胃癌医源性扩散及其防治

胃癌医源性扩散及其防治南京市第一医院肿瘤科王昌林，丁航由于近年来对胃癌根治术的开展，使胃癌临床治愈率显著提高．而有些病例术后过早的发生吻合口复发和远处转移，切口内种植癌，疗效不够理想．如何降低过早的局部复发和远处转移，切口内种植癌发生率，其重要的环节...     

放射性粒子植入术针道医源性肿瘤种植转移的临床观察

随着放射性粒子植入治疗肿瘤临床应用范围的扩大,对其引起的并发症也越显重要。穿刺恶性肿瘤能否引起针道医源性种植转移尚存争论。笔者对2005—2006年16例粒子植入患者术中所用植入针涂片行细胞学检查,现将术后随访结果报道如下。一、材料与方法1.一般资料:16例恶性肿瘤患者均经病理证实,无粒子     

Iatrogenic tumor implantation

Iatrogenic tumor implantation is a condition that results from various medical procedures used during diagnosis or treatment of a malignancy. It involves desquamation and dissemination of tumor cells that develop into a local recurrence or distant metastasis from the tumor under treatment. The main clinical feature of the condition is nodules at the operation＇s porous channel or incision, which is easily diagnosed in accordance with the case history. Final diagnosis can be made based on pathological examination. Tumor implantation may occur in various puncturing porous channels, including a laparoscopic port, abdominal wall incision, and perineal incision, etc. Besides a malignant tumor, implantation potential exists with diseases, such as a borderline tumor and endometriosis etc. Once a tumor implantation is diagnosed, or suspected, surgical resection is usually conducted. During the diagnosis and treatment of diseases, avoiding and reducing iatrogenic implantation and dissemination has been regarded as an important principle for surgical treatment of tumors. In a clinical practice setting, if possible, excisional biopsy should be employed, if a biopsy is needed. Repeated puncturing should be avoided during a paracentesis. In a laparoscopic procedure, the tissue is first put into a sample bag and then is taken out from the point of incision. After a laparoscopic procedure, the peritoneum, abdominal muscular fasciae, and skin should be carefully closed, and/or the punctured porous channel be excised. In addition, the sample/tissue should be rinsed with distilled water before surgical closure of the abdominal cavity, allowing the exfoliated tumor cells to swell and rupture in the hypo-osmolar solution. Then surgical closure can be conducted following a change of gloves and equipment. The extent of hysteromyomectomy should as far as possible be away from the uterine cavity. The purpose of this study is to make clinicians aware of the possibility of tumor implantation and to give special attention to avoid, or re     

Iatrogenic tumor implantation

Iatrogenic tumor implantation is a condition that results from various medical procedures used during diagnosis or treatment of a malignancy. It involves desquamation and dissemination of tumor cells that develop into a local recurrence or distant metastasis from the tumor under treatment. The main clinical feature of the condition is nodules at the operation's porous channel or incision, which is easily diagnosed in accordance with the case history. Final diagnosis can be made based on pathological examination. Tumor implantation may occur in various puncturing porous channels, including a laparoscopic port, abdominal wall incision, and perineal incision, etc. Besides a malignant tumor,implantation potential exists with diseases, such as a borderline tumor and endometriosis etc. Once a tumor implantation is diagnosed, or suspected, surgical resection is usually conducted.During the diagnosis and treatment of diseases, avoiding and reducing iatrogenic implantation and dissemination has been regarded as an important principle for surgical treatment of tumors. In a clinical practice setting, if possible, excisional biopsy should be employed, if a biopsy is needed. Repeated puncturing should be avoided during a paracentesis. In a laparoscopic procedure, the tissue is first put into a sample bag and then is taken out from the point of incision. After a laparoscopic procedure, the peritoneum, abdominal muscular fasciae, and skin should be carefully closed, and/or the punctured porous channel be excised. In addition, the sample/tissue should be rinsed with distilled water before surgical closure of the abdominal cavity,allowing the exfoliated tumor cells to swell and rupture in the hypo-osmolar solution. Then surgical closure can be conducted following a change of gloves and equipment. The extent of hysteromyomectomy should as far as possible be away from the uterine cavity. The purpose of this study is to make clinicians aware of the possibility of tumor implantation and to give special attention to avoid, or reduce iatrogenic implantation during a surgical procedure.     

食管癌切除术中医源性损伤八例分析

在食管癌切除术中,由于肿瘤的部位、外侵程度、麻醉效果及手术者操作熟练程度等原因,可能发生医源性损伤.1996年2月～2000年5月,我科共行食管癌手术283例,术中发现或经二次手术证实,发生医源性损伤8例,为汲取经验教训,结合临床分析报道如下.     

腋下纵切口在肺肿瘤切除术中的应用

回顾分析了20例腋下纵切口行肺肿瘤切除术的临床资料，沿患侧背阔肌前缘做纵切口，在深筋膜浅面向切口两侧以电刀游离皮瓣，于背阔肌前缘切断其筋膜，分别向前，后分开背疾肌，前锯肌，切开肋间肌和胸膜，用两个互相垂直的开胸器开胸，与标准后外侧切口相比，开，关胸时间缩短，术后切口疼痛轻，上臂功能恢复快，肺部感染发生率低，切口愈合好，结果提示，腋下切口具有较多优点，有一定的推广价值。     

头颈部肿瘤选择性动脉插管化疗并发症的防治

目的：探讨头颈部肿瘤选择性动脉插管化疗并发症的防治方法。方法：回顾性分析52例头颈部肿瘤患选择性动脉插管化疗出现的并发症及其处理，结果：并发症有局部血肿、消化道反应、发热、造影剂反应、局部毒性反应、动脉栓塞、脱发等，结论：临床医师应对头颈部肿瘤介入插管出现的并发症引起重视，尽可能避免其发生，一旦发生应正确诊断及处理。     

A GFP-labeled Human Colon Cancer Metastasis Model Featuring Surgical Orthotopic Implantation

Colorectal cancer has become a major disease threatening human health. To establish animal models thatexhibit the characteristics of human colorectal cancer will not only help to study the mechanisms underlying thegenesis and development effectively, but also provide ideal carriers for the screening of medicines and examiningtheir therapeutic effects. In this study, we established a stable, colon cancer nude mouse model highly expressinggreen fluorescent protein (GFP) for spontaneous metastasis after surgical orthotopic implantation (SOI). GFPlabeledcolon cancer models for metastasis after SOI were successfully established in all of 15 nude mice and therewere no surgery-related complications or deaths. In week 3, primary tumors expressing GFP were observed inall model animals under fluoroscopy and two metastatic tumors were monitored by fluorescent imaging at thesame time. The tumor volumes progressively increased with time. Seven out of 15 tumor transplanted mice diedand the major causes of death were intestinal obstruction and cachexia resulting from malignant tumor growth.Eight model animals survived at the end of the experiment, 6 of which had metastases (6 cases to mesentericlymph nodes, 4 hepatic, 2 pancreatic and 1 mediastinal lymph node). Our results indicate that our GFP-labeledcolon cancer orthotopic transplantation model is useful with a high success rate; the transplanted tumors exhibitsimilar biological properties to human colorectal cancer, and can be used for real-time, in vivo, non-invasive anddynamic observation and analysis of the growth and metastasis of tumor cells.     

Implantation Metastasis along the Stereotactic Biopsy Tract in Anaplastic Astrocytoma: A Case Report

Objective and importance: Stereotactic biopsy for brain lesion is usually a safe procedure and the reported rate of complication is minimal. Moreover, local seeding along the trajectory of the stereotactic biopsy is a rare complication. The authors report a case of metastatic implantation along the trajectory of the stereotactic biopsy in anaplastic astrocytoma. Clinical presentation: A 64-Year-old man who presented with a one-month history of speech and memory disturbance underwent magnetic resonance (MR) imaging that disclosed a large mass in the left basal ganglia and medial temporal region. Intervention: Under the impression of high-grade glioma, computed tomography guided stereotactic biopsy was performed using the Riechert–Mundinger system. The histologic diagnosis was anaplastic astrocytoma. MR images after two cycles of chemotherapy showed a small enhancing portion in the middle of the biopsy tract, which was considered a surgical artifact and not included in the field of the following conventional fractionated radiation therapy. MR images three months after the completion of radiation therapy revealed that the enhancing portion had become a larger mass irrespective of good control of the primary tumor. Conclusion: Our findings suggest that tumor seeding along the stereotactic biopsy trajectory must be considered if an enhancing lesion appears in the MR image following the stereotactic biopsy. The cause and the prevention of implantation metastasis along the stereotactic biopsy tract are also discussed.     

Establishment of a Fluorescent Implantation Metastasis Model of Bladder Cancer and Real-time Microscopic Detection in Nude Mice

Objective: To establish a fluorescent implantation metastasis model of bladder carcinoma with high metastaticpotential in nude mice and observe development and metastasis. Methods: Human bladder cancer EJ cells withhigh invasive ability were screened and transfected with GFP plasmid to screen stable enhanced GFP-expressingclones instilled into the bladders of nude mice. Subsequent growth, invasion, and metastasis of the implantedtumors were observed and evaluated with a whole-body fluorescence optical imaging system. Results: Thetransfected bladder cancer EJ cells stably and efficiently expressed EGFP. The growth, invasion and metastasisof the implant bladder tumor were readily observed and accurately evaluated by fluorescent microscopy. Inthe bladders of nude mice, the rates of EGFP expression detected by flow cytometry at weeks 1-4 were 22.6%,46.7%, 62.3% and 72.7%, respectively, with clear increase over time. Conclusion: GFP-labeled bladder cancerEJ cells display green fluorescence under fluorescent microscopy and show stable GFP expression. The model willprovide a simple and reliable means for studying the mechanism of implantation metastasis of human bladdercancers in vivo.     

结肠造口术的并发症及防治

[目的]提高造口成功率，减少并发症，改善造口病人的生活质量。[方法]对我院近15年来的直肠癌行结肠造口术，发生并发症的24例进行了分析。[结果]造口周围皮炎8例，造口狭窄5例，造口处肠管脱垂及造口旁疝各4例，造口肠管坏死、造口肠管回缩及造口肠管侧壁漏各1例。〔结论〕要重视造口过程中的每一步操作。     

乙状结肠造口术并发症73例分析

（目的）探讨乙状结肠造口术并发症的防治。（方法）1985年至1995年间进行了202例乙状结肠造口术。（结果）与造口有关的并发症73例，包括造口周围炎35例、造口狭窄21例、造口结肠旁疝6例、造口出血4例、造口肠管回缩3例、造口肠管脱垂2例、造口肠管坏死2例。73例并发症病人经治疗均痊愈出院。（结论）重视手术操作能降低并发症的发生率，术后加强观察和护理，早期发现和处理是提高治疗成功率的关键。     

Cochlear Implantation in Pediatric Patients: Comparison of Limited-Incision and Standard Cochlear Implantation

Today, cochlear implantation has become the standard procedure for rehabilitation of people with impaired sensory neural hearing. This procedure can be done through different techniques. The present study aimed to compare the standard technique (ST) with creation of “C” incision into the scalp with suture fixation and limited-incision technique (LIT) with creation of subperiosteal pocket without any fixation. The outcomes included operative time and complications. This retrospective study was conducted on 343 consecutive cochlear implantations. The patients received cochlear implants at our institution between 2004 and 2011. The complications were identified as “minor” or “major”. All the complications and operation times were assessed for the two surgical techniques. The overall rates of complications were 4.4 % (11 out of 252) and 2.2 % (2 out of 91) for ST and LIT, respectively. The results revealed no significant difference between the two fixation techniques regarding the complications. The mean operation time was 150 ± 23.7 and 133 ± 23.12 min in ST and LIT, respectively, and the difference was statistically significant. Both ST and LIT are safe techniques with a relatively low complication rate. However, ST can be effectively replaced by LIT because of its shorter operative time.     

结肠造口并发症的原因及防治

[目的]分析结肠造口并发症的原因，探讨其防治措施。[方法]回顾分析1987年至1997年10年间所作结肠造口158例，其中结直肠癌150例，结肠吻合口疾3例，肛管直肠外伤需旷置3例，结-肚吻合口瘘2例；单腔结肠造口122例，双腔结肠造口36例；急诊手术组32例，择期手术组126例。（结果）并发症共27例，发生率为17％；单腔造口为11例，双腔造口为16例；急诊手术组为10例，择期手术组为17例，前者的发生率明显高于后者。[结论]术前充分的肠道准备，合理选择造口术式、造口部位及造口器材；术中正确细心的操作；术后细致的护理及严密观察，是减少结肠造口并发症，提高结肠造口水平的重要步骤。     

胃肠道癌术后种植转移的临床特征及预后分析

摘 要：［目的］ 探讨胃肠道癌术后种植转移的临床特征及预后。［方法］ 回顾性分析52例胃肠道癌并术后种植转移患者的临床资料和随访结果。［结果］ 在种植转移的原发胃肠道癌中,98.1%（51/52）病例为T4期,82.7%（43/52）为低分化腺癌,腹水量≥100ml占73.1%（38/52）,术后常规化疗者占75%（39/52）,术后常规化疗组与未化疗组的种植转移时间差异无统计学意义（P＞0.05）,胃肠道癌术后种植转移1、3、5年总生存率分别为84.0%、54.2%和15.8%;单因素生存分析显示,原发癌的TNM分期、腹水量、远处器官转移是影响患者预后生存的主要因素（P＜0.05）,而多因素分析显示远处器官转移是预后最为明显的危险因素(P<0.05)。［结论］ 种植转移的原发胃肠道癌的恶性程度高、分期晚、分化低,常规化疗不能有效预防种植转移癌,原发癌的TNM分期、术中腹水量、远处器官转移是种植转移主要的不良预后因素,其中远处器官转移是最为明显的危险因素。