腹壁韧带样瘤切除Dacron补片修补11例

目的：总结腹壁韧带样瘤的外科治疗经验。方法：11例腹壁韧带样瘤的患者，采用肿瘤广泛切除，Dacron补片修补。结果：11例手术治愈，无手术死亡、严重并发症的术后肿瘤复发。结论：腹壁韧带样瘤需行广泛切除，用人造材料修补腹壁缺损。这种手术方法简单，安全有效，可减少术后肿瘤复发的机会。     

腹壁韧带样纤维瘤影像学诊断(附3例报告)

目的探讨韧带样纤维瘤的影像学表现。方法结合文献分析3例韧带样纤维瘤的病理起源、临床特点与影像学表现。结果典型的韧带样纤维瘤表现为较均质的、沿着肌纤维生长的单发病灶。CT表现为肌肉密度均质肿块,增强后病灶不规则强化,境界较清。MRI信号较复杂,但对病灶周围组织的侵犯及改变的评估具有优势。结论韧带样纤维瘤的CT和MRI表现具有一定的特征性,结合临床病史可以作出诊断,MRI对手术切除范围的评估具有优势。     

High-intensity focused ultrasound treatment for intra-abdominal desmoid tumors: a report of four cases

Desmoid tumors are rare clonal fibroblastic proliferations that can arise at abdominal or extra-abdominal sites. Complete surgical resection is the primary treatment for resectable desmoid tumors, but a high rate of local recurrence has been reported even after complete resection. For patients with a recurrent tumor, the goals of treatment are to control the recurrence, maintain quality of life, and prolong survival. Radiofrequency ablation, radiotherapy, chemotherapy, and other medical therapies can be used as alternative methods, but there are considerable controversies over the roles of these methods in the management of desmoid tumors. High-intensity focused ultrasound (HIFU) is a minimally invasive and effective method for treatment of solid tumors. We used HIFU to treat four patients with intra-abdominal desmoid tumors from June 2011 to September 2013. Post-procedural pain was seen in all patients. One patient had an intra-abdominal abscess and another suffered a slight injury to the femoral nerve. The patients were followed up for 19–46 months (mean 34 months) until April 2015. The tumor in one patient disappeared, and no tumor progression was observed in the other patients.     

Shrinkage of desmoid tumor with interferon alfa treatment: a case report

We report on a case with desmoid tumor sucessfully treated with low-dose interferon alfa. A desmoid tumor was diagnosed in August 1998 in the right shoulder area of a 23-year-old woman. Surgery would probably have permanently impaired muscle function in her shoulder and arm. Therefore, interferon alfa treatment (0.9 million units twice daily subcutaneously) was started in November 1998 (time = 0). The tumor volume based on magnetic resonance imaging (MRI) was initially 16 cm3. The size of the tumor decreased gradually during 12 months of treatment, and in November 1999 (time = 12 months) MRI showed no clear tumor demarcation. This treatment modality may be considered as an alternative to mutilating surgery in patients with desmoid tumor.     

Intra‐abdominal desmoid tumor after laparoscopic low anterior resection for rectal cancer: A case report

Desmoid tumors are monoclonal fibroblastic proliferations arising from soft tissue classified as intra‐abdominal, extra‐abdominal and abdominal wall types. We present a patient with an intra‐abdominal desmoid tumor diagnosed 20 months after laparoscopic resection of rectal cancer. A 70‐year‐old woman with hematochezia was diagnosed with advanced rectal cancer. Preoperative chemoradiotherapy followed by laparoscopic low anterior resection was performed. During follow‐up, a nodular soft‐tissue density measuring 28 mm was detected in the presacral region. Metastasis from rectal cancer was diagnosed and four courses of chemotherapy were given, including capecitabine, oxaliplatin and bevacizumab. Computed tomography scan showed that the mass slightly decreased in size and surgical resection was performed. Histopathological examination revealed a proliferation of spindle‐shaped cells and collagenous stroma diagnosed as a desmoid tumor. This report highlights the possibility of a desmoid tumor in the differential diagnosis of an intra‐abdominal mass found during follow‐up after resection of colorectal cancer including following laparoscopic resection.     

Results of multidisciplinary limb salvage in 240 consecutive bone sarcomas

From 1979 to 1989, 240 bone sarcomas of limbs were treated by a multidisciplinary limb salvage protocol. The tumors included 112 osteosarcomas, 71 chondrosarcomas, 3 fibrosarcomas, 10 malignant histiocytofibromas, 40 Ewing's sarcomas and 4 other rarer sarcomas. Patients mean age was 28.6 yr (range 4-91 yr). The average tumor size was 13.5 cm (3-43 cm). There were 2 grade IA, 21 IB, 1 IIA, 188 IIB, and 28 III B according to Enneking's classification. Extratumoral en bloc resection was performed in all cases (large in 113, marginal in 121, intrafocal in 6) by the same surgeon. In poor responders to preoperative chemotherapy with Ewing's sarcomas or osteosarcomas, 35 Grays postoperative radiotherapy was administered. Ewing's sarcomas and osteosarcomas received short preoperative and long postoperative chemotherapy. At last follow-up (median 60 months, range 6-120 months), 150 patients were disease-free; 4 were under treatment and had visible disease; 86 had died. Actuarial disease-free survival rate for patients seen with localized previously untreated disease was 83% at 2 yr and 77% at 3 yr. Fifteen local recurrences were observed (6%). Statistical analysis confirmed the poor prognosis factors of visible metastasis, proximal location and large tumor size, and pointed out the major prognostic value of therapeutic factors: the effectiveness of chemotherapy in Ewing's sarcoma and osteosarcomas, and the adequacy of surgery in all cases. Limb salvage can be performed by a well experienced multidisciplinary team in 96% of limb sarcomas without major risk of local recurrence. However, amputation is safer if the surgeon lacks experience.     

儿童肾母细胞瘤术前全身静脉化疗与经导管动脉栓塞化疗临床疗效对比研究

【目的】对比分析术前全身静脉化疗和经导管动脉栓塞化疗对儿童肾母细胞瘤的疗效。【方法】回顾性选取本院2010年1月至2019年12月收治的肾母细胞瘤患儿作为研究对象,其中48例通过经导管动脉栓塞方式进行术前化疗(观察组),33例以全身静脉给药方式进行化疗(对照组)。观察两组的肿瘤减积率、肿瘤坏死率、包膜完整率、术前化疗总体有效率、肿瘤全切率、2年无瘤生存率和不良反应。【结果】观察组的肿瘤减积率、肿瘤坏死率、包膜完整率、术前化疗总体有效率和肿瘤全切率均高于对照组,不良反应发生率低于对照组,差异具有统计学意义(P<0.05)。对照组的2年无瘤生存率(94%)高于观察组(88%),但是差异无统计学意义(P>0.05)。【结论】儿童肾母细胞瘤术前应用经导管动脉栓塞化疗与全身静脉化疗相比,更利于手术切除,疗效更高,不良反应更少,但是在2年无瘤生存率上未展现更好的优势,还需要进一步扩大样本量和随访时间进行临床研究。     

直肠癌患者腹腔镜手术中淋巴结检出数量的相关因素研究*

目的探讨直肠癌腹腔镜手术淋巴结检出数量的相关因素。方法选取2014年1月-2017年1月于该院行腹腔镜下微创手术治疗的98例直肠癌患者为研究对象。统计患者一般资料[性别、年龄、体质指数(BMI)]、术前影像学检查结果、临床病理资料(肿瘤大小、大体类型、TNM分期、远处转移、组织分化程度和浸润深度等)、手术情况(术者、手术时间)和术前放化疗情况。结果年龄、BMI、肿瘤大小、标本长度、浸润深度、术者情况、术前放化疗与直肠癌微创手术患者淋巴结检出数量有关(P0.05),而性别、TNM分期、大体类型、组织分化程度、手术时间与直肠癌微创手术患者淋巴结检出数量无关(P0.05)。多元线性回归分析结果表明,BMI、肿瘤大小、标本长度、浸润深度、术者和术前放化疗是直肠癌微创手术患者淋巴结检出数量的独立影响因素(P0.05)。结论患者因素、肿瘤状况、手术因素均及治疗情况与直肠癌微创手术淋巴结检出数量有关。     

术前磁共振分期联合腹腔镜外科治疗直肠癌临床研究

目的探讨术前磁共振(MRI)分期联合腹腔镜全直肠系膜切除治疗直肠癌临床疗效。方法 89例直肠癌患者分为实验组(n=45)及对照组(n=44),实验组均行MRI扫描术前分期,T_3期及以下者行腹腔镜全直肠系膜切除(TME)术,判定T_4期及环周切缘受累者则先行新辅助化疗,再行腹腔镜TME术。对照组则术前行CT大概评估后行开腹TME术。对照术后组织病理结果,比较术前MRI是否与术后组织病理具有一致性,比较实验组与对照组在获得淋巴结数目、切缘控制、保肛率等指标上是否存在差异。结果 T分期,术前MRI准确性为86.7%(39/45);N分期准确性为71%(32/45);环周切缘准确率为84.4%(38/45),敏感性为100%(4/4)。结论术前MRI与术后组织病理结果具有一致性,对环周切缘评价也具有较高正确性,可以作为挑选合适的新辅助化疗患者的有效方法;术前MRI分期联合腹腔镜TME术能更好地控制切缘,但保肛率无明显差异,有待样本量增多后继续观察。     

局限期小细胞肺癌术前化疗周期对术后临床疗效的影响

目的探讨手术结合新辅助化疗治疗局限期小细胞肺癌术前化疗周期对术后临床疗效的影响。方法回顾性分析150例局限期小细胞肺癌(Ⅰ～Ⅱ期)手术患者的临床资料,术前予不同的化疗周期(1个周期、2个周期及3个周期以上),术后化疗6个周期。比较术前不同周期化疗患者5年生存率及术前不同周期化疗对化疗的毒性反应及对术后并发症的影响。结果根治性手术术前化疗2个周期组5年存活率明显较术前化疗1个周期组、3个周期以上组高(P<0.05);术前化疗2个周期组骨髓抑制、肝肾功能异常及术后并发症发生率与术前化疗1个周期组比较差异无统计学意义(P>0.05),但较术前化疗3个周期以上组明显降低(P<0.05)。结论根治性手术结合术前化疗2个周期治疗局限期小细胞肺癌可获得满意的临床效果,且不增加手术危险性。     

肾母细胞瘤术前化疗的病理学研究

目的探讨术前化疗对肾母细胞瘤病理改变及预后的影响。方法术前化疗组59例,一期手术组52例,分析两组病例病理学改变,凋亡指数（AI）、增值指数（PI）及术后存活率的差别。结果术前化疗组凋亡指数（AI11.67±15.44）、坏死率高于一期手术组（AI7.37±4.53）,一期手术组增值指数（PI24.99±25.83）高于术前化疗组（PI13.58±16.10）。两组存活率差异不明显,可能与部分病例术后非规律化疗有关。结论术前化疗有利于提高肾母细胞瘤切除率。     

18例炎性乳腺癌的临床分析

目的探讨综合治疗对炎性乳腺癌生存率的影响.方法共收治18例炎性乳腺癌患者,11例接受化疗、放疗及手术治疗,4例接受化疗、放疗、手术及内分泌治疗,3例作放疗与化疗.随访时间为6个月～3年.结果结果显示,6个月、1年、2年及3年总生存率分别为88.9%(16/18)、73.3%(11/15)、50%(6/12)、27.3%(3/11).接受综合治疗的患者总生存率为93.9%(14/15)、84.6%(11/13)、54.5%(6/11)、30%(3/10).结论炎性乳腺癌是最具侵袭性的乳腺肿瘤,也是预后极差的实体肿瘤之一.综合治疗可以改善其总生存率.     

Abdominal desmoid masses in Gardner's syndrome

Abdominal masses, desmoid tumors, occur in approximately 4% of patients with Garnder's Syndrome, usually 1–3 years after total colectomy. Histologic sections usually resemble those of an infiltrating fibrous tumor, a desmoid lesion. The radiographic pattern may be similar to any diffuse abdominal retroperitoneal tumor, metastatic disease, lymphoma, or possibly retractile mesenteritis. The clinical setting usually differentiates these entities.     

Extra-abdominal desmoid tumor of the hand: a case report and review of the literature

Extra-abdominal desmoid tumor of the hand is rare and only 10 cases have been described in the literature. We present a 14-year-old boy with a recurrent extra-abdominal desmoid tumor in the dorsal site of the right hand. MR image demonstrated the tumor in the third dorsal interosseous muscle, and adhered to the radial side of the forth metacarpal bone. The lesion revealed iso-signal intensity on T1-weighted images and high intensity on T2. We performed a marginal excision. Histological examination of the tumor showed proliferation of the fibroblastic cells with abundant collagen bundles. He developed local recurrence for the third time. The size of the third recurrent tumor has not been changed for 2 years and 3 months. Therefore, we have not performed any additional surgery. Since extensive resection markedly diminishes the function of the hand, we consider that a marginal surgical margin is acceptable for the quality of daily life of patients with a desmoid tumor of the hand.     

术前放化疗联合手术治疗低位局部晚期直肠癌19例疗效观察

目的探讨术前放化疗联合手术治疗低位局部晚期直肠癌的临床价值。方法2001年2月~2004年12月本院肿瘤科共对19例低位局部晚期直肠癌患者采用术前放化疗联合手术治疗方案。术前放疗总剂量45 Gy,每周5次,每次1.8Gy,同时联合奥沙利铂、甲酰四氢叶酸钙2、5-氟尿嘧啶同步化疗。放化疗结束6周后行手术治疗。结果经过术前放化疗治疗,原发病灶平均直径由4.6 cm缩小为2.5 cm(P<0.05);57.9%的病例T降期,58.3%的病例N降期。全组74%(14/19)的病例采用保留肛门手术,26%(5/19)的患者采用腹会阴联合切除术。术后病理手术标本呈轻度反应2例、中度反应5例、重度反应11例,肿瘤消失2例。结论对低位局部晚期直肠癌患者采用新辅助治疗,可使肿瘤分期降低,提高手术切除率和保肛率。     

影响年轻乳腺癌患者新辅助化疗后病理完全缓解及预后的因素分析

目的探讨影响年轻乳腺癌患者新辅助化疗后病理完全缓解(pathological complete response,pCR)和预后的临床病理因素。方法选取2007年1月至2017年12月青岛市第八人民医院乳腺外科收治的年龄≤40岁的行新辅助化疗的女性乳腺癌患者87例临床资料进行回顾性分析。依据病理结果,将其分为pCR组30例,非pCR组57例。对比pCR、复发/转移及死亡人数构成比与临床病理学特点的相关性,并分析pCR与无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)的关系。结果87例患者新辅助化疗后30例达到pCR(34.5%)。年轻乳腺癌新辅助化疗后的pCR构成比与雌激素受体(estrogen-receptor,ER)、孕激素受体(progesterone receptor,PR)、术前淋巴结状态、Ki67水平及分子分型相关(χ^2值分别为3.592、4.614、8.373、4.251、14.569,P值分别为0.047、0.032、0.039、0.039、0.006);复发转移患者构成比例与ER、PR、人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)、肿瘤大小和淋巴结状态相关(χ2值分别为8.778、6.243、9.413、14.910、23.074,P值分别为0.003、0.013、0.009、0.002、<0.001);死亡患者构成比与ER、PR、HER-2、分级、肿瘤大小和淋巴结状态相关(χ^2值分别为6.686、4.340、11.874、15.707、12.428、26.564,P值分别为0.010、0.037、0.003、<0.001、0.006、<0.001);ER、PR、HER-2、肿瘤大小、术前淋巴结状况及分子分型与DFS相关[HR(95%CI)分别为0.53(0.31~0.93)、2.12(1.21~3.64)、0.46(0.27~0.77)、1.91(1.40~2.62)、2.22(1.55~3.20)、1.21(0.95~1.55),P均<0.05];而ER、PR、HER-2、分级、肿瘤大小及术前淋巴结状况与OS密切相关[HR(95%CI)分别为0.47(0.23~0.98)、2.14(1.03~4.44)、0.37(0.19~0.76)、2.90(1.45~5.79)、1.86(1.24~2.79)、2.22(1.39~3.56),P均<0.05]。33例复发转移的患者中pCR患者5例,占16.7%(5/30);余28例未达到pCR,占所有非pCR患者的49.1%(28/57),两组复发率比较差异有统计学意义(P=0.019)。21例死亡的患者中pCR患者2例,占所有pCR患者的6.7%(2/30);余19例均未达到pCR,占所有非pCR患者的33.3%(19/57),两组病死率比较差异有统计学意义(P=0.026)。结论年轻乳腺癌患者新辅助化疗后的pCR构成比及DFS、OS受多种临床病理因素的影响。     

术前介入治疗对肝癌肿瘤浸润淋巴细胞生物学行为的影响

目的 探讨术前介入治疗对肝癌肿瘤浸润淋巴细胞的影响。方法 13例肝癌患者分成2组，7例接受术前介入治疗者为实验组，6例未接受术前化疗者为时照组。体外培养，检测TIL细胞、抗肿瘤活性、表型。结果 实验组TIL细胞在第2周达到高峰，至第3周平均扩增52倍，而对照组在第3周扩增达到高峰，平均扩增了12倍。术前介入化疗患者TIL细胞肿瘤杀伤活性增强。CD3^ 、CD4^ 、CD8^ 不同程度的增加。结论 术前介入化疗可缩短肝癌患者TIL细胞增殖时间，提高肿瘤杀伤活性。     

Laparoscopic excision of abdominal wall desmoid tumor

Open surgical resection is the mainstay treatment for desmoid tumors. Laparoscopic resection is rarely used and not well described in the literature. We report a case of a single, 35‐year‐old woman who presented with palpable abdominal wall desmoid tumor. The patient had had laparoscopic cholecystectomy 2 years earlier, and the tumor was at the insertion site of the right upper quadrant trocar. The diagnosis was made by a Tru‐Cut biopsy at another institution, after the lesion had increased in size and caused increased discomfort. The patient underwent successful laparoscopic resection of the tumor. This report aimed to promote laparoscopic resection of abdominal wall desmoid tumors, whenever feasible, and describe the laparoscopic technique. We believe this is the second case of laparoscopic excision of desmoid tumor reported in the English‐language literature.     

高频超声在乳腺癌新辅助化疗中的监测价值

目的探讨高频超声在乳腺癌新辅助化疗中的治疗监测和疗效评估价值。方法52例乳腺癌患者58个肿瘤在新辅助化疗前及化疗结束后,应用高频超声对肿瘤的大小和血流情况进行监测,其中16例患者(16个肿瘤)于化疗第二周期结束后增加了一次超声检查。所有超声检查结果与术后病理结果对照分析。结果新辅助化疗后超声测量乳腺癌原发灶各径线均明显缩小,血流丰富程度降低,最大血流速度(Vmax)和阻力指数(RI)明显降低(P<0.01)。术前超声测量的残余癌最大直径与病理测残余癌最大直径显著相关(r=0.894,P<0.01)。超声评估原发肿瘤缓解的总有效率为79.31%(46/58),其中3例(5.17%)达病理完全缓解;超声淋巴结完全缓解率为26.67%(8/30),病理淋巴结完全缓解率为20%(6/30)。12例患者根据化疗早期的超声检查及时调整了治疗方案,避免了无效化疗。结论高频超声对乳腺癌新辅助化疗的疗效评估方便、准确,化疗早期的超声监测有助于临床优化治疗方案。