铜绿假单胞菌注射液联合顺铂胸腔内灌注治疗恶性胸腔积液的疗效

<正>恶性胸腔积液是多种恶性肿瘤晚期患者常见并发症之一,其不仅仅见于肺癌、胃肠道恶性肿瘤、乳腺恶性肿瘤、卵巢恶性肿瘤等,由于病情发展短期内迅速增加造成肺组织压迫,并因胸水量不同引起不同程度的胸闷、呼吸困难、肺不张、纵隔偏移,致使患者生活质量迅速下降,甚至直接导致患者死亡〔1,2〕。积极治疗胸水可改善肿瘤晚期患者生活质量。自2009年7月至2012年7月我科采用铜绿假单胞菌注射液联合顺铂胸腔内     

铜绿假单胞菌注射液治疗恶性胸腔积液的临床观察

目的观察铜绿假单胞菌注射液治疗恶性胸腔积液的有效性和不良反应。方法 53例恶性胸腔积液患者随机分组予B超定位下胸腔置管闭式引流术,经证实胸腔积液已基本排净后,27例治疗组胸腔注入铜绿假单胞菌注射液,26例对照组胸腔注入顺铂。结果治疗组有效率高于对照组(P<0.05)。毒副反应方面,治疗组除轻度发热及轻微胸痛外,其他不良反应明显少于对照组(P<0.05)。结论铜绿假单胞菌注射液胸腔注入治疗恶性胸腔积液安全有效。     

铜绿假单胞菌注射液胸腔注射治疗肺腺癌恶性胸水疗效观察

目的观察铜绿假单胞菌胸腔注射治疗肺腺癌恶性胸腔积液的临床疗效。方法 61例肺腺癌合并中到大量胸腔积液患者随机分成三组,以培美曲塞联合顺铂全身化疗作为基础治疗,分别接受胸腔内注射铜绿假单胞菌注射液、香菇多糖及顺铂治疗。观察胸水疗效及不良反应。结果铜绿假单胞菌注射液治疗组有效率85.7%。香菇多糖治疗组有效率59.1%,顺铂治疗组有效率47.1%。铜绿假单胞菌治疗组疗效好于其它两种药物(χ2=6.73,P0.05)。铜绿假单胞菌注射液治疗组不良反应发生率低,反应轻微。结论铜绿假单胞菌胸腔注射治疗肺腺癌所致恶性胸腔积液疗效显著,副反应发生少且轻微。     

结直肠癌术中腹腔内应用铜绿假单胞菌注射液疗效观察

目的研究结直肠癌患者术中腹腔喷洒铜绿假单胞菌注射液的安全性,并观察该给药方式对患者预后影响。 方法选取2006年7月初至2007年10月我科室收治的经手术治疗的结直肠癌患者,将其分成两组,A组(对照组)行单纯手术治疗的患者119例,B组(治疗组)96例,术中腹腔应用铜绿假单胞菌注射液,观察术后患者体温、WBC(白细胞)数、肠蠕动恢复情况及腹腔引流量等指标。选取其中的III期和IV期结直肠癌患者,随访并进行回顾性分析。 结果术后第三日各指标观察结果,体温高于37.5℃：治疗组为56.25%,对照组为54.62%(P>0.05);肠蠕动恢复情况：治疗组为51.04%,对照组49.58%(P>0.05);腹腔引流液大于50 ml：治疗组为16.67%,对照组18.49%(P>0.05);WBC数值：治疗组26.04%,对照组26.05%(P>0.05),所有患者无吻合口发生。生存曲线分析示III、IV期结直肠癌患者的中位生存期治疗组高于对照组(P>0.05);III期患者的3年生存率和5年生存率,治疗组分别为68.3%和39.0%,对照组分别为51.1%和25.5%(P>0.05),IV期患者3年和5年生存率均无显著差异。 结论铜绿假单胞菌注射液在术中腹腔给药方式安全可行,该给药方式对结直肠癌患者术后肿瘤进展有一定抑制作用,但该作用对患者远期生存率无显著影响。     

铜绿假单胞菌注射液胸腔灌注治疗恶性胸腔积液的临床分析

目的观察铜绿假单胞菌注射液胸腔灌注治疗恶性胸腔积液的临床疗效及毒副反应。方法将70例晚期非小细胞肺癌伴恶性胸腔积液患者随机分为观察组和对照组,每组各35例。对照组在常规辅助治疗的基础上予以洛铂胸腔灌注治疗,观察组在对照组的基础上辅以铜绿假单胞菌注射液胸腔灌注,观察比较两组患者治疗后的临床疗效及毒副反应。结果治疗疗程结束后,多数患者胸腔积液情况得到了有效的控制,两组治疗的总有效率分别为77.1%和48.6%(P0.05)。两组患者治疗过程中的毒副反应主要以发热、胃肠道反应及骨髓抑制为主,两组比较差异无统计学意义(P0.05)。结论洛铂联合铜绿假单胞菌注射液比单独洛铂胸腔灌注治疗恶性胸腔积的疗效显著,毒副反应相当,可推荐临床应用。     

胸腔灌注铜绿假单胞菌注射液治疗非小细胞肺癌患者恶性胸腔积液的临床观察

目的观察胸腔灌注铜绿假单胞菌注射液治疗非小细胞肺癌(NSCLC)患者恶性胸腔积液的临床疗效及毒副反应。方法将65例NSCLC伴恶性胸腔积液患者随机分为实验组和对照组,其中实验组32例,对照组33例。实验组予以胸腔灌注铜绿假单胞菌注射液治疗,对照组予以胸腔灌注洛铂治疗,比较两种药物胸腔灌注治疗NSCLC伴恶性胸腔积液患者的临床疗效及毒副反应。结果治疗后,两组患者中大多数胸腔积液情况均得到了改善,但实验组和对照组治疗总有效率分别为75.0%和54.5%(P0.05),且胃肠道反应及骨髓抑制等毒副反应也明显较对照组少(P0.05)。结论胸腔灌注铜绿假单胞菌注射液治疗NSCLC患者恶性胸腔积液比胸腔灌注洛铂的疗效好,毒副反应少,可考虑临床推广应用。     

假单胞菌注射液治疗恶性胸腔积液116例分析

恶性胸腔积液是由恶性肿瘤胸膜转移或胸膜原发恶性肿瘤引起的 ,约占所有胸腔积液的 18.7%～ 3 3 .3 % [1] ,是癌症晚期的常见并发症之一 ,肺癌和乳腺癌是最主要原因 ,其自然病程平均 <3个月。如何提高恶性胸腔积液的疗效 ,并延长生存期是一个非常重要的课题。自 1991年 1月 1日～ 2 0 0 0年 12月 3 1日 ,我们利用假单胞菌注射液 (PVI)治疗了肺癌与乳腺癌引起的恶性胸胸腔积液患者 116例 ,取得了良好的临床疗效。对象与方法1.对象 :选择经病理学、细胞学证实的原发性支气管肺癌或乳腺癌 ,经X线、CT、B超证实有胸腔积液存在 ,胸腔穿刺抽取…     

热灌注顺铂治疗晚期卵巢癌恶性腹腔积液的临床疗效

目的 探讨热疗联合顺铂对人卵巢癌细胞的毒性增效作用及治疗卵巢癌恶性腹腔积液的疗效.方法 MTT法研究常温及42℃不同作用时间下温热联合顺铂对卵巢癌细胞敏感株SKOV3的生长抑制作用,流式细胞术检测细胞凋亡.观察腹腔热灌注顺铂治疗36例晚期卵巢癌腹腔积液的疗效及不良反应.结果 42℃热疗显著增强顺铂对卵巢癌细胞敏感株SKOV3的生长抑制,42℃热疗60min联合顺铂化疗显著增加SKOV3细胞凋亡率.热灌注顺铂治疗卵巢癌腹腔积液的有效率为61.1％(22/36),不良反应轻微.结论 热疗能显著增强顺铂的卵巢癌细胞毒性作用,热灌注顺铂是晚期老年卵巢癌患者安全有效的治疗方法.     

卡铂和白介素Ⅱ治疗恶性腹腔积液疗效观察

我们于１９９５年２月至１９９７年３月应用卡铂、白介素Ⅱ（ＩＬ－Ⅱ）腹腔内注射治疗３３例恶性体腔积液者,收到了较好疗效。并与同期应用环磷酰胺（ＣＴＸ）、丝裂霉素（ＭＭＣ）治疗者进行了对比分析。现报道于下。１临床资料晚期消化道肿瘤并腹腔转移共６４例。将病人随机分为２组,治疗组３３例,男性２２例,女性１１例,年龄４６．５±６岁,其中胃癌１５例,结肠癌８例,胰腺癌５例,肝癌３例,直肠癌２例。对照组３１例,男性１９例,女性１２例,年龄４５±７岁,其中胃癌１３例,结肠癌７例,胰腺癌４例,肝癌４例,直肠癌３例…     

爱迪注射液联合顺铂、地塞米松治疗癌性胸水的疗效观察

目的探讨局部爱迪注射液联合顺铂、地塞米松胸腔内注射对癌性胸腔积液患者的疗效。方法46例癌性胸腔积液患者随机分为两组,治疗组爱迪注射液联合顺铂、地塞米松胸腔内注射;对照组顺铂加地塞米松胸腔注射;治疗两组胸水吸收、症状改善等情况。结果观察组胸水吸收、症状改善情况均优于对照组,两组比较差异显著(P<0.05)。结论顺铂联合地塞米松、爱迪注射液治疗癌性胸水疗效明显。     

结直肠癌的免疫检查点阻断治疗

结直肠癌是常见的恶性肿瘤之一,总体预后相对较差。对转移性结直肠癌患者而言,探索更有效的治疗方法显得尤为重要。免疫治疗,特别是免疫检查点抑制剂,是近几年研究的热点,在黑色素瘤、肺癌等疾病中取得了较好的疗效。本文将重点阐述抗肿瘤免疫在结直肠癌中的作用,以及各种免疫检查点抑制剂在结直肠癌中应用的最新进展。     

The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction

Background/Aims

We aimed to assess the effectiveness of self-expanding metal stent (SEMS) insertion by evaluating the learning curve in relation to the experience of an endoscopist.

Methods

We retrospectively analyzed the outcomes of 120 SEMS insertion procedures performed by one endoscopist in patients with malignant colorectal obstruction. We compared the technical and clinical success rates, complication rates, and duration of the procedures by quartiles.

Results

The mean age of the patients (76 men and 44 women) was 64.6 years. The overall technical success rate was 95.0% (114/120), and the clinical success rate was 90.0% (108/120). The median procedure duration was 16.2 minutes (range, 3.4 to 96.5 minutes). From the first to the last quartile, the technical success rates were 90.0%, 96.7%, 96.7%, and 96.7% (p=0.263), and the clinical success rates were 90.0%, 90.0%, 96.7%, and 83.3% (p=0.588), respectively. Procedure-related complications were observed in 28 patients (23.3%). The complication rates for SEMS insertion when patients were divided by quartiles were 26.7%, 23.3%, 10.0%, and 33.3% (p=0.184), respectively. Moreover, the number of stents per procedure was 1.13, 1.03, 1.00, and 1.00 (p=0.029), respectively. The median duration of SEMS insertion decreased significantly, 20.9 to 14.8 minutes after the first 30 procedures (p=0.005).

Conclusions

An experienced endoscopist was able to perform the SEMS insertion procedure easily and effectively after performing 30 SEMS insertions.     

Leptin levels in the differential diagnosis between benign and malignant ascites

AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites.
METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhosis and 12 tuberculosis）. Control serum samples were obtained from 20 healthy subjects. Leptin and TNFα levels were measured by EUSA. Body mass index （BMI） and percentage of body fat （BFM） by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients.
RESULTS： In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFα levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. CONCLUSION： In patients with malignant ascites, levels of leptin and TNFα were significantly lower than in patients with tuberculous ascites.     

腹腔内注射贝伐珠单抗治疗结直肠癌患者恶性腹腔积液的疗效和安全性评价

目的探讨腹腔内注射贝伐珠单抗治疗恶性腹腔积液的近期疗效及安全性; 方法收集46例桂林医学院附属医院胃肠外科2010年3月至2014年5月伴有难以控制的恶性腹腔积液的晚期结直肠癌患者。检测其腹腔积液中VEGF含量;并利用单因素生存分析对比两组患者的预后。 结果对照组的血清VEGF平均值为（671.8±499.15）pg/mL,与治疗组［平均值为（665.19.19±499.15）pg/mL］相比差异无统计学意义。治疗组中,治疗前腹腔积液VEGF量的平均值为（1 225.11±609.71）pg/mL,无穿刺中位生存时间为6个月（1~21个月）。与对照组相比,治疗组的穿刺引流时间明显延长（t值=6.328,P<0.05）。治疗后,腹腔积液的VEGF量（317.69±172.14）pg/mL,与治疗前相比差异存在统计学意义。治疗后的血清VEGF平均值为（170.61±115.92）pg/mL,与治疗前差异具有统计学意义。在生存分析中,治疗组的预后明显好于对照组（P<0.05）。 结论对于一部分合适的患者,腹腔内注射贝伐珠单抗对于恶性腹腔积液的治疗可能是一种有效地、安全的治疗手段。     

Comparison of cisplatin plus pemetrexed and cisplatin plus gemcitabine for the treatment of malignant pleural mesothelioma in Japanese patients

BackgroundCisplatin plus pemetrexed is a standard front-line chemotherapeutic regimen for inoperable malignant pleural mesothelioma (MPM). However, no clinical trials have compared the efficacy of cisplatin plus pemetrexed and cisplatin plus gemcitabine, which may be comparable based on previous phase II study results. This study aimed at evaluating the efficacy of cisplatin plus pemetrexed and comparing it with that of cisplatin plus gemcitabine in Japanese MPM patients.MethodsFrom July 2002 to December 2011, 13 and 17 consecutive patients with inoperable MPM were treated with cisplatin plus gemcitabine and cisplatin plus pemetrexed, respectively, at the Shizuoka Cancer Center. We reviewed the medical charts of these patients and evaluated their characteristics as well as data regarding drug toxicity and antitumor efficacy.ResultsThe response rates were 15% and 35% in the cisplatin plus gemcitabine and cisplatin plus pemetrexed groups, respectively (P=0.4069), while disease control rates were 77%, and 82%, respectively (P=0.9999). Progression-free survival was significantly higher with cisplatin plus pemetrexed (median, 215.5 days) than with cisplatin plus gemcitabine (median, 142.5 days) (P=0.0146; hazard ratio [HR], 0.3552). Overall survival showed a tendency towards being superior with cisplatin plus pemetrexed (median, 597.5 days) compared with cisplatin plus gemcitabine (median, 306.5 days) (P=0.1725, HR, 0.5516). Hematological toxicities, especially thrombocytopenia and neutropenia, tended to be more frequent and severe in the cisplatin plus gemcitabine group.ConclusionsCisplatin plus pemetrexed may be superior and should continue to be the standard front-line chemotherapeutic regimen for inoperable MPM.     

One-stage percutaneous triple procedure for treatment of endoscopically unmanageable patients with malignant biliary obstruction and marked ascites

Background and study aimsTo assess the feasibility, safety and efficacy of one-stage percutaneous triple procedure including; ascites drainage, primary metallic biliary stenting, and tract embolisation with N-butyl 2-cyanoacrylate (NBCA), in treatment of patients with malignant biliary obstruction and marked ascites.Patients and methodsThis study involved 25 patients with malignant biliary obstruction and marked ascites (age range, 46–78 y; mean age ± SD, 65 y ± 5) for whom endoscopic treatment failed or was unsuitable. Ascites drainage, percutaneous primary metallic biliary stenting, and tract embolisation with lipiodol/NBCA mixture were performed in a one-stage procedure. The mean ± SD follow up period was 26 ± 2 weeks.ResultsThe technical and clinical success rates were 96% and 88% respectively. No procedure related deaths or major complications were observed. The reported minor complications included; moderate pain and vomiting during and after balloon dilation, postprocedural cholangitis, and bile leakage in 44%, 16%, and 8% of the patients respectively. Primary stent patency was achieved in 96%. The 30-days mortality was 8%. The stent obstruction occurred in 3 (13%) of the 23 patients who survived more than 30-days.ConclusionsPercutaneous drainage of ascites followed immediately by primary biliary stenting, together with tract embolisation with NBCA is technically feasible, safe, and effective alternative palliative treatment for endoscopically unmanageable patients with malignant biliary obstruction and marked ascites.     

Effect of cisplatin in advanced colorectal cancer resistant to 5-fluorouracil plus (S)-leucovorin

Modulation of 5-fluorouracil (5-FU) is currently being investigated in advanced colorectal cancer. In an attempt to improve the results obtainable for the association of 5-FU and leucovorin, we decided to add cisplatin to 5-FU and (6S)-leucovorin (S-LV) after disease progression. The hypothesis was that a pharmacological enhancement of the efficacy of 5-FU would result in responses in 5-FU-unresponsive patients or in a second response in previously responding patients. A group of 28 5-FU+S-LV-pretreated patients, with advanced measurable colorectal cancer, were treated with 80 mg/m² cisplatin on day 1, 80 mg/m² S-LV every 4 weeks. We obtained 3 partial responses (response rate: 11±11%), while 11 patients had stable disease (39±18%). Among the 3 responders, 1 patient had earlier achieved a partial response, a second stable disease and 1 had disease progression after the previous 5-FU+S-LV treatment. The median survival time for all 28 patients was 11 months. Toxicity was minimal and consisted of mild and reversible gastrointestinal symptoms and myelosuppression. We believe that further studies must be carried out to establish the real impact of the synergism between cisplatin, 5-FU and S-LV in untreated patients.Abbreviations S-LV (6S) leucovorin - 5-FU 5 fluorouracil - PD progressive disease - PR partial response - SD stable disease     

洛铂腔内灌注治疗恶性胸腹腔积液的临床观察及安全性研究

目的探讨洛铂（LBP）、顺铂（DDP）腔内分别灌注治疗恶性胸腹腔积液的近期临床疗效及临床安全性。方法对41例恶性胸腹腔积液患者,在尽可能放尽胸腹腔内积液以后,腔内分别注入洛铂50mg／m2,或者顺铂60mg／m2,均为每3周1个周期,1周期后评价近期疗效、生活质量以及毒副反应,并对疗效进行分析。结果41例患者均可进行客观疗效评价及安全性评价,全组患者中完全缓解（CR）5例,病情稳定（SD）27例,疾病进展（PD）9例,疾病控制率（DCR）为78．05％;顺铂一线治疗组疗效：CR2例,SD13例,PD3例,DCR83．33％;洛铂二线治疗组疗效：CR3例,SD11例,PD2例,DCR87．50％;顺铂二线治疗组疗效：CR0例,SD3例,PD4例,DCR42．86％。顺铂一线与洛铂二线治疗间疗效无统计学差异（P〉0．05）,但明显优于顺铂二线治疗,统计学差异显著（P〈0．05）,并且结果与患者生活质量改变相似。三组患者中,恶心、呕吐等消化道反应不明显,但患者乏力明显直接影响患者的生活质量;三组患者白细胞、血小板减少等骨髓抑制反应相当,以Ⅰ-Ⅱ度反应为主,Ⅲ-Ⅳ度反应不明显,三组间比较无统计学差异（P〉0．05）。结论洛铂和顺铂腔内灌注均可以较好的控制恶性胸腹腔积液,既往应用顺铂治疗的患者采用洛铂治疗也具有较好的有效率;洛铂腔内治疗可显著减轻患者的临床症状,改善患者生活质量,临床安全性较好,未增加化疗药物的不良反应发生率。