上尿路移行上皮细胞癌根治术后复发膀胱肿瘤的高危因素分析

目的 探讨肿瘤部位与上尿路移行上皮细胞癌根治术后复发膀胱肿瘤风险的关系.方法 对行根治手术并获随访的168例上尿路移行上皮细胞癌患者的临床资料进行回顾性总结,比较不同部位上尿路移行上皮细胞癌根治术后复发膀胱肿瘤的风险,采用Cox回归分析术后复发膀胱肿瘤风险的独立影响因素.结果 168例患者术后1、3、5年的无复发膀胱肿瘤的生存率分别为88%、76%和63%.观察期内,共有49例术后发生膀胱肿瘤复发,中位首次复发时间为20个月.肾盂癌术后复发率为30.8%(28/91);输尿管中段癌术后复发率为8.3%(2/24),输尿管下段癌术后复发率为48.7%(19/39).肾盂癌与输尿管癌患者术后无复发膀胱肿瘤生存率比较差异无统计学意义(P>0.05).多因素分析结果显示输尿管下段癌为影响上尿路移行上皮细胞癌根治术后复发膀胱肿瘤风险的独立变量(P<0.01).结论 输尿管下段癌患者术后复发膀胱肿瘤的风险高于其他部位上尿路移行上皮细胞癌.

Abstract：

Objective To investigate the relationship between tumor location and the risk of developing bladder cancer in pafients treated by nephroureterectomy(NU)for upper urinary tract transitional cell carcinoma(UUT-TCC).Methods The clinical data of 168 UUT-TCC patients who underwent NU were reviewed.Univariate and multivariate analysis were carried out to determine the risk factors for intravesical recurrence after NU.Results The recurrence-free survival rate at 1,3 and 5 years after NU were 88%, 76%and 63%.All patients were followed up for a median period of 45(12-107)months During this period, a total of 49 patients developed bladder tamors after surgery,of which 28 cases were renal pelvic carcinoma, 2 cases were rniddle ureter carcinoma and 19 cases were distal ureter carcinoma.The recurrence-free survival of renal pelvic carcinoma and ureter carcinoma had no significant difference by Log-Rank test(P>0.05).On multivariate analysis,only locating in distal ureter carcinoma was the independent risk predictor for intravesical recurrence after NU (P<0.01).Conclusion Pafients with UUT-TCC at distal ureter carry a higher risk for intraeesieal recunerrce after NU than those with TCC at other location of upper urinary tract.     

欧洲癌症研究与治疗组织风险评分表对国人非肌层浸润性膀胱癌预后判断的意义

Objective To Validate the prognostic significance of the European Organization for Research and Treatment of Cancer (EORTC) risk tables in Chinese patients with non-muscle invasive bladder cancer (NMIBC). Methods According to the scoring standard of the EORTC system, 225 NMIBC patients were reviewed and divided into 3 groups: low, intermediate and high risk groups for recurrence and progression respectively. The probabilities of recurrence and progression at 1 year and 5 year for each group were calculated using life-table analysis and then compared with the EORTC risk tables. Log-Rank test and multivariable analysis were used to analyze the possible differences between risk groups and to find independent prognostic factors. Results For low (n= 32, 25), intermediate (n=109, 128) and high (n=84, 72) risk groups, the probabilities of recurrence and progression at 1 year were 15. 1%, 31.2%, 55.5% and 0. 3%, 2. 0%, 15.5% respectively. The probabilities at 5 year were 28. 2%, 55.2%, 75.0% and 1.4%, 12.9%, 54. 7%. All the results were similar to that of EORTC tables except the probability of progression at 5 year for the high progression risk group.The differences between different risk groups were significant (P＜0.01). In a multivariable analysis for recurrence and progression, the EORTC scores had independent significance (P＜0.01). Conclusions EORTC risk tables could stratify NMIBC patients effectively according to the risk of recurrence and progression. It could be a useful tool for Chinese urologists.     

肿瘤转移抑制蛋白1在非肌层浸润性膀胱癌中的表达及与预后的关系

目的探讨肿瘤转移抑制蛋白1(MTSS1)在非肌层浸润性膀胱癌(NMIBC)中的表达及与预后的关系。方法采集膀胱移行细胞癌和正常膀胱组织的病理切片,检测MTSS1的表达,并分析表达与临床病理因素的关系。结合临床随访资料,分析MTSS1的表达与预后的关系。结果膀胱癌组阳性率达17%,明显低于正常组的77%。MTSS1蛋白表达与患者年龄、性别、肿瘤大小及数目无明显相关性,但与膀胱癌的病理分级呈负相关(P<0.05)。在随访中,复发组与未复发组MTSS1蛋白表达阳性率分别为4%和27%,两者比较差异有统计学意义(P=0.048)。结论 MTSS1蛋白与NMIBC的预后具有相关性。     

膀胱混合癌的诊断和治疗（附18例报告）

目的 探讨膀胱混合癌的临床特征.方法 结合文献对收治的18例膀胱混合癌患者的临床表现、诊断、治疗及预后进行分析.结果 18例膀胱混合癌中移行细胞癌＋腺癌7例,移行细胞癌＋鳞癌4例,移行细胞癌＋鳞癌＋腺癌2例,移行细胞癌＋小细胞未分化癌4例,移行细胞癌＋腺癌＋小细胞癌1例,经尿道膀胱肿瘤电切术1例,膀胱部分切除术5例,膀胱全切术12例（其中回肠膀胱术7例,输尿管皮肤造口术4例,输尿管乙状结肠吻合术1例）.结论 膀胱混合癌恶性程度高、预后差、早期诊断困难,手术切除是主要治疗方法.     

活性氧基与皮肤疾病

近年来,活性氧基(oxygen radicals,OR)的研究已受到生物与医学界的广泛注意,其研究几乎涉及到基础与临床各学科,如生理生化、药理毒理、免疫病理、环境卫生、放射医学、老年及肿瘤医学等。本文对皮肤疾病中有关 OR 的研究近况作一综述。     

骨盆骨折脱位的并发症(附300例临床分析)

骨盆骨折是一种常见的创伤性疾病,且常合并极为严重的并发症。我院自1965年元月至1985年6月查到资料的共收治骨盆骨折病人300例,占同期骨折病人的3.52％,其中189例合并有其它并发症,占63％。本文重点对骨盆骨折脱位常见的五种并发症的发     

欧洲癌症研究与治疗组织风险评分表对国人非肌层浸润性膀胱癌预后判断的意义

Objective To Validate the prognostic significance of the European Organization for Research and Treatment of Cancer (EORTC) risk tables in Chinese patients with non-muscle invasive bladder cancer (NMIBC). Methods According to the scoring standard of the EORTC system, 225 NMIBC patients were reviewed and divided into 3 groups: low, intermediate and high risk groups for recurrence and progression respectively. The probabilities of recurrence and progression at 1 year and 5 year for each group were calculated using life-table analysis and then compared with the EORTC risk tables. Log-Rank test and multivariable analysis were used to analyze the possible differences between risk groups and to find independent prognostic factors. Results For low (n= 32, 25), intermediate (n=109, 128) and high (n=84, 72) risk groups, the probabilities of recurrence and progression at 1 year were 15. 1%, 31.2%, 55.5% and 0. 3%, 2. 0%, 15.5% respectively. The probabilities at 5 year were 28. 2%, 55.2%, 75.0% and 1.4%, 12.9%, 54. 7%. All the results were similar to that of EORTC tables except the probability of progression at 5 year for the high progression risk group.The differences between different risk groups were significant (P＜0.01). In a multivariable analysis for recurrence and progression, the EORTC scores had independent significance (P＜0.01). Conclusions EORTC risk tables could stratify NMIBC patients effectively according to the risk of recurrence and progression. It could be a useful tool for Chinese urologists.     

银屑病患者的RCIA与CLC的初步观察

本文通过红细胞免疫粘附受体活性(RCIA)与循环免疫复合物(CIC)的测定,来观察银屑病患者的免疫功能状态.     

疱疹样天疱疮合并胃贲门癌一例

患者男,65岁.于1985年11月感胸腹部皮肤痒并出现环状红斑,边缘有小水疱,皮疹渐扩展到腰背及四肢,口腔无损害.