恶性机械性肠梗阻临床诊疗

恶性机械性肠梗阻是晚期肿瘤常见并发症之一，通常以内科综合治疗为主。了解其病理生理机制（包括“不协调蠕动-组织水肿-不协调蠕动”及“分泌-扩张-分泌”恶性循环），明确梗阻的分类、亚型和完善肿瘤内科的系统评估（包括一般情况、脏器功能、肿瘤学评估、营养代谢及肠屏障功能）是其有效治疗的前提。治疗原则和目的是尽量减少，甚至解除机体肿瘤负荷，改善或根治肠梗阻所致不良症状、体征及肠功能异常，纠正水、电解质紊乱及营养代谢紊乱状态，最终改善患者生活质量及总生存。具体措施包括基础治疗、营养治疗和代谢调节、抗炎、减轻肠壁水肿、抑制消化道腺体分泌、修复肠道屏障及防治感染、抗肿瘤病因治疗及运动疗法、心理治疗。其中抗肿瘤病因治疗是临床中的难点，因恶性肠梗阻多伴随营养不良、一般情况差，难以耐受常规抗肿瘤治疗，抗肿瘤治疗上需兼顾肿瘤因素、营养状况及患者一般情况等，有效的抗肿瘤治疗是肠梗阻再通的基本保障。     

全肠外营养在晚期肿瘤中应用价值探讨

目的探讨晚期肿瘤患者全肠外营养支持的临床价值。方法通过多项指标评价38例晚期肿瘤患者的营养状况和免疫功能,38例患者均存在营养不良和免疫功能低下,将病人分为二组,治疗组22例,行颈内静脉置管给予全肠外营养;对照组16例则行口服饮食和(或)常规外周静脉营养。3周后再测定各项指标并行统计学处理。结果治疗组治疗前和治疗组治疗后与对照组治疗后的营养指标、免疫功能指标均明显改善(均P<0.05),治疗组生存期明显延长(P<0.01)。结论全肠外营养可以改善晚期肿瘤患者的营养状况,提高免疫力,改善生活质量,延长生存期。     

大肠癌病友的饮食与营养

大肠包括人体肠道的结肠和直肠部分,其中结肠的生理功能主要为吸收水分,直肠的生理功能主要在于协调控制大便的排出。肠肿瘤患者由于疾病本身或手术、放化疗等原因,部分患者可能发生肠功能紊乱,出现肠梗阻、便秘、腹泻、腹胀腹痛、贫血等症,影响患者的饮食和营养状况。     

谷氨酰胺和生长激素与短肠患者肠功能恢复(附1例报道)(英文)

小肠次全切除通常导致患者营养吸收障碍。在没有肠外营养的条件下,此类患者的长期生存依赖于肠道功能的恢复,即残留小肠的吸收功能的增强。一名56岁男性患者因肠系膜反复自发出血,先后行3次手术治疗,最终导致小肠次全切除并全结肠切除。第3次手术后,在肠外营养的基础上,给予生长激素和L-谷氨酰胺治疗。治疗1个月,患者完全脱离肠外营养。术后1年,患者体重增加7kg。实验室检测血红蛋白浓度112g/L,白蛋白36.8g/L。此病例提示我们在全结肠切除的情况下,120cm残留回肠可以满足患者的营养需求。生长激素和L-谷氨酰胺的应用可以促进残留回肠吸收功能的恢复。     

谷氨酰胺和生长激素与短肠患者肠功能恢复（附1例报道）（英文）

小肠次全切除通常导致患者营养吸收障碍。在没有肠外营养的条件下,此类患者的长期生存依赖于肠道功能的恢复,即残留小肠的吸收功能的增强。一名56岁男性患者因肠系膜反复自发出血,先后行3次手术治疗,最终导致小肠次全切除并全结肠切除。第3次手术后,在肠外营养的基础上,给予生长激素和L-谷氨酰胺治疗。治疗1个月,患者完全脱离肠外营养。术后1年,患者体重增加7kg。实验室检测血红蛋白浓度112g/L,白蛋白36.8g/L。此病例提示我们在全结肠切除的情况下,120cm残留回肠可以满足患者的营养需求。生长激素和L-谷氨酰胺的应用可以促进残留回肠吸收功能的恢复。     

肠道菌群与结直肠癌的研究进展

肠道细菌屏障即肠黏膜生物屏障及肠道益生菌的功能与临床多种疾病的成因和治疗有着紧密的联系,如炎症性肠病、肝硬化、肿瘤等.肠道细菌屏障及肠道益生菌能够通过协同免疫屏障、机械屏障对肿瘤起杀伤作用,并可分泌相关生化产物对抑制肿瘤生成,同时可以促进肿瘤细胞的凋亡,改善肠道肿瘤微环境.全文结合最近国内外的研究状况对肠道细菌屏障及益生菌与肿瘤之间的关系作一综述.     

1例膀胱癌膀胱全切术后合并不全肠梗阻的护理

目的 通过对1例膀胱癌膀胱全切术后合并不全肠梗阻的护理，进一步了解术后肠不全梗阻的护理方法。方法总结1例膀胱癌膀胱全切术后合并不全肠梗阻的护理经验。结果在膀胱全切术后常规护理基础上，加强腹部体征观察，正确运用胃肠减压，肛管排气及温肥皂水灌肠等技术，做好患者心理干预，经过精心的护理，病人肠道功能恢复，痊愈出院。结论术后并发肠黏连、不全肠梗阻及时发现，及时对症处置，是可以通过保守治疗而痊愈的。     

全肠造影CT检查对肠道肿瘤诊断价值的研究

目的评价全肠造影ＣＴ检查对肠道肿瘤诊断的价值。方法口服稀碘糖溶液小肠造影即时肛门充氧气大肠造影进行ＣＴ检查，即全肠造影ＣＴ检查。材料选择全肠造影ＣＴ检查、Ｘ线气钡双重对比造影、内镜等检查资料齐全，且有手术和病理证实的４０例肠肿瘤患者进行分析。结果检出最小病灶小肠为０．７ｃｍ，大肠为０．４ｃｍ。结、直肠癌术前与术后的临床病理分期符合率达７０％，良恶性诊断复合率为８７．５％；区域淋巴结转移诊断复合率为８５．７％，肝转移诊断复合率为１００％。结论①检查方法简便安全，对比度好，较小的肿瘤就能被发现。②病变检出率及临床分期准确率高。③对肠道弥漫占位性疾病通过一次检查即能完成病变分布的诊断。④能清楚地显示因结构复杂，其它肠道检查方法易于漏诊部位（如回盲部）的肠道肿瘤。⑤对大肠肿瘤定位准确。     

肠道上皮细胞再生修复与恶性转化的研究现状

肠黏膜慢性炎症是肠道肿瘤发展的重要组成部分.近期,对肠道肿瘤患者的高通量测序研究发现了一个潜在的、以伤口愈合和先天免疫基因过表达为特征的结肠癌分子亚型,它提示了一种可能依赖于炎症细胞和细胞因子的肿瘤发展机制,增强了我们对细胞恶性转化的理解,以及突出了抗炎在肿瘤治疗中的作用.本文将对正常的肠黏膜更新、伤口愈合和恶变的机制做一综述.     

胰腺癌围手术期营养治疗的策略

胰腺癌患者围手术期易发生营养不良。术前营养不良因素包括胰腺功能不全与肿瘤引起的代谢改变,术后应激与炎症等因素增加了短期内营养不良风险,围手术期营养不良是导致整体预后不良的独立危险因素,因此有必要开展全程化营养管理。入院后患者常规进行营养筛查,应用量化的营养筛查工具可以判断营养风险,对于营养风险较高的患者需进一步行营养评估,加速康复外科建议术前出现体重丢失>15%或体质指数<18.5 kg/m²的患者行营养治疗,营养治疗遵循阶梯递升式原则,术前营养状态将影响手术时机的选择。单一指标无法完整描述术后患者的营养状态,建议采用多种方式动态监测营养状况并综合分析。术后营养治疗需结合患者病情与营养状况制订个体化方案,合理选择营养治疗途径能避免为患者带来额外的痛苦与经济负担。早期经口进食被认为是安全有效的,但对于口服耐受不佳的患者应及时启动人工营养。肠内营养具有维持肠道功能等优势,但全肠外营养在严重肠瘘、胃排空延迟等并发症治疗中具有巨大价值。     

Bowel injury: current and evolving management strategies

The intestine is often dose limiting during abdominal and pelvic radiation therapy. Delayed bowel toxicity is difficult to manage and adversely impacts the quality of life of long-term cancer survivors. Of the 8 to 9 million cancer survivors currently living in the United States, more than half have had abdominal or pelvic tumors, and about 60% of these patients have undergone or will undergo radiation therapy. Therefore, interventions that limit postradiation intestinal dysfunction would significantly improve outcomes in a large number of patients. Worthwhile steps toward reducing toxicity of treatments have been taken recently by introducing dose-sculpting treatment techniques. However, prophylactic or therapeutic approaches derived from an improved understanding of the pathophysiology of bowel injury will result in further advances. This article reviews current principles in the diagnosis and management of intestinal radiation injury. It also provides an overview of investigational strategies aimed at reducing radiation-induced bowel toxicity. These strategies include free radical scavengers, antioxidants, cytoprotective agents, cytokines, and enterotrophic interventions, as well as modulators of intraluminal factors, endothelial dysfunction, and neuroimmune interactions. Preclinical testing in clinically relevant animal models will facilitate translation of these strategies into the clinic and contribute to improving cancer cure rates and quality of life in cancer survivors.     

Sexual function after surgery for prostate or bladder cancer.

BACKGROUND: Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer. METHODS: The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems. RESULTS: Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation. CONCLUSIONS: Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.     

S-1-based chemotherapy for unresectable advanced gastric cancer of the elderly or patients with renal dysfunction

Objective: S-1 based therapy is a valued standard chemotherapy regimen for unresectable gastric cancer in Japan. S-1/ CDDP therapy has been highly effective, especially for patients under 75 years old who have good organ function. However, it is the elderly and/or patients with renal dysfunction who make up the majority of the candidates for chemotherapy in general hospitals. These factors make it difficult to apply the results of RCTs to chemotherapy regimens. Aim and methods: To investigate clinical outcomes, the medical records of patients who had received S-1 based chemotherapy for gastric cancer at our hospital from January 2002 to September 2009 were retrospectively reviewed. Results: A total of 78 patients were evaluated for analyses. Among the patients, 23(29%)were the elderly, 8(10%)had renal dysfunction, and 27(35%)were either the elderly or those who had renal dysfunction. S-1/CDDP therapy was provided for 63% of the patients. Regarding the outcomes from therapy, RR was 44%, mPFS was 5. 4 months, and MST was 10. 6 months. Regarding survival benefit for OS, the elderly, the intestinal type, and therapy with S-1 alone were considered to be good factors in multi-variant analysis, but no significant differences were confirmed. Conclusion: In general practice, the elderly and/or patients with renal dysfunction account for 35%, and S-1-based chemotherapy has been proven to be very effective. However, additional effects of CDDP were not shown in this study.     

肝癌共病抑郁分子机制的研究进展

肝癌患者共病抑郁的发生率极高,且抑郁是影响肝癌患者预后的不良因素。了解肝癌共病抑郁的分子机制对疾病的诊断和治疗至关重要。因此,本文以两者涉及的发病机制为出发点,结合现有的研究成果,从自主神经功能紊乱、下丘脑-垂体-肾上腺(Hypothalamic-pituitary-adrenal, HPA)轴功能异常、炎症因子比例失调、5-羟色胺(5-hydroxytryptamine, 5-HT)系统调节异常、肠道菌群失调和氧化应激反应六个方面就两者共病的分子机制研究进展做一综述。     

Risque élevé de dysfonction cardiaque des leucémies aiguës myéloïdes secondaires à un cancer du sein

Secondary acute myeloid leukaemia (AML) occurring after breast cancer is a rare long-term complication of the chemo- and/or radiation therapy required to treat breast cancer. The usually recognized curative option of these secondary AML includes courses of anthracycline-based chemotherapy followed by haematopoietic stem cell transplantation (HSCT). Cardiac dysfunction during AML treatment of these patients previously treated with anthracyclines for breast cancer has not been reported to date. We evaluated the evolution of cardiac function in seven patients treated with anthracyclines and/or autologous or allogeneic bone marrow transplantation for secondary AML occurring after breast cancer. All of the patients who received a cumulative anthracycline dose above the cardiac toxicity threshold developed cardiac symptoms during AML chemotherapy courses. Moreover, four of the five transplanted patients developed severe heart failure among which two were fatal. Thus, the risk of severe cardiac dysfunction after treatment of secondary AML following breast cancer must be taken in account as part of the therapeutic strategy of those patients. As discussed here, an accurate evaluation of risk factors, the use of sensitive detection tests and of cardioprotective drugs as well as that of non-cardiotoxic chemotherapy might decrease the occurrence and severity of this life-threatening complication.     

Clinical implications of trastuzumab

C-erbB-2 (HER2/neu) protein overexpression or amplification has been noted in some solid tumors a molecular target for tumor suppression. C-erbB-2 protein is localized on the membrane surface and is classified in the EGFR family. Trastuzumab is a humanized monoclonal antibody which binds to the extracellular domain of the c-erbB-2 protein in breast cancer cells. Good responders to trastuzumab may be ICH 2 + and FISH positive breast tumors, and ICH 3 + cancer. The response rate is approximately 15% with single administration of trastuzumab. Combination therapy with paclitaxel for the treatment of patients with metastatic cancer may bring more than 60% response and improve time to disease progression. Congestive heart failure associated with trastuzumab may be severe, and combination therapy which includes anthracyclines increases the incidence and severity of cardiac dysfunction. Other toxicities include infusion reaction.     

Radiotherapy-induced thyroid disorders

Despite their specific functional consequences, radiotherapy-induced thyroid abnormalities remain under-estimated and underreported. These sequelae may include primary or central hypothyroidism, thyroiditis, Graves' disease, euthyroid Graves' ophthalmopathy, benign adenomas, multinodular goitre and radiation-induced thyroid carcinoma. Primary hypothyroidism, the most common radiation-induced thyroid dysfunction, affects 20-30% of patients administered following curative radiotherapy to the neck region, with approximately half of the events occurring within the first 5 years after therapy. The relative risk of radiation-induced cancer (mainly well-differentiated tumours) is 15-53-fold higher than in non-irradiated population. The aetiology of radiation-induced thyroid injury includes vascular damage, parenchymal cell damage and auto-immune reactions. Total radiotherapy dose, irradiated volume of the thyroid gland, and the extent of prior thyroid resection are among the most important factors associated with the risk of hypothyroidism. The contribution of other treatment modalities (chemotherapy, endocrine therapy) as well as patient- and tumour-related factors is less clear. Reduction in radiation dose to the thyroid gland and hypothalamic/pituitary complex should be attempted whenever possible. New radiotherapy techniques, such as stereotactic radiosurgery, three-dimensional conformal irradiation, intensity modulated radiotherapy and proton therapy allow generally better dose distribution with lower dose to the non-target organs. The diagnostic approach to thyroid radiation injury includes baseline thyroid function assays in all patients undergoing thyroid or parasellar irradiation. Recommended follow-up procedures include at least annual evaluation with a history for symptoms of thyroid dysfunction, clinical examination, and measurement of thyroid hormones and thyrotropin. Management of overt hypothyroidism is based on hormone replacement therapy. Thyroid hormone therapy is also recommended in cases of subclinical hypothyroidism. Treatment of other radiation-induced thyroid disorders (thyroiditis, Graves' disease, thyroid cancer) is similar to that employed in spontaneously occurring conditions. Further improvements in radiotherapy techniques and progress in endocrine diagnostics and therapy may allow better prevention and management of radiation-related thyroid injury.     

分化型甲状腺癌131I治疗后导致唾液腺功能障碍的相关研究进展

131I治疗作为分化型甲状腺癌（differentiated thyroid cancer，DTC）常规治疗手段之一，其常见的毒副反应之一是唾液腺功能障碍。由于DTC患者生存期长，唾液腺功能障碍会影响患者的日常生活和心理健康，逐渐引起许多学者的担忧。了解131I治疗后导致的唾液腺功能障碍的机制、临床表现和诊治方法对于提高患者的生活质量至关重要。因此，本文对DTC患者131I治疗后导致的唾液腺功能障碍进行了系统的综述。     

Artificial gastrointestinal tract in gastrointestinal neoplasms]

From 1970 to 1977 an artificial gut was used in 1350 patients suffering from gastrointestinal cancer. This type of prolonged intestinal assistance was recognized to be an important adjuvant in anticancer therapy with indications prior to, during and following the traditional course of treatment. Prolonged intestinal assistance makes it possible to reestablish or maintain a biological and clinical status in patients who must undergo aggressive anticancer therapy. The indications for its use are multiplying. In 54% of the cases parenteral nutrition is associated with therapy of the curative type and this percentage is continuously increasing.     

Andropause: symptom management for prostate cancer patients treated with hormonal ablation

Andropause, or the age-related decline in serum testosterone, has become a popular topic in the medical literature over the past several years. Andropause includes a constellation of symptoms related to lack of androgens, including diminished libido, decreased generalized feeling of well-being, osteoporosis, and a host of other symptoms. The andropause syndrome is very prominent in men undergoing hormonal ablation therapy for prostate cancer. Most significant in this population are the side effects of hot flashes, anemia, gynecomastia, depression, cognitive decline, sarcopenia, a decreased overall quality of life, sexual dysfunction, and osteoporosis with subsequent bone fractures. The concept of andropause in prostate cancer patients is poorly represented in the literature. In this article, we review the current literature on the symptoms, signs, and possible therapies available to men who cannot take replacement testosterone.