目的:当前,临床针对甲状腺癌的手术方式有全切、次全切、全切+颈淋巴结清扫等,不同的手术方式对甲状腺旁腺的损伤不同。越来越多的临床医生已经关注甲状腺旁保护对患者的意义。本研究旨在探讨甲状腺癌全切除术导致甲状旁腺损伤对患者骨...目的:当前,临床针对甲状腺癌的手术方式有全切、次全切、全切+颈淋巴结清扫等,不同的手术方式对甲状腺旁腺的损伤不同。越来越多的临床医生已经关注甲状腺旁保护对患者的意义。本研究旨在探讨甲状腺癌全切除术导致甲状旁腺损伤对患者骨密度及骨代谢的影响。方法:回顾性分析2017年3月至2019年6月南京医科大学第一附属医院收治的167例行甲状腺癌全切除术的患者,检测其甲状旁腺激素(parathyroid hormone,PTH)等指标评估甲状旁腺损伤情况。将甲状旁腺损伤患者纳入研究组,共87例;未损伤者纳入对照组,共80例。在术前术后均检测PTH、游离三碘甲腺原氨酸(free triiodothyronine,FT3)、游离四碘甲腺原氨酸(free tetraiodothyronine,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)、血钙、血磷及血镁水平,同时检测骨密度及骨代谢指标I型胶原氨基端延长肽(N-terminal propeptide of type 1 precollagen,P1NP)、I型胶原羧基末端肽(β-C-terminal telopeptide of typeⅠcollagen,CTX)水平。结果:研究组患者术后PTH和骨密度均低于对照组,骨代谢指标P1NP、CTX均低于对照组,血钙水平也低于对照组,但血磷水平高于对照组,差异均具有统计学意义(均P<0.05)。结论:甲状腺癌全切除术后并发甲状旁腺损伤的患者血清PTH水平显著降低,骨密度及骨代谢指标水平均下降,钙磷紊乱致骨钙流失速度加快,提示患者甲状旁腺损伤可能是骨质疏松的诱发因素。展开更多
Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radi...Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization.展开更多
Yttrium-90 (Y-90) radioembolization,also known as selective internal radiation therapy (SIRT),is a regional hepatic therapy used in the treatment of unresectable colorectal cancer (CRC) liver metastases. In SIRT,Y-90 ...Yttrium-90 (Y-90) radioembolization,also known as selective internal radiation therapy (SIRT),is a regional hepatic therapy used in the treatment of unresectable colorectal cancer (CRC) liver metastases. In SIRT,Y-90 impregnated microspheres are injected into the VASCULAR SUPPLY of hepatic tumor,leading to selective irradiation and necrosis of tumor TISSUE. While several studies demonstrate improved local control and survival with SIRT,the specific indications for this therapy have yet to be defined. Typically,SIRT is given in combination with chemotherapy as multimodal treatment for unresectable hepatic CRC. However,it HAS ALSO FOUND INCREASING USE as a salvage therapy in chemo-refractory patients. Herein,the authors describe their experience with SIRT as "stand alone" therapy in a surgically-prohibitive,chemotherapy naive patient with hepatic CRC metastasis. The results suggest that Y-90 SIRT may have potential applications beyond its usual role as a palliative or salvage therapy for unresectable hepatic CRC.展开更多
AIM:To explore the prognostic variables in rectal cancer patients undergoing curative total mesorectal excision and the effect of postoperative chemotherapy in advanced rectal cancer. METHODS:A total of 259 consecutiv...AIM:To explore the prognostic variables in rectal cancer patients undergoing curative total mesorectal excision and the effect of postoperative chemotherapy in advanced rectal cancer. METHODS:A total of 259 consecutive rectal cancer patients treated with curative total mesorectal excision between 1999 and 2004 were collected. p53,p21,PCNA,and CD44v6 were examined using immunohistochemistry (IHC). The correlation between clinicopathological or molecular variables and clinical outcomes,including local recurrence,metastasis,disease-free survival and overall survival,was analyzed. RESULTS:The median follow-up was 44 mo. Five-year survival rates and 5-year disease free survival rates were 75.43% and 70.32%,respectively. Multi-analysis revealed TNM staging,preoperative CEA,and CD44v6 level were independent risk factors predicting overall survival or disease free survival. The hazard ratio of peroperative CEA was 2.65 (95% CI 1.4-5) and 3.10 (95% CI 1.37-6.54) for disease free survival and overall survival,respectively. The hazard ratio of CD44v6 was 1.93 (95% CI 1.04-3.61) and 2.21 (95% CI 1.01-4.88) for disease free survival and overall survival,respectively. TNM staging was the only risk factor predicting local recurrence. Postoperative chemotherapy without radiotherapy did not improve patients' outcome. CONCLUSION:TNM staging,preoperative CEA and CD44v6 were independent prognostic factors for rectal cancer patients with total mesorectal excision. Postoperative chemotherapy may be only used together with radiotherapy for rectal cancer patients.展开更多
Objective To explore the efficacy of hepatic resection(HR) in a relatively unselected group of patients with ovarian cancer liver metastases(OCLM). Methods A study was conducted between September 2000 and September 20...Objective To explore the efficacy of hepatic resection(HR) in a relatively unselected group of patients with ovarian cancer liver metastases(OCLM). Methods A study was conducted between September 2000 and September 2011 on 60 ovarian cancer patients with hepatic metastases(24 solitary and 36 multiple),40 of whom had extrahepatic metastases.HR was done in all patients provided that curative hepatic resection was feasible,and extrahepatic disease was controlled with medical and/or surgical therapy. Results Most patients(n=54;90.0% ) had a negative hepatic margin(R0),whereas 6 patients(10.0% ) had microscopic disease at the margin(R1).The prognostic value of each study variable was assessed using log rank tests for univariate analysis and Cox proportional hazard models for multivariate analysis.The result was a median survival of 39 months and 5-year overall survival rate of 30% .Univariate analysis showed that surgery result(P=0.001),disease free interval(P=0.018) and the number of hepatic lesions (P=0.018) were significantly related to survival.Furthermore,the surgery result(P=0.004) remained significant for prognosis in multivariate analysis. Conclusions For patients with OCLM,HR is safe and may provide a significant survival benefit compared with medical therapy alone.A long interval time,the number of hepatic lesions,and surgery results are key prognostic factors.Favorable outcomes can be achieved even in patients with medically controlled or surgically resectable extrahepatic disease,indicating that surgery should be considered more frequently in the multidisciplinary care of patients with OCLM.展开更多
Objective:Despite resection with curative intent,a majority of patients with gastric cancer will develop disease recurrence.Postoperative adjuvant chemo-radiotherapy increase the curability of surgery,prevent local re...Objective:Despite resection with curative intent,a majority of patients with gastric cancer will develop disease recurrence.Postoperative adjuvant chemo-radiotherapy increase the curability of surgery,prevent local recurrence and improve survival.Methods:Between December 2005 and February 2010,33 patients were eligible for the study,17 patients were randomly assigned for chemo-radiotherapy (GI) and 16 patients with surgery alone (GII).Patients in GI received chemotherapy (fluorouracil,425 mg/m 2/day,and leucovorin,20 mg/m 2/day,for 5 days) was initiated on day 1 and was followed by chemo-radiotherapy beginning 28 days after the start of the initial cycle of chemotherapy.Chemo-radiotherapy consisted of 4500 cGy of radiation at 180 cGy/day,five days/week for five weeks,with fluorouracil (400 mg/m 2/day) and leucovorin (20 mg/m 2/day) on the first four and the last four days of radiotherapy.One month after the completion of radiotherapy,two five-day cycles of fluorouracil (425 mg/m 2/day) plus leucovorin (20 mg/m 2/day) were given one month apart.Results:Grade 3 gastrointestinal toxicity was more common (23.2%) while grade 3 hematological toxicity were (5.8%).Both 3-year survival (53%) and disease free survival (41%) rates were higher in GI than in GII in which they were 43.7% and 31% respectively.Relapse rate was higher in GII (56.3%) than in GI (35.3%).Conclusion:The present study revealed that chemo-radiotherapy after gastric resection in patients with gastric adenocarcinoma improves survival and relapse rates with manageable toxicities.However,studies with larger number of patients are recommended to confirm our results.展开更多
Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has b...Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy （MIME） for esophageal cancer. Methods： Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department （a single center）. All procedure, operation, oncology, and complication data were reviewed. Results： All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases （24.4%） developed postoperative complications, including anastomotic leak in 4 （4.9%）, single lateral recurrent nerve palsy in 4 （4.9%）, bilateral recurrent nerve palsy in 1 （1.2%）, pulmonary problems in 3 （3.7%）, chyle ~eak in 1 （1.2%）, and other complications in 7 （including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%）. Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time （P=-0.006）, postoperative hospitalization days （P=0.015）, total harvested lymph nodes （P=0.003）, harvested thoracic lymph nodes （P=0.006）, and harvested abdominal lymph nodes （P=0.022） among different periods. Conclusions： Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.展开更多
文摘目的:当前,临床针对甲状腺癌的手术方式有全切、次全切、全切+颈淋巴结清扫等,不同的手术方式对甲状腺旁腺的损伤不同。越来越多的临床医生已经关注甲状腺旁保护对患者的意义。本研究旨在探讨甲状腺癌全切除术导致甲状旁腺损伤对患者骨密度及骨代谢的影响。方法:回顾性分析2017年3月至2019年6月南京医科大学第一附属医院收治的167例行甲状腺癌全切除术的患者,检测其甲状旁腺激素(parathyroid hormone,PTH)等指标评估甲状旁腺损伤情况。将甲状旁腺损伤患者纳入研究组,共87例;未损伤者纳入对照组,共80例。在术前术后均检测PTH、游离三碘甲腺原氨酸(free triiodothyronine,FT3)、游离四碘甲腺原氨酸(free tetraiodothyronine,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)、血钙、血磷及血镁水平,同时检测骨密度及骨代谢指标I型胶原氨基端延长肽(N-terminal propeptide of type 1 precollagen,P1NP)、I型胶原羧基末端肽(β-C-terminal telopeptide of typeⅠcollagen,CTX)水平。结果:研究组患者术后PTH和骨密度均低于对照组,骨代谢指标P1NP、CTX均低于对照组,血钙水平也低于对照组,但血磷水平高于对照组,差异均具有统计学意义(均P<0.05)。结论:甲状腺癌全切除术后并发甲状旁腺损伤的患者血清PTH水平显著降低,骨密度及骨代谢指标水平均下降,钙磷紊乱致骨钙流失速度加快,提示患者甲状旁腺损伤可能是骨质疏松的诱发因素。
文摘Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization.
文摘Yttrium-90 (Y-90) radioembolization,also known as selective internal radiation therapy (SIRT),is a regional hepatic therapy used in the treatment of unresectable colorectal cancer (CRC) liver metastases. In SIRT,Y-90 impregnated microspheres are injected into the VASCULAR SUPPLY of hepatic tumor,leading to selective irradiation and necrosis of tumor TISSUE. While several studies demonstrate improved local control and survival with SIRT,the specific indications for this therapy have yet to be defined. Typically,SIRT is given in combination with chemotherapy as multimodal treatment for unresectable hepatic CRC. However,it HAS ALSO FOUND INCREASING USE as a salvage therapy in chemo-refractory patients. Herein,the authors describe their experience with SIRT as "stand alone" therapy in a surgically-prohibitive,chemotherapy naive patient with hepatic CRC metastasis. The results suggest that Y-90 SIRT may have potential applications beyond its usual role as a palliative or salvage therapy for unresectable hepatic CRC.
文摘AIM:To explore the prognostic variables in rectal cancer patients undergoing curative total mesorectal excision and the effect of postoperative chemotherapy in advanced rectal cancer. METHODS:A total of 259 consecutive rectal cancer patients treated with curative total mesorectal excision between 1999 and 2004 were collected. p53,p21,PCNA,and CD44v6 were examined using immunohistochemistry (IHC). The correlation between clinicopathological or molecular variables and clinical outcomes,including local recurrence,metastasis,disease-free survival and overall survival,was analyzed. RESULTS:The median follow-up was 44 mo. Five-year survival rates and 5-year disease free survival rates were 75.43% and 70.32%,respectively. Multi-analysis revealed TNM staging,preoperative CEA,and CD44v6 level were independent risk factors predicting overall survival or disease free survival. The hazard ratio of peroperative CEA was 2.65 (95% CI 1.4-5) and 3.10 (95% CI 1.37-6.54) for disease free survival and overall survival,respectively. The hazard ratio of CD44v6 was 1.93 (95% CI 1.04-3.61) and 2.21 (95% CI 1.01-4.88) for disease free survival and overall survival,respectively. TNM staging was the only risk factor predicting local recurrence. Postoperative chemotherapy without radiotherapy did not improve patients' outcome. CONCLUSION:TNM staging,preoperative CEA and CD44v6 were independent prognostic factors for rectal cancer patients with total mesorectal excision. Postoperative chemotherapy may be only used together with radiotherapy for rectal cancer patients.
文摘Objective To explore the efficacy of hepatic resection(HR) in a relatively unselected group of patients with ovarian cancer liver metastases(OCLM). Methods A study was conducted between September 2000 and September 2011 on 60 ovarian cancer patients with hepatic metastases(24 solitary and 36 multiple),40 of whom had extrahepatic metastases.HR was done in all patients provided that curative hepatic resection was feasible,and extrahepatic disease was controlled with medical and/or surgical therapy. Results Most patients(n=54;90.0% ) had a negative hepatic margin(R0),whereas 6 patients(10.0% ) had microscopic disease at the margin(R1).The prognostic value of each study variable was assessed using log rank tests for univariate analysis and Cox proportional hazard models for multivariate analysis.The result was a median survival of 39 months and 5-year overall survival rate of 30% .Univariate analysis showed that surgery result(P=0.001),disease free interval(P=0.018) and the number of hepatic lesions (P=0.018) were significantly related to survival.Furthermore,the surgery result(P=0.004) remained significant for prognosis in multivariate analysis. Conclusions For patients with OCLM,HR is safe and may provide a significant survival benefit compared with medical therapy alone.A long interval time,the number of hepatic lesions,and surgery results are key prognostic factors.Favorable outcomes can be achieved even in patients with medically controlled or surgically resectable extrahepatic disease,indicating that surgery should be considered more frequently in the multidisciplinary care of patients with OCLM.
文摘Objective:Despite resection with curative intent,a majority of patients with gastric cancer will develop disease recurrence.Postoperative adjuvant chemo-radiotherapy increase the curability of surgery,prevent local recurrence and improve survival.Methods:Between December 2005 and February 2010,33 patients were eligible for the study,17 patients were randomly assigned for chemo-radiotherapy (GI) and 16 patients with surgery alone (GII).Patients in GI received chemotherapy (fluorouracil,425 mg/m 2/day,and leucovorin,20 mg/m 2/day,for 5 days) was initiated on day 1 and was followed by chemo-radiotherapy beginning 28 days after the start of the initial cycle of chemotherapy.Chemo-radiotherapy consisted of 4500 cGy of radiation at 180 cGy/day,five days/week for five weeks,with fluorouracil (400 mg/m 2/day) and leucovorin (20 mg/m 2/day) on the first four and the last four days of radiotherapy.One month after the completion of radiotherapy,two five-day cycles of fluorouracil (425 mg/m 2/day) plus leucovorin (20 mg/m 2/day) were given one month apart.Results:Grade 3 gastrointestinal toxicity was more common (23.2%) while grade 3 hematological toxicity were (5.8%).Both 3-year survival (53%) and disease free survival (41%) rates were higher in GI than in GII in which they were 43.7% and 31% respectively.Relapse rate was higher in GII (56.3%) than in GI (35.3%).Conclusion:The present study revealed that chemo-radiotherapy after gastric resection in patients with gastric adenocarcinoma improves survival and relapse rates with manageable toxicities.However,studies with larger number of patients are recommended to confirm our results.
基金Project supported by the Medical and Health Technology Development Program of Zhejiang Province(No.2015KYA130)the National Natural Science Foundation of China(No.31571446)
文摘Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy （MIME） for esophageal cancer. Methods： Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department （a single center）. All procedure, operation, oncology, and complication data were reviewed. Results： All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases （24.4%） developed postoperative complications, including anastomotic leak in 4 （4.9%）, single lateral recurrent nerve palsy in 4 （4.9%）, bilateral recurrent nerve palsy in 1 （1.2%）, pulmonary problems in 3 （3.7%）, chyle ~eak in 1 （1.2%）, and other complications in 7 （including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%）. Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time （P=-0.006）, postoperative hospitalization days （P=0.015）, total harvested lymph nodes （P=0.003）, harvested thoracic lymph nodes （P=0.006）, and harvested abdominal lymph nodes （P=0.022） among different periods. Conclusions： Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.
