目的:探讨郎罕氏组织细胞增多症累及甲状腺的临床表现,诊治及预后。方法: 淋巴结病理活检及免疫组化证实郎罕氏组织细胞增多症的诊断,颈部血管彩超发现甲状腺长大。予以小剂量化疗。结果: 2例患者均为系统性郎罕氏组织细胞增多症,累及甲状腺,予以小剂量化疗后,其中1例患者,化疗后淋巴结及甲状腺明显缩小。另1例患者广泛受累,化疗后效果差。结论: 郎罕氏组织细胞增多症累及甲状腺者罕见,可表现为甲状腺单独受累或伴多系统受累,对前者可采用甲状腺部分或全切术,疗效好;对于多器官受累者多采用联合化疗,但疗效较差。
【Abstract】Objective Through using neoadjuvant chemotherapy of different circles combined colorectal cancer operations under multi-disciplinary team (MDT), we evaluate effective treatment strategies that suit to colorectal cancer patients in this country. Methods The retrospective study reviewed patients with colorectal cancer treated in general surgery department Ⅲ in West China Hospital of Sichuan University from October 2006 to April 2007. According to the circle times of neoadjuvant chemotherapy, the patients were divided into single-circle group, double-circle group and triple-circle group. And comparing the difference of treatment time, effect index of neoadjuvant chemotherapy and operative results used these stratagies. Results The difference between the time from the end of neoadjuvant chemotherapy to the operation in three groups had no statistical significance （Pgt;0.05）, which were （5.64±2.00） d in single-circle group, (5.80±3.74） d in double-circle group, （6.22±2.76） d in triple-circle group. According to the treatment effects, CEA value decreased during pre- and post-neoadjuvant chemotherapy in each groups （Plt;0.01）. Subjective reception such as hemafecia, anal tenemus and defecation obstruction in double-circle group and triple-circle group were obviously improved than that in single-circle group （Plt;0.01）. Evaluating the tumor condition, the ratio of CR and PR in double-circle group and triple-circle group was higher than that in single-circle group （Plt;0.01）. According to the adverse effect, WBC value of double-circle group and triple-circle group decreased during pre- and post-neoadjuvant chemotherapy, their difference had statistical significance （Plt;0.01）. The difference of WBC pre- and post- neoadjuvant chemotherapy in single-circle group decreased fewer than that in double-circle group and triple-circle group （Plt;0.01）. Nausea and vomit response in triple-circle group were obviously more serious than that in single-circle group and double-circle group （Plt;0.01）. But abdominal distention and diarrhea response had no difference among three groups （Pgt;0.05）. Through our survey, used different neoadjuvant chemotherapy circle, patients in single-circle group and double-circle group were completely accepted within full confidence; but receptance of strategy in triple-circle group was 66.7％(12/18）. All operations were successful. The difference of postoperative aerofluxus time between single-circle group and double-circle group had statistical significance （Plt;0.05）. The difference of postoperative intake time, between triple-circle group and single-circle group, between triple-circle group and double-circle group, had statistical significance （Plt;0.05）. But wound recover time among three groups had no obvious difference （Pgt;0.05）. Conclusion Analyzing neoadjuvant chemotherapy circles, time between neoadjuvant chemotherapy and operation, treatment effect and operation results, it is a feasible and secure colorectal cancer multi-discipinary strategy for patients in West China that choose the treatment of neoadjuvant chemotherapy with double-circle and short preparation time.
目的阐明数字减影血管造影（DSA）监控在区域性置管栓塞化疗治疗肝癌中的重要性。方法比较152例肝癌区域性置管中DSA监控置管与注射美蓝指导下置管的导管位置准确性； 并对术后发生与置管有关的并发症进行分析。结果DSA监控置管准确率肝动脉及门静脉均为100%，注射美蓝指导下置管肝动脉和门静脉的导管位置准确率分别为70.2%和76.1%，两组比较差异有显著性意义（P＜0.01)。术后有导管移位、肝动脉胆管瘘、导管阻塞、药液外漏、硬化性胆管炎等并发症。结论DSA指导下置管准确，又能保证血管内介入治疗的彻底性； 术后行DSA监控，以指导下一步的治疗，并可防止并发症的发生。
Objective To explore the intervention effect on colorectal cancer operation by neo-adjuvant chemotherapy in multi-disciplinary team. Methods To analyze retrospectively the data of patients diagnosed definitely as colorectal cancer in the West China Hospital of Sichuan University from July 2007 to December 2007, and the planned and actual operative strategy were compared between MDT group and non-MDT group. Results According to the inclusion criteria, 251 colorectal cancer patients were included which had 183 rectal cancer and 68 colon cancer. The baseline between MDT group and non-MDT group was equal, and there was no difference of planned operative strategy between two groups. For patients planned undergoing standard ano-saving radical procedure, the ratio of actual procedure same to the planned and the ratio of radical procedure changed to expansive ano-saving radical procedure showed no significant differences between MDT group and non-MDT group (Pgt;0.05), whereas the difference of the ratio of radical procedure changed to local radical procedure between two groups was statistically significant (Plt;0.01). And the constituent ratio of actual procedure between two groups for patients which planned accepted non-ano-saving procedure didn’t have any significant difference (Pgt;0.05). For the cancer focus, the relief differences of complete remission and partial remission were statistically significant between two groups (P＜0.01), but the difference of the constituent ratio of T staging change was not statistically significant (Pgt;0.05). Conclusion The value of neo-adjuvant chemotherapy should not be limited to decrease the stage of cancer, and it is important to pay more attention to the high quality of combined therapy. Further research should be carried out to find the contribution of neo-adjuvant chemotherapy to mini-invasive surgery.
目的:观察阿霉素持续静脉输注联合国产长春瑞滨(盖诺 NVB)治疗晚期乳腺癌的疗效及毒副反应,探讨治疗方式改变在化疗中的价值。方法:32例晚期乳腺癌患者,用NA方案:NVB 25 mg/m2 ivgtt d1,8、ADM 50 mg/ m2 civ 96h d1~4。每28天为一周期,至少2周期后评价疗效。观察疗效及毒副反应。结果:32例患者均随访。总共用药170周期,平均5.3周期。CR 5例,PR 18例,RR(CR+PR)71.9% 。初治、复治有效率分别为73.3%、70.6%,二者间无显著性差异(Pgt;0.05)。中位缓解期8.2个月。主要毒副反应为白细胞降低,发生率100%(32/32),32例中Ⅲ～Ⅳ度下降15例(46.9%);恶心、呕吐23例(71.9%),Ⅲ～Ⅳ度4例(12.5%);均发生脱发,Ⅲ～Ⅳ度5例(156%);口腔炎16例(50.0%),Ⅲ～Ⅳ度4例(12.5%);静脉炎2例(6.2%),均为Ⅰ度;心脏毒性发生3例(9.4%),为Ⅰ、Ⅱ度不等。无治疗相关性死亡。结论:阿霉素持续静脉输注与盖诺联合治疗晚期转移性乳腺癌疗效明确,毒副反应可以耐受,远期疗效值得进一步研究。
ObjectiveTo explore the best neoadjuvant treatment strategy for esophageal cancer and provide a theoretical basis for clinical formulation of neoadjuvant treatment plan. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched from inception to May 2022. Two researchers independently performed literature screening and data extraction. The quality of the studies was evaluated by the Cochrane risk of bias tool, and data analysis was performed in RStudio environment using R3.6.3 software. ResultsA total of 24 studies were included, covering 5 286 patients treated with surgery alone, neoadjuvant chemotherapy (NCT), neoadjuvant radiotherapy (NRT), or neoadjuvant chemoradiotherapy (NCRT) followed by combined surgical treatment. The risk of bias of the studies was low. The results of the network meta-analysis showed that combined surgical treatments after NCRT [HR=0.77, 95%CI (0.70, 0.85)] and NCT [HR=0.89, 95%CI (0.81, 0.98)] were effective methods to improve patients' overall survival (OS) compared with surgery alone. In addition, NCRT could significantly reduce the incidence of local recurrence [OR=0.43, 95%CI (0.30, 0.58)] and distant metastasis [OR=0.71, 95%CI (0.52, 0.93)] in patients with esophageal cancer. However, NCRT [RR=1.30, 95%CI (0.77, 2.20)] increased the mortality rate of patients at 30 d after surgery. ConclusionThe available evidence suggests that NCRT combined with surgery is the best option for treating patients with resectable esophageal cancer, but this treatment carries the risk of increased 30 d postoperative mortality. Future studies should focus on optimizing the NCRT regimen with the aim of improving patients’ OS while effectively reducing postoperative mortality. In addition, more high-quality randomized controlled trials are needed to support the results of the study.
Objective To systematically review the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy in patients with primary liver cancer (PLC). Methods We electronically searched the following databases including CENTRAL, MEDLINE, EMbase, WanFang Data, CBM, CNKI and VIP to collect randomized controlled trials (RCTs) on the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy vs. hepatectomy alone for PLC from inception to October, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 RCTs involving 951 patients were included. The results of meta-analysis showed that, implanting sustained-release 5-fluorouracil during hepatectomy significantly decreased the total recurrence rates of 1-year and 3-year (1 year: RR=0.48, 95%CI 0.36 to 0.65, Plt;0.000 01; 3 years: RR=0.69, 95%CI 0.50 to 0.96, P=0.03). However, the two groups were alike in decreasing the surem levels of AFP. Besides, the commonly-seen adverse reaction of implanting sustained-release 5-fluorouracil during hepatectomy included abdominal pain and bile leakage. Conclusion Implanting sustained-release 5-fluorouracil during hepatectomy can decrease the 1-year and 3-year recurrence rates of PLC patients, especially for HCC at the early stage. But this conclusion should be interpreted with caution and needs more strictly-designed RCTs with large sample size and enough long follow-up to verify.
ObjectiveTo evaluate the effect of preoperative regional intraarterial infusion chemotherapy on the prognosis of advanced gastric cancer. MethodsThe clinical data of 80 patients who underwent curative resection for advanced gastric cancers were summarized.Among them,33 patients carried out preoperative regional intraarterial infusion chemotherapy were as the interventional chemotherapy group,and the remaining 47 patients were the control group.Eleven factors including clinical and pathological data,treatment procedures and molecular biological makers that contributed to the longterm survival rate were analyzed by Cox multivariate regression analysis.ResultsThe 5year survival rate of the interventional group was 59.3%,and the control group 47.6%.There was significant difference between two groups (P＜0.05).Multivariate regression analysis revealed that the preoperative regional intraarterial infusion chemotherapy was one of the independent factors affecting the longterm survival of patients with advanced gastric cancers.ConclusionThe preoperative regional intraarterial infusion chemotherapy has important value for improving the prognosis of gastric cancer.
Objective To evaluate the rational of peritoneal warm perfusion chemotherapy after the operation. MethodsOne hundred and two patients with gastric cancer were included in this study. One hundred milliliter of peritoneal fluid were collected respectively after opening the abdomen,before closing the peritoneal cavity,and after hyperthermic peritoneal perfusion chemotherapy for free cancer cells examination. ResultsAfter opening the abdomen, the positive rate of free cancer cells was 36.3%(37/102), and the positive rate before closure of peritoneal cavity was 52.9%(54/102), 31 cases of free cancer cells were found killed after the warm perfusion chemotherapy,the effect rate was 57.4%(31/54).The free cancer cells positive rate related to the tumor infiltration depth, serous membrane invasion area and the type of histopathology. Conclusion In the peritoneal cavity of patients with gastric cancer, free cancer cells are able to survive and have a high degree of activity. Hyperthermic peritoneal perfusion chemotherapy is an effective method to kill free cancer cells.