体外循环体腔热灌注顺铂治疗浆膜腔恶性积液的临床观察

目的:将体外循环体腔热灌注顺铂(DDP)应用于恶性间皮瘤、消化道肿瘤和肺癌所致恶性浆膜腔积液的控制,观察其对恶性积液的治疗效果.方法:选择经病理组织学或细胞学确诊或影像学结合肿瘤标志血清学检查临床诊断的恶性间皮瘤、肝癌、胃癌、胰腺癌、大肠癌和肺癌,同时伴发恶性浆膜腔积液的患者54例,治疗前后客观测量积液量.用TRL型体外循环灌注热化疗治疗系统将DDP应用于浆膜腔恶性积液的控制,治疗间隔48 h,每周期3次,3周为1个周期,治疗1个周期后评价积液控制效果,6周后确认疗效,10周后随访,再次评价疗效.结果:5例恶性间皮瘤1个周期后CR 3例,PR 2例,NE 0例;2例PR患者进行第2个周期治疗后转为CR,6周后确认疗效均为CR;10周后随访有2例复发,积液再次出现.41例消化道肿瘤伴发的恶性胸腔积液和腹水,1个周期后CR 25例,PR 10例,NE 6例,临床有效率为85%;10周后随访确认疗效,41例患者有20例仍为CR,PR 10例,NE 11例,临床获益率为73%.8例肺癌并发的恶性胸腔积液,1个周期后CR 5倒,PR 2例,NE 1例;10周后随访结果为CR 4例,PR 2例,NE 2例,临床有效率为75%.结论:体外循环胸腹腔热灌注DDP区域性热化疗可用于治疗恶性间皮瘤、消化道肿瘤和肺癌伴发的恶性浆膜腔积液,积液控制效果显著.     

rAd-p53联合化疗及局部热疗治疗恶性浆膜腔积液

[目的]探讨浆膜腔内灌注重组人p53腺病毒注射液(rAd-p53)及顺铂联合区域热疗治疗恶性浆膜腔积液的临床疗效及毒副作用.[方法] 60例恶性浆膜腔积液患者随机分为2组,观察组30例每周腔内注射rAd-p53 2支(1×1012vp/支),72h后腔内再注入顺铂60mg,连用2周,1h后行局部热疗1h,热疗2次/周,共8次,4周后评价疗效及不良反应.对照组除不给予rAd-p53外,腔内化疗、热疗与观察组相同.[结果]观察组有效率( CR+ PR)为86.7％,对照组为60.0％(P=0.01).观察组生活质量改善率明显优于对照组(70％vs30％,P=0.006).观察组治疗后免疫功能未受损害.观察组不良反应主要为自限性发热.[结论]腔内rAd-p53联合化疗及局部热疗控制恶性浆膜腔积液安全有效,疗效确切,同时可改善患者生活质量.     

重组人p53腺病毒联合香菇多糖治疗癌性浆膜腔积液

目的观察和评价胸腹腔和心包腔置管引流注入重组人p53腺病毒注射液和香菇多糖联合治疗恶性浆膜腔积液的临床疗效。方法11例恶性浆膜腔积液患者,其中胸腔积液6例、腹腔积液3例,心包腔积液患者2例,于B型超声定位后行浆膜腔穿刺置管引流术,并注入重组人p53腺病毒（商品名：今又生）2×10^12VP／次（第1、8、15天）和香菇多糖4．0mg／次（第4、11、19天）,疗效评价依据WHO癌性积液疗效判定标准。结果11例癌性浆膜腔积液患者治疗总有效率81．8％（9／11）,完全缓解率54．5％（6／11）,部分缓解率273％（3／11）。不良反应主要表现为可耐受性的发热（63．6％,7／11）,24h内可自行消退或对症处理后消退。结论浆膜腔置管引流联合注入重组人p53腺病毒和香菇多糖疗效确切,见效快,不良反应轻,是治疗癌性浆膜腔积液安全有效的方法,值得进一步推广应用。     

浆膜腔积液肿瘤标志物与血清肿瘤标志物及脱落细胞学相关性探讨

目的:探讨浆膜腔积液肿瘤标志物癌胚抗原(CEA)、糖类抗原199、125、724、153、242(CA199、CA125、CA724、CA153、CA242)及甲胎蛋白(AFP)与同时期血清肿瘤标志物及脱落细胞学之间的关系。方法:选择202例确诊为恶性肿瘤并伴有浆膜腔积液的患者,依据细胞学检查结果分为脱落细胞学阳性组和脱落细胞学阴性组。对脱落细胞学阳性组的恶性浆膜腔积液患者的同一时间点的血清及浆膜腔积液肿瘤标志物水平进行检测分析。并对脱落细胞学阳性组和阴性组间的浆膜腔积液肿瘤标志物检测分析。结果:恶性浆膜腔积液肿瘤标志物水平明显高于血清,二者比较差异有统计学意义(P<0.05)。恶性胸腹腔积液肿瘤标志物与血清肿瘤标志物相关性好(P<0.01)。胃癌患者脱落细胞学阳性组与阴性组的浆膜腔积液肿瘤标志物水平比较发现CEA、CA125、CA199差异无统计学意义(P>0.05),CA724差异有统计学意义(P<0.05)。结论:恶性浆膜腔积液中肿瘤标志物水平与血清中肿瘤标志物水平具有很好相关性,血清肿瘤标志物的检测可以很好的反应恶性浆膜腔积液中肿瘤标志物水平。且胃癌腹水中CA724水平具有辅助诊断浆膜腔积液良恶性的价值。     

伯尔定腔内给药治疗恶性浆膜腔积液的临床观察

目的评价卡铂(伯尔定)腔内给药治疗恶性浆膜腔积液的疗效及其毒副作用。方法对于恶性浆膜腔积液患者，采用中心静脉导管穿刺并置管，适量抽弃腔内积液后，腔内注入伯尔定150～450mg，每周给药1～2次，直至积液消失或判定无效后换药。结果本组76例可以评价疗效和毒副反应，治疗后完全缓解(CR)21例(28％)，部分缓解(PR)33例(43％)，无效(NR)22例(29％)，总有效率71％。其中胸腔积液34例，有效率为79％(27／34)；腹腔积液26例，有效率为50％(13／26)；心包积液16例，有效率为87％(14／16)。全组毒性反应轻微，主要为Ⅰ～Ⅱ度骨髓抑制。结论伯尔定腔内治疗恶性浆膜腔积液疗效确切，毒副作用小，是一优选药物。     

复方氟脲嘧啶脂质体治疗晚期消化系统肿瘤的疗效观察

目的　观察复方氟脲嘧啶脂质体治疗晚期消化系统肿瘤的临床疗效及毒副反应。方法　 10 6例Ⅲ～Ⅳ期消化道肿瘤 ,其中胃癌 42例 ,食管癌 43例 ,原发性肝癌 2 1例。以复方氟脲嘧啶脂质体或氟脲嘧啶为主 ,单药或联合DDP的方案化疗 ,均化疗 2个周期以上。每个周期间隔 2 1～ 2 8天。结果　复方氟脲嘧啶脂质体组治疗胃癌、食管癌 ,原发性肝癌有效率 (CR PR)分别为 :3 6 4%、40 0 %、10 % ,有轻度的消化道反应、骨髓抑制。氟脲嘧啶组治疗的有效率 (CR PR)分别为 :3 5 .0 %、3 9.1%、9.1%。而毒副作用较大。结论　以复方氟脲嘧啶脂质体为主的联合化疗治疗晚期消化系统肿瘤副反应小 ,疗效可 ,值得推广应用。     

复方氟脲嘧啶脂质体治疗晚期消化系统肿瘤的疗效观察

目的 观察复方氟脲嘧啶脂质体治疗晚期消化系统肿瘤的临床疗效及毒副反应。方法 106例Ⅲ～Ⅳ期消化道肿瘤，其中胃癌42例，食管癌43例，原发性肝癌2l例。以复方氟脲嘧啶脂质体或氟脲嘧啶为主，单药或联合DDP的方案化疗，均化疗2个周期以上。每个周期间隔21～28天。结果 复方氟脲嘧啶脂质体组治疗胃癌、食管癌，原发性肝癌有效率(CR PR)分别为：36．4％、40．0％、10％，有轻度的消化道反应、骨髓抑制。氟脲嘧啶组治疗的有效率(CR PR)分别为：35．0％、39．1％、9．1％。而毒副作用较大。结论 以复方氟脲嘧啶脂质体为主的联合化疗治疗晚期消化系统肿瘤副反应小，疗效可，值得推广应用。     

置管治疗恶性浆膜腔积液的临床观察

2000年10月以来,我们采用浆膜腔置管治疗各类恶性肿瘤引起的浆膜腔积液36例,效果良好,现报告如下:1材料与方法1·1病例选择本组恶性浆膜腔积液患者中男15例,女21例;年龄43~75岁,平均56岁;恶性胸腔积液16例,恶性腹腔积液17例,恶性心包积液3例;原发肿瘤分别为:乳腺癌10例,卵巢癌7     

奥沙利铂联合亚叶酸钙及氟尿嘧啶持续静脉滴注治疗晚期消化道肿瘤121例

 目的　探讨不同用法奥沙利铂（L-OHP）联合亚叶酸钙（CF）、5-氟尿嘧啶（5-Fu）治疗晚期消化道肿瘤的疗效及不良反应。方法　将2000年1月至2005年12月接受化疗的晚期消化道肿瘤患者随机分成两组：试验组58例，应用L-OHP＋CF＋5-Fu连续性静脉滴注，3周为1个周期；对照组63例，应用L-OHP＋CF＋5-Fu常规静脉滴注，3周为1个周期。结果　试验组完全缓解（CR）6例（食管癌3例、胃癌2例、肠癌1例），部分缓解（PR）27例（食管癌8例、胃癌14例、肠癌5例），总有效率为56.9 %。对照组CR 4例（食管癌1例、胃癌2例、肠癌1例），PR23例（食管癌5例、胃癌14例、肠癌4例），总有效率为42.9 %。不良反应以消化道 及血液系统反应为主，试验组比对照组轻。结论　应用L-OHP联合CF、5-Fu持续静脉滴注治疗晚期消化道肿瘤可以提高疗效，且减轻不良反应。     

1466例浆膜腔积液细胞学分析

目的：检查和分析浆膜腔积液中恶性细胞，讨论其临床诊断价值。方法：临床抽取浆膜腔积液立即送检，离b，行HE染色，镜检。结果：1466例浆膜腔积液中，胸腔积液为973例（66．4％），腹水373例（25．4％），心包积液1二I）例（8．2％）。其中细胞学圄赡耻酬蝴楠274例，阳性率为18．7％。恶性积液中，腺癌231例（84．3％），鳞癌9例（1．6％），恶性淋巴瘤7例（1．3％），未分化癌4例（0．7％），恶性间皮瘤4例（0．7％）。结论：浆膜腔积液的细胞学检查对疾病的诊断治疗及预后有重要的指导意义。     

头颈鳞癌基因治疗结合放射治疗的临床研究

目的评价重组人p53腺病毒注射液结合放射治疗头颈鳞癌(HNSCC)的疗效及安全性。方法基因治疗加放疗(GTRT)组36例HNSCC患者,重组人p53腺病毒注射液每周1次瘤内注射1×1012病毒颗粒,共8周,并结合放射治疗;单纯放疗(RT)组33例HNSCC患者,仅行单纯放疗。两组采用同样的常规分次放疗,每次2Gy,每周5次,使原发灶和颈部转移淋巴结均达到70Gy照射剂量。治疗第5周(40Gy)、第8周(70Gy)及疗后2个月(疗效确认)时,用CT图像评定肿瘤变化,进行疗效评价。结果野生型p53基因明显提高了HNSCC放疗的疗效,疗效确认时,GTRT组瘤灶完全缓解(CR)率为64.3%,比RT组提高了2.3倍。除一过性发热外,未发现其他剂量限制性毒性和不良反应。结论HNSCC患者瘤内注射重组人p53腺病毒是安全而有效的,有明显的放射增敏作用。     

EMMP方案治疗晚期恶性肿瘤175例临床研究

自１９９１年５月至１９９３年５月，我们用ＥＭＭＰ方案治疗晚期恶性肿瘤１７５例：ＣＲ３３例（１９％），ＰＲ９１例（５２％），ＭＲ２１例（１２％），ＮＣ１７例（１０％）．ＰＤ１３例（８％），缓解率（ＣＲ＋ＰＲ）７１％，总有效率（ＣＲ＋ＰＲ＋ＭＲ）８３％。小细胞肺癌的缓解率为９１％，非小细胞肺癌为６３％，食管癌为６０％，胃癌和乳腺癌均为７０％，结、直肠癌为７５％，肝癌为３３％，甲状腺癌和恶性淋巴瘤均达１００％。中位生存期１１个月。毒副反应较轻，８１例（４６％）有恶心、呕吐，仅２６例（１５％）有白细胞减少，５例（３％）有血小板减少，１４５例（８３％）有脱发，未见心、肝及肾脏功能损害。     

注射用重组改构人肿瘤坏死因子-NC（rhTNF-NC）治疗恶性肿瘤的Ⅱ期临床研究

【摘 要】目的 观察重组改构人肿瘤坏死因子-NC（rhTNF-NC）注射液单药治疗恶性肿瘤的临床疗效、不良反应以及对患者生活质量的影响。方法 入组的320例患者中,可进行疗效评价310例,脱落9例,剔除1例。310例患者中,恶性淋巴瘤71例,恶性胸腹水169例,恶性黑色素瘤18例,肺癌20例,肝癌12例,乳腺癌10例,结肠癌7例和肾癌3例。恶性淋巴瘤、恶性黑色素瘤、肺癌等实体肿瘤患者给予静脉注射rhTNF NC 60万～90万 IU／m2,最大剂量≤100万 IU／m2,1次／d,连用4周;恶性胸腹水患者予以胸腹腔注射rhTNF NC,剂量为200万～300万 IU／次,1～2次／周,连用2～3周;体表肿瘤（主要为恶性黑色素瘤）患者在rhTNF NC静脉给药的同时予以瘤体内或瘤床注射,推荐注射剂量为50万～100万 IU／次,2～3次／周。结果 可评价的患者310例,其中恶性胸腹水169例,实体肿瘤141例。实体瘤患者中获CR 2例,PR 21例,有效率（RR）为16.3％（23／141）,疾病控制率（DCR）为79.4％（112／141）。恶性淋巴瘤的RR为28.2％（20／71）,DCR为84.5％（60／71）;恶性黑色素瘤的RR为11.1％（2／18）,DCR为83.3％（15／18）;肺癌无CR病例,获PR 1例,MR 2例;肾癌获MR 1例;肝癌、结肠癌、乳腺癌均未见明显疗效。恶性胸腹水病例中获CR 15例,PR 102例,RR为69.2％（117／169）,DCR为98.8％（167／169）;其中,恶性胸水的RR为74.5％（105／141）,恶性腹水为42.9％（12／28）。全组患者治疗后的KPS评分较治疗前有显著提高（P=0.013）,特别是恶性胸水患者提高更为明显。主要不良反应为发热（38.8％）和寒战（23.5％）,绝大多数为1、2级。结论 注射用rhTNF-NC治疗恶性淋巴瘤和恶性胸腹水疗效明确,对肺癌、恶性黑色素瘤也有一定疗效,并能够明显改善各种癌症患者的生活质量,安全性良好。     

Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial

Malignant pleural effusions are a common and significant problem in patients with advanced malignancies. Pleurodesis with tetracycline or other sclerosing agents is the usual treatment for malignant pleural effusions. In contrast to this approach, intrapleural chemotherapy has the potential advantage of treating the underlying malignancy in addition to controlling the effusion. Intracavitary cisplatin-based chemotherapy, which is cytotoxic rather than sclerosing, has proven safe and effective via the intraperitoneal route in ovarian cancer and malignant mesothelioma. There has been little previous experience, however, with intrapleural cisplatin-based chemotherapy. As part of a planned series of trials in malignant mesothelioma, the Lung Cancer Study Group first evaluated intrapleural cisplatin and cytarabine in patients with malignant pleural effusions from a variety of solid tumors. From April 1986 to November 1987, 46 patients with cytologically proven, symptomatic, and previously untreated malignant pleural effusions were entered on study. A single dose of cisplatin 100 mg/m2 plus cytarabine 1,200 mg was instilled into the pleural space via a chest tube, which was then immediately removed. Patients were evaluated for toxicity and response at 24 hours; 1, 2, and 3 weeks; and then monthly. No recurrence of the effusion was considered a complete response (CR). Partial response (PR) was defined as a 75% or greater decrease in the amount of the effusion on serial chest radiographs. One patient experienced reversible grade 4 renal toxicity, four patients had grade 3 hematologic toxicity, and five patients had grade 3 cardiopulmonary toxicity. The overall response rate (CR plus PR) at 3 weeks was 49% (18 of 37 patients). The median length of response was 9 months for a CR and 5.1 months for a PR. The outcome of this trial was sufficiently encouraging that this regimen has been incorporated into subsequent trials for malignant pleural mesothelioma.     

Phase II study of 5'-DFUR (5'-deoxy-5-fluorouridine) by the Cooperative Study Group

Phase II study of 5'-DFUR was conducted in 195 patients with malignant tumors by the Osaka Chemotherapy Cooperative Study Group. Five CR and 20 PR cases were obtained out 133 evaluable cases and the total response rate was 18.8% (15.8% in gastric, 38.1% in breast) One PR was observed for each of head & neck and esophageal cancer. It was noteworthy that four CR were observed in breast cancer. Adverse reaction was observed in 61 out of 151 cases (40.4%), and major side effects were digestive symptoms such as diarrhea (22.5%), nausea-vomiting (11.9%) and anorexia (10.6%). These results suggest that 5'-DFUR can be useful for the treatment of malignant tumors.     

紫杉醇为主方案治疗中晚期上消化道癌的临床研究

 目的　观察紫杉醇为主方案对中晚期上消化道癌复治患者的疗效和不良反应。方法　全组 32例患者 ,其中食管癌 8例 ,贲门癌 10例 ,胃癌 14例 ,应用TP(紫杉醇 6 0mg m2 ,d1、d8、d15 ,顺铂 2 0mg d ,d1～ 5 )或TF方案 (紫杉醇 6 0mg m2 ,d1、d8、d15 ,氟脲嘧啶 2 5 0mg (m2 .d) ,d1～ 14 )治疗 ,2 8天为一周期 ,平均用药3.0 6个周期。结果　总缓解率为 4 0 .6 % ,其中完全缓解 5例 ,部分缓解 8例 ,无变化 15例 ,进展 4例。食管癌缓解率 37.5 % ,贲门癌缓解率 30 .0 % ,胃癌缓解率 5 0 .0 % ;中位缓解期 4 .5个月。主要的不良反应为骨髓抑制和粘膜炎。结论　紫杉醇为主方案对复治性上消化道癌患者疗效较好 ,不良反应可以耐受 ,值得深入研究。     

Clinicopathologic study of esophageal cancer associated with simultaneous metastatic lesions in the stomach

Between 1965 and 1985, 89 Japanese patients with esophageal squamous cell carcinoma underwent esophagectomy. In five of them (5.6%), a simultaneous metastatic lesion from the esophageal cancer was detected within the stomach in the resected specimens. Preoperative diagnosis of the gastric lesions had been made in none of the five patients because of an obstruction that was due to esophageal cancer. All gastric lesions were located at the gastric cardia, close to the esophagocardial junction, with a mean distance of 6.9 +/- 2.0 cm from the primary esophageal lesions. Provision of a gastric tube that contains metastatic lesions, for reconstruction of a new alimentary tract after esophagectomy, must be avoided. In cases of inadequate preoperative gastric examination, gastric lesions should be searched for intraoperatively, not only by serosal inspection and palpation, but also by mucosal inspection and palpation after partial proximal gastrectomy.     

Ca2 and Ca3. New monoclonal antibodies evaluated as tumor markers in serous effusions

Ca2 and Ca3 are new monoclonal antibodies of IgG1 class, directed against the Ca antigen, a mucus-type glycoprotein expressed on the surface of a wide range of malignant human cells and certain specialized normal epithelia. These antibodies were produced by immunization with purified preparations of the Ca antigen. They were tested to assess their value in the diagnosis of malignant effusions. Immuno-alkaline-phosphatase staining was used. Smears of pleural and peritoneal effusions were chosen to show: undoubted malignant cells of various types; and mesothelial cells in effusions from cases in which cancer was not in question. The Ca2 antibody, at 1 in 20 dilution of the culture supernatant, was the most specific, giving no reactions with benign mesothelial cells from any of the 35 cases tested. Malignant cells were clearly stained in 35 of 40 cases of carcinoma or mesothelioma. The staining was negative in two cases of oat cell bronchial carcinoma, and in three of four cases of carcinoma of the colon. Ca3 gave similar, but somewhat stronger, reactions with carcinoma cells, but was less specific, reacting weakly with mesothelial cells in 8 of 35 benign effusions. Because the false-negative reactions given by the Ca series of antibodies are to some extent complementary to those given by monoclonal antibodies directed against the carcinoembryonic antigen (CEA), a combination of Ca2 and anti-CEA is recommended as a most useful addition to the normal cytologic examination of effusions.     

胸腹腔留置中心静脉导管引流恶性积液临床观察

目的 观察中心静脉导管留置引流控制恶性胸腹腔积液的临床疗效及毒副反应.方法 本组40例,其中恶性胸腔积液28例,腹腔积液12例;肺癌12例,乳腺癌10例,卵巢癌5例,胃癌4例,结直肠癌4,淋巴瘤3例,恶性胸膜间皮瘤2例.所有病例均经组织病理学或细胞学确诊为恶性胸腹腔积液;彩超定位处将中心静脉导管留置胸、腹腔中,持续闭式负压引流至抽尽胸、腹水,并通过导管注入化疗药物顺铂、羟基喜树碱、白介素-Ⅱ、地塞米松、氟脲嘧啶、新福菌素、多抗甲素等.结果 全组40例中CR 14例(35%),PR 17例(42.5%),PD 9例(22.5%),总有效率(RR)77.5%(31/40),中位缓解期4个月(1月～3年),生活质量明显改善,无明显毒副反应.结论 应用中心静脉导管装置引流控制恶性胸腹腔积液操作安全、简便、创伤小、保留时间长,能最大限度地排净胸腹腔积液,避免反复多次胸腹腔穿刺给患者带来危险和痛苦,对控制恶性胸腹腔积液有较好的疗效,毒副反应轻,能改善患者生活质量.     

Detection and prognosis of alimentary tract cancers--mass screening

The limitation of detectability and curability in terms of current techniques (screening and details) were sought in otherwise healthy examinees. Not a few cancers were present in the alimentary tract, except for the stomach, in these otherwise healthy examinees who voluntarily underwent gastric cancer mass screening. The prognosis of alimentary tract cancers deteriorates in the descending, following order: colon cancer, stomach cancer, and esophageal cancer. The survival rate of primary liver cancer, cholecyst cancer, and pancreas cancer is extremely low. Unless new techniques are developed in these diagnoses, no improvement in the survival rate can be anticipated.