原发性食管腺癌

目的了解原发性食管腺癌（ＰＥＡＣ）的临床生物学特征及影响患者预后的重要因素,探讨合理的手术指征及综合治疗措施。方法对１０６例ＰＥＡＣ患者的外科治疗结果进行回顾性研究,并与同期３６０３例食管鳞癌进行对比分析。结果ＰＥＡＣ患者的手术切除率、手术死亡率及手术并发症发生率分别为９２．５％、２．８％和２３．５％,与食管鳞癌相似;影响其预后的主要因素有病变分期、淋巴结转移、肿瘤外侵及手术切除性质。其总的术后５年生存率为２１．０％,低于食管鳞癌（Ｐ＜０．０１）;其手术５年后死于转移复发的占８２．４％,高于食管鳞癌（Ｐ＜０．０１）。辅助放疗对Ⅰ、Ⅱａ期患者有一定帮助,对Ｎ１患者帮助不大。结论ＰＥＡＣ和食管鳞癌相比恶性程度高,病变进展快,患者预后差。手术是其首选的主要治疗手段,手术指征为０、Ⅰ、Ⅱ期及估计可切除的Ⅲ期甚至Ⅳ期患者。早发现、早诊断、早治疗以及肿瘤的根治性切除是改善患者预后的主要手段。辅助放疗可能对Ｎ０患者有所帮助,对Ｎ１患者帮助不大。     

原发性肝癌诊治方法变迁对术后疗效的影响（附418例分析）

将我院４１８例手术吻合切除肝癌病例分为近１０年组（１７５例）和前２５年组（２４３例），并进行了对照分析。近１０年组的主要特点是：（１）体检发现的亚临床肝癌较前２５年组多（分别为２６．３％，５．３％，Ｐ＜０．０１）；（２）临床Ⅰ期病例较前２５年组多（２６．３％，１．６％，Ｐ＜０．０１）；（３）手术切除病例较前２５年组高（５６．１％，４０．４％，Ｐ＜０．０１）；（４）手术死亡率较前２５年组低（１．７％，８．６％，Ｐ＜０．０１）；（５）局部切除较前２５年组多（３６．０％，０．２％，Ｐ＜０．０１）；（６）复发癌再治疗是近１０年组独有的；（７）术后１，３，５年生存率较前２５年组高（８０．６％，４７．３％，３４．９％，５７．２％，３０．６％，２５．２％，Ｐ＜０．０１）。本文资料说明原发性肝癌诊治方法的变迁表现了肝癌早期治疗水平的提高，反映了肝癌基础和临床研究的进步。     

直肠癌术后局部复发的治疗

目的：分析比较直肠癌术后局部复发不同治疗方法的疗效。方法：１９８６～１９９３年收治１０１例直肠癌术后局部复发的患者,４９例单纯放疗（１组）,２５例单纯手术切除（２组）,２７例手术切除加放疗（３组）。结果：３组局部复发率分别为１组７７．５％、２组６０．０％、３组２９．６％,以３组局部复发率最低（Ｐ〈０．０１）,局部复发加远处转移率分别为１组８５．７％、２组７６．０％、３组５９．２％,仍以３组为最低Ｐ     

三年以上生存期的胶质母细胞瘤临床分析

作者对８０例手术治疗后的胶质母细胞瘤患者进行随访，其中９例生存期３年以上，占１１％，且有１例生存期６年。结合临床资料，将生存期３年以上病人与其它随访病人进行临床对比分析。结果提示，胶质母细胞瘤病人生存期较长者与下列因素有关：（１）手术切除肿瘤的范围，Ｐ＜０．０１。（２）直线加速放疗，剂量４０～６０Ｇｙ，Ｐ＜０．０５。（３）术后ＢＣＮＵ化疗，Ｐ＜０．０１。     

Barrett食管癌51例报告

报告５１例Ｂａｎｅｔｔ食管癌的外科治疗效果，占同期食管癌切除总数的１０．２％。患者平均年龄８岁，主要就诊症状为吞咽困难。按ＰＴＮＭ分期，Ⅱ期１８例，占３５．３％；Ⅲ期２９例，占５６．９％；Ⅳ期４例，占７．８％。５１例均行食管部分切除、胃食管重建术。术后３０天死亡率为３．９％，１、２和５年生存率分别为４５．９％、２５．０％和１３．６％。Ⅱ期肿瘤５年生存率（２５．０％）明显高于Ⅲ＋Ⅳ期（４．５％），两者差异有显著意义（Ｐ＜０．０５）。肿瘤直径＜６ｃｍ＜或＞６ｃｍ者，５年生存率分别为２５．０％和０（Ｐ＜０．０５）。结果表明，术后长期生存率与临床分期及肿瘤大小等因素有密切关系。     

原发性肺癌胸部CT表现与手术切除的关系探讨

目的探讨原发性肺癌胸部ＣＴ表现与手术切除的关系。方法将９５例经手术和病理证实为原发性肺癌的患者分为３组：根治性切除组、姑息性切除组、探查组。分别测量３组ＣＴ肿瘤直径、纵隔肺门淋巴结受侵ＣＴ纵向厚度,记录纵隔、肺门及胸内结构改变。结果根治性切除组、姑息性切除组、探查组肿瘤直径分别为４．１０±１．７５,３．９０±１．２０,５．２０±３．６６（ｃｍ,ｘ±ｓ,Ｐ＞０．０５）。纵隔肺门淋巴结受侵ＣＴ扫描纵向厚度分别为２．６８±１．６０,４．０２±１．５６,４．８５±３．２８（Ｐ＜０．０１,Ｐ＜０．０５）。手术探查组ＣＴ特征主要表现为纵隔、肺门结构变形。结论肿瘤直径大小与手术切除无明显直接关系,纵隔肺门淋巴结受侵厚度是影响手术切除的重要因素。当纵隔肺门淋巴结受侵、胸部ＣＴ纵向厚度≤２．６８±１．６０ｃｍ时,临床上可行根治性肺切除。明显纵隔、肺门结构变形可视为手术禁忌症。     

全反式维甲酸对阿糖胞苷诱导HL—60细胞凋亡的影响

目的：探讨ＨＬ－６０细胞经全反式维甲酸（ＡＴＲＡ）作用后对化疗药物阿糖胞苷（ＡＲＡ－ｃ）诱导凋亡敏感性的变化。方法：应用光镜检查凋亡细胞形态,ＤＮＡ电泳检查梯状条带及流式细胞周期分布、凋亡细胞率和ｂｃｌ－２蛋白表达的阳性细胞率和相对荧光强度（ＭＦＩ）。结果：ＡＴＲＡ０．３ｍｇ／Ｌ作用ＨＬ－６０细胞７２ｈ后,Ｓ期细胞显著减少至３２．９％（Ｐ〈０．０５）,Ｇ０／Ｇ１期细胞明显增加到５８．５％（Ｐ〈０．０５）,ｂｃｌ－２阳性细胞率和ＭＦＩ分别下降至１８％和０．６３（Ｐ〈０．０５）;Ａｒａ－Ｃ１．５ｍｇ／Ｌ作用ＨＬ－６０细胞４ｈ,凋亡细胞率为５５．１％,ＤＮＡ电泳风明显的梯状条带。当ＨＬ－６０细胞经ＡＴＲＡ０．３ｍｇ／Ｌ作用７２ｈ手中Ａｒａ－Ｃ１．５ｍｇ／Ｌ继续培养４ｈ,细胞凋亡率明显减少至３４．４％（Ｐ〈０．０５）,     

1003例甲状腺单发结节外科治疗分析

本文分析经外科治疗的１００３例甲状腺单发结节，认为：１．甲状腺单发结节中甲状腺癌的发生率较高。２，男性单发甲状腺结节中甲状腺癌的发生率明显高于女性（Ｐ＜０．０１）。３．实性甲状腺单发结节中甲状腺癌的发生率明显高于囊性结节（Ｐ＜０．０１）。４．４５岁以下癌发生率显著高于４５岁以上年龄组（Ｐ＜０．０１）。５．误诊率高。本组甲状腺癌的误诊率为５９．３％，故甲状腺单发结节应采取腺叶切除。     

70岁以及上高龄食管,贲门癌手术治疗进展

目的 探讨高龄食管贲门患者的手术治疗问题，方法和结果 收治７０岁及以上高龄食管，贲门癌患者１１９例，其中前６年５４例，后４年６５例，后期患者中，晚期（Ⅲ，Ⅳ期）比例高于前期，后期Ⅰ，Ⅱ肿瘤瘤根治性切除率显著较前期提高（９１．７％和６７．７％，Ｐ〈０．０５），Ⅲ，Ⅳ期病例间无差异，两组术后并发症无差异，但后期住院死亡率较前期明显降低（１８．５％和３８．９％，Ｐ〈０．０５）。结论 对高龄食管，贲门癌患     

子宫肉瘤54例临床研究

目的 探讨子宫肉瘤预后的相关因素。方法 回顾分析了５４例子宫肉瘤的病理类型、临床分期、子宫大小、绝经情况及治疗方法与生存率进行对照研究;统计学处理采用Ｘ＾２检验。结果 （１）病理类型：子宫平滑肌肉瘤１９例;子宫内膜间质肉瘤１０例;中胚叶混合瘤２４例,５年生存率分别为４７．３％、５０．０％及４１．７％（Ｐ〉０．０５）;（２）肿瘤分期：Ｉ期３１例、Ⅱ期１１例、Ⅲ期５例、Ⅳ期７例、５年生存率分别为６１．３％、３６．４％、０及０（Ｐ〈０．００１）。（３）子宫大小：子宫大小妊娠３个月者３８例,大于妊娠３个月者１６例,５年生存率分别为５３．３％及６．３％（Ｐ〉０．０５）;（４）绝经情况,绝经前３４例,绝经后２０例,５年生存率分别为：５８．３％及３０％（Ｐ〈０．０１）;（５）治疗方法：手术１１例,手术＋化疗３６例,手术＋化疗     

Curative surgery for gastric cancer in the elderly: treatment decisions, surgical morbidity, mortality, prognosis and quality of life

AIMS AND BACKGROUND: Surgical risk is deemed to be higher in the aged population because there are often comorbidities that may affect the postoperative result. This consideration is important for the treatment decision-making for gastric cancer in the elderly. The aim of this study was to identify factors influencing mortality, morbidity, survival and quality of life after curative surgery for gastric cancer in patients aged 75 years and older, and to plan their appropriate management. METHODS AND STUDY DESIGN: From January 1993 to December 2004, 135 patients underwent surgery at our department because of gastric cancer. Ninety-four of these patients (69.6%) underwent potentially curative gastrectomy. A cross-sectional study of 23 patients aged 75 years and older and 71 younger patients who underwent curative gastrectomy was carried out: patient characteristics, tumor characteristics, management, morbidity, mortality, survival, and quality of life were evaluated. RESULTS: Elderly patients had significantly more comorbidities and a poorer nutritional status than younger patients. The surgical procedures were similar in both groups and the overall morbidity rate was 27.9% and the overall mortality rate 8.5%. Medical mortality was significantly higher in elderly patients, and the presence of comorbidities was the only independent factor affecting mortality. The 5-year survival rate was 56.2% in the older group versus 62.1% in the younger group and tumor stage was the only prognostic factor influencing survival. Quality of life after surgery was similar in both groups. The significantly better postoperative functional outcome after subtotal gastrectomy suggested a better compliance of elderly patients with subtotal than total gastrectomy. CONCLUSIONS: In the elderly, surgical strategies must be modulated on the basis of comorbidities, tumor stage and future quality of life. Since elderly patients have no worse prognosis than younger patients, age is not a contraindication to curative resection for gastric cancer. Subtotal gastrectomy should be the procedure of choice mainly in elderly patients as it offers better quality of life.     

Prognostic significance of the age factor in the thyroid cancer: statistical analysis

BACKGROUND AND OBJECTIVES: To determine whether thyroid carcinoma in elderly patients presents any peculiar characteristics, whether the greater biological aggressiveness of the neoplasm modifies the surgical treatment selected, and whether age greater than 70 years represents an independent prognostic factor. METHODS: Retrospective analysis of case histories from the Department of Surgery of "La Sapienza" University of Rome; 403 patients subjected to total thyroidectomy between 1993 and 1999, with a minimum follow-up period of 3 years subdivided into three groups: group I (patients aged between 20 and 50 years), group II (patients aged between 51 and 70 years) and group III (patients aged >70 years). The surgical and postoperative treatment is uniform in all study groups. RESULTS: Age greater than 70 years entails a significant increase in mortality; the mortality rate in the three groups was found to be 3%, 9% and 54%, respectively. Prognosis is significantly worse in the elderly patients group (group III) than in group I (P < or = 0.001) and in group II (P < or = 0.001); group II mortality was significantly higher than that of group I (P = 0.005); in group III, the neoplasm displays features of greater biological aggressiveness (greater incidence of undifferentiated forms, presence of lymph nodes at diagnosis and vascular invasion, locally advanced forms, greater incidence of stage IV). CONCLUSIONS: Statistical analysis shows that the greater biological aggressiveness of the neoplasm in elderly patients worsens the prognosis, although an age exceeding 70 years itself represents an unfavourable prognostic factor; total thyroidectomy does not present any counter-indications in elderly patients.     

The possibility of surgery for aged patients with gastric cancer

The possibility of surgery for aged patients with gastric cancer has been studied. Of 484 cases who underwent a gastrectomy, patients 70 years of age or over amounted to 86 (20%). The postoperative mortality rate for these aged patients was 3% and the postoperative mortality rate with hospital deaths added from other causes than operative deaths was 7%. The postoperative mortality rate of aged patients who underwent total or proximal subtotal gastrectomy improved during the period between 1975-1983 compared with the period between 1967-1974. In the second period, there were no deaths among aged patients who underwent an R3-operation and/or a combine operation. This fact shows that operative procedures have become safer for aged patients.     

胸段食管鳞状细胞癌术后淋巴结转移患者预后影响因素及治疗策略分析

目的:探讨胸段食管鳞状细胞癌术后淋巴结（lymph node,LN)转移患者预后影响因素及治疗策略。方法:回顾性分析我院2008年1月-2014年3月收治的胸段食管鳞状细胞癌根治术后LN转移患者共411例临床资料,对预后影响因素进行单因素和多因素分析,进一步采用倾向性得分匹配法配对后确定最佳治疗策略。结果:入选患者随访1、3及5年累积总生存率分别为81.09%、40.66%、28.14%;随访1、3及5年累积无进展生存率分别为70.54%、41.20%、33.27%;中位总生存时间和无进展生存时间分别为27.0个月［（24.5~31.0）个月］、23.0个月［（21.0~27.0）个月］。单因素分析结果显示,性别、年龄、肿瘤长度、T分期、N分期及治疗策略与术后LN转移患者总生存时间有关（P<0.05）;性别、T分期、N分期及治疗策略与术后LN转移患者无进展生存时间有关（P<0.05）。多因素分析结果显示,性别、年龄、肿瘤位置、T分期、N分期及治疗策略均是术后LN转移患者总生存时间独立影响因素（P<0.05）;性别、肿瘤位置、T分期及N分期均是术后LN转移患者无进展生存时间独立影响因素（P<0.05）。将上述总生存和无进展生存可能影响因素纳入倾向性得分匹配法配对分析结果显示N分期和治疗策略是术后LN转移患者总生存时间和无进展生存时间独立影响因素（P＜0.05）。倾向性得分匹配法配对分析显示,术后辅助放疗和术后辅助化疗患者总生存率均显著高于单纯手术者（P＜0.05）;术后辅助放化疗患者总生存率和无进展生存率均显著高于单纯手术、术后辅助放疗及术后辅助化疗者（P＜0.05）;同时N1期患者总生存率和无进展生存率均显著高于N2、N3期（P＜0.05）。结论:淋巴结转移个数和治疗策略与胸段食管鳞状细胞癌根治术后LN转移患者远期预后密切相关;术后放化疗应作为首选辅助方案以期进一步改善患者生存获益。     

Complications after surgery for gastric cancer in patients aged 80 years and over

Recent studies have shown a considerable increase in the number of aged patients with gastric cancer. In this retrospective study, we report our 18-year experience with 110 patients aged 80 years and over affected with this neoplasm. Postoperative morbidity and mortality rates and risk factors affecting their incidence were examined by univariate and multivariate analysis. Operability and resectability rates were 70.9% and 47.3% respectively. Of the resective procedures, 41 (78.8%) were subtotal gastrectomies. In five cases (9.6%), we performed combined resections. Twenty-five patients (32.1%) experienced postoperative complications; overall mortality rate was 12.8% (10 patients). In resective procedures, morbidity and mortality were 26.9% and 3.8% respectively, which are very low rates compared to other Western reports. Statistical analysis identified the number of preexisting medical illnesses as an independent predictor of morbidity and mortality. Crude five-year survival rate of curatively resected cases was 43%. Although multiple medical illnesses involved much higher operative mortality, neither the presence of postoperative complications nor the number of preexisting medical illnesses significantly influenced five-year survival rate of curatively resected patients. With careful evaluation and selection of patients, correct treatment of concomitant diseases and adequate peri- and postoperative care, gastric surgery provides good immediate and long-term results even in very old patients. Subtotal gastrectomy with limited lymphadenectomy should be the preferred procedure; total gastrectomy, combined resections and extended lymphadenectomy should be performed only when necessary, in patients with fewer than two illnesses. Surgery should be avoided in patients with highly advanced disease, if multiple medical illnesses are present.      

影响肺癌术后胸腔引流时间的多因素分析

目的:探讨肺癌患者术后胸腔引流时间的各种影响因素。方法:回顾总结302例原发性肺癌手术诊治病人的临床资料。按术后胸腔引流时间分为两组,分别为Ⅰ组（引流时间≤5天）和Ⅱ组（引流时间＞5天）。对可能影响术后引流时间的因素在两组间采用单因素分析和二项Logistic多因素回归分析。结果:术后胸腔引流时间≤5天的154例（51.0%）,＞5天的148例（49.0%）。Logistic回归分析结果显示:年龄、开胸手术、术后使用白眉、单肺通气、淋巴清扫数、胸膜粘连及手术时间是术后引流时间的独立影响因素。结论:对于具有多个独立影响因素的患者,应加强围手术期个体化管理,制定合理的治疗策略,以减少术后胸腔引流时间。     

结直肠癌根治术后长期随访结果分析

我院1964年4月～1976年12月根治性切除结直肠癌363例,且随访满10年以上,随访率为97.2％。本组包括结肠癌140例,直肠癌223例。根据Dukes分期法,A期1.7％,B期63.1％,C期35.2％。全部病例均施行根治性切除术,手术死亡率为0.8％(3例)。根治术后5年,10年,15年和20年生存率分别为61.5％,51.9％,48.6％和38.9％。本文对363例结直肠癌进行了临床分析,并将术后生存10年以上的180例和10年内死亡的183例进行比较,以求发现影响术后长期生存的关键因素。结果表明患者年龄、癌瘤部位、病期和淋巴结转移是影响远期疗效最重要的因素。此外,作者通过对治疗失败的原因分析,提出几点提高疗效的措施。     

Indication of peritonectomy for peritoneal dissemination

A total of 521 patients with peritoneal carcinomatosis (PC) were treated by peritonectomy and perioperative chemotherapy. Each of the 95, 58, 316, 31, 10 and 11 patients were from gastric, colorectal, appendiceal, ovarian, small bowel cancer and mesothelioma, respectively. The distribution and volume of PC are recorded by the Sugarbaker peritoneal carcinomatosis index (PCI). Peritonectomy was performed with a radical resection of the primary tumor and all gross PC with involved organs, peritoneum, or tissue that was deemed technically feasible and safe for the patient. The postoperative major complication of grade 3 was found in 14%, and total 30-day mortality was 2.7%. The survival of gastric cancer patients with a PCI score ≤ 6 was significantly better than those with a PCI score ≥ 7. In appendiceal neoplasm, patients with PCI score less than 28 showed significantly better survival than those with PCI score greater than 29. The survival of colorectal cancer patients with a PCI score ≥ 11 was significantly poorer than those with a PCI score ≤ 10. Among the various prognostic factors in appendiceal neoplasm and gastric cancer patients, CC-0 complete cytoreduction was the most important independent prognostic factor. Peritonectomy is done to remove macroscopic disease and perioperative intraperitoneal chemotherapy to eradicate microscopic residual disease aiming to remove disease completely with a single procedure. Peritonectomy combined with perioperative chemotherapy may achieve long-term survival in a selected group of patients with PC. The higher mortality rate underlines this necessarily strict selection that should be reserved to experienced institutions.     

老年眼眶肿瘤摘除术后预后的影响因素分析

目的:探讨老年眼眶肿瘤摘除术后预后影响因素,以期加强防范,提高诊治水平.方法:回顾性分析2010年7月至2015年7月124例老年眼眶肿瘤摘除术患者,对术后出现各种并发症、复发等患者从年龄、性别、术前情况、术中情况等进行影响因素分析.结果:124例老年眼眶肿瘤摘除术后预后不良有11例,发生率为8.87％.这其中影响因素有肿瘤部位(眶内)、肿瘤性质(恶性)、肿瘤累及范围(深部)、肿瘤边界(不清晰)、开眶方式(改良开眶)、存在合并症、手术时间长(≥3 h)、联合脏器摘除、肿瘤低分化等均有关(P均＜0.05);而和性别、年龄、病程、手术入路无关(P＞0.05);经非条件Logistic回归分析,肿瘤部位、肿瘤性质、肿瘤累及范围、肿瘤边界、开眶方式、合并症、手术时间、联合脏器摘除、肿瘤分化是老年眼眶肿瘤摘除术后预后独立影响因素(P均＜0.05).结论:老年眼眶肿瘤摘除术后影响因素较多,术前合并并发症、开眶方式、低蛋白血症、手术时间、联合脏器切除是主要影响因素.     

Local recurrence after total or subtotal esophagectomy for esophageal cancer

Cancer recurrence is a common problem after esophagectomy for esophageal cancer. Local recurrence is especially problematic because it often negates the palliative benefit of esophagectomy. We conducted a retrospective review to assess the effect of extent of esophageal resection (subtotal or total esophagectomy) on local cancer recurrence. Seventy-four consecutive patients with esophageal cancer underwent esophagectomy at our institution over a four-year period. Their charts were reviewed retrospectively and data was collected on age, gender, histology, stage, tumor location, operation, resection margin status, anastomotic leaks, operative mortality, adjuvant therapy, cancer survival, and local recurrence. Total esophagectomy was done in 19 patients (transhiatal - 3; McKeown - 16) and subtotal esophagectomy was done in the other 55 patients (Lewis - 25; left thoracoabdominal - 30). The two groups were similar with respect to age, gender, histology, stage, anastomotic leaks, operative mortality, adjuvant therapy, and overall survival. Resection margins were positive for residual tumor in 2 out of 19 (11%) total esophagectomies and 9 out of 55 (16%) subtotal esophagectomies (p=0.42). Local recurrence occurred in 3 of 19 (16%) patients treated with total esophagectomy and 23 out of 55 (42%) patients treated with subtotal esophagectomy (p=0.04). We conclude that total esophagectomy is associated with fewer local cancer recurrences than subtotal esophagectomy. We, therefore, recommend total esophagectomy for the surgical treatment of esophageal cancer.