1030例早期乳腺癌术后放疗不同年龄组的预后分析

Objective To analyze the prognostic value of age in patients with early stage breast cancer. Methods The clinical characteristics of 1030 patients with early stage breast cancer (the number of positive axillary lymph nodes was less than 3) were retrospectively reviewed. Of all the patients, 468(stage Ⅰ, n = 227; and stage Ⅱ , n = 241) received breast conserving surgery (BCS) and 562 (stage Ⅰ, n =184; and stage Ⅱ, n= 378) received modified mastectomy. Patients were divided into young-age group (≤35,136 patients), middle-age group (> 35-≤60,738 patients) and old-age group (> 60,156 patients).The number of patients without postoperative radiation therapy after BCS is 16, 60 and 39 in the three groups, respectively. Two-dimensional conventional fractionated radiotherapy was administered. The prognostic value of the tumor size, status of axillary lymph nodes or hormonal receptors, postoperative radiation therapy were analyzed. Results The follow-up rate was 97.86%. Of 795 patients followed up more than 5 years, 110,569 and 116 patients were devided into the three groups, respectively. There were 40, 202 and 87 patients without radiation therapy in the three groups. The 5-year recurrence rates of the three groups were 6. 2%, 8. 7% and 10. 4% (χ2 = 1.14, P= 0.567). The 5-year distant metastasis rates were4.3% , 9.5 % and2. 5% (χ2 = 5.31 , P = 0. 070) . The5 - year survival rates were9l. 2% , 92. 6%and 82. 1% (χ2 = 6. 83, P = 0.033). The young-age group had more tumors smaller than 2. 0 cm (65.4%), less positive axillary lymph nodes (13.2%), poorer differential tumor and less positive hormone acceptors (48.0%). Of patients with tumor larger than 2. 0 cm who had no radiotherapy after BCS, the 5-year survival rates were 94%, 87% and 71% (χ2= 20.69, P= 0.000) in the three groups. The corresponding recurrence rates were 23%, 18% ,7%, (χ2 = 9. 97, P = 0. 007), and distant metastasis rates were23%, 25% and 10% (χ2 =8.51, P=0. 014). Conclusions The age is an important prognostic factor in patients with early stage breast cancer undergoing BCS, but not in those undergoing modified mastectomy.     

Operable Breast Cancer： a Clinical Analysis of 6,263 Cases

OBJECTIVE In Europe and America breast cancer commonly occurs in women of middle and old age, with a median age of about 57 years. Modified radical mastectomy now called standard radical mastectomy, has taken the place of traditional radical mastectomy. Patients with breast cancer at an early stage commonly receive BCT (breast conservative therapy). The TNM stage (especially the lymph node status) affects the prognosis, and adjuvant therapy can improve survival. In China, only a few reports have been pubIished studying large numbers of breast cancer patients. This study was designed to analyze the clinical features, surgical pattern and treatment outcome of resectable breast cancer, as well as to explore the prognostic factors and the effect of adjuvant therapy, with a goal to improve the level of diagnosis and treatment.METHODS Records of the 6,263 patients with resectable breast cancer who had been admitted into our hospital from June 1964 to June 2003 were analyzed retrospectively.RESULTS Of the 6,263 cases, 98.8% were female. Breast cancer occurred most frequently in patients of ages 40～49 years (41.0%), especially in patients 45～49 years old (25.2%). A breast lump, which occurred in 96.2% of the patients, was the main clinical manifestation. The overall 5- and 10-year survival rates were 75.16% and 40.44%. Of the patients in TNM stages 0-1,Ⅱ, and Ⅲ, the 5-year survival rates were 96.8%, 73.7% and 46.4% respectively and the 10-year survival rates were 78.7%, 64.6% and 33.5% respectively. The 5-, and 10-year survival rates were higher in the lymph node negative group than in the lymph node positive group (80.3% vs. 55.6%, and 59.2% vs. 31.9%, P＜0.01). Since the 1980s there was no significant difference in survival rates of patients who received a radical mastectomy compared to a modified radical mastectomy(P＞0.05). Of the 73 patients who underwent breast conservative therapy, no local recurrence or metastasis occurred during a maximal follow-up of 17 years. Of the patients in stage T2T4, the 5-, and 10-year survival rates were significantly higher in the group treated with adjuvant chemotherapy compared to the non-chemotherapy group (78.2% vs. 60.1%, and 48.9% vs. 30.7%, P＜0.01).CONCLUSION According to our data, breast cancer most frequently occurred in patients of ages 45～49 years. The TNM stage (especially the lymph node status) relates to breast cancer prognosis. The prognosis was worse in patients with positive lymph nodes compared to the patients with negative lymph nodes. The efficacy of a modified radical mastectomy is equal to that of a radical mastectomy, and breast conservative therapy can be applied to patients in an early stage. Adjuvant chemotherapy and endocrine therapy can improve the survival of resectable breast cancer patients.     

The cardiotoxicity and long-term efficacy of different doses of epirubicin in the adjuvant treatment of breast cancer patients：A case control study

Abstract Objective： The aim of the study was to observe the cardiac toxicity caused by different doses of epirubicin in the adjuvant treatment of breast cancer and to evaluate the long-term efficacy. Methods： The 180 cases of breast cancer patients received epirubicin based adjuvant chemotherapy. The patients were randomly assigned to high-dosage group （90 rag/m^2）, medium-dosage group （70 mg/m^2） and low-dosage group （50 rag/m^2）, the primary endpoint was cardiac toxicity. The secondary outcomes were the 5-year overall survival （OS） and 5-year disease-free survival （DFS）. Results： During chemo- therapy, the clinical symptoms such as palpitation, dyspnea and paroxysmal nocturnal dyspnea occurred in 6 patients with the high-dosage group, 4 patients with the medium-dosage group and 3 patients with the low-dosage group. The number of patients who had changed in electrocardiogram （ECG） was 7, 5 and 4 in three groups, respectively. The echocardiographic showed each group had only one case with LVEF 〈 50%, there was no significantly difference （P 〉 0.05）. In the three groups, the 5-year DFS rates were 73.3% （44/60） in high-dose group, 53.3% （32/60） in medium-dose group and 41.6% （25/60） in low dose group. The 5-year OS rates were 85.0% （51/60）, 68.3% （41/60） and 58.3% （35/60） in three groups, respectively. The differences were statistically significant （P 〈 0.05）. Conclusion： The high-dose epirubicin in adjuvant chemotherapy with CEF （cyclophosphamide, epirubicin and fluorouracil） regimen could improve the 5-year OS rate and 5-year DFS rate on patients of breast cancer. The cardiotoxicity was mild-moderate and well tolerated.     

Efficacy of Yanshu injection (a compound Chinese traditional medicine) combined with concurrent radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma

Objective To evaluate the efficacy and toxicity of Yanshu injection (a compound Chinese traditional medicine from Sophora flauescens Ait) combined with concomitant radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma. Methods Sixty patients with stage Ⅲ nasopharyngeal carcinoma were randomized into Yanshu group and control group (n =30, each). Patients in the Yanshu group received Yanshu injection in addition to intensity modulated radiation therapy ( IMRT) and concomitant chemotherapy, and those in the control group were treated with IMRT and concurrent chemotherapy. Results The 1-year, 2-year, 3-year and 4-year overall survival rates were 100%, 93.3%, 86.7% , 80. 0% for Yanshu group, and 96. 7% , 90. 0% , 83. 3% , 76. 7% for the control group, respectively, with no significant difference between the two groups ( P = 0.565). The 1 -year, 2-year, 3-year and 4-year progression-free survival rates were 96.7% , 90. 0% , 83. 3% , 70. 0% for Yanshu group, and 90.0% , 86.7% , 76. 7% , 66. 7% for control group, respectively, with no significant difference (P = 0.554). However, the reaction of mucosa of oral cavity, myelosuppression and thrombocytopenia in the Yanshu group were significantly lower than that in the control group (P < 0. 05). The quality of life of the patients in the Yanshu group was significantly higher than that in the control group ( P < 0. 05 ). Conclusions Yanshu injection combined with radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma show a good efficacy and can reduce the side effects of radiochemotherapy of nasopharygeal carcinoma, and improve the quality of life of the patients.     

Efficacy of Yanshu injection (a compound Chinese traditional medicine) combined with concurrent radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma

Objective To evaluate the efficacy and toxicity of Yanshu injection (a compound Chinese traditional medicine from Sophora flauescens Ait) combined with concomitant radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma. Methods Sixty patients with stage Ⅲ nasopharyngeal carcinoma were randomized into Yanshu group and control group (n =30, each). Patients in the Yanshu group received Yanshu injection in addition to intensity modulated radiation therapy ( IMRT) and concomitant chemotherapy, and those in the control group were treated with IMRT and concurrent chemotherapy. Results The 1-year, 2-year, 3-year and 4-year overall survival rates were 100%, 93.3%, 86.7% , 80. 0% for Yanshu group, and 96. 7% , 90. 0% , 83. 3% , 76. 7% for the control group, respectively, with no significant difference between the two groups ( P = 0.565). The 1 -year, 2-year, 3-year and 4-year progression-free survival rates were 96.7% , 90. 0% , 83. 3% , 70. 0% for Yanshu group, and 90.0% , 86.7% , 76. 7% , 66. 7% for control group, respectively, with no significant difference (P = 0.554). However, the reaction of mucosa of oral cavity, myelosuppression and thrombocytopenia in the Yanshu group were significantly lower than that in the control group (P < 0. 05). The quality of life of the patients in the Yanshu group was significantly higher than that in the control group ( P < 0. 05 ). Conclusions Yanshu injection combined with radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma show a good efficacy and can reduce the side effects of radiochemotherapy of nasopharygeal carcinoma, and improve the quality of life of the patients.     

延迟辅助化疗对乳腺癌患者生存期的影响(英文)

Objective: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. It is usually prescribed within 2-3 months after definitive surgery. The aim of this retrospective study was to assess the impact of adjuvant chemotherapy (CT) delay beyond 3 weeks ( 21 days) in premenopausal patients with ER-absent tumors being treated for early stages breast cancer on overall survival (OS) and disease-free survival (DFS). Methods: This retrospective study was conducted through revision of medical records of premenopausal patients diagnosed with early stage Ⅰ-ⅢA breast cancer and ER-absent tumors who received adjuvant CT after definitive surgery at the Department of Clinical Oncology, Ain-Shams University Hospitals. Results: Between 2005 and 2008, 105 patients were retrospectively analyzed and included. Patients were divided into 2 groups: Group A including 48 patients who started adjuvant CT<21 days of surgery and group B which included 57 patients who had CT delay ≥ 21 days. Both groups were matched demographically. Comparisons of overall survival, and disease-free survival between group A and group B patients all favored group A. At 5-year the OS rates were 87% and 73% for groups A and B respectively (P=0.001), while DFS rates were 85% and 64% in groups A and B respectively (P=0.001). Analysis of other prognostic factors (age, T, N, grade, HER2 status, surgery type, CT type, local radiotherapy received) were analyzed. Only nodal status predicted for worse DFS (P=0.05) and OS (P=0.006). Conclusion: Delay in initiating adjuvant chemotherapy for early stage breast cancer patients with ER-absent tumors was associated with a decrease in both OS and DFS rates.     

Expression of Presenilin-2 and Glutathione S Transferase π and Their Clinical Significance in Breast Infiltrating Ductal Carcinoma

Objective: To investigate the expressions of presenilin-2 (PS2) and glutathione S transferase π (GSTπ) and their roles in prognosis and therapy of breast infiltrating ductal carcinoma. Methods:The paraffin-embedded specimens of 210 patients with breast infiltrating ductal carcinoma were examined by using LSAB immunohistochemistry for the expression of PS2 and GSTπ. Results: The expression rate of PS2 and GSTπ was 49.5% (104/210) and 48.1% (101/210) respectively. The 5-year and 10-year postoperative survival rates in 4 groups, from high to low, were group 1 (PS2 positive expression/GSTπ negative expression), group 2 (PS2 positive expression/GSTπ positive expression), group 3 (PS2 negative expression/GSTπ negative expression) and group 4 (PS2 negative expression/GSTπ positive expression) in turn. Conclusion: The prognosis of the group 1 was the best, followed by the group 2, group 3 and group 4 in turn. These results suggested that the reasonable use of endocrinotherapy and chemotherapy for patients with breast infiltrating ductal carcinoma is necessary.     

Implantation of 125Ⅰ seeds for recurrence cervical node of head and neck tumor after external beam radiotherapy

Objective To summarize the efficacy and the feasibility of 125I seed implantation for recurrence cervical lymph node of head and neck tumor after radiotherapy or radiotherapy plus neck dissection. Methods Thirty-six patients with the recurrence cervical lymphnode of head and neck tumor after radiotherapy (17 patients) or radiotherapy plus neck dissection (19 patients) were treated with 125I seed implantation guided by ultrasound or CT under local anesthesia. The median number of seeds was 27( range from 3 to 78 ). Postoperative quality evaluation were routinely obtained for all patients. The actuarial D90 ranged from 90-160 Gy (median, 130 Gy). Results The follow-up rate was 100%. The number of the patients who were followed up over 1-and 2-year were 11 and 3. The overall response rate was 81%. The 1-and 2-year over local control rates, over survival rates were 69% and 35%, 50% and 22%, respectively.The 1-and 2-year local control rates in patients with recurrence node after radiotherapy plus neck dissection were 72% and 54%, while those were 67% and 50% in patients with recurrence node after radiotherapy,respectively (χ2=00,P=0.965). The 1-and 2-year survival rates in two groups were 48%, 13% , and 51%, 39%, respectively (χ2=0.17, P=0.676). Conclusions 125I seed implantation is a safe,minimal invasive with low morbidity and high efficacy salvage treatment method for cervical lymph node recurrence of head and neck tumor after radiotherapy with or without neck dissection.     

Retrospective analysis of results of treatment for nasopharyngeal carcinoma in Macao

Background： Nasopharyngeal carcinoma （NPC） is a common malignancy in Southeast Asia, however, a full consensus has not yet been reached as to the value of comprehensive treatment for NPC. This study was designed to evaluate the epidemiological characteristics of NPC and their prognostic value, as well as the long-term efficacy of NPC treatment. Patients and methods： A total of 248 patients, with different stages of NPC, were included in this study. Results： The 5-year overall survival （OS） rates for patients in stages I, II, lII and IV were 90.48%, 76.71%, 76.89% and 33.87%, respectively （P=0.000）, while the respective 5-year progression-free survival （PFS） rates were 85.15%, 72.36%, 63.88% and 26.26% （P=0.000）. The respective 5-year OS rates, according to stage, for the group that received radiotherapy combined with chemotherapy and for the group that received radiotherapy only were as follows： stages I and II, 81.67% and 79.59% （P=0.753）; stage III, 79.91% and 70.38% （P=0.143）; stage IV,, 35.22% and 0% （P=0.000）. The respective 5-year PFS rates in these groups were as follows： stages I and II, 75.83% and 74.98% （P=0.814）; stage III, 74.08% and 42.25% （P=0.027）; stage IV,, 27.31% and 0% （P=0.000）. Conclusions： Clinical staging appears to be the most important prognostic factor for NPC. As the stage number increases, both the 5-year OS and PFS significantly decrease. Adding chemotherapy to radiotherapy was not advantageous for patients with stage I or II NPC, however the addition of chemotherapy to radiotherapy significantly improved OS and PFS in patients with stage IV NPC. The addition of chemotherapy improved PFS, but not OS in patients with stage III NPC.     

154例广泛期小细胞肺癌治疗结果预后因素分析

Objective To investigate independent prognostic factors for overall survival (OS) in extensive disease small cell lung cancer (EDSCLC). Methods Between January 2003 and December 2006, 154 patients diagnosed with extensive stage small cell lung cancer were enrolled in this study.Prognostic factors such as gender, age, performance status, smoking history, weight loss, distant metastasis, the number of matastasis, brain metastasis, the cycle of chemotherapy and thoracic radiation therapy (TRT) for EDSCLC patients were evaluated by univariate and multivariate analysis. Results The median following-up time was 40. 5 months. The rate of follow-up was 92. 2%. The MST and overall survival rates at 3-year in smoking group and no-smoking group were 13 months, 11.8% and 17 months,22. 8%,respectively (χ2=3.40,P =0. 064);in ChT/TRT group and ChT group, they were 17. 2 months, 17.9%and 9.3 months,13.9%, respectively(χ2=10.47,P=0.001);and in the cycle of chemotherapy ≥4 group and ＜ 4 group, they were 16 months, 20. 1% and 9.3 months, 2. 9%, respectively (χ2=17.79,P=0. 000). By multivariate analysis, smoking history was a statistically significant unfavorable factor for OS in EDSCLC patients (versus no-smoking, hazard ratio (HR)=1.462, χ2=4.40, P=0.036). In addition, ≥4 cycles of chemotherapy and TRT were favorable prognostic factors ( ≥4 cycles vs ＜4 cycles, HR =0. 420,χ2 = 17. 17, P = 0. 000; ChT/TRT vs ChT, HR = 0. 634, χ2 = 6. 20, P = 0. 013). Conclusions Smoking is a independent unfavorable prognostic factor and ≥ 4 cycles of chemotherapy And TRT are independent favorable prognostic factors for OS in EDSCLC.     

青年人胃癌

目的 探讨青年人胃癌的临床、病理特点。方法 １９６８年１月￣１９９３年１月２５年间经手术治疗、病理诊断的青年人胃癌３１２例,占同期收治胃癌的５．１％。将所有病例以年龄组划分为４组：≤３５岁组,３６￣５０岁组,５１￣６５岁组,≥６６岁组。对≤３５岁青年人胃癌与各组进行对照观察。结果 青年人胃癌发病率女性高于男性,组织病理学类型以低分化腺癌（４９．２％）、粘液细胞癌（２６．６％）为多,８３．３％的病例     

放化疗同步治疗肺癌脑转移38例临床分析

目的:观察长春瑞滨(NVB)、顺铂(DDP)加用卫萌(Vm-26)联合脑部放射治疗肺癌脑转移患者的疗效、不良反应和生存率。方法:Vm-260·1,静脉滴入,d1~d3;NVB25mg/m2,静脉滴入,d1、d8;DDP20mg/m2,静脉滴入,d1~d3;21d为1个周期,脑部放疗于第1个周期化疗开始后第5天开始,每次DT1·8~2·0Gy,1次/d,每周5次,1~2个病灶者全脑放疗DT40Gy后缩野追加至DT60Gy,≥3个转移灶者给予全颅放疗DT45Gy。结果:治疗后90%患者神经系统症状改善,对脑转移灶的客观有效率为71·1%(27/38),对肺原发灶的有效率为42·1%(16/38),主要不良反应为骨髓抑制和脱发,中位生存期11·01个月,1年生存率39·5%(15/38)。结论:同步放、化疗治疗肺癌脑转移患者有效率和生存率均较高,且患者耐受性好。肿瘤防治杂志,2005,12(19):1502-1504     

尿多胺、尿红及尿紫检验对肿瘤诊断价值的研究

目的 :研究肿瘤临床诊断指标尿多胺、尿红、尿紫的可行性。方法 :尿多胺采用HPLC法测定 ,尿红、尿紫采用化学法测定。结果 :肿瘤患者尿标本中腐胺的浓度为 2 5～ 4 2 4 μg mg肌酐 ,精眯为0 8～ 4 0 2 μg mg肌酐 ,精胺为 0 5～ 11 4 μg mg肌酐 ,肿瘤患者尿样尿红实验阳性率为 82 0 % ,尿紫实验阳性率为 4 6 0 %。结论 :腐胺、精脒、精胺可作为肿瘤临床诊断指标 ;尿红实验仅适用于肿瘤患者的临床筛选和大面积人群普查 ,不能用于临床确诊 ;而尿紫实验则不适用于肿瘤的诊断或普查     

男性乳腺癌的诊断与治疗

目的探讨男性乳腺癌的诊断与治疗方法。方法回顾性总结男性乳腺癌３２例,中位年龄５４岁。分析了男性乳腺癌的诊断、治疗及预后。结果临床Ⅰ期７例,Ⅱ期１７例,Ⅲ期７例,Ⅳ期１例。３２例患者中,３１例有乳腺肿块。腋窝淋巴结转移率５７．１％。总５年生存率６５．６％,根治术与改良根治术后患者５年生存率分别为６８．４％及６６．７％,非根治术患者５年生存率为５７．１％。结论对于确诊为乳腺癌患者首选改良根治术根据患者不同情况辅以放射治疗、化疗或内分泌治疗     

子宫内膜癌卵巢转移(附22例临床报告)

目的了解子宫内膜癌卵巢转移的临床特点及有关因素对预后的影响。方法回顾性分析自１９５８年至１９９５年经我院手术证实的２２例子宫内膜癌卵巢转移的临床资料。结果平均年龄５０．６岁，临床Ⅰ期１０例，Ⅱ期和Ⅲ期各６例，卵巢转移率为４．４％（２２／４９５）。治疗方式以手术加放疗为主，５年和１０年存活率分别为６１．５％和５５．９％。结论子宫内膜癌卵巢转移预后不良，术后应主动给予辅助治疗。对年轻的早期患者，是否保留卵巢应持审慎态度。     

475例壶腹周围癌的外科治疗

目的比较不同年代壶腹周围癌患者外科治疗的特点和疗效．方法回顾性分析1958年至2003年外科治疗的壶腹周围癌患者475例。结果1958年至1976年的128例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌和十二指肠癌的手术切除率分别为26．6％(21／79)、86．2％(25／29)、38．5％(5／13)和57．1％(4／7);1977年至1987年的70例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为26．7％(16／60)、66．7％(4／6)、100％(1／1)和66．7％(2／3);1988年至1998年的147例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为20．2％(22／109)、75．0％(12／16)、50．0％(2／4)和66．7％(12／18);1999年至2003年的130例壶腹周围癌中．胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为20．4％(20／98)、100(4／4)、75．0％(12／16)和83．3％(10／12)。1958年至2003年期间,胆管下端癌的发生率在壶腹周围癌中显著增高,术前总胆红素平均值呈下降趋势,术中输血量较前明显减少;手术切除的肿瘤直径平均值较前缩小。1999年至2003年间所有的胰十二指肠切除患者术前均未行减黄处理,并发症仍然显著降低,结论由于新的围手术期治疗和监护技术的进步,壶腹周围癌的手术死亡率和并发症发生率均有显著下降,但胰头癌的手术切除率和生存率仍然没有显著变化。     

子宫颈癌治疗的回顾与展望

1898年,奥地利的Wertheim以子宫广泛切除及盆腔淋巴切除术治疗子宫颈癌。同年,居里夫妇发现了镭并很快用于子宫颈癌的治疗。自20世纪早期,子宫颈癌的治疗即进入发展时期,特别是放射治疗。在20年代,在欧洲已形成完整的子宫颈癌腔内镭疗的斯得哥尔摩及巴黎体系。此期间,虽然手术也作了改变,如Wertheim将盆腔淋巴切除改为选择性淋巴结切除;Scha櫣ta经阴道施行广泛子宫切除,但手术死亡率及并发症高,生存率低,与放疗比较,相形见绌,一度曾处于低谷。Wertheim本人也承认了这个事实[1]。此后,一些妇科医师将目光转向了放射治疗,促进了子宫颈癌放疗…     

178例胰头癌的诊治分析

目的：分析胰头癌的临床表现,诊治方法,提高胰头癌的诊治水平。方法：用回顾性方法研究178例胰头癌的临床表现,诊治方法及治疗效果。:结果：178例患者主要临床表现有上腹部疼痛及不适,占69．7％;梗阻性黄疸,占74．2％,这两各症状1、Ⅱ期与Ⅲ、Ⅳ期之间差异均有显著性（P＜0．001）,伴腰背部疼痛者占17．9％,其中IV期占81．3％,对胰头肿瘤检出率B超为74．2％,CT为87．3％,MRI为85．5％,全组行根治性胰十二指肠切除术18例（10．1％）,术后1,3,5,年生存率分别为67．5％,36．0％和5．6％,胆汁内引流术115例。肿瘤未切除而行放、化疗者,中位生存期为7个月,结论：上腹疼痛不适及梗阻性黄疸为胰头癌的常见症状,高血糖为多发合并症,腰背疼痛常为晚月。结论：上腹疼痛不适及梗阻性黄为胰头癌的常见症状,高血糖为多发 合并症,腰背疼痛为晚期表现,CT是最重要的影像学诊断方法,B超,CT和（或）MRI联合检查可提高诊断率（达96．6％）,目前,胰十二指肠切除术是胰头癌唯一有效的治疗方法,胆汁内引流是重要的姑息治疗方法。     

局部晚期胃癌术前同步放化疗作用的初步探讨

目的 观察局部晚期胃癌患者术前同步放化疗后的手术切除率、病理缓解率及不良反应发生率,探索最佳的新辅助放化疗方案。方法 2013—2014年间本院初治的潜在可切除或不可切除的局部晚期胃癌患者11例入组,临床分期为cT₄N₀M₀或T_{xN1-3M0(AJCC第7版),病理为腺癌。放疗采用IMRT技术,总剂量40~50 Gy分22~25次4~5周完成。同步化疗采用替吉奥或卡培他滨或紫杉醇联合卡铂的方案。同步放化疗结束后4~8周手术。结果 接受R0手术者9例,R2手术1例,1例因术中发现腹膜种植转移仅行剖腹探查术。术后病理提示重度反应4例,其中包括pCR 1例。共完成放疗10例、化疗8例。3级不良反应主要见于恶心(3例)、呕吐(2例)和食欲下降(2例),无4级不良反应。结论 术前同步放化疗对局部晚期胃癌患者的肿瘤降期率和R0切除率疗效较好,不良反应可耐受。}     

脾脏肿瘤31例临床分析

目的 通过临床病例分析,了解脾脏肿瘤的临床特点。方法 对1990年1月－2000年12月期间收治的31例脾脏肿瘤患者的临床表现、影像学特点和诊断依据、治疗情况进行了分析。结果 31例脾脏肿瘤中良性肿瘤居多（20／31）。临床表现无特异性。影像学特点为脾实质内单发或多发结节。全部患者均是先行B超检查发现脾脏占位,其中19例又行CT检查,7例行MRI检查。7例脾囊肿通过B超等影像学检查明确诊断,其中6例在手术后病理证实;9例脾脏转移性肿瘤通过影像学检查并结合病史在术前明确诊断,有5例经手术切除后病理证实;另外15例脾脏病变,除1例因术前CT检查明确为脾脏淋巴管瘤而放弃手术外,其余14例则以脾脏肿瘤而行脾脏切除手术,术后病理明确诊断。全组31例患者中,25例行脾切除术,术后恢复均较顺利,无手术死亡。结论 病史和影像学检查是诊断脾脏肿瘤的重要依据,术前不易鉴别良恶性肿瘤,手术效果佳。