目的 了解胰十二指肠切除术中良性病例所占比例,分析其病变类型,探讨术前、术中诊断及其它治疗方式的可行性。方法 回顾性分析我院1996～2001年期间206例术前诊断为胰头或壶腹周围恶性肿瘤而作胰十二指肠切除术病例中，术后病理诊断为良性病变者23例的临床、病理资料。结果 术后病理检查发现慢性胰腺炎14例，胰头囊腺瘤2例，十二指肠乳头异位胰腺1例，十二指肠乳头良性腺瘤4例，胆总管下段炎性狭窄2例。良性病变占整个胰十二指肠切除术病例的11.2%。结论 在作胰十二指肠切除术的良性病变中慢性胰腺炎占大多数。术中取活检作冰冻切片病理检查是鉴别良、恶性病变的最有效方法。对这些良性病变可选择保守治疗或行较小的局部切除术。
Objective To investigate the risk factors, diagnosis and treatment of solitary pulmonary nodule （diameter≤3cm）. Methods From Jan. 2001 to Dec. 2002, the clinical data of 297 patients with solitary pulmonary nodule were reviewed. Chi-square or t-test were used in univariate analysis of age, gender, symptom, smoking history, the size, location and radiological characteristics of nodule, and logistic regression in multivariate analysis. Results Univariate analysis revealed that malignancy was significantly associated with age （P=0. 000）, smoking history （P=0. 001）, the size （P=0. 000） and radiological characteristics （P=0. 000） of nodule. In multivariate analysis （logistic regression）, it was significantly associated with age （OR = 1. 096）, the size （OR = 2. 329） and radiological characteristics （OR=0. 167） of nodule. Conclusion Age and the size of nodule could be risk factors. Radiological findings could help distinguish from malignant nodules.
ObjectiveTo investigate the potential role of caudal type homeobox transcription factor-2 (CDX-2) and liverintestine cadherin (LI-cadherin) in the development and progression of gastric tumor by detecting their expressions in gastric cancer and benign lesions. MethodsThe expressions of CDX-2 and LI-cadherin protein were detected by immunohistochemistry in normal gastric mucosa (n=28), chronic superficial gastritis (n=30), chronic atrophic gastritis (n=42), intestinal metaplasia (n=58), gastric adenocarcinoma (n=46), vicinity cancerous tissue (n=30), and gastric stromal tumor (n=10)．Then, the relationship between expression of CDX-2 or LI-cadherin protein and clinicopathologic features was analyzed． Results①The expressions of CDX-2 and LI-cadherin were all negative in normal gastric mucosa, chronic superficial gastritis, vicinity cancerous tissue, and gastric stromal tumor. The positive rates of CDX-2 protein expression in intestinal metaplasia and gastric adenocarcinoma were 91.4% (53/58) and 80.4% (37/46), respectively, and the positive rates of LI-cadherin protein expression were 82.8% (48/58) in intestinal metaplasia and 65.2% (30/46) in gastric adenocarcinoma. The positive rates of CDX-2 and LI-cadherin protein expression in intestinal type gastric adenocarcinoma 〔90.6% (29/32) and 78.1% (25/32)〕 were higher than those in diffuse type gastric adenocarcinoma 〔57.1% (8/14) and 35.7% (5/14)〕, Plt;0.05． ② CDX-2 protein expression was associated with degree of differentiation (P=0.007), and LI-cadherin protein expression was associated with lymph node metastasis (P=0.007) and cancer staging (P=0.013). ③ In the mucosa of intestinal metaplasia, the coexpression positive rate of CDX-2 protein expression in nucleus with LI-cadherin protein in cytoplasm or membrane was 83.0% (44/53), while the coexpression positive rate was 67.6% (25/37) in gastric adenocarcinoma. Although b tendency between CDX-2 and LI-cadherin protein expression was showed, it was not confirmed by the correlation analysis (r=238， P=0.115). ConclusionsThe abnormal expressions of CDX-2 and LI-cadherin may be involved in the development and progress of intestinal metaplasia and gastric adenocarcinoma, respectively, and further studies are needed to determine if they have synergistic effect.
Objective To evaluate the value of bile and serum CA19-9 in diagnosing biliary tract carcinoma. Methods Bile and serum CA199 and CEA were determined by radioimmunoassay (RIA). Results The dividing value of bile CA199 is 12 000 kU/L, and its sensitivity and specificity were 85.71%, 73.91% respectively. The dividing value of bile CEA is 480 μg/L, and its corresponding indexes were 57.14% and 77.17%. The false positive rate of bile CA19-9 and CEA were 26.09% and 22.83%. Serum CA19-9 sensitivity, specificity were 80.00% and 85.11%; the corresponding indexes of serum CEA were 68.57% and 82.97%. Conclusion CA19-9 is an effective tumor marker in diagnosing, deciding whether the tumor has been radically resected and in monitoring its response to the treatment.
ObjectiveTo explore the value of duodenum-preserving pancreatic head resection for benign lesions in pancreatic head. MethodsClinical data of 14 patients with benign lesions in pancreatic head who were underwent duodenum-preserving pancreatic head resection from Jan. 1995 to Dec. 2012 were retrospectively analyzed, to explore the value of the surgery. ResultsAll surgeries of the 14 patients were success. The operation time were 4.0-6.5 hours (5.2 hours on average), the intraoperative blood loss were 100-1 000 mL (450 mL on average). Postoperative complications happened in 3 patients (21.4%), including pancreatic fistula in 2 patients and biliary fistula in 1 patient, which were cured with non-surgical treatment. No deaths happened during surgery and hospitalization. Of the 14 patients, 13 patients were followed-up for 6 months to 2 years with no recurrence, diabetes, postoperative gastric emptying disorders, and other long-term complications happened. ConclusionDuodenum-preserving pancreatic head resection is the safe and effective treatment of benign lesions in the head of pancreas.