结直肠癌肝转移化疗后消失病灶的进展

超过50%的结直肠癌转移患者会发生肝转移,手术切除是唯一可能治愈的方法。欧洲肿瘤治疗研究协作组(EORTC)40983研究表明可切除的结直肠癌肝转移行术前化疗对比单纯手术可以提高3年无进展生存率(PFS)9.2%;而不可切除的结直肠癌肝转移应首选有效的化疗及靶向治疗,部分患者经转化后可获得手术切除的机会。如出现化疗后肝转移灶影像学上消失(CRR)(4%～38%),应用肝动脉灌注化疗(HAI)、患者小于60岁、低CEA水平的患者容易获得临床完全缓解(CCR),而临床完全缓解(CCR)并非是病理完全缓解(CPR),CCR病灶留在原位未做处理有较高的复发率,但术后的5年生存率可高达40%～80%,因此不应作为手术的禁忌症。为获得R0切除,可以考虑联合应用门静脉栓塞/门静脉结扎(PVE/PVL)、射频消融(RFA)等治疗手段。为降低复发风险,可考虑辅助HAI及全身化疗。     

小鼠肝脏样本在不同状态下的相位衬度成像及三维重建

采用同步辐射类同轴相位衬度成像技术．对不同状态下的小鼠肝脏样本成像．并对成像结果进行三维重建。实验是在上海光源X射线成像及生物医学应用光束站线BL13W1上完成的．成像样本为正常小鼠肝脏。实验结果表明．干燥的肝脏样本在相位衬度成像实验中成像效果最好。通过滤波反投影算法,成功得到样本的二维断层图像：使用表面绘制方法．重构三维血管图像既能显示大血管．又能显示7级以上的细小分支。研究证明,采用同步辐射类同轴成像技术能够显示小鼠肝脏组织的内部细节,有望成为观察肝脏细节的手段。     

肝转移介入治疗前后的CT容积测量

目的 比较一维、二维CT和CT容积测量三种方法测量肝转移瘤介入治疗的效果。方法 22例肝转移的患者,在介入治疗前和术后3个月行螺旋CT扫描。在CT工作站分别按一维和二维测量横断层面的全部病灶。用容积测量技术去追踪测量每个病灶,将每个病灶的总和归类分为四组,即全效、部分有效、病变进展和病变稳定。结果 在22例肝转移介入治疗前后肿瘤直径和面积的测量结果是一致的。但容积测量8例与一维测量不符,6例与二维测量不符.4例一维和二维测量结果均为部分有效,而容积测量结果为病变稳定。2例一维和二维测量病变稳定者,容积测量则为部分有效。甚至有2例一维、二维测量为病变进展者,容积测量仍为病变稳定。结论 在肝转移瘤介入治疗前后,肿瘤容积测量结果在大多数病人与一维、二维测量结果不一致.因此,若要证实容积测量的优势,还需要大样本的临床对照研究。     

3.0T磁共振动态增强技术对肝脏病变的临床诊断价值

目的：探讨3.0T磁共振动态增强扫描对肝脏病变的鉴别诊断价值及不同病变的强化特征。方法：收集39例肝脏占位患者,所有病例经手术病理证实,包括原发性肝癌12例、肝脏转移瘤4例、肝脏血管瘤8例、肝脏腺瘤4例、局灶性结节增生3例、肝脓肿2例,术前分别行磁共振常规扫描、动态增强扫描及延迟扫描;对动态增强图像绘制感兴趣区,绘制时间-信号强度曲线（time-signal curse,TSC）。结果：12例原发性肝癌的病变周边见＂假包膜＂;6例巨块型肝癌可见中央坏死及出血;2例病灶可见病灶中脂肪变性,动态增强曲线呈现出＂快进快出＂;肝脏转移瘤4例,病变中央大都为坏死区,可见包膜影,增强包膜早期强化,强化方式为＂快进快出＂;肝脏血管瘤8例在常规T2WI脂肪抑制呈明显的高信号,边界清楚,动态增强曲线为＂慢进慢出型＂;肝脏局灶性结节2例,边缘尚清,病灶中央可见纤维瘢痕,增强方式为＂快增缓增型＂;肝脏腺瘤4例,边缘清楚,动态增强早期明显强化;肝脓肿2例,病灶分布在肝周缘,边界清楚,增强扫描病灶周边强化。结论：3.0T磁共振动态增强扫描具有极高的时间分辨率,结合常规序列对肝脏占位的鉴别诊断具有重要意义。     

Economic Burden of Colorectal Cancer in Korea

Objectives

The incidence and survival rate of colorectal cancer in Korea are increasing because of improved screening, treatment technologies, and lifestyle changes. In this aging population, increases in economic cost result. This study was conducted to estimate the economic burden of colorectal cancer utilizing claims data from the Health Insurance Review and Assessment Service.

Methods

Economic burdens of colorectal cancer were estimated using prevalence data and patients were defined as those who received ambulatory treatment from medical institutions or who had been hospitalized due to colorectal cancer under the International Classification of Disease 10th revision codes from C18-C21. The economic burdens of colorectal cancer were calculated as direct costs and indirect costs.

Results

The prevalence rate (per 100 000 people) of those who were treated for colorectal cancer during 2010 was 165.48. The economic burdens of colorectal cancer in 2010 were 3 trillion and 100 billion Korean won (KRW), respectively. Direct costs included 1 trillion and 960 billion KRW (62.85%), respectively and indirect costs were 1 trillion and 160 billion (37.15%), respectively.

Conclusions

Colorectal cancer has a large economic burden. Efforts should be made to reduce the economic burden of the disease through primary and secondary prevention.     

SPECT/CT融合图像对骨转移瘤的诊断价值分析

目的:分析SPECT/CT融合图像对骨转移瘤的诊断价值。方法:回顾性分析2017年5月~2018年4月本院收治的疑似骨转移瘤患者80例,所有患者均给予全身骨显像(WBBS)及SPECT/CT检查。对比两种检查在骨转移瘤中的诊断价值。结果:SPECT/CT在诊断骨转移瘤诊断价值高于WBBS,差异有统计学意义(P<0.05)。结论:SPECT/CT融合图像在诊断骨转移瘤中具有较高的应用价值,诊断符合率、特异度、灵敏度、阳性预测值、阴性预测值均较高,可尽早的对病情进行诊断,为临床早期治疗骨转移瘤提供指导。     

Economic Evaluation of Voriconazole versus Conventional Amphotericin B in the Treatment of Invasive Aspergillosis in Germany

OBJECTIVE: To assess the costs and cost-effectiveness of voriconazole in comparison to conventional amphotericin B (CAB) for the treatment of invasive aspergillosis in Germany. METHODS: The cost-effectiveness of voriconazole in comparison to CAB was evaluated with a lifetime Markov model, focusing on the long-term survival of patients treated for invasive aspergillosis. Long-term survival was extrapolated from survival after 12 weeks of treatment, obtained from a randomized aspergillosis study. Information on medical resource consumption and treatment pathways were obtained from this study and an expert committee. With probabilistic analysis the cost-effectiveness of voriconazole compared with amphotericin B was analyzed and expressed in incremental costs per life-weeks gained. The evaluation was performed from a limited societal perspective (both inpatient and outpatient costs) and hospital perspective (only inpatient costs). RESULTS: Average survival of patients treated with voriconazole was 174.4 life-weeks (95% confidence interval [CI] 159.4-191.3), compared with 119.4 life-weeks (95% CI 106.4-132.3) for amphotericin B. With voriconazole, the mean total costs per patient were 30,026 euros (95% CI 23 euros ,118-37,947) compared with 26,669 euros for amphotericin B (95% CI 21,259-34,263 euros ) from the limited societal perspective. The corresponding incremental cost-effectiveness ratio was 62 euros per life-week gained (i.e., 3224 euros per life-year gained). Hospital costs were approximately 90% of the mean total costs. CONCLUSIONS: In the treatment of invasive aspergillosis, voriconazole is cost-effective in comparison to amphotericin B. Hospital costs are comparable for both treatments and are expected to be reimbursed based on the German diagnosis-related groups (DRG) system 2005.     

改进术前术后方法治疗结直肠癌31例探讨

目的探讨改进术前术后治疗方法的安全性、优越性。方法将我院2007年3月至2010年2月结直肠癌患者65例分为两组,改进组31例,传统组34例,比较两组吻合口漏,水、电解质失衡情况与术后静脉补液时间。结果改进组无吻合口漏及水、电解质失衡,术后补液时间（5.75±1.06）d;传统组出现1例吻合口漏、1例低钾血症、1例低钾低钠血症,术后补液时间（9.56±1.04）d。结论结直肠癌术前不作常规肠道准备,不置胃肠减压管,能缩短肠道准备时间,减少术前对患者生理功能的干扰,缩短术后补液时间;术后早期进食安全,有利于患者尽快恢复。     

超声造影在肝肿瘤介入治疗中的应用

本文介绍了超声造影在肝脏肿瘤非手术治疗治疗前病灶的定性、治疗中定位、治疗后的疗效评估等方面的应用.     

Critical Analysis of Markov Models Used for the Economic Evaluation of Colorectal Cancer Screening: A Systematic Review

Background

The economic evaluation of colorectal cancer screening is challenging because of the need to model the underlying unobservable natural history of the disease.

结直肠癌有无肝转移血清差异蛋白质表达的研究

目的：利用蛋白质组学技术分离、鉴定结直肠癌有无肝转移患者血清中差异蛋白质,筛选诊断肝转移的血清蛋白标志物。方法：根据入组条件,收集结直肠癌无肝转移病例、有肝转移病例,在两组中随机抽取12例血清样本,同组血清等量混合进行双向凝胶电泳,建立两组血清蛋白质双向电泳图谱,用Image—MasterV5．0软件寻找两组差异蛋白质点,MALDI—TOF—MS对差异蛋白质进行鉴定,查询生物信息数据库对差异蛋白质进行初步分析。结果：两组比较差异在2倍以上蛋白质有8种,其中5个蛋白质表达上调,3个蛋白质表达下调;两组每个差异蛋白灰度体平均值比较差异均有统计学意义（P〈0．05）。通过数据库搜索鉴定出7种蛋白质,上调的5个蛋白质分别是Transferrin、Complement component C9、RN Adirected DNA polymerase（RNA指导的DNA合成酶）、Conserved hypothetical—protein（假定蛋白质）、SEC14L17 kDa protein;下调的2个蛋白质分别是Haptoglobin和Isoform 1 of Serumalbumin。结论：结直肠癌有无肝转移患者血清中的蛋白质表达谱有一定的差异性,这些差异蛋白质可能成为诊断肝转移的血清标志物。     

立体定向放射治疗结直肠癌单发肝转移临床应用研究

目的评价使用全身伽玛射线立体定向放射治疗在结直肠癌单发肝转移中的疗效及其放射反应。方法收集我科2007年1月至2012年12月收治的结直肠癌单发肝转移病患28例,使用全身伽玛射线立体定向放射治疗系统进行治疗。对患者进行密切随访,评价患者近期疗效,观察其6、12和18个月(或随访至患者死亡)生存率和中位生存期。结果全部28例病患均随访18个月以上(或随访至患者死亡),6、12和18个月生存率分别为79%(22/28)、64%(18/28)、46%(13/28),病例中生存超过3年的有4例。治疗前10例患者血AFP>400 ng/m L,最高≥61 000 ng/m L,平均约为1 800 ng/m L;治疗3个月后,8例患者血AFP有不同程度降低,其中5例恢复正常。治疗前20例患者血CEA异常升高;治疗3个月后,有18例患者血CEA出现不同程度下降,其中10例恢复正常。治疗过程中发生的放疗反应主要为早期放疗反应,其中15例出现一般性全身反应(表现为乏力、纳差、恶心、呕吐),2例出现放射性胃溃疡,经对症治疗后均缓解,未发现有其他严重副反应。结论采用全身伽玛射线立体定向放射治疗系统治疗单发结直肠癌肝转移有近期疗效好、放射反应轻特点,但其晚期放射损伤及远期疗效仍有待进一步观察评价。     

磁共振TRICKS技术在下肢疾病中的应用

目的：探讨时间分辨动态增强血管成像（TRICKS）技术在下肢疾病中的应用价值。方法：回顾性分析24例27次下肢肌肉、骨骼及血管疾病患者应用TRICKS动态血管造影技术行下肢血管成像。其中双下肢二段扫描14例;大腿一段扫描5例6次：小腿一段扫描5例7次。扫描序列为常规平扫和TRICKS技术加常规增强扫描。结果：所有病例TRICKS扫描图像满足动静脉期血管变化及结构显示．通过观察病变区循环全过程,均达到诊断要求。结论：TRICKS技术可以获得周围血管成像时血流的动态变化．获得目标血管及肿瘤病变的血供情况．为临床定性诊断提供重要依据。