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81.
Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the
pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical
resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based
on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration,
i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information.
This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2)
are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic
studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic
concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging
modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should
therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since
the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic
and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically
relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be
expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies,
which may soon alter our therapeutic concepts.
相似文献
82.
Noriaki Tsubota Masahiro Myoshimura Akihiro Murotani Yoshifumi Miyamoto Yasumi Matoba 《Surgery today》1994,24(11):978-981
The results of 101 consecutive bronchoplasties performed between 1979 and 1993, including 8 cases of pneumonectomy, 88 cases of lobectomy, 3 cases of segmentectomy, and 2 cases of bronchial resection, are herein reported. Squamous cell carcinoma was the most common disease (59%) followed by adenocarcinoma (30%) and other diseases (11%). Anastomosis was satisfactory in 96 cases. Among the five stenosed cases, local recurrence was found in two cases, and there were three benign strictures. Two of the three benign strictures were treated with bouginage. The pulmonary artery was concomitantly reconstructed in seven cases with satisfactory results. Preoperative chemoradiotherapy was performed in 15 advanced cases and was followed by acceptable surgical results. The 5-year survival rate, according to the post-operative staging of the 86 patients without induction therapy, was 86% in stage I (19 patients), 49% in stage II (21 patients), and 27% in stage IIIA (40 patients). The overall survival rate was 46% at 5 years. There were two indications for this procedure i.e., a positive resection margin in 59 cases and positive hilar nodes in 42 cases. Better survival was noted in patients with squamous cell carcinoma, stage I, and surgery was thus selected for a positive resection margin, and not for a positive node. 相似文献
83.
颈动脉切除术的临床研究 总被引:2,自引:0,他引:2
目的 探讨颈部恶性肿瘤侵犯颈总动脉和I或颈内动脉以及颌面部难控制大出血时对颈总动脉和颈内动脉的外科处理方法及其并发症、后遗症的预防。方法 回顾性分析1990年-2000年行颈总或I和颈内动脉结扎、切除术的6例临床资料。结果 本组均为男性,年龄17-66岁。其中颈部复发性转移癌浸润颈总动脉、颈内动脉3例,鼻咽癌放疗后颈部溃疡侵犯颈总动脉1例,上颌骨中央性血管瘤大出血1例,鼻咽纤维轿管瘤术中、术后大出血1例。单纯结扎、切除颈总动脉4例,颈总及颈内动脉同时结扎、切除2例。经随访,术后短暂性肢体偏瘫2例,脑梗塞、永久性偏瘫1例,无任何并发症3例。无手术死亡病例。结论 颈动脉切除术对已累及颈动脉的颈部恶性肿瘤是一种有效的治疗手段,对于颌面颈难以控制的致命性大出血是一种有效的急救措施。单纯切除颈总动脉所产生的术后并发症的发生率比颈总动脉和颈内动脉同时切除低;而已先期或同时切除颈外动脉,出现并发症的机会更大。术后酌用抗凝或溶栓药物对于脑血栓、脑梗塞的防治作用有待进一步研究。 相似文献
84.
85.
前列腺增生伴逼尿肌无力患者的电切术治疗 总被引:1,自引:0,他引:1
目的 :探讨良性前列腺增生 (BPH)伴有逼尿肌无力 (ACD)患者的治疗方法和效果。方法 :对尿动力学检查确认有ACD的 12例BPH并发膀胱出口梗阻 (BOO)的患者 (A组 )进行经尿道前列腺电切术 (TURP)或加膀胱颈内切开术 (TUIBN) ,同时与逼尿肌功能正常或高于正常的行TURP的BPH患者 2 4例 (B组 )进行对照分析。结果 :A组术后 7~ 30d复查 ,国际前列腺症状评分 (IPSS)为 12 .5 8± 0 .70分 (P <0 .0 0 1) ,最大尿流率 (Qmax)为11.0 5± 0 .85ml/s (P <0 .0 5 ) ,均比术前有改善 ,但术后效果不如B组明显 (P <0 .0 0 1)。术后 3、6个月复查IPSS及Qmax,两组略有改变 ,但差异无显著性意义 (P >0 .0 5 ) ,剩余尿测定也均在正常范围。术后 3个月对ACD的 5例复查逼尿肌收缩力 ,无明显改善。结论 :对ACD并伴有BOO的BPH患者可以采取电切术治疗 相似文献
86.
两种术式治疗多囊卵巢综合征的远期疗效追踪比较 总被引:1,自引:0,他引:1
[目的]评价开腹卵巢楔形切除(OWR)和腹腔镜下双侧卵巢电灼开窗术(LOD)两种术式对多囊卵巢综合征(PCOS)的远期疗效.[方法]1981至2001年在我院诊断为PCOS并接受手术治疗的妇女共151例,其中行OWR 61例、LOD 90例,追踪分析两组妇女术后妊娠率、术后妊娠时间的分布及术前后月经模式变化.[结果]两组的临床特征具有可比性,OWR组累积妊娠率84%,LOD组累积妊娠率72%,两组间没有明显差异,绝大部分妊娠发生在术后18个月内;OWR组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是81.3%、81.3%、77.3%、77.6%、78.9%、85.2%,明显高于术前的31.1%(P值<0.05);LOD组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是80.6%、63.5%、56.7%、58.0%、57.6%、42.9%,明显高于术前的35.6%(P值<0.05);术后OWR组月经规律妇女占的比例明显高于LOD组(P均<0.05).[结论]两种术式的术后妊娠率相似.OWR比LOD更好、更长远地改善PCOS妇女的月经异常. 相似文献
87.
88.
Hwang Choi 《Digestive endoscopy》2006,18(1):1-3
Endoscopic technologies have been developed greatly. As for early gastric cancer, the indications for endoscopic mucosal resection for early colorectal cancer have been widened recently. Technological advances can support wider and deeper resections using endoscopy but the remaining problem for the endoscopic management of cancer is lymph node metastasis. I discuss here the indication for endoscopic mucosal resection for early colorectal cancer to bring into focus the risk factors for metastasis to lymph nodes. 相似文献
89.
A. Sudanese A. Toni N. Baldini D. Tigani M. Campanacci 《International orthopaedics》1988,12(2):115-118
Summary Seven patients with eccentrically placed tumours of the distal end of the humerus treated with partial resection and autogenous iliac bone grafting are reported. The functional results are discussed.
Résumé Présentation de sept cas de tumeurs situées à l'extrémité distale de l'humérus et traitées par résection limitée et reconstruction par autogreffe lilaque. Discussion des résultats fonctionnels.相似文献
90.
Dr. Shosaku Nakahara M.D. Hideaki Itoh M.D. Ryuichi Mibu M.D. Shinichi Ikeda M.D. Yoshihiro Oohata M.D. Kamesaburo Kitano M.D. Yoshihiko Nakamura M.D. 《Diseases of the colon and rectum》1988,31(10):762-766
Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line,
using an EEA™ stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following
surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients
could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure
and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct
tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily
by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation
is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is
a functionally acceptable option for low rectal cancer. 相似文献