水隔离技术对降低肝被膜下肿瘤微波消融术后残存的效果评价

目的探索水隔离技术是否可降低肝被膜下恶性肿瘤行微波消融术(MWA)后肿瘤残存。方法回顾性分析2015年7月至2019年2月诊断为肝被膜下恶性肿瘤(原发性肝癌或肝转移瘤)并行影像引导下MWA治疗102例患者,共122个肿瘤,根据肿瘤是否行水隔离技术分为水隔离组和对照组,水隔离组为应用注水方法隔离肝脏及邻近结构后行MWA,37例患者47个肿瘤;对照组直接行MWA,65例患者75个肿瘤。比较两组治疗后1个月后影像学检查的肿瘤残存情况,并运用单因素、多因素、Cochran’s and Mantel-Haenszel(CMH)分层分析等方法分析肿瘤残存的影响因素。结果消融技术成功率100%,水隔离技术成功率97.9%。水隔离组与对照组残存率分别为6.5%、21.3%(P=0.03),单因素分析提示水隔离(P=0.03)、肿瘤大小(P<0.001)与肿瘤残存相关;logistic回归分析显示水隔离技术可显著降低肿瘤残存率[OR=0.202,95%CI(0.048~0.849),P=0.029],而肿瘤>3 cm显著增加肿瘤残存率[OR=18.449,95%CI(5.242~64.933),P<0.001]。CMH分层分析显示,相比肝继发恶性肿瘤、术前未行TACE治疗的肿瘤、非膈下(靠近胃肠实质脏器、单纯被膜下)肝被膜下肿瘤,肝脏原发肿瘤[OR=0.123,95%CI(0.015~1.019),P=0.025]、术前行TACE治疗的肿瘤[OR=0.123,95%CI(0.015~1.019),P=0.025]和膈下肝被膜下肿瘤[OR=0.081,95%CI(0.009~0.741),P=0.022]应用水隔离技术降低肿瘤残存率方面的作用更加明显。结论水隔离技术可显著降低肝被膜下恶性肿瘤MWA术后肿瘤残存率,尤其在原发性肝癌、术前行TACE治疗的肿瘤和膈下肝被膜下肿瘤中作用更为明显。     

载药微球加载贝伐珠单抗介入栓塞治疗兔VX2肝癌的抗血管生成效果

【摘要】 目的 探讨载药微球加载贝伐珠单抗经导管动脉化疗栓塞（TACE）治疗兔VX2 肝癌模型的抗血管生成效果。方法 构建30只新西兰大白兔VX2 肝癌模型,随机分为HepaSphere载药微球加载贝伐珠单抗组（A组,n=10）、Embosphere微球联合贝伐珠单抗组（B组,n=10）、单纯HepaSphere载药微球组（C组,n=10）。酶联免疫吸附试验（ELISA）法定量检测TACE术前1 d,术后1、7、14 d各组血清血管内皮细胞生长因子（VEGF）水平,术前1 d、术后14 d腹部MRI检测各组肿瘤直径,计算瘤体体积和肿瘤增长率。结果 术后 7 d A组、B组血清VEGF水平与C组相比均较低（P＜0.05）,且A组低于B组;术后14 d 3组血清VEGF水平两两比较差异均有统计学意义（P＜0.05）,A组最低,C组最高。术后14 d 3组肿瘤增长率两两比较差异均有统计学意义（P＜0.05）,A组最低。结论 载药微球加载贝伐珠单抗TACE治疗可明显降低兔VX2 肝癌模型术后血清VEGF水平和肿瘤增长率,疗效优于单纯载药微球或栓塞微球联合贝伐珠单抗治疗。     

靶向超声微泡对结肠癌新生血管分子成像的实验研究

目的 探讨以VEGFR2 (kinase insert domain receptor,KDR)为靶点的靶向超声微泡对裸鼠结肠癌新生血管的成像效果.方法 以生物素-亲和素桥接法将特异性结合VEGF主要受体KDR的小肽K237与脂质微泡耦联构建靶向微泡,用同样方法将对照肽与脂质微泡耦联,构建对照微泡.以KDR阴性表达的人结肠癌LS174T细胞株建立人结肠癌裸鼠移植瘤模型.12只荷瘤鼠经尾静脉随机先后注射靶向微泡、对照微泡,2种微泡注射间隔30 min.注射靶向微泡后5 min和注射对照微泡后5 min荷瘤鼠均行超声造影检查,观察各组微泡在肿瘤组织造影增强情况,测量肿瘤组织的声强度(Ⅵ).另取6只荷瘤鼠预先注射K237肽后再注射靶向微泡,观察微泡的成像效果.靶向微泡组、对照微泡组、小肽预先封闭组肿瘤组织的Ⅵ值比较采用单因素方差分析,组间多重比较采用最小显著性差异t检验.用免疫组织化学技术检测KDR在肿瘤组织表达及分布规律.结果 成功制备了靶向微泡.注射超声微泡后5 min超声检查显示靶向微泡组肿瘤组织超声造影明显增强,对照微泡组及小肽预先封闭组仅见轻度的超声造影增强.3组Ⅵ值差异有统计学意义(F=39.130,P＜0.01).靶向微泡组与对照微泡组Ⅵ值差异有统计学意义(30.18±9.56与8.28±4.74,t=6.91,P＜0.01);小肽预先封闭组Ⅵ值与靶向微泡组差异有统计学意义(9.23±3.44与30.18±9.56,t =4.91,P＜0.01).免疫组织化学结果显示,荷瘤鼠结肠癌新生血管内皮细胞KDR表达较正常组织血管内皮细胞KDR表达显著增加.结论 以KDR为靶点的靶向超声微泡可以与荷瘤鼠肿瘤新生血管内皮特异性黏附并有效评价肿瘤新生血管形成.     

低频超声联合靶向纳米微泡介导siRNA转染肝癌细胞的实验研究

目的探讨低频超声联合靶向纳米微泡介导的NET-1 siRNA转染人肝癌细胞株HepG 2的最佳输出声功率。方法 1)以磷脂复合物为原料、以半乳糖苷化多聚赖氨酸为靶向配体,利用薄膜水化法配合机械震荡法制备靶向纳米微泡,利用生物素-亲和素系统,将NET-1 siRNA与靶向纳米微泡偶联,制备成肝癌靶向载NET-1siRNA纳米微泡;2)采用CGZZ型低频超声基因转染治疗仪,频率为1.00MHz,单路晶片输出声功率在0.11~3.5W,占空比50%;3)将HepG 2细胞分别接种在培养板中,随机分为6组进行低频超声辐照实验;4)以MTT法检测细胞增殖情况;进行Quantitative Realtime PCR检测NET-1 mRNA表达情况;Western Blot法检测NET-1蛋白的表达。结果 C组、D组、E组和F组的细胞增殖能力与A组比较细胞增殖显著受到抑制(P0.05)。C组、D组、E组和F组的细胞增殖在转染后48h分别抑制了54.39%、24.66%、42.49%和63.39%。NET-1mRNA表达抑制率各组间差异有统计学意义(P0.05),D组NET-1 mRNA表达抑制率较其余组明显提高(P0.05)。Western Blot电泳结果显示D组的条带表达最弱、范围最小,D组NET-1蛋白表达抑制率92.81%,与同期的B组(26.45%)、C组(43.39%)、F组(25.14%)比较差异均有统计学意义(P0.05)。结论低频超声联合靶向纳米微泡能有效促进NET-1 siRNA对肝癌细胞的转染,并抑制肝癌细胞的增殖。     

特殊部位小肝癌超声引导下微波消融与手术切除的对比研究

【摘要】 目的 对比研究超声引导下经皮微波消融（MWA）与手术切除治疗特殊部位原发性小肝癌的疗效。 方法 分析240例特殊部位原发性小肝癌患者的资料,对比超声引导下MWA组与手术切除组近、远期疗效。 结果 MWA组与手术切除组围手术期均未出现严重并发症,对比两组肿瘤首次完全消除率、复发率,差异均无统计学意义（P=0.072,P=0.233）。MWA组患者术后肝功能、术中出血量、手术时间、术后体温、术后住院天数以及住院费用均优于手术切除组（P＜0.05）。MWA组与手术切除组1、3、5年总生存率分别为96.6%、86.4%、64.2%,95.1%、88.0%、70.3%,P=0.852。1、3、5年无瘤生存率分别为84.4%、62.8%、42.9%,81.3%、62.0%、57.7%,P=0.341。 结论 超声引导下MWA治疗特殊部位原发性小肝癌与手术切除具有相似的生存疗效,相比于手术切除更经济微创、简便易行。     

耐药VX2肝癌模型的建立

目的　探讨应用经化疗药物诱导后传代的VX2肿瘤建立移植性耐药肝癌模型的可行性。方法　将 2 0只大耳白兔随机分为 4组 ,建立肝癌模型。A、B组和C、D组植入肿瘤分别取自常规传代和药物诱导后的传代兔。模型建立 3周后 ,增强CT检查确定肿瘤大小。直视下穿刺肝动脉 ,A、C两组注入阿霉素 (4mg/2ml) ,B、D两组注入等量生理盐水。 1周后CT复查 ,比较各组肿瘤倍增率。流式细胞仪检测各组肿瘤凋亡率。结果　模型建立 3周后各组肿瘤大小无明显差异。治疗 1周后增强CT复查 ,各组肿瘤体积均增大。其中 ,A组肿瘤倍增率显著低于其他组 (P <0 .0 5 ) ;C组低于B、D组 ,但各组间差异无显著性 (P >0 .0 5 )。A组肿瘤凋亡率显著高于其他组 (P <0 .0 5 ) ;C组高于B、D组 ,但组间差异无显著性 (P >0 .0 5 )。结论　通过药物诱导建立的移植性兔VX2肝癌模型具有明显耐药特征 ,可作为耐药肝癌模型用于肝癌全身与介入性药物治疗的实验研究。     

蛛网膜下腔注射阿霉素磁性明胶微球对家兔体感诱发电位的影响

目的 探讨在外磁场作用下蛛网膜下腔注射阿霉素磁性明胶微球对体感诱发电位的影响。方法 30只雄性新西兰兔，随机分为假手术组（S组）、空白微球5mg对照组（C1组）、空白微球15Mg对照组（C2组）、阿霉素磁性明胶微球5mg组（A1组）、阿霉素磁性明胶微球15Mg组（A2组），每组6只。在外磁场作用下蛛网膜下腔注射微球，连续观察注射后家兔下肢的电痛阈、运动功能及体感诱发电位变化，30天后取腰骶段的脊髓行病理检查。结果 A2组痛阈显著升高（P〈O．01），持续30天仍未见消失；N1波潜伏期显著延长，持续30天仍未恢复。所有组运动功能评分未见明显变化。A2组脊髓背角破坏明显，A1组脊髓背角破坏轻微。所有组脊髓前角未见损毁。结论 阿霉素磁性明胶微球可靶向损毁脊髓背角，使体感诱发电位显著延长，具有“感觉-运动”阻滞分离作用，是一种有效的治疗顽固性疼痛的靶向神经损毁剂。     

载尿激酶阴离子脂质微泡联合低频超声体外溶栓的效率研究

目的制备载尿激酶（uPA）阴离子脂质微泡,探讨其联合低频超声的体外溶栓效果。方法利用二硬脂酸磷酯酰胆碱（DSPC）、二棕榈酰磷酯酰甘油（DPPG）、PEG2000修饰二硬脂酸磷酯酰乙醇胺（DSPE-PEG2000）3种磷脂,通过机械振荡法制备阴离子微泡,再将微泡与uPA混合孵育,两者结合即得载药微泡,用粒径分析仪测定其粒径及分布。用FITC标记uPA,制得荧光标记的载药微泡,在荧光显微镜下观察微泡的形态及uPA与微泡的黏附情况。用Zeta电位仪分别测定载药微泡与未载药微泡的表面电荷;用十二烷基磺酸钠-聚丙烯酰胺凝胶电泳（SDS—PAGE）对载药微泡进行验证;测量加入10000、50000和100000UuPA时微泡的包封率。抽取大鼠血液制作体外血栓模型,测定载药微泡联合低频超声的体外溶栓效果。采用两样本t检验、单因素方差分析及Bonferroni法进行数据比较。结果载药微泡的平均粒径为（1．76±0．29）μm,在荧光显微镜下可以观察到FITC标记的uPA成功结合到阴离子微泡表面。载药微泡的表面电荷明显低于未载药微泡的表面电荷：（-36．64±0．21）mV与（-66．33±2．38）mV,t=21．538,P〈0．05;SDS—PAGE显示载药微泡的泳道有明显的蛋白质条带,而未载药微泡没有;当uPA加入量分别为10000、50000和100000U时,药物包封率分别为（42．01±2．02）％、（33．24±1．95）％和（33．10±1．65）％（F=22．340,P〈0．05）。生理盐水组、生理盐水±超声组、未载药微泡±超声组、载药微泡±超声组、单纯uPA组的体外溶栓效率分别为（4．09±0．80）％、（8．50±1．48）％、（14．27±1．59）％、（35．72±6．31）％、（16．87±0．46）％,载药微泡超声组最高（F=48．783,t=-8．613、-7．273、-5．942及-6．908,均P〈0．05）。结论阴离子微泡能成功搭载uPA,该微泡联合低频超声的溶栓效果良好。     

肝内血管对肝细胞癌微波消融疗效的影响:基于倾向性匹配评分研究

【摘要】 目的 探索肝内血管（＞3 mm）对毗邻血管周围的肝细胞癌微波消融（MWA）疗效的影响。方法 回顾性分析2015年1月至2018年12月采用MWA治疗的肝癌患者126例（共199个肿瘤）。根据肝内肿瘤是否毗邻肝内血管将肿瘤分为毗邻组和非毗邻组:毗邻直径＞3 mm的肝静脉、门静脉或腔静脉血管的肿瘤被定义为毗邻组，共37例40个瘤灶；距离直径＞3 mm的肝静脉、门静脉或腔静脉10 mm以上的肿瘤定义为非毗邻组，共89例159个瘤灶。为避免其他因素干扰，排除距离肝被膜、胆囊、胃肠道5 mm以内的肿瘤。1∶2倾向性匹配评分（PSM）被用以平衡两组选择性偏倚及混杂影响。分析和比较两组肿瘤MWA后技术有效率、肿瘤局部进展率（LTP）及并发症差异有无统计学意义。结果 毗邻组40个瘤灶，非毗邻组80个瘤灶被成功匹配并纳入分析。整体技术有效率为86.7%（104/120），毗邻组和非毗邻组技术有效率分别为35/40（87.5）%和69/80（86.2）%（P=0.849）。多因素分析提示毗邻血管对MWA后技术有效率无显著影响（OR=0.907，95% CI=0.258-3.192，P=0.693）。中位随访时间为13.8个月，整体LTP率为23.1%（24/104）。毗邻组和非毗邻组1年、2年累计局部进展率分别为8.0%、27.0%和9.0%、31.0%。多因素分析显示两组LTP率差异无统计学意义（HR=0.874，95% CI=0.363-2.108，P= 0.765）。两组并发症差异无统计学意义（P=0.492）。结论 MWA治疗毗邻或非毗邻肝内血管的病灶，其技术有效率和局部进展率无明显差别。肝内血管（＞3 mm）对MWA治疗肝细胞癌的疗效无显著影响，并未表现出显著的热沉降效应。     

小型猪颌下腺放射性损伤模型IVIM MRI及与病理的对照研究

【摘要】目的：通过IVIM参数与病理参数的相关性分析，评估体素内不相干运动成像技术在小型猪颌下腺放射性损伤中的应用价值。方法：将9只雌性小型猪随机均分为3组，分别采用20Gy（实验组A）、15Gy（实验组B组）和0Gy（对照组）的剂量对三组小型猪的双侧颌下腺进行放射线照射建立放疗损伤模型，每只小猪在照射前和照射后第4周末分别行IVIM-MRI扫描，随后对每只猪的双侧颌下腺完成病理学检查。比较照射前、后颌下腺IVIM参数（D、D*和f）值的差异，并分析D值与颌下腺腺泡面积百分比、D*值和f值与微血管密度（MVD）的相关性。结果：照射前、后，对照组中颌下腺各项IVIM参数值的差异均无统计学意义（P＞0.05），实验组A和实验组B中颌下腺各项IVIM参数比较，差异均具有统计学意义（P＜0.05）。放疗后，对三组的颌下腺各项IVIM参数、腺泡面积百分比和微血管密度分别进行比较，差异均具有统计学意义（P＜0.05）。D值与腺泡面积百分比呈负相关（r=－0.639，P=0.004）；D*值与MVD呈正相关（r=0.767，P＜0.001）；f值与MVD呈负相关（r=－0.631，P=0.005）。结论：磁共振IVIM参数能在一定程度上反映颌下腺的病理性损伤情况。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…