唑来膦酸注射液治疗恶性肿瘤骨转移疼痛的临床疗效观察

Objective： To evaluate the efficacy and safety of zoledronic acid for the pain caused by metastatic tumor of bone. Methods： 52 patients with metastatic tumor of bone were randomly divided into two groups. The zoledronic acid group received 4 mg zoledronic acid infusion for 30 minutes and the control group received 90 mg pamidronate infusion for 6 hours. Results： The effective rates in zoledronic acid group and control group were 73.08% and 69.23% respectively. No significant difference was observed between the two groups. The median pain relief onset at days 5 and 7, respectively, and no significant difference was observed. The ECOG scores on the 7th day after medication： the differences in the zoledronic acid group before and after medication and between the two groups were both significant （P 〈 0.001 and P = 0.0448）. The adverse reaction was no significant difference between the two groups. Conclusion： Zoledronic acid is efficient and safe in the treatment of pain caused by metastatic tumor of bone and it has low adverse reaction rate and convenient shorter using time.     

Prospective,single-center cohort study analyzing the efcacy of complete laparoscopic resection on recurrent hepatocellular carcinoma

Background: Laparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). How?ever, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efcacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence. Methods: We conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31)underwent laparoscopic hepatectomy, and the control group (n tion time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient= 33) underwent conventional open surgery. Opera?could walk, anal exsufation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse?free survival was compared between the two groups. Results: All surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differencesbetween the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraopera?tive blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6vs. 2.2 ± 0.8 days, P < 0.05), anal exsufation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days,P= 0.014). During the 1?year postoperative follow?up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse?free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recur?rence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was signifi?cantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence. Conclusions: For the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraop?erative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.     

解剖第3肝门切除巨大肝海绵状血管瘤

Objective:To estabhsh a novel and safe operation technique for the resection of giant hepatic cavernous hemangiomas involving the retro-hepatic vena cava.Methods:After ligating the hepatic artery of affected lobe, the short hepatic veins at the third porta hepatis were dissected and ligated individually to separate the tumor from the retrohepatic vena cava, followed by the resection of the tumor under intermittent interruption of the porta hepatis.Results:A total of 62 giant hepatic cavernous hemangiomas were successfully resected without hepatic vascular exclusion. Right and caudate lobectomies were done in 27 cases, right hemihepatectornies in 5 cases, right upper segnentectomies in 7 cases, right posterior lobectomies in 7 cases, extended left and caudate lobectomies in 10 cases, and caudate lobectomies in 6 cases. The blood transfusion requirement during operation was 1 400 ml on average. All did well postoperatively during a follow up of 4 - 84 months.Conclusion:It is safe and feasible to resect giant hepatic cavernous hemangioma following dissection of the third porta hepatis. Duringoperation the key step is dissection of the short hepatic veins.     

控制性低中心静脉压对肝切除术患者肾功能的影响

Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group （n = 23） and control group （n = 23）. In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results： There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss （P 〈 0.01） and RBC transfusion （P 〈 0.05）. Conclusion： Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.     

Comparison of Cancer Incidence between China and the USA

Objective The incidence of cancer varies around the globe,especially between less-developed and developed regions.The aim of this study is to explore differences in cancer incidence between China and the USA. Methods Data were obtained from the GLOBOCAN 2008 database.Estimated numbers of new cancer cases in the USA were obtained from the American Cancer Society,while the numbers of cases in China,including those in urban and rural areas,were obtained from 36 cancer registries(2003-2005).Cancer incidence for major sites between China and the USA were analyzed. Results In China,lung cancer was the predominant type of cancer detected in males;in females,breast cancer was the main type of cancer.Gastrointestinal cancers,such as those of the liver,stomach,and esophagus,were more commonly seen in China than in the USA.A significant difference in the incidence of melanoma of the skin was observed between China and the USA.During comparison of differences in the age-standardized rates by world population(ASRWs) of major cancer sites between the two countries,4 sites in males(i.e.,nasopharynx,esophagus,stomach,and liver) and 6 sites in females(i.e.,nasopharynx,esophagus,stomach,liver, gallbladder,and cervix uteri) showed higher cancer incidence rates in China than in the USA. Conclusions Significant differences in cancer incidence sites were found between the two countries.Cancer may be prevented through public education and awareness.Programs to promote cancer prevention in China,especially those of the lung,breast,and gastrointestinal region,must also be implemented.     

Judgement on Extended Hepatectomy for Primary Liver Cancer

Objective: To expore the indications and safety of extended hepatectomy for primary liver cancer (PLC). Methods: From Nov. 2000 to Oct. 2002, 33 patients with PLC received extended hepatectomy, 26 of whom were complicated with liver cirrhosis. Preoperative findings, intraoperative management and the outcome of postoperative recovery were analyzed and evaluated. Results: Operative mortality was zero in this group and postoperative morbidity of complications was 33.3%, and all complications were cured after proper treatment. Conclusion: Extended hepatectomy for PLC was safe and viable for the patients who had enough reserve of liver function if the incised liver volume was less than 50% of the liver and the supporting treatment of the remnant liver was given as well as the postoperative complications were managed appropriately.     

Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy

Objective:Though D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC),the modified D2 (D1 + 7,8a and 9) lymphadenectomy may be more suitable than D2 dissection for T2 stage GC.The purpose of this study is to elucidate whether the surgical outcome of modified D2 lymphadenectomy was comparable to that of standard D2 dissection in T2 stage GC patients.Methods:A retrospective cohort study with 77 cases and 77 controls matched for baseline characteristics was conducted.Patients were categorized into two groups according to the extent of lymphadenectomy:the modified D2 group (mD2) and the standard D2 group (D2).Surgical outcome and recurrence date were compared between the two groups.Results:The 5-year overall survival (OS) rate was 71.4％ for patents accepted mD2 lymphadenectomy and 70.1％ for those accepted standard D2,respectively,and the difference was not statistically significant.Multivariate survival analysis revealed that curability,rumor size,TNM stage and postoperative complications were independently prognostic factors for T2 stage GC patients.Patients in the mD2 group tended to have less intraoperative blood loss (P=0.001) and shorter operation time (P＜0.001) than those in the D2 group.While there were no significant differences in recurrence rate and types,especially lymph node recurrence,between the two groups.Conclusions:The surgical outcome ofmD2 lymphadenectomy was equal to that of standard D2,and the use of mD2 instead of standard D2 can be a better option for T2 stage GC.     

参麦注射液防治晚期非小细胞肺癌化疗不良反应的临床观察

Objective： To observe the efficacy of Shenmai injection in the treatment for adverse reactions of chemotherapy on advanced non-small cell lung cancer （NSCLC）. Methods： 45 NSCLC patients with stages IIIb-IV were randomly divided into two groups： the treatment group （treated by chemotherapy combined with Shenmai injection） and the control group （treated by chemotherapy only）. The efficacy of the two groups was evaluated after 3 cycles of treatment. Results： There was no significant difference between the two groups in the recent curative effects （P 〉 0.05）, while there were significant differences between them in Karnofsky score and weight （P 〈 0.05）. The treatment group was better than the control group in preventing leucopenia and decreased hemoglobin, and significant differences were found between them （P 〈 0.05）. The incidence of thrombocytopenia, nausea and vomiting, hepatic and renal dysfunction in the treatment group was lower than that in the control group, but no significant differences were found between them （P 〉 0.05）. Conclusion： Shenmai injection would not influence the efficacy of chemotherapy on advanced NSCLC patients, while it could improve the quality of life, increase the body weight of patients, alleviate adverse reactions of chemotherapy as myelosuppression so as to improve the tolerance of organism to chemotherapy.     

Observation of the Curative Effect of Mabthera in Combination with the CHOP Regimen in Treating Invasive B-Cell Lymphoma： A Report of 45 Cases

OBJECTIVE To observe the clinical effcacy and toxic effects of Mabthera (rituximab) in combination with the CHOP (R-CHOP) regimen for treating invasive B-cell non-Hodgkin’s lymphoma. METHODS A total of 45 patients with CD20 positive B-cell non-Hodgkin’s lymphoma were randomly divided into the R-CHOP (22 cases) and CHOP groups (23 cases for controls).They received the regimens of Mabthera in combination with CHOP or single CHOP therapy respectively.An appraisement of the curative effect could only be performed following 4 cycles of chemotherapy for the 45 patients.Follow-up was conducted to observe the conditions of survival. RESULTS The rate of complete remission(CR)in the R-CHOP group was 68.2%,with a total effective rate of 81.8%,and in the CHOP group these rates were 34.8% and 78.3% respectively.There was a significant difference in comparing the CR rates between the two groups (P<0.05).The 1,2 and 3-year overall survival (OS) rates of the RCHOP group were 90.9%,81.8% and 77.3%,respectively.In the CHOP group,the OS rates were respectively 91.3%,69.5% and 47.8%.The difference in the 3-year OS between the two groups was significant (P<0.05).The toxic effects of the two groups were mainly a slight and moderate bone marrow depression and a gastrointesinal reaction,with similar tolerable toxic effects in the two groups (P>0.05). Adverse effects related to the Mabthera infusions occurred in 6 cases of the R-CHOP group (27.2%).These effects lessened after symptomatic treatment. CONCLUSION The therapeutic regimen of Mabthera,in combination with CHOP (R-CHOP) has an obvious curative effect for treating invasive B-cell non-Hodgkin's lymphoma,with a favorable tolerance.It is highly recommended as the treatment of choice.     

Prognostic Factors for Patients with FIGO Stage-IB Cervical Squamous Cell Carcinoma：Does the Tumor Size（≤4 cm or〉4 cm）Really Matter？

OBJECTIVE To investigate the factors that can accurately predict the prognosis for patients with FIGO stage-IB cervical squamous cell carcinoma treated with radical surgery. METHODS A retrospective analysis of clinical data from 174 cases of FIGO Stage-IB cervical squamous cell carcinoma treated in our institute was conducted. RESULTS The 5-year overal disease-free survival of the patients was 79.4%and the recurrence rate was 16.7%.Seventy-five percent of the 60 patients with a tumor>4 cm and 28.1%of the 114 patients with a tumor≤4 cm received preoperative radiotherapy,resuting in a significant difference be- tween the two groups(P<0.001).The 5-year disease-free survival rate for the groups with a tumor≤4 cm without and with preoperative radiotherapy, and with a tumor>4 cm without and with preoperative radiation therapy were 80.5%,85.2%,69.3%and 77.1%,respectively.There was no significant dif- ference between any of the groups(P>0.05).A univariate analysis showed that pelvic node metastasis,a positive parametrial surgical margin and post- operative adjuvant therapy were al significantly correlated with the 5-year disease-free survivals(P<0.05).Multivariate analysis revealed that pelvic node metastasis(P=0.004)and a positive parametrial surgical margin(P= 0.040)were independent factors that influenced the prognosis.The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 57.4%and 44.7%respectively in the high-risk group(patients with pelvic lymphatic metastasis and/or positive parametrial surgical margin)(P=0.575) and the recurrence ratio was 7/18 and 6/14 for the cases of the two tumor sizes in the same risk group.There was no significant difference between the two groups(P=0.821).The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 86.5%and 82.9%respectively in the low-risk group(patients without pelvic lymph-node metastasis and/or positive para- metrial surgical margin),respectively(P>0.05)and the recurrence ratio was 9/95 and 7/47 for the cases of the two tumor sizes in the same risk group. There was no significant difference between the two groups(P>0.05). CONCLUSIONS For FIGO Stage-IB cervical squamous cel carcinoma patients with radical surgery as the major means of treatment,the features of pelvic lymph-node metastasis and a positive parametrial surgical margin are independent factors that influence the prognosis.The tumor size can not be used as a criterion for predicting the prognosis.     

腹腔镜下规则性肝切除与肝肿瘤剥除术治疗肝血管瘤的临床疗效比较

目的 比较腹腔镜下规则性肝切除与肝肿瘤剥除术治疗肝血管瘤的临床效果.方法 回顾性分析60例肝血管瘤患者的临床资料,其中31例在腹腔镜下行规则性肝切除术为A组,29例腹腔镜下行肝肿瘤剥除术为B组.比较两组手术时间、术中出血量、住院时间、术后并发症及复发率.结果 A组手术时间、术中出血量、住院时间分别为(153.96±37.13)min、(440.08±110.03)ml、(9.03±2.01)d,B组分别为(92.06±27.44)min、(327.21±130.51)ml、(7.17±3.14)d,B组手术时间、术中出血量明显少于A组(P<0.05).两组术后多数出现谷丙转氨酶(ALT)、谷草转氨酶(AST)一过性升高,同时A组出现1例胆漏,均未见切口感染、脂肪液化及死亡等情况发生,术后并发症比较无统计学意义(P>0.05).两组术后随访(13.97±3.09)个月,A、B组复发率分别为6.5%、3.4%,两组比较无统计学意义(P>0.05).结论 治疗肝血管瘤倾向于选择腹腔镜下肝肿瘤剥除术,具有创伤小、恢复快、预后好的优点,但具体选择何种术式仍需根据肿瘤实际情况而定.     

Localization of small liver tumors.

Thirty-six patients with small liver tumor were diagnosed by alpha-fetoprotein (AFP); sonography, and computed tomography (CT), and underwent hepatectomy. The pathological types included 23 hepatocelluler carcinoma (HCC), 11 hepatic cavernous hemangioma, and 2 secondary liver cancer. In 22 patients, the tumor nodules were located in the right lobe and 14 cases in the left lobe. The diagnostic accuracy rate of CT was 100% for HCC and secondary liver cancer, but for hepatic cavernous hemangioma it was only 72.2%. However, the accuracy rate of sonography was as high as 81.8% for hepatic cavernous hemangioma and only 60.4% for liver malignancies. The positive rate of AFP for the HCC patients of this series was only 66.6%. The method of intraoperative detection of small liver tumor is introduced, if the tumor was invisible grossly or nonpalpable during exploratory laparotomy. In the series, 7 cases in whom the right lobe lesion was too small to be located by routine manual examination during exploratory laparotomy were detected by this method, and all small liver tumors were resected successfully.     

平阳霉素治疗小儿海绵状血管瘤的疗效分析

目的:评价平阳霉素瘤内注射治疗小儿海绵状血管瘤的临床疗效。方法:回顾性分析234例海绵状血管瘤常规瘤体内注射平阳霉素(注射次数1次-6次)后的临床资料。结果:经过3年随访,治愈168例,基本治愈12例,好转45例,无效9例。总有效率96.15%。结论:平阳霉素瘤内注射治疗海绵状血管瘤疗效高,疗程短,是一种简便、安全的有效方法。     

腹腔镜肝海绵状血管瘤切除7例报道

目的：探讨腹腔镜肝海绵状血管瘤（肝血管瘤）切除的可行性及方法。方法：回顾性分析我院采用超声刀为主要切肝器械,并结合pringle法阻断第一肝门,完成腹腔镜肝血管瘤切除7例。包括局部切除4例,左外叶切除3例。结果：全部顺利完成手术,无中转开腹。手术时间75—225min,（156±47．9）min,术中出血200～1200ml,（460．0±302．5）ml,术后住院时间3-10d,（6．6±3．0）d,除一例出现广泛皮下气肿外,其余病例未发生严重并发症。术后病理均证实为肝海绵状血管瘤。结论：腹腔镜下肝海绵状血管瘤切除对于经选择的病例是安全可行的。     

选择性肝动脉栓塞治疗肝海绵状血管瘤

目的 研究使用平阳霉素碘油乳剂经导管超选择插入肝动脉栓塞治疗肝海绵状血管瘤的方法和效果。方法 对32例肝海绵状血管瘤进行平阳霉素碘油乳剂经肝动脉栓塞治疗，将导管超选择插入肝血管瘤的供血动脉，以平阳霉素碘油乳剂栓塞。男14例,女18例，年龄28～62岁,平均44岁，术前均经US、CT、DSA检查确诊。结果 所有病例均成功实施了栓塞治疗;32 例中有30例分别于术后1 ～24个月进行CT或B超随访;瘤体缩小〉50%者25例,〉 30%者5例，其中B超随访肿瘤完全消失1例;1例患者肿瘤缩小不明显.30例临床有症状患者中,临床症状消失28例，明显减轻1例，总有效率96.7 %（29/30）。术中及术后无严重并发症。结论 平阳霉素碘油乳剂经肝动栓塞是治疗肝海绵状血管瘤的安全、有效的首选方法。     

选择性出入肝血流阻断在肝脏巨大肿瘤切除术中的应用

目的 探讨选择性出入肝血流阻断(SHVE)在肝脏巨大肿瘤切除术中应用的优势.方法 回顾性分析29例施行肝脏巨大肿瘤切除术患者的临床资料,随机分为SHVE组(15例)和第一肝门阻断组[(Pringle组),14例],比较两组患者的术中肝血流阻断时间、肝切除范围、出血量、术后肝功能恢复情况、术后2 d平均腹腔引流量以及并发症发生率等指标.结果 两组患者的性别、年龄、肿瘤大小、术中肝血流阻断时间以及肝切除范围的差异均无统计学意义(P＞0.05).SHVE组患者的术中出血量为(282.1±286.5)ml,明显少于Pringle组[(721.5±512.1)ml,P＜0.05].SHVE组患者术后第1、3、7天血清前白蛋白含量明显高于Pringle组(P＜0.05),血清谷丙转氨酶和总胆红素含量明显低于Pringle组(P＜0.05).SHVE组患者术后2 d平均引流量为(189.4±103.5)ml,明显少于Pringle组[(249.5±108.7)ml,P＜0.05].Pringle组有1例发生肝功能衰竭,SHVE组无一例发生肝功能衰竭.Pringle组有4例发生肝静脉损伤,3例发生肝静脉破裂大出血,1例发生空气栓塞;SHVE组虽有5例发生肝静脉损伤,但无一例发生肝静脉破裂大出血或空气栓塞.结论 SHVE术可以提高肝脏巨大肿瘤切除患者对手术的耐受性,是合理安全的肝脏手术术式.     

Natural course of cavernous hepatic hemangioma

Cavernous hepatic hemangiomas are benign liver tumors and present as incidental findings on sonographic examinations, but little is known concerning their natural course. Therefore, we performed a clinical and imaging follow-up of 64 cases of cavernous hepatic hemangioma in 50 patients during an average 18.8 month period. One case presented a symptom of slightly right upper quadrant pain and two cases showed thrombocytopenia. In one of the thrombocytopenia cases, cavernous hepatic hemangioma was resected because of Kasabach-Merrit syndrome. No case increased in size during follow-up, but one case decreased and disappeared. These results suggested that prolonged clinical and imaging follow-up of cavernous hepatic hemangiomas may be needed.     

肝海绵状血管瘤纯性剥离术的临床应用（附59例报告）

目的：探讨采用包膜外纯性剥离法切除肝海绵状血管瘤的治疗经验。方法：分析总结１９９０年１月至１９９８年１月在肝门阻断下采用包膜外纯性剥离法切除５９例肝海绵状血管瘤患者的临床资料。结果：全部病例手术经过顺利,术中出血少,术后恢复良好,并发症低于其他术式。结论：包膜外纯性剥离治疗肝海绵状血管瘤是一种安全、简便、有效且创伤小的手术方式。     

平阳霉素治疗头颈部血管瘤132例临床分析

目的总结平阳霉素瘤内注射治疗头颈部各种血管瘤的疗效。方法收集我科自1996年3月至2003年12月以平阳霉素注射治疗头颈部毛细血管型、海绵状及混合性等血管瘤132例(155个瘤体)的临床资料进行分析。结果经过6个月～8年随访，治愈和基本治愈率为82．57％，好转11．36％，总有效率为93．93％。毛细血管型、海绵状和混合性血管瘤的治愈和基本治愈率分别为84．0％、88．5％、76．1％。发热反应为8．33％。结论平阳霉素治疗毛细血管型、海绵状和混合性血管瘤疗效高，疗程短，是一种简便、安全有效的方法。     

选择性出入肝血流阻断在肝切除手术中的应用

目的进一步改进无血切肝技术,提高肝脏巨大肿瘤患者的切除率和手术耐受性。方法回顾分析16例肝脏巨大肿瘤切除术,讨论选择性出入肝血流阻断方式在肝切除中的应用。结果巨大肝脏肿瘤在肝切除手术中,应用选择性出入肝血流阻断术,术中出血少,患者耐受性好,提高了肝脏手术的切除率。结论应用选择性出入肝血流阻断术可以提高肝脏巨大肿瘤的切除率和手术耐受性,为肝脏手术提供了一个合理安全的术式。