复合125I粒子植入技术联合TACE治疗肝癌合并门静脉癌栓

【摘要】 目的 评估复合125I粒子植入技术（125I粒子螺旋系统序贯肿瘤同侧分支癌栓粒子植入术）联合TACE治疗肝细胞癌（HCC）合并程氏Ⅲ型门静脉癌栓（PVTT）的安全性及有效性。方法 对24例HCC合并Ⅲ型PVTT患者行门静脉主干内125I粒子螺旋系统植入术,随后同期行TACE治疗;7～10 d后继行肿瘤同侧分支癌栓内125I粒子植入术。每6～8周行CT增强随访,并按需行再次TACE治疗。统计分析患者并发症、治疗反应率及总生存期。 结果 所有患者均未发生3级以上严重并发症。门静脉主干癌栓（MPVTT）的客观反应率（ORR）与疾病控制率（DCR）分别为54.2%及87.5%;肝内病变的ORR及DCR分别为29.2%及37.5%。患者中位生存期为（9.5±1.4）（95%CI,6.7～12.3）个月。结论 复合125I粒子植入技术联合TACE治疗HCC合并Ⅲ型PVTT是安全可行的,该模式有望进一步改善此类患者预后。     

125I粒子条联合门静脉支架及化疗栓塞治疗原发性肝癌合并门静脉癌栓

目的 评估125I粒子条联合金属支架门静脉内植入+动脉化疗栓塞治疗原发性肝癌合并门静脉主干癌栓的疗效.方法 选取17例原发性肝癌伴门静脉主干癌栓患者,行125I粒子条联合门静脉内支架+TACE.粒子植入数量17～23粒(6711型,0.7 mCi/粒),第1个半衰期组织内平均吸收剂量为73.51～76.22 Gy.疗效和不良反应评价指标包括:术后并发症,肝肾功能及血常规改变等.采用Kaplan-Meier生存曲线分析患者的生存时间、支架通畅时间、累积生存率和累积支架通畅率.结果 所有患者门静脉支架和125I粒子条均成功植入,未发生手术相关严重并发症.术后随访2～13个月,12例存活,5例死亡(肝功能衰竭4例,多发转移1例).60、180和360 d的累积支架通畅率为94%、94%和94%;累积生存率为87%、65%和53%.结论 125I粒子条联合金属支架门静脉内植入+动脉化疗栓塞治疗原发性肝癌合并门静脉主干癌栓可以提高支架通畅率,延长生存时间.但远期效果尚需进一步观察.     

125I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的近期疗效

目的探讨¹²⁵I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的安全性及近期疗效。 方法15例原发性肝癌伴门静脉主干癌栓患者行门静脉¹²⁵I粒子条植入术,手术操作在超声及DSA引导下进行。术后对肝功能、血常规及凝血功能的变化、癌栓的改变、不良反应进行评价。 结果所有患者均成功植入放射性¹²⁵I粒子条,门静脉主干癌栓的有效率为40.00%(6/15),疾病控制率为86.67%(13/15)。术后2个月复查所有患者的肝功能、血常规、凝血功能与术前比较差异无统计学意义。未出现与粒子条植入相关的严重并发症。 结论植入¹²⁵I粒子条治疗肝癌伴门静脉主干癌栓是安全、可行、有效的。     

血管内近程放疗在肝癌合并门静脉一级分支癌栓中的应用

目的 评估碘-125(125I)粒子条联合动脉化疗栓塞(TACE)治疗肝细胞肝癌(HCC)合并门静脉一级分支癌栓的安全性及有效性.方法 回顾性分析2013年1月至2018年1月就诊的71例HCC合并门静脉一级分支癌栓患者的病历资料,24例接受门静脉一级分支125I粒子条植入术联合TACE术作为研究组,47例仅接受TAC...     

经导管动脉化疗栓塞术联合经皮 125I粒子植入序贯治疗肝癌伴门静脉主干癌栓

目的评价经导管动脉化疗栓塞术（TACE）联合经皮125I放射性粒子植入序贯治疗肝癌伴门脉主干瘤栓的临床疗效及安全性。 方法2010年1月至2012年3月48例确诊为肝癌合并门静脉主干癌栓患者,TACE术后1周进行经皮门脉瘤栓125I放射性粒子植入序贯治疗。随访时间12-24月,对比序贯治疗前后各项临床指标、影像学的变化,以评价其疗效及安全性。 结果48例患者共接受215次TACE治疗,平均每例患者4.5次,每例患者平均植入粒子数16枚,技术成功率100%,全组未出现治疗相关性死亡,肝内病灶客现缓解率为37.3%（18/48）。瘤栓3个月后影像复查平均回缩3.9mm,完全缓解（CR）15例,部分缓解(PR)25例,稳定（SD）6例,进展（PD）2例,总有效率（CR+PR）为83.3%。门脉主干内径恢复大于80%共41例（85.4%）。1年生存率和2年生存率分别为47.9%,33.33%,中位生存时间为15.8月。48例患者术后3个月患者的肝功能、血常规与术时比较,P=0.028,差异均无统计学意义。 结论TACE联合经皮125I放射性粒子植入序贯治疗原发性肝癌伴门静脉主干癌栓是一种有效安全的方法。     

TACE联合微波消融与联合125I放射性粒子植入治疗不可切除肝癌合并门静脉癌栓疗效比较

【摘要】 目的 探讨经动脉化疗栓塞（TACE）联合微波消融术与联合125I放射性粒子植入治疗不可切除肝癌合并门静脉癌栓的疗效。方法 选取2016年2月至2020年3月内蒙古医科大学附属医院收治的84例不可切除肝癌合并门静脉癌栓患者,以随机数字表法分为研究组42例,对照组42例。对照组行TACE联合125I放射性粒子植入治疗,研究组行TACE联合微波消融术,治疗后随访12个月。观察两组患者近期抗肿瘤疗效、病灶内生物学标志基因表达情况,以及治疗期间的不良反应,随访期间的预后情况。结果 治疗后两组患者的客观缓解率、临床控制率比较,差异均无统计学意义（均P＞0.05）。治疗后两组患者的丝切蛋白-1（CFL1）、B细胞特异性莫洛尼白血病毒插入位点1（BMI-1）、激活转录因子3（STAT3）mRNA 相对表达量均低于治疗前（均P＜0.05）;且研究组患者的 mRNA 相对表达量均低于对照组（均P＜0.05）。治疗后两组患者的Caspase-3、Runx3、p53mRNA 相对表达量均高于治疗前（均P＜0.05）,且研究组患者的mRNA 相对表达量均高于对照组（均P＜0.05）。对照组患者的骨髓抑制发生率低于研究组（P＜0.05）,而高血压、蛋白尿、消化道反应发生率两组差异均无统计学意义（均P＞0.05）。研究组患者12个月总存活率为51.22%（21/41）,对照组为42.50%（17/40）,差异无统计学意义（P＞0.05）。结论 TACE联合微波消融术、TACE联合125I放射性粒子植入这两种治疗方案对不可切除肝癌合并门静脉癌栓患者的疗效、安全性相近,但TACE联合微波消融术可抑制患者病灶内侵袭基因表达、上调抑癌基因表达。     

125Ⅰ粒子植入治疗门静脉癌栓的初步探讨

目的：探讨125I粒子在门静脉癌栓治疗中的应用价值。方法：自2008年2月～2008年8月,我科共对8例经CT或B超证实为门静脉癌栓的患者进行了125I粒子植入术,术后观察门静脉通畅情况。结果：随访6个月,所有患者复查CT显示门静脉癌栓不同程度的缩小,甚至消失,临床症状明显改善,均无明显不良反应。结论：125I粒子植入术对门静脉癌栓具有疗效可靠,无明显副作用等优点,是介入治疗门静脉癌栓的一种重要治疗手段。     

125 I粒子植入治疗门静脉癌栓的初步探讨

目的:探讨125I粒子在门静脉癌栓治疗中的应用价值.方法:自2008年2月～2008年8月,我科共对8例经CT或B超证实为门静脉癌栓的患者进行了125I粒子植入术,术后观察门静脉通畅情况.结果:随访6个月,所有患者复查CT显示门静脉癌栓不同程度的缩小,甚至消失,临床症状明显改善,均无明显不良反应.结论:125I粒子植入术对门静脉癌栓具有疗效可靠,无明显副作用等优点,是介入治疗门静脉癌栓的一种重要治疗手段.     

TACE+门静脉支架联合血管内植入碘-125粒子链治疗肝癌合并门静脉主干癌栓的临床疗效观察

目的 探讨经肝动脉化疗栓塞术(TACE)联合门静脉支架及血管内植入碘-125粒子链治疗肝癌合并门静脉主干癌栓患者的临床疗效.方法 选取120例接受TACE治疗的肝癌合并门静脉主干癌栓患者,按照随机数字表法分为观察组和对照组各60例,观察组给予TACE+门静脉支架+腔内植入碘-125粒子链治疗,对照组给予TA-CE+门静脉支架治疗.观察两组患者的技术成功情况,不良事件发生情况及术后的生存情况、支架通畅情况;两组间比较采用卡方检验或t检验.结果 两组患者的技术成功率均为100％.观察组和对照组的中位生存期分别为14.5个月(95％CI 9.1 ～20.4个月)、8.2个月(95％CI 5.1 ～14.9个月),差异具有统计学意义(t=3.485,P＜0.05);观察组1年的累积生存率为41.7％ (25/60),对照组为15.0％ (9/60),差异具有统计学意义(x2=5.403,P＜0.05);观察组和对照组支架中位通畅期分别为15.2个月(95％ CI 10.5 ～ 22.7个月)、7.7个月(95％ CI 5.2 ～15.3个月),差异具有统计学意义(t=2.925,P＜0.05);观察组1年的支架累积通畅率分别为56.7％(34/60),对照组为25.0％ (15/60),差异具有统计学意义(x2=3.974,P＜0.05).结论 TACE+门静脉支架+血管内植入碘-125粒子链治疗肝癌合并门静脉主干癌栓可显著延长患者生存时间,提高生存率,具有良好的临床应用前景.     

CT引导下125I放射性粒子植入治疗肝癌门静脉癌栓的疗效评价

目的探讨CT引导下^125I放射性粒子植入联合肝动脉化疗栓塞术（TACE）治疗肝癌合并门静脉癌栓（PVTT）的疗效。方法回顾性分析原发性肝癌合并PVTT患者58例,A组（26例）行TACE结合CT引导下^125I放射性粒子植入局部放射治疗;B组（32例）单纯行TACE。对比两组疗效。结果 A组1、2年生存率分别为42.3%、23.0%,平均生存期15.5个月,完全缓解（CR）3例,部分缓解（PR）9例,总有效率（CR＋PR）为46.2%（12/26）。B组1、2年生存率分别为21.9%、6.3%,平均生存期7.5个月CR2例,PR6例,CR＋PR为25.0%（8/32）。A组的生存率及总有效率显著高于B组（P〈0.05）。结论 TACE联合CT引导下^125I放射性粒子植入治疗肝癌门脉癌栓能明显提高其疗效,并具有创伤少,并发症少等优点。     

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…