小肠肿瘤并出血12例诊治体会

回顾性分析近5年间收治的12例原发性小肠肿瘤并消化道出血的临床资料。结果显示原发性小肠肿瘤并消化道出血临床表现无特异性,常规检查包括钡餐、纤维内窥镜、B超、CT等的诊断价值不大,对疑为小肠肿瘤出血者,需进一步行DSA、X线全消化道钡餐、小肠气钡双重造影等辅助检查。在定位小肠出血后,应积极果断地择期或急诊手术处理,勿将时间耗费在过多过久的术前检查诊断上。

肠梗阻导管在肠肿瘤并肠梗阻的临床应用及护理

肠梗阻是外科急症，传统治疗低位肠梗阻的治疗方法是急性梗阻近端结肠造口，待肠壁水肿消除，患者全身情况改善后，再根据病因行二期手术，解除肠道本身病变或造口还纳。患者一般多需经历二次手术，且肠造口给患者本人及家属造成极大的不便。

成人肿瘤性肠套叠急诊手术治疗

【目的】探讨成人肿瘤所致肠套叠的手术治疗特点。【方法】对24例因急诊手术治疗而确诊为原发性小肠肿瘤所致肠套叠进行了临床分析。【结果】其中良性肿瘤10例，主要分布在空肠；恶性肿瘤14例，主要分布在回肠，多系恶性淋巴瘤、腺癌和平滑肌肉瘤，治愈22例。随访18例，14例恶性肿瘤术后2年和5年生存率分别为85．7％和42．9％。【结论】原发性小肠肿瘤所致肠套叠的发病、诊断及治疗有明显的特点，用以确定原发性小肠肿瘤的病理类型及其与肠套叠的关系。

右半结肠癌并存急性阑尾炎21例诊治分析

【目的】探讨结肠肿瘤并存急性阑尾炎的临床特点,以减少急性阑尾炎诊治中结肠癌的漏诊及误诊率。【方法】回顾性分析21例右半结肠癌并存急性阑尾炎的临床资料。【结果】全组入院诊断为急性阑尾炎15例,阑尾周围脓肿4例,2例经外院行阑尾切除术后以右下腹包块急诊转入本院。病理类型结肠腺癌16例、粘液腺癌4例,未分化癌1例。术后2例并发切口感染,1例并发肺部感染,全组均痊愈出院。【结论】结肠癌与急性阑尾炎并存,常易引起误诊、漏诊。对急性阑尾炎患者要详细地询问病史,对可疑患者实施相关检查,是减少误诊及漏诊的关键。

E-cadherin expression pattern in primary colorectal carcinomas and their metastases reflects disease outcome

AIM： To investigate the changes that occur in E-cadherin expression during the process of metastasis in colorectal cancer.METHODS： E-cadherin expression was detected by immunohistochemistry and two indices of expression were calculated which reflected the level of expression and the locations （membrane and cytoplasm）. Univariate and multivariate survival analyses were used to assess the value of these two E-cadherin indices as predictors of both disease-free （DFS） and disease-specific （DSS） survival. RESULTS： E-cadherin membrane index （MI）, but not cytoplasmic index （CI）, was significantly higher in primary tumors than their metastases （P = 0.0001）. Furthermore, both primary tumor MI and CI were higher among the patients who developed subsequent metastasis （P = 0.022 and P = 0.007, respectively）. Interestingly, both indices were higher in liver metastase compared to other anatomic sites （MI, P = 0.034 and CI, P = 0.022）. The CI of the primary tumors was a significant predictor of DFS （P = 0.042, univariate analysis）, with a strong inverse correlation between CI and DFS （P = 0.006, multivariate analysis）. Finally, the MI of primary tumor proved to be a significant independent predictor of DSS, with higher indices being associated with a more favorable outcome （P = 0.016）. CONCLUSION： Examination of E-cadherin expression and distribution in colorectal tumors can be extremely valuable in predicting disease recurrence. The observation that aberrant cytoplasmic expression of E-cadherin can predict disease recurrence is obviously of great importance for both patients and clinicians, and significantly affects decisions concerning the therapy and management of the patients.

Upper gastrointestinal carcinoid tumors incidentally found by endoscopic examinations

AIM: This study shares Asian clinical experiences of carcinoid tumors that originated in the upper gastrointestinal tract.METHODS: From May 1987 to June 2002, we had found only 13 cases of histologically confirmed carcinoid tumors in the upper gastrointestinal tract by endoscopic examinations. There were eight males and five females.The mean age was 53.16±20.51 years that ranged from 26 to 82 years. Each of their clinical presentations,locations, tumor morphology, and size and the treatment outcome were analyzed and discussed.RESULTS: One patient had a polypoid lesion at the lower esophagus, nine were stomach lesions and three located at the duodenum. All patients with polypoid and submucosal tumor types were of small size (＜1.7 cm) and all patients survived after simple excision or polypectomy.Four of the five patients in tumor mass forms died and the tumors were more than 2.0 cm in size.CONCLUSION: Carcinoid tumors rarely originated from the upper gastrointestinal tract and are usually found accidentally after endoscopic study. Bigger size (more than 2 cm) tumor masses may indicate a more severe disease and poor prognosis.

成人小肠间质瘤并套叠1例分析

对成人小肠间质瘤并套叠1例分析如下。 1病历摘要 女,55岁。因间断性中上腹痛3个月,加重5 h入院。3个月前无明显诱因出现中上腹间断性绞痛,无放射痛,伴恶心、呕吐,无呕血或吐咖啡色样物,不伴发热、反酸、烧心,大便2～3 d1次,无黏液、脓血或黑便,病情经对症处理能缓解,但时有反复,间歇期无不适。

小肠腺癌继发肠套叠长期误诊一例

患者，男，45岁。因左中腹部间歇性绞痛1年，加重1周于2013年4月7日入院。患者于1年前无诱因间歇出现左中腹部绞痛，无放射，疼痛持续几分钟至10余小时，无发热、呕吐、腹泻，二便正常。在多家医院行超声、X线钡餐造影、胃镜、结肠镜等检查，以慢性胃炎、胆囊结石、肠易激等疾患，予以制酸、解痉、镇痛、消炎等对症治疗，症状可完全缓解。于半年前实施腹腔镜胆囊切除，但术后腹痛仍发作。近1周每日均发作，且持续时间延长。发病后体质量减轻约10kg。

大肠癌并急性肠梗阻心率变化与手术时机的选择

目的总结大肠合并急性肠梗阻心率变化特点，探讨其与手术时机选择的关系。方法回顾分析盘锦市第二人民医院1995—05-2010—05大肠癌合并急性肠梗阻188例临床资料（不含房室颤病例）。结果大肠癌合并急性肠梗阻患者心率增快与手术病死率承正相关，当心率〉120次／min时患者病死率明显增高。结论心率增快是大肠癌急性肠梗阻患者最易掌握的临床表现也是手术时机选择的重要指证，当心率〉120次／min时，排除低血容量、离子紊乱、发热等可导致心率增快因素后，均应急诊手术。

大肠癌根治术后肝转移的预测因素分析

目的探讨大肠癌根治术后肝转移的预测因素。方法回顾性总结了124例大肠癌病人术前骨髓中微转移、CEA水平、临床病理因素与术后肝转移之间的关系。结果结果显示术前骨髓癌细胞微转移阳性与阴性肝转移的发生率分别是69．6％（32／46）和7．7％（6／78）、外周血CEA升高与正常者肝转移发生率分另066．7％（26／39）和14．1％（12／85）、淋巴结转移阳性与阴性患者术后肝转移发生率分别为52．7％（30／57）和11，9％（8／67），具有统计学意义。通过Logistic多因素分析；结果显示骨髓微转移是影响术后肝转移的独立因素。结论骨髓微转移阳性患者要进行密切随访以早期发现肝转移。

小肠间质瘤伴出血及腹腔转移2例报告并文献复习

目的探讨小肠间质瘤临床表现、诊断及治疗。方法分析大连大学附属中山医院收治的2例小肠间质瘤患者的临床诊治及病历资料并进行文献复习。结果临床表现以消化道出血为首发症状,继而肝脏腹腔广泛转移,经剖腹探查术取病理切片最后确诊。结论小肠间质瘤较少见,临床症状无特异性,易引起误诊误治,动脉血管造影、小肠镜、CT及胃镜均有较高的的术前诊断价值,确诊尚需病理检查,治疗方法为手术切除。