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1.
吕英义  刘振波 《山东医药》2011,51(35):56-57
目的探讨侵及主动脉外膜食管癌的切除在提高食管癌手术疗效中的作用。方法对34例侵及降主动脉外膜的食管癌患者,行受侵降主动脉外膜及食管癌切除并行胃食管左颈部或弓上吻合术。结果手术死亡1例(2.9%),其余手术均顺利。术后并发肺部感染1例、房颤1例、心功能不全1例,经对症治疗均治愈;1、3、5年生存率分别为75.8%、51.5%、27.3%。结论侵及降主动脉外膜的食管癌手术治疗可明显改善患者生活质量,提高5年生存率。  相似文献   

2.
120例原发性肝癌的肝动脉化疗栓塞术疗效观察   总被引:6,自引:1,他引:6  
目的 观察中晚期原发性肝癌经导管肝动脉化疗栓塞术(TACE)治疗的疗效。方法自1990-2003年共有120例中晚期肝癌患者,接受TACE介入治疗,评估和随访治疗前后的疗效。结果经过治疗,79.2%(95/120)的患者临床症状缓解;88.3%(55/120)肿块缩小;78.2%(79/101)AFP明显下降;生存期延长,1、2、3年生存率分别为80.8%(87/120)、48.3%(58/120)和1130%(36/120)。结论TACE治疗是中晚期肝癌的有效手段,使不能手术切除的肝癌成为适应手术治疗,延长了患者的生命,提高了生活质量。  相似文献   

3.
直肠中下段癌手术治疗93例经验体会   总被引:2,自引:0,他引:2  
目的 本文报告经病理诊断确诊为直肠中下段癌89例进行手术治疗的经验体会。方法 为35例低位直肠癌患者行直肠癌根治超低位吻合术。用吻合器行低位直肠癌对端吻合28例,为2例直肠癌患者行局部切除术,为2例直肠癌患者行前切除。结肠拖出术,均成功保留了肛门。为26例行Miles手术。术后配合化疗、放疗以及中医中药和免疫治疗等。结果 手术并发症。术后肠梗阻5例,均经保守治疗而愈。除1例低分化腺癌并肺转移患者,术后1个月死亡外,无手术死亡。均经随访,局部复发6例(6.4%),3年生存率为(75/93)80.64%,5年生存率为(65/93)69.89%。结论 由于对直肠癌特别是中下段直肠癌淋巴转移和局部漫润规律和认识以及吻合器的应用,直肠中下段癌肿的手术出现了各种各样的保肛手术。为保证手术的彻底性,应严格掌握适应证,为提高效果,综合治疗是直肠癌治疗的基本模式之一,目前手术配合化疗、放疗,还有中医中药和免疫治疗等能提高疗效。  相似文献   

4.
肺癌侵及隆突的外科治疗   总被引:1,自引:0,他引:1  
目的:总结肺癌侵及隆突的外科治疗,研究分析其手术适应证、技术方法及术后管理。方法:全组病例共36例,右肺中心型肺癌25例,右侧纵隔型肺癌2例,其中侵及上腔静脉及无名静脉6例;左侧中心型肺癌9例;手术方式:行右隆突全肺或肺叶切除隆突重建术27例,6例同时行受侵上腔静脉及无名静脉切除人工血管置换;左隆突全肺切除9例。结果:全组无手术死亡,术后早期死亡4例(11.1%),循环衰竭3例,呼吸衰竭1例;1年生存率80.6%(29/36),3年生存率47.4%(9/19),5年生存率33.3%(3/9)。结论:对于肺癌侵犯隆突和上腔静脉及双侧无名静脉通过切除原发病变和部分受侵器官可达到临床根治之目的,辅于多学科的综合治疗,患者亦可获得良好的远期生存。  相似文献   

5.
目的1997年6月~2004年12月,本院共进行了各类胸腔镜手术732例,对45例肺转移癌施行了肺部分切除术,占同期手术量的6.15%,男性30例,女性15例,平均年龄53.27岁。26例原发部位为肺。所有病例均行肺部分切除术。其中32例行辅助小切口。每例切除结节1~3个。有37例行孤立肺结节切除术。均为原发灶切除后2年内定期随访中发现转移。术后给予对原发肿瘤敏感的化疗4~6个疗程。结果无手术死亡,1年内失访3例。术后生存率如下:1年为75%(24/32),3年为50%(11/22),5年为45%(9/20)。死亡病例中,肺腺癌转移2例,肺腺鳞混合癌转移2例,直肠癌转移3例,类癌转移1例。术后并发症有:漏气、出血、皮下气肿、肋间神经痛。所有病员在术后1周左右出院。结论对于有条件的病人,辅以合适的全身治疗,胸腔镜肺部分切除手术治疗肺转移癌不失为一种合理的选择,创伤小,且疗效肯定。  相似文献   

6.
对41例早期乳腺癌患者行肿瘤切除+乳房扇形切除+全腋淋巴结清扫术后应用双侧旋转皮瓣进行乳腺整形术。术后辅以放化疗和(或)内分泌治疗。结果:41例共清扫腋窝淋巴结6~28个,平均18个/例,术后均无复发;3、5、8a生存率分别为100%、97.56%、95.12%。保乳的美容效果满意率为95.1%。认为采用双侧旋转皮瓣行早期乳腺癌保乳术,可取得满意的肿瘤局部控制率、患者生存率和美容效果,是早期乳腺癌治疗的首选术式。  相似文献   

7.
633例中晚期食管癌患者的疗效分析   总被引:3,自引:0,他引:3  
将633例中晚期食管癌患者随机分为三组进行治疗,A组单纯手术,B组术前放疗+手术,C组术前放疗、休息2周后手术、术后辅以化疗。结果显示,A组肿瘤切除率低于B、C组(P〈0.05);术后死亡率、并发症三组无明显差异(P〉0.05);2年生存率三组相近(P〉0.05),3年生存率A组低于B、C组(P〈0.05),5年生存率A、B组相近(P〉0.05),但均低于C组(P〈0.05)。提示对中晚期食管癌宜  相似文献   

8.
对35例卵巢颗粒细胞瘤患者的临床病理资料进行回顾性分析。全部患者均接受过至少一次手术治疗,采取单纯手术6例,术后辅助放疗7例,术后辅助化疗13例,辅以放疗+化疗9例。结果:按寿命表法统计,3年、5年生存率分别为87.3%、75.8%,伴有子宫内膜增生者占34.3%。认为卵巢颗粒细胞瘤的治疗应采用以手术为主的综合疗法,除Ia期外,单纯手术治疗复发率高。术后辅以联合化疗是减少肿瘤复发、提高生存率的有效  相似文献   

9.
目的观察直肠癌术后不同方法、不同途径化疗用药对患者的生存及愈后的影响.方法选择无手术及化疗禁忌证的直肠癌患者103例,随机分组.实验组52例,于术中分别置腹腔引流管和髂内动脉化疗泵,自术后d5开始将5-FU750mg,DDP60mg~80mg,MMC6mg~10mg、地塞米松10mg~20mg,2%利多卡因10mL~15mL等溶于生理盐水1.5L~2.0L中,自腹腔引流管注入,1次/d连用3d~5d.并于术后1mo将5-FU500mg,MMC6mg自化疗系注入,1次/wk,连用4wk为一疗程,休息10mo后重复.对照组51例,术后常规行静脉辅助化疗,方案同实验组化疗泵用药.结果术后定期对患者进行随访复查,实验组治疗期间造血系统抑制及消化道反应明显轻于对照组,实验组有2例局部复发(3.8%),5例发生肝转移(9.6%);对照组9例局部复发(17.6%),13例肝转移(25.4%);实验组3a生存率78.8%(41/52),5a生存率69.2%(36/52);对照组3a生存率60.8%(31/51),5a生存率49.0%(25/51),以上各种指标经X平方检验统计学处理,具有显著性差异(P值均<0.05).结论术后腹腔灌注加髂内动脉置泵化疗对减少直肠腔术后复发、转移和提高患者的生存率具有显著性效果.  相似文献   

10.
目的:探讨原发性腹膜后实体瘤的诊断和治疗方法。方法:回顾性分析22例腹膜后实体瘤的临床资料。结果:22例中恶性肿瘤15例(68.2%),良性肿瘤7例(31.8%),22例腹膜后肿瘤中的3例位于盆腔腹膜后。由于本病的症状无特异性,临床误诊率高(22.7%)。结论:早期诊断是提高疗效的关键,手术切除肿瘤仍为当前主要治疗方法。不能行根治性切除的肿瘤或术后肿瘤复发者,应积极行手术减瘤或再次手术治疗。恶性淋巴瘤病人,术后辅以放疗和化疗是获得长期生存的有效措施之一。  相似文献   

11.
The aim of this study was to assess the efficacy and prognostic factors of definitive radiochemotherapy (RCT) for inoperable esophageal cancer. Between 1995 and 2005 all patients with inoperable esophageal cancer that underwent concurrent RCT were included in this retrospective study. Conventional computed tomography-based treatment planning as well as 3D-conformal radiotherapy (RT) was used. Maximum radiotherapy dose was 63 Gy. Chemotherapy consisted of cisplatin (20 mg/m(2) d1-5 and 29-33) and 5-FU (650-1000 mg/m(2) d1-5 and 29-33). Patients not suitable for RCT received radiotherapy alone. Toxicity was measured according to common toxicity criteria (CTC). Two hundred three consecutive patients with inoperable esophageal cancer that received definitive therapy were identified in this time period (160 with squamous cell carcinoma and 43 with adenocarcinoma). The 2-year overall survival probability was 21.2% whereas the progression-free survival at 2 years was 13.8% for all patients. In the univariate analysis, type of histology, T-stage, N-stage, application of chemotherapy, and the radiation dose were significantly correlated with overall/progression-free survival. Moreover, multivariate analysis revealed an independent prognostic impact for N-stage, radiation dose, and concurrent chemotherapy. Definitive RCT is an important palliative treatment option for patients with inoperable esophageal cancer. N-stage, radiation dose, and concurrent chemotherapy are important prognostic factors for survival.  相似文献   

12.
We investigated which prognostic factor could improve survival for esophageal cancer patients who received definite concurrent chemoradiation (CCRT). Eighty patients with age ≥18, Karnofsky Performance Scale (KPS) ≥ 60, and clinical stage T1-4N0-3M0 esophageal squamous cell carcinoma were enrolled from July 2004 to December 2015. They underwent definite intensity-modulated radiotherapy (IMRT) with or without simultaneous integrated boost to the primary tumor, and reception of concurrent chemotherapy ≥ 1 cycle. The primary endpoints were overall survival (OS), locoregional progression-free survival (LRPFS) and distant metastasis-free survival (DMFS). The median follow-up duration for alive patients was 21.5 months. The rates of 2-, 3- and 5-year OS/LRPFS/DMFS were 23.8%/53.5%/49.3%, 19.1%/44.6%/49.3%, and 13.0%/44.6%/43.9%, respectively. Only the non-clinical complete response (non-cCR) after CCRT was an independent poor prognostic factor in OS (HR 3.101, 95% CI 1.535–6.265, p = 0.0016). Radiation dose >50.4 Gy and chemotherapy ≥4 cycles significantly predicted better LRPFS (p = 0.0361 and 0.0163, respectively). Poorly differentiated tumor and stage III disease have poor DMFS (p = 0.0336 and 0.0411, respectively), and chemotherapy ≥ 4 cycles was a better predictor (p = 0.0004). In subgroup analysis, patients who received radiation dose ≤50.4 Gy with concurrent chemotherapy ≥4 cycles had the best survival outcome with 1-, 2-, 3- and 5-year survival rates of 73.7%, 39.4%, 31.5% and 17.5%, respectively. In conclusion, definite radiotherapy with concurrent chemotherapy ≥4 cycles improved the survival for patients with inoperable or locally-advanced esophageal squamous cell carcinoma.  相似文献   

13.
新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响   总被引:1,自引:0,他引:1  
目的:评估新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响。方法:1991-01/2000-12中晚期食管鳞癌患者473例,随机分为4组,新辅助放疗组(n= 118)、新辅助化疗组(n=119)、新辅助放化疗组(n=118)及对照组(单纯手术)(n=118),统计分析4组在切除率、病理分期、并发症、生存期等方面的差别结果:放疗组、化疗组、放化组与对照组相比均可提高根治性切除率(97.5%,86.6%,98.3% vs 73.7%,均P<0.01);放疗组、放化组与对照组相比有明显降期作用(P<0.01);而化疗组没有明显降期作用.放疗组、化疗组、放化组与对照组相比,手术并发症无明显增加(P>0.05),放疗组、放化组的3a生存率相比对照组显著提高(69.5%,73.7% vs 53.4%,均P<0.01).放化组的5a生存率优于放疗组,但无统计学意义(45.O% vs 40.7%,P>0.05).结论:合理应用新辅助放化疗可提高中晚期食管鳞癌患者生存期并提高其生存质量.  相似文献   

14.
OBJECTIVE: Patients with advanced esophageal carcinoma including clinical T4 tumor, extensive lymph node metastasis, or intramural metastasis have a dismal prognosis, despite recent multimodality treatments. The aim of this study was to evaluate the efficacy and toxicity of neoadjuvant chemotherapy using fluorouracil, doxorubicin, and cisplatin or nedaplatin (FAP/N) in these patients. MATERIAL AND METHODS: Twenty-six patients were enrolled in this study. The first 9 patients received 600 mg/m2 fluorouracil on days 1-7 and days 29-35, and 30 mg/m2 doxorubicin and 60 mg/m2 cisplatin on days 1 and 29 (FAP). The next 17 patients received modified FAP, in which 50 mg/m2 nedaplatin was given instead of cisplatin (FAN). RESULTS: Grade 3 or 4 toxicities developed in 6 patients (23.1%) during chemotherapy, but there was no discontinuation of treatment. The clinical response rate was 46.2%. Twenty-one patients (80.8%) underwent esophagectomy, and R0 resection was achieved in 16 patients (61.5%). The 1-year survival rates of 26 patients, 21 patients with resectable tumor, 16 with R0 resection, and 12 clinical responders, were 31.3%, 32.1%, 33.3%, and 45.5%, respectively, each with a median survival time of 9 months. The median progression-free survival time of 26 patients was 6 months; in 16 patients with R0 resection progression-free survival was 6.5 months. There was no correlation between the recurrence pattern and tumor spread before treatment. CONCLUSIONS: FAP/N was found to have acceptable toxicities and the ability to control locoregional tumors, but made little contribution to patient survival. The efficacy of this treatment for patients with advanced esophageal carcinoma, however, may not yet be apparent.  相似文献   

15.
BACKGROUND The rare incidence of esophageal neuroendocrine carcinoma(NEC) and limited treatment experience result in insufficient clinical observations and unsuitable guidelines for its management.AIM To investigate the prognostic value of pretreatment contrast-enhanced computed tomography(CT) characteristics in patients with esophageal NEC.METHODS Seventy-seven esophageal NEC patients who received contrast-enhanced CT at two hospitals were enrolled in this study from June 2014 to December 2019. The clinical features and image characteristics were recorded accordingly. Univariate survival analysis was performed using the Kaplan-Meier method and log-rank test, and multivariate analysis was carried out with a Cox proportional hazards model.RESULTS The multivariate analysis performed using the Cox proportional hazards model showed that N stage, adjuvant chemotherapy, and degree of enhancement were independent prognostic factors for overall survival(OS). Meanwhile, adjuvant chemotherapy was an independent prognostic factor for progression-free survival (PFS). The hazard ratios(HRs) of N stage, adjuvant chemotherapy, and degree of enhancement(mild vs moderate/marked) for OS were 0.426(P = 0.024), 3.862(P = 0.006), and 2.169/0.809(P = 0.037), respectively. The HR of adjuvant chemotherapy for PFS was 6.432(P 0.001). Adjuvant chemotherapy was significantly associated with degree of enhancement(P = 0.018).CONCLUSION Adjuvant chemotherapy is an independent prognostic factor for OS and PFS. Additionally, N stage and degree of enhancement are prognostic factors for OS in patients with esophageal NEC.  相似文献   

16.
SUMMARY.  The Medical Research Council trial for oesophageal cancer (OEO2) trial demonstrated a clear survival benefit from neoadjuvant chemotherapy in resectable esophageal carcinoma. Since February 2000 it has been our practice to offer this chemotherapy regime to patients with T2 and T3 or T1N1 tumors. We analyzed prospectively collected data of patients who received neoadjuvant chemotherapy prior to esophageal resection under the care of a single surgeon. Complications of treatment and overall outcomes were evaluated. A total of 194 patients had cisplatin and 5-fluorouracil prior to esophageal resection. Six patients (5.7%) had progressive disease and were inoperable (discovered in four at surgery). During chemotherapy one patient died and one perforated (operated immediately). Complications including severe neutropenia, coronary artery spasm, renal impairment and pulmonary edema led to the premature cessation of chemotherapy in 12 patients (6.2%). A total of 182 patients with a median age of 63 (range 30–80), 41 squamous and 141 adenocarcinomas underwent surgery. Operations were 91 left thoracoabdominal (50%), 45 radical transhiatal (25%), 40 Ivor-Lewis (22%) and six stage three (3%), and 78.6% had microscopically complete (R0) resections. Median survival was 28 months with 77.3% surviving for 1 year and 57.7% for 2 year. In hospital mortality was 5.5% and anastomotic leak rate 7.7%. A radical surgical approach to the primary tumor in combination with OEO2 neoadjuvant chemotherapy has led to a high R0 resection rate and good survival with acceptable morbidity and mortality.  相似文献   

17.
These articles both report the results of multi-institutional, randomized, phase 3 trials for the treatment of patients with localized (T1-3 N0-1 M0) esophageal squamous cell carcinoma (SCC) or esophageal adenocarcinoma. Both studies were initiated and coordinated by the Radiation Therapy Oncology Group (RTOG) but included patients enrolled by other study groups as well. Cooper et al. report late follow-up results for the RTOG 85-01 trial that was conducted between 1986 and 1990. This trial randomized patients to either radiation therapy (RT) alone (RT, 64 Gy in 32 fractions over 6.4 wk, n = 62) or combined RT and chemotherapy (50 Gy in 25 fractions over 5 wk, plus cisplatin 75 mg/m2 i.v. on first day of wk 1, 5, 8, and 11, and continuous infusion fluorouracil (5FU) 1 g/m2 per day on the first 4 days of the same weeks, n = 61). Most (82%) of the patients had SCC. Eight percent of the cohort randomly assigned to combined modality therapy experienced acute life-threatening toxic effects, and an additional 2% died as a direct consequence of treatment. The randomized trial was halted in 1990 when an interim analysis found a highly significant difference in survival favoring the combined therapy group, after which 73 consecutive patients were enrolled into a nonrandomized study offering only the combined therapy regimen. At 5-yr of follow-up, the overall survival rate for the combined therapy group in the randomized study was 26% (95% CI, 15-37%) compared with 0% for RT alone. In the nonrandomized study, the 5-yr overall survival rate was 14% (95% CI, 6-23%). The histopathological type of tumor did not significantly influence survival. Cooper et al. now report that 22% of the randomized combined modality group survived at least 8 yr after treatment, and that there were no deaths caused by esophageal cancer after 5 yr post-treatment. The study reported by Kelsen et al. included 440 patients with esophageal adenocarcinoma (n = 236) or SCC (n = 204) randomized to either preoperative chemotherapy plus esophagectomy or to esophagectomy alone. The chemotherapy regimen consisted of three cycles of preoperative cisplatin and 5FU and two cycles after operation for responding patients. Doses were higher than those used in the RTOG 85-01 trial. Although radiation therapy was not part of the treatment plan, it could be given in some circumstances. There was no significant difference in median survival (14.9 months for chemotherapy plus surgery compared with 16.1 months for surgery alone), and there were also no significant differences in 1-yr, 2-yr, 3-yr, or disease-free survival rates. There were no significant differences in survival between patients with adenocarcinoma and those with SCC. A clinical response to chemotherapy, as assessed by barium contrast radiography, was found in 19% of patients who received chemotherapy. A complete pathological response was found in 2.5% of patients. There was no significant increase in operative complications in the chemotherapy treated group.  相似文献   

18.
Lu TY  Li WB  Li X  Wang LX  Wang RL  Zhang L  Lu SX  Fan QX 《中华内科杂志》2010,49(10):848-850
目的 观察维A酸受体β(RAR-β)在食管鳞癌中的表达及其与化疗疗效的关系.方法 52例中晚期食管鳞癌患者给予以顺铂(DDP)+5-氟尿嘧啶(5-FU)为基础的联合方案化疗.DDP 80 mg/m2,分为5 d静脉滴注;5-FU每日375 mg/m2,第1~5天静脉滴注,21 d为1个周期.应用免疫组化法检测RAR-β在食管鳞癌组织中的表达.以50例正常食管黏膜作为对照.结果 RAR-β阳性染色主要位于细胞质和(或)胞核,食管鳞癌组织中RAR-β阳性率(61.5%,32/52)明显低于正常食管黏膜组织(92.0%,46/50),P<0.05.52例食管鳞癌患者共完成228个化疗周期,总有效率71.2%,RAR-β阳性表达者有效率84.4%(27/32),显著高于RAR-β阴性表达者的50.0%(10/20),P<0.05.RAR-β阳性表达者中位疾病进展时间为5.9个月,中位生存时间12.1个月,2年生存率56.7%;而RAR-β阴性表达者中位疾病进展时间为2.1个月,中位生存时间5.8个月,2年生存率32.9%,两组间比较差异均有统计学意义(P<0.05).结论 免疫组化法检测RAR-β的表达可作为临床上预测食管癌化疗疗效及预后的指标之一,同时RAR-β可能成为食管癌治疗的靶点.  相似文献   

19.
The purpose of this study was to address the feasibility of combination chemotherapy of docetaxel and nedaplatin for recurrent esophageal cancer patients in an outpatient setting. Patients received docetaxel (30 mg/m(2) intravenously) on day 1 and nedaplatin (40 mg/m(2) intravenously) on day 1 every 2 weeks. In total, 28 patients with recurrent esophageal cancer after the initial treatment (esophagectomy, chemotherapy and/or chemoradiotherapy) were enrolled. Each patient received six cycles of treatment and was evaluated with a computed tomography scan. The percentage of patients who completed this therapy was 60.7%. Complete response and partial response were achieved by 3.6% and 35.7% of patients, respectively. The most frequent toxicities were leukopenia and anemia; non-hematological toxicities were generally mild. There was no treatment-related death. The median survival time and 1-year survival rate were 8.5 months and 15.9%, respectively. This outpatient combination chemotherapy was useful as second-line chemotherapy for recurrent esophageal cancer.  相似文献   

20.
The role of neoadjuvant therapy in the treatment of locally advanced esophageal carcinoma still remains controversial. The aim of this study was to evaluate the effects of neoadjuvant radiochemotherapy on pathological staging and prognosis in the patients with locally advanced esophageal squamous cell carcinoma. Between January 1991 and December 2000, 473 patients with advanced esophageal carcinoma diagnosed by endoscopic biopsy underwent surgical resection in our center. With informed consent, they were randomized into four groups: neoadjuvant chemotherapy, neoadjuvant radiotherapy, neoadjuvant radiochemotherapy, and surgery alone (control group). The preoperative computed tomography staging criteria were the following: Stage I, the tumor limited to the esophageal lumen or the thickness of the esophageal wall varied between 3–5 mm; Stage II, the thickness exceeds 5 mm but no invasion to the mediastinum or distant metastasis; Stage III, the tumor invades adjacent mediastinal structure; and Stage IV, there is distant metastasis. The tumor resection rate, pathological stage, treatment‐related complication, and survival among groups were compared. The radical resection rate for the patients in radiotherapy and radiochemotherapy groups was increased in comparison with the control group (P < 0.05). Their pathological stage after esophagectomy was regressed significantly than that of the control group (50.85%, 55.08% vs. 0%, P < 0.05). The adjuvant chemotherapy group did show significant improvement on resection rate and pathological staging compared with the control group. The treatment‐related complication in the three neoadjuvant groups had no significant difference from that of the control group (P > 0.05). The 3‐year survival rate of radiotherapy and radiochemotherapy groups were significantly higher than that of the control group (69.49%, 73.73% vs. 53.38%, P < 0.05). The 5‐year survival rate of radiochemotherapy group was higher than that of the radiotherapy group although did not show a statistical difference (P > 0.05). Rational application of neoadjuvant radiochemotherapy seems to provide a modest benefit in radical resection and survival in patients with locally advanced esophageal carcinoma.  相似文献   

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