大剂量顺铂联合化疗治疗卵巢癌腹水

目前 ,卵巢癌已居妇科恶性肿瘤病死率的首位。而卵巢癌并发腹水约占总病例数的 1/3～ 1/5。大量腹水蓄积于腹腔内可引起食欲不振、腹胀、腹痛、呼吸急促等一系列症状。我们根据卵巢癌主要为局部蔓延和腹腔种植的特点 ,自 1990年 1月～ 1997年 12月 ,对 49例卵巢癌并发腹水患者采用大剂量顺铂联合化疗治疗 ,疗效较好 ,报告如下。1　资料与方法1.1　病例选择　 1990年 1月～ 1997年 12月初次住院患者 ,根据临床症状 ,结合盆腔检查、B超、CT检查 ,预计腹水量 >2 0 0 0 ml者 ,经 B超下腹腔穿刺抽腹水行细胞学检查明确诊断为卵巢癌 ,并排除卵巢…     

羟基喜树碱腹腔灌注治疗卵巢癌腹水24例

2002年1月～2005年11月应用羟基喜树碱（hydroxycamptothecin,HCPT）腹腔注射化疗治疗卵巢癌腹水患24例,效果满意,现总结报道如下。     

腹腔化疗治疗卵巢癌合并腹水的护理

卵巢癌已成为最致命的妇科恶性肿瘤之一。因为卵巢癌病人早期无自觉症状，无意中发现腹部包块大多已到晚期，常常伴有腹水。选择腹腔化疗是卵巢癌合并腹水最为理想的治疗途径之一。就目前的临床资料看，通常每4周进行一次先期化疗，可持续1～2个疗程腹腔化疗，可直接作用于种植在腹腔脏器表面或腹膜表面的微小病灶，控制恶性腹水生长。然后再进行手术治疗。我科于2001年1月至2003年8月收治81例卵巢癌病人，其中选择35例卵巢癌伴有大量腹水不能进行手术治疗的病人，采用腹腔穿刺放腹水行细胞学检查，找到癌细胞明确诊断后，经腹腔灌注大剂量化疗药物治疗1～2个疗程后，观察腹水消失、肿瘤缩小，为手术创造条件。     

卡铂术前腹腔灌注治疗卵巢癌并腹水23例疗效分析

采用卡铂术前腹腔灌注治疗卵巢癌并腹水２３例，经治疗后总有效率为６６．６％，手术中吸出腹水量明显低于未治疗组（Ｐ〈０．０５），经卡铂治疗后行肿瘤减灭术者亦高于未治疗组（Ｐ〈０．０５），而术中失血量无明显增加（Ｐ〉０．０５），提示：对晚期卵巢癌并腹水患者术前给予卡铂腹腔灌注可减少腹水形成及松动肿块，以增加彻底手术的机会。     

57例卵巢癌合并腹水术前细胞学诊断及处理

目的：研究卵巢癌合并腹水的细胞学诊断价值及术前用顺铂腹腔化疗控制腹水的效果及副作用、并发症。方法：收集北京市妇产医院手术病理证实的卵巢癌合并腹水的病例57例，抽取腹水在显微镜下找到恶性或可疑恶性细胞病例，常规腹腔放尽腹水后注入顺铂60-100mg，观察腹水控制情况及副作用、并发症。结果：找到恶性肿瘤细胞46例（80.7%），找到可疑恶性肿瘤细胞3例（5.3%），未找到恶性或可疑恶性肿瘤细胞8例（14.0%）。49例找到恶性或可疑恶性肿瘤细胞的患者术前顺铂腹腔内注射，40例手术时发现腹水控制理想，有效率81.9%。顺铂的副作用：胃肠道反应Ⅰ-Ⅱ级22例，Ⅲ级19例，Ⅳ级0例，骨髓抑制Ⅰ-Ⅱ级5例，Ⅲ-Ⅳ级0例，无肾毒性及听神经毒性。结论：腹水细胞学检查在卵巢癌合并腹水的病例中阳性率高，方法简单可行。血性腹水较非血性腹水阳性率高，术前腹腔化疗有利于改善全身情况择期手术，顺铂腹腔给药较静脉给药疗效好，用量少，副作用小。     

卵巢癌腹水形成的相关因素分析

分析 10 6例卵巢癌患者的临床资料。结果发现 ,卵巢癌的不同分期组和不同分化组间的腹水量有显著性差异 (P <0 .0 1,P <0 .0 5 ) ;有腹膜转移组及CA12 5 >30 0kIU组的腹水量分别显著大于无腹膜转移组及CA12 5<30 0kIU组 (P <0 .0 1) ;组织类型不同、原发灶和转移灶大小不同、血清蛋白水平不同及有无肝实质和肠壁转移组间腹水量比较无显著性差异 (皆P >0 .0 5 )。结果表明 ,卵巢癌腹水的形成与临床分期、组织分化程度、腹膜受累程度及血清CA12 5水平有关 ,而与组织类型、原发灶和转移灶大小、血清蛋白水平、肝实质和肠壁的转移等因素无关。     

肿瘤细胞减灭术联合化疗治疗晚期卵巢癌106例

目的：探讨肿瘤细胞减灭术在晚期卵巢上皮性癌治疗中的地位和时机。方法：１０６例晚期卵巢上皮性癌行减灭术,术后给予腹腔化疗和全身化疗。Ａ组：５９全减灭术后残存癌灶直径〈２ｃｍ并全部行系统腹膜后淋巴结清除术。Ｂ组：４７例减灭术后残存癌灶直径≥２ｃｍ,部分病例行腹膜后淋巴结清除术。结果：两组均无手术死亡。总５年生存率为４０．６％。Ａ组和Ｂ组生存率分别为５７．６％和１９．１％,Ａ组明显高于Ｂ组（Ｐ〈０．００     

复发性卵巢癌治疗方法的选择

目的:探讨复发性卵巢癌治疗方法的选择。方法:选择2000~2005年50例复发性卵巢癌,分析其临床病理资料,根据首次治疗情况,复发间隔时间,复发病灶的部位、大小、数量以及患者的一般情况,采用再次减瘤术及术后二线药物化疗、单纯静脉化疗和口服化疗方案治疗。结果:50例患者1、2、3、4、5年总生存率分别为82%、64%、42%、34%、30%。3种治疗方法的1年和3年生存率差异均无统计学意义(P>0.05),而5年生存率差异有统计学意义(P<0.05)。结论:复发性卵巢癌治疗应采用个体化原则,综合评估谨慎选择二次减瘤术,可提高满意减瘤率,改善患者生活质量。     

多西他赛与奥沙利铂联合治疗复发性上皮性卵巢癌疗效评价

目的 观察和评估多西他赛联合奥沙利铂方案治疗复发性上皮性卵巢癌的临床疗效及安全性.方法 对病理证实为复发性上皮性卵巢癌患者36例进行化疗.给药方案为:多西他赛75mg/m~2,静脉滴注1 h,第1天:奥沙利铂100mg/m~2,静脉滴注2h,第1天.每21 d重复,至少治疗2个周期.结果 接受治疗的36例患者均可评价疗效,完全缓解率为8.3%,部分缓解率为47.2%,总有效率55.6%.主要毒副反应为骨髓抑制和周围神经炎.结论 多西他赛联合奥沙利铂化疗方案治疗复发性上皮性卵巢癌有较好的疗效,毒副反应轻,耐受性好,值得进一步临床研究推广.

Abstract：

Objective To evaluate the efficacy and safety of docetaxel (Taxotere) (DTX) and oxaliplatin (OXA) for treatment of recurrent epithelial ovarian cancer. Methods Thirty-six patients with histologically confirmed recurrent epithelial ovarian cancer received chemotherapy with DTX and OXA. DTX at the dose of 75 mg/m2 was administered on day 1 by intravenous infusion in 60 min, followed by OXA at 100 mg/m~2 given by a 2 h infusion. The chemotherapy cycles were repeated every 21 days, and the patients received at least 2 cycles. Results All the patients were available for response evaluation, among whom 3 (8.3%) showed complete responses and 17 (47.2%) showed partial responses, with an overall response rate of 55.6%. The main adverse effects included hematological toxicities and peripheral neuropathy. Conclusion Combination of DTX and OXA produces good therapeutic effect with tolerable toxicity profile for treatment of recurrent epithelial ovarian cancer.     

检测 ROC1在卵巢恶性上皮性肿瘤组织中的表达及临床意义研究

目的：探究 ROC1在卵巢恶性上皮性肿瘤组织的表达及临床意义,为卵巢上皮性恶性肿瘤的基因治疗提供新的思路。方法选取2005年10月至2007年10月在遵义医学院附属医院行卵巢癌手术并进行了长达5年随访的261例卵巢癌患者,对卵巢癌组织及相应周围正常组织中 ROC1 mRNA 及蛋白表达水平进行检测,并将结果与患者的预后之间的相关性进行统计分析。结果 ROC1在卵巢癌组织中过度表达,而在相对应周围正常组织中几乎不表达;ROC1表达水平高低与患者的生存率存在负相关性。结论卵巢癌患者中 ROC1表达水平越高,预后越差。     

ATP体外药敏试验指导的卵巢癌预见性化疗

目的　探讨ATP体外药敏试验指导临床卵巢癌化疗的价值。方法　 86例卵巢癌患者中 ,5 7例在化疗前接受了ATP体外药敏试验。其中ATP敏感组 49例 ,根据药敏结果指导化疗 ;ATP耐药组 8例和对照组 2 9例则凭经验化疗。结果　ATP敏感组有效率为 75 5 % (3 7/4 9) ,ATP耐药组和对照组有效率分别为 0 (0 /8)及 5 5 2 % (16/2 9) ,差异有显著意义(P <0 .0 1)。本研究体外药敏和体内疗效的总符合率为 78 9%〔(3 7+ 8) /5 7〕。结论　ATP体外药敏试验指导临床卵巢癌化疗是可行的 ,疗效也是满意的     

Effect of retroperitoneal lymphadenectomy on prognosis of patients with epithelial ovarian cancer

Objective To evaluate prognostic factors which have an influence on overall survival and to assess the rational application of retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer. Methods The data of 131 patients treated between January 1990 and December 1998 in Union Hospital and Tongji Hospital were analyzed retrospectively. Survival was calculated using the Kaplan-Meier method and comparisons were performed using Log-rank test. Independent prognostic factors were identified by the Cox proportional hazards regression model. Results Univariate analysis showed that age, general conditions, menopausal status, stage, pathological types, location of the tumor, residual tumor and retroperitoneal lymphadenectomy were prognostic factors. Multivariate analysis showed that age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors. The survival rate could not be improved through retroperitoneal lymphadenectomy in the patients in early stage, advanced stage with residual tumor &gt;2 cm or those with mucinous adenocarcinoma （P&gt;0.05). Among patients in advanced stage cancer with a residual tumor ≤2 cm, 5-year survival was 65% and 30% for patients who did and did not undergo lymphadenectomy, respectively （P&lt;0.01). Among patients with serous adenocarcinoma, 5-year survival was 61% and 31% for patients who did and did not undergo lymphadenectomy, respectively （P&lt;0.01). Conclusions The prognosis of the patients with epithelial ovarian cancer may be influenced by age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy. Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively.     

用腹水代替卵巢癌组织检测mdr1可行性研究

目的 探讨初治晚期卵巢患者癌组织及腹水细胞中多药耐药基因（mdr1)表达及其相关性。方法 应用RT-PCR技术对34例卵巢癌患者的癌组织及腹水癌细胞的mdr1表达进行检测。结果 卵巢癌组织mdr1阳性表达率为20.6%，腹水癌细胞mdr1阳性表达率为26.5%，经统计学处理二者间无显著性差异。结论 卵巢癌组织与腹水癌细胞mdr1表达具有相关性。腹水mdr1表达情况可间接反映卵巢癌组织细胞对化疗药物耐受程度。     

Neoadjuvant intraarterial chemotherapy and embolization in treatment of advanced ovarian epithelial carcinoma

Background The purpose of the study was to evaluate the role of neoadjuvant chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries in treating patients with advanced ovarian epithelial carcinoma.Methods Forty-two patients with advanced ovarian epithelial carcinoma (study group) were treated via the anterior branches of the bilateral internal iliac arteries after cytoreductive surgery and 7 courses of adjuvant platinum-based combination chemotherapy. Primary cytoreductive surgery was performed in 43 patients with advanced ovarian epithelial carcinoma (control group), and then followed by 8 courses of adjuvant platinum-based combination chemotherapy. The rate of optimal cytoreductive surgery, survival rate, blood loss during operation and operative time were investigated in the two groups. Statistical significance was asessed using Student’s t test, the Chi-squre test and the log-rank test. Results In the study group, the rate of optimum debulking after platinum-based chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries was 71.43%(30/42) (χ2=10.06, P&lt;0.005), and 9 (21.43%) of the 42 patients showed no gross residual disease after surgery. Blood loss and operative time were significantly decreased in the study group as compared with those in the control group (665.24±37.61 ml: 849.31±41.20 ml, t1=33.21, P1&lt;0.001; 4.23±0.21 hours: 6.15±0.38 hours, t2=28.92, P2&lt;0.01). In the study group,the mean survival time and the median overall survival were 33.66 months (95% CI, 24.73 to 42.58) and 26.00 months (95% CI, 19.22 to 32.78), respectively. The median disease-free interval was 18.20 months. In the control group, the mean survival time and the median overall survival were 32.38 months (95% CI, 24.92 to 39.84) and 25.00 months (95% CI, 22.80 to 27.20), respectively. The median disease-free interval was 14.20 months.The overall survival rates were not significantly different between the two groups (χ2=6.48,P&gt;0.05).Conclusions Neoadjuvant platinum-based combination chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries is an alternative treatment for patients with advanced ovarian epithelial carcinoma, in whom the chance of optimal cytoreductive surgery is low. The treatment can reduce blood loss, decrease operative time, and increase the rate of optimal cytoreductive surgery; but the median survival can’t be improved significantly.     

上皮性卵巢癌组织中PTEN和P-Akt 蛋白的表达及其临床意义

目的 探讨上皮性卵巢癌组织中PTEN和P-Akt蛋白的表达及其与临床病理参数的关系.方法 采用免疫组化方法分别检测25例正常卵巢组织、25例良性卵巢上皮性肿瘤、19例卵巢交界性肿瘤及69例卵巢上皮性癌组织中PTEN及P-Akt蛋白的表达状况,并分析其与卵巢癌主要临床病理参数之间的关系.结果 PTEN蛋白在正常卵巢组织与良性卵巢肿瘤组织中表达较高,在交界性卵巢肿瘤组织中表达开始下降,在上皮性卵巢癌中表达量最低,与前三组比较差异有统计学意义(P＜0.05),而P-Akt蛋白在各组中的表达趋势与PTEN相反,上皮性卵巢癌组与前三组比较差异有统计学意义(P＜0.05);PTEN蛋白表达在Ⅰ-Ⅱ期、高、中分化、淋巴结无转移的卵巢癌组织中分别高于Ⅲ-Ⅳ期、低分化、淋巴结有转移者,差异有统计学意义(P＜0.05),而P-Akt蛋白的表达趋势与PTEN相反,差异有统计学意义(P＜0.05).结论 与正常卵巢组织、良性卵巢肿瘤及交界性卵巢肿瘤比较,PTEN蛋白在上皮性卵巢癌中表达下调,而P-Akt蛋白表达上调,且卵巢癌不同分期、不同组织学分级及有无淋巴结转移之间蛋白表达水平不同,因此上皮性卵巢癌组织中PTEN和P-Akt蛋白的表达可能与卵巢上皮性癌的发生、发展及临床预后有关.     

卵巢癌腹水癌细胞端粒酶的检测

目的　探讨卵巢癌患者腹水微量癌细胞中的端粒酶活性检测的临床意义。方法　采用以PCR技术为基础的TRAP方法检测卵巢癌腹水细胞标本中的端粒酶活性,并将检测结果与细胞学诊断结果进行比较。结果　对30例经病理学确诊的卵巢癌腹水细胞标本,采用细胞学检查和端粒酶活性检测发现,20例细胞学阳性腹水标本中,端粒酶阳性19例;7例细胞学阴性腹水标本中,端粒酶阳性3例;3例细胞学可疑腹水标本,其端粒酶活性检测均为阳性。细胞学诊断和端粒酶检测阳性率分别为66.67%(20/30)和83.33%(25/30)。结论　端粒酶活性检测可能在卵巢癌腹腔转移、腹水性质的鉴别诊断和疗后微小残存检测方面有重要辅助诊断价值。