Effect of retroperitoneal lymphadenectomy on prognosis of patients with epithelial ovarian cancer

To evaluate prognostic factors which have an influence on overall survival and to assess the rational application of retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer Methods The data of 131 patients treated between January 1990 and December 1998 in Union Hospital and Tongji Hospital were analyzed retrospectively Survival was calculated using the Kaplan-Meier method and comparisons were performed using Log-rank test Independent prognostic factors were identified by the Cox proportional hazards regression model Results Univariate analysis showed that age, general conditions, menopausal status, stage, pathological types, location of the tumor, residual tumor and retroperitoneal lymphadenectomy were prognostic factors Multivariate analysis showed that age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors The survival rate could not be improved through retroperitoneal lymphadenectomy in the patients in early stage, advanced stage with residual tumor >2 cm or those with mucinous adenocarcinoma (P>0 05) Among patients in advanced stage cancer with a residual tumor ≤2 cm, 5-year survival was 65% and 30% for patients who did and did not undergo lymphadenectomy, respectively (P<0 01) Among patients with serous adenocarcinoma, 5-year survival was 61% and 31% for patients who did and did not undergo lymphadenectomy, respectively (P<0 01) Conclusions The prognosis of the patients with epithelial ovarian cancer may be influenced by age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively

经腹与腹膜后入路机器人辅助腹腔镜肾部分切除术治疗早期肾癌的比较

目的分析比较经腹与腹膜后两种入路在机器人(达芬奇机器人手术系统)辅助腹腔镜肾部分切除术治疗早期肾癌的效果,并探讨两种入路方式的临床应用价值。方法 2011年12月至2015年2月共收治82例行机器人辅助腹腔镜肾部分切除术的肾癌患者,其中49例采取经腹入路,33例行腹膜后入路。比较两种入路的手术时间、肾动脉阻断时间、术中出血量、术后肠道功能恢复时间、切缘阳性率以及术后并发症的发生率。结果两组均成功完成手术。两组在手术时间、肾动脉阻断时间、术中出血量、切缘阳性率及术后并发症发生率方面的差异均无统计学意义(P>0.05);经腹与腹膜后入路术后的肠道功能恢复时间分别为(5.7±1.4)d和(2.1±0.7)d,差异有统计学意义(P<0.05)。结论腹膜后入路机器人辅助腹腔镜肾部分切除术是一种安全、有效的微创术式,可以取得与经腹入路同样的手术效果,并且在术后肠道功能恢复方面具有优势。

后腹腔镜肾盂输尿管切开取石术

目的:探讨后腹腔镜下肾盂输尿管切开取石的技术要点和临床价值。方法:在后腹腔镜下完成肾盂输尿管切开取石135例,肾盂结石63例(均为肾外型肾盂),输尿管上段结石72例,右侧56例,左侧79例,男90例,女45例,结石2～5cm。结果:手术顺利,结石清除率达100%。术后腹膜后引流量不多,3～5天拔引流管,1周出院。结论:腹腔镜下、后腹腔径路肾盂输尿管切开取石术,创伤小、术后恢复快,明显优于开放手术,有望取代常规的开放手术,值得大力推广。

腹膜后恶性外周神经鞘膜瘤13例临床病理分析

目的探讨腹膜后恶性外周神经鞘膜瘤(malignant peripheral nerve sheath tumors,MPNST)的临床病理学特征,及H3K27me3在MPNST中的表达。方法回顾性分析13例MPNST的临床病理特征及预后情况;应用免疫组化法检测MPNST、滑膜肉瘤、去分化脂肪肉瘤及平滑肌肉瘤中H3K27me3的表达,并复习相关文献。结果 13例MPNST均为高级别,肿瘤平均直径20 cm;2年生存率约60%;5年生存率约30%;与NF-1相关型及散发型相比,放疗(radiation therapy,RT)相关型具有较差的预后(P<0.05);复发及远处转移患者具有较差的预后(P<0.05);年龄对患者生存率无明显影响(P>0.05)。免疫组化结果显示13例MPNST中11例H3K27me3表达缺失;且H3K27me3在MPNST中的表达与在滑膜肉瘤、去分化脂肪肉瘤及平滑肌肉瘤中的表达相比差异有统计学意义(P<0.05)。结论腹膜后MPNST以高级别常见,肿瘤体积相对较大,预后较差;RT相关型、复发及远处转移是影响疾病生存率的重要因素;H3K27me3缺失更常见于高级别MPNST,可能是MPNST的有效标志物。