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家族性腺瘤性息肉病的手术治疗

眼底检查在家族性多发性息肉病随访观察中的价值

Analysis of Features of Extracolonic Carcinoma Spectrum in Northeast Chinese with Hereditary Nonpolyposis Colorectal Cancer

Objective　To investigate the features of extracolonic carcinoma spectrum in Northeast Chinese with hereditary nonpolyposis colorectal cancer. Methods　The extracolonic carcinoma spectrum’s characteristics of 85 families registered in strict conformity with the HNPCC Amsterdam criteriaⅡwere analyzed retrospectively. Results　In the 85 HNPCC families， the tumorous patients were 509 cases，the primary tumors were 589 cases， among the total consisted of 219 cases of colon cancer， 91 cases of rectal cancer，and 279 cases of extracolonic cancer， the most common extracolonic carcinoma was lung cancer. Conclusions　Extracolonic carcinoma is an important part of cancer spectrum in HNPCC family， and the common extracolonic carcinoma in Northeast of Chinese are lung cancer， gastric cancer， endometrial cancer， liver cancer， and esophagus carcinoma.

Expression and Significance on Expressions of NKD1 and APC in Breast Carcinoma

ObjectiveTo detect the expressions of NKD1 and APC in breast carcinoma tissues and to explore the clinical significance of their existence and their correlation. MethodsThe study selected 75 patients with breast carcinoma as the observation group, and their corresponding normal breast tissues from the breast carcinoma tissues more than 5 cm as the control group. The expressions of two proteins were detected by immunohistochemistry. Their relationship with the pathological characteristics of breast carcinoma and the correlation of the two proteins were analyzed. ResultsThe positive expression rates of NKD1 and APC in normal breast tissues were significantl higher than those in breast carcinoma tissues (82.67% vs. 36.00%, 89.33% vs. 45.33%, P < 0.05). The expression of NKD1 was not correlated with the age of patients with breast carcinoma (P > 0.05), while correlated with the degree of differentiation, TNM stage, lymph node metastasis, and remote organ metastasis of breast carcinoma (P < 0.05). The expression of APC was not correlated with the age of patients with breast carcinoma, the degree of differentiation and lymph node metastasis of breast carcinoma (P > 0.05), while correlated with the TNM stage and remote organ metastasis of breast carcinoma (P < 0.05). The expressions of NKD1 and APC in breast carcinoma was positively correlated (r=0.609, P < 0.05). ConclusionNKD1 and APC may be involved in the development and remote organ metastasis of breast carcinoma, and the two proteins may have a synergistic role in breast carcinoma.

THE IMPROVEMENT OF ILEOANAL ANASTOMOSIS IN TOTAL COLECTOMY

目的 简化全大肠切除回肠贮袋肛管吻合术，避免全大肠切除术时腹壁回肠造瘘。方法 采用全大肠切除直肠肌鞘内回肠肛管吻合改进术式治疗25例家族性腺瘤性息肉病及1例溃疡性结肠炎患者，并进行了定期随访。结果 术后1年患者的肛门功能恢复正常，大便1～4次/天，可正常参加工作； 除2例发生术后早期不完全性小肠梗阻和1例癌变患者术后发生性功能障碍外无其它并发症。结论 该术式具有技术简单、病变切除彻底、无回肠造袋、不需要回肠造瘘、直视下剥离粘膜完全、止血操作容易、并发症少、术后肛门功能满意等优点。

Surgical Indications of Polypoid Lesions of the Gallbladder

Relationship Between βCatenin，Adenomatous Polyposis Coli Genes and Tumors

Objective To discuss the molecular structures and functions of βCatenin and APC (Adenomatous polyposis coli) genes, as well as the roles they played during the carcinogenesis and progression of tumors. MethodsAdvances in molecular biology and oncology of βCatenin and APC genes in recent years has been reviewed. ResultsHigh expression of βCatenin and APC genes was an early event during the carcinogenesis due to the abnormal regulation of βCatenin and APC genes. But on the contrary, the low expression of these two genes was probably associated with the progression of tumors. Moreover, βCatenin and APC genes could also regulate the expression of p53,cmyc genes and cyclin D1. Conclusion βCatenin and APC genes may play a key role during the carcinogenesis and progression of tumors and modulate other oncogen/suppressor gene and factors.

Relationship Between The Expressions of hMLH1 and hMSH2 Protein and Clinicopathological Features and Prognosis of Hereditary Nonpolyposis Colorectal Cancer

Objective　To investigate the relationship between the expressions of mismatch repair （MMR） genes （include hMLH1 and hMSH2） and clinicopathological features and prognosis of hereditary nonpolyposis colorectal cancer （HNPCC）. Methods　Immunohistochemistry method （Elivision-two step） was used to test expressions of hMLH1 and hMSH2 proteins （both hMLH1 and hMSH2 protein-positive delimited as MMR protein-positive） in 48 patients with HNPCCaccording to revised Bethesda guidelines， and analyzed the relationship between the expression of MMR protein and clinicopathological features and prognosis of HNPCC. Results　Loss rate of hMLH1 protein （20.83%，10/48） was signi-ficantly higher than that of hMSH2 protein （8.33%，4/48）， Ρ＜0.05， and positive expression rate of MMR protein was 70.83% （34/48）. Expression of MMR protein was related with tumor infiltration depth （Ρ＜0.05）. Survival rate of patients with expression and without expression of MMR protein was 85.29% （29/34） and 85.71% （12/14）， respectively， the survival curves of them didn’t significantly differed from each other （Ρ＞0.05）. Conclusions　Loss rate of hMLH1 protein is higher than that of hMSH2 protein. Expre ssions of hMLH1 and hMSH2 protein are related with tumor infiltration depth， but not related with prognosis.

Peutz-Jeghers综合征肠道息肉恶变的临床分析

目的探讨Peutz-Jeghers综合征肠道息肉恶变的临床诊治经验。 方法对2005～2015年期间所诊治的221例Peutz-Jeghers综合征患者中11例息肉恶变患者的临床病理资料进行回顾性分析。 结果11例PeutzJeghers综合征息肉恶变患者确诊时的中位年龄为31.36岁。行肠镜20例次，胃镜8例次，双气囊电子小肠镜19例次，胶囊内镜1例次。手术原因依次为肠梗阻、肠套叠、息肉恶变和消化道出血。癌变息肉分别位于十二指肠（4例）、小肠（4例）和结直肠（3例）。病理类型以管状腺癌（5例）和黏液腺癌（5例）最多见。本组11例患者均无手术死亡，1例术后发生腹部切口感染，经伤口换药等处置后出院。术后3例患者接受XELOX方案化疗，其余未作特殊治疗。1例术后失访，10例随访1个月至7年（中位随访期2.12年），其中4例术后1～3个月死于十二指肠癌肝肺转移、空肠腺癌肝转移和结肠癌肝肺多发转移，其余患者定期复查消化内镜或消化道造影等检查至今。 结论PeutzJeghers综合征息肉恶变患者年龄较小，早诊断、早治疗、定期复查可提高患者的检出率和临床治疗效果。

Clinicopathologic Features Analysis of Patients with Hereditary Nonpolyposis Colorectal Cancer in Northeast Chinese

Objective　To analyze the clinical pathological features of patients with hereditary nonpolyposis colorectal cancer （HNPCC） in northeast Chinese. Methods　The clinical data of 101 probands （HNPCC group） from 1982 to 2011 in the Fourth Affiliated Hospital of China Medical University and Tumor hospital of Liaoning Province and 272 patients with sporadic colorectal cancer （sporadic CRC group） in the same period were collected. The clinicopathologic features were compared in two groups. Results　In the HNPCC group， the age of onset was younger than 45 years old in 24 patients （23.8%）， proximal colon in 31 （30.7%）， multiple primary carcinomas in 26 （25.7%）， extracolonic carcinoma in 13 （12.9%）， mucinous adenocarcinoma in 32 （31.7%）， phaseⅠandⅡin 68 （67.3%）， high-middle differentiation in 70 （69.3%）， and lymph node metastasis in 33 （32.7%）， while in the sporadic CRC group were 12 （4.4%）， 54 （19.9%）， 15 （5.5%）， 11 （4.0%）， 30 （11.0%）， 127 （46.7%）， 152 （55.9%）， and 140 （51.5%）， respectively. There were significant differences between the HNPCC group and the sporadic CRC group （P＜0.05）. Meanwhile， extracolonic carcinomas in the HNPCC group were endometrial cancer in 3， bladder cancer in 3， breast cancer in 2， brain tumor in 2， ovarian cancer in 1， gastric cancer in 1， and lung cancer in 1. Conclusions　Northeast China HNPCC patients with several particular clinicopathologic features such as early onset， frequent localization in proximal colon， proclivity of synchronous and metachronous tumors， excessive mucinous adenocarcinoma， less poorly differentiated tumors， lymph node metastasis， early stage of tumor， and so on. Therefore， clinicopathologic feature is still a preferred method of diagnosis of HNPCC patients or suspected HNPCC patients.