转移性鼻咽癌治疗专家共识

随着IMRT的应用,鼻咽癌局部控制率进一步提高,远处转移成为治疗中亟待解决的临床问题。由于转移性鼻咽癌异质性大,治疗选择及预后差异非常大,目前尚无针对转移性鼻咽癌的治疗指南。该共识对如何规范转移性鼻咽癌的治疗策略进行指导,通过回顾目前转移性鼻咽癌治疗的相关文献和临床试验,把初诊转移、治疗后转移及转移失败后的再治疗等进行分层探讨和总结;对于目前临床资料尚不足但临床意义较大的问题参考专家经验进行编写,旨在就转移性鼻咽癌的最佳治疗选择达成初步共识。     

初治寡转移鼻咽癌的治疗进展

初治转移鼻咽癌异质性较大,因此治疗方法及疗效差异也很大。越来越多的研究发现了初治寡转移鼻咽癌生存情况明显优于其他多发转移。初治寡转移鼻咽癌不仅涉及到全身治疗,还要考虑原发灶和转移灶的处理。全身化疗的基础上增加原发灶的根治性放疗和转移灶的积极处理可明显提高患者的生存获益,甚至获得治愈效果。多种分子标志物及预后模型能够筛选出部分从积极治疗中获益的患者,但仍需更多的研究来证实。     

厄洛替尼在恶性脑胶质瘤中的应用

该研究分析了EGFR或EGFR vⅢ过表达是恶性脑胶质瘤的生物标志特征之一。总结得出结论 ：EGFR抑制剂之一的厄洛替尼有望成为新的治疗方法 。有必要对耐药机制进一步研究,对联合药物方案、药物使用先后顺序、剂量进行尝试,以获得更佳疗效。     

妇女孕前体内铁储存水平评价

目的 了解育龄妇女孕前体内铁储存水平。方法 依据Cook建立的评价体内铁储存的模型，对306例婚检妇女体内铁储存状况进行评价。结果 306例婚检妇女体内铁储存的中住数为186mg，下四分位数为0mg，上四分位数为317．5mg。结论 育龄妇女体内铁储存水平较低，应在孕前及时纠正。     

局部复发鼻咽癌超分割加立体定向适形放疗的临床研究

目的：初步评价超分割外照射加立体定向适形放射剂量治疗局部复发鼻咽癌的临床疗效及毒副反应。方法：对1999～2002年收治的14例复发鼻咽癌进行超分割外照射（1．3Gy／次，2次／d，总剂量42～60Gy）加立体定向适形放射推量（4Gy／次，隔日照射，共10次，总量20Gy）的临床研究。结果：总有效率（CR＋PR）85．7％（12／14），其中完全消退（CR）64．3％（9／14），部分消退（PR）21．4％，肿瘤稳定14．3％，2年总生存率57．1％（8／14），无瘤生存率42．8％（6／14），靶区肿瘤控制率为78．6％（11／14）。结论：超分割外照射加立体定向适形放射剂量治疗局部复发鼻咽癌在临床上是可行及有效的。     

凯西莱减轻鼻咽癌放疗损伤的观察

目的 :观察凯西莱 (Tiopronin)对于鼻咽癌放疗患者急性放射损伤的保护作用。方法 :鼻咽癌患者 80例 ,随机分为用药组 40例 ,放疗期间除常规处理外 ,用凯西莱针剂 ,0 .2 g/ d,3周。对照组40例只作常规处理。结果 : 级粘膜炎发生率在剂量≤ 1 0 Gy时 ,用药组和对照组分别为 40 %和70 % (P<0 .0 5)。 、 级粘膜炎、放射性皮炎发生率 ,用药组也明显低于对照组。 级以上血红蛋白下降 ,用药组和对照组分别为 42 .5%和 80 % (P<0 .0 1 )。 级以上中性粒细胞下降 ,用药组和对照组分别为 32 .5%和 60 % (P<0 .0 5)。结论 :凯西莱对鼻咽癌放疗后严重的急性放射损伤 ,包括放射性粘膜炎、放射性皮炎、中性粒细胞下降、血红蛋白下降有明显的保护作用     

益母草治疗药物流产后出血的疗效观察

米非司酮配合前列腺素终止早孕 ,具有安全、副反应轻、流产效果 >90 %等优点而为广大育龄妇女所接受 ,然而药物流产后阴道出血时间长、血量大 ,为了减少阴道出血 ,缩短出血时间 ,我院 2 0 0 2年 1月— 2 0 0 2年 10月对 14 0例药物流产者随机分组对照研究益母草治疗药物流产后出血的疗效 ,现将结果报告如下。1　资料和方法1.1.　临床资料　药物流产者 14 0例 ,随机分为观察组和对照组各 70例 ,年龄 18～ 35岁 ,平素月经规律 ,停经时间 <4 9d ,尿hCG阳性 ,B超诊断宫内孕 ,胎囊直径≤ 3.5cm ,无药物流产禁忌证。二组年龄、孕产史、停经时间…     

宫腔镜下输卵管插管治疗不孕症40例疗效观察

2006年8～12月，我院开展宫腔镜下输卵管插管治疗不孕症40例，临床效果满意。现报告如下。 资料与方法：110例输卵管性不孕症患者，年龄24～35岁。将其随机分为观察组40例和对照组70例，两组术前进行妇科检查及盆腔B超、白带常规、血常规检查，除外全身及盆腔急性炎症。检查时间选在月经干净后3～5d，且无性生活史。对照组常规行子宫输卵管碘油造影术。观察组行宫腔镜下输卵管插管，采用德国Wolf公司生产的外壳直径7mm的冷光源电视宫腔镜，输卵管疏通管为一次性医用硅胶管。     

鼻咽癌颈部转移性淋巴结的超声造影特征及时间强度曲线分析

Objective To study the character of cervical lymph nodes metastasis in nasopharyngeal carcinoma(NPC) by contrast-enhanced uhrasonography(CEUS) and time-intensity curve. Methods Forty-one lymph nodes of metastasis from 32 patients were studied by CEUS. The enhancement of echogenicity was evaluated,and the time-intensity curve was analyzed. Results Of the 41 lymph nodes examined, 10 (24.4%) showed intense homogeneous enhancement by CEUS, 23 (56.1%) showed inhomogeneous enhancement and 8 (19.5 %) showed scarce intranodal enhancement. There were 20 (48.8%) lymph nodes showed necrosis. Most of the lymph nodes (92.7%) showed peripheral type blood flow, 3 (7.3) % showed mixed type blood flow. There were significant differences in them(P < 0.01). The time-intensity curve displayed steeply in upslope, and gently in decent. The arrival time(AT), time to peak(TTP), peak intensity (PI) ,area and gradient were (7.2±2.5)s,(7.6±2.3)s,(9.5±3.3)dB,(203.4±45.7)dB· s,1.2±0.5 respectively. Between the lymph nodes with envelope infringed and not, there were significant differences in PI and area, while there were not significant differences in AT, TTP and gradient. Conclusions The metastasis cervical lymph nodes of NPC had specific character by CEUS and time-intensity curve. In this way,it may help us to diagnosis cervical lymph nodes metastasis of NPC,and provide more information for the therapy and prognosis judgement.     

鼻咽癌颈部转移性淋巴结的超声造影特征及时间强度曲线分析

Objective To study the character of cervical lymph nodes metastasis in nasopharyngeal carcinoma(NPC) by contrast-enhanced uhrasonography(CEUS) and time-intensity curve. Methods Forty-one lymph nodes of metastasis from 32 patients were studied by CEUS. The enhancement of echogenicity was evaluated,and the time-intensity curve was analyzed. Results Of the 41 lymph nodes examined, 10 (24.4%) showed intense homogeneous enhancement by CEUS, 23 (56.1%) showed inhomogeneous enhancement and 8 (19.5 %) showed scarce intranodal enhancement. There were 20 (48.8%) lymph nodes showed necrosis. Most of the lymph nodes (92.7%) showed peripheral type blood flow, 3 (7.3) % showed mixed type blood flow. There were significant differences in them(P < 0.01). The time-intensity curve displayed steeply in upslope, and gently in decent. The arrival time(AT), time to peak(TTP), peak intensity (PI) ,area and gradient were (7.2±2.5)s,(7.6±2.3)s,(9.5±3.3)dB,(203.4±45.7)dB· s,1.2±0.5 respectively. Between the lymph nodes with envelope infringed and not, there were significant differences in PI and area, while there were not significant differences in AT, TTP and gradient. Conclusions The metastasis cervical lymph nodes of NPC had specific character by CEUS and time-intensity curve. In this way,it may help us to diagnosis cervical lymph nodes metastasis of NPC,and provide more information for the therapy and prognosis judgement.