进展期胃癌术前动脉灌注联合术中温热灌注化疗的疗效观察

目的探讨进展期胃癌手术前动脉灌注化疗联合术中温热灌注化疗的治疗效果。方法 48例进展期胃癌患者随机分为对照组和观察组,每组24例,对照组行单纯胃癌根治术,观察组在术前5 d进行动脉灌注化疗,术后进行温热灌注化疗,并作术后随访2 a的疗效比较。结果观察组1、2 a生存率分别为91.66%、79.17%,高于对照组的87.50%、58.30%（P均〈0.05）;观察组1、2 a复发、转移率分别为16.67%、20.83%,对照组为20.83%、41.67%（P均〈0.05）;不良反应两组比较无统计学差异（P〉0.05）。结论进展期胃癌手术术前动脉灌注联合腹腔温热灌注化疗可以提高近期疗效。     

胃癌腹腔化疗毒副反应的观察和处理

目的 评价胃癌腹腔化疗的毒副反应，并探讨其处理方法。方法 将156例胃癌病人进行随机分组。分为术中即时低渗温热腹腔化疗联合术后早期腹腔化疗组（治疗组），单纯术中即时低渗温热腹腔化疗组（对照组1），未行腹腔化疗组（对照组2），共三组，观察化疗的安全性和毒副反应。结果 治疗组化学性腹膜炎、消化道反应、骨髓抑制和肝功能异常的发生率明显高于两个对照组。结论 应用术中即时，低渗温热腹腔化疗联合术后早期腹腔化疗时化学性腹膜炎的防治不容忽视。     

晚期胃癌术后腹腔灌注化疗联合全身化疗的临床随访研究

118例晚期胃癌患者分为两组。治疗组术中采用顺铂（DDP）腹腔灌注化疗联合静脉全身化疗,同时辅以免疫治疗和中医中药等。对照组除不用腹腔灌注化疗外,余治疗方法同上。随访2a,治疗组1、2a的生存率较对照组均明显改善;术后2a两组间的KPS评分有显著性差异;Cox回归模型显示,肿瘤分期和化疗方法是影响晚期胃癌术后的重要预测因子。提示腹腔灌注化疗联合非根治性手术及静脉全身化疗的综合治疗能够进一步改善晚期胃癌患者的预后。     

围手术期腹腔内化疗联合IL-2和IFN-γ治疗胃癌的临床研究

目的 探讨围手术期腹腔内化疗联合应用IL-2和IFN-γ对胃癌患者预后的影响.方法 将行胃癌根治治疗的患者60例随机分成三组,每组20例.A组：术前2 d及术后3 d腹腔内灌注5-FU、cDDP、IL-2和IFN-γ混合液,B组术后3 d腹腔内灌注上述混合液,C组术后3 d腹腔内灌注5-FU、cDDP混合液.检测化疗后外周血Th亚群变化、NK细胞数量及FCC;评价治疗中各组化疗的副反应及化疗后的治疗有效率和生存率.结果 A组患者在细胞免疫、治疗有效率、肿瘤细胞检出率与B、C组有统计学差异（P＜0.05）,各组副反应无统计学差异（P＞0.05）.结论 术后IPC联合应用IL-2和IFN-γ具有一定的临床应用价值.     

胃癌腹腔灌注化疗近况

目的对近年胃癌腹腔内灌注化疗的现状及进展作一综述．方法①间断性腹腔灌注化疗：对晚期胃癌、进展期胃癌患者手术未切除干净或已合并腹腔内其他部位有转移的患者，将化疗药溶于生理盐水中灌入腹腔，每3wk～4wk为1疗程，一般多采用单一给药，常用药CDDP，5-FU，MMC，MTX，ADM，VP-16等．②持续性温热腹腔灌注疗法（CHPP）：日本广泛开展CHPP作为进展期胃癌术后的一种辅助疗法，用一恒温流动驱动装置、管道及腹腔组成一个封闭式的循环灌流系统，常用EL-Reflsc液或生理盐水为灌流液，并加入化疗药，可单一用药，或联合用药，灌流液温度维持在42℃～45℃为宜．③腹腔内化疗联合免疫疗法：腹腔内注射OK-432，一次剂量为20KE．结果腹腔化疗可增加药物与腹膜的接触面，提高局部药物浓度，减少或降低药物的毒副作用，肿瘤组织直接浸泡在高浓度的药液中，在药物被吸收之前，可透过细胞的脂质膜屏障而被弥散渗入癌细胞与DNA结合而杀伤肿瘤细胞。被部分吸收的药物通过门静脉系进入肝和全身组织，对胃癌伴肝转移者尤为合适．腹腔内游离癌细胞在温热与化疗药物的协同作用下，迅速地发生核固缩或核溶解，对预防胃癌术后复发及有腹膜转移的晚期患者均有较明显的疗效．同时联合免疫疗法，有明显的抗癌活性．结论腹腔化     

胃动脉插管化疗栓塞联合腹腔化疗治疗进展期胃癌

目的不少胃癌患者就诊时已属晚期或因有手术禁忌不宜手术治疗，为进一步探讨该类患者的合理治疗方法，探讨晚期进展期胃癌动脉化疗栓塞并腹腔化疗双途径给药的可行性及临床疗效，对1990／1996住院的98例胃癌患者进行了临床观察．方法98例胃癌患者依性别、年龄、病理类型、临床分期随机分为三组，A组行胃动脉化疗栓塞合并腹腔化疗；B组行腹腔化疗；C组行静脉化疗其中胃动脉栓塞组行内镜随访胃粘膜变化．结果A，B，C三组有效率分别为71．88％，38．7％，14．3％．中位生存期分别为回6，10，8mo．A组与B，C组有明显差异（P＜0．01）．不良反应以胃肠道毒性、骨髓抑制为主内镜检查发现A组术后2wk内胃粘膜有损伤，2wk后开始修复，4wk后可恢复正常．结论胃动脉化疗栓塞并腹腔化疗双途径给药是治疗晚期进展期胃癌的有效方法．     

术前化疗对小细胞肺癌远期生存的影响

目的观察术前化疗联合外科手术治疗对小细胞肺癌（SCLC）长期生存的影响。方法总结北京市结核病胸部肿瘤研究所1994年1月至2005年1月手术切除的263例SCLC的综合治疗效果。比较术前化疗组（A组,n=111例）和术后化疗组（B组,n=96例）的治疗效果。结果全组5年生存率42．16％。A组5年生存率38．25％,B组5年生存4657％。A组5年生存率I期60．15％、Ⅱ期35．70％、Ⅲ。期40．16％、Ⅲb期14．29％、Ⅳ期0,A组5年生存率NO-1和N2为4012％和39．22％。B组5年生存率Ⅰ期61．10％、Ⅱ期50．23％、Ⅲa期42．32％、Ⅲb期2647％、Ⅳ期0,B组5年生存率NO-1和N2组为51．91％和42．69％。结论术前化疗病例比术后化疗病例有预后变差倾向;SCLC要取得较好的治疗效果,手术＋术后化疗模式不可缺少。     

术前新辅助化疗对小细胞肺癌远期生存的影响

目的揭示术前新辅助化疗对小细胞肺癌（SCLC）长期生存的影响对外科临床十分重要。方法总结1994年1月。2005年1月手术切除263例SCLC的综合治疗效果。分析比较术前新辅助化疗组（A组，n=111例）和术后化疗组（B组，n=96例）的治疗效果。结果A组5年生存率38．25％，B组5年生存46．57％。A组5年生存率Ⅰ期60．15％、Ⅱ期35．70％、Ⅲa期40．16％、Ⅲb期14．29％、Ⅳ期0，5年生存率N0-1和N2组为40，12％和39．22％。B组5年生存率Ⅰ期61．10％、Ⅱ期50．23％、Ⅲa期42．32％、Ⅲb期26．47％、1V期0，5年生存率N0-1和N2组为51．91％和42．69％。结论新辅助化疗病例与术后化疗病例相比预后差：SCLC要取得较好的治疗效果，术后化疗模式不可缺少。     

老年胃癌腹腔热灌注化疗联合静脉化疗治疗恶性腹水的临床疗效

目的探讨胃癌腹腔热灌注化疗联合静脉化疗治疗恶性腹水的临床疗效。方法选择该科收治进展期胃癌伴恶性腹水患者26例,腹腔热灌注化疗联合静脉化疗14例作为观察组,静脉化疗、腹腔置管治疗的患者12例作为对照组。比较两组患者的近期疗效及不良反应间的差别。结果两组近期总有效率差异显著(P0.05),观察组较对照组不良反应无显著性差异(P0.05)。结论胃癌腹腔热灌注化疗联合静脉化疗治疗恶性腹水近期疗效优于静脉化疗和腹腔置管治疗。     

Ⅲ期胃癌术后早期腹腔联合静脉化疗的临床观察

目的 评价术后早期腹腔联合静脉化疗对Ⅲ期胃癌患者术后复发、肝转移率、生存情况及不良反应的影响.方法 将66例根治术后的Ⅲ期胃癌患者分为早期腹腔化疗联合全身静脉化疗组(实验组,31例)和单纯静脉化疗组(对照组,35例),观察两组患者术后复发、肝转移率、生存情况及不良反应.结果 实验组局部复发率和肝转移率分别为32.3％和12.9％,对照组分别为57.1％和34.3％;实验组1、3年生存率分别为90.3％和70.9％,对照组分别为82.9％和42.9％;除1年生存率外,两组患者上述各项指标比较差异均有统计学意义(P＜0.05).结论 术后早期腹腔联合全身静脉化疗能减少Ⅲ期胃癌患者术后的复发率和肝转移率,提高3年生存率,不良反应可以耐受.     

健脾益气法联合化疗治疗晚期胃癌的临床观察

[目的]探讨健脾益气方配合TP(紫杉醇脂质体+顺铂)方案化疗治疗晚期胃癌的疗效。[方法]将40例接受含氟尿嘧啶类方案或含紫杉类方案或含铂类方案化疗的胃癌患者,随机分为对照组和治疗组,对照组20例不服用健脾益气方,常规化疗;治疗组20例在化疗前1周开始口服自拟健脾益气方中药,至化疗结束。在化疗结束后评估恶心呕吐评分、生活质量评分及骨髓抑制评分。[结果]治疗组的恶心呕吐评分、生活质量评分及骨髓抑制评分均明显优于对照组,差异有统计学意义(P0.05)。[结论]健脾益气方配合化疗能明显减轻胃癌化疗后的不良反应,增强化疗疗效。     

Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer

AIM: Preoperative intra-arterial infusion chemotherapy could increase the radical resection rate of advanced gastric cancer, but its effect on the long-term survival has not been assessed. This study was designed to evaluate the clinical significance of preoperative intra-arterial infusion chemotherapy for advanced gastric cancer. METHODS: Clinicopathological data of 91 patients who underwent curative resection for advanced gastric cancer were collected. Among them, 37 patients undertaken preoperative intra-arterial infusion chemotherapy were used as the interventional chemotherapy group, and the remaining 54 patients as the control group. Eleven factors including clinicopathological variables, treatment procedures and molecular biological makers that might contribute to the long-term survival rate were analyzed using Cox multivariate regression analysis. RESULTS: The 5-year survival rate was 52.5% and 39.8%, respectively, for the interventional group and the control group (P<0.05). Cox multivariate regression analysis revealed that the TNM stage (P<0.001), preoperative intra-arterial infusion chemotherapy (P = 0.029) and growth pattern (P = 0.042) were the independent factors for the long-term survival of patients with advanced gastric cancer. CONCLUSION: Preoperative intra-arterial infusion chemotherapy plays an important role in improving the prognosis of advanced gastric cancer.     

FOLFOX、XELOX方案联合腹腔镜治疗进展期胃癌的研究

背景:单一的手术、放疗、化疗对进展期胃癌疗效均欠佳,近年来多学科协作诊治模式(MDT)越来越受重视。目的:探讨术前FOLFOX、XELOX化疗方案联合腹腔镜治疗进展期胃癌的疗效。方法:纳入2009年2月~2013年2月新疆生产建设兵团第一师医院和新疆生产建设兵团医院收治的进展期胃癌患者,给予FOLFOX或XELOX化疗方案联合腹腔镜胃癌D2根治术,对两种治疗方案的疗效进行比较分析。结果:共54例患者纳入研究,FOLFOX组29例,XELOX组25例。化疗后临床完全缓解(CR)7例,部分缓解(PR)23例,疾病稳定(SD)15例,疾病进展(PD)9例,总有效率(RR)为55.6%(30/54),FOLFOX、XELOX组间疗效差异无统计学意义(P0.05)。XELOX组患者恶心、呕吐、骨髓抑制以及腹泻的发生率显著低于FOLFOX组(P0.05),口腔黏膜炎、手足综合征的发生率显著高于FOLFOX组(P0.05)。45例患者经腹腔镜切除肿瘤,9例患者行腹腔镜探查术,未切除肿瘤,FOLFOX、XELOX组间手术切除率差异无统计学意义(P0.05)。FOLFOX、XELOX组术后病理分期均较治疗前显著降低(P0.05)。结论:术前FOLFOX、XELOX方案联合腹腔镜治疗进展期胃癌疗效相似,具有良好的有效性和安全性。     

Pseudomyxoma peritonei treated with complete resection and immediate intraperitoneal chemotherapy

AIM: Pseudomyxoma peritonei remains a fatal disease. This clinical pathological entity based on the presence of mucin includes different prognostic groups. Complete resection of macroscopic lesions, combined with immediate intraperitoneal chemotherapy to treat remnant infra-millimetric disease, might improve survival. The aim of this prospective study was to evaluate this treatment strategy. METHODS: Thirty-six patients with pseudomyxoma peritonei underwent resection of supra-millimetric lesions then were given either early postoperative intraperitoneal chemotherapy (5 days) (before January 1996) or intraoperative chemohyperthermia treatment (after January 1996). During this same period, only partial resection of the macroscopic lesion was possible in 15 patients; these patients were not given peritoneal chemotherapy. RESULTS: Postoperative mortality was 13.8% (n=5), including 2 deaths not specifically due to the procedure. Morbidity, including severe and non-severe complications was 44%. After a mean follow-up of 48 months, the overall 5-years survival rate was 66%, and disease-free survival rate was 55% (including the postoperative deaths). The main prognostic factor in this series was the pathological grading: 5-years survival was 74% for grade 1 tumors versus 54% for grades 2-3 (P=0.05). CONCLUSION: The main prognostic factor of the pseudomyxoma peritonei, after the completeness of the resection, is the pathological grading. The addition of an intraperitoneal chemohyperthermia improves long-term survival of grades 2-3 tumors and perhaps that of grade 1 (agreement of experts). This treatment is more easily performed, more well-tolerated, and more efficient when performed early.     

65岁以上老年人胃癌332例临床分析

目的 探讨老年胃癌患者的临床特点及其外科治疗方法的选择及预后。方法 回顾性分析1990年1月至2003年6月收治的332例65岁以上老年人胃癌的临床资料和生存资料。结果 本组临床好转率为97．0％，围手术期病死率为3．0％，手术并发症发生率为24．7％。根治性胃切除组术后1、3、5年生存率分别为89.6％、63.2％和40.6％，姑息性胃切除组分别为68.6％、15．7％和0，未切除组平均生存10个月。各组术后生存率比较差异有显著性(P＜0．05)。结论 老年人胃癌术后并发症较多，围手术期处理至关重要。术中应尽量采用硬膜外麻醉，缩短手术时间。手术方式应视患者全身情况、癌肿所在部位、大小及侵犯范围而定，对早中期患者力争行根治性胃切除术(D1或D2)。     

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.     

加味四逆泻心汤对胃癌根治术后患者的疗效观察

目的观察中药加味四逆泻心汤预防胃癌根治术后复发转移的临床疗效。方法将52例胃癌根治术后患者随机分为处理组和对照组,处理组治疗采用加味四逆泻心汤合并FOLFOX4方案化疗,对照组采用FOLFOX4方案化疗,观察两组半年、1、2、3年累计生存率及复发转移率。结果处理组2、3年累计生存率均显著高于对照组(P0.05);处理组1、2、3年累计复发转移率均显著低于对照组(P0.05)。结论加味四逆泻心汤可以通过降低胃癌根治术后的复发转移,提高生存率。     

神经内镜与微创穿刺手术治疗高血压脑出血的近期效果分析

目的分析对比神经内镜手术与微创穿刺手术治疗高血压脑出血的近期效果与预后。方法回顾性连续纳入2017年6月至2019年5月首都医科大学密云教学医院神经外科高血压脑出血住院患者55例,经头部CT确诊为幕上血肿。根据治疗方式的不同,将55例患者分为神经内镜组(24例)和微创穿刺组(31例)。通过比较两组的基线资料、手术相关指标及治疗前与出院时Barthel指数评分的差值,评价两种治疗方式的效果及预后。基线资料包括性别、年龄、血肿量、出血部位(基底节区、脑叶、丘脑)、术前格拉斯哥昏迷量表(GCS)评分、发病至手术治疗的时间等,手术相关指标包括手术时间、术中出血量、血肿清除率、术后再出血、颅内感染。结果(1)两组患者性别、出血部位(基底节区、脑叶、丘脑)、年龄、血肿量、术前GCS评分、发病至治疗时间的差异均无统计学意义(均P>0.05)。(2)微创穿刺组手术时间、术中出血量、血肿清除率均低于神经内镜组,组间差异均有统计学意义[(36±7)min比(150±20)min、(8±3)ml比(184±50)ml、(75.7±10.4)%比(88.5±6.6)%,t值分别为26.820、17.295、5.534,均P<0.01];两组再出血和颅内感染发生率的差异均无统计学意义(均P>0.05)。(3)神经内镜组术前与出院时Barthel指数评分的差值高于微创穿刺组,组间差异有统计学意义[(51±9)分比(42±10)分,t=3.309,P=0.002]。结论神经内镜术在改善患者近期预后方面可能优于微创穿刺术,可尝试用于高血压脑出血患者的手术治疗。     

多西紫杉醇联合同步放疗治疗局部晚期非小细胞肺癌的临床观察

目的：通过对比三维适形放疗联合化疗同步治疗局部晚期非小细胞肺癌的近期临床效果,评价其临床应用价值和意义。方法将我院2013年12月至2015年12月期间收治的60例局部晚期非小细胞肺癌患者作为本次的研究对象,根据随机数字方法分为对照组和实验组,每组30例。对照组患者给予放化疗序贯疗法,实验组患者给予三维适形放疗同步多西紫杉醇化疗。对比分析治疗后2组患者的近期临床疗效、不良反应发生率、1年和2年的生存率及死亡率,分析三维适形放疗联合化疗同步治疗局部晚期非小细胞肺癌的临床应用价值和意义。结果治疗后实验组患者的近期总有效率(86.7%)高于对照组(56.7%),差异有统计学意义(χ2=6.893,P <0.05)。治疗后对照组患者的不良反应发生率为26.7%,实验组为33.3%,2组比较差异无统计学意义(χ2=5.638,P>0.05)。实验组患者1年生存率为66.7%,死亡率为33.3%;2年生存率为53.3%,死亡率为46.7%。对照组患者1年生存率为43.3%,死亡率为56.7%;2年生存率为33.3%,死亡率为66.7%。2组患者1年、2年生存率比较差异均有统计学意义(χ2值分别为4.299、4.443,P值均<0.05)。结论采用三维适形放疗联合化疗同步治疗局部晚期非小细胞肺癌的近期疗效较好,1年、2年的生存率高,具有一定的临床应用价值。     

Palliation with a glimmer of hope: management of resectable gastric cancer with peritoneal carcinomatosis.

In the United States peritoneal seeding from primary gastric cancer occurs in 20-30% of patients. The diagnosis of this advanced disease is usually not provided by clinical studies prior to abdominal exploration. The surgeon is forced to make an intraoperative judgement concerning the risks and benefits of an aggressive management plan versus supportive care. A treatment strategy for this difficult group of patients has been devised and tested in phase II studies. It utilizes extended gastrectomy plus peritonectomy to maximally cytoreduce tumor combined with perioperative intraperitoneal chemotherapy. The perioperative intraperitoneal mitomycin-C chemotherapy is heated to 42 degrees C and manually distributed to provide uniform treatment to all peritoneal surfaces and the resection site. Early postoperative intraperitoneal 5-fluorouracil is gravity distributed. The pharmacologic parameters have been established. Relevant clinical information was collected in this review. Five-year survival of these patients in whom a complete cytoreduction was possible has been observed and a prolonged median survival occurs. Gastrectomy with peritonectomy to eliminate all visible implants combined with perioperative intraperitoneal chemotherapy should be considered in all patients with primary gastric cancer and peritoneal carcinomatosis.