颈清扫术后乳糜瘘和乳糜胸的诊断和治疗

目的：探讨颈清扫术后颈乳糜瘘及乳糜胸的发生原因、治疗方法。方法：34颈部乳糜瘘者采用颈部加压包扎＋负压引流,4例在保守治疗无效后,改为手术探查结扎瘘口或胸导管。2例乳糜胸行保守治疗,1例保守治疗无效开胸结扎胸导管。结果：34例颈部乳糜瘘采用颈部加压包扎＋负压引流后,30例痊愈,4例失败后经手术治疗痊愈,平均愈合时间10．2天（3-15天）。两例乳糜胸经保守治疗痊愈,1例保守治疗无效开胸结扎胸导管治愈。结论：颈部乳糜瘘和乳糜胸是少见的淋巴结清扫术后并发症,大多可以保守治疗治愈。     

45例甲状腺癌患者术后乳糜漏的护理

目的回顾性总结甲状腺癌术后并发症乳糜漏患者的护理经验。方法选取2017年9月至2018年4月间中国医学科学院北京协和医学院肿瘤医院收治的45例甲状腺癌术后并发乳糜漏患者,分析术后饮食控制、静脉营养支持、局部加压包扎、持续负压引流、手术、感染预防及心理护理等综合治疗和护理对乳糜漏的治疗影响。结果38例乳糜漏患者经过非手术方法得到治愈,6例乳糜漏患者经过胸腔镜下胸导管结扎术得到治愈,1例在局麻下行颈部淋巴管修补术得到治愈。所有患者均无严重感染及其他术后并发症。结论有效的治疗和护理对甲状腺癌术后并发乳糜漏患者的康复起促进作用。     

颈清扫术后乳糜瘘和乳糜胸的诊断和治疗

目的:探讨颈清扫术后颈乳糜瘘及乳糜胸的发生原因、治疗方法.方法:34颈部乳糜瘘者采用颈部加压包扎+负压引流,4例在保守治疗无效后,改为手术探查结扎瘘口或胸导管.2例乳糜胸行保守治疗,1例保守治疗无效开胸结扎胸导管.结果:34例颈部乳糜瘘采用颈部加压包扎+负压引流后,30例痊愈,4例失败后经手术治疗痊愈,平均愈合时间10.2天(3-15天).两例乳糜胸经保守治疗痊愈,1例保守治疗无效开胸结扎胸导管治愈.结论: 颈部乳糜瘘和乳糜胸是少见的淋巴结清扫术后并发症,大多可以保守治疗治愈.     

强负压吸引治疗8例颈淋巴结清扫术后乳糜瘘

背景与目的颈部乳糜瘘是颈部手术后的并发症之一,其产生机制与其特定的解剖位置及变异密切相关,有关其治疗的意见仍有分歧。本文总结8例颈清扫术后并发乳糜瘘患者采用强负压吸引和饮食处理的临床经验,以评价其疗效。方法全部病例在确诊为乳糜瘘后立即采用强负压(-50～-30kPa)吸引,嘱禁食并给予合理的静脉营养。结果7例患者经此保守治疗痊愈,未出现其他严重并发症;1例无效,采用胸大肌肌瓣填塞。结论强负压吸引和合理的饮食处理有可能是颈清扫术后并发乳糜瘘早期处理较为理想且安全的保守疗法之一。     

甲状腺癌中央区淋巴结清扫术后并发乳糜漏临床诊治分析

目的:探讨甲状腺癌行中央区淋巴结清扫术后出现乳糜漏的原因、临床特点以及诊治方法。方法:回顾分析2015年8月至2019年8月西京医院甲乳血管外科行甲状腺癌中央区淋巴结清扫术后发生乳糜漏的9例患者的临床资料。结果:乳糜漏发生率为0.37%,出现在术后的第1～2天,中位时间1.2天;发生乳糜漏之前的引流量峰值为30～100 mL,中位数为85 mL;乳糜漏发生后,最大值为30～300 mL,中位数为75 mL。乳糜漏病人淋巴结清扫区域:左侧中央区清扫1例（11.1%）;右侧中央区清扫2例（22.2%）;双侧中央区清扫6例（66.7%）。淋巴结清扫数目8～27枚。发生乳糜漏后,6例经低脂或禁饮食、应用生长抑素或奥曲肽、持续低负压引流痊愈,3例经禁食、应用生长抑素、持续低负压引流效果不佳,经高负压引流、阶段退管等治疗后痊愈。乳糜漏基本治愈时间为3～15 d,中位时间5 d。结论:甲状腺癌中央区淋巴结清扫术后乳糜漏发生率较低,一般为轻中度,及时采取调整饮食或辅以持续低负压吸引可在短期内治愈,若低负压引流效果不佳,可采用高负压引流。     

甲状腺癌中央区淋巴结清除术后乳糜漏的防治

目的:探讨甲状腺癌中央区淋巴结清除术后乳糜漏发生的原因及有效的防治措施。方法:选取天津医科大学肿瘤医院2013年7 月至2015年6 月6 127 例甲状腺癌中央区淋巴结清除术病例,其中14例患者术后并发乳糜漏。采取全身治疗、局部加压包扎、常压引流、50% 葡萄糖注射液或平阳霉素经引流管注入等保守治疗,保守治疗效果不理想时行手术治疗。结果:12例患者行保守治疗后,引流量逐渐减少,至< 10mL/d时拔除引流管;2 例患者保守治疗后,引流量未见明显减少,行手术治疗。结论:甲状腺癌中央区淋巴结清除术时应仔细操作以预防乳糜漏的发生,发生后行保守治疗,保守治疗无效时行手术治疗。      

甲状腺癌颈廓清术后乳糜瘘的治疗体会

目的：甲状腺癌术中常规需要进行颈廓清术,术后会有乳糜瘘的发生,尽管发生率低,但后果严重。本研究总结治疗乳糜瘘的经验。方法：回顾分析近5年盛京医院普通外科262例因甲状腺乳头状癌行颈廓清手术的患者资料。以术后颈前引流液乳白色作为乳糜瘘判定标准,根据颈前引流量的情况及全身状况,分别采用不同的治疗方法,并对治疗效果进行评价。结果：共9例出现乳糜瘘,发生率3．4％。1例经过手术治疗痊愈,1例并发乳糜胸,经过胸腔穿刺治愈,其余7例均经过局部加压包扎,负压吸引,营养支持,积液穿刺治愈。结论：颈廓清术中应该熟悉解剖,仔细操作,以减少乳糜瘘发生。一旦并发乳糜瘘,多数可以采用保守方法治愈,只有保守治疗无效时才考虑手术治疗。     

颈廓清术并发颈乳糜瘘及乳糜胸的治疗

目的　探讨颈乳糜瘘及乳糜胸的发生原因、治疗方法及预防措施。方法　６２ 例乳糜瘘中３５ 例采用单纯局部压迫,２１ 例采用持续负压引流加局部压迫,６ 例手术缝扎。４ 例乳糜胸１ 例采用胸腔穿刺,３例开胸结扎胸导管。结果　采用单纯压迫的３５例,３０例痊愈,５ 例失败,经手术治疗痊愈,平均愈合时间为１５．２（９～２６）ｄ。采用持续负压引流加局部压迫的２１ 例１８ 例痊愈,３ 例失败,经手术治疗愈合,平均愈合时间为１１．６（９～１５）ｄ。手术缝扎６例,均Ⅰ期愈合。１ 例乳糜胸保守治愈,３ 例经保守治疗（２～３）ｄ 无效,开胸结扎胸导管痊愈。结论　日丢失乳糜液小于５００ ｍ Ｌ或经保守治疗超过１周无效者,手术缝扎。乳糜胸经保守治疗（２～３）ｄ 无效者,开胸结扎胸导管。     

颈清术后乳糜瘘的预防及治疗

目的：探讨颈清术后乳糜瘘的预防及治疗措施。方法：回顾性分析泰安市肿瘤防治院外科１９９４年９月～２００８年３月４９３例颈清术后１１例乳糜瘘的临床资料,评价乳糜瘘的治疗效果。结果：１１例乳糜瘘中左侧９例,右侧２例;直接再手术３例（手术缝扎１例,手术缝扎并肌瓣填塞２例）,均一期愈合;８例采用负压吸引、局部加压及低脂饮食的保守治疗,其中７例获得痊愈,平均愈合时间为１０天（４～２１天）,１例失败,经手术治疗（肌瓣填塞）而痊愈。结论：熟悉颈部胸导管解剖、提高手术技巧是减少颈清术后乳糜瘘发生的关键;乳糜瘘经积极而合理的保守治疗或手术治疗是可以治愈的。     

颈部淋巴结清扫术后乳糜瘘的预防及处理

目的探讨颈部淋巴结清扫术乳糜瘘的发生、预防及处理原则。方法对1990～2002年收治的颈淋巴结清扫术病例516例，行颈侧清扫术528例(其中12例同期行双颈清扫术)进行分析，结果术后乳糜瘘发生率4．73％(25例)，右颈侧乳糜瘘发生率为3．5％(9／256)，左颈侧发生率为5．88％(16／272)。24例轻中度乳糜瘘经保守治疗治愈，1例重度乳糜瘘经保守治疗无效后再行手术治疗，采用右胸锁乳突肌下段肌瓣缝扎 碘仿纱条填塞治愈。结论术中结扎好胸导管或淋巴管破裂口是预防和避免乳糜瘘发生的关键措施之一；轻中度乳糜瘘采用保守疗法可治愈，术后不需禁食；对重度乳糜瘘经保守治疗无效后应采取手术治疗．     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Second-line chemotherapy with cisplatin-ifosfamide in patients with ovarian cancer previously treated with carboplatin-cyclophosphamide.

In an effort to use antineoplastic drug combinations which are active in platinum resistant ovarian cancer or which can induce a second response after a platinum first-line treatment, we conducted a study on 30 ovarian cancer patients previously treated with carboplatin plus cyclophosphamide who were given ifosfamide 5 g/m2 i.v. divided over days 1 to 3 plus mesma combined with cisplatin 100 mg/m2 i.v. divided over days 1 to 3 every 4 weeks as second-line treatment. Eight patients had never entered remission with first-line chemotherapy while 22 patients had tumor recurrence within 6 to 18 months after the end of chemotherapy and their tumors were considered potentially platinum sensitive. Responding patients received 6 courses while palliative treatment for nonresponders was provided. Of the 22 patients with tumor recurrence, 8 patients responded with one partial response (PR) and 7 complete clinical responses (CCR). Two out of the 8 patients with platinum resistant disease demonstrated short lasting PR. Seven patients with CCR underwent second-look operation and in two a pathological CR was documented. Median time to progression was 6 mo (4-12). The median overall survival was 12 mo (4-20). Myelotoxicity despite G-CSF administration was significant with grade 4 leukopenia in 40% and grade 3 thrombocytopenia in 20% of patients. Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide. With a 33% response rate the combination is as effective as new agents employed in relapsed ovarian cancer. Platinum-refractory disease may respond to a lesser degree. The most important determinant of response was the progression-free interval from first-line chemotherapy. Whether patients recurring after carboplatin plus cyclophosphamide have a greater chance to respond to cisplatin plus ifosfamide or vice-versa cannot be supported by the current data and therefore randomized studies should be performed to this end.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.