338例早期胃癌的临床分析

目的 探讨早期胃癌(EGC)淋巴结转移与临床病理特征的关系,找出影响预后因素.方法 回顾性分析1999年7月至2009年6月行胃癌根治术338例EGC患者的临床资料,分析淋巴结转移与肿瘤大小、组织学类型、浸润深度之间的关系;应用Kaplan-Meier法对随访患者资料进行影响预后因素及生存率分析.结果 淋巴结转移与肿瘤大小、浸润深度有关,差异有统计学意义(P<0.05或<0.01).63例随访患者5年生存率为92.1%;肿瘤浸润黏膜层患者5年生存率为97.1%,肿瘤浸润黏膜下层患者5年生存率为85.7%;肿瘤浸润深度、肿瘤大小与EGC术后生存率相关(P值分别为0.043、0.004).结论 根据肿瘤大小、浸润深度、淋巴结转移等生物学特点,合理选择手术方案,有助于提高EGC患者的5年生存率,改善预后.

Abstract：

Objective To find out the relationship between lymph node metastasis and clinical pathological specificity, the prognostic factors for the purpose of improving survival of early gastric cancer (EGC) and quality of life. Methods The clinical data of the 338 EGC patients from July 1999 to June 2009 was analyzed retrospectively, includirg the possible relationship of lymph node metastasis, the size of tumor,types of histopathology,depth of infiltration. Using Kaplan-Meier method to process suvival rate,immunohistochemistry method to detect the micrometastasis. Results Lymphnode metastasis was relative to the size of tumor, depth of infiltration (P < 0.05 or < 0.01). Total 5-year survival rate was 92.1%, intramucosa 5-year survival rate 97.1%, submucosa 5-year survival rate was 85.7% in 63 followed up patients, the survival rate of EGC was related with depth of infiltration and size of tumor (P = 0.043,0.004). Conclusion By precisely estimating depth of infiltration, the size of tumor and correct estimating the state of lymph node metastasis, choosing right 5-year surgical protocol can improve EGC survival rate and prognosis.     

99mTc-硫胶体淋巴结显像联合亚甲蓝在乳腺癌前哨淋巴结活检中的临床研究

目的 探讨99mTc-硫胶体(99mTc-SC)淋巴结显像联合亚甲蓝行乳腺癌前哨淋巴结活检(SLNB),对前哨淋巴结(SLN)阴性者避免行腋窝淋巴结清扫(ALND)的可行性及其临床应用价值.方法 187例乳腺癌患者术前行99mTc-SC淋巴结显像,并进行体表定位,术中加用亚甲蓝示踪SLN,切除后快速冰冻切片.其中51例SLN转移患者行改良根治术,将136例SLN阴性患者分为两组,A组[为腋窝淋巴结阳性患者,58例为术中检测阳性,2例为SLNB术后淋巴结常规病理检查阳性,再次行ALND,共60例]行乳腺切除或象限切除加ALND,B组(术中检测阴性78例,除去术后检测阳性2例,共76例)行SLNB,未行ALND.结果 A组术后上肢麻木、上肢水肿、上肢功能障碍分别为36、8、45例,B组分别为2、0、0例,两组比较差异有统计学意义(P<0.05).A组1、3、5年局部复发分别为0、0、2例,腋窝及锁骨上淋巴结转移分别为1、5、8例,远处转移分别为2、8、12例,无瘤生存分别为60、57、49例;B组1、3、5年局部复发分别为0、0、6例,腋窝及锁骨上淋巴结转移分别为3、8、12例,远处转移分别为4、8、16例,无瘤生存分别为76、70、61例,两组比较差异无统计学意义(P>0.05).结论 99mTc-SC淋巴结显像联合亚甲蓝行SLNB方法 简便,准确率高,疗效确实可靠.

Abstract：

Objective To evaluate the clinical significance of the axillary conservative surgery by sentinel lymph node biopsy (SLNB) using preoperative lymphoscintigraph technique with 99mTc-SC and methylene blue in early-stage breast cancer patients. Methods The sentinel lymph node (SLN) of 187 patients were located with preoperative lymphoscintigraph technique with 99mTc-SC and labeled with methylene blue during the operations. The metastasis of SLN was detected using frozen section technique. There were 51 patients whose SLN were positive having been carried with modified radical mastectomy of breast cancer and axillary lymph node dissection (ALND), 136 patients' SLN were negative,58 patients of those were carried with mammectomy or partial mastcctomy and ALND (group A),while 78 patients were carried out with mammectomy or partial mastectomy only (group B). The sentinel lymph nodes were detected with HE stain after surgery. All the patients were treated with chemotherapy,and the patients with partial mastcctomy must be treated with radiotherapy. There were 2 patients with micrometastasis in group B being treated with mammectomy or partial mastcctomy only,and carried out with ALND again. Results The number of cases with upper limb numbness, edema, dysfunction in group A were 36,8 and 45 cases, in group B were 2,0,0 case respectively. Group A compared with group B was increased significantly (P< 0.05). The number of local recurrence within 1, 3 and 5 years were 0,0,2 cases;lymphatic metastasis were 1,5,8 cases; the distant metastasis were 2,8,12 cases; the disease-free survival were 60,57,49 cases. In group B, the number of local recurrence within 1, 3 and 5 years were 0,0,6 cases, lymphatic metastasis were 3,8,12cases,the distant metastasis were 4,8,16 cases,the disease-free survival were 76,70,61 cases. There were not significant differences between the two groups(P> 0.05). Conclusion It is simple and accurate to carry out SLNB using preoperative lymphoscintigraph technique with 99mTc-SC combined with methylene blue,and the effect is reliable.     

乳腺癌彩色多普勒血流参数及血流丰富程度与淋巴结转移的相关性研究

目的 探讨乳腺癌彩色多普勒血流参数及血流丰富程度与淋巴结转移的相关性.方法 将68例乳腺浸润性导管癌患者按有无淋巴结转移分为Ⅰ组(无淋巴结转移组,37例)和Ⅱ组(有淋巴结转移组,31例),Ⅱ组再根据淋巴结转移程度以胸小肌为标志分为Ⅱ a组(胸小肌外侧淋巴结转移组,19例)和Ⅱ b组(胸小肌后侧、锁骨下淋巴结转移组,12例).测量病灶的彩色多普勒血流参数[血流收缩期峰值流速(PSV)、血流阻力指数(RI)]及血流丰富程度(按Alder分级),比较其与淋巴结转移的关系.结果 Ⅰ组和Ⅱ组PSV、RI比较差异无统计学意义(t=-0.19、-0.63,P＞0.05);Ⅱa组和Ⅱb组PSV、RI比较差异无统计学意义(t=-1.12、-0.13,P＞0.05).Ⅰ组和Ⅱ组肿瘤血流丰富程度Alder分级比较差异无统计学意义(x2=0.46,P＞0.05);Ⅱ a组Alder Ⅰ、Ⅱ、Ⅲ级分别占10.5%(2/19)、63.2%(12/19)、26.3%(5/19),Ⅱb组分别占8.3%(1/12)、16.7%(2/12)、75.0%(9/12),两组肿瘤血流丰富程度Alder分级比较差异有统计学意义(x2=7.41,P＜0.05).结论 乳腺浸润性导管癌血流丰富程度与淋巴结转移有一定相关性;而乳腺癌彩色多普勒血流参数与淋巴结转移无显著相关性.

Abstract：

Objective To study the association among the color Doppler flow pattern, vascular distribution and the lymph nodes metastasis in breast carcinomas. Methods Sixty-eight patients with infiltrating mammary gland duct carcinoma were divided into the no-lymph-nodes-metastasis group (group I , 37 cases) and the lymph-nodes-metastasis group (group Ⅱ , 31 cases), group Ⅱ were subdivided into group Ⅱa (19 cases): lateral lymph nodes positive of pectoralis minor and group Ⅱ b (12 cases): rear of pectoralis minor and subclavian lymph node positive. Blood flow parameters [peak systoltc velocity (PSV),resistent index ( RI)] and vascular Alder grades were observed and measured with color Doppler ultrasound.The results were compared with the incidence of lymph node metastasis. Results PSV and RI were not significantly different between group Ⅰ and group Ⅱ (t = -0.19,-0.63,P＞ 0.05),and also between group Ⅱ a and group Ⅱ b (t =-1.12,-013,P ＞0.05). By using vascular Alder grades,there were no significant differences between group Ⅰ and group Ⅱ (x2= 0.46, P＞ 0.05 ), but the significant differences were observed between group Ⅱ a [10.5%(2/19) ,63.2%( 12/19) ,26.3%(5/19) in Alder Ⅰ , Ⅱ , Ⅲ grade] and group Ⅱ b [8.3%( 1/12), 16.7%(2/12),75.0%(9/12)in Alder Ⅰ , Ⅱ ,Ⅲ grade](x2 = 7.41,P＜0.05). Conclusion The pattern of blood flow has no correlation with lymph nodes metastasis, vascular Alder grades of carcinoma shows some relevance with the lymph nodes metastasis in the patients with infiltrating mammary gland duct carcinoma.     

The Relationship between Gastric Cancer and the Unhealthy Habits and the Gastric Diseases

Objective To explore the relationship between gastric cancer and smoking, drinking spirits and the history of chronic gastric disease s. Method A case-control study was conducted on 361 cases and 1 525 population-controls to interview the history of exposure. The contact stre ngth of each factor with gastric cancer was estimated by Logistic regression mod el. The data were adjusted for confounders. Results The risk of gastric cancer increased 48% for smokers, the longer the year of smoking was,the more the numbe r of smoking per day was, and the younger the age of beginning smoking was, the greater the risk of gastric cance r was.82% of the risk increased for drinkers, the affects of white wine was most obvious(OR=3.14，95% CI=2.23～4.42). The risk rose markedly (OR=7 .87,95% CI=5.72～10.83)for the persons who had chronic gastric diseases, and t he relation of duration-effect was presented, which the risk rose with the exte nsion of having chronic gastric diseases. Smoking, drinking spirits and the hist ory of chronic gastric diseases were the strong independent factors, and they al so had obvious interaction affects. Conclusion Smoking, drinkin g spirits and chronic gastric diseases are the major factors of gastric cancer. Giving up unhealthy habits and radically curing chronic gastric diseases in grai n and in the early stage is the one of major measures to reduce the incidence of gastric cancer.     

NQO1C609T、XRCC1G28152A基因多态性与吸烟的交互作用和胃癌的关系

目的 探讨NQO1C609T、XRCC1G28152A基因多态性与吸烟的交互作用和胃癌的关系.方法 采用1∶1配对病例对照研究方法,应用PCR-RFLP对基因多态性进行分析,根据交互系数γ判断交互作用类型,探询胃癌可能的遗传及环境因素.结果 334例胃癌患者,平均年龄在57岁,其中男性占65.3%;病例组吸烟率(55.09%)显著高于对照组(36.53%);NQO1C609T基因杂合突变型(CT)、纯合突变型(TT)增加了胃癌的发病风险(OR值分别为1.507、3.050);XRCC1G28152A基因多态性与胃癌遗传易感性没有关系;同时携带XRCC1AG和NQO1TT个体较XRCC1AG和NQO1CC个体胃癌的发病增加2.789倍;携带XRCC1GG和NQO1TT个体的胃癌发病风险是XRCC1GG和NQO1CC个体的4.448倍;NQO1纯合突变型(TT)与吸烟在胃癌发生中有正向交互作用(OR=4.057,γ=1.272),XRCC1纯合突变型(GG)与吸烟在胃癌发生中有正向交互作用(OR=3.094,γ=2.070).结论 NQO1、XRCC1基因多态性与吸烟的交互作用增加了胃癌发病风险.胃癌的发生表现为基因及环境因素综合作用的结果.

Abstract：

Objective To investigate the relationship between polymorphism of NAD (P)H quinone oxidoreductase 1 (NQO1)and X-ray repair cross-complementing group 1 (XRCC1) and their correlation with smoking on the susceptibility to gastric cancer. Methods A 1:1 case-control study of 334 patients with primary gastric cancer, with non-cancer or alimentary inpatients as control group (matched for ages ± 5 years, sex and reqion) in Anhui province was conducted to analyze theNQO1C609T and XRCC1G28152A. Gene types by PCR-based restriction fragment length polymorphism techniques. Interaction index (γ) was calculated to determine the type of gene- environment interaction. Results The average age of 334 cases of gastric cancer patients was 57 years, with 65.3% of them were male. Smoking rate in the case group (55.09%) was significantly higher than in the control group (36.53%). The consequence showing that it carried the heterozygous variant (CT)or homozygous variant (TT) of NQO1 could enhance the risk of gastric cancer(OR= 1.507,3.050),but not the XRCC1G28152A gene polymorphism or the susceptibility to gastric cancer. At the same time,individuals that carrying XRCC1AG and NQO1TT could increase 2.789 times the incidence of gastric cancer than those who carrying the XRCC1AG or NQO1CC. The gastric cancer risk of XRCC1GG individuals that carrying NQO1TT was 4.448 times higher than those who carrying XRCC1GG or NQO1 CC. The positive interactions of NQO1 homozygous variant (TT) , XRCC1 homozygous variant (GG) and smoking were revealed in the occurrence rates of gastric cancer (OR=3.094,γ =2.070). Conclusion Our research findings showed that the significant interactions between genetic polymorphisms of NQO1, XRCC1 and smoking added the risk of gastric cancer, while genetic and environmental hazardous factors co-effecting the development of gastric cancer.     

骨桥蛋白和基质金属蛋白酶-9在胰腺癌中的表达及其临床意义

Objective To investigate the expression and the role of osteopontin(OPN)and matrix metalloproteinase-9(MMP-9)in the invasion and metastasis of pancreatic carcinoma.Methods Human pancreatic cancer cell line MIA PaCa-2 was cultured in vitro.The location of OPN protein in pancreatic tumor cell line was detected by immunofluorescence staining.100 cases of pancreatic cancer and 40 cases of adjacent normal pancreatic tissues were used to analysis.The expressions of OPN and MMP-9 were investigated by immunohistochemistry assay.Results OPN expressed in the cell membrane and cytoplasm,OPN and MMP-9 in pancreatic cancer tissues positive rates were 73.0%(73/100)and 68.0%(68/100),which were higher than that in adjacent normal pancreatic tissues(all P ＜ 0.05).OPN and MMP-9 expression were associated with pancreatic tumor grade,lymph node metastasis and perineural invasion of pancreatic cancer(P ＜ 0.05).OPN and MMP-9 in pancreatic cancer tissues were positively correlated(r,=0.39,P ＜ 0.01).Conclusions OPN and M MP-2 might play an important role in the development of invasion and metastasis of pancreatic carcinoma.OPN and MMP-2 might play synergetic roles in the progression of pancreatic carcinoma.     

慢性萎缩性胃炎胃镜下不同病理改变及幽门螺杆菌感染情况研究

目的 探讨慢性萎缩性胃炎胃镜下不同病理改变与幽门螺杆菌(Hp)感染的关系.方法 对1623例行胃镜检查后诊断为慢性萎缩性胃炎患者的胃镜形态表现与Hp感染及病理结果进行回顾性分析,探讨不同胃镜表现患者Hp感染的差异及病理表现.结果 胃镜下诊断为慢性萎缩性胃炎482例,其中A组239例(胃镜表现黏膜红白相间以白为主,皱襞变平甚至消失,血管显露),B组243例(胃镜表现黏膜呈颗粒状或结节状).A组患者病理诊断为萎缩性胃炎173例,诊断符合率为72.4%(173/239);B组患者病理诊断为萎缩性胃炎206例,诊断符合率为84.8%(206/243),两组诊断符合率比较差异有统计学意义(P<0.05).A组患者病理结果肠上皮化生24例(10.0%,24/239),不典型增生25例(10.5%,25/239);B组患者病理结果肠上皮化生45例(18.5%,45/243),不典型增生57例(23.5%,57/243).两组肠上皮化生与不典型增生的发生率比较差异有统计学意义(P<0.05).A组患者Hp感染138例,感染率为57.7%(138/239),B组患者Hp感染177例,感染率为72.8%(177/243),两组Hp感染率比较差异有统计学意义(P<0.05).结论 内镜下以黏膜呈颗粒状或结节状为主要表现的慢性萎缩性胃炎合并肠化生、不典型增生及Hp感染率较高,临床上更应该重视其诊断、治疗和随访.

Abstract：

Objective To investigate the relationship between different appearance and pathology change under gastroseope in chronic atrophic gastritis and Helicobacter pylori (Hp) infection. Method The performance of endoscopic morphology, Hp infection and pathology results of patients diagnosed as chronic atrophic gastritis by endoscopy were analyzed retrospectively in 1623 cases and the relationship between different gastroscope forms of change in chronic atrophic gastritis and Hp infection were investigated and the pathological diagnosis results were analyzed retrospectively. Results Four hundred and eighty-two eases were diagnosed as chronic atrophic gastritis in 1623 cases. Group A included 239 patients (endoscopic features were red and white to white-based mucosal, or even flattened folds disappeared, mucosal blood revealed), group B included 243 patients (endoscopic features were granular or nodular mucosa). In group A, 173 eases (72.4%) were diagnosed as atrophic gastritis. In group B, 206 eases (84.8%) were diagnosed as atrophic gastritis. The diagnosis accordance rate of the two groups had significant difference (P < 0.05). In group A, 24 cases (10.0%) showed intestinal metaplasia,and 25 cases( 10.5% ) showed atypical hyperplasia.In group B, 45 cases (18.5%) showed intestinal metaplasia ,and 57 cases (23.5%) showed atypical hyperplasia. The occurrence rates of intestinal metaplasia and atypical hyperplasia had significant difference between the two groups (P< 0.05). The Hp infection rate of group A and group B was 57.7% (138/239) and 72.8% (177/243) respectively, and there was significant difference (P <0.05). Conclusions The incidences of intestinal metaplasia, dysplasia and Hp infection in chronic atrophic gastritis with endoscopic mucosal rough as the main manifestation are higher than those in other forms of chronic atrophic gastritis.More attention should be paid to clinical diagnosis, treatment and follow-up.     

三阴乳腺癌与非三阴乳腺癌预后的比较分析

Objective To assess whether survival differed among patients who had triple-negative breast cancers compared with patients who had non-triple-negative breast cancers.Methods The clinicopathologic data of 684 patients with operable breast cancer,who were treated with multimodal therapy from December 1998 to June 2007 were analyzed.Of these patients,107 cases were confirmed to have triple-negative tumor histology(triple-negative group),577 cases were confirmed to have non-triple-negative tumor histology(non-triple-negative group).The 7 years cumulative survival and disease-free survival were analyzed by Kaplan-Meier method and compared by Log-rank test.The prognosis Was analyzed by COX regression model.Results The 7 years overall survival rates for triple-negative group and non-triple-negative group were 51.4%(55/107),74.2%(428/577),respectively,there Was significant difference between the two groups(P＜0.01).However,the 7 years overall survival rates of patients with triple-negative group and those who with Her-2 positive were 51.4%(55/107)and 53.1%(43/81)respectively,there Was no significant difference between them (P＞0.05).Univariate analysis revealed that the factors affecting the disease-free survival included age,menopausal status,tumor size,lymph nodes metastasis,estrogen,progesterone,and Her-2 receptors status.Multivariate analysis showed minor size,lymph nodes metastasis,estrogen,progesterone,and Her-2 receptors status were independent prognostic factors.Conclusions This study has shown a trend towards a poorer outcome for patients with triple-negative breast cancer similarity to patients with Her-2 positive cancers.Triple-negative breast cancer is an independent predictor factor of survival.     

Toll样受体2及Toll样受体9基因多态性与胃癌易感性的关系

目的 探讨Toll样受体2(Toll-like receptor 2,TLR2)及TLR9基因多态性与胃癌易感性的关系.方法 以山东省临朐县胃癌高发现场人群为基础,选取248例胃癌患者,采用年龄、性别匹配的方法在同一地区按分层随机抽样方法选取496例浅表性胃炎或轻度萎缩性胃炎患者为对照,用聚合酶链式反应-限制性片段长度多态性方法检测TLR2基因rs3804099位点及TLR9基因rs187084位点基因型.采用多因素logistic回归模型并调整年龄、性别、幽门螺杆菌感染及吸烟因素后,计算OR值(95%CI).结果 TLR2基因rs3804099位点TT、TC、CC基因型频率在病例组分别为53.2%(132/248)、39.9%(99/248)、6.9%(17/248),在对照组分别为43.5%(216/496)、46.6%(231/496)、9.9%(49/496),各基因型频率在两组间分布的差异有统计学意义(χ2=6.665,P=0.036).多因素logistic回归显示,以TT基因型为参照,携带TC+CC基因型者发生胃癌的风险明显降低(OR=0.68,95%CI:0.50～0.93).联合效应分析显示,以携带rs3804099位点TC+CC基因型且未感染幽门螺杆菌者为参照,携带TT基因型并感染幽门螺杆菌者发生胃癌的风险明显增加(OR=3.42,95%CI:2.16～5.42).TLR9 基因rs187084位点TT、TC、CC基因型频率在病例组分别为35.9%(89/248)、50.0%(124/248)、14.1%(35/248),在对照组分别为33.3%(165/496)、49.0%(243/496)、17.7%(88/496),各基因型频率在两组间分布的差异无统计学意义(χ2=1.684,P=0.431).结论 TLR2 基因rs3804099位点多态与胃癌发病风险密切相关.

Abstract：

Objective To explore the relationship between the polymorphisms of Toll-like receptor 2(TLR2) and TLR9 and the susceptibility to gastric cancer.Methods A population-based case-control study was conducted at Linqu county,Shandong province,China,including a total of 248 cases of gastric cancer.Another total of 496 age and sex-matched controls were randomly selected from the same cohorts.TLR2 rs3804099 and TLR9 rs187084 were detected by polymerase chain reaction-restriction fragment length polymorphism method.Odds ratios(ORs) and 95% confidence interval(CI) were computed from logistic regression models after adjusting for age,sex,Helicobacter pylori(H.pylori) infection and smoking status.Results The frequencies of TT,TC and CC genotype on TLR2 rs3804099 in control group were 43.5%(216/496),46.6%(231/496) and 9.9%(49/496),respectively; whereas those in case group were 53.2%(132/248),39.9%(99/248) and 6.9%(17/248),respectively.Significant differences in the frequencies of TLR2 rs3804099 were found between case and control groups(χ2=6.665,P=0.036).It was found that compared with the TT genotype,TC+CC genotype carriers obviously less susceptible to gastric cancer(OR=0.68,95%CI:0.50-0.93).Joint effects analysis indicated that the TLR2 rs3804099 TT genotype carriers and H.pylori infectors had higher susceptility to gastric cancer(OR=3.42,95%CI:2.16-5.42),compared with TC+CC genotype carriers and non-H.pylori infection group.The frequencies of TT,TC and CC genotype on TLR9 rs187084 in control group were 33.3%(165/496),49.0%(243/496) and 17.7%(88/496),respectively; whereas those in case group were 35.9%(89/248),50.0%(124/248) and 14.1%(35/248),respectively.No significant association with gastric cancer was observed for TLR9 rs187084 polymorphism(χ2=1.684,P=0.431).Conclusion Our findings indicate that TLR2 rs3804099 is closely associated with susceptibility to gastric cancer.     

经尿道二次电切术对浅表性膀胱癌术后复发的应用分析

目的 探讨经尿道二次电切术对浅表性膀胱癌术后复发的作用.方法 将120例经尿道等离子电切术治疗的浅表性膀胱癌患者采取机械抽样法随机分为两组,每组60例,试验组于首次电切术后4周进行二次电切术,外加丝裂霉素膀胱灌注化疗;对照组于首次电切术后加丝裂霉素膀胱灌注化疗.所有患者术后每3个月行膀胱镜复检,记录肿瘤复发的时间及数量、部位、大小等情况.结果 随访6～24(12.0±6.5)个月,试验组复发13例(21.7%,13/60),对照组复发38例(63.3%,38/60),试验组总体复发率较对照组明显降低(P＜0.01).试验组高级别肿瘤(G2～G3)复发率为26.2%(11/42),对照组为70.0%(35/50),试验组高级别肿瘤复发率较对照组明显降低(P＜0.01).结论 经尿道二次电切术可以降低浅表性膀胱癌(尤其是高级别肿瘤)的术后复发率,可以更准确地进行肿瘤分期和发现残存肿瘤,在临床治疗中有应用价值.

Abstract：

Objective To investigate the effect of repeat transurethral resection for superficial bladder cancer. Methods One hundred and twenty patients who were newly diagnosed superficial bladder cancer were divided randomly in to two groups by mechanical sampling method,60 patients underwent second of prostate TUPKVP 4 weeks after initial transurethral and received adjuvant MMC intravesically (experiment group) and the other 60 patients received adjuvant MMC following the initial TUPKVP(control group). The two groups were followed up by cystoscopy at 3-month intervals,and then compared the recurrences between the two groups. Carcinoma in situ or muscle invasive disease were excluded from the study. Results Mean following up time was 6-24 (12.0 ±6.5) months, within the following up period,recurrence was observed in 13 (21.7%, 13/60) patients in experiment group and in 38 (63.3%,38/60)patients in control group, there was signiticantly statistical difference between the two groups (P＜ 0.01). Of all the recurrences, the recurrence rate of high grade tumor was 26.2% (11/42) in experiment group and 70.0% (35/50) in control group,the recurrence rate in experiment group was obviously less than that in control group (P ＜ 0.01). Conclusions Repeat transurethral resection can lower the recurrence of superficial bladder cancer (especially for the high grade tumor) which with initial resection, it can improve the classification of malignant rumor, and find the residual tumor, so it has value in clinical treatment.     

胃癌患者血清miR-204、HSP-70及IL-2与Hp感染及病情关系研究

目的探讨胃癌患者血清中微小RNA-204(MicroRNA-204,miR-204)、热休克蛋白-70(Heat shock protein-70,HSP-70)及白细胞介素-2(Interleukin-2,IL-2)的变化与幽门螺杆菌(Helicobacter pylori,Hp)感染、TNM分期及淋巴结转移的关系。方法选取2015年1月-2018年10月郑州大学附属肿瘤医院经病理学或胃镜确诊的初诊胃癌患者96例作为胃癌组、胃炎患者96例作为对照组,检测对比两组的血清miR-204、HSP-70及IL-2与Hp感染水平,并按照Hp感染结果、TNM分期、淋巴结转移结果将胃癌组进行分层分析。结果胃癌组的血清HSP-70为(2.33±0.76)pg/ml高于对照组(1.16±0.40)pg/ml(P<0.05);胃癌组的血清miR-204(0.462±0.117)、IL-2(2.26±0.78)ng/ml低于对照组miR-204(1.330±0.205)、IL-2(3.95±0.92)ng/ml(P<0.05);Ⅰ期和Ⅱ期胃癌患者的血清HSP-70水平低于Ⅲ期和Ⅳ期,血清miR-204、IL-2水平高于Ⅲ期和Ⅳ期(P<0.05);Hp感染阳性胃癌患者的血清HSP-70水平高于阴性患者,血清miR-204、IL-2水平低于阴性患者(P<0.05)。结论胃癌患者血清HSP-70、miR-204、IL-2水平异常表达与TNM分期、淋巴结转移及Hp感染有一定的关系。     

直肠癌微血管密度与临床病理因素相关性研究

目的本研究回顾性评价直肠癌微血管密度(MVD)与临床病理因素之间的关系。方法采用免疫组化法对87例手术切除直肠癌标本的癌灶中心运用单克隆鼠抗人CD34抗体进行血管标记和染色,然后与临床病理因素分析。结果不同临床病理因素癌灶中心MVD计数表达不同,有无淋巴结转移的MVD计数分别为98.78±26.15、80.12±18.40(P<0.05);浸润深肌层以内及浆膜层及以外分别为83.39±19.70、89.00±28.21(P>0.05);Dukes分期A+B与C+D分别为82.47±18.40、96.50±21.36(P<0.05)。结论直肠癌不同病理因素中MVD表达不同,随着肿瘤分期的进展、淋巴结转移,微血管密度增加。MVD可以作为直肠癌分期、预测直肠癌转移及预后的重要指标。     

HP感染对胃癌组织中淋巴管密度的影响

目的探讨幽门螺杆菌(Hp)在胃癌淋巴转移中的作用。方法应用免疫组化方法检测80例胃癌标本中D2-40的表达情况并计数淋巴管密度(lymphatic vessel density,LVD),改良Giemsa染色法检测Hp。结果胃癌标本Hp阳性率为66.25%。有淋巴结转移胃癌标本LVD(15.11±7.30)高于无淋巴结转移标本LVD(10.67±3.80),差异有统计学意义(P0.05)。Hp阳性胃癌标本LVD(16.33±6.89)高于Hp阴性胃癌标本LVD(9.10±3.10),差异有统计学意义(P0.05)。胃癌标本中LVD在不同的性别、年龄、组织学分化程度、临床分期的差异无统计学意义。结论 Hp可能对胃癌的淋巴转移起促进作用。     

血管内皮生长因子C(VEGF-C)在宫颈癌血清中的表达及临床意义

目的:探讨宫颈癌患者血清中血管内皮生长因子C水平与淋巴结转移的关系。方法:采用ELISA法检测13例正常对照、18例宫颈上皮内瘤变CINII/III、31例无淋巴结转移宫颈癌患者、10例淋巴结转移宫颈癌患者血清中VEGF-C的表达并比较各组间差异性。结果:①宫颈癌组无淋巴结转移者血清VEGF-C水平高于正常宫颈组及CIN组,差异有统计学意义(P<0.05),有淋巴结转移者血清VEGF-C水平高于宫颈癌组无淋巴结转移组,差异有统计学意义(P<0.05)。宫颈CINII/III组血清VEGF-C水平与正常宫颈组相比,差异无统计学意义(P>0.05);②浸润深度≤1/2宫颈癌患者血清中VEGF-C的表达较浸润深度>1/2的患者表达较低,差异有统计学意义(P<0.05)。结论:宫颈癌患者血清VEGF-C水平升高可能与宫颈癌淋巴结转移有关,可能成为推测宫颈癌淋巴结转移的有用指标;VEGF-C与宫颈癌浸润深度及淋巴结转移有关,提示其可能预示宫颈癌不良预后,宫颈癌患者血清VEGF-C水平变化有可能成为宫颈癌早期诊断指标之一。     

胃癌中C—erbB-2和nm23基因的表达及其临床意义

目的探讨癌基因C—erbB-2、nm23在胃癌中的表达及其与胃癌发展的关系。方法应用免疫组织化学方法检测85例胃癌组织的C—erbB-2和nm23的表达,分析其与胃癌生物学行为之间的关系。结果（1）85例胃癌标本中C—erbB-2及nm23表达率分别为74．1％（63／85）,52．9％（45／85）;（2）c—erbB-2阳性表达与胃癌部位,肿瘤大小及肿瘤浸润深度密切相关,与胃癌组织学类型及淋巴结转移无明显相关;（3）无淋巴结转移及Ⅰ＋Ⅱ期胃癌的nm23的表达率（85．7％及72．7％）,显著高于伴有淋巴结转移及Ⅲ＋Ⅳ期病例（42．2％及46．0％）（P〈0．01及P〈0．05）;（4）C—erbB-2阳性和nm23低表达者对肿瘤的侵袭和肿瘤发展过程可能有协同作用（P〈0．01及P〈0．05）。结论C—erbB-2对胃癌的生长和浸润有促进作用,nm23在伴有淋巴结转移的肿瘤中呈低表达;C—erbB-2和nm23可作为反映胃癌生物学行为的指标之-。     

术前中性粒细胞/淋巴细胞比值与胃癌患者病理特征及其预后的相关性研究

目的探讨术前中性粒细胞/淋巴细胞比值(NLR)与胃癌患者临床病理特征及其预后的相关性。方法选取2008年9月-2010年12月于我院行胃癌根治术的胃癌患者100例,收集患者的临床资料、病理学资料、影像学资料等,采外周血进行检测,计算术前NLR,对患者各项临床资料进行单因素分析,通过Cox回归模型探讨NLR与胃癌患者预后生存的关系。结果本组中不同性别、年龄、肿瘤大小和分化程度NLR比较差异无统计学意义(P0.05);有淋巴结转移者NLR高于无淋巴结转移者,TNM分期越高NLR水平越高(P0.05)。单因素分析显示,不同肿瘤大小、肿瘤分化程度、淋巴结转移、TNM分期、NLR胃癌患者5年生存率比较差异有统计学意义(P0.01)。多因素Cox分析显示,分化程度(低分化)、TNM分期(Ⅲ期)、NLR(NLR≥3)为影响胃癌患者5年生存率的独立危险因素(P0.001)。结论胃癌患者具有低分化、预后差等临床病理特征,术前NLR≥3是影响胃癌预后的独立危险因素。     

幽门螺杆菌和维生素C与胃黏膜病变关系的研究

目的 研究Hp感染和胃液中维生素C浓度与胃黏膜病变的关系,探讨Hp致病、致癌机制.方法 用高铁还原法测定胃液中维生素C浓度,用快速尿素酶试验、病理Giemsa染色和细菌培养检测Hp.对部分Hp阳性的胃部良性病变患者进行Hp根除治疗,并比较治疗前后胃液中维生素C浓度的变化.结果 Hp阳性各胃部病变组患者胃液中维生素C浓度分别为:慢性浅表性胃炎组(18.3±4.5)mg/L、萎缩性胃炎伴肠上皮化生组(9.1±3.3)mg/L、异型增生组(8.2±2.7)mg/L、胃癌组(5.2±1.6)mg/L,与对照组[(35.2±7.2)mg/L]比较差异均有统计学意义(P＜0.05);经Hp根除治疗后,Hp根除患者胃液中维生素C浓度恢复正常,而Hp未根除患者其胃液中维生素C浓度治疗前后无明显变化.结论 Hp感染可导致胃液中维生素C浓度降低,这可能是Hp致病、致癌机制之一;根除Hp可以恢复胃液中维生素C浓度,这有利于预防胃癌的发生.     

血清 MG7-Ag、PGI、VEGF 在胃癌患者中的变化及临床意义

目的：探讨血清胃癌单抗MG7相关抗原（ MG7-Ag）、胃蛋白酶原（ PG）、血管内皮生长因子（ VEGF）在胃癌患者中的变化及临床意义。方法应用ELISA法测定正常对照组（40例）、胃溃疡组（45例）、萎缩性胃炎组（45例）及胃癌组（40例）血清MG7-Ag、PGI、VEGF水平,分析胃癌患者临床特征与血清MG7-Ag、PGI、VEGF水平的关系。结果胃癌组患者血清MG7-Ag、VEGF水平高于对照组、胃溃疡组及萎缩性胃炎组,胃溃疡组、萎缩性胃炎组及胃癌组血清PGI水平低于对照组,且胃癌组最低,差异均有统计学意义（ P＜0．05）。胃癌组中TNM分期Ⅲ～Ⅳ期、低分化及淋巴转移患者血清MG7-Ag、VEGF水平高于TNM分期Ι～Ⅱ期、中高分化及非淋巴转移患者,而血清PGI水平低于TNM分期Ι～Ⅱ期、中高分化及非淋巴转移患者,差异均有统计学意义（P＜0．05）。结论胃癌患者血清MG7-Ag、VEGF水平显著增高,PGI水平显著降低,转移、恶化者尤甚。     

上皮钙粘素和基质金属蛋白-2在胃癌组织的表达及意义

目的探讨上皮钙粘素和基质金属蛋白酶-2(MMP2)在胃癌组织浸润和转移中的表达和意义。方法采用SP免疫组化法检测胃癌组织及胃良性病变中E-cadherin和MMP2表达情况。计数资料采用χ2检验,P<0.05为差异有统计学意义。结果 E-cadherin在胃癌中的表达低于胃部良性病变,在淋巴结转移组低于无淋巴结转移组(P<0.05),在浸润组的表达低于无浸润组的表达(P<0.05),在胃癌低分化组的表达低于高中分化组(P<0.05)。MMP2在胃癌中的表达高于胃部良性病变,在淋巴结转移组高于无淋巴结转移组(P<0.05),在浸润组的表达高于无浸润组的表达(P<0.05),在胃癌低分化组高于高中分化组(P<0.05)。同时,两者在胃癌中的表达存在相关性(P<0.05)。结论胃癌中存在E-cadherin下调和MMP2上调且两者具有相关性,两者的联合测定有助于判断胃癌患者的病期及预后。     

基质金属蛋白酶-9表达与胃癌侵袭和转移的关系

目的：观察胃癌组织中基质金属蛋白酶9（mmp-9）的表达与侵袭程度和淋巴结转移的关系。方法：应用免疫组化S-19法检测67例胃癌组织中mmp-9的表达。结果：mmp-9表达强度与早期胃癌及进展期胃癌的病理分期显著相关（P〈0．01），与淋巴结有无转移显著相关（P〈0．01）。结论：ppm-9表达强度与胃癌分期以及有无淋巴结转移有显著相关性，是判断胃癌分期和转移有价值的指标。