奎屯地区食管癌600例临床分析

目的总结奎屯地区食管癌的治疗经验。方法回顾性分析600例食管癌患者采用不同治疗手段的相关临床资料。结果食管癌患者600例,其中,上段184例,中段220例,下段196例;通过影像学检查有区域淋巴结转移的患者378例,有远处转移患者151例,未发现淋巴结转移的患者222例;单纯手术组104例,单纯放射治疗组92例,单纯化学治疗组68例,手术后放射治疗组97例,手术后化学治疗组84例,放射治疗加化学治疗组80例,营养支持组75例;随访6个月至3年,1年生存率、3年生存率分别为:单纯手术组80.7%、46.2%;单纯放射治疗组52.2%、28.3%;单纯化学治疗组29.4%、8.8%;手术后放射治疗组79.4%、42.3%;手术后化学治疗组72.6%、29.8%;放射治疗加化学治疗组57.5%、21.3%;营养支持组12.0%、2.6%。结论无淋巴结转移的食管癌患者手术、单纯放射治疗可以取得相同的疗效,但后者生活质量明显提高,有区域淋巴结转移的食管癌患者手术后行辅助放射治疗可以明显提高生存率。     

术前辅助放化疗治疗中晚期食管癌临床疗效分析

目的　探讨中晚期食管癌术前放化疗提高手术切除率及临床疗效。方法　将中晚期食管癌 5 5例患者随机分为术前放化疗组 (A组 ) ,单纯手术组 (B组 )。A组患者术前 1周应用盖诺 DDP方案化疗、4周DT 4 0Gy的病灶及区域淋巴结放疗 ,间隔 2周后手术 ,B组单纯手术治疗。结果　A组手术切除率及生存率与B组比较结果有显著性差异 (P <0 .0 5 )。结论　术前放化疗在提高中晚期食管癌手术切除率及生存率等方面具有临床意义。     

腹腔热灌注化疗在进展期胃癌术后的治疗作用

目的 观察腹腔热灌注化疗在进展期胃癌术后的辅助治疗作用.方法 进展期胃癌根治性手术后患者60例,32例患者术后给予腹腔热灌注化疗,28例患者接受了胃癌根治性手术后单纯恢复体质调节胃肠功能的对症治疗.结果 在术后辅助腹腔热灌注化疗组2年生存率68.8%,高于单纯手术组,5年死亡率25.0%低于单纯手术组,差异均具有统计学意义.结论 进展期胃癌术后辅助腹腔热灌注化疗能明显降低术后复发率及死亡率.     

贲门腺癌淋巴结转移的临床病理意义

目的　探讨贲门腺癌淋巴结转移规律及其影响。方法　对 32 8例贲门癌手术切除的淋巴结分组检查 ,分析淋巴结转移与临床病理因素及生存率的关系。结果　淋巴结转移占 6 1.3% ,转移度 2 2 .7% ,胸下段食管旁组转移2 1.0 % ,腹腔内转移 5 3.0 %。淋巴结无转移组和转移组生存率差异明显 (P <0 .0 0 0 1)。结论　病变长、浸润深、恶性度高 ,淋巴结转移率越高 ;病变累及下段食管时下纵隔淋巴结转移明显增加。淋巴结转移与否是影响远期疗效的独立因素 ,下纵隔淋巴结转移对生存率影响最大。应常规行包括下纵隔与腹腔内的区域淋巴结清扫     

术前放疗、化疗和放化疗与单纯宫颈癌根治术疗效比较

目的探讨术前放疗、化疗和联合放化疗治疗Ⅰb2-Ⅱb期宫颈癌的效果。方法本院106例宫颈活检病理确诊为子宫颈癌的患者，FIGO分期为Ⅰb2-Ⅱb期，且入该院前没接受过治疗。分为NACT组，术前放疗组，NACT和术前放疗联合组，单纯手术组，观察各组淋巴结转移率，生存率等。结果术前化疗组，术前化疗组，放化疗组的2年生存率分别为88．89％，88．46％，92％，与单纯手术组差异有统计学意义（P〈0．05），术前化疗组，术前化疗组，放化疗组的盆腔淋巴结转移率分别为14、81％，15．38％，16％，与单纯手术组差异有统计学意义（P〈0．05），但3组间差异无统计学意义（P〉0．05）。结论术前放疗，术前化疗，术前放化疗联合三种方案对治疗宫颈癌是有效的，能明显提高生存率，降低复发和转移，而三种方案在对生存率等的影响方面是相近的。     

局部晚期非小细胞肺癌术前选择性支气管动脉灌注化疗的临床研究

目的 评估术前选择性支气管动脉灌注(SBAI)化疗对局部晚期(Ⅲ期)非小细胞肺癌(NSCLC)治疗的临床效果及对手术的影响因素.方法 92例局部晚期NSCLC患者随机分为两组:SBAI化疗组41例,先给予2个疗程的SBAI化疗后进行手术治疗;单纯手术组51例,确诊后直接手术.比较两组患者的手术完全切除率及临床疗效.结果 SBAI化疗组的临床有效率和组织学有效率分别为68.3%和51.2%.SBAI化疗组的手术完全切除率(923%)高于单纯手术组(80.4%),P＜0.05.1、2年生存率SBAI化疗组分别为100.0%和74.4%,单纯手术组分别为94.1%和58.8%.结论 术前SBAI化疗安全有效,可获得较好的临床和组织学疗效,并能提高Ⅲ期NSCLC的手术完全切除率.     

食管癌淋巴结微转移规律探讨

目的 通过食管癌淋巴结微转移的检测,探讨食管癌淋巴结转移规律.方法 采用RT-PCR法检测52例食管癌患者术后病理诊断阴性的212枚区域淋巴结(pNO)中CEA-mRNA基因的表达.比较不同部位淋巴结微转移的差异.结果 微转移阳性检测率达32.69%,微转移与肿瘤分化程度及浸润深度有关.颈部淋巴结微转移多见于胸上段食管癌,微转移率为16.67%.纵隔淋巴结微转移多见于胸中段食管癌,微转移率为35.29%;腹腔淋巴结微转移多见于胸下段食管癌,占16.67%."跳跃性微转移"率为17.65%.结论 胸段食管癌易发生颈部、纵隔、腹腔淋巴结微转移,纵向微转移率远大于横向微转移.微转移与肿瘤分化程度及浸润深度有关.食管癌手术中应注意上述部位淋巴结的清扫.     

观察中晚期鼻咽癌应用诱导化疗联合放疗的治疗效果

目的 探讨诱导化疗联合放射治疗中晚期鼻咽癌的近期效果.方法 将我院2006年1月至2010年6月局部中晚期鼻咽癌(T3、T4),单纯放疗组(简称单放组)84例,诱导化疗联合放疗组(简称联合组)84例,共168例,进行回顾性分析.结果 放疗结束后6个月,鼻咽部原发灶完全缓解率(CR):单放组为66.67%(112/168),联合组为90.48%(152/168)(P＜0.05);颈部淋巴结CR:单放组为61.90%(104/168),联合组为85.71%(144/168)(P＜0.05).早期反应主要为白细胞下降和口腔黏膜炎,患者均可耐受.结论 诱导化疗联合放疗治疗中晚期鼻咽癌近期疗效较好,不良反应少,值得医院的临床推广.     

腋窝淋巴结联合原发病灶超声诊断乳腺癌腋淋巴结转移的价值

目的 评价淋巴结超声形态征象结合乳腺原发肿块超声特征综合判断乳腺癌术前腋窝淋巴结状态的诊断价值.方法 超声观察95例乳腺癌患者原发灶和腋淋巴结.以腋淋巴结清扫的病理结果为金标准,对单独应用淋巴结超声征象(单独组)和联合应用淋巴结超声征象及乳腺原发灶声像(联合组)对腋窝淋巴结有无转移进行诊断价值评价.结果 在95例浸润性乳腺癌中,病理证实34例有腋淋巴结转移,61例腋淋巴结阴性.单独组和联合组诊断腋淋巴结转移的敏感度、特异度、阳性预测值和阴性预测值分别为52.9%、82.5%、66.7%和76.5%及76.5%、83.6%、72.2%和86.4%.两组敏感度比较,差异有统计学意义,联合诊断法明显提高诊断敏感度.结论 腋窝淋巴结超声诊断乳腺癌腋淋巴结转移具有中等度敏感性和较高特异性;联合乳腺原发肿块超声征象可明显提高敏感性.     

胸段食管癌淋巴结清扫范围研究

目的 探讨胸段食管癌根治手术淋巴结清扫范围.方法 总结270例胸段食管癌根治切除手术淋巴结的转移方向和部位.结果 270例胸段食管癌手术共清扫和检出淋巴结1137枚,癌转移淋巴结403枚,转移率35.44%,转移的方向以横向为主,转移的部位以食管旁组和纵隔组为最多.结论 胸段食管癌的淋巴结转移多存在跳跃性,食管旁淋巴结阴性并不能否定无远处转移,胸中上段食管癌应行三野淋巴结清扫术,胸下段食管癌应行胸腹部淋巴结清扫术,胸上段食管癌应重视纵隔淋巴结的清扫.     

原发性食管小细胞癌43例临床分析

目的 探讨原发性食管小细胞癌的临床特点和综合治疗方法.方法 分析43例原发性食管小细胞癌的临床资料,其中单纯化疗3例、单纯放疗8例、手术＋化疗7例、放疗＋化疗19例、手术＋放化疗6例,分析其中位生存时间.结果 43例患者,2例失访,单纯化疗、单纯放疗、手术＋化疗、放疗＋化疗、手术＋放化疗的中位生存时间分别为6.5、6.3、15.7、13.2、16.1个月.结论 原发性食管小细胞癌恶性程度高,预后差,该病应早期诊断,并选择合理的综合治疗,以改善患者预后.     

胰头癌根治术中区域性淋巴结清扫的应用价值探讨

目的　研究胰头癌手术中行区域性淋巴结清扫的疗效情况。方法　将符合入选标准的胰头癌患者 4 6例 ,随机分成两组 ,改良胰十二指肠切除术加区域性淋巴结清扫 2 2例为观察组 ,经典胰十二指肠切除手术 2 4例为对照组 ,对两组术后病理检查结果、生存病例、病死率等方面进行比较分析。结果　两组病例在癌肿直径大小、病理组织学分型方面无明显差异 ,P >0 .0 5 ;观察组清除转移的淋巴结数目明显高于对照组 ,P <0 .0 1;术后经随访 2～ 6 6个月 ,观察组死亡 7例 ,对照组死亡 17例 ,观察组死亡例数显著低于对照组 (P <0 .0 1) ,观察组 5年生存病例高于对照组。结论　胰头癌根治术中应用区域性淋巴结清扫可使淋巴结广泛得到清除 ,延长存活的时间 ,提高胰头癌患者的术后生存率     

同步放化疗治疗局部晚期鼻咽癌的疗效观察

目的探讨同步放化疗治疗晚期鼻咽癌的疗效以及患者接受治疗后的耐受性。方法 75例局部晚期鼻咽癌患者随即分为两组,放化疗组37例和单纯放疗组38例。放化疗组采用放疗同步顺铂加氯尿嘧啶化疗,观察两组的临床疗效以及患者的不良反应情况。结果放化疗组总有效率是78.3%(29例),单纯放疗组总有效率是63.1%(24例),两者的差异具有统计学意义(P<0.05)。放化疗组3年生存率是59.4%(22例),单纯放疗组3年生存率是39.4%(15例),两者的差异同样具有统计学意义(P<0.05)。放化疗组的患者不良反应高于单纯放疗组,但经过对症处理后患者均可耐受。结论同步放化疗可以提高晚期鼻咽癌患者的局部控制率和生存率,患者可以耐受不良反应,值得临床推广应用。     

先期化疗在晚期卵巢癌的临床应用与疗效评价

目的探讨先期化疗在治疗晚期卵巢癌中的临床意义和对预后的影响。方法分析我院52例Ⅲ、Ⅳ期卵巢癌患者,22例行先期化疗,然后进行中间肿瘤细胞减灭术及术后化疗（先期化疗组）;30例行初次肿瘤细胞减灭术,再行术后化疗（对照组）。比较两组治疗的疗效及生存率。结果先期化疗组化疗有效率63.6%,胸腹水的控制率达89.5%,先期化疗组和对照组满意肿瘤减灭率分别为81.8%、36.7%,两组比较差异有统计学意义（P〈0.005）;先期化疗组术中出血量及手术时间较对照组少,两组比较差异均有统计学意义（P〈0.05）;先期化疗组术后并发症发生率13.6%,对照组术后并发症发生率20.0%,两组比较差异无统计学意义（P〉0.05）。先期化疗组和对照组中位生存时间分别为35和24个月,两组间生存率比较,差异无统计学意义（P〉0.05）。结论先期化疗能缩小瘤体,控制胸腹水,提高肿瘤细胞减灭率,特别对大量胸腹水、肿瘤体积较大和身体耐受差的患者疗效佳,但并未延长患者总的生存时间。     

Comparative study of preoperative chemotherapy and radiotherapy in squamous cell carcinoma of the oral cavity]

The results of the preoperative Co 60 irradiation and BVMM (bleomycin, vincristine, mitolactol, methotrexate) chemotherapy were compared. Both treatments were used in 50-50 advanced squamous cell cancer of the oral cavity. The general condition, size of lesion and age of the patients were similar. Surgery in the irradiated group was significantly more radical at the primary sites. Local recurrences during a three-year follow-up period were diagnosed in 36% from the radiotherapy group, whilst 8% such recurrences diagnosed in the chemotherapy group. There was no significant difference in the radicality of lymph node surgery. Lymph node recurrences occurred in 8% from the irradiated group, whilst 22% was diagnosed in the chemotherapy group. The main opinion is that BVMM chemotherapy and irradiation can be used to support one another in the interest of better result, like preoperative chemo- and postoperative radiotherapy.     

紫杉醇联合奈达铂用于宫颈癌根治术前新辅助化疗的近期疗效分析

目的：观察紫杉醇联合奈达铂用于宫颈癌根治术前新辅助化疗的近期疗效及安全性。方法：75例宫颈癌患者根据个人治疗意愿分为两组,对照组（37例）仅采用单纯宫颈癌根治术治疗,观察组（38例）在宫颈癌根治术前予以紫杉醇联合奈达铂新辅助化疗治疗,比较两组近期临床疗效、术后病理情况、术中出血量、手术时间、住院时间、膀胱功能恢复时间及术后体力状况评分等。结果：观察组治疗总有效率（86.8%）明显高于对照组（70.3%）（P〈0.05）;观察组阴道边缘、淋巴结转移、宫旁侵犯及血管浸润的阳性率明显低于对照组（P〈0.05）;观察组术中出血量、手术时间、住院时间、膀胱功能恢复时间均明显少于对照组（P〈0.05）,而术后体力状况评分明显好于对照组（P〈0.05）。结论：紫杉醇联合奈达铂用于宫颈癌根治术前新辅助化疗可明显提高患者的近期疗效,改善各项临床及病理指标。     

中晚期中央型肺癌介入治疗的临床研究

目的对比分析中晚期中央型肺癌支气管动脉介入治疗与全身静脉化疗的疗效。方法中央型中晚期肺癌85例,均经病理证实,分为支气管动脉介入治疗组与全身静脉化疗组。结果支气管动脉介入治疗组肺内原发病灶、远处转移灶、肺外淋巴结转移灶的有效率分别为59.52%、18.18%、55.56%;全身静脉化疗组分别为30.23%、53.85%、52.63%。肺内原发病灶、远处转移灶两组间有效率的差异有统计学意义(P<0.05)。结论支气管动脉介入治疗比全身静脉化疗能更有效地控制肺内原发病灶,但对远处转移灶治疗控制能力较低。     

99mTc-硫胶体淋巴结显像联合亚甲蓝在乳腺癌前哨淋巴结活检中的临床研究

目的 探讨99mTc-硫胶体(99mTc-SC)淋巴结显像联合亚甲蓝行乳腺癌前哨淋巴结活检(SLNB),对前哨淋巴结(SLN)阴性者避免行腋窝淋巴结清扫(ALND)的可行性及其临床应用价值.方法 187例乳腺癌患者术前行99mTc-SC淋巴结显像,并进行体表定位,术中加用亚甲蓝示踪SLN,切除后快速冰冻切片.其中51例SLN转移患者行改良根治术,将136例SLN阴性患者分为两组,A组[为腋窝淋巴结阳性患者,58例为术中检测阳性,2例为SLNB术后淋巴结常规病理检查阳性,再次行ALND,共60例]行乳腺切除或象限切除加ALND,B组(术中检测阴性78例,除去术后检测阳性2例,共76例)行SLNB,未行ALND.结果 A组术后上肢麻木、上肢水肿、上肢功能障碍分别为36、8、45例,B组分别为2、0、0例,两组比较差异有统计学意义(P<0.05).A组1、3、5年局部复发分别为0、0、2例,腋窝及锁骨上淋巴结转移分别为1、5、8例,远处转移分别为2、8、12例,无瘤生存分别为60、57、49例;B组1、3、5年局部复发分别为0、0、6例,腋窝及锁骨上淋巴结转移分别为3、8、12例,远处转移分别为4、8、16例,无瘤生存分别为76、70、61例,两组比较差异无统计学意义(P>0.05).结论 99mTc-SC淋巴结显像联合亚甲蓝行SLNB方法 简便,准确率高,疗效确实可靠.

Abstract：

Objective To evaluate the clinical significance of the axillary conservative surgery by sentinel lymph node biopsy (SLNB) using preoperative lymphoscintigraph technique with 99mTc-SC and methylene blue in early-stage breast cancer patients. Methods The sentinel lymph node (SLN) of 187 patients were located with preoperative lymphoscintigraph technique with 99mTc-SC and labeled with methylene blue during the operations. The metastasis of SLN was detected using frozen section technique. There were 51 patients whose SLN were positive having been carried with modified radical mastectomy of breast cancer and axillary lymph node dissection (ALND), 136 patients' SLN were negative,58 patients of those were carried with mammectomy or partial mastcctomy and ALND (group A),while 78 patients were carried out with mammectomy or partial mastectomy only (group B). The sentinel lymph nodes were detected with HE stain after surgery. All the patients were treated with chemotherapy,and the patients with partial mastcctomy must be treated with radiotherapy. There were 2 patients with micrometastasis in group B being treated with mammectomy or partial mastcctomy only,and carried out with ALND again. Results The number of cases with upper limb numbness, edema, dysfunction in group A were 36,8 and 45 cases, in group B were 2,0,0 case respectively. Group A compared with group B was increased significantly (P< 0.05). The number of local recurrence within 1, 3 and 5 years were 0,0,2 cases;lymphatic metastasis were 1,5,8 cases; the distant metastasis were 2,8,12 cases; the disease-free survival were 60,57,49 cases. In group B, the number of local recurrence within 1, 3 and 5 years were 0,0,6 cases, lymphatic metastasis were 3,8,12cases,the distant metastasis were 4,8,16 cases,the disease-free survival were 76,70,61 cases. There were not significant differences between the two groups(P> 0.05). Conclusion It is simple and accurate to carry out SLNB using preoperative lymphoscintigraph technique with 99mTc-SC combined with methylene blue,and the effect is reliable.     

Sexual Functioning and Body Image of Patients Treated for Ovarian Cancer

Aim  The aim of the study was to determine differences in sexual functioning and body image of patients treated for ovarian cancer, depending on treatment modality: surgery, surgery in combination with chemotherapy or chemotherapy alone. Patients and Methods  A total of 483 patients treated for ovarian cancer between 1995 and 2005 completed the questionnaire 2–6 months after finishing the treatment. Patients were divided into three groups. The first group consisted of 156 patients with early ovarian cancer, treated only surgically with hysterectomy and bilateral salphingoophorectomy. The second group consisted of 238 patients with advanced stages of ovarian cancer that were treated surgically in combination with chemotherapy. The third group consisted of 89 patients with advanced inoperable or metastatic ovarian cancer who were treated with chemotherapy alone. Results  A significant number of patients in all three groups (group 1, 2 and 3) was satisfied with their sexual life before the treatment (74.36%, 69.33% and 71.91% respectively). Patients whose sexual life got worse after the treatment in all three study groups were numerous (group 1, 2 and 3—28.85%, 46.64% and 47.19%, respectively) and most intensively affected patients in groups 2 and 3 (p < 0.05). Most of the patients in group 1, 2 and 3 found their partners to have the same (33.33%, 34.87% and 44.94%, respectively) or even better (32.69%, 36.56% and 25.84%, respectively) attitude towards them, and described them as very supportive and tender. Most of the patients in all three treatment groups (51.28%, 54.62% and 52.81%, respectively, p > 0.05) found their body image different after the treatment, but not mutilated. Conclusion  These findings support and extend previous reports of impaired sexual functioning among patients treated for ovarian cancer. Sexual functioning of the patients with more advanced disease stages, who were treated by combination of surgery and chemotherapy or chemotherapy alone, was more jeopardized than those with disease detected in an early stage and treated by surgery alone. Problems in sexual functioning appear to be related to the consequence of artificial menopause symptoms and the extent of disease.