新生儿泪囊炎综合治疗时机的临床研究

[目的]分析探讨综合治疗方法对新生儿泪囊炎不同年龄组患儿治疗临床效果.[方法]回顾性分析100例123眼新生儿泪囊炎患儿,采用泪囊区挤压按摩,泪道加压冲洗,鼻泪管探通等方法综合治疗.[结果]循序采用泪囊区挤压按摩、泪道加压冲洗及鼻泪管探通术能较好地治疗新生儿泪囊炎,总有效率为95.9%.其中,年龄3月以内的患儿泪囊区挤压按摩治愈率显著高于3月以上的患儿(X2=7.485,P=0.006);年龄6月以内患儿泪道加压冲洗或鼻泪管探通成功率亦显著高于6月以上患儿(X2=4.665,P=0.031).[结论]新生儿泪囊炎循序采用泪囊区挤压按摩,泪道加压冲洗,鼻泪管探通的综合治疗,并且根据不同的年龄阶段采用不同的方法,在最佳治疗时机取得了良好的临床效果.     

Quality of life for head and neck cancer patients treated by combined modality therapy: the therapeutic benefit of technological advances in radiotherapy

Purpose  

To evaluate quality of life (QoL) in patients with head and neck squamous cell carcinoma (HNSCC) treated by combined modality therapy, with a focus on the therapeutic benefits of QoL that result from technological advances in radiotherapy (RT).     

调强适形放疗同期TP方案化疗治疗食管上段癌的临床研究

目的 探讨调强适形放疗（IMRT）同期TP方案（多西他赛＋顺铂）化疗治疗食管上段癌的疗效、局部控制率、生存率及不良反应.方法 78例食管上段癌患者以双盲法随机分为IMRT联合同期化疗组（放化组）和单纯IMRT组（放疗组）,每组39例.放化组采用IMRT,总剂量6 400 cGy/32次,5次/周,同期应用TP方案化疗每周1次;放疗组单纯采用IMRT.观察分析各组近期疗效、局部控制率、生存率、不良反应.结果 放化组完全缓解17例,部分缓解20例,稳定2例,总有效率为94.9％（37/39）;放疗组完全缓解9例,部分缓解19例,稳定11例,总有效率为71.8％（28/39）.放化组总有效率高于放疗组,差异有统计学意义（P＜0.05）.放化组3年局部控制率为69.2％（27/39）,明显高于放疗组的35.9％（14/39）,差异有统计学意义（P＜0.05）.放化组3年生存率为74.4％（29/39）,明显高于放疗组的43.6％（17/39）,差异有统计学意义（P＜0.05）.结论 IMRT同期TP方案化疗较单纯IMRT提高了近期疗效、局部控制率、生存率,其近期和远期不良反应可以耐受.     

食管癌放射治疗联合化疗疗效观察

目的：观察食管癌放射治疗联合DF方案化疗的临床疗效和毒副反应。方法：将符合入组条件的92例食管癌患者随机分为单纯放疗组（46例）和放化组（46例）。单纯放疗组采用6MVX直线加速器常规照射,每次1.8-2Gy,每周5次,照射剂量为60～70Gy。放化组外照射同常规放疗组,放射治疗当日开始采用DF方案化疗：氟尿嘧啶（5-FU）500mg/d,d1-5;顺铂（DDP）20mg/d,d1-5,28天一个疗程,每例至少化疗2疗程后评价疗效,共用2～4疗程。结果：放化组和单放组缓解率分别为82.6%和58.7%（P〈0.05）。结论：放射治疗联合DF方案化疗,疗效优于单纯放疗,毒副反应可以耐受,是治疗食管癌的有效方法。     

支架植入联合化疗治疗中晚期食管癌疗效观察

目的 探讨支架植入联合化疗对中晚期食管癌的治疗效果.方法 选择2004年7月～2009年8月在笔者所在医院进行治疗的80例食管癌患者,分成观察组和对照组.观察组采用化疗和支架植入,对照组采用支架植入术.比较两组生存时间和临床症状.结果 观察组平均生存时间（10.10±2.55）个月,对照组平均生存时间（5.35±1.70）个月,两组比较,差异有统计学意义（P〈0.05）.观察组有12例患者在6个月内再发梗阻,而对照组有25例6个月内再发梗阻.观察组再梗阻比例明显低于对照组.结论 支架植入联合化疗临床效果优于单纯支架植入,值得进一步研究推广.     

Radiation therapy combined with hyperthermia in advanced cancer

Radiation therapy combined with radiofrequency (RF) hyperthermia was performed on 5 advanced cancer patients. Included were one each with urinary bladder cancer, hepatoma with left axillary node metastasis, breast cancer, tongue cancer with left cervical metastasis, and mandibular cancer. All had large tumours, which were judged to be uncontrollable by radiotherapy alone. They were treated with irradiation (Linac: 10 MV X-ray 1.8-2.0 Gy/day, 5 days/week), followed within an hour by RF hyperthermia once or twice a week. Partial response was obtained in the urinary bladder cancer patient. Surface overheating around the margin of electrodes occurred in all but no severe complications were observed.     

Increased risk of squamous cell esophageal cancer after adjuvant radiation therapy for primary breast cancer

Prior studies have demonstrated that adjuvant radiation therapy following mastectomy for breast cancer increases the risk of second primary esophageal cancer after 10 years, but the risk following breast-conserving surgery (lumpectomy) has yet to be determined. The authors used 1973-2000 data from the population-based Surveillance, Epidemiology, and End Results Program and estimated relative risks of 2.83 (95% confidence interval: 1.35, 5.92) and 2.17 (95% confidence interval: 1.67, 4.02) for squamous cell esophageal cancer at 5-9 and > or =10 years, respectively, following postmastectomy radiation therapy. This increase was mainly due to tumors located in the upper and middle thirds of the esophagus. No significant increase in risk was found for adenocarcinoma following mastectomy or for any type of esophageal cancer following lumpectomy. In summary, postmastectomy radiation therapy moderately increases the risk of squamous cell esophageal cancer starting 5 years after exposure, which persists after 10 years, with no increase in the risk of adenocarcinoma. This finding appears to be a function of the portals used for postmastectomy radiation therapy, which do not expose the lowest third of the esophagus, where adenocarcinomas commonly arise.     

食管癌术后病人两种营养支持治疗的比较

目的:观察食管癌术后病人两种营养支持疗法的效果。方法:将80例食管癌术后病人随机分为肠外营养(PN)组和肠内营养(EN)组,所有病人在手术前1 d和术后第8天检测血红蛋白(Hb)、血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)、体质指数(BMI)以及肛门排气时间、住院时间和营养费用等指标。结果:两组病人术后血清ALB,住院时间、BMI、Hb比较无显著性差异(P>0.05)。EN组病人血清PA,TF明显高于PN组(P<0.05),术后肛门排气时间明显早于PN组(P<0.05),所用营养费用低于PN组。结论:两种营养支持治疗均可改善食管癌病人的营养状况,但EN与PN比,更具有符合生理、安全、价廉的优点。     

Association of volumetric-modulated arc therapy with radiation pneumonitis in thoracic esophageal cancer

The lung volume receiving low-dose irradiation has been reported to increase in volumetric-modulated arc radiotherapy (VMAT) compared with three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal cancer, which raises concerns regarding radiation pneumonitis (RP) risk. This single institutional retrospective cohort study aimed to explore whether VMAT for thoracic esophageal cancer was associated with RP. Our study included 161 patients with thoracic esophageal cancer, of whom 142 were definitively treated with 3DCRT and 39 were treated with VMAT between 2008 and 2018. Radiotherapy details, dose–volume metrics, reported RP risk factors and RP incidence were collected. The RP risk factors were assessed via multivariate analysis. Dose–volume analysis showed that VMAT delivered more conformal dose distributions to the target volume (P < 0.001) and reduced V_{30 Gy} of heart (57% vs 41%, P < 0.001) but increased V_{5 Gy} (54% vs 41%, P < 0.001) and V_{20 Gy} (20% vs 17%, P = 0.01) of lungs compared with 3DCRT. However, the 1-year incidence rates of RP did not differ between the two techniques (11.3% in 3DCRT vs 7.7% in VMAT, P = 0.53). The multivariate analysis suggested that the presence of interstitial lung disease (ILD) (P = 0.01) and V_{20 Gy} of lungs ≥20% (P = 0.008) were associated with RP. Conclusively, VMAT increased the lung volume receiving low to middle doses irradiation, although this might not be associated with RP. Further studies are needed to investigate the effect of using VMAT for delivering conformal dose distributions on RP.     

去甲斑蝥酸钠联合奥沙利铂和长春瑞滨治疗复发食管癌的近期疗效

目的探讨去甲斑蝥酸钠联合奥沙利铂和长春瑞滨治疗复发食管癌的疗效与不良反应。方法选择38例经病理组织学和影像学证实的食管癌放化疗后复发转移的患者入组。静滴奥沙利铂130mg／m^2,第1天;静滴长春瑞滨25mg／m^2,第1、8天;静滴去甲斑蝥酸钠20mg,每日1次;每21d重复为一周期,至少应用2周期。结果36例可评价病例,完全缓解3例（8．3％）,部分缓解20例（55．6％）,稳定9例（25．0％）,进展4例（11．1％）。客观总有效率63．9％,中位缓解期4．6个月,中位疾病无进展时间（TTP）4．2个月,中位生存期6．3个月。在缓解症状、改善生存质量和提高KPS评分等方面都取得较好疗效。主要不良反应有骨髓抑制、消化道反应、外周神经毒性、静脉炎等。无治疗相关死亡者。结论去甲班蝥酸钠联合奥沙利铂和长春瑞滨治疗复发食管癌疗效较好,缓解率较高,不良反应能耐受,值得临床进一步研究。     

分段弧和全弧旋转容积调强放疗治疗胸中段食管癌的剂量学比较

目的 通过比较不同旋转容积调强放疗（全弧VMAT和分段弧VMAT）治疗胸中段食管癌的剂量学差异，分析应用分段弧VMAT治疗胸中段食管癌的可能性。方法 选择11例胸中段食管癌患者，分别设计全弧VMAT、分段弧VMAT两种治疗计划，统计并比较靶区(PTV)、危及器官(肺、脊髓、心脏)、以及机器总跳数（MU）等参数的剂量学差异。应用SPSS17.0软件对两组数据进行配对t检验分析。结果 全弧VMAT计划PTV D₉₅（t = - 7.699, P = 0.000）、D₉₈(t = - 6.384, P = 0.000)、均匀性指数（HI）(t = 10.423, P = 0.000)均优于分段弧VMAT，分段弧VMAT肺的平均剂量、V₅（t = - 4.048, P = 0.002）要优于全弧VMAT。靶区的适形度指数（CI）、MU、双肺的V₁₀、V₂₀差异无统计学意义（P > 0.05）。结论 胸中段食管癌放疗时应用全弧VMAT、分段弧VMAT均可以满足靶区临床要求，但分段弧VMAT可以明显减少肺低剂量区域照射范围。     

替吉奥联合三维适形放射治疗矽肺合并食道癌40例

目的 探讨替吉奥联合三维适形放射治疗矽肺合并食道癌的疗效和副作用.方法 40例矽肺合并食道癌患者均接受替吉奥胶囊80mg/(d·m2),每日分2次,共服用3周.同时每周接受2 Gy/次剂量的三维适形放射5次,共放疗6周.治疗后1周评价疗效和副作用.结果 完全缓解(CR)23例(57.50％)、部分缓解(PR) 11例(27.50％)、稳定(SD)4例(10.00％)和进展(PD)2例(5.00％),总有效率85.00％.副作用的反应主要为:白细胞减少11例(30.00％)、血小板减少13例(32.50％)、贫血9例(22.50％).结论 替吉奥联合三维适形放射治疗矽肺合并食道癌临床效果显著,副作用主要以血液方面变化为主,人体可耐受,该方法适合在临床广泛应用.