从淋巴结转移规律探讨贲门癌合理治疗

本文通过１２６例病例分析及文献复习，探讨了贲门癌淋巴结转移的特点（１）贲门癌先向腹腔淋巴结转移，晚期才向胸腔淋巴结转移；（２）贲门癌向脾门，脾动脉淋巴 转移机率并不比向比门上，下淋巴结转移机率小。     

贲门癌淋巴结转移规律探讨

目的:探讨贲门癌肿瘤大小、分化程度、浸润深度与淋巴结转移的关系。方法:对86例采用上腹左胸两切口手术的贲门癌患者淋巴结分组行病理检查,依据转移淋巴结的分布,分析转移规律。结果:86例共清扫淋巴结1146个,转移度28.9%,转移率72.1%,胸腔淋巴结转移率27.9%,腹腔淋巴结转移率70.9%。肿瘤大小、浸润深度、分化程度均与淋巴结转移率相关。结论:贲门癌有向胸、腹腔两野淋巴结转移的倾向,多数贲门癌的淋巴结遵循逐站转移、按贲门淋巴在腹腔、胸腔的引流规律转移。对于能够达到根治切除的进展期贲门癌应行胸、腹腔两野淋巴结清扫。     

从淋巴结转移规律探讨贲门癌合理治疗（110例分析及文献复习）

本文通过110例病例分析及文献复习，揭示贲门癌淋巴结转移特点，主要是（1）第二站淋巴结转移并不比第一站低，（2）贲门癌淋巴结转移先向腹腔周围淋巴结转移，晚期才向胸腔转移，对早期贲门癌及老年合并心肺疾患者的中期病例提倡经腹手术；除依据贲门癌淋巴结转移规律外，经腹手术创伤小，清扫淋巴结方便、单屯强度调全胃切除治疗贲门癌是不恰当的。     

贲门癌淋巴转移规律及手术清除范围的探讨

１９７４～１９８８年对贲门癌施行全胃Ｒ２术者４３例，其区域淋巴结转移率为７６．７％。淋巴结转移随病灶的增大而增加。病灶仅位于Ｃ区者淋巴结转移度为１２．５％，而病灶扩展到ＣＭ、ＣＭＡ区时分别增加至１８．２％和４０％。本研究表明：贲门癌第２站淋巴结转移率较高。当病变浸润深庶Ｓ１时，其第２站淋巴结转移率为１６．７％，而Ｓ２、Ｓ３时分别增加至５４．２％和８０％。据此，作者认为：为改善贲门癌术后生存期，对Ⅱ期（Ｔ２、Ｓ１）病例宜积极采用全胃Ｒ２术。对Ⅲ期、部分Ⅳ期则应视患者全身状况有选择地使用。     

食管癌贲门癌淋巴结转移74例临床治疗分析

淋巴结转移是影响食管癌贲门癌手术患者预后的重要因素。我院 1990年 12月至 2 0 0 0年 12月采用以手术切除为主的综合治疗方法治疗食管癌和贲门癌 74例 ,现报告并分析如下。1　临床资料1.1　一般资料本组男性 6 1例 ,女性 13例 ,年龄范围 44～ 70岁 ,平均年龄5 3岁。肿瘤切除者 6 7例 ,总切除率为 90 .5 %。肿瘤未切除者7例 ,占 9.5 % ,其中有 4例行胃空肠造瘘术 ,3例只行单纯探查术。食管癌 5 3例 (中上段食管癌 2 0例、下段食管癌 33例 )和贲门癌 2 1例切除率分别为 94.3 % ( 5 0例 )和 81.0 % ( 17例 )。本组按国际ＵＩＣＣ分期标准分期…     

贲门癌雌激素受体与淋巴结转移关系的探讨

贲门癌雌激素受体与淋巴结转移关系的探讨天津市肿瘤医院（天津市３０００６０）赵锡江王凤明张熙曾胃癌组织中存在雌激素受体（ＥＲ），而且ＥＲ阳性者肿瘤分化多较差，预后也差（１～５）。贲门虽然在解剖学、生理学及病理学等方面有自身的特性，但仍属于胃的一部分，贲...     

贲门癌的胰腺区淋巴结转移

在适当的条件下，使用原子吸收分光光度计直接比色法测定水中低浓度的挥发酚，可以免去繁琐的萃取操作，节省分析时间和试剂，并明显提高分析的灵敏度和准确度。     

63例贲门癌胸腔纵隔淋巴结转移特点分析

目的研究贲门癌胸腔内纵隔淋巴结转移特点。方法采用前瞻性分析2008年6月—2009年10月随机选择63例贲门癌患者进行胸腔内纵隔淋巴结清扫并分析其转移特点。结果63例贲门癌患者腹腔淋巴结转移度、转移率分别为 38.39% 、66.67%。胸腔淋巴结转移度、转移率分别为10.60 %、20.63%。胸腔纵隔淋巴结转移与肿瘤长度、病理分级、浸润深度、肿瘤是否累及食管下段、腹腔淋巴结有关,Logistic回归多因素分析则显示肿瘤是否累及食管下段是主要影响因素。结论贲门癌主要向腹腔、胸腔淋巴结转移,贲门癌淋巴结清扫范围应包括胸腔内纵隔淋巴结与腹腔淋巴结。     

贲门癌淋巴结微转移的临床检测价值

背景与目的贲门癌(Gastric cardia adenocarcinoma,GCA)是发生在胃贲门部的恶性肿瘤,是我国北方常见的恶性肿瘤之一,贲门癌术后长期生存率较低,而淋巴     

从淋巴结转移规律探讨贲门癌合理治疗(附110例分析及文献复习)

本文通过110例病例分析及文献复习,揭示贲门癌淋巴结转移特点,主要是(1)第二站淋巴结转移并不比第一站低,(2)贲门癌淋巴结转移先向腹腔周围淋巴结转移,晚期方向胸腔转移,对早期贲门癌及老年合并心肺疾患的中期病例提倡经腹手术;除依据贲门癌淋巴结转移规律外,经腹手术创伤小,清扫淋巴结方便.单纯强调全胃切除治疗贲门癌是不恰当的.     

乳腺癌胸肌间淋巴结转移的临床分析

 目的 研究乳腺癌中胸肌间淋巴结（IPNs）的检出率、转移率，与乳腺癌临床、病理特征的关系及其临床意义。方法 作者对2004年9月-2006年9月收治的171例行胸肌间淋巴结病理检查的乳腺癌患者进行回顾性分析。结果 IPNs的栓出率为25．7％，转移率为9．9%。IPNs转移患者肿瘤原发灶较大，临床分期较晚，腋尖群淋巴结转移率高，ER阳性率较低。结论 在乳腺癌改良根治术中，对IPNs进行常规清扫，单列送病理检查，并做出正确的评价，对于乳腺癌治疗方案的制定、预后的估计具有重要的意义。     

The Metastatic Rate of Internal Mammary Lymph Nodes When Metastasis of Internal Mammary Lymph Node Is Suspected on PET/CT

Purpose

Metastatic status of internal mammary lymph node (IMLN) has a clinical importance in assessing the stage and prognosis of breast cancer. But, when metastasis of IMLN is suspected; the management is controversial. We retrospectively reviewed 36 breast cancer patients who underwent IMLN biopsy, and investigated the pathologic status of IMLN which suspected metastasis with positron emission tomography and computed tomography (PET/CT).

Methods

From January 2007 to December 2012, 36 patients underwent IMLN biopsy for suspected IMLN metastasis on PET/CT, when diagnosed with primary or recurrent breast cancer. Clinicopathologic features of these patients and metastatic status of IMLNs were investigated.

Results

A total of 36 patients were included in this study. Twenty-four patients diagnosed with primary breast cancer and 12 patients diagnosed with recurrent breast cancer underwent IMLN biopsy. The mean number of IMLNs was 2.72±2.05, and the total metastatic rate of IMLNs was 72.2% (26 out of 36). IMLN metastasis was confirmed on pathologic examination in 19 patients (79.2%, 19 out of 24) with primary breast cancer and in 7 patients (58.3%, 7 out of 12) with recurrent breast cancer. The mean standardized uptake values of metastatic and nonmetastatic IMLNs in primary breast cancer were 3.50±2.51 and 3.72±3.55, respectively and those of metastatic and nonmetastatic IMLN in recurrent breast cancer were 3.92±2.67 and 4.12±3.57, respectively. In both groups, there was no statistically significant difference between the SUVs of metastatic and nonmetastatic IMLNs (p=0.291 and p=0.951, respectively).

Conclusion

Due to the recent advances in diagnostic and surgical skills, IMLN biopsy can be performed safely without any complications without performing radical mastectomy. If IMLN metastasis is suspected on PET/CT, IMLN biopsy is useful to assess the exact stage and to determine the treatment for breast cancer. Further follow-up studies are needed to assess the locoregional recurrence and to compare the improvement in overall survival and disease-free survival.     

Diagnostic Value of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Metastatic Axillary Lymph Nodes in a Sample of Iranian Women with Breast Cancer

Objective: To evaluate the diagnostic value of diffusion weighted magnetic resonance imaging (DW-MRI) in assessment of metastases in axillary lymph nodes (ALNs) in a sample of Iranian women with breast cancer. Methods: A total of 50 axillary lymph nodes from 30 female patients with histologically verified breast cancer were assessed by 1.5 T MRI. DWI was implemented at b-values of 50, 400 and 800 s/mm2. Short axis diameter, presence of fatty hilum and apparent diffusion coefficient (ADC) values (min, max and mean) of metastatic and non-metastatic ALNs was compared. Cutoff ADC values to discriminate between benign and malignant axillary lymph nodes were analyzed with receiver coefficient characteristic (ROC) curves. Result: The final histopathological examination revealed 46% (n=23) metastatic and 54% (n=27) non-metastatic ALNs. There was no statistically significant difference in short axis diameter between the two groups (p = 0.537). However there was significantly correlation between loss of fatty hilum and presence of metastases (p < 0.001) and ADC values (0.255 ± 0.19×10-3 mm2/s vs 0.616 ±0.3×10-3 mm2/s (ADC min), 1.088 ± 0.22×10-3 mm2/s vs 1.497 ± 0.24×10-3 mm2/s (ADC max) and 0.824 ± 0.103 ×10-3 mm2/s vs 1.098 ± 0.23 ×10-3 mm2/s (ADC mean)) of metastatic ALNs were significantly lower than those of non-metastatic ALNs (p < 0.001). The optimal mean ADC cut-off value for differentiation between metastatic and non-metastatic ALNs was 0.904×10-3 mm2/s which had a higher specificity (88.9%) and accuracy (91.8%) as compared with ADC min and ADC max. Conclusion: DWI-MRI and ADC values are promising imaging methods which can assess metastatic ALNs in breast cancer with high sensitivity, specificity and accuracy.     

从淋巴转移规律探讨食管癌合理根治术

1986年9月至1990年6月,按日本“食管癌规约”中食管分段,淋巴结分组、分站对175例胸段 Eca行切除合并淋巴结清除术.全组淋巴结转移(LNM)率 57.7%,颈、胸、腹分别为10.9%、40.6%、32.6%.LNM程度与肿瘤长度、浸润深度呈正相关.胸上段 Eca主要转移到上纵隔和下颈部;胸中段可有颈胸腹LNM;胸下段腹部较胸部LNM率为高.Eca合理根治术应行食管大部切除,颈部食管吻合,颈胸腹三领域淋巴结清除术.Eca病变部位不同其LN清除范围应有所侧重.     

美蓝抗胃癌单克隆抗体在胃癌术中的淋巴结标记

目的　探讨胃癌术中淋巴结的标记方法。方法　 2 2 4例胃癌患者随机分为 3个组 :美蓝 抗胃癌单克隆抗体 (MAb3H 11)注射组 (观察组 ) 76例 ;美蓝组 73例 ;对照组 75例。结果　观察组 76例清扫淋巴结 2 2 0 1个 ,平均每例清扫 2 9.0个 ,平均每例清扫转移淋巴结 7.8个 ( 5 93 / 76) ;美蓝组 73例清扫淋巴结 1619个 ,平均每例清扫 2 2 .2个 ,平均每例清扫转移淋巴结 6.0个( 4 41/ 73 ) ;对照组 75例清扫淋巴结 13 77个 ,平均每例清扫 18.4个 ,平均每例清扫转移淋巴结 4.9个 ( 3 68/ 75 ) ;平均每例清扫的淋巴结数及转移淋巴结数 ,观察组均明显多于美蓝组和对照组 (P <0 .0 1)。结论　应用美蓝 抗胃癌单克隆抗体 (MAb 3H 11)术中胃壁注射 ,可有效的标记胃的区域淋巴结     

胃癌淋巴结转移的模糊数学研究

作者采用模糊数学方法研究了１１４例胃癌组织学表现与胃周淋巴结转移的关系。结果表明：胃癌浸润深度、生长方式、异型性、淋巴管和血管侵犯程度、癌间质淋巴细胞浸润程度、间质胶原纤维反应程度与淋巴结转移密切相关。用以上指标计算出判别值（２．９９９）进行判断，有淋巴结转移的符合率为８０．６％，无淋巴结转移的符合率为６１．９％。作者认为该方法在判断胃癌淋巴结转移方面，尤其对隐性转移和缺乏淋巴结材料的病例具有一定的参考意义。     

Diagnostic Value of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Metastatic Neck Lymph Nodes in Head and Neck Cancer: A Sample of Iranian Patient

Objective: To evaluate the diagnostic value of DWI in assessment of metastatic neck lymph node in a sample ofIranian patients with Head and Neck cancer. Methods: 25 patients with 80 neck lymph nodes were analyzed using 1.5 TMRI. DWI was performed with b values of 0 and 1,000 s/mm2. Short axis diameter and ADC values (min, max and mean)were calculated for metastatic and non-metastatic neck LNs and results were compared with histopathological findings.The optimal ADC thresholds were analyzed using receiver coefficient characteristic (ROC) curves for discriminatingbetween metastatic and benign neck lymph nodes. Result: Histopathological findings revealed that there are 45% (n=36)metastatic and 55% (n=44) non-metastatic neck LNs respectively. There was no statistically significant difference inshort axis diameter between the two groups (p = 0.346). However, The ADC values of metastatic neck LNs weresignificantly lower than those of non-metastatic neck LNs (p < 0.001); 0.90 ± 0.10 × 10-3 mm2/s vs 1.06 ± 0.12 × 10-3mm2/s ( ADC mean ), 0.78 ± 0.08 × 10-3 mm2/s vs 0.92 ± 0.20× 10-3 mm2/s ( ADC min ) and 1.02 ± 0.12 × 10-3 mm2/svs 1.24 ± 0.15 × 10-3 mm2/s (ADC max ). The optimal mean ADC threshold value was equal to 0.996 × 10-3 mm2/sfor differentiating malignant from benign lymph nodes with sensitivity, specificity and accuracy of 80.56 %, 77.27 %and 71.59 % respectively. Conclusion: MR diffusion imaging and ADC values as a non-invasive technique can assessmetastatic neck LNs in head and neck cancer with higher sensitivity, specificity and accuracy.     

肺癌纵隔淋巴结转移规律的分析

目的：探讨肺癌纵隔淋巴结转移的规律与特点。方法：对358例肺癌行肺切除加淋巴结廓清术，对其中132例N2肺癌病例的281组转移性纵隔淋巴结进行临床病理分析。结果：两组以上N2转移占62.1%，跳跃式转移占12.1%，左侧肺癌N2转移发生率较高的依次为5，7，6组淋巴结，右侧肺癌N2转移发生率较高的依次为4，7，3组淋巴结；瘤体越大N2转移发生率越高，肺癌分化程度越差，N2转移发生率越高，病理类型不同，N2转移发生率分别为，小细胞癌80.0%，腺癌45.1%，大细胞癌33.3%，鳞癌24.0%，结论：对N2肺癌行广泛，全面的纵隔淋巴结清扫是十分必要的。