手术切除加X线照射治疗增生性瘢痕及瘢痕疙瘩的临床应用探讨

目的观察手术切除增生性瘢痕及瘢痕疙瘩后行放射治疗的临床效果。方法155例增生性瘢痕及瘢痕疙瘩行手术切除减张后直接缝合或植皮修复,术后24h内（植皮者拆线后）采用X线照射治疗。结果155例术后随访1～3年以上,显效114例,有效36例,无效5例,总有效率约96．8%。结论术后放射治疗对于防治增生性瘢痕及瘢痕疙瘩的复发效果较好,是一种安全有效的方法。     

不同形态瘢痕疙瘩术后采用不同方式放射治疗的疗效观察

目的回顾性分析不同形态瘢痕疙瘩术后采用不同方式放射治疗的治疗效果,方法 2005年1月至2011年1月我院共收治332例瘢痕疙瘩患者,瘢痕疙瘩数目518处,全部瘢痕疙瘩行手术切除,放疗开始时间均为术后8h内。24h内放疗两次,A组,362处瘢痕疙瘩术后采用6MeV电子线放疗,第一次,剂量5 Gy,第二次,剂量4 Gy,第3～7天每天2Gy,总剂量19`Gy/7次/7天。B组,156处瘢痕疙瘩术后采用192Ir后装敷贴放射治疗,第一次,剂量5 Gy,第二次,剂量4 Gy,第5天放疗第三次,剂量3Gy,总剂量12`Gy/3次/5天。结果瘢痕疙瘩术后放疗随访1～7年,所随访病例332例患者中,A组,瘢痕疙瘩362处,治愈343处,治愈率为94.75%;好转19处,好转率为5.25%。B组,瘢痕疙瘩156处,治愈156处,治愈率为100%。结论不同形态瘢痕疙瘩术后采用不同方式放射治疗效果较好,是一种安全有效的治疗瘢痕疙瘩的好方法。     

瘢痕皮回植配合中西药物治疗耳垂瘢痕疙瘩

目的探讨耳垂瘢痕疙瘩手术切除加中西药物的综合治疗方法。手术切除,瘢痕皮回植,术后局部注射曲安缩松加透明质酸酶并口服中药汤剂。结果8例中术后三年,6例无复发,仅有2例术后半年复发,有效率达75%,结论此方法可减少瘢痕复发,是治疗瘢痕疙瘩有效方法。     

胸部瘢痕疙瘩综合治疗的临床体会

目的：探讨胸部瘢痕疙瘩治疗的有效方法。方法：对本院27例，共30处胸部瘢痕疙瘩采用手术切除，术后结合X线放疗，疤痕贴、美宝疤痕平软膏、药物注射等综合治疗方法。结果：创面一期愈合19例，共22处，随访6个月～2年，仅4例共5处复发。结论：胸部瘢痕疙瘩的综合治疗是有效方法。     

手术切除联合早期放射治疗瘢痕疙瘩25例分析

目的：探讨瘢痕疙瘩手术切除联合早期放射治疗的疗效。方法：瘢痕疙瘩在手术切除后24h内行放射治疗,用6MeV电子线垂直照射,隔日照射1次,每次剂量4Gy,共3～5次。结果：25例中治愈20例,有效3例,复发2例,总有效率为92%。复发者经再次治疗,症状明显好转。结论：手术切除联合早期放射治疗是治疗瘢痕疙瘩的有效方法,同时要加强对患者的健康教育,避免复发因素。     

手术切除联合两种不同方式曲安奈德局部注射治疗瘢痕疙瘩疗效观察

目的探讨手术切除联合两种不同方式曲安奈德局部注射治疗瘢痕疙瘩的疗效。方法对瘢痕疙瘩行核心切除,切除后治疗组即时用醋酸曲安奈德混悬液（5ml：∶0 mg）按1：1的比例加2%利多卡因混匀行创缘和基底部注射,对照组于拆线后1周开始行局部曲安奈德注射治疗。然后两组患者每周局部注射1次,连续注射6周,观察疗效。结果对43例患者进行为期2年的观察。治疗组19例痊愈,1例显效,总有效率为90.91%,对照组17例痊愈,2例显效,总有效率为90.48%。两组比较差异无统计学意义（P〉0.05）。结论手术核心切除联合两种不同方式曲安奈德局部注射治疗瘢痕疙瘩疗效确切。     

CO2激光切除术联合醋酸曲安奈德注射治疗瘢痕疙瘩38例疗效观察

目的研究CO2激光切除术与醋酸曲安奈德注射联合应用对瘢痕疙瘩的疗效。方法首先采用CO2激光彻底切除瘢痕疙瘩病灶。术后创面愈合半个月,再给予醋酸曲安奈德局部注射,必要时每隔1周重复注射一次。结果38例瘢痕疙瘩患者,治疗后随访3个月,其中3例轻度复发再次注射,其余均一次治愈。结论CO2激光切除瘢痕疙瘩,具有方法简便易行,手术时间短,创伤小,出血少,易愈合等优点,患者容易接受。术后注射曲安奈德,有效地抑制了纤维结缔组织增生,防止了瘢痕疙瘩的再次形成。二者相结合,标本兼治,疗效显著。     

瘢痕皮瓣与5-氟尿嘧啶在治疗耳部瘢痕疙瘩中的应用

目的评价手术联合局部混合药物注射治疗耳部瘢痕疙瘩的疗效。方法对93例（117侧）耳部瘢痕疙瘩患者采用瘢痕内切除局部瘢痕瓣塑形的术式,术后1周瘢痕区注射曲安奈德加低浓度5-氟尿嘧啶,观察随访结果。结果术后随访1～2年,曲安奈德治疗组治愈28例（29侧）,显效10例（12侧）,无效5例（7侧）;曲安奈德联合氟尿嘧啶组治愈37例（51侧）,显效9例（14侧）,无效4例（4侧）。经Ridit分析,差异有统计学意义（P〈0．05）。结论瘢痕瓣塑形术联合术后曲安奈德、低浓度5-氟尿嘧啶注射治疗耳部瘢痕疙瘩效果满意,是治疗的选择方案之一。     

局部注射曲安奈德治疗瘢痕增生的观察及护理

目的探讨药物治疗瘢痕增生的有效方法及护理措施。方法采用曲安奈德注射液(40mg/mL)与2%盐酸利多卡因按1:2比例混合摇匀进行瘢痕局部注射,同时配合心理护理和准确的护理操作手法以及细心的用药观察等措施。结果136例患者经治疗后局部痛痒感基本消失,瘢痕组织变软,颜色变浅,瘢痕疙瘩缩小,变平坦,经随访1～3年,总效率100%。结论采用曲安奈德加盐酸利多卡因治疗瘢痕疙瘩和瘢痕增生,是目前治疗瘢痕的一种简便有效的方法,值得推广。     

40例瘢痕疙瘩放射治疗的疗效分析

目的探讨利用电子线治疗瘢痕疙瘩的术后效果。方法选取笔者所在科室2007年1月～2011年1月诊治的瘢痕疙瘩患者,均经手术切除,术后运用6MeV电子线照射病变部位,10d为1个疗程,每日1次,每次每个部位照射2Gy。结果运用手术结合6MeV电子线治疗瘢痕疙瘩有效率达90%,且不易复发,不良反应少。结论电子线能有效治愈皮肤瘢痕疙瘩,手术结合放射治疗是治愈瘢痕疙瘩的有效手段。     

Intraperitoneal injection of dipyridamole increases the life span of tumor bearing mice treated with fluorouracil.

This study was carried out to investigate the effect of the Fluorouracil (5-FU) and Dipyridamole (DP) combination on the growth of P388 murine lymphoid neoplasms. The first stage was to determine the lethal dose (LD 50) for each compound (5-FU, DP) to normal B6D2F1 mice after intraperitoneal (i.p.) injection. The LD 50 were 700 and 54 mg/kg for DP and 5-FU respectively. B6D2F1 mice bearing P388 ascitic tumors and receiving a 4-day schedule of 5-FU (2 mg/kg/day) with DP (100 mg/kg/day) 1 hr before each 5-FU dose were studied. DP was found to lower significantly (p < 0.0001) the mortality of 5-FU in tumor bearing mice by nearly 2.5 fold. This study aims at defining the best dose combination of intraperitoneal injection of 5-FU in conjunction with DP. These data allow a prospective evaluation of 4-day, i.p. 5-FU and DP with an increase of life span without toxic death.     

复方氟尿嘧啶多相脂质体对S180荷瘤小鼠肿瘤生长抑制及其不良反应

目的:比较复方氟尿嘧啶多相脂质体(Co-5-FU)和氟尿嘧啶(5-FU)对小鼠肉瘤细胞系S180荷瘤小鼠的抗肿瘤作用及不良反应。方法:将小鼠肉瘤S180细胞悬液接种于小鼠背部皮下或腹腔,建立S180荷瘤小鼠实体瘤和腹水瘤模型。取70只小鼠,分成实验组(Co-5-FU)、阳性对照组(5-FU)和正常对照组,分别腹腔注射40 mg·kg~(-1)、20 mg·kg~(-1)、10 mg·kg~(-1)3种不同浓度的Co-5-FU和5-FU,正常对照组腹腔注射生理盐水。比较Co-5-FU和5-FU对实体瘤小鼠的肿瘤抑制率,腹水瘤小鼠的生命延长率,同时通过血生化和病理等检测观察2种药物对各脏器的不良反应。结果:与正常对照组比较,40 mg·kg~(-1)、20 mg·kg~(-1)、10 mg·kg~(-1) Co-5-FU对S180腹水瘤小鼠的生命延长率分别是52．7％,41．4％和31．9％(P＜0．05),对S180实体瘤小鼠的肿瘤抑制率分别是48．8％和39．2％和32．0％(P＜0．01);同等剂量Co-5-FU比5- FU引起的骨髓抑制轻(P＜0．05);40 mg·kg~(-1)5-FU可引起肝脏ALT、AST、GGP升高(P＜0．05)。结论: Co-5-FU比同等剂量的5-FU具有更强的抗肿瘤作用,对心脏、肾脏、肝脏、骨髓的不良反应明显小于5- FU。     

Investigation of 5-FU disposition after oral administration of capecitabine, a triple-prodrug of 5-FU, using a physiologically based pharmacokinetic model in a human cancer xenograft model: comparison of the simulated 5-FU exposures in the tumour tissue between human and xenograft model.

The nonlinear pharmacokinetics of capecitabine, a triple prodrug of 5-FU preferentially activated in tumour tissues, was investigated in human cancer xenograft models. A physiologically based pharmacokinetic (PBPK) model integrating the activation process of capecitabine to 5-FU and 5-FU elimination was constructed to describe the concentration/time profiles of capecitabine and its three metabolites, including 5-FU, in blood and organs. All the biochemical parameters (enzyme kinetic parameters, plasma protein binding and tissue binding of capecitabine and its metabolites) integrated in this model were measured in vitro. The simulated curves for the blood and tumour concentrations of capecitabine and its metabolites can basically describe the observed values. A simple prodrug of 5-FU, doxifluridine, is known to be activated to 5-FU to some extent in the gastrointestinal (GI) tract, causing diarrhoea, which is the dose limiting side effect of doxifluridine. Consequently, the therapeutic index (the ratio of 5-FU AUC in the tumour to that in GI) after the administration of effective dose capecitabine was predicted by this PBPK model and found to be five times and 3000 times greater than that of doxifluridine and 5-FU, respectively. This was compatible with the previous result for the difference in the ratio of the toxic dose to the minimum effective dose between capecitabine and doxifluridine, suggesting that 5-FU preferentially accumulates in tumour tissue after oral administration of capecitabine compared with the other drugs (doxifluridine and 5-FU). The 5-FU AUC in tumour tissue of human cancer xenograft models at the minimum effective dose was comparable with those estimated for humans at the clinical dose. In addition, the predicted therapeutic indices at the respective doses were correlated well between humans and mice (xenograft model). These results suggest that the 5-FU AUC in human tumour tissue at its clinically effective dose can be predicted based on the PBPK model inasmuch as the 5-FU AUC in a human cancer xenograft model at its effective dose may be measured or simulated.     

单甲氧聚乙二醇/牛血清白蛋白/5-氟尿嘧啶的制备及其抑瘤活性初探

目的:制备单甲氧聚乙二醇/牛血清白蛋白/5-氟尿嘧啶(mPEG/BSA/5-FU)偶联物,以延长5-FU的半衰期并降低其达峰浓度,同时初步探讨偶联物的抑瘤活性。方法:通过在5-FU的N-1处引入乙酸基后再制成活性酯并与BSA偶联,用mPEG修饰偶联物而得mPEG/BSA/5-FU。60只小鼠皮下注射H22肝癌细胞腹水建立实体瘤模型后随机分为生理盐水组、5-FU(25 mg·kg-1.d-1)组、BSA/5-FU组(以5-FU计25 mg·kg-1·d-1)及mPEG/BSA/5-FU(以5-FU计50、25、12.5 mg·kg-1·d-1)剂量组共6组,分别腹腔注射相应试药10 d后处死,计算各组抑瘤率等。结果:得到了偶联率为32.89%的BSA/5-FU,修饰度为48.37%的mPEG/BSA/5-FU。同等5-FU剂量下mPEG/BSA/5-FU组、5-FU组、BSA/5-FU组的抑瘤率分别为40.51%、33.63%、20.54%(P<0.01)。结论:制备mPEG/BSA/5-FU偶联物的偶联反应及修饰反应的工艺简单,抑瘤实验显示所得目标产物的抑瘤率明显高于5-FU组和BSA/5-FU组。     

硫酸壳聚糖体内抗肿瘤作用的实验研究

目的：研究硫酸壳聚糖的体内抗肿瘤作用。方法：用高、低（200、100mg/kg）两个剂量的硫酸壳聚糖分别腹腔注射治疗肉瘤180（S180）小鼠和艾氏腹水癌（EAC）小鼠10d,然后测定其抑瘤率、重要器官的内脏指数和生命延长率,同时设生理盐水组（空白对照组）和氟尿嘧啶组（阳性对照组）进行比较。结果：硫酸壳聚糖高、低剂量组和氟尿嘧啶组的抑瘤率分别为38.67%、30.19%和43.27%,3组的生命延长率分别为65.38%、69.23%和54.93%。和生理盐水组、氟尿嘧啶组相比,硫酸壳聚糖高、低剂量组的S180小鼠的胸腺指数均有明显增加（P〈0.05）。结论：硫酸壳聚糖能有效抑制S180小鼠肿瘤的生长和延长EAC小鼠的生存时间,其作用机制可能与其提高机体的免疫力有关。     

Phase I study of the combination of oxaliplatin, irinotecan and continuous infusion 5-fluorouracil in digestive tumors

Oxaliplatin (L-OHP), irinotecan (CPT-11) and 5-fluorouracil (5-FU) have shown their efficacy in metastatic colorectal cancer. The synergism of these drugs has been demonstrated in vivo and in vitro. The aim of this study was to determine the recommended dose of the triple combination of L-OHP, CPT-11 and CI 5-FU for a further phase II study. Eighteen patients received the study treatment in four dose levels. The male:female ratio was 15:3 and the median age was 51.6 years (range 30-71). The type of tumor was colon in eight patients, rectum in four and other locations in six patients. The treatment was repeated every 2 weeks, at the fixed dose of L-OHP, 85 mg/m, and escalated doses of CPT-11 and 48-h infusion 5-FU of 100/2000, 100/2250, 125/2250 and 150/2250 mg/m. Only one previous treatment for the advanced disease was permitted. Patients received a median of 8 cycles (range 1-26) and a total of 152 cycles were administered. Dose intensity administered at dose level L-OHP 85 mg/m, CPT-11 150 mg/m and 5-FU 2250 mg/m was 95, 92 and 95% for L-OHP, CPT-11 and 5-FU, respectively. One patient in level 2 and one patient in level 4 presented dose-limiting toxicity that was not confirmed in the three required additional patients by level. The anti-tumor activity was assessed in nine patients: seven partial responses, one stable disease and one progressive disease. The maximum-tolerated dose was not reached, and thus the recommended dose for this combination schedule is L-OHP, 85 mg/m, CPT-11, 150 mg/m and 5-FU, 2250 mg/m 48-h continuous infusion, the same doses that were recommended for the drugs when administered in combination therapy of L-OHP + 5-FU or CPT-11 + 5-FU. A phase II study in first-line treatment of patients with metastatic colorectal cancer with this dose regimen is ongoing.     

皮质类固醇激素局部注射副作用136例临床分析

目的探讨皮质类固醇激素局部注射的副作用。方法将136例接受皮质类固醇激素局部注射的患者分为A组和B组,A组68例使用Triameinolone Acetonide（醋酸曲安缩松）20—40mg＋1％procaine sol2～4ml,B组68人使用Hydroprednisone Acetatis（醋酸氢化泼尼松）1-2ml（25mg／ml）＋1％procaine sol2～4ml作皮损内注射,疗程为每周1次,共4-8次。观察其副作用。结果皮质类同醇激素局部注射副作用常见,其中最常见为月经紊乱,皮肤萎缩和色素减退,而且Triamcinolone比Hydroprednisone引起者更常见。结论使用皮质类固醇激素局部注射要注意选择药物,注意用药剂量浓度和每次注射的间隔时间。     

A protein-bound polysaccharide immunomodulator, PSK, does not suppress the conversion from 1-(2-tetrahydrofuryl)-5-fluorouracil to 5-fluorouracil in patients with gastric cancer.

Effects of the immunomodulator PSK on the metabolism of 1-(2-tetrahydrofuryl)-5-fluorouracil (tegafur) to 5-fluorouracil (5-FU) were examined in 10 patients with advanced gastric cancer and who had undergone curative resection. PSK is a protein-bound preparation, extracted from Coriolus versicolor and belongs to Basidiomycetes. The 5-FU concentration in the plasma was 0.024 micrograms/ml at 15 min after the intravenous injection of 400 mg of tegafur and the area under the curve of 5-FU was 0.58 micrograms.h/ml. Following administration of PSK, 3 g/day for 8-14 months, there was no change in the plasma level of 5-FU, in any patient. As the clinical dose of PSK had no apparent influence on the metabolism of tegafur to 5-FU, the combination of PSK and tegafur can be prescribed to treat patients with advanced gastric cancer.