残胃癌的淋巴结转移规律与手术治疗

目的 探讨残胃癌吉转移规律及其合理的根治术式。方法 回顾性分析我院从１９７９年３月至１９９７年９月收治的６４例残胃癌患者的淋巴结转移规律、手术及其疗效。结果 本组残胃癌患者６４例,占同期手术病人的２．１％。其中包括治愈性切除者３０例,其淋巴结转移率分别为第１组５９．１％、２组３３．３％、３组８０．０％、４组４６．７％、７组２５．０％、８组３６．４％、９组４０．０％、１０组６０．０％、１１组７２．３     

颅内转移瘤

报告５８例颅内转移瘤，男３４例，女２４例，平均年龄５１．７岁，占同期住院脑肿瘤的９．８％。５０例手术，术后辅以放疗及化疗。近期疗产治愈２２例，好转２４例，恶化４例。随访２２例，平均生存期１３．５个月，１年，２年，５年生存率分别为４０．９％，１３．６％和４．５％。     

胃癌患者骨髓转移癌细胞的检测和临床观察

作者自１９９２年１１月至１９９４年６月应用膜上皮抗原（ｅｐｉｔｈｅｌｉａｌｍｅｍｂｒａｎｅａｎｔｉｇｅｎ，ＥＭＡ）单克隆抗体为探针，连续对８８例胃癌患者进行了１１３次骨髓中转移癌细胞的检测。８８例中查出阳性癌细胞者５８例，阳性率为６５．９％。癌细胞阳性率与胃癌分化程度有关，以低分化腺癌和粘液腺癌阳性率较高，分别为６０．９％和９３．９％。胃癌ＴＮＭ分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期阳性率分别为４２．９％、５７．１％、７３．７％和６９．０％。骨髓转移癌细胞与淋巴结转移无明显关系。单纯手术、手术＋化疗以及手术＋化疗＋免疫治疗三组癌细胞转阴率分别为２５．０％、４２．８％和６２．５％。     

腺泡状软组织肉瘤22例临床治疗分析

目的探讨腺泡状软组织肉瘤的临床治疗和预后。方法对１９７３～１９９６年间收治的２２例腺泡状软组织肉瘤患者的临床资料进行回顾性分析。结果２２例均接受手术治疗,其中１７例行肿瘤局部切除,５例行扩大切除。７例病理误诊为其他软组织肿瘤（占３２％）。９例术后进行了预防性辅助放疗和（或）化疗。对２１例患者随访４个月至９年。６例患者术后复发（占２８％）,１３例出现肺转移（占６２％）,５例在随访８个月至４年５个月时死亡（占２４％）,６例患者生存５年以上。全组经ＫａｐｌａｎＭｅｉｒｅ生存率计算其３年、４年、５年生存率分别为８３％、７５％及６６％。结论腺泡状软组织肉瘤多需病理学诊断,肿瘤局部切除是复发和转移最重要的因素,术后预防性辅助治疗对局部复发和转移没有明显的控制作用,对出现肺转移的患者采取多程标准化疗方案进行治疗,临床效果尚满意     

骨源性肉瘤肺转移的手术治疗

目的 回顾性总结骨源性肉瘤肺转移的手术治疗经验，探讨影响疗效的相关因素。方法 自1980年10月～2003年3月共治疗骨源性肉瘤肺转移患者32例，男22例．女10例；年龄11～61岁，平均22.1岁，多数为青少年。骨肉瘤25例，皮质旁骨肉瘤2例．软骨肉瘤3例．骨纤维肉瘤1例．Ewing肉瘤1例。ⅡB期26例(83.9％)．ⅢB期5例(16．1％)，另1例Bwing肉瘤按Enncking外科分期系统规定不能纳入分期。双肺多发转移25例(78.1％)，单肺多发转移1例(3.1％)．单肺单发转移6例(18．8％)，合并肺外引流区淋巴结转移3处，锁骨转移2处，Ta椎体转移1处，胸骨转移1处。臀大肌转移1处，项部肌肉转移1处。共施行开胸术62例次。术式以肺转移瘤局部切除为主．施行肺叶切除术仅5次。结果 32例中30例获得随访．2例失坊。25例骨肉瘤中完成双肺转移瘤切除的18例，无瘤生存7例(38．9％)．平均生存7年3个月．其中ⅢB期2例。Ewing肉瘤、软骨肉瘤各1例．分别无瘤生存22年5个月、13年3个月。皮质旁骨肉瘤2例．分别无瘤生存19年3个月和1个半月，死亡的21例(包括失访的2例)中除死于术后感染2例及麻醉意外2例外，余生存期均得到延长。结论 手术切除肺转移瘤是挽救患者生命的有效措施，术式应以转移瘤局部切除为主，新辅助化疗是提高骨源性肉瘤肺转移手术治疗疗效、挽救患者生命的重要前提。     

57例婴幼儿复杂心脏畸形的外科治疗

报告１９９１年９月至１９９４年８月期间收治的５７例婴幼儿复杂先天性心脏病，包括右室双出口１６例、完全性大动脉转位８例、完全性心内膜垫缺损７例、完全性肺静脉畸形引流６例、肺动脉闭锁４例、单心房４例、三尖瓣闭锁和主动脉弓中断各３例、左冠状动脉右室瘘２例、单心室和镰刀综合征各１例及其他复杂畸形２例。６例行姑息性手术，手术早期死亡１例（１６．７％）；５１例行一期矫治术，手术早期死亡９例（１７．６％）。总手术早期死亡为１７．５％，最近２年早期死亡率为１２．５％。主要死亡原因为肾功能衰竭和低心输出量综合征。     

前列腺肉瘤：附10例报告

自１９４９－１９９４年５月共诊治前列腺肉瘤１０例，占同期收治前列腺恶性肿瘤的２．７％年年１８－５５岁，平均３５．２岁。其中６例以进行性排尿困难为第一症状，仅１例血尿为第一症状，且继而出现排尿困难，直肠指现巨大前列腺肿瘤９例术前活检确诊。７例作非根治性切除术或放疗，术后２－６个月死亡。３例作根治性切除术，其中１例单纯手术，术后９个月死亡，２例术前化疗和术后化疗或放疗，术后５和１３个月均发现复发或转移     

Ⅲ期胃癌治疗的探讨

１９７５年至１９８９年作者共收治Ⅲ期胃窦、体部癌患者２３８例，随访９０．７％，总５年生存率为４５．４％，１０年生存率为３３．７％。扩大根治组（选择性Ｒ＿３或Ｒ＿３）术后５年和１０年生存率分别为５６．３％和４７．５％，显著高于普通根治组（Ｒ＿２）的３５．７％和２３．３％。术后辅助化疗组５年生存率和１０年生存率分别为３６．４％和１２．１％。显著高于未用化疗组（９．５％和３．６％）。化疗加中药组术后生存率（７８，１％和４５％）显著高于单用化疗组。腹腔冲洗、化疗组和腹腔化疗组的腹膜转移率分别为１８．７％和２０．６％，显著低于腹腔未治疗组（３１．９％）。作者认为Ⅲ期胃癌最佳治疗方案为切除足够的胃和淋巴结，防治腹膜和血行转移。     

不同尿液引流法在尿道成形术后的应用价值

１９９０年１月－１９９７年７月采用各种术式一期矫治尿馘上裂患者７０例。术后均作尿液引流。按尿液引流方法分为３组；Ａ组，行膀胱造瘘引流，３５例，Ｂ组，行会阴尿道造瘘引流１８例，Ｃ组、经悄道导管引流１７例，Ａ，Ｂ，Ｃ组患者住院天数分别为４０．２，３７．４，２０．０ｄ；１次手术成功率分别为４５．７％，７２．２％，８２．４％。     

脐尿管腺癌(附12例报告)

目的　提高脐尿管腺癌的诊治效果。　方法　回顾性总结１９７８ ～１９９７ 年收治１２ 例脐尿管腺癌的诊治结果。　结果　脐尿管腺癌占同期收治膀胱癌６８８ 例的１ ．７ ％ ，膀胱腺癌的３８ ．７ ％ 。血尿为最常见的临床症状，膀胱镜检见膀胱顶部肿瘤直径小于 Ｂ 超或 Ｃ Ｔ 扫描结果。７ 例行扩大性膀胱部分切除，无１ 例局部复发，５ 例行膀胱部分切除术，其中４ 例复发。５ 年生存率３３ ％ 。２ 例肺转移患者经放疗＋ 化疗后分别生存２８ 个月和６０ 个月。　结论　扩大性膀胱部分切除术可作为脐尿管腺癌的主要手术方式，对复发、转移病例应积极采取综合治疗。     

Prognosis for patients who have osteosarcoma with skip metastasis

We analyzed the cases of twenty-three patients who had Stage-IIB osteosarcoma and skip metastasis to determine the rates of disease-free and long-term survival. The regimens of preoperative and postoperative chemotherapy varied. The patterns of relapse and long-term survival were studied in relation to the skip lesions, and these patterns were compared with those of 224 patients who had Stage-II osteosarcoma but no skip lesion. Of the twenty-three patients who had a skip lesion, twenty-two had either a local recurrence or a distant metastasis; twenty-two patients died, and one remained disease-free at thirty-eight months. Kaplan-Meier analysis showed significant differences in the rates of local recurrence and distant metastasis (Mantel-Cox test statistic, p less than 0.0001) and in the over-all survival (Mantel-Cox test statistic, p less than 0.0001) between the patients who had and those who did not have skip metastasis. The cases of fourteen patients who had skip metastasis from a lesion in the distal end of the femur were compared with those of eighty-seven patients who had a similarly situated primary lesion but no skip metastasis. The difference was significant, although less so than when lesions in all anatomical sites were analyzed. The follow-up data indicated that the use of adjuvant chemotherapy did not improve the poor prognosis of patients who had skip metastasis. Therefore, we regard a skip lesion, along with regional lymphatic metastasis or metastasis to a distant organ, as another criterion for considering an osteosarcoma to be Stage III.     

Osteosarcomas after the Age of 50: A Clinicopathologic Study of 64 Cases—an Experience in Northern Japan

Background: The clinicopathologic profile and prognostic factors of osteosarcomas after the age of 50 years have been obscure.Methods: Clinicopathologic features were analyzed in 645 patients with osteosarcoma who were registered at the Tohoku Musculoskeletal Tumor Society and National Cancer Center in Tokyo between 1972 and 2002.Results: Sixty-four patients (9.9%; 34 men and 30 women) were more than 50 years old. The most common location was the distal femur (n = 13), followed by the pelvis (n = 10), proximal femur (n = 9), and proximal fibula (n = 6). Seven (11%) patients had lung metastasis at initial presentation. On radiographs, an osteolytic appearance without periosteal reactions was a common and characteristic feature. Forty-eight tumors (75%) were classified as conventional osteosarcomas. Fourteen cases (22%) were secondary; postradiation osteosarcoma was most common in these patients, but there was no Pagets sarcoma. At the initial presentation, misdiagnoses without biopsy were made in 15 (23%) of the 64 cases. Preoperative chemotherapy was given to 22 patients, but the effect was poor in 18 cases (82%). Fifty-four patients underwent surgery, whereas the other 10 patients were treated without surgery because of systemic or inoperable local conditions. The overall survival rate at 5 years was 55.5%. Multivariate analysis showed initial pulmonary metastasis, axial tumor location, and larger tumors as significant prognostic factors.Conclusions: In northern Japan, most patients with osteosarcoma after the age of 50 had primary osteosarcoma. Careful radiological examination and biopsy are mandatory for correct diagnosis. Current systemic chemotherapy is not effective for this age group. Alternative treatment strategies should be considered.     

40~60岁肢体骨肉瘤病人的临床治疗效果与策略

目的 分析40~60岁肢体骨肉瘤病人的临床治疗疗效,总结预后相关因素并探讨治疗策略。方法 回顾性分析2002年4月至2015年10月国内7家骨肉瘤治疗中心收治的确诊为肢体骨肉瘤的62例病人的资料,其中男34例,女28例;年龄范围限定在40~60岁,平均年龄为50.4岁;收集病人一般情况、发病部位、术前穿刺、化疗情况、手术方式、复发转移及生存情况等。以上述因素为变量指标,应用Kaplan-meier法测算生存率,研究这些因素与3年、5年生存率之间的关系。结果 62例肢体骨肉瘤病人中发病于膝关节周围者50例,约占80.6%。62例病人均得到随访,随访12~115个月,平均随访时间为43个月;3年和5年总生存率为80.6％、56.5%;3年和5年无瘤生存率为41.9%、32.3%;5年总生存率：术前化疗组与未化疗组分别为51.5%、62.1%;术后化疗组与未化疗组分别为52.1%、71.4%;术前术后均化疗组与均未化疗组为51.6%,61.3%;保肢手术组和截肢手术组分别为57.1%、53.8%。术后无复发转移、单纯复发、肺转移、多发转移的病人3年生存率分别为89.7%、78.6%、50.0%、73.3%。结论 40~60岁肢体骨肉瘤病人,膝关节周围发病率高于年轻病人,且预后较差,其预后与术前穿刺明确诊断、术后复发转移情况密切相关,其临床治疗应当建立在充分切除肿瘤的基础之上,严格遵照Enneking外科分期,降低肿瘤的复发转移率,以期改善预后。     

含洛铂方案的新辅助化疗在骨肉瘤及尤因肉瘤中的疗效观察

背景：化疗是骨肉瘤及尤因肉瘤最主要的治疗手段之一,目前化疗疗效已进入平台期,选择低毒高效的化疗药物及方案是关键。目的：观察含洛铂（LBP）方案的新辅助化疗对骨肉瘤及尤因肉瘤的疗效及不良反应。方法：2011年10月至2012年10月收治经病理学检查确诊为原发恶性骨肿瘤患者22例,其中骨肉瘤13例,尤因肉瘤9例;男17例,女5例,年龄9～23岁,平均18.3岁;Enneking分期：ⅡA期3例,ⅡB期19例。给予LBP-多柔比星（AMD）方案交替异环磷酰胺（IFO）方案（LBP 30mg/m2,AMD 60mg/m2;IFO12g/m2;全身静脉给药）的新辅助化疗,后行保肢手术治疗。采用RECIST评价标准评价其疗效,并观察不良反应。结果：22例中完全缓解（CR）1例,部分缓解（PR）18例,疾病稳定（SD）3例,总有效率（RR）为86.4%。随访3～14个月,平均9.2个月,1例脊柱骨肉瘤患者术后5个月复发,其余患者未发现复发或转移征象。主要不良反应为限制性骨髓抑制,化疗间歇期患者恢复快,无明显肾功能异常及过敏反应。结论：骨肉瘤及尤因肉瘤接受含LBP方案的新辅助化疗的近期疗效满意,不良反应可耐受,值得进一步临床研究。     

四肢Ⅱ期骨肉瘤的化疗效果评价

目的 对四肢骨肉瘤患者实施化疗的效果以及与生存率的关系进行总结.方法 1997年7月至2007年7月采用新辅助化疗及手术治疗ⅡB期骨肉瘤患者296例,其中男性184例,女性112例,年龄7～65岁.其中股骨近端10例,股骨干部7例,股骨远端148例,胫骨近端80例,胫骨远端5例,腓骨11例,肱骨33例,桡骨远端2例.外科分期(Enneking分期):6例为ⅡA期,290例为ⅡB期.对所有病例进行术前化疗反应评估,72例进行肿瘤坏死率分析.结果 296例患者平均随访时间47个月,出现远处转移98例,占33.1%.对术前化疗反应明显有效的103例患者中,15.5%出现转移;部分有效的145例患者中,31.0%出现转移;术前化疗无效的48例患者77.1%出现转移.在坏死率分析研究中,化疗后肿瘤体积明显缩小、肿瘤边界变清晰的病例,肿瘤坏死率明显升高.结论 骨肉瘤一旦诊断明确,应尽早给予化疗,化疗效果良好的患者,全身转移的可能性减小,无瘤生存率高.     

骨膜骨肉瘤与高度恶性表面骨肉瘤

目的报告表面骨肉瘤的两种少见亚型,即骨膜骨肉瘤和高度恶性表面骨肉瘤的诊治经验。方法回顾 5例骨膜骨肉瘤和 4例高度恶性表面骨肉瘤患者的影像学和病理学特点,并对临床治疗结果进行分析。 5例骨膜骨肉瘤患者,男 1例,女 4例;年龄 28～ 42岁,平均 35岁;肿瘤位于胫骨上段者 4例,股骨下段者 1例。 4例高度恶性表面骨肉瘤患者,男 3例,女 1例;年龄 17～ 23岁,平均 19.25岁; 4例患者肿瘤均位于股骨下段。结果 5例骨膜骨肉瘤均予以广泛切除,除 1例因局部复发行截肢术,现无瘤生存 1年 3个月外,余 4例已无瘤生存 3～ 9年,平均 5年 9个月。 4例高度恶性表面骨肉瘤患者,虽经积极综合治疗,但仅 1例无瘤生存 7年; 1例术后 2年 5个月复发而截肢,现无瘤生存 1年 9个月; 1例于术后 2年 4个月死于肺转移;另 1例在确诊后 3个月死亡。结论骨膜骨肉瘤和高度恶性表面骨肉瘤各具鲜明的影像学和病理学特点,骨膜骨肉瘤恶性程度较低,应采用以局部广泛切除为主的手术治疗,预后相对较好;而高度恶性表面骨肉瘤的生物学行为则与经典的髓内骨肉瘤相似,预后较差,必须采用手术与化疗相结合的综合治疗方法。     

Kissing pleural metastases from metastatic osteosarcoma of the lung.

Two patients with osteosarcoma lung metastases of which migrated to the parietal pleura due to contact are reported. The first patient was a 16-year-old male who had a pleural metastasis in the diaphragm within an area in contact with a single lung metastasis. Both of the tumors were resected, followed by systemic chemotherapy. Nine months after the resection of the first metastases, two other lung metastases were found which were resected after chemotherapy. The patient is alive without recurrence 84 months after the first resection of the metastases. The second patient was an 11-year-old female with a pleural metastasis of osteosarcoma which was within an area in contact with a single lung metastasis, which had been resected 4 months before. We concluded (1) that a lung metastasis of osteosarcoma occasionally metastasizes to the pleura due to contact; and (2) that because this kissing metastases of osteosarcoma could be cured by a complete resection, the intrathoracic cavity should be thoroughly observed.     

外科治疗胃癌肝转移疗效分析

目的探讨外科治疗胃癌肝转移的方法与疗效。方法1996年1月至2003年12月间行外科治疗的胃癌肝转移患者25例，17例为同时性肝转移，8例为术后发现的异时性肝转移。其中单转移灶15例，多转移灶10例。行不规则肝切除16例，左外叶切除4例，左叶切除3例，右叶切除2例，术后行肝动脉灌注化疗9例，肝动脉化疗栓塞16例。结果1例同时性肝切除患者术后死于肺部感染、成人呼吸窘迫综合征，余24例均获随访，中位时间25(7—60)个月。胃癌肝转移灶切除后1、3年生存率为68．5％和29．8％，原发癌浸润表浅、淋巴结转移少、单转移灶、异时性转移及转移灶有包膜是影响生存率的有利因素。结论同时及异时性胃癌肝转移可经外科手术切除肝转移灶，但应注意手术指征的把握。     

三氧化二砷联合化疗治疗Ⅲ期成骨肉瘤、尤文肉瘤的初步报告

目的 探讨三氧化二砷（Arsenic trioxide,As2O3）联合化疗治疗转移性成骨肉瘤、尤文肉瘤的可行性。方法自2002年12月至2005年6月,32例转移性成骨肉瘤、尤文肉瘤患者接受了以三氧化二砷为主的二线化疗方案。其中男性19例,女性13例,年龄7～32岁。成骨肉瘤27例,尤文肉瘤5例;肿瘤转移部位包括肺转移25例,多发骨转移7例。所有病例均为手术后患者,术前及术后共接受过4～6周期的规范化疗。化疗方案：三氧化二砷、VP-16、紫杉醇。化疗2个周期28例,3个周期4例。结果所有患者均获得随访,随访时间6～36个月,平均20个月。经三氧化二砷联合化疗2个疗程后,5例完全缓解（15．6％）,转移病灶消失,无新发病灶出现;6例部分缓解（18．8％）;13例稳定（40．6％）,转移病灶无明显缩小,但出现明显钙化,其中完全钙化2例,部分钙化11例;8例进展（25％）,肿瘤体积增大或转移数目增多。21例治疗前碱性磷酸酶或乳酸脱氢酶增高的病例,9例（42．9％）明显下降。32例患者中病情持续稳定,肿瘤得到控制者24例,病情加重5例,死亡3例。结论三氧化二砷是一种低毒、有效的化疗药物,对于Ⅲ期成骨肉瘤、尤文肉瘤患者有较好的近期临床疗效。     

骨肉瘤患者血清中整合素α2β1的表达水平

目的 检测骨肉瘤患者血清中整合素α2β1的表达,探讨其与骨肉瘤生物学行为的关系及在治疗前后和肺转移时的变化.方法 应用酶联免疫吸附技术检测43例骨肉瘤患者(病例组)术前及术后、化疗前及化疗后血清整合素α2β1含量,男28例,女15例;年龄8～47岁,平均(18.42±9.10)岁;骨母细胞型24例,纤维母细胞型9例,软骨母细胞型7例,其他3例;EnnekingⅡA期13例,ⅡB期26例,Ⅲ期4例;其中22例患者接受新辅助化疗.26例志愿者为正常对照组,男16例,女10例;年龄18～32岁,平均(23.54±3.82)岁.病例组分别根据肿瘤大小、原发部位、临床分期、组织学分型以及转移情况进行分组,比较各组血清中整合素α2β1表达的差异.结果 病例组患者术前血清整合素α2β1为(2.44±0.89)μg/L,显著高于对照组(1.85±0.43)μg/L.术前表达水平与骨肉瘤Enneking临床分期、肿瘤大小和远处转移存在相关性,而与肿瘤原发部位及Dahlin组织学分型无关.骨肉瘤保肢术后患者整合素α2β1的血清浓度降低.接受新辅助化疗的患者化疗前后血清中整合素α2β1表达水平的差异具有统计学意义.结论 整合素α2β1的表达与骨肉瘤的发生、发展、转移呈正相关,可能成为一项新的诊断及评估骨肉瘤预后的生物学指标.

Abstract：

Objective To evaluate the expression of Integrin α2β1 in serum of osteosarcoma patients and to investigate the effect of Integrin α2β1 on metastasis of osteosarcoma. Methods Sandwich enzymelinked immunosorbent assay was applied to test Integrin α2β1 in serum of 26 healthy controls (male 16, female 10; age 18-32, average age 23.54±3.82) and 43 osteosarcoma patients (male 28, female 15;age 8-47,average age 18.42±9.10)before and after the surgery and the chemotherapy. The patients included osteoprogenitor cells type in 24 cases, fibroblast type in 9 cases, chondroblast type in 7 cases, and other types in 3cases; with Enneking stage ⅡA in 13 cases, stage ⅡB in 26 cases, stage Ⅲ in 4 cases. Among them, 22 patients receive the neo-adjuvant chemotherapy. After that, we compared the data of different groups. At the same time, in accordance with tumor size, position, clinical stage, histology grade and metastasis situation to categorize groups compared among the groups of serum Integrin α2β1 differences in order to explore its relationship with patients' prognosis and metastasis. Results The Integrin α2β1 of osteosarcoma patients in blood before the surgery was expressed highly. It was significantly higher than the control group. The expression before surgery had significant correlation with osteosarcoma Enneking clinical stages, tumor size and metastasis. And it was independent of tumor position and Dahlin histology grade. The expression of Integrin α2β1 in blood of the osteosarcoma patients after limb salvage surgery decreased significantly. And the expression of Integrin α2β1 in blood of patients receiving new adjuvant chemotherapy was significant differences before and after the chemotherapy. Conclusion The expression of Integrin α2β1 has positive correlation with the occurrence, development and metastasis of the osteosarcoma. It is probably a new biological indicator for diagnosis and estimating prognosis of osteosarcoma. Simultaneously surgery and new adjuvant chemotherapy are still effective methods to treat osteosarcoma.