目的 探讨T3期喉癌采用支撑喉镜下CO2激光切除术和部分喉切除术两种手术治疗方式的临床治疗效果。 方法 将2003年8月－2010年7月收治的31例患者按所接受手术方式分为A、B两组（非随机分组），A组16例中男15例，女1例，年龄38～72岁，中位年龄51岁；B组15例，均为男性，年龄46～68岁，中位年龄58岁。病变均累及前联合，A组10例和B组11例累及对侧声带约1/3。A组选择支撑喉镜下CO2激光切除术，B组选择气管切开＋部分喉切除术。两组患者首次术后均未接受放射（放疗）或化学治疗（化疗）。术后第1、3、6、12、24个月门诊纤维喉镜复查。随访时间14～78个月。 结果 A组5例复发或颈部淋巴结转移，复发率31.3%；5例患者均行再次手术、颈清扫及放、化疗。B组4例复发，复发率26.7%；4例均行全喉切除双侧选择性颈清扫术，其中3例术后辅以放、化疗。两组复发率比较差异无统计学意义（P＞0.05）。 结论 采用支撑喉镜下CO2激光切除治疗T3期喉癌，有望得到类似部分喉切除的临床治疗效果。
ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
Objective To summarize the research progress of preoperative staging diagnosis for gastric cancer. Methods Both the domestic and international literatures involving the preoperative staging diagnosis of gastric cancer in recent years were collected and reviewed. Results Transabdominal ultrosonography, EUS, CT, MRI, PET and diagnostic laparoscopy could provide objective evidences, and enhanced the accuracy of preoperative staging diagnosis for gastric cancer. Conclusion With the development of examination methods, the assessment of preoperative staging diagnosis of gastric cancer has been improved, and operation strategy can be made according to the correct preoperative staging.
Objective To evaluate the value of plain and dual-phasic enhanced 16-slice CT in the diagnosis and preoperative TNM staging of the gastric carcinoma, and to discuss the relationship between image signs and pathologic findings. Methods Fifty-three cases of the gastric carcinoma confirmed histopathologically underwent 16-slice CT examination. The scan protocol included plain scanning, the arterial phase and portal venous phase scanning. The manifestation of the three series images and multiplanar reconstruction (MPR) images were analyzed. Results ①The accuracies of 16-slice CT for the T stage, the N stage and the M stage of the gastric carcinoma were 83.02%, 80.00% and 92.45% respectively. ②The overall accuracy of 16-slice CT for judging TNM stage was 84.91%. Conclusion The plain scan and dual phase enhanced scans of 16-slice CT, especially the thin slice and MPR with proper windows technique are helpful for the diagnosis of gastric carcinoma and the TNM stage, which is useful for the selection of the operative project and the therapy plan.
目的 探讨腹腔镜结肠癌根治术的临床效果。方法 应用腹腔镜外科技术对25例结肠癌患者实施腹腔镜结肠癌根治术。结果 本组25例手术时间110～310 min，平均195 min； 术中出血量约100～350 ml，平均约180 ml； 术后胃肠功能恢复时间1～4 d，平均 1.7 d。所有标本残端无肿瘤细胞残留、浸润。所有病例术后未出现出血、吻合口漏和狭窄并发症，仅有2例出现伤口感染。术后住院6～10 d，平均7.5 d； 术后19例随访2～38个月，平均13个月，其中2例于手术后第12个月和14个月因肿瘤广泛转移、衰竭而死亡； 余17例随访期间均未发现有转移复发及切口种植。结论 腹腔镜结肠癌根治术具有微创、安全、术后恢复快、肿瘤根治彻底等优点，值得临床推广应用。
【Abstract】Objective To evaluate the value of pTNM classification in predicting the prognosis of hepatic cell carcinoma after liver transplantation. Methods Fifty-nine HCC cases undergoing liver transplantation between April 1993 and January 2003 were retrospectively reviewed. Fiftynine cases were staged by using the pTNM classification. Results The 1-year survival rates were 66.67%, 66.67%, 40.91% and 31.75% for Ⅰ，Ⅱ，Ⅲa and Ⅳa stages，2-year survival rates were 66.67%, 66.67%, 21.29% and 31.75%, the difference was not statistically significant. Conclusion The pTNM classification is not good enough to predict the prognosis of hepatic cell carcinoma after liver transplantation.
【Abstract】Objective To study the surgical therapy and staging investigation about stage Ⅳ breast carcinoma. Methods The clinical data of 38 patients with stage Ⅳ breast carcinoma were summarized, and the patients were followed up. Results The stage Ⅳ patients who had isolated metastasis and removable primary tumor were treated by radical surgery with good effect. On the other hand, the stage Ⅳ patients who had extensive metastasis and primary tumor unresectable were treated by palliative operation with the living quality of patients becoming better and chemotherapy load cutting down. Conclusion The stage Ⅳ patients should be divided into stage Ⅳa and stage Ⅳb. And the stage Ⅳa patients should be treated by radical operation, and the stage Ⅳb by palliative operation.
目的 探讨直肠癌的外科治疗及其并发症的防治。方法 回顾性分析了我院1995～2000年收治的360例直肠癌患者外科手术治疗情况，其中施行Miles手术196例，双吻合器吻合96例，手术缝合30例，姑息性手术38例。发生并发症19例。结果 341例治愈出院，18例并发症患者经手术或相应处理治愈，1例因多器官功能衰竭死亡。结论 直肠癌患者应根据肿瘤部位、恶性程度、Dukes分期而采用不同的术式，应注意从手术技巧的改进与提高上来防治其并发症的发生。