目的 分析乳腺恶性肿瘤患者的诊断和治疗方法的动态变化,了解该疾病的患者诊治相关行为方式的变化。方法 抽取我院1999年—2014年收治的所有乳腺恶性肿瘤患者,比较不同初诊时间和初诊年龄分组间,患病部位、肿瘤大小、手术方式、治疗方式的差异。结果 比较1999年—2004年组、2005—2009年组,近年诊断的肿瘤最大直径有所下降,经过卡方比较,构成比有差异(χ²=14.2,P=0.007)。近年诊断的患者更愿意选择积极的改良根治术作为手术治疗方式(χ²=38.8,P<0.001)。就不同年龄而言,年轻的患者选择改良根治术和化疗的比例也较年老的患者高,而年龄大的患者则选择姑息治疗的比例较高(χ²=154.9,P<0.001)和(χ²=129.8,P<0.001)。结论 乳腺恶性肿瘤的认知的加强,诊治技术的提高,乳腺恶性肿瘤能够更早的被发现诊断,治疗方式的选择也更加积极。

Objective To analyze the dynamic changes of breast cancer diagnosis and treatment. and to understand the changes of related behaviors of the patients. Methods From 1999 to 2014, breast cancer patients were chosen, the differences of tumor size, operation and treatment were not compared. Results The results were compared within different groups of diagnosis years, such as 1999-2004,2005-2009, and 2010-2015. The maximum diameter of the tumor diagnosed in recent years was decreased, χ²=14.2,P= 0.007. At the same time, patients that were diagnosed in recent years were more likely to choose radical surgery as surgical treatment, χ²=38.8,P<0.001. Comparing within groups of different ages, more patients chose radical surgery and chemotherapy in younger patients than older ones, we found that the older patients chose a higher proportion of palliative care, χ²=154.9,P<0.001 and χ²=129.8,P<0.001. Conclusion Understan-ding of breast cancer malignancies was enhanced. Breast cancer may be diagnosed earlier and the choice of treatment is more positive with the development of technology.

目的 分析睾丸非肿瘤性病变的超声与CT诊断价值。方法 回顾性分析58例经临床病史、超声、CT或病理证实的睾丸非肿瘤性病例,结合临床病史,分析其超声与CT表现,包括炎性(或感染性)病变、外伤性病变、先天性病变及扭转急症。结果 所有病例均行CT检查,睾丸炎症性病变共39例(包括一般性炎症,脓肿和结核),其中19例行超声检查;睾丸外伤8例,隐睾9例,睾丸扭转2例,均行超声检查。睾丸炎症性病变临床表现为患侧或双侧阴囊不同程度的红、肿、痛,或白细胞升高、其他脏器伴发结核,超声表现为睾丸体积不同程度增大,根据炎症坏死程度不同,回声表现为回声均质、回声减低、回声不均质,坏死灶内无血流信号;CT表现为睾丸体积增大,根据炎症性病变的不同可表现为睾丸轻度强化、环形强化,可伴有睾丸鞘膜积液、点状钙化或积气;睾丸外伤均有阴囊外伤史,根据受伤程度表现为白膜下血肿、实质出血、睾丸破裂;隐睾表现为睾丸位置异常或缺如;睾丸扭转表现为睾丸短时间内剧烈疼痛,并进行性加重,超声表现为“镯环征”,CT表现为精索扭转、水肿,睾丸实质水肿。结论 睾丸非肿瘤性病变超声与CT征象均具有特征性,结合患者病史可作出准确诊断。超声检查较为便捷,CT检查可免除受检者接触性疼痛、可对盆腔及腹腔进行更为全面的观察。

Objective: Discussion on diagnosis of testicular non-tumorous lesions by ultrasound and CT.Methods: Rretrospective analysis of 58 testicular non-tumor cases proved by clinical history, Ultrasound, CT or pathologically,combined with the clinical history, and analysis of the Ultrasound and CT features,including inflammatory or infectious disease, traumatic disease, congenital disease and acute torsion.Results: All cases were examined by CT,the testicular inflammatory lesions were 39 cases, 19 of them were examined by ultrasound; testicular trauma 8 cases,cryptorchidism 9 cases, testicular torsion in 2 cases, all of them were examined by ultrasound. The clinical symptom of the inflammatory lesions of the ipsilateral or bilateral scrotum with different degrees of red, swollen, painful, or leukocytosis, other organs associated with TB, Ultrasound showed the testicular volume increased to varying degrees,according to the degree of inflammation and necrosis, the echo showed homogeneous echo, echo reduction, echo heterogeneity, and no blood flow signal in the necrotic area.CT showed an increase in testicular volume, according to the different inflammatory lesions showed mild enhancement of testis, ring enhancement, with a hydrocele, calcification or gas; testicular trauma had scrotal trauma history, according to the severity of injury showed subcapsular hematoma, hemorrhage and rupture of testis; testicular cryptorchidism showed abnormal position or absent; testicular torsion showed testicular short time severe pain, and progressive, Ultrasound showed “bracelet ring sign”, CT showed testicular torsion, edema, testicular parenchyma edema.Conclusion: Ultrasound and CT features of testicular non-tumorous lesions are characteristic, and the accurate diagnosis can be made with the combination of the patient's clinical history. Ultrasound examination is more convenient, CT examination can relieve the patient's contact pain, can be more comprehensive observation of the pelvic and abdominal.

目的 探讨声触诊组织定量(virtual touch tissue quantification,VTQ)技术在肾上腺肿瘤诊断中的应用价值。方法 对50例患者共50个肾上腺肿瘤及同侧肾皮质进行VTQ检查,获取肾上腺肿瘤及同侧肾皮质剪切波速度(shear wave velocity,SWV)值,比较肾上腺肿瘤与同侧肾皮质及肾上腺肿瘤各类型之间SWV值,全部病例均经手术后病理证实。结果 病理证实恶性肿瘤5个,良性肿瘤45个。良、恶性肿瘤之间SWV值的差异无统计学意义。肿瘤与同侧肾皮质之间SWV值的差异有统计学意义。髓样脂肪瘤、神经鞘瘤、皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间,除皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间SWV值的差异无统计学意义外,其余任两组之间SWV值的差异有统计学意义。结论 VTQ技术可以提供肾上腺肿瘤的硬度及弹性信息,在肾上腺肿瘤的诊断中具有一定应用价值。

Objective To evaluate the application value of virtual touch tissue quantification (VTQ) technique in the diagnosis of adrenal tumors.Methods VTQ was performed in 50 patients with 50 adrenal tumors and ipsilateral renal cortex, to obtain the shear wave velocity(SWV) of adrenal tumors and ipsilateral renal cortex, the comparison between adrenal tumor and ipsilateral renal cortex and adrenal tumors of various types of SWV. All cases were pathologically confirmed after operation.Results 5 malignant tumors and 45 benign tumors were confirmed by pathology. The difference of SWV between benign and malignant tumors was not statistically significant. The difference of SWV between tumor and ipsilateral renal cortex was statistically significant. Among myelolipoma, schwannoma, adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma in addition to differences in adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma, SWV value was not statistically significant; it was statistically significant difference between the two groups in any other SWV.Conclusion VTQ technology may provide hardness and elasticity of the adrenal tumors; it has certain application value in the diagnosis of adrenal tumors.

目的 探究彩色多普勒超声在乳腺良恶性肿瘤鉴别诊断中的应用价值。方法 抽取2012年2月—2016年6月我院门诊、社区普查中的病例中选取符合研究标准的298例乳腺肿瘤疾病患者,所有患者均行彩色多普勒超声检查。通过SPSS 19.0软件对数据进行分析,以病理检查结果作金标准,分析彩色多普勒超声诊断结果,对比良性肿瘤与恶性肿瘤血流分级情况及良性肿瘤与恶性肿瘤收缩期流速峰值(PSV)及(阻力指数)RI水平。结果 经病理检查证实,298例患者中恶性肿瘤32例,良性肿瘤266例;超声诊断恶性肿瘤42例,良性肿瘤256例;超声诊断灵敏度为93.75%(30/32)、特异度为95.49%(254/266)、准确度为95.30%(284/298)。良性肿瘤血流信号检出率为55.26%(147/266),恶性肿瘤血流信号检出率为96.87%(31/32),其中良性肿瘤以0～I级血流为主,为83.83%(223/266),恶性肿瘤以I～III级血流为主,为96.87%(31/32),各分级情况对比,差异有统计学意义(P＜0.05)。恶性肿瘤PSV(20.11±6.76)cm/s、RI(0.65±0.07)均明显高于良性肿瘤[(15.30±9.21)cm/s、(0.56±0.09)],差异有统计学意义(P＜0.05)。结论 彩色多普勒超声在乳腺良恶性肿瘤临床鉴别诊断中具有较高准确度、特异度及灵敏度,可结合血流分级和RI水平提高乳腺良恶性肿瘤鉴别准确度。

目的 探讨直肠神经内分泌肿瘤的临床病理特征。方法 回顾性分析46例直肠神经内分泌肿瘤患者的临床病理资料,对不同病理分级的患者在性别、年龄、肿瘤直径、浸润深度、肝及淋巴结转移等方面进行比较。结果 直肠神经内分泌肿瘤男性多见,肿瘤多位于直肠中下段。免疫组化检测显示CgA、Syn、CD56阳性率分别为40.0%、97.8%、100%。36例Ki-67阳性指数≤2％,6例Ki-67阳性指数在3％～20％,4例Ki-67阳性指数＞20％。不同病理分级的肿瘤与患者年龄、肿瘤直径、浸润深度、淋巴结及肝转移相关,与性别不相关。结论 直肠神经内分泌肿瘤缺乏临床特异性症状,联合CgA、Syn和CD56染色可提高直肠神经内分泌肿瘤的诊断率。病理分级对预测肿瘤浸润深度、肝或淋巴结转移有重要参考价值。

Objective To investigate the pathological and clinical significance of 46 cases of rectal neuroendocrine tumors(NET). Methods Retrospectively analyzed the clinical and pathological feature of 46 patients with rectal NET, and assessed possible interactions between different pathological grades and gender, age, tumor diameter, depth of invasion, lymph node and liver metastasis. Results Rectal NET appeared more frequently in males than in females. Most tumors located in middle and distal third of rectum. The positivity rates of immunohistochemical marker CgA, Syn, CD56 were 40.0%, 97.8%, 100.0%, respectively. The cases of Ki-67 positivity rate under 2%, ranged between 3%-20%, above 20% were 36, 6, 4, respectively. Different pathological grades were significantly correlated with age, tumor diameter, depth of invasion, lymph node and liver metastasis, but not with gender. Conclusion Rectal NET had nonspecific symptoms. Combined immunohistochemical staining, such as CgA, Syn and CD56, was important in the evaluation of rectal NET. Pathological grading might be very useful for prediction of invasion depth, lymph node and liver metastasis.

目的 研究EGFR基因突变与系列肿瘤标志物在160例原发性肺癌患者及51例肺部良性占位病变患者中的表达状况,为肺部占位病变的诊断、鉴别诊断和治疗提供参考依据。方法 160例肺癌患者取新鲜病理组织标本,采用扩增阻滞突变系统荧光PCR(ARMS-PCR)技术检测EGER基因突变;160例肺癌患者和51例良性占位病变患者取外周静脉血用化学发光法检测系列肿瘤标志物,用χ²检验统计分析数据。结果 160例肺癌病例中,EGFR基因野生型比率为47.56%(78/164),EGFR基因突变型比率为52.44%(86/164),突变型中21L858R点突变占23.17%(38/164),19Del缺失突变占22.56%(37/164)。肺癌组中系列肿瘤标志物较良性占位组具显著高表达,P＜0.01。差异有统计学意义。结论 肺癌致病与EGFR基因突变、肿瘤标志物高表达有显著正相关,通过肿瘤标志物和EGFR基因突变检测,结合影像学检查,将有助于肺部占位病变诊断和鉴别诊断,并为治疗手段选择提供参考依据。

Objective To research EGFR gene mutation and series of tumor markers expression in 160 patients with primary lung cancer and 51 patients with lung benign placeholder lesions, provide some references for the diagnosis, differential diagnosis and treatment in lung placeholder lesions. Methods We took fresh pathological tissue specimens from 160 cases of patients with lung cancer, Then used ARMS PCR technique to detect EGER gene mutations. We took the peripheral venous blood in 160 patients with lung cancer and 51 patients with lung benign placeholder lesions, with chemiluminescence method to detect series of tumor markers,and used thechi-square test to statistic and analysis data. Results In 160 cases of lung cancer patients,The EGFR gene wild type rate was 47.56%(78/164).The EGFR gene mutation type rate was 52.44%(86/164).In EGFR gene mutation type,The proportion of 21L858R mutation was 23.17%(38/164),19del mutation was 22.56%(37/164). Series of tumor markers had significantly higher expression in lung cancer group than in benign placeholder lesions group. P＜0.01.The difference was statistically significant. Conclusion Lung cancer pathogenesis and EGFR gene mutations, tumor markers high expression was significantly positive correlation. Through a series of tumor markers and EGFR mutation testing, combined with imaging examination, it will contribute to the diagnosis and differential diagnosis in lung placeholder lesions, and provide the basis for treatment.

目的 观察比较术中及术前化疗干预对进展期胃恶性肿瘤手术患者p53、ki-67表达及预后的影响,为临床化疗时间的选择提供理论依据。方法 自2014年8月—2015年5月,我院共收入胃恶性肿瘤患者40例,将40例患者随机分为两组,每组各20例,保证两组患者在性别、年龄、胃癌分期等方面可比,无统计学差异(P＞0.05),标记为Ⅰ组和Ⅱ组。Ⅰ组20例患者于术前进行化疗干预,Ⅱ组在术中给予化疗干预。观察比较两组患者p53、ki-67表达状况及预后。结果 Ⅰ组及Ⅱ组治疗后p53及ki-67均比治疗前升高,差异有统计学意义(P<0.05)。但是治疗后,Ⅰ组和Ⅱ组的p53表达状况组间差异不明显,无统计学意义(P>0.05)。治疗前后,AI差异有统计学意义(P<0.05)。Ⅰ组效果明显好于Ⅱ组,两者差异有统计学意义(P <0.05)。术后六个月、一年随访时发现两组复发率、死亡率差别不大,无统计学意义(P>0.05),术后两年随访发现Ⅱ组复发率、死亡率明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论 术中化疗的疗效优于术前化疗,患者预后较术前化疗好。

Objective To observe the effect of intraoperative and preoperative chemotherapy on the expression of p53, Ki-67 and prognosis in patients with advanced gastric cancer. Methods 40 cases of advanced gastric cancer in our hospital from Aug 2014 to May 2015 were enrolled in the study, and were divide into 2 groups randomly. In group I, 20 patients received chemotherapy intervention befoerer operation, and the other group received chemotherapy intervention during operation. The expressions and prognosis of p53 and Ki-67 were observed and compared between the two groups. Results Group Ⅰ and group Ⅱ after treatment, p53 and Ki-67 were higher than that before treatment, with statistical significance(P<0.05). However, there was no significant difference in the expression of p53 between group Ⅰ and group Ⅱ after treatment, and there was no significant difference(P>0.05). Before and after treatment, the difference of AI was significant, with statistical significance (P<0.05). The effect of group Ⅰ was obviously better than that of group Ⅱ, the difference was statistically significant(P<0.05). Six monthse after the operation and one year follow-up found two groups of recurrence rate and mortality rate had no significant difference(P>0.05). After two years follow-up found the group Ⅱ recurrence rate, mortality was lower than in group Ⅰ (P<0.05). Conclusion The effect of intraoperative chemotherapy is better than that of preoperative chemotherapy, and the prognosis is better than that of preoperative chemotherapy.

目的 探讨原发性脾脏肿瘤的诊断与治疗。方法 选取2006年1月—2014年12月期间收治的58例原发脾脏肿瘤患者进行临床观察。结果 脾脏良性肿瘤45例,其中脾血管瘤21例,脾囊肿11例,脾淋巴管瘤8例,脾脏窦岸细胞血管瘤3例,脾错构瘤1例,脾脏硬化性血管瘤样结节性转化1例;脾脏恶性肿瘤13例,其中脾脏B细胞淋巴瘤11例,脾脏霍奇金淋巴瘤及脾脏血管肉瘤各1例。B超和CT是主要的检查方法。全组行脾切除术51例,其中开腹脾切除术23例,腹腔镜脾切除术28例;部分脾切除术5例;脾切除+胰腺体尾部切除术2例。所有病例无手术并发症。术后随访9个月~9年,平均随访时间(43.8±21.3)个月,41例脾脏良性肿瘤患者预后良好,无复发和转移;11例脾脏恶性肿瘤患者的1、3、5年生存率分别为81.8%、63.6%和27.2%。结论 原发性脾脏肿瘤的诊断主要依靠临床表现和影像学检查。手术切除不仅是脾脏肿瘤一种有效的治疗手段,也是重要的确诊方法。脾脏局限性良性肿瘤可选择部分脾切除术以保留脾脏功能。早期手术及术后联合放化疗可改善脾脏恶性肿瘤的预后。

Objective To investigate the diagnosis and treatment of primary splenic tumor. Methods The clinical data of 58 patients with primary splenic tumor from January 2006 to December 2014 were retrospectively analyzed. Results 45 cases were benign splenic tumor, including 21 hemangioma, 11 splenic cyst, 8 lymphangioma, 3 littoral cell angioma, 1 hamartoma and 1 sclerosing angiomatoid nodular transformation of spleen. 13 cases were malignant splenic tumor, including 12 lymphoma and 1 angiosarcoma. Ultrasound and CT were the main diagnostic methods. 51 cases underwent splenectomy, including 23 open splenectomy and 28 laparoscopic splenectomy. 5 cases underwent partial splenectomy and 2 splenectomy combined distal pancreatectomy. There had no postoperative complications. The follow-up period was 9 months to 9 years. 41 cases with benign splenic tumor had no recurrence or metastasis. The 1-, 3-, 5-years survival rate were 81.8%, 63.6% and 27.2% respectively of 11 patients with malignant splenic tumor. Conclusion The diagnostic of primary splenic tumor mostly rely on clinical features and imagic examination. Surgical resection is not only an effective treatment, but also a confirmed diagnosis method for primary splenic tumor. Partial splenectomy is a reasonable procedure for local benign splenic tumor. Early surgery, combined adjuvant chemotherapy and radiotherapy are important for improving the prognosis of malignant splenic tumor.

目的 探讨年轻恶性肿瘤化疗女性的发病情况及保留生育功能和卵巢功能的意义。方法 回顾性分析和总结在我院行化疗的17～40岁年轻恶性肿瘤女性患者的年龄、肿瘤类别、构成等临床资料。结果 5年间在我院化疗的1261例女性恶性肿瘤患者中,年龄15～40岁者共786例(占62.3％),其中乳腺癌355例、大肠癌89例、白血病80例、宫颈癌67例、卵巢癌46例、恶性淋巴瘤39例,胃癌38例,肺癌30例,肝癌18例。15～25岁年龄段的女性恶性肿瘤化疗以白血病和卵巢癌为主。随年龄增长,大部分女性恶性肿瘤化疗的发生率增高。结论 15～40岁年轻恶性肿瘤化疗女性中乳腺癌占首位,其次为大肠癌、白血病和宫颈癌。保留年轻患者卵巢功能和生育功能的保守治疗具有重要意义。

Objective To analyze the clinical characteristics of malignant tumor in young women receiving chemotherapy aged from 15 to 40 and investigate the role of conservative treatment. Methods The clinical data of female aged from15 to 40 years old who were received chemotherapy in our hospital between 2010 and 2014 were retrospectively analyzed. Results 786 cases were identified from 1261 cases of malignant tumor receiving chemotherapy. Including 355 cases of breast cancer,89 cases of colorectal cancer,80 cases of leukemia,67 cases of cervical carcinoma,46 cases of ovarian cancer,39 cases of lymphoma,38 cases of gastric cancer,30 cases of lung cancer and 18 cases of liver cancer. Leukemia and ovarian cancer is the most common malignant tumor in young female between 15 to 25 years old. The cases of malignant tumor receiving chemotherapy increased with increasing age. Conclusion Breast cancer is the most common malignant tumor in young female receiving chemotherapy, followed by colorectal cancer, leukemia, and cervical carcinoma. It is very important to conserve young women's ovary function and fertility function.

目的 探讨ε-3多不饱和脂肪酸在胃肠道肿瘤患者化疗后的胃肠道毒性及生活质量的作用。方法 在研究前经过化疗筛选,按照WHO化疗副反应在2级或者以上的50名住院的胃癌或者直结肠癌患者,随机分为对照组(单纯化疗)(n=25)和研究组(化疗加ε-3多不饱和脂肪酸)(n=25),两组的化疗方案均为化疗筛选的方案。预防性每天静脉使用ε-3多不饱和脂肪酸 200 mg,连续5天,记录评估胃肠道并发症,如恶心、呕吐和腹泻,以及KPS评分、血清白蛋白、IL-2、IFN-γ和CRP。结果 与对照组比较,恶心、呕吐和腹泻评分、IL-2、IFN-γ和CRP低于于对照组,相反,生活质量评分研究组高于对照组,差异有统计学意义(P<0.05)。结论 预防性使用ε-3多不饱和脂肪酸能够减轻胃肠道肿瘤患者化疗后的胃肠道毒性症状、降低全身炎症因子反应并改善生活质量。

Objective To explore the effect omega-3polyunsaturated fatty acid omega-3 FA on clinical manifestations of gastrointestinal toxicity and quality of life (QOL) induced by chemotherapy for patients with gastric or colorectal cancer. Methods After screening chemotherapy, Fifty patients with gastric or colorectal cancer, according to developing WHO side-effect grading system of grade 2 or higher were randomly divided into either control group (n=25) or omega-3 FAs group (n=25) during next cycle of chemotherapy. In the control group, the patients received the same chemotherapy regimens as screening cycle and in the omega-3 FA group, received chemotherapy and omega-3 FAs. Prophylactic intravenous 200 mL /d was given for 5 days. The gastrointestinal complications such as nausea,vomiting or diarrhoea and Karnofsky performance status(KPS ),IL-2,IFN-γandCRP,ect, were evaluated respectively. Results Compared with the control group, the scores of nausea vomiting and diarrhea and IL-2,IFN-γor CRP levels decreased , significantly,on the contrary, the score of QOL increased. There was significantly statistical difference (P<0.05). Conclusion Prophylactic intravenous omega-3 FA can ameliorate clinical manifestations of gastrointestinal toxicity and systemic inflammatory response syndrome(SIRS) induced by chemotherapy and improve QOL for patients with gastric or colorectal cancer.