微泵输注氟尿嘧啶结合生长抑素治疗壶腹部周围癌

目的:生长抑素(SS)结合氟尿嘧啶(5-Fu)治疗晚期壶腹部周围癌的疗效评价.方法:28例晚期壶腹部周围癌患者均采用静脉插管及随身携带微型输注泵,SS/5-Fu持续静脉滴注(civ法).结果:经2周期治疗后,临床症状缓解(DRSI)为89.3 %(25/28);肿瘤完全缓解(CR)占3.7 %,部分缓解(PR),占28.6 %,稳定(NC)占46.4 %,有效率为32.1 %.结论:SS/5-Fu化学治疗效果稳定,毒副作用轻微,是治疗晚期壶腹部周围癌的有效手段之一.     

晚期贲门癌动脉灌注化疗栓塞的临床观察

目的　探讨晚期贲门癌胃左动脉灌注化疗 /栓塞治疗的方法。方法　先行胃左动脉插管超选择化疗栓塞 ,药物为 CF30 0 mg、5 - Fu 10 0 0 - 15 0 0 mg、CDDP6 0 - 80 mg、MMCl0 - 2 0 mg与 4 0 %碘化钾 5 - 8ml混悬液。介入化疗栓塞后或两次介入之间行放疗。结果　 2 1例患者完全缓解 (CR) 8例 (38.1% ) ,部分缓解 (PR) 11例 (5 2 .3% ) ,总有效率 (CR PR)90 .4 %。 6个月、1年、3年存活率为 85 .7% ,5 2 .3% ,33.3%。结果　动脉灌注化疗栓塞治疗晚期贲门癌安全 ,疗效可靠。     

胰肠内引流术治疗晚期壶腹周围癌26例

995年 4月— 2 0 0 3年 5月我院对无手术切除条件的 2 6例晚期壶腹周围癌 (PeriampullaryCarcinoma,PAC)患者行胆囊 -空肠吻合术同时行主胰管 -空肠吻合内引流术 ,获得满意效果 ,现报告如下。1　资料与方法1.1.　一般资料　本组 2 6例 ,男 18例 ,女 8例 ,年龄最大 71岁 ,最小 4 2岁 ,平均 5 4 .7岁。临床主要症状为无痛性阻塞性黄疸 15例 ,阻塞性黄疸伴有上腹部胀痛 4例 ,均无发热。实验室检查总胆红素 14 2～ 6 70mmol/L ,平均 376mmol/L ,直接胆红素占总胆红素的 5 0 %以上 ,淀粉酶 2 80～ 12 6 0U/L。术前结合各种影像检查 ,2 6例均…     

壶腹周围癌PCNA、p53表达与E-cd关系的研究

目的 :探讨壶腹周围癌中的E -钙粘素 (E -cadherin)、PCNA及p5 3表达 ,及与分化、浸润、转移及预后的关系。方法 :采用免疫组化S -P法检测 4 4例壶腹周围癌组织和 11例炎性壶腹部粘膜组织E -cadherin、PC NA及p5 3的表达。结果 :1)壶腹周围癌E -cd的异常表达率为 70 5 % (31/ 4 4 ) ,PCNA、p5 3的阳性率为 98% (4 3/4 4 )和 38 6 % (17/ 4 4 ) ,强表达率为 95 4 % (4 1/ 4 3)和 76 5 % (13/ 17)。 2 )PCNA、p5 3、E -cd三项检测结果进行Rid it分析 ,x2 =6 9 96 ,结果之间差别有显著性 (P <0 0 1)。 3)PCNA/E -cd联合检测与壶腹周围癌的分化 (x2 =18 375 )及转移 (x2 =13 0 6 )有关 ,差别有显著性意义 (P <0 0 1) ;与浸润深度无明显相关关系 (P >0 0 5 ) ;p5 3/E-cd联合检测与壶腹周围癌的分化、浸润深度及转移无明显相关关系 (P <0 0 5 )。以术后生存 33个月为界 ,E-cd保留表达及PCNA阴性者预后好于E -cd异常表达及PCNA阳性者 (P <0 0 5 ,x2 =4 9) ;p5 3与E -cd联合检测与预后未见明显相关关系 (P <0 0 5 )。结论 :1)E -cd表达与PCNA及p5 3表达之间有相关关系 (P <0 0 5及P <0 0 1) ,且E -cd表达检测效果优于PCNA及p5 3表达者。 2 )E -cd/PCNA的联合检测可能有助于肿瘤恶性程度及增殖状态的     

不同浓度5-氟脲嘧啶并肾上腺素尿道灌注治疗男性尿道尖锐湿疣临床观察

目的 :探讨男性尿道尖锐湿疣 (CA)采用 5 -氟脲嘧啶 (5 - Fu)局部给药治疗的较适宜方法。方法 :6 7例男性尿道 CA患者随机分为 3组 ,分别使用 3种浓度 (1%、2 %和 5 % ) 5 - Fu/肾上腺素 (均为 0 .0 5 g/ L )溶液反复短时间尿道灌注治疗。结果 :3种浓度治疗组比较 :2 % 5 - Fu溶液组治愈率较高 ,和 5 % 5 - Fu溶液组比较差异无统计学意义 (P >0 .0 5 ) ,明显高于 1% 5 - Fu溶液组 (P <0 .0 1) ,而局部副反应发生率 ,2 % 5 - Fu溶液组和 5 % 5 - Fu溶液组相比明显降低 (P <0 .0 1) ,虽高于 1% 5 - Fu溶液组(P <0 .0 5 ) ,但均为轻度接触性皮炎反应。结论 :2 % 5 - Fu/肾上腺素溶液尿道反复短时间灌注治疗为治疗男性尿道 CA的一种较理想方法。     

B超在壶腹部周围癌79例诊治方式的临床价值

目的:探讨分析B超在壶腹部周围癌诊断中的价值,以及在治疗方式选择中的应用价值.方法:对1995～2006年南通某院79例壶腹部周围癌的临床资料进行分析,其中胰头癌61例,壶腹部癌18例.手术治疗病例术前行B超检查并与术后病理对照分析.结果:术前行B超检查胰头癌阳性44例(81.5%),其中示胆管和胰管扩张39例:B超查壶腹部癌阳性17例(68.0%)均示胆管和胰管扩张.全部79例壶腹部周围癌中B超发现侵犯周围血管18例,肝脏和腹腔淋巴结转移11例.行经典胰十二脂肠切除术48例,姑息性手术27例,单纯剖腹探查术4例.讨论:B型超声检查可运用多种促使胆道及局部肿块显示的方法来了解梗阻部位,且能清晰显示肿瘤与血管关系、远处有无转移,对壶腹部周围癌诊治方式的选择有重要的临床价值.     

5-氟脲嘧啶持续滴注联合亚叶酸钙、顺铂治疗胃癌的临床研究

目的 :观察比较 5 -氟脲嘧啶 (5 - Fu)持续静脉滴注联合亚叶酸钙、顺铂治疗胃癌和常规静脉滴注联合亚叶酸钙、顺铂治疗胃癌的临床疗效和毒副反应。方法 :6 2例胃癌患者按数字随机法分为两组 ,一组予持续 4 8h滴注 5 - Fu,另一组则予常规滴注 5 - Fu,两组 5 - Fu累积剂量相同 ,均联合使用亚叶酸钙、顺铂 ,比较其疗效及副反应。结果 :持续滴注组有效率为 4 8.4 % (15 /31) ,常规滴注组有效率为 2 5 .8% (8/31) ,两组疗效比较差异有统计学意义 (P <0 .0 5 )。常规滴注组骨髓抑制及胃肠道反应发生率高于持续滴注组 ,而持续滴注组口腔黏膜炎、腹泻发生率则高于常规滴注组 ,但其差异无统计学意义 (P >0 .0 5 )。结论 :持续滴注 5 - Fu治疗胃癌疗效优于常规滴注     

Detailed deletion mapping on chromosome region 9p21 in human periampullary neoplasms

目的　进一步限定壶腹周围肿瘤染色体 9p2 1区域缺失范围。方法　选择染色体 9p2 1区域 5个微卫星多态性标记 ,通过聚合酶链反应、聚丙烯酰胺凝胶电泳和银染法 ,检测 35例壶腹周围肿瘤组织及其外周血杂合性丢失 (LOH)状况。结果　 50 % ( 4 /8)胰腺癌有至少一个微卫星位点的LOH ,其中D9S974 ( 37 5% )和D9S94 2 ( 2 8 6% )丢失频率较高 ,并且有连续性丢失现象。 62 5% ( 5/8)壶腹癌在部分或全部位点出现LOH ,其中D9S94 2 ( 4 2 9% )丢失频率最高 ,其次为IFNA( 37 5% )和D9S171( 37 5% )。 14 2 % ( 1/7)胰岛素瘤有一个位点LOH。结论　壶腹周围肿瘤染色体 9p2 1最小共同缺失区位于D9S974和D9S94 2位点之间 ,距离小于 15kb ,其中可能存在一个新的涉及该肿瘤发生的相关抑癌基因。     

壶腹周围癌围手术期处理体会（附48例分析）

壶腹周围癌(Periampullary adenocarcinoma)是指环绕胆总管壶腹部发生的癌肿，是临床上较常见的恶性肿瘤之一，其中壶腹部癌约占10％，胰头癌约占90％。我院自1985-2000年共收治本病48例报告如下.     

血清糖类抗原19-9、癌胚抗原在壶腹周围癌中的诊断和预后价值

目的 :观察壶腹周围癌病人术前血清 CA 19- 9和 CEA水平 ,探讨 CA19- 9和 CEA诊断壶腹周围癌的敏感性 ,预后价值。方法 :回顾性分析 130例经手术证实的壶腹周围癌病例 ,术前 1周内测量血清 CA19- 9和 CEA水平 ,比较病人血清 CA19- 9、CEA诊断敏感性 ,术后随访为 2～ 6 3个月 ,在全部病例及切除病例中分别评价血清 CA19-9、CEA阳性和阴性的预后。结果 :壶腹周围癌 5 9例切除 ,71例未能切除。CA19- 9检测壶腹周围癌阳性率为 81.5 4 % ,而 CEA阳性率为 2 9.2 3% ,两者比较差异有显著性 (P<0 .0 5 )。全部病例中 CA19- 9阳性者中位生存期 11个月明显短于 CA19- 9阴性者 32个月 (P<0 .0 5 )。同样 ,CEA阳性者中位生存期 6个月明显短于 CEA阴性者 17个月 (P<0 .0 5 )。结论 :CA19- 9比 CEA能提供更重要的诊断和预后价值 ,血清 CA19- 9在检测壶腹周围癌 ,评价切除性和预测预后方面可作为重要的辅助检查     

Carcinoma of the ampulla of Vater associated with other organ malignancies

Because of its location with respect to the biliary system, carcinoma of the ampulla of Vater is considered to manifest earlier in its course of development than carcinoma of the pancreas. The most common physical finding is jaundice, which occurs in 93-100% of cases [1,2]. This retrospective study describes the results of the treatment and prognosis for double primary cancers in which cancer of the ampulla of Vater was associated with malignancies in other organs in 5 patients who were diagnosed and treated at Kurume University Hospital. The patients included 5 men with an average age of 72.8 years. There were 3 synchronous double and 2 metachronous double cancer patients. Regarding prognoses of these patients, 1 patient with associated lung cancer died because of postoperative complications after pneumonectomy, 1 patient died due to carcinomatosa peritonei developing from the ampulla Vater carcinoma, and 1 patient died because of metastatic liver tumors from the ampullary carcinoma. In multiple cancers including ampulla Vater carcinoma, gastrointestinal cancers such as gastric or colon cancer occur frequently. Therefore, a careful gastrointestinal examination should be done preoperatively. We report our experience with 5 cases of ampullary carcinoma associated with malignancies in other organs and review the literature.     

66例胆胰疾病逆行胰胆管造影诊治分析

目的： 探讨逆行胰胆管造影（ERCP）和内镜下Oddi括约肌切开（EST）在胆胰疾病诊疗中的应用效果.方法： 66例胆胰疾病患者行ERCP 68例次,其中 2例行2例次. 44例胆道梗阻患者同时行磁共振胆道成像（MRCP）,分析ERCP的诊疗效果,并与MRCP诊断胆管结石符合率相比较.结果： 66例行ERCP诊断胆总管结石31例（41.7%）,胆管狭窄 18例（27.3%）,乳头炎性狭窄11例（16.7%）,壶腹癌2例（3.0%）,慢性胰腺炎2例（3.0%）,乳头旁憩室综合征1例（1.5%）,单纯胰管显影1例（1.5%）.ERCP与MRCP 诊断胆总管结石的符合率为81.8%.术后出现并发症4例（5.9%）,其中轻型胰腺炎1例,高淀粉酶血症1例, 2例 EST术后出血,均经临床治疗痊愈.结论： ERCP具有创伤小、安全有效等特点,在胆胰疾病治疗中具有重要地位.     

瓦特壶腹癌行胰十二指肠切除术后生存相关因素分析

目的 探讨瓦特壶腹癌胰十二指肠切除术后长期生存的相关因素,从而制订出更具针对性的治疗方案.方法 回顾性分析解放军总医院1997年1月至2005年9月间收治的行胰十二指肠切除术的77例瓦特壶腹癌患者的临床资料,采用Kaplan-Meier法进行生存分析,独立样本t检验进行统计学比较,应用COX比例风险模型进行多因素分析.结果 全组无手术死亡,总的5年生存率为40.7%;单因素分析表明,术前癌胚抗原(CEA)水平(P=0.012)、肿瘤浸润深度(P=0.000)、TNM分期(P=0.000)、肿瘤直径(P=0.001)是影响瓦特壶腹癌患者术后生存时间的相关因素;多因素回归分析显示肿瘤直径是有统计学意义的独立预后指标(P=0.000).结论 瓦特壶腹癌行胰十二指肠切除术后预后良好,肿瘤直径是惟一影响预后的独立相关因素,而术前CEA水平、肿瘤浸润深度、TNM分期可能也对术后生存时间有一定影响,还需进一步行随机分组对照前瞻性研究来明确.     

胆总管下段软组织病变的超声诊断

目的　探讨胆总管下段软组织病变的超声检查及其临床意义。　方法　对 87例胆总管下段软组织病变的超声诊断结果与手术病理或随访结果进行对照。　结果　超声检查怀疑胆总管癌 16例 ,术后病理诊断为胆总管癌 12例 ,壶腹癌 4例。超声检查怀疑壶腹癌 18例 ,术后病理诊断为壶腹癌 15例 ,胆总管癌 2例 ,软组织炎症 1例。超声检查拟诊为胰头癌 4 0例 ,均与术后病理诊断结论相符。超声检查怀疑十二指肠乳头癌 7例 ,术后病理诊断为十二指肠乳头癌 5例 ,壶腹癌 2例。胆总管癌合并胆总管下段结石 4例 ,其中 3例超声检查胆总管癌漏诊。2例超声诊断无法确定病变性质 ,随访结果为软组织炎症。超声诊断结果与病理诊断或临床随访结果相符率为 83.9%(73/87)。　结论　超声检查对胆总管下段软组织病变与胆总管结石容易鉴别 ,对软组织病变的良恶性病变鉴别有困难 ,必要时应结合十二指肠镜或 ERCP检查     

Vater壶腹癌行胰十二指肠切除术后复发的危险因素分析

目的探讨影响Vater壶腹癌胰十二指肠切除术后复发的危险因素,进一步指导临床治疗。方法回顾性分析我院1997年1
月~2005年9月间收治的行胰十二指肠切除术的77例Vater壶腹癌患者的临床资料,采用独立样本t检验、χ2检验进行统计学比
较,应用Logistic回归模型进行多因素分析Vater壶腹癌切除术后复发的危险因素。结果30例患者术后出现肿瘤复发和/或转
移,单因素分析表明,肿瘤直径（P=0.008）、肿瘤侵润深度（P=0.003）、淋巴结转移情况（P=0.039）、TNM分期（P=0.027）、肿瘤分化
情况（P=0.019）是影响Vater 壶腹癌患者术后复发的危险因素;多因素回归分析显示肿瘤直径（P=0.032）、肿瘤分化情况（P=
0.027）是有统计学意义的独立预后指标。结论Vater壶腹癌行胰十二指肠切除术后复发方式以远处转移为主;肿瘤直径、肿瘤
分化情况是影响预后的独立相关因素。
     

HISTOGENESIS OF PANCREATIC ~XEAD AND AMPULLARY REGION CARCINOMA

The pancrea.tic tissue and common bile duct of 97 surgical specimens of carcinomas of the pancreatic head and ampullary region are studied histologically and histochemically. Pan- creatic duct hyperpilasia (epithelial) is divided int0 3 types: simple hyperplasia, papillary hyper- plasia (local and diffuse) and atypical hyper- plasia All types of ductal epithelial hyperpilasia, especially papillary and atypical hyperplasia of the medium duct are much more frequently seen in the pancreatic tissue adjacent to p,ancreatic head carcinoma than in ampulla of Vater or common bile duct carcinoma Mucin histo- chemical examination revealed similar tinctorial characteristics in pancreatic ductal hyperplasia (papillary and atypical) and tluctal carcinoma. Epithelial cells adjoining ampulla of Vater and common bile duct carcinoma also display vary- ing degre'es of hyperplasia and the same mucin histochemistry pict.ure a;s their malignant coun- terparts. T'ransition from papillary and atypical hyperplasia .of the metlium and large pancreatic ducts to pancreatic ducta.l carcinoma ancl from bile duct epithelium yperplasia to common bile duct and ampulla of Vater ca.rcinoma are de- tected in most cases of this series. The results suggest that most of the ampulla of Vater car- cinomas probably arise fr:om the common bile duct terminal portion ancl the papillary and/or atypical hyperplasia of the large and medium pancreatic duct seems to be a precancerous state of pancreatic ductal carcinoma.     

Local resection for tumor of papilla of Vater: an analysis of 25 cases

Objective： To investigate the clinical features, diagnostic methods, and treatment choice of tumor of the papilla of Vater. Methods： The clinical data of 25 patients with tumor of the papilla of Vater treated by local resection in our hospital from December 1983 to May 2006 were retrospectively analyzed. Results： The morbidities of abdominal pain, jaundice and recurrent cholangitis were 84%, 80% and 48%, respectively. The accordant rate for preoperative duodenoscopic biopsy and post-operative pathological diagnosis was 80%. Intraoperative frozen section examination accurately predicted the final pathological results in all the patients. The post-operative complication rate was 20% and the operative mortality rate was 4%. The 5-year survival rates of local resection for benign tumors and malignant tumors were 75% and 28.5%, respectively. Conclusion： Abdominal pain, jaundice and recurrent cholangitis are the main symptoms and signs of tumor of the papilla of Vater. Duodenoscopy is the principal preoperative diagnostic method and intraoperative frozen section examination is reliable in assessing the operative specimens. Selective local resection is an effective treatment option for tumor of the papilla of Vater.     

CLINICAL SIGNIFICANCE OF HEPATOMA-SPECIFIC BAND OF SERUM GAMMA-GLUTAMYL TRANSFERASE

Using vertical slab elcctrophoresis on polyacryla- mide gel, a total of 11 activity bands are displayed, they are designated as GGT I-XI in order of their distance from the positive pole. Positive GGT II was found in 81(90%) of 90 cases of primary hepatic carcinoma (PHC), in 9(90%) of 10 cases of secondary hepatic carcinoma (SHC), and iii only 4 (Iess than 5%) of 128 cases of acute and chronic hepatitis. A patient with ampulla of Vater carcinoma had positive GGT II but possible hepatic metastasis was not ex cluded. No GGT II was displayed in 250 healthy per- sons and 21 pregnant women. PHC with AFP less than 50ng,:ml has a positive GGT II rate of 84.6% whereas in cases with negative GGT II the positive rate of AFP is only 44.4%. The data show that GGT II is of significant sensitivity, specificity, predic- tability and accuracy in hepatoma diagnosis.     

肝素钠、氨茶碱治疗小儿哮喘60例疗效观察

目的观察肝素钠、氨茶碱联合治疗小儿哮喘的临床疗效.方法治疗组(n=60)用肝素钠50u/kg加入5%葡萄糖30ml中静脉点滴,1次/d,疗程3～5d;氨茶碱2～3mg/kg加入5%葡萄糖50ml中静脉点滴,1次/d,疗程3～5d.对照组(n=60),氨茶碱2～3mg/kg加入5%葡萄糖50ml中静脉点滴,1次/d,疗程3～5d.结果治疗组呼吸困难明显缓解,喘息消失,显效率达98.33%,明显高于对照组(P＜0.05).结论肝素钠在改善肺功能基础上,联合氨茶碱治疗小儿哮喘,临床效果比较显著,疗效稳定.     

PANCREATICODUODENAL RESECTION REPORT OF 75 CASES

Pancreaticoduodenal resection as performed from 1960 t0 1979 at our hospital is reported. Serious complications occurred in 32 cases, a 42.7% incidence. The incidence of postoperative biliary and pancreatic fistulas is 8.O% and 5.3%, 1 case dying of biliary fistula. There are 69 cases of malignant tumors in the periampullary region including pancreatic head carcinoma 22 and ampulla of Vater car- cinoma 39, the 5 year survival rates are 19.6% in the former and 36.2% in the latter. But almost all with malignancies in the other parts of the periampullary region died within 2 years post- operatively. Two cases of stomach carcinoma and 1 of transverse colon carcinoma'i underwent this operation because the primary lesions had in- vaded to the pancreatic head. Two are alive more than 2 years afterwards. Despite the poor prognosis, we suggest that pancreaticoduodenectomy is the treatment of choice for those with resectable les.ions in the periampullary region.