内镜光动力微创疗法治疗胆管癌的临床疗效分析

【摘要】〓目的〓探讨内镜光动力微创疗法(PDT)联合支架置入术治疗胆管癌的临床疗效。方法〓将2005年10月至2009年6月我院收治的62例胆管癌患者分为两组,对照组32例,给予内镜下支架置入术;治疗组30例,在支架置入术的基础上,给予内镜下光动力治疗。对62例晚期胆管癌患者的生存时间及生活质量进行随访。 结果〓经过3年以上的随访,治疗组中位生存时间18个月,1、2、3年生存率分别为63.3%、43.3%及20.0%;对照组中位生存时间8个月,1、2、3年生存率分别为43.8%、25.0%及9.4%,生活质量FACT-Hep量表术后6个月、9个月及12个月,治疗组量表总分明显高于对照组(P<0.05),术前胆红素水平、远处转移及治疗方法是影响胆管癌患者生存期的独立预后因子。结论〓内镜光动力微创疗法(PDT)联合支架置入术提高了胆管癌患者的生存率,改善了生活质量,是胆管癌一种有效的治疗方法。     

20 肿瘤细胞耐受光动力疗法分子机制的研究进展

光动力疗法（PDT ）可诱导肿瘤细胞凋亡，治疗消化道肿瘤，或对无法手术的癌症晚期患者进行姑息治疗。因PDT致肿瘤细胞的凋亡率并未达100%，肿瘤细胞耐受PDT的原因目前还不明了，据相关文献报道可能与血红素加氧酶 1、热休克蛋白、锰超氧化物歧化酶、Bcl 2蛋白家族等许多因素相关。现就已知的造成肿瘤细胞耐受光动力疗法的各种分子机制作一简要综述。     

晚期胰腺癌术中放射治疗的疗效评价

目的 探讨术中放射治疗对晚期胰腺癌的疗效. 方法 对16例晚期胰腺癌患者作姑息性手术加术中放疗,用9-15Mev电子线照射病灶区域,照射20~25 Gy,并与同期未作术中放疗的20例姑息性手术治疗的患者(对照组)进行疗效比较. 结果 术中放疗组腰背痛及腹痛缓解率为93.8%(15/16),对照组腰背痛及腹痛缓解率为40.0%(8/20)(P<0.01),术中放疗组中位生存期为13.5月,对照组为8.6月(P<0.05). 结论 姑息手术联合术中放疗能有效地缓解晚期胰腺癌患者的腰背痛及腹痛,并可延长生存期.     

放射介入、姑息手术以及姑息手术联合^125I粒子植入治疗晚期胰腺癌临床疗效比较

目的探讨放射介入、姑息手术以及姑息手术联合^125I粒子植入3种方法治疗晚期胰腺癌的疗效。方法1994年3月-2005年10月，我院对103例无法切除的胰腺癌分别行放射介入（经肝穿刺置管内引流组，15例），胆肠、胃肠吻合术（姑息手术组，60例）及姑息手术同时行超声引导下^125I粒子植入治疗（姑息手术联合^125I粒子植入组，28例）。结果姑息手术联合^125I粒子植入组术前的疼痛的21例术后疼痛部分缓解率及完全缓解率分别为14．3％（3／21）及76．2％（16／21），显著高于其他2组（x^2=6．305，P=0．012；x^2=4．525，P=0．033）。姑息手术联合^125I粒子植入组的中位生存时间（8个月）显著长于姑息手术组（7个月）及经肝穿刺置管内引流组（2个月）（P=0．0005）。结论对于不能耐受手术的晚期胰腺癌可行经肝穿刺置管内引流治疗，姑息手术联合^125I粒子植入治疗在延长生存期的同时可明显缓解患者的疼痛。     

放射介入、姑息手术以及姑息手术联合125Ⅰ粒子植入治疗晚期胰腺癌临床疗效比较

目的探讨放射介入、姑息手术以及姑息手术联合125Ⅰ粒子植入3种方法治疗晚期胰腺癌的疗效.方法1994年3月～2005年10月,我院对103例无法切除的胰腺癌分别行放射介入(经肝穿刺置管内引流组,15例),胆肠、胃肠吻合术(姑息手术组,60例)及姑息手术同时行超声引导下125Ⅰ粒子植入治疗(姑息手术联合125Ⅰ粒子植入组,28例).结果姑息手术联合125Ⅰ粒子植入组术前的疼痛的21例术后疼痛部分缓解率及完全缓解率分别为14.3%(3/21)及76.2%(16/21),显著高于其他2组(x2=6.305,P=0.012;x2=4.525,P=0.033).姑息手术联合125Ⅰ粒子植入组的中位生存时间(8个月)显著长于姑息手术组(7个月)及经肝穿刺置管内引流组(2个月)(P=0.0005).结论对于不能耐受手术的晚期胰腺癌可行经肝穿刺置管内引流治疗,姑息手术联合125Ⅰ粒子植入治疗在延长生存期的同时可明显缓解患者的疼痛.     

胆管癌的光动力治疗

胆管癌是种恶性程度很高的消化道肿瘤,且超过一半的患者在诊断时已是疾病晚期,错失了手术的机会。光动力疗法（PDT）是一种局部消融方法,它使用系统性光敏剂,优先聚集在恶性细胞中,并被非热光激活,通过氧自由基介导的过程导致恶性细胞的破坏。胆管癌的PDT潜在治疗方案包括联合化疗、联合支架植入、复发肿瘤的术后治疗,或对患者进行治疗使肿瘤降期后行根治性手术。在治疗胆汁淤积的同时,PDT疗法可提高生存率和生活质量,并减少肿瘤生长。     

海扶刀联合吉西他滨在中晚期胰腺癌治疗中的应用

[摘 要] 目的 探究采用高强度聚焦超声联合吉西他滨治疗中晚期胰腺癌的效果及安全性。方法 将2012年6月至2017年6月间郑州大学第一附属医院诊治的165例中晚期胰腺癌患者随机分为高强度聚焦超声联合静脉滴注吉西他滨治疗组（联合组,92例）和吉西他滨治疗组（化疗组,73例）。对比两组患者治疗2个月后的疼痛缓解率、外周血CA19-9水平、肿瘤体积变化、并发症的发生情况以及治疗后3、6个月的生存率。结果 治疗两个月后,联合组患者疼痛缓解率明显高于化疗组（94.4% vs 21.1%）;联合组治疗2个月后VAS评分[（2.7±3.2）vs（6.2±2.8）]及CA19-9水平[（204.6±195.6）U/mL vs（537.2±274.5）U/mL]明显下降（P<0.05）;肿瘤体积[（20.13±13.25）cm 3 vs （33.45±13.68） cm 3 ]明显缩小（P<0.05）。治疗3个月后,联合组生存率为97.6%,化疗组生存率为94.3%,两组对比无统计学差异（P>0.05）;治疗6个月后,联合组生存率为69.5%,化疗组生存率为24.3%,两组对比有统计学差异（P<0.05）。联合组患者均未出现胃肠道穿孔、胰瘘和出血等HIFU治疗并发症。结论 高强度聚焦超声联合吉西他滨治疗中晚期胰腺癌可明显缩小肿瘤体积,减轻患者的疼痛症状,且并发症少,有效改善生活质量,延长患者的生存期。     

局部切除胰体尾联合血管切除重建治疗晚期胰腺癌的疗效分析

目的:探讨局部切除胰体尾联合血管切除重建手术治疗晚期胰腺癌的效果。方法:将2010年—2012年收治的58例胰腺体部及体尾部晚期胰腺癌患者分为观察组和对照组,观察组患者采用局部切除胰体尾联合血管切除重建手术治疗后配合化疗,对照组仅接受化疗,比较两组患者的临床治疗效果与生存情况并分析预后因素。结果:两组患者的一般资料具有可比性;与对照组比较,观察组的客观有效率(44.9%vs.6.9%)、疾病控制率(82.8%vs.55.2%)明显升高(均P0.05);半年生存率(79.3%vs.48.3%)、1年生存率(55.2%vs.17.2%)、平均生存时间(17.6个月vs.10.3个月)、总生存率和无进展生存率均明显增加(均P0.05);两组患者的不良反应发生率差异无统计学差异(P0.05);单因素分析结果显示,肿瘤分期、有无淋巴/血管转移是胰腺癌患者无进展生存的影响因素(均P0.05)。结论:对于可以采取手术治疗的晚期胰腺癌患者而言,采用局部切除胰体尾联合血管切除重建手术疗效良好,可推荐应用。     

晚期胰腺癌综合治疗的疗效观察

目的 探讨改善晚期胰腺癌预后的有效治疗措施。方法 43例晚期胰腺癌患者采用转流手术、动脉灌注化疗或联合术中癌内注射和围手术期免疫调节综合治疗,随访生存期与对照组病例比较。结果 43例患者术后生活质量明显提高,无治疗相关并发症。术后平均生存期11.4±7.3月,1、2、3年生存率分别为30.2%、9.3%、2.3%,生存期明显延长。结论 动脉灌注化疗联合围手术期免疫调节综合治疗,有助于改善晚期胰腺癌患者的预后,是一种安全有效的新方法。     

放射介入、姑息手术以及姑息手术联合~(125)I粒子植入治疗晚期胰腺癌临床疗效比较

目的探讨放射介入、姑息手术以及姑息手术联合125I粒子植入3种方法治疗晚期胰腺癌的疗效。方法1994年3月~2005年10月,我院对103例无法切除的胰腺癌分别行放射介入(经肝穿刺置管内引流组,15例),胆肠、胃肠吻合术(姑息手术组,60例)及姑息手术同时行超声引导下125I粒子植入治疗(姑息手术联合125I粒子植入组,28例)。结果姑息手术联合125I粒子植入组术前的疼痛的21例术后疼痛部分缓解率及完全缓解率分别为14.3%(3/21)及76.2%(16/21),显著高于其他2组(2χ=6.305,P=0.012;2χ=4.525,P=0.033)。姑息手术联合125I粒子植入组的中位生存时间(8个月)显著长于姑息手术组(7个月)及经肝穿刺置管内引流组(2个月)(P=0.0005)。结论对于不能耐受手术的晚期胰腺癌可行经肝穿刺置管内引流治疗,姑息手术联合125I粒子植入治疗在延长生存期的同时可明显缓解患者的疼痛。     

纳米技术介导的光动力疗法治疗肝细胞癌的研究进展

肝脏恶性肿瘤包括原发性和转移性肿瘤,肝细胞癌又是肝脏恶性肿瘤中最常见的类型。然而,目前临床上常用的治疗手段在提高不宜手术的晚期肝细胞癌患者生存率方面取得的进展有限。因此,肝细胞癌的临床治疗除了手术、放化疗、经动脉化疗栓塞治疗、射频消融治疗、介入治疗、靶向治疗以及免疫治疗外,急需一种新的治疗方式。光动力疗法(PDT)是治...     

Adenosquamous carcinoma of the pancreas: a single-institution experience comparing resection and palliative care

BACKGROUND: Adenosquamous carcinoma is a rare malignancy of the exocrine pancreas. Previous literature has reported dismal survival for these patients. We examined our single-institution experience with this tumor to compare survival for sugical resection and palliative therapy. STUDY DESIGN: Records were reviewed for patients with adenosquamous pancreatic cancer evaluated during the years 1985 to 2003. Pathology specimens were reviewed. Survival was calculated by Kaplan-Meier method and categorical variables were compared with Chi-square analysis. A p value < 0.05 was considered significant. RESULTS: Twenty-three patients were identified with adenosquamous carcinoma of the pancreas. Twelve patients underwent curative resection and 11 patients had either no surgery or a palliative bypass procedure. For the resection group the mean age was 69 years (7 men). In the nonoperative group the mean age was 65 years (6 men). Operative procedures included standard pancreaticoduodenectomy (PD), 4 patients; pyloruspreserving PD, 3 patients; and distal pancreatectomy, 5 patients. Median length of stay was 13.5 days (7-30 d). Morbidity included delayed gastric emptying (4 patients), leak (2 patients), superficial skin infection, abscess, and GI bleed (1 patient each). There was no operative or inhospital mortality in the resection group. For R0 resection median survival was 14.4 months compared to 8 months for R1 and 4.8 months for patients undergoing palliative therapies. CONCLUSIONS: The retrospective review of our single-institution experience with resection and palliative care for adenosquamous cancer of the pancreas has demonstrated a longer survival for patients that can undergo an R0 resection. Although this is a small series we continue to recommend resection for these patients.     

腹腔镜手术在胰腺疾病中的临床应用探讨

目的探讨腹腔镜手术在胰腺疾病中的临床应用效果。方法对12例胰腺疾病患者施行腹腔镜手术,其中包括胰腺囊性疾病9例,分别行保留脾脏的胰体尾切除术(4例)、胰体尾加脾脏切除术(2例)及单纯胰腺囊肿切除术(3例);胰岛素瘤2例,均行胰岛素瘤切除术;胰腺癌术后复发1例,行左侧内脏神经离断术。结果所有手术均获成功,其中完全腹腔镜下手术8例,经腹腔镜辅助手术4例。平均手术时间225min(100～420min),平均出血量80ml(2～150ml);1例术后发生胰瘘,经保守治疗治愈;术后平均住院时间7.2d(5～13d)。胰腺癌术后复发患者术后存活6个月,止痛效果满意;其余患者随访10～36个月,效果良好,无复发。结论腹腔镜手术治疗部分胰腺疾病安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点,具有广阔的应用前景。     

晚期胆管癌姑息性切除、光动力治疗及支架引流疗效的Meta分析

目的评价晚期胆管癌患者姑息性R1、R2切除与支架引流治疗的疗效及光动力治疗与支架引流的疗效。 方法计算机检索PUBMED、中国生物医学文献数据库(CBMdisc)、万方数据库、中国学术期刊全文数据库(CNKI),查找1980年1月至2013年12月发表的有关对比分析胆管癌姑息性(R1、R2)切除与支架引流治疗及光动力治疗与支架引流治疗效果的随机对照试验文献。按照纳入与排除标准选择文献、提取资料、评价质量后,采用RevMan 5.2软件进行Meta分析。 结果共有9篇研究585例患者纳入姑息性R1、R2切除和支架引流分析,其中姑息性切除组208例,支架引流组377例。共有4篇研究纳入光动力治疗和支架引流分析,包括252例患者,其中光动力治疗组132例,引流治疗组120例。分析显示:总体并发症发生率、死亡率、1年生存率指标中,姑息性R1、R2切除组与引流治疗组相比1年生存人数较多,差异有统计学意义[(OR 0.79,95%CI 0.42~1.50,P=0.48)、(RD-0.00,95%CI-0.04~0.04,P=0.94)、(OR 2.87,95%CI 1.82~4.54,P<0.05)],胆瘘发生率、胆管炎或胆道梗阻发生率差异无统计学意义[(OR 1.74,95%CI 0.73~4.17,P=0.21)、(OR 0.50, 95%CI 0.22~1.12,P=0.09)]。光动力治疗组和支架引流的疗效对比中光动力治疗术后生存时间较支架引流明显延长。 结论晚期胆管癌患者R1、R2切除及光动力疗效均好于单纯支架引流,但光动力治疗与手术相比是一种安全、恢复快、创伤小的治疗方式。     

微创技术治疗肝细胞癌的进展

Minimally invasive therapy is gaining increasing attention as an important part of therapies in hepatocellular carcinoma (HCC). It includes laparoseopic liver resection, transarterial therapy, local ablative therapy and some new extraeorporeal energy therapies. The theoretical advantages of laparoscopic liver resection are those of minimally invasive surgery in general, such as early recovery, shorter hospital stay, and better cosmetic outcome. However, laparoseopie liver resection for HCC is still considered as controversial because of the uncertainty of the long-term results, and fear of compromising the principles of oncologic resection. Transarterial chemoembolization is the most promising palliative medality for uuresectable HCC, but other techniques, such as transarterial radioembolization and local ablative therapy, have also shown promising results. Recent evidence suggests that local ablative therapy may offer comparable survival outcomes in patients with small HCC and preserved liver function when compared with partial hepatectomy. This article focuses on the development in minimally invasire therapy of HCC.     

腹腔镜结直肠癌切除术后应用羟乙基淀粉的临床研究

目的 探讨腹腔镜结直肠癌术后应用羟乙基淀粉（130/0.4,6%）对于患者术后恢复的影响。方法 选自中山大学孙逸仙纪念医院胃肠外科2011年1月至2011年7月腹腔镜结直肠癌切除术共45例,随机分为羟乙基淀粉组（23例）和血清白蛋白组（22例）。术后3天分别连续使用羟乙基淀粉（130/0.4,6%） 500ml/d和人血白蛋白10g/d。比较两组术前及术后1d、3d、5d患者心率（P）、中心静脉压（CVP）、平均动脉压（MAP）、凝血功能（PT、APTT）、红细胞压积（HCT）、肌酐（Cr）、血清白蛋白以及术后排气时间和术后住院天数。结果 两组患者术前临床资料、肿瘤分期、病理分型具有可比性（P>0.05）。与术前和血清白蛋白组相比,羟乙基淀粉组CVP在术后1d、3d显著升高,差异有统计学意义（P<0.05）;羟乙基淀粉组HCT在术后1d、3d、5d与术前及血清白蛋白组比较降低,差异有统计学意义（P<0.05）。而两组在凝血功能（APTT、PT）、MAP、HR、Cr、白蛋白水平、术后住院时间、及排气时间方面比较,差异无统计学意义（P>0.05）。结论 腹腔镜结直肠癌手术患者围术期应用羟乙基淀粉（130/0.4,6%）可以维持血流动力学稳定、提高血浆胶体渗透压、早期应用可以有效节约白蛋白的使用。     

Effect of curative versus palliative surgical treatment for stage III pancreatic cancer patients.

During the last decade, significant progress has been made in pancreaticoduodenectomy for patients with pancreatic carcinoma. Pancreatic resection performed by surgeons in tertiary referral centres is therefore justified, while the indications for pancreatic resection could be extended in patients with advance stages of disease. The aim of our study is to compare the effect of curative (pancreaticoduodenectomy) versus palliative surgery in patients with stage III pancreatic cancer, during a 20-years period. We retrospectively reviewed the charts of 58 consecutive patients with stage III ductal adenocarcinoma of the head of the pancreas. 23 patients underwent pancreatoduodenectomy with curative intent while the remaining 35 patients had surgery for palliative purposes (combined biliary and gastric bypass was performed in 83%). The hospital mortality rate was similar in both groups (4% vs 6%). 43% of patients undergoing pancreaticoduodenectomy had an uncomplicated post-operative course compared with 49% of patients undergoing palliative bypass. The length of surgical procedure and post-operative hospital stay in pancreaticoduodenectomy group were significant longer compared to those patients undergoing palliative bypass (p = 0.03 and p = 0.02 respectively). The overall actuarial survival was significantly (p < 0.01) longer in the group of patients who underwent pancreaticoduodenectomy compared with the group with palliative intent surgery. CONCLUSION: Pancreaticoduodenectomy with curative intent for stage III pancreatic cancer patients, could improve prognosis with similar peri-operative morbidity and mortality when compared with palliative bypass.     

腹腔镜手术治疗胰腺肿瘤的现状

Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use.In the past,minimally invasive techniques in pancreatic surgery were only used for diagnostic laparoscopy,staging of pancreatic cancer and palliative procedures for unresectable pancreatic cancer.A growing number of case series and multi-institutional reports on safety and efficacy of minimally invasive pancreatic resection have been published.Current knowledge on minimally invasive pancreatic resection is based mainly on short-term outcomes from a small number of centers with cohorts too small to make strong arguments for or against its use.In carefully selected patients,minimally invasive pancreatic resection is safe and feasible.However,the procedure should only be attempted by surgeons who are experienced in open pancreatic surgery and in laparoscopic surgery.The role and oncologic safety of minimally invasive approach for pancreatic resection for pancreatic cancer remain unknown.     

肝癌转化治疗相关技术方法及评价

由于肝癌发病早期无明显症状,大部分肝癌病人确诊时已属中晚期,失去根治性手术切除的机会.转化治疗有望将部分初始不可切除肝癌转化为可切除或接受更为有效的局部治疗手段,为病人争取根治性治疗机会、进一步延长生存期.对于病灶局限肝内的中晚期病人,肝动脉栓塞化疗(TACE)及肝动脉灌注化疗(HAIC)治疗可以缩小肿瘤负荷,或通过门...     

Pancreatic cancer--characteristics of the Japanese Guidelines for the Diagnosis and Treatment of Pancreatic Cancer and my opinion on this subject

Guidelines are meant to reduce differences in therapies among hospitals and increase awareness of gold-standard therapies. The Japanese Guidelines for the Diagnosis and Treatment of Pancreatic Cancer were published on March 10, 2006. When compared with other Japanese guidelines, these guidelines are relatively new and their deficiencies are still being pointed out. They cover diagnosis, chemotherapy, radiation therapy, surgery, and adjuvant therapy. Each of the 22 sections gives three to six clinical questions. The recommendations are ranked from "A" to "D" as in other guidelines, and "B" or "D" remain in the surgical sections. Gemcitabine receives recommendation "A," showing the potential for future therapies for pancreatic carcinoma. The distinguishing features of these guidelines compared with others are that they were estimated by outsiders, the methodologies used in the reports on which they were based are described, recommendations for future therapy are given, and it was already reconsidered.