原发性胆囊癌的早期诊断

目的：探讨原发性胆囊癌早期诊断的方法和意义。方法：对我院1991-01／2002-07入院手术并病理证实为NeviaI、Ⅱ期的9例原发性胆囊癌患者进行回顾性分析。结果：本组占同期原发性胆囊癌患者的11．0％(9／82)，术前确诊率为55．6％(5／9)。行胆囊切除术4例，胆囊癌根治术5例。结论：胆囊癌的早期诊断在于提高对胆囊癌的认识，加强对高危人群的随访，B超等影像学检查仍是主要的术前诊断手段。     

原发性胆囊癌的早期诊断及相关对策

目的 探讨原发性胆囊癌的早期诊断及对策。方法 回顾分析64例原发性胆囊癌病人的临床病理资料及手术治疗情况。结果 64例原发性胆囊癌病人有胆道疾病史者47例，占73．4％；首发症状以右上腹痛最常见，共48例(75％)，其次为黄疸21例(32．8％)，右上腹包块14例(21．9％)，发热11例(17．2％)。术前诊断胆囊癌41例，诊断率64．1％(41／64)，B超和CT诊断率分别为72％(36／50)和82．4％(28／34)。结论 提高对原发性胆囊癌发病的认识，加强对高危人群的定期监测随访，联合运用B超和CT检查可明显提高本病的早期诊断，改善预后。     

76例早期胆囊癌的诊断及手术治疗预后分析

目的：探讨早期胆囊癌的诊断方法及术后预后的影响因素。方法选择76例早期胆囊癌患者,通过整理相关临床资料,对所有患者的治疗方法以及对影响患者预后的相关因素予以分析。结果采取单纯胆囊切除术中Ⅰ期患者24例,Ⅱ期患者21例;采取胆囊癌标准根治术中Ⅰ期患者5例,Ⅱ期患者14例;采取胆囊癌扩大根治术中Ⅰ期患者2例,Ⅱ期患者10例。所有患者术后均未出现死亡情况。1年生存率为100．00％,3年生存率为75．00％,5年存活率为44．74％。手术方式、Nevin分期、肿瘤所在位置、分化程度、黄疸为影响早期胆囊癌手术治疗预后的独立因素。结论根据早期胆囊癌患者不同的病理分期以及实际的侵犯范围,采取相应的手术治疗方式,能够提高患者的预后,延长生存时间。及时发现、正确的手术方式是提高其预后、延长生存期的关键。     

原发性胆囊癌的早期诊断及相关对策

目的　探讨原发性胆囊癌的早期诊断及对策。方法　回顾分析 64例原发性胆囊癌病人的临床病理资料及手术治疗情况。结果　 64例原发性胆囊癌病人有胆道疾病史者 47例 ,占 73 .4% ;首发症状以右上腹痛最常见 ,共 48例 ( 75 % ) ,其次为黄疸 2 1例( 3 2 .8% ) ,右上腹包块 14例 ( 2 1.9% ) ,发热 11例 ( 17.2 % )。术前诊断胆囊癌 41例 ,诊断率 64 .1% ( 4 1/64 ) ,B超和CT诊断率分别为72 % ( 3 6/5 0 )和 82 .4% ( 2 8/3 4)。结论　提高对原发性胆囊癌发病的认识 ,加强对高危人群的定期监测随访 ,联合运用B超和CT检查可明显提高本病的早期诊断 ,改善预后。     

原发性胆囊癌的早期诊断与外科治疗

胆囊癌是胆道系统最常见的恶性肿瘤,居消化道恶性肿瘤第5～6位[1].近年来由于B超、CT等影像学检查的广泛开展,胆囊癌已逐渐被认识,发现率有所提高.但由于其早期确诊率较低,恶性程度高,根治机会少,预后仍很差[2].我院1983～2001年共收治经手术及病理证实的胆囊癌27例,现报告如下.     

原发性胆囊癌的诊断分析

目的通过对36例原发性胆囊癌的诊断分析提高该病的诊断水平。方法对我院1990年1月~2004年7月间收治的36例原发性胆囊癌的诊断进行回顾性分析。结果36例原发性胆囊癌中,22例(61.11%)有胆道疾病史,术前诊断胆囊癌26例,占72.22%,B超、CT及MRI术前诊断率分别为69.44%、76.47%和85.00%。结论提高对原发性胆囊癌的认识,联合运用BUS、CT等检测手段可明显提高本病的早期诊断;加强对高危人群定期监测随访,是预防胆囊癌的关键。     

胆囊癌29例分析

目的探索胆囊癌的防治方法。方法分析29例胆囊癌病人临床资料、治疗方法及结果。结果术前诊断明确者21例，剖腹探查发现已属晚期，9例为Ⅳ期行根治术，12例为Ⅴ期未行根治术，均于术后1年内死亡。术前怀疑胆囊癌者5例，剖腹探查冰冻切片证实为Ⅴ期及Ⅳ期者各1例，Ⅴ期未行根治术，Ⅳ期行根治术，均于术后1年内死亡；Ⅲ期者3例，行胆囊癌根治术分别于术后10月、13月、17月死亡。2例术中冰冻切片发现的Ⅱ期胆囊癌，行胆囊癌根治术，分别于术后23月、26月死亡。1例意外胆囊癌属Ⅰ期胆囊癌，术后5年半死亡。结论要减少胆囊癌危害，重在及时治疗胆囊结石。     

胆囊癌17例诊治体会

我院自1987年至1996年,在574例胆囊切除术中发现胆囊癌17例,现分析报道如下。临床资料本组17例,均经术后病理证实,男4例,女13例,年龄50~78岁;全组均有胆道疾病史;17例术前均经B超检查,14例提示胆囊炎、胆石症,3例提示胆囊内隆起样病变。CT检查5例,提示胆囊癌4例。     

45例胆囊癌的临床诊治分析

胆囊癌是胆道系统中常见的一种恶性肿瘤,男女发病率比例大约为1∶ 3[1],发病年龄大多为50岁以上.由于CT以及MRI等在临床上的广泛运用,明显提高了胆囊癌的早期诊断率,使胆囊癌的诊治也取得了一些进展.但是,胆囊癌仍是一种早期诊断困难、根治切除率低、预后差的恶性疾病,且近年来该病的发病率有逐渐增高的趋势,成为严重威胁人类健康的生命杀手.胆囊癌的预后主要取决于肿瘤所处的生长阶段.因此,如何提高胆囊癌的早期诊断率已成为目前治疗胆囊癌中一个急需解决的问题.我们收集了2004年3月至2010年6月间在我院肝胆外科采用手术治疗的45例胆囊癌患者的临床资料,并对其进行了回顾性分析,现将结果报告如下.     

胆囊癌的诊断分析(附127例报告)

目的探讨胆囊癌各种诊断方法的价值,以期进一步改善胆囊癌患者的预后.方法回顾性分析本院1989～2004年收治的经手术确诊的127例胆囊癌患者的临床资料.结果最常见症状为持续性右上腹疼痛90例(70.87%),腹胀不适65例(51.18%),食欲减退60例(47.24%),黄疸58例(45.67%)及消瘦38例(29.92%),合并急性胆囊炎24例(18.89%),合并胆囊结石101例(79.53%).血清γ-GT明显升高85例(66.93%),胆汁酸明显升高占51.52%(34/66例).影像学检查阳性率分别为B超82.68%,CT 85.06%,MRI 81.25%,DSA 64.86%,ERCP 51.02%.结论长期胆囊结石患者出现疼痛规律改变,尤其伴有血清胆汁酸升高者,应高度怀疑胆囊癌,及时进行B超及CT检查.凡胆囊结石患者,尤其女性、50岁以上患者,应及时切除病变胆囊,以防发生癌变.     

晚期原发性胆囊癌的化疗

目的:回顾性分析比较联合化疗及最佳支持治疗对晚期原发性胆囊癌的临床受益反应率及生存期。方法:将39例晚期原发性胆囊癌的患者非随机地分成3组,其中FAP组12例;GFO组8例;BSC组19例。化疗组每3～4周重复1次,治疗2周期后进行疗效评价,采用KaplanMeier法分析患者生存期,Logrank法进行检验。结果:FAP组的客观有效率16.7%(2/12),GFO组为25.0%(2/8),两组相比无显著性差异(P>0.05)。临床受益反应(CBR)率三组分别为25.0%、37.5%和26.3%;如将FAP组和GFO组合并成化疗组,化疗组与BSC组无显著性差异(P>0.05)。化疗组和BSC组的平均生存时间分别为6.7月和5.2月,两组用Logrank检验后无显著性差异(P>0.05)。结论:对于晚期原发性胆囊癌患者,应用FAP和GFO方案化疗并不优于最佳支持治疗。     

Current status of diagnosis and treatment of primary breast cancer in Beijing, 2008

Objective:To investigate the status of diagnosis and treatment of primary breast cancer in Beijing,2008.Methods:All the patients who were diagnosed as primary breast cancer in Beijing in 2008 were enrolled in this study.Information of these patients,including the features of tumors,clinical diagnosis and treatment was collected,and filled in the well-designed questionnaire forms by trained surveyors.The missing data were partly complemented through telephone interviews.Results:A total of 3473 Beijing cit...     

Chronic inflammation and gallbladder cancer

Gallbladder cancer (GBC) is the most common biliary tract malignancy with an extremely poor prognosis. Epidemiological data have demonstrated that chronic inflammation resulting from infection of gallbladder or gallstones predispose individuals to GBC. Recent studies have begun to elucidate molecular mechanisms underlying the development of GBC in the setting of chronic inflammation. It is possible that persistently local inflammatory reactions may contribute to the development and progression of GBC through inducing genetic alterations, and subsequent promoting survival and proliferation of mutated sells, inhibiting apoptosis, stimulating angiogenesis and metastasis. This article reviews the current understanding of the involvement of chronic inflammation in gallbladder tumorigenesis.     

Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis,treatment and follow-up

Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30%–40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5%–8% at onset, and rates of metastatic progression after primary treatment between 10 and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16–18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80%–90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer.     

The risk of gallbladder cancer from polyps in a large multiethnic series

Background

The aim of this study is assess whether patients with Indian ethnic background are at an increased risk of developing gallbladder cancer (GBC) if they have been diagnosed with ultrasonic abnormalities of the gallbladder.

Methods

Between January 1998 and July 2006, 137,655 abdominal ultrasound examinations were performed in Leeds Teaching Hospitals NHS Trust. After the exclusion of repeat scans and those performed for renal or pelvic disease, 71,431 reports were included in this analysis. Patients in whom the diagnosis of GBC has been made without histology have been identified from the database of Northern and Yorkshire Cancer Registry and the presence of GBC was correlated with ultrasonic gallbladder abnormalities.

Results

Gallbladder polyps (GBP) were detected in 3.3% of patients and these were larger than 10 mm in 0.1% of the cases. Age above 60 years, Indian ethnic background, single GBP larger than 10 mm, the presence of gallstones, severe gallbladder wall thickening and irregular thickening were independently associated with the higher odds of developing GBC. The prevalence of malignancy in those with GBP was significantly higher among patients with Indian ethnic background compared to Caucasian patients, 5.5% versus 0.08%, p < 0.001.

Conclusions

The presence of GBP, irrelevant of size, amongst patients of Indian ethnic decent, is an indication for further investigation and/or cholecystectomy.     

Development of artificial intelligence technology in diagnosis,treatment, and prognosis of colorectal cancer

Artificial intelligence (AI) technology has made leaps and bounds since its invention. AI technology can be subdivided into many technologies such as machine learning and deep learning. The application scope and prospect of different technologies are also totally different. Currently, AI technologies play a pivotal role in the highly complex and wide-ranging medical field, such as medical image recognition, biotechnology, auxiliary diagnosis, drug research and development, and nutrition. Colorectal cancer (CRC) is a common gastrointestinal cancer that has a high mortality, posing a serious threat to human health. Many CRCs are caused by the malignant transformation of colorectal polyps. Therefore, early diagnosis and treatment are crucial to CRC prognosis. The methods of diagnosing CRC are divided into imaging diagnosis, endoscopy, and pathology diagnosis. Treatment methods are divided into endoscopic treatment, surgical treatment, and drug treatment. AI technology is in the weak era and does not have communication capabilities. Therefore, the current AI technology is mainly used for image recognition and auxiliary analysis without in-depth communication with patients. This article reviews the application of AI in the diagnosis, treatment, and prognosis of CRC and provides the prospects for the broader application of AI in CRC.     

脊柱骨母细胞瘤的诊断与治疗

目的 探讨脊柱骨母细胞瘤的临床特点、治疗方法及预后.方法 回顾性分析2001年7月至2009年7月本院收治的12例脊柱骨母细胞瘤患者的临床表现、诊断和治疗方法.结果其中男4例,女8例;中位年龄21岁(9～63岁).累及颈椎1例,胸椎4例,腰椎3例,胸腰段1例,骶椎3例.均有疼痛,伴有神经损伤症状6例,伴有脊柱侧凸4例,1例患者存在肿块,1例存在脊髓压迫.7例为复发病例或术前活检明确诊断,4例患者术前影像学表现典型,考虑为骨母细胞瘤,其中1例误诊为骨肉瘤.所有患者均行手术治疗,根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除,并予以相应方式重建.手术时间平均3.3h(1.5-6.5h).出血量平均1975ml (300～4500ml).术后疼痛和神经根损害表现均消失,3例脊柱侧弯患者畸形得到纠正,2例患者4次出现脑脊液漏,经应用抗生素和床尾抬高治疗后愈合.10例随访平均4年(1-8年),2例分别于术后3个月、2年6个月复发,其余均无疼痛症状,未见肿瘤复发.结论 脊柱骨母细胞瘤临床特征复杂,临床表现、影像学检查结合穿刺病理有助于确诊.根据不同的肿瘤部位,采取不同的手术入路行彻底的切除肿瘤能够取得良好效果.     

T-category reflects the histopathologic characteristics of gallbladder cancer

Aims

Gallbladder (GB) cancer is a relatively uncommon gastrointestinal malignancy and is known to often result in unfavorable outcomes. Recent advances in aggressive surgical resection have improved the overall survival rate of patients with GB cancer. We aimed to evaluate the outcomes and prognostic factors of GB cancer following a surgical resection with curative intent.

Methods

Between March 2001 and March 2009, 89 patients with GB cancer underwent surgical resection with curative intent at the National Cancer Center of Korea. We then conducted a retrospective analysis of clinicopathologic data.

Results

Nineteen patients underwent simple cholecystectomy and 70 patients underwent extended cholecystectomy. Tumor-free resection margins were obtained in 84 cases. The 1-, 3- and 5-year disease-specific survival rates in the 89 patients were 85.8%, 68.0% and 64.1%, respectively. By multivariate analysis, only the T-category was significant (p < 0.001). The T-category showed a close correlation with all of the other histopathologic factors which were significant in univariate analysis.

Conclusion

The T-category of GB cancer represents not only the depth of the primary tumor but also the aggressiveness of its histopathologic nature.