肾母细胞瘤和神经母细胞瘤术前化疗及超微结构改变

目的了解术前化疗对小儿恶性肿瘤组织结构的改变及应用价值。方法对７例肾母细胞瘤和５例神经母细胞瘤进行光镜和透镜检查，比较前化疗对其组织结构的影响及疗效。术前化疗可造成肿瘤组织不同程度的破坏，肿瘤缩小，肿瘤的切除率有提高。结果术前化疗对不能一期切除的肿瘤有实际应用价值，在神经母细胞瘤尤为明显。     

肾母细胞瘤和神经母细胞瘤术前化疗及超微结构改变

目的了解术前化疗对小儿恶性肿瘤组织结构的改变及应用价值。方法对7例肾母细胞瘤和5例神经母细胞瘤进行光镜和透射电镜检查，比较术前化疗对其组织结构的影响及疗效。结果术前化疗可造成肿瘤组织不同程度的破坏，肿瘤缩小，肿瘤的切除率有提高。结论术前化疗对不能一期切除的肿瘤有实际应用价值，在神经母细胞瘤尤为明显。     

肾母细胞瘤术前化疗的优劣分析

目的评估肾母细胞瘤术前化疗的优缺点.方法对同期44例肾母细胞瘤中的26例以长春新碱、放线菌素D和环磷酰胺进行术前化疗,其中8例另加肾动脉介入栓塞化疗.其余18例经术前检查诊断后,即行手术治疗作为对照.结果术前化疗组病例经手术证实其中4例出现"降期",有6例出现"升期";16例经B超或CT检查瘤体有明显缩小;术后病理检查发现4例大部分瘤体细胞已坏死,另4例则瘤体细胞完全坏死无法进行术后病理诊断.全组术中瘤体破溃2例,低于对照组的3例.术前化疗后瘤体明显缩小病例的2年无瘤存活率为81.3%,瘤体缩小不明显的病例为7例.两组术后临床分期、病理亚型的分布及无瘤生存率的比较,差异均无显著性(P＞0.05).结论术前化疗可能在缩小瘤体,减少术中瘤体破溃率,在评估肿瘤化疗敏感性等方面有其优越性;术前化疗可能改变临床分期和病理分型;凭影像学检查较难进行准确的术前术后临床分期比较;当瘤体完全坏死后,病理诊断,及术后治疗均较困难.     

肾动脉远近端联合栓塞在巨大肾癌术前的应用

目的　探讨肾癌术前碘化油及明胶海绵联合肾动脉栓塞的应用价值。方法　对 16例肾癌患者术前2 4～ 72小时用碘化油及明胶海绵行患肾动脉远、近端联合栓塞 ,使患肾动脉完全闭塞。对照组 15例肾癌患者术前未作栓塞。结果　术前栓塞组的手术时间、术中出血量、完全切除率分别为 :(15 0± 12 )分钟、(10 5 .5± 3 .8) ml及10 0 % ;而未栓塞组为 (2 3 8± 13 )分钟、(2 15± 4.6) m l及 66.7% ,两者差异有显著性 (P<0 .0 1)。结论　肾动脉远近端联合栓塞疗效确切 ,值得临床推广     

儿童晚期肾母细胞瘤的术前化疗分析

目的探讨术前化疗对肿瘤较大或有远处转移的肾母细胞瘤的手术帮助和手术时机的选择。方法回顾性分析16例肾母细胞瘤的诊治过程。Ⅱ期10例,Ⅲ期5例,Ⅳ期1例。16例患儿术前均经影像学检查及穿刺活栓明确诊断。所有病例均予术前化疗后行手术治疗。结果5例瘤肾根治性切除,1例手术过程中发生肿瘤破裂,术后病理检查有镜下残留。在术前化疗后2～3周手术13例,2例因术前化疗后肿瘤坏死彻底未获得术后病理分型,术后化疗方案制定依据术前细针穿刺结果。结论术前化疗可以使肿瘤体积变小,减少肿瘤破溃,改善瘤体对毗邻器官浸润程度,使外科手术变得容易。     

肾动脉灌注化疗加栓塞术在治疗巨大肾肿瘤中的临床应用

目的 研究肾动脉灌注化疗加栓塞术在治疗巨大肾肿瘤中的临床作用。方法 对15例肾恶性肿瘤行肾动脉灌注化疗加栓塞术，肿瘤直径10～22.5,化疗使用药物为丝裂霉素20mg，长春新碱0.02mg/kg，应用明胶海绵加碘油施行肾动脉栓塞。结果 治疗后行根治性切除12例（80%）。3例症状缓释。术中出血少，易剥离。手术时间缩短。结论 该法安全、有效，适用于巨大肾肿瘤治疗的辅助治疗。     

肾母细胞瘤术中术后化疗的远期疗效观察

本文对１９８２年２月－１９９４年１２年收治的６６例肾母细胞瘤患儿，采用术中腹膜后顺铂１０ｍｇ稀释液浸泡，及术后配合静脉化疗。结果显示：术中术后联合化疗对提高肾母细胞瘤患儿３、５年生存率有重要作用。给药途径、化疗疗程数、手术方式一病的疗铲有明显的     

晚期直肠癌的插管化疗栓塞

经导管股动脉插箜经疗栓塞治疗晚期直肠癌２８例，治疗后合组病人临床症状均有明显改善，肿瘤病灶缩小＞５０％者５例，缩小２５％－５０％者１２例，小于２５％者６例，无变化者５例。４例经治疗后，肿瘤灶明显缩小，获得二期手术切除。     

肾动脉灌注化疗加栓塞术在治疗巨大肾肿瘤中的临床应用

目的　研究肾动脉灌注化疗加栓塞术在治疗巨大肾肿瘤中的临床作用。方法　对 15例肾恶性肿瘤行肾动脉灌注化疗加栓塞术 ,肿瘤直径 10～ 2 2 .5cm ,化疗使用药物为丝裂霉素 2 0mg ,长春新碱 0 0 2mg/kg。应用明胶海绵加碘油施行肾动脉栓塞。结果　治疗后行根治性切除 12例 (80 % ) ,3例症状缓解。术中出血少 ,易剥离。手术时间缩短。结论　该法安全、有效 ,适用于巨大肾肿瘤治疗的辅助治疗。     

儿童肾母细胞瘤的CT诊断价值

目的：探讨ＣＴ对肾母细胞瘤的诊断价值,指导临床治疗。资料与方法：回顾性分析４３例病理证实为肾母细胞瘤平扫加增强扫描的ＣＴ征象。结果：肿瘤单侧多见,也可为双侧,多发生于肾脏一极,也可全部,常表现为强化不明显的实性肿块,瘤内常有坏死、囊变,少数有出血、钙化,典型表现为残存肾实质变薄,呈新月形、环形、或肾的正常结构消失。本组术前发现病灶１００％,诊断准确率９５％。结论：ＣＴ增强扫描能发现小病灶的痛母细胞     

舒芬太尼在肾母细胞瘤患儿术后镇痛中的应用效果及对患儿免疫功能的影响

目的探讨舒芬太尼在肾母细胞瘤患儿术后镇痛中的应用效果及对患儿免疫功能的影响。方法采用随机数字表法将42例肾母细胞瘤患儿分为低剂量、中剂量和高剂量组,每组14例,低剂量组、中剂量组、高剂量组患儿术后舒芬太尼镇痛剂量分别为1.0、2.5、4.0μg/kg。术后6、24、48 h,采用中文版儿童疼痛行为量表(FLACC)评估三组患儿的镇痛效果,以及不良反应发生情况;麻醉前和术后1、24、72 h,检测三组患儿免疫功能指标,包括免疫球蛋白(Ig)G、IgA、IgM。结果术后6、24、48 h,中剂量组、高剂量组患儿FLACC评分均低于低剂量组患儿,差异均有统计学意义(P﹤0.05)。术后1、24、72 h,低剂量组患儿IgG、IgA、IgM水平均低于本组麻醉前,差异均有统计学意义(P﹤0.05);术后1、24 h,中剂量组和高剂量组患儿IgG、IgA、IgM水平均低于本组麻醉前,差异均有统计学意义(P﹤0.05),但术后72 h,中剂量组和高剂量组患儿IgG、IgA、IgM水平与麻醉前比较,差异均无统计学意义(P﹥0.05)。低剂量组患儿未发生不良反应,中剂量组患儿发生恶心1例,高剂量组患儿发生恶心5例、呕吐3例。结论2.5μg/kg的舒芬太尼在肾母细胞瘤患儿术后镇痛中效果明显,且对患儿的免疫系统发挥一定的保护作用,可以减轻患儿术后免疫功能抑制。     

Cystic partially differentiated nephroblastoma

Cystic partially differentiated nephroblastoma is a relatively rare tumour of the kidney usually affecting infants. Cystic Wilms’ tumour and multilocular cystic nephroma should be distinguished from cystic partially differentiated nephroblastoma. Multilocular cystic nephroma is a benign tumour whereas cystic Wilms’ tumour is at the malignant end of the range of classification of such tumours. Cystic partially differentiated nephroblastoma may undergo local recurrence but there is no report of metastasis.     

The challenge of nephroblastoma in a developing country.

BACKGROUND: Advances in paediatric oncology has tremendously improved the outcome in children with nephroblastoma. In most developing countries, however, the survival rate is still very low. Objective: To study the outcome and the impediments to the management of nephroblastoma in Southeast Nigeria. METHODS: Analysis of 42 children managed for nephroblastoma over a 10-year period (January 1995-December 2004) at the University of Nigeria Teaching Hospital, Enugu, Nigeria is made. Diagnosis was based on clinical, radiologic and histologic evaluation. RESULTS: The peak age incidence was 2-5 years with a male:female ratio of 1.1:1. Abdominal mass was the main presentation in all the children. Treatment consisted of nephroureterectomy followed by adjuvant chemotherapy with Vincristine, Actinomycin D and Cyclophosphamide. Adriamycin was added for metastatic disease. Twenty-two children (52.3%) had stage III disease, 13 (31.0%) had stage IV, while the remaining seven (16.7%) children had stage II. Stage I disease was not encountered. Seven children had inoperable tumor requiring pre-operative chemotherapy. While 25 children were available for evaluation, 17 were lost to follow up. Four children died of complications of treatment, while 11 relapsed with poor outcome. With a mean follow up of 21 months, the 5-year survival rate is 40%. CONCLUSION: Morbidity and mortality with nephroblastoma is high in our environment. Late presentation, poverty, ignorance and poor compliance to treatment constitute a great challenge to the paediatric oncologist in a developing country. Solutions may lie in improving health funding and health information in the health care delivery system. Free health care for children with malignancy is advocated. Collaboration with institutions in the privileged parts of the world may help.     

Problems of nephroblastoma in children

An evaluation of 388 cases of Wilms tumor within 13 years established a high proportion of advanced cases among children: stage II - 30.6; III - 35.4; IV - 27.6 and V (bilateral) - 6.4%. Main homeostatic indices remained unchanged until stages III-IV. Primary tumor and metastases can be detected by a complex of clinical, X-ray and radioisotope methods the effectiveness of which is determined by degree of tumor extension. Dissemination of tumor at different sites were detected by primary examination in 40.5% and at later stages in 15% of patients. Most metastases (96%) were detected within the first 12 months of therapy. They were significantly more frequent at stage III and their frequency was in correlation with the patient's age at the time of tumor detection. Out of 388 cases, 112 (28.9%) survived for more than 3 years, stage II - 57.1; stage III - 25.4 and stage IV - 4.6% included. 1.5 - 2 year-long courses of pre- and postoperative polychemotherapy proved to be effective, whereas in cases of stage III tumor they should be supplemented with irradiation of primary tumor, its bed, regional lymph collectors and metastases. These measures ensured a 3-year survival in 69.5% of stage II patients and in 32.3% of stage III patients.     

p21WAF1在小儿肾母细胞瘤组织中的表达及临床意义

目的探讨p21WAF1在肾母细胞瘤中的表达水平,评价p21WAF1的检测对肾母细胞瘤的诊断和预后判断的应用价值.方法用免疫组织化学技术检测32例小儿肾母细胞瘤(肿瘤组)和7例小儿非瘤肾组织(对照组)石蜡标本中p21WAF1的表达,分析p21WAF1的表达与肾母细胞瘤组织学分型、临床肿瘤分期和淋巴结转移间的关系.结果1)p21WAF1在非瘤肾组织中存在基础水平的表达;2)p21WAF1在肾母细胞瘤中的表达与其组织学分型、临床肿瘤分期和淋巴结转移相关.结论p21WAF1的表达在一定程度上有助于肾母细胞瘤的诊断和预后判断.     

The effect of trans arterial chemoembolization in the management of intrahepatic cholangiocarcinoma. A systematic review and meta-analysis

BackgroundA comprehensive re-evaluation on the role of trans-arterial chemoembolization (TACE) in patients with intrahepatic cholangiocarcinoma.MethodsA thorough database searching was performed in PubMed, EMBASE, and the Cochrane Library. Eligible studies were restricted to comparative studies between TACE and non-TACE cohorts. RevMan5.3 software and Stata 13.0 software were used for statistical analyses. The primary endpoint of our study was long-term survival.ResultsA total of 11 studies with 2036 patients were finally identified. Pooled results revealed that patients receiving TACE had a significantly better overall survival (OS) versus those without TACE (P < 0.05). Subgroup analyses were performed according to different types of TACE. Prophylactic post-surgical TACE (PPTACE) was associated with a significantly better OS versus those without PPTACE (P < 0.05). Palliative TACE (PTACE) also achieved a significantly better OS compared with those with supportive treatment (ST) only (P < 0.00001). However, TACE had no impact on disease-free survival (P = 0.87) and was less effective than surgical resection (P = 0.003).ConclusionPPTACE has a remarkable impact on OS versus those with surgical resections only and should be regularly performed. Regarding patients with unresectable disease, apart from conventional ST, adjuvant PTACE is also recommended. Upcoming prospective randomized controlled trials are warranted for further validation.     

Pulmonary embolism after transcatheter arterial chemoembolization

Metastatic hepatic tumours can be treated with hepatic transcatheter arterial chemoembolization (TACE). Common complications associated with TACE include hepatic insufficiency, fever, and pain. However, pulmonary embolism is rarely documented as a fatal adverse effect. We report a case of pulmonary embolism following TACE in a renal cell carcinoma patient with liver metastases. Total recovery is noted after the effective treatment.     

肝癌白芨粉栓塞化疗与常规栓塞化疗的比较研究

比较白芨粉栓塞化疗与常规栓塞化疗的临床效果。 46例中晚期肝癌行白芨粉栓塞化疗 ,60例行常规栓塞化疗。两组病例在肿瘤大小、部位、TNM分期、是否合并肝硬化等方面差异无统计学意义 ,P >0 0 5。所有病例随访 1～ 3年。白芨组 1、2、3年累计生存率分别为 84 8% ( 3 9/4 6)、48 7% ( 19/3 9)、42 9% ( 12 /2 8) ,常规组则相应为 68 3 %( 4 1/60 )、3 9 6% ( 19/4 8)、3 6 1% ( 13 /3 6) ,统计学处理是差异有统计学意义 ,P <0 0 5或P <0 0 0 1。白芨粉栓塞化疗对肝癌病灶作用持久 ,杀伤性强 ,远期疗效明显优于常规栓塞化疗