经内镜支架置入术联合腹腔镜手术治疗左侧大肠癌性梗阻的临床效果观察

目的观察左侧大肠癌性梗阻患者临床治疗应用经内镜支架入术联合腹腔镜手术的临床疗效。方法选取我院收治的46例左侧大肠癌性梗阻患者作为研究对象,对照组(n=23)与观察组(n=23)患者分别给予结肠灌洗与经内镜支架入术联合腹腔镜手术进行治疗,观察临床效果。结果经治疗后,观察组患者手术相关情况(手术时间、术中出血量、住院时间等)均显著优于对照组;治疗后观察组的并发症发生率为8.6%,对照组的并发症发生率为26.1%,观察组明显低于对照组(P<0.05)。结论临床治疗中经内镜支架置入术联合腹腔镜手术对左侧大肠癌性梗阻患者具有良好的效果,明显改善手术各项情况,降低并发症发生率,值得推广使用。     

内镜下支架治疗结直肠恶性梗阻临床研究

目的探讨经内镜结肠支架置入术治疗结直肠癌恶性肠梗阻的I】盎床价值。方法采用内支架置入治疗结直肠恶性梗阻15例,梗阻部位位于直肠8例,直肠乙状结肠交界处6例,乙状结肠l例。CT及X线检查发现7例肝转移。3例肺转移。选取自膨型支架或带膜支架,术后观察患者排便通畅度、每日排便次数、粪便性状、以及有无腹痛、便血等症状。支架置入术后24h复查腹部立位平片。24h后梗阻缓解为治疗成功的标准。结果15例患者中,置入成功率为100％,直肠乙状结肠交界处肿瘤术中穿孔行外科手术治疗1例,术后6月近端再次梗阻给予支架叠加治疗缓解3例,死于胃癌出血1例。结论内镜下支架引流术主要应用在恶性肿瘤所致急性结肠梗阻晚期的姑息治疗,其侵袭性较小,能迅速缓解梗阻,安全,经济,有效,患者易于接受,被认为是治疗急性结直肠癌梗阻的首选治疗方式．     

内镜联合X线下结直肠支架置入术治疗结直肠癌伴肠梗阻

目的：观察探讨内镜联合X线下结直肠支架置入术治疗结直肠癌伴肠梗阻的方法及疗效。方法结直肠癌并肠梗阻、内镜放置支架失败患者8例,行内镜联合X线下结直肠支架置入术。结果8例患者均一次性放置支架成功,成功率100%,2例术后发现有黏液血便,经静脉止血治疗后缓解;无1例出现肠穿孔等严重并发症;5例过渡性支架置入患者转入外科行Ⅰ期肠切除吻合术,术后无1例出现切口感染、吻合口瘘等并发症。结论内镜联合X线下结直肠支架置入治疗结直肠癌伴肠梗阻是一种安全、有效的治疗措施。     

记忆钛合金支架置入术治疗乙状结肠、直肠癌所致急性梗阻的体会

目的 探讨肠道支架放置对乙状结肠、直肠癌所致的急性梗阻之治疗效果和安全性.方法 对2010年10月至2012年12月收治的24例乙状结肠、直肠癌所致的急性梗阻进行临时性或姑息性支架放置;观察支架置入后梗阻缓解情况和并发症.结果 24例中21例支架植入成功（87.5％）,梗阻缓解率为100％,全组无死亡发生.术后并发症主要有腹部疼痛12例、少量便血10例及里急后重感8例.3例患者因支架移位脱落引起肛门疼痛,予取出,3例均行了直肠前切术加回肠末端预防性造口.10例在支架置入术后2周内成功施行了Ⅰ期左半结肠切除或直肠前切除术,8例因肿瘤全身扩散或肿瘤固定,接受放化疗或未作进一步治疗.结论 肠道支架置入术对乙状结肠、直肠癌所致的急性梗阻是一种安全有效的临时过渡性或永久性姑息性治疗手段.     

老年结、直肠癌性梗阻的诊断与治疗体会

目的探讨老年结、直肠癌性梗阻的诊治方法。方法回顾分析56例老年完全性结、直肠癌性梗阻的临床表现、诊断和治疗。结果本组56例行手术治疗,入院至手术时间为3小时至5天。术中诊断13例为绞窄性肠梗阻,其中5例术前做出诊断,符合率38.5%。术后发生并发症19例,死亡3例,病死率5.4%,其中绞窄性肠梗阻死亡2例。结论对于老年结、直肠癌性梗阻,能够早期并准确地认识到绞窄性肠梗阻的发生,对治疗和预后具有重要意义。     

肠道支架在结直肠癌伴梗阻治疗中的应用效果

目的 总结在结直肠癌伴梗阻患者治疗过程中肠道支架应用的经验。方法 回顾性分析2018年10月至2021年9月北京怀柔医院收治的54例结直肠癌伴梗阻患者的病历资料,按是否应用肠道支架治疗分为支架组（21例）和未行支架组（33例）,对两组患者的后续治疗效果及转归进行分析及经验总结。结果 支架组21例患者中,有19例成功完成梗阻病变段的肠道支架置入术,随后有17例患者限期行腹腔镜下结直肠癌根治性切除术;未行支架组患者均接受手术治疗,15例完成腹腔镜下结直肠癌根治性切除术,支架组患者腹腔镜手术完成率高于未行支架组,加做预防性造口术率及吻合口瘘发生率低于未行支架组,两组数据差异有统计学意义（P <0.05）。结论 结直肠癌伴梗阻的临床治疗要根据患者基础条件及病情情况,个体化的选择治疗方案,方能使得患者获得最大收益。如条件允许,先行肠道支架置入术以快速缓解病变段梗阻,改善患者基础条件,亦能增加患者一期手术吻合的成功率,降低患者术后相关并发症发生率。     

高龄老人结直肠癌致急性肠梗阻47例外科治疗分析

目的：探讨高龄老人患结直肠癌并发急性肠梗阻的外科治疗原则及方法。方法：分析1995/2007年60岁以上47例结直肠癌致急性肠梗阻的外科治疗资料。结果：I期行右半结肠切除14例,I期行横结肠切除10例,I期行左半结肠或直肠上段癌近端结肠造口,关闭远端结肠或直肠备II期吻合11例,行双腔造瘘12例;术后并发症32%,围手术期病死率4%。结论：重视对高龄老人结直肠癌急性肠梗阻的认识,合理选择手术术式,做好围手术期的准备是减少老人并发症、提高疗效、降低死亡率的重要措施。     

支架置入术后择期腹腔镜治疗结直肠癌伴肠梗阻的疗效分析

目的:探讨支架置入术后择期腹腔镜治疗结直肠癌伴肠梗阻的疗效。方法:选取某院2015年1月~2017年4月收治的90例结直肠癌伴肠梗阻患者,按治疗方式分为两组,每组45例。其中观察组先行结肠镜下支架治疗,再行腹腔镜手术治疗,对照组仅采用急诊腹腔镜治疗,观察两组患者相关手术指标、淋巴结清扫数目以及术后并发症发生情况。结果:观察组手术时间、术中出血量、术后肛门排气时间、住院时间及淋巴结清扫数目均明显优于对照组(P0.05);观察组术后并发症发生率为2.22%,明显低于对照组17.78%(P0.05)。结论:支架置入术后择期腹腔镜治疗结直肠癌伴肠梗阻与单纯腹腔镜治疗比较,效果显著,能有效减少并发症,术后恢复时间短,安全可靠,临床上值得进一步推广。     

支架置入术在治疗脑缺血性疾病中的应用

目的:探讨血管内支架置入治疗脑缺血性疾病的临床效果和安全性.方法:对58例脑缺血性疾病患者,在局麻下,经股动脉置管行主动脉弓、颈动脉、椎动脉、颅内血管造影,于狭窄的颈动脉、椎动脉处置入Smart支架,术后24小时、3、6、12个月随访.结果:造影成功率为100%,支架置入成功率96.6%.支架置入后,30例TIA患者临床症状完全消失,显效率为100%,26例脑梗死患者中18例临床症状有明显好转,显效率为69.2%.术后随访3～12个月,患者恢复良好,未再次发生脑血管意外事件.结论:血管内支架置入后能明显改善患者临床症状,减少脑卒中再次发生,是一种操作简单、安全有效的治疗脑缺血性疾病的方法.     

Application of biliary stents in endoscopic stenting of biliary ducts

Extra hepatic bile ducts with the gallbladder are the center place for many disease processes. In extreme cases of significant strictures of bile ducts and impairment of bile flow, obstructive jaundice occurs. There are benign and malignant biliary strictures. The treatment of obstructive jaundice depends on the removal of blockage using endoscopic and surgical methods which return the efficient bile flow to the digestive tract. The endoscopic treatment from Vater's papilla access using plastic and metal stents is the method of choice. The choice of proper prosthesis depends on the reason for biliary strictures. The plastic stents (straight, pigtail) are applied the most. Due to their low cost, easy insertion to biliary ducts and exchangeability, they are applied in benign and malignant strictures. However, metal stents (Wallstent, Diamond, Z-stent, InStent), due to the wide diameter after expansion and no possibility of removal, are applied only in malignant strictures. Endoscopic insertion of biliary endoprostheses can be burdened with complications. There have been reports of occlusion, migration with duodenal wall injury and hemorrhaging.     

Comprehensive comparison of trace metal concentrations in cancerous and non-cancerous human tissues

The roles of metals in the development and inhibition of cancer have a complex character and have risen many questions because of their essential and toxic effects on human health. Question of whether trace metal concentrations in tissues are increased or decreased in cancerous patients in comparison with non-cancerous patients has not been answered yet, due to the fact that the data known in this field is rare and have contradictory results. Although Zn and Cu concentrations in serum and tissues of cancerous patients have been extensively studied, the precise role of these metals in carcinogenesis is not clearly understood. On the other hand, the comprehensive review on trace metal concentrations in cancerous and non-cancerous tissues is uncommon. The differences in literature on the increases or decreases in trace metal concentrations of cancerous tissues in comparison with non-cancerous tissues may be attributed to a few reasons such as the tissue basis-dry or wet weight, different sensitivities and basis of analysis methods that affect the accuracy, and the difficulties in taking of the sample representing the cancerous or non-cancerous area. In this study, the data published up to now have been reviewed. Comparison of results was done according to tissue and cancer types and trace metal species. The probable causes of differences in literature data were discussed. Especially, the published studies in recent years needed such a review.     

Panitumumab safety for treating colorectal cancer

Introduction: Panitumumab is a human IgG2 mAb against the EGFR, inhibiting tumor cell proliferation, survival and angiogenesis. It has demonstrated clinical efficacy in metastatic colorectal cancer (CRC) in combination with chemotherapy in first- and second-line settings and as monotherapy in third-line setting. Recently, mutations in the RAS genes have been shown to be predictive of lack of efficacy, panitumumab should be restricted to patients with RAS wild-type (wt) tumors.

Areas covered: This review focuses on main efficacy results of panitumumab in metastatic CRC in first-, second- and third-line settings in combination with chemotherapy or as monotherapy. Additionally, we have covered safety aspects of this agent in these indications, especially in K-RAS and all RAS wt patients. These safety aspects refer to the most common toxicities (i.e., acne-like skin rash, diarrhea and hypomagnesaemia).

Expert opinion: Panitumumab adds to the armamentarium of effective agents in the treatment of metastatic CRC. Due to its human origin, panitumumab is a well-tolerated agent with low rates of infusional reactions. Skin toxicity is frequent and should be pre-emptively treated. Other common toxicities related to panitumumab treatment, such as diarrhea and hypomagnesaemia, should be closely monitored to ensure early treatment or substitution.     

鼻内镜下微波治疗会厌囊肿疗效观察

目的探讨会厌囊肿的治疗方法和疗效。方法回顾性分析我院2003年1月至2010年1月共收治120例会厌囊肿患者行鼻内镜下微波治疗的临床资料。结果 120例患者均顺利完成手术,术后有3例出现创面出血,2例出现会厌面及会厌谷水肿致轻度呼吸困难,其余无出血及呼吸困难等并发症发生。术后1个月囊肿完全消失,随访6～12个月,无1例复发。结论鼻内镜下微波治疗会厌囊肿疗效显著,操作简单,并发症少,值得临床推广。     

鼻内窥镜下微波治疗变应性鼻炎

目的探讨鼻内窥镜下微波治疗变应性鼻炎的疗效。方法 190例变应性鼻炎在鼻内窥镜下利用微波凝固筛前神经分布的鼻丘、下鼻甲和鼻中隔黏膜治疗;随访1年以上,采用治疗前后的症状分级记分和体征分级记分对远期疗效进行对比。结果总有效率为91.7%,症状分级记分和体征分级记分明显低于治疗前症状及体征分级记分,其差异均有显著性(P<0.01)。结论鼻内镜下微波热凝治疗变应性鼻炎可在直视下准确定位,视野清楚,操作简单,疗效满意。     

慢性鼻窦炎鼻内镜手术治疗的临床效果评价

目的评价鼻内镜手术治疗慢性鼻窦炎的临床效果。方法对我院收治127例慢性鼻窦炎患者予以鼻内镜手术进行治疗,同时在术中对合并症进行处理。并予以6个月以上的随访。结果全部患者中,92例治愈,约占72．4％,31例好转,约占24．5％,4例无效,约占3．1％,总有效率为96．9％。2例患者出现鼻腔少量出血,予以微波烧灼后出血情况消失。2例鼻腔粘连,予以局麻下粘连松解术,并采用明胶海绵对创面进行分隔,1周后痊愈。结论鼻内镜手术治疗慢性鼻窦炎创伤小、恢复快,且效果满意,同时在术中还需注意其他病变的处理,可使其远期疗效进一步提高。     

The potential role of nintedanib in treating colorectal cancer

Introduction: Angiogenesis leads to the growth, progression, and metastases of a variety of solid tumors, including metastatic colorectal cancer (mCRC), involving particularly the family of vascular endothelial growth factors (VEGF) and their receptors (VEGFR). Several anti-angiogenic inhibitors are already registered for mCRC therapy: bevacizumab, aflibercept, ramucirumab, regorafenib. Nintedanib is a new triple angiokinase oral inhibitor that potently blocks the proangiogenic pathways mediated by VEGFR, platelet-derived growth factor receptor (PDGFR), and fibroblast growth factor receptor (FGFR).

Areas covered: The current state-of-the-art of anti-angiogenic inhibitors employed in the treatment mCRC patients, and in particular the role of nintedanib in this setting, is reviewed and discussed here. A structured search of bibliographic databases for peer-reviewed research literature and of main meetings using a focused review question was undertaken.

Expert opinion: In first-line therapy, a phase II randomized trial showed that nintedanib plus chemotherapy was not inferior to the bevacizumab-based regimen. In heavily pretreated mCRC patients nintedanib improved some outcomes. During the natural history of mCRC resistances to anti-angiogenic therapies can set in and in this context, nintedanib, due to its triple inhibition, might play a role in compensatory angiogenesis overcoming the resistance developed due to VEGF directed therapy.     

腔内灌注化疗和热疗治疗癌性胸腹腔积液的疗效观察

目的 探讨腔内灌注化疗联合全身热疗在治疗癌性胸腹腔积液中的疗效.方法 将临床确诊的63例恶性胸腹腔积液患者随机分成3组,治疗组(21例)于排胸腹腔积液后腔内灌注顺铂(cis-diamminedichloroplatinum,DDP),30 min后即行红外线全身热疗,恒温期温度41.5～42℃,维持60 min以上;对照1组(21例)除不做全身热疗外,其余治疗同治疗组;对照2组(21例)除不做腔内灌注化疗外,其余治疗同治疗组.结果 3组患者经治疗后总有效率为43.6％,其中观察组有效率(76.2％)显著高于对照1组(33.3％)(P＜0.01)及对照2组(19.05％) (P＜0.001).结论 腔内化疗联合全身热疗治疗晚期肿瘤恶性胸腹腔积液较常规单纯腔内灌注化疗或单纯全身热疗效果好,能在一定程度上改善患者生活质量,有临床应用价值.