腹腔镜辅助D2根治术对远端进展期胃癌患者肿瘤及复发转移相关指标的影响研究

目的 研究与观察腹腔镜辅助D2根治术对远端进展期胃癌患者肿瘤及复发转移相关指标的影响情况.方法 将行D2根治术治疗的70例远端进展期胃癌患者,根据手术方式的不同分为对照组(开腹手术组)35例和观察组(腹腔镜辅助手术组)(35例),然后分别检测两组患者手术前后的肿瘤标志物及复发转移相关指标水平并比较.结果 术前两组患者的肿瘤标志物及复发转移相关指标比较,P均＞0.05,而术后两组的上述指标检测结果均低于术前,且观察组复发转移相关指标水平均低于对照组,P均＜0.05,差异均有统计学意义.结论 腹腔镜辅助D2根治术对远端进展期胃癌患者的肿瘤及复发转移相关指标水平均有积极的影响,因此腹腔镜手术的临床应用价值较高.     

新辅助化疗在局部晚期宫颈癌患者中的疗效观察

目的 探讨新辅助化疗在局部晚期宫颈癌患者中的疗效.方法 根据术前是否接受新辅助化疗将108例局部晚期宫颈癌患者分为对照组(n=53)和观察组(n=55),对照组患者不给予新辅助化疗而直接进行开腹根治性手术治疗,观察组患者术前给予新辅助化疗.比较两组患者一般手术指标、血清肿瘤标志物[血管内皮生长因子(VEGF)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平、病理学结果、生命质量和观察组不良反应发生情况.结果 观察组患者手术时间明显短于对照组(P﹤0.01),术中出血量明显低于对照组(P﹤0.01).术后,两组患者血清VEGF、CEA、SCC-Ag水平均低于本组术前(P﹤0.05),且观察组患者血清VEGF、CEA、SCC-Ag水平均低于对照组(P﹤0.05).观察组患者淋巴结转移阳性率、阴道切缘阳性率和宫旁累及阳性率均明显低于对照组(P﹤0.01).术后,两组患者欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评分均高于本组术前(P﹤0.05),且观察组患者EORTC QLQ-C30评分高于对照组(P﹤0.05).观察组新辅助化疗过程中发生胃肠道反应9例、轻度骨髓抑制1例、皮疹2例,不良反应总发生率为21.82％(12/55),对症治疗后均好转,未影响正常手术时间.结论 术前进行新辅助化疗有助于缩短手术时间,减少术中出血量,降低血清肿瘤标志物水平,有效控制肿瘤转移,提高术后生活质量.     

结肠癌术后早期腹腔热灌注化疗的疗效分析

目的 观察结肠癌术后早期腹腔热灌注化疗的临床效果.方法 将90例结肠癌术后患者按随机数字表法分为观察组和对照组,各45例.2组患者术后均进行全身静脉化疗,观察组在术后早期进行腹腔热灌注化疗(continuous hyperthermic peritoneal perfusion chemotherapy,CHPPC).观察2组患者生活质量、不良反应、肿瘤标志含量、复发、转移以及生存情况.结果 观察组术后KtPS评分高于对照组(P＜0.05).2组化疗不良反应发生情况差异无统计学意义(P＞0.05).观察组肿瘤标志物含量低于对照组(P＜0.05).观察组复发率和转移率均低于对照组(P＜0.05),观察组患者3年生存率明显高于对照组(P＜0.05).结论 CHPPC是结肠癌术后有效的辅助治疗方式.     

辅助化疗预防卵巢癌患者术后复发的效果及对血清肿瘤标志物的影响

目的探讨辅助化疗预防卵巢癌患者术后复发的效果及对血清肿瘤标志物的影响。方法选取2011年8月至2013年8月间新疆医科大学第二附属医院收治的行肿瘤减灭术治疗的82例卵巢癌患者,采用随机数字表法分为观察组与对照组。其中观察组47例,对照组35例。观察组患者手术前给予辅助化疗,对照组患者术后给予化疗,比较两组化疗效果、血清肿瘤标志物水平和生活质量。随访2年,观察两组患者局部复发率及远期生存率。结果治疗后观察组患者临床化疗效果及生活质量评分均高于对照组患者,而血清肿瘤各标志物水平均低于对照组,组间差异均有统计学意义(均P<0.05)。随访2年,观察组患者生存率和局部复发率均优于对照组患者,组间差异均有统计学意义(均P<0.05)。结论术前辅助化疗能有效提高手术治疗效果,降低患者术后复发率,提高远期生存率。     

结直肠癌新辅助化疗患者术后预后的相关影响因素分析

目的 探讨结直肠癌新辅助化疗患者术后预后的相关影响因素。方法 选取接受新辅助化疗与根治术治疗的85例结直肠癌患者作为研究对象,术后随访2年,记录患者随访期间复发情况与患者基线资料,分析结直肠癌新辅助化疗患者预后的影响因素。结果 85例结直肠癌患者术后2年内复发16例(18.82%),未复发69例(81.18%)。复发患者与未复发患者在年龄、吸烟史、肿瘤分化程度、术前癌胚抗原(CEA)方面比较,差异有统计学意义(P<0.05);经Logistic回归分析结果显示,年龄大、有吸烟史、肿瘤分化程度低、术前CEA高表达是导致结直肠癌新辅助化疗患者预后不佳的因素(OR>1,P<0.05)。结论 结直肠癌新辅助化疗患者术后预后情况受患者年龄、吸烟史、肿瘤分化程度、术前CEA水平的影响。     

新辅助化疗联合保肢术治疗四肢骨肉瘤疗效观察

目的 探讨新辅助化疗联合保肢术治疗四肢骨肉瘤的疗效.方法 45例四肢骨肉瘤患者根据治疗方法的不同分为2组,治疗组25例接受新辅助化疗、保肢术及术后化疗;而对照组20例接受截肢术及术后化疗.治疗结束后比较观察2组的疗效、毒副反应及手术并发症.结果 治疗组25例患者中,3例(12.0％)出现复发或转移;对照组20例患者中,12例(60.0％)出现复发或转移,差异有统计学意义(P＜0.05).治疗组患者肢体功能评分高于对照组,差异有统计学意义(P＜0.05).治疗组优良率高于对照组,差异有统计学意义(P＜0.05).治疗组1、2a生存率与对照组相似(P均＞0.05),但3a生存率明显高于对照组(P＜0.05).2组患者均未发生严重手术并发症.2组主要毒副反应均为血液学毒性和胃肠道反应,2组毒副反应发生率相似,所有毒副反应经对症处理后均可缓解.结论 新辅助化疗联合保肢术治疗四肢骨肉瘤疗效较好.     

Survivin在Dukes''''C期结直肠癌中的表达及其生物学意义

目的:探讨Survivin在Dukes'C期结直肠癌中的表达情况及其对辅助化疗疗效的预测作用.方法:应用免疫组化法检测85例根治性术后,行标准辅助化疗的Dukes'C期结直肠癌患者的癌组织和14例正常结直肠组织中Survivin的表达,分析与临床病理因素的相关性,并进行生存分析.结果:肿瘤组织Survivin阳性率为51.76%,正常组织中无Survivin表达,两组阳性率差异有显著性(P＜0.05).Survivin的表达与患者的年龄、性别、病程、肿瘤部位、肿瘤最大径、大体类型、组织分型、分化程度、肠壁浸润深度、淋巴结转移部位之间均无显著相关性(P均＞0.05).Survivin蛋白的表达与肿瘤的复发转移显著相关,Survivin阳性者复发转移率54.52%,显著高于Survivin阴性者(26.83%)(P=0.009).Survivin阳性患者3年、5年无病生存率和总生存率显著低于阴性患者,Cox模型多因素分析,Survivin是影响肿瘤复发转移和生存的独立的预后因素.结论:Survivin在Dukes'C期结直肠癌中表达上调,与辅助化疗的疗效相关,可作为预测辅助化疗疗效的分子指标.     

E-cadherin表达丢失与Vimentin表达在结直肠癌预后判断中的临床意义

目的分析E-cadherin表达丢失与Vimentin的表达在结直肠癌预后判断中的临床意义。方法收集行手术治疗的80例结直肠癌患者的结直肠癌组织标本,设为观察组,另收集同期因其他原因切除的正常结直肠标本30例,设为对照组。比较观察组和对照组标本中E-cadherin蛋白表达丢失率与Vimentin蛋白表达阳性率,分析E-cadherin蛋白表达丢失率与Vimentin蛋白表达阳性率与结肠癌临床资料的关系;80例患者均术后通过电话随访2年,统计2年内复发转移情况及存活与否。结果结直肠癌组的E-cadherin表达丢失率(77.50%)和Vimentin表达阳性率(51.25%)均显著高于对照组(16.67%,10.00%)(P<0.05);E-cadherin的表达丢失与结直肠癌患者的肿瘤大小、病理分化程度、TNM临床分期、DUCK分期、淋巴结是否转移相关(P<0.05);Vimentin的阳性表达与结直肠癌患者的肿瘤大小、淋巴结是否转移相关(P<0.05);生存时间<2年、2年内发生复发转移的结直肠癌患者的E-cadherin的表达丢失率和Vimentin表达阳性率,均显著高于生存时间>2年、2年内未发生复发转移的患者(P<0.05)。结论 E-cadherin表达丢失与Vimentin的表达上调与结直肠癌患者的肿瘤大小、病理分化程度、TNM临床分期、DUCK分期、淋巴是否移关系密切,且对患者术后的生存时间和复发转移的预判具有一定的临床应用价值。     

化疗-放疗-巩固化疗的序贯治疗模式治疗晚期宫颈癌的疗效分析

目的 探讨化疗-放疗-巩固化疗的序贯治疗模式治疗晚期宫颈癌的疗效.方法 依据术前治疗方法将110例晚期宫颈癌患者分为观察组(n=61)和对照组(n=49),观察组患者术前接受化疗-放疗-巩固化疗的序贯治疗,对照组患者术前接受新辅助化疗.比较两组患者的近期疗效、肿瘤标志物水平、病理特征、不良反应发生情况等.结果 观察组患者临床总有效率为95.08％,高于对照组患者的85.71％(P﹤0.05).治疗后,两组患者癌胚抗原(CEA)、鳞状上皮细胞抗原(SCCA)和糖类抗原125(CA125)均低于本组治疗前(P﹤0.05),且观察组患者CEA、SCCA和CA125水平均明显低于对照组(P﹤0.05).观察组患者的术中出血量、淋巴结转移率、脉管癌栓发生率、直肠炎和胃肠道反应发生率均低于对照组(P﹤0.05).结论 与新辅助化疗相比,化疗-放疗-巩固化疗序贯治疗晚期宫颈癌患者效果显著,可降低肿瘤标志物水平和不良反应发生率.     

直肠癌根治术后行多动脉联合化疗对预防复发和转移的价值

目的观察肠系膜上动脉、髂内动脉及肝固有动脉联合化疗对直肠癌根治性切除术后患者肿瘤复发和转移的预防效果.方法随机选取103例直肠癌根治性切除术后患者分为两组,治疗组56例,以肠系膜上动脉、髂内动脉及肝固有动脉为靶血管,采用介入导管技术分别注入化疗药物5-氟尿嘧啶+丝裂霉素C+顺铂.对照组47例,术后采用全身静脉化疗,用药同治疗组.治疗后每组均随访5年,观察术后1～5年内肿瘤复发和转移的部位及数量.结果治疗组5年内共复发和转移18例,复发和转移率为32.1%(18/56),对照组复发和转移共22例,复发和转移率为47.0%(22/47),两组复发和转移率相比差异显著(P＜0.01).结论肠系膜上动脉、髂内动脉及肝固有动脉联合化疗对直肠癌根治性切除术后患者肿瘤复发和转移有预防作用.     

Clinicopathological study of carcinomas of the lip and the mucosa of the upper and lower lips

BACKGROUND: Lip carcinomas are rare oral tumors, and there have been few reports of lip carcinoma in Japan. METHODS: Of 914 patients with oral carcinomas treated between January 1980 and December 1998, 12 (1.3%) had lip carcinoma and 5 (0.5%) had lip mucosal carcinoma. We investigated the clinicopathological features of these 17 patients. RESULTS: Of the 12 patients with carcinoma of the lip, 10 had squamous cell carcinomas (9, external lower lip; 1 commissures) and 2 had mucoepidermoid carcinomas (external upper lip). Of the 5 patients with lip mucosal carcinoma, 3 had squamous cell carcinomas (2, mucosa of the lower lip; 1, mucosa of the upper lip), 1 had mucoepidermoid carcinoma (mucosa of the lower lip), and 1 had acinic cell carcinoma (mucosa of the lower lip). Of the 12 patients with lip carcinoma, 9 were classified as stage I, 2 as stage II, and 1 as stage III; all 5 of the patients with lip mucosal carcinoma were stage I. Five patients with lip carcinoma were treated by resection, 5 by a combination of resection and reconstruction, and 2 by radiotherapy alone. All patients with lip mucosal carcinoma were treated by resection. After the initial therapy, 3 patients without neck dissection had regional recurrences and received delayed neck dissection, and 2 died with neck regional recurrence after dissection. The 5-year cumulative survival rates of the patients with lip carcinoma and those with lip mucosal carcinoma were 82.5% and 80.0%, respectively. CONCLUSION: We suggest that early-stage carcinomas of the lip and of the mucosa of the upper and lower lips are frequent, and we found that the outcome of these patients was excellent. However, an aggressive therapeutic approach to the lip carcinoma patient with cervical metastasis appears warranted, in an attempt to improve locoregional control and ultimate survival.     

Experience in the treatment of synchronous and metachronous carcinoma of the oesophagus and the head and neck

BACKGROUND AND OBJECTIVES: Treatment of multiple primary squamous cell carcinomas of the head and neck and oesophagus is controversial. The poor prognosis of these 2 types of carcinoma taken individually and their anatomic proximity complicate the therapeutic strategy and limit the treatment choices for each location. METHODS: From 1986 to 1998, 43 patients received curative treatment for multiple synchronous (n = 30) or metachronous (n = 13) primary neoplasms of the oesophagus and head and neck. For synchronous cancers, the therapeutic strategy consisted of first curing the head and neck cancer and then planning oesophagectomy according to the type of head and neck cancer therapy. RESULTS: Ten total oesopharyngolaryngectomies and 33 subtotal oesophagectomies were performed. The postoperative mortality rate was 9.3% (4/43). The rate of anastomotic leakage was 30% (13/43), and all such leaks were cervical. Pulmonary infection occurred in 19% of cases (8/43). A past history of cervical radiation therapy or cervicotomy did not appear to be a significant risk factor for anastomotic leakage or pulmonary complications. Oesophagectomy did not affect the functional results in the 31 patients whose larynx could be preserved. CONCLUSIONS: Oesophagectomy after head and neck cancer treatment is possible with a low mortality rate and acceptable morbidity.     

胆囊结石及胆囊切除与结直肠癌的关系探讨

目的 探讨胆囊结石及胆囊切除与结直肠癌的关系.方法 回顾性分析347例结直肠癌及608例其他消化道癌的临床资料.结果 结直肠癌患者胆囊结石发生率及既往胆囊切除率显著高于对照组(P<0.05).结论 胆囊结石及胆囊切除可能是结直肠癌的高危因素.     

Comparison of the Efficacy and Safety of Ceftibuten and Cefaclor in the Treatment of Pneumonia and Bronchiectasis

Summary

In a multicentre, international study of 187 adult patients with bacterial pneumonia or bronchiectasis, the safety and efficacy of a regimen of 200 mg ceftibuten administered twice-daily was compared with cefaclor given in a dosage of 500 mg three times a day. Of the 94 evaluable patients, 66 received ceftibuten and 28 received cefaclor. The overall bacteriological response was similar in the two treatment groups with elimination of the original pathogen in 91% and 89% of the patients receiving ceftibuten and cefaclor, respectively. The overall clinical response mirrored the bacteriological results with a successful clinical outcome in 92% of ceftibuten-treated patients compared with 93% in patients receiving cefaclor. Adverse experiences were, in general, few and mild, being reported in 8% and 17% of patients receiving ceftibuten and cefaclor, respectively.     

The relation between the aging of the steroid generating system and the geneses of cancers of the stomach, the breast and the uterine cervix

The purpose of the present study is to test the validity of the steroid carcinogenesis hypothesis in humans by investigating the problem whether or not a cancer-specific change of the hormonal milieu emerges at a specified stage of life where the growth rate of cancer risk is at its zenith. A case-control study of 14 urinary steroid excretions was conducted for each of 3 human neoplasias. The identification and the size (in parenthesis) of the population units used in this study were,given as follows: a) the male gastric cancer group (421); b) the male control group (104); c) the female breast cancer group (245); d) the cervical cancer group (345); e) the female control group (127). Two kinds of steroid parameters were employed for the statistical analysis of hormonal data: a) the logarithm of a steroid excretion figure (mu g/day), as expressed by log x; b) the logarithm of a relative weight of a given steroid to tetrahydrocortisol, as expressed by log x/THF. The case-control difference for each parameter was expressed in terms of a t-value of Student's t-test. The steroid deviation profile was prepared for each neoplasia and for each of the log x data set and the log x/THF data set. The results obtained are as follows: a) the 2 steroid parameters (log x and log x/THF) for each of 14 urinary steroids were both subject to change with the progress of host age. The rate of age-dependent change was different for each steroid parameter and for each population unit. b) The above differential age dependency of the steroid parameters gave rise to a continual transition of the steroid deviation profile in the course of aging. c) The hormonal traits of male gastric cancer, female breast cancer and cervical cancer were described each as a complex of androgen depression and glucocorticoid stimulation (male gastric cancer), a sequential emergence of premenopausal progestin depression and postmenopausal predominance of glucocorticoid over androgen (female breast cancer), and a complex of androgen-glucocorticoid depression over progestin (cervical cancer). d) The emergence of the above cancer-specific steroid disorders chronologically coincided with the quasiexponential growth phase of cancer risk (and slow growth phase of cancer risk in postmenopausal breast cancer). e) The usefulness of the log x/THF type deviation profile for the assessment of the hormonal milieu of the host was verified by both theoretical approach to the problem and its application to the real data of a case-control study. f) The age dependent decline of androgens was generally much faster in their progressions than that of glucocorticoids - a finding to suggest the possibility that the production of a cancer-specific steroid deviation profile might have taken the form of the stress shift of Hans Selye, since both phenomena share depletion of gonadal steroids relative to glucocorticoid in common. The etiological relevancy of the 3 cancer-specific steroid changes to the geneses of 3 cancers:was discussed in the light of the experimental pathology studies in our laboratory as well as in other laboratories.     

Effect of freezing the helix and the rim or edge of the human and pig ear

We have studied the effect of increasing freeze times on the normal pig's ear and on a variety of lesions of the human ear. The clinical and laboratory data suggest that cartilage necrosis secondary to cryosurgery is a dose-related phenomenon and is uncommon with the freeze times used in clinical practice. Cryosurgery is an effective and cosmetically acceptable treatment for superficial skin lesions of the ear.     

Degree of manifestation of therapeutic pathomorphosis and the nature of the change in the estrogen and progesterone receptors after the radiation and chemotherapy of breast cancer

Estradiol and progesterone receptor levels were measured in 130 patients with stage III breast tumors before treatment and following preoperative radiation or chemotherapy. The data were evaluated versus the morphologic features of posttreatment pathomorphosis of tumor. Standard fractionated radiation (total dose of 70 Gy) was followed by pronounced postradiation pathomorphosis and a decrease in the level and incidence of steroid receptors in 72.7-87.5%. The essentially unchanged receptor profile of tumor following large-fraction (total dose-20 Gy) irradiation as well as presence of estradiol and progesterone receptors in the originally receptor-negative neoplasms after chemotherapy were matched by a slight degree of pathomorphosis.     

Social inequalities in the incidence and case fatality of cancers of the lung,the stomach,the bowels,and the breast

Objective  In order to examine health inequalities in terms of incidences and case fatalities in a German health insurance population. Lung cancer, stomach cancer, intestinal carcinoma, and breast cancer were considered. Social differentiation was depicted by income and occupational position in order to examine which one is more strongly associated with incidence and case fatality. Methods  Analyses were performed using data from a statutory health insurance (n = 170,848). Incomes were divided into quintiles, and subjects were grouped according to occupational status. Results  For lung cancer incidence a gradient between the highest and the lowest 20% of the income distribution emerged. The relative risk of the lowest category was RR = 7.03, for occupational position the figure was RR = 6.98. For stomach cancer the relative risks were RR = 5.33 for income and RR = 7.11 for occupational position. For intestinal carcinoma only income was significantly related with incidence (RR = 4.37 for the lowest 20% of the income distribution), and for breast cancer incidence no social inequalities were found. For case fatality increased relative risks emerged for lung cancer, but only for income. Conclusions  Income and occupational position were associated with cancer incidence with the exception of breast cancer. Apart from lung cancer, case fatalities were unrelated to measures of social differentiation.     

一氧化氮与肿瘤的发生、发展及转移相关的研究进展

一氧化氮（NO）作为一种自由基性质的气体分子,参与了肿瘤的发生、发展、转移等过程。NO一方面介导了巨噬细胞、内皮细胞的杀瘤作用,另一方面又通过促进血管生成、增加血流量肿瘤生成。对NO的深入研究,将为探索肿瘤的发生、发展和开辟新的治疗途径带来希望。     

Urbanization and the incidence of abnormalities of squamous and glandular epithelium of the cervix

BACKGROUND: The large data bases of the Dutch cervical screening program can be exploited to establish the relation between urbanization and the incidence of abnormalities of the squamous and glandular epithelium, including mild or greater changes of the squamous and glandular epithelium of the cervix. METHODS: Six cytology laboratories in the context of the Dutch cervical screening program screened over 190,000 cervical smears. Urbanization (place of residence) data were derived from postal codes. All smears were coded with the Dutch national coding system, the Dutch national classification system KOPAC, in which squamous abnormalities are coded S4-S9, and glandular cell changes are coded G4-G9. From the scores per 1000 screened women, the relative risk (RR) of living in a large city compared with living in rural areas was calculated. To investigate a trend in incidence in relation to urbanization, the Schaafsma method was used. RESULTS: Of the smears with positive cytology, mild squamous dysplasia (S4) had the highest incidence per 1000 screened women (4.32), and the lowest incidence was found for adenocarcinoma (in situ; G7/G9; RR, 0.07). The RR for urban women ranged from 1.73 for moderate squamous dysplasia (S5) to 7.55 for adenocarcinoma (in situ; G7/G9). For smears with positive cytology for both squamous and glandular abnormalities, the Schaafsma method indicated a significant positive trend. CONCLUSIONS: The incidence of squamous and glandular abnormalities are maximal in women who live in a large city, which, in The Netherlands, is where there also is a population at high risk for human papillomavirus and bacterial vaginosis.