胰头癌手术切除可能性的术前评价

目的通过总结胰头癌病人的临床表现和影象学检查结果来评价手术切除的可能性。方法总结32例胰头癌病人的临床表现和CT、磁共振（MRI）检查结果,判断肿瘤是否已发生邻近浸润或远处转移,以此来评价其手术切除的可能性。结果在22例作CT检查的病例中,判断正确的为17例,准确率为77．3%。作MR检查9例,全部判断正确,准确率为100%。结论某些特殊的临床表现和CT、MR检查对判断肿瘤是否发生邻近浸润或转移有较大价值,为术前评价手术切除的可能性提供依据。     

胰头癌根治术后患者预后相关因素分析

目的:探讨影响胰头癌根治性切除病人术后生存的相关因素。方法:回顾性分析2012年1月至2015年12月中国医科大学附属盛京医院111例行根治性手术切除的胰头癌患者的临床病理资料和随访资料。结果:111例患者术后中位生存时间12.1个月,1、3、5 年生存率分别为52.3%、20.6%、10.8%。单因素分析显示,年龄、术前CA19-9水平、被膜外浸润、肿瘤大小、淋巴结转移、肿瘤分化程度、肿瘤分期、胰腺切缘、术后是否化疗为影响胰头癌预后的因素（P＜0.05）。COX多因素分析显示,术前CA19-9水平、肿瘤分化程度、淋巴结转移、被膜外浸润、肿瘤大小、术后是否化疗及胰腺切缘为胰头癌患者预后的独立影响因素（P＜0.05）。结论:肿瘤分化水平差、淋巴结转移、肿瘤直径大于等于4 cm、未达到R0切除的胰头癌患者预后较差,根治性手术术后联合化疗可明显延长胰头癌病人的生存时间。     

CT对胰头癌手术切除可行性的评估（附30例报告）

作者对３０例胰头癌患者进行了术前ＣＴ扫描评估手术可切除性的前瞻性研究。结果显示：术前ＣＴ判断为可切除的１３例中，有１２例术中证实确能行根治性胰十二指肠切除术，准确率为９２．３％；而术前ＣＴ依据肠系膜上静脉或门静脉受侵，肿瘤过大侵及十二指肠以及肝或肝门淋巴结转移等判为不能切除的１７例均未能施行根治性胰十二指肠切除术，准确率达１００％，表明术前ＣＴ检查对胰头癌能否施行根治性切除手术确有很好的预测价值。     

CT对胰头癌手术切除可行性的评估

作者对３０例胰头癌患者进行了术前ＣＴ扫描评估手术可切除性的前瞻性研究。结果显示；术前ＣＴ判断为可切除的１３例中，有１２例术中证实确能行根治性胰十二指肠切除术，准确率为９２．３％；而术前ＣＴ依据肠系膜上静脉或门静脉受侵，肿瘤过大侵及十二指肠以及肝或肝门淋巴结转移等判为不能切除的１７例均未能施行根治性胰十二指肠切除术，准确率达１００％，表明术ＣＴ检查对头癌能否施行根治性切除手术确有很好的预测价值。     

胰头癌和壶腹癌的淋巴结转移及病理特点分析

目的:探讨胰头癌和壶腹癌的淋巴结转移及病理特点.方法:回顾性分析201例胰头癌和壶腹癌根治手术后的淋巴结转移及病理特点,χ2检验分析淋巴结转移与病理因素的相关性.结果:201例胰头癌和壶腹癌行胰十二指肠切除术,淋巴结转移率分别为32.65%(16/49),30.92%(47/152),其转移淋巴结累及部位基本相同,其中88.89%(32/36)单个淋巴结转移位于胰十二指肠周围.x2检验显示壶腹癌淋巴结转移相关的病理因素有:肿瘤直径(P=0.002),肿瘤分化程度(P=0.012),十二指肠壁浸润(P=0.008),T分期(P=0.000),胰腺受侵(P=0.005),胰头癌与上述病理因素无关,但神经浸润比例高.结论:胰头癌的淋巴结转移及病理特点与壶腹癌有所不同,手术方式的应有所区别,胰头癌应行扩大根治性手术切除.     

门静脉血管内超声检查法——一种诊断胰腺癌侵袭门静脉的新技术

包括门静脉切除的胰胆系统癌瘤的积极根治手术最近已有报道。对这类手术术前准确判断门静脉有无肿瘤侵犯相当重要。尽管影像技术在不断进展,但有时仍难以确认肿瘤是否已累及门静脉。现首次报告以门静脉血管内超声诊断胰腺癌侵袭门静脉的初步研究结果。 1992年2～8月,共6例胰腺癌(胰头癌5例,胰体癌1例)病人接受该法检查。剖腹术后,先暴露肠系膜上静脉分支,由此将超声导管置入肝内门静脉中。然后边退导管边观察     

影像学检查对结肠癌手术切除可能性评估的价值

为分析结肠癌放射学诊断对手术切除可行性评估的价值 ,回顾性分析 2 8例经双对比造影检查、CT扫描及手术病理证实的结肠癌患者资料。根据肿瘤的大小、范围、形态及浆膜面是否光滑、有无周围淋巴结肿大、周围器官的侵犯及远处淋巴结转移 ,决定能否行手术切除进行对照。结果双对比造影结合CT扫描对结肠癌手术切除可行性判断的准确率为隆起型 10 0 %、溃疡型 8/8、浸润型 4/8。回顾性分析结果提示 ,结肠双对比造影检查与CT扫描相结合 ,对大部分结肠癌患者术前能做出可否手术切除的可能     

胰头癌淋巴结转移的特性及其相关影响因素的研究

背景与目的:淋巴结转移是胰腺癌主要的转移方式,也是影响胰腺癌手术治疗疗效和预后的重要因素之一。本文研究胰头癌淋巴结转移的特性及临床病理特点,为胰头癌淋巴引流和进行术中淋巴结清扫提供依据。方法:借助手术显微镜解剖和检出胰头癌根治手术标本中的淋巴结,常规制作石蜡切片HE染色光镜下检测淋巴结有无肿瘤转移。总结并分析了胰头癌根治手术后的淋巴结转移及临床病理特点,通过χ2检验分析淋巴结转移与临床分期、肿瘤大小、病理类型以及有无神经浸润等的相关性。结果:132例胰头癌根治性胰十二指肠切除术标本中,术后检出淋巴结转移发生率为59.85%(79/132),尤以第13、14、16、12、8组淋巴结转移发生频率较高。有第16组有淋巴结转移的14例患者,转移淋巴结多属16b1亚组,主要分布于腹主动脉、下腔静脉和左肾静脉围成的三角形区域内。有10例胰头癌仅发生第14组淋巴结转移而不伴第13或17组淋巴结转移。χ2检验显示与胰头癌淋巴结转移密切相关的病理因素有:肿瘤分化程度、肿瘤分期(T)和神经浸润。结论:胰头癌淋巴结转移发生的范围广、发生频率高,以第13、14、16、17、12、8组为主,对相关淋巴结累及的区域进行淋巴结清扫有可能提高胰腺癌手术的根治性。     

CT对食管癌手术可切除性的临床评估

目的　比较计算机断层扫描 (CT)和传统临床分期判断食管癌手术可切除性的临床价值。方法　 5 8例食管癌患者 ,术前均经CT检查并进行CT分期 ,CT分期和传统临床分期结果分别与手术病理分期比较。结果　传统临床分期准确率仅为 41 4%,CT对肿瘤浸润程度、局部淋巴结受累及PTNM分期的准确率分别为 62 1%、81 4%、79 3 %。结论　食管癌传统分期方法准确性欠佳 ,CT能明确显著的肿瘤外浸及局部淋巴结转移 ,并能排除远处转移 ,是判断食管肿瘤能否切除的最佳手段     

影像学检查对结肠癌手术切除可能性评估的价值

为分析结肠癌放射学诊断对手术切除可行性评估的价值，回顾性分析28例经双对比造影检查、CT扫描及手术病理证实的结肠癌患者资料。根据肿瘤的大小、范围、形态及浆膜面是否光滑、有无周围淋巴结肿大、周围器官的侵犯及远处淋巴结转移。决定能否行手术切除进行对照。结果双对比造影结合CT扫描对结肠癌手术切除可行性判断的准确率为隆起型100％、溃疡型8／8、浸润型4／8。回顾性分析结果提示，结肠双对比造影检查与CT扫描相结合，对大部分结肠癌患者术前能做出可否手术切除的可能。     

乏特氏壶腹癌局部切除术的改进

为克服乏特氏壶腹癌局部切除术后的合并症──十二指肠瘘，而行术式改进。方法：局部肿瘤切除及重建完成后，于十二指肠第一段应用丝线结扎十二指肠，使之完全关闭，再补以胃空肠吻合术，使食物不流经十二指肠，而大大避免了十二指肠瘘的发生。此种十二指肠结扎伴胃空肠吻合术可用于十二指肠及乏特氏壶腹区域肿瘤伴出血、内瘘无法切除者，或十二指肠损伤无法修补或修补不确切时。     

Malignant melanoma of the female genital system: A report of 48 patients and review of the literature

Malignant melanoma of the female genital tract comprises 3% of all melanomas afflicting females. Melanoma of the vulva is most common, comprising 45 patients treated by the author. Thirty-two percent had metastases to the regional lymph nodes on presentation. Five-year survival is 31.6%. Radical vulvectomy and radical groin dissection is the treatment of choice. Only 80 melanomas of the vagina have been reported, with cures being an extreme rarity. Forty cases of the female urethra reported in the literature and only five survivors have been reported. Melanoma of the uterus is extremely rare, with no cures recorded. Melanoma of the ovary may occur within a teratoma but most frequently is metastatic.     

Radiation therapy of seminoma of the testis

This study is a review of 66 patients with a diagnosis of testicular seminoma, treated at the Department of Radiation Oncology, University of Louisville, from 1959 to 1978. Sixty-four of the patients were diagnosed as pure seminomas and two as spermatocytic type. The age of the patients ranged from 16 to 75 years with a median of 39. Fifty-four patients (82%) presented with swelling or mass in the testis, 7 patients with pain, 1 patient with hydrocele, and 4 patients had seminoma diagnosed incidentally. The distribution was equal for both right and left sides. There were 39 (59%) and 27 (41%) patients in stages I and II, respectively. All stage I patients received only infradiaphragmatic irradiation by a "hockey stick" field, and the majority of them received a dose of 3,200-3,600 rads in 3-4 weeks time. Stage II patients received elective irradiation to the mediastinum and neck region, in addition to the infradiaphragmatic irradiation. The 5-year actuarial survival rates for stage I and II seminomas are 96% and 92%, respectively. There were no serious complications during follow-up. The role of elective irradiation in stage I disease is discussed with a brief review of the literature.     

A note from history: landmarks in history of cancer, part 2

Events that took place in medicine during the 15th, 16th, and 17th centuries signaled the end of the Dark Ages. The Renaissance movement, spreading from Italy across Europe, ended the religious and public prohibitions that had prevented progress in medicine. Pioneer physicians and surgeons who gave their attention to discoveries in anatomy, physiology, and chemistry established the foundations for tumor pathology, surgical oncology, and medical oncology. This review is a summary of their accomplishments.     

The Patterns of Care Outcome Studies: results of the National practice in carcinoma of the larynx

The Patterns of Care Study conducted a survey of patients with glottic and supraglottic carcinomas treated in 1973 and 1974. Patients for this study were randomly selected from all types of treatment facilities, including those with full and part-time therapists and large and small institutions. Detailed evaluation and treatment parameters were recorded for a total of 707 patients. Overall three-year recurrence free survival for glottic carcinoma was: Stage I, 90%; Stage II, 78%; Stage III, 65%; and Stage IV, 23%. For supraglottic carcinoma the rates are: Stage I 78%, Stage II, 60%, Stage III, 34% and Stage IV, 30%. The use of surgery in this study for advanced lesions varied among different departments. For advanced lesions, those treated with combined radiation and surgery had improved survival; this was also related to completeness of work-up and departmental equipment.     

The quality of life of patients following treatment for laryngeal cancer

One hundred and twenty-nine patients have been interviewed 9 to 15 months following treatment for laryngeal cancer to determine the post treatment quality of voice and life. The patients were subdivided into 3 groups, successfully irradiated TI and T2 patients, (89 patients successfully irradiated T3 and T4 patients (24 patients) and those treated by surgery (16 patients). Ninety-three percent of TI and T2 patients and 79% of T3 and T4 patients are working following treatment as compared to 44% of the surgery patients. Ninety-eight percent of the T1 and T2 and 87.5% of the T3 and T4 patients were able to use the telephone normally as compared to 12% of the surgery patients. Similarly major differences between the successfully irradiated patients and the surgically treated patients in terms of ability to live a normal social life have been noted. The patients also rated their voice in terms of volume, pitch, ability to communicate, quality, rate of speech, flow of speech and dry throat. In every parameter of rating of the voice, with the exception of dryness of the throat, the successfully irradiated patients in all stage groupings had better ratings than the surgery group. Since, in Toronto, survival in advanced glottic and supraglottic cancer is the same using radical radiation with surgery in reserve as survival with primary surgery, it is concluded in view of the superior quality of voice and life in the successfully irradiated patients that irradiation with surgery in reserve is the optimal treatment for these patients. We also conclude that the measurement of quality of life in patients with cancer of the larynx is of vital importance in determining optimal treatment and that further studies in this area are indicated.     

胰十二指肠切除术71例分析

目的　探讨胰十二指肠切除术的围手术期准备和术中处理的方法 ,提高手术安全性。方法　对 71例行胰十二指肠切除术患者的术后并发症、死亡率和围手术期准备与术中处理方法进行回顾性分析。结果　 71例胰十二指肠切除术后 14例发生并发症 (19.7% ) ,死亡 2例 (2 .8% )。结论　完善的围手术期准备和精湛的手术技巧是提高胰十二指肠切除手术安全性、降低并发症的重要手段     

保持下颌骨连续性的舌癌口底癌根治术后复发因素的探讨

为了提高舌癌口底癌手术疗效，作者对４７例施行保持下颌骨连续性的舌癌口底癌联合根治术的复发因素进行分析。结果显示：术后复发１４例，复发率为２９．８％。局部复发均在原发灶的内侧软组织。９例舌侧缘口底后部癌中有５例复发（５５．６％），而５例舌侧缘前部癌中无１例复发，两者比较有显著性差异（Ｐ＜０．０５）；Ｔ３～４复发率（４８．０％）明显高于Ｔ１～２复发率（９．１％），Ｐ＜０．０１；有同侧颈淋巴结转移者的复发率（５４．５％）高于无颈淋巴结转移者的复发率（２２．２）％，Ｐ＜０．０５。作者认为：对适应证恰当的病例，术后复发与保持下颌骨连续性无关，而与肿瘤原发部位、大小、颈淋巴结转移及切除范围有关。