经透视机引导行食管贲门癌术后吻合口狭窄扩张术

1995年3月－2000年12月,对收治120例食管贲门癌术后吻合口狭窄患者,采用透视机引导行食管贲门癌术后吻合口狭窄扩张术。扩张治愈率为56．67％（68／120）,接受二次扩张治愈者占30％（36／120）,3次以上扩张者治愈率为13．33％（16／120）。结果提示,扩张术疗效确切可靠,无大出血等严重并发症发生,患者易于接受,易于临床推广应用。     

自制食管组合扩张器治疗食管癌、贲门癌术后复杂型吻合口狭窄32例

目的　探讨食管组合扩张器治疗食管癌、贲门癌术后复杂型吻合口狭窄的应用价值。方法　对食管癌、贲门癌术后吻合口重度狭窄 ,残留食管明显扩张 ,吻合口下方残留食管有盲袋形成和 (或 )吻合口轴线与食管轴线有明显成角畸形的复杂型吻合口狭窄者 ,均采用自制食管组合扩张器行扩张术治疗。结果　 32例中成功 31例(96 .9% ) ,失败 1例。扩张后进食顺利 ,无穿孔、大出血等并发症发生 ,随访 3～ 48个月 ,饮食正常。结论　该组合扩张器治疗复杂型食管胃吻合口狭窄是一种安全有效的方法。     

食管胃吻合口狭窄的扩张治疗

食管胃吻合口狭窄的扩张治疗杭州市第一人民医院（杭州市３１０００６）胡伟恩食管癌和贲门癌切除术后发生食管胃吻合口狭窄是较常见的并发症，及时有效的治疗对缓解进食困难是十分必要的．我院１９８９年１月至１９９３年１２月。在纤维内窥镜直视，弹住钢丝引导下用Ｓａ...     

经透视机引导行食管贲门癌术后吻合口狭窄扩张术

1995年 3月～ 2 0 0 0年 12月 ,对收治 12 0例食管贲门癌术后吻合口狭窄患者 ,采用透视机引导行食管贲门癌术后吻合口狭窄扩张术。扩张治愈率为 5 6 67% ( 68 12 0 ) ,接受二次扩张治愈者占 30 % ( 36 12 0 ) ,3次以上扩张者治愈率为13 33% ( 16 12 0 )。结果提示 ,扩张术疗效确切可靠 ,无大出血等严重并发症发生 ,患者易于接受 ,易于临床推广应用。     

食管胃吻合口瘘的防治体会

有文献报告食管贲门癌切除术后，有4．8％～9．4％的病例发生吻合口瘘。我院于1988年10月至1998年6月共进行食管、贲门癌切除术66例，由于我们采取了预防措施，术后无1例发生吻合口瘘，仅有3例发生吻合口狭窄，后经口腔探条术扩张，症状好转。现就吻合口瘘的预防措施谈一些体会。1 临床资料 66例中，男58例，女8例。年龄44～72岁，平均年龄58岁。食管中段癌6例，下段癌13例，贲门癌47例其中胃角小弯癌侵及贲门 5例。弓上吻合4例，弓下吻合62例。2 方法与结果2．1 做好术前准备，改善患者营养状况 有大部分患者因长期进食受限，病灶慢…     

应用国产吻合器治疗食管癌和贲门癌2160例

目的 探讨国产吻合器在食道癌和贲门癌手术中应用的优缺点。方法 1994年4月至2003年7月，我们应用国产吻合器，进行了2160例食管癌、贲门癌切除后食管胃底吻合术，其中食管癌1342例，贲门癌818例。食管胃颈部吻合106例，主动脉弓上吻合1034例。结果 术后绝大部分病人恢复良好，发生吻合口漏14例，占0．65％(14／2160)；胸内吻合口漏11例，占0．48％(11／2054)；吻合口狭窄22例，占0．51％(22／160)。、结论 吻合器是减少食管胃吻合口漏的有效方法，且价格低廉。经胸食管胃胸顶或超胸顶吻合，可代替以前需作颈部吻合的部分病人，而颈部吻合变得更加方便可靠。     

食管癌和贲门癌术后吻合口狭窄的外科治疗

我院自１９６６年６月至１９９３年１２月共施行食管癌和贲门癌手术分别１７７５例及６１０例，可切除肿瘤并作食管与胃或肠吻合者分别为１５９２例及４９６例，前者５例，后者１例发生重度吻合口狭窄，故狭窄率分别为０．３％（５／１５９２）及０．２％（１／４９６），二者合计为０．３％（６／２０８８），本文讨论了食管癌和贲门癌术后吻合口狭窄的成因，分级和外科治疗。     

金属内支架在治疗食管狭窄中的应用

目的 阐述自膨式金属内支架(Self—Expanding Metallic Stent,SEMS)在治疗食管狭窄性疾病,如食管癌、贲门癌、食管吻合口狭窄中的应用价值。方法 本组病例17例,其中食管癌7例,贲门癌1例,食管吻合口狭窄9例,采用SEMS18根,在X线监视下,标定狭窄部位,再行球囊扩张后,置入SEMS。结果 SEMS置入术本组病例成功率100％。术后病人吞咽功能均得以恢复,吞咽困难由术前2级、3级改善到0级水平,并无严重并发症的出现,大大提高了病人的生存质量和生存期。结论 应用SEMS治疗中晚期食管癌、贲门癌及食管术后吻合口狭窄所致的食管狭窄、梗阻是一种操作简便、安全、疗效明显、快捷、很受患者欢迎和临床医生认可的介入治疗新方法。     

国产自膨式镍钛记忆合金带膜食管支架的临床应用

背景与目的：晚期恶性食管狭窄、食管癌或贲门癌术后单纯吻合口狭窄、食管癌放疗后狭窄所致的进食困难甚至出现食管气管瘘、食管纵隔瘘是影响患者生存质量及生存时间的一个重要因素。如何微创、简便、有效的治疗上述食管狭窄或食管气管瘘、食管纵隔瘘一直是临床工作者研究的热点之一。本研究探讨国产自膨式镍钛记忆合金网状带膜支架治疗食管狭窄的价值和注意事项。方法：自1998年4月至2005年10月，我科采用国产自膨式镍钛记忆合金网状带膜支架治疗食管狭窄患者96例（其中食管恶性狭窄65例，包括食管气管瘘18例、食管纵隔瘘3例；食管癌或贲门癌术后单纯吻合口狭窄26例；食管癌放疗后狭窄5例），男性71例，女性25例，平均年龄70岁。所有患者均在X线辅助下行食管内支架置入术。结果：本组共置入食管内支架114枚，均一次成功，成功率100％，近期疗效满意。随访1～60个月，无一例发生支架移位，术后平均生存时间8．6个月。恶性食管狭窄行内支架置入后联合化疗，中位生存期7．4个月。本组患者术后再狭窄率38．5％，予球囊扩张或再次内支架置入治疗（再次介入治疗29．2％）。结论：食管内支架置入是恶性食管狭窄的良好的姑息性治疗手段，也适用于食管癌或贲门癌术后单纯吻合口狭窄、食管癌放疗后狭窄，有助于延长患者生存时间、提高生活质量。但如何降低食管内支架置入后的再狭窄仍有待进一步的研究。     

食管贲门癌切除术中CDH型吻合器吻合的术后转化过程

目的 动态观察食管贲门癌切除行食管胃机械吻合患者的术后转化过程，探讨其形成和处理方法。方法 在68例食管贲门癌根治性切除术中，以CDH-25或29型吻合器行食管胃吻合术，动态观察患者的术后转化过程。结果 68例随访3～29个月，发生胃食管反流和反流性食管炎者，经使用制酸剂和胃动力药后症状缓解。发生吻合口轻度狭窄56例（82.4%）其中37例做了扩张治疗，24例（64.9%)治愈，13例（35.1%）疗效欠佳。通过进一步随访，发现手术后5个月，钛钉自吻合口完全脱落，56例患者出现的胃食管反流、反流性食管炎和吻合口狭窄症状自然缓解。结论 CDH型吻合器吻合具有快捷、安全和易掌握等优点。在食管胃吻合中完全可取代手工操作。多数患者术后通常经历反流、反流性食管炎和吻合器狭窄到吻合口再通畅的转化过程。这一转化过程与吻合口区钛钉的存在密切相关。制酸剂、胃动力药和扩张术在转化过程中起着重要作用。     

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.     

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.     

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     

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.     

再放疗并同步使用Docetaxel在鼻咽癌放疗后复发病人中的应用

目的:不能手术切除的鼻咽癌放疗后再复发的病人,其治疗困难,化疗疗效差,而单独再放疗只能挽救一小部分病人,本文探讨再放疗并同步使用多西紫彬醇(Docetaxel)在鼻咽癌首次放疗后复发病人中可行性及毒副反应,并评价其疗效。方法:对11例鼻咽癌足量放疗后经组织病理学证实复发、而无法行手术及腔内放疗的患者进行了同步放化疗。放疗采用三维适形放疗,外照射鼻咽部,分次量为1.8Gy,总剂量为36Gy-39.6Gy。化疗采用Docetaxel,15mg/m2,每周一次,静脉滴注。结果:10%、33%的患者分别出现Ⅲ度、Ⅳ度皮肤反应,18%、10%的病人分别出现Ⅲ度、Ⅳ度黏膜反应,18%患者出现Ⅲ度恶心呕吐,27%的患者出现Ⅲ度-Ⅳ度白细胞下降,10%患者出现Ⅲ度血小板下降。1例患者因严重的黏膜反应致使治疗延迟2周。治疗结束后,9例(82%)患者达到CR,2例(18%)达到PR,反应率为100%。结论:对于放疗后局部复发的鼻咽癌患者,采用同步放化疗,3D-CRT同时每周使用Docetaxel是可行的,其毒性反应在可以接受的范围内,短期疗效显著。     

Protothecosis successfully treated with amikacin combined with tetracyclines

Summary We report a case of protothecosis in an 18-year-old female student caused by Prototheca zopfii successfully treated with amikacin combined with tetracyclines. Zusammenfassung Es wird über eine Protothecose, verursacht durch Prototheca zopfii, bei einer 18-j?hrigen Studentin berichtet, die erfolgreich mit Amikacin in Kombination mit Tetracyclinen behandelt wurde.