胰腺囊性肿瘤良恶性诊断的影响因素

目的 鉴别胰腺囊性肿瘤良恶性诊断的影响因素.方法 回顾性分析北京协和医院1984年1月至2008年6月126例胰腺囊性肿瘤的病例数据、资料.根据病变组织学特征将病人分为恶性与良性两组,评估各种术前因素对恶性胰腺囊肿诊断的预测价值.结果 126例胰腺囊性肿瘤病人中,37例为恶性,89例为良性.单变量分析显示病人性别、症状(黄疸和体重下降)、血清CA199升高以及肿瘤内存在突起、实性成分或分隔等影像学特征在良恶性病变间存在显著差异.多因素分析显示病人性别和肿瘤的影像学特征是恶性肿瘤的独立预测因素.结论 病人性别,肿瘤大小、临床症状(黄疸或消瘦)、影像学特征(肿瘤内有乳头状突起、实性成分或分隔)和血清CA199是诊断胰腺恶性囊性肿瘤的重要指标,临床可据此确定是否手术治疗.     

25例膀胱瘘诊断和治疗的临床分析

目的：探讨膀胱瘘的病因、临床特点及治疗方法。方法回顾性分析北京协和医院1986-2010年住院诊治的膀胱瘘患者的临床资料。结果膀胱瘘25例,主要病因是手术损伤（12例,48%）、恶性肿瘤（6例,24%）和慢性感染/炎症（5例,20%）,表现为粪尿（9例,36%）、气尿（5例,20%）、尿路刺激症（11例,44%）、腹部包块（7例,28%）、排水样大便（9例,36%）等。对膀胱瘘阳性发现率较高的检查是膀胱镜（73%,11/15）,膀胱造影（73%,8/11）和 CT （67%,8/12）。18例（72%）患者接受手术,术后发生切口感染6例、吻合口漏3例、瘘复发2例;死亡5例（27.8%）。7例（28%）给予非手术治疗,5例瘘口愈合。结论膀胱瘘的病因主要是手术损伤、恶性肿瘤和慢性感染/炎症。 CT、膀胱镜和结肠镜是诊断膀胱瘘及寻找病因的首选方法。手术是其主要治疗方法,保守治疗可尝试用于某些患者。     

胰腺癌患者新辅助治疗前后营养状况的改变及其对术后结局和预后的影响

新辅助治疗已成为临界可能切除和局部进展期胰腺癌的标准治疗之一, 但其可能在控制肿瘤进展的同时加重胰腺癌患者的营养不良, 从而影响这部分患者的术后结局及长期预后。通过回顾相关文献发现, 新辅助治疗会在不同程度上造成患者术前营养状况恶化, 但及时有效的营养干预可改善这种情况。这也提示有必要对接受新辅助治疗的患者进行早期营养干预以改善预后。但鉴于目前相关研究有限, 且均存在一定局限性, 未来仍需更多严谨、系统的研究来阐明问题, 为早期对行新辅助治疗的胰腺癌患者进行有效的营养干预提供依据。     

无创性检查在胰岛素瘤定位诊断中的价值

目的 探讨无创性检查方法在胰岛素瘤定位诊断中的价值.方法 回顾性分析北京协和医院2005年1月至2008年11月手术治疗的88例胰岛索瘤患者的临床资料.其中男性40例,女性48例;年龄15～74岁,平均46.5岁.结果 B超、增强CT、多排螺旋CT胰腺灌注、磁共振成像、奥曲肽显像、超声内镜、腹腔镜超声和术中超声的诊断阳性率分别为19.3%(17/88)、52.4%(11/21)、95.5%(64/67)、1/6、30.0%(6/20)、83.9%(26/31)、8/8和5/5.其中8例多发胰岛素瘤患者共切除肿瘤31个,多排螺旋CT胰腺灌注、术中超声的定位诊断准确率分别为48.4%(15/31)和100%(14/14).结论 目前胰岛素瘤的术前定位诊断已进入无创检查时代,应首选多排螺旋CT胰腺灌注.对于多发性胰岛素瘤的患者,术中超声在定位诊断中具有重要价值.     

RCAS1在胰腺癌诊断中的作用

Objective To evaluate the effect of receptor-binding cancer antigen expressed on SiSO cells(RCASI) as serum tumor marker on the diagnosis of pancreatic cancer. Methods Receiver-operating characteristics(ROC) curve methods were used to assay the serum content of RCAS1 ,CA19-9 and CA242 in 46 patients with pancreatic cancer, 18 patients and 20 normal tissues of chronic pancreatitis detected by enzymelinkod immunosorbent assay (ELISA), and the results were analyzed by statistics methods. The expressions of RCAS1 protein were analyzed by immunohistochemical method in 32 patients with pancreatic cancer, 10 patients with chronic pancreatitis and 6 cases of normal pancreatic specimens. Results The serum levels of RCAS1 ,CA19-9 and CA242 in pancreatic cancer were higher than that in chronic pancreatitis respectively (P ＜ 0.01). The area under curve of RCAS1, CA19-9 and CA242 were 0.826, 0.804 and 0.737 ,respectively. Subgroup analysis indicated that the RCAS1 and CA19-9 levels of pancreatic cancer patients without obstructive jaundice were lower than those for patients with obstructive jaundice (P＜0.01). CA19-9 levels of patients with resectable pancreatic cancer were lower than those with unresectable pancreatic cancer(P ＜ 0.01). Immunohistochemistry showed that the expression rates of RCAS1 in pancreatic cancer and chronic pancreatitis were 87.5% and 40.0% ,respectively (P ＜0. 05). Conclusions In diagnosis of pancreatic cancer,the clinical value of RCAS1 is available. And the combination test of RCAS1 and CA19-9 have clinical value to evaluate if the pancreatic cancer can be resected before operation.     

RCAS1在胰腺癌诊断中的作用

Objective To evaluate the effect of receptor-binding cancer antigen expressed on SiSO cells(RCASI) as serum tumor marker on the diagnosis of pancreatic cancer. Methods Receiver-operating characteristics(ROC) curve methods were used to assay the serum content of RCAS1 ,CA19-9 and CA242 in 46 patients with pancreatic cancer, 18 patients and 20 normal tissues of chronic pancreatitis detected by enzymelinkod immunosorbent assay (ELISA), and the results were analyzed by statistics methods. The expressions of RCAS1 protein were analyzed by immunohistochemical method in 32 patients with pancreatic cancer, 10 patients with chronic pancreatitis and 6 cases of normal pancreatic specimens. Results The serum levels of RCAS1 ,CA19-9 and CA242 in pancreatic cancer were higher than that in chronic pancreatitis respectively (P ＜ 0.01). The area under curve of RCAS1, CA19-9 and CA242 were 0.826, 0.804 and 0.737 ,respectively. Subgroup analysis indicated that the RCAS1 and CA19-9 levels of pancreatic cancer patients without obstructive jaundice were lower than those for patients with obstructive jaundice (P＜0.01). CA19-9 levels of patients with resectable pancreatic cancer were lower than those with unresectable pancreatic cancer(P ＜ 0.01). Immunohistochemistry showed that the expression rates of RCAS1 in pancreatic cancer and chronic pancreatitis were 87.5% and 40.0% ,respectively (P ＜0. 05). Conclusions In diagnosis of pancreatic cancer,the clinical value of RCAS1 is available. And the combination test of RCAS1 and CA19-9 have clinical value to evaluate if the pancreatic cancer can be resected before operation.     

如何提高胰腺癌的手术切除率

目前胰腺癌的总体5年生存率仍徘徊在5%左右,但是近年来随着外科手术和放化疗技术的进步,胰腺癌的治疗模式已有明显的改善。对于能够达到肿瘤完整切除(R0切除)的胰腺癌患者,其5年生存率可达20%²3%,所以提高胰腺癌的手术切除率和R0切除率是目前胰腺癌治疗中的关键环节。胰腺癌的手术切除可能性的评估是胰腺癌治疗的第一步,该文对目前胰腺癌可切除性的评估方法进行了总结。同时,文章汇总了胰腺癌的新辅助治疗策略和相关手术技术的进展,以期对提高胰腺癌手术切除率和R0切除率的相关治疗措施有更深入的认识,进一步提高胰腺癌的整体治疗效果。     

胆石性胰腺炎的实验室诊断

目的：验证生化检测在胆石性胰腺炎诊断中的价值。方法：总结北京协和医院1993年1月－1999年12月182例急性胰腺炎患者，进行回顾性病例对照分析。将性别，年龄，血清谷丙转氨酶（ALT）、总胆红素（TBIL）和血淀粉酶作为研究变量，数据输入SPSS软件包进行χ^2检验，ROC曲线分析。结果：当女性，年龄≥50岁，ALT≥100U／L，TBIL≥2．3mg/dl时，存在显著的统计学差异。ALT≥100U／L时，诊断胆石性胰腺炎的敏感性和特异性分别为47．8％和94．1％，阳性预测值为93％。TBIL≥2．3mg/dl时，诊断胆石性胰腺炎的敏感性和特异性分别为60％和82．4％，阳性预测值为81％。结论：实验室生化检查有助于急性胰腺炎病因的诊断，对于血清ALT≥100U／L，TBIL≥2．3mg/dl，应考虑到急性胆石性胰腺炎的可能。     

RCAS1在胰腺癌诊断中的作用

Objective To evaluate the effect of receptor-binding cancer antigen expressed on SiSO cells(RCASI) as serum tumor marker on the diagnosis of pancreatic cancer. Methods Receiver-operating characteristics(ROC) curve methods were used to assay the serum content of RCAS1 ,CA19-9 and CA242 in 46 patients with pancreatic cancer, 18 patients and 20 normal tissues of chronic pancreatitis detected by enzymelinkod immunosorbent assay (ELISA), and the results were analyzed by statistics methods. The expressions of RCAS1 protein were analyzed by immunohistochemical method in 32 patients with pancreatic cancer, 10 patients with chronic pancreatitis and 6 cases of normal pancreatic specimens. Results The serum levels of RCAS1 ,CA19-9 and CA242 in pancreatic cancer were higher than that in chronic pancreatitis respectively (P ＜ 0.01). The area under curve of RCAS1, CA19-9 and CA242 were 0.826, 0.804 and 0.737 ,respectively. Subgroup analysis indicated that the RCAS1 and CA19-9 levels of pancreatic cancer patients without obstructive jaundice were lower than those for patients with obstructive jaundice (P＜0.01). CA19-9 levels of patients with resectable pancreatic cancer were lower than those with unresectable pancreatic cancer(P ＜ 0.01). Immunohistochemistry showed that the expression rates of RCAS1 in pancreatic cancer and chronic pancreatitis were 87.5% and 40.0% ,respectively (P ＜0. 05). Conclusions In diagnosis of pancreatic cancer,the clinical value of RCAS1 is available. And the combination test of RCAS1 and CA19-9 have clinical value to evaluate if the pancreatic cancer can be resected before operation.     

胰腺癌生物治疗现状与进展

近年来,对胰腺癌虽然在诊断技术和治疗手段上有了长足的进步,但胰腺癌患者的生存时间并没有延长.