胆囊结石胆囊切除与大肠癌关系

[目的]探讨胆囊结石、胆囊切除与大肠癌之间的相关性。[方法]1996年1月～2005年1月共收治大肠癌患者356例(大肠癌组),同期收治胃癌426例(对照组),对比观察两者的胆囊结石、胆囊切除百分率,并对年龄、性别、发病部位等因素作分析。[结果]大肠癌组胆囊结石、胆囊切除百分率12.64%(45/356);对照组胆囊结石、胆囊切除百分率8.69%(37/426),差异无显著性(P>0.05)。右半结肠癌胆囊结石、胆囊切除百分率20.34%(12/59),与对照组比较,差异有显著性(P<0.05)。不同性别、年龄组,大肠癌胆囊结石、胆囊切除百分率差异无显著性意义。[结论]胆囊结石、胆囊切除是右半结肠癌的危险因素之一。     

胆囊结石及胆囊切除与结直肠癌的关系探讨

目的 探讨胆囊结石及胆囊切除与结直肠癌的关系.方法 回顾性分析347例结直肠癌及608例其他消化道癌的临床资料.结果 结直肠癌患者胆囊结石发生率及既往胆囊切除率显著高于对照组(P<0.05).结论 胆囊结石及胆囊切除可能是结直肠癌的高危因素.     

大肠癌癌前疾病的研究进展

大肠癌(CRC)又称结直肠癌,已成为全球最常见的恶性肿瘤之一,其发病率居全部消化道恶性肿瘤首位.大多数CRC患者早期无明显临床症状,发现时多为晚期阶段.近年来由于CRC早期筛查率的提高,其发病率呈逐年升高且年轻化趋势.CRC的发生发展是一个多步骤、多阶段、多基因参与的过程.早期进行CRC癌前疾病的筛查可以降低CRC发病率和病死率.CRC癌前疾病主要包括家族性腺瘤性息肉病、大肠息肉、炎性肠病、慢性结肠血吸虫病等.国内外学者对CRC癌前疾病进行了研究和探讨,为CRC的治疗提供了新思路,本文就CRC癌前疾病的研究进展进行综述.     

DNA甲基化与大肠癌发生的研究进展

DNA甲基化由于影响基因突变、基因表达调控、基因组稳定性等方面 ,因此在肿瘤的发生和演进过程中扮演着一定的角色。近来 ,DNA甲基化机制及其与大肠癌发生关系的研究进展很快 ,现对最近 3年这方面的进展作一简要介绍。1　 DNA甲基化的概念DNA甲基化主要指在胞嘧啶的 5位碳上加上一个甲基基团 ,该反应由 S-腺苷蛋氨酸 (SAM)提供甲基 ,由 DNA甲基转移酶 (DMT)催化 ,形成 5甲基胞嘧啶 (5 m C)。 5 m C是真核细胞中唯一天然存在的修饰碱基 ,约占整个胞嘧啶的 3% ,而 90 %的 5 m C存在于 Cp G序列中。哺乳动物 DNA中 5 0 %～ 90 %的…     

DNA损伤修复与大肠癌关系的研究进展

大肠癌是人类恶性肿瘤之一,具有比较明确的遗传背景.近年来的研究表明,患者DNA的损伤修复与肿瘤的关系密切,本文综述DNA的错配修复、碱基切除修复、核苷酸切除修复等3种损伤修复机制与大肠癌相互关系的研究进展.     

早期大肠癌的诊治进展

大肠癌早期诊治是改善生存的唯一希望,因而早期大肠癌得到广泛重视。随着早期大肠癌病例数增加,其病理学研究愈加深入,大体和镜下分类到到深刻的阐明。与此同时,早期大肠癌诊断有了很大改善,治疗因类而异,已取得长足进步。本文综述早期大肠癌的病理学,分类,诊断和治疗等的进展。     

大肠癌基质溶素与血管生成的关联性

 目的 探讨大肠癌基质溶素(Matrilysin，MMP-7)表达和肿瘤血管生成的关系。方法 用免疫组织化学法检测大肠癌中MMP-7表达及肿瘤微血管密度(Microvessel density．MVD)。结果 从正常肠黏膜、腺瘤、早期大肠癌到进展期大肠癌MVD表达呈上升趋势(P<0.05)。大肠癌MVD随肿瘤侵袭深度增加呈增高趋势(P<0.05)；有转移者高于无转移者(P<0.05)。50例大肠癌中，32例MMP-7阳性表达，MMP-7阳性表达组的MVD明显高于阴性组(P<0.05)；MMP-7和MVD显著正相关(r=0.7236，P<0.05)。结论 MMP-7可能通过促进肿瘤血管的形成参与大肠癌的发生、浸润和转移。     

1116例胆囊切除标本分析—附31例胆囊癌报道

１１１６例胆囊切除标本分析──附３１例胆囊癌报道江荣美，陈军，金庆丰上海金山县中心医院病理科金山县中心医院病理科，金山县中心医院外科（上海２０１５００）胆囊炎、胆石症、胆囊癌是常见病、多发病，近年来呈上升趋势。本文收集我院１９８７年～１９９２年５月胆...     

胆囊疾病与结直肠腺瘤及结直肠癌关系的研究进展

在中国,结直肠癌（CRC）的发病率较高,疾病负担较为严重。胆囊疾病（包括胆囊结石、胆囊息肉、胆囊切除术后状态）在临床中较为常见,近几年来,大量研究认为胆囊疾病与CRC及结直肠腺瘤（CRA）有关,但也存在争议。胆囊结石及胆囊息肉与结直肠肿瘤之间的关系可能与它们存在共同的危险因素有关,例如肥胖、脂代谢异常、高龄等,有学者提出胆囊疾病可能通过影响胆汁酸代谢、微生物菌群改变及炎症反应等促进结直肠肿瘤的发生发展。本文就胆囊疾病与CRA和CRC关系的研究进展及可能存在的机制进行综述。     

胆囊胆汁癌胚抗原诊断大肠癌肝转移的临床意义

目的　探讨胆囊胆汁癌胚抗原 (CEA)值诊断大肠癌肝转移的临床价值。方法　应用竞争放射免疫分析法共测定胆囊胆汁及同期血清CEA值 75例。共分为三组 :A组 (大肠癌组 ) 34例、B组 (术后肝转移组 ) 11例、C组 (良性疾病组 )为对照组 30例。胆汁标本于术中细针穿刺胆囊抽取 5ml ,血清标本于术晨采集静脉血 2ml。结果　胆汁CEA测定结果 :A组均值 ( 173 2± 2 5)ng ml;B组均值 ( 752± 117)ng ml;C组均值 ( 4 1 3± 2 8)ng ml。经统计学处理 ,A、B与C组比较有显著性差异P <0 0 1,A与B组比较有显著性差异P <0 0 1。血清CEA测定结果 :A组均值 ( 17 3± 2 7)ng ml;B组均值 ( 19 5± 4 3)ng ml ;C组均值 ( 11 3± 1 4 )ng ml。经统计学处理 ,A、B与C组比较有明显差异P <0 0 5。A与B组比较无明显差异P >0 0 5。结论　胆囊胆汁CEA值 >640ng ml时对诊断大肠癌肝转移有一定临床意义。     

Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases

BACKGROUND AND OBJECTIVES: It was proposed that occult pancreaticobiliary reflux (OPBR) was associated with precancerous mucosal changes in the gallbladder, hence the importance of this disorder. There are no published reports investigating the incidence of OPBR in patients operated on for the entire spectrum of benign gallbladder diseases and gallbladder cancer. Our aim was to determine the incidence of OPBR and measure the levels of active pancreatic enzymes (amylase and lipase) in gallbladder bile of patients undergoing cholecystectomy for benign and malignant gallbladder diseases. METHODS: One hundred eight patients with normal pancreaticobiliary junction evidenced by operative cholangiography were included in the study. RESULTS: According to gallbladder bile amylase and lipase levels, 84.2% and 89% patients respectively had OPBR. OPBR was present in all gallbladder cancer patients; in these patients the biliary levels of amylase and lipase were significantly higher than the levels found in patients with benign gallbladder pathology (P < 0.0001). CONCLUSIONS: OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.     

Laparoscopic cholecystectomy for treatment of unexpected early-stage gallbladder cancer

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy (LC) may result in the incidental diagnosis of early stage (T1 and T2) gallbladder cancer. LC is useful for T1 patients, however, its role in T2 patients remains controversial. We sought to determine the effect of initial LC on patient outcome in early-stage gallbladder cancer. METHODS: Twenty-nine patients with T1 or T2 disease were reviewed retrospectively to assess preoperative diagnosis, intraoperative findings, and outcomes. RESULTS: Diagnoses included gallbladder stones (5), gallstones with polyps (5), and gallbladder polyps (19). Malignancy was suspected in 15 patients (14 polyp lesions and 1 gallbladder stone with wall thickening). After frozen sections, two T2 patients were immediately treated with radical operation owing to positive margins. Of 14 patients diagnosed by pathology, 4 T2 patients with positive margins underwent a second radical operation. Five-year survival rate was 100% and 49.6 % (T1 and T2 patients). No mortality or recurrence was detected in T1 patients (mean follow-up, 45.8 months; range, 6-98 months). Three T2 patients died, and one T2 patient relapsed after LC. No port site metastasis was detected. CONCLUSIONS: LC for T1a and T1b gallbladder cancer needs no additional treatment, however, radical operation for T2 patients is recommended, regardless of the margin condition.     

胆囊癌与胆囊结石关系的临床分析

目的　探讨胆囊癌与胆囊结石的关系。方法　对所收集的胆囊癌病人 47例 ,胆囊结石病人 2 86 3例进行了分析。结果　 47例胆囊癌病人均伴有胆囊结石 ,全部经手术治疗。其生存率 :1年为 46例 ( 97.87% ) ,2年 32例 ( 6 8.0 8% ) ,3年 2 8例 ( 5 9.5 7% ) ,4年 12例 ( 2 5 .5 3% ) ,年 2例 ( 4 .2 5 % )。胆囊结石病人 2 86 3例 ,经手术治疗 10 6 9例。结论　胆囊癌与胆囊结石的关系极为密切 ,胆囊结石是诱发胆囊癌的重要因素之一。对胆囊结石的病人行胆囊切除是预防胆囊癌发生的较为有效的方法之一。     

中国人群胆囊疾患和结直肠癌关系的Meta分析

背景与目的：有研究报道胆囊切除后更易发生结直肠癌,但关于胆囊疾患与结直肠癌的关系尚无定论。本研究对中国人群中胆囊疾患包括胆囊结石和胆囊切除与结直肠癌的关系的相关文献进行Meta分析,旨在了解中国人群中胆囊疾患与结直肠癌的关联性并定量计算关联性的大小。方法：基于观察性研究的Meta分析规范（MOOSE声明）进行研究及撰写。计算机检索有关数据库并辅以手工检索已有文献的参考文献。对纳入研究的文献采用Newcastle—Ottawa量表进行质量评价。提取文献原始数据,采用Revman5．0统计软件对数据进行Meta分析,计算合并OR值和95％可信区间（95％CI）。结果：最终纳入26篇文献,经Meta分析发现胆囊疾患、胆囊结石、胆囊切除术均与结直肠癌相关;比值比分别为3．00（2．30～3．91）、2．85（2．13～3．81）、2．68（1．93～3．72）。对患者性别和发病部位的亚组进行分析,除了男性亚组分析中胆囊疾患与结直肠癌无明显关系以外,其余亚组分析显示二者关系仍然显著。结论：中国人群胆囊疾患可能与结直肠癌相关。     

Serum sHLA‐G levels: A useful indicator in distinguishing colorectal cancer from benign colorectal diseases

Soluble human leukocyte antigen‐G (sHLA‐G) has been reported in malignancies and is implicated in mediating immune surveillance of tumor. The aim of our study is to detect serum sHLA‐G levels in colorectal cancer and to determine whether sHLA‐G may be helpful in distinguishing colorectal cancer from benign colorectal diseases. Serum sHLA‐G levels were determined using enzyme‐linked immunosorbent assay. Receiver operating characteristic (ROC) curve was used to evaluate the feasibility of sHLA‐G in differentiating colorectal cancer from benign colorectal diseases. Median sHLA‐G concentrations were significantly higher in colorectal cancer compared to normal colorectum, hyperplastic polyp, inflammatory bowel disease and adenoma (all at p < 0.001, respectively). ROC curve for sHLA‐G revealed an area under the curve of 84.2%, and when 88.6 U/mL was used as cutoff, a sensitivity of 72.2% and a specificity of 87.8% were achieved. Comparison of sHLA‐G and carcinoembryogenic antigen ROC curves indicated that sHLA‐G was superior to CEA in differentiating colorectal cancer from benign colorectal diseases (p < 0.001). ROC curves analysis of the combined sHLA‐G and CEA showed a higher detection capacity (area under the ROC curve, 87.4%) than that of markers considered singly. These findings reveal that serum levels of sHLA‐G are significantly increased in colorectal cancer which may serve as a potent mediator of immune escape in colorectal cancer, and sHLA‐G may be a useful indicator in differentiating colorectal cancer from benign colorectal diseases.     

Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy

BACKGROUND: The long-term prognosis of laparoscopic cholecystectomy (LC) for patients with unsuspected gallbladder carcinoma (GBC) remains unclear. We investigated retrospectively the role of examination of frozen sections and the prognosis of patients with unsuspected GBC detected during or after LC. METHODS: LC was performed on 1,793 consecutive patients. If a suspicious lesion was found, intraoperative frozen section examination was performed. RESULTS: Of all these patients, 38 (2.1%) were histopathologically diagnosed as having a GBC during (28) or after LC (10). The tumor stages of the 28 diagnosed during LC were: pT1a (17), pT1b (2), pT2 (8), and pT3 (1). The sensitivity and specificity of intraoperative frozen section examination were 90 and 100%, respectively. On the other hand, those 10 cases diagnosed after LC had pT1a (1) and pT2 (9) tumors. Survival rates were not significantly affected by whether the patient was diagnosed with GBC during or after LC. CONCLUSIONS: The survival with unsuspected GBC was related to stage and it was confirmed that a carefully performed LC is adequate treatment for Stage 1A and B cancer. The LC procedure does not adversely affect the prognosis of unsuspected GBC, regardless of whether it is detected during or after LC.