p53基因突变是结直肠肿瘤最常见的基因学改变之一，参与调节细胞增殖和基因不稳定性，其能否引起肿瘤细胞DNA含量异常目前尚不清楚。我们应用流式细胞术和免疫组化方法检测结直肠癌标本DNA倍性和p53蛋白表达，旨在探讨二者的相关性及其在结直肠癌发生和预后中的作用。

目的探讨p53蛋白过度表达对不同部位大肠癌患者预后判断的价值.方法应用免疫组化方法检测75例大肠癌组织中p53蛋白表达情况.结果p53蛋白表达阳性率为46.7%(35/75).远侧大肠癌p53蛋白表达率(59.5%)显著高于近侧者(30.3%)(P＜0.05).p53蛋白表达与其它临床病理因素无明显相关.全组中位数随访时间为60个月,p53蛋白表达阳性与阴性患者术后总生存率比较有显著性差异(P＜0.05).在远侧大肠癌组织中p53阳性患者的预后明显差(P＜0.01).而在近侧大肠癌中,2组患者的预后则无显著性差异(P＞0.05).结论不同部位大肠癌p53蛋白表达存在一定差异,p53蛋白过度表达对远侧大肠癌患者预后判断有重要作用.

目的:观察吗啡与罗哌卡因配伍用于结肠癌术后硬膜外镇痛的有效性和安全性.方法:选择结肠癌手术患者75例,随机分为三组(n=25):0.1%吗啡组(I组)、0.15%吗啡组(Ⅱ组)和0.1%吗啡加0.2%罗哌卡因组(Ⅲ组),持续注入4ml/h,术后镇痛48h.采用视觉模拟评分法(VAS法)估计镇痛效果.结果:Ⅲ组镇痛效果明显好于其它两组(P＜0.05),对下肢肌力无影响,排气时间明显提前.结论:0.2%罗哌卡因与0.1%吗啡配伍用于结肠癌术后镇痛效果确切、安全.

ObjectiveTo evaluate 125I-labeled monoclonal antibody(McAb) CL58 in radioimmunoguided surgery(RIGS) for patients with colorectal cancer(CC).Methods 125I-McAb-CL58 was injected submucously into pericancerous site under endoscope in 29 CC patients. Intraoperative radioimmunodetection on targets(T) of tumors, regional lymph nodes and incisional margins, was carried out using a portable gamma-detecting probe. The T/NT ratio of 3∶1 was taken as the lowest threshold value of positivity for primary lesions, wall infiltration and lymph node metastasis. Lymph nodes were stained immunohistochemically for micrometastasis. Results The sensitivity for primary lesions was 93 1%. The specificity for tumor margin was 95 5%. For lymphatic metastasis, the sensitivity of RIGS was 92 0%, and the specificity was 87 8%(all P0 05,compared with that not using RIGS). Immunohistochemistry verified the existence of lymphatic micrometastasis in the RIGS-positive but histology-negative lymph nodes. Conclusions RIGS for colorectal cancer detects lymphatic metastasis, which could otherwise be overlooked.

Objective To observe the influence of 5 FU on the G1/S progress and cell cycle regulation in CA Ⅱ cell line in human colorectal cancer, and evaluate the point whether highly concentrated drugs would cause better effect. Methods The technic of cell cycle synchronization was used to observe the influence of 5 FU on G1/S phase progress and cell cycle regulation in human colon cancer CA Ⅱcell line. The changes of transcription in cell cycle regulation pathway P16/cyclin D1/CDK4/Rb were also measured by RT PCR. Results G1/S progress were prolonged when the CA Ⅱ cells were pre treated by 5 FU before synchronization, the checkpoint of G1/S was also delayed under the effect of 5 FU. Cell cycle arrest in CA Ⅱ cell by 5 FU was dose dependent. In G1/S checkpoint, the transcription of P16 increased and the trancription of cyclin D1 decreased. Conclusion G1/S arrest caused by highly concentrated drugs may be the possible reason of 5 FU taking effect in treating colorectal cancer.

Objective To evaluate the relationship between flow cytometric DNA ploidy, biological features and prognosis in patients with stage Ⅱand stage Ⅲcolorectal cancer. Methods Nuclear DNA content was measured by flow cytometry using frozen tumor samples in a prospective series of 82 patients with stage Ⅱand stage Ⅲcolorectal adenocarcinomas receiving curative resection. Results Of 82 samples, 36(43 9%) were diploid and 46(56 1%) were aneuploid. The diploid tumors were significantly more common in the proximal colon than that in the distal colon (65 7%vs.27 7%, P=0 001).There was no correlation between DNA ploidy and clinicopathological variables.Median follow up duration was 61 months. Patients with DNA aneuploid tumors showed a lower overall survival than those with DNA diploid tumors (P=0 043).Furthermore, a poorer prognosis of DNA aneuploid tumors was observed in patients with proximal colon tumors or with stage Ⅱtumors (P 0 0001, P=0 0005).Conclusion Flow cytometric DNA analysis may explain the difference of colorectal carcinogenesis and biological features between the proximal and distal colorectal cancer and can be used as a prognostic factor in colorectal cancer.

Objective: To evaluate the relationship between flow cytometric DNA ploidy, biological features and prognosis in patients with Stage II colorectal cancer. Methods: Nuclear DNA content, proliferation index and S-phase fraction were measured in a prospective series of 45 patients with curatively resected Stage II colorectal adenocarcinomas by means of flow cytometry using frozen tumor samples. Results: Of the 45 samples examined, 17 tumors (38%) were diploid and 28 (62%) aneuploid. The diploid tumors were significantly more common in the proximal colon than in the distal colon (67% vs. 23%; P<0.01). There was no correlation between DNA ploidy and the other clinicopathological variables (P>0.05). The proliferation index and S-phase fraction in the distal tumors were higher than those in the proximal tumors, but the difference was not significant (P>0.05). When the 5-year survival rate of patients with Stage II colorectal cancer was compared by the log rank test, a significant relationship between DNA ploidy status and disease free survival was observed in the group of all patients. Patients with DNA diploid tumors had a better disease free survival than those with DNA aneuploid tumors (P<0.05). Conclusion: These findings support that DNA ploidy status, proliferation index and S-phase fraction may differ in the proximal and distal colorectal cancer. Flow cytometric DNA ploidy status might be a useful prognostic factor in patients with Stage II colorectal cancer.

目的:探讨冷冻治疗肝癌的临床应用技术和效果.方法:应用LCS-2000型深度液氮冷冻治疗机,对原发性肝癌6例和继发性肝癌2例进行了冷冻治疗.结果:全部患者均手术顺利,无手术死亡及严重并发症,多数不良反应为疼痛、发热、ALT/AST和胆红素升高.病理显示冷冻区内肝细胞和癌细胞呈凝固性坏死.2例转移性肝癌均于手术后2年内死亡.1例巨块型肝癌于手术后1年死亡.2例肝癌于手术后3年死亡.另3例肝癌现健在,已分别存活3年、3年和4年.结论:冷冻治疗肿瘤成功的关键是能否将肿瘤细胞彻底地冷冻致死.冷冻治疗是肝癌治疗的一种手段,它有一定的适应证和局限性.如果掌握的好,疗效高,并发症少.

Objective: To explore the death-related factors of stage I rectal cancer patients. Methods: 89 cases of stage I rectal cancer patients between 1985 and 2000 were retrospectively studied for prognostic factors. Factors including age, gender, tumor size, circumferential occupation, gross type, pathological type, depth of tumor invasion, surgical procedure, adjuvant chemotherapy and postoperative complication were chosen for cox multivariate analysis (forward procedure) using Spss software (10.0 version). Results: multivariate analysis demonstrated that muscular invasion was an independent negative prognostic factor for stage I rectal cancer patients (P=0.003). Conclusion: Muscular invasion is a negative prognostic factor for stage I rectal cancer patients.

Objective: To study the association of DNA ploidy abnormality and p53 overexpression with the carcinogenesis of colorectal cancer. Methods: DNA ploidy and p53 expression were measured in a series of 42 colorectal adenocarcinomas by means of flow cytometry and immunohistochemical test. Results: 17 tumors (40%) were diploid and 25 (60%) aneuploid. The aneuploid tumors were significantly more common in the distal colon than in the proximal colon (P<0.01). Aneuploidy was significantly associated with lymph node metastasis (P<0.05). There was no correlation between DNA ploidy and the other clinicopathological variables. Of the 22 samples examined, the positive rate of p53 expression was 59% (13/22). p53 expression was more frequently observed in the distal tumors (11/13) than in the proximal tumors (2/9) (P<0.05). Conclusion: Our data support the hypothesis that the carcinogenesis of colorectal cancer might differ in proximal and distal tumors. DNA ploidy abnormality and p53 overexpression may play an important role in the development of distal colorectal cancer.

患者男,61岁.因前列腺癌行睾丸切除术后用快中子、光子放射治疗,8个月后骶会阴、双腹股沟及下腹部放疗照射野形成多个深在溃疡,以中西医治疗无效,创面继续溃烂加深.

Eleven clinical and pathological factors were eligible for study in relation to the survival of 617 female patients with breast cancer treated by radical mastectomy. All the patients have been followed for more than five years. The data were analyzed by the Cox's proportional hazards regression model. A final set of five independent significant prognostic factors was obtained. In order of importance, they were clinical stage, age at diagnosis, axillary lymph node status, histologic type and size of the primary. To test the time-dependency of these factors using Cox's model, all except age reduced their prognostic impact significantly after five years, however, age was a powerful prognostic factor for long-term survival. A prognostic index based on the regression coefficients was constructed. This index can give a better prediction for our patients' survival and be taken as reference when formulating treatment protocols for breast cancer.