FOLFOX-6化疗方案与贝伐珠单抗靶向治疗在转移性结肠癌中的应用效果及安全性分析

目的：分析FOLFOX-6化疗方案与贝伐珠单抗靶向治疗在转移性结肠癌中的应用效果及安全性。方法：将50例转移性结肠癌患者采用抽样法分为对照组和观察组,每组25例。对照组患者采用FOLFOX-6化疗方案治疗,观察组患者采用FOLFOX-6化疗方案联合贝伐珠单抗靶向治疗,比较2组患者的疗效、肿瘤标志物水平以及免疫功能。结果：观察组患者治疗总有效率和疾病控制率高于对照组（P <0.05）;治疗后,观察组患者肿瘤标志物水平低于对照组（P <0.05）,免疫指标水平高于对照组（P <0.05）。结论：采用FOLFOX-6化疗方案与贝伐珠单抗靶向治疗转移性结肠癌,可以提高患者的疗效和免疫功能,降低血清肿瘤标志物水平,具有较高的安全性。     

分子靶向药物在胃肠道肿瘤综合治疗中的应用

分子靶向药物在晚期胃肠道肿瘤治疗中,被证实可提高患者的客观缓解率并延长总生存期.因此,其在局部进展期胃肠道肿瘤综合治疗中的价值被逐渐重视.曲妥珠单抗用于HER-2基因阳性的局部进展期胃癌新辅助化疗中的临床研究正在进行中,结果值得期待.大量研究证明,西妥昔单抗联合化疗对于KRAS基因野生型潜在可切除的结直肠癌肝转移患者,能提高手术切除率并延长总生存期;而贝伐珠单抗在KRAS基因突变型结直肠癌肝转移术前转化治疗中的作用正在评估中.对于可切除的结直肠癌肝转移,虽现有的证据显示,分子靶向药物在新辅助治疗中未能带来长期生存益处,但最终结论仍存议甚多.对于局部进展期直肠癌患者,新辅助化疗中的西妥昔单抗在二期临床研究中未能显示治疗获益,贝伐珠单抗的作用同样需要在三期临床研究后进一步证实.与晚期肿瘤单一治疗模式不同,在肿瘤综合治疗中,需要系统评估分子靶向药物与细胞毒药物、手术以及放疗之间可能的相互影响及协同作用,制定出科学并适用于临床实践的综合治疗模式.     

结肠癌急性肠梗阻31例诊治体会

目的　总结 31例结肠癌并急性肠梗阻的诊断、治疗经验。方法　对结肠癌并急性肠梗阻的诊断、手术治疗的术前准备、手术时机、手术方式选择进行分析。结果　本组术前能确诊为结肠癌的 15例全部依靠钡剂灌肠。右半结肠癌 7例 ,左半结肠癌 15例行一期切除吻合 ,术后均无吻合口漏 ;右半结肠癌 2例 ,左半结肠癌5例行一期切除近侧结肠造瘘。本组死亡 3例。结论　钡剂灌肠检查是结肠癌急性梗阻病因诊断唯一有效的辅助检查方法。只要患者一般情况好 ,中毒症状轻 ,均应争取一期切除吻合。术中结肠减压及灌洗是左半结肠癌安全进行结肠一期切除吻合的重要措施     

结肠癌并急性肠梗阻一期手术治疗11例报告

我院 1 9981 999年共收治结肠癌伴急性肠梗阻患者 1 1例 ,男 9例 ,女 2例 ,年龄 54 76岁。右半结肠癌 3例 (结肠肝曲 1例 ,升结肠 2例 ) ,左半结肠癌 8例 (乙状结肠 7例 ,结肠脾曲 1例 )。腺癌 9例 ,未分化癌 2例。梗阻时间为 472小时 ,均为完全性结肠梗阻。表现为腹痛腹胀 8例 ,肛门停止排便排气 2例 ,腹胀伴呕吐 1例。伴慢性支气管炎、肺气肿 1例 ,其余 1 0例全身情况尚好。 3例右半结肠癌梗阻患者常规行右半结肠切除、回肠 横结肠一期吻合。 8例左半结肠癌梗阻患者采用术中肠道灌洗 ,灌洗管为尿管 ,从回肠末端或切除阑尾后从阑尾残端插…     

结肠癌致肠梗阻患者的外科治疗（附32例报告）

目的探讨结肠癌致肠梗阻的外科治疗方法。方法回顾分析1991—2007年32例结肠癌致肠梗阻的外科治疗资料。结果32例患者中行Ⅰ期结肠癌根治性切除肠管端端吻合术共24例，其中右半结肠切除7例，横结肠切除3例，左半结肠切除5例，乙状结肠切除9例。行左半结肠切除、横结肠造口，关闭远端结肠备Ⅱ期吻合2例；乙状结肠癌根治性切除结肠造口1例；肿瘤无法切除行结肠侧侧吻合或造口5例。术后并发症发生率21．9％（7／32），围术期死亡率3．1％（1／32）。结论重视对结肠癌致肠梗阻的认识，早期诊断，根据病情选择合理手术方式，做好围术期处理是减少术后并发症、提高疗效的重要措施。     

31例结肠癌并肠梗阻诊治体会

目的探讨结肠癌并肠梗阻的临床症状特点和诊治方法。方法回顾性分析31例结肠癌并肠梗阻患者的临床资料。结果 4例行内科保守治疗;27例行手术治疗,术前20例表现为不完全行肠梗阻,右半结肠Ⅰ期切除吻合9例;横结肠Ⅰ期切除吻合4例;左半结肠Ⅰ期切除吻合2例;左半结肠Ⅰ期切除,Hartmann结肠造口3例;仅行结肠造口2例。术后吻合口漏2例,1例经引流、营养支持痊愈,1例肠瘘生存状态;肺部感染2例。术前7例表现为完全性肠梗阻患者,左半结肠Ⅰ期切除,Hartmann结肠造口4例;右半结肠Ⅰ期切除吻合3例。术后吻合口漏1例,经引流、营养支持等对症治疗后痊愈。术后病理类型:腺癌25例,未分化癌2例。结论根据患者癌性梗阻症状及体征,选择合理的治疗手段,是提高癌性梗阻治疗的关键。     

初始不可切除结直肠癌肝转移转化治疗结局影响因素分析

目的研究初始不可切除结直肠癌肝转移(CRLM)转化治疗结局影响因素, 为制定患者的个体化治疗策略提供循证医学证据。方法本研究采用回顾性病例对照研究方法, 纳入中山大学肿瘤防治中心2013年1月至2020年1月期间新初始不可切除、经过一线全身治疗且转化成功的98例CRLM患者, 并将同期入院、但转化失败的134例CRLM患者纳为对照组。转化治疗方案:38例接受FOLFOXIRI方案化疗(伊立替康、奥沙利铂、亚叶酸钙和氟尿嘧啶), 152例接受FOLFOX方案化疗(奥沙利铂、亚叶酸钙和氟尿嘧啶), 19例接受FOLRIRI方案化疗(伊立替康、亚叶酸钙和氟尿嘧啶), 23例接受全身化疗联合氟尿苷肝动脉灌注化疗;168例接受了靶向治疗, 其中68例贝伐单抗, 100例西妥昔单抗。采用Logistic回归分析临床因素对转化治疗结局的影响。结果 232例纳入分析的患者中, 98例转化成功, 转化成功率42.2%, 其中30例接受单纯肝切除, 68例接受肝切除联术中射频消融。一线化疗后获得部分缓解111例(47.8%), 疾病稳定57例(24.6%), 疾病进展64例(27.6%)。中位随访18.8...     

一期切除吻合术治疗左半结肠癌并急性肠梗阻临床疗效观察（附46例报告）

目的 探讨左半结肠癌并急性肠梗阻行一期切除吻合术的安全性及其临床应用.方法 对46例左半结肠癌并梗阻患者行一期肠切除肠吻合术,术中进行有效的结肠减压及清洁灌洗,术后观察疗效.结果 有31例患者左半结肠恶性梗阻患者经保守治疗肠梗阻缓解改限期手术行一期肠切除吻合术,其余15例患者一般情况较好,经全结肠灌洗后一期肠切除吻合术,所有手术均顺利完成,术后并发切口感染8例（17.4％）,吻合口漏4例（8.7％）,经保守治疗痊愈.结论 左半结肠癌并发急性肠梗阻患者行一期肿瘤切除吻合术是安全有效的.     

左半结肠癌并肠梗阻一期切除吻合30例

左半结肠梗阻最常见的病因是左半结肠癌,目前对右半结肠癌伴梗阻患者,施行右半结肠切除、回结肠-期吻合术,已形成共识,而左半结肠癌并肠梗阻的手术尚有争论。自2002年1月以来。永州职业技术学院附属医院普外科共收治左半结肠癌并肠梗阻患者38例。其中30例行-期切除肠吻合术,总结报道如下。     

44例结肠癌引起急性结肠梗阻的治疗体会

我院自1990年以来共收治结肠癌引起的急性结肠梗阻44例,现初步作一小结,并对有关治疗问题加以讨论。临床资料本组44例中男26例,女18例,年龄28~70岁,平均49岁。结肠癌引起梗阻占同时期住院急性结肠梗阻的首位(55.4%),占同时期住院结肠癌患者的42%。左半部结肠癌36例(82%):乙状结肠癌32例,其中2例引起急性结肠梗阻继发盲肠穿孔,脾曲结肠癌2例,降结肠癌2例;右半结肠癌8例(18%):升结肠癌4例,肝曲结肠癌2例,盲肠癌2例。全组病例于入院后经过积极的术前准备,采用了3种手术方法:①结肠一期切除20例。在癌位于左半结肠的16例中,施行左半结肠切除12例…     

结肠癌肝转移外科治疗的临床与病理分析(附25例报告)

目的　探讨结肠癌肝转移的外科治疗方法及其病理因素对预后的影响。方法　本组79例结肠癌肝转移患者中共有 2 5例接受原发灶根治术以及肝转移灶切除术或射频消融术。其中 14例进行了原发灶根治术及肝脏转移灶切除术 ,11例进行了肝脏转移灶射频消融术。结果　本组结肠癌肝转移患者术后 1年、3年生存率分别为 84 %、4 8%。分化程度高以及单个转移灶的患者预后较好。肝脏肿瘤切除与肝脏肿瘤射频消融术后患者生存时间无明显差异。结论　结肠癌肝转移患者原发肿瘤的分化程度、肝脏转移灶的数量对预测患者的预后有一定的作用。手术切除及射频消融术对治疗结肠癌肝转移能够达到较为接近的治疗效果。     

The effect of UFTM therapy on primary and metastatic colon cancer from the same human xenotransplanted into nude mice

Successful simultaneous transplants of a cancer of the ascending colon from a 60 year old woman, taken from 3 sites: the primary focus, a lymph node metastasis, and a hepatic metastasis, into nude mice yielded KHC (-P,-N,-H) strains. These three strains were compared under uniform conditions of nude mouse transplantation from the standpoints of morphological variation, growth rate, and sensitivity to chemotherapy. The results showed no major differences in morphology or growth rate. However, an effect on chemotherapeutic sensitivity was observed in KHC-P and KHC-N, with reduction rates of 25.8 per cent and 31.4 per cent, respectively, in the MMC only treatment group with large doses, and in KHC-N and KHC-H, with reduction rates of 46.5 per cent and 34.9 per cent, respectively, in the UFTM group. Chemotherapy sensitivity not only exhibited heterogeneity by site, but also differed according to the chemotherapeutic agent used. These results indicate that this method of nude mouse transplantation is a good experimental system for comparing primary foci and metastases under uniform conditions, and also strongly suggest the presence of heterogeneity in sensitivity to chemotherapy.     

Relapse of colon cancer followed by polymyositis: Report of a case and review of the literature

The direct causal relationship between dermatomyositis-polymyositis (PM) and malignancy remains controversial. We describe herein the case of a patient who underwent surgical treatment for colon cancer, which had preceded the onset of PM with tumor relapse. The PM markedly improved following the initiation of steroid therapy, and has remained under control, probably as a result of chemotherapy. The current concepts of variable clinical courses and the possible mechanism for the association of PM with malignancy are discussed following this case report.     

Preliminary outcome of a treatment strategy based on perioperative chemotherapy and surgery in patients with locally advanced colon cancer

Aim

Preoperative chemotherapy followed by radical surgery is an attractive treatment for locally advanced colon cancer (LACC) given the promising results of this approach in other locally advanced tumours. The study evaluates the outcome and treatment‐related complications of perioperative oxaliplatin‐ and capecitabine‐based chemotherapy and surgery for clinical Stage III colon cancer.

Method

Twenty‐two consecutive patients with a CT‐staged LACC were included. All were staged at baseline and before surgery. Surgery‐related complications and oncological outcome were determined.

Results

Toxicity was manageable, with 19/22 patients completing the planned chemotherapy protocol. The median time from initial diagnosis to surgery was 65.5 days. The median time from the end of chemotherapy to surgery was 22 days. After neoadjuvant treatment, tumour reduction of 69.5% was observed by CT scan and a 59.9% decrease of SUV_max (standard uptake value) was achieved on positron emission tomography/CT. No progressive disease was reported during preoperative chemotherapy and surgery was performed in all 22 patients. Four patients developed postoperative complications. After a median postoperative follow‐up of 14.4 months, the actuarial overall and disease‐free survival rates were 100 and 90%.

Conclusion

Neoadjuvant chemotherapy followed by surgery and chemotherapy for LACC is safe without apparent increase of early and medium‐term complications.

     

老年结肠癌Survivin蛋白的表达

目的　为探讨Survivin基因在老年结肠癌的表达。方法　采用免疫组织化学方法对 89例老年结肠癌标本Survivin基因表达进行检测。结果　Survivin在正常结肠组织中不表达 ,89例老年结肠癌中Survivin表达阳性率 74 .2 % ,16例结肠息肉中Survivin表达阳性率为 4 7.8% ,老年结肠癌Sur vivin基因蛋白阳性表达高于结肠良性病变 (P <0 .0 5 )。老年结肠癌Survivin基因蛋白表达与病理类型差异无显著性意义 (P >0 .0 5 )。老年结肠癌Survivin基因蛋白阳性表达与Dukes分期差异有显著性意义 (P <0 .0 5 )。结论　Survivin基因对老年结肠癌的发生、发展有重要意义     

经内镜钳道肠道支架在高位结肠癌梗阻患者治疗中的应用

目的分析高位结肠癌所致的急性结肠梗阻患者术前应用内镜钳道肠道支架对手术的有效性及安全性,探讨其临床应用价值。方法高位结肠癌合并梗阻的患者36例,癌梗阻为回盲部升结肠癌4例,升结肠癌20例,横结肠近肝曲12例。36例患者均先置入肠道支架解除梗阻,经术前准备后再行肿瘤切除术。分析手术肠切除的成功率、并发症发生率、手术时间及住院时间。结果经内镜钳道肠道支架置入成功率为100%,术后1~2 d均能解除梗阻,术后5~7 d接受手术,其中34例行一期行根治性切除术,1例术中发现肝转移,1例术中发现盆腔转移,术后均恢复顺利,无感染、吻合口漏及腹腔出血等并发症。结论高位结肠癌所致的急性结肠梗阻患者术前经内镜钳道肠道支架置入经济有效、并发症少,可以显著降低患者的创伤和痛苦,提高患者的生活质量,是一个安全、有效的的治疗方法。     

降低结肠癌术后复发和转移的体会

目的　探讨降低结肠癌术后复发和转移发生率的方法。方法　回顾性分析 79例结肠癌在不同治疗方式后的复发和转移情况。结果　 1990年前 17例行不规范根治术同时未进行化疗的病人术后复发或转移 9例 ( 5 2 .94% ) ;1990年后应用肿瘤隔离技术行规范根治性手术的病人中 ,10例不同时给予以化疗的术后复发或转移 3例 ( 3 0 % ) ,而 16例同时给予规则化疗的术后复发或转移仅 2例 ( 12 .5 % ) ,χ2 =6.18,P =0 .0 46。在肿瘤不能行根治切除的病例中 ,2 0例给予规则化疗 ,而另 16例未进行化疗 ,平均生存期分别为 8和 4.5个月。结论　重视术中肿瘤隔离技术 ,术中和术后化疗可降低结肠癌术后的复发和转移发生率     

Malakoplakia occurring in association with Colon carcinoma

Malakoplakia, characterized by histiocytes with Michaelis-Gutmann bodies, is a rare entity. It is particularly so in the gastrointestinal tract, where it has been described in association with colon cancer, with about 20 cases described worldwide. The significance of this condition lies in its potential effect upon the preoperative staging and treatment of associated colorectal cancer. Its presence may lead to preoperative clinical and radiological over staging and more extensive resection, as well as the use of neoadjuvant therapy or a decision to undertake palliative care. This condition is more common in males. We present the case of the oldest reported patient with this association. The patient was a 90-year-old female who was treated with a sigmoid resection for an obstructing sigmoid lesion. At operation, the left ureter was embedded within an inflammatory pericolic mass but was not grossly involved with tumor. The tumor was a Dukes’ stage B adenocarcinoma and occurred in association with malakoplakia.     

腹腔镜结肠癌根治术规范实施与关键点

腹腔镜结肠癌根治手术作为腹腔镜消化道肿瘤手术中最为成熟的手术方式,已得到欧美大宗病例的循证医学证据的支持。树立正确的微创外科观念,建立腹腔镜结肠手术的关键技术、操作规范与培训体系,以及引入循证医学,提供高级别循证医学证据,是腹腔镜结肠癌手术在我国得到规范化推广的几个关键点。