支气管动脉超选择性介入治疗中晚期肺癌

目的 探讨支气管动脉超选择性介入化疗及栓塞治疗肺癌的疗效。方法 58例肺癌病人均行支气管动脉超选择性介入化疗栓塞术，观察治疗前后原发癌灶体积及最大直径与垂直直径的变化，比较肺CT影像学改变；观察栓塞剂用量与癌灶体积之间的关系；观察临床病征、介入并发症等情况，并进行分析。结果 支气管动脉超选择性介入化疗栓塞术治疗肺癌疗效显，术后原发癌灶的体积大多有不同程度缩小，肿瘤最大直径与垂直直径乘积缩小，降低50％以上的占89．66％，栓塞剂用量小，介入并发症出现率低，副反应轻。     

支气管动脉灌注治疗中晚期肺癌258例临床分析

目的探讨经支气管动脉灌注抗癌药治疗中晚期肺癌的方法和疗效。方法258例中晚期肺癌患者进行687次支气管动脉灌注化疗,2次治疗137例,3次和3次以上121例。统计分析治疗效果。结果258例肺癌患者中,完全缓解(CR)125例,部分缓解(PR)83例,稳定(NC)29例,进展(PD)21例;支气管动脉造影显示肿瘤单病灶染色83例,多病灶染色175例。结论应用支气管动脉灌注抗癌药治疗中晚期肺癌,近期效果使肿瘤缩小,患者症状改善,副作用低于全身静脉化疗。     

支气管动脉内灌注药物治疗肺癌的护理

肺癌的治疗 ,虽临床上采用多种方法 ,但对中晚期肺癌的治疗仍是一个难题。经导管支气管动脉内灌注化疗药物已成为治疗中晚期肺癌的首选方法。我科自 1995年开始采取支气管动脉内灌注化疗药物治疗中晚期肺癌取得了一定的治疗效果。动脉内灌注化疗药物是利用动脉血流将高浓度抗癌药物直接输送到所选动脉分布的肿瘤组织中 ,从而达到提高疗效的目的。因此护理工作在整个治疗中起了很大作用 ,具体护理方法介绍如下 :1　动脉插管术后观察局部伤口情况如有渗出及时更换敷料。2　检查动脉插管有无回血及是否畅通如有回血用 5 ml肝素盐水冲管 ,保持插…     

以卡铂为主的抗癌药合并化疗行支气管动脉灌注治疗肺癌疗效观察

目的 探讨卡铂为主的抗癌药联合化疗行支气管动脉灌注治疗肺癌的疗效。方法 在数字减影X光机下对83例肺癌行支气管动脉灌注化疗。结果 83例中小细胞肺癌25例，CR＋PR21例，有效率84％；非小细胞肺癌58倒，CR＋PR30例，有效率51．7％。结论 以卡铂为主联合选择支气管动脉灌注化疗，可将药物直接灌入肿瘤的供血血管患侧支气管动脉，有效地选择性地形成肿瘤局部药物的高浓度，增强抗癌作用，并能一次性大剂量联合给药，临床应用不必水化，利尿，使用方便，奏效快，疗效高，安全，全身毒性反应低，适应症广泛，且能多次重复进行，特别是对无法手术治疗的中晚期肺癌患者，不失为一种有效安全的治疗手段。     

支气管动脉局部解剖在肺癌灌注治疗的应用

支气管动脉化疗药物灌注治疗晚期肺癌,是一切实有效的治疗方法.目前支气管动脉插管的成功率为80％左右,右侧支气管动脉灌注偶有胸壁坏死甚至截瘫等并发症出现。分析其原因,主要与病人支气管动脉局部解剖及变异有直接关系。作者自1994年6月～1995年2月对22例晚期肺癌病人,支气管动脉插管灌注化疗药物,成功灌注19例,失败3例.现就支气管动脉的局部解剖及治疗效果分析报道如下;     

中西医结合治疗中晚期非小细胞肺癌的临床研究

目的探讨中药自拟补肺抗癌方联合化疗及氩氦刀冷冻综合方案治疗中晚期非小细胞肺癌的安全性及临床疗效。方法按照前瞻性随机分组原则,把符合入组条件的50例原发性非小细胞肺癌患者分为2组：对照组（化疗联合氩氦刀组）25例,治疗组（中药联合化疗及氩氦刀组）25例。观察两组治疗后近期疗效、1a生存率、治疗前后T淋巴细胞亚群水平、生活质量（KPS评分）变化及不良反应。结果两组治疗后总有效率分别为84%（21/25）、92%（23/25）,1a生存率分别为68%（17/25）、88%（22/25）,T淋巴细胞亚群（CD3＋,CD4＋,CD8＋,CD4＋/CD8＋）水平及生活质量KPS评分值均比治疗前有不同程度提高,治疗组总有效率稍高于对照组,但无统计学意义,而两组治疗后1a生存率、T淋巴细胞亚群水平及KPS评分值及骨髓抑制发生率的差异均有统计学意义。结论自拟补肺抗癌方可以明显提高原发性中晚期非小细胞肺癌患者的免疫功能及生存质量,延长生存期,减轻化疗的毒性反应,其配合西医治疗中晚期非小细胞肺癌效果明显优于单纯西医治疗效果,是一种疗效肯定、安全可靠、具有推广价值的中西医结合综合治疗方法,远期疗效有待进一步观察。     

中西医结合治疗中晚期非小细胞肺癌的临床研究

目的 探讨中药自拟补肺抗癌方联合化疗及氩氦刀冷冻综合方案治疗中晚期非小细胞肺癌的安全性及临床疗效.方法 按照前瞻性随机分组原则,把符合入组条件的50例原发性非小细胞肺癌患者分为2组:对照组(化疗联合氩氦刀组)25例,治疗组(中药联合化疗及氩氦刀组)25例.观察两组治疗后近期疗效、1a生存率、治疗前后T淋巴细胞亚群水平、生活质量(KPS评分)变化及不良反应.结果 两组治疗后总有效率分别为84%(21/25)、92%(23/25),1a生存率分别为68%(17/25)、88%(22/25),T淋巴细胞亚群(CD3+,CD4+,CD8+,CD4+/CD8+)水平及生活质量KPS评分值均比治疗前有不同程度提高,治疗组总有效率稍高于对照组,但无统计学意义,而两组活疗后1a生存率、T琳巴细胞亚群水平及KPS评分值及骨髓抑制发生率的差异均有统计学意义.结论 自拟补肺抗癌方可以明显提高原发性中晚期非小细胞肺癌患者的免疫功能及生存质量,延长生存期,减轻化疗的毒性反应,其配合西医治疗中晚期非小细胞肺癌效果明显优于单纯西医治疗效果,是一种疗效肯定、安全可靠、具有推广价值的中西医结合综合治疗方法,远期疗效有待进一步观察.     

NP方案治疗老年晚期非小细胞肺癌20例

目的观察NP方案治疗老年晚期非小细胞肺癌患者的，临床疗效及不良反应。方法对住院治疗的20例老年晚期非小细胞肺癌患者采用NVB联合顺铂化疗方案（NP方案），NVB25mg／m2，iv．第1、8天，顺铂100mg／m2，iv．drop，第1天。每4周重复，至少治疗两周期，按标准评价疗效和毒副反应。结果可评价患难者20例，有效率为45％，中位和存期7个月，1年生存率为30％。主要毒性反应为骨髓移植、消化道反应及静脉炎，多数为Ⅰ-Ⅱ度反应。结论NVB联合顺铂方案治疗老年晚期非小细胞肺癌临床疗效较好，恶性反应可以耐受。     

紫杉醇联合铂类药物治疗晚期非小细胞肺癌的临床研究

目的 评价紫杉醇联合铂类药物对晚期非小细胞肺癌的客观疗效及毒副作用.方法 经病理组织学证实的晚期非小细胞肺癌59例,采用紫杉醇135 mg/m2,静脉滴注,第1天,顺铂80 mg/m2,分3天给药,第2～4天,或卡铂350 mg/m2.静脉滴注,第2天,21天为1个周期,2个周期以上评价疗效及毒副作用.结果 全组PK 24例,SD 23例,PD12例,总有效率为40.7%.主要毒副作用为恶心、呕吐、骨髓抑制、关节肌肉痛等.大部分为Ⅰ～Ⅱ度不良反应,患者耐受良好.结论 紫杉醇联合铂类方案是1种对晚期非小细胞肺癌有效的治疗方案,毒副作用轻,值得临床进一步研究应用.     

动脉灌注与栓塞治疗中晚期大肠癌的临床研究

目的　研究和探讨动脉灌注与栓塞治疗中晚期大肠癌的价值。方法　26例中晚期大肠癌,按Seldinger法进行血管造影了解肿瘤血供后,超选择性插管至肿瘤供血动脉进行灌注与栓塞治疗。结果　灌注栓塞术后病人症状改善。所有病灶均有不同程度的缩小,不完全梗阻症状消失,近期疗效明显。结论　采用动脉灌注化疗与栓塞是治疗中晚期大肠癌的一种有效方法,特别是对已有肝转移的病例;同时行转移瘤的介入治疗具有重要价值。     

A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable,advanced hepatocellular carcinoma

Background/Aims

Transarterial chemoembolization (TACE) has long been used as a palliative therapy for unresectable hepatocellular carcinoma (HCC). High-dose hepatic arterial infusion chemotherapy (HAIC) has showed favorable outcomes in patients with intractable, advanced HCC. The aim of this study was to compare the effectiveness and safety of high-dose HAIC and conventional TACE using doxorubicin for advanced HCC.

Methods

The high-dose HAIC group comprised 36 patients who were enrolled prospectively from six institutions. The enrollment criteria were good liver function, main portal vein invasion (including vascular shunt), infiltrative type, bilobar involvement, and/or refractory to prior conventional treatment (TACE, radiofrequency ablation, or percutaneous ethanol injection), and documented progressive disease. Patients received 5-fluorouracil (500 mg/m² on days 1~3) and cisplatin (60 mg/m² on day 2 every 4 weeks) via an implantable port system. In the TACE group, 31 patients with characteristics similar to those in the high-dose HAIC group were recruited retrospectively from a single center. Patients underwent a transarterial infusion of doxorubicin every 4~8 weeks.

Results

Overall, 6 patients (8.9%) achieved a partial response and 20 patients (29.8%) had stable disease. The objective response rate (complete response+partial response) was significantly better in the high-dose HAIC group than in the TACE group (16.7% vs. 0%, P=0.030). Overall survival was longer in the high-dose HAIC group than in the TACE group (median survival, 193 vs. 119 days; P=0.026). There were no serious adverse effects in the high-dose HAIC group, while hepatic complications occurred more often in the TACE group.

Conclusions

High-dose HAIC appears to improve the tumor response and survival outcome compared to conventional TACE using doxorubicin in patients with intractable, advanced HCC.     

区域灌注疗法治疗原发性肝癌的临床观察

目的：探讨肝动脉、门静脉双重插管区域灌注化疗在中晚期不能切除原发性肝癌应用方法及临床疗效。方法：将1988年－1999年68例中晚期不能切除原发性肝癌肝动脉、门静脉插管皮下埋藏灌注器区域灌注化疗,对其疗效进行观察。结果：本组显效率22．1％、有效率57．3％、无效率20．6％。半年带瘤存活率73．5％、一年带瘤存活率55．9％、二年带瘤存活率8．8％。结论：中晚期不能切除的原发性肝癌使用肝动脉、门静脉双重插管灌注化疗,可以改善临床症状、延长存活期。     

Efficacy and safety of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma as first-line therapy

Background/Aims

Hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and cisplatin for intractable advanced hepatocellular carcinoma (HCC) may have survival benefits. We aimed to determine the efficacy and safety of HAIC for advanced HCC as first-line therapy.

Methods

A total of 54 patients who received only HAIC with 5-fluorouracil (750 mg/m² on days 1-4) and cisplatin (25 mg/m² on days 1-4) for advanced HCC from Jan. 2009 to Dec. 2011 were selected. According to Child-Pugh class, the overall survival (OS), progression-free survival (PFS), and adverse events after HAIC were investigated retrospectively.

Results

Median OS and PFS between the Child-Pugh A group (n=24) and the Child-Pugh B/C group (n=30) were 8.7 (95% confidence interval [CI]: 4.7-12.7) vs. 3.7 months (95% CI: 2.0-5.3), and 7.1 (95% CI: 3.8-10.4) vs. 3.6 months (95% CI: 2.0-5.2), respectively. Although median OS and PFS were not statistically significant between the two groups (P=0.079, P=0.196), the Child-Pugh class B/C tended to influence poor OS. Serious adverse events ≥ grade 3 occurred frequently in both groups (83.3 vs. 96.7%, P=0.159). Responders (22.2%, complete or partial response) significantly differed in median OS, compared to non-responders (13.1 vs. 4.4 months, P=0.019). Achievement of complete or partial response was an independent prognostic factor of OS (hazard ratio: 0.4, 95% CI: 0.2-0.8, P=0.011).

Conclusions

Achievement of response after HAIC provide a survival benefit in patients with advanced HCC, but HAIC should be administered cautiously in patients with Child-Pugh class B/C, because of a relatively low survival and high incidence of serious adverse events.     

中性粒细胞/淋巴细胞比值对晚期肝细胞癌FOLFOX肝动脉灌注化疗近期疗效的影响

目的:探讨中性粒细胞/淋巴细胞比值（NLR）对晚期肝细胞癌（HCC）动脉灌注化疗近期疗效的影响。方法:回顾性收集分析2017年5月~2019年3月使用FOLFOX肝动脉灌注化疗的晚期HCC患者共92例。通过CT或MR比较患者每个治疗周期后肿瘤局部反应,通过相关检查结果及临床症状观察患者疗效及肝动脉灌注安全性等。结果:根据mRECIST标准对肝内病灶进行评价,NLR＜4.0组患者的客观缓解率显著高于NLR≥4.0组患者（41.5% vs 17.9%, P=0.016）。NLR＜4.0组患者的疾病控制率显著优于NLR≥4.0组（52.8% vs 28.2%;P=0.018）。对于肝内病灶,NLR＜4.0组的中位PFS（月）较NLR≥4.0组更长（6.1 vs 4.1, P=0.013）。针对全身肿瘤病灶进行疗效评估,NLR＜4.0组和NLR≥4.0组之间的中位PFS（月）也有显著差异（4.3 vs 3.1, P=0.022）。结论:使用FOLFOX肝动脉灌注治疗HCC安全性及有效性均较好,且NLR是预测HCC灌注化疗术后疗效的指标,术前高NLR的HCC患者治疗后PFS较短。     

Clinical applications of infusion systems

Continuous delivery of drugs from portable and implantable pumps offers several advantages over intermittent therapy, including control and maintenance of blood levels of the drug within a narrow therapeutic range, and increased predictability of response. Clinical applications are discussed in the areas of diabetes mellitus, infertility and delayed puberty, iron overload, anticoagulation, analgesia, prevention of premature labour, cardiac arrhythmias, dissolution of gallstones and anticancer therapy.     

Prolonged infusion of prostacyclin in patients with advanced stages of peripheral vascular disease: A placebo-controlled cross-over study

Summary Twelve patients (age 33–77 years, mean age 68.4 years) with peripheral vascular disease (PVD) stage III–IV received continuous intravenous infusions of 5 ng prostacyclin (PGI₂)/kg/min and physiological saline for 7 days. The administration was randomized and double-blind with an interval of 7 days between the infusions. During PGI₂ infusion systolic blood pressure fell significantly from 147.8±4.8 mm Hg to 140.6±4.0 mm Hg (P<0.01) and returned to 144.5±4.9 mm Hg post infusion. Transcutaneous p ₂ ^O (tcp ₂ ^O ) measured on the instep of the affected limb increased significantly by 8.9±3.8 Torr during PGI₂ infusion and remained elevated during the subsequent week. A significant reduction of pain was observed from the 5th day of PGI₂ infusion, lasting for at least the following observation period. Platelet cAMP increased from 18.8±1.5 pmol/10⁸ platelets to 24.7±1.6 pmol/10⁸ platelets on the 3rd day of PGI₂ infusion (P<0.01). Spontaneous platelet aggregation was also significantly reduced during PGI₂ infusion. However, 7 days after the infusion thromboxane B₂ (TXB₂) in plasma and spontaneous platelet aggregation significantly increased in comparison with the preinfusion values, indicating a rebound phenomenon. The clinical outcome was favorable in 9 of 12 patients, was unchanged in two patients, while progressing to limb amputation in one patient.Abkürzungsverzeichnis TXA₂ Thromboxane A₂ - PGI₂ Prostacyclin - PVD Peripheral Vascular Disease - tcpO₂ transcutaneous pO₂ - VAS Visual Analog Scale - PAT III Platelet Aggregation Test III by Breddin - HDL high density lipoprotein - AT III antithrombin III - SFMC Soluble fibrinogen-fibrin monomer complexes - PAR platelet aggregation ratio For Professor Dr. W. Kaufmann on his 60th GeburtstagSupported by the Landesamt für Wissenschaft und Forschung, NRW     

肺癌组织内肺动脉供血活体灌注观察

目的:探讨肺癌组织内肺动脉动态供血情况.方法:选择未作任何化疗栓塞的5例肺癌患者,根据普通X线、CT、MRI及肺叶分段定位,按照肺叶分段原理,结扎肺动脉之前,肺动脉内注入美蓝溶液5～10ml,术后将取出的肺叶作连续厚切片,组织块厚约5 mm.并用数码机连续摄片.结果:肺癌组织呈分叶状,癌巢间肿瘤血管染色密集,呈血湖状,主要集中在肿瘤的中央部,癌叶内亦见点状肿瘤血管分布,但相对较少,肿瘤与正常肺组织间肿瘤血管相对稀疏.结论:通过肿癌组织肺动脉注射美蓝溶液,进一步证实了肺癌组织内肺动脉参与供血.     

静脉注射L-NAME对肉鸡肺动脉压的影响

目的：观察静脉注射一氧化氮合酶抑制剂L-NAME对肉鸡肺动脉压的影响。方法：AA肉鸡40羽随机等分为A、B、C、D组,按常规条件饲养至44 d龄进行实验。A组为对照组,B、C、D组分别为静脉注射一氧化氮合酶抑制剂L-NAME 1、2、4 h的3个实验组。应用右心导管技术逐羽测定肺动脉压,并采集血样作一氧化氮 （nitric oxide,NO）和内皮素（endothelin-1,ET-1）水平测定。结果：与A组相比,静注L-NAME 1-2 h后肉鸡血浆NO含量低于A组（P<0.05）,肺动脉压高于A组 （P<0.05）,血浆ET-1未见明显差异;静注4 h后血浆NO含量、肺动脉压与A组水平无明显差异但血浆ET-1水平明显高于A、B、C组（P<0.05）。结论：L-NAME可能通过抑制NO的合成从而促进了肉鸡肺动脉高压的形成。     

微波固化术结合肝动脉、门静脉双化疗对中晚期肝细胞癌治疗的临床研究

目的 探讨经皮微波固化术(PMCT)结合经导管肝动脉、门静脉双化学治疗(简称化疗)中晚期肝细胞癌的临床疗效及安全性.方法 选取2005年6月～2008年12月第四军医大学唐都医院普通外科收治的136例中晚期肝细胞癌患者,其中男性89例,女性47例;年龄17～82岁,中位年龄62.3岁.随机分为PMCT微创治疗组(A组,...