腹腔镜全膀胱切除术加回肠原位膀胱术的临床疗效观察 （附15例报告）

目的：总结腹腔镜下膀胱肿瘤根治术加回肠原位膀胱术的经验。方法：15例患者中男11例, 女4例, 年龄46～72岁,平均61.8岁, 采用5点穿刺法, 腹腔镜由脐部下缘导管进入, 手术者经左侧2个套管操作, 助手经右侧2个套管操作。从右到左分别游离输尿管中下段并进行盆腔淋巴结清扫, 输尿管暂不离断。男性患者先游离并离断输精管、 精囊, 前列腺后壁及前壁, 紧贴前列腺尖部离断尿道, 再行膀胱前列腺全切; 女性患者在行膀胱全切除的同时作子宫及附件切除。在下腹正中线上作长4～5 cm切口, 取出标本, 回肠拉出切口外, 取回盲部交界15 cm近侧隔离50 cm回肠段纵行剖开该肠后M形折叠形成贮尿囊, 将输尿管末段1 cm插入贮尿囊后顶部作吻合。贮尿囊最低位开口与尿道断端行6针吻合。结果：手术耗时5～8 h, 平均6.3 h, 出血量400～800 mL, 平均447 mL, 术后所有患者3～4 d肠道功能开始恢复,1个月行B超、 IVU及新膀胱造影检查示： 双肾显影良好, 无输尿管返流及梗阻, 新膀胱充盈良好, 容量约300 mL,15例患者均于术后4～6周内均恢复控尿能力, 无排尿困难及尿失禁症状。结论：腹腔镜下行膀胱全切除视野清楚, 有助于精确地处理盆底深部的重要结构, 术中出血少, 尿道括约肌损伤概率较小, 有助于减少术后肠粘连, 保护身体的免疫机制, 减少术后感染, 小切口取出标本, 体外构建贮尿囊, 吻合输尿管, 可缩减手术时间, 减少腹腔内污染。     

改良阑尾输出道,盲升结肠可控膀胱术(附2例报告)

我院 1997年 7月～ 1999年 12月对 2例膀胱癌患者行全膀胱切除术并应用改良脐部造口阑尾输出道 ,盲升结肠可控性膀胱术 ,手术疗效满意。现报告如下。临床资料 :2例患者均为男性 ,5 2岁 ,48岁各 1例。病程 2～ 15个月。膀胱镜检查 :1例病变位于膀胱颈 6～ 12点 ,三角区及左侧壁 ,约 6× 6× 6ｃｍ ,菜花状 ,广基。另 1例病变位于膀胱底部偏右及三角区 ,约 7× 6× 5ｃｍ ,菜花状 ,广基。病理均为移行细胞癌。手术方法 :根治性全膀胱切除 ,盆腔淋巴结清扫。取盲升结肠 30ｃｍ并附末段回肠 10ｃｍ。近段回肠与横结肠吻合恢复肠道连续性。 0 .0 …     

人工胃底折叠重建His角的抗反流作用——附食管胃连接部癌102例分析

目的探讨人工胃底折叠重建His角预防食管胃连接部癌根治术后吻合口反流的价值。方法食管胃连接部癌根治术中利用人工胃底折叠重建His角，使其接近恢复食管胃连接部的生理解剖。术后通过上消化道造影及胃镜检查来评定其抗反流效果。结果实验组51例，无手术死亡，无吻合口狭窄及吻合口瘘，上下切缘均无癌残留。其中6例有反流症状，反流发生率11．8％；对照组51例，有反流者22例，反流发生率43．1％。两组反流发生率差别有统计学意义（P〈0．001）。结论该术式具有较好的抗反流作用，且具有操作简单、安全等优点。     

可溶性TRAIL分子的同源性模建

目的:为进一步研究其结构与功能的关系.方法:利用MSI公司的Insight Ⅱ分子模拟软件,参照TNF-α的三级结构信息文件,对TRAIL分子胞外区的R117到G281共165个氨基酸残基进行了同源性模建;并利用Profile-3D程序中的Inverse Fold-ing方法对模建结果进行可靠性分析.结果:模建出的TRAIL分子共含10个β-片层结构,且这些β-片层均对应于TNF-α中相应的β-片层区.这与同一家族的分子在结构保守区,特别是形成二级结构的保守区中序列组成变化不大的理论相吻合.而且验证模建结果的结果可靠性积分值为55.80.结论:模建结果基本正确,为TRALL的结构与功能研究提供了基础.     

African Organization for Research and Training in Cancer: position and vision for cancer research on the African Continent

The African Organization for Research and training in Cancer (AORTIC) bases the following position statements on a critical appraisal of the state on cancer research and cancer care in Africa including information on the availability of data on cancer burden, screening and prevention for cancer in Africa, cancer care personnel, treatment modalities, and access to cancer care.     

直肠拖出双吻合器21例超低位直肠癌保肛手术应用

[目的]探讨直肠拖出双吻合器保肛术在超低位直肠癌的临床应用价值。[方法]1999年1月～2006年12月对21例超低位直肠癌采用直肠拖出双吻合器技术行保肛手术切除。[结果]全组21例患者手术均获得成功,术后发生吻合口瘘1例,发生率为4．8％。术后控便功能优12例、良8例、差1例,术后肿瘤复发3例（14.3％1,出现吻合口狭窄3例（14．3％）,无手术死亡。[结论]直肠拖出双吻合器技术行超低位直肠癌保肛术能较好保留排尿、排便及性功能,提高了超低位直肠癌保肛手术的成功率。     

放疗联合卡莫氟治疗颈、上胸段食管癌疗效观察

[目的]评价放射治疗联合卡莫氟治疗食管癌的疗效。[方法]比较30例颈段和上胸段食管癌放疗合并卡莫氟(观察组)增敏治疗与30例颈段和上胸段食管癌单纯放疗(对照组)疗效及副作用。[结果]观察组:完全缓解率50.0%、1年生存率73.3%、3年生存率26.7%、放射性食管炎发生率26.7%、白细胞下降发生率36.7%;对照组:完全缓解率23.3%、1年生存率46.7%、3年生存率23.3%,放射性食管炎发生率20.0%、白细胞下降发生率26.7%。两组完全缓解率和1年生存率比较,差异有显著性(P<0.05),其余指标差异均无显著性(P>0.05)。[结论]放疗合并卡莫氟治疗颈段和上胸段食管癌能提高近期疗效,耐受性较好。     

The Carcinogenic Liver Fluke Opisthorchis viverrini is a Reservoir for Species of Helicobacter

There has been a strong, positive correlation between opisthorchiasis-associated cholangiocarcinoma andinfection with Helicobacter. Here a rodent model of human infection with Opisthorchis viverrini was utilized tofurther investigate relationships of apparent co-infections with O. viverrini and H. pylori. A total of 150 hamsterswere assigned to five groups: i) Control hamsters not infected with O. viverrini; ii) O. viverrini-infected hamsters;iii) non-O. viverrini infected hamsters treated with antibiotics (ABx); iv) O. viverrini-infected hamsters treatedwith ABx; and v) O. viverrini-infected hamsters treated both with ABx and praziquantel (PZQ). Stomach,gallbladder, liver, colonic tissue, colorectal feces and O. viverrini worms were collected and the presence ofspecies of Helicobacter determined by PCR-based approaches. In addition, O. viverrini worms were cultured invitro with and without ABx for four weeks, after which the presence of Helicobacter spp. was determined. In situlocalization of H. pylori and Helicobacter-like species was performed using a combination of histochemistry andimmunohistochemistry. The prevalence of H. pylori infection in O. viverrini-infected hamsters was significantlyhigher than that of O. viverrini-uninfected hamsters (p≤0.001). Interestingly, O. viverrini-infected hamsters treatedwith ABx and PZQ (to remove the flukes) had a significantly lower frequency of H. pylori than either O. viverriniinfectedhamsters treated only with ABx or O. viverrini-infected hamsters, respectively (p≤0.001). QuantitativeRT-PCR strongly confirmed the correlation between intensity H. pylori infection and the presence of liver flukeinfection. In vitro, H. pylori could be detected in the O. viverrini worms cultured with ABx over four weeks. Insitu localization revealed H. pylori and other Helicobacter-like bacteria in worm gut. The findings indicate thatthe liver fluke O. viverrini in the biliary tree of the hamsters harbors H. pylori and Helicobacter-like bacteria.Accordingly, the association between O. viverrini and H. pylori may be an obligatory mutualism.     

Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire

BACKGROUND: Quality-of-life instruments that measure specific functional consequences of mucositis are needed to assess the efficacy of therapeutic interventions targeted against mucositis and to guide patient care. The authors undertook a prospective, multicenter, observational study to assess the validity, reliability, and feasibility of a new instrument, the Oral Mucositis Weekly Questionnaire-Head and Neck Cancer (OMWQ-HN). The OMWQ-HN is a patient-reported outcome questionnaire that measures the symptoms of mucositis, including mouth and throat soreness (MTS), and their impact on patient well-being and function. METHODS: The OMWQ-HN, along with the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN), was administered 5 times over an approximately 6-week period to patients with head and neck cancer (HNC) who were receiving radiation therapy with or without chemotherapy. Information on supportive care measures also was collected. RESULTS: Seventy-five patients were enrolled and completed 93% of scheduled assessments (100% at baseline). The OMWQ-HN demonstrated good test-retest reliability (correlation coefficient, 0.80-0.89). Cross-sectional analyses to assess validity showed that OMWQ-HN scores were different across levels of pain, with those in the worst pain category reporting the highest OMWQ-HN scores. Strong correlations were observed between OMWQ-HN and FACT-HN. Patients experienced increases in MTS, which corresponded with a steady decline in function. MTS scores were highest in the patients who were taking opioid analgesics, suggesting that mucositis pain continued despite standard pain therapy. CONCLUSIONS: The current results indicated that the OMWQ-HN is a valid, reliable, and feasible instrument for assessing the impact of mucositis on patients who are receiving radiation therapy with or without chemotherapy for HNC.     

间置空肠人工贲门在抗返流性食管炎上的应用

我们自1991年11月起,在对食管下贲门癌根治术的同时,行间置空肠人工贲门成形术,通过术后5例病人的临床观察,上消化道钡餐电视录像、纤维胃镜检查及pH检测对比,并进行分析讨论,证实了间置空肠人工贲门在抗返流性食管炎上的有效的单向性屏障作用.     

Longitudinal study on birthweight and the incidence of endometrial cancer

From 1976 to 2004, we followed 71,751 participants of the Nurses' Health Study and identified 676 invasive endometrial cancer cases. Birthweight, assessed in 1992, was not associated with the incidence of endometrial cancer. No effect modification by menopausal status was observed, but statistical power to detect an interaction was limited.