经纤维支气管镜微波联合局部化疗治疗晚期支气管肺癌的疗效观察

目的探讨经纤维支气管镜微波联合局部化疗药物注射治疗中、晚期中心型肺癌的疗效。方法对18例不适合常规开胸手术或拒绝手术的中、晚期中心型肺癌患者进行治疗,并与治疗前比较,以观察其疗效。结果经2～4周(平均3周)治疗,症状缓解率:咳嗽71%(13/18)、咯血83%(15/18)、呼吸困难94%(17/18)。结论纤维支气管镜镜微波联合局部化疗药物注射治疗是治疗中、晚期中心型肺癌的疗效有效的方法,是一种简便有效的微创治疗方法,痛苦小,安全性大。     

经纤维支气管镜局部化疗治疗老年晚期肺癌

目的观察经纤维支气管镜(纤支镜)局部化疗加香菇多糖静滴治疗老年晚期中心型肺癌的疗效。方法老年晚期中心型肺癌42例,采用信封抽签随机分为观察组(21例)与对照组(21例),观察组采用olympus BF及配套的NM-8L型注射针注入卡铂400 mg至瘤体中央及周围,并加用香菇多糖全身静脉滴注。对照组单纯用香菇多糖静脉滴注。结果观察组21例中完全缓解4例,部分缓解12例,无变化5例,有效率66.7%,明显高于对照组有效率(14.3%),P<0.05,治疗过程中毒副作用轻微,且发生率低。结论经纤支镜局部化疗能较快使肿瘤缩小,缓解临床症状,毒副作用少,适宜老年晚期中心型肺癌患者。     

经纤维支气管镜联合局部化疗治疗肺癌的效果分析

目的观察经纤维支气管镜联合局部化疗治疗中晚期中央型肺癌的临床疗效。方法选取2012年2月至2014年1月期间我院收治64例中晚期中央型肺癌患者作为研究对象,随机分为两组,对照组采取全身化疗,观察组在全身化疗的基础上进行经纤维支气管镜联合局部化疗,两组患者每周进行2次治疗,疗程8w,治疗结束后比较患者KPS和ZPS评分并评价两组患者的临床治疗效果。结果两组患者治疗后的KPS和ZPS评分较治疗前明显提高,对照组治疗后的KPS为(71.2±5.6),ZPS评分为(3.3±0.1);观察组治疗后的KPS和ZPS评分为(83.7±6.8),ZPS评分为(4.1±0.3),两者具有统计学差异(P0.05)。对照组治疗有效率,观察组治疗有效率,两者具有统计学差异(P0.05)。结论经纤维支气管镜联合局部化疗可有效控制中晚期中央型肺癌的进展,改善患者的阻塞性肺炎肺不张症状,疗效较为显著,值得在临床上推广应用。     

经纤维支气管镜局部化疗治疗气管支气管结核的疗效及方案研究

目的 探讨合理的经纤维支气管镜局部化疗治疗气管支气管结核的方案.方法 对255例予全身化疗联合经纤维支气管镜局部化疗的气管支气管结核患者的疗效等进行回顾性分析.其中局部注入异烟肼+丁胺卡那霉素+利福平者(多药组)49例,局部注入异烟肼+利福平者(双药组)152例,局部单用利福平者(单药组)54例.结果 ①多药组和双药组平均治疗次数[(4.3±3.9)次,(5.0±4.0)次]少于单药组[(9.9±5.2)次](P<0.01).②经纤维支气管镜局部化疗4周后,50%以上的患者镜下病变缩小或消失,三组的好转率差异无统计学意义.③经纤维支气管镜局部化疗4周后,三组患者胸片或胸CT病变均有不同程度的吸收,但差异无统计学意义.④局部化疗治疗终止时,三组胸片或胸CT病变吸收总有效率依次为82%、80%、44%,多药组和双药组优于单药组(P<0.05).⑤局部化疗治疗终止时,多药组支气管狭窄的发生率(16.3%)高于双药组(4.6%)和单药组(5.6%)(P<0.05).结论 经纤维支气管镜局部注人异烟肼+利福平,给药次数较少,疗效较好,不良反应小,是气管支气管结核局部治疗的最佳方案.     

经纤维支气管镜选择性腔内局部放疗治疗中心型肺癌

现代肺内近距离放疗技术的确立以两项基本技术为基础，即纤维支气管镜（纤支镜）及计算机程控微型铱源后装机。经纤支镜介入支气管腔内后装机放射治疗肺癌技术的建立是现代肺内近距离放疗技术的标志。其特点是：①纤支镜可屈，可准确地将施源器送至亚肺段支气管开口以上的...     

经支气管镜植入放射性粒子治疗晚期中央型肺癌

目的探讨经支气管镜植入125I放射性粒子治疗晚期中央型肺癌的疗效及可行性。方法纤维支气管镜检查明确植入粒子部位后,把装好125I放射性粒子的软枪经支气管镜插入到病变气道,远端的穿刺针刺入病灶,推进针芯植入粒子。粒子分布间距在1cm左右,分腔内、管壁上及管壁外3种方法植粒。结果22例共植入125I放射性粒子48粒,每例植粒1~5粒。腔内植粒14例,管壁上植粒5例,管壁外植粒3例。术后症状均明显减轻。术后1个月胸部CT见阻塞的支气管管腔扩大20例,肺不张或阻塞性肺炎消失18例。22例均未出现严重并发症。结论通过支气管镜植入125I放射性粒子疗效肯定、操作安全,可用于晚期中央型肺癌的姑息治疗。     

47例支气管肺癌局部化疗分析

我院自１９９６年以来采用经纤维支气管镜（纤支镜）瘤体局部注射化疗药物治疗各种类型支气管肺癌４７例,现报告如下。临床资料本组４７例均经纤支镜活检病理确诊,男性３６例,女性１１例,年龄４４～７２岁,平均５４岁。多为已失去手术机会、不愿接受全身化疗或放疗及...     

经支气管镜氩气刀治疗中央型晚期肺癌

目的探讨经支气管镜介导氩气刀治疗中央型晚期肺癌气道狭窄的临床效果。方法对55例经支气管镜活检确诊的合并中心气道狭窄的晚期肺癌患者,在支气管镜引导下行氩气刀治疗,并追踪观察。以病变狭窄获得再通、临床症状改善进行疗效评价。结果 55例患者共行氩气刀治疗150次,临床评价完全有效12例（21.82%）,部分有效25例（45.45%）,轻度有效17例（30.91%）,无效1例（1.81%）。结论经支气管镜介导氩气刀治疗中央型晚期肺癌疗效好、并发症少、安全性高。     

纤维支气管镜下氩气刀治疗中心型肺癌临床研究

目的 观察经纤维支气管镜（纤支镜）氩气刀联合全身化疗治疗原发气管支气管肺癌的近期疗效。方法 20例经纤支镜氩气刀治疗，氩气刀功率20-40W，时间2～3S，每次治疗总时间100～150S，1周后重复治疗，共3～5次。非小细胞性肺癌用GP方案：吉西他滨（GEM）1000mg／m^2，第1天和第8天静脉注射；顺铂（DDP）100mg／m^2，第1天静脉注射；小细胞性肺癌用CE方案：卡铂（CBP）400或500mg，第1天静脉注射；足叶乙甙（VP-16）100mg，第1～5天静脉注射。28d为1周期。结果 20例氩气刀联合全身化疗后，18例症状明显改善，纤维支气管镜下病灶好转率为90％，胸部X线复查病灶吸收率达75％。结论 氩气刀联合全身化疗治疗管内型肺癌疗效明显。     

经纤维支气管镜确诊的支气管肺癌的临床研究

目的评价纤维支气管镜检查对支气管肺部肿瘤的诊断价值。方法回顾性分析宁夏医学院附属医院呼吸内科支气管镜室1984～2002年1882例经纤维支气管镜确诊的支气管肺癌患者的特点。结果①支气管肺癌的发病率随年龄增长而增高，其中60～69岁年龄段发病率最高（36．1％）。②男性多于女性，男女之比为3．56：1；近20年男女患者比例无明显变化。鳞癌、小细胞癌、大细胞癌男性均明显多于女性，而腺癌男女性别比例差异不大。③职业以工人、农民所占比例最高，分别占37．6％和35．5％。④鳞癌、小细胞癌好发于上叶，而腺癌好发于下叶。⑤病理以鳞癌所占比例最高（59．6％），小细胞癌次之（22．6％），腺癌较少（6．8％）。鳞癌、小细胞癌均以增殖型为主，腺癌以浸润型为多。结论①纤维支气管镜是确诊支气管肺癌的一个重要手段。②肺癌的发病率逐年升高，60岁以上者最为明显。男女两性发病比例逐步缩小。③肺癌好发于上叶，以鳞癌为主。鳞癌、小细胞癌镜下以增殖型多见，腺癌镜下以浸润型多见。     

老年原发性肺癌的外科治疗

本文报道自１９７５年１月～１９９４年１２月我院收治的７６例７０岁以上原发性肺癌外科治疗结果。肺叶切除５７例，袖状肺叶切除９例，肺楔形切除７例，全肺切除３例。发生并发症占２７．６％（２１／７６），１例术后５天死于呼吸衰竭，手术死亡率为１．３％。作者认为对７０岁以上原发性肺癌外科治疗，应选择无严重心肺功能障碍的Ⅰ、Ⅱ期非小细胞肺癌患者，以肺叶切除术为首选术式。术后应重视血氧饱和度监测，及时发现和处理低氧血症。本组术后３年生存率为３８．２％（２９／７６），５年生存率为３１．６％（２４／７６），１０年生存率为１８．４％（１４／７６），提示对老年原发性肺癌患者采取积极的外科治疗亦可以取得较好的疗效。     

纤维支气管镜在AIDS并发肺部感染中的应用

肺部机会性感染在艾滋病(AIDS)病人中非常常见,是发病和死亡的重要原因。但其病因复杂,涉及细菌、分枝杆菌、真菌、病毒和寄生虫等多种微生物,缺乏特异性的临床及影像学表现,诊断困难,往往需要使用侵入性诊断技术,因此纤维支气管镜在这一领域具有重要的应用价值。文章就艾滋病肺部感染支气管镜镜下的特点,支气管肺泡灌洗、纤维支气管镜刷检、经支气管肺活检、经支气管针吸、经支气管镜治疗等,在AIDS肺部感染中的应用进行综述。     

纤维支气管镜检查对不明原因慢性咳嗽诊断价值的临床研究

目的 探讨纤维支气管镜检查对成年人不明原因慢性咳嗽的诊断价值.方法 对2004年10月至2006年12月在咳喘专科门诊就诊、胸片、免疫功能正常、无咯血症状并且经慢性咳嗽诊断程序仍病因未明的成年慢性咳嗽患者,经纤维支气管镜进行病因诊断.结果 37例患者平均年龄(38±13)岁,中位咳嗽时间6个月.经纤维支气管镜检查,59.5%获得了病因诊断:支气管结核(6例),气管肿瘤(4例)、气管骨化症(3例)、化脓性支气管炎(3例)、支气管异物(2例)、侵袭性气管支气管曲菌病、气管息肉、声带下囊肿、原发性气管支气管淀粉样变各1例.纤维支气管镜检查未确诊的15例患者中,6例组织病理为慢性非特异性气道炎症.全部患者术中、术后无显著不良反应.结论 作为一项安全的诊疗手段,纤维支气管镜检查能在不明原因慢性咳嗽的病因诊断中发挥重要作用.     

肺癌化疗的研究进展

本文综述和分析了近年来肺癌化疗的临床应用现状和研究新进展。包括新的细胞毒性抗肿瘤药、铂类化合物及针对关键靶点的新型抗肿瘤药,如肿瘤新生血管（TA）抑制剂、拓扑异构酶I抑制剂、微管蛋白活性抑制剂等。大量的临床实验及临床应用结果显示,这一系列新型抗肿瘤药物的研制成功,为人类最终战胜肿瘤开辟了新的途径,标志着人类对肿瘤治疗的研究已进入了一个新的阶段。     

肺癌在支气管镜下的特征

目的深入了解肺癌在支气管镜下的特征。方法采用纤维支气管镜、痰细胞学及病理学等方法对１１０５例患者进行了观察。结果经纤维支气管镜确诊支气管肺癌１１０５例，占同期支气管镜检查的２５５％。其中６３８例（５７７％）可见肿瘤直接征象，即新生肿物；４１２（３７３％）例可见肿瘤的间接征象。２７例（２４％）镜下符合黏膜炎性改变，但黏膜病理活检确诊为肺癌。此外，２８例（２５％）镜下未见明显异常，但支气管黏膜盲目活检得到肺癌的病理诊断。在可见肿瘤直接和间接征象的１０５０例中鳞癌４２１例（４０１％），小细胞癌３２２例（３０７％），腺癌１７６例（１６８％），大细胞未分化癌２０例（１９％），肺泡细胞癌１７例（１６％）。此外还有鳞腺癌４例（０４％），细胞类型不明确者９０例（８６％）。然而，１０５０例中３２例镜下虽显示新生物肿块，５４例可见癌的间接征象，但第一次支气管镜下病理活检报告为急性和慢性炎症。结论（１）肺腺癌患者中男性仍稍多于女性；（２）绝大部分肺泡细胞癌在支气管镜下仅显示管腔狭窄、黏膜肿胀等非特异的间接征象；（３）各肺叶前侧段支气管癌的发生率与后侧段没有显著差别。     

Assessment of neoadjuvant chemotherapy for patients with advanced squamous cell carcinoma of the esophagus

Background  Neoadjuvant chemotherapy for advanced esophageal cancer is beneficial for responders, whereas it may provide no clinical benefits or even prove harmful in non-responders. Methods  This study retrospectively compared the pathological findings and prognosis of 60 patients with UICC non-T4 stage III and IV, who received chemotherapy followed by surgery, and 96 patients with non-T4 stage III and IV cancer, who underwent surgery alone. The treatment regimen of cisplatin (70 mg/m²/day on day 1), adriamycin (30 mg/m²/day on day 1), and 5-fluorouracil (750 mg/m²/day on days 1–7) was administered for two cycles. Responders represented patients with histological effect of grade 1b-3 following therapy; non-responders represented those with grade 0-1a histological effect. Results  Survival was not significantly different between the neoadjuvant chemotherapy group and the surgery-alone group. Responders showed a tendency of earlier postoperative pStages than preoperative cStages (P = 0.08), better survival (P = 0.10), significantly fewer metastatic nodes, and significantly less extensive lymphatic invasion than the surgery-alone group. However, non-responders showed no significant differences in the degree of downstaging, number of metastatic nodes, extent of lymphatic and venous invasion, and survival rate as compared with the surgery-alone group. Comparison of overall survival between the chemotherapy and surgery-alone groups after matching for pathological stage showed that the survival of pStage II patients of the chemotherapy group was significantly better than the pStage II patients of the surgery-alone group (P = 0.04), whereas that of pStage III and IV patients of the chemotherapy group was not significantly different from the same-stage patients of the surgery-alone group. Conclusions  These results suggest that chemotherapy improves prognosis of responders significantly more than those who show downstaged pathological stage. However, the chemotherapy does not give any clinical benefit for non-responders.     

Cyclic alternating combination chemotherapy for small cell bronchogenic carcinoma.

Sixty-one protocol-eligible patients with small cell bronchogenic carcinoma received cyclic alternating combination chemotherapy with two or three non-cross-resistant drug combinations. No chest or prophylactic brain radiation therapy was used. Twenty-eight months after starting treatment, disease-free survival was 23% for patients achieving a complete response (CR) and 13% overall. Initial treatment consisted of high-dose cyclophosphamide, methotrexate, and CCNU (CMC) for 6 weeks. Patients then received vincristine, adriamycin, and procarbazine (VAP) for 6 weeks. The addition of VAP increased the CR rate from 42% to 74% in limited-disease patients and from 24% to 36% in extensive-disease patients. Half of the patients were randomized to a third combination of VO-16-213 and ifosfamide. These patients were cycled at 6-week intervals through the three drug regimens while the remaining patients were cycled between CMC and VAP. The addition of VP-16-213 and ifosfamide did not increase the CR rate or prolong survival. Only complete responders survived beyond 24 months. Sequential use of non-cross-resistant drug combinations represents one method for increasing the CR rate.     

Regional chemotherapy for advanced pancreatic carcinoma

BACKGROUND/AIMS: Since 1990, 14 patients with advanced pancreatic cancer were treated by regional chemotherapy. Five patients had locally advanced unresectable cancer and 9 had locally advanced disease with liver metastasis. METHODOLOGY: Fourteen patients underwent laparotomy, splenic artery catheterization and received a mean therapy of 3.8 cycles and 3 patients had completed 6 cycles of chemotherapy. Every cycle given monthly consisted of 5-fluorouracil 600 mg/m2 3 days, mitomycin 10 mg/m2 1 day, and cisplatinum 60 mg/m2 1 day. Tumor response was evaluated on the basis of imaging methods, tumor markers and life quality marker pain relief. RESULTS: Four patients had stabilization, 4 had partial response, 5 had progression and 1 had complete response. Median survival was 8 months for the whole group. Palliation for pain was successful and 71.4% of the patients had pain palliation. One patient had complete, 1 patient had partial, 8 patients had stable pain relief. Four patients had poor response to treatment and had progressive pain. Side effects, mainly leukopenia and thrombocytopenia, occurred in 5 patients and responded to medical measures. Mild to moderate nausea and vomiting was common and they responded well to antiemetic treatment. CONCLUSIONS: Although the objective response rate of regional chemotherapy for overall survival is low, in an individual patient it may produce an adequate response and acceptable toxicity so that the patient experiences overall improvement in symptoms, and rarely as in one case in our group may be cured by this method.     

肺复张策略对防止纤支镜治疗后肺泡塌陷的作用观察

目的:探讨肺复张策略对防止纤支镜治疗后肺泡塌陷的效果.方法:将机械通气需纤维支气管镜检查的60例患者随机分为治疗组及对照组,治疗组采用肺复张策略,对照组行常规机械通气.比较2组动脉血气和氧代谢、血流动力学指标.结果:治疗组纤维支气管镜检查前PaO2(114.25±24.75) mmHg,PaCO2 (32.56±7.73) mmHg,肺复张30 min后PaO2(112.12±20.41) mmHg,PaCO2(31.56±6.63) mmHg,PaO2及PaCO2肺复张前后无明显差异(均P ＞0.05);对照组纤维支气管镜检查前PaO2(116.11±26.53) mmHg,PaCO2(30.12±5.53) mmHg,常规机械通气30 min后PaO2(86.21±16.23)mmHg,PaCO2(31.56±6.63) mmHg,常规机械通气治疗前后PaO2有显著性差异(P＜0.01),而PaCO2无明显差异(P＞0.05).结论:支气管镜检查后采用肺复张策略能复张塌陷的肺泡,减少低氧血症对机体的危害,并对血流动力学影响较小.