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胆道恶性肿瘤外科治疗的焦点及热点 被引量:10
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作者 刘颖斌 吴向嵩 《肝胆胰外科杂志》 CAS 2019年第2期69-71,75,共4页
胆道恶性肿瘤根据解剖部位分为胆囊癌、肝外胆管癌以及肝内胆管癌,肝外胆管癌又分为肝门胆管癌、中段胆管癌及下段胆管癌。胆道恶性肿瘤因其恶性程度高、手术复杂、缺乏有效辅助治疗手段、预后差等特点而被学者所关注。本文就近年来胆... 胆道恶性肿瘤根据解剖部位分为胆囊癌、肝外胆管癌以及肝内胆管癌,肝外胆管癌又分为肝门胆管癌、中段胆管癌及下段胆管癌。胆道恶性肿瘤因其恶性程度高、手术复杂、缺乏有效辅助治疗手段、预后差等特点而被学者所关注。本文就近年来胆道恶性肿瘤外科治疗领域的相关焦点及热点问题进行讨论。1 胆道恶性肿瘤的术前评估胆道恶性肿瘤术前需对肿瘤患者进行全身以及局部两方面评估。 展开更多
关键词 胆道恶性肿瘤 外科治疗 手术切缘 淋巴清扫 意外胆囊癌
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《法国胆道恶性肿瘤临床实践指南》解读
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作者 吴向嵩 杨越 龚伟 《中国实用外科杂志》 CAS 2024年第11期1246-1253,共8页
胆道恶性肿瘤恶性程度高、治疗效果不佳、预后差。2023年9月《法国胆道恶性肿瘤临床实践指南》发布,其英文版于2024年3月发表。该指南由法国12个医学或外科协会组成的多学科团队联合制定,对2023年8月前胆道恶性肿瘤相关诊治循证医学证... 胆道恶性肿瘤恶性程度高、治疗效果不佳、预后差。2023年9月《法国胆道恶性肿瘤临床实践指南》发布,其英文版于2024年3月发表。该指南由法国12个医学或外科协会组成的多学科团队联合制定,对2023年8月前胆道恶性肿瘤相关诊治循证医学证据进行总结,针对肝内胆管癌、胆囊癌、肝门部胆管癌和远端胆管癌的临床实践进行详细阐述,其内容涵盖流行病学、诊断分型、外科治疗、药物治疗、放疗、随访等。该指南强调了胆管恶性肿瘤的个体化诊治原则及多科学讨论的重要性。但需注意的是,由于胆道恶性肿瘤的高质量临床研究数量有限,很多临床争议悬而未决,实际工作中结合具体情况决定病人诊疗方式,不能对指南生搬硬套。同时,该指南提及的争议也是将来开展高质量临床研究的重要方向。 展开更多
关键词 胆道恶性肿瘤 胆管癌 胆囊癌 指南 解读
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胆囊癌转化治疗模式探索与思考 被引量:19
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作者 龚伟 吴向嵩 杨自逸 《中国实用外科杂志》 CAS CSCD 北大核心 2022年第2期163-166,共4页
胆囊癌病人预后不佳。如何进一步精确评估手术可行性、提高外科根治性手术比例,是改善胆囊癌治疗效果的关键。以病人是否能从外科手术中获益为标准,可将处于局部进展状态而尚未发生远处转移的胆囊癌病人,进一步细分为临界可切除胆囊癌... 胆囊癌病人预后不佳。如何进一步精确评估手术可行性、提高外科根治性手术比例,是改善胆囊癌治疗效果的关键。以病人是否能从外科手术中获益为标准,可将处于局部进展状态而尚未发生远处转移的胆囊癌病人,进一步细分为临界可切除胆囊癌和局部进展期胆囊癌两种类型,并应对局部进展期胆囊癌开展转化治疗。随着综合治疗手段的进步,有望通过系统性治疗联合外科手术的转化治疗模式,提高此类病人的R0切除率,从而改善预后。 展开更多
关键词 胆囊癌 临界可切除 局部进展期 转化治疗
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基于循证医学模式对胆囊癌术后复发转化治疗后行R0切除1例报告并文献复习 被引量:9
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作者 吴向嵩 杨自逸 龚伟 《中国实用外科杂志》 CAS CSCD 北大核心 2021年第3期306-309,319,共5页
目的基于循证医学模式为1例评估为局部进展期的胆囊癌术后复发病人制定治疗方案。方法上海交通大学医学院附属新华医院2020年3月收治1例胆囊癌术后肝十二指肠韧带淋巴结复发侵犯门静脉主干及肝总动脉后壁病人,胆道肿瘤多学科综合治疗协... 目的基于循证医学模式为1例评估为局部进展期的胆囊癌术后复发病人制定治疗方案。方法上海交通大学医学院附属新华医院2020年3月收治1例胆囊癌术后肝十二指肠韧带淋巴结复发侵犯门静脉主干及肝总动脉后壁病人,胆道肿瘤多学科综合治疗协作组(MDT)在详细评估病情后,检索国内外主流医学文献数据库,寻找循证医学证据并进行评价,结合病人实际情况,最终拟定以根治切除为目标的转化治疗策略。结果根据所获证据,成功对病人实施转化治疗。经4周期AG方案(白蛋白结合型紫杉醇125 mg/m^(2)+吉西他滨1000 mg/m^(2),第1、8天静脉给药,21 d/周期)化疗后,影像学评估达部分缓解,存在R0切除可能。因此进行胆囊床肝楔形切除术+胆总管切除+区域淋巴结清扫术+胆管空肠吻合术,达到R0切除。术后病理学检查提示完全缓解。目前随访6个月无复发。结论对于胆囊癌术后复发的病例,应仔细进行可切除性评估,对直接手术获益不明显的病人,可考虑以化疗为主的转化治疗策略,以期实现根治性切除。 展开更多
关键词 胆囊癌 局部进展期 转化治疗 循证医学 化疗
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肝内胆管癌外科治疗进展 被引量:11
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作者 李雪川 吴向嵩 刘颖斌 《中国实用外科杂志》 CSCD 北大核心 2020年第12期1445-1447,1456,共4页
肝内胆管癌(ICC)是发病率仅次于肝细胞肝癌的肝恶性肿瘤,约占其发病率的15%,近年来肝内胆管癌的全球发病率呈上升趋势。其进展较快,易转移复发,故预后较差。根治性手术切除(R0切除)仍是惟一可能治愈肝内胆管癌的治疗方式,是改善病人预... 肝内胆管癌(ICC)是发病率仅次于肝细胞肝癌的肝恶性肿瘤,约占其发病率的15%,近年来肝内胆管癌的全球发病率呈上升趋势。其进展较快,易转移复发,故预后较差。根治性手术切除(R0切除)仍是惟一可能治愈肝内胆管癌的治疗方式,是改善病人预后的关键之一。目前针对肝内胆管癌的外科治疗方面如术前黄疸的处理、肝切除范围、淋巴结清扫、联合血管切除、微创手术治疗、术后复发等仍存在很多争议。 展开更多
关键词 肝内胆管癌 根治术 进展
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Characteristic gene expression profiles in the progression from normal gastric epithelial cells to moderate gastric epithelial dysplasia and to gastric cancer 被引量:8
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作者 LI Mao-lan ZHANG Jing-cheng +13 位作者 LI Song-gang wu Wen-guang RAO Long-hua DONG Ping GU Jun LU Jian-hua ZHANG Lin DING Qi-chen wu xiang-song MU Jia-sheng YANG Jia-hua ZHANG Wen-jie CHEN Lei LIU Ying-bin 《Chinese Medical Journal》 SCIE CAS CSCD 2012年第10期1777-1783,共7页
Background Gastric cancer ranks high among the most common causes of cancer-related death worldwide. This study was designed to explore key genes involved in the progression of normal gastric epithelial cells to moder... Background Gastric cancer ranks high among the most common causes of cancer-related death worldwide. This study was designed to explore key genes involved in the progression of normal gastric epithelial cells to moderate gastric epithelial dysplasia (mGED) and to gastric cancer. Methods Twelve pairs of mGED tissues, gastric cancer tissues, and normal gastric tissues were collected by gastroscopy. Total RNA was then extracted and purified. After the addition of fluorescent tags, hybridization was carried out on a Gene chip microarray slide. Significance analysis of microarrays was performed to determine significant differences in gene expression between the different tissue types. Results Microarray data analysis revealed totally 34 genes that were expressed differently: 18 highly expressed (fold change 〉2; P 〈0.01) and 16 down-regulated (fold change 〉2; P 〈0.01). Of the 34 genes, 24 belonged to several different functional categories such as structural molecule activity, extracellular regions, structural formation, cell death, biological adhesion, developmental processes, locomotion, and biological regulation that were associated with cancer. The remaining 10 genes were not involved in cancer research. Of these genes, the expression levels of Matrix metalloproteinase-12 (MMP12), Caspase-associated recruitment domain 14 (CARD14), and Chitinase 3-like 1 (CHI3L1) were confirmed by semi-quantitative RT-PCR. A two-way clustering algorithm divided the 36 samples into three categories and the overall correct classification efficiency was 80.6% (29/36). Almost all of these genes (31/34) showed constant changes in the process of normal gastric epithelial cells to mGED to gastric cancer. Conclusions The results of this study provided global gene expression profiles during the development and progression from normal gastric epithelial cells to mGED to gastric cancer. These data may provide new insights into the molecular pathology of gastric cancer which may be useful for the detection, diagnosis, and treatment. 展开更多
关键词 gastric cancer DYSPLASIA gene chips technology
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Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy 被引量:4
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作者 LIU Ying-bin KONG Ying +14 位作者 WANG Xu-an WANG Jian-wei LI Jiang-tao WANG Yong CHEN Yan CHEN De-qing WENG Wei-hong ZHANG Zhi-ping wu xiang-song FEI Xiao-zhou QUAN Zhi-wei Li Song-gang LI Ji-yu CAO Li-ping PENG Shu-you 《Chinese Medical Journal》 SCIE CAS CSCD 2008年第22期2250-2253,共4页
Background It is well known that conventional splenectomy, which requires careful handling and ligation of tissue of the splenic hilum, can easily cause complications such as splenic fever and pancreatic fistula. Here... Background It is well known that conventional splenectomy, which requires careful handling and ligation of tissue of the splenic hilum, can easily cause complications such as splenic fever and pancreatic fistula. Here, we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy. Methods We retrospectively compared and analyzed the complications, postoperative hospital stay, operative time, and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007. The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle. In addition, we analyzed the relationship between size of the spleen and occurrence of complications. Results The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively). In addition, there was no significant difference in operative time and volume of blood loss between two groups. The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications. Conclusions These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula, and shorten the postoperative hospital stay, especially in the patients with a large spleen. So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy. 展开更多
关键词 SPLENECTOMY portal hypertension
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