胃癌术后应用盐酸羟考酮控释片直肠给药联合硬膜外自控镇痛的临床观察

目的:探讨盐酸羟考酮控释片(商品名:奥施康定,oxycontin)直肠给药联合硬膜外自控镇痛(PCEA)用于胃癌术后镇痛的疗效以及安全性。方法:将100例胃癌患者随机分为4组,A组采用PCEA镇痛,B组采用PCEA+盐酸羟考酮控释片塞肛镇痛,C组采用盐酸羟考酮控释片塞肛镇痛,D组采用半量PCEA及盐酸羟考酮控释片塞肛镇痛。观察记录各组患者的术后镇痛效果、肠鸣音恢复情况、肛门排气时间,以及恶心、呕吐和便秘等不良反应。结果:4组镇痛效果满意率的差异有统计学意义,P=0.011;B、D两组镇痛效果满意度高于A、C两组;4组肛门排气时间之间的差异有统计学意义,P<0.05;C、D两组的肛门排气时间短于A、B两组,P<0.05。结论:半量的盐酸羟考酮控释片联合PCEA用于胃癌术后镇痛效果可靠,且对肠功能恢复无明显影响。     

ⅠL-33、ⅠL-35在晚期胃癌术后加味五苓散联合超声药物透入治疗中的临床意义

目的：分析加味五苓散联合超声药物透入在晚期胃癌患者术后恢复胃肠道功能中的价值。方法将68例行晚期胃癌术后患者随机分为试验组和对照组,2组综合治疗相同,试验组加用加味五苓散联合超声药物透入治疗,观察2组患者血清ⅠL-33、血清ⅠL-35、腹围变化、肠鸣音恢复、肛门排气排便及住院时间。结果试验组血清ⅠL-33、ⅠL-35较对照组明显下降（ P＜0.05）;2组腹围差在治疗后48 h、72 h、96 h及120 h时比较差异均有统计学意义（ P均＜0.05）;2组肠鸣音恢复、排气、排便时间比较差异均有统计学意义（ P均＜0.05）。结论加味五苓散联合超声药物透入治疗可促进胃癌患者术后肠鸣音恢复、加快胃肠功能、减轻腹胀;血清ⅠL-33、ⅠL-35可评估治疗效果。     

IL-33、IL-35在晚期胃癌术后加味五苓散联合超声药物透入治疗中的临床意义

目的 分析加味五苓散联合超声药物透入在晚期胃癌患者术后恢复胃肠道功能中的价值。方法将68例行晚期胃癌术后患者随机分为试验组和对照组,2组综合治疗相同,试验组加用加味五苓散联合超声药物透入治疗,观察2组患者血清IL-33、血清IL-35、腹围变化、肠鸣音恢复、肛门排气排便及住院时间。结果 试验组血清IL-33、IL-35较对照组明显下降(P<0.05);2组腹围差在治疗后48 h、72 h、96 h及120 h时比较差异均有统计学意义(P均<0.05);2组肠鸣音恢复、排气、排便时间比较差异均有统计学意义(P均<0.05)。结论 加味五苓散联合超声药物透入治疗可促进胃癌患者术后肠鸣音恢复、加快胃肠功能、减轻腹胀;血清IL-33、IL-35可评估治疗效果。     

达芬奇机器人胃癌根治术对患者胃肠动力及胃肠激素的影响

目的 研究达芬奇机器人胃癌根治术对患者胃肠动力和激素的影响。 方法 选择行胃癌根治术的患者217例,按照不同手术方式分为达芬奇组和开腹手术组。记录两组术后肠鸣音恢复时间、首次肛门排气时间并测定术前及术后胃肠激素、手术相关因素及炎性因子水平后行统计分析。 结果 达芬奇组术后肠鸣音恢复时间和首次肛门排气时间均短于开腹组（均P<0.05）。两组术后24 h血液胃动素、胃泌素和生长抑素的测量值均明显较术前12 h下降（均P<0.05）,而血管活性肠肽的测量值均显著升高（P<0.05）;术后24 h达芬器组胃动素和胃泌素的测量值均高于开腹组（均P<0.05）,而血管活性肠肽的测量值低于开腹组（P<0.05）;所有患者术后肠鸣音恢复时间和首次肛门排气时间与术后24 h血液胃动素、胃泌素值负相关（均P<0.05）,与血管活性肠肽值正相关（P<0.05）。两组手术时长、术中出血量、术后拔除引流管时间、术后疼痛VAS评分以及炎性相关因子间差异有统计学意义（均P<0.05）。 结论 达芬奇机器人胃癌根治术患者胃肠动力恢复明显快于传统开腹术;而创伤引起的炎性反应、应激反应可能是影响患者胃肠激素分泌的重要因素。     

厚朴排气合剂在胃癌术后胃肠道功能恢复中的作用

目的:探讨厚朴排气合剂对于胃癌术后早期胃肠功能恢复的影响。方法:将87例胃癌患者随机分为治疗组和对照组,治疗组常规方法处理基础上加用厚朴排气合剂,观察术后首次肠鸣音出现时间、排气排便时间、恶心呕吐及腹胀发生情况并进行统计学分析。结果:治疗组的规律肠鸣音出现时间、第一次排便排气时间均明显短于对照组（P<0.05）,恶心呕吐及腹痛腹胀等不良反应发生率均明显低于对照组（P<0.05）。结论:胃癌术后早期应用厚朴排气合剂不但可以恢复胃肠功能,而且可以减少术后并发症的发生。     

奥施康定联合氟比洛芬酯治疗晚期胃癌骨转移的临床观察

目的 分析奥施康定联合氟比洛芬酯治疗晚期胃癌骨转移患者的镇痛效果。方法 选取2020年8月至2022年3月我院收治的153例晚期胃癌骨转移患者的临床病历资料，根据患者治疗方式不同分为对照组(奥施康定)72例与观察组(奥施康定联合氟比洛芬酯治疗)81例。比较两组患者疼痛缓解效果；比较两组Mcmil Lan疼痛评分[包含疼痛分级指数(PRI)、目测类比定级法(VAS)、现有疼痛强度(PPI)];记录镇痛起效时间、爆发疼痛次数、镇痛药物用量；观察不良反应。结果 治疗后观察组患者疼痛缓解效果明显优于对照组，差异有统计学意义(P<0.05)。治疗前两组PRI、VAS、PPI评分比较均无差异(P>0.05),治疗后PRI、VAS、PPI评分均降低(P<0.05),观察组治疗后PRI、VAS、PPI评分明显低于对照组(P<0.05)。观察组镇痛起效时间快于对照组，爆发疼痛次数、镇痛药物用量均少于对照组(P<0.05)。两组不良反应总发生率差异无统计学意义(P>0.05)。结论 奥施康定联合氟比洛芬酯可降低晚期胃癌骨转移者Mcmil Lan疼痛评分，提高综合镇痛水平...     

胃癌术后早期肠内营养支持71例分析

[目的]探讨胃癌术后早期实施肠内营养的合理方案。[方法]将71例胃癌术后随机分为全肠内营养组（TEN）32例，肠内营养（EN）＋肠外营养（PN）组39例．分别于术后24h后予营养支持，临床观察营养支持期间胃肠功能恢复情况，有无腹胀、腹泻、呕吐等并发症。[结果]临床观察肛门恢复排气时间TEN组较EN＋PN组略短（P〉0．005），胃肠道相关并发症TEN高龄患者（年龄〉60岁）较EN＋PN高龄患者多（P〈0．05），但TEN组非高龄患者与EN＋PN组非高龄患者比较无显著性差异。[结论]高龄胃癌患者术后EN应联合应用PN．逐渐过渡TEN，可减少胃肠相关并发症。     

胃癌术后超声药物透入联合针灸治疗促肠功能恢复及IL-35、miRNA-488意义的研究

目的探讨超声药物透入治疗联合针灸在胃癌术后促进胃肠道功能恢复中的作用。方法将79例胃癌术后患者随机分为实验组和对照组,在综合治疗方法相同的情况下,实验组加用超声药物透入联合针灸治疗,观测两组患者血清IL-35、miRNA-488,腹围变化,肠鸣音恢复、肛门排气、排便等胃肠功能恢复情况,以及住院时间。结果术后120 h实验组血清IL-35、miRNA-488较对照组下降明显(P0.05)。术后48 h、72 h、96 h及120 h时实验组患者的腹围减小速度快于对照组,腹围变化值比较差异有统计学意义(P0.05);实验组在术后120 h时腹围变化进入平台期,即腹围基本恢复正常,比对照组缩短约24 h。肠鸣音恢复时间、肛门初次排气排便时间两组比较也具有统计学意义(P0.05)。两组24 h腹围变化值、住院时间相比,差异无统计学意义(P0.05)。结论超声药物透入联合针灸治疗可促进胃癌术后患者肠鸣音恢复及排气排便,减轻腹胀,加快胃肠功能恢复。血清IL-35、miRNA-488可评估超声药物透入联合针灸治疗的疗效。     

盐酸羟考酮缓释片与硫酸吗啡缓释片治疗晚期恶性肿瘤重度疼痛的比较观察

目的观察盐酸羟考酮缓释片（奥施康定）与硫酸吗啡缓释片（美施康定）治疗晚期恶性肿瘤重度疼痛的临床效果及毒副反应。方法58例晚期恶性肿瘤重度疼痛患者随机分为2组,奥施康定组30例,美施康定组28例。奥施康定起始剂量10mg·（12h）-1,美施康定起始剂量20mg·（12h）-1,根据疼痛缓解程度调整剂量,评价镇痛效果及毒副反应。结果2组患者疼痛程度均显著减轻,镇痛总有效率分别为96．7％、96．4％,比较差异无统计学意义（P〉0．05）。奥施康定组起效更快,其起效时间均为1h之内,而美施康定组起效时间为2～3h。奥施康定组的毒副反应发生率为40．0％,低于美施康定组的53．6％,差异有统计学意义（P〈0．05）。2组均无严重毒副反应发生。结论奥施康定与美施康定治疗晚期恶性肿瘤重度疼痛的临床效果相近,但奥施康定起效更快,毒副反应更轻,服用安全,是治疗晚期恶性肿瘤重度疼痛的首选药物之一。     

术后早期肠内营养对胃癌术后胃肠功能恢复和营养状况的影响

目的 观察术后早期肠内营养对胃癌术后胃肠功能恢复以及和营养状况的影响.方法 收集胃癌手术患者共90例,随机分为对照组45例和观察组45例.对照组于术后24h开始进行肠外营养,观察组于术后24h起进行肠内营养.比较2组排气和排便时间及肠鸣音恢复时间.检测2组腹胀发生情况.应用酶联免疫法(Elisa)测定2组前白蛋白(PA)、白蛋白(ALB)和生长激素(GH)水平.结果 术后观察组患者的排气、排便以及肠鸣音恢复时间明显少于对照组(P＜0.01).术后24 h和48 h观察组的腹胀发生率显著低于对照组(P＜0.01).观察组患者胃肠功能恢复优良率为53.33％,对照组为28.89％,2组差异有统计学意义(P＜0.05).术后10d,观察组患者血清PA、ALB和GH水平显著高于对照组(P＜0.01).结论 胃癌术后早期肠内营养可促进胃肠功能恢复,改善机体营养状况.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.