结肠癌肝转移35例疗效观察

目的通过不同治疗方法来观察结肠癌肝转移的生存期,以选择最佳的治疗方案.方法回顾性分析本院自1990年来采用不同方法治疗结肠癌肝转移35例,其中术中同时切除结肠癌肿瘤及肝转移病灶3例,结肠癌术后出现肝转移再切除2例,术中肝动脉、门静脉双置泵化疗8例,术后肝动脉插管介入化疗10例,常规化疗12例.结果术后其1、3、5年生存率为切除组＞置泵组＞介入化疗组＞常规化疗组,术后三年生存率分别为40%、25%、20%和0.结论切除肝转移组优于置泵组和介入化疗组,后两者又优于单纯化疗组.     

CapeOX方案结合手术治疗不可切除的结直肠癌肝转移

目的应用CapeOX方案作为一线化疗方案,结合手术切除治疗仅局限于肝脏的不可切除性结直肠癌肝转移的患者,评估是否改善预后。方法对不可切除性转移性结直肠癌患者应用capeOX方案化疗,每2周期评估1次,如可行治愈性切除则考虑手术。术后继续CapeOX方案化疗。记录化疗缓解率及手术切除情况,手术并发症、术后复发及生存状态。结果2005年7月至2007年8月共收治51例患者符合标准,化疗后缓解22例,缓解率为43．1％（22／51）,其中15例行治愈性切除。术后有5例出现并发症,无手术死亡,随访中位时间21个月,6例复发,其中4例死亡,其他均存活。化疗无效的或化疗后肿瘤缓解但未能行肝切除的中位生存期为12个月和19个月。结论应用CapeOX方案化疔可以使部分患者肿瘤缓解．结合肝切除术,可延长患者的生命。     

结肠癌肝转移氩氦刀治疗后并发DIC 1例

弥漫性血管内凝血(DIC)是在某些严重疾病的基础上,由特定诱因引发的以凝血功能紊乱为特点的临床综合征。致病因素引起血管内多系统的凝血活化并导致弥散性血管内微血栓形成,继而出现细胞和组织供氧紊乱,器官功能障碍直至急性功能衰竭;同时大量凝血因子和血小板被消耗并     

手术切除联合化疗对晚期结肠癌肝转移患者生存状况的影响

目的：探讨手术切除联合化疗对晚期结肠癌肝转移患者生存状况的影响。方法选择晚期结肠癌肝转移患者102例,将采用手术切除联合化疗的35例患者纳入观察组,将单纯采用化疗的67患者纳入对照组。随访3年,观察两组患者治疗开始至肿瘤病灶进展的时间（ TTP）,化疗过程中出现的不良反应,对比两组患者的1、2、3年累积生存率。结果观察组患者共化疗160个疗程,平均4．57个疗程,TTP为14个月;对照组患者共化疗359个疗程,平均5．35个疗程,TTP为8个月,两组之间差异有统计学意义（P＜0．05）。观察组患者贫血发生率显著高于对照组（P＜0．05）,其余不良反应发生率差异无统计学意义（P＞0．05）。观察组中位生存时间为26．5个月,对照组中位生存时间为22．7个月,差异有统计学意义（P＜0．05）。观察组1、2、3年生存率分别为88．6％,57．1％和42．9％;对照组1、2、3年生存率分别为71．6％,44．8％和34．3％。其中1年生存率两组之间差异显著（P＜0．05）,2、3年生存率两组之间的差异无统计学意义（P＞0．05）。结论手术联合化疗治疗晚期结肠癌肝转移患者不会增加化疗的不良反应,可以提高患者的疗效和生存率。有手术指征的晚期结肠癌肝转移患者应积极采取手术治疗。     

结肠癌肝转移物理消融治疗的新进展

物理消融治疗是一种局部治疗,它可以有效地原位破坏结肠癌肝转移病灶,同时保留周围正常肝组织。与手术相比,消融治疗创伤较小、易于开展且可以重复。对于不能切除的结肠癌肝转移患者有较好的局部控制,对于肝功能较差或存在严重合并症的患者可以作为替代治疗。它可以人为地增大手术切缘,增加手术切除率。当结合肝切除时可以清除肝多发病灶和外科手术不能切除的病灶。消融治疗的主要限制在于局部复发和治疗相关并发症,将其作为多学科治疗的一部分可以提高治疗效果。      

脾切除法建立人结肠癌细胞肝转移模型及对肝转移的评估

目的：建立类似临床大肠癌根治术后肝转移动物模型，并建立精确评估肝转移的方法。方法：在裸鼠脾内注入人结肠癌细胞５ｍｉｎ后切除脾脏。术后第３１天对裸鼠行病理检查并测定肝转移ＤＮＡ含量。结果：发现肝转移率为１００％，肝外其它脏器未见转移结节，组织学证实肝转移结节为低分化腺癌。脾内注入１０＾５癌细胞、脾切除组肝转移癌ＤＮＡ的含量比脾内注入１０＾６癌细胞、脾切除组肝转移癌ＤＮＡ的含量低６１．４％。结论：本实     

结肠癌伴肝转移26例手术治疗体会

结肠癌肝转移是结肠癌患者主要的死亡因素之一，采用何种方法治疗结肠癌肝转移日益受到重视。我院自2002年1月至2005年1月共收治结肠癌伴肝转移患者31例，其中26例以行I期同时手术切除原发病灶和肝转移灶为主的综合治疗，取得较满意的结果，现报道如下。     

血管生成抑制剂治疗结肠癌肝转移的研究进展

血管生成抑制剂与传统的细胞毒化疗药物不同，可作用于包含多种变异的正常细胞。因此，血管生成抑制剂与细胞毒药物临床应用的传统策略不同。许多临床研究正在用一种新的途径评价这些涉及到抑制细胞生长繁殖不同时期的药物。     

Folfox6方案治疗结肠癌肝转移的疗效观察

目的探讨Folfox6方案对结肠癌肝转移患者的疗效。方法将63例新诊断的且不能手术切除的结肠癌肝脏转移患者随机分为2组,A组患者接受FOLFOX6方案(奥沙利铂85 mg/m2和亚叶酸200 mg/m2静脉输注2 h,然后用5-FU 400 mg/m2推注和5-FU 2 400 mg/m2持续输注46 h)化疗,每2周重复治疗直至疾病进展或出现不可接受的毒性。B组患者接受奥沙利铂130 mg/m2静脉输注2 h,第1天;亚叶酸钙200 mg/m2静脉输注2 h,第1~5天,5-FU 500mg/m2静脉输注4~6 h,第1~5天;每21天为1个周期。评估2组临床反应及疗效,主要终点是疾病进展时间(TTP)。卡方检验组间差异,Kaplan-meier法计算中位生存时间,Log-rank法比较生存差异。结果 63例患者中CR 3例,PR 23例,SD 13例,PD 24例,有效率41.3%。其中A组CR 3例,PR 17例,SD 11例,PD 10例,有效率48.8%;B组CR 0例,PR 6例,SD 2例,PD 14例,有效率27.3%。2组有效率无统计学差异(χ2=2.13,P>0.05)。63例患者中位生存15个月,A组中位生存21个月,B组中位生存13个月;疾病进展时间(TTP)中位数为9.8个月(范围0.5~31.8个月),A组12个月,B组7个月,2组TTP组间差异具有统计学意义(P=0.002)。2组血液不良反应和非血液不良反应差异具有统计学意义(P=0.023,P=0.037)。结论 FOLFOX6方案治疗结直肠癌肝转移,疗效确切,不良反应较轻,是较为理想的临床治疗方案。     

Metachronous Colon Metastases from Gastric Adenocarcinoma: A Case Report

The colon is a very rare metastatic localization. Here we report a case of colonic metastases from gastric adenocarcinoma whose clinical presentation was suggestive of a de novo adenocarcinoma of the ascending colon. The authors discuss that in the presence of a previous history of gastric cancer, immunohistochemical analysis on endoscopic biopsies may help in the definition of a differential diagnosis. Furthermore, this rare metastatic localization might suggest a poor prognosis and a more accurate diagnostic work-up.Key Words: Gastric adenocarcinoma, Colonic metastases, CDX-2     

Radiofrequency Ablation in the Treatment of Breast Cancer Liver Metastases

Minimally invasive, image-guided thermal ablation is gaining acceptance for the treatment of solid tumour deposits and its use is increasing. This overview discusses one method of thermal ablation in one palliative setting; the local control of breast cancer liver metastases (BCLM) using radiofrequency ablation. Breast cancer is common and over half of all women diagnosed with metastatic disease develop BCLM. The mainstay of therapy remains chemotherapy and supportive care, which may prolong survival to a median of 18–24 months. Despite breast cancer being considered a systemic disease, surgical series of metastectomy for BCLM have shown a survival advantage. Despite this, surgery for BCLM is rarely practiced due to the associated morbidity for a relatively meagre survival benefit. Similarly, radiofrequency ablation has been used for local control of BCLM; the reported series show a median survival of between 30 and 60 months, with no treatment-related deaths and only three serious treatment-related adverse events in 164 patients reported. Despite this, scepticism remains over the efficacy of BCLM ablation due to the heterogeneity of patient inclusion and selective nature of reporting. Randomised trials are needed to formulate robust evidence-based recommendations and direct the necessary allocation of health care resources. Whether or not local ablative treatment of BCLM conveys a survival advantage is an important consideration. However, in this non-curative setting, it is essential that other outcome measures are carefully evaluated in conjunction with survival, including symptoms (local and constitutional), quality of life and psychological morbidity. To these ends, a randomised, multicentre trial to assess best medical therapy alone versus best medical therapy plus radiofrequency ablation in patients presenting with newly diagnosed BCLM with or without the presence of stable extra-hepatic disease will shortly be underway.     

Total Vertebral Body Breast Cancer Metastases: One Case Report and Literature Review

Breast cancer is one of the most commonly seen malignant tumors in the female population, and it ranks the first in the incidence of malignancies among women. The skeleton is a common metastatic site for advanced breast cancer and is where spinal metastasis is most frequently seen. The incidence rate of spinal metastasis in descending order is as follows: thoracic vertebrae, lumbar vertebrae, sacrococcy-geal vertebrae and cervical vertebrae. Although osseous metastasis of breast cancer is very common, cases with metastasis to all vertebral bodies is currently very rare. The diagnostic method of osseous metastasis of breast cancer typically includes radiograph, CT and MRI. Ordinary radiograph has a high specificity but a low sensitivity, so total vertebral body metastases can only be detected when the extent of osteoclasia exceeds 50%. Some diagnostic shortcomings remain, although the sensitivity of CT and MRI has been greatly improved compared to the radiograph. At present, the most advanced synchronous PET-CT visualization can presumably raise the sensitivity and specificity in the diagnosis of breast cancer, based on the features of 18F-FDG imaging, and combined with morphologic change and precise localization. The following case report is in regard to a patient with total vertebral body metastasis from breast cancer detected by PET-CT.     

Radiofrequency Ablation in Treating Colorectal Cancer Patients with Liver Metastases

Purpose: To evaluate efficacy of radiofrequency ablation (RFA) in treating colorectal cancer patients with liver metastases. Methods: During January 2010 to April 2012, 56 colorectal cancer patients with liver metastases underwent RFA. CT scans were obtained one month after RFA for all patients to evaluate tumor response. (CR+PR+SD)/n was used to count the disease control rates (DCR). Survival data of 1, 2 and 3 years were obtained from follow up. Results: Patients were followed for 10 to 40 months after RFA (mean time, 25±10 months). Median survival time was 27 months. The 1, 2, 3 year survival rate were 80.4%, 71.4%, 41%, 1 % respectively. 3-year survival time for patients with CR or PR after RFA was 68.8% and 4.3% respectively, the difference was statistically significant. The number of CR, PR, SD and PD in our study was 13, 23, 11 and 9 respectively. Conclusions: RFA could be an effective method for treating colorectal cancer patients with liver metastases, and prolong survival time, especially for metastatic lesions less than or equal to 3 cm. But this result should be confirmed by randomized controlled studies.     

经皮穿刺微波凝固联合替吉奥治疗结肠癌肝转移的疗效观察

目的观察经皮穿刺微波凝固治疗(PMCT)术后联合替吉奥胶囊(S-1)治疗结肠癌肝转移的疗效。方法选择本中心2009年5月-2011年1月收治的56例结肠癌肝转移患者,分为PMCT术后联合替吉奥组(实验组,n=28)和单用PMCT组(对照组,n=28)。实验组PMCT术后口服替吉奥胶囊每日50 mg/m²,连续给药14天,停药7天,共化疗6个疗程。结果实验组和对照组治疗结束时完全缓解率分别为67.85%(19/28)和35.71%(10/28),部分缓解率分别为25%(7/28)和21.42%(6/28),稳定率分别为3.5%(1/28)和28.57%(8/28),有效率分别为92.85%(26/28)和57.14%(16/28),两组相比差异均有统计学意义(P<0.05)。不良反应主要为骨髓抑制、胃肠道反应等。结论结肠癌肝转移患者PMCT术后联合替吉奥化疗可提高患者术后生存率且不良反应较轻,是结肠癌根治术后伴肝转移有益的辅助治疗方案。     

肺鳞癌十二指肠转移1例报道

肺癌是我国发病率及死亡率最高的恶性肿瘤,其远处转移常发生于脑、肝脏、肾上腺和骨,发生于消化系统少见,十二指肠更为罕见[1-3].现发现1例有症状的肺癌十二指肠转移病例,报道如下.     

Early Start of Chemotherapy after Resection of Brain Metastasis from Colon Cancer with Synchronous Multiple Liver Metastases

Brain metastasis (BM) is infrequent in colorectal cancer (CRC) patients. Although BM from CRC is a late-stage phenomenon with an extremely poor prognosis, some subsets of patients would benefit from a multidisciplinary management strategy. The prognosis of patients with BM from CRC is associated with the curability of the therapy for BM and number of metastatic organs. The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary CRC having synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. Here, we present a case where combination chemotherapy with capecitabine and oxaliplatin (XELOX) was started within 1 week after resection of BM from colon cancer for synchronous multiple liver metastases. To our knowledge, this is the first report of the start of chemotherapy, involving treatments such as folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and XELOX within 1 week after resection of BM from colon cancer with synchronous multiple liver metastases. These findings suggest possible changes in the start time of chemotherapy after surgery in the future.Key Words: Colorectal cancer, Chemotherapy, Brain metastasis, Surgery, XELOX     

同时性三原发癌1例

1资料患者男性,70岁,于2012年10月因"进食梗噎"在慈溪市人民医院行胃镜检查见"食管距门齿30cm处隆起病灶约5cm×5cm(进展期),胃窦黏膜改变",分别取活检病理示:胃窦腺癌(位于黏膜内),食管鳞癌。腹部CT示肝右叶类圆形稍低密度影,边缘欠清,最大截面2.6cm×2.3cm,增强后动脉期见明显强化呈高密影,边缘欠清,门脉及延迟期呈相对低密度影。     

Tumor Ablation for Treatment of Colorectal Liver Metastases

As the treatment options for colorectal liver metastases continue to expand, ablation has been integrated into the multidisciplinary management of this disease. Following the success of earlier modalities such as cryotherapy and radiofrequency ablation, more options have emerged, including use of microwaves, irreversible electroporation, laser therapy, and focused ultrasound. Indications have also widened from unresectable disease to include treatment with curative intent, often in combination with surgery and systemic and regional therapies. Randomized evidence is relatively lacking overall, but there are ample retrospective data to support the use of ablation. Good patient selection is important, and the treating clinician must understand the strengths and weaknesses of each modality to ensure safety and maximize efficacy. In this review, we discuss the principles of the more commonly used ablation techniques and summarize the evidence, with emphasis on recent data.     

多发性骨髓瘤肝占位1例报道

多发性骨髓瘤（MM）是一种以骨髓浆细胞异常增生为特征的恶性肿瘤。并伴有单克隆免疫球蛋白和轻链蛋白异常增高。MM起病隐匿,症状多样,临床上容易误诊,主要临床表现为转移性骨痛、贫血、肾脏损害和感染等,其侵袭部位以骨和淋巴结多见,但以肝转移和黄疸为主要表现的非常少见。现报道1例,并结合国内外文献对其临床特点进行分析,以加强对本病的认识。