经内镜胆管引流术在肝门部恶性胆管梗阻中的应用及其评价

肝门部恶性肿瘤手术切除率极低，临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤２８８例次（肝门部胆管癌１８４例、胆囊癌２３例、肝细胞癌侵犯肝门部胆管４７例、其他转移性肿瘤３４例），其中行内镜鼻胆管引流１６２例次、塑料内置管引流８０例次、放置可膨式金属胆道支架４６例、４例患者接受同期双内置管引流。引流总有效率为６７．０％，其中效果满意者４３．１％；４０例患者术后１个月内发生胆管炎，发生率为１３．８％，３例死亡；长期随访病例的平均存活期５．３个月。我们观察到治疗的效果与Ｂｉｓｍｕｔｈ分型有密切关系，如果全肝４０％以上的胆系得到引流，黄疸有望消退；左、右两侧胆管同时引流可扩大引流范围，提高疗效；应合理选择三种内镜胆管引流方法并适时灵活转换才能获得满意的疗效。结论：对于肝门部肿瘤，内镜胆管引流术是一种安全有效的治疗手段，可作为首选的姑息性治疗。     

应用吻合器行中、下段直肠癌切除术后吻合口漏──附10例报告

我科自１９８１年３月至１９９１年１２月应用吻合器行中、下段直肠癌切除术６７例，同期发生吻合口漏１０例（１４９％）。本文分析了吻合口漏发生的因素。病变部位、病灶范围、术中操作技术、术前肠道灌洗以及术后骶前引流是影响吻合口漏的重要因素。本文总结了吻合口漏的治疗方法，提倡保守治疗，或加作暂时性横结肠造口术。     

Rapidly enhancing hepatic hemangiomas at MRI: Distinction from malignancies with T2-weighted images

The purpose of this study is to describe a subset of atypical hepatic hemangiomas that enhance rapidly and diffusely and to determine whether heavily T2-weighted images could distinguish between atypically enhancing liver hemangiomas and hypervascular malignancies. A retrospective search of MR records identified seven patients with liver hemangiomas that demonstrated diffuse early enhancement and 23 patients with biopsy-proven malignant liver lesions that were hypervascular on dynamic gadolinium-enhanced MR images. Quantitative analysis of signal intensity measurements was performed on the T2-weighted images, heavily T2-weighted (TE < 140), and dynamic gadolinium-enhanced images. Blinded reader comparison of the T2-weighted images and gadolinium-enhanced images was performed. Hypervascular hemangiomas enhanced to a greater degree than hypervascular malignant liver lesions on the early phase gadolinium-enhanced images. Perilesional parenchymal enhancement was demonstrated in five cases of rapidly enhancing hemangiomas. Signal intensity and contrast-to-noise ratios on the heavily T2-weighted images of the hemangiomas were significantly greater than that of the hypervascular malignant lesions (P < .05). Hemangiomas were differentiated from the hypervascular malignant liver lesions with high accuracy (97–100%) by three blinded readers based on the T2-weighted images. A subset of hemangiomas have atypical rapid diffuse enhancement on dynamic gadolinium-enhanced images. These atypical hemangiomas can be distinguished from hypervascular malignant liver lesions on T2-weighted MR images.     

血清MUC1粘蛋白IRMA及其初步临床应用

建立有效的ＭＵＣ１粘蛋白免疫放射分析法（ＩＲＭＡ），并初步用于乳腺肿瘤的诊断。利用纯化的ＭＵＣ１及其多抗，建立ＭＵＣ１双抗夹心ＩＲＭＡ法，对５５例健康女性、１１例乳腺良性肿瘤、２７例乳腺癌及２８例乳腺癌术后患者进行血清ＭＵＣ１的测定。结果：血清ＭＵＣ１ＩＲＭＡ的灵敏度为０７４ｋＵ／Ｌ；健康女性、乳腺良性肿瘤、乳腺癌及乳腺癌术后患者血清ＭＵＣ１的平均含量分别为７２３±３６７、１７８０±１０５６、３００４±２３８４和３１８４±２４７９ｋＵ／Ｌ；正常值上限为１３５４ｋＵ／Ｌ，假阳性率为１８２％；乳腺肿瘤患者血清ＭＵＣ１水平较健康女性明显提高；乳腺癌患者血清ＭＵＣ１水平高于乳腺良性肿瘤患者，但两者的阳性率（７７８７％和７２７０％）差异无显著性（χ２＝０１５４，Ｐ＞００５）；乳腺癌与乳腺癌术后患者血清ＭＵＣ１水平差异无显著性（ｔ＝－０２２，Ｐ＞００５）。ＭＵＣ１血清水平与肿瘤恶性程度成正相关，对于乳腺癌的诊断具有重要参考价值。     

原癌基因C－erb B－2蛋白产物在前列腺癌中的表达

应用抗Ｃ－ｅｒｂＢ－２癌蛋白抗体对３０例前列腺癌进行研究，同时选取１０例正常前列腺组织作为对照。结果表明Ｃ－ｅｒｂＢ－２蛋白与肿瘤分化程度有关。并可能对判断其生物学行为，评估预后有重要意义。     

Morphometric study of nucleolar organizer regions in human oral normal mucosa, papilloma and squamous cell carcinoma

A morphometric study of nucleolar organizer regions (NOR) was performed to analyze their distribution, volume, number and shape in the different strata of human normal oral mucosa epithelium and papilloma and in squamous cell carcinoma employing microphotographs of silver-stained paraffin sections. The different NOR-related parameters evidenced significant differences between normal mucosa, papilloma and squamous cell carcinoma. The functional polarity of normal mucosa epithelium and of papilloma is also evidenced in terms of NOR-related parameters. The discriminative value of certain NOR parameters was demonstrated.     

Precise and accurate measurement of proton T1 in human brain in vivo: Validation and preliminary clinical application

Precise and accurate inversion-recovery (PAIR) magnetic resonance (MR) measurements of T1 were obtained in eight brain regions and cerebrospinal fluid of 26 healthy volunteers. Accuracy of the technique was assessed by measuring T1 in small fluid volumes with the PAIR technique and with two independent spectroscopic techniques. The mean difference between T1 measured with PAIR and with the two spectroscopic techniques was 3.1% ± 1.3. The precision (reproducibility) of measurements with the PAIR technique was excellent. The coefficient of variation (CV) across 16 measurements in a head phantom was 2.0%, compared with a CV of 2.7% across 45 separate measurements in a single subject. The within-subject CV was 1.8% ± 0.6 in white matter and 1.4% ± 1.0 in basal ganglia. The between-subject CV in 26 healthy volunteers was 3.6% ± 0.6 in white matter and 4.1% ± 1.9 in basal ganglia. Comparison between a patient with an active recurrent brain tumor and an agematched patient with an inactive brain tumor showed that T1 was significantly elevated throughout the brain of the active-tumor patient, especially in white matter tracts, even though no tumor or edema was detected in the white matter on standard MR images. Comparisons between five brain tumor patients and four healthy volunteers of similar age showed that T1 was significantly and substantially elevated throughout the white matter tracts and in the caudate nucleus, putamen, and thalamus. These results are consistent with the hypothesis that white matter tracts are selectively vulnerable to edema and that T1 increases in white matter are a sensitive indicator of patient status or tumor aggressiveness.     

椎管内转移癌病人氨甲喋呤配伍高渗盐水硬膜外灌注治疗顽固性疼痛的临床探讨

１０例椎管内转移癌病人曾长期使用大剂量镇痛药难以奏效，而少数病例便采用硬膜外腔注射吗啡２～４ｍｇ疼痛缓解仅１ｈ。采用硬膜外腔灌注氨甲喋呤配伍高渗盐水，使抗癌药直接与肿瘤接触，几分钟内杀死癌细胞，加之高渗盐水能促使肿瘤和神经干脱水，肿瘤体积缩小和破坏，改善局部动脉缺血和组织水肿，从而减轻或消除肿瘤对神经根的压迫，缓解和消除神经痛。     

28例青年人胃癌的临床及病理分析

对２８例青年人胃癌的临床及病理分析结果表明，其发病具有症状隐匿、病程短、进展快的特点，本组病例从出现症状到漏诊在６个月内为５７．１％（１６例），首发症状以上腹部疼痛、吐血、黑便多见，病理特征以结节蕈伞型、高分化腺癌多见。     

16例胸膜间皮瘤临床分析

１６例胸膜间皮瘤，其中１例有石棉接触史，占６．１７％；＞４０岁者占８１．５％。主要临床表现为胸痛、气短、咳嗽、低热和胸腔积液，临床上易误诊为结核性胸膜炎、肺癌胸膜转移等。胸部ｘ线检查及胸部ＣＴ对该病的诊断有帮助，大都有特征性表现。确诊靠针刺胸膜活检及开胸活检。胸膜间皮瘤的治疗主要采用手术、放疗和化疗，对于局限型治疗首选手术切除。肿瘤的良、恶性、疾病的分期及治疗与预后有一定关系。