PGGT、PGGT单克隆抗体和GGT mRNA表达在胰头癌诊断中的价值

目的: 探讨PGGT、PGGT单克隆抗体和GGT mRNA表达在胰头癌诊断中的价值. 方法: 采用改良DEAE Sephadex A50离子交换柱层析法、PGGT单抗Elisa间接混合夹心法、RT-PCR等方法对142例黄疸患者血清PGGT、TGGT及组织中GGT mRNA的表达进行研究. 结果: 以血清PGGT>4 U/L、PGGT/TGGT>0.1作为诊断胰头癌的指标,其阳性率为62.5%.PGGT单克隆抗体检测血清中PGGT恶性阻塞性黄疸及胰头癌阳性率分别为59.0%及100%.通过RT-PCR法检测GGT mRNA的相对表达量,胰头癌组(占62.5%)>胆管癌组(占35.8%)>正常组(占29.4%). 结论: PGGT、PGGT/TGGT、PGGT单克隆抗体及GGT mRNA表达在梗阻性黄疸鉴别诊断中有其重要意义,有望成为诊断胰头癌的方法.     

胰头癌早期论断的探讨

目的:探讨运用现代诊断方法早期诊断胰头癌的方法.方法:回顾分析我们收治的96例胰头癌的病例资料.结果:在各种检查中,对胰头癌的第三性依次是术中穿刺抽吸细胞学检查(FNA),ERCP,CT,血管造影(DSA),B超和CA19-9.结论:在各种检查中,首选B超和CT,对B超和CT不能确诊的病例,如无黄疸,宜行ERCP检查,如有黄疸,且排除了肝炎等情况,可直接剖腹探查,术中行FNA,以明确论断,而DSA在显著瘤侵犯血管程度从而判断能否切除肿瘤方面的有重要价值.     

胰头癌的早期诊断

早期诊断和早期治疗是提高胰头癌治疗效果的关键。为探讨临床各种诊断手段在小胰头癌诊断中的意义，回顾分析了８４例根治性手术中肿瘤≤２ｃｍ和＞２ｃｍ两组患者间的临床表现、影像学检查、血清学检查结果及其在小胰头癌诊断中的地位和作用。临床首现症状以黄疸、上腹部痛常见，但组间无差异。ＥＲＣＰ的诊断准确率明显高于Ｂ超（Ｐ＜０．０５）和ＣＴ（Ｐ＞０．０５），同时对小胰头癌的敏感性均高于Ｂ超（Ｐ＜０．０５）和ＣＴ（Ｐ＞０．０５），而Ｂ超和ＣＴ在诊断２ｃｍ以上胰头癌时有较高的确诊率。ＣＡ１９－９对小胰头癌的敏感性高于ＣＥＡ（Ｐ＜０．０１），但早期的确诊率仅为４２％。作者认为，重视胰头癌的临床表现是早期诊断的基础，合理的选择影像学检查是提高小胰头癌诊断准确率的关键，ＥＲＣＰ是诊断小胰头癌的有效手段。     

Studies on diagnosis of pancreas head region cancer using echotomography

On 67 cases of pancreas head region cancer with its definite diagnosis confirmed by laparotomy, studies were made of their ultrasonograms and of their urtrasonic tissue characterization obtained from the ultrasonography of the resected specimens immersed in water in 17 of 29 cases resected. The following results have been obtained. Ultrasonogram of pancreas head region cancer has the following characteristics. Direct findings: i) abnormal internal echo level of tumor images, ii) irregular images of tumor margin, iii) irregular internal echo of tumor images, iv) localized enlargement of the pancreas, v) altenuation or disappearance of back echo of tumor images. Indirect findings: i) dilated common bile duct ii) enlarged gallbladder, iii) dilated intrahepatic bile duct, iv) dilated pancreatic duct, v) abnormal deformation of vascular images surrounding the pancreas. Resected cases had less scanty ultrasonographic findings than non-resected cases. The detection of pancreas head region cancer by ultrasound was possible in 43 cases (64.2%). Differential diagnosis of pancreas head region cancer by ultrasound may be possible to a certain extent. Internal echo level of tumor images had a close relation with tissue-type, interstitial connective tissue hyperplasia and the cut surface structure of the resected specimens.     

Pancreatoduodenal resection in cancer of the head of the pancreas

The nearest results of surgical treatment of 375 patients with carcinoma of the pancreatic head and of 104 patients with cancer of other organs of the pancreatoduodenal area are described. Radical operations were made on 62 of them. Resectability was 16.5%, lethality--9.7%, postoperative complications were noted in 35.5% of the patients.     

Clinical course and diagnosis of cancer of the gallbladder]

Basing on clinical observations over 51 patients with cancer of the gallbladder the authors support the opinion of many medical researchers that, in most cases, the disease develop with cholelithiasis in the background. To establish the diagnosis of cancer of the bladder prior to surgery is possible only taking into account the complex of manifestations in patients with a persistant anamnesis of cholelithiasis. The mortality rate is high. One of the effective prophylactic measures against development of the bladder cancer is felt to be an early operative treatment for cholelithiasis and its complications.     

Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer

We report a rare case of a curative resection performed on a carcinoma developing in the remnant pancreas at 3 years 7 months after a pancreaticoduodenectomy for pancreatic cancer. A 63-year-old man underwent a pancreaticoduodenectomy for pancreatic cancer on November 1999. Because the celiac trunk was occluded by atherosclerosis, an aortohepatic bypass with a saphenous vein graft was performed simultaneously. In May 2003, tumor marker levels increased, and a tumor was detected in the remnant pancreas on computed tomography. There were no findings such as invasion into the surrounding tissue or distant metastasis, and therefore we removed the remnant pancreas in July 2003. Histopathologically, the tumor consisted of a well-differentiated tubular adenocarcinoma and was limited to the pancreas. Moreover, the anastomotic site of the pancreaticojejunostomy was negative for cancer, and some foci of papillary hyperplasia and goblet cell metaplasia of the pancreatic ductal epithelium, which was thought to be the precursor of the pancreatic cancer, were seen. These findings suggested that the tumor was a second primary cancer developing in the remnant pancreas. This case provided suggestive evidence for the development of pancreatic cancer, and the surgical procedure for a pancreaticoduodenectomy with occlusion of the celiac trunk is discussed.     

Pancreaticoduodenectomy for cancer of the head of the pancreas

Many modifications of the original technique have been proposed to try to improve the results of the pancreaticoduodenectomy described by Whipple. To evaluate these modifications, we have reviewed randomized controlled trials, meta-analyses, and well-conducted retrospective series. Neither total pancreatectomy nor extended lymph node dissections have shown an improve of survival in retrospective studies. Preoperative evidence of mesenteric or portal vein involvement does not contraindicate pancreatic resection and survival rates are similar to those of patients with no venous involvement. Prospective trials and one meta-analysis have shown neither advantage nor disadvantage of pylorus-preserving pancreaticoduodenectomy or of pancreatico-gastric anastomosis. Three trials and one meta-analysis of pancreatico-gastric anastomosis have failed to demonstrate a decrease in the risk of pancreatic fistula. Two trials suggest that the risk of fistula formation is decreased by implantation of the pancreatic remnant into the jejunum or by trans-jejunal stenting of the pancreatico-jejunal anastomosis with external drainage; but these findings are not supported by a third trial. The results of the antisecretory use of somatostatin are contradictory. Leak and fistula formation were decreased when the criteria for leakage was based on laboratory findings; but in 4 out of 5 trials, somatostatin did not decrease the incidence of clinical fistula. The use of fibrin glue to occlude the pancreatic duct or seal the cut surface of the pancreas did not decrease the rate of intra-abdominal complications. In conclusion, the pancreaticoduodenal resection described by Whipple may still be considered the gold standard for resection of pancreatic cancer. The technical experience of surgeons and their institutional support staff resulted in lower perioperative morbidity and mortality and in higher survival rates.     

肿瘤标志物在胰头实性占位病变鉴别诊断中的意义

目的 评价血清肿瘤标志物联合检测对胰头实性占位病变良恶性鉴别诊断的临床价值.方法 对69例胰头癌患者和26例胰头肿块型慢性胰腺炎患者的血清糖类抗原CA19-9、CA242、CA50和癌胚抗原（CEA）四种肿瘤标志物进行检测,绘制ROC曲线（receiver-operating characteristics curve）并计算曲线下面积,计算CA19-9、CA242、CA50和CEA的似然比,并运用相关统计学方法进行分析.结果 CA19-9、CA242、CA50和CEA曲线下面积分别为0.745、0.712、0.717和0.725,阳性似然比依次为1.91、3.43、5.09和5.46;阴性似然比依次为0.41、0.56、0.59和0.71.以四项检查均为阳性诊断胰头癌,即系列联合检测,其特异性较单项检查均明显增高;而以四项检查中有一项为阳性诊断胰头癌,即平行联合检测,四种血清肿瘤标志物检测敏感性较单项检查均明显增高.结论 CA19-9等四种血清肿瘤标志物联合检测对鉴别胰头实性占位良恶性有重要的临床意义,其中CA19-9临床意义较大,系列联合检测可提高鉴别诊断的特异性.     

Histometric analysis of the distal pancreas in pancreatic head cancer

To clarify the histological status of the pancreas tail after pancreatoduodenectomy (PD), fibrosis, islets of Langerhans, and A, B, and D cells were examined histometrically in surgical cases of pancreatic cancer. The same investigations were also performed during an autopsy examination of the pancreas tail of survivors of surgery who had received either PD or total pancreatectomy with segmental autotransplantation (SAT). In the surgical cases, fibrosis and the islet percentage compared with nonpancreatic cancer cases were significantly higher while the B cell ratio was significantly lower. In addition, in pancreatic cancer patients, the fibrosis and islet ratio in the group with a blocked pancreatic duct were higher while the B cell ratio was lower than in the group with an open pancreatic duct. A direct relationship between the islet ratio and the degree of fibrosis, and an inverse relationship between the B cell ratio and the degree of fibrosis, were thus found. From the autopsy cases, the fibrosis progressed and the islet ratio increased following PD, but after SAT only the islet ratio increased compared to the time of surgery. The progression of fibrosis after PD thus suggests the presence of some problems in both the surgical method and postoperative management.     

Measurement of serum PSA values by DELFIA PSA and its clinical significance on diagnosis and follow-up of prostate cancer patients]

Serum prostate specific antigen (PSA) values detected by DELFIA PSA were evaluated for usefulness in the diagnosis and follow-up of patients with prostate cancer. The system is time-resolved fluoroimmunoassay using europium as a tracer, which has a detectable range of 0.10-500 ng/ml with a small sample volume (25 microliters) and reliable quality control data. Furthermore, serum PSA values detected by the assay were equivocal to those detected by Tandem-R PSA. From the mean +3 S.D. of serum PSA values obtained on 227 normal males, 1.98 ng/ml was decided as an upper normal level. Serum PSA values in benign prostatic hyperplasia (BPH) (n = 69) and prostate cancer (n = 86) patients were statistically higher than those in normal males. However, when 1.98 ng/ml was used as a cut-off value, the false positive rate in BPH cases elevated up to 80%. Therefore, in the differential diagnosis of prostate cancer and BPH, we recommend 11.7 ng/ml (mean + S.D. in BPH cases) as a cut-off value, in which sensitivity is 72.1%, 88.4% are true negative in BPH, and efficacy is 79.4%. Serially determined serum PSA values in following up the patients with prostate cancer were confirmed to be highly effective for diagnosing recurrence and evaluating treatment responses. These findings suggest that DELFIA PSA is a useful tool for determination of serum PSA values.     

Chronic pancreatitis of the head of the pancreas in hyperplasia of the body and tail of the pancreas]

We report a case of chronic pancreatitis of the head of the pancreas complicated with insulin-requiring diabetes mellitus, in a 44-year-old woman with hypoplasia of the dorsal pancreas. Preoperative ultrasonography, computerized tomography and angiography revealed a calcifying retroperitoneal mass, which on explorative laparotomy proved to be a severe chronic pancreatitis of the head of the pancreas with a finding of abnormal visibility of the confluens venosum and absence of both the corpus and the tail of the pancreas. The postoperative course following pylorus-preserving duodenopancreatectomy was uneventful.