纯酒精与联合抗癌药治疗肝癌的疗效比较

选用纯酒精单用或联合抗癌药治疗原发性肝癌患者５３例，经２个疗程后，完全缓解１６例，部分缓解２１例，总有效率６９．８％，中位生存期１０．１个月，３种不同治疗方案中纯酒精联合阿霉素方案有效率较高，毒副反应主要为消化道反应及肝功能损害，但低于纯酒精联合多种抗癌药方案，故认为此方案在对不适合手术或不接受手术治疗的肝癌患者，可作为一种补救方法。     

原发性肝癌合并严重肝硬化门静脉高压症的外科治疗选择

目的探讨原发性肝癌合并严重肝硬化门静脉高压症的外科治疗方法及疗效。方法回顾性分析我院1998年1月至2006年8月手术治疗的肝癌合并严重肝硬化门静脉高压症161例，其中行脾切除＋贲门周围血管离断术联合肝癌局部根治性切除70例，脾切除＋贲门周围血管离断术联合术中射频消融治疗68例，肝移植23例。结果肝癌切除组、术中射频治疗组和肝移植组术后5年生存率分别为34．3％、39．7％和82．6％，并发症发生率分别为20．0％、4，4％和8．7％，无围手术期死亡。结论对于可切除的原发性肝癌合并严重肝硬化门静脉高压症的患者，在加强围手术期处理的同时根据病情合理选择外科治疗方法，可以有效地治疗肝癌和门静脉高压症，提高患者的生存质量及延长生存期。     

集束电极射频热凝治疗肝癌

目的：总结集束电极射频热凝治疗肝癌的效果及经验。方法：对经皮射频治疗或术中射频治疗不宜手术切除的肝癌102例的临床资料进行回顾性分析。结果：用射频毁损102例患者195个肿瘤（肿瘤直径1．5－9．5cm，平均直径5．6cm），其中原发性肝癌80例，转移性肝癌20例。经皮和经手术进行射频毁损的患者数分别为77人（75．5％）和25人（24．5％）。未发生与治疗相关的严重并发症。随访3－24月，治疗后症状有改善，AFP阳性者治疗后转阴率70．3％（52／74），彩色B超示肿瘤血管消失或CT提示肿瘤凝固性坏死者达88．2％（90／102）。1年生存率为93．8％。结论：肝癌射频治疗是一种安全、疗效可靠的治疗方法。对于容易接近、不宜手术的小肝癌，可行经皮射频治疗。对于患有较大肿瘤、多病灶或肿瘤靠近肝内主要血管采用术中射频治疗。采用TACE或术中阻断入肝血流的方法有助于提高射频治疗的疗效。     

术中超声在原发性肝癌手术以及射频消融中的应用

目的探讨术中超声在原发性肝癌手术切除以及射频消融治疗中的作用。方法对45例原发性肝癌患者行术中超声检查并将其结果与术前经腹超声检查进行对比，观察术中超声在原发性肝癌手术切除以及射频消融治疗中的作用。结果45例原发性肝癌患者共有肿瘤瘤灶60个，术前超声、术中超声诊断符合率分别为78．30％、95．00％，术中超声高于术前超声检查（P=0．0072）。对直径0．5～2．0cm的肿瘤瘤灶检出率术中超声为100％，高于术前超声的63．00％（P=0．012）。对术中未触及的8个瘤灶于术中超声引导下行肝脏局部切除术。对14个不宜手术切除的瘤灶行术中超声引导下射频消融治疗并短期随访观察，有效率为85．70％。结论术中超声可提高肝癌小瘤灶的检出率，减少漏诊以及误诊，并可在术中对无法触及以及不宜手术切除的瘤灶行术中超声引导的肿瘤切除以及射频消融治疗，具有很高的实用价值。     

B超引导经皮肝穿刺射频治疗肝癌

目的：探讨B超引导经皮肝穿刺射频（PRFA）治疗肝癌的价值。方法：1999年10月－2000年3月对70例肝癌患者进行了B超引导PRFA治疗,并于治疗后每个月进行肿瘤标记物和B超检查,治疗后1个月复查MRI或CT。结果：患者肝功能分级Child A级53例,B级15例,C级2例,原发性肝癌53例,继发性肝癌17例,原发性小肝癌（小于等于5cm,未手术）21例,其中AFP阳性17例,PRFA术后转阴12例,明显降低4例,未降低1例。MRI显示肿癌完全凝固性坏死16例,根治率76．2％,小肝 癌各组PRFA术后3,6个月生存率均为90．5％－100％,大肝癌各组术后3,6个月生存率分别为66．7％－72．7％和27．6％－72．7％,结论：射频作为肿瘤透热治疗的一种方法,对于肝癌尤其是无手术指征,或有手术指征但位于肝中央区,临近腔静脉或肝门区的小肝癌,PRFA具有微创,时间短,安全方便,疗效可靠,对于大肝癌,PRFA可与肝动脉介入化疗栓塞联合应用,以提高疗效。     

长强穴切挂术联合生物反馈治疗耻骨直肠肌综合征的临床研究

为探讨长强穴切挂术联合生物反馈治疗耻骨直肠肌综合征（PRS）的临床疗效,对120例PRS患者先行长强穴切挂术治疗,手术创面愈合后开始行生物反馈治疗,观察其疗效,并与先期行单纯手术治疗及单纯生物反馈治疗的患者疗效进行对比。结果显示,本组120例患者中,治愈71例,显效32例,有效16例,无效1例,总有效率为99．2％（119／120）。与单纯手术治疗（总有效率为94．9％）和单纯生物反馈治疗（总有效率为75．9％）相比,差异均有统计学意义,P〈0.05或P〈0．01。结果表明,长强穴切挂术联合生物反馈治疗PRS疗效确切,疗效优于单纯手术治疗或单纯生物反馈治疗。     

肝癌合并门静脉高压症的同期联合手术治疗（附19例报告）

目的 肝癌合并门静脉高压症同期联合手术治疗的方法和疗效。方法 回顾性分析1994年8月至2002年2月施行肝癌和门静脉高压症同期联合手术治疗19例。结果 除1例于术后4周因并发肝肾综合征及上消化道出血死于多器官功能衰竭（手术死亡率5．26％）外，其余18例皆康复出院，术后并发症发生率为4．1％（8／19）。随访中死亡11例，死亡原因：肝癌复发3例，肝功衰竭5例，上消化道出血3例。术后1，2，3年生存率分别为79．8％，28．6％，0％。结论 只要合格掌握手术适应证和术式，对肝癌合并门静脉高压症施行同期联合手术治疗是安全的，可望延长病人的生存期。     

原发性肝癌破裂出血的临床分析(附76例报告)

目的探讨原发性肝癌破裂出血的诊疗。方法回顾性分析1990-2004年我院76例资料完整的原发性肝癌破裂出血患者的诊断和治疗。结果76例患者均有急性上腹部疼痛和急性腹膜炎表现，影像学检查和腹腔穿刺均阳性。76例中非手术治疗34例，占44．7％，12例死亡（占非手术治疗的35．3％）；手术治疗42例，占54．3％。6例死亡（占手术治疗的14．3％）。结论病史、影像学检查和腹腔穿刺在原发性肝癌破裂出血的诊断中起重要作用。治疗根据患者的具体情况而采取保守治疗或缝扎止血、手术肝切除、肝动脉结扎等手术治疗方法。     

紫杉醇联合卡铂治疗晚期非小细胞肺癌疗效观察

目的 观察紫杉醇联合卡铂治疗晚期非小细胞肺癌疗效及不良反应。方法 29例晚期非小细胞肺癌患者给予紫杉醇联合卡铂治疗，其中紫杉醇135mg／m^2，第1天静滴，卡铂300mg/m^2，第1天静滴，28d为1个周期，每例患者治疗2个周期以上。结果 全组无完全缓解病例，部分缓解13例，稳定10例，进展6例，总有效率44．8％。初治组有效率为46．1％，复治组有效率为43．8％，两组间有效率差异无显著性（P〉0．05），KPS评分增加者占65．5％（19／29）。最常见的毒副反应为骨髓抑制，Ⅲ～Ⅳ度白细胞和血小板下降分别为34．5％和10．3％，其他毒副反应轻微，均可耐受。结论 紫杉醇联合卡铂治疗晚期非小细胞肺癌，无论初治或复治均有较高有效率，且本方案还能改善患者的机体功能状态。     

高龄小肝癌患者的治疗（附52例报告）

目的探讨高龄小肝癌患者的治疗方法和疗效。方法对52例70岁以上高龄小肝癌患者进行了治疗，年龄70～82岁，平均74．2岁，最大82岁。90％患者合并肝硬化，70％合并其他脏器慢性疾患。手术切除15例，非手术治疗37例。结果行手术治疗的15例无手术死亡，术后无严重并发症发生；术后1、3、5年生存率为93．3％、80．0％、66．7％。非手术的37例，术后1、3、5年生存率为89．2％、70．2％、53．8％。结论手术切除仍是首选的治疗方法，但应严格掌握适应证；各种局部治疗方法的联合应用可进一步提高疗效。     

Combination chemotherapy of advanced bladder cancer

Patients with carcinoma of the urinary bladder have a poor prognosis. When distant metastasis develops, such patients seldom survive for more than several months. For them, surgery and/or radiotherapy are of little value, and systemic chemotherapy has been thought to be the most useful treatment. Forty-six patients with advanced transitional cell carcinoma, including bladder cancer, (33 bladder, 9 ureter, 4 renal pelvis cases) were treated by a three drug combination chemotherapy, using two protocols (protocol I: adriamycin + cyclophosphamide + 5-fluorouracil, protocol II: adriamycin + cyclophosphamide + cis-platinum). Protocol I induced responses in 5 of the 24 patients (21%, 1 complete response, 4 partial responses), and protocol II in 7 of the 22 patients (32%, 1 complete response, 6 partial responses). The overall response rate was 26%. The durations of response (median duration 5.1 months) and of survival (median duration 11.3 months) in all responders were relatively short. The three-combination chemotherapy, especially protocol II, was effective against transitional cell carcinoma of the urinary tract, but the results were not satisfactory.     

A trial of bacillus Calmette-Guérin versus adriamycin in superficial bladder cancer: a South-West Oncology Group Study

One hundred and sixty-one evaluable patients with biopsy-confirmed transitional cell carcinoma of the bladder were studied in a cooperative protocol comparing intravesical BCG and adriamycin. Patients have been followed for 2-25 months (median 15.7 months) with cystoscopy at 3-month intervals, urinary cytology, and bladder biopsy. Sixteen of 88 patients (19%) who received BCG immunotherapy developed tumor recurrence compared with 45 recurrences (54%) in the 83 patients who received adriamycin chemotherapy (p less than 0.001, chi 2). Eighty-nine of the randomized patients had documented carcinoma in situ. The complete response rate in 41 patients with carcinoma in situ who received BCG was 85%, compared with a complete response rate of only 39% in 46 patients who received adriamycin (p less than 0.001, chi 2). These data suggest that BCG immunotherapy is superior to adriamycin chemotherapy in the prevention of recurrent superficial transitional cell carcinoma and the treatment of in situ carcinoma of the urinary bladder.     

Study of consolidation chemotherapy in advanced epithelial ovarian carcinoma

Objective:A prospective randomized study was designed to evaluate the role of consolidation chemotherapy in advanced epithelial ovarian carcinoma.Methods:50 patients with advanced epithelial ovarian carcinoma treated in our hospital during the period from March 2000 to October 2005 were enrolled in this study.All patients had achieved clinical complete remission by means of standard treatments,and were randomly divided into consolidation chemotherapy group and control group.Relapse rate,and disease-free survival(DFS)time were analyzed in both groups.Results:24 patients were assigned in consolidation chemotherapy group,and 26 patients in control group.Tumor relapse interval in consolidation group was(26.5±7.4)months,vs.(16.8±7.0)months in control group respectively,P=0.001.Time to relapse(TTR)in consolidation group was(19.2±6.8)months,vs.(10.0±6.9)months in control group,P=0.002.Analysis of DFS time and overall survival time,Log Rank test:P=0.042 and P=0.062,respectively.Conclusions:Consolidation chemotherapy could be the relevant factor that postpones tumor relapse interval and prolongs DFS time in advanced epithelial ovarian carcinoma patients who had achived chlinical complete remission.But so far the statistic result of our clinical study is beyond the conclusion that consolidation chemotherapy can decrease relapse rate or increase survival rate.Multicenter randomized clinical trial should be performed to confirm the role of consolidation chemotherapy in advanced epithelial ovarian carcinoma.     

综合治疗中晚期胰头癌38例体会

目的 探讨中晚期胰头癌综合治疗效果。方法 对我院2001年1月至2007年10月无法手术切除的38例中晚期胰头癌行高位肝胆管空肠吻合术和胃空肠吻合术，术中同时行肿瘤局部无水酒精消融和腹腔神经丛无水酒精阻滞及区域动脉置管皮下埋泵术后化疗等综合治疗（简称为综合组），并就治疗效果与同期单纯行胆肠内引流治疗（简称为单纯组）的39例病人进行对比分析。结果 综合治疗组病例未增加手术并发症，术后疼痛缓解率和肿瘤缓解率有显著性提高，综合组半年、1年、2年生存率为94．37％、51．62％和7．02％。单纯组半年、1年、2年生存率为61.8％、17．34％和0。结论 综合治疗有助于延长中晚期胰腺癌病人的生存期和减轻病人疼痛、提高病人生活质量。     

Clinical research on prevention of recurrence of superficial bladder cancer--comparative study on clinical efficacy of bleomycin intravesical instillation and bestatin

Objectives and methods of the study: Although superficial bladder carcinoma can be surgically eliminated by TUR, recurrence is common. Various attempts have been made to prevent recurrence, but to date an excellent prophylactic method with few adverse reactions has not been established. We conducted a clinical trial study for prophylaxis of bladder carcinoma recurrence, using intravesical instillation of bleomycin, a drug which cause little local irritation, in combination with bestatin, a recently developed immunomodulator. Bleomycin was selected on the bases of experimental results. That is, in beagle dogs, the 1-hour intravesical instillation of bleomycin gained a drug concentration in the bladder wall of 2.08 micrograms/g, which is approximately 4 times higher than that in the intravenous administration of the same dose. The above bleomycin concentration was thought enough to obtain a good clinical effect. A total of 124 patients were randomly divided into the two treatment groups: An only bleomycin intravesical instillation group (60 mg on each treatment day) (58 patients) and a bleomycin with bestatin (60 mg per every day) group (66 patients). In the 2-year follow-up period the recurrence of bladder carcinoma in the two treatment groups was studied. Analysis of non-recurrence rate by life-table method and Kaplan-Meier method: The non-recurrence rate of the bladder carcinoma every three months was calculated by the life-table and Kaplan-Meier methods. The non-recurrence rate in the bleomycin group was approximately the same as the rates in adriamycin or mitomycin reported in the literature. In the bleomycin + bestatin group, the recurrence rates at 9 months and 12 months were significantly (at P = 0.09 and P = 0.08, respectively) lower, and in addition, even the 2-year overall non-recurrence rate curves showed a nearly significant difference (P = 0.179). Especially in the case of papillary pedunculated tumors, the difference in the non-recurrence rate curves was almost statistically significant (P = 0.104). The stratified analysis on the basis of various tumor factors, were as follows. Pathological grade: Although no differences were found in Grades 1 and 2, the bleomycin + bestatin group had a lower recurrence rate in Grade 3 cases (P = 0.1).(ABSTRACT TRUNCATED AT 400 WORDS)     

Maintenance immunosuppression therapy and outcome of renal transplantation in North American children — a report of the North American Pediatric Renal Transplant Cooperative Study

The North American Pediatric Renal Transplant Cooperative Study collects extensive data on all transplants entered into its registry. For this study we evaluated 568 cadaver kidney and 492 live-donor recipients with graft function at 30 days post transplant. Utilizing maintenance immunosuppressive therapy at 30 days post transplant we evaluated patient and graft outcome, mortality and morbidity over the first 6 months post transplant. For cadaver kidney recipients, 36 patients were receiving prednisone and azathioprine (PA), 114 were maintained on prednisone and cyclosporine (PC) and 418 were on prednisone, cyclosporine and azathioprine (PCA). Patients receiving PA had a greater incidence of rejection prior to 30 days, a greater incidence of hospitalization for rejection and for hypertension over the next 6 months and a greater loss of allograft in the first 6 months compared with the other two groups. The only difference noted between PC and PCA was a lower serum creatinine in the PCA group at 6 months. For living-related kidney recipients, there were 78 patients maintained on PA, 97 on PC and 317 on PCA. Again patients receiving PA had a higher rate of hospitalization for rejection and a higher rate of graft loss. When patients receiving PC were compared with those receiving PCA, no differences were noted in the 6-month serum creatinine values, but a greater percentage of PCA patients were receiving antibiotics on day 30. We conclude that PA is poor therapy for both groups, PCA is ideal therapy for cadaver kidney recipients, but no beneficial effects are noted when PCA is used over PC for live-related donor kidney transplants.Presented at the 10th annual meeting of the American Society of Transplant Physicians, 29 May 1991, Chicago     

Can topical chemoprevention modify the rate of recurrence and progression of superficial bladder cancer?

Several studies indicate that intravesical chemotherapy is an effective treatment for superficial bladder tumors. We have carried out a retrospective study of 321 patients with superficial bladder cancer who where treated between 1972 and 1982 at our Institute. In 63 of the 321 patients, adriamycin 50 mg or mitomycin C 20 mg was administered topically. In an average follow-up of 20.2 months the overall recurrence rate was 54.2%. In the control group the mean times to recurrence were 21 months for Ta tumors and 17.4 months for T1 tumors, while those in the topically treated patients were 14 and 8 months for the mitomycin and 17 and 6 months for the adriamycin group. The only factor that influenced the recurrence rate was the depth of infiltration of the lamina propria. Our data indicate that topical chemotherapy has no effect in patients with superficial cancer of the bladder.     

阿霉素加环孢素膀胱灌注预防膀胱癌术后复发

目的 探讨膀胱癌术后复发率。方法 应用阿霉素加环孢素化疗方案行膀胱腔内灌注化疗预防复发;同时采用免疫组织化学方法检测初发膀胱癌组织４２例标本Ｐ－糖蛋白（Ｐ－ｇｐ）和多药耐受相关蛋白（ＭＲＰ）的表达。结果 ４２例患者应阿霉素和环孢素联合腔内灌注化疗,平均观察２０．４个月。随访期间未复发３８例;４例复发,复发率为９．５２％,病理分级与前次相同。初发膀胱癌中,ＭＲＰ总阳性率为３８．１％,Ｐ－ｇｐ总阳性率为４０．４％。结论 环孢素与细胞毒制剂联合化疗,能不增加毒副作用的同时,增加化疗效果,抑制耐药性的形成,降低复发率,具有广泛的临床应用前景。     

Chemotherapy of advanced gastric cancer

Twenty-eight patients with inoperable or metastatic gastric cancer were treated with combination chemotherapy using 5-fluorouracil, adriamycin and mitomycin-C (FAM). Twenty-one patients had measurable disease parameters and 57 per cent of these experienced a major regression of disease following chemotherapy. The median survival of the responding patients was 13.2 months compared with 6.8 months in the group who did not achieve a major response. These results demonstrate the sensitivity of gastric carcinoma to this drug combination.     

Para-Aortic Involvement and Interest of Para-Aortic Lymphadenectomy after Chemoradiation Therapy in Patients with Stage IB2 and II Cervical Carcinoma Radiologically Confined to the Pelvic Cavity

Background Pelvic radiation therapy with concomitant chemotherapy (PCRT) is the standard treatment of stage IB2/II cervical carcinoma. The impact of concomitant chemotherapy on positive para-aortic nodes (PA+), however, remains unknown. The aim of this study was twofold: to evaluate the rate of histological PA+ after PCRT and to determine the survival of patients with PA+. Methods Patients fulfilling the following inclusion criteria were studied: (1) stage IB2/II cervical carcinoma, (2) histological subtype: squamous cell, adenocarcinoma or an adenosquamous tumor, (3) exclusion of patients with radiological PA+ (CT scan/MRI), (4) pelvic external radiation therapy of 45 Gy with concomitant chemotherapy (cisplatin 40 mg/m²/week) + utero-vaginal brachytherapy, and (5) completion surgery after the end of PCRT including at least a para-aortic lymphadenectomy. Results Seventy-three patients (16 stage IB2, 57 stage II) treated between 1998 and 2004 fulfilled all the inclusion criteria. PA+ after PCRT were observed in 13 patients (18%) with a median of five (range, 2–22) positive nodes. Overall and disease-free survival at 24 months in patients with PA+ was 40% and 17%. Only two patients with PA+ are currently alive and in remission. Conclusions The rate of PA+ remains high after PCRT in patients treated for stage IB2/II cervical carcinoma. Furthermore, the survival rate of patients with PA+ is very low. These important results suggest that detection of PA + at the time of completion surgery (after PCRT) is not beneficial for improving survival.