老年大肠癌659例的临床及病理特点分析

目的 探讨老年大肠癌的临床及病理特点。方法 回顾性分析1994年2月至2006年5月间手术并经病理确诊的65岁及65岁以上（老年组）大肠癌659例的临床资料，对发病情况、肿瘤部位、病理分期、组织分型等方面进行分析，并与同期收治的1115例65岁以下（非老年组）大肠癌的资料进行比较。结果 老年组年龄为65～99岁，平均71．6岁，男：女为1．51：1，具有癌瘤或息肉家族史的患者占3．5％（23／659），非老年组为7．5％（84／1115），两组比较差异有统计学意义（P=0．000）。老年组伴发肠梗阻或同时肝转移的比例分别是14％和9％，老年组中45％的患者肿瘤发生于直肠，其次是乙状结肠（24％），组织学上老年大肠癌以恶性程度较低的腺癌最为常见，而恶性程度高的低分化癌、黏液腺癌和印戒细胞癌所占的比例明显低于非老年组。老年大肠癌临床Dukes分期相对较早，58％的患者为DukesA、B期，明显高于非老年组。结论 老年大肠癌遗传性较低，其发病部位仍以直肠最为常见，同时也表现向近段大肠迁移的趋势，组织分型好、分化程度高、临床分期较早。     

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.     

胰腺癌肝转移致发作性低血糖1例报告

患者 男,35岁。1989年9月2日入院。入院前四个月来饥饿时头晕、乏力、出汗,继之不省人事,共发作6—7次。发作时当地医院检查血糖为2.1～2.4mmol/L,经静脉注射葡萄糖后苏醒。发作以来未发生精神异常,无腹痛。食欲及大小便如常,体重略有增加。体查 全身营养状况良好,体重60kg。腹部检查未发现异常。血象、大小便常规及血生化检查无特殊。SGPT 257 单位r-GT 180μ/L,凝血酶原时间15秒(正常对照13.4秒),AFP<20μg/L。饥饿试验于禁食14小时后出现低血糖症状,抽血查血糖1.0mmol/L,静注50％葡萄糖80ml后症状消失。纤维胃镜及X线钡灌肠检查无异常。B超显示肝右叶可见多个大小不等的园形低回声     

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.     

淋巴结清扫手术治疗胃癌的现状

几十年来，淋巴结清扫的范围始终是胃癌手术治疗争议的热门话题。广泛淋巴结清扫（ｅｘｔｅｎｄｅｄｌｙｍｐｈｎｏｄｅｄｉｓｅｃｔｉｏｎ，ＥＬＮＤ）由阵内（ｊｉｎｎａｉ）于６０年代推介，其对并发症和长期生存的影响的意见很不一致。基本上有两大流派，大多数日本、...     

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近年来 ,高脂血症 (HL)与急性胰腺炎 (AP)的关系逐渐引起人们的重视。其发病及病情演变机制较复杂 ,目前仍未十分清楚。高脂血症与急性胰腺炎之间存在一定关系已有共识[1] ,但是否互为因果仍存有争议[2 ,3 ] ,高脂血症可能是胰腺炎的病因 ,也可能是胰腺炎的结果 ,抑或是一些其他因素引起这两者同时发生。各作者报告高脂血症合并AP占总AP的发病率高低不一 ,为 4 %～ 5 3%之间。在我国 ,由于饮食习惯的西化和对高脂血症合并AP认识的提高 ,其发病率呈逐年上升趋势。1　HL合并AP的病因Ⅰ型、Ⅳ和Ⅴ型 (Frederickson分型 )高脂血症以高甘油…     

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急腹症 (acuteabdomen)是一组以急性腹痛为主要表现的临床疾患。除外科疾病外 ,内科、妇产科、神经科及全身性疾病均可引起。外科急腹症是泛指常需手术治疗的腹腔内非创伤性急性病。广义的外科急腹症应包括腹部的创伤性疾病。剖腹探查在外科急腹症的诊断、治疗中有重要意义。由于以急性腹痛为主要表现的病种很多 ,临床表现十分复杂 ,有些病人即使经剖腹探查也难以确诊。出现这一情况 ,外科医生常束手无策 ,减少剖腹探查的阴性率以及出现这一情况时如何进一步处理是外科医生十分关注的问题。现就剖腹探查阴性的急腹症处理问题进行阐述。1　全…     

术后反流性胃炎反流指标和病理形态的研究

术后反流性胃炎是晚近所认可的一种胃手术后并发症,其发病机理和诊断标准意见仍有分歧。本文为对30例BillrothⅡ式胃大部切除后的反流性胃炎症状,反流指标及残胃病理形态的研究,探讨本病的发病原因和病理形态的临床意义。 材料和方法 病理选择 我们对BillrothⅡ式胃大部分切除术后的病例随访选择有典型反流性胃炎症状和没有症状或症状轻微病人作为研究对象。按文献所述反流性胃炎的常见症状,设计症状评分表,按症状评分,依总分高低将病人分为2组,每组各15例。症状低分组中3例无任何症     

进一步加强我国胃癌外科的实验研究

现代胃癌外科的发展依赖于临床与基础实验研究两个方面的协调进行。临床上提高诊断水平、改进手术操作、提高综合治疗措施等是促进胃癌外科发展的关键,但临床诊治水平的提高从根本上还是取决于基础实验研究的发展状况。加强胃癌外科基础实验研究在于揭示胃癌发生发展的内在机制,提高胃癌防治的总体水平。我国胃癌外科的基础实验研究近2 0多年来已经取得了很大的进步,但是我国胃癌外科实验研究的总体水平还有待进一步提高。应结合我国国情,力所能及的进行针对性研究,特别应加强与胃癌外科临床防治相关的实验研究,鼓励开展多中心跨学科的原始…     

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目的　总结胃癌术后复发的临床特点并探讨复发癌切除术的临床意义。方法　回顾性分析 1994年 8月至 2 0 0 1年 5月共收治的 30例胃癌术后复发病人的临床资料 ,将其分成切除组 (7例 )和非切除组 (2 3例 ) ,比较两组的临床特点和预后。结果　首次术后平均随访 2 1个月 (3～ 4 7 5个月 ) ,平均复发时间为 11 5个月 (1 3～4 5 0个月 )。切除组复发后平均存活期为 13 4个月 ,非切除组为 4 7个月 ,两组差别明显。复发癌切除对复发后生存超过 10个月有统计学意义 (P <0 0 5 )。结论　进展期胃癌根治术后局部复发癌切除可延长病人生存期。