高龄胰腺癌病人的外科处理(附36例报道)

胰腺癌的发病率有明显增高之势，现已成为我国因癌症死亡的常见恶性肿瘤，目前外科治疗是其惟一有效的治疗方法。随着人口向老龄化发展。临床上高龄胰腺癌病人(年龄≥70岁)越来越多，在过去常因手术风险大而放弃根治性外科治疗。我院1995～2000年间外科治疗高龄胰腺癌病人36例，现报道如下。     

36例青年胰腺癌临床分析

目的探讨青年胰腺癌的临床特点，以提高青年胰腺癌早期诊断水平和治疗效果。方法分析36例青年胰腺癌的临床表现、误诊情况、临床病理、治疗与预后，与老年胰腺癌152例进行回顾性临床对比分析。结果①青年组胰腺癌首发主要表现上腹饱胀不适，上腹痛或背部痛；②青年组胰腺癌误诊率为77．78％，明显高于老年组（P〈0．01）；③根治性手术率低、预后差。结论青年胰腺癌首发临床表现主要为上腹痛及背部痛或上腹饱胀不适，这些症状的发生率明显高于老年胰腺癌病人；首发黄疸症状少，误诊率高；根治性手术率低，预后差。故应重视青年胰腺癌的临床早期诊断。     

胰腺癌的临床病理分析

胰腺癌是一种比较常见的恶性肿瘤，其发病率在近年有增加的趋势。目前胰腺癌的根治切除是获得长期存活的重要手段，但切除率仍很低，仅10％～15％，80％以上的病人确诊时已属晚期，失去了行根治性手术的机会。第一军医大学南方医院在1990年1月～2002年10月共手术治疗胰腺癌病人126例，其中病灶切除性手术32例，剖腹探查、胃肠吻合、胆肠吻合等非切除手术94例。现将胰腺癌切除病例的临床病理特点报告如下。     

胰腺癌57例手术治疗的临床分析

随着生活节奏加快，环境污染日益加重，近年来胰腺癌发病率呈上升趋势，且男性发病率较女性高。由于其发病早期缺乏特异的临床症状，早期诊断困难，发现时多为晚期，预后不佳。我院自1995-2004年共收治各类胰腺癌57例，现分析报告如下。     

经腹高龄贲门癌切除38例临床分析

目的探讨高龄贲门癌患者的特点与手术方法。方法对38例70岁以上的贲门癌患者经认真术前准备,采取经腹手术,当癌肿侵及食管下段,但不超过3cm时,向剑突方向切开部分膈肌,确保食管切缘和下纵隔淋巴结的清扫。结果全组手术切除率92%,并发症发生率26.3%,病死率2.6%。病检肿瘤两切缘均无癌细胞残留。结论高龄贲门癌患者只要全身情况许可,应积极采取手术治疗,切口选择以经腹径路效果较好。     

高龄肺癌患者围手术期心律失常234例临床分析

心律失常是肺癌术后常见的并发症，尤其是高龄患者。由于开胸手术的创伤、手术操作的直接刺激以及手术造成的自主神经功能紊乱等因素，围手术期心律失常发生率较高，严重者可显著影响循环系统，危及患者生命；而术后某些并发症，也以持久不易纠正的心律失常为早期表现。因此，及时正确地处理术后心律失常十分重要。我院自1999年1月至2003年12月手术治疗高龄（≥70岁）肺癌患者363例，发生围手术期心律失常者234例，发生率64．5％。     

高龄患者行双膝人工关节置换术的临床分析

膝关节创伤性或退行性病变在高龄人群中较为常见,症状反复,严重者无法行走,生活不能自理。目前对于膝关节重度病变的治疗,除了行人工全膝关节置换术外,尚无根治的办法。而高龄患者多年老体弱,合并有内科疾病,全身状况较差,能否耐受手术创伤,尤其是双膝同时手术的打击,文献罕见报道。自2000年10月以来,我们对12例70岁以上高龄患者成功实施双侧人工全膝关节置换术,效果满意。     

胰腺癌手术治疗85例分析

胰腺癌手术治疗８５例分析江苏省无锡市第三人民医院外科（２１４０４１）顾元龙，陈布克，马荣赓我院自１９６８年４月至１９９６年３月收治并经手术、病理证实的胰腺癌８５例，报道如下：临床资料１一般资料：男性４６例、女性３９例，平均年龄６３．４岁。５０～７０岁...     

食管穿孔外科治疗33例临床分析

食管穿孔是指食管由各种意外性损伤或自发性破裂所引起的严重危及生命的疾病，其病死率高达20％∽40％，因食管穿孔的原因、部位、诊断延误时间、患者年龄、循环系统状况、纵隔及胸腔污染程度以及食管基础病变等不同，在治疗不同病例时所采用的方法也不尽相同。现就采用不同方法治疗的33例食管穿孔的经验和体会进行讨论。     

胆囊息肉样病变33例临床分析

我院于1994年4月～2002年10月手术切除，并经病理检查证实的胆囊息肉样病变(PLG)33例，分析讨论如下。     

胰十二指肠切除术治疗胰头和壶腹部癌230例分析

了解胰十二指肠切除术治疗胰头和壶腹部癌的效果和影响病人生存的因素。方法:分析230例胰头和壶腹部癌的主要表现,辅助检查、手术并发症、手术死亡率,调查术后生存情况及影响病人长期生存的因素。结果:本组病人出现黄疽90.9％,腹痛56.1％,发热32.6％,白陶土样大便13.5％。B超、CT和ERCP检查准确率分别为68.3％、79.3％和66.6％。手术并发症72例(31.3％),死亡20例(8.7％)。术后1、3、5年存活率分别为46.7％,17.4％和52％。肿瘤直径、淋巴结转移和切缘状态是影响病人术后生存的因素,而肿瘤分化程度和病人年龄对生存率无明显影响。结论:胰头和壶腹部癌临床表现有多样性,B超和CT等辅助检查有局限性,手术有高并发症,5年生存率低下,手术治疗远近期效果都不理想。     

再手术治疗局部复发性直肠癌33例临床分析

目的总结直肠癌术后局部复发的临床特点，探讨再手术的治疗效果。方法回顾性分析1998年1月。2004年1月间收治的33例复发性直肠癌的临床资料，初次手术行Miles12例，Dixon17例：Hartmann3例，局部切除1例，手术后平均26．5个月复发。再次手术方式包括：Miles9例，Dixon6例，Hartmann 4例，阴道子宫或双附件切除12例，局部切除2例；其中根治性切除15例，姑息性切除18例。结果本组无手术死亡，术中损伤输尿管1例，术后发生肺部感染4例，伤口感染6例，吻合口漏1例，均痊愈出院。根治性手术组和姑息性手术组中位生存期分别为30．2和8．5个月。结论对适宜的局部复发性直肠癌病人行再次手术治疗有一定的疗效，但需严格掌握其适应证，并选择合理的手术方式。     

Histopathological Determinants of Survival in Resected Cases of Pancreas Cancer

We have examined the histopathological factors affecting the degree of local spread, regional lymph node (RLN) metastases, and overall survival (O.S.) in a group of 39 cases of resected carcinoma of the exocrine pancreas. Although the mean O.S. for the group was 14.3 months, resected patients without RLN involvement had a mean survival of 24 months. In contrast the mean O.S. rate was 8 months for patients with RLNs involved. Size, tumor location, and histological grade were compared to RLN involvement and O.S. The mean size of primary tumor did not differ significantly between patients with or without RLN''s (r.1 versus 4.6cms). However, 7 or 8 T₁ tumors were <4cm and 35% of tumors <4cm were T₁ lesions. In contrast, only of 17 tumors (6%) >4cm was T₁. Histological grade was correlated with nodal status and O.S. There was a significant difference between histological grade and the presence of metastatic lymph nodes (G1, 37% positive, G2-4.50% positive). Patients with well differentiated tumors had a mean survival of 21 months compared to a mean survival of 10 months for less differentiated tumors (p<0.05). This difference was even more significant when stratified for nodal status. The patients with well differentiated tumors and no RLN involvement had a mean survival of 32.5 months compared to 8.6 months for well differentiated tumors with RLN involvement. In summary, we have shown that size, histological grade, and local spread predict for nodal status. However, specific patient subsets (G1, node negative) may exhibit an excellent survival when curative pancreas resection is successful.     

老年结直肠癌患者术后近期门诊随访的影响因素分析

目的探讨影响老年结直肠癌患者术后近期门诊随访的因素,以期为提高随访效率和质量提供一定的依据。方法回顾性分析2009年1月至2010年5月期间于我院胃肠外科中心行手术治疗的253例老年结直肠癌患者的资料,利用医院信息系统统计其术后半年内门诊随访日期和随访次数,计算随访率,分析可能影响随访次数和随访率的因素。结果本组患者总体随访率为84.2%(213/253),随访次数(4.08±0.03)次/人(0～24次/人)。随访次数方面:本市内患者高于本市外患者,有内科合并症者高于无内科合并症者,有术后并发症者高于无术后并发症者,造口患者低于非造口患者,其差异均有统计学意义(P<0.05),而其余各因素的组间差异均无统计学意义(P>0.05)。随访率方面:根治术患者高于非根治术者,造口患者低于非造口患者,差异均有统计学意义(P<0.05),而其余各因素组间差异均无统计学意义(P>0.05)。结论老年结直肠癌患者术后近期门诊随访情况尚不容乐观,可能影响其随访率或随访次数的因素包括患者居住地与就医地点的距离、有无内科合并症、有无术后并发症、是否行根治术以及是否造口。     

The Improvement of Surgical Treatment for Patients with Gallbladder Cancer: Analysis of 208 Consecutive Cases Over the Past Decade

Objectives

The aim of this study was to determine if there has been improvement in survival for patients with gallbladder cancer treated with surgical procedures.

Methods

A retrospective review of all patients with gallbladder cancer admitted during the past 11?years was conducted. The patients were categorized into two periods: period 1, from 1 January 2000 to 31 December 2005 (group 1, n?=?77); and period 2, from 1 January 2006 to 31 December 2010 (group 2, n?=?131).

Results

The two groups have similar age, sex distribution, and symptoms. There were more patients with advanced stage in group 2 (P?=?0.001). And patients in group 2 were treated with more aggressive surgical procedures compared with group 1. Patients of group 2 had a better surgical outcomes and longer 5-year overall survival (9?% vs. 19?%, P?=?0.040) and disease-free survival (P?=?0.017). Median survival in group 1 was 14.7?months, while in group 2 it was 22.3?months. Patients underwent R0 resection in group 2 had better survival than that in group 1 (P?=?0.009), while they had similar survival for those who underwent non-R0 resection in both periods (P?=?0.108).

Conclusions

A significant improvement of disease-free survival and long-term survival results was observed in the past decade.     

加长柄双极股骨头置换治疗高龄股骨转子间骨折

目的探讨加长柄双极人工股骨头置换治疗高龄股骨转子间骨折的疗效。方法本组49例,男19例,女30例;年龄75～92岁,平均82.3岁。骨折类型按Evans分型,型5例,A型22例,B型9例,型13例,其中2例为内固定治疗失败病例。患者多合并内科疾病,相关内科协同治疗后,对所有患者采用标准人工骨水泥、加长柄人工双极股骨头置换术,术后早期进行康复锻炼。结果 49例患者都顺利度过围手术期,住院期间无死亡病例,术后并发症均在住院期间治愈。术后1～3周下床活动。所有病例均获得随访,随访时间3～24个月,平均9个月,患者均能生活自理。按Harris评分标准,优良率达85.7%。结论用加长柄股骨头治疗高龄转子间骨折,是一种有效的治疗方法 ,可早期下床活动,减少并发症,提高生活质量。     

3麻醉方式对高龄股骨粗隆问骨折患者术后恢复效果的影响

目的比较椎管内麻醉和全身麻醉对高龄股骨粗隆间骨折患者术后恢复效果的影响。方法56例高龄股骨粗隆间骨折手术患者随机分为椎管内麻醉组和全身麻醉组,椎管内麻醉组31例,平均年龄78．2岁,全身麻醉组25例,平均年龄79．5岁。手术方式全部采用闭合复位,y3型髓内钉内固定术。观察比较两组患者术后早期功能恢复情况,包括下地活动时间、术后住院时间以及术后并发症。结果全部骨折患者手术均得到良好复位及固定,无死亡及感染病例。椎管内麻醉组术后下地活动所需时间为（79．6士23．1）h,而全身麻醉组为（106．4±35．6）h,差异具有统计学意义（P〈0．05）。椎管内麻醉组术后平均住院日为（9．1±3．3）d,而全身麻醉组为（11．6±4．2）d,差异具有统计学意义（P〈0．05）。全身麻醉组术后在认知障碍及呼吸系统感染等并发症方面明显高于椎管内麻醉组。结论对于高龄股骨粗隆间骨折患者,闭合复位、y3型髓内钉内固定可获得较理想的治疗效果;椎管内麻醉患者术后在下地活动时间、术后住院天数以及术后并发症方面明显优于全身麻醉组。     

Breast Cancer Metastases to the Pancreas

Introduction

The pancreas can serve as the destination for metastatic spread of malignancies from multiple organ sites. Breast cancer metastases to the pancreas are part of this spectrum and surgeons evaluate such patients as part of their practice. Uniform clinical guidelines for these cases do not exist and care is primarily driven by the personal experience of the treating surgeon.

Discussion

We present two patients with breast cancer metastases to their pancreas and review their workup and clinical management in light of our experience and the existing published literature. We propose that metastatic disease to the pancreas has to remain in the differential diagnosis for any patient with a new pancreatic mass and prior cancer history. Surgical resection is a viable treatment option for patients with isolated metastatic disease to the pancreas if the underlying biology of the metastatic tumor is favorable.