放疗化疗联合治疗局部晚期非小细胞肺癌43例

目的 探讨以顺铂为主的化疗方案加放疗对局部晚期非小细胞肺癌的疗效。方法 86例局部晚期非小细胞肺癌患随机分为治疗组及对照组各43例，放疗方案以CAP、EP、MVP或MOP，每人至少化疗两个周期，化疗后10～14天放射治疗，放疗采用^60Co外照射。结果 治疗组有效率83．7％，中位生存期14．5个月，对照组有效率67．4％，中位生存期10个月，两组不良反应为骨髓抑制、胃肠道反应。结论 以顺铂为主的化疗方案加放疗治疗局部晚期非小细胞肺癌的疗效较高，可提高肿瘤的局部控制率和延长生存期。     

后腹腔镜手术切除肾上腺节细胞神经瘤疗效观察

目的 :探讨后腹腔镜微创手术治疗肾上腺节细胞神经瘤的适应证和可行性。方法 :采用后腹腔镜手术治疗肾上腺节细胞神经瘤患者 5例 ,其中左侧肾上腺节细胞神经瘤 2例 ,右侧 3例。结果 :5例后腹腔镜手术全部获得成功 ,4例肾上腺肿瘤为单发 ,1例为多发 (4个肿瘤 ) ;肿瘤最大直径 2 .5～ 8.0 (4 .2± 1.8)cm ;手术时间35～ 10 5 (5 9± 2 7)min ,估计出血量 10～ 30 (19± 7)ml,术后镇痛剂吗啡用量 0～ 2 0 (8± 8)mg ,2例未用镇痛剂 ;排气、恢复进食时间 1～ 3(1.4± 0 .5 )d ;术后住院时间 4～ 7(5 .4± 1.5 )d。无围手术期并发症发生。结论 :后腹腔镜手术切除肾上腺节细胞神经瘤是安全可行的 ,能充分体现腹腔镜手术创伤小、恢复快的优点。肾上腺节细胞神经瘤是腹腔镜手术很好的适应证。     

Surgical management of insulinoma: Diagnosis of tumor location and high incidence of malignancy

The findings in twenty-two patients with insulinoma were reviewed, as continuous efforts should be made to establish preoperative localization of the tumor. Superselective arteriography and percutaneous, transhepatic portal vein and pancreatic venous catheterization are highly recommended approaches. At the time of surgical intervention, a cautious exploration of the pancreas after thorough mobilization is most important. Recent use of intraoperative ultrasonography increases the likelihood of finding these occult tumors which locate deeply in the head of the pancreas. Apart from the diagnostic problems, we wish to emphasize the high incidence of malignancy (7/22, 31.8 per cent) in our series. Althout patients with malignant isulinoma had a much better prognosis compared to those with a pancreatic ductal malignancy, pancreatic resection with regional lymphnode dissection seems to be a rational procedure. Enucleation can be done when intraoperative findings of the tumor and regional lymphonode indicate no malignant features and no multiple lesions. However, at the first operation, enucleation is still a procedure of choice, even for the malignant insulinoma in the head with a well-defined capsule and no metastatic lesions, the objective being to avoid a duodenopancreatectomy or total pancreatectomy. These data were reported at the 30th Congress of Société Internationale de Chirurgie, Hamburg, Germany, 1983     

Bilateral malignant phyllodes tumours.

We report a rare example of bilateral primary malignant phyllodes tumours. The diagnosis was supported by the identification of a benign epithelial element in each lesion. The case illustrates the typical dimorphic features of malignant phyllodes tumours. A contralateral tumour should not be regarded as metastatic without histological confirmation.     

Hypothalamic hamartoma with bilateral anophthalmia

Introduction Hypothalamic hamartomas are congenital malformations. Clinically, they can be asymptomatic, but they cause seizures, mental retardation and precocious puberty in many cases. Case report A 20-day-old boy with hypothalamic hamartoma and bilateral anophthalmia was presented. Except those, no other congenital anomaly was detected. Conclusion This is a rare case of hypothalamic hamartoma with bilateral anophthalmia. The mutations at SOX2 has an important role in the developing brain and eyes.     

MicroRNAs及其在泌尿系肿瘤的研究进展

microRNAs（miRNAs）是一类分布十分广泛的内源性非编码RNA,在动物、植物、病毒中广泛存在。miRNAs与肿瘤的发生发展预后有关,并在肿瘤的增殖、分化及调亡等方面有重要的作用。结合最近相关文献,本文就miRNAs与泌尿系肿瘤方面的进展作简要概述。     

不同类型正常乳腺表观扩散系数值差异的研究

目的 研究不同类型正常乳腺表观扩散系数（ADC）值的差异，探讨ADC值与组织学分型之间的关系。方法 采用单次激发平面回波（EPI）技术，扩散敏感因子（b）值分别为0、500、1000s／mm^2，对62个正常乳腺（包括42例乳腺病变患者的对侧正常乳腺及10名健康志愿者20个乳腺）进行MR扫描及MR扩散加权成像（DWI）检查，计算62个正常乳腺分别在不同b值时的ADC值。将62个正常乳腺分为3型，比较3型之间ADC值的差异及不同b值时ADC值的差异。结果 42例乳腺病变患者对侧正常乳腺的DWI及ADC图与组织切片对比，不同类型乳腺组织学结构不同，其DWI及ADC图表现亦有差异。62个正常乳腺分为致密型10个，分叶斑点型42个及退化型10个。致密型和分叶斑点型乳腺随b值降低ADC值升高，而退化型乳腺随b值降低ADC值变化不明显。b=1000—0s／mm^2时，致密型、分叶斑点型、退化型乳腺ADC值分别为（1．70±0．37）、（1．93±0．46）、（1．18±0．65）×10^-3mm^2／s，3组间比较差异有统计学意义（F=12．998，P=0．000）。不同b值时每2种类型间进行单因素方差分析，致密型和分叶斑点型之间差异无统计学意义（F=2．167，P=0．147）；致密型和退化型之间、分叶斑点型和退化型之间差异均有统计学意义（F值分别为5．593、19．128，P值分别为0．029、0．000）。结论 3型正常乳腺ADC值受乳腺组织学结构的影响，致密型和分叶斑点型乳腺ADC值受b值高低的影响。     

乳腺癌改良根治术后自帖式敷料包扎刀口35例临床观察

目的:探讨乳腺癌改良根治术后自帖式敷料包扎刀口的临床效果。方法:将70例乳腺癌改良根治术患者随机分为两组,对创面不同包扎方式进行对比。结果:自帖式敷帖对术后创面包扎并发症少于传统绷带加压包扎方式。结论:自帖式敷帖包扎乳腺癌改良根治术后创面,能预防切口并发症的发生。     

TECHNIQUES AND PITFALLS OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL TUMORS

Endoscopic submucosal dissection (ESD) for colorectal tumors is steadily being developed. Safety and standardization of ESD for colorectal tumors have not been yet established because of the technical difficulties and the unsuitable anatomical characteristics of the colon and rectum. The authors mainly use a Flex knife for mucosal incision and a Hook knife for submucosal dissection to perform ESD safely. Skillful colonoscopic control, selection of scope, distal attachment tip hood, adequate high‐frequency generator and correct approach strategy should all be considered for safe performance of ESD. However, the incidence of indicative lesions is rare because the majority of colorectal tumors are adenomatous large laterally spreading tumors, which can be cured by intentional endoscopic piecemeal resection. At present, ESD for colorectal tumors should be performed only at central facilities that have expert colonoscopists. With the development of new devices and associated techniques, technical standardization of ESD for colorectal tumors is expected in the near future.     

235例乳腺病变粗针吸微创性活检及免疫组织化学检测意义

目的评价乳腺病变粗针吸活检（CNB）方法，探讨CNB组织免疫组织化学检测的临床意义。方法对CNB后接受手术治疗的235例乳腺病变病理资料进行分析对比，对其中CNB诊断为浸润性癌后行术前化疗的87例进行p53、c-erbB-2、ER和PR免疫组织化学（SP法）检测，并与观测化疗后癌组织形态学变化结合分析。结果235例中CNB诊为乳腺癌者204例，与手术后病理良恶性符合率为100％；CNB诊为非浸润性癌中60％病例术后病理发现浸润性癌成分；CNB诊为不典型增生者中50％术后病理证实为癌；CNB组织与术后常规组织免疫组织化学表达阳性率一致，差异无统计学意义（P〉0．05）；有、无化疗反应的病例p53、c-erbB-2表达差异有统计学意义（P〈0．05）；p53和c-erBb-2阳性病例多无明显化疗后形态学改变。结论CNB对乳腺病变是一种有效且创伤轻微的诊断方法，但它仍有一定局限性，用CNB组织做免疫组织化学检测有较为重要的临床意义。