胃泌素瘤的诊断及治疗

胃泌素瘤是一种神经内分泌肿瘤, 异位分泌胃泌素, 导致卓-艾综合征。大部分胃泌素瘤为散发病例, 20%～25%患者作为多发性内分泌腺瘤综合征1型(MEN1)临床表现之一存在。因为散发胃泌素瘤及MEN1治疗策略不同, 所以临床上需要将其加以区分。胃泌素瘤药物治疗主要分为控制高胃泌素血症相关症状和控制肿瘤生长两类。散发病例的手术治愈率为20%～40%, 而对于MEN1人群是否进行手术治疗尚存在争议。本文对近年来胃泌素瘤诊断及治疗相关临床进展进行阐释, 以期为临床工作提供参考。     

转移性肺癌的外科治疗及预后影响因素

目的：讨论转移性肺癌的外科治疗以及影响预后的因素。方法：本组经外科治疗的肺转移癌59例，同时选取36例未经手术治疗的患者作对照，分别随访预后情况，并用逐步回归方法分析影响预后的因素。结果：手术与非手术患者的1，3，5年生存率分别为70％，39％，34％和28％，8％，0％，无病生存期（DFI）＜1年和≥1年患者的5年生存率分别为21％和40％，结论：对于符合手术指征的转移性肺癌患者，应尽可能手术治疗，且DFI越长，术后生存时间越长。     

Surgery and prognosis of duodenal gastrinoma as a duodenal neuroendocrine tumor

It has become increasingly clear that duodenal gastrinomas are the most common cause of Zollinger-Ellison syndrome (ZES). However, attempts to find these tumors before and during surgery for ZES have had limited success until duodenotomy (opening the duodenum) was described. The routine use of duodenotomy in patients with non-familial gastrinoma increases the number of duodenal tumors found, and the immediate and long-term cure-rate. The increase in cure-rate appears to be secondary to increased detection of small, previously undetectable duodenal gastrinomas. Duodenotomy detects small tumors (<1 cm) in the proximal duodenum. It does not detect more duodenal gastrinomas per patient, nor does it detect tumors in unusual duodenal locations. Duodenotomy decreases the death-rate associated with these tumors. However, it has not affected the rate of development of liver metastases. Duodenotomy is a critical method to find duodenal gastrinomas. It should be routinely performed in all surgery to find and remove gastrinoma for cure of ZES.     

肺粘液表皮样癌的外科治疗与预后分析

目的分析肺粘液表皮样癌的诊断、临床特点、外科治疗及预后情况。方法回顾总结34例手术切除的原发性肺粘液表皮样癌,行肺叶切除术23例,全肺切除7例,肺楔形切除1例,纵隔镜淋巴结活检1例,转移肋骨活检1例,开胸探查1例,分析其临床特点、外科治疗方法及预后情况。结果术前确诊21例,术后1、3、5年生存率分别为84.4%、73.9%和62.5%。其中23例低度恶性肺粘液表皮样癌,1例有肺门淋巴结转移,1、3、5年生存率分别为100%、100%和90.9%;11例呈高度恶性,淋巴结转移率63.64%,术后1、3、5年生存率分别为50.0%、14.3%和0。结论原发性支气管粘液表皮样癌以低恶性为主,低恶性粘液表皮样癌经彻底手术切除可获治愈,高恶性病人术后易早期发生远处转移,预后差。     

Surgical treatment and prognosis of gastric cancer in 2,613 patients

AIM: To analyze the factors influencing the prognosis of patients with gastric cancer after surgical treatment, in order to optimize the surgical procedures.METHODS: A retrospective study of 2 613 consecutive patients with gastric cancer was performed. Of these patients, 2 301 (88.1%) received operations; 196 explorative laparotorny (EL), 130 by-pass procedure (BPP), and 1 975 surgical resection of the tumors (891 palliative resection and 1 084 curative resection). The survival rate was calculated by theactuarial life table method, and the prognostic factors were evaluated using the Cox regression proportional hazard model.RESULTS: Of the patients, 2 450 (93.8%) were followed-up.The median survival period was 4.6 mo for patients without operation, 5.2 mo for EL, 6.4 mo for BPP, and 15.2 mo for palliative resection (P = 0.0001). Of the patients with surgical resection of the tumors, the overall 1, 3 and 5-yearsurvival rates after were 82.7%, 46.3% and 31.1%,respectively, with the 5-year survival rate being 51.2% in patients with curative resection, and 7.8% for those with palliative resection. The 5-year survival rate was 32.5% for patients with total gastrectorny, and 28.3% for those with total gastrectomy plus resection of the adjacent organs. The factors that independently correlated with poor survival included advanced stage, upper third location, palliative resection, poor differentiation, type IV of Borrman nclassification, tumor metastasis (N3), tumor invasion into the serosa and contiguous structure, proximal subtotal gastrectomy for upper third carcinoma and D1 lymphadenectomy aftercurative treatment.CONCLUSION: The primary lesion should be resected as long as the local condition permitted for stage III and IV tumors, in order to prolong the patients‘ survival and improve their quality of life after operation. Total gastrectomy is indicated for carcinomas in the cardia and fundus, and gastric cancer involving the adjacent organs without distant metastasis requires gastrectomy with resection of the involved organs.     

Surgical treatment and prognosis of octogenarians with non-small cell lung cancer

ObjectiveTo explore the clinical characteristics, surgical treatment and prognosis of non-small cell lung cancer (NSCLC) among elderly patients over 80 years.MethodsThe clinical data, surgical methods, perioperative management, postoperative complications and prognosis of 52 NSCLC patients aged over 80 years were retrospectively analyzed.ResultsOut of 52 cases, 27 had a long-term smoking history (51.9%) and 44 were with other diseases (84.6%). Lobectomy was done in 32 cases (65.4%), sub-lobectomy in 20 cases (38.5%), including pulmonary wedge resection in 16 cases (30.8%) and lung segment resection in 4 cases (7.7%). The postoperative complication rate was 44.2% (23/52); the complication rate after lobectomy was 62.5% (20/32) and that after sub-lobectomy was 25% (5/20), with significant difference between lobectomy and sub-lobectomy (P<0.05). Postoperative mortality was 3.8% (2/52). Pathological TNM staging: I a 27 cases (51.9%), I b 12 cases (23.1%), II a 8 cases (15.4%), II b 3 cases (5.8%) and III a 2 cases (3.8%). The 1-, 3- and 5-year survival rate after operation was 87.1%, 59.8%, 19.1%. The 1-, 3- and 5-year survival rate was 86.0%, 61.8%, 21.5% in the patients after lobectomy; that was 89.0%, 58.3%, 18.7% in the patients after sub-lobectomy, with no significant difference between two surgical methods (P>0.05).ConclusionsOctogenarians with NSCLC are often afflicted with comorbidity, so perioperative management is more complex. Strictly adhering to indications, surgery is still an important treatment of NSCLC patients over 80.     

Successful treatment of a malignant gastrinoma with streptozotocin.

The treatment with streptozotocin of a patient with metastatic gastrinoma is described. Two courses of intravenous streptozotocin were without effect. However, three months after two doses of 4 g streptozotocin were given into the coeliac axis, there was a marked reduction in hepatic size and a fall in fasting plasma gastrin levels from 1430 pmol/l to 240 pmol/l. Seven months after treatment fasting plasma gastrin levels were 125 pmol/l.     

Surgical treatment for better prognosis of patients with liver metastases from colorectal cancer

BACKGROUND/AIMS: Hepatic resection is established as the best available treatment for colorectal cancer metastases to the liver, but the optimal procedure for the resection is now controversial. In this study we retrospectively evaluated the influence of the selection of surgical procedures for hepatic resection in determining the prognostic factors. METHODOLOGY: A population of 111 patients with liver metastases from colorectal cancer underwent initial and radical hepatic resection. Survival rates as a function of clinical, primary tumor pathologic TNM classification and surgical determinates were examined retrospectively with univariate and multivariate analyses. RESULTS: The overall, 1-, 3-, 5- and 10-year survival rates were 85.5%, 51.4%, 41.6% and 30.9%, respectively. Patient survival was uncorrelated with any of the following factors: sex, age, temporal relationship, primary tumor site, tumor stage, pathological depth, pathological vascular invasion, pathological lymphatic invasion and pathological lymph node metastases of the primary tumor, maximum diameter of liver lesions, intrahepatic distribution patterns, type of hepatectomy, and number of hepatectomies. However, the number of liver tumors and the tumor-free margins were significantly associated with good prognosis. CONCLUSIONS: Safe hepatectomy with adequate tumor-free margins leads to a better prognosis.     

Hypergastrinaemia without detection of gastrinoma

We present a case-report of a woman with persisting gastric ulcers, who had elevated gastrin blood levels. First of all, a rare cause of hypergastrinaemia was excluded - a gastrinoma. It was not found despite of extensive investigation. Ulcers were repetitively biopted and transition of high grade dysplasia to adenocarcinoma was detected. Gastrin levels normalised after surgical antrectomia. Afterwards pernicious anaemia was diagnosed as the underlining cause of hypergastrinaemia.     

Surgical therapy and prognosis of sarcomatoid carcinoma of the gallbladder

BACKGROUND:Sarcomatoid carcinoma of the gallbladder is rare and its characteristics are poorly understood.This study aimed to understand the behavior and prognosis of sarcomatoid carcinoma of the gallbladder as well as its clinical manifestations and survival rate of patients after radical or palliative surgery,and to review the reported data worldwide and our 10 patients. METHODS:From 2004 to 2009,ten patients were pathologically diagnosed with sarcomatoid carcinoma of the gallbladder and underwent operati...