中国部分市县前列腺癌发病趋势比较研究

目的 探讨中国大陆前列腺癌发病的流行病学特征.方法收集整理中国大陆30个肿瘤登记处1988-2002年15年间前列腺癌发病登记的数据资料,选取数据较为齐全的北京、天津、上海、武汉、哈尔滨、河北磁县、江苏肩东、浙江嘉善、广西扶绥、福建长乐、河南林州11个登记处的资料,按5年1个时段分为1988-1992、1993-1997、1998-2002年3个时间段,比较分析前列腺癌发病率、病死率,采用美国癌症研究所开发的统计软件Joinpoint Regression Program 3.3.1分析其流行趋势.通过对发病率的对数转换线性回归分析计算年度变化百分比.结果 30个登记处1988-1992、1993-1997、1998-2002年前列腺癌的发病率分别为1.96/10万、3.09/10万、4.36/10万,发病率有明显上升趋势.但与美国、加拿大、欧洲部分国家和地区比仍处于较低水平.结论 我国前列腺癌发病率呈现逐年上升趋势,将成为影响我国居民健康的主要恶性肿瘤之一,需引起重视.     

肾癌区域淋巴结转移的临床分析

目的 了解肾癌区域淋巴结转移的临床特点及发生发展规律,提高对本病的诊治效果.方法 回顾性分析2004年1月至2008年12月19例肾癌伴有区域淋巴结转移患者的资料.男15例,女4例.年龄29～77岁,中位年龄57岁.肿瘤位于左肾12例,右肾7例.腹膜后肿大淋巴结最大径1.5～5.0 cm,中位数2.8 cm,其中4例影像学检查未发现肿大淋巴结,术中探查证实.行腹膜后肿大淋巴结切除11例,区域淋巴结清扫8例.结果 肾癌发生区域淋巴结转移占同期收治肾癌的1.6%(19/1213).术后19例均获随访,随访时间8～78个月,中位数34个月.无瘤生存6例,带瘤生存7例,死亡6例,5年生存率68.4%.腹膜后区域淋巴结清扫组与肿大淋巴结切除组生存期及术后复发转移率比较差异均无统计学意义(P=0.644;P=0.319).结论 肾癌发生单纯区域淋巴结转移少见,术前影像学可能漏诊,部分患者通过区域淋巴结清扫或肿大淋巴结切除可获得无瘤生存.

Abstract：

Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.     

中国前列腺癌筛查与早诊早治指南(2022, 北京)

前列腺癌是好发于老年男性的生殖系统恶性肿瘤。前列腺癌高风险人群筛查与患者的早诊早治对提高前列腺癌治愈率至关重要。制定符合中国国情的前列腺癌筛查与早诊早治指南, 将促进中国前列腺癌筛查的同质性和规范性, 提高前列腺癌筛查的效果。中国前列腺癌筛查与早诊早治指南受国家卫生健康委员会疾病预防控制局委托与指导, 由国家癌症中心发起, 联合多学科专家, 根据《世界卫生组织指南制定手册》的原则和方法, 整合近年来国内外在前列腺癌筛查与早诊早治方面的新进展, 同时考虑中国前列腺癌筛查的实际经验, 针对前列腺癌筛查对象、技术、流程、质控等15个关键问题给出了详细的循证推荐, 旨在规范前列腺癌筛查与早诊早治实践, 提升中国前列腺癌防控效果。     

积极发展成人高等医学教育的思考

成人高等医学教育是我国高等医学教育的重要组成部分,对提高广大在职卫生技术人员的思想文化素质和技术水平发挥了重要的作用。本文阐述了成人高等医学教育在建设有中国特色的社会主义卫生事业中的重要地位和不可替代作用;总结了成人高等医学教育的特点,提出了新时期成人高等医学教育面临的五大主要任务;根据全国卫生工作会议精神,结合成人高等医学教育的现状,提出以继续医学教育为发展重点,调整专业结构、拓宽办学渠道、深化教学改革等积极发展成人高等医学教育的设想。     

流式细胞术检测肾上腺肿瘤DNA含量及临床意义

目的 明确ＤＮＡ量测定是否枳和为肾上腺肿瘤良、恶性诊断的指标之一。方法 采用ＰＣＭ技术对１３例肾肯朱嗜铬细胞列肾上腺皮质肿瘤,肾上腺转移瘤和肉眼正常肾上腺组织各５例新鲜标本进行了ＤＮＡ含量测定。结果 病理为肾上腺嗜铬细胞瘤及其瘤旁肾上腺标本ＤＮＡ含量多为非整倍体（１２／１３）,但求后无１例复发和转移,而６全 理为皮质腺瘤标本２例ＤＮＡ含量为非整倍体,其中１例术后出现肝转移而确诊为恶性,１例为二倍体     

索拉非尼联合干扰素α-2b治疗转移性肾癌的初步报告

目的 探讨索拉非尼联合干扰素治疗转移性肾癌的疗效和安全性. 方法 17例无法手术切除的转移性肾透明细胞癌患者接受索拉非尼联合干扰素α-2b治疗.给药方法:索拉非尼400 mg 2次/d;干扰素α-2b 3 MU每周5次,连续3～4个月,休息2个月.其中1例患者索拉非尼初始剂量为600 mg,2次/d.如病情进展,可视患者耐受性情况将索拉非尼剂量增至600 mg 2次/d,同时继续联合干扰素α-2b治疗.按RECIST标准每2个月评价疗效. 结果 中位治疗时间120(51～442)d.17例患者均可评价疗效,部分缓解5例,另1例部分缓解未能确认,稳定9例,进展2例.客观反应率29%(5/17),疾病控制率(完全缓解加部分缓解加稳定)88%(15/17).由于随访时问短,尚不能报告中位无进展时间和总生存时间.常见的一般不良反应包括:发热14例(82%),腹泻14例(82%),手足皮肤反应12例(71%),乏力11例(65%),皮疹9例,脱发7例,黏膜炎7例,高血压5例,食欲下降4例,声音嘶哑4例,肌肉关节疼痛4例,恶心、呕吐2例,头疼、头晕2例.其中3级不良反应有腹泻4例,黏膜炎2例,乏力2例,皮疹1例,手足皮肤反应1例.中性粒细胞减少11例(65%),血小板下降5例,贫血5例.转氨酶升高者4例. 结论 索拉非尼联合干扰素α-2b治疗转移性肾细胞癌可提高客观反应率,不良反应可耐受.     

人工智能在肾细胞癌诊断中的研究现状

目前,人工智能在肾癌诊断研究中的应用正处于起步阶段,影像学诊断的报道多于病理学,主要是关于人工智能通过CT检查鉴别肾肿瘤的良恶性和预测肾细胞癌的病理类型,但尚未涉足MRI检查,而病理学诊断主要是通过人工智能对细胞核进行分级。未来,人工智能在肾细胞癌诊断方面的研究有很大的发展潜力,有待进一步深入研究。     

结肠癌临床路径导入精细化目标管理模式探讨

[目的]探讨在现有结肠癌临床路径基础上导入精细化管理的效果。[方法]在国家卫生计生委推荐的结肠癌临床路径管理基础上,重新细化路径表单,从住院时间、次均费用等4个方面进行优化,构建结肠癌信息管理模型,确定5大类36项指标作为日常监控指标。[结果]经过5个月的临床实践,平均住院日缩短了2.76天,次均费用下降了15.71%,抗菌药物平均费用、使用天数逐月下降。[结论]临床路径导入精细化管理目标的模式更具有适宜性、针对性、可控性、开放性,有助于将临床路径管理引向深入,为管理效果带来增益。     

多房性囊性肾癌一例报告及文献复习

Objective To discuss the diagnosis and outcome of multilocular cystic renal cell car-cinoma. Methods The clinic data of 1 case of multilocular cystic renal cell carcinoma were reviewed with its clinical manifestation, imaging, pathology and therapy in our hospital. The male patient aged 49 was incidentally found to have a right renal tumor. The CT scan showed a multiloeular cystic tumor in the low pole of the right kidney with a clear outline. The thin septa were found in the tumor, which were enhanced in the enhancement CT scan. The enhancement MRI showed the cystic wall was en-hanced. Results The patient received a partial nephrectomy as his treatment. The pathological char-acteristics were as following: the multilocular cystic tumor was about 3 cm×2 cm×2 cm with clear serosity in it. The cystic wall was smooth with the width of 0.1-0.2 cm. Most of the cystic cavities were covered by monostratified or stratified cubic clear cells, and some were covered by squamous epi-thelium or no epithelium at all. The septum was composed of collagen fiber, and clear cells were found in it. The clear cells form small collections but do not form expansile nodules. The final pathological diagnosis was multilocular cystic renal cell carcinoma. The follow-up was 20 months, without local re-currence or distant metastasis was found. Conclusions Multilocular cystic renal cell carcinoma (MCRCC) is a rare variant of renal cell carcinoma with a good prognosis. MCRCC is an uncommon tumor of the kidney composed of multiple cysts with clear cells in the septa indistinguishable from grade I renal cell carcinoma. Most patients are asymptomatie and the tumors are discovered inciden-tally. The preoperative diagnosis of MCRCC immediately depends on imaging studies. Pathology is the key to diagnosis.