肿瘤患者省钱“四大绝招”

肿瘤病人省钱有四个诀窍： 第一招：早期检查和治疗 早期肿瘤患者应定期进行复查，以在期早期发现肿瘤转移的迹象，早发现、早诊断、早治疗，省去因延误病情而导致的昂贵的治疗费。     

骨盆肿瘤的手术治疗

目的探讨骨盆肿瘤的切除与重建方式。方法1991年7月～2006年12月,20例骨盆肿瘤患者接受骨盆肿瘤切除手术,其中18例又接受重建手术。男12例,女8例。软骨肉瘤9例,骨巨细胞瘤5例,尤文氏肉瘤1例,骨嗜酸性肉芽肿1例,腺泡状肉瘤1例,转移癌3例。根据Enneking骨盆肿瘤分区:I区7例,II区8例,III区5例。I区的2例切除范围较局限未重建。重建方法为I区肿瘤切除后使用自体腓骨重建2例,斯氏钉 骨水泥重建1例,钢板 骨水泥重建2例。II区的肿瘤切除后4例行股骨头旷置,2例行人工半骨盆置换,2例行钢板、骨水泥 人工全髋关节植入方式重建。III区的肿瘤切除后,5例均采用钢板 骨水泥重建。术后随访3个月～15年。结果局部复发5例,再次接受复发灶切除2例,放弃治疗3例。所有股骨头旷置病例均无复发。死亡6例。侵犯I、III区的肿瘤切除后,患者步态基本正常。侵犯II区的肿瘤切除后行人工半骨盆置换或行钢板、骨水泥 人工全髋关节植入的患者,半年后行走基本正常。接受股骨头旷置的患者,有较满意的活动度,行走时跛行。结论骨盆肿瘤切除重建的原则是首先完整切除肿瘤,然后再作功能重建。重建方式的选择应考虑各种方法的优缺点,尽量减少并发症的发生。     

SPECT/CT断层骨显像对骨盆转移性病灶的诊断价值

目的:探讨单光子发射计算机断层显像(SPECT)/X线计算机断层显像(CT)在骨盆骨良恶性病变诊断中的价值。方法:对全身骨显像中骨盆骨出现异常放射性浓聚灶的53例患者行局部骨断层,获得局部骨断层图像、同机定位CT图像以及两者的融合图像。所有病例经病理、PET/CT、磁共振诊断或1年以上随诊为最终诊断结果。结果:53例患者73处病灶中,42处诊断为肿瘤骨盆骨转移,占总病灶数的57.5%;31处诊断为良性病变,占总病灶数的42.5%。SPECT/CT对于骨盆病灶恶性及良性病变的诊断准确度分别为95.3%和96.7%。结论:SPECT/CT可以提高骨盆病灶诊断的特异性和准确性,对鉴别骨盆良恶性病变有重要的临床诊断价值。     

骨肉瘤的早期症状及延迟诊断

通过对 8 1例骨肉瘤患者临床资料进行回顾分析 ,提示骨肉瘤延误诊断的原因有 3个方面 :①错误的认为只有夜间剧烈疼痛是恶性肿瘤的典型症状 ,对于间歇性疼痛或无明显肿块体征的患者 ,都考虑为良性病变 ,简单地诊断为腱鞘炎、神经痛、滑膜炎等 ;②X线无明显异常就排除了肿瘤的存在 ,一些肿瘤如骨盆肿瘤、脊柱肿瘤在X片上不易显现 ;③对于诊断为良性病变的患者不进行复诊或复诊间隔时间太长。     

骨盆肿瘤诊断和治疗体会

骨盆部位的肿瘤在骨肿瘤中比较常见。由于骨盆所处的部位及骨盆内包含许多重要脏器、血管、神经,使得该部位的肿瘤在诊断和治疗上都存在着一定的困难。本文报道我院１９８８年至１９９７年收治的１２例骨盆肿瘤病人的诊断治疗体会。临床资料本组１２例病人中男性１０例,...     

原发性气管肿瘤治疗进展

原发性气管肿瘤是呼吸系统的少见疾病,早期临床症状无特异性,易误诊为哮喘、慢性肺疾病等呼吸道疾病而延误诊断。其目前缺乏统一规范的治疗策略,以手术为主的综合治疗是目前的主要治疗模式,但对于手术切除范围、放疗范围、方式及剂量、化疗的作用、方案等方面仍缺乏共识。随着内镜技术的提高,内镜下治疗也成为治疗原发性气管肿瘤的局部治疗措施,但手术治疗仍是不容置疑的治愈手段。     

直肠癌误诊原因分析

直肠癌是常见恶性肿瘤之一,若能早期发现,早期诊断,早期治疗,疗效尚为满意。但延误诊断现象尚普遍存在。回顾找院1975年5月至1985年12月共收治直肠癌患者583例,2/3病人有被误诊为肠道其它疾病史,而延误治疗良机。下面仅就此583例直肠癌患     

骨肉瘤的早期症状及延迟诊断

通过对81例骨肉瘤患者临床资料进行回顾分析，提示骨肉瘤延误诊断的原因有3个方面：①错误的认为只有夜间剧烈疼痛是恶性肿瘤的典型症状，对于间歇性疼痛或无明显肿块体征的患者，都考虑为良性病变，简单地诊断为腱鞘炎、神经痛、滑膜炎等；②X线无明显异常就排除了肿瘤的存在，一些肿瘤如骨盆肿瘤、脊柱肿瘤在X片上不易显现；③对于诊断为良性病变的患者不进行复诊或复诊间隔时间太长。     

骨盆肿瘤46例回顾性分析

目的探讨骨盆肿瘤的发病特点、治疗和预后.方法回顾性分析2004年1月至2012年12月,我科收治的46例骨盆肿瘤及瘤样病变,男30例,女16例;年龄16~70岁,平均48岁;良性肿瘤20例,占44%.其中内生性软骨瘤6例,骨软骨瘤5例,单纯骨囊肿2例,骨巨细胞瘤2例,韧带样纤维瘤2例,骨巨细胞瘤并动脉瘤样骨囊肿1例,骨纤维结构不良1例,良性纤维组织细胞瘤1例.恶性肿瘤26例,占56%.其中骨肉瘤2例,软骨肉瘤6例,骨转移瘤18例.从临床、影像和病理分析骨盆肿瘤特点,39例行手术治疗,术后随访肿瘤复发情况及关节功能恢复情况.结果20例良性肿瘤完整随访,随访1~96个月,中位随访时间为54个月,均无复发,髋关节正常.26例恶性肿瘤随访1~9年,平均5年,6例软骨肉瘤未复发,2例骨肉瘤局部无复发,出现肺转移,均死于呼吸功能衰竭,18例恶性肿瘤骨转移患者中仍存活3例,19例手术后患者骨盆处症状明显改善,9例行骨盆重建术的患者术后复查均能做蹲起动作,步态基本恢复正常.7例行耻骨扩大切除术患者术后均未出现内脏器官的下坠.结论骨盆肿瘤中恶性肿瘤占较高比例,良性肿瘤手术后复发机会少;骨肉瘤及软骨肉瘤采取半骨盆截肢效果佳,肿瘤局部复发率低;骨盆恶性肿瘤切除重建术后患者肢体功能明显优于半盆截肢术,但须严格掌握手术适应证;对于恶性肿瘤单纯骨转移患者手术可明显减轻局部症状,改善患者的生存质量.04.co m编辑部(版权)     

骶骨脊索瘤的临床病理分析

为了探讨骶骨脊索瘤的临床特点、外科治疗方法与疗效,回顾性分析接受手术治疗的26例骶骨脊索瘤患者的临床资料。26例患者均无术中死亡,术后平均随访3.5年,7例患者局部复发,局部复发率26.9%,肺转移1例,死亡2例,术后病理检查可见典型的"Physaliphorous"细胞。初步研究结果提示,骶骨脊索瘤早期症状不典型,诊断应重视CT和MR检查。广泛手术切除是有效的治疗方式,结合术中化疗和术后局部辅助放疗可降低肿瘤的局部复发率,延长生存期,提高患者的生活质量。     

骨盆良性肿瘤201例流行病学分析

目的：分析骨盆良性肿瘤的流行病学特征及影像学特点,提高对骨盆良性肿瘤的认识及疾病的诊断水平。方法回顾北京积水潭医院肿瘤科1958年7月至2011年10月收治的201例骨盆良性肿瘤患者资料,记录患者的年龄、性别,分析骨盆肿瘤的好发年龄、性别比例;回顾病理资料,确定肿瘤的病理类型;影像资料由两位高年资骨肿瘤专科医生阅片,确定肿瘤的解剖部位、影像学特点;综合上述资料按性别、年龄、肿瘤类型、发生部位、影像学特点进行统计,分析各骨盆良性肿瘤的流行病学特点。结果男114例,女87例,男∶女为1.31∶1;发病年龄5～72岁,中位年龄28.0岁,平均30.1岁。20岁以下病例58例（28.86%）,21～30岁52例（25.87%）,31～40岁54例（26.87%）,41～50岁21例（10.45%）,50岁以上16例（7.96%）。较多见的有骨巨细胞瘤59例,骨软骨瘤53例,单纯性骨囊肿17例,动脉瘤样骨囊肿15例,骨纤维结构不良14例,软骨母细胞瘤13例。髋臼周围为肿瘤好发部位,骨巨细胞瘤及动脉瘤样骨囊肿具有较强侵袭性,易累及多个分区。结论骨盆良性肿瘤好发于40岁以下人群,好发于髋臼周围。综合流行病学情况及影像学研究有利于疾病的早期诊断和鉴别诊断。     

355例恶性肿瘤骨转移的临床分析

目的 分析恶性肿瘤骨转移的临床特征,提高肿瘤骨转移的诊治水平.方法 对355例恶性肿瘤骨转移患者的发病特点、临床特征及生存期等进行回顾性分析.结果 恶性肿瘤骨转移男性多见,原发肿瘤以肺癌(44.5%)、乳腺癌(11.0%)多见.转移部位以胸椎(51.0%)、肋骨(43.1%)、腰椎(42.3%)、骨盆(26.8%)等多见.骨转移灶多发常见(83.4%).75.2%的患者表现为不同程度的疼痛,少数以局部肿块、功能障碍、病理性骨折甚至截瘫为主要临床表现,78例(22.0%)患者无症状.影像学表现以溶骨性破坏为主(82.2%).采用化疗、内分泌治疗、生物治疗、放疗、姑息性手术、双膦酸盐类药物及止痛等综合治疗.骨痛治疗临床获益率为98.5%,影像学有效率为72.2%.中位生存期为13.9个月,其中前列腺癌骨转移为34.9个月,肝癌骨转移为4.6个月.未合并其他部位或脏器转移者生存期长,中位生存期可达14.7个月,骨转移灶单发与多发者生存期无明显差异.结论 恶性肿瘤骨转移应争取早期诊断,其治疗应以提高患者生存质量、延长生存期为目标,以姑息治疗为主,采取综合治疗.     

Diagnostic problems of evaluating vertebral metastasis from breast carcinoma with a higher degree of malignancy

BACKGROUND: Bone metastases from breast carcinoma are frequently observed as postoperative pathologic conditions; however, in many cases, diagnosis and treatment are difficult. Although most diagnoses of bone metastases are made by plain radiography (X-P) or bone scintigraphy, the use of magnetic resonance imaging (MRI) has enabled detailed imaging of foci, and many more lesions have become detectable. In the current study, the authors evaluated the relation between the diagnosis of bone metastases of breast carcinoma and clinicopathologic factors, especially those of proliferative activity and effects of treatment. METHODS: The subjects consisted of 51 breast carcinoma patients (mean age, 51.2 years) with vertebral metastases diagnosed by plain radiography, bone scintigraphy, or MRI. Twenty-eight of the 51 patients were premenopausal and 27 of the 51 had bone metastases only. The patients were classified into the following groups: Group A, 24 patients who showed similar findings in plain radiography, bone scintigraphy, and MRI; Group C, 14 who showed no abnormalities on radiography or bone scintigraphy but whose lesions were diagnosed by MRI only; and Group B, 13 patients with findings intermediate between Groups A and C. The proliferative activity of tumors was evaluated by determining the level of DNA polymerase alpha. RESULTS: Regarding the relation to clinicopathologic factors, a significant number of patients with estrogen receptor (ER) negative tumors who had a high level of DNA polymerase alpha, short disease free intervals (DFI), and metastases to other organs were included in Group C. Prognoses of patients in Group C were poor. CONCLUSIONS: For the diagnosis of breast carcinoma with bone metastasis, different correlations were noted among the various biologic characteristics, such as ER status and proliferative activity. That is, bone scintigraphy sufficiently reflected foci in patients with ER positive tumors or tumors with low proliferation, whereas bone scintigraphy was false-negative in patients with ER negative or highly proliferative tumors, showing that MRI was useful in diagnosing such patients. Therefore, consideration of malignant features, such as proliferative activity and ER status, is believed necessary during the postoperative follow-up of breast carcinoma patients.     

Osteosarcoma of the pelvis in children and young adults: the St. Jude Children's Research Hospital experience

BACKGROUND: Pelvic osteosarcomas are difficult to resect. The authors reviewed their institution's experience with patients who had such tumors to characterize the patients' clinical findings and to assess the impact of surgical resection on outcome. METHODS: A review was conducted of the records from patients with pelvic osteosarcoma who were treated at the authors' institution between January, 1970 and March, 2004. RESULTS: Among 442 patients with osteosarcoma, 19 patients (4%) had high-grade tumors arising in the pelvic bones, including the ilium in 15 patients, the pubis in 2 patients, and the sacrum in 2 patients. The median patient age at diagnosis was 16.8 years. Four tumors were secondary to radiation therapy. Five patients had metastases in the lung (n = 4 patients) or bone (n = 1 patient) at diagnosis. Ten tumors were chondroblastic. The median greatest tumor dimension for the 13 tumors with known size was 10 cm. Ten patients had unresectable pelvic tumors, and 9 patients underwent hemipelvectomy (2 internal and 7 external); complete resection with negative margins was achieved in 5 patients. Four patients survived, including one patient who survived with disease. Of the three patients who survived disease-free, one patient underwent complete resection, one patient underwent incomplete resection (nonviable tumor at the soft tissue margin) with a good response to chemotherapy, and one patient with a sacral tumor underwent radiotherapy only for local control. Of the 9 patients who underwent resection, 7 experienced disease recurrence (n = 5 patients) or progression (n = 2 patients) at distant sites and died. All patients with metastatic disease at diagnosis died. CONCLUSIONS: Pelvic osteosarcomas often were large and unresectable. A high propensity for metastasis contributed to the poor outcome of patients with pelvic osteosarcoma. New therapeutic approaches are needed.     

超声诊断恶性骨肿瘤的临床价值探讨

目的:探讨超声对恶性骨肿瘤的诊断价值.方法:将27例恶性骨肿瘤患者的超声诊断结果与病理结果对照并分析恶性骨肿瘤超声图像特征.结果:27例恶性骨肿瘤病例中,超声检出25例,灵敏度92.59%,特异度96.87%,对于骨肿瘤良恶性的鉴别超声检查与病理检查具有较高的一致性,Kappa值为0.897,良恶性骨肿瘤的血流分级和阻力指数(RI) 均存在显著差异(P<0.01).结论:对于恶性骨肿瘤的超声与病理诊断结果一致性较高,超声检查是一种简便有效的骨肿瘤的辅助检查方法.     

Pelvic insufficiency fractures in patients with pelvic irradiation

BACKGROUND: Insufficiency fractures (IF) occur as a result of normal physiological stress on bones with deficient elastic resistance. Pelvic insufficiency fractures are a complication of osteoporosis due to postmenopausal status, high dose of corticosteroids, or local irradiation. They are important because differential diagnosis includes pelvic bone metastases. Diagnosis is based on both clinical manifestations and radiographic and scintigraphic findings. METHODS AND MATERIALS: We examined eight patients with pelvic cancer who had previously undergone external beam radiation therapy as part of their treatment. In the follow-up, they developed insufficiency fractures, and no factor other than pelvic irradiation was present. Diagnosis was confirmed by radionuclide bone scan followed by conventional radiography and computed tomography (CT) scan. RESULTS: The average onset of symptoms was 13.7 months after radiation therapy was completed. The initial symptom in all cases was pain. In all of the patients, the bone scan showed abnormalities. One to four increased uptake foci were observed, in the sacroiliac joint in all cases, and in the pubis in three cases. The initial diagnosis was bone metastases in five patients. CT scan showed fractures in all of the patients, in sacrum and pubis, both endostic and cortical. Treatment, consisting of nonsteroidal anti-inflammatory drugs and rest, led to symptomatic relief in all cases. CONCLUSION: Knowledge of pelvic insufficiency fractures is essential in order to rule out metastasic disease, and thus avoid inaccurate treatment. Although radionuclide bone scan is useful in early detection of pelvic IF, definitive diagnosis is provided by CT scan.     

骨生化指标在骨肿瘤中的临床应用进展

骨肿瘤是起源于间充质细胞,发生于骨组织及其附属结构的一类良、恶性肿瘤的总称,骨肿瘤的发病率女性约为1.060/10万,男性约为1.112/10万,虽属少见的肿瘤类型,但对人体的危害大,特别是恶性肿瘤,目前疗效虽然提高,但仍不令人满意,发病趋势呈年轻,在骨科领域中占有重要地位[1]。正常的骨代谢是骨生成和骨吸收的动态平衡,这种平衡主要有骨组织中成骨细胞或破骨细胞维持,当这种平衡被打破时就会表现出各种骨疾病。骨生成和骨吸收异常伴随的生化指标及导致骨生成和骨吸收变化的相关因素均可作为骨肿瘤的生物标记。随着分子生物学技术的发展,有望通过检测骨肿瘤患者体内的生化指标变化达到早期诊断和治疗的目的。现在就骨组织生化指标在骨肿瘤患者诊治中的研究作一综述,以探讨他们的临床应用价值。     

磁共振成像对骨结核和骨肿瘤的诊断价值

目的探讨磁共振成像（MRI）对骨结核和骨肿瘤的诊断价值。方法收集2008年5月至2012年3月间拟诊断为骨结核的24例患者和24例骨肿瘤患者,所有患者均行MRI检查。结果骨结核与骨肿瘤的MRI表现多样,但是骨肿瘤的MRI诊断准确率明显高于骨结核（P〈0．05）。当b=150s／mm2时,骨结核与骨肿瘤的ADC值差异无统计学意义（P〉0．05）;而当b=300s／mm2时,骨肿瘤的ADC值明显低于骨结核的ADC值（P〈0．05）。结论MRI对于骨结核和骨肿瘤都有比较高的诊断价值,但是对骨肿瘤的诊断能提供更丰富的信息。     

盆腔肿块40例手术治疗

目的:探讨盆腔肿块的种类、特征以及外科手术治疗的可行性和疗效.方法:对本院2008年1月到2010年1月间40例盆腔肿块并行手术治疗病例的临床资料进行回顾性分析.结果:40例中,卵巢肿瘤32例,占80%(良性肿瘤27例,占84.4%;恶性肿瘤4例,占12.5%;交界性瘤1例3.1%);慢性盆腔炎症性肿块5例,占总例数12.5%;其他3例,占总例数7.5%.结论:由本组案例见,盆腔肿块以卵巢肿瘤占大部分,且恶性肿瘤发生率高,提示盆腔肿块应积极行手术治疗,可以及早诊断、治疗,改善预后和病人的生存质量.     

Factors associated with tumor volume and primary metastases in Ewing tumors: Results from the (EI)CESS studies

Background: Tumor volumes of more than 100 ml and the presence of primary metastases have been identified as determinants of poor prognosis in patients with Ewing tumors. We sought to assess the prevalence of critical tumor size and primary metastases in a large national sample of patients at the time of first diagnosis and to identify factors that are associated with their occurrence.Patients: The present report is based on data of 945 German patients who were enrolled into the (EI)CESS therapy studies between 1980 and 1997. It is assumed that registration of German patients with Ewing tumors under the age of 15 years was almost complete since around 1985. Diagnoses of primary tumors were ascertained exclusively by biopsies. Analyses were restricted to patients with Ewing tumors of bone due to the few occurrences in soft tissues.Methods: Tumor volume data as assessed by radiography, computed tomography or nuclear magnetic imaging were available for 821 patients. The diagnosis of primary metastases was based on thoracic computed tomography or on whole body bone scans in 936 patients. Suspicious lesions had to be confirmed by bone marrow biopsies. We explored how year of first diagnosis, age at first diagnosis, sex, histological subtype and site of the primary tumor related to tumor size and presence of metastases by univariate and multivariate statistical techniques.Results: Sixty-eight percent of the patients (n = 559) had a volume above 100 ml with smaller tumors being more common in childhood than in late adolescence and early adulthood. Extensive volumes were observed in almost 90% of the tumors located in femur and pelvis while they were less common in other sites (P < 0.001). On average, 26% of all patients presented with clinically apparent primary metastases. The detection rate of metastases was markedly higher in patients diagnosed after 1991 (P < 0.001). Primary metastases were also significantly more common for tumors originating in the pelvis and for peripheral neuroectodermal tumors (PNET; P < 0.01). Tumors greater than 100 ml were positively associated with metastatic disease (P < 0.001). Multivariate analyses, which included simultaneously all univariate predictors in a logistic regression model, indicated that most of the observed associations were essentially unconfounded. The adjusted odds ratios (OR) for the presence of tumor volumes 100 ml were OR = 1.5 per age rise of 10 years, and OR = 5.8 for pelvis and OR = 7.1 for femur as primary tumor site (all P < 0.001). The presence of metastases was significantly associated with the year of diagnosis (OR = 1.9, after 1991 vs. before 1986), pelvis as site of the primary tumor (OR = 1.8), a PNET (OR = 1.5), and tumor size 100 ml (OR = 1.6).Conclusions: In conclusion, we find that the prevalence of established factors for an unfavorable prognosis is disturbingly high among patients diagnosed with Ewing tumors. Recent progress in imaging techniques seems to account for much of the rise in the detection rate of metastases after 1991. We identify age and, in particular, pelvic and femoral site as the major determinants of local tumor extension. Occurrence of primary metastases is independently related to tumor size, pelvic site, and PNET.