胃平滑肌肉瘤手术治疗选择

胃平滑肌肉瘤是源于胃平滑肌的极少见肿瘤，约占胃恶性肿瘤的1％～3％，仅次于胃癌及胃淋巴瘤。由于倾向于胶外生长，发病隐匿，在早期多无任何表现，当肿块生长过快、体积大，造成面部压迫或肿块中心缺血坏死而出现腹部包块、胃出血、幽门梗阻、发热等临床症状。胃平滑肌肉瘤好发于胃底、体部，少见于贲门、胃窦部及幽门部，故幽广］梗阻症状很少见。该肉瘤可向浆膜下或粘膜下呈膨胀及浸润性生长，形成粘膜下或浆膜下圆形或分叶状包块，周围常见假包膜。在早期肿瘤不影响胃粘膜，故消化不良症状并不多见，但发展到一定大小后常可出现粘膜溃…     

胃平滑肌肉瘤的外科治疗

目的 探讨胃平滑肌肉的诊断,病理学特点及外科治疗。方法 轭生分析１６例胃平滑肌肉瘤的临床资料。结果 术前确诊仪５例（３１．３％）。１６例均于手术治疗并经病理学证实。随访中３例因肿瘤广泛扩散而衰竭死亡,１例于 ３年发生肝转移而予再次手术,再次手术后已存活５年,其余病例情况良好。结论 胃平滑肌肉瘤的诊断要根据病史、多种辅助检查、以及术中、术后病理等综合分析。手术切除肌肉瘤的诊断要根据病史、多种辅助检查     

胃平滑肌肿瘤的诊断和外科治疗

目的 探讨胃平滑肌肿瘤的诊断及治疗方法。方法 对34例经手术治疗的胃平滑肌肿瘤的临床资料进行回顾性分析。结果 胃平滑肌肉瘤肿块较大，本组中最大直径≥5cm者占68％，≥10cm者占50％；胃平滑肌肉瘤大多位于胃底体区，占94％；胃平滑肌肉瘤有三大临床表现：上腹痛、上腹包块、出血。胃镜、钡剂X线透视、CT有助于诊断。随访结果：本组3、5、10年生存率分别是87％、52％及26％。结论 对胃平滑肌肉瘤应积极考虑手术治疗。根据肿块大小、部位和浸润程度决定手术方式。     

胃平滑肌肉瘤的诊治体会

目的 总结我院治疗胃平滑肌肉瘤（ＧＬＳ）的临床经验，以提高对本病的认识和疗效。方法 回顾性分析本院３３年来收治的ＨＬＳ２１例的临床资料，生存过程描述采用Ｋａｐｌａｎ－Ｍｅｉｅｒ生存曲线法。结果 本组ＧＬＳ以上腹胀痛不适、上消化道出血及腹部肿块为主要临床表现，其中以上消化道出血尤为突出。本组肿瘤全切除的１２例患５年、１０年生存率为６７％和５０％，肿瘤不全切除的８例患仅２例生存了５年，１０年生存率     

胃平滑肌瘤与平滑肌肉瘤

胃平滑肌瘤与平滑肌肉瘤中山医科大学附属第一医院胃肠外科（５１００８０）王吉甫胃平滑肌肿瘤发生于胃壁平滑肌组织，较为少见。在胃的非上皮性肿瘤中仅次于淋巴瘤占第二位［１］。平滑肌肿瘤多发生于胃，这种肿瘤主要分类３类，平滑肌瘤（良性）、平滑肌肉瘤（恶性）和...     

胃肠道平滑肌肉瘤的外科处理

目的 探讨胃腑道平滑肌肉瘤的临床表现、诊断、外科手术处理原则及影响预后的因素。方法 报告1972年～1995年78例胃腑道平滑肌肉瘤的诊断、手术处理及5年生存情况。结果 本组胃腑道平精肌肉瘤术前诊断率为(69．2％)．消化道钡餐、CT扫描及内窥镜检查阳性率分别达88．5％、63．6％、85．7％。术后5年生存率为65．9％。结论 胃肠道平滑肌肉瘤的治疗技果及预后与肿瘤大小、病理分级、临床分期和是否掌握正确手术原则有密切关系。     

胃平滑肌肉瘤的诊治体会

目的总结我院治疗胃平滑肌肉瘤 (GLS)的临床经验 ,以提高对本病的认识和疗效 .方法回顾性分析本院 33年来收治的 GLS 21例的临床资料 ,生存过程描述采用 Kaplan- Meier生存曲线法 .结果本组 GLS以上腹胀痛不适、上消化道出血及腹部肿块为主要临床表现 ,其中以上消化道出血尤为突出 .本组肿瘤全切除的 12例患者 5年、 10年生存率为 67%和 50% ,肿瘤不全切除的 8例患者仅 2例生存了 5年 , 10年生存率为 0,本组总的 5年、 10年生存率为 47%和 37% .结论 GLS是胃部常见非上皮性恶性肿瘤 ,但临床极易误诊 ,故应提高警惕 ,综合分析 ,才能提高本病的诊断率 .为了提高生存率和生存质量 ,对原发肿瘤主张肿瘤全切除 ,对术后的复发灶和转移灶 ,主张积极的再切除 ,但不主张行扩大的淋巴结清除术 .     

腹膜后肉瘤的外科处理及影响预后的因素

软组织肉瘤有 1 0 %～ 1 5%原发于腹膜后。尽管辅助治疗对肢体肉瘤有一定疗效 ,但迄今化学治疗对腹膜后肉瘤无效 ,而放射线因对胃肠道和神经的损伤限制了足够放射剂量 ,故放射治疗的效果亦较差 ,因此积极的外科手术对腹膜后肉瘤显得尤为重要 ,只有完全切除肉眼可见的肿瘤组织才能为患者长期存活提供机会。但要达到完全切除肿瘤而又不切除部分周围组织或器官则很困难 ,甚至不可能。本文就此探讨腹膜后软组织肉瘤的外科处理和影响生存的主要预后因素。一、处理方法1 .手术治疗手术切除是治疗腹膜后软组织肉瘤的主要手段。手术治疗前需判断肿瘤…     

Gastric leiomyosarcoma. Prognostic factors and surgical management

Information on gastric leiomyosarcoma, such as important prognostic factors, patterns of disease recurrence, and optimal methods of treatment, are derived from limited patient experience. We address these questions, with specific focus on whether an advantage could be demonstrated for radical resection compared with wide local excision, by retrospectively investigating 53 patients who underwent surgical treatment at Mayo Clinic, Rochester, Minn. Abdominal pain and/or gastrointestinal bleeding associated with an intramural or exogastric mass were typical features of this disease. Only tumor size and histologic grade were statistically significant prognostic factors. With analysis of survival curves and patterns of recurrence, neither the addition of lymphadenectomy nor the wider tumor-free margins of a radical gastrectomy seemed superior to the more conservative local excision. Therefore, wide local excision remains the preferred treatment when technically feasible.     

Prognostic data analysis of surgical treatments for intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is a commonly occurring disease in neurosurgery, yet its surgical treatment is controversial. This paper pertains to the study of the effects of different treatment regimens on the outcome of ICH population. Based on a globally shared third-party MIMIC-III database, the researchers firstly described the dissimilarities in survival probability, mortality, and neurological recovery among mainstream treatments for ICH; secondly, patient classification was determined by important clinical features; and outcome variations among treatment groups were compared. The 28-day, 90-day, and in-hospital mortality in the craniotomy group were significantly lower than minimally invasive surgery (MIS) and non-surgical group patients; and, the medium/long-term mortality in MIS group was significantly lower than the non-surgical group. The craniotomy group positively correlated with short-term GCS recovery compared with the MIS group; no difference existed between the non-surgical and MIS groups. The craniotomy group 90-day survival probability and short-term GCS recovery were superior to the other two treatments in the subgroups of first GCS 3–12; this tendency also presented in the MIS group over non-surgical group. For milder patients (first GCS?>?12), the three treatment regimens had a minimal effect on patient survival, but the non-surgical group showed an advantage in short-term GCS recovery. Craniotomy patients have a lower mortality and a better short-term neurological recovery in an ICH population, especially in short-to-medium term mortality and short-term neurological recovery over MIS patients. In addition, surgical treatment is recommendable for patients with a GCS?≤?12.

     

Prognostic factors in the surgical treatment of azoospermia

Surgery for male obstructive infertility is not always successful. A number of clinical and operative findings, not previously reported, may influence the outcome. We have studied 182 patients with azoospermia who underwent vasoepididymostomy. The pre-operative and operative findings which adversely affected the function of the anastomosis were identified. The presence of spermatozoa in the semen sample was taken to mean a successful anastomosis. Abnormal testicular histology was an adverse pre-operative finding. Adverse operative findings included non-canalisation of the epididymal tubules and hypoplasia of the epididymis; both factors were associated with a high failure rate (almost 100%). The anastomosis was a failure in 78% of the patients when no fluid was seen on sectioning the epididymis. In the absence of adverse findings the success rate of vasoepididymostomy was 59%. Pre-operative testicular biopsy, together with careful observation and recording of findings before and during surgery, are recommended to avoid needless exploration and anastomosis.     

Carcinoma of the male breast. Prognostic factors and outcome of surgical treatment

A retrospective study was made on 18 male patients with breast carcinoma treated at the Department of Surgery "Pietro Valdoni" of the University "La Sapienza" of Rome, Medical School. Demographics, pathology, stages, and treatment were determined from clinical reports. All patients but one underwent modified radical mastectomy. The length of follow up averaged 57.5 months. Five years actuarial survival rate was 62%. In the current study the Authors suggest that the clinical, prognostic and treatment features of breast carcinoma in men are similar to those reported in literature for post-menopausal women.     

Smooth muscle tumors of the stomach

In retrospect, we analyzed 12 cases of gastric smooth muscle tumor, nine cases of leiomyomas and three of leiomyosarcomas. In only half the number of these patients was an adequate preoperative diagnosis made. Ulceration of the tumor apparently led to a misjudgment in some cases. Features more relevant to leiomyosarcoma than to leiomyoma were findings of a larger size, exogastric growth, ulceration and tumor in patients over 50 years of age. It is stressed that enculeation is the treatment of choice for leiomyoma and an extensive gastrectomy for cases of leiomyosarcoma. Presented at the 14th Congress of Gastroenterological Surgery, Japan, 1979     

Prognostic factors and results after surgical treatment of primary sarcomas of the lung.

BACKGROUND: Primary sarcoma of the lung is a rare tumor. Our purpose was to study survival after resection and prognostic factors, which have been rarely reported. METHODS: In a 24-year period, we performed 20 complete resections and three exploratory thoracotomies only for primary lung sarcomas. One patient declined operation. Mean diameter of resected tumors was 9 cm (range, 4 to 18 cm). There were eight stage IB, eight stage IIB, one stage IIIA, and three stage IIIB. Sixty percent of patients with resected tumors received adjuvant therapy. Age, sex, resectability, tumor size, histologic cell type, stage, and adjuvant therapy were analyzed as predictors of survival. RESULTS: No postoperative deaths occurred. All 4 patients who had no resection died within 15 months. The 5- and 10-year actuarial survival after complete resection was 48%. The 5- and 10-year actuarial survival in stage IB was 83%, whereas the 4-year actuarial survival in stage IIB was 30% (p < 0.05). Complete resection and stage of disease were the sole significant prognostic factors. CONCLUSIONS: Complete resection of primary sarcoma of the lung, when feasible, can achieve prolonged survival, although almost half of the patients died of metastasis within 2 years of operation. Adjuvant therapy needs to be investigated.     

Prognostic factors in the surgical treatment of gallbladder carcinoma

A clinical and pathologic review was undertaken of 36 patients with primary carcinoma of the gallbladder who could tolerate curative resection. The 5-year survival rate of the patients with tumor exposed to the serosa (n = 17) was significantly lower than that of the patients with tumor limited to the mucosa (n = 7), muscularis (n = 7), or subserosa (n = 5). Macroscopically, all tumors limited to the mucosa and 6 of 7 limited to the muscularis were of the papillary form, which was associated with a better patient survival (p less than 0.05) than the nodular or infiltrative form present in 11 of 17 tumors that penetrated to the serosa. The papillary or well-differentiated carcinoma--present in all patients with tumors superficial to the gallbladder subserosa--had a higher survival (p less than 0.001 and p less than 0.01) than the moderately or poorly differentiated carcinoma present in 7 of 17 tumors with spread to the serosa. Incidences of venous, lymphatic, or perineural invasion were higher in tumors that spread beyond the serosa than those limited to the mucosa (p less than 0.05), and survival differed between patients with and without these characteristics (p less than 0.001). Analysis for nuclear DNA pattern of those tumors limited to the mucosa revealed its lower cellular malignancy. Patients with tumors superficial to the subserosa survived longer after undergoing extended cholecystectomy than those who underwent simple cholecystectomy (p less than 0.05). The prognosis of gallbladder carcinoma was highly influenced not only by the biologic nature of tumor but by the surgical procedures used.     

Invasive adenocarcinoma of the stomach: prognostic factors and surgical technics

Between 1976 and 1987, 183 patients with an invasive adenocarcinoma of the stomach were treated in the Department of Surgery of the CHUV in Lausanne. This study allows us to conclude: 1. The localisation, age, sex and the association with atrophic gastritis have no prognostic significance. 2. Histologic subtype does not influence prognosis. Eighty percent of patients with isolated cell carcinomas survived less than 2 years, as did 68% of those with intestinal cell carcinomas. 3. No patients with distant metastasis survived over 2 years: mean survival for these patients was 4.1 months. 4. Patients without distant metastasis had a survival of 24 months regardless of the type of operation and degree of stomach wall invasion. 5. Wide gastric resection seems wise to avoid local recurrence but in itself did not improve survival. 6. Wide lymph node resection should be offered to patients who can withstand the procedure by medicosurgical teams with low predictable morbidity and mortality. The improved survival seems clear for patients with stage T1N1 and T1N2 tumors. 7. These results need to be confirmed by a prospective study.     

胃肠道平滑肌肉瘤的外科处理

目的探讨胃肠道平滑肌肉瘤的临床表现、诊断、外科手术处理原则及影响预后的因素。方法报告1972年～1995年78例胃肠道平滑肌肉瘤的诊断、手术处理及5年生存情况。结果本组胃肠道平滑肌肉瘤术前诊断率为(69.2％),消化道钡餐、CT 扫描及内窥镜检查阳性率分别达88.5％、63.6％、85.7％。术后5年生存率为65.9％。结论胃肠道平滑肌肉瘤的治疗效果及预后与肿瘤大小、病理分级、临床分期和是否掌握正确手术原则有密切关系。