目的：探讨胆囊癌肝侵犯的CT诊断及临床价值。方法：回顾性分析经手术、病理证实的17例胆囊癌肝侵犯CT资料。结果：肿块型11例，腔内型2例，厚壁型4例。侵犯肝左内叶5例，肝右叶前段3例，同时侵犯肝左内叶及右叶前段9例。5例侵犯深度＜2 cm，12例侵犯深度＞2 cm。CT表现为胆囊窝脂肪间隙消失，邻近胆囊窝的肝脏组织内出现不规则形低密度影，边界模糊，胆囊癌肿与肝脏组织分界不清，增强后肝内病灶不规则强化。结论：CT对胆囊癌肝侵犯的诊断及临床分期、治疗方案的选择具有重要价值。
【Abstract】Objective To evaluate the prognostic value of plasma D-dimer level in cancer thrombosis and vascular invasion assessment and to analyze the correlation between plasma D-dimer level and the Pittsburgh modified TNM staging in patients with hepatocellular carcinoma for orthotopic liver transplantation. MethodsThe plasma D-dimer level was quantitated using Golden method in 120 patients with hepatocellular carcinoma for orthotopic liver transplantation. Cancer thrombosis in trunk vein and microvascular invasion was diagnosed by pathology. The relationship between plasma D-dimer level in different Child-pugh’s classification patients and vascular invasion as well as the Pittsburgh modified TNM staging was analyzed with χ2 test, factorial analysis of variance and q test by microsoft SPSS 9.0.ResultsIn ChildPugh’s A, B and C patients, the difference of plasma D-dimer level between patients with trunk vein cancer thrombosis and patients without vascular invasion was significant (P＜0.05). The differences of plasma D-dimer level between patients with microvascular invasion and patients without vascular invasion were significant (P＜0.01) in Child-Pugh’s B and C patients but was insignificant in Child-Pugh’s A patients (Pgt;0.05). The differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅲ tumor, and between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅳ tumor were significant (P＜0.05), but the differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅲ tumor and patients with TNM Ⅳ tumor were insignificant (Pgt;0.05).ConclusionPlasma D-dimer level, which increasing as upgrade of the Pittsburgh TNM staging, is useful in the vascular invasion and cancer thrombosis assessment in patients with hepatocellular carcinoma for liver transplantation, and the correlation was more significant as progression of vascular invasion and upgrade of Child-pugh’s classification.
目的:探讨MRI及多层螺旋CT多平面重建显示胆囊癌对邻近结构侵犯的价值。方法:前瞻性分析18例(CT及MRI各9例)胆囊癌对邻近结构侵犯情况。CT及MRI均包括平扫及增强扫描,CT扫描病例除横断断位外,行冠状位、矢状位重建;MRI病例行横断位、冠状位及矢状位扫描。结果:胆囊癌对邻近结构侵犯的敏感度、特异度、准确度如下:①横断位和矢状位显示邻近肝实质侵犯分别为81.2％、100.0％、83.3％,冠状位分别为87.5％、100.0％、88.9％;②横断位显示胃窦侵犯分别为75.0％、90.0％、83.3％,冠状位及矢状位均分别为75.0％、80.0％、77.7％;③横断位显示十二指肠侵犯分别为70.0％、75.0％、72.2％,冠状位分别为80.0％、75.0％、77.7％,矢状位分别为70.0％、75.0％、72.5％;④横断位和冠状位显示结肠肝曲侵犯均分别为25.0％、85.7％、72.2％,矢状位分别为50.0％、71.4％、66.6％;⑤横断位和冠状位显示胆管侵犯均分别为75.0％、100.0％、83.3％,矢状位分别为66.6％、100.0％、77.7％;⑥横断位、冠状位及矢状位显示邻近腹膜侵犯及淋巴结转移准确度均为66.6％;显示网膜侵犯准确度均为50.0％。结论:横断位、冠状位及矢状位显示胆囊癌对邻近肝实质、胃、十二指肠、胆管侵犯的敏感度、特异度、准确度较高;而显示对结肠肝曲、腹膜、网膜侵犯的准确度较低。
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
ObjectiveTo investigate expressions and biological function of membrane type matrix metallopro-teinase-1 (MT1-MMP) and matrix metalloproteinase-2 (MMP-2) in papillary thyroid carcinoma. MethodsThe expre-ssions of MT1-MMP and MMP-2 in 164 cases of papillary thyroid carcinoma and paracancerous tissues were detected by immunohistochemistry.The association between the expressions of MT1-MMP and MMP-2 and clinicopathological characteristics of papillary thyroid carcinoma was analyzed. ResultsIn paracancerous tissues, the positive expression rate of MT1-MMP was 11.0% (18/164), and the positive expression rate of MMP-2 was 14.0% (23/164).In papillary thyroid carcinoma tissues, the positive expression rates of MT1-MMP and MMP-2 was 61.6% (101/164) and 67.7% (111/164), respectively.The expressions of MT1-MMP and MMP-2 in carcinoma tissues and para carcinoma tissues were statistically significant differences (P < 0.05).The expressions of MT1-MMP and MMP-2 in papillary thyroid carcinoma tissues correlated with the lymph node metastasis (P < 0.05).In addition, the expression of MMP-2 in papillary thyroid carcinoma tissues correlated with capsule invasion (P < 0.05).The positive correlation was found between the expressions of MT1-MMP and MMP-2 in papillary thyroid carcinoma tissues (r=0.256, P < 0.05). ConclusionsMT1-MMP and MMP-2 may be involved the thyroid capsule invasion and lymph node metastasis of papillary thyroid carcinoma.MT1-MMP and MMP-2 may be involved in the progression of papillary thyroid carcinoma.
Objective To summarize the research progress of MRI in the assessment of rectal cancer before surgery. Methods Literatures about the recent studies on the research progress of MRI in the assessment of rectal cancer before surgery were reviewed according to the results searched from Pubmed, CNKI, and WanFang database. Results Preoperative staging, circumferential resection margin, and extramural vascular invasion were closely related to the prognosis of rectal cancer patients, MRI could provide a good assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion for rectal cancer patients, but it still had some deficiencies which needed further studies. Conclusion Application of MRI in the assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion before surgery, is conducive to the development of the most appropriate treatment options for patients with rectal cancer.
ObjectiveTo evaluate therapeutical effects of Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection of primary hepatocellular carcinoma with microvascular invasion. MethodsThe clinical data of 45 cases of primary hepatocellular carcinoma with microvascular invasion underwent Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection from June 2010 to June 2013 in Liaoning Cancer Hospital were retrospectively analyzed. These patients were divided into Huaier granule plus TACE treatment group (20 cases) and simple TACE treatment group (25 cases) according to the postoperative treatment of the patients. The immune function (CD4+/CD8+ ratio and IL-2 level), 1and 3-year tumor recurrence rates and 3-year cumulative survival rate were compared between two groups after operation. Result① The CD4+/CD8+ ratio and IL-2 level had no significant differences between the 2 groups before operation (P > 0.05), which in the Huaier granule plus TACE treatment group were significantly higher than those in the simple TACE treatment group (P < 0.05) on month 3, 6, and 12 after operation.② 1and 3-year tumor recurrence rates in the Huaier granule plus TACE treatment group were significantly lower than those in the simple TACE treatment group[15% (3/20) versus 48% (12/25), P < 0.05; 45% (9/20) versus 80% (20/25), P < 0.05]. ③ The 3-year cumulative survival rate was 75% and 68% in the Huaier granule plus TACE treatment group and the simple TACE treatment group, respectively. The survival curve analysis showed that the 3-year survival rate had a decreased trend, which in the Huaier granule plus TACE treatment group was slightly higher than that in the simple TACE treatment group, but the difference had no statistical significance between the 2 groups (P > 0.05). ConclusionsAlthough the results of this study fails to confirm that Huaier granule plus TACE treatment for primary hepatocellular carcinoma with microvascular invasion following radical resection could significantly improve the 3-year cumulative survival rate, it could effectively decrease the recurrence rate. It is needed larger sample size to further explore in future research.
ObjectiveTo evaluate the prognostic significance of visceral pleural invasion in diameter 3-5 cm nonsmall cell lung cancer(NSCLC). MethodsA total of 112 patients who underwent lobectomy and pathologically diagnosed with NSCLC(3-5 cm) were included in our hospital between January 2006 and December 2010.There were 72 males and 40 females at average age of 61(28-72) years. There were 62 patients diagnosed as adenocarcinoma and 44 as squamous cell lung cancer. Viceral pleural invasion(VPI) was identified in 63 patients as a VPI group. The other 49 patients without VPI were as a NVPI group. All patients were performed with lobectomy and mediastinal lymph node dissection. ResultsThere was no perioperative mortality. More smokers were included in the VPI group when compared with the NVPI group(53.9% vs. 28.6%, P=0.007). More squamous cell cancers were included in the VPI group, while more adenocarcinoma were included in the NVPI group with a statistical difference(P=0.003). The average follow-up duration was 52 months. A total of 32 death occurred at the endpoint. The overall survival(OS) of all included patients was 71.4%. The average follow-up duration was 51 months in the VPI group and 54 months in the NVPI group(P=0.441). There was no statistical difference in OS between the VPI group and the NVPI group(61.7% vs. 83.7%, P=0.017). Cox regression showed age less than 65 years(P=0.007), TNM stage(P=0.013), and VPI(P=0.035) were significant prognostic factors for NSCLC. ConclusionWe identified the presence of VPI as an independent poor prognostic factor in NSCLC patients with diameter at 3-5 cm.
ObjectiveTo assess the efficiency, safety and long-term prognosis for interventional bronchoscopy in the treatment of trachea invasion by thyroid cancer. MethodsThe clinical data of forty-three patients with trachea invasion by thyroid cancer in Changhai Hospital from January 2006 to September 2015 were retrospectively analyzed. The trachea diameter and dyspnea score were compared before and after interventional treatment to explore the efficiency. The complications during and after therapy were observed. All patients were treated with interventional modalities including electrocautery, argon plasma coagulation, laser, cryotherapy, stent insertion or radioactive seeds implantation according to different invasion types, degree of stenosis and base situation. ResultsThe trachea diameter increased from (3.9±1.5)mm to (10.6±0.6)mm after bronchoscopy therapy (t=-17.314, P < 0.000 1). The dyspnea score decreased from 3.3±0.7 to 2.3±0.7 after bronchoscopy therapy (t=9.274, P < 0.000 1). The complications during therapy included haemorrhage (46.5%), vocal cord paralysis (4.7%) and glottis edema (7.0%). The restenosis rate in the patients with stent insertion was 26.7%. Thirty-seven patients were followed up successfully, and the medium survival time for follow-up patients was 27 months. The univariate and multivariate analysis indicated that the kind of interventional modalities used for therapy was an independent prognostic factor of survival (HR=0.261, P=0.036). The medium survival time for the patients treated with≥3 methods, 2 methods and 1 method was 47 months, 36 months and 13 months, respectively. ConclusionsFor trachea invasion by thyroid cancer, bronchoscopic therapy can effectively relieve airway obstruction and dyspnea symptom. Combination of multiple interventional modalities could have a favorable prognosis after treatment.