157例早期胃癌淋巴结转移特点及预后分析

目的探讨早期胃癌（EGC）临床病理特征和淋巴结转移规律及其对预后的影响。方法回顾性分析1995年10月至2005年10月间经手术治疗的157例EGC的临床病理特征和淋巴结转移规律及患者3年、5年的生存率。结果157例EGC患者有22例（14％）伴有淋巴结转移,其中黏膜癌2例（2.4％）,仅累及N1淋巴结;黏膜下癌20例（27．0％）,除累及N1淋巴结外,有7例同时累及N2淋巴结;两者比较,差异有统计学意义（P〈0．01）。微小胃癌（直径小于或等于0．5cm）者未见有淋巴结转移：直径小于或等于2．0cm和大于2．0cm的胃癌患者．淋巴结转移率分别为6.4％和21．5％;两者比较,差异有统计学意义（P〈0．01）。高分化EGC未见淋巴结转移;中分化及低分化EGC的淋巴结转移率分别为11．1％和20．9％;两者比较,差异有统计学意义（P〈0．01）。有9例出现脉管癌栓．其中4例伴淋巴结转移。Logistic回归多因素分析结果显示,肿瘤大小、分化程度、浸润深度、脉管癌栓均为影响EGC淋巴结转移的独立因素。伴有淋巴结转移的EGC患者3年、5年生存率分别为81．6％和79．5％,明显低于无淋巴结转移者的95．7％和93．2％（P〈0．01）。结论EGC的淋巴结转移主要与肿瘤浸润深度、肿瘤大小、脉管癌栓及肿瘤分化程度密切相关。应根据淋巴结转移的风险合理选择EGC的治疗方式。     

《日本胃癌处理规约》的制订与胃癌淋巴结的跳跃性转移

胃的淋巴回流系统特殊而复杂,研究观察胃癌的淋巴结转移规律以正确评价胃癌的淋巴结转移程度一直在困扰着我们。19世纪末,当人们开始认识到淋巴结转移是胃癌最常见的转移方式,以单纯的胃切除术治疗胃癌难以达到满意效果时,许多欧美学者就着手研究胃的淋巴回流系统,探索胃癌淋巴结转移规律。当时已经发现,胃癌的淋巴结转移不仅在胃周,也常出现在胰腺上缘等部位。     

让淋巴瘤患者享有长期生存

淋巴瘤是恶性肿瘤的一种，通常被认为是不治之症。随着淋巴瘤诊断和治疗水平的摊高，越来越多的淋巴瘤患者也能获得长期生存，享受健康生活。     

胃癌根治术规范化

胃癌是最常见的恶性肿瘤之一，其死亡率仅次于肺癌。全球每年新增胃癌患者约934000例，死亡患者约734000例，其中我国与日本约占56％。目前，胃癌的总体治疗效果仍然不理想，在缺乏有效预防手段的情况下，早期发现和规范化的治疗是提高疗效的关键。外科治疗在胃癌综合治疗中的地位至关重要，因此胃癌根治性手术的规范化尤为重要。     

有一种致命的粗心叫做“把直肠癌当痔疮”

老李:熊猫医生,我最近总是便血,还有点排便困难,是不是得了痔疮啊? 阿缪:便血可不是简单的事儿,我建议你还是做个肠镜检查一下. 老李:啊?痔疮应该不是很严重的疾病吧,还要做肠镜? 阿缪:你这说法就是典型的误区.谁说更血、排便困难只是痔疮的症状,我看得让季大侠给你好好上一课.     

Detection of p53 gene mutation in plasma of patients with gastric cancer

Objective:To investigated p53 gene mutation in plasma of gastric cancer patients. Methods: DNA extracted from plasma and matched tumor and tumor-adjacent non-cancerous tissues of 96 gastric cancer patients, and DNA from 20 healthy volunteers were studied. Exon 5, 6, 7, and 8 of p53 were amplified by Polymerase Chain Reaction (PCR). The mutation status was analyzed by denaturing high-performance liquid chromatography (DHPLC), followed by direct sequencing of cases with aberrant chromatographic patterns. Results: Heterozygous mutations of p53 gene were detected in 19.9% (19/96) of primary tumor tissues and 5.2% (5/96) of corresponding plasma. All p53 gene mutations detected in plasma DNA consisted with mutations in the matched primary tumor samples.Neither the tumor-adjacent gastric mucosa tissues nor control plasma from healthy volunteers showed p53 gene mutation. No correlation was found between p53 mutation status and clinicopathological features of gastric cancer patients. Conclusion: p53 gene mutation in plasma can be detected in tissues and plasma of gastric cancer patients, which could be applied in screening and surveillance of this disease.     

小肠间质瘤的外科治疗

胃肠道间质瘤(Gastrointestinal Stromal Tumors,GIST)是一种发生于消化道的少见的肿瘤,所占比例不足1%,发病率约2/10万.但它是胃肠道最常见的间质细胞肿瘤,其中小肠间质瘤占胃肠道间质瘤的第2位.     

不可忽视的胃疼

2007年春天,年逾花甲的杨老先生偶感胸口憋闷,试着吃了些小药调理之后身体果真舒服许多,老人对此便没有太在意。可过了不久,不但胸口憋闷,胃又有些发紧的感觉,到医院看了看,吃了些治心脏病的药,胸闷胃紧的症状非但未减轻,反而出现了胃疼的感觉,想着自己不舒服的情况持续近一年了,老人有些着急了,这好好的一个人,年轻的时候工作生活那么辛苦都没有患上胃病,怎么上了年纪,生活规律了,反倒添上了胃疼的毛病呢？     

Clinicopathological analysis of 50 rectal cancer cases diagnosed as adenoma in biopsy

Objective: To evaluate the clinicopathological characteristics of rectal cancer diagnosed as adenoma in biopsy.Methods: 50 rectal cancer cases diagnosed as adenoma in biopsy were analyzed retrospectively in this study by comparing the biopsy and postoperative pathology. Results: Among these 50 patients, biopsy pathology showed 26% (13/50) adenoma with mild dysplasia, 30% (15/50) adenoma with moderate dysplasia, and 44% (22/50) adenoma with severe dysplasia. In 8 cases, the adenomas were smaller than 2cm. On postoperatively surgical pathology, only 10 cases were carcinoma-in-situ, while 40 cases were invasive cancer. Conclusion: Special emphasis should be taken to biopsy-negative rectal adenomas and those smaller than 2cm.