胃肉瘤的诊断与治疗

目的 探讨胃肉瘤的临床特点及治疗方法。方法 回顾性分析５８例胃肉瘤（其中平滑肌肉瘤４４例,恶性淋巴瘤１１例,神经纤维瘤２例,脂肪肉瘤１例）患者的临床资料。结果 胃大部切除２３例,胃大部切除加淋巴清扫１６例,全胃切除７例,联合切除８例,未切除４例,手术无并发症及死亡。结果 胃肉瘤以根治性胃切除为主,伴胃财脏器浸润或转移,则联合切除术,胃肉瘤手术切除率主,预后好。     

胃平滑肌肿瘤30例诊治体会

本文通过对３０例胃平滑肌肿瘤诊治的分析，认识到上消化道出血是胃平滑肌肿瘤不可忽视的临床表现，对原因不明的上消化道出血应考虑本病的可能，并通过超声胃镜等检查以获得早期诊断。胃平滑肌肿瘤良恶性的鉴别应根据其生长方式、有无转移和浸润性生长、术后是否复发及病理检查等综合分析。治疗上胃平滑肌肿瘤一旦确诊均应积极手术治疗，术式选择的原则是：胃平滑肌瘤以局部切除为主，肿块较大者行胃大部切除；胃平滑肌肉瘤和平滑肌母细胞瘤以根治性胃次全切除为主；有淋巴结转移者应同时行淋巴结清扫；肝转移可行手术切除、经肝动脉插管化疗和／或栓塞、无水酒精局部注射等治疗，可望获得较好疗效。     

胃平滑肌肿瘤的诊断和治疗

目的　探讨胃平滑肌肿瘤的诊断和治疗。方法　回顾我院近二十年来收治并经手术切除和病理证实的 2 8例胃平滑肌肿瘤对其诊断和治疗进行分析。其中胃局部切除 4例 ,近端胃大部切除 15例 ,远端胃大部切除加淋巴结清除 9例。结果　平滑肌瘤 14例随访 6～ 12年未见复发 ,5例 2～ 5年无复发。平滑肌肉瘤 9例 ,5年生存率 47%。结论　几种检查方法相结合才能提高胃平滑肌肿瘤的诊断率 ,手术切除仍是其主要治疗方法。     

胃肠平滑肌肉瘤的临床及病理探讨

作者报道经手术切除的胃肠道平滑肌肉瘤２６例，结果发现其区域淋巴结转移率为１１．５％，小肠平滑肌肉瘤较胃平滑肌肉瘤分化差，且易发生穿孔（４５．５％），结果提示本病部分病例需行局部淋巴结清扫是必要的。小肠平滑肌肉瘤预后较差的原因可能是：①病理分化不良者多；②易发生肿瘤穿孔致腹腔内播散。表阿霉素化疗可能对本病有一定疗效。     

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:预后因素和手术治疗

胃平滑肌肉瘤的治疗有肿瘤局部切除,局部扩大切除、胃次全切除或全胃切除不等,为了比较根治性切除和广泛局部切除的疗效,作者分析了 Mayo 临床中心于1964～1988年手术切除53例胃平滑肌肉瘤的资料。按肿瘤细胞镜检每10个高倍镜视野可见有丝分裂相1～3个、3～6个、6个和6个以上者分别列为1、2、3和4级,后2级细胞丰富、非典型明显,并有坏死。取肿瘤侵犯邻近器官、肿瘤大干5cm、分级高为危机因素,无上述危机因素者列为0期肿瘤,其     

壁外型胃平滑肌肉瘤诊治体会(附5例报告)

编者按：一、胃平滑肌肉瘤并不需作全胃切除和局部淋巴结切除术，如此种壁外型者只要距瘤3cm切除即可。因为它是血行转移，局部淋巴结转移绝少。二、此5例病理诊断皆为平滑肌肉瘤，实际上胃平滑肌瘤预后决定于随访多年有无转移。病理学诊断肉瘤或瘤对预后判断不可靠，有良性瘤病例术后出现肝转移；也有肉瘤术后多年良好。另一方面肉瘤的病理诊断标准不统一，虽然近10年来文献已经统一，但国内基层各地病理诊断标准仍停留在20年前水平。有的以连续10高倍视野有核分裂细胞＞5个／视野为恶性，也有以细胞分化分级和瘤体内坏死区判定为肉瘤。实…     

五例胃平滑肌肉瘤误诊分析

目的　加深对胃平滑肌肉瘤的认识 ,提高诊治水平。方法　对 5例胃平滑肌肉瘤的临床资料及误诊原因进行分析。结果　 5例中 ,1例术前误诊为腹膜后神经纤维瘤、肠系膜肿瘤 ;1例单纯诊断直肠癌 ;1例术前误诊为结肠脾区肿瘤、腹膜后肿瘤 ;1例术前误诊为胰腺肿瘤 ;1例术前误诊为结肠肿瘤。术后全部确诊 ,均行肿瘤及胃大部切除。结论　胃平滑肌肉瘤症状无特征性 ,确诊需病理检查。全面细致的检查有助于该病的正确诊断 ;对上腹部包块患者应积极实施剖腹探查 ,以减少误诊。本病对化疗、放疗不敏感 ,手术治疗为首选治疗方法     

肾原发性平滑肌肉瘤3例病理分析

目的探讨原发于肾脏的平滑肌肉瘤的临床病理学特点、诊断、鉴别诊断、治疗及组织发生。方珐对3例肾平滑肌肉瘤进行常规HE、组织化学及免疫组织化学染色观察。焙杲3例显微镜下表现、组织化学及免疫组织化学染色均显示平滑肌源性肿瘤的特点。由病理确诊，术前无1例怀疑平滑肌肉瘤。2例分别于术后2个月、38个月后死亡，1例术后至今无复发（42月）。结论肾原发性平滑肌肉瘤罕见，临床诊断较困难，但依靠肾切除标本的病理检查，结合组织化学染色和免疫组织化学染色可确诊。该肿瘤恶性度高，预后较差。     

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。     

腹腔镜残胃癌根治术

残胃癌一般是指胃或十二指肠溃疡等行胃大部切除术后5年以上,或胃癌根治术后10年以上残胃发生的原位癌。因腹腔镜残胃癌根治术切除率低故操作仍困难。虽然腹腔镜胃癌根治术技术趋于成熟,但关于腹腔镜残胃癌的报道仍较少。2009年1月至2012年6月兰州军区兰州总医院在完成700余例腹腔镜胃癌根治术的基础上成功施行腹腔镜残胃癌切除术18例,其结果显示：腹腔镜残胃癌切除术技术上安全可行并有满意的近期效果,已掌握腹腔镜胃癌D2根治术的外科医师可实施腹腔镜残胃癌切除术。     

Re-study of Gastric Cancer: Analysis of Outcome

Cancer of the stomach (CaS) is a dreaded disease. Fortunately, there is a decreasing incidence, except in the East. The authors did a re-study of CaS, a widely investigated but unresolved gastrointestinal malignancy. The clinicopathologic features were evaluated to identify and measure the prognostic factors that would help the surgeon decide optimal therapy. Among 383 admitted for CaS at the East Avenue Medical Center, Quezon City, Philippines between January 1987 and December 1996, 149 underwent radical resection with curative intent. (As historical control, the experience in 136 cases was reviewed during the immediately preceding 5-year period [1982–1986] when extended lymphadenectomy was not the standard policy.) For staging, the TNM system (tumor-node-metastasis) was used; to describe anatomy and surgery of stomach lymphatics, the "Japanese Rules," as modified, were adapted. Curative radical gastrectomy would include removal of the diseased stomach and regional lymphatics as defined by frozen section, including subtotal (or total) gastrectomy and "extended" D2 (with no. 12) node dissection. The clinicopathologic factors were statistically analyzed, using the accepted methods: Kaplan-Meier for survival, univariate analysis, and multivariate analysis for independent predictors. Of the 12 risk factors assessed by univariate analysis, the following were identified by multivariate analysis as independent prognosticators of survival: (1) wall penetration; (2) node invasion; (3) TNM stage; (4) resection margin; and (5) tumor size. After curative resection, the operative mortality was 5.3% and the complications, 19.4%. The 5-year survival was 60.4%, and recurrence, 15.4%. The results have shown that the pathology-related factors, (1) wall penetration; (2) node invasion; and (3) resection margin, are independent prognosticators of survival, remarkably affecting outcome. In conclusion, the study supports radical gastrectomy with extended D2 lymphadenectomy for CaS as safe and effective. Survival and recurrence are a function of pathology and adequate resection; operative mortality is defined by the patient’s condition.     

具有神经内分泌特征胃癌的诊治及预后分析

目的探讨具有神经内分泌特征胃癌的临床病理特点、治疗及预后。方法回顾性分析北京大学临床肿瘤学院1997年1月至2008年12月收治的19例具有神经内分泌特征胃癌病例的临床资料。结果本组19例患者中胃神经内分泌癌14例,其中9例位于胃底贲门,5例位于胃体;另5例胃癌伴神经内分泌分化者中2例位于胃底贲门,2例位于胃窦,1例位于全胃。根据2000年WHO肿瘤国际组织新分类标准．本组19例患者可分为Ⅰ型胃类癌2例（10．5％）,Ⅱ型散发性胃类癌9例（47．4％）,胃小细胞癌3例（15．8％）,胃癌伴神经内分泌分化5例（26．3％）。临床无特异性表现,诊断主要依靠病理及免疫组织化学检查。18例患者接受手术治疗,手术采用根治性胃大部切除术或全胃切除术．3例伴肝转移者行同时性肝转移灶切除：另1例胃体小细胞癌伴肝转移无耘．手术切除者予以单纯化疗。本组患者1年及3年生存率分别为73．7％和38．6％。结论胃神经内分泌癌好发于贲门、胃底部及胃体,胃癌伴神经内分泌分化可发生于胃的各个部位。免疫组织化学染色对该病的诊断具有重要价值。本病总体预后不佳．治疗应尽可能行根治性切除术。     

Stromal sarcoma of the stomach: therapeutic considerations.

OBJECTIVE: To present our experience of the surgical treatment of primary gastric stromal sarcomas and to compare it with reported results. DESIGN: Retrospective study. SETTING: University hospital, Germany. SUBJECTS: 17 patients (13 men and 4 women, median age: 58 years) who were operated on for stromal sarcomas of the stomach from April 1987 to March 1999. MAIN OUTCOME MEASURES: Extent of resection, morbidity and mortality, histopathological features, survival. RESULTS: Stromal sarcomas made up 0.8% of all gastric malignancies. Abdominal pain and gastrointestinal bleeding were the main symptoms. 16/17 were resected succesfully. The main type of resection was total gastrectomy (n = 11, in 6 cases as extended gastrectomy), followed by wide local excision of the stomach wall (n = 4), and proximal gastrectomy (n = 1). Of all resections 10 were radical (R0) and 6 were palliative (R1/R2). 5 patients developed complications. One patient died postoperatively. Median tumour size was 70 mm (range 30-230). The serosa was penetrated in 11 cases, lymph node metastases were found in 3 patients, and distant metastases in 8. Overall median survival was 19 months (2-64) and 5 patients survived 5 years. After radical resection (n = 10) median survival was 39 months (2-64) and the above mentioned 5 patients survived 5 years. CONCLUSION: Stromal sarcomas of the stomach are rare, the resection rate is high and the type of resection varies with the extent of the tumour. Wide local excision may be sufficiently radical. Long-term results after radical resection seem to be better than those after gastric adenocarcinoma.     

Systematic review of anorectal leiomyosarcoma: Current challenges and recent advances

BACKGROUND The anorectal leiomyosarcoma(LMS) is an aggressive malignant neoplasm.Owing to the rarity of LMSs, an optimal treatment modality has yet to be determined.AIM To collect all published data on anorectal LMS characteristics, explore current treatment options, and review recent cases of postradiation LMS.METHODS A literature search of the Pub Med electronic database was conducted using the Me SH terms "rectal neoplasms", "anus neoplasms" and "gastrointestinal neoplasms" combined with "leiomyosarcoma". The search was limited to English language and human studies. All available case reports and case series of anal or rectal LMSs that were published from the beginning of January 1996 to May 2017 were included if the diagnosis of LMS had been confirmed by histopathologic examination. Data were analyzed using simple statistics(mean, median, and standard deviation). Independent sample t-test was used to compare means for continuous variables.RESULTS A total of 27 articles reporting on 51 cases of anorectal LMS were identified.Among these cases, 11.7% had undergone previous pelvic radiotherapy(developing LMS at 13-35 years afterwards). Anorectal LMS affected the rectum in 92.2% of the cases, and no sex-based predominance was observed. Surgical resection with negative margins remains the mainstay of treatment, which can be accomplished with wide local excision or radical resection. The local recurrence rate was higher among cases who received wide local excision(30%), as compared to radical resection(20%); however, the overall rate of metastasis was 51.61% regardless of the treatment approach. The use of neoadjuvant radiation lowers the risk of local recurrence compared to adjuvant radiotherapy, and facilitates R0 resection of the tumor. Cases treated with adjuvant chemotherapy showed better rates of distant recurrence and overall survival. Nonetheless,multidisciplinary team discussion is necessary to determine the optimal management plan whilst considering patient-and disease-related factors.CONCLUSION A multidisciplinary team approach, considering the underlying patient-and disease-related factors, is necessary for optimal management of these complex tumors.     

Elective Total Gastrectomy for Cancer of the Stomach: End Results

There has been no apparent improvement in overall salvage of patients with cancer of the stomach treated by elective extended total gastrectomy from 1950-1964 as compared with those treated by partial gastrectomy during the preceding 20-year period, 1931-1950 at Memorial Hospital in New York City. Criteria of resectability have been extended in recent years, and, therefore, the two series of patients cannot be considered strictly comparable. In the 94 patients subjected to elective total gastrectomy for cancer of the stomach, more than half (55 patients) had cancer in the proximal 1/3 of the stomach. The results obtained in this group by total gastrectomy are inferior to those obtained in the earlier series by partial gastrectomy. Patients with carcinoma of the mid 1/3 of the stomach showed essentially the same 5-year survival by elective total gastrectomy (34.8%) as by partial gastrectomy (33.5%), while those with carcinoma of the distal 1/3 of the stomach showed a greater 5-year survival by elective total gastrectomy (43.7%) than by partial gastrectomy (29.8%). However, of significance is the fact that the incidence of nodal metastasis was 3 times greater in the patients undergoing elective total gastrectomy than in those undergoing partial gastrectomy. Despite this unfavorable finding, 5-year survival in the patients undergoing elective total gastrectomy for carcinoma of the mid 1/3 or distal 1/3 of the stomach was equal to, or better than, that found in those undergoing partial gastrectomy for lesions similarly located. On the basis of this finding alone, we believe that elective total gastrectomy is a worthwhile endeavor and should be performed for operable carcinomas arising in the mid 1/3 or distal 1/3 of the stomach.     

Results of an aggressive surgical approach to gastric carcinoma during a twenty-three-year period

The early work of Dr. William Longmire with total gastrectomy for gastric carcinoma prompted us to initiate an aggressive surgical approach to gastric carcinoma in 1960: in curative resections radical total gastrectomy with hepaticoceliac-left gastric arterial node dissection was to be performed for tumors involving the entire stomach or upper two thirds and radical 80% to 90% subtotal gastrectomy with similar node dissection for tumors located in the antrum. During a 23-year period 213 patients with confirmed gastric carcinoma were studied. Celiotomy was performed in 192: advanced gastric cancer was found in 185 and seven had early gastric cancer. In only 80 patients could resections for "cure" be done. In 31 patients who underwent total or extended total gastrectomy the operative mortality rate was 9.6%, and life table survival curves show a better survival rate than in 49 patients treated by subtotal gastrectomy, with an operative mortality rate of 16.3%. The study shows the urgent need for diagnosis of early gastric cancer by gastroscopic screening of adults at risk and the meager salvage by radical resection in advanced disease.     

侵及邻近结构的胃底贲门癌手术方式的探讨

目的　探讨肿瘤侵及邻近结构 (tumorinvadesadjacentstructures ,T4 )的胃底贲门癌外科治疗的最佳方式。　方法　对 2 0 1例T4 胃底贲门癌进行外科治疗 ,其中探查手术 31例 ,联合脏器切除术 170例。对联合脏器切除术后 3、5年生存率及术后病死率和并发症发生率进行分析。　结果探查手术和联合脏器切除术患者的中位生存期分别为 4 9个月和 2 9 3个月 ,二者间差异有非常显著性意义 ( χ2 =37 0 80 ,P <0 0 1)。 170例施行联合脏器切除术患者的 3、5年生存率分别为 46 2 %、2 2 8% ;其中全胃切除术患者的 3、5年生存率分别为 5 4 9%、2 9 2 % ,明显高于近侧胃大部切除术患者的 32 2 %、12 5 % ( χ2 =7 5 89、P <0 0 1,χ2 =5 792、P <0 0 5 )。术后病死率和并发症发生率分别为4 1%和 2 4 1%。结论　对于T4 胃底贲门癌患者 ,只要术中没有发现肝脏血行转移、淋巴结广泛转移和腹膜种植转移等 ,局部病变允许行联合脏器整块切除 ,且患者的身体状况许可 ,就应尽可能施行联合脏器切除术 ,以达到根治的目的。全胃切除术能够提高疗效。     

The surgically treated chronic gastric ulcer: an extended followup.

Since the overall results of the medical management of chronic gastric ulcer are discouraging, the records of 595 patients with chronic gastric ulcers who underwent surgical treatment at the Mayo Clinic from 1961 through 1965 were reviewed. Gastric and duodenal ulcer (or scar) occurred together in 18%. Partial gastric resection was the predominant surgical procedure employed. There was an uneventful postoperative course in 83.2% of patients. Early complications occurred in 16.8%, death in 1%, and early reoperation in 3.4% of patients. Followup extended from 1 to 14 years. Late complications occurred in 31.1% of patients. The overall results, graded according to a modified Visik classification, were excellent in 31.9%, good in 48.4% and unsatisfactory in 8.1%. In patients undergoing partial gastrectomy for "channel ulcers", the incidence of reo 1% recurrence rate for ulcers elsewhere in the stomach, with or without truncal vagotomy. For the majority of gastric ulcers, partial gastric resection, with or without vagotomy, remains theoretically advantageous and clinically proven.     

残胃癌18例诊治分析

我院自1982年1月至1995年1月收治经手术和病理证实的残胃癌18例,占同期收治胃癌的2.06％,其中男14例,女4例,年龄自43岁～78岁,平均58.3岁。发生残胃癌的时间自胃切除术后10年—25年,平均15.6年。再次手术切除12例,切除率为66.6％,其中根治切除5例,占27.7％,6例因病变广泛固定,仅行探查活检和腹腔置管化疗。严格胃切除指征,降低残胃基数和尽量采用毕氏Ⅰ式或Roux—y型及间置空肠吻合是目前减少残胃癌发生的有效途径,自胃切术后10年起定期进行胃镜检查,是发现早期残胃癌的可靠方法,早期手术是目前改善残胃癌预后的唯一途径。