糖尿病与发生肝细胞癌的关系分析

目的:分析糖尿病罹患病者与肝细胞癌发生的相关性。方法:采用基于病案1:1配对的病例对照研究,共入选2006年7月—2006年12月在复旦大学附属中山医院住院治疗的,经病理证实的初发肝细胞癌患者;对照组为同期在中山医院其他病区住院的患者,以性别和年龄(±3岁)配对,除外其他肝脏恶性肿瘤,或以糖尿病和慢性肝病为主要诊断入院的患者。糖尿病的诊断以入院时空腹血糖大于7.1mmol·L-1,或有明确的糖尿病史者。应用调查表收集患者的年龄,性别,入院诊断,空腹血糖,糖尿病史,乙肝病毒5项抗原抗体,丙型肝炎抗体等。计算暴露糖尿病的比数比(oddsratio,OR),并应用条件Logistic回归调整年龄,乙肝病毒/丙肝病毒(HBV/HCV)感染状态等因素。结果:在病例组中有糖尿病史12.5%(47/376),而对照组中为7.98%(30/376),单因素分析糖尿病史发生肝癌的OR为1.65,95%CI(1.02,2.69)。平衡HBV感染状态和HCV感染状态后,发现糖尿病史的OR值为2.64,95%CI(1.36,5.12),HBeAg阳性的OR值为39.82,95%CI(18.24,86.92),HBe-Ab阳性的OR值为33.61,95%CI(20.19,55.96)。HCV阳性的OR值为6.75,95%CI(1.90,24.02)。结论:本研究结果表明糖尿病是肝细胞癌发生的独立危险因素,能增加2.5倍左右的肝癌发生风险。     

大型医疗设备配置与使用情况研究

目的新会计制度下,通过成本核算系统,研究医院大型医疗设备的配置及使用情况。方法建立新会计制度下的全成本核算系统,明确责任中心,建立大型医疗设备的经济效益的跟踪分析制度,为每台大型设备建立科学的管理档案,系统分析研究购进大型医疗设备的必要性、合理性、可行性及大型医疗设备的使用情况。结果提高了科学购置、使用大型医疗设备水平,减少盲目购入,合理配置社会资源。结论严格购置程序、规范标准、遵守各项制度是做好大型医疗设备购置及使用的保证。     

肝细胞癌四种临床分期系统预后判断和治疗指导价值的比较

Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.     

从正虚为本、癌毒为标辨治癌性发热

从气的一元论角度介绍了癌性发热的常见病因病机,并结合自身临床实践从正虚为本、癌毒为标,实邪夹杂论述了癌性发热的不同证型、不同治法。     

肝细胞癌四种临床分期系统预后判断和治疗指导价值的比较

Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.     

肝细胞癌四种临床分期系统预后判断和治疗指导价值的比较

目的 比较4个分期系统[巴塞罗那临床肝癌分期标准(BCLC)、日本综合分期积分(JIS)、意大利肝癌评分(CLIP)和国内分期]对中国肝癌患者预后判断和对治疗方案选择的指导意义.方法 回顾性分析2001年至2002年复旦大学附属中山医院收治的861例初发肝细胞癌患者的临床资料,分别按4个分期系统分期或评分,比较各期患者的生存情况以及不同治疗方案对其生存的影响.结果 在判断预后方面,BCLC、JIS和国内分期系统的各分期间生存率差异均有统计学意义;而在CLIP分期的一些评分间的生存率差异无统计学意义.在指导治疗方面,BCLC C期,CLIP 3、4分以及国内分期ⅢA期的患者接受手术治疗与接受肝动脉化学治疗栓塞(TACE)和(或)肝动脉栓塞(TAE)治疗的生存率差异无统计学意义;而比这些更早期的患者接受手术治疗的生存率优于接受TACE和(或)TAE治疗的生存率.结论 BCLC、JIS和国内分期系统在判断预后方面适用于中国患者;但仅国内分期和BCLC分期同时兼备了判断预后和指导治疗两方面的作用.     

张海波针药并用治疗肠癌经验

总结张海波针药并用治疗肠癌的临床经验。张海波认为脾肾亏虚、肝气郁结、湿热瘀阻为肠癌的主要病因,其中脾虚为其致病因素,肾虚为肠癌重要预后因素。治疗上以健脾益肾,疏肝理气,通腑祛邪为法,通过针药并施,在治疗肠癌过程中提高了患者生活质量、延长了患者生存期。     

针灸辅助治疗胃癌现状及展望

针灸辅助治疗胃癌具有广阔的应用前景。针药协同增效、降低不良反应和防治并发症是现阶段针药联合的三大思路。针灸抗瘤方面,针药联合疗效更优,而针灸维持治疗可延长胃癌患者生存; 术前降期、术后预防复发和晚期控制进展是胃癌针药联合抗瘤的探索方向。不良反应和并发症防治方面,针药联合具有预防围术期不良反应、防治药物相关不良反应,改善生活质量和精神心理症状,缓解癌痛的作用。针灸防治不良反应和并发症的研究较多,但研究的质量问题限制了其指导力度。总之,未来研究应积极探索抗瘤治疗模式、明确研究指向和规范研究设计,以构建成熟、规范的针灸科研体系,推进胃癌针灸的临床应用。     

中医药联合化疗治疗晚期结直肠癌近期疗效和生存质量的Meta分析

目的比较中医药联合化疗与单纯化疗治疗晚期结直肠癌在近期疗效和生存质量方面的差异。方法应用Meta分析方法的随机效应模型,对国内2000年1月-2012年6月为止单纯采用中医药联合化疗治疗晚期结直肠癌,并以单纯化疗作对照的研究文献进行定量合并分析。结果在肿瘤患者缓解率方面,中医药联合化疗组的418例患者中有159例取得了完全或部分缓解,化疗组363例患者中有107例取得了完全或部分缓解,2组比较,P0.01。中医药联合化疗组的147例患者中有89例生存时间超过1a,化疗组102例患者中有47例生存时间超过1a,2组比较,P0.01。在生存质量方面,中医药联合化疗组的267例患者中有155例卡氏评分提高,化疗组243例患者中有76例患者卡氏评分提高,2组比较,P0.01。结论中医药联合化疗方案在治疗晚期结直肠癌患者有效率和1年生存率上优于单纯化疗方案,而且中医药联合化疗在提高生存质量上有明显优势。