大肠腺瘤的形态特征和染色后内镜检查对腺瘤的诊断价值

目的探讨大肠腺瘤的形态特征和染色后内镜检查对大肠腺瘤的诊断价值。方法分析1872例大肠镜检查的病人，并对其中240例肉眼未发现明显病变病人的直肠再用0．5％美兰液染色后内镜检查，同时进行活检组织病理学检查。结果发现腺瘤或息肉者74例，总共132枚息肉，其中大肠腺瘤84枚，增生性息肉25枚，炎性息肉23枚。在对肉眼未发现明显病变的240例病人中直肠再用0．5％美蓝液染色进行观察，发现黏膜改变31例，其中4例为稍隆起型、23例为平坦型、4例为凹陷型。组织学检查18例为炎性增生，13例为腺瘤。结论大肠镜检查是发现大肠腺瘤的重要方法，染色后内镜检查可发现肉眼不易发现的病变，明显提高诊断的准确性，值得进一步推广应用。     

大,小肠息肉及肿物的腔内治疗（附6091枚息肉分析）

近１０年来应用纤维结肠镜检查了有腹痛、腹泻或便血等患者１１０４２例，检出大、小肠息肉２６１４例（２３．６７％）。摘除０．３～１０ｃｍ息肉６０９１枚，其中镜从小肠中段切口或从肛门插入清除小肠息肉９例，息肉６２枚。无肠穿孔、大出血等严重并发症。在摘除巨大息肉时，每圈套一块组织应＜２．０ｃｍ。对全身情况好的中青年患者，如息肉有蒂，可适当增加摘除息肉的枚数。本组１次圈套摘除１．０～２．５ｃｍ的有蒂息肉１０枚以上者８１例次，其中１次摘除最多者４６枚，最大１枚１０ｃｍ×９ｃｍ×８ｃｍ。１次凝除小息肉最多的是７０枚。     

成年人大肠幼年性息肉临床病理分析

目的: 探讨成年人大肠幼年性息肉的临床及病理特点.方法:对2004年6月～2009年6月在我院内窥镜中心经电子结肠镜检查发现的21例成年人大肠幼年性息肉患者的内镜检查及临床病理等结果进行回顾性分析.结果:21例患者共检出29枚幼年性息肉,均经病理检查证实,病变部位以直肠最多,其次为乙状结肠.随访1年后未见复发息肉和癌变.结论:成年人幼年性息肉病变主要位于直肠及乙状结肠,单发息肉癌变可能性小.     

内镜下高频电凝切除术治疗大肠息肉334例临床分析

大肠息肉是大肠癌的前期病变，且息肉呈多部位多发性。因此，全结肠镜检查是发现息肉最好的办法。自1968年常冈报道内镜下单纯机械摘除胃肠道息肉及Shinye首先报道结肠镜下息肉电凝切除术后，各种内镜治疗的新技术不断出现。内镜技术近年来已不仅仅做为常规的检查工具，治疗内镜已迅速发展并有广阔的应用前景。本文对334例大肠息肉患者，采用内镜下高频电凝切除治疗效果满意。报告如下。     

经纤维结肠镜对结肠息肉病的诊断和治疗应用的初步报告

从七十年代起纤维结肠镜在临床已广泛应用,近年来国内也在逐步展开,对提高结肠病变的诊断和治疗结肠息肉都很大价值。可使一部分病人免除剖腹手术的痛苦。我院自一九七五年八月起至今共进行三百九十例纤维结肠镜检查,发现结肠息肉病人九十六例,息肉一百三十三只。其中四十六例,七十二只息肉在纤维结肠镜下配用电凝热圈套器作摘除。现将初步体会介绍如下: 资料三百九十例纤维结肠镜检查,三百二十二例用Olympus CF-LB型(一百八十七公分长)     

3例家族性腺瘤性息肉病家系诊治分析

目的 分析一家族性腺瘤性息肉病（FAP）家系的临床表型,对显性发病患者确定结肠镜随访间隔时间,探讨大数量切除结肠息肉的安全性与临床意义。 方法 在确定先证者后,对该家族成年成员进行结肠镜检查,对发现的显性发病患者进行结肠息肉的结肠镜下治疗以及随访。 结果 该家系成员共25人,其中女性14人,男性11人;显性发病3人,均属于传统型FAP,其中女性2人,男性1人且为其中1位女性之子;向上家系追溯,该家系有3位女性发病且故于结肠癌。自2007年10月至2012年11月,对3例显性发病患者共进行结肠镜随访与治疗27次,切除息肉1 801枚,除2枚（2.5 cm和3.0 cm）分别进行息肉剥脱+圈套切除术外,其余息肉均采用高频电圈套法、热活检钳摘除与灼除等方式。在集中处理高危息肉后,结肠镜随访间隔时间为每6月1次。手术过程安全,随访中未发现癌变腺瘤,但发现高危腺瘤（伴鱼鳞样黏膜）。结论 结肠镜下大数量切除结肠息肉具有较高的安全性,此种方式对不接受结肠手术的人群具有临床意义。从预防角度初步确定结肠镜随访间隔时间为6月,但需要进一步探讨,包括同时增加药物预防措施。     

全结肠镜检出大肠息肉及大肠癌患者的结果分析

目的回顾性分析大肠息肉癌变的相关影响因素及探讨全结肠镜检查对大肠癌及腺瘤患者诊断治疗的重要性。方法 对电子肠镜检查中检出的大肠息肉及大肠癌患者的内镜特点及病理资料进行总结和分析。结果 在1100例肠镜检查者中, 发现大肠息肉患者387例(1543枚), 大肠息肉中有42例发生癌变(42枚), 息肉好发部位为左半结肠。左半结肠息肉、宽基息肉、直径＞2cm息肉和绒毛状腺瘤容易癌变。大肠癌患者326例, 检出率29.63%。大肠息肉、大肠癌以及大肠息肉癌变高发年龄均为45岁以上, 具有相似性。大肠癌伴结直肠息肉患者92例, 多原发癌29例。术后再发息肉患者66例。结论 大肠息肉癌变与患者年龄, 息肉部位、大小、形态以及病理类型显著相关。大肠癌及腺瘤患者做全结肠镜检查可以防止漏诊, 降低死亡率。     

纤维光导结肠镜与细胞学检查

纤维光导结肠镜是很有价值的诊断工具,本文作者用此镜检作放射学检查对比、息肉摘除,以及用于结肠癌切除术后定期复查,镜检时还可作灌洗细胞学检查(增加了细胞学诊断的可靠性)。灌洗的适应证为:①息肉摘除时遇到机械性困难,如急性结肠成角;②切除大息肉时,息肉破碎;③病变为扁平溃疡区;④梗阻使管腔狭窄不能直接窥视病变;⑤结肠癌切除后,缝合处的检查。本组镜检查95例,同时行灌洗细胞学检查。病变从距肛门缘15厘米到回肠(180厘米)。应用纤维光导结肠镜为 CF-MB 或 CF-LM 型,可作吸引活检,细胞     

564例大肠癌结肠镜资料分析

目的对564例大肠癌结肠镜检查结果进行总结分析。方法回顾564例经结肠镜检查及病理确诊的大肠癌患者，就性别、年龄、病变部位、结肠镜检查及病理特征进行分析。结果9151例接受结肠镜检查者中，共发现大肠癌患者564例，检出率为6．16％。男女比例为1．4：1；≥50岁为高发年龄（占70．39％）；直肠病变占多数，乙状结肠其次，分别为52．01％和15．24％，右半结肠癌占25．91％；腺癌仍为大肠癌最常见的病理类型（94．25％），鳞癌及腺鳞癌各有1例和2例，腺瘤性息肉癌变48例，占8．36％。结论≥50岁为大肠癌高发年龄，直肠和乙状结肠为大肠癌的高发部位，全结肠镜检查是筛查和诊断大肠癌的有效手段。     

结直肠锯齿状息肉患者临床与内镜特征

目的探讨结直肠锯齿状息肉(SA)的临床和内镜特征。方法选取2016年11月至2018年10月间漳州正兴医院收取完成结肠镜检查的6 440名检查者,其中包括60例结直肠锯齿状病变患者,分析比较不同年龄段和不同性别的检查者的一般资料,并探讨锯齿状息肉患者的相关因素。结果 60例息肉锯齿状病变患者中,男46例,女14例,年龄25～78岁,平均(52. 3±12. 6)岁。锯齿状息肉患者中,青年组(<45岁) 17例,同年龄段的结肠镜检查者2 544例,锯齿状息肉检出率为0. 7%(17/2 544),同年龄段检出结肠息肉共476例,锯齿状病变占结肠息肉的3. 6%(17/476);中年组(年龄≤45岁且<60岁) 26例,同年龄段的结肠镜检查者2 530例,锯齿状息肉检出率为1. 0%(26/2 530),同年龄段检出结肠息肉共775例,锯齿状病变占结肠息肉的3. 4%(26/775);老年组(年龄≥60岁) 17例,同年龄段的结肠镜检查者1 366例,锯齿状息肉检出率为1. 2%(17/1 366);同年龄段检出结肠息肉共418例,锯齿状病变占结肠息肉的4. 1%(17/418)。锯齿状息肉单发19例,多发锯齿状息肉41例。纳入所有单发性息肉,多发性锯齿状息肉每例选取较大的2枚代表性锯齿状息肉纳入分析。共纳入101枚锯齿状息肉,其中增生性息肉(HP)为71枚,无蒂锯齿状腺瘤/息肉(SSA/P)为25枚,TSA为5枚。HP与SSA/P的内镜特征比较显示,HP在结直肠远端的比例为69. 0%,明显高于SSA/P的32. 0%,差异有统计学意义(P <0. 05);息肉形态方面,HP扁平型、半球型、亚蒂和有蒂的比例分别为50. 7%、38. 0%、8. 5%和2. 8%,SSA/P扁平型、半球型、亚蒂和有蒂的比例分别为64. 0%、20. 0%、8. 0%和8. 0%,HP与SSA/P的不同形态比例分布,两者差异无统计学意义(P> 0. 05);息肉直径方面,HP≤5mm、6～10mm、11～20mm和> 20mm的比例分别为60. 6%、21. 1%、15. 5%和2. 8%,而SSA/P相应的比例分别为28. 0%、40. 0%、16. 0%和16. 0%,两者病变直径比较,差异有统计学意义(P <0. 05);病理内瘤变方面,HP低级别内瘤变发生率为28. 2%,无高级别内瘤患者,而SSA/P内瘤变发生率为64. 0%,其中低级别内瘤变11例,高级别内瘤变4例,高级别内瘤并黏膜内癌1例,SSA/P内瘤变发生率明显高于HP,差异有统计学意义(P <0. 05)。结论SSA/P患者病变较HP大,一般> 0. 5mm,SSA/P内瘤变发生率高,临床要重视SSA/P患者的内镜和病理诊断,降低SSA/P漏诊率。     

A case of primary adenosquamous carcinoma of the stomach associated with gastric polyposis

We report a 76-year-old woman with Borrmann 3 carcinoma associated with gastric polyposis, who underwent total gastrectomy and splenectomy. Histopathological study of resected specimens revealed squamous cell carcinoma in some sections keratinization was seen; other sections evidenced adenocarcinoma. Due to intra- acinous epithelial stratification and platyform development, the adenosquamous carcinoma was considered to have originated from squamous epithelial metaplasia of the adenocarcinoma cells. Of 90,639 patients who had undergone resection to treat gastrocarcinoma, 236 (0.26%) had adenosquamous carcinoma. However, only 7 cases were associated with polyposis.     

Posttreatment ureteral obstruction in invasive carcinoma of uterine cervix

There were 2,016 new cases of invasive carcinoma of the cervix (Stages I-IV) who were seen from January 1951 to January 1981, in LSU Medical Center. One thousand, one hundred and five cases were Stages I and II (early stages), and 911 cases were Stages III and IV (advanced stages). One hundred and thirty-seven cases of early stages (12%) were recorded to have ureteral obstruction that developed after completion of the treatment for cervical carcinoma. Ninety-four (69%) of the 137 patients with ureteral obstruction in early stages are dead, and autopsy information is available in 28 cases. There was evidence of cervical carcinoma causing ureteral obstruction in 13 autopsy cases. Of the 66 patients who died and were not autopsied, 26 cases had biopsy-proven evidence of either persistent or recurrent cervical carcinoma. All 43 patients surviving in this group are biopsy negative or clinically with no evidence of disease (NED). One hundred and sixty-three patients in advanced stages (18%) who did not have ureteral obstruction prior to definitive treatment for cervical carcinoma developed ureteral obstruction after completion of treatment. One hundred and forty-two (87%) of the 163 patients with ureteral obstruction in advanced stages are dead, and autopsy information is available in 36 cases. There was evidence of recurrent or persistent carcinoma causing ureteral obstruction in 25 cases (69%). Of the 106 patients who died and were not autopsied, 76 had biopsy-proven Ca (72%) in the pelvis and abdomen prior to death. In this group, 21 patients survived until January 1, 1985, and four of them had biopsy-proven Ca which caused ureteral obstruction. In both early and advanced stages, 13 patients with post-treatment ureteral obstruction were lost to follow-up, but the remaining 287 cases have been followed until death or at least 4 years after detection of the ureteral obstruction. The median follow-up was 64.2 months, and seven patients have survived beyond 10 years. This review shows that 12% of the patients with early stage and 18% with advanced stage carcinoma of the uterine cervix seen in this institution developed some degree of detectable ureteral obstruction. Biopsy-proven evidence of recurrent or persistent carcinoma indicating the Ca to cause posttreatment ureteral obstruction in early stages of cervical carcinoma was 40% and in advanced stages was 66%.(ABSTRACT TRUNCATED AT 400 WORDS)     

高剂量率后装腔内放射治疗宫颈癌的主要并发症及生存质量

本文报告了２０３例宫颈患者使用高剂量率后装腔内放射治疗的主要并发症及生存情况，外放射用６０钴机或加速器，腔内用西德产布克勒后装机治疗。全组已随访３～５年，其中无癌生存１８１人，带癌生存９人，１３人死亡。无癌生存的１８１人，有１５１例无明显症状，不仅可维持正常生活、部分年纪较轻者还能照常上班和参加田间劳动。本组病例近期放疗反应不明显，远期反应主要是放射性直肠炎和膀胱炎，其发生率各为９．８％和８．９％。除１例发生直肠阴道瘘及两例膀胱出血较多经补血治疗外，其余均用药物治疗，多在６个月治愈。     

非小细胞肺癌单纯放疗300例临床分析

本文总结了非小细胞肺癌单纯放疗300例。男性224例、女性76例。年龄在28～78岁,41岁以上占97％。中心型179例,周围型121例。有病理或细胞学诊断者141例,放疗结果证明病理类型与存活率有关,鳞癌及腺癌5年生存率基本相同(5％),而大细胞癌均在1年内死亡。剂量与存活率有明显关系、小于49Gy均死于1年之内,60～70Gy以上者5年存活率为7.5～22％。肿块变化与存活率有一定关系、肿块发展者多在1年内左右死亡、而消失缩小或无变化者则对生存率影响不大。肿块无变化尚能长期生存者5例可能与放疗后肿瘤细胞静止而表现的自限作用有关。     

Coexistence of Papillary and Nodular Carcinomas in the Urinary Bladder

Of 203 patients with transitional cell carcinoma of the urinarybladder which had been cystectomized and examined by step-sectioningduring the period between 1969 and 1986, 33 had coexistent papillary,papDlonodular and/or nodular carcinomas in the bladder. Of them,12 (36%) had a history of papillary carcinomas, 26 (79%) hadmultiple rumors and 22 (67%) had a concomitant carcinoma insitu, and/or mucosal dysplasia. Moreover, microscopic papillarystructures were identified in 32 out of the 33 (97%) cases withpapillonodular and/or nodular carcinomas, indicating some ofthe nodular invasive carcinomas in the bladder to have developedfrom papillary carcinomas.     

The histologic diagnosis of adenocarcinoma in situ and related lesions of the cervix uteri. Adenocarcinoma in situ

Seventy-two cases of in situ adenocarcinoma (AIS) of the cervix were reviewed. Forty-five cases had associated cervical intraepithelial neoplasia and 20 cases had changes of wart virus infection. Five cases had associated microinvasive squamous cell carcinoma and one cases showed frankly invasive squamous cell carcinoma (SCC). Of the 72 cases, 41 showed an endocervical type of AIS and three cases an endometrioid type. There was no case of pure intestinal type AIS. Twenty-eight cases showed a mixed pattern. Architectural patterns characterized by tunnel clusters, cribriform glands, glandular budding and papillary formations were assessed. Most cases showed varying combinations of these patterns but in ten cases significant changes were absent. Both cellular apoptosis and mitotic activity were seen in varying degrees in all cases of AIS. The significance of these and other features of AIS are discussed as well as the conditions involved in the differential diagnosis.     

Breast carcinoma in situ in 167 women--incidence, mode of presentation, therapy and follow-up.

In the city of Malm?, in southern Sweden, 1693 women were diagnosed as having breast carcinoma during 1976 through 1984. Of these, 167 women had pure in situ breast carcinoma (9.9%). One hundred and thirty-two had ductal carcinoma in situ (DCIS) alone or in combination with lobular carcinoma in situ (LCIS), intracystic carcinoma and/or Paget's disease of the nipple. Thirty-three had pure LCIS and two had pure intracystic carcinomas. The incidence of breast carcinoma in situ (CIS) in women 20 years of age or older was 18.7 per 10(5) woman years with high rates of DCIS for all ages above 40, whereas a decline in incidence rate was seen for LCIS in the postmenopausal age groups. The ratio of DCIS to LCIS was 4:1. Of the 132 patients with DCIS, 46% were asymptomatic and were diagnosed by mammography, 35% presented with clinical symptoms, and 19% of the cases were incidental findings in breasts operated on for benign lesions. Mammography had been performed on all patients with DCIS and contributed to diagnosis in 75%. Sixty-one per cent of all DCIS lesions had microcalcifications suspicious for carcinoma. Eighty-nine of 132 patients with DCIS underwent fine-needle aspiration biopsy (FNAB) before surgical biopsy. FNAB was suspicious or diagnostic for carcinoma in 57/89 (64%). Of 33 cases with LCIS all but one were incidental findings. In one of 28 cases with LCIS examined by mammography there was suspicion of carcinoma. Sixteen per cent of the patients with DCIS were treated by a breast-conserving operation (BCO), the remaining patients by mastectomy (ME) (52%) or subcutaneous mastectomy (SCM) (33%) with immediate reconstruction. Thirty-three per cent of the patients with LCIS were treated by BCO, the remaining patients by ME (18%) or SCM (49%) with immediate reconstruction. Only one patient had radiotherapy postoperatively. In 60% of all CIS cases where an excisional biopsy had been performed there were further foci of CIS in the final ME/SCM specimen. After a median follow-up of 7 years for the DCIS group, three patients out of 21 treated by BCO had invasive carcinoma appearing ipsilaterally. They were alive and without symptoms of recurrent disease 2.5 to 6 years following further surgery. One patient treated by SCM died from generalized ductal breast carcinoma. In the LCIS group (median follow-up 8 years) one patient out of 11 had an invasive tubular carcinoma diagnosed 4 years after BCO. Eight years later she was alive and well after bilateral SCM.     

Carcinoma of the endometrium results of treatment

From 1955 to 1974, 294 patients with primary carcinoma of the endometrium were treated by a combination of preoperative irradiation and surgery or by irradiation alone. Of these 294 patients, 12 had biopsy-proven involvement of the cervix. The current FIGO classification was used. The overall 5-year survival was 79%. The 5-year survival for Stage I, II, and III was 83%, 91%, and 40% respectively. The 5-year survival was 88% for operable Stage I carcinoma of the endometrium and 65% for inoperable Stage I. One hundred ninety-six patients with operable Stage I carcinoma of the endometrium received preoperative irradiation followed by total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) and were studied in greater detail. In this group, the incidence of sterilization and the degree of myometrial invasion in the removed uterus were important factors in determining the prognosis. Preoperative radium yielded better results than preoperative external irradiation.     

Transitional cell carcinomas of the urinary bladder. Effects of preoperative irradiation on morphology

The effects of preoperative irradiation on the morphology of transitional cell carcinomas (TCCs) were evaluated by studying the pretreatment biopsy and radical cystectomy specimens from 35 patients. Twenty-six of these patients had received 2000 rad within the week preceding surgery, and nine patients had received no preoperative treatment. The frequency of bladders without residual TCC was 23% for irradiated and 22% for nonirradiated cases. Of the TCCs classified as papillary in the biopsy specimens and irradiated, 79% lacked a papillary component at cystectomy, but in no case was the invasive component eliminated or regression from muscle invasion to superficial TCC noticed. Flat carcinoma in situ (CIS) did not respond to irradiation. At cystectomy nuclear pleomorphism was greater than at biopsy in 60% of the irradiated TCCs, whereas all nonirradiated cases retained the same grade as at biopsy. In addition, irradiation induced squamous differentiation in neoplastic cells only, without affecting the nonneoplastic urothelium.     

食管贲门癌伴窦性心动过缓术后非特异性心率增快效应的临床研究

 目的　探讨食管贲门癌伴窦性心动过缓术后非特异性心率增长效应的原因和机制。方法　总结分析 48例食管贲门癌伴窦性心动过缓病员术前、术中、术后的心率变化。结果　术后 1～7d,心率 60～ 79次 /分 1 3例 ;80～ 1 0 0次 /分 30例 ,1 0 0次 /分以上 5例。术后 8～ 1 4d,60～ 79次 /分2 6例 ;80～ 1 0 0次 /分 2 2例。结论　食管贲门癌伴窦性心动过缓术后发生非特异心率增快效应的原因和机制可能与下列四点有关 :1肿块对迷走神经的挤压刺激 ,使迷走神经兴奋性增强进而引起窦性心动过缓。 2术后单侧切断迷走神经使其作用减弱。 3交感神经兴奋性相对增强。 4手术可能引起血管活性肠肽及降钙素相关基因肽增多。