前哨淋巴结活检与腋窝淋巴结清扫术在乳腺癌手术中的应用效果

目的 探讨前哨淋巴结活检与腋窝淋巴结清扫术在乳腺癌手术中的应用效果。方法 回顾性分析86例女性乳腺癌患者临床资料,将术中接受前哨淋巴结活检的43例患者设为观察组,将术中接受腋窝淋巴结清扫术治疗的43例患者设为对照组。比较2组手术情况、肩关节活动度、肩关节功能、疼痛程度、免疫功能及并发症。结果 观察组术中出血量[(76.52±6.29)ml]少于对照组[(89.74±7.35)ml],手术时间[(62.35±6.25)min]、拔管时间[(4.35±0.49)d]及住院时间[(8.63±1.12)d]短于对照组[(69.74±6.48)min、(5.24±0.67)d、(10.39±1.35)d],有统计学差异(P<0.05)。观察组术后外旋[(76.24±5.73)°]、内旋[(74.14±5.82)°]、屈曲[(150.32±9.82)°]、外展[(137.52±9.43)°]及肩关节Neer评分[(86.32±6.15)分]高于对照组[(68.78±5.42)°、(67.06±5.49)°、(138.97±9.37)°、(122.37±9.26)°、(80.54±6.07)分...     

喉部分切除术与喉部全切术对喉癌患者生存质量及预后的影响分析

目的 探讨喉部分切除术与喉部全切术对喉癌的临床效果及安全性。方法 选取80例喉癌患者,按随机数字表法分为两组,各40例。对照组予以喉部全切术治疗,观察组予以喉部分切除术治疗,术后随访1年。比较两组吞咽功能恢复情况、手术情况、疼痛评分、血清炎症因子水平、生存质量、预后情况及并发症。结果 观察组吞咽功能恢复优良率较对照组高,术后喉黏膜水肿时间[(8.69±1.12)d]、住院时间[(9.54±1.18)d]短于对照组,有统计学差异(P<0.05);观察组术后1 d、3 d及7 d时视觉模拟评分[(5.82±1.09)分、(3.56±0.52)分、(2.04±0.35)分]低于对照组,有统计学差异(P<0.05);观察组术后C反应蛋白(CRP)[(9.95±1.24)mg/L]、白介素-6(IL-6)水平[(7.89±1.14)ng/L]低于对照组,有统计学差异(P<0.05);观察组术后生活质量中生理领域[(84.76±7.29)分]、心理领域[(87.58±7.14)分]、社会领域[(88.31±8.25)分]及环境领域[(89.65±7.29)分]评分高于对照组,有统...     

甲状腺癌“低位领”式与“L”型切口淋巴结清扫术的比较

目的 比较“低位领”式与“L”型切口淋巴结清扫术治疗甲状腺癌的临床效果。方法 选取80例甲状腺癌患者,按随机数字表法分为2组,各40例。对照组采取“L”型切口淋巴结清扫术,观察组施行“低位领”式淋巴结清扫术,观察至术后3个月。对比2组手术相关指标、切口满意度、颈肩部疼痛程度与心理状态、生活质量、并发症。结果 观察组术中出血量[(40.53±4.26)ml]少于对照组[(58.75±6.31)ml],手术时间[(118.79±10.53)min]与住院时间[(6.35±1.03)d]短于对照组[(146.35±12.69)min、(9.42±1.69)d],切口满意度[95.00%(38/40)]高于对照组[80.00%(32/40)],视觉模拟疼痛评估量表(VAS)评分[(3.56±0.48)分]与焦虑自评量表(SAS)评分[(39.46±4.33)分]、抑郁自评量表(SDS)评分[(40.63±5.20)分]低于对照组[(5.23±0.79)分、(47.53±6.36)分、(48.56±6.48)分],有统计学差异(P<0.05)。术后3个月,观察组生活质量综合评定问卷(GQO...     

不同手术方式治疗早期宫颈癌的近、远期疗效及术后生活质量的影响

目的 分析不同的手术方式治疗早期宫颈癌患者的近、远期临床疗效及术后生活质量的影响.方法 选取257例早期宫颈癌患者进行研究,按随机数字法分为对照组和观察组.对照组患者行开腹手术,观察组患者行腹腔镜手术.记录两组患者术中和术后的相关手术指标;出院后,并对患者进行1月/次的定期电话回访或检查,记录患者治疗后3个月、6个月及1年的FACT-G评分.结果 术中观察组手术时间[(243.56±51.24)min]、清扫淋巴结个数[(24.56±4.71)个],明显多于对照组的手术时间[(161.87±42.39)min]、清扫淋巴结个数[(19.37±3.56)个];但观察组的术中出血量[(317.82±51.36)ml]少于对照组术中出血量[(352.44±62.17)ml](P<0.05).术后,观察组排气时间(47.59±7.82)h、住院时间(7.45±2.13)d及并发症总发生率(3.75%),明显低于对照组的[排气时间(60.27±11.56)h、住院时间(10.78±2.39)d、并发症总发生率10.31%(P<0.05)].观察组的术后3个月、6个月及1年的FACT-G评分与对照组比较无明显差异(P>0.05).结论 采用腹腔镜手术治疗早期宫颈癌患者,与开腹手术对比创伤小、恢复快,且患者术后的远期疗效与开腹手术治疗的患者相当,有较好的临床应用前景.     

经尿道电切术和开放手术治疗早期膀胱癌的近期疗效分析

目的探讨经尿道膀胱肿瘤电切术(TURBT)和开放手术治疗早期膀胱癌的近期疗效。方法按照随机数字表法将102例早期膀胱癌患者分为研究组和对照组,每组51例。研究组患者接受TURBT治疗,对照组患者接受开放手术治疗。比较两组患者手术时间、术中出血量、留置导尿管时间、住院时间、并发症发生率及术后复发率。结果研究组患者的手术时间[(25.4±6.2)min]、术中出血量[(30.3±11.2)ml]、留置导尿管时间[(2.0±0.6)d]、住院时间[(5.5±1.1)d]均少于对照组的[(36.1±7.3)min、(58.2±12.2)ml、(3.0±0.8)d及(7.2±1.3)d],差异均有统计学意义(P<0.05)。研究组患者有2例(3.9%)发生尿道狭窄,其发生率低于对照组(13.7%,P<0.05);研究组患者膀胱穿孔(9.8%)及闭孔神经反射(11.8%)的发生率均高于对照组(0.0%、2.0%)(均P<0.05)。术后随访1年,两组均未见死亡病例,研究组有7例(13.7%)复发,对照组有8例(15.7%)复发,差异无统计学意义(P>0.05)。结论 TURBT治疗早期膀胱癌可改善患者手术情况,并能取得与开放手术相近的疗效,值得临床推广应用。     

颏下岛状瓣在口腔癌根治术后软组织缺损修复中的应用价值

目的 探讨颏下岛状瓣(SMIF)在口腔癌(OC)根治术后软组织缺损修复中的应用价值。方法 选取100例OC根治术后软组织缺损患者,按随机数字表法分为对照组(50例)与观察组(50例)。对照组实施吻合血管游离前臂皮瓣修复,观察组实施SMIF修复,两组患者均观察到术后3个月。对比两组手术相关指标、口腔开口度、吞咽与咀嚼功能、生活质量、并发症。结果 观察组术中出血量[(242.84±12.78)ml]少于对照组[(326.75±14.69)ml],手术与住院时间[(356.93±16.27)min、(13.29±2.82)d]短于对照组[(448.65±17.84)min、(17.48±3.46)d],而并发症发生率[6.00%(3/50)]低于对照组[20.00%(10/50)],有统计学差异(P<0.05);术前、术后,两组口腔开口度、吞咽与咀嚼功能、生活质量综合评定问卷(GQOLI-74)内的各维度评分相比,无统计学差异(P>0.05);但术后,两组口腔开口度、吞咽与咀嚼功能与GQOLI-74内各项维度的评分均较术前高,有统计学差异(P<0.05)。结论 SMIF与吻...     

三维重建技术在老年肺癌合并肺结核患者胸腔镜肺癌根治术中的应用效果

目的 探讨三维重建技术在老年肺癌合并肺结核患者胸腔镜肺癌根治术中的应用效果。方法 回顾性分析84例行胸腔镜肺癌根治术的老年肺癌合并肺结核患者的病历资料，依据治疗措施的不同将其分为2组，依据多排螺旋CT增强图像施行手术治疗的38例患者为对照组，运用三维重建技术制定并施行手术的46例患者纳入观察组，所有患者均观察到术后3个月。对比2组手术相关指标、生活质量、并发症。结果 观察组手术时间[(102.36±10.58)min]、住院时间[(7.15±1.63)d]短于对照组[(113.59±12.75)min、(9.48±2.31)d],术中出血量[(78.63±8.29)ml]、术后引流量[(438.97±24.23)ml]少于对照组[(106.59±10.71)ml、(620.57±26.75)ml],术中淋巴结清扫个数[(11.69±1.92)个]多于对照组[(8.31±1.57)个],并发症发生率[6.52%(3/46)]低于对照组[23.68%(9/38)],有统计学差异(P<0.05)。术前，2组生活质量综合评定问卷(GQOLI-74)内各个维度的评分比较，无统计学差异(P&...     

内镜黏膜下剥离术与内镜下黏膜切除术治疗早期食管癌的临床效果分析

目的 探讨内镜黏膜下剥离术(ESD)与内镜下黏膜切除术(EMR)在早期食管癌治疗中的应用效果。方法 选取78例早期食管癌患者，按随机数字表法分为2组，各39例。对照组予以EMR治疗，观察组予以ESD治疗。术后随访6个月。比较2组手术情况、病灶切除率、肿瘤标志物、生活质量及并发症。结果 观察组手术时间[(73.58±6.25)min]长于对照组，术中出血量[(89.63±6.12)mL]少于对照组，差异有统计学意义(P<0.05);观察组整块切除率(89.74%)、完全切除率(79.49%)高于对照组(71.79%、56.41%),差异有统计学意义(P<0.05)。观察组术后鳞状细胞癌抗原(SCCA)[(3.15±0.42)μg/L]、癌胚抗原(CEA)[(6.89±1.13)μg/L]及细胞角蛋白19血清片段21-1(CYFRA21-1)[(2.89±0.38)μg/L]水平较对照组低，有统计学差异(P<0.05)。观察组术后生活质量中生理领域评分[(87.63±7.15)分]、心理领域评分[(86.59±6.78)分]、社会领域评分[(88.57±6.58)分]及环...     

呼吸道管理及呼吸训练对肺癌术后患者肺功能指标、排痰效果、肺部感染及康复情况的影响

目的 探讨呼吸道管理及呼吸训练对肺癌术后患者肺功能指标、排痰效果、肺部感染及康复情况的影响.方法 采用随机数字表法将82例接受手术治疗的肺癌患者分为观察组(n=43)和对照组(n=39),对照组患者接受常规术后管理,观察组患者在对照组的基础上给予呼吸道管理及呼吸训练.比较两组患者的肺功能指标、术后排痰效果、肺部感染情况及康复情况.结果 干预后,观察组患者的呼气流量峰值(PEF)、第1秒用力呼气容积(FEV1)和用力肺活量(FVC)均高于对照组(P<0.05);观察组患者的日排痰量明显多于对照组(P<0.01),痰液黏稠度低于对照组(P<0.05);观察组患者的肺部感染率低于对照组(P<0.05),住院时间和胸导管留置时间均明显短于对照组(P<0.01);观察组患者的呼吸困难程度评分、急性生理和慢性健康评分Ⅱ(APACHEⅡ)评分均明显低于对照组(P<0.01).结论 呼吸道管理及呼吸训练能够有效改善肺癌术后患者的排痰效果和肺功能,有效预防肺部感染,促进患者恢复.     

心理护理对妊娠合并子宫肌瘤患者心理状况的影响

目的探讨心理护理对妊娠合并子宫肌瘤患者心理状况的影响。方法选取2013年7月至2014年9月间收治的妊娠合并子宫肌瘤患者260例,依照护理模式分为心理护理组和对照组,各130例。心理护理组患者给予常规护理+心理干预,对照组患者给予常规护理干预,分析两组患者的心理状况。结果心理护理组患者疾病控制时间、住院时间均短于对照组(均P<0.05),心理护理组并发症发生率(3.1%)低于对照组(10.0%,P<0.05)。心理护理组患者知识掌握评分(25.6±20.2)明显高于对照组(14.3±9.8)(P<0.05),心理护理组患者焦虑自评量表评分[(32.6±1.7)分]、抑郁自评量表评分[(32.4±2.8)分]均低于对照组[分别(52.6±3.5)分和(52.6±3.4)分,P<0.05],心理护理组患者护理满意度(99.2%)高于对照组(95.4%,P<0.05)。结论在妊娠合并子宫肌瘤患者治疗中,采用心理护理能够改善患者的心理状态,具有推广价值。     

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.     

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.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

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     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.