食管拉网细胞学诊断172例近癌的随诊

目的 探讨食管癌前病变近癌的癌变危险度和细胞学整体疗效。方法 以细胞学诊断的 172例近癌为观察对象 ,随机分为治疗组和对照组 ,治疗组口服中药增生平 ,对照组服用安慰剂 ,服药 3 8个月做细胞学复查。疗效统计采用Ridit分析和RR。结果 RR =0 76,95 %CI=(0 2 4～ 2 44 )。Ridit=0 5 ,95 %CI =(0 3 7～ 0 62 )。结论 细胞学诊断的近癌RR高 。

乳腺癌近癌区、远癌区血管生成的研究

目的 通过对Ⅰ、Ⅱ期乳腺癌及癌周组织血管生成的研究 ,为临床决定乳腺癌局部切除范围提供一定的理论依据。方法 在光镜下观察乳腺癌及癌周组织 ,通过免疫组织化学的方法观察乳腺癌及癌周微血管密度和血管内皮生长因子的表达 ,比较它们在不同组织区域的表达差异。结果 微血管密度在癌区、癌周组织差异无显著性 ,血管内皮生长因子在癌区表达显著高于癌周组织 ,近癌区与远癌区表达无差异。结论 乳腺癌癌周组织除癌细胞浸润外 ,细胞微环境 -间质的变化即癌周血管生成丰富 ,可作为病理诊断的补充 ,也应为乳腺癌局部切除的考虑因素。

近端胃腺癌中DKK-1和β-catenin的表达及其相关性

目的:探讨DKK-1和β-catenin蛋白表达在胃近端癌发生过程中的作用。方法:采用免疫组织化学S-P方法分别检测61例胃近端癌、癌旁组织及20例正常胃黏膜组织的DKK-1和β-catenin蛋白表达,并分析其临床意义。结果:胃近端癌中DKK-1阳性表达率和β-catenin异常表达率分别为34.4%(21/61)和68.9%(42/61),癌旁组织中DKK-1阳性表达率和β-catenin异常表达率分别为8.2%(5/61)和6.6%(4/61),正常组织中DKK-1阳性表达率和β-catenin异常表达率分别为15.0%(3/20)和10.0%(2/20)。胃近端癌的表达明显高于其他两者(P<0.05),胃近端癌中DKK-1和β-catenin的表达呈正相关(r=0.454,P<0.05),而在癌旁组织及正常胃黏膜中的表达无明确相关性。结论:高表达和异常表达上升与胃近端癌的发生密切相关。

DKK-1和β-catenin在近端胃腺癌中的表达及临床意义

目的探讨DKK-1(Dickkopf-1)和β-catenin在近端胃腺癌中的表达及其临床意义。方法采用免疫组织化学SP法检测61例近端胃腺癌组织中DKK-1和β-catenin表达情况,并结合近端胃腺癌的临床病理特征进行分析。结果在61例近端胃腺癌组织中,DKK-1阳性表达率和β-catenin异常表达率分别为34.4%(21/61)和68.9%(42/61)。DKK-1的表达在肿瘤的分化程度、临床分期及淋巴结转移方面差异有统计学意义(P<0.05);β-catenin的表达在肿瘤的分化程度方面差异有统计学意义(P<0.05)。在近端胃腺癌中DKK-1和β-catenin的表达存在关联性(P<0.05)。结论 DKK-1的表达上调可能在近端胃腺癌的发生、发展中发挥一定的作用并可提示预后及转移,它与β-catenin可能存在调节及负反馈调节。

异体骨段复合人工股骨头置换治疗股骨近端骨转移癌的护理

异体骨段复合人工关节置换是股骨近端骨转移癌手术治疗的较好选择,本文报道应用此法治疗13例的护理经验。强调术前全身情况和局部转移灶的评估,避免因不能承受手术而发生意外。术后严密观察生命指征;遵守无菌操作和消毒隔离制度,从各个环节杜绝感染;早期发现并控制排斥反应。康复训练主要是保持患肢正确位置和被动运动,应制定个体化的训练计划。

T_(3)期胆囊癌癌旁及背景肝组织的扩散加权成像术前对比研究

目的探讨表观扩散系数(ADC)及其标准差(ADCsd)对T_(3)期胆囊癌(GBC)近癌旁、远癌旁及背景肝组织的术前区分可行性。方法回顾性收集经手术病理证实的T_(3)期GBC病人45例,以手术病理结果为金标准,将其分为肝脏受侵组(31例)和肝脏未受侵组(14例)。所有病人均在术前于3.0 TMRI行多b值(b值包括0、20、50、80、100、200、400、600、800及1000 s/mm^(2))DWI扫描,并在各b值DWI影像上分别测量近癌旁、远癌旁及背景肝组织的ADC及其ADCsd。采用单因素方差分析或Kruskal-Wallis H检验比较3种肝组织ADC及ADCsd的差异。采用受试者操作特征(ROC)曲线评估ADC和ADCsd区分3种肝组织的效能,并计算ROC曲线下面积(AUC)。结果肝脏受侵组中,b值为600、800及1000 s/mm^(2)时,近癌旁肝组织的ADC和ADCsd均低于远癌旁及背景肝组织(均P<0.05),而ADC和ADCsd在远癌旁与背景肝组织间差异无统计学意义(均P>0.05)。当b值≤400 s/mm^(2),ADC和ADCsd值在近癌旁、远癌旁及背景肝组织间的差异无统计学意义(均P>0.05)。肝脏未受侵组中,所有b值对应的ADC和ADCsd在近癌旁、远癌旁及背景肝组织三者间的差异均无统计学意义(均P>0.05)。b值为800 s/mm^(2)时,ADC区分近癌旁与远癌旁肝组织的AUC值最高(0.696)。b值为1000 s/mm^(2)时,ADCsd区分近癌旁与远癌旁肝组织的AUC值最高(0.696)。b值为800及1000 s/mm^(2)时,ADC区分近癌旁与背景肝组织的AUC值相近(分别为0.713及0.714)。b值为1000 s/mm^(2)时,ADCsd区分近癌旁与背景肝组织的AUC值最高(0.710)。结论当GBC侵犯肝脏,选取b值为600、800及1000 s/mm^(2)时,其ADC和ADCsd有助于近癌旁与远癌旁、背景肝组织的区分,但不能区分远癌旁与背景肝组织。

胃近端癌联合脏器切除临床51例分析

目的：探讨胃近端癌的外科治疗。方法：对51例胃近端癌联合脏器切除病例进行分析。结果：对侵犯邻近脏器的的胃近端癌行联合脏器切除，淋巴结转移为影响预后的主要因素。结论：胃近端癌侵犯周围脏器时应联合切除，清除转移淋巴结可提高远期生存率。

经皮骨成形术和假体置换术治疗股骨近段转移癌疗效比较

目的探讨将经皮骨成形术与假体置换术分别应用于股骨近段转移癌治疗中的临床效果。方法选取116例股骨近段转移癌患者作为研究对象,并将其按照治疗方案的不同随机分成观察组(n=58)与对照组(n=58),观察组患者行经皮骨成形术治疗,对照组患者行假体置换术治疗,分别对两组患者的临床手术指标、治疗前后患肢功能评分及术后并发症发生情况进行对比。结果观察组患者的平均手术时间明显短于对照组,观察组的平均术中出血量明显少于对照组;治疗前两组患者的患肢功能评分差异不明显,治疗后观察组的患肢功能评分明显低于对照组;观察组患者的术后并发症发生率明显低于对照组患者; P <0. 05为差异具有统计学意义。结论经皮骨成形术治疗股骨近段转移癌的临床手术指标更优、并发症发生率更低,假体置换术治疗股骨近段转移癌的患肢功能恢复更好,两种术式均可作为股骨近段转移癌治疗的有效手段,而经皮骨成形术更适用于身体条件较差、不耐受长时间手术等患者。

近端胃次全与全胃切治疗近端胃癌的临床比较

目的探讨近端胃次全切除术与全胃切除术治疗近端胃贲门癌的临床疗效。方法将我科收治的54例近端胃贲门癌患者分为两组,甲组29例采用近端胃次全切除术治疗;乙组25例采用全胃切除术治疗,对两组的术后并发症及2年生存率分别进行比较。结果近端胃次全切除术后患者术后并发症少,且2年生存率与全胃切除术后患者的生存率无差异。结论近端胃次全切除术是治疗近端胃贲门癌安全而有效的方法 。

全胃切除治疗进展期胃近侧癌58例临床分析

目的 研究全胃切除治疗进展期胃近侧癌的安全性 ,评价疗效和手术适应证。方法 回顾性分析了 1980～ 2 0 0 0年行全胃切除进展期胃癌 5 8例 ,其中根治性切除 49例 ,姑息性切除 9例 ;联合脏器切除 2 3例 ,与同期非手术治疗组比较。结果 两组病例对比 ,生存率明显优于非手术治疗组 ,其术后1、3、5年生存率分别为 96.5 %、78.6%、45 .3 %。结论 严格掌握手术适应证 ,合理确定淋巴结切除范围和联合脏器切除 ,选用最佳的消化道重建方式 ,全胃切除进展期胃近侧癌是安全可靠的 ,可明显提高病人生存率。

乳腺癌保留乳房手术切除范围的探讨

目的:探讨合适的乳腺癌保留乳房手术切除范围。方法:对104例乳腺癌根治手术患者的切除标本进行观察研究。每一患者标本分为“癌肿区”、“近癌区”和“远癌区”。以肿瘤切除活检标本或肉眼可见肿瘤及其周围0.5cm区域为“癌肿区”;“癌肿区”边缘向外1cm～3cm区域为“近癌区”;3cm～5cm区域为“远癌区”。对三个区域乳腺组织非典型增生和c-erbB-2、p53基因蛋白异常表达发生情况分别进行研究。结果:104例乳腺癌手术标本中,“近癌区”和“远癌区”发生非典型增生率分别为56.7%、32.7%,其中Ⅱ、Ⅲ级非典型增生率“近癌区”明显高于“远癌区”。49例c-erbB-2阳性乳腺癌中,“近癌区”亦发现有c-erbB-2阳性表达者26例(53.6%),“远癌区”阳性表达者8例(16.3%)。两组比较均P<0.01。25例p53阳性者中,“近癌区”及“远癌区”检测均阴性。结论:提示在行保留乳房手术时,一并切除近癌组织是必要的。

全胃切治疗进展期胃近侧癌32例

目的:探讨全胃切在治疗进展期近侧癌的应用效果.方法:回顾分析行全胃切除的胃近侧癌32例临床资料.结果:男性20例,女性12例,年龄48～65岁,平均56岁.根治性切除24例,姑息切除8例,根治性切除1年生存率100%,2年生存率64%;姑息性切除生存时间10～38个月,平均1年6个月.结论:全胃切除是治疗进展期胃近侧癌的有效方式.

全胃切除术与近端胃次全切除术治疗近端胃体食管胃结合部腺癌的临床效果分析

目的 :探讨全胃切除术与近端胃次全切除术治疗近端胃体食管胃结合部腺癌的临床疗效。方法 :回顾性分析2010年1月—2016年12月在我院治疗的近端食管胃结合部腺癌患者128例。根据手术方式将患者分为两组,每组各64例。对照组采用近端胃次全切除术,观察组选用全胃切除术。以术中、术后基本情况、并发症发生率、术后营养状态、近期复发率为评价指标。结果:观察组手术用时与术后肛门排气时间指标明显比对照组长(P<0.05),观察组术中出血量、术后住院时间与对照组相比,差异无统计学意义(P>0.05)。观察组并发症发生率为7.81%,明显低于对照组(20.31%)(P<0.05)。两组患者手术后各营养状态指标均有明显改善(P<0.05),但在血红蛋白、总蛋白、白蛋白方面对照组的改善程度较观察组更佳(P<0.05),体质量方面两组术后差异无统计学意义(P>0.05)。观察组术后复发率为1.56%,明显低于对照组(9.37%)(P<0.05)。结论 :全胃切除术治疗近端胃体食管胃结合部腺癌手术后并发症发生率与术后复发率均低于近端胃次全切除术,但手术复杂耗费时间较长,术后肛门排气时间也较长,营养恢复情况较差,临床上选择手术方式时因根据患者实际情况而选择。

基于计算机图形处理与有限元仿真的前列腺穿刺变形模拟

前列腺癌近距离放射治疗是有效治疗前列腺癌的一种微创治疗方法,然而在手术针向前列腺内部植入放射性粒子的过程中,前列腺和周围软组织器官的变形会导致粒子植入偏差。运用计算机图像处理与有限元仿真技术,使用患者术前的核磁图像,结合盆腔解剖学知识和三维重建技术,建立前列腺器官群有限元模型,并对粒子植入手术过程进行术前的有限元模拟计算,从而得到目标位置的变形量。有限元计算中的输入量均由实验数据结合有限元软件反求获得。结果表明,模型的穿刺变形量符合术中前列腺变形情况,周边组织器官均能提供有效约束。该方法可以应用于术前穿刺轨迹规划、剂量规划和手术模拟训练机。

CT引导下子宫内膜癌3 D腔内近距离治疗计划的剂量学分析

目的：通过比较子宫内膜癌腔内近距离治疗3D计划和2D计划，探讨子宫内膜癌3D腔内近距离治疗的剂量学特性。方法回顾性分析11例子宫内膜癌患者的39次3D近距离治疗计划并重新设计2D计划，从DVH上比较靶区V150、D90，膀胱、直肠、小肠及乙状结肠D2 cm3。采用配对t检验方法分析组间差异。结果靶体积＜60 cm3时，3D、2D计划靶区D90分别为（551.17±90.33）、（574.15±117.18） cGy （P＝0.390），随着靶体积增加3D计划的D90增加（P＝0.001）。3D、2D计划靶区V150分别为（51.05±21.61）、（53.41±1.71） cm3（P＝0.482）。当靶体积＞60 cm3时，与2D计划相比，3D计划提高靶区覆盖同时增加了危及器官受量，但小肠受量增加不明显（ P＝0.128）。此外，不同计划模式下BMI增加对直肠、小肠、膀胱及乙状结肠的受量无显著影响， P值分别为0.239、0.198、0.744和0.834。结论子宫内膜癌3D腔内近距离治疗与2D计划相比可显著提高较大靶区的覆盖范围，有效控制OAR受量，临床疗效与不良反应尚需进一步观察。

Proteomic profiling of fetal esophageal epithelium, esophageal cancer, and tumor-adjacent esophageal epithelium and immunohistochemical characterization of a representative differential protein, PRX6

AIM To understand the molecular mechanism of esophageal cancer development and provide molecular markers for screening high-risk populations and early diagnosis. METHODS Two-dimensional electrophoresis combined with mass spectrometry were adopted to screen differentially expressed proteins in nine cases of fetal esophageal epithelium, eight cases of esophageal cancer, and eight cases of tumor-adjacent normal esophageal epithelium collected from fetuses of different gestational age, or esophageal cancer patients from a high-risk area of esophageal cancer in China. Immunohistochemistry(avidin-biotin-horseradish peroxidase complex method) was used to detect the expression of peroxiredoxin(PRX)6 in 91 cases of esophageal cancer, tumoradjacent normal esophageal tissue, basal cell hyperplasia, dysplasia, and carcinoma in situ, as well as 65 cases of esophageal epithelium from fetuses at a gestational age of 3-9 mo.RESULTS After peptide mass fingerprint analysis and search of protein databases, 21 differential proteins were identified; some of which represent a protein isoform. Varying degrees of expression of PRX6 protein, which was localized mainly in the cytoplasm, were detected in adult and fetal normal esophageal tissues, precancerous lesions, and esophageal cancer. With the progression of esophageal lesions, PRX6 protein expression showed a declining trend(P < 0.05). In fetal epithelium from fetuses at gestational age 3-6 mo, PRX6 protein expression showed a declining trend with age(P < 0.05). PRX6 protein expression was significantly higher in well-differentiated esophageal cancer tissues than in poorly differentiated esophageal cancer tissues(P < 0.05).CONCLUSION Development and progression of esophageal cancer result from interactions of genetic changes(accumulation or superposition). PRX6 protein is associated with fetal esophageal development and cancer differentiation.

Clinical study of three dimensional conformal radiotherapy combined with intracavitary brachytherapy in the treatment of cervical cancer

Objective: The aim of our study was to evaluate the outcome and complications of cervical cancer patients undergoing conventional intracavitary brachytherapy (ICBT) treated with 3D-conformal radiotherapy (3DCRT). Methods: Sixty cervical cancer patients were divided randomly into the conformal group and the conventional group. Thirty patients treated with 3D-conformal radiotherapy in the 3DCRT group, when the whole pelvic received DT 40 Gy, a planning CT scan of each patient was obtained and the second 3DCRT therapy plan was taken. Then, continued to irradiate to 50 Gy. At last, 3DCRT was boosted at local involved volumes to the total dose of 60 Gy. When 3DCRT was combined with intracavitary brachytherapy, the dose of brachytherapy to point A was 30 Gy/5 fractions. In the conventional group, after a total tumor dose of 40 Gy was delivered by the whole pelvic irradiation, the four-field technique was used to irradiate the total pelvic and regional nodes (median dose of 10 Gy), and the involved volumes were boosted to 60 Gy and the dose of brachytherapy to point A was 30 Gy-36 Gy/5-6 fractions. Moreover, both groups were combined with intracavitary brachytherapy respectively. Results: The 1, 2, 3-year survival rates for the 3DCRT group and the conventional group were 96.7%, 93.3%, 90.0% and 86.6%, 76.7%, 70% respectively (P = 0.04, P = 0.02 and P = 0.02). There was a statistically significant difference between the two groups. Compared to the two groups each other in toxic effects, except for the I-II grade rectal and bladder reaction and pelvic fibrosis which was lower in the 3DCRT group (P = 0. 007, P = 0. 006 and P = 0. 015), the side effects were similar and well tolerated in two groups. Conclusion: The all-course 3DCRT combined with intracavitary brachytherapy can be considered as an effective and feasible approach to cervical cancer and may significantly improve the survival rate and reduce the late toxicity. This new role for 3DCRT merits need further evaluation with large patient numbers and longer follows up.

The influence of interstitial brachytherapy with ～(125)I seeds on Caspase-3 and Egr-1 expressions of Lewis lung carcinoma in C57BL mice

Objective:The aim of our study was to explore the influence of interstitial brachytherapy with 125I seeds on Caspase-3 and Egr-1 expressions of Lewis lung carcinoma in C57BL mice.Methods:Model mice of C57BL were planted with Lewis lung cells (LLC) and divided into the treatment group (n=18) and the control group (n=17).In each mouse of the treatment group,two BT-125-1 Model 125I seeds with apparent activity of 9.25 MBq were implanted into the tumor;whereas in each mouse of the control group two dummy seeds were implanted.The mice survival rates of both groups were recorded after 21 days.The tumor weights and dimensions of survived mice were measured,and the tumor volume inhibition rate was calculated.T-test was performed to compare differences of tumor weights and volumes between these two groups.Routine pathological slides of tumor tissue were observed under light microscope.The expression of Caspase-3 was detected by immunohistochemical method and the expression of Egr-1 was detected by RT-PCR method.Results:The survival rates were 88.88% in the treatment group and 70.59% in the control group,the difference had no statistical significance (P > 0.05).The tumor volume inhibition rate was 71.12%.Pathological examination showed degeneration and necrosis of cancer cells at the site nearby the seed in the treated group,but the tumor cells alive were still presented nearby the seed in the control group.The expressions of Caspase-3 and Egr-1 in the treated group were higher than those in the control group (t=12.825,P < 0.01;t=7.039,P < 0.01;respectively).Conclusion:The interstitial brachytherapy with 125I seeds could significantly inhibit the growth of Lewis lung carcinoma of mice.The possible mechanism may be that 125I interstitial brachytherapy can enhance the expressions of Egr-1 and Caspase-3,which could induce tumor cellular apoptosis.

甲状腺恶性肿瘤外科手术治疗进展

甲状腺恶性肿瘤是内分泌系统常见恶性肿瘤之一,对患者心理、生命安全有重要不良影响。近年来,随着甲状腺恶性肿瘤发病率的提升,相关临床治疗方法的探讨也在逐渐增多,外科手术仍是目前临床治疗甲状腺恶性肿瘤最主要的方法。随着科技的发展,甲状腺外科治疗技术日益更新变化。本文简要介绍甲状腺恶性肿瘤的诊断、外科手术建议等,重点阐述甲状腺恶性肿瘤外科手术治疗,以期为临床工作者提供参考。

临床多选题与题解

答1.答案是B。早期胃癌即可有出血,有时黑便为唯一的症状,因此粪便隐血检查对胃癌的诊断有一定临床意义。据国内例胃癌粪便隐血检查的分析阳性者达420例。