老年直肠癌临床特征及治疗的变迁

目的 了解近年来老年直肠癌临床特征及治疗的变迁。方法 回顾性分析10年间313例老年直肠癌患者的临床特征及治疗情况，对比第一个5年和第二个5年的临床特征及治疗方法的变迁。结果发病年龄后延，误诊率降低，早期病例增多；Dixon手术增多，辅助治疗由简单变为综合治疗方法；5年生存率明显提高，术后的复发率明显减低。结论 老年直肠癌发病年龄后延，误诊率降低，早期病例逐渐增多；治疗上更趋有效、合理。     

Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage ⅠB2 and ⅡA bulky cervical cancer

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.     

Design and test of a vascular access device

Transarterial left ventricular assist devices (LVADs), such as the Hemopump, IABP, and PUCA-pump, are meant to be introduced into the body via the femoral or axillary artery without major surgery. For certain applications, introduction is performed directly into the aorta via an open thorax procedure. A prototype of a vascular access device has been realized that allows direct access into the aorta as an alternative for the common surgical graft anastomosis suturing technique. The device consists of a metal tube acting as a circular knife to cut a hole in the aortic wall, a screw to store the removed part of the aortic wall, and a plastic tube that is introduced through the hole and tightly connected to the aortic wall. The device could be placed without aortic clamping. The device has been tested on a slaughterhouse porcine aorta. A low-pressurized aorta appeared to be the worst case; thus, two animal experiments in the low-pressurized pulmonary artery were performed. No leakage occurred for pressures between 40 and 300 mm Hg.     

Use of N-butyl-2-cyanoacrylate in oral surgery: biological and clinical evaluation

N-butyl-2-cyanoacrylate based tissue adhesive, Tisuacryl, was employed as a nonsuture method for closing wounds in oral surgery. One hundred thirty patients were treated with the adhesive and 30 with suture. The surgical procedures were apicectomy, extraction of molars, and mucogingival grafting. The studied product was well tolerated by the tissue and permitted immediate hemostasis and normal healing of incisions. When Tisuacryl was used as dressing material for donor sites and mucosal ulcerations, pain relief was observed.     

Cystosarcoma phyllodes: Our institutional experience

Twenty‐six patients of Cystosarcoma phyllodes, treated between July 1994 and July 2001, were analysed retrospectively. Median age at presentation was 38 years (range 13?61 years). Mean size of the lesion was 6 cm. There were 77% left‐sided lesions and 23% right‐sided lesions. Histologically, 58% lesions were benign, 11% borderline and 31% malignant lesions. All patients underwent definitive surgical procedure in the form of wide local excision or mastectomy. Four patients received postoperative radiotherapy. Median follow‐up period was 35 months. Six patients showed recurrence, and four of these were malignant. Median disease‐free survival period was 34 months.     

38例腹膜后脂肪肉瘤的临床分析

目的 分析腹膜后脂肪肉瘤的治疗结果。方法 1958～1998年我院收治38例腹膜后脂肪肉瘤。21例为首程治疗,17例局部复发后再程治疗。21例初治患者均接受手术治疗,手术完整切除率为86％。3例接受术后放射治疗。17例外院术后复发再程治疗患者有13例在我院接受手术,4例接受单纯放疗。再程手术完整切除率为54％,1例接受术后放放射治疗。放疗剂量DT30Gy～70Gy,中位剂量50Gy。结果 全组患者5年总生存率为50％,5年远转率为7.3％,5年局部复发率为65％,初程治疗和再程治疗组的5年总生存率为53％和48％,无显著性差异(P=0.293,5年局部复发率为59％和74％,无显著差别(P=0.615)。全组手术完整切除组5年生存率为58％,部分切除或未切除者5年生存率为27％,有显著性差异(P=0.006)。34例有肿瘤大小记录的患者,其中4例肿瘤<10cm,均存活;22例肿瘤10～30cm,有13例死亡;8例肿瘤≥30cm,有6例死亡。结论 腹膜后脂肪肉瘤的治疗以手术为主,手术完整切除可显著提高生存率。经积极治疗,复发患者仍能取得很好的效果。     

73例70岁以上妇女妇科恶性肿瘤手术分析

[目的]探讨70岁以上妇科恶性肿瘤患者手术的耐受情况。[方法]收集浙江省肿瘤医院自1996年1月到2001年12月间,70岁以上妇科恶性肿瘤患者接受盆腔姑息性和根治性手术治疗73例,分析不同年龄及手术范围对术后恢复的影响。[结果]73例患者66例选择了根治性手术,7例接受姑息性手术。术后70~75岁组和>75岁组,其手术方式、平均住院时间、术前术后并发症等无明显差别。术中出血量、手术时间及并发症发生率均明显较姑息性手术组增加,12例严重并发症中,11例发生在根治性手术组。[结论]经过严密的术前准备、术后处理,70岁以上的老年妇女能够耐受根治性手术治疗。     

结直肠癌并发急性穿孔的处理

[目的]探讨结直肠癌并发急性穿孔处理方式。[方法]1994年至2002年11例结直肠癌伴发急性穿孔者均急诊手术，4例行I期肿瘤切除肠吻合术，6例I期肿瘤切除、远端关闭，近端造瘘术(Hartmann手术)，l例行穿孔修补术。[结果]全部病例无手术死亡。随访6—85个月，4例健在，中位生存期27．7个月。[结论]结直肠癌伴急性穿孔应以挽救生命为关键及时手术，尽量争取行I期肿瘤切除以提高生存率。     

非小细胞肺癌的治疗进展

全文综述了近年来非小细胞肺癌手术、化放疗临床治疗上的一些进展，并就可能出现的新的治疗模式作一展望。     

乳腺癌根治术后皮瓣坏死原因及预防措施探讨

目的 探讨乳腺癌术后皮瓣坏死的原因及预防皮瓣坏死的新方法。方法 将1990～1999年420乳腺癌病例分为对照组和实验组,将其手术方法进行对比研究。结果 前6年对照组皮瓣坏死率为43.3％,后4年实验组皮瓣坏死率为11.8％。经统计学处理,两组差异有显著性(P<0.01)。结论 实验组的新措施对预防乳腺皮瓣坏死有重要作用,真皮层血管网的损伤是皮瓣坏死的根本原因。