腹腔灌注治疗晚期胃肠道肿瘤47例疗效观察

目的探讨腹腔灌注治疗晚期胃肠道肿瘤的疗效。方法对患者行腹腔穿刺,抽尽腹水,注入化疗药物,观察疗效。结果肝转移癌有效率41．7％,腹腔或腹膜后淋巴结转移有效率37．5％,腹水有效率83．3％。结论腹腔灌注化疗既可以在局部直接作用于腹膜和肿瘤组织,又能使药物通过门静脉系统,增加肝内的药物浓度,是治疗胃肠道癌肝及腹腔转移的有效方法。     

卵巢癌术后腹腔灌注化疗的应用及护理

腹腔灌注化疗是治疗卵巢癌疗效好而副反应轻的一个重要给药途径。腹腔内肿瘤易复发或转移,因病变范围,而无法手术,加之空腔器官对X线剂量的限制,多不采用放疗。因腹膜的弥散屏障作用,全身静脉化疗药物到达腹腔的浓度极低,而腹腔灌注化疗腹腔内药物浓度远高于静脉给药时的浓度,且化疗药物在腹腔内维持时间长,浓度恒定,体循环浓度极低。因而对于腹腔内肿瘤的复发和转移的预防及治疗,腹腔灌注化疗是一条有效的治疗办法。基于以上认识笔者对63例卵巢癌术后患者采用腹腔灌注化疗配合静脉用药的疗法,取得了较好的疗效,现报告如下。     

人表皮生长因子受体2蛋白及间皮素在卵巢癌免疫靶向治疗中的应用研究进展

<正>卵巢癌死亡率居妇科肿瘤的首位,卵巢癌治疗所面临的主要问题是首次治疗即晚期。手术治疗及化疗(以铂类药物为基础)对晚期卵巢癌患者的预后有所改善,但超过80%的患者会复发,复发转移是卵巢癌的主要死亡原因之一~([1])。因此晚期卵巢癌的治疗需要探索新的治疗方式。T细胞肿瘤免疫治疗是最备     

给腹膜肿瘤洗“桑拿”——腹腔温热灌注化学治疗简介

什么是腹腔温热灌注化疗肿瘤的复发和转移是肿瘤治疗失败和影响患者生存的核心问题。其中,肿瘤腹腔转移或腹膜浸润造成的恶性腹水是临床常见的恶性肿瘤并发症。一般来说,这类患者的中位存活期只有几周至几个月,1年生存率〈10％。导致这种情况的常见肿瘤包括胃癌、结直肠癌、胰腺癌、肝癌、卵巢癌、子宫癌、淋巴瘤等。     

腹腔热灌注化疗在卵巢癌治疗中的研究进展

肿瘤热疗以其无手术痛苦、无术后并发症及无化疗及放疗带来的副反应而发展成为癌症治疗的第5种方法.卵巢癌患者早期多无明显症状,多数患者就诊时已有腹腔内广泛转移.腹腔热灌注化疗将局部热疗与腹腔灌注化疗结合起来,综合利用两者的协同作用,能有效地清除游离癌细胞及微小病灶.虽然应用于卵巢癌的治疗较晚,但近年来已取得了显著的进步,为晚期、复发、耐药性和难治性肿瘤的挽救性治疗提供了新的思路和指导.该文就腹腔热灌注化疗在卵巢癌治疗中的研究近况作以综述.     

卵巢癌的综合治疗

女性生殖器官常见的恶性肿瘤中，卵巢癌发病率仅次于子宫颈癌和子宫体癌而列居第三位。由于卵巢位于盆腔内，起病隐匿，且易于腹腔内播散转移，初诊的卵巢癌患者中70％～80％可以取得一定的疗效，但复发率高，五年生存率仅为20％～30％。所以，相比其它妇科肿瘤，卵巢癌发病率高，80％就诊时已属晚期（Ⅲ、Ⅳ期）。卵巢癌虽然经过手术和化疗等各种治疗，但存活率低。目前卵巢癌的首选治疗方法仍是手术治疗，但部分晚期卵巢癌患者腹腔广泛转移，大量腹水，全身情况差，需全面评估选择手术时机。化疗在晚期卵巢癌的治疗中占有很重要的地位，但期别越晚，癌肿越大越容易耐药。因此，新抗癌药的不断开发应用，是提高晚期卵巢癌疗效的主要途径之一。卵巢癌的播散转移主要位于盆腹腔内，为了增加肿瘤与药物接触以提高治疗效果，腹腔化疗已成为治疗卵巢癌的一个重要给药途径。卵巢癌复发率高，复发性卵巢癌的综合治疗也成为近年卵巢癌治疗研究的热点。     

卵巢癌化疗新进展

上皮性卵巢癌(简称卵巢癌)是死亡率较高的肿瘤,卵巢癌对化疗敏感,以铂类为基础的化疗对近80%的卵巢癌患者有明显的临床疗效,但其中50%-80%在初治1-2年后复发。加之卵巢癌早期诊断率很低,60%-70%患者确诊时已属晚期。因此,如何进一步提高化疗的疗效、延长晚期和复发患者生存期是卵巢癌综合治疗中的一个重要问题。本文就卵巢癌一线、二线化疗新进展作以下综述。     

消化道肿瘤化学治疗病人的护理

目的:对消化道肿瘤化疗病人的护理探讨.方法:对我院2001～2006年10月消化道肿瘤48例患者进行全方位的护理.结论:通过综合措施,可防止肿瘤的复发和转移,对晚期广泛转移者,化疗可控制肿瘤的发展,延长生存期.     

消化道肿瘤化学治疗病人的护理

目的：对消化道肿瘤化疗病人的护理探讨。方法：对我院2001～2006年10月消化道肿瘤48例患者进行全方位的护理。结论：通过综合措施，可防止肿瘤的复发和转移，对晚期广泛转移者，化疗可控制肿瘤的发展，延长生存期。     

卵巢癌术中腹腔内热化疗研究进展

卵巢癌是一种常见的妇科肿瘤，目前主要的治疗方法为手术治疗联合药物化疗，为提高该病的治疗效果和患者术后的生存率，近20年来，将腹腔热化疗（IHCP）作为进展期腹腔肿瘤的辅助疗法应用于临床，大大地提高了患者的生存质量。就IHCP治疗卵巢癌的理论依据、技术方法、临床应用、疗效、并发症和副作用等方面的研究进展作综述。     

新辅助化疗治疗晚期卵巢癌的研究进展

卵巢癌是女性生殖系统常见的三大恶性肿瘤之一，由于卵巢位于盆腔深部，起病隐匿，约70%～75%的患者出现症状时已达晚期，5年生存率小于40%。目前卵巢癌的治疗方法主要有手术、化疗、放疗和生物免疫治疗等。常规手术为了提高晚期卵巢癌（advanced ovarian cancer，AOC）患者肿瘤细胞减灭术成功率，术中除切除子宫、附件外，还要清扫盆腹腔周围相关淋巴结及转移灶，手术损伤大，并发症高。因此，对于一般状况差且合并症多、细胞学证实为ⅢC期及Ⅳ期的AOC患者以及首次肿瘤细胞减灭术不满意或因体质差不适合立即手术者，可先进行2～3个疗程新辅助化疗（neoadjuvant chemotherapy，NACT）后进行手术，术后继续化疗。NACT是在对患者进行手术治疗之前给予化疗，即先期化疗。然而，对于NACT在AOC的应用仍未达成共识，现对其进行综述。     

小细胞肺癌治疗62例分析

目的 比较小细胞肺癌的治疗模式及治疗效果.方法 1、2期小细胞细胞肺癌患者62例A组（32例）行手术治疗,术后给予放化疗,B组（30例）单纯给予放化疗.结果 A组中位生存时间为50个月,1、2、3年生存率分别为96%、70%、52%,B组总中位生存时间为48个月,1、2、3年生存率分别为93%、71%、48%;A组术后治疗中或治疗后出现转移病灶的情况依次为：失败原因包括局部复发（12%）、远处转移（32%）、局部复发加远处转移（8%）和脑转移（19%）,B组失败原因包括局部复发（14%）、远处转移（30%）、局部复发加远处转移（9%）和脑转移（29%）.手术＋化疗＋放疗组与放化疗组的生存率差异无统计学意义（P〉0.05）.结论 手术＋化疗＋放疗和放化疗对临床Ⅰ、Ⅱ期小细胞肺癌的治疗均有较好的疗效.     

Treatment of epithelial ovarian cancer

Epithelial ovarian cancer is the most lethal gynecological cancer among women. The median age at diagnosis is 63 years. The vast majority of patients present with advanced disease and require a combination of cytoreductive surgery and adjuvant chemotherapy. Important features that determine the outcome of treatment include the stage of disease, hystological type, grade and the size of the residual tumour after initial surgery. Current guidelines recommend that standard first-line chemotherapy should include a platinum-based regimen with paclitaxel. Despite the combined therapy, over 50% of all the patients has relapse. Relapsed ovarian cancer is incurable, however chemotherapy can improve quality of life and survival. Currently, there is no worldwide accepted standard treatment for patients with platinum-refractory ovarian cancer. Docetaxel, topotecan, gemcitabine, pegylated liposomal doxorubicin, etoposide and tamoxifen can be used in this group. However response duration rarely exceeds 12 months. Intraperitoneal chemotherapy, gene therapy, immunotherapy, signal transduction inhibitors (trastuzumab) and angiogenesis inhibitors (bevacizumab) are all potential future therapies, and are being investigated in ongoing clinical research. In this publication authors review the literature of current treatment options in epithelial ovarian carcinoma.     

先期化疗在晚期卵巢癌的临床应用与疗效评价

目的探讨先期化疗在治疗晚期卵巢癌中的临床意义和对预后的影响。方法分析我院52例Ⅲ、Ⅳ期卵巢癌患者,22例行先期化疗,然后进行中间肿瘤细胞减灭术及术后化疗（先期化疗组）;30例行初次肿瘤细胞减灭术,再行术后化疗（对照组）。比较两组治疗的疗效及生存率。结果先期化疗组化疗有效率63.6%,胸腹水的控制率达89.5%,先期化疗组和对照组满意肿瘤减灭率分别为81.8%、36.7%,两组比较差异有统计学意义（P〈0.005）;先期化疗组术中出血量及手术时间较对照组少,两组比较差异均有统计学意义（P〈0.05）;先期化疗组术后并发症发生率13.6%,对照组术后并发症发生率20.0%,两组比较差异无统计学意义（P〉0.05）。先期化疗组和对照组中位生存时间分别为35和24个月,两组间生存率比较,差异无统计学意义（P〉0.05）。结论先期化疗能缩小瘤体,控制胸腹水,提高肿瘤细胞减灭率,特别对大量胸腹水、肿瘤体积较大和身体耐受差的患者疗效佳,但并未延长患者总的生存时间。     

Pure dysgerminoma of the ovary. 12 case reports

Data from the files of 12 patients with pur ovarian dysgerminoma managed between January 1970 and december 1990 were evaluated. Pur ovarian dysgerminoma accounts for 2% of all ovarian malignancies and 28% of malignant germ cell tumors. A palpable pelvic mass was detected in three-fourth of patients. Echography objective ovarian tumor in all cases. Diagnosis was histological. Primary treatment was surgery followed by radiotherapy in 8 cases and chemotherapy in 2 cases. 2 patients developed local recurrences were irradiated and 1 patient developed distant metastases was given chemotherapy in association to radiotherapy. The 5 years survival rate was 91.7%. CONCLUSION: Treatment of ovarian dysgerminoma remains controversial. However, patients with stage la who desire further childbearing can be safely treated with unilateral adnexectomy. For all other patients, radical surgery followed by radiation therapy or chemotherapy for the advanced stages and recurrents dysgerminoma is the treatment of choice. Prospective randomized clinical trials are needed for a well codified therapeutic strategy.     

Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion for peritoneal carcinomatosis caused by recurrent inflammatory myofibroblastic sarcoma: a case report and review of the literature

Peritoneal carcinomatosis is a fatal diagnosis, associated with poor prognosis and quality of life. Survival is usually estimated in month. Traditionally surgery for peritoneal carcinomatosis was indicated only for palliative effort. Advances in tumour biology, cytoreductive surgery and pharmacology have improved the approach for this condition. An aggressive combined approach to peritoneal surface malignancy involves peritonectomy and intraperitoneal perioperative hyperthermic chemotherapy. Cytoreductive surgery reduces carcinomatosis to microscopic residual disease so that intraperitoneal hyperthermic chemotherapy is able to eradicate cancer. Hyperthermic chemotherapy enhances the cytotoxicity of the drugs and increases their penetration into the cancerous tissue. Careful patient selection is crucial for this multimodality approach. Quantitative prognostic indicators are useful in the assessment of outcome, like peritoneal cancer index and completeness of cytoreduction score. Cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy improves survival but is associated with significant morbidity and mortality. This review is based on a case report of a 22-year-old female patient who had peritoneal carcinomatosis of inflammatory myofibroblastic sarcoma and was treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy at our department.     

综合治疗中晚期前列腺癌的疗效分析

目的探讨一种对中晚期前列腺癌较理想的治疗方法。方法回顾性分析2001年3月~2005年1月收治的前列腺癌临床病例78例,采用综合治疗:经尿道等离子束腔内微创手术加双侧睾丸白膜下切除去势,术后应用抗雄激素药物阻断治疗,对伴有骨转移者同时行核素89Sr内放射治疗。与同期用单纯膀胱造瘘加双侧睾丸切除的45例病人进行比较。结果随访3~48个月,综合治疗后下尿路梗阻症状明显改善,血清PSA水平下降,骨痛缓解,生活质量显著提高,生存时间明显延长。结论对于中晚期前列腺癌采取积极的综合治疗可取得较好的疗效,是一种较为理想的治疗手段。     

卵巢癌的诊治进展

卵巢癌的早期诊断除了经典的肿瘤标记物癌抗原125(cancer antigen 125,CA_125)及经阴道超声(transvaginal ultrasonography,TVS)以外,新型标志物人附睾蛋白4(human epididymis protein4,HE_4)及蛋白质组学对监测卵巢癌的发病、治疗效果、临床转归及复发等几个方面都有很好的临床意义。卵巢癌的初始治疗手术的规范性和彻底性,以及手术与化疗的合理配合至关重要。早期卵巢癌要进行全面的分期手术,必要时应该在化疗开始前进行再分期手术。晚期卵巢癌要尽量做到满意的肿瘤细胞减灭术,并要适时合理配合新辅助化疗。经过早期诊断和规范治疗,卵巢癌的生存率得到了明显上升,但较高的复发率及死亡率仍是妇科肿瘤医师不容忽视的问题。     

肿瘤生殖学及宫颈癌治疗中生理和生育功能保护问题

随着年轻肿瘤患者的发病率和治愈率均不断提高,以及手术和放化疗常带来不同程度的生育功能损害,保留和保存年轻肿瘤患者的生育功能,成为越来越迫切的需求,肿瘤生殖学(oncofertility)应运而生。肿瘤生殖学是在降低和预防肿瘤复发及由此导致患者死亡的风险,延长患者生存期,甚至治愈癌症的同时,减轻治疗干预方法本身导致的不孕风险,为患者提供选择具有更高生活质量的机会。女性肿瘤患者保存和保护生育功能的主要方法包括：卵巢移位术/性腺屏蔽、在化疗中应用促性腺激素释放激素类似物(GnRHa)保护卵巢功能、胚胎冷冻、卵子冷冻、卵巢组织/卵巢冷冻与移植、干细胞的诱导分化、人工卵巢工程及子宫移植等。宫颈癌治疗中生育功能保留方法包括宫颈广泛切除术(RT)、宫颈锥切术等,此外,保留神经的广泛性子宫切除术和阴道延长术等,也可在宫颈癌治疗中进行生理功能保护,在有效控制肿瘤的同时,使患者生存质量提高。     

Choice of surgical strategy for colorectal liver metastases depending on clinical and pathological response to neoadjuvant chemo- and targeted therapy

Surgical strategy of colorectal liver metastases depends on clinical and pathological response to neoadjuvant chemo- and target therapy. Recently, surgical treatment of advanced colorectal cancer appears as an everyday challenge for surgeons and oncologists. The new oncologic procedures invented last years led to significant therapeutic improvement. Combination of neoadjuvant chemotherapy with biological answer modifiers increased greatly the clinical response rate given to cytoreductive therapy. Due to these facts the complete disappearance of liver metastases can be observed more and more frequently after 2000. Literature of metastasis surgery clarified the exact difference between clinical and pathological response, at the same time exact criteria of the connections between two responses have been set. In complex treatment of colorectal liver metastases complete pathological response became the end point of treatment. Aims and Methods: Between January, 2009 and August, 2010, 39 patients with originally non resectable liver metastases (colorectal cancer origin) have been studied. All patients were treated by neoadjuvant chemo- and targeted therapy before the resection of liver. Results: Complete pathological response has been observed in 3 patients, major pathological response (necrosis: >50%) in 11 patients, minor pathological answer (necrosis <50%) in 22 patients and finally no necrosis at all in 3 patients. Conclusions: Complete pathological response can be regarded as the final goal of neoadjuvant targeted therapy. Pathological response seems to be the most important prognostic factor which reflects long-term survival after the R0 resection of liver metastases. Complete disappearance of liver metastases is an undesirable side effect of oncological therapy, which causes difficulties during surgical intervention. In this term the overtreatment of patients resulting in a disappearance of metastases should be avoided. Multidisciplinary team is responsible for the indication of resection of liver metastases in time before their disappearance.