105例胸壁肿瘤的诊断和外科治疗

目的：总结105例胸壁肿瘤的诊断和外科治疗经验,探讨胸壁大块缺损的重建方法.方法：回顾性总结分析105例胸壁肿瘤的临床资料.男78例,女27例.年龄6～70岁.94例原发性肿瘤,其中良性75例,恶性19例;11例为转移癌.19例行胸壁肿瘤切除及胸壁大块缺损重建术.结果：所有病例手术过程顺利,无手术死亡.术后随诊：48例良性肿瘤患者健在,16例死于其它原因.13例恶性肿瘤生存21个月至8年,恶性者术后主要死于复发及远处转移.11例转移癌全部死亡,术后生存10个月至6年4个月.结论：对无病理诊断的原发性肋骨肿瘤,应先做限制性根治切除术.大块胸壁缺损的重建,应用理想的修复材料是十分重要的.     

六例胸骨肿瘤的切除与重建报告

目的探讨胸骨肿瘤的临床特点、诊治方法和重建方法。方法回顾性选取2015年1月至2018年12月间新疆医科大学第三附属医院收治的6例胸骨肿瘤患者,均行胸骨肿瘤扩大切除术和胸壁重建。结果术后病理诊断,软骨肉瘤3例,纤维瘤病1例,炎症性肌纤维母细胞肿瘤1例,骨巨细胞瘤1例。1例患者术后1周出现切口渗液,经换药及清创后恢复好转,余病例切口均达到一期愈合。术后所有患者循环呼吸功能均正常,随访6~29个月患者均存活,随访期间均无肿瘤复发及转移。结论胸骨肿瘤多为恶性肿瘤,需保证足够的切除范围,无法达到扩大切除时,可行屏障切除。扩切后缺损较大时,需积极重建胸壁的稳定性。     

58例胸壁肿瘤的外科治疗

为了探讨胸壁肿瘤的诊断治疗及胸壁缺损的重建方法,回顾性分析58例胸壁肿瘤患者的临床资料。采用外科手术切除胸壁肿瘤及胸廓重建修复胸壁缺损,结果全组无手术死亡,无严重并发症。对12例恶性胸壁肿瘤患者随访1个月～11年,生存最短者6个月,最长者11年9个月。对46例良性肿瘤随访3个月～12年,全部生存。结果提示,胸壁肿瘤无论良恶性均首选手术切除,尤其对较大恶性肿瘤病灶患者,应进行胸壁扩大切除,并行胸廓重建修复胸壁缺损。     

胸壁肿瘤切除后涤纶布修补巨大胸壁缺损42 例临床分析

 目的 探讨胸壁肿瘤切除后胸壁重建的方法。方法 自1990年10月至2004年6月对42例胸壁肿瘤切除后行涤纶布修补重建，将涤纶布修剪成大小及形状与缺损胸壁相仿，缝合于缺损胸壁边缘的软组织上，然后行皮肤软组织修复，局部加压包扎。结果 本组无手术死亡及严重并发症发生。并发症发生率为12％，其中皮下积液1例，心律失常4例。随访5个月～5年，4例良性肿瘤无复发，恶性肿瘤的1、3、5年生存率分别为86．8％、57．9％、36．8％。结论 胸壁肿瘤切除有较好的愈后，应积极手术治疗。涤纶布修补胸壁缺损具有组织相容性好，有一定的韧性及弹性，手术操作简单，并发症少等优点。     

联合化疗加外敷治疗乳腺癌性溃疡5例

对乳腺癌晚期局部治疗不当,可引发胸壁癌性溃疡,本院近来收治5例,报告如下:1 材料与方法1.1 一般资料 本组5例均为女性,年龄40岁～67岁.乳腺癌根治术后发生胸壁溃疡者4例,初诊时已广泛转移并胸壁破溃者1例,未手术.既往曾经化疗3例,初次化疗2例.有胸壁放疗史1例.破溃范围2cm×1cm～8cm×5cm;胸壁破溃时间为2个月～8个月.有肺转移者3例,骨转移1例,淋巴结转移5例,双侧卵巢转移1例.病理学诊断:浸润性导管癌3例,硬癌1例,腺癌1例.5例均行破溃处皮肤 切取活检,病理与原发灶相同.雌激素受体、孕激素受体均阳性3例,雌激素受体阳性1例,孕激素受体阳性1例. 1.2治疗方法1.2.1 全身化疗 CTX500mg/m~2,静注,d1,8;ADM40mg/m~2,静注,d2;DDP100mg/m~2,静滴,     

乳腺癌术后胸壁转移的外科治疗

目的　探讨乳腺癌术后胸壁转移的外科治疗及方法。方法　 1997年 6月～ 2 0 0 0年 12月手术治疗 30例乳腺癌术后胸壁转移瘤。胸壁肿物切除后行对侧乳腺劈裂瓣修补术 16例 ,行同侧腹直肌瓣修补术 6例 ,行大网膜瓣修补+中厚皮瓣植皮术 8例。术后予以CAF方案化疗 14例 ,NP方案化疗 16例。结果　术后皮瓣部分坏死 2例 ,均为大网膜瓣修补 +中厚皮瓣植皮术治疗病例 ,经清创再植皮而痊愈。全部病例均获得随访。术后肿瘤远处再发转移 5例 ,予以继续化疗获得缓解。结论　外科治疗使乳腺癌术后胸壁转移取得良好效果 ,提高患者的生活质量。     

胸壁肿瘤切除与胸壁重建

目的探讨胸壁肿瘤切除要点及缺损胸壁的重建方式。方法回顾分析1985年4月至2010年9月间手术治疗83例胸壁肿瘤患者的临床资料。其中胸骨肿瘤12例,肋骨肿瘤46例,软组织肿瘤25例。原发67例中良性40例,恶性27例;继发16例中转移10例,侵袭6例。手术行肿瘤切除48例,肿瘤切除加胸壁重建34例,探查1例。10例胸骨肿瘤和22例肋骨肿瘤切除后采用有机玻璃、同种异体胸骨、钢板、钢丝、缝线、涤纶布及胸大肌或膈肌重建;2例软组织肿瘤切除后采用转移肌瓣及转移皮瓣加植皮重建。结果 1例左全肺切除加胸壁重建患者突发心肌梗死死亡,1例全胸骨切除胸壁重建患者并发胸腔感染,其余81例术后恢复顺利,移植物未发生排斥反应。随访71例,其中恶性肿瘤总1,3,5年存活率分别为79.0%、48.0%和31.0%。良性肿瘤术后有2例复发,最长已观察12年。结论原发性胸壁肿瘤应首选手术,继发性胸壁肿瘤在原发灶可一并切除或控制前提下亦可手术。切线距肿瘤4 cm以上可降低复发。胸壁缺损较大者应行胸壁重建。骨性缺损宜选硬质材料如有机玻璃重建,软组织缺损可采用自体组织如肌瓣修复。     

微波治疗骨肿瘤23例临床观察

我院 1994年 5月～ 2 0 0 0年 3月采用微波治疗骨肿瘤 2 3例 ,效果满意。报道如下。1　临床资料1.1　一般资料具有明确诊断的骨肿瘤患者 2 3例 ,男 15例 ,女 8例 ;年龄10～ 47岁 ,平均 2 6 .5 0岁。发病至确诊时间为 16个月～ 3年 ,平均 9.5个月。肿瘤性质 :骨肉瘤 12例 ,皮质旁骨肉瘤 3例 ,软骨肉瘤 3例 ,平滑肌肉瘤 3例 ,骨巨细胞瘤 2例。肿瘤分期 :术前采用ＭＳＴＳ分期 :ⅡＢ 17例 ,ⅡＡ 4例 ,ⅢＢ 2例。在ⅢＢ 2例中有 1例为肺转移 ,另 1例为远处淋巴结转移。1.2　方法以股骨下端为例 ,行膝关节内侧切口 ,显露股骨下端肿瘤及肿瘤以上 1…     

晚期上皮性卵巢癌肠肿瘤切除的作用

目的：分析晚期上皮性卵巢癌行肿瘤细胞减灭术时肠道转移瘤行肠道肿瘤切除的临床应用。方法：回顾性分析1998～2003年52例晚期上皮性卵巢癌行肿瘤细胞减灭术时肠道转移瘤行肠道肿瘤切除的患者,与同期未行肠道肿瘤切除的仅行姑息性手术的16例患者进行比较,采用统计学方法进行处理。结果：68例手术治疗患者中,52例完成肠道肿瘤切除手术,其中34例无肉眼呵见残余肿瘤,8例残余肿瘤〈1cm,10例残余肿瘤〉1cm,其中位生存期分别为28个月、23个月和13个月,16例因肿瘤广泛转移未行肠道肿瘤切除仅行姑息性手术的患者中位生存期为7．66个月,肠道肿瘤广泛转移及肠系膜根部广泛种植是手术失败的关键。结论：晚期上皮性卵巢癌行肿瘤细胞减灭术时行肠道转移瘤切除,达到满意手术效果时对生存期提高足有帮助的,而选择恰当的患者是手术治疗的关键。     

乳癌术后局部复发或区域淋巴结转移放疗价值

对44例乳癌术后局部和/或区域淋巴结复发病人进行放射治疗。年龄30～78岁,中位年龄485岁。首程治疗后至局部复发或区域淋巴结转移时间:<3月者6例,～1年者9例,～3年者15例,～5年者9例,>5年者5例。最短1月,最长10年4个月。病灶在1个部位32例,两个部位以上12例。36例病理证实,8例临床诊断。胸壁局部复发25例中12例为多发病灶,其它部位为单发病灶,病灶共107个,胸壁复发肿瘤大小为05～7ｃｍ,锁骨上及腋下转移肿瘤大小为1～10ｃｍ,2例发生在健侧锁骨上。12例胸壁多发者中5例用大野照射,3例用切线野照射,4例用旋转照射,其余部位病灶用局部野照射。…     

Combination radical surgery and multiple sequential chemotherapy for the treatment of advanced carcinoma of the testis (stage III).

Nineteen patients with advanced testicular carcinomas (Stage III) were treated by a combination of multisequential chemotherapy with vinblastine, bleomycin, platinum, adriamycin, cytoxan, actinomycin D, and reductive surgery. Of the sixteen patients who were operated on 10 patients are alive and free of disease from 5 to 15 months. Two patients are alive with residual disease and four patients died. (Three were free of malignant tumor and one had residual malignant disease.) Three patients are still receiving preoperative chemotherapy. Pathology reported benign tumors in 8 out of 16 patients operated on. All these patients were previously treated with multiple chemotherapy. Several facts emerge from this study: (1) the great effectiveness of the combination of multisequential chemotherapy and reductive surgery to produce complete clinical remission in advanced testicular carcinomas (63.6%, 13 out of 19 patients); (2) the possibility of benign transformation of these tumors (50%, 8 out of 16); (3) the importance of the second-look surgery in testicular tumors.     

Malignant ovarian neoplasms in childhood.

From 1962 to 1976, 15 children up to the age of 15 years with malignant neoplasms of the ovary were observed at the Istituto Nazionale Tumori of Milan. 13 patients had a germ cell tumor and 2 a stromal tumor. Natural history and treatment results are reported. Out of 7 patients with dysgerminoma, 3 at stage IA, 2 at stage III retroperitoneal and 1 with recurrent disease are alive and disease free 38+, 20+, 36+, 16+, 23+, 156+ months after the histologic diagnosis; the last case with stage III peritoneal disease died 2 months after the diagnosis. Four children had immature malignant teratoma: 2 patients are alive and disease free 19+ and 51+ months, 1 is alive with disease 20+ months and 1 died 16 months after histologic diagnosis. Two patients with extra-embryonal teratoma died 7 and 12 months after diagnosis. One patient, treated by surgery plus chemotherapy for granulosa cell tumor at stage III, is alive 43+ months later. The child with arrhenoblastoma at stage III treated by surgery plus radiochemotherapy died 6 months after diagnosis. Through a close scrutiny of the literature and by drawing on experience gained in the treatment of the same tumors in adults, a rational approach to the diagnosis and treatment of each childhood ovarian tumor histotype is worked out.     

骨盆髋臼周围恶性肿瘤切除后人工骨盆假体重建手术探讨——附12例报告

背景与目的:骨盆髋臼周围的恶性肿瘤,由于肿瘤部位深,切除范围又是身体负重力线必经之路,故肿瘤切除及肿瘤切除后骨盆髋关节的修复重建,是骨肿瘤手术治疗中一项非常复杂的外科技术.本文总结骨盆髋臼周嗣恶性肿瘤的切除及肿瘤切除后骨盆髋关节假体修复重建的方法和临床经验.方法:回顾中山大学附属第一医院1995年至2006年对12例骨盆髋臼周围恶性肿瘤切除后进行骨盆及髋关节假体修复重建的临床资料,就术前准备、手术方案制定、肿瘤假体设计、手术操作、髋关节修复重建、术后肢体功能康复训练等进行分析,探讨该类肿瘤的临床手术治疗特点.结果:12例均能按照原定手术方案切除肿瘤和修复重建髋关节,术后随访时间8～86个月,中位时间46个月,4例复发,其中2例骨肉瘤患者分别在术后15个月和22个月死于双肺广泛转移;1例软骨肉瘤患者术后26个月局部复发,38个月死亡;1例骨巨细胞瘤患者术后13个月局部复发,再行局部病灶清除术,至末次随访日未见再复发.其余病例至末次随访仍生存,未见肿瘤复发或转移.按Kaplan-Meier法计算1年生存率为75.0%,3年、5年生存率均为33.3%,7年生存率为25.0%.肢体功能评分参照人工全髋关节置换术后Rarris评分标准,60～69分3例,70～79分5例,80～90分4例.结论:骨盆肿瘤切除及髋关节假体修复重建具有手术难度大、风险高的特点,对于恶性程度相对较低的骨肿瘤,该手术治疗是较理想的方法之一.     

Radiotherapy of esthesioneuroblastoma

PURPOSE: Only 3% of all malignant intranasal tumors are esthesioneuroblastomas (ENB). As the tumor is very rare, the number of ENB treated in individual departments is small. In order to evaluate the efficacy of radiotherapy (RT), patients' data of 2 centres were analysed with reference to new reports in literature. METHODS AND MATERIALS: From 1981 to 1998, 17 patients with ENB, 8 men and 9 women aged between 6 and 81 years, were treated in the departments of radiotherapy of the universities of Cologne and Muenster. The tumors were Kadish Stage B in 4/17 patients and Stage C in 13/17 patients. Treatment included incomplete surgery and irradiation in 2/17 patients, adjuvant RT postoperatively in 6/17 patients, definitive RT in 7/17 patients and RT after incomplete surgery of recurrent tumors in 2/17 patients. Postoperatively, the median target dose of EBRT was 56 (range 50-60) Gy; for definitive RT it was 58 (range 40-70) Gy. RESULTS: After a median follow-up period of 86 (range 2-208) months 10/17 patients showed no evidence of disease (NED). There were 6 patients treated with radical complete surgery plus postoperative irradiation and 5 of them were NED. There were 7 patients treated with only irradiation and 3 of those patients were NED. Of 2 patients with incomplete surgery and irradiation there was one patient NED. Of 2 patients with incomplete resection of recurrent tumor who received irradiation, there was one patient NED. 2 of the patients with NED died after 22 and 94 months respectively. 4/17 patients died as a result of local recurrence and 2/17 patients as a result of distant metastases (liver, brain). One patient with a recurrent tumor is alive. Median survival of all 17 patients was 94 months. Progressive disease after definitive RT occurred after a median of 11 months. CONCLUSION: Esthesioneuroblastomas are radiocurable tumors. In correlation to literature a primarily complete tumor resection followed by adjuvant RT (50-60 Gy) offers the best disease free survival.     

Spinal cord ependymomas in adults: analysis of 15 cases

This retrospective analysis was performed to examine the outcome of patients with spinal cord ependymomas treated with surgery and postoperative radiation therapy between 1982 and 1998. There were 10 male and 5 female patients, ranging from 16 to 74 years of age with a median age of 38 years. Surgery was gross total resection in 2 patients, subtotal resection in 10, biopsy in 3. All patients received radiation therapy with a total dose of 40-56 Gy. The 5 and 10 year overall survival rates were 83.3 and 83.3%, respectively. Twelve patients are still alive at a median follow-up period of 70 months. Of the 15 patients, 6 developed recurrent disease on follow-up. The median time to recurrence was 45 months (range: 24-80 months). Local failure within the initial irradiated volume occurred in 3 out of 6 patients who received less than 45 Gy and 2 out of 8 patients treated with more than 45 Gy. Four out of the six failures were salvaged with additional treatment. Re-irradiation was used as a part of salvage or sole treatment in 3 cases. The patient who was salvaged with radiation therapy only died of disease progression 41 months following recurrence and the other two who received a combination of surgery, radiotherapy or chemotherapy were still alive 57 and 30 months following relapse. The present study shows that surgery and post-operative radiation treatment for spinal ependymoma patients resulted in high survival rates. Patients with residual disease after surgery should be treated with radiation therapy with a dose of more than 45 Gy. Re-irradiation may be the treatment of choice for recurrent patients having less than complete resection or no surgery.     

Nasopharyngeal carcinoma in children review of 16 cases

Of fifty two children with nasopharyngeal tumors who were registered and treated at Memorial Sloan-Kettering Cancer Center (MSKCC), from 1961 through 1977, 16 had carcinoma. The results of retrospective analysis of these patients are presented here. There were 7 girls and 9 boys between 12 and 16 years of age. One patient had a Stage I tumor; one had a Stage II tumor and 14 had Stage IV tumors. The histology was poorly differentiated epidermoid carcinoma in all patients. All patients had radiotherapy to the primary site. Six patients received chemotherapy for distant metastases, and 2 had adjuvant chemotherapy. Of the 13 patients who were treated initially with radiation alone, 2 were alive and free of disease at 12 and 14 years respectively. Of the 3 patients who had chemotherapy at initial treatment, one was alive and free of disease 18 months from diagnosis and one patient died of treatment without tumor. Bone was the most common site of distant metastases. While radiation therapy alone appears to be adequate treatment for early tumors, adjuvant chemotherapy should be tried to improve results in advanced tumors.     

Extragonadal germ cell tumors in Taiwan: an analysis of treatment results of 59 patients

BACKGROUND: Extragonadal germ cell tumors (EGCT) are rare. They are biologically distinct from their testicular counterparts. Information regarding these tumors from the Far East is limited. More investigations are warranted to define the optimal treatment. METHODS: Retrospective review of the medical records of 59 patients with EGCT treated between 1983 and 2001 at a large, tertiary care institute in Taipei. RESULTS: The study population comprised 54 males and 5 females, ranging in age from 1 to 68 years old (median age, 21 years). Primary tumors occurred in the mediastinum (n = 27), retroperitoneum (n = 6), central nervous system (CNS; n = 24), and other sites (n = 2). Patients received surgery, chemotherapy, radiotherapy, or a combination of treatment modalities as the primary treatment. Three patients with mediastinal seminoma achieved complete remission (CR) and are alive with no evidence of disease (NED), with a median follow-up of 118 months. Of 24 patients with mediastinal nonseminomas, 8 (33%) are alive with a median disease-free survival (DFS) period of 33 months. Two of six patients with retroperitoneal nonseminomas obtained CR and are alive with NED at 41 and 110 months, respectively. Of 24 patients with intracranial germ cell tumors, 16 had germinoma and 13 (81%) achieved CR with NED at 8-228 months (median duration, 104 months). Four of eight patients with CNS nongerminomas remain in CR and are alive with a median DFS period of 48 months. Four patients with mediastinal nonsemonimas treated with salvage chemotherapy died. CONCLUSIONS: The treatment results of our patients with seminomatous EGCT are comparable to those of Western countries. However, the treatment results of patients with nonseminomatous EGCT are not as good. The reason for this discrepancy needs to be explored for a better treatment outcome of for patients in Taiwan with EGCT.     

Outcome following resection for patients with primary mediastinal nonseminomatous germ-cell tumors and rising serum tumor markers post-chemotherapy

BackgroundTo assess the outcome of surgical resection in patients with primary mediastinal nonseminomatous germ-cell tumors (PMNSGCT) with rising serum tumor markers (STM) following standard platinum-based chemotherapy.Patients and methodsA total of 158 consecutive patients with PMNSGCT who received platinum-based chemotherapy followed by complete surgical extirpation of residual disease at Indiana University from 1982 to 2007 were retrospectively reviewed. Thirty-five of these 158 patients had rising STM at time of resection.ResultsThirty-five patients (34 males and 1 female) comprise the basis of this report. Three patients had rising human chorionic gonadotropin, and the remaining 32 patients had rising alpha-fetoprotein at the time of thoracic surgery. Twenty-four of the 35 (69%) pathologically demonstrated viable germ-cell tumor, while 8 patients had teratoma and 3 patients had necrosis only at time of resection, despite the presence of rising STM. Twenty-seven patients normalized their tumor markers postoperatively. Twenty-one of 35 died, 5 were lost to follow-up, and 9 are alive. Of the nine patients alive, seven are continuously disease free with median follow-up of 64 months (range 25–220 months).ConclusionThe presence of rising STM doesn’t preclude successful therapy with surgical resection, especially if carried out by experienced thoracic surgical oncologists.     

Intracranial Germ Cell Tumors: A Single Institution Experience and Review of the Literature

There is little literature to guide therapy in children and young adults with intracranial germ cell tumors. We present 17 consecutively diagnosed intracranial germ cell tumors at The Children's Hospital, Denver, from 1995 to 2001. Of 17 patients, 3 had considerable delay in diagnosis. Two with suprasellar tumors presented with dementia, blindness and pan-hypopituitarism and another with recurrent subarachnoid hemorrhage. Seven had germinoma, three were metastatic at diagnosis. Ten had non-germinomatous germ cell tumors (NGGCT), 5/10 were alpha feto-protein (AFP) positive only, one beta-human chorionic growth (betaHCG) factor positive only, 3 positive for AFP and betaHCG, and 1 malignant teratoma. Therapy for metastatic patients consisted of chemotherapy followed by craniospinal radiation (CSI). Patients with localized disease received chemotherapy followed by focal radiation. Two patients received chemotherapy only, one because she died of sepsis while receiving chemotherapy and one because of neurologic injury incurred during surgery parents elected for no therapy. Three patients have died, one of tumor recurrence, one from a remote complication of surgery and one of sepsis. Twelve patients are alive without evidence of disease from 10 to 68 months (median 31.5 months). All five children with only AFP positivity, treated with chemotherapy and focal radiation are alive without evidence of disease at 10, 16, 22, 41 and 41 months. Thus, there is little evidence that CSI is necessary in non-metastatic germinomas and AFP positive NGGCTs when combined chemotherapy and radiation therapy is used. However, complications of delayed diagnosis, surgery and chemotherapy are important causes of mortality, with only one patient dying of tumor.