肝胰肿瘤264例细针吸取细胞学诊断

目的 对比分析细针吸取细胞学和组织学检查对肝细胞癌及胰腺癌的诊断价值。方法 在B超引导下进行定位穿刺 ,应用细胞学和组织学方法观察了 2 6 4例临床怀疑肝、胰占位性病变患者的针吸标本。结果 本组恶性肿瘤 114例 ,良性病变 15 0例。肝、胰恶性肿瘤细针吸取细胞学检查阳性率为 89 5 % (10 2 /114 ) ,其中肝恶性肿瘤诊断正确率为 90 1% (82 /91) ;胰恶性肿瘤诊断正确率为 86 7% (13/15 )。结论 肝、胰恶性肿瘤的细胞学和组织学联合检查对提高诊断的阳性率及肿瘤准确分型有重要意义。

《胃肠肝胰肿瘤淋巴系统解剖与临床》书讯

哈尔滨医科大学解剖教研室的王云祥教授和哈尔滨医科大学附属第二医院的王锡山教授主编的《胃肠肝胰肿瘤淋巴系统解剖与临床》已由人民卫生出版社出版发行。2011年和2013年,在人民卫生出版社的大力支持下,王云祥教授已编写了《淋巴管结构与癌转移》和《妇科肿瘤淋巴系统解剖与临床》两部专著,本书为其第三部专著。本书主要是介绍胃肠肝胰的淋巴系统解剖学和临床肿瘤学研究的新进展、新资料和新技术。

壶腹癌胰十二指肠切除术后预后影响因素的Meta分析

目的通过综合评价总结出影响壶腹癌预后的因素,为壶腹癌患者的预后判断及个性化治疗提供依据。方法对符合入选标准的1995年至今公开发表的关于壶腹癌术后生存分析的研究进行Meta分析,并计算每个危险因素的优势比值(OR值)以及其95%可信区间(95%CI)。结果共纳入文献13篇,累积病例986例。局部浸润(浸润至胰腺、浸润至十二指肠壁、浸润至Oddi括约肌外)、淋巴结转移、输血、肿瘤分化程度对壶腹癌术后5年死亡率影响的合并后P值及OR值分别为P<0.001,OR=4.74、P=0.01,OR=2.75、P<0.001,OR=4.25、P<0.001,OR=4.16、P<0.001,OR=2.56、P=0.002,OR=2.38。结论肿瘤局部浸润(浸润至胰腺、浸润至十二指肠壁、浸润至Oddi括约肌外)、淋巴结转移、输血、肿瘤分化程度均为壶腹癌预后影响因素。

壶腹癌并病理性胆肠瘘的术前诊断和治疗:附12例报告

目的探讨壶腹癌并病理性胆肠瘘的临床表现，以提高其术前诊断率。方法回顾性分析近9年间以壶腹部癌收治人院，术中诊断合并病理性胆肠瘘12例患者的临床资料。结果所有患者术前临床无阻塞性黄疸的症状及体征。B型超声检查提示壶腹部占位并肝内外胆管扩张，胆囊萎缩，与周围组织粘连，轮廓不清。胆肠瘘均在术中确诊，胆囊十二指肠瘘7例，胆囊结肠瘘5例，瘘口直径为0．4～2．8cm。4例行根治；8例姑息性手术。术后病理证实均为壶腹癌。结论对于超声检查有上述发现的老年患者，若临床无阻塞性黄疸的表现，往往反映病理性胆肠瘘存在。

Aggressive behaviour of solid-pseudopapillary tumor of the pancreas in adults:A case report and review of the literature

Solid-pseudopapillary tumor (SPT) is a rare neoplasm of the pancreas that usually occurs in young females. It is generally considered a low-grade malignant tumor that can remain asymptomatic for several years. The occurrence of infiltrating varieties of SPT is around 10%-15%. Between 1986 and 2006, 282 cystic tumors of the pancreas were observed. Among them a SPT was diagnosed in 8 patients (2.8%) with only one infiltrating variety. This was diagnosed in a 49-year-old female 13 years after the sonographic evidence of a small pancreatic cystic lesion interpreted as a pseudocyst. The tumor invaded a long segment of the portal- mesenteric vein confluence, and was removed with a total pancreatectomy, resection of the portal vein and reconstruction with the internal jugular vein. Histological examination confirmed the R-0 resection of the primary SPT, although a vascular invasion was demonstrated. The postoperative course was uneventful, but 32 mo after surgery the patient experienced diffuse liver metastases. Chemotherapy with different drugs was started. The patient is alive and symptom-free, with stable disease, 75 mo after surgery. Twenty-five patients with invasion of the portal vein and/or of mesenteric vessels were retrieved from the literature, 16 recent patients with tumor relapse after potentially curative resection were also retrieved. The best treatment remains a radical resection whenever possible, even in locally advanced or metastatic disease. The role of chemotherapy, and/or radiotherapy, is still to be defined.

Effect of blocking IGF-I receptor on growth of human hepatocellular carcinoma cells

AIM： To study the expression level and localization of insulin-like growth factor -Ⅰ receptor （IGF-IR） in HepG2 cells and Chang liver cells, and to observe the effect of anti-IGF-IR monoclonal antibody （αIR3） on the growth of HepG2 cells. METHODS： The expression of IGF-IR in HepG2 cells and Chang liver cells was detected by immunohistochemistry. The influences of αIR3 on proliferation and apoptosis were examined by the 3- （4, 5-dimethylthiazol-2-yl）-2, 5- diphenyltetrazolium bromide （MTT） assay and electron microscopy, respectively. Flow cytometry （FCM） was applied for the analysis of cell cycle and apoptosis was observed under electron microscope. RESULTS： IGF-IR was located in the membranes of both HepG2 and Chang liver cell lines, and the expression level of IGF-IR was higher in HepG2 cells than in Chang liver cells. Treated with 0.1 μg/mL αIR3 for 48 h in vitro, the cell growth index （GI） of HepG2 cells was significantly higher than that of control （103.41% ys 100%, P 〈 0.01）. However, the αIR3 for 24 h at final concentration of 4.0 μg/mL made the GI of HepG2 cells lower than that of control （93.37% vs 100%, P 〈 0.01）. Compared with control, treated with αIR3 for 48 h at final concentrations ranging from 2.0 μg/mL to 4.0 μg/mL markedly reduced the GIs of HepG2 cells （97.63%, 97.16%, 95.13%, 92.53% vs 100%, P 〈 0.05 or P 〈 0.01）, treated with αIR3 for 72 h at final concentrations ranging from 0.2 μg/mL to 4.0 μg/mL decreased the GIs of HepG2 cells obviously （95%, 91.63%, 90.77%, 89.84%, 88.51% vs 100%, P 〈 0.01）, and treated with αIR3 for 96 h at final concentrations ranging from 0.5 μg/mL to 4.0 μg/mL made GIs of HepG2 cells lower significantly （88.86%, 83.97%, 79.81%, 77.24%, 70.51% vs 100%, P 〈 0.05or P 〈 0.01）. Moreover, treated with αIR3 from 24 h to 96 h at final concentrations ranging from 0.2 μg/mL to 4.0 μg/mL reduced the GI of HepG2 cells from 97.63% to 70.51% in a dose- and time-dependent manner. Also, αIR3 treatment for 72 h at final concentration from 0.5 μg/mL to 2.0 μg/mL increased the proportion of G0/G1 phase cells（61.73%, 67.1%, 83.7%,76.87% vs 44.47%, P 〈 0.01） and significantly decreased that of S phase cells（28.63%, 25.13%, 15.63%, 23.13% vs 53.17%, P 〈 0.01）, in contrast to the proportion of G2/M phase cells. The apoptotic rates of HepG2 cells were increased more than that of control （7.83%, 16.13%, 21.1%, 37.73% vs 4.13%, P 〈 0.01）. CONCLUSION： The malignant cell phenotype of human hepatocarcinoma cell is related to overexpression of IGF- IR. The blockage of IGF-IR with αIR3 may contribute to the inhibition of proliferation and induction of apoptosis in HepG2 cells.

Osteoclast-like giant cell tumors of the pancreas and liver

Osteoclast-like giant cell tumors （OGCT） are rare abdominal tumors, which mainly occur in the pancreas. The neoplasms are composed of two distinct cell populations and frequently show an inhomogenous appearance with cystic structures. However, due to the rarity of these tumors, only very limited clinical data are available. Imaging features and sonographic appearance have hardly been characterized. Here we report on two cases of osteoclast-like giant cell tumors, one located within the pancreas, the other within the liver, in which OGCTs are extremely rare. Both patients were investigated by contrast sonography, which demonstrated a complex, partly cystic and strongly vascularized tumor within the head of the pancreas in the first patient and a large, hypervascularized neoplasm with calcifications within the liver in the second patient. The liver OGCT responded well to a combination of carboplatin, etoposide and paclitaxel. With a combination of surgical resection, radiofrequency ablation and chemotherapy, the patient＇s survival is currently more than 15 too, making him the longest survivor with an OGCT of the liver to date.

纳米炭注射液在壶腹部癌淋巴结清扫中的应用

目的:探索纳米炭注射液在壶腹部癌术中指导淋巴结清扫的作用。方法:选择壶腹部癌患者60例,分为观察组和对照组,每组30例,观察组患者暴露术野后,取纳米炭注射液1mL,在癌旁周缘的十二指肠降段浆膜及胰头包膜下分上、下、左、右4点注射,对照组则以相同的方式注射取生理盐水。比较两组手术中清扫淋巴结的数目及其他相关临床指标。结果:观察组总淋巴结清扫数为468枚,其中416枚黑染(88.9%);对照组总淋巴结清扫数为268枚;观察组平均淋巴结清扫数明显高于对照组[(15.23±2.13)枚/例vs.(9.77±1.33)枚/例,P<0.01],差异主要在于N1站淋巴结(P=0.002),两组N2、N3淋巴结清扫数均无统计学差异(均P>0.05)。两组手术时间、淋巴漏的发生率、住院时间均无统计学差异(均P>0.05),但观察组术中出血量明显少于对照组[(318±30)mLvs.(592±60)mL,P<0.05)。结论:纳米炭注射液在壶腹部癌根治术中可提高淋巴结清扫数目,减少术中出血量,且不增加并发症发生率,是一种安全有效的示踪剂。