80 岁以上高龄患者胰十二指肠切除术体会

目的 总结80岁以上高龄患者施行胰十二指肠切除术的体会。方法 回顾性分析3例80岁以上患者施行胰十二指肠切除术的临床资料及随访情况。结果 3例患者手术均获得成功,手术时间分别为340 min、390 min、410 min,术中出血量分别为300 ml、800 ml、1 000 ml,分别于术后42 d、51 d、83 d康复出院。围手术期2例发生并发症,其中胃瘫2例,肺部感染、深静脉导管菌血症、上消化道出血各1例,无胰瘘、腹腔出血和腹腔感染者。3例均康复出院,无围手术期死亡。2例分别于术后5个月、13个月因腹膜后淋巴结转移而死亡,另1例术后随诊53个月,肿瘤无复发、转移,生活质量良好。结论 高龄不是胰十二指肠切除术的禁忌证,只要具备熟练的专科手术技能及围手术期综合救治能力,80岁以上高龄患者仍可安全施行胰十二指肠切除术,并获得较好的治疗效果。     

保留幽门的胰十二指肠切除术（附15例报告）

目的 掌握保留幽门的胰十二指肠切除术（简称ＰＰＰＤ术）,以预防术后胃排国能障碍,方法 术中保留胃窦,幽门和十二指肠球完整的血管支配和神经分布,确保切断十二指肠距幽门环的适宜距离,折叠缝合缩短肝胃韧带,结果 本组１５例恶性肿瘤,病检十二指肠切缘均无癌残留,术后均未发生胃排空功能障碍,生活质量明显提高,结论 ＰＰＰＤ术是治疗胰腺及壶腹周围癌的一种良好术式。     

胰十二指肠切除术后并发症的防治

胰十二指肠切除术(pancreaticoduodenectomy，PD)是唯一可能治愈胰头癌及壶腹周围癌的有效方法。但由于该手术涉及组织器官多，手术范围大，并发症多而一直影响着手术的效果和术后病人的恢复及预后。有些并发症甚至是致命性的，如胰漏、出血等，还有些并发症很难治愈。因此，胰十二指肠切除术后并发症的防治与处理是外科医生一直重视的问题。本文着重讨论其中一些严重的并发症，包括胰漏、出血、胆漏、胃排空障碍等，     

保留幽门胰十二指肠切除术

保留幽门胰十二指肠切除术方宏宜宾地区第一人民医院普外科（６４４０００）为了防止并发症的发生和提高病员术后的生存质量。我们认为，胰十二指肠切除后的消化道重建应接近原始的消化道排列方式，同时应防止胰漏的发生。为了达到这一目的，我院采用一种保留幽门、胰十二...     

扩大淋巴结清扫的胰十二指肠切除术治疗胰腺癌的临床意义

摘 要：［目的］ 探讨扩大淋巴结清扫的胰十二指肠切除术（PD）对于胰腺癌治疗的临床意义。［方法］ 回顾性分析195例行胰十二指肠切除术胰腺癌患者的临床及病理资料。根据手术方式不同将患者分为对照组：标准化淋巴结清扫的胰十二指肠切除术（110例）和实验组：扩大淋巴结清扫的胰十二指肠切除术（85例）。比较两组胰腺癌患者的手术情况、病理检查结果、术后并发症发生率、死亡率及术后生存时间等。［结果］ 实验组和对照组的平均手术时间分别为554min和443min,中位术中出血量分别为800ml和500ml,两组比较,差异均有统计学意义（P<0.05）。实验组和对照组患者的死亡率分别为3.53%和3.64%,两组比较差异无统计学差异（χ2= 0.483,P>0.05）。实验组和对照组术后并发症发生率分别为27.1%和24.5%,两组比较差异无统计学意义（χ2=3.804,P>0.05）。术后中位生存时间分别为18.6个月（95%CI：12.7~21.5）和16.9个月（95%CI：10.6~23.2）,两组比较差异无统计学意义（χ2=0.143,P>0.05）。［结论］ 扩大淋巴结清扫的胰十二指肠切除术虽然增加了手术时间及出血量,但并不增加术后并发症的发生率和死亡率。虽然对患者预后影响差异无统计学意义,但扩大淋巴结清扫的PD术总体生存时间仍比标准淋巴结清扫PD术延长1.7个月。     

胰十二指肠切除术在胃癌治疗中的应用

目的 :探讨胃癌侵犯或累及胰头十二指肠区域的手术治疗选择。方法 :回顾性分析了自 1981年 1月至 2 0 0 0年 12月间收治的 5 1例胃癌侵犯或累及胰头十二指肠的患者的资料。结果 :原发性胃癌 5 1例 ,术式分别为胃次全切除术 2 9例 (SG组 ) ,胃癌根治及胰十二指肠切除术 (PD组 ) 11例和胃空肠吻合术 8例 ,腹腔内肿物活检术 3例。PD组的一、三年生存率为 6 3.6 %和 36 .4 % ,而SG组为 17.2 %和 3.4 % ,PD组的生存率要比SG组明显提高 (P<0 .0 1)。结论 :胃癌侵犯胰头十二指肠区域患者进行胃癌根治联合胰十二指肠切除术是合理和安全的 ,可提高术后生存率     

胰十二指肠切除术的体会

胰十二指肠切除术并发症较多 ,死亡率较高 ,切除率较低。1996年 9月以来 ,我们改进操作方法 ,行胰十二指肠切除术 7例 ,获良好疗效 ,总结报道如下。1　临床资料1.1　一般资料男 6例 ,女 1例 ;年龄 2 5～ 6 5岁 ,平均 5 3岁。胰头腺泡细胞癌 3例 ,导管细胞癌 2例 ,胆总管下端癌     

胰十二指肠切除术后胰管胃粘膜缝合术

1988年4月～1991年7月,作者为7例胰头腺癌、壶腹部癌行胰十二指肠切除术,改进消化道重建,胰管胃粘膜缝合术,胰断面胃粘膜下埋植术.胰管经胃经鼻外减压引流.手术操作简单、安全、可靠.1 临床资料男性5例,女性2例.年龄45岁～69岁,重度黄疸2例,轻度黄疸4例,1例无黄疸.7例行胰十二指肠切除术后,3例胰管—胃粘膜缝合术,4例行胰管—胃粘膜固定术.病理报告:5例为胰头腺癌,2例为壶腹部腺癌.手术操作 游离胰断端1cm,保留胰管于胰断     

胰十二指肠切除术后胰瘘的防治

目的探讨胰十二指肠切除术后胰瘘的预防及治疗措施.方法回顾分析我院183例胰十二指肠切除术,按年份将本组资料分为前6年和后4年两组,其中后组改进了术式,提高了综合治疗手段.结果后组的胰瘘发生率及死亡率较前组明显降低(P＜0.01).结论充分的术前准备、熟练的手技、优选良好的术式、术后密切监护能降低胰瘘的发生率和死亡率.     

胰肠吻合方式对胰十二指肠切除术后胰瘘的影响

目的：探讨胰肠吻合方式对胰十二指肠切除术后胰瘘的影响。方法：回顾性分析2008年10月至2013年8 月天津医科大学肿瘤医院收治的145 例术前诊断为壶腹周围肿瘤行胰十二指肠切除术患者的临床资料。对影响术后胰瘘发生的相关因素进行统计分析。结果：本组患者中27例术后发生胰瘘。在4 种胰肠吻合方式中,胰管空肠黏膜吻合和Blumgart 吻合的胰瘘发生率低,且皆无C 级胰瘘。多因素分析应用Logistic回归,结果表明不同的胰肠吻合方式及性别为术后胰瘘发生的独立预后因素。结论：胰肠吻合方式是影响胰十二指肠切除术后胰瘘发生的危险因素。     

急性非早幼粒细胞白血病患者早期颅内出血预警评分系统的建立及应用CSCD

目的回顾性分析急性非早幼粒细胞白血病(ANPL)早期颅内出血(ICH)的高危因素,建立预警评分系统。方法纳入1 281例ANPL成人患者(模型组)和378例成人患者(验证组),所有患者均随访12月。模型组数据归纳ICH发生的相关因素并建立风险评分系统,验证组数据对风险评分系统进行验证(评分系统对验证组的每例患者进行评分,分为高、中、低风险),并通过绘制ROC曲线评价该评分系统的预测效能。结果单、多因素分析表明,ANPL早期ICH的独立危险因素为WBC≥30.00×10~9/L、FIB<2.92 g/L和PT≥12.91 s。用上述3个因素依据各自权重建立新的预警评分系统,该评分系统ROC曲线下面积为0.774(95%CI:0.688~0.859)。验证组证实,该评分系统ROC曲线下面积为0.715(95%CI:0.559~0.872)。结论新建预警评分系统能较好预测ANPL早期ICH的发生,可指导临床及早识别潜在危重患者。     

胰头十二指肠切除术联合替吉奥治疗胰腺癌对患者血清MIC-1、REG4水平的影响

目的 探讨胰头十二指肠切除术联合替吉奥治疗胰腺癌对患者血清MIC-1、REG4水平的影响.方法 回顾性分析110例胰腺癌行胰头十二指肠切除术后患者的临床资料,按术后辅助化疗方式的不同,分为观察组和对照组,各55例.对照组用吉西他滨辅助化疗,观察组用替吉奥辅助化疗,2组均连续治疗2个疗程.比较2组化疗前后血清肿瘤标志物水...     

高龄老年胃癌的外科治疗

目的：面对日益增多的高龄老年胃癌，探讨适当的外科手术治疗。方法：回顾性分析我院普外科１９８４～１９９３年间２１２例７０岁以上高龄老年胃癌的临床资料及手术疗效。结果：高龄老年胃癌起病隐匿，常伴有出血、梗阻及贫血；绝大多数合并有其他疾病。手术证实绝大多数为中晚期胃癌，病理检查无明显特殊性。１６３例行胃癌切除术，切除率为７６．９％，根治性切除达５９．３％。姑息性切除平均生存期１１．８个月。临床早期胃癌（     

Stratifying Patients with Haematuria into High or Low Risk Groups for Bladder Cancer: a Novel Clinical Scoring System

Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This studyaimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groupsfor having bladder cancer to help clinicians decide which patients need more urgent assessment. This crosssectionalstudy included all adult patients referred for haematuria and subsequently undergoing full urologicalevaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the studypopulation were used to design the scoring system. Accuracy was determined by the area under the receiveroperating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70(21.5%) were diagnosed to have bladder cancer. Significant risk factors associated with bladder cancer were malegender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinicalparameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicatedhigh risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of80.4%, while the sensitivity and specificity were 90.0% and 55.7%, respectively. The scoring system designedin this study has the potential to help clinicians stratify patients who present with haematuria into high or lowr isk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.     

65岁以上老年早期乳腺癌手术治疗84例

目的：分析早期老年乳腺癌手术治疗的临床效果及预后, 进而探讨早期老年乳腺癌的合理术式。方法： 对武警医学院附属医院肿瘤外科1994年1月至2008年12月间收治的84例行改良根治手术和单纯全乳切除手术治疗的早期老年乳腺癌患者进行回顾性分析, 患者年龄均≥65岁, 44例行改良根治术, 40例行单纯全乳切除术。结果： 64.3% （54/84） 患者合并其他疾病, 中位随访36.5个月 （11～280个月）, 改良根治手术组与单纯全乳切除手术组5年累积生存率分别为86.0%和84.7%, 无统计学差异 （P=0.786）; 改良根治手术组与全乳切除手术组5年复发率分别为3.3%和7.9%, 差异无统计学意义 （P=0.565）。结论： 全乳切除术后并发症少, 恢复快, 适用于早期老年乳腺癌患者。改良根治术并未明显增加早期老年乳腺癌患者的生存率。     

Development and Validation of a Preoperative Scoring System to Distinguish Between Nonadvanced and Advanced Axillary Lymph Node Metastasis in Patients With Early-stage Breast Cancer

BackgroundIt has been determined that axillary lymph node dissection after the detection of limited axillary lymph node metastasis does not improve the prognosis of patients with breast cancer. Thus, a need exists for less-invasive axillary surgery. However, it remains unclear whether a predictive model based on preoperative data would be sufficient to accurately predict the probability of pN2-N3 (> 3 lymph node metastases). We sought to develop an easy-to-use scoring system to distinguish between pN0-N1 (0-3 lymph node metastases) and pN2-N3 using only preoperative data and validate its predictive performance.Patients and MethodsWe retrospectively identified 2687 patients diagnosed with cT1-3cN0-N1 who had undergone surgery in our hospital from 2013 to 2019. We evaluated the risk factors associated with pN2-N3 by logistic regression analysis and developed a scoring system. Predictive performance was assessed by calculating the receiver operating characteristic area under the curve (AUC) and was validated using K-fold cross-validation.ResultsWe identified 1987 patients with stage pN0, 522 with pN1, and 178 with pN2-N3. Multivariate analysis revealed tumor size, number of suspicious lymph nodes on axillary ultrasound examination, histologic type, histologic grade, and receptor status were significant risk factors for pN2-N3. The AUC value was 0.87, and the mean AUC of the 10-fold cross-validation was 0.88. When the cutoff score was set at 6, the negative predictive value for excluding patients with pN2-N3 was 98.4%.ConclusionOur easy-to-use scoring system could be useful to preoperatively identify patients at lower risk of pN2-N3 and avoid unnecessary axillary lymph node dissection.     

Clinicopathological Findings and Five Year Survival Rates for Patients with Central Nervous System Tumors in Yazd,Iran

Background: The incidence rate of brain tumors has increased more than 40% in the past 20 years, especiallyin adults. We aimed to study the clinical and pathological findings of central nervous system (CNS) tumor patientsand to evaluate their 5 year survival rates. Materials and Methods: The archives of all patients with CNS tumorsin 6 health care centers in Yazd, Iran, from 2006 to 2013, were studied. Patients data were extracted using achecklist which included age, sex, date of reference and diagnosis, date of death, clinical signs, radiographyfindings, pathology report, size and location of tumor, patient treatment and grade of tumor. Results: A totalof 306 patient records were studied in the 8 year period. The most prevalent type of tumor was astrocytoma(n=113, 36.9%). The frequency of almost all tumor types was statistically higher in male patients (p=0.025). Inmost cases surgery with radiotherapy was the treatment of choice (49.3%). The most frequent symptom reportedwas headache (in 60.8% of patients) followed by convulsions (15.7%). Most of the tumors were located in theright hemisphere (46.1%) and the frontal and parietal lobe (26% and 12%, respectively). Radiography findingsdisplayed edema with a nonhomogeneous lesion in majority of the patients (87%). The survival fraction of thepatients with malignant tumors decreased over time (0.807 in the first year and 0.358 at the end of the 5th year).Conclusions: Astrocytoma was the more common CNS tumor with male predominance. Overall survival ratesof malignant tumors decreased over time and this was in relation with tumor grade.