小肠原发性恶性肿瘤72例临床分析

1984～1999年山东省肿瘤医院收治的72例小肠原发性恶性肿瘤患者的临床资料进行回顾性分析。肿瘤部位和手术方式。结果提示，20例行X线胃肠钡剂造影检查，诊断准确率达80％。腺癌1、3、5年生存率分别为53．3％(16／30)、26．7％(8／30)和13．3％(4／30)；平滑肌肉瘤1、3、5年生存率分别为85．7％(24／28)、71．4％(20/28)和42．9％(12／28)；恶性淋巴瘤1、3、5年生存率分别为40．0％(4／10)、20．0％(2／10)和0(0／10)。十二指肠肿瘤1、3、5年生存率分别为66．7％(12／18)、33．3％(6／18)和0(0／18)；空肠肿瘤1、3、5年生存率分别为85．7％(24／28)、57．0％(16／28)和42．9％(12／28)；回肠肿瘤1、3、5年生存率分别为53．8％(14／26)、30．8％(8／26)和15．4％(4／26)。根治性切除术后1、3、5年生存率分别为80．0％(32／40)、65．0％(26／40)和45．0％(18／40)，姑息性切除术后1、3、5年生存率分别为50．0％(8／16)，37．5％(6／16)和12．5％(2／16)。回顾分析结果提示，X线胃肠钡剂检查是最有价值的诊断方法。根治性手术是最有效的治疗手段。影响小肠原发性恶性肿瘤惠者预后的因素有组织学类型、肿瘤部位和手术方式。     

49例胃癌根治术后残胃复发的外科治疗和预后分析

目的：探讨胃癌根治术后残胃复发癌的可切除性和预后影响因素，方法：对1986～2002年间在我院接受手术治疗的胃癌根治术后残胃复发的49例患者进行回顾性研究。结果：本组病例的根治性切除率为36．7％(18／49)。合并腹膜复发者无1例获得根治性切除。非吻合口处残胃复发的根治切除率为45．5％(10／22)，吻合口处残胃复发者为29．6％(8／27)。获得根治切除患者的5年生存率为26．7％，未获得根治切除者为0。未合并腹膜复发患者的5年生存率为15．6％，合并腹膜复发者为0，结论：残胃复发癌不能被根治切除的主要原因是同时合并腹膜复发．或肿瘤复发侵犯周围重要脏器，吻合口处的复发肿瘤的根治性切除率有减低的趋势．复发肿瘤能否被根治切除、是否合并腹膜复发直接影响患者的预后。     

原发性气管癌的治疗分析

目的 探讨原发性气管癌临床与病理特点及不同治疗对生存率的影响。方法 1983年至2001年，本科收治经放疗的原发性气管癌14例，6例手术加术后放疗，单纯放疗8例。结果 全组病例伴发鼻咽重复癌1例。1、2、5a生存率分别为64．28％(9／14)、57．14(8／14)、25％(3／12)。2a生存率比较：手术加术后放疗组100％(6／6)，单纯放疗组25％(2／8)，P=0．01。腺样囊性癌100％(5／5)、非腺样囊性癌33％(3／9)，P=0．03。结论 本组原发性气管癌伴发重复癌比例为7．14％。2a生存率比较手术加术后放疗及腺样囊性癌病人预后较好。显示有统计学意义。     

18例原发性腹膜癌诊治分析

目的探讨原发性腹膜癌的临床特点、诊断标准、治疗方法及预后。方法对本院收治的18例原发性腹膜癌的临床资料进行回顾性分析，以腹胀、腹水、食欲差、消瘦为首发症状16例（88．89％）。18例均行肿瘤减灭术，病理为浆液性乳头状腺癌。术后给予铂类为主方案化疗6～8个疗程。结果随访＜2年2例，均无瘤生存；＞2年16例。总2年、3年、5年生存率分别为75％（12／16）、43．75％（7／16）、25％（4／16）。14例Ⅲ期患者2年、3年、5年生存率分别为78．57％（11／14）、50％（7／14）、28．57％（4／14），Ⅳ期2例，1例生存13个月，1例生存25个月；残存肿瘤＜2．0em和＞2．0em，2年生存率各为100％（9／9）和42．86％（3／7），3年生存率各为87．5％（7／9））和0，5年生存率各为44．45％（4／9）和0；腹腔化疗＋全身化疗与单纯全身化疗2年生存率各为90％（9／10）和50％（3／6），3年生存率各为70％（7／10）和0，5年生存率各为40％（4／10）和0。结论临床警惕腹胀、腹水患者原发腹膜癌的可能。积极减瘤术和以DDP为主腹腔化疗目前是原发性腹膜癌的最好方法。术前化疗有利于减瘤术。     

头颈部腺样囊性癌血行转移的临床研究

目的：观察头颈部腺样囊性癌远处转移情况、影响因素以及其对生存的影响。方法：回顾性分析51例头颈部腺样囊性癌的临床资料。结果：远处转移率为41．2％(21／51)；单部位和多部位远处转移分别占71．4％(15／21)和28．6％(6／21)；肺、骨、肝和脑的转移依次占81．0％(17／21)、23．8％(5／21)、14．3％(3／21)和9．5％(2／21)。远处转移的平均发生时间在首次治疗后5．36年。远处转移组和末远处转移组的生存期、10年生存率分别为9．81年和14．31年，53．8％和41．0％。远处转移后平均生存期为2．55年，2年生存率为47．8％。单纯肺转移组与肺外转移组Log—rank检验生存差异有显著性(P＝0．032)，其平均生存期、2年生存率分别为3．48年和1．49年，72．7％和20．0％。分析结果还表明，远处转移率与患者的性别、年龄、病程长短以及侵犯解剖部位多少无关，但与首次手术是否规范(P＝0．025)、术后综合治疗是否规范(是否术后辅以放疗)(P＝0．045)以及是否局部复发(P＝0．043)相关。结论：头颈部腺样囊性癌生存期长，远处转移率高，远处转移出现的时间较晚，出现远处转移后患者仍可长期生存。通过根治性手术加术后放疗可能能够降低远处转移率。     

原发性肝癌合并胆管癌栓的外科治疗

目的：提高对原发性肝癌合并胆管癌栓的认识，探讨其诊断、治疗方法及疗效。方法：回顾性分析我院1998年1月至2004年1月间收治的42例原发性肝癌合并胆管癌栓的临床资料，施行根治性手术26例，其中18例肝叶切除＋胆总管切开取栓、T管引流术；8例肿瘤局部切除＋胆总管切开取栓、T管引流术；姑息性手术16例，其中6例胆总管切开取栓、T管引流术，10例胆总管切开取栓、T管引流术＋患侧肝动脉结扎术（其中4例＋门静脉DDS泵置入术）。均获得病理诊断，肝细胞癌32例（76．2％）。结果：根治性手术及姑息性手术1年、3年、5年生存率分别为65．4％（17／26），42．3％（11／26），15．4％（4／26）及18．8％（3／16）、6．3％（1／16），0（0／16）；总的1年、3年、5年生存率分别为47．6％（20／42），28．6％（12／42），9．5％（4／42）。结论：外科治疗明显改善患者生活质量，提高了生存时间，而根治性手术是原发性肝癌合并胆管癌栓的积极有效方法。     

恶性纤维组织细胞瘤20例临床分析

目的：探讨恶性纤维组织细胞瘤(MFH)的诊断和合理治疗方法。方法：分析20例MFH患者的临床及病理特征。结果：男15例，女5例，平均年龄56．4a，肿瘤发生于肢体的10例，占50％(10／20)，2a、3a和5a生存率分别为29．4％、17．6％和5．9％。首次手术后复发率为100％，CAVD方案治疗的有效率为15％。结论：MFH的临床诊断困难，术后复发率高，预后差，根治性切除后行化疗和放疗的序贯治疗非常重要。     

原发性小肠肿瘤31例临床分析

目的：探讨小肠肿瘤临床特点、病理类型和早期诊断手段。方法：回顾性分析1994年～2004年31例原发性小肠肿瘤患者的临床资料。结果．小肠良性肿瘤4例均为平滑肌瘤；恶性肿瘤27例，其中平滑肌肉瘤12例（44．4％），淋巴肉瘤10例（37％），腺癌3例（11．1％），类癌2例（7．4％）。临床上无特异性症状及可靠的诊断方法，内窥镜和全消化道钡餐造影是主要诊断手段。53．2％的恶性病例在手术时已有远处转移，仅11例（35．5％）行根治性切除。根治切除术后5年生存率为45．1％。结论：早期诊断、早期治疗是提高小肠恶性肿瘤患者生存率的关键，对无远处转移者应争取行根治术。     

原发性甲状腺鳞状细胞癌42例诊治分析

目的：探讨原发性甲状腺鳞状细胞癌的临床特征和综合治疗效果。方法：回顾性分析我院1964年-2006年收治甲状腺鳞状细胞癌患者42例,22例行原发灶完整切除＋患侧侧颈或区域颈淋巴结清扫,其中病理证实有淋巴结转移者18例;13例行原发灶扩大切除;姑息切除术7例,其中2例同时行气管切开。术后行根治性局部放疗37例,剂量为60—75Gy。结果：患者总的半年生存率为52．3％（22／42）,1年生存率为荔．6％（12／42）,2年生存率为19．0％（8／42）,中位生存期为10．1个月。结论：甲状腺鳞状细胞癌是罕见的恶性肿瘤,病情发展迅速,预后差。早期发现并进行扩大根治性手术,并辅以足量放疗,能最大限度提高生存率。     

高龄贲门胃底癌经腹手术治疗的评价(附84例)

目的：探讨高龄患者胃底贲门癌的外科治疗，总结高龄贲门胃底癌患者手术治疗的经验。方法：回顾性分析高龄贲门胃底癌84例手术治疗情况，平均年龄69．5（65～84）岁。插管全麻下，经腹行贲门癌根治性切除术；围手术期予营养支持、呼吸道管理。结果：术后发生并发症14例（16．7％），其中呼吸道并发症6例（42．9％）；死亡0例。随访58例，平均随访3．5（1～7）年，3年生存率为70．7％（41／58），5年生存率为53．4％（31／58）。结论：贲门胃底癌经腹手术可提同高龄患者的生存率和生活质量，取得满意疗效。     

Carcinoma of the external auditory canal and middle ear.

PURPOSE: To evaluate therapeutic modalities used at our institutions regarding local control, disease-free survival and actuarial survival in carcinoma of the external auditory canal and middle ear, in an attempt to provide guidelines for therapy. METHODS AND MATERIALS: A series of 27 patients with carcinoma of the external auditory canal and middle ear treated between 1978 and 1997 in our institutions were analyzed with particular reference to tumor size and its relation to surrounding tissues, patterns of neck node involvement, surgical procedures, and radiation techniques employed. Clinical endpoints were freedom from local failure, overall survival, and disease-free survival. The median follow-up was 2.7 years (range 0.1-17.9 years). RESULTS: Treatment by surgery and radiotherapy resulted in an overall 5-year survival rate of 61%. According to the Pittsburgh classification, the actuarial 5-year survival rate for early disease (T1 and T2 tumors) was 86%, for T3 tumors 50%, and T4 stages 41%. Patients with tumors limited to the external auditory canal had a 5-year survival rate of 100%, patients with tumor invasion of the temporal bone 63%, and patients with tumor infiltration beyond the temporal bone 38%. The rate of freedom from local recurrence was 50% at 5 years. Unresectability by dural and cerebral infiltration, and treatment factors such as complete resection or resection with tumor beyond surgical margins are of prognostic relevance. All patients with dural invasion died within 2.2 years. The actuarial 5-year survival rate of patients with complete tumor resection was 100%, but 66% in patients with tumor beyond surgical margins. 192Iridium high-dose-rate (HDR) afterloading brachytherapy based on three-dimensional computed tomography (3D CT)-treatment planning was an effective tool in management of local recurrences following surgery and a full course of external beam radiotherapy. CONCLUSION: Surgical resection followed by radiotherapy adapted to stage of disease and grade of resection is the preferred treatment of cancer of the external auditory canal and middle ear.     

Leiomyoma of External Auditory Canal

This article reports a case of piloleiomyoma of external auditory canal, which is the 7th case of leiomyoma of the external auditory canal being reported and the 2nd case of leiomyoma arising from arrectores pilorum muscles, all the other five cases were angioleiomyomas, arising from blood vessels. A 52 years old male presented with a mass in the right external auditory canal and decreased hearing of 6 months duration. Tumor excision done by end aural approach. Histopathological examination report was leiomyoma. It is extremely rare for leiomyoma to occur in the external auditory canal because of the non-availability of smooth muscles in the external canal. So it should be considered as a very rare differential diagnosis for any tumor or polyp in the ear canal.     

外耳道腺样囊性癌临床病理分析及文献复习

目的:探讨外耳道腺样囊性癌的临床病理特点,提高对该病的认识。方法:观察6例外耳道腺样囊性癌的组织学特点及免疫组化特性。结果:患者男性3例,女性3例,年龄41~68岁,平均年龄55岁,6例均有耳部疼痛,2例发生肺转移。肿物最大径0.8~4 cm,实性,无包膜,镜下均以筛状结构为主,伴有不同比例的管状和实性结构,4例见神经浸润,免疫组化CK和p63均阳性。结论:外耳道腺样囊性癌较少见,易发生肺转移,诊断靠病理诊断。     

Adenomatous Neoplasia Presenting as Aural Polyp

Adenomatous neoplasia or glandular tumours in the ear are very rare to occur. We are reporting two patients who presented with polypoid mass in external auditory canal of whom one patient was diagnosed to have ceruminous adenoma of external auditory canal and the other adenomatous carcinoma of middle ear based on histopathology findings of biopsied specimen. Review of available literature shows that both ceruminous adenoma of external auditory canal and adenocarcinoma of middle are very rare to occur and are even difficult to diagnose histopathologically. We would like to emphasize the importance of considering even such rare pathologies while evaluating aural polyps.     

Metastatic hepatocellular carcinoma in the tympanic membrane

Primary tympanic membrane cancer is very rare; metastatic cancer to the tympanic membrane is extremely rare and presents diagnostic challenges. We report a case of metastatic hepatocellular carcinoma in the tympanic membrane. The presenting symptom was hearing loss. Physical examination revealed a friable granulomatous mass over the left anterior tympanic membrane extended from the external auditory canal. Computed tomography scan of the temporal bone revealed one soft tissue mass involving the left external auditory canal and tympanic membrane. A left middle ear mass biopsy was performed. The tumor cells were uniformly positive for cytokeratin and hepatocyte paraffin-1, confirming a diagnosis of metastatic tympanic membrane. A tympanic membrane mass might easily be misdiagnosed and improperly treated. This case serves as a reminder that the differential diagnosis of acute hearing loss in cancer patients should include the metastasis occurring in the auditory canal or tympanic membrane, and that tissue biopsies are necessary to establish the definitive diagnosis for such lesions.     

Diagnosis and treatment of otomycosis in southern China

To analyse and discuss the clinical features and pathogenic characteristics, diagnosis and treatment of patients with otomycosis in southern China. Two hundred fifty‐six patients from southern China diagnosed with otomycosis were randomly separated into two groups: the drug filling group and drug smearing group. Patients in the drug filling group were first examined and then had the pathogenic secretions in their external auditory canals cleared by otoendoscopy. Then, the local antifungal cream triamcinolone acetonide clotrimazole was injected into the external auditory canal. The same treatment was undertaken 1 week later and repeated once or twice more. Patients in the drug smearing group were also treated by otoendoscopy. Then, they were told to smear their external auditory canals once per day with the antifungal cream. All cases were followed for more than 6 months after the 3‐ to 4‐week treatment. The main symptoms and otoendoscopic examination were used to evaluate the prognosis. Aspergillus was the commonest fungus. The cure rate was 93% in the drug filling group and 81% in the drug smearing group. Otomycosis is very common in southern China, but it lacks characteristic features in its early stages. Once diagnosed, the local lesions in the external auditory canal should be cleared thoroughly using otoendoscopy, and then, the local antifungal cream is injected into external auditory canal. The cure rate can be significantly improved with the foregoing treatment.     

盯ning腺肿瘤：附七例报告及文献复习

Seven patients with ceruminal gland tumors originating from the external auditory canal are reported. The review of literature of this tumor showed that ceruminal gland tumors are commonly considered to arise from ceruminal gland but also from heterotopia salivary gland in the external auditory canal as believed by others. The term "ceruminal adenoma or adenocarcinoma" is still used by many authors. Histologically, this tumor is divided into four subtypes: adenoma, pleomorphic adenoma, adenocarcinoma and adenoid cystic carcinoma. Different treatments should be given for this tumor according to their different benign or malignant degrees.     

Results in treatment of carcinoma of the external auditory canal and middle ear

Of 31 patients treated for carcinoma of the external auditory canal and/or middle ear, 19 patients (61%) presented with a long-term history of otitis. Thirteen patients (42%) had cranial nerve involvement. The patients were treated by surgery, radiotherapy, or a combined treatment of surgery and radiotherapy. The overall 5-year crude survival rate was 29%. Irrespective of the final outcome, 19 patients (61%) obtained pain relief after initial treatment. Three of the patients with facial nerve involvement survived 5 years after the initial treatment. Postmortem examinations of ten patients revealed distant metastases in four patients.     

Adenoid cystic carcinoma involving the external auditory canal. A clinicopathologic study of 16 cases

Sixteen patients with a rare tumor, adenoid cystic carcinoma (ACC) involving the external auditory canal, have been studied. Clinically, most patients complained of ear pain, often of several years duration. On physical examination, a mass or a nodule usually was identified in the ear canal. In most cases, treatment consisted of a wide surgical resection of the auditory canal and adjacent structures. Histologically, these neoplasms had the same appearance as ACC originating in salivary glands. In eight cases, the tumor was confined to the ear canal wall and unquestionably arose in this area, probably within the ceruminous glands. When incompletely excised, these lesions usually recurred locally. Nine patients had a total of 26 local recurrences. Most recurrences were found within two years of the preceding treatment, but the interval in some cases was long, ranging up to 14 years. Of the 16 patients, seven had no evidence of recurrence following surgical resection, two were living with recurrent, unresectable tumor, five had died of disease, one had died of other causes, and one was lost to follow-up. Some patients died of tumor after a prolonged clinical course with multiple recurrences. Death usually was caused by intracranial extension by the tumor, or by pulmonary metastases. Radiotherapy did not appear to cure the lesion, but probably resulted in palliation. An increased incidence of recurrent, unresectable tumor or of death from the neoplasm correlated with the following histologic features: demonstration of tumor on the lines of surgical excision, involvement of the parotid gland, extension into bone, perineural invasion and local recurrence of tumor.     

The role of radiotherapy in treating squamous cell carcinoma of the external auditory canal, especially in early stages of disease.

PURPOSE: Our intent was to investigate the role of radiotherapy in treating external auditory canal squamous cell carcinoma, especially in early stages of disease. MATERIALS AND METHODS: The treatment results for 20 patients treated between 1980 and 1998 were retrospectively analyzed. Radiotherapy was used as an initial treatment without surgery in eight patients and with surgery in 12 patients. The patients treated by radiotherapy alone received 65 Gy in 26 fractions over 6.5 weeks. The patients treated with radiotherapy perioperatively received 30-75 Gy in 12-30 fractions. The follow-up period for survivors including patients died of intercurrent disease ranged from 7 to 205 months (mean: 71 months). RESULTS: The 5-year survival rate calculated by the Kaplan-Meier method for all patients was 59%. According to Stell classification (Laryncol. Otol. 99 (1985) 847), the 5-year survival rates for eight patients with T1 disease and eight with T2 disease were 100 and 38%, respectively. In the eight patients with T1 disease, disease control was 100%. Local control with hearing preservation was achieved in five patients with T1 disease by radiotherapy alone. No late complications related to radiotherapy were observed. CONCLUSIONS: A precise diagnosis of the disease in terms of whether or not it has invaded the bone is important in order to predict the treatment outcome. Radiotherapy with or without surgery is the treatment of choice for patients with T1-stage disease. Surgery with radiotherapy is recommended as standard care for tumors with bony invasion.