胃癌化疗后致重度骨髓抑制继发出血和红皮病1例的护理

<正>胃癌是我国常见肿瘤之一,中晚期胃癌单纯手术疗效甚差。近年来,随着人们对肿瘤生物学认识的提高,胃癌的治疗模式从单一的手术发展为围手术期治疗加规范化手术的新治疗模式[1],新辅助化疗作为综合治疗的一种方法越来越受关注。胃癌化疗有各种毒副作用,骨髓抑制是肿瘤化疗最常见且重要的并发症之一[2],文献报道[3],以IV度骨髓抑制的治疗性相关的病死率达4%~     

胃癌术后卡培他滨和奥沙利铂方案辅助化疗的毒副反应护理

胃癌是最常见的恶性肿瘤之一,围手术期综合治疗被认为是进一步改善胃癌预后的关键。临床试验表明,术后进行辅助化疗能明显提高胃癌术后患者的生存率[1,2]。氟尿嘧啶类联合铂类为基础的化疗方案已作为胃癌围手术期化疗的推荐     

~(18)F-FDG PET/CT与血清CEA对进展期胃癌新辅助化疗联合手术治疗后转移或复发监测价值

目的探讨18F-FDG正电子发射断层成像术(PET/CT)显像与血清癌胚抗原(CEA)水平检测对进展期胃癌新辅助化疗联合手术治疗后转移或复发的诊断价值。方法选择96例进展期胃癌且行新辅助化疗联合手术治疗患者为研究对象,对其进行2年以上随访,进行PET/CT显像与血清CEA水平检测,评价二者对患者治疗后复发或转移的诊断价值,并进行统计学分析。结果纳入研究的96例患者,复发、转移47例,PET/CT联合CEA对复发或转移阳性确诊率及阴性确诊率显著高于单纯PET/CT、血清CEA,差异有统计学意义(P0.05);PET/CT联合CEA对复发或转移诊断敏感度、特异度及准确度著高于单纯PET/CT、血清CEA,差异有统计学意义(P0.05)。结论对进展期胃癌新辅助化疗合并手术治疗后采用18 F-FDG PET/CT显像与血清CEA水平检测联合监测,有助于提高化疗后转移或复发诊断。     

进展期胃癌新辅助化疗的临床疗效

胃癌是最常见的恶性肿瘤之一,外科手术仍是胃癌治疗的主要方法.目前,我国多数胃癌患者就诊时已属进展期,手术切除率低,尤其获得根治性切除的比例更少,术后局部复发及转移的发生率仍很高[1].近年来,随着人们对肿瘤生物学行为认识的提高,胃癌的治疗模式从单一的手术发展到以围手术期治疗加规范化手术的新的治疗模式.国内外众多学者对如何改善胃癌患者预后作了大量的探索和研究,其中,新辅助化疗是胃癌综合治疗的重要组成部分[2-3].2007年8月～2009年6月,笔者采用随机对比研究,评估进展期胃癌患者新辅助化疗后再行手术治疗的临床疗效.     

进展期胃癌新辅助化疗的临床疗效

胃癌是最常见的恶性肿瘤之一,外科手术仍是胃癌治疗的主要方法.目前,我国多数胃癌患者就诊时已属进展期,手术切除率低,尤其获得根治性切除的比例更少,术后局部复发及转移的发生率仍很高[1].近年来,随着人们对肿瘤生物学行为认识的提高,胃癌的治疗模式从单一的手术发展到以围手术期治疗加规范化手术的新的治疗模式.国内外众多学者对如何改善胃癌患者预后作了大量的探索和研究,其中,新辅助化疗是胃癌综合治疗的重要组成部分[2-3].2007年8月～2009年6月,笔者采用随机对比研究,评估进展期胃癌患者新辅助化疗后再行手术治疗的临床疗效.     

胃癌多药耐药的研究进展

胃癌为我国最常见的恶性肿瘤之一,早期发现率低,多数为进展期胃癌,单纯手术常难以根治,化疗在综合治疗中发挥了重要作用,成为治疗胃癌的主要方法之一。但化疗的效果还远不够理想,原发性或获得性多药耐药（MDR）成为阻碍化疗效果提高的主要素之一。多药耐药（MDR）是指肿瘤细胞接触一种化疗药物并产生耐药性,同时对其他多种结构和作用机制不同的化疗药物也产生耐药。因此胃癌多药耐药的机制、临床意义及耐药逆转成为肿瘤研究中的热点之一。     

胃癌新辅助化疗

胃癌是消化道最常见的恶性肿瘤之一。近年来,胃癌发病率在世界范围内呈逐渐下降的趋势,但东亚地区仍是全球胃癌发病率及病死率最高的地区［1］。2011年中国城市和农村胃癌病死率分别为19.66/10万和22.09/10万,均居恶性肿瘤死因第3位［2］。目前,国内外针对胃癌的治疗主要采取手术联合放化疗的综合治疗方案。胃癌的术后辅助治疗并无统一方式,日本倾向于术后辅助化疗采用单药治疗的方法,美国则采取术后同步放化疗（INT0116试验）［3］。近几年研究认为,新辅助化疗可以缩小肿瘤,使不能手术的患者获得手术根治的机会,从而提高手术切除率。     

FOLFOX6新辅助化疗联合手术治疗进展期胃癌的价值分析

目的 探讨FOLFOX6新辅助化疗联合手术治疗进展期胃癌的价值。方法 选取收治的75例进展期胃癌患者,根据治疗方法分为对照组35例和研究组40例。对照组采用FOLFOX4新辅助化疗联合手术治疗,研究组采用FOLFOX6新辅助化疗联合手术治疗。比较两组治疗效果。结果 研究组总缓解率(67.50%)高于对照组(40.00%)(P0.05);研究组R0切除率高于对照组(P0.05);两组化疗不良反应发生率比较,差异无统计学意义(P0.05)。结论 进展期胃癌采用FOLFOX6新辅助化疗联合手术治疗效果显著,且用药安全。     

新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的效果

目的 探讨新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的效果.方法 回顾性分析洛阳市中医院2019年11月至2020年11月收治的行腹腔镜辅助胃癌根治术的进展期胃癌患者90例.根据是否行新辅助化疗分为单纯根治术组和新辅助化疗+根治术组,每组45例.比较单纯根治术组和新辅助化疗+根治术组患者的近期疗效、围术期指标、术...     

进展期胃癌患者新辅助化疗不良反应的观察及护理

胃癌是我国最常见的恶性肿瘤之一,手术仍然是唯一可能根治的手段,但实际应用时仅限于较早期胃癌。2008年美国国立综合癌症网络（NCCN）胃癌临床实践指南（中国版）显示,中国多数胃癌患者就诊时已处于进展期,早期胃癌比例不足10％。对于进展期胃癌,近年来提出了“新辅助化疗”的综合治疗措施,可减低肿瘤负荷,降低临床分期,提高进展期胃癌的手术切除率,改善患者的预后。2007年1月至2009年1月,本院采用奥沙利铂联合5-氟尿嘧啶及亚叶酸钙作为新辅助化疗方法治疗进展期胃癌52例,现对其不良反应及采取的护理措施报告如下。     

Trastuzumab for gastric cancer

Background: Gastric cancer is a disease with different management approaches in different regions, especially between Western and Asian countries. Surgery is the mainstay of treatment for non-metastatic disease. Perioperative chemotherapy or adjuvant radio-chemotherapy is recommended, since recurrences are common after curative resection. Unfortunately, advanced or metastatic gastric cancer constitutes the majority of patients in clinical practice. For these patients systemic chemotherapy is the standard treatment, to provide palliation and prolong survival; however, prognosis remains poor. Several molecular targeting agents are under evaluation in international randomized studies. Objective: To review chemotherapy and targeted therapies for gastric cancer, chemical and pharmacological characteristics of trastuzumab, and evidence for its clinical use in gastric cancer. Methods: Examination of relevant literature. Results/conclusions: HER-2 is overexpressed/amplified in approximately 22% of gastric cancer patients. Trastuzumab, a recombinant humanized anti-HER-2 monoclonal antibody, is, to our knowledge, the first biological therapy that has showed a survival improvement by nearly 3 months (reduced risk of death by 26%), thus trastuzumab in combination with chemotherapy is a treatment option for patients with HER2-positive advanced gastric cancer. Trastuzumab's role in curative gastric cancer treatment needs to be studied, as well as monotherapy, maintenance therapy and second line treatment in the palliative setting.     

术中动脉灌注化疗于胃癌根治术中的应用研究进展

胃癌发病率死亡率均较高,早期胃癌行根治性切除术后复发转移率较低,但进展期胃癌（AGC）即使行R0切除术后复发转移率仍较高,究其原因为外科手术治疗无法根除肿瘤微转移灶。术中动脉灌注化疗（IAIC）能使肿瘤及肿瘤周围组织形成高化疗浓度场所,杀灭外科根治术后残留癌细胞。对AGC行肿瘤R0切除加D2淋巴结清扫配合IAIC能达到宏观及微观上的根治,降低肿瘤的复发转移概率,延长患者生存时间,提高生存质量。IAIC起源于20世纪90年代,经过近30年的发展,其临床效果已得到认可,但缺乏相关大宗随机试验证据支持,其灌注血管选择、用药方案选择等仍未得到规范。本文就IAIC的研究现状做一综述,为相关临床工作提供参考。     

Laparoscopic gastrectomy for heart failure patients with left ventricular assist devices

Left ventricular assist devices (LVADs) currently play an important role in the treatment of patients with end-stage heart failure who require a bridge to heart transplantation. As the LVAD population increases, the incidence of cancer patients with an LVAD is assumed to be increasing as well. For gastric cancer patients with an LVAD, surgery may be the only curative treatment, especially as chemotherapy is scarcely available. However, we cannot perform an upper-middle incision in these patients because of the LVAD's location and driveline. Furthermore, to reduce the risk of driveline infection, minimally invasive surgery is desirable. Therefore, laparoscopic surgery is, where possible, suitable for achieving a secure approach to the abdominal cavity. However, laparoscopic surgery for patients with LVAD requires careful consideration not only for anesthetic management, but also for the technical procedure. We ingenuously performed laparoscopic gastrectomy for a gastric cancer patient with LVAD to preserve the device and obtain a good surgical view.     

Gastric cancer

OBJECTIVES: To review the current status, recent advances, and ongoing research related to screening, diagnosis, staging, and treatment of gastric cancer. DATA SOURCES: Professional journals, research studies, and review articles relating to gastric cancer. CONCLUSIONS: Surgical resection is the gold standard curative treatment for gastric cancer; however, diagnosis is often at later stages of disease, leaving poor long-term survival rates. An emphasis has been placed on developing more effective chemotherapy regimens; currently, fluorouracil is the standard single agent used for gastric cancer. Radiation therapy has been used for palliative symptom management. IMPLICATIONS FOR NURSING PRACTICE: An understanding of current treatment modalities for gastric cancer will help oncology nurses assist their patients throughout their course of treatment with education, nutritional support, and symptom control.     

Preoperative therapy in esophageal cancer

Progress has been made in the treatment of locally advanced esophageal cancer. Preoperative and postoperative chemotherapy also appears to improve survival in gastroesophageal junction adenocarcinoma compared to surgery alone. Adding radiotherapy to preoperative chemotherapy enhances rates of curative resection, achieves measurable rates of pathologic complete response, and recent trials indicate a survival benefit for preoperative chemoradiotherapy compared to surgery alone in esophageal cancer. Given the achievement of pathologic complete responses with combined chemoradiotherapy in esophageal cancer, recent trials have evaluated the contribution of surgery after chemoradiotherapy. With currently available systemic therapy for squamous cancers of the esophagus that respond to combined chemoradiotherapy, there is no clear survival benefit for the addition of surgery after chemoradiotherapy despite improvements in local tumor control with the addition of surgery. Surgery may salvage nonresponding patients with biopsy-positive residual disease. For adenocarcinoma of the esophagus, a histology with consistently lower rates of pathologic complete response than squamous cell cancer, surgery appears to play a greater role. Trials are now evaluating the use of newer chemotherapy agents combined with radiotherapy, including taxanes, irinotecan, and oxaliplatin. Response on postiron emission tomography early on during induction chemotherapy may be a strong prognostic measure of outcome. Targeted agents, including monoclonal antibodies that target the epidermal and vascular endothelial growth factor receptors, are in active development in phase II and III trials.     

胆道系统肿瘤的药物治疗

手术切除是目前胆道系统肿瘤唯一的根治方法,但早期手术切除后复发率高,且患者诊断时大多为中晚期,已失去手术机会,预后较差。荟萃分析认为,术后辅助治疗能改善患者预后,BILCAP研究中卡培他滨辅助化疗虽未在意向治疗患者中达到研究终点,但在协定治疗患者中显示存在生存获益。吉西他滨联合顺铂(GC方案)仍是晚期一线标准化疗方案,吉西他滨联合替吉奥(GS方案)和吉西他滨、替吉奥联合顺铂(GCS方案)亦是一线治疗可选择的方案。IDH1、FGFR2作为肝内胆管癌的两种主要驱动基因已成为靶向治疗的研究热点,免疫检查点抑制剂单药或联合治疗研究亦逐步开展。本文旨在回顾胆道系统肿瘤的药物治疗进程,展望其治疗前景。     

Surgical and ablative modalities for the treatment of colorectal cancer metastatic to the liver

Colorectal cancer is the second leading cause of mortality from cancer in the United States. Death from colorectal cancer usually results from metastatic disease to the liver. Complete surgical resection is the only potentially curative treatment option for metastatic colorectal cancer to the liver, with a five-year survival rate of approximately 30%-40%. The addition of adjuvant systemic or hepatic intra-arterial pump chemotherapy appears to improve survival. Treatment options for unresectable disease in the liver are cryosurgery (intraoperative freezing of tumors), radiofrequency ablation (intraoperative or percutaneous heating of tumors), hepatic intra-arterial infusion pump chemotherapy (regional chemotherapy), and systemic chemotherapy. This article describes metastatic colorectal cancer disease presentation, extent of disease evaluation, and nonchemotherapeutic treatment options, including surgical and ablative therapies. The nurse's role in caring for this population also will be discussed.     

600例上消化道恶性肿瘤微创治疗的临床研究

目的观察进展期食管癌及胃癌内镜下微创治疗的疗效。方法将600例不能手术或不愿意手术的进展期食管癌及胃癌患者随机分成三组。200例患者给予微创治疗联合全身化疗；200例患者给予微创治疗；200例患者给予全身化疗。治疗过程中观察患者的治疗疗效、生存期、转移情况及不良反应。结果微创治疗组治疗有效率为77．0％；微创联合化疗组，治疗有效率为89．5％；全身化疗组治疗有效率为21．5％。微创治疗组较化疗组治疗效果两者间差异有显著性（P〈0.05）。微创联合化疗能提高微创治疗的效果。微创治疗组生存期30个月．微创联合化疗组生存期35个月，化疗组生存期16个月。原发灶转移率组相差不大。结论微创治疗在上消化道进展期恶性肿瘤治疗中有较好的临床疗效，联合全身化疗能提高临床治疗效果。     

Efficacy of adjuvant immunochemotherapy with OK-432 for patients with curatively resected gastric cancer: a meta-analysis of centrally randomized controlled clinical trials

The benefit of immunochemotherapy employing a streptococcal preparation, OK-432 (Picibanil), in patients with curatively resected gastric cancer was reassessed by meta-analysis of data from 1,522 patients enrolled in six clinical trials with central randomization. All six trials began between 1985 and 1993, and patients were followed-up for at least 3 years after surgery and enrollment of the last patient. In these trials, standard chemotherapy was compared with the same chemotherapy plus OK-432. The endpoint was overall survival and intent-to-treat analysis was done without patient exclusion. Data were analyzed using the Mantel-Haenszel method. The 3-year survival rate for all eligible patients in the six trials was 67.5% in the immunochemotherapy group versus 62.6% in the chemotherapy group. The 3-year overall survival odds ratio was 0.81 (95% confidence interval: 0.65-0.99). The treatment effect was shown to be statistically significant (p = 0.044). The results of this meta-analysis suggest that immunochemotherapy after surgery with OK-432 can improve the survival of patients with curatively resected gastric cancer.     

Lung cancer.

Only patients with localized lung cancer benefit from curative resection. Curative radiotherapy is recommended in patients with a resectable tumor in whom surgery is precluded for medical reasons. Adjuvant preoperative or postoperative therapy of any type does not improve the results of surgery except in patients with Pancoast tumor. Therapy for nonlocalized tumors does not affect survival. Radiotherapy has a palliative effect in 50 to 75 per cent of patients presenting with symptoms from either a primary lesion or metastases and should therefore be recommended in symptomatic patients. The palliative effect of chemotherapy is limited in lung cancers other than small cell carcinomas. However, chemotherapy alone or in association with radiotherapy produces remarkable tumor regression and some improvement of survival in small cell carcinoma. The use of immunotherapy in the treatment of lung cancer is still under evaluation.