VX2移植性兔直肠癌淋巴结转移动物模型的建立及其生物学特性

背景与目的：直肠癌淋巴结转移模型是研究肿瘤发生、发展、转移及抗肿瘤治疗的工具,但较大型动物模型鲜见报道。该研究旨在建立可行性强、重复率高的VX2移植性兔直肠癌淋巴结转移模型。方法：采用原位移植方法,将切好的小瘤块置入穿刺针内,并使用穿刺针将小瘤块推入到新西兰大白兔的直肠壁内。共制作模型20只。每周使用MR扫描2只实验兔,MR上观察肿瘤生长情况及肠周淋巴结个数,使用MR后处理软件测量实验兔的直肠壁肿瘤体积,扫描完成后进行详细解剖,切除直肠壁上肿瘤及肠周淋巴结,进行标本固定及HE染色,并探讨肿瘤体积与生长时间及转移淋巴结个数的关系。结果：成功制作模型13只,成功率为65%。于第4周开始在MR上可观察到局限于直肠壁肿块。随着时间增长,肿瘤体积不断增大,且不同时期(生长周数)肿瘤体积差异有统计学意义(F=52.865,P<0.05);进一步分析得出,肿瘤的平均体积与生长周数呈正线性相关(r=0.910),差异有统计学意义(P<0.05)。当肿瘤体积大于9 cm3时,实验兔开始出现转移性淋巴结,第9周开始转移淋巴结个数明显增多。统计分析得出肿瘤体积越大,转移性淋巴结个数就越多(F=92.531, P<0.05),且两者呈线性相关(r=0.945),差异有统计学意义(P<0.05)。结论：本实验将组织学完整的VX2移植瘤组织块原位种植到新西兰大白兔直肠内,成功建立了VX2移植性兔直肠癌的淋巴结转移模型。本模型对于研究直肠癌的局部生长、浸润机制、淋巴结转移灶及生物学特性均有一定价值。     

高频彩色多普勒超声联合超声造影在乳腺癌腋下转移性淋巴结鉴别诊断中的应用

目的:探讨高频彩色多普勒超声联合超声造影对乳腺癌腋下转移性淋巴结鉴别诊断的价值。方法:收集2017年1月至2018年6月入住我院并经病理证实的女性乳腺癌患者87例,转移淋巴结患者45例,未转移患者42例,所有患者术前均行高频彩色多普超声检查和超声造影检查,对高频彩色多普超声检查和超声造影检查的诊断结果进行分析。结果:乳腺癌患者转移性淋巴结皮质增厚程度显著高于未转移淋巴结,同时其L/S值较未转移淋巴结相比,显著降低;未转移淋巴结血流表现以门型（64.29%）为主,转移淋巴结血流表现以周围型（68.89%）为主（P<0.001）;未转移淋巴结血流信号以2级（71.43%）为主,转移淋巴结血流信号以3级（71.11%）为主（P<0.001）;未转移淋巴结超声造影以均匀强化（78.57%）为主,转移淋巴结以周围型或混合型强化（75.56%）为主(P<0.001);未转移淋巴结超声造影强化时间显著低于转移淋巴结者(P<0.001);高频彩色多普勒超声联合超声造影诊断乳腺癌患者腋窝淋巴结转移的灵敏度、特异度、正确率及约登指数等均高于高频彩色多普勒超声或者超声造影单独诊断;高频彩色多普勒超声联合超声造影诊断下ROC曲线下面积与单独高频彩色多普勒超声、单独超声造影诊断下ROC曲线下面积差异均具有统计学意义（P<0.05）。结论:高频彩色多普勒超声与超声造影联合应用可以提高乳腺癌腋下淋巴结转移的鉴别诊断水平。     

高频彩超诊断乳腺癌腋窝转移性淋巴结的临床价值

 目的　评价彩超与临床触诊在诊断乳腺癌腋窝转移性淋巴结中的价值。方法　 60例乳腺癌行腋窝淋巴结清扫术患者作术前前瞻性彩超检查 ,并和术后病理对照 ,双盲法观察分析影像所见 ,将其结果做统计学处理。结果　在 60例乳腺癌腋窝淋巴结清扫术后病理检查中 3 3例有转移性淋巴结。临床触诊检出其中 1 7例 (敏感性 5 1 .5 %、特异性 88.9%、准确性 68.3 % ) ,彩超检出 2 8例 (敏感性 84.8%、特异性1 0 0 %、准确性 88.3 % )。彩超可确诊 68.7%临床漏诊的隐匿性转移淋巴结。结论彩超明显优于临床检查 ,是目前预计腋窝淋巴结是否受累的较准确方法     

按第七版肺癌T分期和新分级与淋巴结转移关系分析

目的:探讨第7版肺癌T分期和新分级与淋巴结转移的关系.方法:回顾性分析442例行根治性切除及淋巴结清除术的肺癌患者的临床资料、原发肿瘤大小、淋巴结转移情况,运用SPSS软件行数据分析.结果:442例肺癌淋巴结转移率为39.1%,其中肺内淋巴结转移率为17.6%,纵隔淋巴结为7.2%、既有肺内又有纵隔淋巴结转移为14.3%;T1、T2、T3、T4期的淋巴结转移率分别为25.4%、45.3%、41.1%、53.8%,4组间P=0.002.T1与T2、T3、T4间淋巴结转移率比较差别有显著性.T2、T3、T4间两两比较淋巴结转移率无显著差别.N1淋巴结转移例数T1、T2、T3、T4间 P=0.274.N2淋巴结转移例数T1、T2、T3、T4间P=0.001.T1a淋巴结转移率为16.4%,T1b淋巴结转移率为32.0%,两者P=0.043.T2a淋巴结转移率为43.9%,T2b淋巴结转移率为48.1%,P>0.05.结论:第七版肺癌T分期的不同,淋巴结转移率有显著差别,其差别主要在N2上,T1 淋巴结转移率最低.肿瘤大小的分级与淋巴结转移率有关,T1a与T1b比有显著差异,但T2a与T2b间无差别.     

Prognostic role of p‐mTOR expression in cancer tissues and metastatic lymph nodes in pT2b gastric cancer

Despite the great interest in mammalian target of rapamycin (mTOR) as a potential anticancer therapy target, the prognostic role of mTOR in gastric cancer has not been elucidated. In this study, we investigated mTOR expression in gastric cancer tissues and in metastatic lymph nodes and examined its association with clinical outcome. A total of 290 patients with pT2b gastric cancer were enrolled in this study. Patients were divided into 3 groups according to metastatic lymph node status: Group 1 contained 96 patients without lymph node metastasis, Group 2 contained 102 patients with a few (1–2) metastatic lymph nodes and Group 3 contained 92 patients with extensive (>16) lymph node metastasis. Phosphorylated mTOR expression was determined immunohistochemically using tissue microarrays. p‐mTOR expression was observed in 36.5% of the gastric cancer tissues in Group 1, 39.2% in Group 2 and 60.9% in Group 3. A significant correlation was found between p‐mTOR expression in gastric cancer tissues and in metastatic lymph nodes. The Borrmann type in Group 1, perineural invasion and p‐mTOR expression in metastatic lymph nodes in Group 2 and p‐mTOR expression in metastatic lymph nodes in Group 3 were found to be independent prognostic factors of disease‐free survival. The 5‐year disease free survival rate of Group 2 patients was 84.4% in negative p‐mTOR and 66.1% in positive p‐mTOR expression in metastatic lymph nodes (p = 0.015). The 5‐year disease free survival rate of Group 3 patients was 37.3% in negative p‐mTOR and 14.9% in positive p‐mTOR expression in metastatic lymph nodes (p = 0.037). There was a linear correlation between the rate of tumor recurrence and mTOR expression scores in metastatic lymph nodes. In pT2b gastric cancer, p‐mTOR expression in gastric cancer is associated with the extent of lymph node metastasis, and p‐mTOR expression in metastatic lymph nodes is correlated with poor disease‐free survival. mTOR may harbor significant potential for a prognostic biomarker and therapeutic target for gastric cancer treatment.     

按第七版肺癌T分期和新分级与淋巴结转移关系分析

目的：探讨第7版肺癌T分期和新分级与淋巴结转移的关系。方法：回顾性分析442例行根治性切除及淋巴结清除术的肺癌患者的临床资料、原发肿瘤大小、淋巴结转移情况,运用SPSS软件行数据分析。结果：442例肺癌淋巴结转移率为39.1%,其中肺内淋巴结转移率为17.6%,纵隔淋巴结为7.2%、既有肺内又有纵隔淋巴结转移为14.3%;T1、T2、T3、T4期的淋巴结转移率分别为25.4%、45.3%、41.1%、53.8%,4组间P=0.002。T1与T2、T3、T4间淋巴结转移率比较差别有显著性。T2、T3、T4间两两比较淋巴结转移率无显著差别。N1淋巴结转移例数T1、T2、T3、T4间P=0.274。N2淋巴结转移例数T1、T2、T3、T4间P=0.001。T1a淋巴结转移率为16.4%,T1b淋巴结转移率为32.0%,两者P=0.043。T2a淋巴结转移率为43.9%,T2b淋巴结转移率为48.1%,P〉0.05。结论：第七版肺癌T分期的不同,淋巴结转移率有显著差别,其差别主要在N2上,T1淋巴结转移率最低。肿瘤大小的分级与淋巴结转移率有关,T1a与T1b比有显著差异,但T2a与T2b间无差别。     

Photodynamic detection of diseased axillary sentinel lymph node after oral application of aminolevulinic acid in patients with breast cancer

Benign as well as malignant tumour tissues of the breast demonstrate higher fluorescence intensity (FI) than normal breast tissue after application of a photosensitiser. As a follow-up study, we evaluated the FI of metastatic sentinel lymph nodes and metastatic axillary lymph nodes compared to nonmetastatic sentinel and axillary lymph nodes in patients with breast cancer. In all, 11 patients received 30 mg 5-aminolevulinic acid (ALA) kg(-1) bodyweight orally 3 h prior to surgery. The sentinel lymph node was marked with Nanocoll preoperatively and with a blue dye intraoperatively. Tumour excision, excision of the sentinel lymph node and an axillary lymph node dissection were performed during the same surgical session. The operation site was illuminated with blue light (400 nm) to obtain macroscopic tissue characterisation of fluorescence. Tissue samples were stored protected from light, and analysed using a fluorescence microscope. Results were correlated with histopathology. In all, 14 sentinel lymph nodes, seven axillary lymph nodes and seven primary tumours were analysed. Metastatic sentinel lymph nodes demonstrated a statistically significant higher FI than nonmetastatic sentinel lymph nodes (2630 vs 526, P<0.0001). The FI of metastatic sentinel lymph nodes, of metastatic axillary lymph nodes and of the primary tumour were comparably high, and were statistically significantly higher compared to the normal mammary tissue. Intraoperatively, only in a few cases, it was possible to recognise the metastatic sentinel lymph node macroscopically with blue light. Our study indicates that photodynamic diagnosis with ALA has a potential in the diagnosis and detection of the sentinel lymph node in patients with breast cancer, and is worth to be further investigated and developed for intraoperative photodynamic diagnosis and possibly therapy.     

彩色多普勒超声预测鼻咽癌颈部转移淋巴结放疗敏感性的研究

 目的 探讨彩色多普勒超声预测鼻咽癌颈部转移淋巴结放疗敏感性的应用价值。方法 对138例首程放疗的鼻咽癌患者的颈部转移淋巴结行放疗前、放疗中彩色多普勒超声检查，了解其血供情况，测定有关血流参数，定期检查淋巴结转移灶消退程度和速度。结果 鼻咽癌颈部转移淋巴结血供丰富者，放疗疗效优为89.7%，明显高于血供中等者（70.0 %）、血供贫乏者（50.0 %）（P＜0.05），血供与病灶消退呈正相关系；病灶直径＜4 cm者，放疗疗效优为90.6 %，直径≥4 cm者为50.0 %（P＜0.05），病灶消退与本身大小呈负相关（P＜0.05）。结论 彩色多普勒超可初步作为鼻咽癌颈部转移淋巴结放疗敏感性预测指标之一。     

胸段食管鳞癌颈部淋巴结转移特点及其临床意义

背景与目的：食管癌颈部淋巴结转移率较高,但少有专门报道。本研究分析胸段食管鳞癌颈部淋巴结转移特点,探讨其临床意义。方法：选择1993年1月—2003年12月在福建省肿瘤医院行胸段食管鳞癌三野淋巴结清扫根治术患者1 131例,对术后病理证实颈部淋巴结转移患者376例的具体情况进行分析。结果：全组颈部淋巴结转移率为33.2%,其中胸上、中及下段的颈部淋巴结转移率分别为43.7%、33.0%和16.0%。单因素分析显示,颈部淋巴结转移率与肿瘤部位、病理分化程度、病变X线长度、pT分期以及淋巴结转移个数有关(P<0.05),但多因素回归分析显示,颈部淋巴结转移率只与肿瘤部位、pT分期及淋巴结转移个数有关(P<0.05)。颈段食管旁淋巴结转移最多见,其次是锁骨上淋巴结转移,颈深淋巴结及咽后淋巴结转移少见;胸上、中及下段的颈部淋巴结转移数占该段淋巴结总转移数的比率分别为57.7%、32.0%和10.0%,差异有统计学意义(P<0.05);各段食管癌右颈部淋巴结转移多于左颈部。结论：影响胸段食管鳞癌颈部淋巴结转移独立因素是肿瘤部位、pT分期及淋巴结转移数;颈段食管旁淋巴结转移最多见,其次是锁骨上淋巴结转移,颈深淋巴结及咽后淋巴结转移少见。     

100例腹股沟淋巴结清扫术的临床分析

目的探讨腹股沟淋巴结清扫术在不同癌肿中的意义。方法回顾性分析2000～2006年间本院收治的100例腹股沟淋巴结清扫术患者，其中恶性黑色素瘤78例，软组织肉瘤8例，直肠肛管腺癌12例，其他2例。结果全部患者均行腹股沟淋巴结清扫术，极少病例发生炎症，淋巴管炎及下肢水肿，100例中共有47例证实为淋巴结转移，共清扫654枚淋巴结，其中192枚（29％）为转移。47例有淋巴结转移组随访，27例健在，20例死亡。结论某些恶性黑色素瘤病例实施腹股沟淋巴结清扫术是安全及必要的，今后应根据AJCC制定的新分期确定治疗方案。     

甲状腺癌颈部淋巴结转移区域的超声特点研究

目的：探究甲状腺癌颈部淋巴结转移区域的超声特点。方法回顾性分析58例甲状腺癌患者的临床资料。将患者术前颈部淋巴结转移区域的超声诊断与患者的病理诊断进行比较,分析其超声表现的特点。结果58例患者中经术前超声诊断显示,有36例（62．07％）颈部淋巴结转移,其中3例单纯中央区淋巴结转移、18例单纯颈侧区淋巴结转移、15例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为31．03％,显著低于颈侧区淋巴结转移率56．89％。病理诊断结果显示,58例患者中有33例（56．89％）颈部淋巴结转移,其中21例单纯中央区淋巴结转移,2例单纯颈侧区淋巴结转移,10例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为53．44％,显著高于颈侧区淋巴结转移率20．68％。超声诊断颈部转移性淋巴结的特异性为80．0％（12／15）,敏感性为100．0％（33／33）。超声检查对中央区转移性淋巴结的检出率为58．06％（18／31）,显著低于颈侧区转移性淋巴结的检出率100．0％（12／12）。超声诊断颈侧区淋巴结转移与病理结果的符合率为36．36％（12／33）,显著低于中央区淋巴结转移与病理结果的符合率58．06％（18／31）,差异具有统计学意义（P＜0．05）。颈侧区和中央区中淋巴门回声消失和低回声占较高的比例,且颈侧区和中央区颈侧区转移性淋巴结中L／T＜2所占的比例差异具有统计学意义（P＜0．05）。结论甲状腺癌多转移至颈部中央区淋巴结,采用超声检查具有较高的特异性,对中央区淋巴结的诊断有十分重要的意义。     

超声弹性成像对乳腺癌腋窝淋巴结诊断价值的探讨

目的：腋窝淋巴结性质是影响乳腺癌预后的重要因素,也是临床选择治疗方式的重要依据。通过常规超声、超声弹性成像及二者联合的方法探讨诊断乳腺癌患者反应性淋巴结和转移性淋巴结的临床价值。方法选择2015-10-01－2016-04-30山东大学附属山东省肿瘤医院乳腺外科42例乳腺癌患者,共66个同侧腋窝淋巴结,应用常规超声、超声弹性成像评分法检查,与手术病理结果对照。结果在66个淋巴结中,反应性淋巴结34个,转移性淋巴结32个。常规超声反应性淋巴结得分1．12±0．98,转移性淋巴结得分2．53±1．37,差异有统计学意义,P ＜0．05。超声弹性成像反应性淋巴结得分2．21±0．64,转移性淋巴结得分3．13±0．66,差异有统计学意义,P ＜0．05。常规超声、超声弹性成像及二者联合的灵敏度分别为71．9％、84．4％和87．5％,特异度分别为76．5％、67．6％和52．9％,准确度分别为57．0％、58．1％和69．7％,三者受试者工作特征（receiver operating characteristic curve,ROC）曲线下面积分别为0．783、0．815和0．932,联合应用与常规超声比较差异有统计学意义,Z ＝2．28,P ＜0．05;联合应用与弹性成像比较,差异无统计学意义, Z ＝1．95,P ＞0．05;常规超声与弹性成像比较差异无统计学意义,Z ＝0．41,P ＞0．05。结论常规超声联合超声弹性成像有助于提高乳腺癌腋窝淋巴结性质的诊断效能。     

超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值

目的 探究超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值.方法 选取51例甲状腺癌患者为研究对象,利用超声对患者的甲状腺及颈部肿大淋巴结进行诊断,并将超声诊断结果与术后病理诊断结果进行比较.结果 经超声探测的51例患者颈部转移性淋巴结为109枚,非转移性淋巴结16枚;术后病理检测患者颈部转移性淋巴结98枚,非转移性淋巴结12枚.与术后病理检测结果对比,利用超声检测患者颈部淋巴结转移的准确率为88.0％,敏感度为64.8％,特异度为85.3％,阳性预测值为80.7％,阴性预测值为66.7％.超声对多个淋巴结转移的检出率明显高于单个淋巴结转移的检出率,二者差异有统计学意义(x2=6.736,P=0.031);甲状腺癌肿瘤边界不清或呈锯齿状、肿瘤直径＞2 cm的颈部淋巴结转移率较高,并且转移性淋巴结的血流信号多于非转移性淋巴结,差异有统计学意义(P＜0.05).结论 利用超声诊断甲状腺癌颈部淋巴结转移的准确率较高,可在临床推广应用.     

Validity of modified gastrectomy combined with sentinel node navigation surgery for early gastric cancer

Background The present study examined the clinical validity of modified gastrectomy for early gastric cancer, in terms of the results of sentinel node navigation surgery (SNNS), using infrared ray electronic endoscopy (IREE) plus indocyanine green (ICG) staining. Methods One-hundred and sixty-one patients with fT1N0 gastric cancer were enrolled in the study. ICG (0.5 ml, 5 mg/ml) was injected endoscopically into four quadrants of the submucosa surrounding the cancer. Twenty minutes after the injection, sentinel lymph nodes (SNs) stained with ICG were observed intraperitoneally around the serosa and surrounding fat tissue. IREE was used to illuminate regional lymph nodes from the serosal side. Results Group 2 lymph nodes were judged as SNs in 52 patients (32%). The most common locations of the SNs were stations No. 7 in each of the upper-, middle-, and lower-thirds of the stomach. In two patients, lymph node metastasis was positive. One of these patients, with cancer in the middle one-third of the stomach, had SNs in stations No. 3, 4sb, 4d, 7, and No. 11p, and had metastatic lymph nodes in No. 3 and No. 7 (all SNs). The other patient, with cancer in the lower one-third of the stomach, had SNs in No. 1, 3, 4d, and 6, and had a metastatic lymph node in No. 4d (SN). Skip metastasis was not observed in this study, and metastatic lymph nodes were judged to have been dissected by the D1+a procedure. Conclusion For T1N0 gastric cancer, modified gastrectomy (D1+a dissection) combined with SNNS is suitable; however, for those whose Group 2 lymph nodes are judged to be SNs, additional dissection of lymphatic basins detected by SNNS should be performed to confirm the absence of lymph node metastasis.     

超声对乳癌腋窝转移淋巴结的诊断价值

目的探讨超声对腋窝转移淋巴结的诊断价值和诊断标准.方法对经临床和病理确诊为乳癌腋窝淋巴结转移的初诊患者40例(共89个淋巴结),行腋窝肿块灰阶超声、彩色多普勒超声和多普勒能量图检查.结果本组转移淋巴结大小从0.5～3.5cm,85%以上的长短径之比＜2,内部回声主要为不均匀的低回声,淋巴结皮质不均匀增厚或消失,淋巴结门偏心或消失,边界模糊居多.血流分布主要为周边型(43.8%)和混合型(31.5%),RI值较高,为0.69.部分可见腋静脉受压.结论乳腺癌腋窝转移淋巴结的超声图像在形态、边缘、内部回声结构、血流分布、血流动力学及淋巴结包膜外转移等方面均有较为特征性的表现,根据二维灰阶超声和彩色多普勒超声检查结果,多可作出正确诊断.     

High-resolution ultrasound to diagnose melanoma metastases in patients with clinically palpable lymph nodes

High-resolution ultrasound was used to determine if it could predict the presence of metastatic disease in 52 patients with melanoma who had developed newly palpable lymph nodes during clinical follow-up. Ultrasound proved accurate in diagnosing the presence of nodal metastases; it had a sensitivity of 94%, a specificity of 87% and an accuracy of 89%. The ultrasound features which together were diagnostic of the presence of nodal metastases were a node thickness greater than two-thirds of the node length and the presence of low-level echoes in the node. When these two features were both present on ultrasound, node metastases were present in every case. Ultrasound can be used to evaluate newly palpable lymph nodes in patients with melanoma. A normal ultrasound finding does not exclude micrometastases, but a lymph node showing the two key ultrasound features aforementioned is highly likely to contain metastatic disease and should be treated accordingly.     

Number of Metastatic Sentinel Nodes As Predictor of Axillary Involvement in Patients with Breast Cancer

BACKGROUND AND OBJECTIVES: More than half of patients with positive sentinel node (SN) have no metastases in non-sentinel nodes (NSNs) on axillary lymph node dissection (ALND). The aim of this study was to investigate factors predictive of NSNs involvement, in order to identify patients with metastatic disease confined to the SN which might avoid ALND. METHODS: ALND was performed in 167 patients with metastatic SN. Axillary NSNs status was correlated with the size of SN metastases, the size of the primary tumor and the occurrence of lymphovascular invasion. In 72 cases, the radiotracer (Tc-99m albumin colloid) marked multiple (in most cases 2 or 3) nodes. In this group, NSNs status was correlated with the number of metastatic radioactive nodes (1 or > 1), and with the above mentioned histopathologic factors. RESULTS: NSNs metastases were found in 57/167 cases (34.1%), the rate increasing proportionate to the size of both SN metastases (p < 0.0001) and primary tumor (p = 0.0075), while no significant correlation was found for lymphovascular invasion (p = 0.1769). At univariate and multivariate analysis of findings from the 72 cases with multiple probe-detected hot nodes, positivity in more than one hot node was the strongest predictor of NSN involvement (p = 0.0019). CONCLUSIONS: The identification and excision of multiple hot nodes can be useful in the prediction of NSNs involvement in patients with metastatic SN.     

鼻咽癌颈部淋巴结转移综合治疗的远期疗效观察

目的 观察鼻咽癌放化疗配合颈部淋巴结微波热疗的远期疗效.方法 154例初治N2～N3期鼻咽癌患者随机分为对照组(78例)和热疗组(76例).对照组用氟尿嘧啶+顺铂化疗1～2周期(21 d为1周期)后原发灶常规放疗DT 70～78 Gy分35～39次,颈淋巴结转移灶DT 68～72 Gy分34～36次.热疗组放化疗方法同对照组,颈淋巴结于放疗第1周开始配合局部热疗,每次加温45min,2次/周,共8～14次.结果 热疗组、对照组5年颈淋巴结局部控制率分别为97%和77%(X2=14.24,P<0.01),远处转移率分别为37%、44%(X2=0.73,P>0.05),无瘤生存率分别为51%、21%(X2=15.91,P<0.01),总生存率分别为59%、41%(X2=5.09,P<0.05).结论 对N2、N3期鼻咽癌放化疗配合颈淋巴结微波热疗的5年颈淋巴结局部控制率、无瘤生存率和总生存率均优于单纯放化疗组.     

鼻咽癌颈部淋巴结转移综合治疗的远期疗效观察

目的 观察鼻咽癌放化疗配合颈部淋巴结微波热疗的远期疗效.方法 154例初治N2～N3期鼻咽癌患者随机分为对照组(78例)和热疗组(76例).对照组用氟尿嘧啶+顺铂化疗1～2周期(21 d为1周期)后原发灶常规放疗DT 70～78 Gy分35～39次,颈淋巴结转移灶DT 68～72 Gy分34～36次.热疗组放化疗方法同对照组,颈淋巴结于放疗第1周开始配合局部热疗,每次加温45min,2次/周,共8～14次.结果 热疗组、对照组5年颈淋巴结局部控制率分别为97%和77%(X2=14.24,P<0.01),远处转移率分别为37%、44%(X2=0.73,P>0.05),无瘤生存率分别为51%、21%(X2=15.91,P<0.01),总生存率分别为59%、41%(X2=5.09,P<0.05).结论 对N2、N3期鼻咽癌放化疗配合颈淋巴结微波热疗的5年颈淋巴结局部控制率、无瘤生存率和总生存率均优于单纯放化疗组.     

胃中部癌前哨淋巴结邻近、横向和跳跃性转移的临床分析

Objective: To investigate the distribution pathway of sentinel lymph nodes (SLN) in middle third gastric carci-noma, as the foundation for rational lymphadenectomy. Methods: 52 cases of middle third tumors with solitary lymph nodes from 1852 gastric carcinomas were selected. The locations and histological types of metastatic lymph nodes were analyzed retrospectively. Results: Of 52 solitary node metastases cases, 37 were limited to perigastric nodes (N1), while 15 with skipping metastasis. In the 35 cases with tumor of lesser curvature, there were 17 cases found lymph nodes of the lesser curvature side (No. 3), 5 cases involved lymph nodes of the greater curvature (No. 4), and 8 cases with lymph nodes of the left gastric artery (No. 7). In the 17 cases with tumor of greater curvature, 7 cases spread to No. 4, while 3 metastasized to lymph nodes of the spleen hilum (No. 10). The difference of the histological types in groups N1 and over N1, were not statistically significant (P > 0.05). Conclusion: Adjacent metastasis formed the primary distribution pattern of SLN in middle third gastric carcinoma, transversal and skipping metastases being also notable.