目的 探讨老年低位直肠癌经肛门局部切除后加放、化疗的临床意义。方法 对18例年龄≥65岁，肿瘤距肛缘≤6 cm且经病理证实但拒绝Miles术的直肠癌患者行经肛门局部切除； 于术后1个月给予放疗（总剂量50 Gy）； 化疗： 亚叶酸钙200 mg、5-FU 400 mg/m2，第1次于术后第1~5 d，每3~4周重复1次，共3~6次。结果 全部病例无手术死亡，术后均有良好的肛门功能。16例获随访，随访5年，其中3例局部复发，拒绝再次手术，给予放、化疗。死亡12例，其中2例死于远处转移，10例死于其他因素。本组患者1年生存率为77.8%（14/18），5年生存率为38.9%（7/18）。结论 对老年低位直肠癌拒绝Miles术的患者行经肛门局部切除加放、化疗，疗效确切，可提高患者生活质量，延长生存期。
Objective To study the effectiveness of local excision of low rectal tumor by Mason operation. Methods Twenty-our patients with low rectal tumor underwent Mason operation from 1997-2002 and their information was collected and studied. Results o recurrence was observed in the follow-p period from 5 months to 6 years after operation.Conclusion Mason operation for resection of tumor in low segment of rectum has the advantages of easy manipulation, minimal invasiveness and good exposure in operation.
Toexploretheinfluenceoflocalmassiveexcisionbeforeradicalsurgeryonprognosisofpatientswithbreastcancer,wecomparedtheprognosisbetweenthegroupunderwentlocalresectionpriortoradicalsurgery(106cases)andthegorupwithdirectradicalresection(143cases).Theresultsshowedthatthelocalrecurrencerate,distancemetastasisrateandthesurvivalrateat3,5yearsofthegroupunderwentlocalexcisionpriortoradicalsurgerywere16.0%,26.4%,79.2%,71.7%respectivelyandofthegroupunderwentdirectradicalresectionwere4.9%,16.1%,89.5%,82.5%respectively,thedeferencewassignificant(Plt;0.01,0.05,0.05,0.05respectively).Theresultsindicatethatthelocalexcisionbeforeradicalsurgerycanaffecttheprognosisofpatientswithbreastcancer.
ObjectiveTo summarize the diagnosis and treatment process of a patient who underwent laparoscopic local excision of duodenal papillary tumor, and to explore the safety and feasibility of this surgery. MethodThe clinicopathologic characteristics and surgical procedure of the patient with duodenal papillary neuroendocrine tumor admitted to the West China Hospital of Sichuan University in June 2021 were retrospectively analyzed. ResultsThe patient underwent the laparoscopic local excision of duodenal papillary tumor + in situ cholangiojejunostomy and pancreaticojejunostomy. The operation lasted about 3 hours, the blood loss was about 20 mL, and the patient exhausted on the 3rd day after the operation. On the 7th postoperative day, the gastric tube was pulled out and oral feeding was started. On the 8th day, the plasma drainage tube was pulled out and the patient was discharged smoothly. There was no duodenal fistula, bleeding, wound infection, and other complications. After 6 months of follow-up, the general condition of this patient was good, and no tumor recurrence or metastasis was found. ConclusionLaparoscopic local excision is an appropriate option for benign or low-grade malignancies involving the duodenal papillary tumor.
目的 探讨十二指肠良性肿瘤的手术治疗方式及术后早期营养管理的效果。方法 回顾性分析2009年1月至2011年12月期间我科收治的15例十二指肠良性肿瘤患者的临床资料，根据肿瘤的生长部位及肿瘤大小实施不同的手术方式，术后早期给予肠内营养治疗及消化液回输，观察术后患者并发症发生率及术后2个月内的返院情况。结果 15例患者中2例患者肿瘤位于十二指肠乳头下、直径2.5cm和2.0cm，2例位于降部与水平部交界处、直径2.3cm和2.5cm，1例位于十二指肠升部、直径3.5cm，该5例患者行十二指肠节段切除并空肠吻合术。4例患者肿瘤位于十二指肠乳头、直径1.0～2.0cm，3例位于乳头上缘、直径1.5～1.8cm，2例位于球部与降部交界处、直径2.0cm和1.8cm，1例位于十二指肠乳头下、直径1.2cm，该10例患者均行肿瘤局部切除术（位于乳头部的肿瘤同时行乳头成形术）。围手术期无死亡病例。1例（1/15）发生胃排空障碍，经禁食、减压及营养支持治愈出院。术后住院时间为7～10d，平均8d。术后2个月患者均接受随访，恢复良好，无返院患者。结论 手术切除是十二指肠良性肿瘤的首选治疗手段，手术方式取决于肿瘤的生长部位和大小，术后早期营养管理安全、有效。