细胞黏附分子在肝癌复发转移中的作用研究进展

细胞黏附分子（CAMs）是位于细胞表面的糖蛋白,通过介导细胞与细胞、细胞与细胞外基质间的相互作用参与多种生理及病理过程。细胞黏附分子与包括肝癌在内的多种肿瘤的复发转移有着非常密切的关系。本文就细胞黏附分子在肝癌复发转移中作用的研究进展作一综述。     

31 例局部复发性直肠癌的再手术治疗

 目的　总结直肠癌局部复发的手术治疗经验。方法　对 31例局部复发性直肠癌进行了再手术治疗。结果　无症状者和有症状者的手术切除率分别为 80 .0 %和 2 8.6% ,3年生存率分别为 60 .0 %和 2 3.8% ,5年生存率分别为 40 .0 %和 9.5% ,两者间均存在显著差异。另外 ,从复发部位来看 ,无论是切除率还是生存率 ,均以盆腔复发者最低。结论　外科手术是治疗局部复发性直肠癌切实有效的方法 ;而定期复查、早期诊断又是影响切除率和生存率的最重要因素。     

Penetrating serosa in human T4aN0M0 gastric carcinoma correlates closely to patients’ worse prognosis after D2 gastrectomy

BACKGROUND AND OBJECTIVE: In both the 7th edition of the UICC staging system for gastric cancer and the 14th edition of the JGCA system, the definition of T4a is “Tumor perforates serosa (visceral peritoneum) without invasion of adjacent structures”. The aim of this study is to investigate the prognostic difference between T4aN0M0 patients with serosa-penetrating and without serosa-penetrating of gastric carcinoma. METHODS: A total of 221 patients with T4aN0M0 gastric carcinoma who underwent D2 resection at our Cancer Center between January 1990 and December 2008 were collected. The cohort included 42 patients with serosa-penetrating and 179 patients without serosa-penetrating. Average follow-up time was 85.5 months. Spearman’s rank correlation, Kaplan-Meier plots and Cox proportional hazards regression model were used to analyze the data. RESULTS: The 5-year survival rate for the patients serosa-penetrating and the patients without serosa-penetrating were 31% and 62% respectively (p<0.05). The relapse rates of these two groups after D2 radical surgery were 16.2% and 59.5%, respectively (p<0.05). The peritoneal dissemination and distant organ/lymph node metastatic rates were 44.8% and 55.2% versus 76.0% and 24.0%, respectively (p<0.05). CONCLUSION: Our findings provide a basis for the concept that serosa-penetrating in T4aN0M0 gastric carcinoma may be important in the acquisition of an aggressive phenotype, suggesting that serosa-penetrating, is an independent factor for poor prognosis of patients with gastric carcinoma.     

Clinicopathologic findings of recurrent primary sclerosing cholangitis after orthotopic liver transplantation

Whether primary sclerosing cholangitis (PSC) occurs after orthotopic liver transplantation is controversial, largely because the pre-transplant diagnosis of PSC is based on nonspecific radiological and histological findings. We reviewed clinical, radiological, and histological records of 53 patients who underwent liver transplantation for PSC between 1985 and 1998. Three patients with patent hepatic arteries and no evidence of chronic rejection had radiological and histological findings that may have been due to recurrent PSC. Bile duct stricturing in these patients proved permanent and progressive and affected both the quality of life and graft survival. The first patient, who is 110 months after transplantation, has had repeated episodes of cholangitis for the last year. The second patient underwent excision of a strictured hepatic duct 45 months after transplantation and was ultimately retransplanted 95 months after initial transplantation. The third patient underwent left hemihepatectomy of an atrophied lobe 50 months after transplantation. Although the patient population assessed in this study is limited, putative recurrent PSC in the allografts has led either to graft loss or to clinically significant hepatobiliary complications of the graft. Received for publication on March 8, 1999; accepted on April 30, 1999     

康复训练量对多发性硬化症运动功能水平和复发的影响

 目的 观察适当的康复训练量对多发性硬化症(multiple sclerosis,MS)患者运动功能状态和复发率的影响。方法 将140例MS后3个月以内的患者随机分为观察组 105例(按康复训练强度分为低、中、高运动量组各35例)和对照组35例。所有MS患者均接受常规的康复护理和药物治疗;观察组同时给予40 min/次,2次/d的康复功能训练,训练时间均为12周。在治疗后进行疗效判定,且分别在治疗前及治疗12周时进行Kurtzke功能障碍状态评定、功能独立性评定(FIM)量表积分和复发率的比较。结果 治疗12周后,(1)观察组在疗效、运动功能积分状态、复发率等方面都明显优于对照组;(2)观察组内三组比较:中运动量组治疗后在疗效、运动功能状态、复发率方面都明显优于低、高运动量组。结论 适量的康复训练对改善MS患者运动功能状态和降低复发率有显著效果。     

Laparoscopic ventral incisional hernia repair: A more effective alternative to conventional repair of recurrent incisional hernia

Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair of primary incisional hernia (11%-20%). Laparoscopic incisional hernia repair (LIHR) can significantly reduce the recurrence rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically. One-hundred and seventy consecutive patients undergoing LIHR between January 1995 and December 2002 were prospectively reviewed. Patients with recurrent incisional hernia (n = 69) were compared to patients with primary incisional hernia (n = 101). Patient demographics and perioperative and postoperative data were recorded prospectively. Follow-up was obtained from office visits and telephone interviews. Statistical analysis was performed using the Student t test and the x ²test. Results are expressed as means ± standard deviation. The patients with recurrent incisional hernia had a mean of 1.9 ± 1.3 previous repairs, higher body mass index (BMI) (34 ± 6 kg/m² vs. 33 ± 8 kg/m², P = 0.46), larger defect size (123 ± 115 cm² vs. 101 ± 108 cm², P = 0.06), and longer operative time (119 ± 61 minutes vs. 109 ± 44 minutes, P= 0.11). The complication rate was higher in the recurrent group (28% vs. 11%, P = 0.01), but the recurrence rate was not different (7% vs. 5%, P= 0.53). The mean time to recurrence was significantly shorter in the recurrent group (3 ± 2 months vs. 14 ± 7 months, P < 0.0001). The mean follow-up interval was 19 ± 18 months in the recurrent group and 27 ± 20 months in the primary group. Although laparoscopic repair of recurrent incisional hernia resulted in a higher recurrence and complication rate than laparoscopic repair of primary incisional hernia, the rates were lower than those reported for conventional repair of recurrent incisional hernia. Laparoscopic repair of recurrent incisional hernia is an effective alternative to conventional repair. Supported in part by Tyco/US Surgical Corporation through an educational grant to the University of Kentucky Center for Minimally Invasive Surgery.     

Axillary lymph node metastasis following resection of abdominal wall laparoscopic port site recurrence of gallbladder cancer

Abdominal wall port site recurrence of gallbladder cancer is well described in the literature in patients that have undergone laparoscopic cholecystectomy with the incidental finding of a gallbladder cancer. The etiology and consequences of this type of metastatic recurrence are unclear. This report describes two cases with the unique sequelae of the interval development of nodal metastases to the axillary lymph nodes following resection of an abdominal wall laparoscopic port site recurrence of gallbladder cancer. The first case involves a patient who developed an isolated left axillary lymph node metastasis approximately 10 months after undergoing resection of a left-sided abdominal wall port site recurrence for a T2 gallbladder cancer. The original tumor had been found at laparoscopic cholecystectomy and definitively treated surgically approximately 3 years earlier. The second case involves a patient who developed isolated nodal metastases to the right axillary lymph nodes approximately 4 months after undergoing resection of right-sided abdominal wall port site recurrence, segment 4/5 hepatic resection, and portal lymphadenectomy for a T2 gallbladder cancer. This tumor had originally been found at laparoscopic cholecystectomy approximately 1 year earlier. These unique sequelae of the interval development of nodal metastases to the axillary lymph nodes demonstrated in both cases has not been previously reported.     

大鼠肝癌肝移植模型的建立

目的　建立肝癌肝移植动物模型并观察术后肝癌复发的生物学特点。方法　 130只近交系SD雄性大鼠 ,10 0ppm二乙基亚硝胺饲喂诱癌。共 98只大鼠据Kamada袖套技术行原位肝移植 ,术中根据肿瘤大小分为三组 :1组有明确肝癌结节但直径 <1 0cm (n =2 5 ) ,2组肝癌结节直径1 0～ 1 5cm(n =4 1) ,3组肝癌结节直径 >1 5cm(n =32 )。不行肝移植术的 10只大鼠作对照组。结果　三组大鼠肝移植术中死亡率 2 6 5 % (2 6 / 98) ,术后 30d累计死亡率 71 5 % (70 / 98)。术后存活 30d后计算平均生存期 ,1组 (81 3± 33 2 )d ,2组 (6 7 6± 2 4 9)d ,3组 (5 4 4± 2 4 9)d。对照组从诱癌开始 15 0d后计算 ,平均生存期为 (2 9 4± 12 9)d。术后肝癌复发率 35 7% (10 / 2 8) ,单纯移植肝内复发7 1% (2 / 2 8) ,肝和肺同时复发 10 7% (3/ 2 8) ,肝和腹腔同时复发 3 6 % (1/ 2 8) ,单纯腹腔肿瘤 7 1% (2 /2 8) ,单纯肺部肿瘤 7 1% (2 / 2 8)。结论　大鼠肝癌肝移植良好地模仿了临床过程 ,但诱癌大鼠体质差导致术中和术后短期死亡率高。大鼠术后长时间存活是观察到肿瘤复发的重要条件 ,肝癌复发的形式多样。该模型为肝癌肝移植术后抗复发和复发机制研究提供了极好的平台。     

Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?

OBJECTIVE: To evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer. PATIENTS AND METHODS: Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of > or = 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was >3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented. RESULTS: Of the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow-up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of < 7 ng/mL. In group 2 the mean PSA at the bone scan was 30.7 ng/mL and all patients had a PSA of >7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P < 0.001). CONCLUSION: Bone scintigraphy is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. A bone scan in patients with a serum PSA of <7 ng/mL on biochemical recurrence after RRP is unlikely to be positive, whereas a PSA of > or = 20 ng/mL is. The presence of skeletal symptoms or a PSA level of >7 ng/mL should prompt the clinician to obtain a bone scintigram.