肺癌的肺动脉供血及介入化疗

肺癌是常见的恶性肿瘤，近年来发病率迅速上升，且７０％～８０％的病人在诊断时已失去根治性手术的机会。肺癌介入化疗疗效确切、副作用小，在手术后辅助治疗和提高晚期病人生存质量方面备受青睐。现就肺癌的肺动脉供血及介入化疗综述如下：肺癌的肺动脉供血肺癌供血来源...     

肺结核与肺癌并存25例的诊断及外科治疗

目的探讨肺结核与肺癌并存的临床特点、诊断及手术治疗方法。方法对25例肺结核并存肺癌患者的临床和实验室资料进行综合分析。结果患者多为老年，多有肺结核病史，有咳嗽、咯血、胸痛等表现。肺癌漏诊率高，手术治疗效果好。结论肺结核并存肺癌时，易发生漏诊，有条件时应手术治疗。     

自身抗体检测在肺癌早期诊断筛查中的应用

肺癌的发病率及病死率均位居各恶性肿瘤首位,大部分患者确诊时已处于晚期。对高危人群进行CT筛查被认为可以降低肺癌病死率并发现更多早期患者。但是CT的假阳性率高,需要长期随访或有创检查才可确诊。血清肿瘤标志物以其微创、稳定性好等特点,成为肺癌早期诊断研究的热点。肺癌相关抗原被免疫系统捕获后可产生自身抗体,且在肿瘤早期即可大...     

EBUS-TBNA联合组织、细胞蜡块免疫组化与基因检测在肺癌临床诊断中的作用探究

目的探究EBUS-TBNA联合组织、细胞免疫组化与基因检测在肺癌临床诊断中的作用。方法利用EBUS-TBNA的方法提取76例疑似肺癌患者的组织,进行组织及细胞蜡块免疫组化检测,并进行EGFR突变基因的检测,分析两种方法肺癌诊断的临床诊断效能。结果 76例疑似肺癌患者经组织病理学检测确认68例为肺癌,组织及细胞蜡块免疫组化检测出鳞癌35例,小细胞癌20例,腺癌7例,间皮癌3例,多发性骨髓瘤2例;组织、细胞免疫组化及联合诊断诊断肺癌的阳性率分别为85.29%(58/68)、88.24%(60/88)及98.53%(67/68),联合检测的灵敏度及准确性显著提高(P0.05);68例确诊为肺癌的患者中EGFR突变阳性患者56例,阳性率为82.35%。结论 EBUS-TBNA联合组织、细胞免疫组化能够显著提高肺癌的临床诊断效能,基因检测能够为肺癌治疗提供依据。     

颌面部软组织肿物的介入栓塞与手术治疗

目的 探讨介入栓塞与手术治疗在颌面部软组织肿物诊断和治疗中的应用价值.方法 搜集2005年2月至2008年3月,采用介入栓塞与手术整复治疗的血管畸形、混合型血管瘤、神经纤维瘤等体表软组织肿物患者42例,分析其临床效果及并发症.结果 10例混合型血管瘤患者采用硬化治疗后,瘤体明显缩小、变硬;26例海绵状静脉畸形患者中,20例采用栓塞硬化治疗,6例采用栓塞硬化与手术相结合的方法进行治疗,有2例患者面部及咽后壁软组织肿物造影显示病变侵犯广泛,行栓塞硬化治疗2次,未行手术治疗;3例动静脉畸形及3例神经纤维瘤患者.采用栓塞硬化与手术相结合的方法进行治疗,治疗后瘤体萎缩变小,其中1例神经纤维瘤患者术后6个月再次手术修复.术后随访6～12个月,所有瘤体缩小或消失.结论 介入栓塞与手术综合治疗是诊断和治疗颌面部软组织肿物安全有效的方法.     

胃癌的诊断进展

<正>我国胃癌的早期诊断、规范化治疗是医务工作者共同努力的方向。近年,对于胃癌的诊断涌现出多种新方法、新技术,临床医生迫切需要加深对各种诊断技术的了解,以提高胃癌的整体治疗水平。我国胃癌发病率与病死率居高不下,仅次于肺癌,位居恶性肿瘤的第二位[1]。胃癌的早期诊断、规范化治     

介入止血治疗1例肾穿刺并发大出血患者的护理

对1例肾穿刺并发大出血患者进行介入治疗的术前、后护理,分析肾穿刺出血的相关因素及经验教训。提出肾动脉介入栓塞止血具有诊断、治疗双重效果,做好术前、后护理是介入止血成功的基础。     

影像学引导肺癌冷冻消融治疗专家共识2018版

正肺癌发生率逐年增加,并已经成为威胁人民健康的主要疾病。2017年国家癌症中心统计结果显示,肺癌位居导致患者死亡疾病的第一位。研究~([1-4])显示,仅有不到30%的肺癌患者可接受外科手术切除。影像学引导肿瘤的各种消融技术在肺癌治疗中发挥着较大作用。物理消融创伤小、安全性高及疗效可与外科手术媲美,已获得医患双方认可~([5-6])。物理消融方法中,以射频和微波为代表的热消融及以氩氦刀为代表的冷     

介入止血治疗1例肾穿刺并发大出血患者的护理

对1例肾穿刺并发大出血患者进行介入治疗的术前、后护理，分析肾穿刺出血的相关因素及经验教训。提出肾动脉介入栓塞止血具有诊断、治疗双重效果，做好术前、后护理是介入止血成功的基础。     

原发性肺癌并发肾损害临床分析

目的分析原发性肺癌并发肾损害的发生率、临床特点、诊断、治疗。方法对我院有随诊资料的169例肺癌患者的临床资料进行回顾性分析。结果不同性别、年龄、组织病理学类型的肺癌并发肾损害的发生率无显著差别（P〉0．05），但不同分期的肺癌患者肾损害的发生率不同，与早期患者比较，晚期患者肾损害的发生率较高，二者之间的差异具有统计学意义（P〈0．05）。原发病治疗后24h尿蛋白定量显著减少，与治疗前比较，差异具有统计学意义（P〈0．05）。结论单纯性蛋白尿或血尿是原发性肺癌并发肾损害的主要临床表现。晚期肺癌患者容易发生肾损害。对原发性肺癌的有效治疗可缓解肾损害的程度。     

食道癌术后吻合口瘘的介入置管的保守治疗效果探讨

目的：分析介入置管在食道癌术后吻合口瘘保守治疗中的效果。方法选择我院收治的24例食道癌术后出现吻合口瘘并发症的患者作为研究对象进行分析,患者均行介入置管治疗,观察患者的治疗效果。结果22例行空肠营养管、胃肠减压管、瘘口引流管三管治疗的患者中,有21例治愈,另外1例患者由于严重感染而死亡。放置瘘口封堵支架进行治疗的2例患者也治愈,患者恢复进食所用时间为（18.0±8.2）d,平均住院时间为（32.0±10.4）d,并发症发生率为20.0%。结论介入置管的保守治疗在食道癌术后吻合口瘘并发症患者中的应用具有较好效果,可以解决并发症问题,与手术治疗相比,可以有效解决吻合口操作空间小、避免感染与血液供应障碍等问题,创伤性更小,患者的耐受性更好,患者瘘口愈合更快,病程得以有效缩短。     

彩超用于诊断及介入治疗肝移植术后并发症的评价

目的　评估彩超用于肝移植术后并发症诊断及介入治疗中的价值。方法　回顾性分析88例肝移植病人术后并发症彩超诊断和介入治疗的资料。结果　彩超正确诊断右侧胸腔积液 78例、腹腔积液 30例、腹腔出血 6例、腹腔脓肿 2例、肝动脉血栓 2例、肝静脉血栓 1例、胆道并发症及肝癌复发各 2例。误诊肝动脉血栓形成 1例。成功进行超声引导介入治疗 5 1例及肝活检 4 0例。结论　彩超在肝移植术后并发症诊断及介入治疗中具有不可替代的重要作用     

肺隔离症4例诊治体会及文献复习

目的 探讨肺隔离症的诊断和治疗策略。方法 2017年7月至2019年6月收治的4例肺隔离症患者,3例患者行胸腔镜手术治疗,1例行介入下血管塞封堵迷走供血动脉,对其诊治过程和临床资料进行回顾性分析,总结诊治过程中的体会。结果 4例肺隔离症患者均接受治疗,1例患者接受介入下血管塞封堵迷走供血动脉后恢复顺利;1例患者胸腔镜下肺叶切除术后恢复顺利;2例患者接受胸腔镜下隔离肺叶切除术,其中1例恢复顺利,1例因胸腔进行性出血行胸腔镜下开胸止血术,后恢复顺利。术后3月复查胸部螺旋计算机体层摄影血管造影显示,3例行胸腔镜下隔离肺叶或肺叶切除手术患者的异常肺叶及供血动脉消失,行介入下血管塞封堵异常血管的1例患者的迷走供血动脉被栓塞,栓塞血管远端已无血流供应,隔离肺组织充血表现较前明显好转,4例患者随访7~31个月,未见复发。在手术时间、术中出血量、术后疼痛、术后胸腔闭式引流量、术后并发症、住院时间及住院费用等方面,介入栓塞治疗均优于胸腔镜手术治疗。结论 胸腔镜手术是目前处理肺隔离症的主要方式,介入栓塞治疗肺隔离症同样是一种安全、有效、微创的治疗方法,尤其对以咯血为主要症状,凝血功能异常且病情较重者效果佳。     

介入栓塞术在头颈部肿瘤放疗后出血中的应用

目的评价介入栓塞术用于治疗头颈部肿瘤放疗后出血的可行性及安全性。方法收集20例因头颈部肿瘤放疗后大出血患者,对所有患者介入栓塞治疗,观察介入栓塞术的疗效及并发症。结果 20例患者共接受介入栓塞治疗21次;4例患者出血责任血管为颈内动脉,采用弹簧圈栓塞颈内动脉载瘤段,15例患者责任血管为上颌动脉分支,采用明胶海绵或聚乙烯醇(PVA)颗粒栓塞;1例患者为右侧甲状腺下动脉分支假性动脉瘤,采用PVA颗粒及弹簧圈栓塞。对所有患者治疗均有效,随访期内均未出现严重并发症。结论介入栓塞术治疗头颈部肿瘤放疗后出血有效、安全。     

Thoracic surgical radiographic and CT pathology: radiology in the radical treatment of lung cancer

Radiology has an important role in the diagnosis, staging and treatment of lung cancer and can offer minimally invasive therapies for poor surgical candidates. Radiology is also important in the follow-up of patients after treatment, the assessment of treatment complications and detection of recurrent disease. Understanding the normal postoperative and post-radiation appearances, and recognizing early and late complications is useful for all clinicians involved in the care of patients with cancer.     

Thoracic surgical radiographic and CT pathology: radiology in the radical treatment of lung cancer

Radiology has an important role in the diagnosis, staging and treatment of lung cancer and can offer minimally invasive therapies for poor surgical candidates. Radiology is also important in the follow up of patients after treatment, the assessment of treatment complications and detection of recurrent disease. Understanding the normal post-operative and post-radiation appearances, and recognizing early and late complications is useful for all clinicians involved in the care of patients with cancer.     

Bronchoscopic palliation of primary lung cancer: Single or multimodality therapy?

Background An obstructing primary lung cancer is a challenging disease frequently requiring endobronchial interventional therapy. A variety of interventional modalities, including Nd:YAG laser, stenting, photodynamic therapy (PDT), and endoluminal brachytherapy, are utilized to relieve airway obstruction and bleeding. The aim of this study is to compare the effect on patient survival of bronchoscopic palliation for lung cancer utilizing one interventional modality compared to the use of combination of modalities to relieve the airway problem.Methods We reviewed our longitudinal experience with interventional bronchoscopy in 75 patients who underwent 176 procedures for the management of endobronchial lung cancer between 1994 and 2002. Indication for intervention was hemoptysis in 24 patients (32%) and airway obstruction in the remaining. Six patients died within 30 days from the first intervention and were excluded. Forty of the surviving 69 patients (58%) were treated with a single interventional modality (group A). In 29 patients (42%) a multimodality endoscopic treatment was utilized (group B). Single-modality treatment in group A included Nd-YAG laser in 60%, stent in 17%, brachytherapy in 20%, and PDT in 3%. A variety of combinations of the aforementioned modalities were used in group B to enhance airway patency. Patient data were compared with the Students t-test and chi-square test. Survival analysis and the log rank test were used to compare difference in survival between the two groups. A p-value of 0.05 was considered significant.Results There were 46 males and 23 females, with a mean age of 67 years. The tumor was located in the trachea 9%, in the carina in 7%, and primary bronchial in 84%. Two patients had complications due to stent malposition. There was no significant difference between the two groups in relation to age, gender, tumor location, histology, and type of previous cancer therapy. There was a significant improvement in survival for the multimodality group (p = 0.04). The 1- and 3-year cumulative survival rate for groups A and B was 51.3% versus 50% and 2.3% versus 22%, respectively.Conclusions Improvement in survival can be seen with diligent airway surveillance after interventional bronchoscopy and liberal use of a variety of endobronchial treatment modalities for airway obstruction or bleeding. Physicians involved in the management of this difficult problem should be versed in the use of all available treatment modalities to enhance therapeutic outcome.     

肝癌自发性破裂出血的诊断和治疗

目的：探讨肝癌自发性破裂出血的诊治方法。方法：回顾性分析36例肝癌自发性破裂出血患者的临床资料。36例患者中,单纯保守治疗组9例,介入治疗组13例,手术治疗组14例,其中急诊行肝癌切除术8例,出血局部缝扎加肝动脉结扎4例,大网膜填塞缝扎2例。结果：保守治疗组术后再出血3例,其中2例死于肝功能衰竭;介入治疗组均彻底止血,围手术期无肝功能衰竭发生;外科手术组术后均彻底止血,1例死于肝功能衰竭。保守治疗组9例中,生存1年者3例,2年者1例,3年者1例;介入治疗组13例,生存1年者8例,2年者5例,3年者3例;外科手术组14例中,生存1年者9例,2年者7例,3年者3例。结论：手术及介入治疗均是治疗肝癌破裂出血的有效方法,介入治疗止血满意,术后并发症少,可作为不能行切除手术患者的首选治疗方法。应根据患者肝功能状态、肿瘤大小、肿瘤分期,制定个体化治疗方案,争取最佳疗效。     

治疗特发性肺间质纤维化合并早期非小细胞肺癌进展

特发性肺间质纤维化(IPF)易合并非小细胞肺癌(NSCLC);后者发病隐匿,给诊治带来难度,且针对其进行的手术、化学治疗、放射治疗及靶向治疗等均可致IPF急性加重(AE-IPF)。近年来微创介入方法已广泛用于诊断、治疗肺部疾病。本文就治疗IPF合并NSCLC进展进行综述。     

Surgical management of lung cancer in Western Australia in 1996 and its outcomes

BACKGROUND: All cases of lung cancer diagnosed in Western Australia in 1996 in which surgery was the primary treatment, were reviewed. Reported herein are the characteristics of the patients, the treatment outcomes and a comparison of the management undertaken with that recommended by international guidelines. METHODS: All patients with a new diagnosis of lung cancer in Western Australia in the calendar year of 1996 were identified using two different population-based registration systems: the Western Australian (WA) Cancer Registry and the WA Hospital Morbidity Data System. A structured questionnaire on the diagnosis and management was completed for each case. Date of death was determined through the WA Cancer Registry. RESULTS: Six hundred and sixty-eight patients with lung cancer were identified; 132 (20%) were treated with surgery. Lobectomy was the most frequently performed procedure (71%), followed by pneumonectomy (19%). Major complications affected 23% of patients. Postoperative mortality was 6% (3% lobectomy, 12% pneumonectomy). At 5 years the absolute survival was as follows for stage I, II, IIIA, IIIB, respectively: 51%, 45%, 12%, 5%. CONCLUSIONS: Investigations and choice of surgery in WA in 1996 reflect current international guidelines. The survival of patients with resectable lung cancer remains unsatisfactory.