目的 探讨进展期胃癌D2根治术中No.8p淋巴结转移与临床病理参数的相关性.方法 回顾性分析安徽医科大学附属六安医院2018年1月至2020年12月70例进展期胃癌患者的临床资料,采用多因素logistic回归分析肿瘤大小、发生部位、组织类型、组织学分级、Borrmann分型、浸润深度、肿瘤N分期、No.8a组淋巴结转移情况与No.8p组淋巴结转移的关系.结果 No.8p组淋巴结转移率为11.43％.单因素分析显示,病灶位于胃大弯侧和小弯侧、低分化和高中分化、浸润型和局限型、No.8a组淋巴结转移与否之间,No.8p组淋巴结转移情况差异存在统计学意义(P<0.05).logistic多因素分析显示,肿瘤位于小弯侧、低分化、No.8a组淋巴结转移,No.8p组淋巴结转移的危险因素(P<0.05).结论 进展期胃癌No.8p组淋巴结转移率较高,肿瘤位于小弯侧、低分化、No.8a组淋巴结转移时需重视No.8p组淋巴结转移.

探讨胃蛋白酶原和4种肿瘤标志物CEA、CA50、CA199、CA242联合检测对胃癌诊断的临床意义.102例胃癌患者(胃癌组)、87例胃部良性病变患者(胃良性病变组)和71例健康体检患者(对照组).应用全自动电化学发光免疫分析仪,测定不同临床分期患者血清肿瘤标志物含量水平,分析检测结果.结果 显示,胃癌组血清胃蛋白酶原Ⅰ和CEA、CA50、CA199、CA242水平高于良性病变组和对照组患者(P＜0.05),良性病变组上述指标高于对照组(P＜0.05);胃癌Ⅲ、Ⅳ期组患者血清胃蛋白酶原Ⅰ和CEA、CA50、CA199、CA242含量明显高于胃癌Ⅰ、Ⅱ期组;指标联合检测的阳性率高于单项检测阳性率(P＜0.05).结果 表明,胃癌患者血清胃蛋白酶原Ⅰ和CEA、CA50、CA199、CA242含量较高,转移后上述指标血清含量增加,联合检测比单一检测更具诊断价值.

Objective Excision repair cross-complementing gene-1(ERCC1) are key regulatory enzymes whose expression patterns are associated with overall survival(OS) in several malignancies.Their expression patterns and prognostic value in resected gastric adenocarcinoma(GAC) are not known and need to investigate.Methods A total of 109 patients who underwent resection for GAC in Liu′an People′s Hospital from January 2010 to June 2013 had tissue available for analysis.The primary objective was to assess for the differential expression of ERCC1 using by immunohistochemistry.The secondary objective was to assess for the association between OS and the expression of ERCC1.Results The median follow-up was 21.2 months,and the median OS was 28.8 months.Resected GAC exhibited differential expression of ERCC1(high expression,n=25(23%)).ERCC1 expression was not associated with OS(18.9 months vs.27.7 months,P=0.72).In a subset analysis of patients who received chemotherapy(n=73),high ERCC1 expression was associated with decreased OS(16.7 months vs.53.8 months,P=0.03).After controlling for known adverse pathologic features,high ERCC1 expression persisted as a negative prognostic factor in multivariate Cox regression analysis(HR=2.22,95% CI1.05-4.98,P<0.05).Conversely,in patients who underwent resection only(n=35),high ERCC1 expression demonstrated a trend toward improved OS(40.4 months vs.12.7 months,P=0.10).A positive prognostic influence also was present on multivariate analysis(HR=0.20,95% CI0.05-0.84,P=0.03).Conclusion Resected GAC exhibited differential expression of ERCC1.Among all patients,ERCC1 expression levels were not associated with OS.High ERCC1 tumor expression is associated with decreased OS in the patients who received chemotherapy but is associated with increased OS in those who underwent surgery alone.ERCC1 expression have prognostic value in resected gastric cancer,and further investigation is needed.

原发性肝癌(简称肝癌)根治性切除术后的复发甚为常见，且多为肝内复发，肝内复发又分为单发、多发或肝内弥漫性播散，肝癌复发后的再治疗方法的选择是目前肝癌外科治疗研究的重点和难点。现将复发后的再治疗方法综述如下。

Objective To explore the effects of different therapies in patients with postoperative recurrent primary hepatic carcinoma(PHC).Methods Clinical data of 246 postoperative recurrent PHC patients were analyzed retrospectively.Of these,18 underwent hepatectomy again,20 underwent hepatectomy again combined with comprehensive therapy,62 were treated with transcatheter arterial chemoembolization(TACE),and 146 were given conservative therapy.Results Survival rates in the 1st,3rd and 5th years were 76.3%,39.4% and 25.8% for patients who underwent hepatectomy again,compared to 53.2%,19.6% and 9.3% for patients treated with TACE.The corresponding rates for patients given conservative therapy were 37.7%,8.0% and 1.5%.The survival rates differed significantly among the three groups(P<0.05).Conclusions Secondary surgical resection is still the preferred method for recurrent PHC,and surgical excision combined with comprehensive treatment is the best treatment.It is associated with higher survival rate and tumor-free survival,lower intrahepatic PHC relapse,and longer survival time.