经尿道钬激光切除术与等离子电切术治疗非肌层浸润性膀胱肿瘤的疗效及安全性对比

目的 探讨经尿道钬激光切除术与等离子电切术治疗非肌层浸润性膀胱肿瘤的疗效及安全性.方法 选择60例非肌层浸润性膀胱癌患者,根据入院时间先后,分为TURBT组(31例)及钬激光切除组(29例).观察2组的手术时间、术后膀胱冲洗时间、术中闭孔神经反射发生率、术中穿孔率、住院时间、住院费用、留置尿管时间及术后1年复发率.结果 TURBT的手术时间、术后膀胱冲洗时间均明显长于钬激光切除组,而其术中闭孔神经反射发生率及术中膀胱穿孔发生率也高于钬激光切除组,P均＜0.05.钬激光切除组的住院时间、平均住院花费、平均留置导管时间及术后1年复发率均明显低于TURBT组,P均＜0.05.结论 相较于等离子电切术,钬激光切除术治疗非肌层浸润性膀胱肿瘤,术中术后情况均更好.     

HU-150半导体激光联合经尿道膀胱肿瘤电切术治疗非肌层浸润膀胱肿瘤

目的探讨HU-150半导体激光联合经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗非肌层浸润性膀胱肿瘤(non-muscle invasive bladder cancer,NMIBC)的临床疗效和使用安全性。方法回顾分析丰县人民医院2012年7月至2015年7月行HU-150半导体激光联合经尿道膀胱肿瘤电切术29例的临床资料及术后定期行羟基喜树碱或吡柔比星膀胱灌注化疗的门诊随访资料。结果所有患者手术均获成功。病理类型均为膀胱尿路上皮癌,1例浸润至深肌层。无改开放手术病例。术中3例出现闭孔反射,2例闭孔反射强,改行全身麻醉。术后留置尿管7~10 d。术后3例肿瘤复发,再行膀胱癌根治术。1例失访,其他患者均存活。结论 HU-150半导体激光联合经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱肿瘤具有疗效确切,手术时间短,复发率较低,相互弥补对方不足的优点。     

2 μm激光整块切除与电切治疗非肌层浸润性膀胱癌的临床分析

目的:比较2 μm激光整块切除与电切治疗非肌层浸润性膀胱癌的有效性及安全性。方法:回顾性分析2015年4月-2017年4月分别采用经尿道2微米激光整块切除(50例)和经尿道电切(48例)治疗非肌层浸润性膀胱癌患者临床随访资料。结果:所有患者手术均顺利完成，激光组与电切组患者手术时间相当，两组比较差异无统计学意义(P>0.05)，激光组患者留置尿管、膀胱冲洗及住院时间均少于电切组，比较差异有统计学意义(P<0.05)；激光组患者并发症发生率、一年复发率及术区复发率低于电切组，两组比较差异均有统计学意义(P<0.05)；激光组术后病理含肌层率高于电切组，两组比较差异有统计学意义(P<0.05)。结论:经尿道2微米激光整块切除治疗非肌层浸润性膀胱癌是一种安全、有效的治疗方式且术后肿瘤分期精确、减少肿瘤残留，是治疗非肌层浸润性膀胱癌较好的手术治疗选择，值得临床上推广应用。     

促进术后恢复理念对经尿道内镜黏膜下膀胱肿瘤海博刀剥离术患者术后康复的影响

目的:探究运用促进术后恢复理念（ERAS）在经尿道内镜黏膜下膀胱肿瘤海博刀剥离术（BT-ESD）患者围手术期护理中的临床成效。方法:选取我院2015年5月至2017年5月入院的非肌层浸润性膀胱肿瘤患者98例，通过随机分组法将其分为ERAS组和对照组，每组49例。ERAS组应用ERAS理念，对照组患者护理方法为常规基础护理。两组患者均接受BT-ESD。针对术后患者恢复时间情况、术后并发症发生率等观察指标对两组患者进行对比分析。结果:术后患者饥饿程度评分，对照组轻度、中度及重度饥饿比例分别为46.9%、49.0%及4.1%，饥饿严重程度显著高于ERAS组（87.8%、12.2%及0.0%）（P<0.05）；而术后患者口渴程度评分，对照组的严重程度亦显著高于ERAS组（轻度、中度及重度口渴比例分别4.1% vs 32.6%、20.4% vs 40.8%、75.5% vs 26.5%）（P<0.05）。进一步研究发现除术后住院时间外，ERAS组患者术后疼痛视觉模拟评分（VAS）（5.9分 vs 3.1分）、通气时间（12小时 vs 8小时）、尿管拔除时间（2.5天 vs 2天）、膀胱痉挛次数（3次 vs 1.8次）及膀胱冲洗时间（9.0小时 vs 6.0小时）均显著优于对照组（P值均<0.05）。结论:ERAS可以显著改善BT-ESD患者围手术期护理效果，具体体现在:缩短患者膀胱冲洗时间、尿管拔除时间、肠道通气时间；降低术后不良反应发生率，显著增加患者满意度，应在临床广泛推广应用。     

绿激光治疗非肌层浸润性膀胱癌(附56例报告)

目的:总结应用经尿道选择性绿激光汽化术治疗非肌层浸润性膀胱癌患者的疗效.方法: 2004年-2008年,在骶管麻醉下利用经尿道选择性绿激光汽化术对56例非肌层浸润性膀胱癌患者进行肿瘤汽化术.应用80W绿激光,行经尿道膀胱肿瘤汽化术.治疗时间5-50min,平均20min,术后留置尿管1-7d,均无出血.术后结合立刻吡柔比星膀胱灌注化疗及长期规律吡柔比星膀胱灌注化疗,术后前2年中每3个月随访一次,第3年开始每6个月随访一次.结果: 本组56例患者均直接汽化成功,无出血,肿瘤汽化至肌层.54例术后每3个月复查膀胱镜见肿瘤消失、膀胱黏膜修复完整,2例分别术后3月、19个月膀胱肿瘤复发,治疗效果满意.结论: 经尿道选择性绿激光汽化术治疗非肌层浸润性膀胱癌,是一种操作简单、安全、疗效确切的腔道泌尿外科理想的手术方法.     

改良全膀胱切除术治疗浸润性膀胱癌188例疗效总结

背景与目的:全膀胱切除和尿流改道是公认的治疗肌层浸润性膀胱癌的有效方法,但手术复杂、时间长、出血多、并发症多,临床上开展困难.我们对全膀胱切除和尿流改道进行了多处改良,获得较好的效果.本研究总结我们应用改良全膀胱切除术治疗肌层浸润性膀胱癌的临床效果.方法:对2000年1月至2007年12月进行改良全膀胱切除和尿流改道治疗的188例浸润性膀胱癌患者的资料进行回顾性分析和总结.结果:188例浸润性膀胱癌患者接受改良全膀胱切除和尿流改道手术时,中位手术时间为300(120～525)min,全组输血率为39.9%,无手术死亡,发生早期并发症39例(20.7%).术后中位随访时间31(2～97)个月,5年无复发生存率和总生存率分别为74.9%和71.5%.肿瘤局限于膀胱者5年生存率和总生存率分别为82.5%和82.8%,肿瘤浸润膀胱外者分别为19.0%和34.3%,淋巴结阴性者分别为82.2%和79.1%,淋巴结阳性者分别为25.2%和11.4%.结论:改良全膀胱切除尿流改道治疗肌层浸润性膀胱癌疗效确切、安全;但对肿瘤浸润至膀胱外或有淋巴结转移者,单纯全膀胱切除疗效有限.     

经尿道膀胱肿瘤切除术前阻断瘤体血管的效果观察

目的探讨经尿道膀胱肿瘤切除术前阻断瘤体血管对手术及肿瘤复发的影响。方法选取非肌层浸润的膀胱肿瘤患者72例,根据入院先后时间不同分为观察组与对照组,各36例。2组均行经尿道膀胱肿瘤铥激光切除术。观察组在切除肿瘤前,阻断瘤体周围可见的浅表血管,对照组直接切除瘤体。对比2组术中和术后出血率、术后1年肿瘤复发情况。结果观察组术中和术后出血率均显著低于对照组(P<0.05),2组出血影响视野、手术时间、留置尿管时间对比无统计学差异(P>0.05)。术后1年内,观察组有4例肿瘤复发,对照组有5例,组间比较无统计学差异(P>0.05)。结论提前阻断瘤体周围浅表血管,可减少经尿道膀胱肿瘤激光切除术术中及术后出血,降低手术风险及难度,有助于术后恢复,但对术后短期肿瘤复发无影响。     

绿激光治疗非肌层浸润性膀胱癌（附56例报告）

目的：总结应用经尿道选择性绿激光汽化术治疗非肌层浸润性膀胱癌患者的疗效。方法：2004年-2008年,在骶管麻醉下利用经尿道选择性绿激光汽化术对56例非肌层浸润性膀胱癌患者进行肿瘤汽化术。应用80W绿激光,行经尿道膀胱肿瘤汽化术。治疗时间5—50min,平均20min,术后留置尿管1—7d,均无出血。术后结合立刻吡柔比星膀胱灌注化疗及长期规律吡柔比星膀胱灌注化疗,术后前2年中每3个月随访一次,第3年开始每6个月随访一次。结果：本组56例患者均直接汽化成功,无出血,肿瘤汽化至肌层。54例术后每3个月复查膀胱镜见肿瘤消失、膀胱黏膜修复完整,2例分别术后3月、19个月膀胱肿瘤复发,治疗效果满意。结论：经尿道选择性绿激光汽化术治疗非肌层浸润性膀胱癌,是一种操作简单、安全、疗效确切的腔道泌尿外科理想的手术方法。     

经尿道钬激光与电切治疗表浅性膀胱肿瘤的临床疗效比较

目的:总结比较经尿道行钬激光治疗(holmium laser resection)与电切治疗(transurethral resection)表浅性膀胱肿瘤的临床疗效.方法:共收治64例膀胱肿瘤患者,其中26例行经尿道钬激光切除手术,38例行经尿道电切手术;分析2组患者手术时间、膀胱穿孔例数、术后膀胱冲洗例数、导尿管留置时间、尿道狭窄发生率、肿瘤复发等指标,并比较其临床疗效.结果:随访6.28个月,2组患者平均手术时间、导尿管留置时间、术后尿道狭窄发生率、肿瘤复发率均经比对差异均无统计学意义(P＞0.05),但钬激光治疗组的膀胱穿孔及术后膀胱冲洗例数明显少于电切治疗组(P＜0.05).结论:钬激光治疗表浅性膀胱肿瘤疗效确切,并发症少,在减少膀胱穿孔等方面比电切治疗更有优势.     

2 μm激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱肿瘤的比较

 目的　比较2 μm激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术（TURBT）治疗非肌层浸润性膀胱肿瘤的安全性与疗效,评价2 μm激光治疗非肌层浸润性膀胱肿瘤的临床应用价值。方法　62例非肌层浸润性膀胱肿瘤患者按照随机数字表法分为两组,32例行2 μm激光膀胱肿瘤切除术（2 μm激光组）,30例行TURBT（TURBT组）,记录手术时间、出血情况、相关并发症、导尿管留置时间、膀胱持续冲洗时间、术后住院天数及术后复发情况等。术后定期行吡柔比星膀胱灌注化疗。结果　两组手术均成功,所有患者均未输血,2 μm激光组手术时间（32.5±10.5） min,与TURBT组的（31.3± 9.8） min比较差异无统计学意义（t＝0.364,P＝0.674）。2 μm激光组未出现闭孔神经反射,TURBT组为3例。2 μm激光组和TURBT组术后平均膀胱冲洗时间分别为（6.2±2.6） h和（23.8±6.5） h（t＝8.294,P＝0.006）;术后平均留置尿管时间分别为（4.2±1.5）d和（5.2±1.8）d（t＝1.468,P＝0.103）;术后平均住院时间分别为（5.3±1.5）d和（5.8±2.8）d（t＝0.627,P＝0.531）。术后随访6～18个月, 2 μm激光组3例复发,复发率9.4 %,TURBT组3例复发, 复发率10.0 %,两组复发率差异无统计学意义（χ2＝0.481,P＝0.562）。结论　2 μm激光治疗非肌层浸润性膀胱肿瘤疗效确切,与TURBT相似,且具有并发症少、恢复快等优点。     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

再放疗并同步使用Docetaxel在鼻咽癌放疗后复发病人中的应用

目的:不能手术切除的鼻咽癌放疗后再复发的病人,其治疗困难,化疗疗效差,而单独再放疗只能挽救一小部分病人,本文探讨再放疗并同步使用多西紫彬醇(Docetaxel)在鼻咽癌首次放疗后复发病人中可行性及毒副反应,并评价其疗效。方法:对11例鼻咽癌足量放疗后经组织病理学证实复发、而无法行手术及腔内放疗的患者进行了同步放化疗。放疗采用三维适形放疗,外照射鼻咽部,分次量为1.8Gy,总剂量为36Gy-39.6Gy。化疗采用Docetaxel,15mg/m2,每周一次,静脉滴注。结果:10%、33%的患者分别出现Ⅲ度、Ⅳ度皮肤反应,18%、10%的病人分别出现Ⅲ度、Ⅳ度黏膜反应,18%患者出现Ⅲ度恶心呕吐,27%的患者出现Ⅲ度-Ⅳ度白细胞下降,10%患者出现Ⅲ度血小板下降。1例患者因严重的黏膜反应致使治疗延迟2周。治疗结束后,9例(82%)患者达到CR,2例(18%)达到PR,反应率为100%。结论:对于放疗后局部复发的鼻咽癌患者,采用同步放化疗,3D-CRT同时每周使用Docetaxel是可行的,其毒性反应在可以接受的范围内,短期疗效显著。     

Protothecosis successfully treated with amikacin combined with tetracyclines

Summary We report a case of protothecosis in an 18-year-old female student caused by Prototheca zopfii successfully treated with amikacin combined with tetracyclines. Zusammenfassung Es wird über eine Protothecose, verursacht durch Prototheca zopfii, bei einer 18-j?hrigen Studentin berichtet, die erfolgreich mit Amikacin in Kombination mit Tetracyclinen behandelt wurde.