FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.     

针灸联合生物反馈治疗对脑卒中后偏瘫功能恢复及预后的影响分析

目的研究针灸联合生物反馈治疗对脑卒中后偏瘫功能恢复及预后的影响。方法选择2016年12月-2018年9月接诊的60例高血压脑出血患者进行研究。按照随机数表法,将所有患者随机均分为研究组和对照组。对照组给予常规对症治疗合并针灸疗法。研究组在对照组治疗方案的基础上给予生物反馈疗法进行治疗。比较治疗前后两组患者日常生活活动能力及运动功能,并对两组患者的疗效及康复质量进行比较分析。结果研究组治疗后总有效率明显高于对照组(P 0. 05),差异有统计学意义。研究组治疗后踝关节、髋关节以及膝关节的肌力以及骨骼肌含量的改善情况明显优于对照组(P 0. 05),差异有统计学意义。研究组治疗后SDSS评分以及QOLI评分得分结果改善情况明显优于对照组(P 0. 05),差异有统计学意义。两组患者治疗前Barthel指数及Fugl-Meyer评分比较差异无统计学意义(P 0. 05);治疗后,研究组患者Barthel指数及Fugl-Meyer评分均明显高于对照组(P 0. 05),差异有统计学意义。研究组治疗后躯体症状、心理情况以及康复情况评分明显高于对照组(P 0. 05),差异有统计学意义。结论采用针灸联合生物反馈治疗脑卒中后偏瘫,可显著提高治疗效果,有效改善患者的肢体功能,值得临床推广应用。     

腹腔镜下直肠癌扩大根治手术5例报告

腹腔镜下直肠癌手术是目前腹腔镜消化道手术中较成熟的一种手术方式，但腹腔镜下直肠癌淋巴结清扫难度大。我院2006年1～6月施行5例腹腔镜下直肠癌切除扩大淋巴结清扫（其中1例为后盆腔切除加淋巴结清扫术），现报道如下。     

双侧上尿路结石梗阻并发急性肾功能衰竭12例报告

目的：探讨双侧上尿路结石梗阻并发急性肾功能衰竭的治疗经验。方法：对12例患者联合应用血液透析和体外震波碎石进行治疗。结果：12例患者经治疗后，梗阻解除，尿量迅速增加，肾功能得以恢复。结论：联合应用血液透析和体外震波碎石是治疗双侧上尿路结石梗阻并发急性肾功能衰竭安全、有效的方法之一。     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

目的 比较FOLFOX-6方案全身化疗与传统以氟尿嘧啶为主的肝动脉灌注化疗对结直肠癌术后肝转移病人的疗效并分析影响结直肠癌术后肝转移病人的预后因素.方法 46名结直肠癌术后肝转移病人随机分配到全身化疗组(实验组)和介入治疗组(对照组),对比观察近远期疗效、毒副作用和生活质量.将影响预后的临床特征和治疗方式进行单因素和多因素分析.结果 实验组、对照组总生存率差异有统计学意义(P=0.048),中位生存时间分别为15.0个月和11.2个月(P＜0.05);治疗总有效率两组差异有统计学意义(50%和10%;P=0.011);两组治疗期间的PS评分差异无统计学意义(P=0.126).毒副作用除骨髓抑制、腹痛外,其它比较差异均无统计学意义.单因素分析显示,原发病灶是否浸润浆膜、肝转移灶分布、肝转移病灶最大直径、肝转移灶数目、原发癌有无淋巴结转移以及治疗方式与预后相关.多因素分析后发现,肝转移灶最大直径、肝转移病灶数目、原发癌灶是否浸透浆膜层和治疗模式为影响预后的独立因素.结论 以草酸铂为主的FOLFOX-6方案比传统的以氟尿嘧啶为主的肝动脉灌注化疗有更好的治疗缓解率和远期疗效;肝转移灶最大直径＞5 cm、肝转移灶多发和原发病灶浸透浆膜层提示病人预后不良,采取以草酸铂为主的全身化疗,预后更好.传统药物介人治疗需要改进,局部介入与全身治疗结合的方式值得进一步探究.     

国产艾恒联合方案治疗结直肠癌肝转移的结果分析

目的:探讨含国产草酸铂(艾恒,L-OHP)的FOLFOX-6辅助化疗对结直肠癌术后肝转移的临床治疗价值.方法:对病理检查确诊的26例结直肠癌术后肝转移患者,采用辅助化疗方案FOLFOX-6,每次予以艾恒120 mg/m2,第1天静脉点滴;甲酰四氢叶酸钙200 mg/m2,第1、2天静脉点滴;氟脲嘧啶400 mg/m2,第1、2天静注;氟脲嘧啶2.0 g/m2,第1～2天连续静脉滴注48 h.2周为一个周期,2～6个周期化疗结束后评价新辅助化疗疗效,并进行随访.结果:26例患者共完成78个周期治疗,平均3个周期.经辅助化疗后,潜在手术切除率由原来的19.2％增为34.6％.CR7例,PR6例,SD5例,PD8例,总有效率(CR+PR)为50％,平均生存时间19.0个月,中位生存时间15.0个月,主要不良反应为轻中度的血液学毒性、恶心呕吐和外周感觉神经异常.结论:含国产艾恒的FOLFOX-6方案是治疗结直肠癌肝转移有效且毒性较小的联合方案,可使肿瘤分期降低,明显提高手术切除率.     

食管贲门癌术后胃排空障碍探讨

目的：探讨食管癌、贲门癌术后并发胃排空障碍的原因、诊断和合理的治疗。方法：对1997年。2004年间施行的食管癌、贲门癌术后出现10例胃排空障碍的临床资料进行回顾分析。结果：本组10例患者保守治疗8例,手术治疗2例,无1例死亡。结论：食管贲门癌术后胃排空障碍多数为功能性,少数为机械性,因治疗方法不同,因此应注意两者的鉴别诊断。功能性胃排空障碍保守治疗可治愈,机械性胃排空障碍尽早确诊、及时手术,效果满意。     

乳腺癌新辅助化疗28例临床观察

目的探讨CF化疗方案在乳腺癌新辅助化疗中近期疗效及毒副反应。方法用CF方案对Ⅱ～Ⅲ期乳腺癌患者进行新辅助化疗2个周期。结果总有效率为67．9％，其中临床完全缓解（cCR）2例，部分缓解（PR）17例，稳定（SD）6例，进展（PD）3例。主要毒副反应为胃肠道反应、骨髓抑制、腹泻、乏力及脱发，但均可耐受。结论CF方案在乳腺癌新辅助化疗中安全、有效，临床应用毒副反应可耐受。     

食管结核误诊为食管肿瘤7例分析

食管结核在临床上极为少见，易被误诊为食管肿瘤。因其与食管肿瘤疾病在临床治疗上迥然不同，误诊会给患者带来较大影响。为提高对该病的诊断治疗水平，现将20a来收治的7例报告如下：     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.