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为提高肿瘤临床的姑息治疗水平,提高患者的生活质量。本文着重对肿瘤患者的生活质量,症状控制,姑息治疗的时机、范围和内容、临终关怀以及疼痛治疗等方面的常见误区进行分析讨论。 相似文献
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肿瘤姑息治疗状况及医务人员对肿瘤姑息治疗态度调查 总被引:5,自引:0,他引:5
目的 了解姑息治疗的现状及医务人员对姑息治疗的态度,以推动此项工作的开展。方法 采用问卷调查法对姑息治疗有关的六个方面进行调查。结果 428名被调查者来自全国22个省市自治区的44家医院,其中住院医师占34.6%,主治医师占34.6%,副主任医师占21.0%,护士占10.0%。肿瘤内科专业占大部分(66.4%)。绝大多数医院收治的Ⅲ~Ⅳ期患者占40%以上,其中半数医院甚至达80%以上。大部分患者治疗的目的是积极抗肿瘤治疗和控制症状,平均住院时间在两周至两个月内,部分肿瘤专科医院能够提供临终关怀的有关服务,对便秘、疼痛、中性粒细胞下降控制能力较强,而对厌食、抑郁或焦虑、气短控制则较为困难。城市患者(90%)更多的愿意在医院渡过生命的最后时光,而农村患者(95%)则相反,更多的愿意在家中。半数多的人(51.6%)认为对生存期只有几个月的患者的治疗意见应以姑息治疗为主,但也有近一半的人(46.5%)认为应尽量将延长生命和姑息治疗相结合。三分之一的人认为只有约50%的患者有对临终前不抢救的要求,对是否抢救的观点,多半(60.2%)的医务人员未发表意见。而对不抢救应与患者商量多数表示同意。四分之一的人曾经使用安慰剂治疗疼痛,并且多数人听说过安慰剂治疗疼痛。三分之一的人仍将成瘾看成是疼痛治疗的一个 相似文献
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从姑息治疗想到临床决策 总被引:1,自引:0,他引:1
对于根治希望渺茫的晚期癌症患者 ,是给予积极抗癌治疗以期延长生命 (有时未必能达到此目的 ) ,还是姑息处理 ,减轻痛苦 ,提高生存质量 ,这是肿瘤科医生经常面临的问题。诚然 ,对于癌症患者应尽量争取根治 ,以获得最大的生存时间。但如果目前的治疗手段不能达到根治时 ,或患者的身体情况不允许时 ,或肯定抗癌治疗弊大于利时 ,临床医生就应识“时务” ,退而求次 ,以改善患者生存质量为主要目标。作为临床医疗护理的一种特殊方式 ,姑息治疗主要是控制症状 ,减轻疼痛。通过缓解症状、积极止痛、营养支持等 ,辅以精神心理治疗 ,改善患者的生存质… 相似文献
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晚期癌症患者的姑息性治疗 总被引:3,自引:0,他引:3
晚期癌症患者的姑息性治疗问题,越来越引起医学界和社会各界的重视。尽管人类经过近百年的努力,在肿瘤防治工作中取得了一些成功的经验,但癌症发病率并未下降,并呈上升趋势。据有关资 相似文献
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姑息治疗又称缓解性治疗,是对已不能根治的癌症的一种积极而全面的治疗。采用治愈疗法的患者中有60%会复发,最终转变为姑息治疗。姑息治疗的目标是减轻症状,提高生活质量,延长生命 相似文献
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目的:回顾性分析重组改构人肿瘤坏死因子(rmhTNF)在晚期肿瘤伴恶性胸腔积液患者姑息治疗中的效果。方法将25例晚期肿瘤伴发恶性胸腔积液的患者最大限度地引流胸腔积液,然后给予rmhTNF 300万IU,每3天一次,连续4次,观察疗效和不良反应。结果治疗后4例患者由于已经进入肿瘤终末期,于4周内死亡。在治疗4周内有76.2%(16/21)的患者未复发;对于曾经使用其他方法治疗过的15例患者,有73.3%(11/15)未复发。25例患者共给药83次,其中发热发生率10.8%(9/83),流感样症状发生率1.2%(1/83),总发生率为12.0%(10/83)。所有的不良反应是完全可逆的,对症治疗即可消失。结论胸腔内灌注rmhTNF治疗恶性胸腔积液是一种不良反应相对较少,疗效确切的方法,在其他方法失败的情况下也有效,适用于身体状况较差进行姑息治疗的患者。 相似文献
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崔建英 《中国肿瘤临床与康复》2014,(1):115-116
<正>中枢神经系统肿瘤是指发生在颅内和椎管内的肿瘤,可分为原发性和继发性两大类。肿瘤患者的护理是一个涉及身体、心理、社会和伦理道德等多方面的复杂过程。姑息护理是随着临终关怀活动而逐渐产生和发展起来的一种全新理念的护理模式。2002年,世界卫生组织(WHO)将姑息护理定义为对那些患有无法治愈的疾病患者提供积极的整体护理,主要通过预防和评估,有效控制疼痛及其他躯体症状,处理心理、社会和精神方面的一系列问题[1]。为探讨姑息性护理对神经系统肿瘤患者身心健康的影响,我们对30例神经系统肿瘤患者进行姑息性护理,取得了良好效果。 相似文献
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鼻咽癌放疗后远处转移发生率在20%~28.1%,远处转移最常见的部位是骨、肺、肝,其中肺转移的发生率约在4%~20%。通常的治疗方法是:单个肺转移灶可以作放疗与手术,多个肺转移病灶以化疗为主。本院1989~1996年治疗鼻咽癌肺转移病人47例,回顾性将其分为化疗组与单纯放疗组,比较临床疗效。 相似文献
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目的:分析天津医科大学肿瘤医院肿瘤姑息治疗多学科专家协作组(Multidisciplinary team ,MDT )的工作概况,评价MDT 模式在肿瘤姑息治疗领域的作用。方法:回顾性分析2014年1 月1 日至2015年3 月31日参加本院肿瘤姑息治疗MDT 会诊的371 例患者的临床资料,总结其基本特征、MDT 决策执行情况,并对部分姑息治疗方案进行疗效评价。结果:全组患者401 例次共获得318(79%)项治疗建议,其中293 项为姑息治疗建议。MDT 为119 例疼痛患者提供了合理化镇痛方案,对95例患者提出营养治疗意见,对36例患者采取了抗焦虑抑郁药物治疗。有效随访到的374 项MDT 决策,全部执行者273 项(73%),部分执行者49项(13%),总体执行率86% 。执行MDT 决策的患者,在疼痛控制、营养状况改善及与抑郁相关的躯体症状缓解方面均优于未执行者(P < 0.001,P < 0.001 及P < 0.01)。 结论:肿瘤姑息治疗多学科会诊能为患者提供规范的个体化综合治疗建议,执行MDT 决策有助于改善癌症患者疼痛、营养障碍及焦虑抑郁等症状,值得进一步完善和推广。 相似文献
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H Takagi T Morimoto M Yasue E Ochiai E Yamada T Ashizawa C Kido 《Journal of surgical oncology》1983,23(4):219-222
Eleven unresectable hepatoma patients and three metastatic tumor patients with colonic cancer underwent ligation and/or catheterization of the hepatic artery of the main tumor-bearing zone. Mitomycin C (liquid or microcapsulated) or Adriamycin were administered via the catheter intermittently or continuously with a portable pump device. In follow-up study the tumor size was frequently visualized by arteriography via the cannula. Some tumors became smaller with calcification. The levels of alpha-Fetoprotein of CEA in some cases dropped remarkably and stayed low for a fairly long period. There was no immediate postoperative death. Six of 11 unresectable hepatoma patients survived longer than 8 months with a maximum survival of 17.5 months. Two of three metastatic patients have survived more than 11 months at this writing. This method seems effective for prolongation of patient survival. 相似文献
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目的 :探讨原发性心脏恶性肿瘤的诊断和治疗方法。方法 :回顾分析 1986年 1月~ 1997年 12月 ,上海市胸科医院及上海市第六人民医院心外科 10例原发性心脏恶性肿瘤的诊断及手术治疗。结果 :7例成功切除肿瘤 ,3例因肿瘤广泛侵犯心脏周围组织仅作局部活检。 1例术后第 2天因急性肾功能衰竭死亡 ,其余顺利出院。结论 :原发性心脏恶性肿瘤较为罕见 ,一旦诊断成立应尽快手术 ,其积极意义是确定无疑的 相似文献
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肢体韧带样瘤的临床特点与治疗 总被引:1,自引:0,他引:1
目的:探讨肢体韧带样瘤的临床病理特点与治疗。方法:对我院自1994年至2007年所收治的肢体韧带样瘤74例的临床资料进行回顾性分析。结果:男性26例,女性48例,中位年龄33岁(13-69岁)。均为单发病灶,表现为肢体缓慢长大的质地硬韧的软组织肿块。初治47例,复发再治27例。肿块大小2cm×3cm-16cm×46cm。20例位于上肢,54例位于下肢。诊断全部经术后病理证实。33例仅接受手术治疗,41例接受手术联合放疗。术后所有病例获随访,中位随访期为47月(7-146月)。术后肿瘤复发率:单纯手术治疗为36.4,而手术联合放疗为14.6,差异显著(P=0.03)。结论:肢体韧带样瘤表现为缓慢长大、质地硬韧的肌肉内病灶,其治疗应尽可能采取手术切除联合术后放疗,以达到控制肿瘤和保留肢体功能的目标。 相似文献
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骨巨细胞瘤的诊断与治疗 总被引:4,自引:0,他引:4
骨巨细胞瘤是一高侵袭性良性肿瘤,主要发生于年轻人中,骨端发病.典型的影像学表现是骨端完全溶骨的膨胀性改变,多不伴有骨膜反应及软组织包块.CT及MRI可以很好地显示肿瘤的侵及范围,X线平片最具诊断意义.圆形及卵圆形基质细胞及多核巨细胞是骨巨细胞瘤的基本组织构成成分.刮除术是治疗骨巨细胞瘤的基本外科手段,但其复发率较高,应加用物理及化学的方法扩大至边缘或广泛的外科治疗边界.放疗可用于治疗难以手术的病例,但可致肉瘤变.化疗对于骨巨细胞瘤基本无效.骨巨细胞瘤的转移及恶变可能与以往治疗有关. 相似文献
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Duo Chen Xiangtai Wei Qiang Yin Junhong Guan Weiran Pan Chenglin Wang Yunhui Liu 《临床肿瘤与癌症研究(英文版)》2009,6(2):95-99
OBJECTIVE To analyze and discuss about the clinical characteristics, pathological types, surgical modalities and techniques, and postoperative complications in children with tumor of posterior cranial fossa.
METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa, admitted and treated in our hospital during the period of January 1996 to January 2007. All patients underwent microscopic surgical treatment. Fiftyeight were male and 44 cases were female. The age ranged from 9 months to 14 years old, with an average of 6.1 ± 0.5 of age. Cranial CT or MRI examination was conducted before and after the surgery on all patients. RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia. Postoperative pathological diagnoses showed: 46 cases of medulloblastoma, 43 cases of astrocytoma, 11 cases of ependymoma (including 1 case of degenerative ependymoma), 1 case of dermoid cyst, and 1 case of teratoma. In this group of the patients, radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases, while surgical removal of large section was performed on 3 cases. There were no deaths from surgery reported. Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions, while 11 cases showed either no improvement or more severely affected afterward. For 6 cases, postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery. Sixty-three patients gained follow-up for 3 to 60 months in duration. Thirty-nine patients regained normal life and were able to learn well, while there were 7 patients who could not live normally on their own. During the follow-up period, there were 17 cases of recurrence and 7 cases of death. In 23 cases of medulloblastoma in children with age of 3 years old or above, 2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord. Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of Carmustine.
CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa, right followed by ependymoma, and dermoid cysts and teratomas were rare. Early correct diagnosis, proper selection of appropriate surgical modality and the surgical margin, proper treatment of postoperative complications, and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with tumor of posterior cranial fossa. 相似文献
METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa, admitted and treated in our hospital during the period of January 1996 to January 2007. All patients underwent microscopic surgical treatment. Fiftyeight were male and 44 cases were female. The age ranged from 9 months to 14 years old, with an average of 6.1 ± 0.5 of age. Cranial CT or MRI examination was conducted before and after the surgery on all patients. RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia. Postoperative pathological diagnoses showed: 46 cases of medulloblastoma, 43 cases of astrocytoma, 11 cases of ependymoma (including 1 case of degenerative ependymoma), 1 case of dermoid cyst, and 1 case of teratoma. In this group of the patients, radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases, while surgical removal of large section was performed on 3 cases. There were no deaths from surgery reported. Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions, while 11 cases showed either no improvement or more severely affected afterward. For 6 cases, postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery. Sixty-three patients gained follow-up for 3 to 60 months in duration. Thirty-nine patients regained normal life and were able to learn well, while there were 7 patients who could not live normally on their own. During the follow-up period, there were 17 cases of recurrence and 7 cases of death. In 23 cases of medulloblastoma in children with age of 3 years old or above, 2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord. Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of Carmustine.
CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa, right followed by ependymoma, and dermoid cysts and teratomas were rare. Early correct diagnosis, proper selection of appropriate surgical modality and the surgical margin, proper treatment of postoperative complications, and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with tumor of posterior cranial fossa. 相似文献