结直肠癌患者围手术期并发症和病死率的研究

目的研究一家教学医院结、直肠癌患者住院期间的并发症和病死率情况。方法收集北京大学第三医院1992—2005年903例结、直肠癌患者的资料,对住院期间的并发症和病死率进行分析研究。结果903例患者中,结肠癌518例,占57.4%;直肠癌385例,占42.6%。住院期间并发症的总发生率为21.8%(197/903),结肠癌为18.3%(95/518),直肠癌为26.5%(102/385)。其中会阴部伤口感染、腹部伤口感染、肺部感染、肠梗阻较常见。吻合口漏的发生率为1.2% (8/717),在结肠癌为0.8%(4/518),直肠癌为2.0%(4/199)。2000年前、后并发症的总发生率没有明显变化。急诊手术的伤口感染、肺部感染、腹腔内感染的发生率明显高于择期手术。结、直肠癌患者住院期间病死率为1.0%。急诊手术的病死率为3.8%(3/80),择期手术为0.5%(2/438)(P= 0.028)。结论2000年后新技术的引入并没有改变结、直肠癌患者住院并发症的发生率。     

胃癌组织中human kallikrein 10基因表达的意义

目的探讨human kallikrein 10(hKl0)mRNA与蛋白在胃癌组织中的表达及其意义。方法采用半定量RT-PCR、蛋白印迹法和免疫组化技术对41例手术切除的胃癌癌灶中心及其远端切缘中hK10的表达情况进行检测。结果hK10 mRNA在胃癌癌灶中心和远端切缘组织中的相对表达量分别为0.21±0.20、0.02±0.03,两者相比差异有统计学意义(t=6.06,P<0.01)。蛋白印迹法检测结果与其一致。癌灶中心的hK10阳性表达率为90%,远端切缘对照组为12%,两者相比差异有统计学意义(x~2=49.98,P<0.01)。hK10表达与患者的性别、年龄、组织分级、临床分期、淋巴结转移无关(P>0.05)。结论hK10的表达异常可能与胃癌的发生有关,可能作为一种新的分子标记物在胃癌的诊断中起一定的作用。     

胰腺囊腺瘤和囊腺癌的诊断及外科治疗

目的探讨胰腺囊腺瘤和囊腺癌的诊断和治疗方法。方法对2000年6月～2005年6月复旦大学附属中山医院收治的24例胰腺囊腺瘤和囊腺癌的临床资料进行回顾性分析。结果胰腺囊腺瘤和囊腺癌无特征性临床表现。B超和CT对胰腺囊性肿瘤的诊断正确率分别达到88%(21/24)和92%(22/24),但不能准确区分其类型。3例浆液性囊腺瘤未行手术治疗;21例手术者中,行胰十二指肠切除术9例,远端胰腺切除术8例,胰腺节段切除术1例,肿瘤摘除术3例,胰瘘是主要的并发症。本组患者均获随访,3例未手术者肿瘤无增大,1例囊腺癌因复发转移于术后11个月死亡,其余均健在,术后无复发。结论B超和CT是胰腺囊性肿瘤主要的影像学检查方法。黏液性囊性肿瘤以及伴有症状的浆液性囊腺瘤需手术治疗。胰腺囊腺瘤手术切除后可获治愈,囊腺癌术后疗效也较满意。     

421例同种原位肝移植肝动脉重建体会

目的探讨肝移植手术过程中肝动脉重建的技术要点,分析肝移植术后肝动脉合并症发生的原因。方法回顾性总结2000年5月至2006年5月,6年间我院连续实施的同种原位肝移植421例患者的临床资料,分析肝移植手术过程中可能影响肝动脉重建的因素,以及术后肝动脉合并症发生的可能原因,总结术中肝动脉重建的技术要点。结果421例肝移植患者中共发生肝动脉相关合并症者14例,发生率为3.3%,肝移植术后血管合并症主要是动脉血栓形成及肝动脉狭窄。14例合并症患者中死亡9例,死亡率为64.3%。按合并症出现时间分类,早期动脉合并症8例,死亡6例,晚期动脉合并症6例,死亡3例。结论供肝动脉的完整性、供受体动脉的重建方法以及显微外科技术的应用是影响肝动脉重建结果的重要因素。     

3TSR对胰腺癌的抑制作用及机制探讨

目的研究血管形成抑制剂3TSR在体内外对胰腺癌的抑制作用,并初步探讨其机制。方法分别在体外培养条件下比较对照组、3TSR、键择(Gem)和3TSR Gem组对胰腺癌MIAPaCa-2细胞增殖及凋亡的影响,以及对裸鼠原位移植瘤肿瘤体积、细胞增殖指数及凋亡的影响。结果体外培养时3TSR对胰腺癌细胞无增殖抑制及诱导凋亡的作用,而Gem对胰腺癌细胞具有明显的抑制增殖及诱导凋亡的作用,但3TSR与Gem在体外无协同作用。体内实验时3TSR组、Gem组和3TSR Gem组肿瘤体积较对照组分别缩小70.1%,79.3%和84.9%;3TSR组、Gem组和3TSR Gem组胰腺癌细胞增殖指数分别为(19.7±3.1)%,(8.1±1.9)%和(13.2±4.2)%,其中3TSR组增殖指数与对照组比较差异无统计学意义,而Gem组和3TSR Gem组细胞增殖指数明显小于对照组和3TSR组(P<0.05);3TSR组、Gem组和3TSR Gem组胰腺癌细胞凋亡率分别为(5.0±2.2)%,(21.1±4.2)%和(22.8±4.2)%,其中3TSR组胰腺癌细胞凋亡率与对照组比较差异无统计学意义(P<0.05),而Gem组和3TSR Gem组细胞凋亡率显著大于对照组和3TSR组(P<0.05);3TSR组及3TSR Gem组血管内皮细胞凋亡率又高于对照组和Gem组(P<0.05)。结论3TSR体内外对胰腺癌细胞无直接增殖抑制及诱导凋亡作用,但能显著减少肿瘤体积,其机制可能与诱导内皮细胞凋亡有关;3TSR与化疗药物Gem合用未明显提高胰腺癌的治疗效果。     

重组腺病毒携带人血管抑素基因抑制胰腺癌血管生成的研究

目的研究重组腺病毒介导的人血管抑素基因(Ad-hAG)对胰腺癌血管生成的抑制作用。方法通过病毒重组技术将人血管抑素K5基因克隆人增殖缺陷型腺病毒基因组中,获得腺病毒滴度达5.5×10~(10)pfu/ml。转染人胰腺癌细胞,Western印迹和ELISA法检测人血管抑素基因的蛋白表达情况,并通过建立荷人胰腺癌的裸鼠动物模型(每组15例),微血管密度计数分析血管抑素对胰腺癌血管形成的影响。结果成功构建了携带血管抑素K5基因的腺病毒Ad-hAG;检测到重组腺病毒载体介导的血管抑素基因在胰腺癌细胞内高表达,微血管密度计数(MVD)治疗组为8.75±2.12,对照组MVD分别为20.52±1.25、18.52±1.36(t=6.165,P<0.05)。结论重组腺病毒介导的血管抑素基因在体内、外均获得高效表达,可明显抑制裸鼠胰腺癌血管形成和肿瘤生长。     

Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation

PURPOSE: We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with penile cancer and no palpable inguinal adenopathy. MATERIALS AND METHODS: The records of 31 patients with invasive penile cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with (99m)technetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status. RESULTS: Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for cancer detection was 86%. Using dynamic sentinel node biopsy with blue dye plus radiotracer 5 sentinel lymph nodes were positive for cancer, although 2 false-negative results were obtained. Thus, the sensitivity of dynamic sentinel node biopsy per groin for cancer detection was 71%. CONCLUSIONS: In our experience preoperative lymphoscintigraphy and dynamic sentinel node biopsy as currently performed remain insufficient for detecting occult inguinal disease. Superficial lymph node dissection remains the gold standard for detecting inguinal microscopic metastasis in select patients.     

Prostate cancer

PURPOSE: We quantified the burden of prostate cancer in the United States by identifying trends in incidence, disease presentation, survival rates and use of health care resources, and by estimating the economic impact of the disease. MATERIALS AND METHODS: The analytic methods used to generate these results were described previously. RESULTS: Age adjusted prostate cancer incidence rates peaked in 1992 at 237/100,000 men, decreased in 1995 and then increased at approximately 1.7% yearly through 2000, when the rate was 180/100,000. Marked stage migration and an improvement in 5-year overall survival were also noted. Age adjusted inpatient hospitalizations for prostate cancer decreased in the 1990s from 729/100,000 population in 1992 to 309/100,000 in 2001. Considerable ethnic and regional variation was noted. During the same period age adjusted radical prostatectomy rates varied from 128/100,000 men in 1994 to 108/100,000 in 2000. Surgery rates decreased in older men, while they increased in younger men. Outpatient physician office visits also varied in the 1990s with ethnic and regional variation again noted. Finally, the total medical expenditure for prostate cancer treatment was $1.3 billion in 2000, which represents a 30% increase over the total expenditure for 1994. CONCLUSIONS: The burden of prostate cancer in the United States is considerable and it appears to have markedly increased in the prostate specific antigen era. Further research is needed to determine if we are using our limited health care resources appropriately for the diagnosis and treatment of this common malignancy.     

腹腔镜胃腔外楔形切除胃间叶源性肿瘤13例报告

目的：探讨腹腔镜胃腔外楔形切除胃间叶源性肿瘤的临床应用价值。方法：回顾分析腹腔镜胃腔外楔形切除治疗胃间叶源性肿瘤13例的临床资料。结果：13例手术均顺利完成,术后病理切缘均阴性,手术时间平均140min,术中出血量50～100ml,术后24～36h肠道功能恢复,术后住院5～7d,无一例发生并发症。结论：腹腔镜胃腔外楔形切除术治疗部分（2～5cm）胃间叶源性肿瘤安全可靠,胃腔外切除使胃内容物不外溢,污染少,患者创伤小、康复快,值得推广。