静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的应用

目的 探讨静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的意义.方法 将我科334 例单侧瞳孔散大的脑疝患者采用随机数字表法随机分为三组.A 组(外周静脉输液组):静脉留置针行外周静脉穿刺输液120 例.B组(中心静脉输液组):中心静脉穿刺置管输液102 例.C 组(静脉留置针行股静脉输液组):静脉留置针行股静脉穿刺输液112 例.比较三组患者穿刺成功所需时间(T1 )、输注20%甘露醇250 ml 所需时间(T2 )、术前瞳孔回缩例数.结果 T1 :A 组为(2.16 ±0.82)min,B 组为(11.73 ±4.43)min,C 组为(2.29 ±0.92)min.经t 检验:PAB ＜0.05,PBC ＜0.05,PAC ＞0.05.T2 :A 组为(35.78 ±1.69)min ,B 组为(19.74 ±1.97)min,C 组为(19.81 ±2.03)min.经t 检验:PAB ＜0.05,PBC ＞0.05,PAC＜0.05.瞳孔回缩例数:A 组为18 例,B 组为20 例,C 组为36 例.经χ2 检验:χ2 ＝0.825,PAB ＞0.05,χ2 ＝4.341,PBC ＜0.05,χ2 ＝9.533,PAC ＜0.01.结论 静脉留置针行股静脉穿刺置管输液能快速建立输液通道,且输液速度快,能够快速有效输注20%甘露醇等高渗脱水降颅内压抢救药物,迅速降低颅内压,缓解脑疝,为进一步手术治疗赢得时间,效果优于外周静脉输液及中心静脉输液,且并发症低,在神经外科脑疝患者的抢救中意义明显.     

新辅助放化疗对食管癌手术和预后的影响

目的对术前放化疗(新辅助放化疗,CRTS)与单纯手术(S)治疗食管癌的随机对照试验研究(RCTs)进行Me-ta分析,探讨CRTS对食管癌手术及预后的影响。方法 PubMed及手工检索所有已发表的关于CRTS与S治疗食管癌的RCTs。检验异质性,并根据异质性结果选择相应的效应模型。结果 14项RCTs纳入本研究,共1737例食管癌患者,文献质量评价根据Cochrane Reviewers′ Handbook4.2.2为A或B。CRTS组与S组比较,1年生存率差异无统计学意义,但CRTS组2年、3年、4年、5年生存率明显提高。相对危险度(RR)分别为1.06(95%CI0.99～1.13;P=0.1)、1.18(95%CI1.04～1.33;P=0.01)、1.39(95%CI1.23～1.58;P<0.00001)、1.27(95%CI1.04～1.55;P=0.02)、1.41(95%CI1.18～1.69;P=0.0001)。切除率二者差异无统计学意义,RR1.01(95%CI0.97～1.05;P=0.67),但CRTS组有较高的完全切除率,RR1.44(95%CI1.23～2.74;P=0.008)。总体死亡率二者比较,差异无统计学意义,RR1.12(95%CI0.89～2.48;P=0.503),但CRTS组手术相关死亡率相对较高,RR1.70(95%CI1.12～2.56;P=0.01)。二者并发症发生率差异无统计学意义,RR1.23(95%CI0.93～1.78;P=0.13)。二组远处转移率及总体肿瘤复发率比较,均差异无统计学意义,RR分别为1.18(95%CI0.75～1.68;P=0.71)、1.07(95%CI0.76～1.56;P=0.18),但CRTS组局部区域复发率降低,RR1.18(95%CI1.22～1.61;P=0.0001)。CRTS组病理完全缓解率达10.0%～45.5%。同步CRTS与序贯性CRTS比较,前者(RR1.34,95%CI1.06～1.89,P=0.013)比后者(RR0.86,95%CI0.67～1.38,P=0.29)更有益于提高患者5年生存率。结论与S治疗食管癌相比,CRTS降低了肿瘤局部区域复发率,提高了患者的3年、5年生存率;手术切除率二者差异无统计学意义,而CRTS完全切除率提高,但其手术相关死亡率相对较高。二者并发症发生率比较差异无统计学意义。     

新辅助化疗联合外科保肢手术治疗骨肉瘤远期生存分析

目的探讨骨肉瘤经新辅助化疗联合外科保肢手术的临床疗效。方法采取前瞻性研究方法,将骨肉瘤患者68例根据治疗方式分为观察组(保肢手术+新辅助化疗)38例,对照组(保肢手术+术后常规化疗)30例。采取Kaplan-Meier法及Log-rank检验,估计各组生存时间的生存率以及中位生存时间,比较两组生存时间的差异。结果观察组的中位生存期为71个月,3年、5年生存率分别为73.7%(28/38)、65.8%(25/38);对照组中位生存期为59个月,3年、5年生存率分别为53.3%(16/30)、46.7%(14/30),观察组的生存率明显优于对照组,差异有统计学意义(χ2=19.403,P=0.000)。结论新辅助化疗联合外科保肢手术是治疗骨肉瘤安全、有效的方法,术前积极有效化疗是改善预后的重要环节。     

NSCLC术前化疗后“T”降期的临床评价

目的研究NSCLC术前化疗后临床、组织学缓解率和化疗前后"T"分期变化及中数生存期的关系.方法自1995年2月～1997年2月,56例经诱导化疗后手术的非小细胞肺癌,以铂类为基础的联合化疗1～2个疗程,按TNM分期系统评价期别、"T"降期.结果期别降期发生率为21.4%,"T"降期发生率23.2%.化疗2个周期的"T"降期比例明显高于1个周期(P＜0.05),"T"降期与化疗临床缓解率和组织学缓解率相关(P＜0.05);"T"降期组的中数生存期高于"T"无变化和"T"升期组,分别为45.28个月、33.30个月和24.03个月,但差异无统计学意义,P=0.1423.进一步分析,在N2中"T"降期组MST较长,但P=0.0686.同样在腺癌中,"T"降期组MST较"T"无变化和升期组延长.P=0.0594.结论化疗后降期和"T"降期分别是反映化疗疗效因素之一;可延长生存期.     

Ⅲ期非小细胞肺癌新辅助化疗后手术的预后因素分析

目的：探讨Ⅲ期非小细胞肺癌（NSCLC）新辅助化疗后影响手术并发症和生存期的相关危险因素。方法：152例ⅢA、ⅢB期NSCLC患者接受新辅助化疗和手术,收集其术前功能性指标、分期、并发疾病、化疗方法、手术方式、术后并发症、生存期等资料,采用卡方检验、Kaplan-Meier和Cox比例风险模型分别分析影响术后并发症和生存期的危险因素。结果：单因素分析显示第1秒用力呼气量占预计值百分比（FEV1%,P=0.040）和术前并发疾病（P=0.020）对手术并发症的发生有影响。Kaplan-Meier生存分析分期（P=0.050）和是否全肺切除（P=0.018）对术后生存时间有影响。进一步多因素Cox回归分析示,只有全肺切除对术后生存时间有影响（P=0.026）,而左、右全肺切除无区别（P〉0.05）。结论：Ⅲ期NSCLC新辅助化疗的术后并发症危险因素是可接受的。全肺切除是影响患者生存期的高危因素。     

术前新辅助化疗对提高局部晚期非小细胞肺癌生存期的作用

目的通过对局部晚期非小细胞肺癌（Locally advanced nonsmall cell lung cancer,LANSCLC）先行新辅助化疗，后再手术治疗，观察术前新辅助化疗对提高术后5年生存率中的作用。方法对1996年1月至2001年10月本院NSCLC 203例进行前瞻性对照研究。85例行术前新辅助化疗（新辅助化疗组）2～3周期，化疗结束后3～4周手术，另118例直接手术（对照组）。结果新辅助化疗组总有效率68．24％（58／85），病期下调率35．29％（30／85）；手术切除率新辅助化疗组91．25％（73／80），对照组为81．36％（96／118）；两组手术并发症和手术死亡率差异无显著性（P〉0．05），新辅助化疗组术后1、3、5年生存率分别为77．52％、53．85％和35．39％，对照组分别为70．88％、40．32％和24．19％，新辅助化疗组术后生存率显著高于对照组（P〈0．01）。结论术前新辅助化疗安全有效，能降低NSCLC病期，提高手术切除率，改善患者术后长期生存率及生活质量。     

进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

目的 探讨术前动脉灌注化疗对进展期结直肠癌的远期临床疗效.方法 选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为2组:试验组68例行术前动脉灌注化疗,方案为:奥沙利铂(艾恒)130mg/m2、羟基喜树碱20 mg/m2、氟脲苷600 mg/m2,经股动脉插管灌注化疗1、2次,8～14 d后接受手术治疗;对照组60例直接手术治疗.观察动脉灌注化疗不良反应及组织学疗效,比较2组手术切除率、手术并发症、术后病理分期及远期生存率.结果 试验组动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均属Ⅰ、Ⅱ度.试验组手术切除率为97.1%(66/68)、根治性切除率为96.9%,分别高于对照组的73.3%(44/60)和79.5%(x2=14.848、8.906,P均＜0.05);试验组组织学有效率达72.7%,病理分期均较术前降低,其中Ⅱ期病例明显较对照组增多(P＜0.05);试验组中位生存期为53.0个月,1、3、5年生存率分别为95.3%、85.9%、44.6%;对照组的中位生存期为42.0个月,1、3、5年生存率分别为92.6%、75.9%、22.0%,试验组生存率高于对照组,但只有5年生存率差异具有统计学意义(x2=6.385,P＜0.05).术后并发症2组比较差异无统计学意义(P＞0.05).结论 术前动脉灌注化疗对进展期结直肠癌降低临床分期、提高手术切除率尤其是根治性切除率作用和疗效确切,并能提高患者的远期生存率.

Abstract：

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

Outcomes of Elderly Recipients of Implantable Cardioverter Defibrillators

Aims of the Study: To examine the patterns of use, complication rates, and survival in elderly recipients of implantable cardioverter defibrillators (ICD).
Methods and Results: We followed 500 consecutive patients included in the Marburg Defibrillator database for 48 ± 39 months. There were 40 patients (8%) ≥75 and 460 (92%) <75 years of age at the time of implant. The 5-year Kaplan-Meier estimate for appropriate treatment of VT or VF by ICD was 49% among patients <75- versus 57% among patients ≥75-years-old (P = 0.17). The 5-year sudden death rate was similarly low in both groups of patients (2% versus 3%). The 5-year overall mortality rate was significantly higher in patients ≥75 than in patients <75 years of age (55% versus 21%, P = 0.001), due to a higher mortality from heart failure (HF). All procedure-related, lead-related, and pulse generator-related complications were similar in both patient groups (23% versus 25%).
Conclusions: ICD therapy was equally effective in patients ≥75 and patients <75 years of age in the prevention of sudden cardiac death. While the complication rates were similar in both age groups, the long-term mortality was considerably higher in elderly patients, due to a higher mortality from HF. The current ICD therapy guidelines appear applicable to elderly patients who are otherwise medically stable and without advanced HF.     

自体造血干细胞移植与新药化疗治疗新诊断多发性骨髓瘤的倾向性评分匹配研究

目的:比较新药时代自体造血干细胞移植(ASCT)和新药化疗治疗新诊断多发性骨髓瘤(NDMM)的临床疗效、生存期及预后分析。方法:回顾性分析2012年1月至2019年12月华中科技大学同济医学院附属协和医院采用新药方案诱导化疗的149例NDMM患者的临床资料,24例接受ASCT的患者为移植组,125例未接受ASCT的患者为非移植组,中位随访时间43(1-90)个月。采用倾向性评分匹配法均衡组间混杂因素后比较组间缓解深度、总生存时间(OS)、无进展生存时间(PFS),并进行亚组分析。结果:通过匹配组间的协变量达到均衡,51例患者进入研究,移植组15例,非移植组36例。匹配后,移植组完全缓解(CR)率较非移植组接受维持治疗的CR率高(93.3%vs 42.3%,P=0.004),而深度缓解率和总有效率差异均无统计学意义(93.3%vs 65.4%,P=0.103;93.3%vs 96.2%,P=1.000)。匹配前,移植组较非移植组3、5年的PFS率和中位无进展生存时间(m PFS)分别为(89.6%vs 66.5%,P=0.024;69.8%vs 42.7%;未达到vs 51.0个月),3...     

新辅助治疗在进展期胃癌中的临床应用效果及对预后的影响

目的探讨新辅助治疗在进展期胃癌中的临床应用效果及对预后的影响。方法选取86例进展期胃癌患者作为研究对象,将其随机分为观察组和对照组,每组43例。观察组患者于术前接受新辅助化疗并于术后接受辅助化疗,对照组患者只在术后接受辅助化疗。对观察组的术前化疗疗效和2组患者的毒性反应、根治性切除率、术后1年复发率和术后2年生存率进行观察和分析。结果观察组患者经过新辅助化疗治疗后,临床有效率达到74．4％,有37例患者（86．0％）进行了胃癌根治性手术,而对照组中有28例患者（65．1％）进行了胃癌根治性手术,观察组行根治性手术的患者比例显著高于对照组（P〈0．05）;观察组行远端胃大部切除术的比例显著高于对照组（P〈0．05）;观察组和对照组患者消化道毒性反应的发生率分别为76．7％和72．1％,差异无统计学意义（P〉0．05）;2组患者出现骨髓抑制反应的比例分别为9．3％和7．0％,差异无统计学意义（P〉O．05）,给予对症治疗后均能顺利完成化疗,未发生严重并发症和死亡病例;观察组和对照组患者的术后1年肿瘤复发率分别为11．6％和32．6％,差异有统计学意义（P〈0．05）,且观察组患者的肿瘤复发时间显著长于对照组（P〈0．05）;2组患者的2年生存率分别为90．7％和72．1％,差异有统计学意义（P〈0．05）。结论新辅助治疗可有效控制进展期胃癌患者病情的进展,有利于肿瘤的切除,并可显著降低复发率,延缓复发时间并提高生存率,对改善患者预后有积极的作用,且安全性和患者耐受性较高,值得临床推广应用。     

淋巴结转移数目对结肠癌患者预后的影响

目的探讨淋巴结转移数目对行手术治疗的结肠癌患者预后的影响。方法回顾性分析2005年1月2007年12月符合筛选标准的148例行手术治疗的结肠癌患者的临床和随访资料,按照淋巴结转移数目进行分组：N0组（0枚）91例、N1组（1～3枚）41例、N2组（≥4枚）16例,采用Kaplan-Meier法进行生存分析,用Log-rank比较3组术后3年生存率,等级资料采用秩和检验,用χ2检验进行两两比较术后3年局部复发率、远处转移率和死亡率情况。结果 N0、N1、N2 3组的术后3年生存率分别为88.1%、71.4%、61.1%,3组生存率差异有统计学意义（P=0.003）;N0、N1、N2 3组的总体局部复发率、远处转移率和死亡率的差异有统计学意义（P=0.006,0.001,0.005）。结论淋巴结转移数目是结肠癌患者术后3年生存情况的危险因素,无淋巴结转移的患者术后3年生存情况明显比有淋巴结转移者好。     

Management and extended outcome of patients with synchronous bilateral solid renal neoplasms in the absence of von Hippel-Lindau disease

OBJECTIVE: To gain information regarding long-term follow-up in patients with synchronous bilateral solid renal neoplasms in whom renal-preserving surgery is imperative. PATIENTS AND METHODS: We examined our surgical experience and the survival outcome, as evaluated by Kaplan-Meier and log-rank analysis, of 94 patients (64 men and 30 women) who presented to the Mayo Clinic in Rochester, Minn, from 1973 to 1998 with bilateral synchronous solid renal neoplasms in the absence of von Hippel-Lindau disease. Follow-up of these patients ranged from 1 to 25 years, with a mean of 5.86 years and a median of 4.18 years. Tumors were staged according to the TNM classification. Pathologic staging and grading were usually performed on the kidney with the most extensive cancer. The Cox proportional hazards model was used to assess the relationship of grade (1-4), tumor size, and enucleation as opposed to extended (1 cm) partial nephrectomy on overall, cancer-specific, local recurrence-free, and metastasis-free survival. RESULTS: Seventy-one patients (76%) had bilateral synchronous renal cell carcinoma, and 14 patients (15%) had a unilateral renal cell carcinoma with a contralateral benign solid neoplasm. Nine patients (10%) had bilateral benign solid lesions. Sixty-six patients (70%) underwent a single procedure, whereas 28 (30%) underwent staged surgical procedures. Fifty-one patients (54%) are alive, and 43 (46%) have died. Twenty patients (21%) died of metastatic disease, and 5 (5%) had a local recurrence. Cancer-specific survival of the 85 patients with at least 1 renal cell carcinoma still under observation was 81% (+/- 4.9% SE) and 59% (+/- 8.1% SE) at 5 and 10 years, respectively, and survival to local recurrence was 96% (+/- 2.6% SE) at 5 years and 93% (+/- 3.7% SE) at 10 years with 14 patients still under observation. Grade 3 was a statistically significant factor for metastasis (P < .001). A significant difference in metastasis-free survival and cancer-specific survival was noted dependent on pathologic T stage (P < .001 and P = .02, respectively), with patients with local pT3 disease having a higher rate of metastasis and cancer-specific death. Multivariate analysis revealed that tumor grade was associated with metastasis-free survival (P = .002) and tumor size with cancer-specific survival (P = .04). There was no statistical significance on survival outcome end points according to procedure performed, i.e., enucleation vs extended partial nephrectomy. CONCLUSION: Long-term results of renal-preserving procedures for a series of patients with bilateral solid renal neoplasms indicate that grade, stage, and tumor size are significant predictors of outcome. Mean follow-up of over 5 years supports nephron-sparing techniques in selected patients because local recurrence was infrequent compared with distant metastasis.     

新辅助化疗后保乳治疗局部进展期乳腺癌52例疗效分析

[目的]探讨局部进展期乳腺癌新辅助化疗降期后保乳手术的可行性及新辅助化疗后保乳手术的选择标准。[方法]2005年1月至2011年10月本院接受新辅助化疗后行保乳治疗的52例局部进展期乳腺癌患者,化疗方案：吡柔比星50 mg/m2,紫杉醇150 mg/m2,21 d为1周期,共3～4周期,符合保乳条件者新辅助化疗完成后行保乳手术。术后常规放疗、化疗和内分泌治疗。[结果]新辅助化疗总有效率92．3％（48/52）,新辅助化疗完成后,13例（25％）临床完全缓解（cC R ）,6例（11．5％）病理完全缓解（pC R ）,35（67．3％）例临床部分缓解,无进展病例。经过36个月中位随访（18～78个月）,局部复发率11．5％（6/52）;5例术后发生远处转移,远处转移率9．6％（5/52）,其中2例已死亡。保乳综合治疗后满1年进行乳腺外形评估,外形优17．3％（9/52）,良40．4％（21/52）,差42．3％（22/52）。[结论]经新辅助化疗降期后的局部进展期乳腺癌保乳手术治疗效果满意,严格把握新辅助化疗后的保乳指征,规范的手术治疗及术后综合治疗是保乳治疗成功,降低局部复发率的关键。     

Annual fat mass change is a significant predictor of mortality in female hemodialysis patients.

BACKGROUND: Although obesity confers an increased risk of mortality in the general population, it has been reported to be associated with improved survival in dialysis patients. However, the influence of fat mass change over time on mortality in dialysis patients has not been determined. METHODS: This relationship was examined in 190 female maintenance hemodialysis patients. Fat mass was measured twice with a 12-month interval, using dual energy X-ray absorptiometry (DEXA). The patients were followed up for 5 years, and predictors for all-cause death were examined using Kaplan-Meier analysis and Cox proportional hazards analyses. RESULTS: During the 5-year follow-up period, 65 patients died. Annual fat mass changes in the expired group tended to be greater than in the surviving group (-1.0 +/- 2.5 vs. -0.3 +/- 2.6 kg; P = 0.0776), although initial body fat mass was not significantly different. Kaplan-Meier analysis revealed that patients with decreased fat mass (N = 110) had a significantly lower survival rate, compared with those with increased fat mass (N = 80; P = 0.021). Multivariate Cox proportional hazards analyses demonstrated that annual fat mass change was a significant predictor of all-cause mortality after adjustments for confounding factors, such as age, serum albumin, serum creatinine, and the presence of diabetes. An increase in annual fat mass of 1 kg reduced mortality by 14.5%. CONCLUSIONS: These results demonstrate that the decrease in annual fat mass is a significant predictor for mortality in female hemodialysis patients. Fat mass change is also a useful parameter for measurement of nutritional status in hemodialysis patients.     

Impact factors of lymph node retrieval on survival in locally advanced rectal cancer with neoadjuvant therapy

BACKGROUNDConventional clinical guidelines recommend that at least 12 lymph nodes should be removed during radical rectal cancer surgery to achieve accurate staging. The current application of neoadjuvant therapy has changed the number of lymph node dissection.AIMTo investigate factors affecting the number of lymph nodes dissected after neoadjuvant chemoradiotherapy in locally advanced rectal cancer and to evaluate the relationship of the total number of retrieved lymph nodes (TLN) with disease-free survival (DFS) and overall survival (OS).METHODSA total of 231 patients with locally advanced rectal cancer from 2015 to 2017 were included in this study. According to the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification system and the NCCN guidelines for rectal cancer, the patients were divided into two groups: group A (TLN ≥ 12, n = 177) and group B (TLN < 12, n = 54). Factors influencing lymph node retrieval were analyzed by univariate and binary logistic regression analysis. DFS and OS were evaluated by Kaplan-Meier curves and Cox regression models.RESULTSThe median number of lymph nodes dissected was 18 (range, 12-45) in group A and 8 (range, 2-11) in group B. The lymph node ratio (number of positive lymph nodes/total number of lymph nodes) (P = 0.039) and the interval between neoadjuvant therapy and radical surgery (P = 0.002) were independent factors of the TLN. However,TLN was not associated with sex, age, ASA score, clinical T or N stage, pathological T stage, tumor response grade (Dworak), downstaging, pathological complete response, radiotherapy dose, preoperative concurrent chemotherapy regimen, tumor distance from anal verge, multivisceral resection, preoperative carcinoembryonic antigen level, perineural invasion, intravascular tumor embolus or degree of differentiation. The pathological T stage (P < 0.001) and TLN (P < 0.001) were independent factors of DFS, and pathological T stage (P = 0.011) and perineural invasion (P = 0.002) were independent factors of OS. In addition, the risk of distant recurrence was greater for TLN < 12 (P = 0.009).CONCLUSIONA shorter interval to surgery after neoadjuvant chemoradiotherapy for rectal cancer under indications may cause increased number of lymph nodes harvested. Tumor shrinkage and more extensive lymph node retrieval may lead to a more favorable prognosis.     

Postremission therapy without prednisolone improves survival in adults with acute leukemia.

This prospective randomized clinical trial was to clarify whether postremission therapy without prednisolone (PSL) was more effective than therapy with PSL in improving the 5-year survival of adults with acute leukemia. Thirty consecutive adult patients with newly achieved complete remission were randomized to receive postremission therapy either with or without PSL between September 1985 and September 1988. The patients ranged from 16 to 57 years in age. Patients treated without PSL had a significantly better 5-year survival rate than those receiving PSL according to Kaplan-Meier analysis (53.5% vs 15.3%, p < 0.05). In the group treated without PSL, eight out of 15 patients were alive at 72 months, and seven patients maintained their first complete remission at 72 months. Among patients with acute lymphoblastic leukemia (ALL) who were treated without PSL the median duration of remission was 24 months, and the survival rate at 72 months was 50.0%. On the other hand, the median survival was only 13 months for the 5 patients with ALL treated with PSL. Thus, it is desirable that adults with acute leukemia are treated by postremission therapy without PSL.     

早期原发扁桃体非霍奇金淋巴瘤的治疗

目的　分析早期原发扁桃体非霍奇金淋巴瘤 (NHL)的治疗。方法　分析 1983年 1月至1997年 12月初治的、有病理证实的 2 13例早期原发扁桃体非霍奇金淋巴瘤。根据AnnArbor分期 ,Ⅰ期 35例 ,Ⅱ期 178例。Ⅰ期单纯放射治疗 12例 ,综合治疗 2 3例 ;Ⅱ期单纯放射治疗 5 7例 ,单纯化疗 2例 ,综合治疗 119例。结果　全组 5年总生存率、癌症相关生存率和无病生存率分别为 6 5 %、70 %和6 1%。全组单纯放射治疗和综合治疗的 5年癌症相关生存率分别为 6 3%和 72 %(P >0 .0 5 ) ,5年无病生存率分别为 5 6 %和 6 2 %(P >0 .0 5 )。Ⅰ期患者单纯放射治疗和综合治疗的 5年癌症相关生存率均为 10 0 %;5年无病生存率分别为 10 0 %和 80 %,两者差异无显著性 (P >0 .0 5 )。Ⅱ期患者单纯放射治疗和综合治疗的 5年癌症相关生存率分别为 5 8%和 6 6 %,两者差异接近有显著性 (P =0 .0 5 1) ;5年无病生存率分别为 46 %和 6 0 %,两者差异有显著性 (P <0 .0 5 )。结论　Ⅰ期原发扁桃体NHL单纯放射治疗和综合治疗均取得好的疗效 ,综合治疗改善了Ⅱ期患者的无病生存率。综合治疗可改善早期扁桃体非霍奇金淋巴瘤患者的生存率。     

新辅助化疗加手术在可切除小细胞肺癌中的疗效分析

目的探讨可手术切除小细胞肺癌以外科手术为主综合治疗的意义。方法回顾性分析2000年1月至2005年1月外科治疗82例小细胞肺癌的临床与生存资料,根据综合治疗方案中手术与化疗的先后顺序将本组患者分为新辅助化疗组(NAC组)与直接手术组。结果 NAC组53例,术前经1～2周期EP方案(足叶乙甙、顺铂)新辅助化疗,有效率81.1%(43/53),3例组织学完全缓解;直接手术组29例。NAC组1、3、5年生存率分别为86.8%、49.1%、28.3%,显著高于直接手术组的79.3%、31.0%、10.3%(P均<0.05),中位生存时间分别为36个月、25个月。结论可手术切除小细胞肺癌应采取以外科手术为主的综合治疗策略,术前确诊并采用NAC能够进一步提高长期生存率。     

伴胸腺瘤的重症肌无力患者治疗和预后

目的研究伴有胸腺瘤的重症肌无力(MG)患者的治疗方法和预后.方法回顾性研究20例经手术证实的MG伴胸腺瘤患者.给予皮质类固醇、放射疗法等治疗,观察患者的远期疗效和生存率.结果显示远期有效率80%(16/20),其中3例(15%)获完全缓解、10例(50%)获药物缓解、3例(15%)症状明显改善;1例症状不变;5年存活率88.9%、10年存活率57.1%;结论手术治疗MG伴胸腺瘤患者远期疗效良好,术后应给予皮质类固醇和放疗等综合治疗,以提高疗效和患者生存率.     

食管癌放疗与放化疗综合治疗的疗效比效

目的 :探讨影响食管癌疗效的因素。材料与方法 :对 1993年 1月至 1999年 9月间病理和临床资料完整的 2 0 0例食管癌进行临床分析。所有病例均为初次治疗 ,经病理证实 ,鳞癌 196例 ,小细胞未分化癌 2例 ,腺癌 1例 ,腺鳞癌 1例 ,按UICC1987分期标准分期 ,原位癌 1例 ,Ⅰ期 3例 ,Ⅱ期 47例 ,Ⅲ期 12 7例 ,Ⅳ期 2 2例 ,全部病例中单纯放疗 (简称单放组 ) 113例 ,放化综合治疗 (简称综合组 ) 87例 ,所有病例均行60 Co或 6MVX线外照射 ,常规设野 ,常规分割 ,1 8～ 2Gy/次·天 ,5次 /周 ,DT5 0～ 73Gy ,有锁骨上淋巴结转移者加照锁骨上区 ,DT5 0～ 70Gy ,综合组多数在放疗结束后给予化疗 ,每 3～ 4周为一周期 ,共 2～ 5个周期不等 ,方案多为DDP +5 -Fu ,有的病例加PYM和或CF。统计分析方法 :生存率分析用Kaplan -MeierMethod ,生存差异性检验采用Log -ranktest,多元回归分析采用CoxProportionalHazardsMode。结果 :随访至 1999年 12月 31日 ,中位随访时间 14个月。 (1～ 80月 ) ,1、 3、 5年生存率综合组分别为 6 0 %、 2 2 %、 10 % ,单放组为 30 %、 11%、 2 % ,两组生存曲线的差异有显著性 ,P =0 0 470 ;1、 3、 5年无远处转移生存率综合组和单放组分别是 80 % ,5 5 % ,37% ;6 0 % ,2 1% ,8% ,两组生存曲线