天津壶腹周围癌诊断与治疗的进展

分析天津过去三十余年胰头及乏特氏壶腹周围癌的诊断和治疗的进展,可归纳如下: 1.1977年以前壶腹周围癌的诊断主要根据临床梗阴性黄疸,特殊检查只有钡餐X线检查或低张力十二指肠照影。1978年以后,B型超声、ERCP、PTC、十二指肠镜检查和CT等已普遍应用,很多情况下能确定肿瘤位置或提出异常所在。 2.手术切除率增加,由31％增加到70％。 3.切除手术死亡率由21.4％降至16.6％。 4.切除手术后的并发病和死亡原因,早年多因直接与手术有关的并发病,而近年则多为非直接与手术有关的原因,如心肌梗塞,ARDS。 5.术后远期生存率增加,5年绝对生存率由12.5％升到20％。3例已生存11年以上,现仍健在。     

胰腺壶腹周围占位病变术中细针活检的临床价值

目的　探讨术中细针活检细胞组织学诊断在胰腺壶腹周围占位性病变的诊断价值。方法　对天津肿瘤医院 ,自 1991年 12月至 1996年 12月经手术治疗 87例胰腺壶腹周围占位病变行术中细针活检 ,所有病例均再经手术切除标本 ,或随访结果进一步证实其符合率。结果　 87例中细针活检诊断找到恶性肿瘤细胞 49例 ( 5 6% ) ,未找到恶性肿瘤细胞为 3 0例 ( 3 5 % ) ,3例 ( 3 % )为可疑 ,5 ( 6% )例为取材不满意。无假阳性诊断 ,假阴性为 10 %。结论　胰腺壶腹周围占位病变术中细针活检细胞学检查 ,对明确良恶性诊断、指导术式选择是一种较实用 ,有效的方法。     

CT在壶腹周围癌鉴别诊断中的价值

作者报道了经手术和病理证实的壶腹周围癌２３例ＣＴ表现，其中胆总管远端癌６例、胰头癌（直径≤３ｃｍ）７例、壶腹癌８例、十二指肠乳头部癌２例。着重分析了壶腹周围癌的ＣＴ直接征象、间接征象和特征性改变，２０例（８６．９％）在手术前经ＣＴ作出了正确诊断。对各种肿瘤之间以及与壶腹部其他病变的鉴别诊断和ＣＴ扫描技术进行了讨论。作者认为应用ＣＴ诊断壶腹周围癌是有效而准确的方法。     

局部广切术治疗限局性壶腹周围癌

目的　探讨肿瘤局部广切术治疗限局性壶腹周围癌的可行性。方法　自 1997年 1月～ 2 0 0 0年 6月在本院收住的 2 0例壶腹周围癌采用肿瘤局部广切术治疗 ,术中所有标本切缘及局部淋巴结均送冰冻。结果　 2 0例壶腹周围癌采用局部广切术后并发症发生率为 15 % ,其主要是术后胃排空延迟 ,术后无腹腔内出血、胰瘘、胆瘘发生 ,无手术死亡。术后 1年复发率为 15 % ,2年复发率为 3 5 %。术后 1年存活率 90 % (18/2 0 ) ,2年存活率为 70 % (14 /2 0 ) ,3年存活率为 60 % (12 /2 0 )。结论　结合术中快速冰冻诊断 ,肿瘤局部广切术治疗限局性壶腹周围癌是一种比较理想的手术方式 ,值得推广。     

475例壶腹周围癌的外科治疗

目的比较不同年代壶腹周围癌患者外科治疗的特点和疗效．方法回顾性分析1958年至2003年外科治疗的壶腹周围癌患者475例。结果1958年至1976年的128例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌和十二指肠癌的手术切除率分别为26．6％(21／79)、86．2％(25／29)、38．5％(5／13)和57．1％(4／7);1977年至1987年的70例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为26．7％(16／60)、66．7％(4／6)、100％(1／1)和66．7％(2／3);1988年至1998年的147例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为20．2％(22／109)、75．0％(12／16)、50．0％(2／4)和66．7％(12／18);1999年至2003年的130例壶腹周围癌中．胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为20．4％(20／98)、100(4／4)、75．0％(12／16)和83．3％(10／12)。1958年至2003年期间,胆管下端癌的发生率在壶腹周围癌中显著增高,术前总胆红素平均值呈下降趋势,术中输血量较前明显减少;手术切除的肿瘤直径平均值较前缩小。1999年至2003年间所有的胰十二指肠切除患者术前均未行减黄处理,并发症仍然显著降低,结论由于新的围手术期治疗和监护技术的进步,壶腹周围癌的手术死亡率和并发症发生率均有显著下降,但胰头癌的手术切除率和生存率仍然没有显著变化。     

胰腺及壶腹癌手术治疗远期结果分析

本文报告天津市第一中心医院外科1972年～1989年施行了53例胰十二指肠切除术治疗胰头及壶腹周围癌的远期结果。通过随访,作者分析出影响胰腺及壶腹周围癌手术治疗远期结果的因素有患者的病期长短;肿瘤的大小、病理性质及胰腺周围淋巴结有无转移;也与患者有无黄疸、及其程度和持续时间等有一定关系。而与患者的性别、年龄及肿瘤部位似无明显关系。     

胰十二指肠切除术治疗壶腹周围癌疗效分析

目的：探讨壶腹周围癌的手术方式，方法：对１０５例壶腹周围癌患者行胰十二指肠切除术。结果：１、３、５年生存率分别为６６．６７％，４０．８５％，２５．００％。影响术后过 铲的主要因素有病程长短，肿瘤部位、大小；病理性质及组织来源，局部浸润和淋巴结转移状况。与患者的性别、年龄等因素无明显关系。结论：在进一步探讨手术方式的基础上，深入了解壶腹周围癌分子生物学行为，提高早期诊断水平，加强辅助治疗，有望提高     

100例壶腹周围癌的诊断和治疗

目的 总结壶腹周围癌的诊疗经验。方法 回顾性分析１００例壶腹周围癌的临床诊治资料。结果 ３０例Ⅰ￣Ⅱ期的壶腹周围癌患者行胰十二批肠切除（ＰＤ）和Ｃｈｉｌｄ消化道（一层）重建术，术后接受区域性动脉介入化疗，手术并发症发生率为１０．０％，死亡率３．３％，１、３、５年生存率分别为６６．７％、４６．７％和２０．０％；７０例Ⅲ￣Ⅳ期壶腹周围癌病例行胆－肠内引充术，术后平均生存时间为４．２个月。结论 早期诊断     

全胰腺切除术(综述)

1943年由Rocky 首次施行的全胰腺切除术(以下简称全胰术),经过多年的争议与演进,已成为目前治疗某些胰腺疾病的一种手术方式。Ross 1954年曾倡用全胰术治疗胰腺癌,指出就根治程度而言,全胰术优于胰十二指肠切除术(以下简称Whipple 术)。但由于当时全胰术合併症多,死亡率高,未能被外科医生广为接受。另外,自1935年一度用作为壶腹周围癌根治术的Whipple 手术,也由于合併症多,死     

MRCP及LAVA联合应用在壶腹周围癌鉴别诊断中的价值

目的:探讨磁共振胰胆管造影(MRCP)联合动态增强扫描(LAVA)对壶腹周围癌诊断的价值.方法:对48例壶腹周围癌患者进行MRI、MRCP和LAVA检查,进行诊断及鉴别诊断,并与病理结果行对比分析.结果:48例壶腹周围癌共同的MRI表现为低位胆道梗阻和连接区的软组织肿块,不同来源的肿瘤引起胆管系统的改变及强化方式有一定的差异.本组壶腹周围癌MRI诊断与手术病理结果一致者42例(87.5%),未明确诊断者4例(8.3%),不一致者2例(4.2%).胆管癌及乳头区十二指肠癌诊断符合率较高,壶腹癌及胰头癌诊断符合率略低.结论:MRI、MRCP和LAVA联合应用对壶腹周围癌的鉴别诊断及判断肿瘤周围组织浸润和转移具有重要价值,其影像学结果对临床治疗决策有指导意义.     

The possibility of surgery for aged patients with gastric cancer

The possibility of surgery for aged patients with gastric cancer has been studied. Of 484 cases who underwent a gastrectomy, patients 70 years of age or over amounted to 86 (20%). The postoperative mortality rate for these aged patients was 3% and the postoperative mortality rate with hospital deaths added from other causes than operative deaths was 7%. The postoperative mortality rate of aged patients who underwent total or proximal subtotal gastrectomy improved during the period between 1975-1983 compared with the period between 1967-1974. In the second period, there were no deaths among aged patients who underwent an R3-operation and/or a combine operation. This fact shows that operative procedures have become safer for aged patients.     

Surgery after radiochemotherapy for stage III lung cancer: Postoperative complications and late results

Fifty-seven stage III lung cancer patients underwent radiochemotherapy and subsequent surgery. Forty radical (R?), six non-radical, and eleven exploratory operations were performed. Pneumonia (five cases), pulmonary insufficiency (one case), bronchial fistula (one case) were the major non-fatal complications. Four deaths due to adult respiratory distress syndrome (ARDS) or pulmonary embolism occurred. Sixty percent of the 10 patients who had no viable tumor at operation survived 3 years, as well as 41% of those who achieved a complete remission by resection and 11% of those with residual disease (R+) after operation. However, the 1- and 2-year survival rates were similar. The main pattern of failure in R? and R+ patients was extra- and intra-RT-field progression, respectively. A slightly higher rate of postoperative complications, with respect to current practice, was observed. However, data lead to argument on the improvement of locoregional control and long-term survival following radical surgery. © 1994 Wiley-Liss, Inc.     

子宫颈癌手术治疗的经验：820例远期疗效分析

From 1962 to November 1985, 1000 cases of cervical cancer were treated surgically, of whom 820 (37 Stage 0, 371 Stage I, 399 Stage II, 10 Stage III and 3 Stage IV lesions) had been operated before 1982. In the 820 cases, squamous cell cancer comprised 90.5%, adenocarcinoma 8.8% and adenoacanthoma or adenosquamous cancer 0.7%. Pelvic lymph node metastasis rate was 8.9% and 24.1% in Stages I and II. The obturator region was the most vulnerable to metastasis. The 5-year survival rate was 86.7% in 173 cases of infiltrative cancer treated during 1978-1982. The 10-year survival rate was 85.25% (520/610) in the infiltrative cancer, 95.9% in Stage I and 75.3% in Stage II. Two cases with Stage IV without pelvic lymph node metastasis treated with surgery have survived for over 10 years. All thirty-seven cases of cervical cancer in situ treated with surgery are still alive. Pelvic lymph node metastasis is the major factor influencing operation and survival.     

甲状腺癌首次手术不规范原因及再手术情况的调查分析（附298例报告）

目的:调查并分析甲状腺癌（thyroid carcinoma,TC）首次手术不规范的原因,探讨再次手术方式、手术时机及提高无瘤生存率（disease-free survival,DFS）的方法。方法:收集四家二级以上医院收治因首次手术不规范需要再次手术的TC患者298例,分析产生的原因和不良后果。结果:首次手术中没有快速病理诊断114例,占比38.26%。首次手术前或手术中已经发现对侧有结节,因技术原因而未做处理的有7例,占比2.35%;双侧多发病灶或有隐匿性病灶首次手术未发现175例,占比58.72%;有2～5气管软骨环侵犯又能进行切除因条件所限未做气管切除双侧均有病灶的2例,占比0.67%;总计184例,占比61.74%。首次手术颈部淋巴结均未做处理,再次手术术前、术后经检查证实有Ⅵ和/或Ⅲ、Ⅳ、Ⅴ、Ⅱ淋巴结转移,再次行颈部淋巴结清扫术161例,占54.03%;首次手术发生喉返神经损伤11例,再次手术修复3例,占比1.01%。结论:首次手术规范与否,是减少再次手术、提高TC治愈率的关键;TC双侧、多发或隐匿性病灶的比例较高,应引起手术者的重视;TC的颈部淋巴结转移率较高,需要在首次手术中进行Ⅵ和/或Ⅲ、Ⅳ、Ⅱ、Ⅴ淋巴结清扫;再次手术的并发症发生率明显增高,应尽可能一次完成或请有经验的专家术中会诊。     

胸部肿瘤术后并发症及死亡原因分析

目的：探讨胸部肿瘤围术期死亡及并发症发生原因，对避免手术风险，提高手术生存率。方法：分析我院20年来手术切除3490例胸部肿瘤。结果：手术死亡90例，手术病死率2．58％(90／3490)；其中：肺癌切除手术死亡67例，手术病死率1．72％(67／2896)；食管及贲门癌手术死亡19例，手术病死率3．9l％(19／486)；纵隔肿瘤手术死亡2例，手术病死率1．85％(2／108)。围术期并发症主要为心肺系统疾病，应激性溃疡，术后出血，残端瘘，吻合口瘘，乳糜胸及隔疝。结论：肺脏、心血管系统并发症及吻合口瘘为围术期死亡主要原因，尤以呼吸系统并发症为第一位原因。     

腹腔镜下结直肠癌手术--80例的初步体会

目的探讨腹腔镜结直肠癌手术的安全性、有效性及手术适应证.方法回顾分析2001年12月～2004年5月间共80例结直肠癌患者施行腹腔镜下手术的经验.结果全组中直肠癌30例,肛管癌1例,共施行Dixon手术11例,Miles手术20例;结肠癌49例,施行乙状结肠癌切除术6例,右半结肠切除术41例,横结肠和左半结肠切除术各1例.中转开腹率20%,术中并发症发生率3.8%,术后并发症发生率3.75%,无吻合口漏,无手术死亡病例,平均清扫淋巴结12.5枚,平均随访12.6个月.结论只要严格掌握适应证,选择适合病人,结直肠腹腔镜手术是安全、有效的.     

Brain cancer incidence,mortality and case survival: Observations from two australian cancer registries

Data from 2 Australian cancer registries covering a population of 1.7 million people were combined for the purposes of analysing brain cancer incidence, mortality and survival patterns for the time period 1978 through 1992. A total of 1,752 cases of primary brain cancer were registered, representing age-standardised incidence rates of 6.7 per 100,000 in men and 4.6 in women. Histological confirmation was available for 94% of cases. The incidence rate among persons aged 75 or over was higher during 1986–1992 than during 1978–1985, the rate for men increasing from 16.3 to 26.2 and that for women increasing from 9.7 to 18.0. The largest increases in this age group occurred for cases of glioblastoma multiforme. During the study period, 1,411 brain cancer deaths were notified to the 2 registries at age-standardised rates of 5.3 in men and 3.4 in women. Mortality rates among persons aged 75 years or older were higher during 1986–1992 than 1978–1985, increasing from 15.7 to 28.4 in men and from 10.1 to 15.3 in women. Only among men aged 15–49 years was a decline in mortality rates observed, from 3.3 to 2.4. Survival analyses indicated that age and histological type were the most powerful prognostic indicators. There was no improvement in 5-year survival for any of the age groups or histological types. An improvement in 36-month survival was noted for the 15–49 year age group diagnosed with gliomas other than glioblastoma multiforme.     

Removal of esophageal benign tumors with gastroscope-assisted thoracoscopic surgery

The purpose of the study was to report our experience in the treatment of benign esophageal tu- mors with fiberoptic gastroscope-assisted thoracoscopic surgery. Methods： We retrospectively analyzed the clinical data of 24 consecutive patients （22 with esophageal leiomyoma and 2 with esophageal mesenchymoma） who underwent gas-troscope-assisted thoracoscopic surgery. There were 17 male and 7 female with a mean age of 36 years. The tumors were located in the upper and middle part of the esophagus in 17 cases and lower part in 7 cases. Results： All 24 procedures were successfully performed. The median operative time was 84 minutes and the median hospital stay was 7.5 days. One esophageal perforation due to dissection of a large lesion occurred intraoperatively, which was repaired by suturing. No deaths or other severe postoperative complications were encountered during the median follow-up period of 20.5 months. Conclusion： Gastroscope-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of benign esophageal tumors.     

Factors Influencing the Postoperative Course 113 Patients With Early Gastric Cancer

One hundred and thirteen patients with early gastric canceroperated on during the period from 1967 to 1982 were followedup until 1985; 24 of them died. The 5- and 10-year cumulativesurvival rates of 99 patients, excluding 14 (12.4%) who diedof diseases unrelated to gastric cancer, were 97.8% and 89.1%,respectively. Of the 24 deaths, seven were due to recurrenceof gastric cancer, one to pulmonary metastasis found preoperativelyand 16 to diseases unrelated to gastric cancer. Recurrence took the form hepatic metastasis in four cases, bonemetastasis in two and recurrence in the gastric remnant in one.The metastases were distant in the majority of cases of recurrence,and recurrence characteristically occurred late, with six patientsdying more than 5 years and one dying 10 years after surgery.The recurrences were mostly found in patients with poorly differentiatedadenocarcinoma. On the other hand, the causes of death in 16 patients were diseasesunrelated to gastric cancer, i.e., primary cancer of other organsin six, operative complications, heart diseases, senility, andpneumonia in two each, and a traffic accident and apoplexy inone each. Thus, Many of the deaths were due to primary cancerof other organs. Four patients underwent noncurative resection. One had lungmetastasis found preoperatively and the remaining three hadpositive margins. The latter three did not undergo a secondoperation, but the causes of their deaths were not recurrenceof gastric cancer. It is necessary to follow up patients from the standpoint notonly of recurrence of gastric cancer, but also of diseases otherthan gastric cancer and multiple gastric cancer in elderly patients.     

Urinary trypsin-inhibitor protects neutrophil chemotaxis in the inflammatory response

In a retrospective analysis of a complete geographic series of cervical carcinomas treated by Wertheim-Meigs radical surgery, a number of important prognostic factors were evaluated and long-term survival data are presented. In all, 367 women with FIGO stage I-II tumors were included. The main histopathologic types were squamous cell carcinoma in 84% and adenocarcinoma in 12%. The mean age of the patients was 42.5 (range 19-68) years. In 125 women (34%), adjuvant radiotherapy was administered pre- or postoperatively. The median period of follow-up was 12 (range 2-27) years. In 88% of the specimens surgery (93% in stage I and 66% in stage II) was classified as radical with regard to the excision margins. This was an important and highly significant prognostic factor. If the margins were wide and free of tumor, the 10-year survival rate was 93%, but if margins were infiltrated by the tumor, the survival rate was 14%. Pelvic lymph node involvement was recorded in 52 cases (14%). The frequency of lymph node spread was associated with tumor stage (IA O%, IB 14%, IIA 32%). The probability of survival of the complete series was 93% at 5 years and 84% at 10 years. In cases of lymph node involvement, the 10-year survival rate was 57%. The preoperative tumor stage had a highly significant influence on long-term tumor-specific survival. Tumor grade was also a significant prognostic factor, but not the histologic type (squamous, adenosquamous, or adenocarcinoma). Age and parity were also insignificant prognostic factors. The tumor recurred in 59 cases (16%). The mean time to relapse was 28 months. The 10-year survival was 29% for this group of patients. Peroperative complications were recorded in 50 patients (14%). Excessive bleeding (11%) and urinary tract injuries (3%) were most frequent. Postoperatively, 101 patients (28%) had some kind of complication associated with the surgical procedure. Surgical complications were more frequent among women over 50 years of age. Bladder dysfunction (11%) and obstruction of the ureter (8%) were recorded most frequently. In 19 cases (5.2%), urinary tract or intestinal fistulas were diagnosed during the period of follow-up. With increasing experience of the surgeons and fewer stage II tumors, the frequency of fistulas associated with the surgical procedure decreased to 2.4% during the latter part (1975-90) of the period. Adjunctive postoperative radiotherapy increased the risk of late complications. In 8 cases (6.4%), serious complications associated with the combination of surgery and radiotherapy were reported.