食管及上消化道多原发性恶性肿瘤的诊断和治疗(附22例分析)

对２２例食管及上消化道多原发性恶性肿瘤作了回顾性分析。全部病例均经手术及病理证实。２２例中同时性癌２１例，异时性癌１例。同时性癌术前诊断率为３３．３％（７／２１）。其漏诊原因主要与临床医生对该病认识不足有关，钡透时仔细观察上消化道全貌及行全面内窥镜检查有助于提高诊断率。治疗以手术切除为首选，术中应仔细检查以防遗漏，并尽可能扩大切除范围     

食管及上消化道多原发性恶性肿瘤的诊断和治疗

对２２例食管及上消化道多原发性恶性肿瘤作了回顾性分析。全部病例均经手术及病理证实。２２例中同时性癌２１例，异时性癌１例，同时性癌术前诊断率为３３．３（７／２１）。其漏诊原因主要与临床医生对该病认识不足有关，钡透时仔细观察上消化道全貌及行全面内窥镜检查有助于提高诊断率、治疗以手术切除为首选，术中应仔细检查以防遗漏，并尽可能扩大切除范围。     

同时性大肠多原发癌16例报告

目的 为了提高同时性大肠多原发癌的正确诊断率。方法 对４２２例大肠病人进行术前纤维结肠镜检查、钡灌肠检查及术中纤维结肠镜检查。结果 发现１６例同时性多原发性大肠癌，占同期大肠癌病人的２．９％。钡灌肠检查的正确诊断率在７５％以上，纤维结肠镜检查的正确诊断率９０％以上，同时性多原发大肠癌常因临床医生重视不够或发现一个病灶而忽视多发病状的存在，从而造成术前漏诊、结论 我们主张大肠癌病人术前钡灌肠检查及针     

同时性大肠多原发癌16例报告

为了提高同时性大肠多原发癌的正确诊断率。方法对４２２例大肠癌病人进行术前纤维结肠镜检查、钡灌肠检查及术中纤维结肠镜检查。结果发现１６例同时性多原发性大肠癌，占同期大肠癌病人的２．９％。钡灌肠检查的正确诊断率在７５％以上，纤维结肠镜检查的正确诊断率９０％以上，同时性多原发大肠癌常因临床医生重视不够或发现一个病灶而忽视多发病状的存在，从而造成术前漏诊。结论我们主张大肠癌病人术前钡灌肠检查及纤维结肠镜检查应做为常规，对于术前未能行纤维结肠在检查的病人应做术中结肠镜检查，以减少同时性多发癌的漏诊。手术中应将切下的标本剖开检查，从而决定手术切除的范围是否合理。     

血管造影对“不明原因”慢性肠出血的诊断价值

目的：通过血管造影对１８ 例“不明原因”慢性肠道出血（ＣＩＢＵＣ） 的诊断，结合术后病检，评价其应用价值。方法：对我院１８ 例“不明原因”慢性肠道出血患者，通过肠系膜上、下动脉造影诊断，并经手术及病理证实，与小肠灌肠、内窥镜检查进行比较。结果：１８ 例病例小肠灌肠、内窥镜检查均无明确诊断或可疑阳性诊断，血管造影示肿瘤性病变１４ 例、非特异性溃疡１ 例，血管畸形３ 例。结论：小肠灌肠、内窥镜检查，不易显示病变和血管畸形以及容易漏诊之小肠引起的消化道出血，而血管造影有较高的诊断率     

多原性支气管肺癌

目的 探讨多原发性支气管肺癌的诊断与治疗，以减少误诊。方法 经手术、病理证实的６７３例原发性肺癌中，多原发性肺癌３例，占０．４％。结果 ３例均为同时性双原发癌，组织学类型组合：鳞癌－－鳞癌。２例在诊治中忽视了对侧肺内病变，造成漏诊，在术后随访中得以确诊。结论 多原发性肺癌的确诊依据是：各个肿瘤在组织学上均应具备原肺癌的病理特征。肺癌患者术后出现临床症状，且纤维支气管镜检阳性，只要排除支气管残端癌得     

多原发大肠癌51例分析

本文报告了经手术病理证实的多原发大肠癌５１例，其中同时性多发癌３１例，异时性多发癌１５例，同时性癌兼异时性癌５例。５１例多原发癌中伴腺瘤者２８例（５４．９％）；１８例腺瘤癌变，占癌伴腺瘤者的６４．３％。本病易被误诊和漏诊，术前常规结肠镜检查，术中全结肠探查和术后长期随访．是提高多原发大肠癌诊断率的重要措施。手术切除范围应根据分布部位、Ｄｕｋｅｓ分期及伴发腺瘤的多少与部位分布而定。     

同时多原发大肠癌与大肠腺瘤

本组１６６例大肠癌，发现同时多原发大肠癌８例（４．８％）。肿瘤分布广，但直、乙结肠占一半以上（５５．５％）。单发癌有２７．７％合并腺瘤，同时癌５０％合并腺瘤；４例合并腺瘤的同时癌有腺瘤１４处，其中２例３处癌变，癌变率为伴腺瘤的５０％。全组１８个癌灶中８个小于２ｃｍ，术前钡灌肠及术中探查均易漏诊。术前全结肠镜检查是提高诊断率的重要手段。     

内窥镜检出X线钡透漏诊的食管癌15例分析

食管癌的诊断,近年来主要依靠X线、内窥镜及食管拉网细胞学检查,仅X线钡透仍有误诊、漏诊。现就我院近11年来内窥镜检出X线钡透漏诊的食管癌15例作一小结分析。临床资料本组男性10例,女性5例,年龄最小34岁,最大70岁。自觉症状出现至内窥镜检查的时间,最短月余,最长12个月。本组进食有阻塞感者12例,消瘦伴乏力、纳差者10例,有胸骨后疼痛者8例,伴声音嘶哑呛咳者2例,仅感咽部不适者1例。全部病例均在县级以上医院行上消化道     

食管鳞癌贲门腺癌同时性双源癌37例分析

上消化道双源癌少见，国内有关文献报道其发病率为0．76％～6．40％。陈虹等报道河南省林州（原林县）地区食管鳞癌和贲门腺癌同时性双源癌的发生率为0．7％，临床漏诊率较高（83．3％～100．0％）。根据文献报道多在手术探查或术后病理检查中发现。目前，根治性手术切除仍然是该病首选的治疗方法，确保手术切缘无残留癌达到R0切除是手术成功的标志之一，要达到这一目的，无疑术前确诊对决定治疗措施、制定手术方案尤为重要。我们回顾性分析37例食管、贲门双源癌的临床资料，以提高术前确诊率。     

Multicentric carcinoma of the esophagus and double primary malignant neoplasm of the upper alimentary tract--report on 44 patients

During the past fifteen years, 44 patients with multicentric carcinoma of the esophagus or double primary malignant neoplasm of the upper alimentary tract, collected from 5316 patients with cancer of esophagus or gastric cardia in the same period, were treated in our hospital. The incidence was 0.83%. All were proven by pathology. Exploratory thoracotomy was done in 32 patients and 26 lesions were resected with a resection rate of 81.3%. All patients with cancer resected survived over 1 year, 6 out of 9 survived over 3 years and 2 out of 3, over 5 years. In the 18 patients who received chemotherapy alone, 12 were followed and all died within 1 year. It is shown that multicentric carcinoma of the esophagus or double malignant neoplasm of the upper alimentary tract should be given energetic treatment. Finally, the incidence, diagnosis criteria, diagnosis method, etiology and management are discussed with a review of literature.     

十二指肠恶性肿瘤的影像诊断

目的回顾性分析十二指肠恶性肿瘤的影像所见。方法原发肿瘤１３例,继发肿瘤３例,１６例病人均行上消化道气钡双重造影。５例病人行ＣＴ检查,２例行血管造影,２例壶腹部癌行Ｂ超检查,其中１例行ＥＲＣＰ检查。结果所有病人均经手术切除,将Ｘ线所见与病理结果对照分析,腺癌７例,平滑肌肉瘤６例,继发性癌３例。结论消化道造影是十二指肠病变的首选检查方法。本组病例均能提示病变部位,其中１３例定性诊断正确,但对一些外生性肿瘤,造影有其局限性,应结合ＣＴ、Ｂ超综合诊断。     

Tumorigenesis by oxygenated nitrosopiperidines in rats.

Three oxygenated N-nitrosopiperidines--nitroso-3-piperidinol, nitroso-4-piperidinol, and nitroso-4-piperidone--were prepared and given in drinking water at equivalent molar doses to Sprague-Dawley rats. All were potent carcinogens, 100% of the rats developed tumors in all treatment groups. Nitroso-3-piperidinol resembled nitrosopiperidine in inducing a high incidence of tumors of the nasal cavity and upper alimentary tract, and a few liver tumors. Nitroso-4-piperidinol and nitroso-4-piperidone caused a high incidence of tumors of the nasal cavity but very few tumors of the upper alimentary tract. After treatment with the 4-substituted compounds, a high incidence of liver tumors was observed in females but not in males.     

胃肠道间质肿瘤伴肝转移18例临床分析

目的:总结胃肠道间质肿瘤(gastrointestinal stromal tumors,GIST)伴肝转移的诊断及治疗经验。方法:回顾性分析18例胃肠道间质肿瘤伴肝转移的临床资料。结果:胃肠道间质瘤伴肝转移18例,其中12例位于胃,2例位于十二指肠,4例位于结肠。临床表现主要为消化道出血(60%),腹部包块(25%),体检发现贫血(25%)。术前均行内窥镜、B超及CT检查,术前12例病理确诊(66.7%)。全组均行手术切除,无手术死亡和手术并发症,其中局部切除3例,12例扩大切除 肝转移灶切除 淋巴结清扫。6例患者术后服用甲磺酸伊马替尼(格列卫)辅助治疗。16例患者获得随访,1年生存率为88.9%,3年生存率为48.6%。结论:GIST伴肝转移术前确诊率低,综合分析有助于提高确诊率。手术切除为主的综合治疗是最可靠的治疗方法。     

Synchronous bilateral ureteral and renal pelvic carcinomas: incidence, etiology, treatment and outcome

BACKGROUND: Synchronous bilateral urothelial tumors of the upper urinary tract are very rare. The authors reported baseline and long-term follow-up data for all patients in western Sweden during a 28-year period. METHODS: The authors performed a clinical and histopathologic study of all patients in western Sweden who were diagnosed with a malignant neoplasm in the renal pelvis or ureter between 1971 and 1998. RESULTS: Of 936 patients, 15 (1.6%) had synchronous bilateral tumors. The incidence of such tumors decreased in each successive decade. Abuse of phenacetin-containing analgesics by patients also decreased during the study period, as did the incidence of renal papillary necrosis. The median age at diagnosis of bilateral tumors was 68 years, and 80% of the patients were male. Eleven patients had bilateral tumors of the renal pelvis, two had bilateral ureteral tumors, and two had tumors of the renal pelvis and contralateral ureter. Partial renal pelvic, ureteral, or kidney resection on at least one side was possible in eight patients, and four patients were left untreated on at least one side. Only three patients underwent bilateral nephroureterectomy. Twelve patients (80%) had bladder carcinoma diagnosed either before or after diagnosis of the upper tract tumors. The median survival period for the 11 patients who received surgery for their bilateral tumors was 84 months. CONCLUSIONS: The decreasing incidence of synchronous bilateral upper tract tumors may be related to the prohibition of phenacetin-containing analgesics in the 1960s. Partial resection with preservation of the renal parenchyma was possible in the majority of patients. Survival for patients with bilateral tumors did not differ from that of patients with unilateral tumors.     

食管癌、贲门癌术后胸胃排空障碍的诊断和治疗

目的：探讨食管癌、贲门癌术后胸胃排空障碍的发生原因、诊断和治疗。方法：对1997年1月到2001年12月五年问施行1861例食管癌、贲门癌切除术的病人临床资料进行回顾性分析。结果：本组病例发生胸胃排空障碍27例，发生率1．45％，其中机械性胸胃排空障碍6例，功能性胸胃排空障碍21例，均发生于术后3天～12天，再次手术治疗8例；治愈26例，死亡1例。结论：鉴别胃排空障碍是由机械性还是功能性引起的尤为重要，上消化道造影、胃镜检查是鉴别两者的重要方法。对食管癌、贲门癌术后功能性胃排空障碍应采取保守治疗，而由机械性原因所致，一旦确诊应立即手术。     

Malignant melanoma of the alimentary tract

We reviewed case reports of malignant melanoma in the alimentary tract and discussed the diagnosis and treatment. Cases of malignant melanoma in the alimentary tract have mostly originated from the esophagus and an anorectal lesion. Metastatic tumors occurred mainly in the stomach and the small intestine. Although resection with lymph node dissection was performed, the prognosis of these patients was worse than that of patients with carcinoma. Malignant melanoma of the alimentary tract might be more aggressive than that of the skin. A combined modality treatment including progressive chemotherapy and biotherapy is expected to improve the prognosis of these patients.     

颅后窝髓母细胞瘤的治疗(附89例临床分析)

目的　对近几年收治的儿童髓母细胞瘤患者的临床资料进行回顾性分析 ,旨在提高对该疾病的认识和治疗效果。方法　 89例全部采用手术切除加术后放疗。结果　手术全切除 72例、次全切除 17例 ;术后 2例死于脑干功能衰竭 ,2例术后 2月出现脑积水 ,3例出现缄默症 ,2例上消化道出血 ,所有患者均有不同程度的发热 ;随访 5 2例 ,术后 3年无瘤生存 49例 ,桥小脑角 1例术后 7年原部位复发。结论　手术应尽量全切并注意保护脑干及蛛网膜下腔 ,若肿瘤较大者应首先分块切除中心部位 ,减少体积后再沿边界切除 ,以减少术后并发症 ;术后放疗应作为常规治疗手段 ,放疗范围及剂量应视患者年龄而定。     

Multiple simultaneous inverted papillomas of the upper urinary tract. A case report with a review of ureteral and renal pelvic inverted papillomas

An asymptomatic 73-year-old woman was found to have multiple, simultaneous, inverted papillomas of the renal pelvis and ureter. A review of the world literature yielded 34 cases of inverted papillomas in the upper urinary tract: 13 in the renal pelvis, and 21 in the ureter. Among these 34 cases, there were 26 male and five female patients, with gender not given for three others. Patients ranged in age from 19 to 89 years (mean, 64.1 years). Many cases lacked complete clinical details but, among the others, gross painless hematuria was the presenting symptom in seven; hematuria with flank pain or colic in six; and pain without hematuria in six. Only six patients lacked urinary tract symptoms, and three of these had microscopic hematuria. Only two patients had more than one inverted papilloma, and these were not multicentric. Adequate pathologic documentation and follow-up data were, unfortunately, absent in many of the cases. Although inverted papillomas are curable with surgical resection, with a low rate of local recurrence, they appear to be associated with synchronous or asynchronous carcinomas, especially other transitional cell tumors in the urinary tract.     

Tumor vs non-tumor origin of occult and obscure gastrointestinal bleeding requiring hospitalization

AIMS AND BACKGROUND: Occult/obscure gastrointestinal bleeding is often problematic to diagnose. It often leads to delayed treatment, a particularly dangerous circumstance when tumor origins are involved. This study reports the six-year experience of an Italian Surgery Center in the identification of the nature (tumor versus non tumor) and site of origin (upper, middle, lower gastrointestinal tract) of occult/obscure bleeding requiring hospitalization, as well as in its treatment. METHODS: Diagnostic instrumental examinations employed were: esophagogastroduodenoscopy, rectocolonoscopy, computerized tomography small bowel follow-through examination, capsule endoscopy, biopsy, angiography, abdominal computerized tomography scans and ultrasound. Therapies included: interventional radiology and surgery. RESULTS: Thirty-five cases of obscure and 27 cases of occult bleeding were examined; all received a definite diagnosis during hospitalization. In the cases with obscure bleeding the diagnosis was inflammatory bowel disease (n = 7), angiodysplasia (5 gastric, 2 duodenal, 2 jejunal, 3 ileal, 4 right colon), small bowel tumors (4 non-Hodgkin lymphomas, 1 leiomyoma, 6 adenocarcinomas), and gastric metaplasia of Meckel's diverticulum (n = 1). There were significantly more nontumor lesions than tumors (P < 0.005), and a middle tract source was significantly more frequent than upper/lower tract sources (P < 0.0001). Intestinal resections were performed for all small bowel tumors (8 laparotomic, 3 laparoscopic), 5 angiodysplasias, all cases of inflammatory bowel disease and gastric metaplasia of Meckel's diverticulum; arterial embolization was performed for 11 angiodysplasias. In the cases with occult bleeding the diagnosis was sigmoid colon polyps in 6 (treatment, endoscopic polypectomy) and right colon cancer in 21 (treatment, right hemicolectomy). There were significantly more tumors than nontumor lesions (P < 0.0001); all derived from the lower gastrointestinal tract. In all cases, the interventions resolved the bleeding completely. CONCLUSIONS: The results show that more than 50% of cases with obscure/occult bleeding requiring hospitalization are motivated by malignant gastrointestinal tumors, 34% of which are located in the small bowel, usually a difficult tract to explore. Thanks to modern technology, however, their diagnosis and treatment can nowadays be promptly and successfully achieved.