化学栓塞治疗血吸虫病大肠癌肝转移40例报道

为探讨血吸虫病大肠癌切除术后肝转移的化学治疗。对 40例血吸虫病大肠癌肝转移患者行化学栓塞治疗 ,通过肝动脉的选择性血管造影术识别转移的营养血管 ,向该血管注射化学乳剂 (由 10 0 m g 5 - Fu,10 mg MMC和 10 ml超液化碘化罂粟油 ) ,然后用止血棉塞栓塞 ,直到血液不流动为止。结果显示 ,从第一次化学栓塞起 ,总的中数生存期为 10个月。当肝硬化程度按 Child- Pugh分级时 ,A级与 B级的中数生存期较有肝外转移者高 (P<0 .0 2 ) ,分别为 14个月和 3个月 ;血管多的转移癌中数生存期较血管少的转移癌的中数生存期高 ,有显著差异 (P<0 .0 1) ;最常见的副作用是短暂的发热、腹痛和疲劳 ;在化疗过程中有 3人死亡。血吸虫病大肠癌肝转移全身化疗的疗效不佳 ,且副作用较多 ,选择性化学栓塞治疗不仅疗效好 ,且副作用少 ,可预防肝功能衰竭 ,延长生存期     

纤维支气管镜检查对肺癌的诊断价值

本文报告了经纤支镜检确诊肺癌５０２例，描述了肺癌的组织学类型与纤支镜下的独特表现。着重分析了鳞癌、腺癌、未分化癌纤支镜下表现与病理类型的关联，并对如何提高镜下取材阳性率以及纤支镜检对肺癌手术根治有何指导意义进行分析。     

经颈静脉肝内门体支架分流术的并发症及其防治

目的探讨经颈静脉肝内门体支架分流术（ｔｒａｎｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｔｅｎｔ－ｓｈｕｎｔ，ＴＩＰＳＳ）的并发症及其防治。方法分析３１例行ＴＩＰＳＳ术患者的情况。结果手术成功率９６７％，术后近期并发症有转氨酶升高（１００％）、术后炎性反应（３２２％）、胆道出血（６４％）、术后死亡（６４％）、腹膜炎（３２％）。术后远期并发症有胆红素升高（５４８％）、白蛋白下降（２９０％）、支架狭窄或阻塞（１９３％）、低蛋白水肿（１６１％）、肝性脑病（１６１％）、合并肝癌（６４％）。结论ＴＩＰＳＳ术应严格掌握适应证并应严密注意术后并发症的防治。     

RECOVERY OF ADRENAL FUNCTION AFTER TREATMENT OF ADRENOCORTICAL CARCINOMA WITH o,p''-DDD

The adrenolytic agent, 2,2-bis[2-chlorophenyl-4-chlorophenyl] 1,1 dichloroethane (o,p'-DDD), was used over a 20-month period following surgery in a 2 3/12-year-old girl for treatment of adrenocortical carcinoma. The child remained free of disease and was maintained on glucocorticoid and mineralo-corticoid supplements for 7 years. Hormonal evaluation was undertaken at 9 9/12 years of age to determine remaining adrenal steroidogenic capacity. Following discontinuation of both hydrocortisone and 9 alpha-fludrocortisone, she remained stable and asymptomatic. Immediately after discontinuing 9 alpha-fludrocortisone, the adrenal glomerulosa was able to respond to stimulation by the renin-angiotensin system as shown by the ability to achieve renal sodium conservation on a restricted sodium intake (less than 10 mEq/d for 5 d). The response of the adrenal fasciculata to ACTH stimulation showed a slower recovery. Baseline levels of cortisol were in the low normal range, but there was no increase in plasma cortisol or urinary 17-hydroxysteroids following stimulation with ACTH. The responses of cortisol, deoxycorticosterone, and corticosterone to ACTH stimulation gradually improved to achieve normal stimulated levels 18 months after stopping medications. Serum testosterone and delta 4-androstenedione were initially increased for level of puberty, while levels of dehydroepiandrosterone were prepubertal. Testosterone and delta 4-androstenedione did not suppress with dexamethasone (2 mg/d for 2 d; 4 mg/d for 2 d), and dehydroepiandrosterone decreased only slightly. However, administration of norethindrone (Norlutin) (10 mg orally, three times a day for 3 d) resulted in suppression while human chorionic gonadotrophin (hCG; 5000 U i.m. daily for 3 d) produced stimulation of testosterone, delta 4-androstenedione and dehydroepiandrosterone. Thus the androgens were felt be predominantly of ovarian origin. Dehydroepiandrosterone rose to low normal levels by 18 months after discontinuation of hydrocortisone. We thus demonstrate for the first time that both the adrenal glomerulosa and fasciculata have the capacity to recover normal function following treatment with o,p'-DDD. Further, we suggest that early exposure to excess adrenal androgens may result in mild alteration of gonadal function.     

LONG-TERM TREATMENT OF METASTATIC MEDULLARY THYROID CARCINOMA WITH THE SOMATOSTATIN ANALOGUE OCTREOTIDE

Three patients with symptomatic metastatic medullary thyroid carcinoma (MTC), one with sporadic form and two with MEN IIa, were treated with the long-acting somatostatin analogue octreotide (SMS 201-995, Sandoz) for 3 to 17 months. Octreotide was administered subcutaneously in a starting dose of 0.6 to 1.0 mg/day by automatic pump (Travax ASH6, Travenol). Symptoms of diarrhoea, weight loss and malaise improved in all patients. Maximal percentage decrease in mean serum calcitonin was 47, 52 and 81% of the basal values, and was observed 1-3 months from the beginning of treatment. Likewise, carcinoembryonic antigen (CEA) levels initially dropped to 45, 60 and 63% of the levels before therapy. A continuing effect was seen in the two patients with MEN IIa after 15 and 17 months of treatment. However, after the initial decrease, calcitonin (CT) levels went up again to 67 and 68% of the basal values and the dose of octreotide had to be increased to 1.5 mg and 2.0 mg/day. CEA also returned to 84 and 105% of the pretreatment titres. Response to 1.5 mg/day octreotide was lost in the patient with the sporadic form of disease after 3 months. Side-effects were minimal. Effects on tumour size could not be evaluated. These suggest that octreotide might be a valuable adjuvant in the long-term management of metastatic MTC. Tachyphylaxis may occur.     

肝癌动脉化疗栓塞术中肝脏能量储备功能研究 

对３６例行ＴＡＥ治疗的肝癌患者，术前氧化还原耐受指数（ＲＴＩ）及术后动脉血酮体比（ＡＫＢＲ）测定来评价肝脏能量储备功能。按术后ＡＫＢＲ值分Ａ：≥０．７，Ｂ：０．４～０．７及Ｃ：＜０．４，在ＲＴＩ≥０．５的２１例中，属Ａ、Ｂ及ｃ者分别为１５、６及０例，术后１个月内无死亡；而在ＲＴＩ＜０．５的１５例中，属Ａ、Ｂ及ｃ者分别为５、８及２例，术后１个月内Ｂ有１例死亡，Ｃ中２例均死亡。由此认为术前ＲＴＩ及术后ＡＫＢＲ测定可准确判断患者肝脏能量储备功能并评价预后。     

老年肝门部胆管癌的诊治特点

目的探讨老年肝门部胆管癌的诊治特点。方法回顾性分析111例60岁以上肝门部胆管癌的临床资料及随访情况。结果43例行肿瘤根治性切除，10例行肿瘤姑息性切除，20例行手术胆道引流，38例行内镜置管或PTCD引流。行根治性或姑息性肿瘤切除的患者，减黄效果、生活质量改善及术后生存时间均明显优于其他方法。结论对老年肝门部胆管癌的手术治疗应持积极态度。     

老年大肠癌急性梗阻的外科治疗

目的 探讨老年大肠癌急性梗阻外科治疗的有关问题。方法 回顾性分析1994年1月至2000年3月41例65岁以上老年大肠癌急性梗阻病人的外科处理。结果 老年大肠癌急性梗阻以右半结肠居多,占63．41％,一期切除31例,占75．61％,其中根治性切除26例,结肠造口4例,短路6例,围手术期死亡4例。结论 对老年大肠癌急性梗阻应加强术前诊断和认识,充分的术前准备,适当的手术时机和手术方式的选择,加强围手术期的营养支持,是手术成功的有效措施。