＭＴ在肿瘤中的表达与手术时腋淋巴结转移无相关性,但在腋淋巴结有转移的肿瘤其ＭＴ表达阳性者死亡率高于表达阴性者。     

OVER-EXPRESSION OF METALLOTHIONEIN AND DRUG-RESISTANCE IN BLADDER CANCER

Metallothionein (MT) in tumor cells has been implicated as one of the factors involved in mechanisms of resistance to anti-cancer drugs, including cis-diaminedichroloplatinum (CDDP) and adriamycin (ADM). The relationship between the expression of MT and chemotherapy with anti-cancer drugs was studied in CDDP- and ADM-resistant human bladder cancer cell lines and tissue samples from clinical cases. In drug-resistant cell lines (T-24/ADM, CI-7/CDDP) established in our laboratory, MT expression was studied by immunohistochemistry using the avidin-biotin peroxidase complex (ABC) method and radioimmunoassay (RIA), using anti-MT antibody. In addition, other potentfal mechanisms of drug resistance, such as P-glycoprotein expression were examined and the levels of reduced glutathione (GSH), oxidized glutathione (GSSG) and glutathione-S-transferase (GST) determined in these cell lines. The results of these investigations demonstrate that the expression of MT in resistant cell lines increased 2.1- and 2.5-fold when compared with parent cell lines (CI-7, T-24). GSH, GSSG and GST levels were unchanged and P-glycoprotein was not over-expressed. A total of 120 tissue samples from 35 clinical cases of bladder cancer, before and after chemotherapy, were stained for MT which was detected in 10 of the 35 cases before chemotherapy. The incidence of MT expression was significantly higher (p less than 0.05) in cases with lower pathological tumor grades. By analyzing the MT staining after chemotherapy in the cases whose MT staining was negative before chemotherapy, it was found that cases receiving continuous administration (intravesical chemotherapy or peroral chemotherapy) showed a higher incidence (9/13) of positive staining for MT, than patients receiving intermittent administration (intravenous chemotherapy) (1/8), (p less than 0.05). These results demonstrate that: 1) a correlation exists between MT expression and tumor differentiation and 2) repetitive and continuous administration of anti-cancer drugs results in increased MT expression in bladder cancer cells. MT expression may therefore be one of the mechanisms by which urothelial tumors acquire resistance to anti-cancer drugs.