ras癌基因产物p~（21）蛋白在人肺癌中的表达及意义

本研究用免疫组织化学方法研究了ｒａｓ癌基因产物ｐ￣２１蛋白在５８例人肺癌中的表达。结果表明：ｐ￣２１蛋白在鳞癌中最高，达８１．５％（２２／２７），在腺癌中较低，为６５．２％（１５／２３），２例大细胞癌和１例腺鳞癌均为阳性，５例小细胞肺癌均为阴性，提示ｐ￣２１蛋白是非小细胞肺癌的一个较好标志物。在高分化肺癌，ｐ￣２１蛋白表达的阳性率为８７．５％（１２／１４），在中、低分化的肺癌，则分别为７５．０％（１８／２４）和６６．７％（１０／１５），三者之间无显著差异（Ｐ＞０．０５），提示ｐ￣２１蛋白和肺癌分化的关系尚需进一步研究。     

晚期胃癌在内镜下局部治疗为主的综合治疗

对２８例晚期胃癌患者进行以内镜下微波烧灼后局部注射化疗药物治疗为主，配合全身化疗及中药扶正的综合治疗，其中溃疡型７例，肿块型２１例，均行病理检查证实为胃腺癌。对有随访可评价的２４例患者进行治疗效应分析。结果显示：一个疗程后肿瘤缩小〉２５％者占９５．８％（２３／２４），〉５０％者占９１．７％（２２／２４），〉７５％者占６６．７％（１６／２４）；存活率为１年７５％（１８／２４），３年３３．３％（８／２     

早期胃癌126例临床分析

目的分析早期胃癌病例的临床表现和手术治疗的远期疗效。方法早期胃癌１２６例，占同期收治胃癌患者的４．８７％。其中小胃癌１０例，微小胃癌７例，一点癌３例，男与女之比为２．５：１。平均年龄为５１岁。平均病程为１２．２个月。胃窦小弯病变多见，有７８例（６１．９％）。有１例呈双病灶。管状腺癌多见，有５０例（３９．７％），低分化腺癌或印戒细胞癌４９例（３６．５％）。结果均行规范性Ｒ２根治术。淋巴结转移率为１９．０４％（２４／１２６）。手术后５年和１０年生存率分别为９９．１８％和９６．５７％。预后与肿瘤浸润深度、淋巴结是否转移密切相关。结论提高胃癌生存率的关键是早期发现。胃肠Ｘ线造影检查与胃镜相互配合，对溃疡可疑的病灶作多方位活检、刷片，并在短期内复查，可发现更多的早期胃癌。     

青年人胃癌

目的 探讨青年人胃癌的临床、病理特点。方法 １９６８年１月￣１９９３年１月２５年间经手术治疗、病理诊断的青年人胃癌３１２例,占同期收治胃癌的５．１％。将所有病例以年龄组划分为４组：≤３５岁组,３６￣５０岁组,５１￣６５岁组,≥６６岁组。对≤３５岁青年人胃癌与各组进行对照观察。结果 青年人胃癌发病率女性高于男性,组织病理学类型以低分化腺癌（４９．２％）、粘液细胞癌（２６．６％）为多,８３．３％的病例     

治疗65例肺癌脑转移探讨

目的：探讨影响肺癌脑转移综合治疗的预后因素及提高生存质量的可能性。方法：１９９０年３月￣１９９５年３月间对６５例癌脑转移患者行单纯放疗及手术切除加放疗。放疗（全脑）分为２组：常规放疗剂量２２￣４０Ｇｙ／２．２￣４ｗ,后缩野追加１５￣２０Ｇｙ／１．５￣２ｗ;全脑快速照射剂量１８￣２４Ｇｙ／１．１￣１．５ｗ,后缩野追加１５￣２０Ｇｙ／１．５￣２．０ｗ。结果：手术切除加放疗物中位生存期９．５个月和１年生     

右半结肠癌误诊急性阑尾炎临床分析(附18例报告)

自１９９２年４月至１９９８年１２月间，经我科收治误诊为急性阑尾炎的右半结肠癌１８例，致使部分病人贻误了结肠癌的最佳治疗时机，教训颇深，现总结分析如下。临床资料本组１８例，占同期结肠癌病例总数（２８５例）的６．３２％，其中男１４例（７７．８％），女例（２２．２％）。年龄最小１９岁，最大７０岁，平均年龄４７．８岁。其中盲肠癌１２例，升结肠癌６例。１８例中，３例术前诊断为急性阑尾炎，２例术中发现为盲肠癌，１例发现为升结肠癌；其中２例行一期右半结肠切除术，１例关腹后行二期手术切除。有１５例第一次因急性阑…     

卡铂,阿霉素,环磷酰胺联合治疗晚期乳腺癌的临床疗效

作者采用ＣＡＣ方案（卡铂十阿霉素十环磷酰胺）治疗晚期乳腺癌２７例，其中１８例（包括辅助化疗８例）为初治。２０例病人有２处以上转移。卡铂３００ｍｇ／ｍ￣２，静滴，ｄ＿１或１５０ｍｇ／ｍ￣２，ｄ＿（１、２）；阿霉素４０ｍｇ／ｍ￣２，静冲，ｄ＿３；环磷酰胺５００ｍｇ／ｍ￣２，静冲，ｄ＿（３、１０）。２８天为一周期。总有效率６３％（１７／２７），其中完全缓解５例（１８％），部分缓解１２例（４４％），中位缓解期９个月，中位生存期１７个月。对软组织转移有效率为６１％（１１／１８），肺转移为３／５，肝转移和胸膜转移分别为３／３和４／４，骨转移为１／１０。初治者有效率７２％（１３／１８），复治者４／９。本组胃肠反应不重；未发现肾毒性；白细胞减少（Ⅱ、Ⅲ度）占８９％。作者认为，ＣＡＣ方案是治疗晚期乳腺癌的有效方案。     

原发性食管小细胞未分化癌5例报告及文献综合分析

原发性食管小细胞未分化癌少见。本文对从国内文献收集的１３７例加上本院的５例共１４２例进行分析。发病年龄以５０～６０岁多见，男女之～为３．７９：ｌ，肿瘤长径范围为１．２～１５ｃｍ，平均５．６ｃｍ。病变发生于食管上１／３者１０例（７．５％）、中１／３８６例（６４．２％）、下１／３３８例（２８．３％）。髓质型５０例（４１％）、蕈伞型２６例（２１．３％）、溃疡型２４例（１９．７％）、腔内型１６例（１３．１％）、缩窄型６例（４．９％）。统计国内文献各该组发病率为０．７％～５．１％，本院组为０．１％。本病预后主，在可评价疗效的１３１例中，中位生存期和１年生存率：全组为７．６个月和２９％；单纯手术６．３个月和１８．４％；单纯放疗１１．８个月和３６．６％；放疗加化疗１２．３个月和５０％；手术加化疗１２．２个月和３９．３％。单纯化疗和手术加放疗中位生存期分别为５．５个月和５个月，无１年生存者。根据资料，作者认为使用放疗或根治性手术加用化疗可以提高本病的疗效。     

ELFP治疗24例晚期上消化道癌的近期疗效分析

本文总结我院１９９４年２月至１９９６年１月，将醛氢叶酸（ＣＦ）合并５－氟脲嘧啶（５－Ｆｕ）足叶乙甙（ＶＰ－１６）及顺铂（ＰＤＤ），构成ＥＬＦＰ联合化疗方案治疗晚期食道癌和胃癌２４例，总有效率６２．５％（１５／２４），其中ＣＲ８．３％（１／２４），ＰＲ５４．２％（１３／２４）毒副作用主要为胃肠道反应，胃髓抑制，脱发。     

维吾尔族胃癌临床病理学研究

本文对１０１４例维吾尔族胃癌进行了统计分析，结果发现，（１）维族胃癌检出的平均年龄为４８．２２岁，男性为４８．８９岁，较女性高４．３０岁。（２）男性胃癌的高发年龄组为４１～５０岁，占３３．１８％（２８４／８５６），其次为５１～６０岁，占２９．９１％（２５６／８５６）；女性胃癌的高发年龄组为４１～５０岁，占３２．９１％（５２／１５８），其次为３１～４０岁，占２４．６８（３９／１５８）。（３）贲门胃癌占４３．８８％（４４５／１０１４），其中男性占４６．２６％，较女性高１５．２５％（Ｐ＜０．０１）；胃窦部胃癌占２９．１９％，男性占２７．５７％，较女性低１０．４％（Ｐ＜０．０１）。     

40例胃癌急性穿孔诊治临床分析

目的探讨胃癌急性穿孔的临床特点,指导临床诊治和提高疗效.方法对本院40例胃癌急性穿孔病人采用不同形式的治疗.10例行单纯穿孔修补术,其中4例在穿孔修补术后3周、1例在穿孔修补术后4周施行姑息性胃大部切除术,1例在穿孔修补术后3周施行二期根治性手术;6例行穿孔修补和胃空肠吻合术;16例行姑息性胃大部切除术,其中6例于术后3周行腹腔淋巴结清扫术;4例行胃癌根治术;2例行胃造口,空肠营养性造口术;2例行单纯腹腔引流、灌洗术.结果本组死亡4例.单纯腹腔引流灌洗术.穿孔修补、胃大部切除、胃癌根治术后平均生存期分别为10个月,9.8个月、14个月和31个月.结论早期诊断,综合治疗,注重护理,强调个性化原则,是降低病死率提高生存质量的重要因素;分期手术,先施行胃大部切除术,而后五淋巴结清扫术,是胃癌穿孔患者的最佳治疗方案.     

Two-stage radical gastrectomy for perforated gastric cancer

Introduction Perforation represents a severe complication of gastric cancer. Because it is rare, only few data are available regarding treatment and prognosis. Methods Patients with perforated gastric cancer were identified from two prospective registers of gastric cancer and of gastroduodenal ulcer. Results Between February 1982 and June 1999 23 patients with perforated gastric cancer were treated surgically. This corresponds to only 1.8% of 1273 patients presenting with gastric cancer, but to 14% of 161 patients presenting with gastric perforation during this time period. Overall, post-operative mortality was 13% (3/23). Initially, 21 patients had palliative operations. Two patients had a potentially curative procedure at the emergency operation and one of the two died post-operatively. Another six patients had potentially curative gastrectomy at a second stage and no patient died post-operatively. The 5-year overall survival was estimated at 50% for all eight curatively-treated patients. Median survival of palliatively treated patients was 6 months.Conclusions Perforation of the stomach should raise suspicion of malignancy, particularly in elderly patients. At the time of perforation radical gastrectomy with lymphadenectomy is mostly not advised, either because a diagnosis of gastric cancer is not confirmed or because the patient's condition does not allow extended surgery. In this situation it is suggested to consider a two-stage procedure and direct the primary operation at the treatment of perforation and peritonitis. Tumour staging can be completed when the patient has recovered and a radical operation with curative intent can be planned without compromising long-term prognosis. Our observations and a review of the literature confirm that perforation of gastric cancer does not preclude long-term survival per se in a substantial number of patients.     

术前介入治疗预防胃癌术后复发的疗效评价

[目的]探讨术前介入治疗预防胃癌术后复发的临床意义。[方法]74例可根治性手术切除的胃癌患者分为两组,一组在根治性切除术前行经胃动脉灌注化疗(GAI)或经胃动脉灌注化疗栓塞(GAI GAE)．另一组直接行根治性切除术，观察介入治疗后患者的临床反应，比较两组患者术后相同时间复发率的差异。[结果]22例术前行GAI治疗的患者出现一过性恶心、呕吐，14例行GAI GAE治疗的患者恶心、呕吐较重，有4例出现黑便．经保守治疗后症状消失；36例术前介入治疗的患者术后6、12、18、24个月的复发率分别为0、2．8％、11．1％、25．0％，38例直接行根治性切除术的患者分别为5．3％、10．5％、23．7％、39．5％，两组患者术后远期复发率存在显著差异。[结论]胃癌切除前行介入治疗(胃动脉灌注化疗或胃动脉灌注化疗栓塞)安全有效．对减少术后复发有显著的临床效果．值得推广．     

腹腔镜辅助早期胃癌根治术的临床研究（附18例报告）

目的探讨腹腔镜辅助胃癌根治术在早期胃癌中的临床应用。方法回顾性分析2006年5月至2009年12月间接受腹腔镜辅助胃癌根治术的早期胃癌病例的临床资料,包括手术方式、手术时间、术中失血量、排气时间、术后住院时间、术后病理、随访等。结果 18例手术均在腹腔镜辅助下完成,没有中转开腹。其中远端胃切除15例,近端胃切除3例,腹腔镜下D1＋α式淋巴结清扫13例,Dl＋β式淋巴结清扫2例,D2式淋巴结清扫3例。手术时间为（140.5±30.6）分钟,术中失血（120.7±20.2）mL,术后排气时间（3.0±0.5）天,术后住院天数为（9.7±1.2）天;3例（3/18）患者出现并发症,其中腹腔内出血、淋巴漏、切口感染各1例,经手术和非手术治疗后痊愈。标本上、下切缘病理检查均无肿瘤残留,平均清扫淋巴结（13.6±4.0）枚,其中有2例（2/18）发现淋巴结转移。除1例失访外,其余17例随访8-51月,均无肿瘤复发和远处转移。结论腹腔镜辅助胃癌根治术是治疗早期胃癌安全、可行、有效的手术方法。     

Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer

BACKGROUND AND OBJECTIVES: Perforated gastric cancer is rare and generally not diagnosed preoperatively or intraoperatively, if a frozen section is unavailable. Therefore, the elucidation of its clinicopathological features and disease outcomes will help surgeons manage perforated gastric cancer. PATIENTS AND METHODS: The clinicopathological features, surgical management, and disease outcomes of 13 patients with perforated gastric cancer from March 1989 to May 2003 were retrospectively analyzed. Disease outcomes were analyzed in-depth based on tumor stage, depth of tumor invasion, operative curability, and three treatment groups. RESULTS: All 13 patients (median age of 72 years) received emergent laparotomy. Malignant gastric perforation was diagnosed intraoperatively in eight (61.5%) patients. Four patients whose frozen sections exhibited perforated gastric cancer underwent radical surgery with curative intent and were assigned to Group 1. Another four patients with overt distal metastases underwent palliative surgery and were assigned to Group 2. The remaining five patients were misdiagnosed as having benign gastric perforation and underwent local surgery; these patients were assigned to Group 3. All patients received follow-up for a median of 26 months. The survival rates for Stage I disease (P = 0.0342), T1/T2 tumors (P = 0.0342), and curative resection (P = 0.0012) significantly exceeded those of Stage III/IV, T3/T4 tumors, and non-curative resection. Additionally, the survival rates of Group 1 (P = 0.0067) and Group 3 (P = 0.0067) significantly exceeded those of Group 2. Stepwise logistic regression analysis revealed no significant predictor of prognosis. CONCLUSIONS: In resectable cases, one-stage radical gastrectomy with possible extensive lymphadenectomy should be encouraged if conditions allow. In cases of misdiagnosis, non-radical local surgery with curative resection is sufficient to treat early-stage cancer.     

The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy

Background

Surgery for perforated gastric cancer has a dual purpose: treating life-threatening peritonitis and curing gastric cancer. An emergent one-stage gastrectomy may place an undue burden on patients with a poor general status and could impair long-term survival even if the gastric malignancy is curable. A two-stage gastrectomy, in which the initial treatment of peritonitis is followed by elective gastrectomy, can accomplish both desired purposes.

Methods

We retrospectively analyzed 514 Japanese cases of perforated gastric cancer. 376 patients underwent a one-stage gastrectomy and 54 patients underwent a two-stage gastrectomy. We evaluated patient characteristics, surgical outcomes, postoperative complications, and survival rates in both groups.

Results

The two-stage gastrectomy group saw a 78.4 % rate of curative R0 resection and 1.9 % hospital mortality rate, while corresponding rates in the one-stage gastrectomy group were 50 and 11.4 %, respectively. Among cases in which curative R0 resection was performed, there was no significant difference in overall survival between 136 one-stage gastrostomies and 40 two-stage gastrostomies. In a multivariate analysis, curative R0 resection [hazard ratio (HR) 2.937, p = 0.001] and depth of tumor invasion (HR 1.179, p = 0.016) were identified as independent prognostic factors.

Conclusions

Regardless of whether patients underwent a one-stage or two-stage gastrectomy, curative R0 resection improved survival in patients with perforated gastric cancer. When curative R0 resection cannot be performed in the initial treatment phase due to diffuse peritonitis, non-curative and palliative gastrectomy should be avoided, and a two-stage gastrectomy should be planned following peritonitis recovery and detailed examinations.     

Early and late gastric cancer arising in the remnant stomach after distal gastrectomy

AIM: Following distal gastrectomy, carcinogenesis has been suggested to result from gastroduodenal reflux. In this study, surgical cases of gastric cancer arising after distal gastrectomy were analyzed clinico-pathologically and the possible link to reflux examined. PATIENTS: Thirty-two patients (24 males, 8 females; mean age, 68.7 years; age range, 33-84 years) with gastric cancer arising in the remnant stomach after gastrectomy (also known as gastric stump cancer) were included in this study. Patients were divided into two groups on the basis of the initial diagnosis (benign or malignant) prompting surgery, and distal gastrectomy reconstruction method (Billroth I or II). RESULTS: The interval between distal gastrectomy and detection of cancer in the remnant stomach of patients treated initially for a benign gastric condition vs. malignancy was 360+/-33.04 and 63+/-19.16 months (median+/-SE), respectively (p<0.0001). However, the benign and malignant groups did not differ significantly in the clinicopathological analysis of their stump cancers. All 10 patients in whom gastric cancer was diagnosed within five years of initial surgery had initially been surgically treated for malignancy. The interval between surgery and detection of gastric cancer in the Billroth I and Billroth II groups was 84+/-26.67 and 276+/-44.26 months (median+/-SE), respectively (p<0.01). In the remnant stomach, cancer tended to occur near the site of gastrojejunostomy in the Billroth II group (p=0.05). Helicobacter pylori infection was only detected histologically in four patients who had undergone Billroth I reconstructions after distal gastrectomy for malignancy. CONCLUSION: After distal gastrectomy, careful periodic endoscopic examination for microcarcinoma is required in patients, particularly in those who undergo surgery for malignancy, to maximize detection of gastric cancer.     

Indication of radical surgery (R2, R3) based upon the pattern of lymph node metastasis from gastric cancer

From Jan. 1980 to June. 1984, radical operation was performed in 156 patients with gastric cancer according to the "protocol" introduced by the Gastric Cancer Research Society of Japan. There were 24 early and 132 advanced gastric cancers. Seventy patients were treated by type R2, 86 by R+2 and R3. Radical distal subtotal gastrectomy was done in 116, proximal subtotal gastrectomy in 7, simple total gastrectomy in 13 and subtotal or total gastrectomy combined with neighbouring organ resection in 20. According to TNM staging, 24 (15.4%) lesions were stage I, 9 (5.8%) stage II, 100 (64.1%) stage III and 23 (14.7%) stage IV. Twenty four lesions were within the mucosa or submucosal layer, 11 in proprius muscle layer, 18 to subserosa, 15 to serosa, 46 beyond serosa, 42 involving the surrounding organs. Lymph node metastatic rate was 66% (103 cases), metastatic degree was 21.5% (558/2593). The metastatic degree of lymph node line I, II and III was 24.7%, 20% and 8.3%, respectively. Basing on lymph node metastatic rate and degree as well as the line degree, it is proposed that, in the early stage of gastric cancer, type R1 be performed for cancer limited to the mucosa, especially the minute type, R2 for cancer invading the submucosa, in which, R+2 be indicated for some isolated patients. In the advanced gastric cancer, type R+2 be performed in the majority of patients and R3 in a few. R3 or total gastrectomy combined with neighbouring organ resection be carried out only in a part of cases with the limited type infiltrating beyond the serosa or invading the neighbouring organs.     

胃癌切除术切端癌残留的原因,预后及预防

本文报告胃癌切除术切端癌残留２３例，残留率７．２％，食管切端癌残留１６例占６９．６％，十二指肠侧切端癌残留５例占２１．７％，食管侧切端和十二指肠侧切端均有癌残留２例占８．７％。姑息性胃癌切除术的切端癌残留率０．０％，根治性胃癌切除术的切端癌残留率５．２％，二者经统计学检验无显著差异。远侧胃切除切端癌残留率６．４％，近侧胃切除和全胃切除术的切端癌残留率１１．１％，统计学检验无显著差异。２３例切端癌残