大肠癌肝转移的综合治疗

大肠癌术后肝转移发生率高 ,目前手术切除是惟一能够治愈肝转移癌的最佳手段。我院于 1998～ 2 0 0 1年期间收治随访资料完整的大肠癌肝转移患者 19例 ,现分析总结如下。一、临床资料本组男 15例 ,女 4例。年龄 4 6～ 6 0岁 ,平均 5 0 .3岁。有 10例属同时性肝转移 ,其中 6例经术前Ｂ超、ＣＴ检查发现 ,4例为术中探查时发现 ;有 9例为术后异时性肝转移 ,在原发癌切除术后 6个月至 4年定期复查时 ,Ｂ超、ＣＴ或ＭＲＩ发现肝脏转移性病变。右肝转移 13例 ,其中单结节 10例 ,2个结节 3例 ;左肝转移 6例 ,其中单结节 4例 ,2个结节1例 ,3个结节 1…     

肝动脉置注药泵治疗大肠癌肝转移

目的　探讨改善大肠癌肝转移的治疗方法。方法　应用肝动脉置注药泵对 3 2例大肠癌肝转移进行栓塞化疗 ,所用化疗药为5 -FU联合丝裂霉素 ,所用栓塞剂为碘油 ,其中 6例行联合肝转移癌切除术。结果　其中 2 9例术后近期出现消化道症状 ,术后 1年、2年和 5年的生存率分别为 82 % (2 3例 )、5 7% (16例 )、14 % (4例 )。其中 4例存活 5年以上。结论　经肝动脉置注药泵对大肠癌肝转移进行栓塞化疗 ,具有较好的治疗效果     

肝动脉置注药泵治疗大肠癌肝转移

目的 探讨改善大肠癌肝转移的治疗方法。方法 应用肝动脉置注药泵对32例大肠癌肝转移进行栓塞化疗,所用化疗药为5－FU联合丝裂霉素,所用栓塞剂为碘油,其中6例行联合肝转移癌切除术。结果 其中29例术后近期出现消化道症状,术后1年、2年和5年的生存率分别为82％（23例）、57％（16例）、14％（4例）。其中4例存活5年以上。结论 经肝动脉置注药泵对大肠癌肝转移进行栓塞化疗,具有较好的治疗效果。     

肝动脉门静脉栓塞治疗肝癌

本文首次报告碘化油加抗癌药经肝动脉门静脉栓塞治疗不能手术切除的晚期肝癌9例,计肝细胞癌7例,胆管细胞癌1例,结肠癌术后肝转移1例。5例为巨块型肝细胞癌(直径为7～16cm),4例为多发结节型。X线证实有4/7的肝细胞癌侵犯了肝内门静脉,提示门静脉内用药的必要性。治疗后,5例巨块型病灶明显缩小,AFP增高者术后均有不同程度下降。生存 15、12、9、8和 6个月者各为1,2,1,2和2例,1例失访。     

结肠类癌15例报道

结肠类癌是一种潜在的恶性肿瘤,临床上易误诊为腺癌.自1956年11月～1995年10月共收治结肠类癌15例,现报道如下.临床资料一、一般资料 15例中,男性9例,女性6例.年龄25～66岁,平均47岁.病程最短10天,最长4年,平均12.9个月.二、临床表现 腹部肿块14例,腹痛9例,消瘦7例,腹泻、便血、贫血各4例,便秘、腹胀各3例.本组未发现类癌综合征.三、X线检查 本组行钡剂灌肠检查14例,X线表现为肠管僵硬狭窄,腔内充盈缺损,粘膜破坏,误诊为结肠癌11例,结肠肿物3例.四、肿瘤情况 肿瘤位于升结肠9例,盲肠2例,横结肠肝曲、脾曲各1例,降结肠、乙状结肠各1例,肿瘤直径4cm～15cm,平均9.7cm,直径>5cm者12例(占80%).淋巴结转移5例,腹膜转移、肝转移各1例.肿瘤浸润肌层及浆膜8例(占53.3%).全组行右半结肠切除术10例,回盲部切除术1例,左半结肠切除术3例,回肠、横结肠捷径术1例.五、随访 本组随访14例,失访1例.有10例随访已5年以上,其中6例于术后11个月～3年死于肿瘤复发,已生存5年以上4例,最长者已生存19年.讨论类癌又称嗜银细胞癌,90%发生在消化道,结肠类癌仅占胃肠道类癌病例的5%.国内统计的1088例消化道类癌中结肠类癌占8%,发病部位顺序为直肠、阑尾、小肠、胃、结肠.本病多见于中老年人,男略多于女.本组平均年龄为47     

再次肝切除手术对结直肠癌肝转移复发患者的临床疗效和生存情况的影响因素

目的 探讨再次肝切除手术对结直肠癌肝转移复发患者的临床疗效和生存情况的影响因素.方法 回顾性分析94例结直肠癌肝转移复发患者临床相关资料,其中38例行再次肝切除术(观察组),其他56例进行内科化疗(对照组).结果 分别进行再次手术和化疗后,结直肠癌肝转移复发患者的1、3、5年生存率观察组为81.6%、52.6%和31.6%;对照组为62.5%、21.4%、7.1%,观察组患者生存率显著高于对照组(P<0.05).针对结直肠癌肝转移复发患者再次切除术的预后可能影响因素进行分析,其中癌直径大小、复发转移灶个数、切缘情况与患者5年生存率有关(P<0.05).术后并发症发生率为28.9%,均经过对症处理可耐受.结论 对于结直肠癌肝转移复发患者,再次肝切除术能提高远期疗效,对于癌直径较小、复发转移灶个数少、切缘阳性的患者效果更好.     

乳腺癌肝转移的临床病程及预后分析

198 6年 10月～ 2 0 0 0年 12月 ,我院收治乳腺癌肝转移 5 6例 ,以下就其病程特点及治疗作一回顾性分析。一般资料 :全组共 5 6例 ,均为女性 ,中位年龄 4 7岁 (31～ 72 ) ,原发肿瘤均经病理或细胞学证实为乳腺癌。肝转移经Ｂ超、ＣＴ或ＭＲＩ确诊。原发灶处理方法 :根治术和改良根治术 5 1例 ,肿块切除术 1例 ,原发灶未处理 4例。病理类型 :导管浸润癌 4 0例 ,单纯癌13例 ,腺癌、粉刺样癌、鳞癌各 1例。方法 :全组病例中 ,行全身化疗 2 6例 ,采用ＣＡＦ或ＣＡＰ方案 ;行肝动脉插管或ＤＳＡ介入化疗 2 1例 ,化疗药物从 5 氟脲嘧啶、顺铂、蒽…     

结直肠癌肝转移外科治疗体会

[目的]探讨结直肠癌肝转移的外科治疗效果及对临床生存时间的影响。[方法]回顾性分析1998年1月至2007年1月结直肠癌肝转移患者行外科手术治疗22例的资料。[结果]术后随访存活1年者19例，存活3年者9例，存活5年及以上者5例。10例同期行肝切除者平均生存期26个月，7例分期行肝切除者平均生存期30个月。术后发生并发症3例，无手术死亡。[结论]掌握外科手术时机和适应证，积极行肝切除术并创造条件提高手术切除成功率，是提高结直肠癌肝转移患者存活率的关键。     

结肠癌肝转移的诊断与治疗--附53例报告

结肠癌肝转移的高发生率日益受到临床的重视。 1992年 1月～ 2 0 0 1年 1月 ,滨州市人民医院收治结肠癌并肝转移患者 5 3例 ,结果总结报道如下。1　临床资料1.1　一般资料结肠癌肝转移患者 5 3例 ,男 3 8例 ,女 15例。年龄 3 4～ 75岁 ,平均年龄 5 3岁。同时性肝转移 7例 ,异时性肝转移 46例。单纯肝转移 44例 ,肝转移合并其他部位复发转移者 9例。1.2　治疗方法及结果手术切除 8例 ,其中肝左叶切除 2例 ,不规则楔形切除 6例 ,全部存活 1年以上 ,3年生存 4例。无水乙醇注射 6例 ,1年生存 6例 ,3年生存 2例 ;开腹置管皮下置入式输注泵灌注化…     

放射治疗转移性肝癌的临床观察——附36例分析

1986年4月～1993年4月，我科以放射为主治疗转移性肝癌36例，其中结直肠癌肝转移19例，鼻咽癌肝转移5例，其他12例，结果：1.6个月、12个月、24个月和36个月生存率分别为75．0％（27／36）、55.6％（20／36）、28.1％（9／32）和9．7％（3／31）。已死亡30例，其生存时间为4～57个月，中位生存12个月。2．单发肝转移癌生存期优于多发者（P＜0．001）。3．放射剂量≥3200cGy者生存期优于＜3200cGy者（P＜0．01）。4．肿瘤完全消失者生存期优于未完全消失者。5.肝内转移癌≤5cm，且肝内转移癌≤2个，是放射冶疗的良好指征，并有可能达到完全消失的效果．     

复发性肝癌再次肝切除的效果

在392例次肝癌切除中,19例为复发性肝癌作再次肝切除.第1次至第2次肝切除的间隔时间平均为35月.作第2次肝切除的肿瘤平均5cm.切除术的类型有剔出术4例,1肝段切除8例,2肝段切除7例.复发性肝癌再次术后生存5年以上4例,最长14年健在.已知死亡6例,其生存平均11个月,表明再次肝切除可提高复发性肝癌的生存期.     

40例胃癌肝转移的手术治疗及预后

目的 分析胃癌肝转移患者的手术治疗效果及影响预后的因素,以探讨其手术指征。 方法 回顾性分析2010年1月1日至2012年1月1日于我院胃肠外科行原发灶+肝转移灶切除的40例胃癌合并肝转移患者的临床资料,分析其手术效果并用Log-rank检验及Cox风险比例模型分别对胃癌肝转移患者的主要临床病理因素与预后的关系进行单因素和多因素分析。 结果 40例患者均顺利完成手术,其中行R0切除30例,R1切除10例,无R2切除者。术后并发症发生率为15.0% （6/40）,无术后大出血及死亡病例。1年、2年及3年总生存率分别为37.5% （15/40）、10.0% （4/40）、0,中位生存期为10.5个月。单因素分析显示原发灶病理类型、原发胃癌侵犯浆膜、胃周淋巴结转移、血管癌栓、神经侵犯、转移灶分布、转移灶直径、肝转移类型、肝切除方式和手术根治程度与预后相关。多因素分析显示原发胃癌侵犯浆膜、血管癌栓、神经侵犯、转移灶直径和手术根治程度为预后的独立影响因素。 结论 原发胃癌未侵犯浆膜、无血管癌栓、无神经侵犯、肝转移灶直径＜5 cm和R0切除者可能是胃癌肝转移行原发灶+肝转移灶切除术的受益人群,亦可能是较佳的手术适应证。     

羟基喜树碱联合FOLFOX4方案二线治疗晚期胃癌的临床分析

Objective: To evaluate the therapeutic as well as side effects of hydroxycamptothecin (HCPT) plus FOLFOX4 regimen as salvage therapy for patients with advanced gastric cancer. Methods: A total of 19 patients with advanced gastric cancer received HCPT plus FOLFOX4 as salvage therapy, in detail, Oxaliplatin 85 mg/m2 was given intravenously on day 1, CF 200 mg/m2, 5-Fu 400 mg/m2 given in bolus immediately after CF, days 1-2; 5-Fu 600 mg/m2 given continuously after bolus for 22 h on day 1, day 2, HCPT given intravenously at dosage of 10 mg/m2 on days 1-2. Therapeutic effects were evaluated at least after two cycles of treatment. Results: 17 cases among the 19 patients were valid for response evaluation, with CR 1 , PR 6, SD 4, PD 6. The response rate was 41.2%. For the 12 patients with liver metastasis, response rate of the liver foci was 50%. The main toxicities were bone marrow suppression, nausea and vomiting, and peripheral neuropathy; there were no chemotherapy-related deaths. Conclusion: The combination regimen with HCPT plus FOFLOX4 regimen was effective as salvage therapy for patients with advanced gastric cancer, with particularly high response rate for liver metastasis, and the side effects were tolerable and manageable.     

Pathological evaluation of neoadjuvant chemotherapy with low-dose FP therapy for advanced gastric cancer

In the present study, we evaluated the pathological effects of preoperative chemotherapy with low-dose CDDP and 5-FU (low-dose FP therapy) in patients with advanced gastric cancer. 50 patients diagnosed as advanced gastric cancer were administered continuous infusion of 5-FU (300 mg/m(2)/day, x 14 days) and intermittent infusion of CDDP (3 mg/m(2)/day, day 1-5 and 8-12) before surgery. The pathological effects were considered comparatively regarding the response rate of chemotherapy for gastric cancer between primary lesions and metastasis of lymph nodes and the rate of downstaging cases with low-dose FP therapy. The rates of effective cases were 26% (primary lesions) and 28% (lymph nodes). Furthermore,in the same patient,the results of low-dose FP therapy with primary tumor were more effective than those of lymph nodes (the rates of effective cases were 34% and 19%, respectively). The rate of downstaging cases with low-dose FP therapy for gastric cancer was 6%, histologically. These results indicate low-dose FP therapy for gastric cancer is promising for effective clinical management of advanced gastric cancer in preoperative treatment.     

Clinical evaluation of intra-arterial infusion of hyperthermo-chemotherapy in gastric cancer]

We performed intra-arterial infusion hyperthermochemotherapy by retaining an intra-arterial reservoir in 17 lesions of 12 patients with non-resectable, metastatic or recurrent gastric cancers. The 12 patients consisted of one with a primary gastric cancer lesion, 6 with a solitary gastric cancer lesion metastasizing to the liver, 4 with gastric cancer accompanied by hepatic metastasis, lymph node metastasis or local recurrence, and one with a gastric cancer lesion metastasizing to Douglas' pouch. A catheter was retained in the hepatic artery of all 6 patients with a solitary gastric cancer lesion metastasizing to the liver, and a catheter was retained in the aorta of the patient with a primary lesion, 3 of the 4 patients with two or more metastatic lesions, and the patient with a lesion metastasizing to Douglas' pouch. The duration of each hyperthermia session was 50 minutes, and one or two sessions were performed within a week. One course consisting of 5 or 6 sessions was repeated. Antineoplastic drugs such as MMC, 5-FU, ADR, epi-ADR, CDDP and VP-16 were injected in bolus form or administered serially through the reservoir. Nine of the 12 patients had polypharmacy. One to 3 courses or 4 to 20 sessions at maximum (average 9.8 sessions) were given. The rate of efficacy of intra-arterial infusion hyperthermochemotherapy was 44% for hepatic metastasis and 25% for lymph node metastasis. The local recurrent lesions, the lesion metastasizing to Douglas' pouch and the primary lesion did not respond to therapy.     

Second malignant tumors in patients with nasopharyngeal carcinoma and their association with Epstein-Barr virus

Since previous published studies about second malignant tumors (SMTs) in nasopharyngeal carcinoma (NPC) patients usually included a limited sample size and did not attain consistent results, we conducted a large retrospective study in a cohort of 1,549 patients to assess the risk of SMT in NPC patients following radiotherapy (RT) in Taiwan. The follow-up period ranged from 2 to 16 years, with a median of 7 years. Thirty-nine patients developed SMTs during the 7,145 person-year follow-up [standardized incidence ratio (SIR): 2. 8; 95% confidence interval (CI): 2.0 to 3.9]. Increased risks of developing SMTs were observed for head and neck (H/N) cancer (SIR: 16.5; 95% CI: 10.0 to 26.8), gastric cancer (SIR: 5.5; 95% CI: 2.2 to 11.4) and leukemia (SIR: 9; 95% CI: 1.9 to 26.3). Paraffin-embedded specimens of secondary H/N cancer (11), secondary gastric cancer (6) and their corresponding NPC specimens were examined by EBER in situ hybridization to assess the association between Epstein-Barr virus (EBV) and these SMTs. Twenty-six primary H/N and 5 gastric cancer specimens were chosen as the control groups. In H/N cancer, EBV was detected in 3.8% of the primary cancers and 9.1% of the secondary cancers. All the positive specimens resulted from hypopharyngeal cancer. Of the secondary gastric cancers, only 1 case (16.6%) was associated with EBV. None of the primary gastric cancers was associated with EBV. Our results indicate an increased risk of developing SMTs, with a preference for head and neck cancer, gastric cancer and leukemia, in NPC patients after RT in Taiwan. Only a small proportion of the secondary H/N and gastric cancers was associated with EBV.     

Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors

BACKGROUND: The indication for liver resection for gastric metastases remains controversial and few previous studies have reported the outcome of surgery in the treatment of liver metastases of gastric cancer. The aim of this study is to clarify the effectiveness of surgical resection for liver metastases arising from gastric cancer. METHODS: A retrospective analysis was performed on the outcome of 42 consecutive patients with synchronous (n = 20) or metachronous (n = 22) gastric liver metastases that were curatively resected. RESULTS: The overall 1, 3 and 5 year survival rates after hepatic resection were 76, 48 and 42%, respectively, and the median survival was 34 months. Univariate analysis revealed that survival significantly differed between cases of solitary and multiple metastases (P = 0.03). Multivariate analysis revealed that solitary liver metastasis and the absence of serosal invasion by primary gastric cancer were favorable independent prognostic factors (P = 0.005 and P = 0.02, respectively). All eight patients who survived for more than 5 years after initial hepatectomy had a solitary metastasis, and six of these had no serosal invasion by the primary gastric cancer. No patient with multiple metastatic diseases survived beyond 3 years. CONCLUSIONS: Patients with a solitary liver metastasis are good candidates for surgical resection, whereas those with multiple gastric liver metastases should be treated by multimodal approaches.     

羟基喜树碱联合FOLFOX4方案二线治疗晚期胃癌

目的：评价羟基喜树碱（HCPT）联合FOLFOX4方案作为二线治疗晚期胃癌的疗效和毒性。方法：19例晚期胃癌患者,先给予奥沙利铂（L-OHP）85mg/m^2静脉滴注2h,第1天;亚叶酸钙（CF）200mg/m^2静脉滴注2h;随后5-FU400mg/m^2静脉快速冲入,5-FU600mg/m^2静脉滴注22h,第1～2天;HCPT10mg静脉滴注3h,第1～2天。2周重复,至少2个周期后评价疗效。结果：全组19例患者,17例可以进行疗效评价,完全缓解1例,部分缓解6例,稳定4例,进展6例,总有效率为41.2%。12例存在肝脏转移患者中,肝转移灶有效率50%。毒副作用主要是骨髓抑制、恶心呕吐、神经毒性,无化疗相关死亡。结论：羟基喜树碱联合FOLFOX4方案二线治疗晚期胃癌疗效肯定,特别是对于肝转移灶有效率高,毒副作用能够耐受。     

合并肺癌的多原发恶性肿瘤70例临床病理特征分析北大核心

目的:探讨合并肺癌的多原发恶性肿瘤(multiple primary malignancies,MPM)患者临床病理特征。方法:收集2017年01月01日至2019年12月31日陕西省肿瘤医院收治的3438例肺癌患者病例资料,回顾性分析其中70例合并肺癌MPM患者的临床病理特征。结果:同时多原发肿瘤(synchronous MPM,SMPM)16例,异时多原发肿瘤(metachronous MPM,MMPM)54例,男女比例为1∶1.06(男34例,女36例);入组病例次原发肿瘤发生的年龄为(61.37±11.22)岁;初原发肿瘤和次原发肿瘤发生平均时间间隔77.09月;肺癌先发组(lung cancer first,LCF)和其他器官肿瘤先发组(other cancer first,OCF)中肺癌病理类型均以肺腺癌最为多见,共42例(60.00%);肺癌分期为Ⅳ期患者共38例(54.29%);62.86%(44/70)患者伴有肺门或纵隔淋巴结转移;吸烟患者更容易出现SMPM。男性OCF组的初原发肿瘤中胃癌比例最高(31.82%,7/22),而原发性乳腺癌在女性中OCF组比例最高(32.26%,10/31)。结论:无病生存期超过5年的肿瘤患者应长期随访监测多原发肿瘤的发生;初原发乳腺癌、宫颈癌、胃癌患者应加强次原发肺癌的筛查,初原发肺癌患者应加强双原发肺癌及次原发胃癌、食管癌的筛查,以尽早发现MPM的发生,规范治疗,争取治愈机会。     

Serum determination of CA 19-9 in patients with digestive cancers and its diagnostic evaluation

The precision of CA 19-9 RIA kit was evaluated by recovery, reproducibility and dilution test with very satisfactory results. The CA 19-9 value in sera from 52 healthy individuals and from 224 patients with gastric intestinal cancer and other benign disease, showed an increased positive rate in several cases of gastric intestinal cancer. For example, the positive rate in pancreatic cancer, bile duct cancer, colo-rectal cancer, gastric cancer, esophagus cancer, primary biliary cirrhosis diabetes mellitus, liver cirrhosis and chronic hepatitis was 60%, 75%, 55.6%, 45.6%, 20%, 28.6%, 22.7%, 13.7% and 1.7% respectively. By contrast, values from patients with acute hepatitis, fulminant hepatitis, fatty liver, gastric duodenal ulcer, pancreatitis, and primary liver cancer were within the normal range. In this study, CA 19-9 RIA were found to be significant as an adjunct in the management of patients with gastrointestinal cancer, especially pancreatic cancer, and bile duct cancer.