高龄妇科恶性肿瘤患者围手术期护理

我院 1996年 1月 -2 0 0 2年 12月共收治 70岁以上妇科恶性肿瘤患者 3 6例。笔者就其围手术期护理 ,报道如下。1　临床资料3 6例中 ,年龄 70～ 79岁 ,平均年龄 74岁。手术治疗 2 2例 ,其中宫颈癌 8例 ,宫体癌 4例 ,卵巢癌 10例。 18例患者术后恢复良好 ,无明显并发症 ,腹部切口一期愈合 ,术后按期出院。 2例肺部感染给以抗感染治疗 ,2例切口裂开经二次缝合愈合出院。2　护理措施与讨论2 .1　术前护理2 .1.1　正确估计病情及手术耐受力　高龄患者特定的生理条件导致心理上的变化 ,对手术效果抱有疑虑 ,对手术痛苦感到紧张和恐惧 ,还可表现为…     

机器人手术治疗妇科恶性肿瘤新进展

机器人手术是在内镜基础上发展起来的一种新的微创外科手术技术,因其具有传统腹腔镜手术无可比拟的优点,例如安装了灵巧的器械臂和三维成像装置等,近年来已被广泛应用于临床实践中.在妇科恶性肿瘤诊疗领域,机器人手术被用于宫颈癌根治术、子宫内膜癌和卵巢癌的分期手术以及盆腔廓清术等.初步研究显示,这项新的技术至少能够达到与传统腹腔镜和开腹手术相同的效果,同时减轻了患者的痛苦,缩短了术后恢复时间,是一种有效的手术新技术.     

调节性T细胞与妇科恶性肿瘤免疫研究进展

调节性T细胞(regulatory T cell, Treg)是一群具有抑制其他免疫细胞功能的负调控细胞,包括CD4+ Treg、CD8+ Treg、自然杀伤T细胞(natural killer T cell,NKT)和双阴性Treg(double negative Treg,DN Treg)细胞等4大类。Treg细胞在妇科恶性肿瘤免疫抑制及逃逸机制中起重要作用。肿瘤可诱导生成特异性Treg细胞,CD4+ CD25+ T细胞向Treg细胞的转化可能是引起肿瘤微环境中Treg细胞数量增多的原因。本文就CD4+ CD25+ Treg细胞与妇科恶性肿瘤免疫抑制及逃逸之间的关系进行综述。     

胚胎发育基因Twist与妇科肿瘤研究

胚胎发育基因Twist属于螺旋-环-螺旋蛋白家族中高度保守的转录因子,在肿瘤发生、转移、耐药和血管形成中发挥重要作用,近年来研究发现,妇科肿瘤的发生发展与细胞Twist基因表达异常相关,提示它的激活有可能成为一种新的妇科肿瘤预后判断指标和肿瘤治疗的新靶点.     

女性癌症发病的社会心理因素研究

目的 :研究社会心理因素与女性癌症发病的相关性。方法 :采用 1∶1配对研究方法 ,对 2 4 2例女性恶性肿瘤患者及与之相配的健康女性分别使用相关的“生活事件量表”、“社会支持评定表”、“防御机制问卷”进行问卷调查 ,考察相关社会心理因素与女性癌症的关系。结果 :单因素分析显示 ,家族史、少吃新鲜蔬菜、生活无规律、饮酒、别人认为自己性格内向为女性癌症发病的危险因素 ;经多元配对Lo gistic回归分析 ,掩饰因子、负性事件、吃饭好生闷气、少吃新鲜蔬菜、饮酒、别人认为自己性格内向为女性癌症发病的危险因素。结论 :不良生活习惯、家族史、负性生活事件和个性因素与女性癌症发病相关。     

胚胎发育基因Twist与妇科肿瘤研究

胚胎发育基因Twist属于螺旋-环-螺旋蛋白家族中高度保守的转录因子,在肿瘤发生、转移、耐药和血管形成中发挥重要作用,近年来研究发现,妇科肿瘤的发生发展与细胞Twist基因表达异常相关,提示它的激活有可能成为一种新的妇科肿瘤预后判断指标和肿瘤治疗的新靶点.     

鼻咽癌患者放疗过程中血清VEGF水平的动态变化

为了观察鼻咽癌放疗过程中血清VEGF水平的动态变化,为放射治疗联合靶向VEGF治疗鼻咽癌提供理论依据,对33例鼻咽癌初治患者在治疗前、治疗期间及治疗后每周抽血检测血清中VEGF一次,采用ELISA酶连免疫吸附实验检测血清VEGF浓度.鼻咽癌患者放疗前、放疗中和放疗后的血清VEGF值分别为(308.63±203.04)、(483.36±245.11)和(381.41±249.95)ng/L.放疗前VEGF浓度与放疗中、放疗后浓度差异有统计学意义,P值分别为0.003、0.008,而放疗中与放疗后差异无统计学意义,P=0.209;放疗期间血清VEGF最高值以放疗第3～5周为主,占血清VEGF最高值周数的63.7%.初步研究结果提示,鼻咽癌患者放疗期间血清VEGF水平较治疗前明显升高,放射治疗联合靶向VEGF治疗鼻咽癌疗效显著,值得应用.     

洛铂在妇科肿瘤治疗中的研究新进展

洛铂是第3代铂类抗肿瘤药物,已上市用于临床治疗晚期乳腺癌、小细胞肺癌和慢性粒细胞白血病.研究表明洛铂作为最新的第3代铂类抗肿瘤药物,具有水溶性好,抗瘤谱广、抗瘤活性强,与其他铂类药物无交叉耐药性及不良反应低诸多特点,已经显示出明显的优势.     

妇科多发性原发癌 10 例分析

回顾分析了 10 例妇科多发性原发癌患者的临床资料.初步研究结果提示,多发性原发癌与复发转移癌两者截然不同的治疗原则是影响预后最重要因素,重复癌治疗与第一原发癌相同,多采取积极地根治,可望获得长期生存,而转移癌则往往是姑息疗法,预后较差.     

70岁以上妇科肿瘤患者的手术治疗

目的 :探讨 70岁以上妇科肿瘤患者手术治疗的可行性及意义。方法 :回顾性分析了我科近 10年来收治的 70岁以上的妇科肿瘤患者 87例 ,对患者的一般情况、合并症、对麻醉和手术的耐受情况、手术持续时间、出血量、输血量、术后的恢复情况、并发症等资料进行统计学分析 ,并将患者按肿瘤的性质 (良性组 ,恶性组 )及手术范围 (附件切除术+,子宫切除术+)进行分组比较分析。结果 :所有患者均安全度过麻醉期和手术期 ,恶性病变组和子宫切除术 +组的手术持续时间、术中出血量及术后住院时间均较良性病变组和附件切除术 +组显著增多 ;但子宫切除术 +组的术后严重并发症的发生率无显著增高。结论 :70岁以上的妇科肿瘤患者可以耐受手术 ,但应加强对合并症的处理及对并发症的防治     

Interleukin-6 serum levels in patients with gynecological tumors

Serum levels of IL-6 were evaluated in a large group of patients with benign or malignant gynecological tumors. The results obtained were correlated with the patients' clinicopathological features and follow-up data. Using a highly sensitive immunoenzymatic method for the evaluation of serum IL-6 levels, we observed that > 5% of normal healthy women exhibited values within the range of 1.9-6 pg/ml. Using a cut-off of pg/ml, elevated levels of serum IL-6 were found in 53% of 45 patients with primary epithelial ovarian cancer and less frequently in patients with endometrial and cervical cancer (37% and 10% respectively). Elevated levels of IL-6 were occasionally seen in patients with benign disease. IL-6 serum levels appeared to be less sensitive than CA 125 in ovarian cancer diagnosis. In cancer patients, increased IL-6 serum levels were related to the presence of the tumor since all post-operative patients exhibited a marked decrease. In patients with advanced ovarian cancer post-operative levels of IL-6 correlated with residual disease. Very high levels of IL-6 were observed in the ascitic fluid of9 ovarian cancer patients, but IL-6 mRNA was not detected in tumor cells. This suggests that the increased production of IL-6 observed in ovarian cancer is reactive. Higher levels of IL-6 were found in patients unresponsive to chemotherapy, as compared with responsive ones. Univariate analysis of survival data suggests that increased IL-6 serum levels correlate with negative prognosis. © 1994 Wiley-Liss, Inc.     

Mitomycin C in patients with gynecological malignancies

Mitomycin C (MMC) is an effective cytostatic agent used in the treatment of patients with gynecological malignancies and breast carcinoma. This review presents and discusses the current treatment options with MMC in patients with breast, cervical, and vulvar carcinomas, as well as rarer gynecological malignancies. New combinations and developments are also presented and their potential clinical relevance is examined. Consequently, also for the next years a MMC-containing chemotherapy continues to be a relevant part of an individualized therapy despite numerous innovative new drugs, especially for the salvage therapy of metastatic breast cancer and the simultaneous radiochemotherapy of other gynecological malignancies.     

Home hospice care for the patients with gynecological malignancies

In order to clarify the clinical characteristics along with the practical care of home hospice care for gynecological cancer patients, we analyzed 37 terminally-ill gynecological cancer patients who died at home from July 1, 2003 through June 30, 2010, and these patients were compared with 762 non-gynecology cancer patients. The range of patients' ages with gynecological malignancies was statistically younger(p<0. 05)than that of the control patients, whereas the duration of home care and home death ratio did not show significant differences. As for medical treatment, the frequency of the management of nephrostomy was significantly higher in cases with gynecological malignancies. However, the frequencies of the usage of strong opioids, home oxygen therapy, home parenteral hyperalimentation, management of central venous port and indwelling bladder catheter showed no significant differences. There were patients, who needed special treatments by a gynecologist, with vesicovaginorectal fistula in one case, subcutaneous abscess probably caused by rectocutaneous fistula in one case, vaginal bleeding in one case and acute urinary retention treated by an emergent bladder puncture. By analyzing the focus problem lists of the total suffering at each clinical phase, in patients living longer than 15 days at home,(Kawagoe's classification in 1991)this did not show significant difference against the control group. In conclusion, gynecologic cancer patients were significantly younger than those with non-gynecologic malignancies, though not statistically significant, showing the tendency of short duration. Thus, in cases of gynecologic malignancies, it is important to take these characteristics into consideration.     

Radiation enterocolitis requiring surgery in patients with gynecological malignancies

PURPOSE: To identify the characteristics, risk factors, and clinical outcomes of radiation enterocolitis requiring surgery in patients with gynecologic malignancies. METHODS AND MATERIALS: The records of 1,349 patients treated with pelvic radiotherapy were retrospectively reviewed. The majority of the patients (88%) were treated with 50 Gy or 50.4 Gy pelvic irradiation in conventional fractionations with anteroposterior fields. RESULTS: Forty-eight patients (3.6%) developed radiation enterocolitis requiring surgery. Terminal ileum was the most frequent site (50%) and most of the lesions had stenosis or perforation. On univariate analysis, previous abdominopelvic surgery, diabetes mellitus (DM), smoking and primary site had an impact on the complications, and on multivariate analysis, abdominopelvic surgery, DM, and smoking were independent predictors of the complications requiring surgery. After the surgical intervention, the frequency of Grade 2 or more bleeding was significantly lower in patients treated with intestinal resection in addition to decompression than those treated with intestinal decompression alone. CONCLUSIONS: Severe radiation enterocolitis requiring surgery usually occurred at the terminal ileum and was strongly correlated with previous abdominopelvic surgery, DM, and smoking. Concerning the management, liberal resection of the affected bowel appears to be the preferable therapy.     

Prognostic factors in pelvic exenteration for gynecological malignancies

Objectives

Analyze morbidity, mortality and prognostic factors after pelvic exenteration (PE) for gynecological malignancies.

Methods

We reviewed a series of 107 individuals who underwent PE at A.C. Camargo Cancer Hospital from August 1982 to September 2010.

Results

Median age was 56.4 years. Primary tumor sites were uterine cervix in 73 cases (68.2%); vaginal, 10 (9.3%); endometrial, 14 (13.1%); vulvar, 7 (6.5%); and uterine sarcomas, 3 (2.8%). Median tumor size was 5.5 cm. Total PE was performed in 56 cases (52.3%), anterior in 31 (29.9%), posterior in 10 (9.3%) and lateral extended in 10. Median operation time, blood transfusion and hospital stay length were 420 min (range: 180–780), 900 ml (range: 300–4500) and 13 days (range: 4–79), respectively. There was no intra-operative death. Fifty-seven (53.3%) and 48 (44.8%) patients had early and late complications, respectively. Five-year progression free survival (PFS), overall survival (OS) and cancer specific survival (CSS) were 35.8%, 27.4% and 41.1%, respectively. Endometrial cancer had better 5-year OS (64.3%) than cervical cancer (23.1%). Lymph node metastasis negatively impacted PFS, CSS and OS. Presence of perineural invasion negatively impacted PFS and CSS. No variable retained the risk of recurrence or death in the multivariate analysis.

Conclusions

PE has acceptable morbidity and mortality and may be the only method that can offer long-term survival in highly selected patients.     

Clinical significance of different serum tumor markers in gynecological malignancies

The purpose of this study was to compare the diagnostic significance of serum tumor markers in patients with gynecological malignancies and to evaluate the usefulness of the markers in the follow-up after primary treatment. Determined were tissue polypeptide antigen (TPA), carcinoembryonic antigen (CEA), and phosphohexose isomerase (PHI). Serum samples from 200 patients with cervical cancer, 206 patients with endometrial cancer, and 254 patients with ovarian cancer were analyzed. With regard to specificity, CEA and PHI exhibited false positive rates below 10% in normal controls (N = 96). For TPA, the same result was obtained only by using 120 U/l as a cut-off level. As for sensitivity, positive rates above 50% prior to therapy were demonstrated by PHI and TPA in ovarian cancer as well as CEA in cervical cancer. All three tumor markers showed some decline in positiveness after primary therapy. In ovarian cancer the decline of PHI and TPA strongly correlates with the achievable tumor resection. During the follow-up, all markers demonstrated some discriminatory power by comparing patients with recurrent disease versus recurrence free. Especially PHI and TPA in ovarian cancer, CEA in cervical cancer, and PHI in endometrial cancer seem to be the most suitable markers.     

Evaluation of circulating tumor necrosis factor-alpha in patients with gynecological malignancies

TNF-alpha levels in sera from patients with gynecological cancers were evaluated by ELISA and compared with those of patients with benign ovarian cysts or of anonymous healthy donors. Patients with cervical and endometrial carcinoma and with benign ovarian cysts showed levels of TNF-alpha similar to those of healthy donors. In contrast, significantly increased levels of TNF-alpha were found in patients with ovarian carcinoma, regardless of the stage of disease.     

前列腺癌患者血清白细胞介素-18和VEGF相关性

Objective  

The aim of our study was to analyze interleukin-18 (IL-18) and vascular endothelial growth factor (VEGF) serum levels in patients with prostate cancer before and after operation and the possible correlation between IL-18 and VEGF serum levels.