高能聚焦超声治疗腹盆腔淋巴结转移癌97例分析

目的：观察FEP—BY01型肿瘤超声治疗机治疗腹、盆腔淋巴结转移癌的近期疗效。方法：应用FEP—BY01肿瘤超声治疗机治疗腹、盆腔淋巴结转移癌患97例。结果：显有效率(CR)29．9％(29／97);有效率(PR)50．5％(49／97);总有效率80.4％(CR PR);无效率19．6％(19／97).癌性疼痛缓解率77．5％(55／71)。结论：高能聚焦超声治疗中晚期腹、盆腔肿瘤患淋巴结转移癌疗效确切,是中晚期恶性肿瘤局部姑息治疗的一种较好的方法.     

高强度聚焦超声治疗腹膜后淋巴结转移癌87例疗效观察

目的 了解高强度聚焦超声(HIFU)治疗腹膜后淋巴结转移癌的治疗效果及安全性.方法 应用FEP-BY01或FEP-BY02型肿瘤超声治疗机对87例腹膜后淋巴结转移癌患者进行治疗.结果 完全缓解率为8%(7/87);部分缓解率为28.7%(25/87);有效率为36.7%.能明显缓解癌性疼痛,有效率达78.3%.所有病例治疗时均未出现出血、胃肠道穿孔、皮肤烧伤等并发症.结论 HIFU是治疗腹膜后淋巴结转移癌一种新的安全有效的局部治疗方法.     

HIFU合并化疗治疗腹盆腔复发或转移癌的临床观察

目的:探讨高能聚焦超声刀(Highintensityfocusedultrasound,HIFU)合并化疗治疗腹盆腔复发或转移癌的疗效及不良反应。方法:选取既往病史有过手术和/或放、化疗史,病理诊断明确的腹盆腔复发或转移癌68例,随机分为治疗组(36例)和对照组(32例),前者采用HIFU 化疗,后者单纯用化疗,均在完成2周期化疗后评价其有效率、临床受益反应,并至少随访1年。结果:治疗组完全缓解(CR)1例,部分缓解(PR)24例,总有效率69.4%(25/36),临床受益率(CBR)为83.3%(30/36),平均生存期为9.1±3.1个月;对照组CR0例,PR10例,总有效率31.3%(10/32),CBR为56.3%(18/32),平均生存期为6.8±2.4个月;两组比较有显著性意义(P<0.01、P<0.05、P<0.01),主要不良反应为骨髓抑制和消化道反应,两组间比较无统计学差异,治疗组无脏器穿孔、大出血、胰漏、腹膜炎等并发症发生。结论:HIFU合并化疗治疗腹盆腔复发或转移癌可取得较高的局控率和临床受益率,并能延长其生存期,对于无手术和(或)放疗适应症的晚期腹盆腔恶性肿瘤不失为一种安全、有效的高姑息治疗手段。     

高能超声体外聚焦治疗腹膜后转移淋巴结的临床观察

目的了解FEP-BY01型高能超声体外聚焦肿瘤热疗机、用于治疗腹膜后转移淋巴结的有效性和临床可行性.方法应用FEP-BY01型高能超声体外聚焦肿瘤热疗机治疗腹膜后转移淋巴结45例、其中辅助放疗28例.结果治疗结束后一个月、复查彩超和CT提示CR 37.78%(17/45),PR 40%(18/45)PC22.22%(10/45).全组病例治疗中无损伤、无痛苦、无副作用.结论高能超声体外聚焦(FEP)技术,用于治疗腹膜后转移淋巴结是有效的、临床可行的.     

聚焦超声高温热疗在治疗实体瘤方面的临床研究

目的　研究聚焦超声高温热疗对实体瘤的治疗效应。方法　用高强可控圆阵聚焦超声 (highintensitycontrolfocusultrasoundHICFU)肿瘤治疗机对入选的 30例进行治疗 ,同时在非该机治疗的另外 2 8例进行对照。结果　HICFU组 :完全缓解 (CR) 5例 ,部分缓解 (PR) 9例 ,好转 (MR) 16例 ,总缓解率 (OR) 46 67% ;KPS评分提高 2 0例 ,稳定 8例 ,下降 2例。对照组 :CR 0例 ,PR 2例 ,MR 14例 ,PD 12例 ,OR 7 14 % ;KPS评分提高 5例 ,稳定 11例 ,下降 12例。两组OR(CR +PR)差异非常显著 (P <0 .0 1)。结论　高强聚焦超声肿瘤治疗机在临床应用过程中具有以下优点 :( 1)技术先进 ,性能优越。 ( 2 )安全、有效。 ( 3)无明显副作用。 ( 4)适用于所有经机载B超可以观察到病灶全貌的良、恶性肿瘤病人。是肿瘤治疗领域里的一种新手段 ,值得推广应用     

卡培他滨联合铂类抗癌药治疗晚期消化道肿瘤

目的 :评价希罗达联合铂类抗癌药治疗晚期消化道肿瘤的近期疗效和毒副反应。方法 :希罗达 2 5 0 0mg/m2 ·d-1,分 2次口服 ,连续口服 2周 ,停药 1～ 2周 ;顺铂 6 0～ 80mg/m2 ,分 3天静脉滴注 ,对有肝转移和腹盆腔转移者 ,DDP一次性腹腔灌注 (卡铂 30 0mg/m2 ,用法与顺铂相同 ;草酸铂 130mg/m2 一次性静脉滴注 )。 2 1～ 2 8天为一个周期 ,每个患者最少接受 2个周期的化疗。结果 :完全缓解 (CR) 0例 ,部分缓解 (PR) 17例 ,稳定 (SD) 13例 ,进展 (PD) 6例。有效率 (CR +PR)4 7 2 %。 8例肝转移患者 4例取得部分缓解 ,本组主要毒性反应表现为骨髓抑制、消化道反应、口腔粘膜溃疡、手足综合征。结论 :本方案对治疗晚期消化道肿瘤疗效确切 ,尤其是那些复治和有肝转移者 ,且毒性反应可以耐受     

高强度聚焦超声治疗消化道肿瘤腹膜后淋巴结转移癌67例疗效观察

目的探讨高能聚焦超声（HIFU）治疗胃肠道肿瘤腹膜后淋巴结转移癌的疗效及安全性。方法应用HIFUNIT9000型肿瘤超声治疗机,对67例胃肠道肿瘤腹膜后淋巴结转移癌患者进行治疗。结果完全缓解率为8．95％（6／67）,部分缓解率为28．35％（19／67）,有效率为37．31％.所有病例均未出现胰液外漏、腹腔内出血、皮肤烧伤等并发症,结论HIFU是治疗腹膜后淋巴结转移癌的1种安全有效的局部治疗方法。     

高能聚焦超声治疗腹腔及盆腔恶性肿瘤93例报告

目的研究高能聚焦超声(HIFU)治疗腹腔及盆腔恶性肿瘤临床疗效及安全性。方法应用FEP-BY02型高能聚焦超声肿瘤治疗机治疗腹腔及盆腔恶性肿瘤93例患者。其中实质脏器肿瘤69例,空腔脏器肿瘤24例,疼痛患者63例。结果经高能聚焦超声治疗的实质脏器肿瘤显效率19%,有效率74%,无效率7%;空腔脏器肿瘤显效率8%,有效率75%,无效率17%;疼痛完全缓解率59%,疼痛部分缓解率33%,无效率6%。所有患者无皮肤灼伤、出血、穿孔等并发症。结论高能聚焦超声治疗腹腔及盆腔恶性肿瘤是安全有效的局部治疗方法。     

化疗对肺癌疼痛镇痛作用的临床评价

目的评价化疗对肺癌疼痛的镇痛作用并探讨肺癌疼痛的治疗策略.方法 63例肺癌中度疼痛40例,重度疼痛23例.16例小细胞肺癌以CEP(CTX,Vp-16,DDP)或VMF-CP(Vp-16,MTX,5-Fu,CTX,DDP)方案化疗,47例非小细胞肺癌以NP(NVB,DDP)或CAP(CTX,ADM,DDP)方案化疗,并评价镇痛作用.结果疼痛完全缓解(CR)34例(54.0%),部分缓解(PR)27例(42.9%),无效2例,总疼痛缓解率96.8%.16例小细胞未分化癌疼痛缓解率100%,CR 11例(68.8%),PR 5例(31.2%);22例差分化癌疼痛缓解率100%,CR 12例(54.5%),PR 10例(45.5%);17例高分化鳞、腺癌疼痛缓解率94.1%,CR 6例(35.3%),PR 10例(58.8%),无效1例,不同分化程度肺癌疼痛CR率差异有显著性(χ2=4.0166,P<0.05).胸部、内脏和淋巴结及骨转移疼痛CR率分别为84.2%(16/19),50.0%(5/10)和38.2%(13/34),差异有显著性(χ2=10.39,P<0.001).肿瘤CR 7例均获疼痛CR(100%),肿瘤PR 30例疼痛CR 18例(58.1%),肿瘤稳定25例疼痛CR 9例(36.0%),不同肿瘤疗效组疼痛CR率差异有显著性(χ2=10.04,P<0.001).中度与重度疼痛CR率(50.0%对41.2%)差异无显著性(χ2=0.7,P>0.05).结论化疗对缓解肺癌疼痛疗效显著,可作为肺癌疼痛的重要治疗措施.分化程度、疼痛部位和肿瘤客观疗效显著影响化疗镇痛效果.     

消化道肿瘤腹腔转移淋巴结适形放射治疗的价值

[目的]探讨消化道肿瘤腹腔转移淋巴结适形放射治疗的价值。[方法]自2005年1月至2006年6月对56例消化道肿瘤腹腔转移淋巴结的患者进行三维适形放射治疗,95%等剂量曲线包绕计划靶区,每日一次,1.8～2Gy/次,40Gy后根据肿瘤情况缩野加量至总量50～60Gy,中位剂量56Gy。[结果]52例完成放疗计划,其中CR16例,PR22例,总有效率为（CR＋PR）73.1%（38/52）,1年生存率50.0%（24/48）,2年生存率25.0%（12/48）。治疗后腹痛缓解率为90.6%（29/32）,腹胀缓解率90.0%（18/20）,腰背部疼痛缓解率96.7%（29/30）。急性消化道反应发生率为69.2%,白细胞减少发生率为21.2%。[结论]采用适形放射治疗消化道肿瘤腹腔转移淋巴结,具有治疗效果可靠、正常组织损伤轻、副作用小的优点,从而达到有效改善患者生活质量的目的。     

Detection of distant metastases in patients with oesophageal or gastric cardia cancer: a diagnostic decision analysis

Computed tomography (CT) is presently a standard procedure for the detection of distant metastases in patients with oesophageal or gastric cardia cancer. We aimed to determine the additional diagnostic value of alternative staging investigations. We included 569 oesophageal or gastric cardia cancer patients who had undergone CT neck/thorax/abdomen, ultrasound (US) abdomen, US neck, endoscopic ultrasonography (EUS), and/or chest X-ray for staging. Sensitivity and specificity were first determined at an organ level (results of investigations, i.e., CT, US abdomen, US neck, EUS, and chest X-ray, per organ), and then at a patient level (results for combinations of investigations), considering that the detection of distant metastases is a contraindication to surgery. For this, we compared three strategies for each organ: CT alone, CT plus another investigation if CT was negative for metastases (one-positive scenario), and CT plus another investigation if CT was positive, but requiring that both were positive for a final positive result (two-positive scenario). In addition, costs, life expectancy and quality adjusted life years (QALYs) were compared between different diagnostic strategies. CT showed sensitivities for detecting metastases in celiac lymph nodes, liver and lung of 69, 73, and 90%, respectively, which was higher than the sensitivities of US abdomen (44% for celiac lymph nodes and 65% for liver metastases), EUS (38% for celiac lymph nodes), and chest X-ray (68% for lung metastases). In contrast, US neck showed a higher sensitivity for the detection of malignant supraclavicular lymph nodes than CT (85 vs 28%). At a patient level, sensitivity for detecting distant metastases was 66% and specificity was 95% if only CT was performed. A higher sensitivity (86%) was achieved when US neck was added to CT (one-positive scenario), at the same specificity (95%). This strategy resulted in lower costs compared to CT only, at an almost similar (quality adjusted) life expectancy. Slightly higher specificities (97-99%) were achieved if liver and/or lung metastases found on CT, were confirmed by US abdomen or chest X-ray, respectively (two-positive scenario). These strategies had only slightly higher QALYs, but substantially higher costs. The combination of CT neck/thorax/abdomen and US neck was most cost-effective for the detection of metastases in patients with oesophageal or gastric cardia cancer, whereas the performance of CT only had a lower sensitivity for metastases detection and higher costs. The role of EUS seems limited, which may be due to the low number of M1b celiac lymph nodes detected in this series. It remains to be determined whether the application of positron emission tomography will further increase sensitivities and specificities of metastases detection without jeopardising costs and QALYs.     

从淋巴结转移规律探讨贲门癌合理治疗

本文通过１２６例病例分析及文献复习，探讨了贲门癌淋巴结转移的特点：（１）贲门癌先向腹腔淋巴结转移，晚期才向胸腔淋巴结转移；（２）贲门癌向脾门、脾动脉淋巴结转移机率并不比向幽门上、下淋巴结转移机率小。依据淋巴结转移规律，对贲门癌治疗提出两点探讨意见：（１）对早期贲门癌及老年合并心肺疾患者应提倡经腹手术；（２）贲门癌在行全胃切除时必须附加脾或脾、胰尾切除，否则单纯强调全胃切除是不恰当的。     

63例贲门癌胸腔纵隔淋巴结转移特点分析

目的研究贲门癌胸腔内纵隔淋巴结转移特点。方法采用前瞻性分析2008年6月—2009年10月随机选择63例贲门癌患者进行胸腔内纵隔淋巴结清扫并分析其转移特点。结果63例贲门癌患者腹腔淋巴结转移度、转移率分别为 38.39% 、66.67%。胸腔淋巴结转移度、转移率分别为10.60 %、20.63%。胸腔纵隔淋巴结转移与肿瘤长度、病理分级、浸润深度、肿瘤是否累及食管下段、腹腔淋巴结有关,Logistic回归多因素分析则显示肿瘤是否累及食管下段是主要影响因素。结论贲门癌主要向腹腔、胸腔淋巴结转移,贲门癌淋巴结清扫范围应包括胸腔内纵隔淋巴结与腹腔淋巴结。     

Interstitial magnetic resonance lymphography is an effective diagnostic tool for the detection of lymph node metastases in patients with cervical cancer

ABSTRACT: BACKGROUND: The aim of the present study was to determine the feasibility of detecting sentinel lymph node (SLN) metastases using interstitial magnetic resonance (MR) lymphography in patients with cervical cancer. MR data were compared to pathological results from the lymph nodes excised during surgery. METHODS: Twenty-eight patients with cervical cancer were enrolled and studied from January 2006 to December 2010. All patients underwent interstitial MR lymphography to determine the presence of sentinel lymph nodes and visualize lymphatic vessel drainage in the pelvis. Radical hysterectomy and excision of pelvic lymph nodes was performed according to their lesion grade. Gadodiamide was injected either intradermally into the bipedal toe web, into the labia majora or into the cervical tissue. MR results were compared with pathological reports. RESULTS: In 28 patients, lymphatic vessel drainage and lymph node groups were clearly visualized. Of these, 5 were MR lymphography positive and 23 were MR lymphography negative. Six had pathologically proven metastasis, five had true positives and 1 had a false negative in the obturator lymph node. CONCLUSIONS: Interstitial MR lymphography can be used to determine the extent and shape of pelvic lymphatic vessel drainage and lymph node metastases in patients with cervical cancer.     

高强度聚焦超声治疗乳腺癌骨转移的疗效

目的:研究高强度聚焦超声（high intensity focused ultrasound,HIFU）治疗乳腺癌骨转移的疗效。方法:选取乳腺癌骨转移患者50例,随机将患者分为观察组与对照组,每组各25名。观察组采用HIFU治疗,对照组采用放疗。观察2组患者治疗前后的疼痛缓解率及骨显像浓集影区别。结果:观察组与对照组疼痛缓解显效分别为15例（60%）、5例（20%）（P＜0.01）,观察组与对照组治疗前后骨显像CR分别为19例（76%）、1例（4%）（P＜0.01）。结论:HIFU是一种从体外无创治疗骨转移瘤的有效手段。与传统治疗方法相比,治疗时间短,一般需2~3小时,治疗即可完成。局部复发后可再次应用HIFU治疗。HIFU治疗将成为骨转移的又一有效治疗手段。     

宫颈癌复发肿瘤适形照射联合化疗30例临床观察

目的:研究三维适形照射技术(ThreeDimensionalConformalRadiationTherapy,3DCRT)联合化疗治疗宫颈癌复发肿瘤病灶,探讨其临床效果。方法:针对宫颈癌放疗后复发病灶的照射。13例放疗后复发,原照射野内复发者,适形照射剂量DT20～40Gy,照射野外复发者(主动脉旁淋巴结)适形照射DT60～70Gy;17例宫颈癌根治术后盆腔复发患者,全盆腔常规照射DT40～45Gy,针对病灶适形照射DT25～30Gy;腹主动脉旁淋巴结转移者,适行照射DT60～70Gy。放疗过程中联合化疗,方案为:5-FU4g/96h静脉点滴,PDD30mgD1～4静脉冲入。结果:随访时间为6～40个月。1)86.6&/30例有疼痛症状,76.9%(20/26)完全缓解,23.1%(6/26)部分缓解,有效率为100%。2)30例患者,CR16例,PR11例,SD3例,有效率90%。肿瘤缓解时间:3～40个月,中位5个月,平均12.3个月;有12例肿瘤再次进展。3)28例行SCC检查,治疗前25例高于1.5ng/ml者,治疗后23例(82.2%)降到正常,5例下降但未至正常,17.8%。4)生存超过1年者11例(36.7%);超过2年者4例(13.3%);超过3年者2例(6.7%)。5)近期并发症,骨髓抑制≤Ⅲ度者11例(36.7%),Ⅳ度者2例(6.7%);消化道症状2例(6.7%)。2,远期并发症,放射性膀胱炎1例(3.3%)。结论:适形照射联合化疗近期效果好,特别是腹主动脉旁淋巴结转移灶的患者;而放射治疗野内的复发病灶,因受剂量的限制,治疗效果不佳。     

High-intensity focused ultrasound for treatment of unresectable tumors located in the walls of chest and abdomen in 10 patients

Objective: To present our results of high-intensity focused ultrasound (HIFU) treatment in 10 patients with unresectable tumors involved in the walls of chest and abdomen. Methods: Tumors located in the walls of the chest and abdomen in 10 patients were treated by HIFU,including local recurrence of fibrosarcoma in 1 case and local invasion or metastases in 9 cases. All of the 10 patients had received anti-cancer treatments before HIFU, 3 patients were complicated with intercostal neuralgia. Results:Partial responses were obtained in 2 patients, minor response in 1 patient, stable disease in 4, progressive disease in 2 after HIFU treatments. All the intercostal neuralgia in 3 patients was disappeared after HIFU. Bone scan showed that site of rib metastasis before HIFU became normal after HIFU in one patient. Conclusion: Our preliminary results showed that HIFU could get good results for patients with malignant tumors located in the walls of chest and abdomen if they are focal tumors, even if they are complicated with rib metastasis.     

Frühes Ovarialkarzinom (FIGO Stadium I–IIA)

About 25% and 7% of ovarian cancer patients are diagnosed as having FIGO stage I or IIA disease, respectively. If the suspicion of ovarian cancer exists, operative exploration and histologic confirmation are necessary. It is almost never possible to preoperatively diagnose ovarian cancer at an early stage. For example, if only one positive lymph node in the paraaortic region is diagnosed at final histology, the patient will be allocated to stage IIIC disease. In stages I and II disease in which ovarian cancer is limited to the pelvis, accurate surgical staging leads to upstaging of the disease to stage III in 31% of cases because of subclinical metastases in the greater omentum, the peritoneum, and/or retroperitoneal lymph nodes. Primary surgery comprises operative staging via midline laparotomy and radical surgery with the intent to accurately diagnose the extent of the disease and to resect all visible disease in the pelvis and abdomen, including a pelvic and paraaortic lymphadenectomy. Unfavorable prognostic factors in FIGO stage I disease mainly include intraoperative rupture of the capsule of the tumor as well as tumor grading of G3.