早期胃癌不同淋巴结清除术的合理评价

目的 合理选择早期胃癌不同淋巴结清除术式。方法 以临床病理资料完整的325例早期胃癌为研究对象,总结其各站淋巴结转移规律及其不同淋巴结清除术的效率,并分析淋巴结转移与病理生物学行为的相关性。结果 全组淋巴结转移率为14．8％,转移度为3．0％。胃下部癌第1站淋巴结转移率为14．5％,各号淋巴结均有转移;第Ⅱ站淋巴结转移率为6．9％,以No．7、8a淋巴结转移率较高,而No．1、9、11P、12a和14v淋巴结几乎无转移。胃中部癌第Ⅰ站淋巴结转移率为13．8％,No．1、3、5、6淋巴结有转移;第Ⅱ站淋巴结转移率为6．9％,仅№．7、8a淋巴结有转移。大癌灶（〉3．0cm）、黏膜下癌、低分化和淋巴管癌栓阳性者的第Ⅰ、Ⅱ站淋巴结转移率较小癌灶（≤3．0cm）、黏膜内癌、高分化和淋巴管癌栓阴性者明显增高（P〈0．05）。结论 单纯D,或D1＋No．7淋巴结清除术适合于癌灶直径≤1．0cm或黏膜内癌;D1＋No．7、8a淋巴结清除术适合于早期胃中、下部癌中直径〉1．0cm、凹陷型、黏膜下癌,其中癌灶直径〉3．0cm、淋巴管癌栓阳性者应加行No．1、9淋巴结清除;标准D：、D,淋巴结清除术应尽量避免施行。     

胃癌的淋巴结转移规律及其意义

目的:探讨胃癌淋巴结转移规律及合理淋巴结清除术的原则和适应证.方法:采用病理组织学、免疫组织化学法研究转移淋巴结分型、分期、分级和计量学及淋巴结的检出率.结果:全组淋巴结转移率为74.8%,以No3、No7为高;不同病期的转移率有明显差别;转移淋巴结数量、级别和类型是反映胃癌生物学行为和预后的重要指标.胃癌组织中淋巴管癌栓(+)、FDP、TPA高表达,E-cd低表达和DNA含量增高与淋巴结转移密切相关.术中胃壁内注射CH40,认识淋巴结跳跃性转移规律,切除标本美蓝染色结合淋巴结连续切片,对提高淋巴结清除率和检出率有一定的应用价值.结论:针对胃癌淋巴结清除率、分型、分期、分级和计量学,以及淋巴结转移率、检出率和分子标志物研究,对选择合理根治术式、提高生存率具有重要的临床意义.     

低分化型黏膜内胃癌淋巴结转移的危险因素与腹腔镜手术探讨

  目的  探讨低分化型黏膜内胃癌淋巴结转移的危险因素, 从而对低分化型黏膜内胃癌患者, 制定合理腹腔镜术式提供理论依据。  方法  回顾性分析60例低分化型黏膜内胃癌的临床病理资料, 按照临床病理特征与淋巴结转移的关系进行统计学分析。  结果  通过多因素分析, 多发肿瘤, 肿瘤大小≥2 cm和淋巴管癌栓阳性对淋巴结转移差异具有统计学意义(P < 0.05)。无危险因素的患者, 淋巴结转移率为0;三个危险因素均有者, 淋巴结转移率高达66.7%。  结论  多发肿瘤, 肿瘤大小≥2 cm和淋巴管癌栓阳性是低分化型分化型黏膜内胃癌淋巴结转移的独立危险因素。对于无危险因素的患者, 行腹腔镜下胃局部切除术是可行的; 对于具有危险因素的患者, 可以实施腹腔镜下胃癌根治术治疗。      

41例多发胃癌的临床病理及诊治

为了进一步研究多发胃癌的临床病理及其诊断治疗，作者选择４１例多发胃癌患者的９８个癌粒为研究对象，对患者年龄、性别及癌灶所占分区、癌灶间距离、组织学类型、淋巴结转移特点、多发早期癌和多发展期癌的区别等进行相关分析。     

早期胃癌浆膜分型与淋巴结转移的关系

目的:探讨早期胃癌浆膜分型与淋巴结转移的关系,为淋巴结的合理清除提供依据。方法:回顾性分析164例早期胃癌的浆膜分型与淋巴结转移情况。结果:浆膜正常型胃癌患者的淋巴结转移率为9.4%,反应型为20.2%,两者淋巴结转移率比较差异有统计学意义,χ2=3.85,P<0.05。浆膜正常型患者中,黏膜癌淋巴结转移率为2.0%,且局限于第1站(N1);黏膜下癌淋巴结转移率为20.0%,且局限于(N1 No.7)。浆膜反应型患者中,m癌、sm癌第2站(N2)转移率分别为3.0%和26.1%。结论:浆膜分型评估早期胃癌淋巴结的转移规律是较实用和可靠的方法。     

早期低分化型胃癌淋巴结转移的危险因素与腹腔镜局部切除术的探讨

  目的  探讨早期低分化型胃癌淋巴结转移的危险因素, 从而对早期低分化型胃癌患者, 行腹腔镜下局部切除术提供理论依据。  方法  回顾性分析80例早期低分化型胃癌的临床病理资料, 按照临床病理特征与淋巴结转移的关系进行统计学分析。  结果  通过多因素分析, 肿瘤大小≥2cn, 黏膜下癌和淋巴管癌栓阳性对淋巴结转移有统计学意义(P < 0.05)。无危险因素的患者, 淋巴结转移率为0;三个危险因素都具有者, 淋巴结转移率高达42.9%。  结论  肿瘤大小≥2 cm, 黏膜下癌和淋巴管癌栓阳性是早期低分化型胃癌淋巴结转移的独立危险因素对于早期低分化型胃癌患者, 行腹腔镜下局部切除术, 这三项危险因素是判断是否进行附加手术的简单标准。      

进展期胃窦癌No.14v组淋巴结的研究现状

胃癌是常见的消化道恶性肿瘤,好发于胃窦部,其总体死亡率高居恶性肿瘤前列[1,2].包含区域淋巴结清扫的根治性手术是胃癌的主要治疗手段[3].淋巴转移是胃癌的主要转移途径,也是影响患者预后的独立危险因素.进展期胃癌的淋巴结清扫范围目前尚存争议[4],其中肠系膜上静脉旁淋巴结(No.14v)作为胃周淋巴结,1999年《日本胃癌处理规约》第13版将其列入第2站淋巴结范畴,但在第14版《日本胃癌处理规约》将进展期胃窦癌的标准D2根治术处理中把No.14v归入到区域外淋巴结,同时NCCN指南也作了类似的更改[5-8].目前进展期胃窦癌No.14v组淋巴结转移规律和有无清扫必要仍然是国内外学者热点关注的问题.本文就进展期胃窦癌No.14v淋巴结转移规律和淋巴结清扫相关临床研究进展进行简要综述,以期对胃窦癌外科治疗中淋巴清扫范围提供参考.     

胃癌淋巴转移特点分析——与结肠,直肠癌的对比研究

本文通过对135例进展期胃癌与50例进展期直肠癌和211例进展期结肠癌的对比研究。发观淋巴结转移率和第3站以远(含第3站)的淋巴结转移率和转移度,胃癌均是大肠癌的2倍左右。在影响腹部消化管癌淋巴结转移的诸多临床病理因素中,癌侵犯范围、浸润深度及癌细胞生长方式在各脏器癌中均起主导作用,在结肠癌,直肠癌主要表现于对淋巴结转移率、即淋巴结转移有或元的影响上,而在胃癌则主要表现于对第3、4站淋巴结转移率即转移程度的影响上。     

简化大肠癌大体类型的临床意义

目的 探讨简化大肠癌大体分型的可行性和临床意义.方法 回顾性分析1379例有完整随访记录的大肠癌患者的临床资料,所有患者按照大体类型分组:1组为隆起型,2组为限局溃疡型,3组为浸润性,4组为浸润溃疡型;简化分型后,A组为限局型,B组为浸润型.比较原大体分型和简化大体分型与大肠癌组织学类型、肠肇浸润深度、淋巴结转移程度、淋巴结转移数量之间的关系以及对患者生存期的影响.结果 在低级别大肠癌比例、大肠癌浸润深度、淋巴结转移程度、淋巴结转移数量和5年生存率等指标上,1组和2组、3组和4组之间的差异均尢统计学意义(均P>0.05);而3、4组的上述指标分别与1、2组相比,差异有统计学的意义(均P<0.05),即浸润型和浸润溃疡型癌的组织学分化程度更差、肠壁浸润更深、淋巴结转移更严重.简化分型后,A、B两组的组织学分化程度、肠壁浸润深度、淋巴结转移程度、淋巴结转移数量和5年生存率的差异均有统计学意义(均P<0.05).结论 原大肠癌大体分型中,隆起型和限局溃疡型、浸润型和浸润溃疡型的临床病理学特征相似,可以通过分别合并达到简化大体分型的目的 .简化大体分型在临床医生对大肠癌的诊断治疗和预后判断中均有莺要的指导意义.     

胃癌的淋巴结转移规律及其意义

目的：探讨胃癌淋巴结转移规律及合理淋巴结清除术的原则和适应证。方法：采用病理组织不学、免疫组织化学法研究转移淋巴结分型、分期、分级和计量学及淋巴结的检出率。结果：全组淋巴结转移率为74.8%，以No3、No7为高；不同病期的转移率有明显差别；转移淋巴结数量、级别和类型是反映胃癌生物行为和预后的重要指标。胃癌组织中淋巴管癌栓（ ）、FDP、TPA高表达，E-cd低表达和DNA含量增高与淋巴结转移密切相关。术中胃壁内注射CH40，认识淋巴结跳跃性转移规律，切除标本美蓝染色结合淋巴结连续切片，对提高淋巴结清除率和检出率有一定的应用价值。结论：针对胃癌淋巴结清除率、分型、分期、分级和计量学，以及淋巴结转移率、检出率和分子标志物研究，对选择合理根治术式、提高生存率具有重要的临床意义。     

Twinning and the Incidence of Breast and Gynecological Cancers (United States)

Increasing epidemiological and experimental evidence indicates that the carcinogenic pathway in the breast and female reproductive organs is driven, at least in part, by factors associated with reproduction. We conducted a retrospective cohort study, comparing the risk of ovarian, breast, endometrial, and cervical cancers among women who had records of at least one twin pregnancy, compared with women who had given birth to only single children. Subjects were selected from the Utah Population Database, which consists of multiple linked datasets including genealogy, births and deaths and cancer registries. We used Poisson regression to calculate relative risks, adjusted for the number of pregnancies and the age of the mother at the birth of first and last children, with singleton mothers as the reference group in each case. The risks of breast and ovarian cancers did not differ between mothers of twins and mothers of single children. The risk of endometrial cancer was slightly lower in mothers of twins than in mothers of singleton children (RR = 0.90, 95% CI 0.67-1.21). Conversely the risk of cervical cancer was higher among twin mothers (RR = 1.78, 95% CI 0.88-3.52). This latter finding supports previous data suggesting that reproductive hormones act as cofactors in the etiology of cervical cancer.     

从高发现场视角看食管癌和贲门癌的临床研究趋势

我院流行病室开展食管癌和贲门癌高发现场研究已历30余年,所取得的最显著成绩主要有以下4个方面：（1）对食管癌癌前病变（即鳞状上皮不典型增生）及其逐级发展和演变规律的确认,以及对各级不典型增生诊断及处理的经验;（2）对食管癌早诊早治方法的探索,以及实践所得的优异效果;（3）食管鳞状细胞癌易发部位的发现及其对食管癌早期诊断的贡献;（4）胃贲门癌高发位点的发现及其对贲门癌早诊早治的贡献。在此基础上,结合我们长期在高发现场的实际工作经验,展望今后食管癌和贲门癌临床研究的趋势。     

结直肠神经内分泌肿瘤的研究进展

结直肠神经内分泌肿瘤来源于结直肠神经内分泌细胞,发病率较低,但近年有上升趋势.WHO病理学将结直肠神经内分泌肿瘤分为神经内分泌瘤、神经内分泌癌、混合型腺-神经内分泌癌和增生性及肿瘤前病变.结直肠神经内分泌肿瘤细胞具有激素合成及分泌功能,但不一定都出现相应的临床症状.不同分类、分期的结直肠神经内分泌肿瘤的诊断及治疗方法也...     

子宫颈癌放疗后子宫体恶性肿瘤47例临床分析

目的分析宫颈癌放疗后子宫体恶性肿瘤的临床特点。方法回顾性分析47例宫颈癌放疗后子宫体恶性肿瘤的临床资料。结果诊断宫体恶性肿瘤的中位年龄为62岁,放疗后至确诊发生肿瘤的中位时间为14年。47例中,子宫内膜癌30例,子宫中胚叶混合瘤17例。30例子宫内膜癌的FIGO分期为IB期1例,IC期2例,Ⅱ期6例,ⅢA期4例,ⅢB期2例,ⅢC期11例,Ⅵ期4例,Ⅱ期以上者占90%;病理高分化2例,中分化9例,低分化14例,不能分级者2例,浆液性乳头状腺癌3例;7例疗后复发,中位复发时间为24个月;中位生存时间为26个月,总3、5年生存率分别为60%、38%。17例子宫中胚叶混合瘤,中位生存10个月,6例疗后复发,中位复发时间9个月;复发者中位生存6个月,总3、5年生存率分别为12%、0。结论宫颈癌放疗后发生的肿瘤以内膜腺癌多见,内膜腺癌中具有高危因素者比例大,预后差;放疗后发生子宫肉瘤中以中胚叶混合瘤最常见,预后差。     

508例恶性肿瘤患者外周血淋巴细胞亚群分析

目的 研究肿瘤患者外周血淋巴细胞亚群变化特点.方法 收集天津中医药大学第一附属医院肿瘤患者508例(肺癌256例,胃癌152例,乳腺癌100例),健康志愿者50例,采集入组人员外周血2 ml,应用BD流式细胞仪进行淋巴细胞亚群检测,所得数据采用SPSS 16.0软件进行统计分析.结果 淋巴细胞均数(比例)比较:肿瘤患者淋巴细胞数量降低,健康志愿者为5125 (34.2％)、乳腺癌为3642(24.3％)、胃癌为3178(21.2％)、肺癌为2895(19.3％),依次降低.淋巴细胞亚群总异常病例数分别为肺癌218例(85.2％)、胃癌133例(87.5％)、乳腺癌88例(88.0％);T细胞亚群异常病例数为肺癌83例(32.4％)、乳腺癌32例(32.0％)、胃癌44例(28.9％);CD4 +/CD8+异常病例数为肺癌185例(72.3％)、胃癌108例(71.1％)、乳腺癌84例(84.0％);自然杀伤细胞亚群异常病例数为肺癌32例(12.5％)、胃癌22例(14.5％)、乳腺癌16例(16.0％);B细胞亚群异常病例数肺癌38例(14.8％)、胃癌52例(34.2％)、乳腺癌12例(12.0％).与健康志愿者相比,肺癌患者CD19+％(12.8±5.0∶11.5±5.7,t=3.006,P=0.003)降低;胃癌患者CD4+％ (39.2 ±7.7∶35.3±7.6,t=2.315,P=0.023)降低,CD19+％ (12.8±5.0∶8.9±4.2,t=3.302,P=0.010)降低;乳腺癌患者CD8+％(24.0±8.1∶29.1 ±13.0,t=2.019,P=0.047)升高.结论 肿瘤患者淋巴细胞数量减少,淋巴细胞亚群异常率增高,不同肿瘤患者淋巴细胞亚群异常变化表现出不同的特点.     

子宫颈癌放疗后子宫体恶性肿瘤47例临床分析

Objective  To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods  Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results  The median age at uterine neoplasms diagnosis was 62 years (range: 38–77 years), and the median latency period from initial therapy to development of uterine neoplasms was 14 years (range: 5–35 years). Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma (UPSC). Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows: stage Ib, 1 case; stage Ic, 2 cases; stage II, 6; stage IIIa, 4; stage IIIb, 2; stage IIIc, 11; stage IV, 4 cases; grade 1, two cases; grade 2, nine; grade 3 (include 3 UPSC patients), seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences (23.3%), at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence (35.9%), at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion  The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.     

老年早期双原发癌38例临床分析

目的 探讨老年人早期多原发癌(MPC)的临床特点及合适的治疗方法。方法 回顾分析38例老年早期MPC患者的累及器官、手术、内镜黏膜切除(EMR)、放疗、内科治疗的远期疗效。结果 消化系统受累最高,泌尿生殖系统、肺癌列第2,3位。EMR、手术、放疗远期效果优于其他疗法;消化道肿瘤预后优于前列腺癌、血液系统肿瘤。多发癌随年龄增高,手术率减低。EMR、手术、放疗后5年生存率分别为85．7％、71．1％和75．0％。38例MPC首癌中位生存时间120个月,次癌中位生存时间39个月。首癌5年生存率88．6％,次癌5年生存率53．8％。结论 老年人每年常规内镜、B超、肺部X线检查有助于发现早期肿瘤;手术仍是治疗MPC的最佳方法,高龄患者手术率降低,EMR适于高龄消化道、膀胱肿瘤患者。     

Risk of cancers of the lung, head and neck in patients hospitalized for alcoholism in Sweden

Alcoholic patients are at increased risk of cancers of the head and neck but little information is available on the magnitude of the risk for specific sites and for different histological types. We followed 182 667 patients with a hospital discharge diagnosis of alcoholism during 1965-1994, for an average of 10.2 years. We compared their incidence of site- and histological type-specific cancers of the oral cavity, pharynx, larynx and lung with that of the national population. The standardized incidence ratio (SIR) of cancer of the oral cavity and pharynx was 5.33 (95% confidence interval [CI] 5.04-5.64, based on 1207 cases). The SIRs of laryngeal and lung cancer were 4.21 (95% Cl 3.78-4.68, 347 cases) and 2.40 (2.29-2.51, 1880 cases), respectively. The SIR was highest for cancers of the hypopharynx, floor of the mouth, mesopharynx and base of the tongue. The relative excess of lung cancer was similar for squamous cell carcinoma and adenocarcinoma. Low age at first hospitalization was associated with higher SIRs for all sites under study. 25 years after first hospitalization for alcoholism, the cumulative probability of developing a lung cancer was in the order of 5%, for oral and pharyngeal cancer it was 2.5%, and for oesophageal or laryngeal cancer 1% each. Our study shows that the risk of head and neck cancer among heavy drinkers is highest for sites in direct contact with alcohol. The high risk of head and neck neoplasms may justify specific medical attention.