Clinical stage II non-seminomatous germ cell testicular tumours. Results of management by primary chemotherapy

Between 1977 and 1984, 92 patients with clinical Stage II non-seminomatous germ-cell testicular tumours were treated by primary chemotherapy, with surgery reserved for the excision of persisting masses. Eighty patients (87%) are alive and disease-free: 96% for Stages IIA and IIB and 74% for Stage IIC. Of 43 Stage IIA, B and C patients treated with bleomycin, etoposide and cisplatin (BEP), 40 (93%) are disease-free. For the whole group there was a significant difference between the outcome of treatment in patients with retroperitoneal masses greater than 8 cm in transverse diameter compared with those in whom masses were less than 8 cm, the disease-free rates being 54 and 97% respectively. Primary histology did not influence the outcome of treatment. However, whereas 51% of patients with teratocarcinoma had masses resected after chemotherapy, only 26% of embryonal carcinoma patients came to surgery. The results obtained in this series are as good as those obtained when lymph node dissection is employed as the initial form of treatment. The avoidance of surgery with preservation of ejaculatory function in 78% of Stage IIA and IIB patients argues in favour, of an initially non-surgical approach to management.     

颈淋巴结清扫在分化型甲状腺癌再手术中的价值

目的：探讨颈淋巴结清扫术在分化型甲状腺癌再手术中的价值。指导甲状腺癌再手术的术式选择。方法。回顾性分析122分化型甲状腺癌再次手术病人中88例作颈淋巴结清扫术的临床资料。88例中，甲状腺肿瘤局部切除术38例，甲状腺腺叶加峡部切除术16例，全甲状腺切除2例，颈淋巴结活检32例，结果：甲状腺微小癌11例，颈淋巴结转移率65．91％（58／88），甲状腺残癌率31．59％（12／38）。结论：颈淋巴结清扫术在甲状腺癌再次手术中具有明确的治疗作用，对侵及包膜，颈淋巴结肿大以及甲状腺微小癌应作颈淋巴结清扫术。对复发癌应再次手术。再手术需彻底切除癌灶，保护甲状旁腺及喉返神经。     

Clinicopathologic characteristics and survival of patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus treated with three-field lymph node dissection

Objective: Clinicopathologic characteristics and survival rates of patients with clinical Stage I tumors treated with three-field lymph node dissection have not been well investigated. This report documents the results of a series of cases of clinical Stage I squamous cell carcinomas treated with this surgical procedure in our institute. Methods: From January 1988 to March 1997, 326 patients with carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with three-field lymph node dissection. Two hundred and ninety-seven (91%) of these had squamous cell carcinomas. Fifty-seven (18%) patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus were retrospectively reviewed here. Results: Among 57 clinical Stage I squamous cell carcinomas, ten (18%) were diagnosed as T1-mucosal and 47 (83%) as T1-submucosal. Seventy percent of the patients with clinical T1-mucosal tumors had additional primary esophageal lesions. The operative morbidity and in-hospital mortality rates were 63 and 0%, and the overall 1-, 3-, 5-, and 10-year survival rates were 95, 86, 78, and 70%, respectively. Of the 57 tumors assessed pathologically, 12 (21%) were T1-mucosal, 42 (74%) were T1-submucosal, and three (5%) were T2. Nineteen (33%) exhibited lymph node metastasis. The 1-, 3-, 5-, and 10-year survival rates for patients with lymph node metastasis were 90, 79, 73, and 58%, respectively, as compared with 97, 90, 80, and 76, respectively for patients without lymph node metastasis (P=0.24). The accuracy of preoperative staging, based on both wall penetration and the status regarding lymph node metastasis, was 63%. With reference to the 1997 UICC-TNM staging system, 36 (63%) were pStage I, two (4%) were pStage IIA, 18 (28%) were pStage IIB, and three (6%) were pStage IVB. The 1-, 3-, 5-, and 10-year survival rates for patients with pStage I disease were 97, 92, 85, and 81%, respectively. In those with pStage II or IV disease, the values were 91, 76, 65, and 52%, respectively. Conclusions: Three-field lymph node dissection may be indicated even for patients with clinical Stage I squamous cell carcinoma requiring surgical intervention because this surgical procedure provides for possible cure by removing unsuspected lymph node metastasis.     

前哨淋巴结活检术在早期乳腺癌治疗中的疗效分析

目的对比早期乳腺癌行前哨淋巴结活检术(SLNB)与行SLNB加腋窝淋巴结清扫(ALND)后的并发症及远期预后。方法回顾性分析2012年10月至2013年10月50例早期乳腺癌前哨淋巴结阴性患者,并将其分为腋窝淋巴结保留组与腋窝淋巴结清扫组,每组25例。保留组行SLNB治疗,清扫组在保留组的治疗基础上加行ALND。采用SPSS19.0软件进行统计分析,年龄、平均住院时间计量资料用(x珋±s)表示,采用t检验;病理特征、并发症、生存率两组比较采用χ2检验。P0.05时差异有统计学意义。结果 50例患者共检出前哨淋巴结(SLN)87个,平均每例检出1.74个。保留组共检出SLN 42枚,平均检出1.68枚,清扫组共检出SLN 45枚,平均检出1.8枚(χ2=0.180,P0.05)。出现并发症的例数:保留组为4例(16.0%),清扫组为15例(60.0%);平均住院时间:保留组为(6.0±1.1)d,清扫组为(8.3±1.7)d。保留组的术后住院时间及并发症均明显少于清扫组,且两组比较均有统计学意义(t=5.679,χ2=10.272,P0.05)。50例患者随访2~3年,随访率100%。截至2015年6月,两组患者术后两年生存率均为100%,无瘤生存率均为100%。结论 SLNB经济实用、安全可靠、推广方便,能够较准确地预测乳腺癌腋窝淋巴结的分期状态,可以减少不必要的腋窝淋巴结清扫及其术后并发症的发生。     

Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer

BACKGROUND: Neck dissection is the surgical gold standard for the treatment of patients with cervical lymphatic spread. The purpose of this study was to determine the presence of metastases in the supraretrospinal (level IIB) nodal group and the necessity of routine dissection of level IIB during neck dissection, in patients with squamous cell carcinoma of the larynx. METHODS: Over a 4-year period (between January 2000 and June 2004), the records of patients undergoing laryngectomy and neck dissection were retrospectively evaluated. The numbers of the lymph node and carcinoma metastases at level IIB were recorded. The American Joint Committee on Cancer tumor-node-metastasis classification system was used to classify the primary tumor and neck, and the Memorial Sloan-Kettering Cancer Center classification was used to classify the cervical lymphatic chain. RESULTS: Sixty-three patients with 98 neck dissections were included in the study. Two patients (3.17%) had subglottic lesions, 19 patients (30.15%) had glottic lesions, and 42 patients (66.66%) had supraglottic lesions. In total, 673 lymph nodes were dissected from level II, and 340 were dissected from level IIB. The 11 supraretrospinal lymph nodes of the 340 dissected nodes demonstrated histologic evidence of metastases (3.23%). Six patients (9.52%; 6/63) had metastases at level IIB, and 2 of them also had synchronous metastases at the contralateral level IIB. The patients without palpable lymph nodes at the neck had no metastases at level IIB. CONCLUSION: Our results showed that, if the level IIA shows positive metastatic changes, perioperative pathologic examination by frozen section that includes level IIb could be an alternative approach. This area may not be routinely dissected during the surgical management of laryngeal carcinoma with no palpable lymph nodes.     

Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series

PURPOSE: We examined complications in a contemporary population of patients with penile cancer undergoing inguinal lymphadenectomy with or without pelvic lymphadenectomy. MATERIALS AND METHODS: The records of all patients treated for squamous cell carcinoma of the penis from January 1992 to May 2003 were reviewed. Complications and length of stay were examined. Complications were divided into early (30 days or less after surgery) and late (greater than 30 days). RESULTS: A total of 41 men were diagnosed with squamous cell carcinoma of the penis, of whom 22 underwent a total of 40 inguinal lymphadenectomies (ILs). Of the patients 13 underwent unilateral IL, 9 underwent simultaneous bilateral ILs and 10 underwent pelvic lymphadenectomy. Mean followup was 34.2 months (range 9.2 to 69.3). Early complications were lymphedema in 4 of 40 cases (10%), minor wound infection in 3 (7.5%) and minor wound separation in 3 (7.5%). Additionally, 5 of 40 patients (12.5%) had lymphoceles, which spontaneously resolved. Late complications were lymphedema in 2 of 40 patients (5%), flap necrosis in 1 (2.5%) and lymphocele in 1 (2.5%), requiring percutaneous drainage. There was no significant difference in the complication rates in patients with unilateral dissection compared to bilateral or pelvic lymph node dissection. Median length of stay was 2 days (range 1 to 9). There was no significant difference in hospital stay for unilateral dissection compared to bilateral or pelvic lymph node dissection. CONCLUSIONS: These data demonstrate the relative safety of a contemporary lymphadenectomy. We believe that these results lend support to early lymphadenectomy, including simultaneous bilateral dissections, when clinically indicated. Furthermore, these results demonstrate the benefits of a standard postoperative pathway using compression stockings, sequential compression devices and early ambulation with restricted anticoagulant use.     

胃癌根治术175例临床分析

目的 提高进展期胃癌手术治愈率。方法 回顾性分析１９９３－１９９８年间我院施行的胃癌根治术１７５例。结果 早期胃癌１６例（９.１％）,进展期癌１５９例（９０.９％）。Ｄ２术患者１２２例。绝对根治率（淋巴结清扫范围大于淋巴结转移范围）５９.８％（７３／１２２）,包括Ｎo.１６在内的扩大淋巴清扫术患者５３例,绝对根治率８３％（４４／５３）。总体５年生存率３０.５％（２１／６９）。绝对根治术５年生存率３６.３％（１６／４４）,相对根治术（淋巴结清扫范围内有转移）５年生存率２０％（５／２５）。包括Ｎo.１６清扫术在内的绝对根治患者５年生存率４１.７％（５／１２）。结论 有选择性的施行包括Ｎo.１６在内的扩大淋巴结清扫对提高进展期胃癌生存率是合理和必要的。     

肾癌区域淋巴结转移的临床分析

目的 了解肾癌区域淋巴结转移的临床特点及发生发展规律,提高对本病的诊治效果.方法 回顾性分析2004年1月至2008年12月19例肾癌伴有区域淋巴结转移患者的资料.男15例,女4例.年龄29～77岁,中位年龄57岁.肿瘤位于左肾12例,右肾7例.腹膜后肿大淋巴结最大径1.5～5.0 cm,中位数2.8 cm,其中4例影像学检查未发现肿大淋巴结,术中探查证实.行腹膜后肿大淋巴结切除11例,区域淋巴结清扫8例.结果 肾癌发生区域淋巴结转移占同期收治肾癌的1.6%(19/1213).术后19例均获随访,随访时间8～78个月,中位数34个月.无瘤生存6例,带瘤生存7例,死亡6例,5年生存率68.4%.腹膜后区域淋巴结清扫组与肿大淋巴结切除组生存期及术后复发转移率比较差异均无统计学意义(P=0.644;P=0.319).结论 肾癌发生单纯区域淋巴结转移少见,术前影像学可能漏诊,部分患者通过区域淋巴结清扫或肿大淋巴结切除可获得无瘤生存.

Abstract：

Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.     

甲状腺微小乳头状癌的诊治：附47例报告

目的:探讨甲状腺微小乳头状癌(PTMC)的临床病理特征及诊治策略。方法:回顾性分析2011年6月—2016年5月经手术与病理证实的47例PTMC患者临床资料。结果:47例患者中,男9例,女38例;年龄(46.3±12.1)岁;病程(12.4±23.7)个月;均行术前超声检查,14例行超声引导下细针穿刺细胞学检查(FNA),经FNA确诊PTMC 11例(78.6%);13例行患侧甲状腺全切,3例行患侧甲状腺全切+对侧叶大部切除术,31例行双侧甲状腺全切;14例行中央区颈淋巴结清扫术,15例行中央区加颈侧区淋巴结清扫。肿瘤病灶平均长径(0.68±0.23)cm;21例(44.7%)为多发病灶,其中14例(29.8%)为双侧甲状腺多发病灶;中央区淋巴结转移率48.3%(14/29),颈侧区淋巴结转移率53.3%(8/15)。单因素分析显示,肿瘤侵犯包膜与淋巴结转移有关(P=0.035)。8例患者术后发生并发症,其中暂时性甲状旁腺功能不全5例,切口积液1例,暂时性喉返神经损伤1例,暂时性喉上神经损伤1例。结论:甲状腺外科医生需熟悉甲状腺癌超声特点,不建议扩大FNA指征。对于术前超声已提示多发结节、术中探查可疑多发结节或存在高危因素者,手术建议行双侧甲状腺全切。预防性中央组淋巴结清扫结合术中冷冻病理对确定个体化手术方案及指导术后治疗是必要的。     

胃癌D3淋巴结清扫术的临床价值

目的探讨D3淋巴结清扫术对进展期胃癌患者的预后、并发症和生活质量的影响。方法对2000年4月至2002年10月收治的132例进展期胃癌患者进行前瞻性研究,随机分为D3组74例,行D3淋巴结清扫术;D2组58例,行D2手术。结果D2组和D3组术后1、2年的生存率无差别,但3至5年的生存率D2组分别为56.9%、46.6%和36.2%,D3组71.6%、62.2%和56.8%,两者有明显差异(P<0.05)。术后并发症发生率D2组和D3组分别为8.6%和13.5%,两组比较无明显差异(P>0.05),但D2组手术时间为(182.0±32.3)min,明显短于D3组的(236.0±23.7)min(P<0.05)。在生活质量评估方面,D2组和D3组患者术后2、4、6个月组间各项特殊症状评分指标差异无显著性意义(P>0.05)。结论进展期胃癌D3淋巴结清除术是安全的,能够显著改善患者的预后且不影响生活质量。     

Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer

The purpose of this study was to evaluate the feasibility of sentinel lymph node mapping in patients undergoing neoadjuvant chemotherapy for breast carcinoma prior to lumpectomy or mastectomy and sentinel lymph node mapping followed by complete axillary dissection. A retrospective analysis of 14 patients from February 1998 to July 2000 with stage I to stage IIIB breast cancer diagnosed by core biopsy underwent neoadjuvant chemotherapy (doxorubicin/cyclophosphamide) prior to definitive surgery, including lumpectomy or mastectomy and sentinel lymph node mapping, followed by full axillary dissection. Thirteen of 14 patients had successful sentinel lymph node identification (93%), and all 14 underwent full axillary dissection. An average of 2.2 sentinel nodes and a median of 16 axillary lymph nodes (including sentinel nodes) were found per patient. Of the 13 patients in whom a sentinel lymph node was identified, 10 were positive for metastases (77%). Only 4 of the 10 had further axillary metastases (40%). Three patients had negative sentinel lymph nodes shown by hematoxylin and eosin and cytokeratin stainings and had no axillary metastases (0% false negative). The single patient in whom a sentinel lymph node could not be identified had stage IIIA disease with extensive lymphatic tumor emboli. Sentinel lymph node mapping is feasible in neoadjuvant chemotherapy breast cancer patients and can spare a significant number of patients the morbidity of full axillary dissection. Further study to evaluate sentinel lymph node mapping in this patient population is warranted.     

胃癌合并门静脉高压症的手术治疗选择

目的 探讨胃癌合并门静脉高压症的手术方式选择.方法 回顾分析近5年内手术治疗的22例胃癌合并门静脉高压症临床资料,其中肝功能Child A级12例,Child B级10例.具体术式:全胃切除+贲门周围血管离断术11例,远端胃切除术9例,远端胃切除+脾切除术1例,远端胃切除+贲门周围血管离断术+保留胃后及左膈下动脉1例.肝功能Child A级患者均行胃癌D2根治术,Child B级患者均行胃癌D1根治术.术中均行肝活检.结果 本组手术并发症发生率为50%,死亡率为9%.肝功能Child A级患者行D2根治术的术后肝功能恶化率为42%,Child B级患者行D1根治术的术后肝功能恶化率为70%,两者相比差异无统计学意义(P＞0.05),但前者并发症发生率为25%,后者并发症发生率为80%,两者相比差异有统计学意义(P＜0.05).同期处理门静脉高压症的术后并发症发生率为77%,未处理门静脉高压症的术后并发症发生率为11%,两者相比差异有统计学意义(P＜0.05).结论 胃癌合并门静脉高压症的外科治疗须根据患者的肝功能分级和门静脉高压程度等因素采取个体化处理.

Abstract：

Objective To evaluate the surgical approaches for gastric carcinoma accompanied by portal hypertension ( PHT).Methods The clinical data of 22 patients with PHT undergoing operation during 5 years were retrospectively analyzed.The liver function was Child's A in 12 cases, Child's B in 10 cases.Total gastrectomy + pericardial devascularization was performed in 11 cases, distal subtotal gastrectomy in 9 cases, distal subtotal gastrectomy + splenectomy in one, distal subtotal gastrectomy + pericardial devascularization in one.12 cases with Child's A underwent D2 lymph node (LN) dissection and 10 cases with Child's B were treated with D1 LN dissection.Liver biopsy was taken in all patients.Results Postoperative complications developed in 50% and mortality rate was 9%.The rate of liver function deterioration in patients of Child A ungergoing D2 lymph node dissection was 42% , and that of patients with Child B was 70%.The rate of postoperatiave complications in patients with Child A ungergoing D2 lymph node dissection was 25% , while that of patients with Child B was 80%.There was no significant difference in liver function deterioration rate between Child A and Child B (P ＞ 0.05) , but the rate of postoperative complications in Child A is much lower than those in Child B(P ＜ 0.05).The complication rate in patients receiving PHT targeting measures was 77% ,much higher than 11% in those without concurrent treatment of PHT ( P ＜ 0.05 ).Conclusions Individualized surgical approache is crucial for treatment of gastric carcinoma accompanied by PHT.Surgical treatment should be on the basis of liver function and the severity of PHT.     

A role of interpectoral (Rotter's) lymph node dissection in modified radical mastectomy for breast cancer]

To study the influence of interpectoral lymph node (IPN) dissection on the prognosis of patients who underwent modified radical mastectomy, IPN was carefully dissected and studied pathologically on 168 cases of our breast cancer patients operated with modified radical mastectomy. There were 1.2 lymph nodes on an average in the interpectoral region, and they were almost 1-2mm in diameter. IPN metastases were found in 10 cases. (Tis: 0%, Stage I: 4.9%, Stage II: 5.7%, Stage III: 13%). Tumors located in outer quadrant in almost all these cases. Positive IPN were found in 6 (16%) of n1 alpha group, 1 (10%) of n1 beta group, and in 3 (50%) of n2 group. All these 3 cases of n2 died of distant metastasis and local recurrence. Two (1.7%) of axillary node (1a, 1b) negative patients had microinvolvement of cancer only in IPN, and are currently disease-free. These data suggest that IPN metastasis may occur even in the early breast cancer patients, and that may be controllable by lymph node excision. Therefore, routine and careful dissection of IPN through wide opening of sulcus interpectoralis is necessary for modified radical mastectomy and even for breast preserving operation.     

选择性中央区淋巴结清扫治疗cNO甲状腺乳头状癌的临床价值

目的探讨选择性中央区淋巴结清扫术在临床颈淋巴结阴性（cN0）的甲状腺乳头状癌患者中的治疗价值。方法回顾性分析中国医科大学附属第一医院2007年1月至2011年12月期间收治的326例cN0甲状腺乳头状癌患者的临床资料,并对影响中央区淋巴结转移的相关因素进行分析。结果本组326例cN0甲状腺乳头状癌患者的中央区淋巴结转移率为35．89％（117／326）。年龄在〈45岁、肿瘤直径〉1cm及原发灶浸润包膜的cN0甲状腺乳头状癌患者的淋巴结转移率明显高于年龄≥45岁、肿瘤直径≤1cm及原发灶未浸润包膜的oN0甲状腺乳头状癌患者（年龄：46．56％比28．72％,P=0．001;肿瘤直径：44．44％比26．45％,P=0．001;包膜浸润：50．00％比33．09％,P=0．020）。进一步的多因素分析显示,年龄〈45岁和肿瘤直径〉1cm是cN0甲状腺乳头状癌中央区淋巴结转移的独立危险因素（P〈0。05）。术后6例出现暂时性喉返神经损伤,18例并发暂时性甲状旁腺功能低下,4例出现暂时性喉上神经损伤,1例并发急性喉头水肿,无永久性喉神经损伤、甲状旁腺功能低下等并发症发生。术后266例（81．60％）获得随访,随访7～67个月（平均31．2个月）,有3例发生侧颈区淋巴结转移。结论cN0甲状腺乳头状癌行选择性中央区淋巴结清扫术是必要的、安全的处理方式,建议对cN0甲状腺乳头状癌常规行患侧中央区淋巴结清扫术,特别是年龄〈45岁和肿瘤直径〉1cm的cN0甲状腺乳头状癌患者。     

甲状腺髓样癌临床诊疗方案分析

目的探讨影响甲状腺髓样癌(medullary thyroid carcinoma,MTC)治疗方案制订与转归的关键要素。方法回顾性分析2007年4月至2020年3月湖南省人民医院乳甲外科收治的23例MTC患者病例资料、典型病例的临床特点及生存随访结果,结合ATA等指南对MTC治疗方案和转归进行分析。结果23例MTC中,有22例(95.65%)术前血清降钙素(calcitonin,Ctn)不同程度的升高;15例(65.22%)术前癌胚抗原(carcinoembryonic antigen,CEA)不同程度的升高;3例(13.04%)术前超声及增强CT提示颈部有可疑异常淋巴结;2例(8.70%)术中探查可见包膜侵犯。23例中行患侧甲状腺腺叶切除术1例、患侧甲状腺腺叶切除术+患侧中央区淋巴结清扫术2例、甲状腺全切术3例、甲状腺全切术+患侧中央区淋巴结清扫术1例、甲状腺全切术+双侧中央区淋巴结清扫术13例、甲状腺全切术+双侧中央区淋巴结清扫术+单侧侧颈区淋巴结清扫术3例。8例(34.78%)术后出现复发,其中有7例为第一次手术不规范导致。2例术前Ctn明显升高,仅行甲状腺全切+双侧中央区淋巴结清扫术,术后未见复发。结论规范化的手术治疗是MTC生物治愈的关键,但也不能简单参照如Ctn等单一因素来决定手术方式,MTC现代治疗方案需同时遵循规范化原则及个体化原则来制定。     

CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值

目的探讨CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值。方法采用回顾性描述性研究方法。收集2009年10月至2016年12月2家医疗中心收治的628例(中山大学肿瘤防治中心236例、郑州大学附属肿瘤医院392例)胸段食管鳞癌病人的临床病理资料;男462例,女166例;中位年龄为62岁,年龄范围为38~85岁。观察指标:(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能。(3)最佳截断值确定。(4)不同诊断标准的检测情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。以受试者工作特征曲线(ROC)的曲线下面积(AUC)评估检测方法的效能。约登指数最大值对应最佳截断点。结果(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况:628例病人中,572例行二野淋巴结清扫,56例行三野淋巴结清扫;408例行微创手术,220例行开放手术。628例病人中,60例发生左侧喉返神经旁淋巴结转移。628例病人共清扫左侧喉返神经旁淋巴结1666枚,其中左侧喉返神经旁淋巴结转移75枚,转移率为4.502%(75/1666)。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能:CT检查左侧喉返神经旁淋巴结短径预测左侧喉返神经旁淋巴结转移的AUC为0.854(95%可信区间为0.792~0.916,P<0.05)。(3)最佳截断值的确定:分别以CT检查左侧喉返神经旁淋巴结短径为5、6、7、8、9、10 mm作为最佳截断值,其对应的约登指数分别为0.556、0.384、0.258、0.063、0.003。确定CT检查左侧喉返神经旁淋巴结短径5 mm为最佳截断值。(4)不同诊断标准的检测情况:分别以CT检查左侧喉返神经旁淋巴结短径≥5 mm和≥10 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移的诊断标准,两者灵敏度、特异度、准确度、阳性预测值、阴性预测值、漏诊情况分别为66.3%和5.0%、92.3%和99.8%、89.5%和90.7%、46.3%和75.0%、96.0%和90.9%、20和57例。结论CT检查淋巴结短径可用于评估胸段食管鳞癌左侧喉返神经旁淋巴结转移。以淋巴结短径≥5 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移标准时,灵敏度、特异度和准确度较好。     

Clinical evaluation of systematic lymph node dissection for the intrathoracic esophageal carcinoma

We evaluated the effectiveness and complication of systematic lymph node dissection for the intrathoracic esophageal carcinoma, which includes cervical, intrathoracic and abdominal lymph node dissection. Two hundred and thirteen individuals with intrathoracic esophageal carcinoma underwent esophageal resection in the Department of Surgery II, Kyushu University from 1979 to 1988. Of these 213, systematic lymph node dissection in addition to esophageal resection was performed on 19 patients. Lymph node recurrence has been reduced with this procedure and survival rate was more favorable in the cases with systematic lymph node dissection than those without it at present. On the other hand, although the occurrence of postoperative recurrent nerve palsy in the cases with systematic lymph node dissection and in those without it were 47.4 and 11.9%, rates of postoperative pulmonary complications were 5.2 and 16.0%, respectively. Operative death was none in those with systematic lymph node dissection. Therefore, this procedure has been performed in safety with intensive perioperative cares and it would contribute more favorable prognosis.     

甲状腺微小癌颈淋巴结转移危险因素分析及手术范围的探讨

目的:探讨影响甲状腺微小癌(TMC)颈淋巴结转移的危险因素以及颈淋巴结清扫的范围。方法:回顾性分析2009年1月—2013年6月收治的269例TMC患者资料,患者均在原发灶根治的同时行中央区淋巴结清扫,27例患者行颈侧区淋巴结清扫,分析患者各临床病理因素与颈淋巴结转移的关系。结果:269例患者中107例(39.8%)发生颈淋巴结转移,其中中央区淋巴结转移103例(96.3%),颈侧区淋巴结转移25例(23.4%)。单因素分析显示,男性、肿瘤直径5.0 mm、包膜侵犯与TMC颈淋巴结转移有关(均P0.05);多因素分析显示,肿瘤直径5.0 mm(OR=3.358,P0.05)、包膜侵犯(OR=5.230,P0.05)是颈淋巴结转移的独立危险因素。结论:对于肿瘤直径5.0 mm或有包膜侵犯的TMC患者,中央区淋巴结转移的几率增加,行中央区淋巴结清扫是必要的。     

Validity of the study of sentinel lymph nodes in the treatment of breast carcinoma

Since it was introduced in the 1990s, axillary sentinel lymph-node biopsy has been rapidly and widely adopted to avoid complete axillary dissection (though this is still the standard procedure). The aims of the study were two-fold: (i) to determine the value of different techniques of sentinel lymph-node identification and (ii) to verify the predictive value of such procedures through histological examination of the sentinel lymph node and axillary dissection in the same patients. Both sentinel lymph-node biopsy and axillary dissection were performed in 230 patients with T1 and T2 (< 3 cm) carcinoma of the breast. Preoperative lymphoscintigraphy was able to identify the sentinel lymph node in 97.4% of cases, but, with an intraoperative hand-held probe, it was possible to find the sentinel lymph node in 98.2% of cases (226/230 patients). The sentinel lymph node was metastatic in 49.1% of cases (111/226 patients) and negative in 50.9% (115/226). The incidence of false-negative cases was 2.6% (2/115 patients). The predictive value of the sentinel lymph node was 98.7%. Finally, lymph-mode mapping is possible is a very high percentage of patients and therefore it is always advisable to use all three methods of identification together. The diagnostic reliability of sentinel lymph-node status is equally high. At present there no studies are available with a long-term follow-up to confirm these findings, and therefore axillary dissection is still the standard surgical treatment for breast cancer.     

Laparoscopic Pelvic Lymph Node Dissection Combined with Real-time Interactive Transrectal Ultrasound Guided Transperineal Radioactive Seed Implantation of the Prostate

Laparoscopic pelvic lymph node dissection with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation is a new method of treatment for localized carcinoma of the prostate. A total of 58 patients with clinically confined prostate cancer and negative seminal vesicle biopsies underwent staging laparoscopic pelvic lymph node dissection immediately followed by prostate implantation: 50 had¹²⁵ iodine and 8 had¹⁰³ palladium implants. Mean operating time was 226 minutes (range 120 to 475), mean blood loss was 57 cc (range 5 to 400) and average hospital stay was 2.2 days (range 0.5 to 8). At a mean followup of 12 months (range 6 to 24), complications included proctitis in 1.7 percent of the cases, dysuria in 24 percent, nocturia in 21 percent and outlet obstruction in 17 percent. Erectile function remained unchanged.Prostate volume decreased to 58.9 percent of the pretreatment value by 12 months and to 44.3 percent by 24 months. Mean prostate specific antigen level was 18.4 plus/minus 26.3 ng./ml. before treatment, 3.4 plus/minus 3.9 ng./ml. at 6 months, 2.3 plus/minus 2.3 ng./ml. at 12 months and 4.9 plus/minus 6.0 ng./ml. at 24 months (1.2 plus/minus 1.0 ng./ml. for patients with no evidence of disease). Of the patients 15.8 percent had local failure at 18 to 24 months as determined by positive transrectal ultrasound guided biopsy. Five of 58 patients (8.6 percent) had persistently elevated prostate specific antigen levels, only 1 of whom had a positive biopsy. Laparoscopic pelvic lymph node dissection with transrectal ultrasound guided implantation is a safe and promising mode of therapy for patients with localized prostate cancer.