舒尼替尼治疗腹膜后平滑肌肉瘤一例

患者女,54岁,2007年1月首诊右肾内侧腹膜后肿物,在外院行手术切除,术后病理诊断"平滑肌肉瘤,Actin(+),Desmin(-),CD117(-),CD34(-),S100(-)"术后15个月内2次局部复发,2次在我院接受手术切除,其中末次手术行肿物并右肾切除.然而,术后仅3个月,即发现切口种植瘤、右肝两处转移、右下肺小结节,无手术指征.     

保留脾血管和脾脏的胰体尾切除手术

Background  Distal pancreatectomy traditionally included splenectomy; the spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation. The aim of this research was to study the feasibility, safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy.

Methods  A retrospective review was performed for 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy (n=13) or splenic preservation (n=13) at the First Hospital of Sun Yat-sen University and Guangdong General Hospital in Southern China from May 2002 to April 2009.

Results  All 26 pancreatectomies with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in mean operative time ((172±47) minutes vs. (157±52) minutes, P >0.05), intraoperative estimated blood loss ((183±68) ml vs. (160±51) ml, P >0.05), incidence of noninfectious and infection complication and mean length of postoperative hospital stay ((10.1±2.2) days vs. (12.1±4.6) days, P >0.05). The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than the other group ((37.3±12.8)×10⁹/L vs. (54.7±13.2)×10⁹/L, P <0.05).

Conclusions  Spleen-preserving distal pancreatectomy appears to be a feasible and safe procedure. In selected cases of benign or low-grade malignant disease, spleen-preserving distal pancreatectomy is recommended.

     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

胃癌淋巴结转移规律的探讨

目的探讨胃癌淋巴结转移的规律。方法回顾我院1994年1月至2003年5月间608例胃癌术后病理资料,分析各组淋巴结的转移率,并用二值Logistic回归似然比法分析与第7～9组淋巴结转移相关的因素。结果本组608例中,第3组淋巴结转移率最高,为444%,其次为第15组的432%。第7、8、9组淋巴结转移率分别为372%、248%和207%,3组综合转移率为375%。与第7～9组淋巴结综合转移密切相关的因素有第1～6组淋巴结综合转移情况和肿瘤的浸润程度(P<005)。第7～9组淋巴结有转移时,预测第1～6组淋巴结有转移的准确率为822%,假阳性率为15%;第7～9组淋巴结无转移时,预测第10～16组淋巴结无转移的准确率为593%,假阳性率为127%。结论第7～9组淋巴结有类似前哨淋巴结的作用,术中病理活检有利于指导胃癌术式的选择。胃下部癌第7～9淋巴结有转移时宜常规清扫第15组淋巴结。     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

直肠癌术后早期肠梗阻的临床特点和治疗

目的 探讨直肠癌手术后早期肠梗阻的临床特点和手术时机。方法 回顾分析直肠癌手术４０８例术后早期肠梗阻２６例的临床资料。结果 ２１例经手术探查发出以机械性梗阻占多数（１９／２１），手术治愈１８例，死亡３例，死亡原因均为延误手术时机造成。非手术治愈５例。结论 直肠癌术后早期肠梗阻虽有梗阻症状，但由于术后诸多 影响，大多缺乏典型机械性梗阻的临床表现，易与术后肠麻痹，炎性粘连梗阻相混淆，应注意加以鉴别。处     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

胰十二指肠切除术后胰胃吻合术与胰肠吻合术的营养状况比较

目的比较胰十二指肠切除术后胰胃吻合术与胰肠吻合术患者的远期营养状况。方法回顾性分析2006年4月至2010年12月间在中山大学附属第一医院胃肠胰腺外科接受胰十二指肠切除术的37例患者的临床资料,其中胰胃吻合者19例,胰空肠吻合者18例。比较两组患者的体质量指数（BMI）以及白蛋白、前白蛋白和转铁蛋白等营养参数。结果胰胃吻合组和胰空肠吻合组的手术时间、术中失血量、术后胰瘘发生率、围手术期死亡率及术后住院时间的差异均无统计学意义（均P〉0．05）。术后1个月,胰胃吻合组和胰肠吻合组的BMI分别为（17．1±7．0）和（19．0±4．8）kg／m2。白蛋白分别为（30．1±0．5）和（32．1±1．3）g／L,转铁蛋白分别为（1．89±0．57）和（2．01±0．61）g／L,前白蛋白分别为（0．18±0．05）和（0．18±0．09）g／L。较术前均略有下降,但两组间差异并无统计学意义（均P〉0．05）。术后6个月,两组的上述营养参数均恢复到术前或高于术前水平,但两组间差异仍无统计学意义（均P〉0．05）。结论胰十二指肠切除术后胰胃吻合和胰空肠吻合对患者术后营养状况的影响无明显差别。     

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目的：探讨局部进展期结直肠癌侵犯膀胱的临床特点及其诊断。方法；回顾性分析12年间收治的29例结直肠癌 侵犯膀胱的病人资料。结果：原发癌26例和复发癌3例。常见症状为排便习惯与粪便性状改变20例（占69．0％），其次为腹痛16例（55．2％）、泌尿系统症状15例（51．7％）、体重下降12例（41．4％）和食欲减退8例（27．6％）。常见体征为腹部包块11例（37．9％）和直肠肿物7例（24．1％）。B超、结肠镜、膀胱镜和盆腔CT扫描检查发现肿物的阳性率分别为93．8％（15／16）、95．0％（19／20）、91．7％（11／12）和100％（18／18）。入院前误诊率达62．1％（18／29），入院时误诊率为44．8％（13／29）。结论：本病缺乏特异性临床表现而易误诊，应根据本病的临床特点，并结合B超、结肠镜、膀胱镜和盆腔CT扫描检查而作出正确的诊断。     

胰十二指肠切除术后上消化道出血

目的探讨胰十二指肠切除术后上消化道出血。方法回顾性研究我院自1983年1月至1997年12月间施行胰十二指肠切除术(PD)共115例的并发症。结果 PD 术后并发症41例(35.7%),死亡7例(6.1%);并发症中以上消化道出血(UGIB)为最多,共21例(18.3%)。按并发 UGIB 与否分为 UGIB 和非 UGIB 两组,UGIB组的 PD 术中估计失血量、输血量多于非 UGIB 组;UGIB 组的死亡率为23.8%,高于非 UGIB 组的死亡率2.1%(P<0.05)。UGIB 组死亡5例,均合并其他严重的并发症。出血的主要原因为应激性溃疡8例(38.1%),胃空肠吻合口出血6例(28.6%),胆道出血3例(14.3%),原因不明10例(47.6%);其中吻合口出血均伴不同程度的应激性溃疡。出血后的处理以保守治疗为主,手术止血6例(28.6%),保守治疗15例(71.4%),止血术后死亡3例,非手术治疗死亡2例。结论上消化道出血是 PD 术后常见的严重并发症,应积极防治。