早期卵巢交界性肿瘤不同手术方式对妊娠结局的影响

目的:观察早期卵巢交界性肿瘤患者保留生育功能的不同手术方式治疗效果及对患者妊娠结局和复发的影响。方法:回顾性分析山西医科大学附属第一医院及运城市中心医院2010年1月至2018年12月收治的190例接受保留生育功能手术的早期卵巢交界性肿瘤患者临床资料,将经腹腔镜手术患者为观察组(95例),常规开腹手术组患者为对照组(95例),对两组患者手术相关指标、术后并发症发生情况、妊娠结局以及术后复发情况进行综合评价。结果:观察组患者手术时间、肛门排气时间及住院时间均短于对照组,术中出血量较对照组少,两组差异有统计学意义(P<0.05);观察组术后并发症发生率为4.21%,与对照组(18.95%)对比,差异有统计学意义(P<0.05);观察组治疗后成功妊娠及足月分娩率均显著高于对照组(P<0.05);两组患者术后复发率比较差异无统计学意义(P>0.05)。结论:早期卵巢交界性肿瘤患者行腹腔镜下保留生育功能手术治疗,安全性高、创伤小,对疾病复发无影响,能够提升患者妊娠结局,降低并发症发生率,值得推广应用。     

微创手术对早期宫颈癌妇女保留生育功能的作用

目的探讨微创手术对早期宫颈癌妇女保留生育功能的作用。方法选取2013年3月至2015年3月间新疆医科大学第二附属医院收治的194例早期宫颈癌患者,综合病理检测结果和患者意愿,对其中82例患者采用腹腔镜微创手术方式进行治疗,保留生育功能,设为试验组。对其余112例患者采用传统经腹宫颈癌根治方式进行治疗,设为对照组。比较两组患者围手术期相关指标及试验组术后妊娠情况。结果试验组患者中有79例成功完成保留生育功能手术,3例患者因术中冰冻切片病理检查结果不符合保留生育功能手术条件,改行腹腔镜下子宫广泛切除手术。试验组患者手术时间长于对照组,出血量、术后肛门排气时间和住院时间均低于对照组,两组比较,差异均有统计学意义(均P<0.05)。试验组患者中妊娠成功22例(27.8%),早产3例(3.8%),流产7例(8.9%),成功分娩12例(15.2%)。结论早期宫颈癌妇女接受微创保留生育功能手术损伤小,术后恢复较快,出血量较少,且能有效改善术后妊娠结局,具有一定的临床价值。     

保留生育功能手术对交界性卵巢肿瘤患者生育结局的影响

目的 分析保留生育功能手术对交界性卵巢肿瘤(BOT)患者生育结局的影响。方法 回顾性分析97例保留生育功能手术的BOT患者临床资料,依据妊娠结局分析其影响因素。结果 97例BOT患者中42例无生育需求,55例有生育需求。55例有生育需求的患者中妊娠患者26例,妊娠率为47.27%(26/55)。妊娠组年龄为(32.13±3.05)岁,小于未妊娠组(48.17±10.05)岁,有统计学差异(P<0.05);2组在FIGO分期、生育史、不孕史、组织学类型、附件手术史、肿瘤部位、浸润性种植、手术方法、术前CA125水平及肿瘤直径等方面对比,无统计学差异(P>0.05)。经Pearson相关性检验结果显示,BOT患者生育结局与年龄呈负相关(P<0.05)。结论 BOT患者采用保留生育功能手术治疗是安全可行的,对患者生育结局无影响,年龄为影响患者生育结局的重要因素。     

关注早期宫颈癌年轻患者根治性子宫颈切除术的应用

根治性子宫颈切除术为未生育的早期宫颈癌年轻患者保留生育功能带来新的希望。应关注术前的准确评估,同时重视术后肿瘤复发、生存率及妊娠结局。     

宫颈环状电切术对早期宫颈癌患者生育能力和妊娠率的影响

目的探讨宫颈环状电切术(LEEP)对早期宫颈癌患者生育能力和妊娠率的影响。方法选取2013年6月至2015年6月间临朐县人民医院收治的40例早期宫颈实施宫颈锥切术患者为观察组,另选取同期门诊收治的40例无宫颈锥切术史计划的妇女为对照组。随访2年,对比两组产妇的妊娠情况、分娩方式、围生儿结局。结果与对照组比较,观察组患者的妊娠率和分娩率降低,不孕率提高,差异均有统计学意义(均P<0.05)。观察组患者中,输卵管性不孕5例(12.5%),宫颈粘连不孕1例(2.5%),宫颈管狭窄不孕1例(2.5%)。对照组中输卵管性不孕2例(5.0%)。与对照组比较,观察组患者的平产率降低,剖宫产率升高,差异均有统计学意义(均P<0.05)。与对照组比较,观察组患者的胎膜早破发生率、早产率、新生儿窒息率和新生儿低体重率明显升高,差异均有统计学意义(均P<0.05)。结论采用LEEP刀锥切术对早期宫颈癌患者的生育能力可造成一定的影响,一方面降低了妊娠率,另一方面提高了胎膜早破、早产、新生儿窒息和新生儿低体重发生率,应引起临床医师的重视。     

宫颈环形电切术和冷刀锥切术治疗早期宫颈癌的疗效及对患者生育功能的影响

目的 探讨宫颈环形电切术(LEEP)和冷刀锥切术(CKC)治疗早期宫颈癌的疗效及对患者生育功能的影响.方法 109例早期宫颈癌患者,依据治疗方式不同分为CKC组(n=51)和LEEP组(n=58),CKC组患者给予CKC治疗,LEEP组患者给予LEEP治疗.比较两组患者的手术相关指标、并发症发生情况、妊娠情况和复发情况...     

妊娠合并卵巢癌患者行保留生育功能治疗对其妊娠结果的影响及安全性

目的探讨妊娠合并卵巢癌患者行保留生育功能治疗对其妊娠结果的影响及安全性。方法回顾性分析2013年6月至2014年6月间山东省临朐县人民医院收治的40例妊娠合并卵巢癌患者的临床资料,观察并记录患者卵巢肿瘤首次确诊时间、方式、病理类型、处理方式及妊娠结果。结果妊娠合并卵巢癌患者首次确诊时间在孕晚期的百分率明显高于孕前、孕早期、孕中期,差异有统计学意义(P<0.05)。妊娠合并卵巢癌患者确诊发现方式为超声检查的显著高于妇科检查及剖宫产手术,差异有统计学意义(P<0.05)。妊娠合并卵巢癌患者成熟畸胎瘤发生率显著高于卵巢瘤样病变、卵巢巧克力囊肿、黏液性囊肿、卵巢冠囊肿、浆液性囊腺瘤,差异有统计学意义(P<0.05)。妊娠合并卵巢癌患者处理例数中剖宫产显著高于自然分娩、流产、早产,差异有统计学意义(P<0.05)。妊娠合并卵巢癌患者自然分娩、早产、剖宫产术胎儿生存率相近,差异无统计学意义(P>0.05)。妊娠合并卵巢癌患者自然分娩、早产、流产、剖宫产术胎儿生存率相近,差异无统计学意义(P>0.05)。结论对于妊娠合并卵巢癌患者于剖宫产期间实施保留生育功能治疗可获得显著疗效,胎儿及产妇存活率较高,安全性较为肯定,值得推广。     

早期子宫颈癌保留生育功能手术的研究进展

早期子宫颈癌保留生育功能手术的开展是妇科恶性肿瘤治疗的里程碑之一,其治疗效果逐步得到妇产科医生和患者的肯定,如何更优化的选择及评估患者、提高手术效果、减少并发症、改善肿瘤结局和妊娠结局是目前的热点问题.文章通过对近年国内外治疗的新进展及尚存争议的问题进行综述,以期推动今后的治疗不断向安全、高效、微创的方向发展,在获得临床治愈的前提下更好地改善患者的生活质量.     

不同手术方式对宫颈癌患者生活质量的影响

目的探讨不同手术方式对宫颈癌患者术后生活质量的影响。方法选取2015年2月至2017年10月间湖北省中西医结合医院收治的120例早期宫颈癌患者,根据手术方式不同分组,采用开腹手术并清扫盆腔淋巴结治疗的40例患者纳入开腹组,采用腹腔镜下广泛性子宫切除术(LRH)治疗的40例患者纳入LRH组,采用腹腔镜下保留盆腔自主神经的广泛性子宫切除术(LNSRH)治疗的40例患者纳入LNSRH组。比较各组患者手术时间、术中出血量和术后住院时间,及术后3个月内的并发症发生情况和膀胱功能恢复指标,包括尿管留置时间、腹压排尿比率和排尿满意度。评价患者术后半年时的癌症患者生命质量测定量表评分(FACT-G)。结果 LRH组和LNSRH组患者术中出血量均明显少于开腹组,术后住院时间均明显短于开腹组,差异均有统计学意义(均P <0. 05)。LNSRH组患者手术时间长于开腹组和LRH组,LRH组短于开腹组,差异均有统计学意义(均P <0. 05)。开腹组患者并发症发生率高于LRH组和LNSRH组,差异均有统计学意义(均P <0. 05)。LRH组和LNSRH组患者尿管留置时间短于开腹组,LNSRH组短于LRH组,LNSRH组腹压排尿比率明显低于开腹组,LNSRH组高于LRH组和开腹组,差异均有统计学意义(均P <0. 05)。LRH组和LNSRH组患者FACT-C评分明显高于开腹组,LNSRH组高于LRH组,差异均有统计学意义(均P <0. 05)。结论 LNSRH是保留宫颈癌患者生理功能的重要改良术式,安全性高,能改善患者的膀胱功能,提高生活质量。     

不同类型黏膜下子宫肌瘤患者宫腔镜手术治疗对妊娠结局的影响

目的探讨不同类型黏膜下子宫肌瘤患者行宫腔镜手术治疗对妊娠结局的影响。方法选取2011年3月至2014年6月间深圳市龙岗区第六人民医院收治的162例黏膜下子宫肌瘤患者,均采用宫腔镜电切除术治疗。根据子宫肌瘤与肌层的关系,将患者分为0型组(78例)、Ⅰ型组(54例)、Ⅱ型组(30例),对3组患者的妊娠结局进行统计对比。结果 0型组患者的足月生产率、流产率、早产率和难产率与Ⅰ型和Ⅱ型组比较,差异均有统计学意义(均P<0.05)。Ⅰ型组与Ⅱ型组患者的足月生产率、流产率和早产率比较,差异无统计学意义(P>0.05)。但Ⅰ型组患者的难产率显著低于Ⅱ型组,差异有统计学意义(P<0.05)。3组患者均未发生子宫破裂(P>0.05)。结论不同类型黏膜下子宫肌瘤患者实施宫腔镜电切除术治疗的妊娠结局存在差异,带蒂肌瘤、肌层扩展越浅,患者的妊娠结局越好,提示黏膜下子宫肌瘤应当早诊断、早治疗。     

直径小于2厘米胃癌预制因素分析

Objective  

The aim of our study was to identify clinicopathological characteristics as predictive factors for gastric cancer tumours of less than 2 cm in diameter.     

经皮消融治疗微小肝癌的疗效和预后因素分析

目的 评估经皮消融微小肝癌的疗效并进行预后因素分析.方法 2003年7月至2006年10月,对单个结节直径≤2 cm的33例微小肝癌行超声引导经皮消融,视肿瘤所在部位分别采用水冷式低杆温微波消融或多极无水酒精消融,每个肿瘤治疗一次.结果 肿瘤完全消融率为93.9%,局部复发率9.1%,远处复发率33 3%,1年、2年和3年无瘤生存率63.4%、63 4%和63.4%,总生存率84.5%、76.6%和71.2%.单因素分析显示甲胎蛋白基线水平与无瘤生存率显著相关,甲胎蛋白、治疗后远处复发与总生存率显著相关.多因素相关分析显示高甲胎蛋白水平和远处复发是显著影响总生存率的独立危险因子.结论 经皮消融对微小肝癌长期疗效良好,病人的甲胎蛋白基线水平和治疗后远处复发是影响预后的主要因素.     

Histopathologic prognostic factors in adenocarcinomas of the peripheral lung less than 2 cm in diameter

The histologic prognostic factors of pulmonary adenocarcinomas of the lung less than 2 cm in diameter were analyzed in 75 patients who had undergone surgical resection. The pathologic stage, lymph node involvement, and pleural involvement were found to be the major determinants of prognosis (P less than 0.01). In addition, other single factors, such as tumor differentiation (P less than 0.01), vascular invasion (P less than 0.01), the degree of collagenization in the fibrotic focus (P less than 0.01), the standard deviation (SD) of nuclear areas (P less than 0.05), and mitotic index (P less than 0.05) correlated significantly with prognosis by the log-rank test on the Kaplan-Meier survival curves of these factors. Patients with dense infiltration of "T-zone histiocytes" survived significantly longer than those with less infiltration (P less than 0.05). Cox's proportional hazard general linear model analysis showed the importance of factors, such as lymph node or pleural involvement and the SD of nuclear area, when the pathologic stage was excluded, and of the mitotic index when all four factors were excluded to emphasize the cellular characteristics. It is possible to predict the postoperative prognosis of patients with small pulmonary adenocarcinoma more precisely by combination of the above histopathologic factors.     

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

PURPOSE: To assess the need for adjuvant radiotherapy following mastectomy for patients with node-negative breast tumors 5 cm or larger. METHODS AND MATERIALS: Between 1981 and 2002, a total of 70 patients with node-negative breast cancer and tumors 5 cm or larger were treated with mastectomy and adjuvant systemic therapies but without radiotherapy at three institutions. We retrospectively assessed rates and risk factors for locoregional failure (LRF), overall survival (OS), and disease-free survival (DFS) in these patients. RESULTS: With a median follow-up of 85 months, the 5-year actuarial LRF rate was 7.6% (95% confidence interval, 3%-16%). LRF was primarily in the chest wall (4/5 local failures), and lymphatic-vascular invasion (LVI) was statistically significantly associated with LRF risk by the log-rank test (p=0.017) and in Cox proportional hazards analysis (p=0.038). The 5-year OS and DFS rates were 83% and 86% respectively. LVI was also significantly associated with OS and DFS in both univariate and multivariate analysis. CONCLUSIONS: This series demonstrates a low LRF rate of 7.6% among breast cancer patients with node-negative tumors 5 cm and larger after mastectomy and adjuvant systemic therapy. Our data indicate that further adjuvant radiation therapy to increase local control may not be indicated by tumor size alone in the absence of positive lymph nodes. LVI was significantly associated with LRF in our series, indicating that patients with this risk factor require careful consideration with regard to further local therapy.     

Prognostic factors of gastric cancer tumours of less than 2 cm in diameter: rationale for limited surgery.

BACKGROUND: A recent trend in the surgical treatment of patients with early gastric cancer in Japan has been to limit surgery to an extent that ensures complete cure and improvement in the patient's quality of life. If a gastric cancer tumour can be completely eradicated by laparoscopic surgery, the patient can be cured of cancer without major operative stress. A small gastric cancer tumour of less than 2 cm in diameter is an indication for laparoscopic surgery, but little is known about what protocol of surgical treatment is appropriate for this type of tumour. PATIENTS AND METHODS: The clinicopathological features of 150 patients with gastric cancer tumour of less than 2 cm in diameter were reviewed retrospectively from hospital records between 1985 and 1995. The results of retrospective analysis of clinicopathological data of 24 patients with advanced cancer were compared with those of 126 patients with early cancer. Univariate and multivariate analyses of patients with small gastric cancer tumours were performed to evaluate the prognostic significance of clinicopathological features. RESULTS: A significant difference was seen between the gross tumour appearances in the two groups; Borrmann type-4 tumours were more common in the advanced group. Lymph-node metastasis, lymphatic vessel invasion and vascular invasion were found more frequently in the advanced cancer group than in the early cancer group. Scirrhous type was more common in the advanced cancer group. In univariate analysis, unfavourable prognostic factors included deep cancer invasion, presence of lymph-node metastasis, lymphatic invasion and vascular invasion. Using Cox's proportional hazard regression model, only nodal involvement emerged as an independent statistically significant prognostic parameter associated with long-term survival. CONCLUSION: Laparoscopic surgery should not be performed on tumours that are Borrmann type in macroscopic appearance and scirrhous-type histologically. Lymph-node metastasis is an independent prognostic factor. We recommend laparoscopic surgery involving local resection of the stomach without lymphadenectomy for small, early gastric cancer tumours that satisfy the criteria mentioned above. However, the validity of this recommendation should be tested by a prospective randomized control trial in the future.     

Results of bladder-conserving treatment, consisting of brachytherapy combined with limited surgery and external beam radiotherapy, for patients with solitary T1-T3 bladder tumors less than 5 cm in diameter

PURPOSE: To evaluate the long-term, local relapse-free, distant metastasis-free, and overall survival rates in patients with a solitary bladder tumor <5 cm in diameter who were treated with external beam radiotherapy, limited surgery, and brachytherapy. METHODS AND MATERIALS: The results of 122 patients after bladder-saving treatment were analyzed. After EBRT, the patients underwent cystotomy, and catheters were implanted. Of the 122 patients, 99 were treated with a continuous low-dose-rate technique and 23 patients with a pulsed-dose-rate technique. The median follow-up period was 5 years. RESULTS: The 5-year local and distant relapse-free survival rate was 76% and 83%, respectively. The 5 and 10-year relapse-free survival rate was 69% and 66%, respectively. For overall survival, the corresponding rates were 73% and 49%. Toxicity was low. No differences were found between the continuous low-dose-rate and pulsed-dose-rate groups. CONCLUSION: The results of our study have shown that external beam radiotherapy followed by brachytherapy as a bladder-saving treatment for a selected group of patients with bladder cancer yields excellent local tumor control and low toxicity.     

多层螺旋CT与立体定向穿刺系统导引下肺内小结节穿刺活检的临床应用

 目的 探讨MSCT与Pinpoint导引下穿刺活检术在肺内小结节诊断的临床应用价值。方法 32例肺内小结节（＜2 cm），均经MSCT与Pinpoint导引穿刺行组织学检查，分析穿刺病理取材正确率及并发症发生率。结果 32例均经手术病理及临床随访而明确诊断。其中恶性22例，良性病变10例，穿刺确诊30例；2例穿刺未取得病理结论，经手术证实分别为腺癌、错构瘤。恶性预测值及敏感性分别为100 %，95.7 ％，穿刺总准确性93.8 ％。气胸2例（6.2 ％），未经闭式引流或抽气处理；肺出血4例（12.5 ％），其中1例有一过性咳血，均未经特殊处理。结论 MSCT与Pinpoint导引下肺内小结节穿刺活检可以获得较好的组织学标本，是一种安全、准确的诊断和鉴别方法。