43例Ⅱb期宫颈癌术前放疗疗效分析

目的　探讨Ⅱb期宫颈癌经术前放疗的治疗效果。方法　 1993年 1月～ 2 0 0 1年 3月 ,43例Ⅱb期宫颈癌均接受术前放疗 ,放疗剂量DT3 6～ 40Gy ,休息 14d～ 2 0d后行宫颈癌根治术。结果　 3年、5年生存率分别为 77 6%、62 4% ,3年内复发率为 15 3 %。结论　对部分Ⅱb期宫颈癌患者 ,经术前放射治疗后 ,有手术适应症 ,行广泛性全子宫切除术加盆腔淋巴结清扫术 ,可提高生存率 ,同时避免单纯放射治疗引起的并发症     

中晚期宫颈癌腹主动脉旁淋巴结转移治疗的临床研究

目的:研究中晚期（Ⅱb-Ⅲb期）宫颈癌腹主动脉旁淋巴结(PALN)转移采用手术和放疗治疗的疗效。方法:选择中晚期（Ⅱb-Ⅲb期）腹主动脉旁淋巴结转移的宫颈癌患者76例,观察组43例,行腹主动脉旁淋巴结清扫术,术后行同步放化学治疗。对照组33例,行宫颈癌同步放化学治疗。分析与患者3年生存率有关的临床病理因素,探讨影响患者预后的因素。结果:手术分期、病理分级、SCCA水平、局部肿瘤大小、腹主动脉旁淋巴结大小、治疗方法与患者的3年生存率有关。多因素分析表明影响患者生存期的因素是分期、分级、局部肿瘤大小、腹主动脉旁淋巴结大小、治疗方法。结论:中晚期宫颈癌腹主动脉旁淋巴结转移,行腹主动脉旁淋巴结切除并辅以术后延伸放疗联合同期化疗,对于病人治疗有重要意义。     

182例喉癌手术疗效分析

目的:分析影响喉鳞癌的预后因素。方法:男176例,女6例,年龄18岁～78岁,声门上型56例,声门型126例;全喉切除109例,部分喉切除61例,近全喉切除12例;未行颈清术51例,行颈清术131例;单纯手术124例,手术加放疗58例。结果:影响患者生存率的因素有:年龄、喉癌分期、转移淋巴结分期、病理淋巴结转移个数、术后放疗,而喉癌分区、术前呼吸困难、颈部肿块时间不影响生存率。5年生存率为67.58%。结论:中晚期以全喉切除为主,喉部分切除为辅;切缘阳性或淋巴结转移者,需行术后放疗;局部淋巴结复发是喉癌患者死亡的主要原因。     

局部不良型宫颈癌的综合治疗

目的：探讨局部不良型宫颈癌的综合治疗。方法：40例宫颈癌术前行常规综合放疗,A点剂量＞70Gy30例,60－70Gy7例,50－59Gy2例,44Gy1例,放疗后1－8周行筋膜外子宫切除术15例,次广泛子宫切除术23例,广泛性子宫切除加盆腔淋巴结清扫术2例,结果：2例死于夹杂症,12例死于肿瘤未控或复发。3年生存率为74．9％,5年生存率为66．8％,50％治疗失败发生于治疗后1年内,2年内死亡率为9／12（75．0％）,3例发生术后并发症,均经保守治疗痊愈。结论：放疗后辅以近期子宫切除的综合治疗,对治疗局部不良型宫颈癌有其合理性及可行性。     

ⅠB2及ⅡA2期宫颈癌患者的手术治疗方案研究

目的探讨ⅠB2及ⅡA2期宫颈癌患者宫颈癌根治术中加行腹主动脉旁淋巴结切除的价值。方法选择2007年1月至2012年12月手术治疗的ⅠB2~ⅡA2期宫颈癌患者70例,其中33例行宫颈癌根治术加腹主动脉旁淋巴结切除术作为观察组,37例行宫颈癌根治术作为对照组,比较2组术后并发症发生率、复发率及生存率。结果 2组患者术中出血量、手术时间及并发症发生率比较,差异无统计学意义(P>0.05)。腹主动脉旁淋巴结转移与盆腔淋巴结转移个数有关,盆腔淋巴结转移>1个更容易发生腹主动脉旁淋巴结转移(P<0.05),2组患者复发率比较差异有统计学意义(P<0.05),生存率比较差异没有统计学意义(P>0.05)。结论宫颈癌根治术加行腹主动脉旁淋巴结切除安全可行,可以降低患者术后复发率,但不能明显改善患者的生存率。     

Ⅰb2Ⅱa期子宫颈癌腔内放疗加手术与单纯手术治疗的临床对比分析

目的：比较术前近距离腔内后装放疗和单纯手术治疗Ⅰb2、Ⅱa期宫颈癌的疗效，以探讨Ⅰb2、Ⅱa期宫颈癌术前适当剂量阴道腔内放疗的意义。方法：选取北京妇产医院1998年6月至2005年6月，Ⅰb2、Ⅱa期且宫颈肿块均〉4cm的宫颈癌患者78例。患者随机分为两组：术前放疗组38例行术前^192Ir近距离腔内放疗，阴道盒源旁1cm 2000～3000cGy，分2～3次，2～3周完成，放疗后10～14天行宫颈癌根治术即广泛子宫切除＋盆腔淋巴结清扫术；单纯手术组40例直接行宫颈癌根治术。评定两组的疗效和术前阴道腔内后装放疗对手术的影响及术后并发症的情况。结果：术前放疗组宫颈肿块均有不同程度的缩小，总有效率（CR＋PR）94．7％（36／38），术前放疗组和单纯手术组相比未增加手术难度和术后并发症，两组局部控制率分别为1年（89．5％和80．0％，P〉0．05）、3年（82．9％和61．3％，P〈0．05）、5年（76．9％和52．6％，P〈0．05）；两组1、3和5年生存率分别为（85．0％和92．1％，P〉0．05）、（83．9％和87．9％，P〉0．05）和（78.3％和80．0％，P〉0．05），差异无显著性。结论：术前近距离阴道腔内后装放疗可作为Ⅰb2、Ⅱa期宫颈癌综合治疗的一种有效的治疗方法，对Ⅰb2、Ⅱa期宫颈癌有满意的局部控制率。     

43例Ⅱb期宫颈癌术前放疗疗效分析

目的：探讨Ⅱb期宫颈癌经术前放疗的治疗效果。方法：1993年1月－2001年3月，43例Ⅱb期宫颈癌均接受术前放疗，放疗剂量DT36－40Gy，休息14d-20d后行宫颈癌根治术，结果：3年、5年生存率分别为77．6％，62．4％，3年内复发率为15．3％，结论：对部分Ⅱb期宫颈癌患，经术前放射治疗后，有手术适应症，行广泛性全子宫切除加盆腔淋巴结清扫术，可提高生存主,纲时避免单纯放射治疗引起的并发症。     

晚期宫颈癌并发双侧输尿管梗阻40例治疗预后分析

  目的   分析晚期宫颈癌并发双侧输尿管梗阻的预后因素, 探讨其治疗意义。   方法   通过肾图、CT、肾功能检查诊断晚期宫颈癌并发双侧输尿管梗阻患者40例, 膀胱镜下输尿管逆行置管内引流13例, 经皮肾穿刺输尿管顺行置管内引流25例、外引流2例, 肾功能恢复正常后行放射治疗29例, 对比研究输尿管导管置入前是否接受过治疗、肾功能是否正常, 置管后是否接受放疗三种因素对预后的影响。   结果   输尿管导管置入后肾功能恢复正常率为91.3% (21/23)。未治疗组、术后和放疗后复发组中位生存时间分别为27、15、10个月(χ2=9.379, P=0.009)。置管后接受放疗组与未行放疗组中位生存时间分别为25、9个月(χ2=17.329, P < 0.001), 置管前肾功能是否正常对预后影响无显著性差异(χ2=1.37, P=0.242)。   结论   对于初治或术后复发的宫颈癌并发双侧输尿管梗阻患者, 在解除输尿管梗阻后, 应接受放射治疗, 可获得较好疗效。      

一期肠切除吻合术治疗左半结肠癌急性肠梗阻的体会

目的 探讨左半结肠癌急性梗阻一期切除吻合术的可行性.方法 回顾分析33例左半结肠癌急性梗阻行Ⅰ期切除吻合术的适应证及术中、术后处理方法.结果 本组病例全部行一期肠切除吻合.术后切口感染3例,吻合口漏1例,无手术死亡病例.结论 只要病例选择得当,术前、术中和术后得到正确处理,左半结肠癌急性梗阻一期手术切除吻合是安全可行的.     

宫颈癌术前放疗37例报道

目的探讨Ⅰb~Ⅱb期宫颈癌术前放疗的优势及放疗后的手术适应症。方法37例Ⅰb~Ⅱb期宫颈癌接受术前放疗后行广泛性子宫切除加盆腔淋巴结清扫术。结果全组病人均能如期按手术规范完成手术,术中未发生不可控制的大出血,无输尿管、膀胱、直肠等损伤发生。术后常见并发症发生率低。结论Ⅰb~Ⅱb期宫颈癌经术前放疗,降低了手术难度,并使Ⅱb期病人具有手术机会,且不增加术中术后并发症的发生。     

Manifestation,latency and management of late urological complications after curative radiotherapy for cervical carcinoma

BACKGROUND: Radiotherapy alone or in combination with radical hysterectomy remains a potentially curative treatment for cervical carcinoma. Late urological complications after curative radiotreatment are rare but often present difficult problems of management due to the progressive nature of radiogenic tissue damage. We reviewed all cases of radiogenic urologic complications after radiotherapy for cervical carcinoma treated at our institution over the past 10 years. PATIENTS AND METHODS: In a retrospective analysis, out of all female patients treated for hydronephrosis (n = 543), 93 patients with hydronephrosis occurring after curative treatment for gynecological malignancies were identified. The most frequent cause was progressive disease (n = 55); 30 patients without recurrence had severe radiogenic urological complications (study population). RESULTS: Out of 30 patients with a mean age of 44.9 years at the time of treatment for cervical cancer, 6 had undergone primary radiotherapy and 24 had received adjuvant radiotreatment after radical hysterectomy. The observed late urological complications were: distal ureteral stenoses (bilateral in 4 cases, unilateral in 15 cases), distal ureteral necrosis (n = 1), bilateral ureteral reflux (n = 3), vesico-vaginal fistulae (n = 5), vesico-intestinal fistula (n = 1), severe fibrotic bladder shrinkage (n = 6) and urethral stenosis (n = 2). Marked signs of radiogenic cystitis were observed in almost all patients. The mean latency time between radiotherapy and manifestation of severe radiogenic urological sequelae was 19.4 years (range 0.5-41.5). Primary treatment of urological complications consisted in temporary urinary diversion by percutaneous nephrostomies or insertion of internal ureteral stents. Permanent treatment for radiogenic ureteral stenosis in all patients with sufficient general health consisted of surgical or endourological urinary diversion or reconstruction. However, the majority of patients were managed by permanent endourological measures. Lower tract fistulae were treated by distal ureteral occlusion and diversion. CONCLUSIONS: Although severe late urological sequelae of curative radiotherapy for cervical carcinoma are rare they represent major complications, result in considerable distress for the patient, and often present difficult therapeutic problems for the urologist. As these urological complications can have extremely long latency times, focussed follow-up for early detection may be advisable.     

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。     

Posttreatment ureteral obstruction in invasive carcinoma of uterine cervix

There were 2,016 new cases of invasive carcinoma of the cervix (Stages I-IV) who were seen from January 1951 to January 1981, in LSU Medical Center. One thousand, one hundred and five cases were Stages I and II (early stages), and 911 cases were Stages III and IV (advanced stages). One hundred and thirty-seven cases of early stages (12%) were recorded to have ureteral obstruction that developed after completion of the treatment for cervical carcinoma. Ninety-four (69%) of the 137 patients with ureteral obstruction in early stages are dead, and autopsy information is available in 28 cases. There was evidence of cervical carcinoma causing ureteral obstruction in 13 autopsy cases. Of the 66 patients who died and were not autopsied, 26 cases had biopsy-proven evidence of either persistent or recurrent cervical carcinoma. All 43 patients surviving in this group are biopsy negative or clinically with no evidence of disease (NED). One hundred and sixty-three patients in advanced stages (18%) who did not have ureteral obstruction prior to definitive treatment for cervical carcinoma developed ureteral obstruction after completion of treatment. One hundred and forty-two (87%) of the 163 patients with ureteral obstruction in advanced stages are dead, and autopsy information is available in 36 cases. There was evidence of recurrent or persistent carcinoma causing ureteral obstruction in 25 cases (69%). Of the 106 patients who died and were not autopsied, 76 had biopsy-proven Ca (72%) in the pelvis and abdomen prior to death. In this group, 21 patients survived until January 1, 1985, and four of them had biopsy-proven Ca which caused ureteral obstruction. In both early and advanced stages, 13 patients with post-treatment ureteral obstruction were lost to follow-up, but the remaining 287 cases have been followed until death or at least 4 years after detection of the ureteral obstruction. The median follow-up was 64.2 months, and seven patients have survived beyond 10 years. This review shows that 12% of the patients with early stage and 18% with advanced stage carcinoma of the uterine cervix seen in this institution developed some degree of detectable ureteral obstruction. Biopsy-proven evidence of recurrent or persistent carcinoma indicating the Ca to cause posttreatment ureteral obstruction in early stages of cervical carcinoma was 40% and in advanced stages was 66%.(ABSTRACT TRUNCATED AT 400 WORDS)     

Relevance of combined radiation and surgical treatment of early invasive carcinoma of the cervix]

The aim of this study was to assess the result and the postherapeutic complications rates of preoperative radiation therapy and radical surgery in association, for stage IB to IIB cervical carcinoma. For 1983 to 1990, 314 patients were treated at the Institut Curie for stage IB to IIB cervical carcinoma. For small lesions, less than 4 cm, preoperative uterovaginal brachytherapy was performed (60 to 65 Gy), followed, 6 weeks later, by a modified radical hysterectomy (Piver type 2) with pelvic lymphadenectomy. Larger tumors were treated with pelvic radiotherapy (36 Gy), then by brachytherapy (30 Gy), followed, 6 weeks later, by the same surgical procedure. 82% of the tumors were 4 cm or smaller. 64% of tumors were completely sterilised by the preoperative radiation. 5 and 10-year actuarial survival rates were respectively 81% and 70 %. 5-year actuarial survival rate was 87.5% for stage I and 63% for stage II patients. 5-year local disease free survival rate was 88% for stage I and 73% for stage II patients. All complications were prospectively recorded. The early post operative complication rate was 6.3%, with no urinary complications. The late complication rate was 3.3%, mainly grade 2 sequelae. No ureteral fistulas were observed. By combined preoperative radiotherapy and surgery, adapting the dosimetry and the radicality of the procedure, we obtained cure rates and recurrence rates identical to those obtained with exclusive surgery or radiotherapy alone. However, the complication rate of the association of both adapted treatments, has considerably reduced the early and late complication rate.     

早期宫颈癌术后辅助治疗疗效分析

目的：研究宫颈癌术后辅助治疗的选择与疗效。方法：回顾性分析159例宫颈癌根治术后辅助放疗加或不加化疗的患者治疗效果,选取130例同期行宫颈癌根治术的Ⅰb期及Ⅱa期未作术后辅助治疗患者作为对照组,进一步分析宫颈癌预后因素。159例患者中有87例放疗化疗综合治疗,72例单纯放疗。结果：289例患者总的5年生存率为89.3%,（单纯放疗组5年生存率88.9%,放疗化疗综合治疗5年生存率为89.7%）,对照组5年生存率72.9%。两者差异有显著性（P〈0.05）。结论：宫颈癌术后辅助治疗尤其对于盆腔淋巴结转移者有意义,临床和术后病理分期是术后辅助治疗的选择与疗效最主要的影响因素,不同病理类型及分级的宫颈癌术后辅助治疗可有不同的选择。     

Postoperative radiotherapy in carcinoma of the cervix with microscopically positive resection margin

Background Patients with cervical cancer who have positive surgical resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with microscopically positive surgical resection margins were analyzed to evaluate the role of radiotherapy. Methods Between 1979 and 1992, 60 patients with cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of microscopic positive vaginal (48 patients), or parametrial (12 patients) resection margins. Patients were treated with external beam radiation therapy (EBRT) alone (12 patients), or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 55 months. Results The 5-year actuarial disease-free and overall survival rates for all patients were 75% and 84%, respectively. The overall recurrence rate was 23% (14/60). Among the 48 patients with positive vaginal resection margins, 4 had pelvic recurrence (8%), and 7 had distant metastasis (15%); the recurrence rate was 21% (9/43) in those treated with EBRT and VOI, and 40% (2/5) in the EBRT-only treated group. In the 12 patients with positive parametrial margins, 3 patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32% (19/60), and grade III complications occurred in 3 patients (5%). Conclusion Postoperative radiotherapy can produce excellent control rates in patients with microscopically positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.     

原发灶不明的颈部淋巴结转移癌的治疗

目的 探讨原发灶不明的颈部转移癌的治疗方式。方法 分析81例病例资料，采用治疗方法为手术(S)、手术加放疗(S R)、手术加化疗(S C)、单纯放疗(R)、放化疗(R C)。结果 (S)11例，(S R)18例，(S C)5例，(R)19例，(R C)28例。手术包括单侧颈清30例，双侧颈清2例，局部切除2例。放射治疗剂量为40Gv～75Gv。全组5年总生存率为59．26％。中上颈部转移者5年生存率65．7％，其中转移性低分化癌的治疗方式为以放疗为主的综合治疗；转移性鳞癌则以手术为主；转移性腺癌以手术为主，其中的乳头状腺癌采用甲状腺癌联合根治术式，其5年生存率分别为62．5％、71．43％、62．5％。锁骨上区转移癌以化疗及放疗为主，5年生存率为28．57％。转移灶的部位、N分期、综合治疗及放疗范围影响5年生存率。结论 对原发灶不明的颈部转移癌的治疗，应根据淋巴结转移的部位和病理类型决定。     

Choanal stenosis: a rare complication of radiotherapy for nasopharyngeal carcinoma]

Choanal stenosis is usually a congenital anomaly in children. Acquired choanal stenosis after radiotherapy for nasopharyngeal carcinoma is a very rare pathology; only two publications report seven cases in the literature. We describe the clinical history, preoperative evaluation, surgical treatment and outcome of a case of acquired choanal stenosis after radiotherapy. The patient, a 56-year-old woman, presented with a history of nasopharyngeal carcinoma (T2- NO-MO) one year before that had been successful treated with radiotherapy (68 Gy). At the end of radiotherapy, she complained of complete nasal obstruction, anosmia and hearing loss due to a bilateral serous otitis media. Bilateral complete choanal stenosis was confirmed by endoscopy and CT scan. Functional endoscopic surgery was performed, and nasal stents were left in place for 3 weeks. One year after, the patient have good airflow, and a patent nasopharynx without choanal stenosis. In conclusion, choanal stenosis is an unusual complication of radiotherapy that can be successfully treated with transnasal endoscopic resection.     

宫颈癌根治性放疗后复发并肠梗阻高危体质患者的手术理念及技巧

目的探讨宫颈癌根治性放疗后复发并肠梗阻高危体质患者肠梗阻的治疗方法。方法回顾性分析2012年5月至2018年5月就诊于河南省肿瘤医院、行手术治疗的10例宫颈癌根治性放疗后肿瘤复发、伴高危虚弱体质肠梗阻患者的临床资料,分析患者术前放疗剂量、体质、梗阻情况、手术时间、手术出血量、术后患者消化道通畅效果和饮食情况。10例宫颈癌患者均为根治性放疗后肿瘤复发合并肠梗阻,自立行走活动障碍。结果10例患者的中位禁食时间为21 d,中位体重为35.5 kg,中位体质指数为13.3 kg/m^2,中位血红蛋白值为67 g/L,中位血小板值为44×10^9/L。10例患者均行肠造口,中位手术时间为6.0 min,中位出血量为5.0 ml。术后10例患者造口均排便,术后1 d进流食,术后5 d均能自立行走。结论对于宫颈癌根治性放疗后复发的高危体质肠梗阻患者,尽管体质极度虚弱,如果治疗策略及手术方法得当,部分患者仍有机会解除肠梗阻。