化疗饮食表在妇科恶性肿瘤患者化疗期间的应用

目的提高妇科恶性肿瘤患者化疗前后的抵抗力,减轻化疗时胃肠道不良反应。方法将90例妇科恶性肿瘤化疗患者随机分为干预组和对照组各45例,对照组于化疗期间实施常规健康教育及饮食指导;干预组按照制定的化疗不同阶段的饮食表指导患者进餐,必要时提供个体化食谱。结果干预组化疗期间饮食相关不良反应显著少于对照组,白细胞下降率显著低于对照组,患者对饮食护理满意度显著高于对照组（P〈0．05,P〈0．01）。结论化疗期间给予科学的饮食护理干预可有效提高患者免疫力,降低饮食相关不良反应,促进患者康复。     

妇科肿瘤患者化疗所致周围神经病变的症状体验与应对方式

目的 了解我国妇科肿瘤患者化疗所致周围神经病变(CIPN)症状体验及应对方式,从而为进一步制定针对性护理干预措施提供参考依据。方法 采用便利抽样法,选取2022年4—6月在北京协和医院使用神经毒性化疗药物的12名有CIPN症状的妇科肿瘤患者为访谈对象进行半结构式访谈,采用现象学分析方法对资料进行分析和归纳。结果 11名患者出现麻木,但症状出现时间、具体部位、顺序、严重程度不一。9名患者出现疼痛,包括局部膝盖、胳膊、手腕、指尖以及全身疼痛,对疼痛的表述不仅有酸痛、骨痛,还有针扎感、过电感、电击感等。其他症状还包括异物感、蚂蚁移动感、灼热、痒痒以及睡眠、排便的改变。CIPN对患者日常生活的影响涉及家务劳动、活动锻炼和工作社交三方面。CIPN使得患者减少或免于家务劳动;肢端麻木尤其是脚部麻木,影响患者活动锻炼的频率、时长,严重者不能走路。CIPN给患者造成了痛苦体验,使其放弃工作,影响与家人、朋友的日常沟通。患者应对CIPN的方式包括按摩、揉搓、泡脚、药物,但效果不尽相同。结论 妇科肿瘤患者CIPN症状体验不一,肢端麻木和疼痛常见,严重影响到患者的生活和社交。医护人员应及时评估患者CIPN症...     

妇科恶性肿瘤患者围术期症状群和核心症状的研究

目的 探讨妇科恶性肿瘤患者在围术期不同时间点症状群的构成及动态变化,构建症状网络,探索核心症状,为制定精准的症状管理方案提供参考。方法 便利抽样法选取260例妇科恶性肿瘤（宫颈癌、卵巢癌、子宫内膜癌）手术患者进行调查,采用一般资料调查问卷和中文版安德森症状系列量表-妇科恶性肿瘤围手术期模块分别于手术前1 d（T1）、术后第3天（T2）和术后第7天（T3,即出院前）3个时间点对患者进行纵向调查。对3个时间点中发生率＞20%的症状行探索性因子分析提取症状群,运用R语言构建症状网络,分析中心性指标。结果 妇科恶性肿瘤患者围术期共提取4个症状群,分别是疲乏-疼痛-情绪症状群、消化道症状群、能量不足症状群和潮热-神经症状群。其中疲乏-疼痛-情绪症状群持续存在于T1~T3,且群内症状组成较稳定。潮热-神经症状群存在于T1~T3、消化道症状群存在于T2和T3、能量不足症状群仅存在于T2,且群内症状组成呈动态变化。症状网络中,悲伤和苦恼是围术期3个时间点的核心症状,其他中心性指标动态变化。T1除悲伤外,潮热的紧密中心性和中介中心性最大,T2恶心、T3疲乏的紧密中心性和中介中心性最大。结论 医护人员应对稳定存在的症状群及核心症状进行全程干预,将症状群与网络中心性指标相结合,制定更为精准的管理方案,改善患者围术期生活质量。     

术后化疗对妇科恶性肿瘤患者骨密度及骨代谢的影响

目的 观察术后化疗对切除卵巢后的妇科恶性肿瘤患者骨密度及骨代谢的影响,并探讨其可能的影响机理。方法 两组观察对象,肿瘤组20例,术后行PC方案化疗,连续6个疗程,每次间隔4周;对照组与肿瘤组年龄匹配,因良性病变切除卵巢,两组在研究期间均无激素应用。术前及术后6个月采用双能X线骨密度仪对腰椎(L2-L4)及髋部进行骨密度的测定,同时测定血清雌二醇(E2),卵泡刺激素(FSH),黄体生成素(LH),骨钙素(BGP),尿钙/肌酐(ca/Cre),对检测结果进行分析。结果 化疗组腰椎骨密度在治疗后下降22.9％±8.4％,髋骨的骨密度下降12.6％±6.39％,对照组腰椎骨密度下降8.86％±2.87％,髋骨骨密度下降6.12％±2.38％,两组比较差异有显著性P<0.01;E2水平在治疗后下降明显,FSH、LH均在治疗后明显升高,组间无差异;反映骨代谢的指标BGP、Ca/Cre均升高,组间差异无显著性。结论 术后化疗可加重妇科恶性肿瘤患者切除卵巢后的骨质丢失,提示化疗药物(PC)对骨质代谢存在直接的不良影响。     

苦参注射液治疗晚期妇科恶性肿瘤临床分析

目的探讨苦参注射液治疗晚期妇科恶性肿瘤的疗效。方法选择52例恶性肿瘤患者（均无手术、放疗、化疗指征）随机分为治疗组（26例,给予一般治疗＋复方苦参注射液10mL/d静滴治疗）和对照组（26例,给予一般治疗）。结果治疗组临床受益率为61.54%,疼痛缓解率为80.00%,腹胀、食欲不振、乏力、睡眠障碍、体重、生活质量改善率分别为69.57%、88.46%、84.62%、72.73%、42.31%、80.77%,0.5年生存率为46.15%,其临床疗效明显优于对照组（P〈0.05）。     

妇科恶性肿瘤患者术后性心理变化调查分析

目的探讨妇科恶性肿瘤患者术后康复过程中的性心理变化,促进其性生活质量的提高。方法自行设计妇科恶性肿瘤患者术后性心理及性生活情况问卷表,对88例患者进行问卷调查,分析患者术后性关注程度,以及性生活恢复情况与患者年龄、文化程度的关系。结果患者术后性关注程度、性生活恢复情况与年龄和文化程度密切相关。年龄越低,对性问题越关注,性生活恢复比例越高(P<0.05);文化程度越高,对性问题越关注,性生活恢复比例越高(P<0.05)。结论妇科恶性肿瘤患者的年龄、文化程度对患者术后的性心理有较大影响。术前及术后对患者的性知识教育及指导尤为重要。     

肝动脉化疗栓塞患者症状及生活质量调查分析

目的了解肝癌患者行肝动脉化疗栓塞(TACE)术后的症状严重度、生活质量,分析两者的关系,以从症状干预角度改善患者术后生活质量。方法采用Anderson症状量表,自行设计的肝癌特异性症状增补条目,以及FACT-G量表于首次TACE术后第3天对142例患者进行症状和生活质量测评。结果TACE术后患者生活质量均分为(64.16±10.87)分;Anderson症状量表症状严重度均分(3.41±1.29)分,肝癌特异性症状严重度均分(2.36±1.18)分。疼痛、悲伤感、食欲下降、腹胀、疲乏是影响患者术后生活质量最为显著的5个因素(P<0.05,P<0.01)。结论TACE术后患者生活质量不高,症状是患者生活质量的重要影响因素。临床护理人员除重视较为突出的疼痛症状外,也要关注悲伤、食欲下降、腹胀和疲乏症状,探索实际有效的干预方法,提高患者生活质量。     

卵巢癌患者化疗期间症状群与日常生活的相关性研究

目的探索卵巢癌患者化疗期间症状群及其对日常生活的影响。方法采用中文版安德森症状评估量表和自行设计的卵巢癌特异性症状模块对135例卵巢癌化疗患者进行调查;探索性因子分析法提取症状群,多元回归分析症状群对患者日常生活的影响。结果卵巢癌患者化疗期间各症状发生率为6.67%~99.26%,日常生活困扰发生率为51.85%~100%;存在胃肠道、疾病行为、围绝经期、情绪紊乱、性特征及治疗相关六大症状群。六大症状群对患者日常生活的困扰有显著影响(均P<0.01),可解释总变异的93.6%。结论卵巢癌患者化疗期间存在多个严重影响其日常生活的症状群,医护人员应准确及时地评估症状,对症状群进行有效管理,以改善患者的生活质量。     

恶性肿瘤患者化疗期间的护理

目的 探讨减轻肿瘤患者化疗期间不良反应的护理方法。方法 对接受化疗的100例肿瘤患者，化疗前做好心理评估，熟悉化疗方案，掌握给药的时间与技巧，创造良好环境，饮食指导，加强化疗后期护理。结果 98例顺利完成化疗，2例患者出现轻度的不良反应。结论 化疗前后采取有针对性的护理，可减少化疗期间的不良反应，减轻患者的痛苦，使化疗程顺利进行。     

Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies.

OBJECTIVE: To evaluate the feasibility of integrating robot-assisted technology in the performance of laparoscopic staging of gynecologic malignancies. METHODS: Seven patients underwent robot-assisted laparoscopic staging procedures for gynecologic cancers. Data were collected and analyzed as a retrospective case series analysis. RESULTS: We attempted 7 robot-assisted laparoscopic staging procedures with no conversions to laparotomy. The median lymph node count for lymphadenectomy was 15 (range, 4 to 29). Mean operating time was 257 minutes (range, 174 to 345). The average estimated blood loss was 50 mL. One patient developed sinusitis and required intravenous antibiotics. The median hospital stay was 2 days. CONCLUSION: Robot-assisted laparoscopic staging is a feasible technique that may overcome the surgical limitations of conventional laparoscopy.     

Outcomes of small bowel obstruction in patients with previous gynecologic malignancies

BackgroundFeatures predictive of malignant small bowel obstructions among patients with previous gynecologic malignancies remain undetermined.MethodsPredictors of malignancy and mortality among patients with gynecologic malignancies and bowel obstructions were identified through a retrospective review of records.ResultsMalignancy was noted among 69.8% of 189 patients included in the analysis. Advanced-stage cancer (P = .006, odds ratio [OR] = 6.62), ovarian malignancy (P = .001, OR = 25.64), and early-onset obstruction (P = .014) predicted malignant etiology, whereas chemotherapy (P < .001, OR = .02) or radiation therapy (P = .027, OR = .09) predicted benign obstruction. The average survival was 9 months versus 49 months for malignant and benign obstructions, respectively. Ovarian cancer (P = .009, hazard ratio [HR] = 4.45), anemia (P = .001, HR = 1.11), and renal dysfunction (P < .001, HR 1.81) impaired survival.ConclusionsPalliative care should be considered for patients with advanced-stage cancer, ovarian malignancy, and a shorter time interval between cancer diagnosis and bowel obstruction, especially in the setting of anemia and renal dysfunction.     

Urinary diversion in gynecologic malignancies

A variety of methods for urinary diversion are employed in patients with gynecologic malignancies depending on whether there is an obstruction or fistula formation due to either tumor growth or radiotherapeutic injury. Percutaneous nephrostomy (PCN) has a low complication rate and is a good method for palliative urinary diversion or may precede some form of permanent diversion to restore the kidney function first. Indication for palliative diversion in tumor obstruction depends on many individual factors. A relative contraindication is tumor progression during therapy. 6-month survival was about 70% in patients with previously untreated tumors or recurrences. This rate is far better than reported in earlier studies, so that a palliative diversion has to be considered for these patients. Also a high rate of recanalization after therapy could be observed in the untreated group, allowing the PCN to be removed. However, this has not been shown to be a prognostic factor. In the individual patient some other aspects, such as quality of life and social status, have to be taken into account before a final decision can be made. Ureteral obstruction after radiotherapy is a rare finding and often mistaken for a more likely recurrence. Different methods to restore the urinary tract, such as reimplantation of the ureter, should be used as a first choice. When the stenosis is due to radiocystitis, enterocytoplasty will often be indicated. Diversion has then to be omitted. The poor quality of life because of permanent incontinence due to fistula formation makes diversion mandatory even if life expectancy is very short. Surgical closure of a large radiogenic fistula is rarely successful. In this situation, ileal conduit has proven its efficacy for long-term urinary diversion.     

化疗期肺癌患者症状困扰及其影响因素分析

目的了解化疗期肺癌患者的症状困扰发生情况及影响因素,为临床症状评估和有效症状管理提供依据。方法采用症状困扰量表、社会支持评定量表、医学应对问卷对109例化疗期肺癌患者进行测评,采用单因素分析和多元回归分析探讨症状困扰的影响因素。结果化疗期肺癌患者症状困扰发生率为96.33%,症状困扰得分(31.48±6.75)分。年龄、性别、临床分期、社会支持、面对、回避、屈服能够显著影响化疗期肺癌患者的症状困扰水平(P<0.05,P<0.01),面对、回避、屈服、社会支持共同解释症状困扰43.20%的变异。结论护理人员应重视症状困扰对化疗期肺癌患者生活质量及疾病康复造成的消极影响;可根据患者一般资料对症状困扰进行预测评估,提供社会支持、调整应对策略等干预措施进行症状管理,以改善患者症状困扰。     

胃癌术后化疗患者症状严重度与困扰度调查研究

目的分析基于症状困扰形成的症状群与基于症状严重程度形成的症状群的异同,为形成适合我国人群的胃癌管理方案奠定基础。方法采用安德森症状评估量表胃癌特异性模块对85例胃癌术后首次化疗患者进行调查,分别基于症状严重程度和症状困扰程度提取症状群,分析两者的异同。结果 18项症状中,严重程度得分前3位为疲乏、疼痛、苦恼;困扰程度得分前3位为疲乏、恶心、吞咽困难。因子分析,14项症状进入严重程度分析,形成病感症状群(3项)、消化道症状群(5项)、情绪症状群(3项)、胃癌特异性症状群(3项)4个因子,累计方差贡献率为83.49%;13项症状进入困扰程度分析,形成病感症状群(2项)、情绪症状群(4项)、消化道症状群(4项)、胃癌特异性症状群(3项)4个因子,累计方差贡献率为86.38%。结论两种分析模式均形成4种症状群;疲乏的严重度及困扰度均排第一,疼痛困扰度相对较轻,恶心等胃肠道症状困扰度高于严重度。在护理中除重视严重度及困扰度均高的疲乏等症状外,要特别关注严重度不高而困扰度较高的症状,以便采取措施缓解症状,利于患者顺利完成化疗疗程。     

Staging of gynecologic malignancies

The staging of gynecologic cancer is one of the fundamental aspects of the activity of the Committee on Gynecologic Oncology of the International Federation of Gynecology and Obstetrics. The rules for proper staging according to scientific evidence are presented in this article. Some of the most debatable issues are also discussed.     

踩球运动对妇科恶性肿瘤患者术后下肢血流动力学的影响

目的探讨踩球运动对妇科恶性肿瘤术后患者下肢深静脉血流动力学的影响,为临床预防下肢静脉血栓形成提供参考。方法将40例妇科恶性肿瘤术后患者随机分为对照组和观察组各20例,在常规治疗和护理的基础上,对照组麻醉清醒后指导患者床上进行踝泵运动,观察组麻醉清醒后指导患者床上进行踩球运动。于首次运动前后及术后第3天观察两组下肢股静脉血流峰速及血流平均速度情况。结果术后首次运动不同时间点及术后第3天两组下肢血流峰速和血流平均速度比较,差异无统计学意义(均P0.05)。组内单因素重复测量方差分析示,两组运动前后血流峰速和血流平均速度比较,差异有统计学意义(均P0.01)。踩球运动或踝泵运动后立即及30 min下肢静脉血流峰速和血流速度显著高于静息状态(均P0.01)。结论对妇科恶性肿瘤术后患者行早期踩球运动可提高下肢血流速度,促进下肢血液回流,可以部分替代踝泵运动或作为踝泵运动的有益补充,作为预防下肢静脉血栓形成的干预措施。     

Clinical course of haemodialysis patients with malignancies and dose-adjusted chemotherapy.

BACKGROUND: Chemotherapy is not given routinely to patients with malignancies receiving chronic haemodialysis because evidence of a clear benefit is still lacking and severe side effects are feared. The aim of our retrospective study was to analyse the methods of dose adjustment and the clinical course of chronic haemodialysis patients with malignancies treated by chemotherapy. METHODS: Between 1985 and 2001, a total of 48 cycles of 21 chemotherapy protocols were administered to 16 dialysis patients with nine haemoblastic and seven solid malignancies. We compared the dose actually administered with that theoretically derived from the proportional dose reduction rule of Dettli and the rule of Giusti and Hayton, using published pharmacokinetic parameters. RESULTS: Kaplan-Meier estimates of median survival time were 30 months in patients with haemoblastic malignancies and 10 months for patients with solid malignancies. Eleven chemotherapies were administered in standard dosages and 10 chemotherapies in reduced dosages (39-80% of the regular dose); in all therapies, however, the dose was significantly higher than proposed by the Dettli rule (P<0.01). CONCLUSION: Chemotherapy in patients with haemodialysis is feasible. Individual dose adjustment should be performed on the basis of pharmacokinetic data and the general condition of the patient, but it is still a matter of expert judgement, as there is no formal evidence available.