子宫动脉插管化疗联合放疗治疗晚期宫颈癌36例疗效观察

目的观察子宫动脉插管化疗联合放疗治疗晚期宫颈癌的疗效。方法晚期宫颈癌患者72例,1998年以后收治的36例为A组,1998年以前收治的36例为B组。A组采用超选择子宫动脉插管化疗联合放疗进行治疗,B组单纯放疗。结果两组症状缓解率、肿块消退率、Ⅱ期患者手术率及3、5a存活率相比,P〈均0．01。结论对晚期宫颈癌患者采用宫动脉插管化疗联合放疗,其近、远期疗效明显,可提高宫颈癌手术切除率。     

局部晚期宫颈癌动脉栓塞化疗的近期疗效观察

目的探讨顺铂联合5-氟脲嘧啶方案经子宫动脉置管96 h续贯化疗治疗局部晚期宫颈癌的近期疗效。方法选择肿瘤直径≥4 cm的Ⅰb_2～Ⅲb期宫颈癌患者29例,通过介入方法双侧子宫动脉内灌注顺铂70 mg/m~2,同时栓塞病轻侧子宫动脉,并留管于病重侧子宫动脉主干,5一氟脲嘧啶4 000 mg/m~296 h持续化疗,观察近期疗效及化疗不良反应。结果完全缓解18例,部分缓解8例,总有效率为89.6%;所有患者均有不同程度胃肠道反应,2例患者出现轻度谷丙转氨酶升高(40一80U/L),6例患者出现Ⅰ～Ⅱ°骨髓抑制,1例出现外阴部皮肤红肿脱皮,经对症处理缓解;无一例出现穿刺感染、血肿、下肢血栓形成,未发现肾功能异常患者。结论子宫动脉插管并栓塞+顺铂联合5-氟脲嘧啶方案续贯化疗对局部晚期宫颈癌患者安全有效。     

血管内皮生长因子的表达在动脉化疗栓塞联合腔内放疗治疗宫颈癌中的临床意义

目的评价血管内皮生长因子(VEGF)的表达对动脉化疗栓塞联合术前腔内放疗治疗宫颈癌的临床意义。方法 2000-08～2007-11收治的51例宫颈癌患者中,26例接受了双侧子宫动脉化疗栓塞,其中12例加用了腔内放疗;25例接受了双侧髂内动脉灌注化疗,其中10例加用了腔内放疗。化疗方案均以卡铂为主的联合方案。介入治疗或腔内放疗后2周进行广泛性子宫切除术和盆腔淋巴结清扫术,对治疗前的宫颈活检标本和手术后的标本共102份采用免疫组化方法测定血管内皮生长因子的表达。结果宫颈癌组织中VEGF的阳性表达由治疗前的64.7%下降为45.1%,差异具有统计学意义,治疗前VEGF的阳性表达与FIGO分期、肿瘤分级和病理缓解有明显的相关性。VEGF阳性表达的患者动脉化疗/栓塞或联合腔内放疗后的临床有效率(54.5%,18/33)低于VEGF阴性表达者(77.8%,14/18),但差异无统计学意义(P=0.105)。治疗前VEGF表达阴性的宫颈癌患者5年总生存率和无病生存率均高于表达阳性者(100%、94% vs.73%、75%,P=0.043,P=0.112),总生存率差异具有统计学意义。结论治疗前VEGF表达可能是评价动脉化疗栓塞联合术前腔内放疗治疗宫颈癌临床疗效和预后的指标。     

简化调强放疗联合腔内后装治疗同步化疗治疗ⅡB~ⅣA期宫颈癌的近期疗效

目的探讨简化调强放疗联合腔内治疗及同步化疗治疗ⅡB~ⅣA期宫颈癌的疗效及毒副反应。方法 173例初治宫颈癌患者,分为调强组(75例)和常规组(98例)。调强组采用5野简化调强全盆腔处方剂量给予95%PTV 45~50.4 Gy,1.8~2 Gy/次,5次/w,共25~28次。盆腔及腹膜后淋巴结转移灶,同步加量至55~60 Gy;常规组全盆腔给予处方剂量DT 50 Gy,2 Gy/次,5次/w,共25次。两组中的ⅢB期宫颈癌,采用盆腔前后对穿照射单侧或双侧宫旁,加量10 Gy,使B点剂量达60 Gy。腔内放疗:A点给予6 Gy/次,1次/w,共5~6次。两组病人均接受紫杉醇同步化疗,每周60 mg,4~6 w。结果调强组与常规组的近期总有效率分别为96.0%(72/75),92.9%(91/98);两组比较差异无统计学意义(P>0.05)。放化疗不良反应:胃肠道反应、骨髓抑制、膀胱反应两组无统计学差异,但Ⅰ~Ⅱ级胃肠道反应两组有统计学差异。结论简化调强放疗结合腔内放疗并同步紫杉醇化疗治疗局部晚期宫颈癌近期效果满意,是一种肯定、有效的治疗方法。     

介入动脉灌注化疗联合同步调强放疗进展期食管癌的疗效观察

目的探讨介入动脉灌注化疗联合同步调强放疗进展期食管癌的疗效。方法选取2016年2月-2017年2月我院收治的食管癌患者64例,采用随机数字表法,均分为两组,对照组应用常规的放射治疗方式,观察组应用动脉灌注化疗联合同步强调放疗,比较两组患者治疗的总有效率。结果观察组患者总有效率为93.75%(30/32),对照组总有效率为78.13%(25/32),观察组总有效率明显高于对照组(P0.05)。结论介入动脉灌注化疗联合同步调强疗效可有效治疗进展期食管癌,提高总有效率,改善患者生活质量,提高患者生存率。     

宫颈癌调强放疗联合奈达铂化疗的近期疗效

目的探讨宫颈癌调强放疗联合奈达铂同步放化疗的近期疗效。方法选择宫颈癌患者92例,分为单纯放疗组和放疗联合奈达铂组,放疗方法采用三维调强外照射联合后装腔内治疗,放疗联合奈达铂组为放疗的第1天起予以奈达铂每周20 mg/m2。结果调强放疗联合单药NDP化疗组患者中CR+PR高于单纯放疗组(P0.05),调强放疗联合单药NDP化疗组患者13个月内无复发生存率和无转移生存率明显高于单纯放疗组(P0.05)。结论调强放疗同步联合小剂量单药奈达铂化疗近期疗效可靠,不良反应少,患者耐受性好。     

以顺铂为主的化疗疗法联合调强放疗与图像引导调强放疗对局部晚期咽喉癌患者的疗效及安全性对比

目的对比研究以顺铂为主的化疗疗法联合调强放疗与图像引导调强放疗对局部晚期咽喉癌患者的疗效及安全性。方法选取局部晚期咽喉癌患者70例,以数字法随机分为观察组及对照组各35例。两组均给予以顺铂为主的化疗治疗,在此基础上对照组予联合调强放疗,而观察组联合图像引导调强放疗,对比两组疗效及安全性。结果两组近期疗效总有效率差异无统计学意义(P0. 05)。两组血液毒性、胃肠道不良反应、肝肾功能损伤差异均无统计学意义(均P0. 05)。观察组口干、放射性皮肤炎、放射性黏膜炎的发生率均显著低于对照组(均P0. 05)。两组局部控制率及无病生存率差异均无统计学意义(均P0. 05)。结论以顺铂为主的化疗疗法联合调强放疗或图像引导调强放疗治疗局部晚期咽喉癌的疗效均显著,图像引导调强放疗能更有效降低放疗不良反应发生率。     

晚期鼻咽癌患者调强放疗治疗的2年生存率及预后影响因素分析

目的探讨晚期鼻咽癌患者调强放疗治疗的2年生存率及其预后影响因素。方法选取本院收治的晚期鼻咽癌患者80例为研究对象,患者均接受调强放射治疗(IMRT)。放疗结束4周后,评估放疗效果;随访2年,分析患者的2年生存情况,对影响患者预后的因素进行单因素和多因素Logistic回归分析。结果放疗结束4周后,患者的肿瘤控制率为88. 75%;放疗结束后2年患者无进展生存率为65. 0%、总生存率为77. 5%。多因素Logistic回归分析结果显示,年龄、肿瘤T分期及N分期是影响晚期鼻咽癌患者预后的独立因素,姑息性手术治疗是改善患者预后的保护因素。结论调强放疗治疗晚期鼻咽癌患者可获得较高的肿瘤控制率;高龄、T分期、N分期是晚期鼻咽癌患者预后的独立影响因素,姑息性手术治疗有助于改善患者预后。     

调强放疗联合不同化疗方案治疗局部晚期鼻咽癌的近期疗效观察

目的对比局部晚期鼻咽癌患者调强放疗时分别联合奈达铂+5-Fu(NF)或奥沙利铂+5-Fu(OF)化疗的临床疗效。方法回顾性分析2016-02~2016-05在广西壮族自治区人民医院肿瘤中心收治的40例局部晚期鼻咽癌患者,其中一组采用调强放疗联合NF方案同步化疗(NF组),另一组则采用调强放疗联合OF方案同步化疗(OF组),每组20例,比较两组患者的近期临床治疗效果及不良反应发生情况。结果治疗1个月后,两组疗效差异无统计学意义(P0.05);NF组3级以上严重不良反应中,除口腔黏膜反应高于OF组(P0.05)外,其他不良反应两组的发生率均低于10%,差异无统计学意义(P0.05)。结论调强放疗联合NF方案与OF方案同步化疗治疗局部晚期鼻咽癌的近期疗效相当,OF组的重度口腔黏膜反应相对较低。     

术前介入化疗与栓塞在中晚期贲门癌治疗中的应用价值

目的探讨术前介入化疗与栓塞治疗中晚期贲门癌的疗效。方法对68例中晚期贲门癌患者术前先行介入化疗与栓塞1～2次后再行贲门癌根治术,观察疗效并随访。结果 68例患者中,86.8%（57/68）的患者术前临床自觉症状减轻或消失,术中83.8%（57/68）的患者可见病灶缩小,肿瘤轻度水肿、缺血,术中出血量少,手术易切除。术后病理分期降级者33例,占48.5%。结论晚期贲门癌术前介入化疗及栓塞有较满意的近期疗效。     

超选择经导管子宫动脉分支栓塞治疗子宫肌瘤

目的 探讨超选择经导管子宫动脉分支栓塞治疗子宫肌瘤的临床价值。方法 将65例子宫肌瘤患者分为观察组及对照组。对照组52例插管至子宫动脉主干栓塞,观察组13例使用微导管栓塞子宫动脉肌瘤供血分支。结果 两组临床症状改善情况、性激素水平及子宫、肌瘤的平均体积、缩小率均无显著差异（P均〈0．05）;观察组不良反应发生率为0、平均住院时间6d,对照组为13．5％、11d,P均〈0．05。结论 超选择经导管子宫动脉分支栓塞治疗子宫肌瘤效果确切,术后并发症发生率较低。     

Implementation of uterine artery embolisation for symptomatic uterine fibroids: an inventory

The validity of uterine artery embolisation (UAE ) as an alternative treatment for hysterectomy to treat symptomatic uterine fibroids has been well established. Despite its favourable outcomes, UAE is still only marginally applied in the Netherlands. The aim of this inventory is to identify factors which either restrict or facilitate the implementation of UAE. Gynaecologists and interventional-radiologists in three hospitals in Amsterdam were interviewed by means of questionnaires. One of these hospitals had ample experience in UAE for uterine fibroids, one hospital had just started providing this treatment, and one hospital did not perform UAE. Also patients with symptomatic fibroids who were scheduled for either UAE or hysterectomy were interviewed about the counselling for UAE. The following obstacles in the implementation of UAE were found: lack of knowledge about UAE , absence of a multidisciplinary protocol, and above all, the absence of UAE as one of the treatment options in the Dutch national guideline on the management of menorrhagia. 75% of all patients claimed to be well informed about UAE by their gynaecologist. Our recommendations for the implementation of UAE are: 1) adding UAE to the Dutch guideline for the management of menorrhagia with clearly defined indications and contraindications; 2) educating gynaecologists about UAE; 3) composing a patient information leaflet and a website, and 4) arranging a protocol in a multidisciplinary team.     

Characterization of purified rabbit uterine renin: influence of pregnancy on uterine inactive renin

Using specific antibody raised against renal renin, we have documented that the majority of the uterine renin-like activity in gravid and nongravid uteri is immunoreactive renin. To characterize its physiochemical properties, we obtained highly purified uterine renin by two affinity chromatographic steps, pepstatin and antirenin. Uterine renin has a pH optimum of 6, an apparent mol wt of 38K, and a Km of 1.7 microM for homologous substrate. These properties are identical to those of renal renin and are not influenced by the pregnant state. In the basal state, an inactive form of the uterine enzyme constitute 55 +/- 10% of the total uterine renin. During pregnancy, active renin increased 40-fold as inactive renin fell to 4 +/- 3% of the total renin concentration. The renal renin concentration fell as plasma renin increased during pregnancy. These data suggest that the increased uterine renin concentrations during pregnancy are probably due to increased local production and conversion of renin precursor to the active enzyme. This stimulation of the uterine renin level appears to be independent of renal renin.     

Stimulation of glucose transport in cultured uterine cells by rat and rabbit uterine extracts

Estradiol-17 beta was previously shown to stimulate glucose transport (as measured by phosphorylation of 2-deoxyglucose) in rat uterine tissue in vivo (Meier, D.A. and Garner, C.W. (1987) Endocrinology 121, 1366-1374) but attempts to demonstrate this in uterine organ strips in vitro, in uterine tumor cell lines or in uterine cells in primary culture have been unsuccessful. However, aqueous uterine extracts and uterine luminal fluid did stimulate glucose transport in uterine tumor cells and uterine cells in primary culture. Estradiol in vivo and uterine extracts in vitro each increased the initial rate of glucose transport 1.5- to 3-fold. In each case, 2-3 h were required for the stimulation to be fully expressed. The stimulation was not inhibited by cycloheximide suggesting that protein synthesis was not required. Uteri from ovariectomized rats injected daily for 4 days with 10 micrograms estradiol contained 4-fold more activity than uteri from saline-injected control animals. The activity was acid- and heat-stable, inactivated by trypsin treatment but not removed by dextran-coated charcoal treatment, suggesting that the activity is (or is associated with) a protein. The activity eluted in the 6-12 kDa range upon chromatography on Sephadex G-50. Insulin (1-1000 ng/ml) and epidermal growth factor (1-100 ng/ml) stimulated glucose transport, but only less than 50% of the stimulation by extracts. The substance(s) present in the extracts, possibly a known growth factor, may be involved in the estradiol stimulation of glucose transport and other estradiol actions in vivo.     

Augmentation of the response of mouse uterine epithelial cells to estradiol by uterine stroma

The effect of estrogen on the in vitro growth of mouse uterine epithelial cells was assessed. Epithelial cells from the immature mouse uterus were successfully cultivated in a 1:1 mixture of Dulbecco's Modified Eagle's Medium and Ham's F-12 supplemented with insulin (5 micrograms/ml), transferrin (10 micrograms/ml), hydrocortisone (10(-7) M), BSA (2 mg/ml), and fetuin (1 mg/ml). Addition of 17 beta-estradiol in the range of 1-100 nM did not significantly change the total DNA content of the epithelial cells. A binding component of [3H]estradiol by cultured uterine cells was shown to be specific, saturable, and of high affinity. Kd values for specific binding by epithelial and stromal cells were 1.0-1.7 x 10(-10) M. Maximal specific binding was 0.74 and 2.3 fmol/micrograms DNA for epithelial and stromal cells, respectively. Treatment of epithelial and stromal cells for 4 days with 10 nM estradiol led to a 2- to 6-fold increase in progesterone receptor concentration. Treatment of epithelial and stromal cells in mixed culture for 4 days with 10 nM estradiol resulted in a significant increase in total DNA. That epithelial-stromal contact was critical for estradiol stimulation was shown by the fact that if the cell types were separated into two compartments which still allowed free media mixing, total DNA was not enhanced by estradiol. These observations are organized into a model for mitogenic action of estradiol that seems to reconcile observed disparities in the action of the hormone in vivo and in vitro.