目的 探讨神经内镜下经鼻扩大入路切除鞍结节脑膜瘤的安全性及有效性.方法 结合临床表现及影像学回顾性分析2013年9月～2019年4月在兰州大学第二医院诊断为鞍结节脑膜瘤并接受神经内镜下经鼻扩大入路切除的37例患者.结果 37例患者,肿瘤全切31例(83.8％),次全切除6例(16.2％),围术期死亡1例(2.7％),术后共11例(29.7％)出现并发症,其中5例(13.5％)发生单纯脑脊液鼻漏,2例(5.4％)出现脑脊液鼻漏并发颅内感染,2例(5.4％)出现尿崩症,2例(5.4％)出现垂体功能低下,所有患者术后随访8～72个月无复发.结论 神经内镜经鼻扩大入路切除鞍结节脑膜瘤有效、可靠,术中强调显微外科操作、保护肿瘤周围结构、术后防治并发症,对提高患者手术疗效具有重要意义.

近年来,免疫检查点抑制药给癌症的治疗带来了革命性的变化,并已成为多种晚期癌症治疗的重要手段之一.2020年3月,国家药品监督管理局正式批准纳武利尤单抗用于治疗既往接受过2种或2种以上全身性治疗方案的晚期或复发性胃或胃食管连接部腺癌的程序性死亡受体-配体1阳性患者.中国临床肿瘤学会胃癌诊疗指南2020年版将纳武利尤单抗三线治疗的推荐级别提升为最高级别,使我国胃癌治疗进入了新阶段.本文就免疫检查点抑制药在胃癌治疗及其生物标志物的研究现状做一综述.

2017年12月至2019年8月兰州大学第二医院神经外科采用单纯神经内镜下经幕下小脑上入路切除松果体区肿瘤5例，术后MRI提示肿瘤全部切除。术后行单纯放疗4例，放疗加化疗1例。病理学结果提示：生殖细胞瘤3例，畸胎瘤1例，混合型生殖细胞肿瘤1例。术后1例患者出现精神症状，2例患者出现双眼上视不能合并复视。随访0.2～1.8年，5例患者均可正常生活，无一例肿瘤复发。单纯神经内镜下经幕下小脑上入路适用于病变主体位于Galen静脉复合体以下的松果体区肿瘤，其安全性和有效性良好。

Objective:To summarize and assess the diagnostic and therapeutic experiences of solid pseudo-papil-lary tumor of pancreas(SPTP).Methods:Clinical manifestation,imaging examination,pathological results,treatment and diagnosis information of 14 case of SPTP treated in our hospital from Jan.2008 to Dec.2014 were studied retrospectively. Results:There were no specific clinical manifestations in people with SPTP who mainly presented abdominal pain or dis-comfort.CT scanning suggested cystic-solid or solid masses occupation seen in pancreas.All patients underwent surgical resection including 2 cases of pancreaticoduodenectomy,3 cases of local resection,3 cases of distal pancreatectomy plus splenectomy,2 cases of distal pancreatectomy,3 cases of middle pancreatectomy,and 1 case of distal and middle pancrea-tectomy.The histological examination revealed typical pathological presentation of SPTP.Follow-up period ranged from 3 months to 5 years,and no recurrence and metastasis were found in all.Conclusion:SPTP is a kind of less aggressive tumor with good prognosis.Surgery is the first choice for its treatment.The surgical procedures should be chosen based on the finding of preoperative CT imaging and intra-operative exploration of tumor location.

肥胖是一个国际公共卫生问题,其增加了许多慢性疾病(如糖尿病、心血管疾病)的发病风险,也是癌症包括胃癌在内的主要危险因素.肥胖可能通过胃食管反流、胰岛素抵抗、高胰岛素样生长因子及瘦素水平升高、脂联素表达过低、性激素水平改变等引起胃癌发生.幽门螺杆菌感染可导致消化系统及非消化系统疾病,目前研究发现,其与肥胖也密切相关.健康的饮食习惯和体力活动有利于预防肥胖,药物和手术治疗也是控制肥胖的方法.

1病例资料<br>　　男性患者，63岁。因发现上腹部肿物半年，进行性增大伴疼痛半月收住入院。查体：全身皮肤黏膜无黄染，浅表淋巴结未触及肿大。腹软，剑突下可触及一直径约5cm的质硬包块，表面皮肤发红，边界清楚，活动度差，压痛明显；肝于右肋缘下6cm可扪及，质软。上腹部增强CT示（图1）：肝左叶较大类圆形团状异常混杂密度灶，边缘不光整，最大直径约为77mm，病灶内可见胆管不规则扩张，内见多发高密度结节影；增强扫描示病灶不均匀延迟强化，门静脉左支闭塞，肝门部、肝胃间隙及前腹壁下见多发异常密度灶，边界尚清；肝内、外胆管见扩张。

Objective To explore the surgical outcome and complications of limited removal in several sessions for giant pituitary adenomas via endoscopic transsphenoidal approach or in combination with pterional approach. Methods Clinical data of 45 patients with giant pituitary adenomas were analyzed retrospectively, who underwent fractional resection by craniotomy via endoscopic transsphenoidal or combined with pterional approach. The clinical outcome and postoperative complications were observed. Results In the first surgery, total removal was achieved in 26 patients, subtotal removal in 12, partial removal in 7. Nine patients got total resection and 6 got subtotal removal in the second surgery. The optimal interval between the two operations was 6 to 8 weeks. The postoperative complications included transient diabetes insipidus in 13 patients, cerebrospinal fluid nasal leakage in 5, central hyponatremia in 2, central high fever in 10 and hypopituitarism in 12. All the above symptoms were improved or disappeared after symptomatic support treatment. Sphenoid infection occurred in 3 patients including improvement in 2 by endoscopic debridement and recovery in 1 by anti-inflammatory treatment. Thirty-nine patients were followed up for 2 months to 3 years at a mean period of 2.1 years. The recurrence occurred in 9 patients including 6 receiving surgery again and 3 giving up. Conclusions Staged endoscopic transsphenoidal surgery combined with pterional approach could be an effective method for increasing total removal rate and decreasing the mortality and complications of giant pituitary adenomas.

<正>脊索瘤起源于人体残余器官或异位性骨化组织。McMaster等[1]报道脊索瘤人群发病率为9.5%;发病年龄3~95岁,平均58.5岁,40岁以下较罕见。颅底脊索瘤约占原发颅内肿瘤的0.1%~0.2%[2]。脊索瘤起源于脊柱占62%、颅骨占32%、外轴骨骼及其他边界不清者约6%[2]。颅底脊索瘤好发于斜坡区。脊索瘤患者常以颅神经损害(其中以动眼神经和外展神经症状常见)、

<正>患者男,69岁,因"右上腹胀痛伴呕吐1个月余"于2011年5月31日入院。入院查体:皮肤巩膜无黄染,全身浅表淋巴结无肿大;肝脏肋下未触及,剑突下4cm,质地软,无结节感,胆囊可触及,有压痛。超声示:肝右叶可探及一大小约170mm×60mm的异常回声包块,以中等回声为著,并可见不均匀分布的无回声区,边界清,似有包膜,形态不规则,其内可见血流信号。CT(图1)示:胆囊窝及肝下极腹腔内占位性病变,考虑:(1)胆囊癌;(2)胆囊多发结石。肝右叶及肝下包块穿刺病理活检:低分化腺癌。实验室检查:甲胎蛋白(AFP)199.30ng/ml,癌胚抗原(CEA)70.40ng/ml,肝功能指标正常。

对胶质母细胞瘤误诊为脑脓肿1例分析如下. 1 病历摘要 女,46岁.主因右侧肢体渐进性无力10 d门诊以左额脑脓肿收住,患者自诉于入院前10 d无明显诱因出现右手拇指、示指、中指及右下肢无力,次日出现右手五指及右下肢无力,且程度有所加重,急诊到当地医院行头颅MRI检查示:左额脑脓肿.随入我院进行治疗,患者自发病以来抽搐两次,每次持续约数分钟,可自行缓解,抽搐仅见于右侧肢体,左侧如常,自发病以来有头疼、头晕症状,但无恶心、呕吐等症.

Objective To discuss the management of solid-pseudopapillary tumor of the pancreas. Methods Four patients of solid-pseudopapillary tumor of the pancreas (SPT) were diagnosed by pathology. One patient was underwent magnetic resonance and two enhanced computer tomography scan. The mass was located in tuberculum (1 case), neck (1 case), and body-tail (2 cases) of pancreases respectively. Four cases were underwent duodenopancreatectomy, local resection of mass, resection of body-tail of pancreases respectively. The maximal diameter of tumor ranged from 5 cm to 16cm, averaged 10.3cm. The blood regular test and biochemistry were normal, and the tumor markers including AFP,CA19-9,CA125,CEA also were normal. The specimens were examined by pathology and immunohistochemistry. Results Four cases all were diagnosed solid-pseudopapillary tumor of the pancreas by pathology. At histologic analysis, the tumor was composed of uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of degeneration characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide rich ground substance. The expressions of Vimentin, α-ACT, α-AAT were positive, and CgA negative. Four cases were followed up for six months and norecurred. Conclusions SPT of pancreases was a kind of tumor of low potential malignancy, and the magnetic resonance and computer tomography were often to be used. The effective therapy was thoroughly resection, and the prognosis in most patients is excellent. Key words: Solid-pseudopapillary tumor of pancreas

对右颞顶叶巨大脑膜瘤1例分析如下. 1 病历摘要 男,36岁.藏族农民,主因头痛0.5 a,突然加重1个月余,以头痛待查收住入院.自诉0.5 a前无明显诱因出现间断头疼,无恶心、呕吐等症状,未予以重视,也未行任何治疗,1个月前晨起后自觉头疼加重,无其他不适,未做特殊处理前我院就诊.查体:神志清楚,查体合作尚可,颅神经检查无异常, 右侧肢体肌力、肌张力均正常,深浅感觉可,生理反射存在,病理反射未引出.

Objective To prove the clinical characteristics, diagnosis and treatment of prolactin pituitary adenoma. Methods The clinical presentations, imaging studies, endocrine and surgical outcomes in 45 patients with invasive prolactin pituitary adenomas and 67 patients with nonin - vasive prolactin pituitary adenomas were analyzed retrospectively. Results Invasive pituitary adenomas were more common in patients with macroadenomas than those with micro- adenomas( P ＜0.01 ). The occurrence of pituitary apoplexy was higher in invasion pituitary adenomas patients than those noninvasion ( P＜0.05 ). The rate of total tumor resection was lower and the rate of post operative recurrence was higher in patients with invasive tumors than those with noninvasive tumors ( P＜0.01 ). Conclusions The diagnosis and treatment of invasion prolactin pituitary adenoma are complicated. The postoperation treatment is often necessary in invasive pituitary adenoma patients.

新生血管形成是实体肿瘤侵袭性生长的必要条件.血管内皮生长因子(VEGF)是一个主要的肿瘤血管生长调节因子[1],我们观察VEGF在胃癌组织、癌旁组织的表达状况,并检测微血管密度(MVD)及微淋巴管密度(MLD),分析它们表达与胃癌临床病理特征及生存期的关系,探讨VEGF在胃癌发病机制中的作用.