目的 探讨临床治疗原发性肝癌合并门静脉癌栓的有效方法及疗效。方法 对我院2008年1月至2010年1月期间收治的29例原发性肝癌合并门静脉癌栓患者的临床资料进行回顾性分析,并按治疗方法的不同将患者分为经动脉导管栓塞术（TAE）治疗组和TAE＋门静脉灌注化疗治疗组，比较2组患者的治疗效果。结果 TAE治疗组治疗有效率、门静脉癌栓缩小率和AFP转阴率分别为43.75%、18.75%和37.50%，TAE＋门静脉灌注治疗组分别为76.92%、61.54%和61.54%，2组比较后者优于前者（P＜0.05）。TAE＋门静脉灌注治疗组患者治疗后半年及1年生存率高于TAE治疗组（P＜0.05）。TAE治疗组患者生存时间为４～18个月，中位生存期为8个月；TAE＋门静脉灌注治疗组患者生存时间为5～18个月，中位生存期为11个月。结论 TAE＋门静脉灌注化疗是一种安全可行的治疗方法，可延长原发性肝癌合并门静脉癌栓患者的生存时间。
【摘要】 目的 探讨高级别胶质瘤患者放射、化学治疗后假性进展的临床特点、诊断与处理。 方法 分析2008年6月-2009年6月接受综合治疗的31例高级别胶质瘤患者临床资料，对假性进展的患者进行回顾分析，按照实体瘤疗效评判标准应用磁共振进行疗效评价。 结果 31例术后病理诊断为高级别胶质瘤的患者，替莫唑胺（TMZ）同期放射、化学治疗后维持TMZ辅助化学疗法，放射治疗后早期发生假性进展4例（14%)。 结论 对于TMZ同期放射、化学治疗后早期出现的影像学疑似进展，不要急于下结论，了解假性进展的临床特点，结合功能影像学检查可能会有助于临床医生的判断与处理。【Abstract】 Objective To discuss the clinical feature, diagnosis, and management of pseudoprogression after radiochemotherapy of high-grade glioma patients. Methods The clinical data of 31 high-grade glioma patients who underwent postoperative radiochemotherapy from June 2008 to June 2009 were reviewed. Pseudoprogression cases were analyzed. The treatment response was assessed through magnetic resonance imaging (MRI) according to the established response evaluation criteria in solid tumors. Results All the 31 high grade gioma patients received postoperative fractioned radiotherapy with concomitant TMZ chemotherapy, followed by TMZ maintenance chemotherapy. Four cases of pseudoprogression occurred after radiotherapy (14%). Conclusion Doctors should be careful in making early diagnosis for the suspected early progression after TMZ concomitant radiochemotherapy. It would be helpful for management to combine the clinical features of pseudoprogression with functional imaging technology.
ObjectiveTo investigate healing of rat colonic anastomoses after early postoperative intraperitoneal chemotherapy (EPIC).MethodsFortyfive Wistar rats with colonic anastomoses were divided randomly into 3 groups (15 rats each). From postoperative 1 day to 5 day, rats were injected with normal saline (NS) to the peritoneal cavity with 20 ml/(kg·d) for the NS group; 5Fu with 20 mg/(kg·d) for the 5Fu group; 5Fu with 20 mg/(kg·d) and leucovorin with 10 mg/(kg·d) for the 5Fu+LV group. On the 7th postoperative day, rats were killed and the anastomoses were evaluated whether anastomotic complications (leakage or dehiscence) occurred, the anastomotic bursting pressure (ABP) and hydroxypoline content (HPC) were measured. ResultsIn the NS group, 1 rat had incision dehiscence, another one had anastomostic leakage with but no death. In the 5Fu+LV group, 2 rats showed anastomotic leakage and 1 death. On the 7th postoperative day, the ABP in NS, 5Fu and 5Fu+LV groups were (169.1±32.6) mm Hg, (116.8±25.5) mm Hg and (154.9±31.2) mm Hg respectively; the HPC was (1.54±0.28) μg/mg, (0.9±0.33) μg/mg and (1.24±0.29) μg/mg respectively. Both the ABP and HPC, in the NS group were much significantly higher than in 5Fu group (P＜0.01). Both the ABP and HPC in the 5Fu+LV group were significantly higher than which in the 5Fu group (P＜0.05).ConclusionEPIC with 5Fu significantly impairs healing of the colonic anastomosis. 5Fu combined with LV for EPIC might reduce this inhibition to the process of the anastomotic healing.
ObjectiveTo summarize the value of imaging in the evaluation of non-surgical therapy for pancreatic cancer.MethodThe relevant literatures about imaging evaluation of non-surgical therapy for pancreatic cancer were collected to make an review.ResultsAt present, most of the imaging evaluation of non-surgical therapy for pancreatic cancer were based on the assessment of morphological characteristics of tumors, such as contrast-enhanced CT and MRI. However, only morphological changes of tumors could not accurately evaluate the response of pancreatic cancer after non-surgical treatment. A few studies had explored the value of functional imaging and artificial intelligence.ConclusionsNon-surgical therapy provides new treatment opportunities for unresectable pancreatic cancer, especially the proposed of neoadjuvant therapy, which provides the possibility of operation for patients with advanced pancreatic cancer. More imaging indicators with stronger objectivity, higher accuracy, and wider universality need to be improved and developed in the future.
Objective To investigate the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy (HIPC) in treatment of advanced colorectal cancer.Methods The Meta-analysis was applied to analyze 8 randomized controlled quantitative studies published at domestic and abroad. These patients treated by HIPC after radical operation with colorectal cancer were included for the treatment group, and those treated only by radical operation with colorectal cancer for the control group. Relative risk (RR) of outcome variable of 3-year and 5-year survival rate and safety between the two groups were compared. Results There were 8 selected literatures, including 1 501 cases, in which 765 cases for treatment group, and 736 cases for control group. RR of 5-year survival rate of the total patients was 2.39 (95% CI: 1.66-3.45). RR of 3-year survival rate of the total patients was 2.13 (95% CI: 1.45-3.13). The results demonstrated that HIPC could improve 5-year and 3-year survival rate, and sensitivity analysis confirmed the conclusions more reliable. The security was described in 5 literatures, the available information showed smaller potential security issue. Conclusions HIPC after radical operation of advanced colorectal cancer can increase 5-year and 3-year survival rate of patients, improve the prognosis of patients. Whether patients with increased incidence of postoperative complications related to the HIPC is no clear-cut conclusions for lack of related research.
目的 探讨老年低位直肠癌经肛门局部切除后加放、化疗的临床意义。方法 对18例年龄≥65岁，肿瘤距肛缘≤6 cm且经病理证实但拒绝Miles术的直肠癌患者行经肛门局部切除； 于术后1个月给予放疗（总剂量50 Gy）； 化疗： 亚叶酸钙200 mg、5-FU 400 mg/m2，第1次于术后第1~5 d，每3~4周重复1次，共3~6次。结果 全部病例无手术死亡，术后均有良好的肛门功能。16例获随访，随访5年，其中3例局部复发，拒绝再次手术，给予放、化疗。死亡12例，其中2例死于远处转移，10例死于其他因素。本组患者1年生存率为77.8%（14/18），5年生存率为38.9%（7/18）。结论 对老年低位直肠癌拒绝Miles术的患者行经肛门局部切除加放、化疗，疗效确切，可提高患者生活质量，延长生存期。
ObjectiveTo evaluate the efficacy and toxicity of TEC and CEF regimen in preoperative chemotherapy for patients with breast cancer. MethodsA total of one hundred breast cancer patients undergoing preoperative chemotherapy were divided into TEC group (n=50) and CEF group (n=50) by the pairgroup method and received surgical therapy after three courses of chemotherapy. The efficacy and toxicity of preoperative chemotherapy of patients in two groups were analyzed. ResultsFour patients with stage ⅢB breast cancer quit from CEF group after two courses of treatment because of the worse satisfaction. Clinical complete remission (cCR) was 7 cases, clinic partial remission (cPR) was 34 cases, stable disease (SD) was 9 cases, therefore, the remission rate (RR) was 82.0% (41/50), and reduction rate of tumor was 64.0% (32/50) in TEC group. cCR was 2 cases, cPR was 32 cases, SD was 12 cases, thus the RR was 680% (34/50), and reduction rate of tumor was 40.0% (20/50) in CEF group. The clinical efficacy and reduction rate of tumor of patients in TEC group were significantly superior than those in CEF group (Plt;0.05). The negative conversion ratio of lymph nodes were 54.1% (20/37) and 57.1% (20/35) in TEC group and CEF group, which was not statistically different (Plt;0.05). The occurrence of hair loss and leukopenia of patients in TEC group were significantly higher than those in CEF group (Plt;0.05), while the differences in thrombocytopenia, low concentration of hemoglobin, nausea, vomiting, diarrhea, cardiac toxicity, and neurotoxicity were not significant (Pgt;0.05). ConclusionTEC regimen is better than CEF regimen in the efficacy and safety of neo-adjuant therapy for patients with breast cancer, and well tolerated.