120例原发性肝癌的肝动脉化疗栓塞术疗效观察

目的 观察中晚期原发性肝癌经导管肝动脉化疗栓塞术(TACE)治疗的疗效。方法自1990-2003年共有120例中晚期肝癌患者，接受TACE介入治疗，评估和随访治疗前后的疗效。结果经过治疗，79．2％(95／120)的患者临床症状缓解；88．3％(55／120)肿块缩小；78．2％(79／101)AFP明显下降；生存期延长，1、2、3年生存率分别为80．8％(87／120)、48．3％(58／120)和1130％(36／120)。结论TACE治疗是中晚期肝癌的有效手段，使不能手术切除的肝癌成为适应手术治疗，延长了患者的生命，提高了生活质量。     

光动力及光动力联合重组人白介素-2治疗中晚期食管癌30例

目的:探讨光动力联合重组人白介素-2(interleukin-2,IL-2)对中晚期食管癌临床预后的影响.方法:将30例中晚期食管癌患者随机分为2组,其中15例仅行单纯光动力治疗(photodynamic therapy,PDT);15例行PDT联合IL-2肌肉注射,对所有患者进行不良反应监测,复查内镜随访治疗结束后3、6 mo、1年局部复发患者数,随访1年死亡例数.结果:发热发生率B组较A组升高(93.3%vs53.3%,P0.05),胸痛、咳嗽、咳痰发生率两组差异无统计学意义;随访6 mo局部控制率B组优于A组(6.7%vs 13.3%),差异无统计学意义;1年局部控制率B组优于A组(14.3%vs53.8%,P0.05);1年生存率B组高于A组(73.3%vs 53.3%),但差异无统计学意义.结论:PDT联合IL-2治疗模式发挥了免疫协同效应,改变肿瘤微环境,免疫效应扩大,降低肿瘤复发,不良反应轻微,显示了良好临床前景,值得临床推广.     

内镜引导沙氏探条扩张治疗十二指肠溃疡瘢痕性狭窄

目的：探讨内镜引导沙氏探条扩张治疗十二指肠溃疡瘢痕性狭窄的临床效果。方法：经内镜引导沙氏探条扩张治疗十二指肠溃疡瘢痕性狭窄45例。观察扩张后狭窄部内镜通过情况、临床症状缓解情况等。结果：原狭窄部孔隙0．1～0．4 cm，扩张后胃、十二指肠镜均能通过狭窄进入十二指肠降部，临床症状缓解，随访6、12、18、24、30、36个月症状缓解率为97.8％、97．8％、94．4％、93．7％、91．7％、87．5％。扩张后未进行正规溃疡治疗的患者症状复发率(4／18)明显高于坚持溃疡病治疗者(2／37)。结论：内镜引导沙氏探条扩张治疗十二指肠溃疡瘢痕性狭窄是一种安全有效的方法。     

鼻内镜手术对成人鼻窦炎伴哮喘患者疗效的影响分析

目的探讨鼻内镜手术对成人鼻窦炎(CRS)伴哮喘患者的治疗效果及对患者生活质量的影响。方法回顾性分析2012年6月-2015年6月在我院接受治疗的成人CRS伴哮喘患者的临床资料,根据其治疗方式分为保守治疗组和鼻内镜手术治疗组。比较两组患者治疗前后症状积分、肺功能和生活质量的差异。结果两组患者治疗前VAS和Lund-Kennedy评分无明显差别,治疗6个月后,两组患者的上述指标均较治疗前降低,且鼻内镜组降低更明显(P0.05);两组患者治疗前6MWT、FVC和FEV_1/FVC等肺功能指标无明显差别,治疗后,两组患者的肺功能指标均较治疗前增高,且鼻内镜组增高更明显(P0.05);两组患者治疗前活动受限、哮喘症状、心理状况等生活质量评分无明显差别,治疗后,两组患者的生活质量均较治疗前增高,且鼻内镜组增高更明显(P0.05)。结论鼻内镜手术对成人CRS伴哮喘患者治疗效果较好,可明显改善相关症状,提高患者生活质量。     

内镜黏膜剥离术与切除术治疗食道早癌及癌前病变的临床应用研究

<正>食道癌是一种严重威胁人类健康的恶性肿瘤,食道癌早期基本无特异性症状,所以患者感受到临床症状时到医院就诊时多数患者已经处于中晚期,从而造成食道癌患者的死亡率较高,早期确诊对降低食道癌致死率具有非常重要的作用~([1])。所以本研究对2015年1月至2016年6月间在本院采用内镜黏膜下剥离术及切除术进行食道早癌及癌前病变治疗的76例患者的临床应用情况进行统计分析,现报告如下。     

恩他卡朋双多巴治疗中晚期帕金森病疗效观察

目的观察对22例中晚期帕金森病(PD)患者采用恩他卡朋双多巴(LCE)治疗的效果。方法选择中晚期PD患者22例,先给予多巴丝肼片62.5 mg餐前1 h口服,3次/天,依据症状改善情况加量至125 mg餐前1 h口服,3次/天。待临床症状改善时,替换为LCE片口服,1片/次,2~3次/天,均在餐前1 h服用。分别于治疗前、治疗4周时,使用统一帕金森病评分(UPDRS)量表评价临床疗效及PD症状改善情况,用日常生活能力(ADL)量表评价PD患者的ADL,用PD生活质量问卷(PDQL-39)评价PD患者生活质量。结果22例中晚期PD患者治疗4周时的总有效率为100%(22/22)。治疗后UPDRS评分、ADL评分均低于治疗前(t分别为29.76、17.40,P均<0.01),治疗后PDQL-39评分高于治疗前(t=-12.06,P<0.01)。结论LCE可以显著改善PD中晚期患者的症状,提高ADL及生活质量。     

急性结直肠癌性梗阻内镜治疗的临床价值

目的探讨经内镜放置金属支架和肠梗阻导管治疗急性结直肠癌性梗阻的可行性与临床疗效。方法在X线辅助下,经内镜放置金属支架或肠梗阻导管治疗26例急性结直肠癌性梗阻的患者。其梗阻的部位分别为直肠14例,乙状结肠8例,降结肠3例,横结肠1例。结果 26例结直肠癌性梗阻中,20例放置金属支架,成功18例；6例放置肠梗阻导管,成功6例,总的操作成功率为92．3％(24／26)。操作成功的24例中。1例无效,23例术后1～2 d梗阻症状缓解或消除,临床有效率为88．5％(23／26)。其中13例为永久性姑息治疗,10例经内镜治疗解除梗阻后7～10d行1期肿瘤切除,术后均恢复顺利,无感染及吻合口漏等并发症发生。1例直肠癌术后复发伴盆腔广泛转移者治疗失败,1例乙状结肠癌广泛转移者术中穿孔而急诊行Hartmann术。1例术后6周支架移位,导致梗阻复发。置入第2根支架后缓解。1例术后1个月粪块堵塞支架。以探条及网篮疏通后缓解。结论经内镜放置金属支架或肠梗阻导管治疗急性结直肠癌性梗阻。能够有效缓解患者的梗阻症状,避免行结肠造瘘术,显著降低患者的创伤和痛苦。提高患者的生活质量。     

Barrett食管的光动力治疗

目前Barrett食管(BE)的治疗主要有几种方式:改变生活方式;内科药物治疗;手术则安全性较差,副作用较多,患者不易接受。随着内镜技术的发展,内镜介入治疗BE,收到较为理想的效果,方法主要包括内镜下黏膜切除术、激光、电凝、热探头、液氮冷冻治疗、光动力疗法(PDT)等。其中PDT 因疗效较佳、并发症较少而受到重视,国外近几年应用较多, 特别是对伴有异型增生或食管早癌的BE,认为PDT对不能或不愿手术患者来说是一个很好的选择。     

光动力疗法与支架放置术治疗进展期食管癌比较

目的对比光动力疗法与内镜下支架放置术对进展期食管癌的疗效和安全性。方法18例行内镜下光动力治疗，22例行内镜下支架放置术，根据患者的耐受情况辅助化疗。两组患者的年龄、性别、肿瘤大小、分期、合并症等相比，无统计学差异。对比两种治疗方法对进展期食管癌的疗效和安全性，观察毒副作用，随访生存时间。结果光动力治疗组平均随访时间6．7（0．5～19）月；临床症状缓解率77．8％（14／18）；内镜下完全应答率16．7％（3／18），部分应答率为38．9％（7／18）；半年生存率55．6％（10／18），1年生存率22．2％（4／18）；中位生存期为7个月。1例术后1周出现大出血，并发症发生率为5．6％（1／18）；未见光过敏等不良反应发生。支架术组平均随访时间3．5（1～19）月；临床症状缓解率81．8％（18／22）；半年生存率22．7％（5／22），1年生存率9．1％（2／22）；中位生存期为3个月。两组相比，半年生存率和中位生存期之间差异有统计学意义（P〈0．05）。结论光动力疗法与支架放置术均可显著改善进展期食管癌患者的临床症状，但前者更明显延长患者的生存期，是治疗进展期食管癌又一有效手段。     

莫沙比利联合抗幽门螺杆菌（HP）三联方案治疗反流性食管炎

目的观察莫沙比利联合抗HP三联方案治疗反流性食管炎的疗效；方法对2组HP感染阳性的RE患者采用莫沙比利加PPI三联及莫沙比利加铋剂三联的两种方法治疗，观察RE患者的临床症状、内镜下愈合及胃内HP感染阴转情况；结果PPI组RE临床症状4周缓解率为81．4％，(22／27)，内镜下RE愈合及好转率为88．8％(24／27)。铋剂组为69．2％(27／39)和81．0％(30／39)。转阴率2组用药4周后分别为72％和84％；PPI组在快速消除症状上明显优于铋剂组但HP感染的治疗两组无明显差异；结论莫沙比利联合抗HP方案治疗反流性食管炎(RE)在临床上近期有明显疗效，并具有抗HP感染的作用，远期疗效尚待进一步观察。     

Efficacy and toxicity of fluorouracil, doxorubicin, and cisplatin/nedaplatin treatment as neoadjuvant chemotherapy for advanced esophageal carcinoma

OBJECTIVE: Patients with advanced esophageal carcinoma including clinical T4 tumor, extensive lymph node metastasis, or intramural metastasis have a dismal prognosis, despite recent multimodality treatments. The aim of this study was to evaluate the efficacy and toxicity of neoadjuvant chemotherapy using fluorouracil, doxorubicin, and cisplatin or nedaplatin (FAP/N) in these patients. MATERIAL AND METHODS: Twenty-six patients were enrolled in this study. The first 9 patients received 600 mg/m2 fluorouracil on days 1-7 and days 29-35, and 30 mg/m2 doxorubicin and 60 mg/m2 cisplatin on days 1 and 29 (FAP). The next 17 patients received modified FAP, in which 50 mg/m2 nedaplatin was given instead of cisplatin (FAN). RESULTS: Grade 3 or 4 toxicities developed in 6 patients (23.1%) during chemotherapy, but there was no discontinuation of treatment. The clinical response rate was 46.2%. Twenty-one patients (80.8%) underwent esophagectomy, and R0 resection was achieved in 16 patients (61.5%). The 1-year survival rates of 26 patients, 21 patients with resectable tumor, 16 with R0 resection, and 12 clinical responders, were 31.3%, 32.1%, 33.3%, and 45.5%, respectively, each with a median survival time of 9 months. The median progression-free survival time of 26 patients was 6 months; in 16 patients with R0 resection progression-free survival was 6.5 months. There was no correlation between the recurrence pattern and tumor spread before treatment. CONCLUSIONS: FAP/N was found to have acceptable toxicities and the ability to control locoregional tumors, but made little contribution to patient survival. The efficacy of this treatment for patients with advanced esophageal carcinoma, however, may not yet be apparent.     

气道恶性肿瘤患者光动力治疗24例临床分析

目的回顾性分析经电子支气管镜腔内激光光动力疗法(photodynamic therapy, PDT)治疗的气道恶性肿瘤患者临床资料,探讨PDT治疗的规律性。 方法选择2019年2月至2021年3月由我院呼吸与危重症医学科进行PDT治疗的气道恶性肿瘤患者24例,分别对一般临床资料、PDT治疗情况和治疗后随访,以及治疗后存活患者和死亡患者的特征进行分析。 结果截止2021年8月7日,PDT治疗后获益最大的患者随访时长达13.2个月,远远大于PDT治疗后获益较小患者的随访时长总生存期(overall survival, OS)4.7个月(P＝0.02)。前者以管腔壁型为主(80%),而后者以管腔内型为主(50%)(P＝0.034)。前者腔内病变短于后者(中位数分别是3 cm和5 cm,P＝0.03)。前者年轻、病程短、以腺样囊性癌为主,而后者年龄大、病程长、以鳞癌为主(P>0.05)。 结论管腔壁型、气道腔内病变短,以及年轻、病程短和肺腺样囊性癌的气道恶性肿瘤患者可能在PDT治疗中获益较多;相反,管腔内型、气道腔内病变长,以及年老、病程长和非肺腺样囊性癌的气道恶性肿瘤患者可能在PDT治疗中获益较少。     

The effect of endoscopic laser therapy on survival in patients with squamous-cell carcinoma of the esophagus. Further experience.

Although endoscopic laser therapy is effective for symptom palliation in esophageal cancer, few studies have investigated its effect on survival. We previously reported a 300% improvement in survival in 10 patients with squamous-cell carcinoma of the esophagus after endoscopic Nd:YAG laser energy. We now report a study to determine if the survival advantage persisted after treating an additional 26 patients. Thirty-six patients with squamous-cell carcinoma of the esophagus treated with endoscopic laser therapy were compared to 20 controls identified by our hospital Tumor Registry. There was no difference between the groups with respect to age, sex, race, location of tumor, or clinical stage. More control patients (25%) had previously undergone surgery than laser patients (0%) (p less than 0.05). Survival analysis demonstrated a significant improvement in overall survival (p less than 0.05), with an improvement in median survival from 5.7 to 9.7 months (p less than 0.05). One-year survival was 38% in laser patients, compared to 20% in control patients. Our experience continues to demonstrate that endoscopic laser therapy is effective in prolonging life as well as palliating the symptoms of patients with squamous-cell esophageal carcinoma.     

Diagnostic utility of interleukin-6 (IL-6) for primary bile duct cancer and changes in serum IL-6 levels following photodynamic therapy

OBJECTIVES: Difficult diagnoses and a lack of effective therapy complicate biliary tract malignancies. Interleukin-6 (IL-6) is a human bile duct epithelium growth factor correlated with tumor burden. We evaluated the usefulness of serum IL-6 in the diagnosis of primary BDC and measured changes in serum IL-6 levels following photodynamic therapy (PDT). METHODS: We prospectively measured serum IL-6 levels in patients with BDC (N = 26: 14 patients treated with PDT, 12 with biliary drainage alone), hepatocelluar carcinoma (HCC, N = 26), and healthy adults (N = 23). Serum IL-6 levels were measured by an enzyme-linked immunosorbent assay. Patients with clinical conditions known to increase IL-6 levels were excluded. RESULTS: IL-6 was detected in all patients with BDC and HCC, and in 6 of 23 healthy adults. Median and mean levels of IL-6 were higher in patients with BDC than in both other groups (P < 0.001). Using a 25.8 pg/mL cutoff, IL-6 provided a diagnostic sensitivity of 73% and a specificity of 92%; positive and negative predictive values were 83% and 87%, respectively. Serum levels of IL-6 were correlated with tumor burden in BDC patients. One month after treatment of BDC with PDT, the mean IL-6 level decreased significantly from 282.1 +/- 121.8 to 38.2 +/- 9.9 pg/mL (P= 0.008). CONCLUSIONS: Serum IL-6 concentration is a useful addition to the available tests for the differential diagnosis of BDC, and serves as a marker for monitoring the response to treatment of BDC with PDT.     

Comparison of survival of advanced hilar cholangiocarcinoma after biliary drainage alone versus photodynamic therapy with external drainage]

BACKGROUND/AIMS: Photodynamic therapy (PDT) has a promising effect on non-resectable hilar cholangiocarcinoma. The aim of this study was to compare overall survival of PDT plus biliary drainage versus biliary stent alone in advanced hilar cholangiocarcinoma. METHODS: Twenty patients who were treated with endoscopic biliary drainage alone (Group A) and 27 patients treated with PDT under percutaneous cholangioscopy and additional percutaneous biliary drainage (Group B) were analyzed retrospectively. RESULTS: The mean bilirubin level declined effectively in both group after treatment. One-year survival was 28% in group A, 52% in group B (p<0.05). Median survival time was 288 days in group A, 558 days in group B (p=0.0143). CONCLUSIONS: PDT under percutaneous cholangioscopy seems to be more effective in extending survival than biliary drainage alone in advanced hilar tumor. To investigate whether PDT can increase survival rates, further prospective, randomized study is needed.     

Definitive concomitant chemoradiotherapy with docetaxel and cisplatin in squamous esopheageal carcinoma

Chemoradiotherapy is a standard treatment for esophageal carcinoma. This study evaluated the docetaxel‐based definitive concomitant chemoradiotherapy in patients with esophageal squamous cell carcinoma to determine its clinical response and overall survival. In this unicenter trail, we enrolled 59 patients with histologically proven squamous cell carcinoma in the esophagus between March 2004 and December 2007. All patients were staged II to IV and treated with definitive concomitant chemoradiotherapy. Radiotherapy was delivered with conventional fraction, 50–64 Gy in 25–35 fractions. Patients received two cycles of a 1‐day regimen containing docetaxel (60 mg/m²) and cisplatin (80 mg/m²) every 3 weeks during the period of radiotherapy. The chemoradiotherapy was applied as planned in all patients and the median chemotherapy delay time was 6 days (ranging from 2 to 8 days). The overall response rate for 59 evaluable patients was 98.3%, with 42 complete responses and 26 partial responses. During the follow‐up time (median 18 months, 4～53 months), the median overall survival time was 22.6 months. The rate of locoregional progression‐free survival, progression‐free survival, and overall survival in 3 years was 59.6%, 29.2%, and 36.7%, respectively. Hematologic toxicity Grade 3 and Grade 4 were observed in 39.0% and 20.3% of patients respectively, with severe non‐hemotologic acute toxicity being infrequent. Eleven patients had pleural effusion after chemoradiotherapy and four of them required therapeutic thoracentesis. Definitive concomitant chemoradiotherapy with docetaxel and cisplatin in squamous cell esophageal carcinoma was associated with a satisfactory outcome and manageable toxicity.     

Late course accelerated hyperfractionated radiotherapy for clinical T1－2 esophageal carcinoma

AIM: This retrospective study was designed to analyze the results and the failure patterns of late course accelerated hyperfractionated radiotherapy for clinical T(1-2)N(0)M(0) esophageal carcinoma. METHODS: From Aug. 1994 to Feb. 2001, 56 patients with clinical T(1-2) esophageal carcinoma received late course accelerated hyperfractionated radiotherapy in Cancer Hospital, Fudan University. All patients had been histologically proven to have squamous cell carcinoma (SCC) and were diagnosed to be T(1-2)N(0)M(0) by CT scan. All patients were treated with conventional fractionation (CF) irradiation during the first two-thirds course of the treatment to a dose of about 41.4Gy/23fx/4 to 5 weeks, Which was then followed by accelerated hyperfractionation irradiation using reduced fields, twice daily at 1.5Gy per fraction, to a dose about 27Gy/18 fx. Thus the total dose was 67-70Gy/40-43fx/40-49 d. RESULTS: The 1-, 3- and 5-year overall survival was 90.9 %, 54.6 %, 47.8 % respectively. The 1-, 3- and 5-year local control rate was 90.9 %, 84.5 % and 84.5 %, respectively. Twenty-five percent (14/56) patients had distant metastasis and/or lymph nodes metastasis alone. Eight point nine percent (5/56) patients had local disease alone. Another 3.6 % (2/56) patients had regional relapse and distant metastasis. CONCLUSION: Late course accelerated hyperfractionated radiotherapy is effective on clinical T(1-2) esophageal carcinoma. The main failure pattern is distant metastasis.     

内镜电化学(5-FU)治疗中晚期食管癌

目的 探讨内镜电化学加局部化疗对中晚期食管癌的治疗作用。 方法 采用内镜电化学加食管癌肿局部注射5-FU治疗16例中病例确诊的晚期食管癌。 结果 治疗后达CR 6例,PR 8例,NC 2例。总有效率(CR PR)87.5％(14/16)。无明显毒副作用。 结论 内镜电化学治疗加局部化疗对严重吞咽困难失去手术时机的中晚期食管癌有较好的治疗作用。     

Natural course of inoperable esophageal cancer treated with metallic expandable stents: quality of life and cost-effectiveness analysis

BACKGROUND AND AIM: The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with self-expanding metallic endoprostheses in the management of malignant esophageal obstruction or stenosis and the cost-effectiveness of the method in patients suffering from primary esophageal carcinoma. All patients with inoperable esophageal cancers treated with either laser palliation or endoprosthesis insertion were studied retrospectively. METHOD: Between May 1997 and December 2002 obstruction of the esophagus was diagnosed in 78 patients (52 male, 26 female, age range 53-102 years, mean 72.3 years). The etiology of obstruction was squamous cell carcinoma (n = 42) and adenocarcinoma of the esophagus (n = 36). The site of obstruction was in the upper (n = 1), in the middle (n = 38) and in the lower esophagus (n = 39). In 16 cases the gastroesophageal junction was also involved. Four patients had broncho-esophageal fistulas. In all cases the tumor was considered non-resectable. A total of 89 Ultraflex metal stents were introduced endoscopically. In 46 patients dilation with Savary dilators prior to stent placement was required. RESULTS: Stents were placed successfully in all patients. After 48 h, all patients were able to tolerate solid or semisolid food. During the follow-up period eight patients developed dysphagia due to food impaction (treated successfully endoscopically). Eleven patients presented with recurrent dysphagia 4-16 weeks after stenting due to tumor overgrowth and were treated with placement of a second stent. The median survival time was 18 weeks. There was no survival difference between squamous cell and esophageal adenocarcinoma. A cost-effective analysis was performed, comparing esophageal stenting with laser therapy. The mean survival and the cost were similar. A small difference of 156 Euro was noted (3.103 Euro and 2.947 Euro for each group of patients, respectively). A significant improvement in quality of life was noted in patients that underwent stenting (96% and 75%vs 71% and 57% for the first 2 months). CONCLUSION: Placement of self-expanding metal stents is a safe and cost effective treatment modality that improve the quality of life, as compared with other palliative techniques, for patients with inoperable malignant esophageal obstructions. In cases of expansion of the mass a second stent can be used; however, the overall survival of these patients, is poor.     

Superficial Esophageal Carcinoma: A Clinicopathological Review of 59 Cases

During the period from 1975 to 1989, a total of 59 patients with superficial esophageal carcinoma (SEC) were operated on in our Surgical Clinic. Forty patients of the 59 (68%) had been treated during the previous 5 yr. Although 22 patients (37%) complained of slight esophageal symptoms, 12 patients had only symptoms unrelated to esophageal disease, and 25 patients were asymptomatic. In the latter patients, the lesion was found by chance at the time of screening or follow-up examination of upper gastrointestinal tract disease. Endoscopy was very useful for the diagnosis of SEC, and Lugol's solution staining technique was an effective adjunctive means. The lesions in about half of the patients were initially diagnosed by endoscopy in our series. Radiologic diagnosis of the lesions confined to the mucosal epithelium or lamina propria was particularly difficult. Lymph node metastasis was not observed in patients with intraepithelial or mucosal carcinoma. However, the metastasis was demonstrated in 18 of 38 patients (47%) with submucosal invasion. The 5-yr survival rate of patients with SEC was 73%, which was significantly superior to that of patients with advanced esophageal carcinoma (26%). Since the prognosis for the patients with submucosal invasion and lymph node metastasis was poor, we should be enthusiastic about extended lymph node dissection in the surgical treatment for patients in whom submucosal invasion is suspected.