原发性腹膜后肿瘤600例临床研究(英文)

目的总结原发性腹膜后肿瘤(PRPT)临床诊断治疗经验,分析影响 PRPT 手术效果和预后的因素。方法回顾性分析解放军总医院600例 PRPT 的临床诊断、手术治疗、疗效和预后。结果 600例 PRPT 中546例行手术,肿瘤全部切除326例(占59.7%),肿瘤部分切除192例,肿瘤未切除取活检28例。同时行联合脏器切除于术113例(占20.7%)。PRPT 完全切除组的1、3、5年生存率分别为:90.5%、73.2%、53.6%,恶性 PRPT 部分切除组的1、3、5年生存率分别为:70.6%、32.0%、5.7%(P<0.01)。Cox 多因素回归分析显示:PRPT 的局部复发、生存期与(1)肿瘤是否完全切除;(2)肿瘤大小;(3)肿瘤细胞的分化程度明显相关。结论充分做好 PRPT 手术前准备,提高肿瘤完全切除率,是降低 PRPT 肿瘤复发,提高生存率和预后的关键。     

原发性腹膜后肿瘤600例临床研究

目的总结原发性腹膜后肿瘤(PRPT)临床诊断治疗经验,分析影响PRPT手术效果和预后的因素。方法同顾性分析解放军总医院600例PRPT的临床诊断、手术治疗、疗效和预后。结果600例PRPT中546例行手术,肿瘤全部切除326例(占59.7%),肿瘤部分切除192例,肿瘤未切除取活检28例。同时行联合脏器切除手术113例(占20.7%)。PRPT完全切除组的1、3、5年生存率分别为:90.5%、73.2%、53.6%,恶性PRPT部分切除组的1、3、5年牛存率分别为:70.6%、32.0%、5.7%(P<0.01)。Cox多因素回归分析显示:PRPT的局部复发、生存期与(1)肿瘤是否完伞切除;(2)肿瘤大小;(3)肿瘤细胞的分化程度明显相关。结论充分做好PRPT手术前准备,提高肿瘤完全切除率,是降低PRPT肿瘤复发,提高生存率和预后的关键。     

19例结直肠胃肠道间质瘤的外科治疗

目的:探讨结直肠的胃肠道间质瘤(gastrointestinal stromal tumors,GIST)外科治疗效果及其影响因素.方法:对我院1990年1月至2004年3月首次治疗的19例结直肠GIST临床资料和病理切片(含免疫组织化学检查)重新复核并加以随访,分析手术切除的效果以及影响手术疗效的因素.结果:手术者中位生存时间为60.0个月,术后1、3、5年生存率分别为100%、79.3%和69.4%.非扩大切除术者(即肿瘤局部切除和肿瘤及所在器官切除)与扩大切除术者比较,差异有显著性(P=0.001).完全切除术患者的生存率与肿瘤大小、病理类型、核分裂和复发转移有关;但多因素COX回归分析显示,术后生存率仅与肿瘤大小、核分裂和复发转移相关(P＜0.05).结论:结直肠GIST仍以外科治疗为主,原则上行局部完全切除即可.     

胃间质瘤37例诊治及预后分析

[目的]探讨胃间质瘤（GST）临床病理特点、手术治疗及预后。[方法]回顾性分析1997—2007年间37例手术切除的GST临床病理资料。[结果]37例GST中肿瘤位于胃底部、胃体部、胃窦部分别为6例、11例、20例,肿瘤平均直径5．45±4．53cm。免疫组化分析CD117阳性表达率为97．0％。全组35例施行肿瘤完全切除术,另2例分别行姑息切除或活检。32例患者获随访,1、3、5年生存率分别为97．O％、88．2％、81．1％。Fletcher恶性风险分级与生存率密切相关（P=O．002）,极低度、低度、中度风险组与高度风险组间生存率差异有显著性意义（P值均〈0．05）。[结论]应高度重视GST初次手术的完全切除,对恶性风险较高的GST需积极施行切除范围较大的手术治疗。     

乳腺分叶状肿瘤临床特点与复发危险因素

目的探讨乳腺分叶状肿瘤的临床特点、诊治方法和局部复发的危险因素。方法选取1990年1月至2016年7月间柳州市工人医院收治的48例乳腺分叶状肿瘤患者的临床病理和随访资料作回顾性分析,采用卡方检验分析各临床病理因素、手术方式与局部复发的关系,采用Logrank检验分析上述因素对无病生存率的影响。结果所有患者术后病理诊断结果中,良性乳腺分叶状肿瘤29例,交界性乳腺分叶状肿瘤11例,恶性乳腺分叶状肿瘤8例,无一例发现腋窝淋巴结转移。39例随访患者,1年、3年和5年无病生存率分别为83.8%、69.4%和66.1%,5年总生存率为93.0%。局部复发者10例,其中6例患者为肿块切除术后局部复发。患者是否采用肿块切除术与局部复发关系比较,差异有统计学意义(P=0.01)。结论外科手术是乳腺分叶状肿瘤的主要治疗方法,术式选择不当与局部复发有关,对乳腺分叶状肿瘤应选择局部广泛切除、乳房切除或乳房重建术,不宜采用肿块切除术,不必常规行腋淋巴结清扫术。     

恶性胰腺实质性假乳头状肿瘤2例分析

[目的]探讨恶性胰腺实质性假乳头状肿瘤（SPT）临床病理特点及其治疗。[方法]对2001年～2005年收治的2例经手术及病理证实的恶性SPT患者临床资料进行回顾分析。[结果]2例恶性SPT患者中，1例为老年男性患者，伴后腹膜转移，行胰体尾切除＋脾切除＋后腹膜淋巴结清扫术。术后10个月死于肿瘤复发。另1例为年轻女性，行胰体尾切除＋脾脏切除，术后随访未见复发及转移。[结论]恶性胰腺实质性假乳头状肿瘤大多生长缓慢，具有典型的影像及病理特点，积极手术切除预后良好。     

尿道切除和膀胱肌瓣尿道成形术在外阴癌治疗中的应用

[目的]探讨尿道切除和膀胱肌瓣尿道成形术在外阴癌治疗中的应用价值。[方法]从1970年8月至1998年8月手术治疗外阴癌侵犯尿道者70例。肿瘤侵犯尿道外口或侵犯尿道<1 0cm行2 0cm尿道切除31例 ;肿瘤侵犯尿道下1/2段行全尿道切除39例 ;全尿道切除后用膀胱颈与膀胱不分离膀胱肌瓣尿道重建14例 ,膀胱颈与膀胱分离尿道重建25例。[结果]手术并发症 :部分尿道切除者尿失禁4例(12 9 %) ,尿道残端癌复发4例(12 9 %) ;全尿道切除者膀胱阴道瘘4例 ,4例均发生在膀胱颈与膀胱不分离尿道重建法中 ,占28 6 %(4/14)。全尿道切除病例无癌复发。本组总的5年生存率为79%。其中部分尿道切除者为73 1 % ,全尿道切除者为83 3 %。[结论]部分尿道切除仅适用于肿瘤侵犯尿道外口或侵犯尿道<1 0cm者 ;全尿道切除适用于肿瘤侵犯尿道下1/2段 ,并能大大减少癌复发和提高生存率。应用膀胱颈与膀胱分离膀胱肌瓣尿道重建 ,还可避免发生膀胱阴道瘘 ,大大提高病人的生活质量     

复发性胃癌再次手术的临床意义

[目的]探讨复发性胃癌再次行外科手术治疗的意义。[方法]回顾性分析1990年1月~2005年12月收治的103例复发性胃癌的临床资料。[结果]103例胃癌,复发局限于残胃45例,首次术后2年内复发61例。全组再手术切除54例,其中根治性切除43例,姑息性残胃切除11例,合并联合脏器切除25例。全组再次手术后1、3、5年生存率分别为71.2%、21.6%和9.5%,其中根治性残胃切除术后1、3、5年生存率分别为86.2%、49.1%和19.5%,中位生存期32.0个月;姑息性切除术后1、3、5年生存率分别为45.5%、10.0%和0,中位生存期15.0个月;未切除患者均于1年内死亡。[结论]残胃局部复发癌以残胃、吻合口局部复发及邻近器官浸润为主,具有较高的切除率,应积极行再手术治疗。     

影响脑胶质瘤术后生存时间的因素分析（附56 例随访报告）*

目的:了解脑胶质瘤生长部位、手术方式、病理分级和术后治疗对患者术后生存时间的影响。方法:对第三军医大学西南医院2000年7 月～2007年5 月间经手术治疗的脑胶质细胞瘤患者中56例进行随访,分析肿瘤生长部位、手术切除程度、病理分级和术后治疗与患者术后生存时间的关系。结果:本组病例肿瘤位于大脑半球者48例,术后1 年生存率和3 年生存率分别为43.8% 和12.5% ,位于小脑半球者6 例,术后1 年生存率和3 年生存率分别为100% 和66.7% ,差异显著。肿瘤达肉眼全切的患者1 年和5 年生存率最高,分别为61.1% 和38.9% ,大部分切除者次之,分别为59.1% 和13.6% ,而部分切除或活检或活检者最短,分别为18.8% 和0。Ⅰ～Ⅱ星形胶质细胞瘤术后1 年和5 年生存率分别为68.8% 和28.1% ,而Ⅲ～Ⅳ级者分别为13.6% 和0。单纯手术、手术+ 放疗、手术+ 化疗、手术+ 放疗+ 化疗治疗的患者1 年生存率分别为16.7% 、63.6% 、71.4% 、78.6% ,5 年生存率分别为0、27.3% 、14.3% 、42.9% 。提示高级别胶质瘤患者的生存期短;小脑胶质细胞瘤患者术后生存时间明显高于大脑半球和丘脑区肿瘤;而手术切除肿瘤的彻底性仍是影响胶质瘤患者术后生存期最重要的因素,手术显微镜下肿瘤全切除和大部切除的术后生存时间明显优于部分切除或活检;术后放、化疗等综合治疗能显著延长患者的生存期。结论:手术方式、病理分级及术后治疗均能影响脑胶质细胞瘤患者术后生存时间,其中手术显微镜下全切和有效的术后治疗起决定作用。      

颈椎后路手术治疗原发性椎管内肿瘤临床分析

[目的]探讨颈椎后路手术治疗原发性椎管内肿瘤的可行性。[方法]回顾性分析采取颈椎后路手术治疗11例颈椎管内肿瘤患者（颈椎管内神经鞘瘤6例,神经纤维瘤4例,脊膜瘤1例）的临床资料,5例患者在切除肿瘤后行颈椎稳定性重建。采用JOA评分评价颈椎功能改善情况。[结果]11例患者肿瘤于肉眼下完全切除,所有病例随访5个月～3年,JOA评分改善率52.9%±14.0%。未发现复发病例。[结论]原发性颈椎管内肿瘤可行后路手术切除。     

Primary malignant retroperitoneal tumors: analysis of a single institutional experience.

AIMS: In order to achieve complete resection in the surgical management of retroperitoneal tumors, it is crucial to know the tumor's anatomical location relative to neighboring organs. METHODS: Forty-nine patients with primary malignant retroperitoneal tumors were divided by tumor location into two groups [upper abdomen (group 1) or lower abdomen (group 2)], and clinicopathological features, tumor recurrence, and patient survival were assessed. RESULTS: No significant differences in preoperative clinical characteristics existed between two groups, and liposarcoma was the most frequently observed tumor type. The difference in the rates of complete resection between the two groups was not statistically significant (75.9% for group 1 and 85% for group 2). En-bloc combined resection was performed in 52% and 30% of patients in groups 1 and 2, respectively. The local recurrence rate in group 2 (31.3%) was higher than that in group 1 (9.5%), despite the fact that the differences in rates of complete resection and distant recurrence rates (14.3% in group 1 and 12.5% in group 2) between the two groups were not statistically significant. The overall 5-year survival rates were 67.9% for group 1 and 43.2% for group 2 (p=0.038). The 5-year survival rate of patients with tumors smaller than 10 cm was 78.4%, while that of patients with tumors larger than 10 cm was 38.1% (p=0.017). The 5-year survival rate after complete excision was 61%, whereas that after incomplete resection or biopsy only was 40.0% (p<0.0001). CONCLUSIONS: An upper abdominal tumor location is a positive prognostic factor even if small tumor size (<10 cm) and complete resection of the tumor are still more important factors to improve outcome in patients with malignant primary retroperitoneal tumors. Because complete resection was shown to be the most important prognostic factor, an aggressive and careful surgical approach is recommended for the treatment of such tumors.     

促纤维组织增生性小圆细胞肿瘤的临床特征及治疗模式探讨

目的 探讨促纤维组织增生性小圆细胞肿瘤(DSRCT)的临床特征和治疗模式.方法 收集中国医学科学院肿瘤医院1999年1月至2009年5月收治的5例DSRCT患者的临床资料,并结合1989年至2007年国内外发表的文献23篇,对其中有完整临床病理资料的48例DSRCT患者进行统计分析.结果 全组53例DSRCT患者的中位年龄为23岁(1.5～66岁),其中男性40例,占75.5%.首诊症状为腹部包块或腹痛41例,占77.4%;病变原发于腹腔或盆腔46例,占86.8%;首诊即出现淋巴结转移或远处转移15例,占28.3%.中位随访时间为1.8年(0.1～10.0年).全组患者的1、3和5年生存率分别为45.8%、20.8%和5.7%.53例患者中,接受手术治疗47例,其中行根治性手术者的1年和3年生存率分别为70.5%和53.7%,明显高于行姑息性手术者的1年和3年生存率(37.2%和4.8%,P=0.0020).接受全身化疗34例,患者的1年和3年生存率分别为60.1%和35.2%,明显高于未接受化疗者的1年和3年生存率(29.7%和12.7%,P=0.0396).接受放射治疗12例,患者的1年和3年生存率分别为75.0%和38.9%,明显高于未接受放疗者的1年和3年生存率(36.9%和14.8%,P=0.0314).进一步分层分析显示,与单一治疗模式相比,采用根治性手术联合化疗或放疗以及化疗联合手术或放疗的患者有生存优势(P=0.0466和P=0.0100).结论 根治性手术、全身化疗或放射治疗均能够延长DSRCT患者的生存期,但采用根治性手术联合化疗或放疗以及化疗联合手术或放疗的疗效更好.     

Therapy of meningeal melanocytomas

BACKGROUND: Meningeal melanocytomas are rare, benign central nervous system lesions with a high probability of recurrence. To the authors' knowledge, approximately 100 cases have been reported since 1972, when the entity first was described. In the current study, four therapies were compared with regard to local control and survival to identify which is best. METHODS: All reported cases were reviewed with regard to extent of resection, radiotherapy, local control, and survival. If published data were incomplete, the authors were contacted for additional data. Patients were categorized by therapy: complete resection (CTR), complete resection followed by radiotherapy (CTR-RT), incomplete resection (ITR), and incomplete resection followed by radiotherapy (ITR-RT). Local control and survival were calculated using the Kaplan-Meier method. A multivariate analysis was performed including age, gender, tumor location, confirmation of extent of resection, and treatment schedule. RESULTS: A total of 89 patients were included: 46 with CTR, 3 with CTR-RT, 23 with ITR, and 17 with ITR-RT. The 5-year local control rate was 80% after CTR, 100% after CTR-RT, and 72% after ITR-RT versus 18% after ITR (P < 0.001). The 5-year survival rate was 100% after CTR, CTR-RT, and ITR-RT, respectively, versus 46% after ITR (P < 0.001). Multivariate analysis demonstrated that therapy was the only variable that affected local control and survival significantly. In 14 patients treated with ITR-RT, RT was restricted to the tumor region. The radiation dose was 30-40 grays (Gy) in 6 patients, 45-55 Gy in 7 patients, and unknown in 1 patient. The 5-year local control rate was 86% after a dose of 45-55 Gy versus 27% after a dose of 30-40 Gy (P = 0.1). CONCLUSIONS: CTR was found to be significantly superior to ITR with regard to both local control and survival. Outcome was significantly improved by RT after ITR. Doses of 45-55 Gy appeared to be more beneficial than doses of < or = 40 Gy.     

RESULTS OF HEPATECTOMY FOR 600 CASES WITH PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦ　ＨＥＰＡＴＥＣＴＯＭＹＦＯＲ６００ＣＡＳＥＳＷＩＴＨＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ李国辉；ＬｉＪｉｎｑｉｎｇ李锦清；Ｚｈａｎｇｙａｑｉ张亚奇；Ｙｕａｎｙｕｎｆｅｉ元云飞；ＣｈｅｎＭｉｎｓｈａｎ陈敏山；ＧｕｏＲ...     

Clinical study and treatment of uterine sarcoma at Niigata City General Hospital

We report a retrospective study of 16 patients with uterine sarcoma from 1986 to 2001 in Niigata City General Hospital. Five-year survival rates in stage I, II, III and IV (FIGO) were 68% (n = 4), 50% (n = 2), 0% (n = 3), and 0% (n = 7), respectively. Overall survival for the patients with incomplete resection of tumor at primary laparotomy (n = 7) was significantly poorer than that with complete resection (n = 8). Patients with a high-LDH (lactic acid dehydrogenase) value tended to have poorer prognoses, but there was no significant difference of overall survival between the high-LDH group (n = 8) and the normal-LDH group (n = 8). Fifteen patients had postsurgical adjuvant chemotherapy. Out of 5 evaluable patients undergoing first-line chemotherapy, there were only 2 partial responders with IAP (ifosfamide, adriamycin, cisplatin) chemotherapy, and out of 11 evaluable patients undergoing second-line chemotherapy, there was only 1 partial responder with IAP. Out of 10 patients who had no evidence of disease after prior therapy, 6 patients had recurrences. Five patients underwent secondary surgery for recurrence and residual tumor. Of them, 3 patients did not have complete resection of residual tumor and died within 1 year after secondary surgery. Although prognosis of advanced uterine sarcoma and recurrence is poor, it is suggested that aggressive resection for recurrence and residual tumor improves prognosis.     

肺癌外科治疗210例的远期结果分析

目的 探讨影响肺癌切除术后患者远期疗效的因素。方法对1987年1月～1999年12月间210例接受肺癌切除术患者的临床、病理和随访资料进行回顾性研究。选择9个可能对预后产生影响的因素，通过COX比例风险模型进行多因素生存分析。结果全组患者3年生存率为37．4%，5年生存率为30．1％，10年生存率为23．5％。单因素分析显示：p-TNM分期中T和N的不同分期、肺癌组织学类型、手术方式和手术性质对手术后远期生存率的影响有统计学意义。多因素分析显示：p-TNM分期中T和N的不同分期和手术性质是影响预后的独立因素；N2-3期肺癌患者手术后死亡的危险比(hazard ratio)是N0-1者的2．42倍(P=0．0001)，T24期肺癌患者术后死亡危险比是T1者的3．50倍(P=0．0330)，接受姑息性手术的患者术后死亡危险比是根治性切除者的1．77倍(P=0．0224)。结论p-TNM分期中T和N的不同分期和手术性质是影响预后的最重要的三个因素，要提高肺癌患者术后远期生存率，早期手术治疗是关键，同时手术中必须彻底清扫淋巴结,避免非根治性手术。     

Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy

Purpose: To evaluate the effectiveness of complete resection and postoperative radiotherapy in spinal cord ependymomas. Methods and materials: We conducted a retrospective study over 20 patients (13 males and 7 females) with histologically confirmed spinal cord ependymomas between July 1985 and April 2001. Among them, 13 patients had ependymomas, 6 had myxopapillary ependymomas, and 1 had anaplastic ependymoma. All patients received radical surgery for tumor removal with 13 patients achieving complete resection and 7 incomplete resection due to technical difficulty. Among those with incomplete resection, 6 patients received postoperative radiotherapy to tumor bed and only one patient with anaplastic ependymoma received surgery alone. The total tumor dose ranged from 50 to 60 Gy. Results: Among the 20 patients, 19 patients were alive and showed local control. The median survival time of all patients was 109 months, with 104 months in the complete resection alone group and 135 months in the incomplete resection with postoperative radiotherapy group. One patient with anaplastic ependymoma and no postoperative radiotherapy developed leptomeningeal seeding 9 months after surgery. Salvage therapy of radiotherapy and chemotherapy maintained normal neurological functions. The patient expired 34 months from the initial diagnosis due to progression of leptomeningeal seeding. Conclusion: Complete resection alone in spinal cord ependymoma can achieve excellent local control and survival. Patients should receive complete resection if technically possible. Postoperative radiotherapy is not recommended for complete resection. For incomplete resection, postoperative local radiotherapy is recommended and it can also achieve excellent local control and survival. Local radiotherapy with 50-60 Gy is effective and safe. Salvage radiotherapy improves quality of life for local recurrence or leptomeningeal seeding patients.     

胸段食管癌手术治疗后的死因与复发类型

背景与目的：食管癌的死因包括局部浸润和／或远处转移，手术的介入会对死因产生影响。本研究对食管癌术后死亡时的复发类型及死亡原因进行总结，分析食管癌死亡时间以及导致食管癌死亡的危险因素。方法：1999年6月-2004年6月手术治疗后确诊死亡的食管癌80例，收集临床病理资料。用Spearnmn法进行各个临床因素与复发类型、生存时间的相关分析；用Kaplan—Meier法绘制生存曲线，以log—rank比较各因素埘死亡时间的影响：结果：全组一年内死亡为49例（61．3％），2年内死亡为67例（83．8％）。死亡原因为纵隔内复发16例（20％），淋巴道转移30例（37．5％），血道转移为34例（42．5％）。行淋巴结清扫的复发类型以血道转移为主，与淋巴结采样的相比有明显差异，P〈0．01；纵隔内复发、淋巴道转移与血道转移3组患者的生存时间无显著区别。64例肿瘤完全切除的患者，淋巴结阴性的比阳性的生存时间长（P=0．0468）。淋巴结采样的一年内死亡比淋巴结清扫的明显多，P=0．02；姑息切除的无一例活过2年。结论：血道转移、纵隔内复发及淋巴道复发都是引起食管癌死亡的重要原因，而复发类型与淋巴结切除程度有关：食管癌的完全切除及淋巴结清扫可降低局部复发，减少因局部及区域复发而导致的死亡。