胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

Objective To summarize and compare the short-term and long-term clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic biliary stent (PTBS) in the treatment of malignant obstructive jaundice. Methods 210 cases of malignant obstructive jaundice underwent interventionsl therapy, of which 161 cases of drainage catheters placement and 49 cases of metalic stent implantation.Follow-up information was obtained through telephone review or check-up records. Results The technical success rate of technique was 100%. At 3-5 days after treatment, the serum total bilirubin in 15 metalic stent-treated patients was decreased by (178. 04 ± 42. 32) μmol/L, and direct bilirubin by (83. 97 ± 23. 63) μmol/L.Compared with those of 28 cases treted with drainage catheters: (95.67 ± 34. 28) μmol/L and (49. 84 ± 28. 21) μmol/L, there were statistically significant differences between the two groups (P =0.017 and P= 0.035). At 6-9 days after treatment, the serum total bilirubin in 28 cases of metalic stent group was decreased by (188. 22 ± 79. 90) μmol/L,and that in 126 cases of drainage catheter group decreased by (141. 39 ± 65. 32) μmol/L The difference was statistically significant (P =0.014). But the decline value of direct bilirubin had no significant difference. The median patency period and the median survival time of the drainage catheter group were 60 and 148 days, respectively,those of metalic stent group were 197 days and 245 days. There were statistically significant differences between the two groups ( P <0.05). Conclusion The results of this study indicate that the short-term and long-term efficacies of metalic stent implantation are better than those of catheter drainage technique.     

胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

Objective To summarize and compare the short-term and long-term clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic biliary stent (PTBS) in the treatment of malignant obstructive jaundice. Methods 210 cases of malignant obstructive jaundice underwent interventionsl therapy, of which 161 cases of drainage catheters placement and 49 cases of metalic stent implantation.Follow-up information was obtained through telephone review or check-up records. Results The technical success rate of technique was 100%. At 3-5 days after treatment, the serum total bilirubin in 15 metalic stent-treated patients was decreased by (178. 04 ± 42. 32) μmol/L, and direct bilirubin by (83. 97 ± 23. 63) μmol/L.Compared with those of 28 cases treted with drainage catheters: (95.67 ± 34. 28) μmol/L and (49. 84 ± 28. 21) μmol/L, there were statistically significant differences between the two groups (P =0.017 and P= 0.035). At 6-9 days after treatment, the serum total bilirubin in 28 cases of metalic stent group was decreased by (188. 22 ± 79. 90) μmol/L,and that in 126 cases of drainage catheter group decreased by (141. 39 ± 65. 32) μmol/L The difference was statistically significant (P =0.014). But the decline value of direct bilirubin had no significant difference. The median patency period and the median survival time of the drainage catheter group were 60 and 148 days, respectively,those of metalic stent group were 197 days and 245 days. There were statistically significant differences between the two groups ( P <0.05). Conclusion The results of this study indicate that the short-term and long-term efficacies of metalic stent implantation are better than those of catheter drainage technique.     

A multi-institutional retrospective study of hyperthermic plus intravesical chemotherapy versus intravesical chemotherapy treatment alone in intermediate and high risk nonmuscle-invasive bladder cancer

Objective:To compare the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)and intravesical chemotherapy(IVEC)in patients with intermediate and high risk nonmuscle-invasive bladder cancer(NMIBC)after transurethral resection.Methods:We included 560 patients diagnosed with primary or recurrent NMIBC between April 2009 and December 2015 at 1 of 6 tertiary centers.We matched 364 intermediate or high risk cases and divided them into 2 groups:the HIVEC+IVEC group[chemohyperthermia(CHT)composed of 3 consecutive sessions followed by intravesical instillation without hyperthermia]and the IVEC group(intravesical instillation without hyperthermia).The data were recorded in the database.The primary endpoint was 2-year recurrence-free survival(RFS)in all NMIBC patients(n=364),whereas the secondary endpoints were the assessment of radical cystectomy(RC)and 5-year overall survival(OS).Results:There was a significant difference in the 2-year RFS between the two groups in all patients(n=364;HIVEC+IVEC:82.42%vs.IVEC:74.18%,P=0.038).Compared with the IVEC group,the HIVEC+IVEC group had a lower incidence of RC(P=0.0274).However,the 5-year OS was the same between the 2 groups(P=0.1434).Adverse events(AEs)occurred in 32.7%of all patients,but none of the events was serious(grades 3–4).No difference in the incidence or severity of AEs between each treatment modality was observed.Conclusions:This retrospective study showed that HIVEC+IVEC had a higher 2-year RFS and a lower incidence of RC than IVEC therapy in intermediate and high risk NMIBC patients.Both treatments were well-tolerated in a similar manner.     

Recombinant human granulocyte-macrophage colony stimulating factor gargle for prevention and treatment of oral mucosal inflammation caused by concurrent radiotherapy and chemotherapy for locally advanced nasopharyngeal carcinoma

purposeTo observe the clinical effect of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) mouthwash on the prevention and treatment of oral mucosal inflammation caused by concurrent radiotherapy and chemotherapy in locally advanced nasopharyngeal carcinoma. method From April 2015 to April 2017, 64 patients with locally advanced nasopharyngeal carcinoma treated by the Department of Oncology at the Second Affiliated Hospital of Xi'an Jiaotong University were randomly divided into observation group and control group according to the random number table method, with 32 cases in each group. IMRT and concurrent TP regimens (docetaxel + cisplatin) were used for 2 cycles of chemotherapy. Both groups of patients used mouthwash to prevent oral mucositis at the beginning of radiotherapy. The observation group received rhGM-CSF mouthwash and the control group received compound borax mouthwash. The incidence of oral mucositis and oral pain in the two groups of patients during and after the treatment was evaluated using the American Radiation Oncology Group (RTOG) Oral Mucositis Grading Criteria and the Visual Analog Scale (VAS) pain grading criteria. The time when oral mucositis began to appear in both groups and the total time of radiotherapy. result All patients completed the concurrent radiotherapy and chemotherapy program. The total radiotherapy time in the observation group [(46.4 ± 1.6) d] was shorter than that in the control group [(48.2 ± 3.2) d], and the difference was statistically significant ( t = -2.720, P = 0.009 ). The clinical total effective rates of observation group and control group were 93.8% (30/32) and 96.9% (31/32), respectively, and the difference was not statistically significant ( χ2 =0.35, P =0.554). The mean time for grades 1 and 2 and 3 of oral mucositis in the observation group were (20.9±2.5), (29.3±2.4), (34.5±1.8) days, and later than the control group (16.3±2.0), (24.2±). 2.2), (31.0 ± 2.2) d, the difference was statistically significant ( t= 8.125, P = 0.000; t = 8.840, P = 0.000; t = 6.944, P = 0.001). The incidence of grade 3 oral mucositis was 31.2% (10/32) in the observation group, which was lower than the 56.2% (18/32) in the control group. The difference was statistically significant ( Z =-2.197, P). = 0.028). The total incidence of grade 2 and 3 oral mucositis in the observation group at the end of concurrent chemoradiation was 53.1% (17/32), which was lower than the 81.2% (26/32) in the control group. The difference was statistically significant. ( Z =-2.708, P= 0.007). The incidence of moderate or severe oral pain caused by oral mucositis in the observation group was 46.9% (15/32) and 6.2% (2/32), respectively, lower than the 59.4% (19/32) and 15.6% of the control group (5 /32), the difference was statistically significant ( Z = -2.009, P = 0.045). in conclusion rhGM-CSF mouthwash can delay the occurrence of oral mucositis, reduce the incidence of oral mucositis and oral pain, effectively prevent and treat locally advanced nasopharyngeal carcinoma caused by simultaneous radiotherapy and chemotherapy of oral mucositis, worthy of clinical application. © 2018 Chinese Medical Association Publishing House Co. Ltd. All rights reserved.     

Prospective,single-center cohort study analyzing the efcacy of complete laparoscopic resection on recurrent hepatocellular carcinoma

Background: Laparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). How?ever, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efcacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence. Methods: We conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31)underwent laparoscopic hepatectomy, and the control group (n tion time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient= 33) underwent conventional open surgery. Opera?could walk, anal exsufation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse?free survival was compared between the two groups. Results: All surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differencesbetween the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraopera?tive blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6vs. 2.2 ± 0.8 days, P < 0.05), anal exsufation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days,P= 0.014). During the 1?year postoperative follow?up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse?free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recur?rence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was signifi?cantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence. Conclusions: For the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraop?erative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.     

重组人白细胞介素-11治疗消化道肿瘤化疗后血小板减少症的临床研究

Objective: To evaluate the efficacy and safety of recombinant human interleukin-11 (rhIL-11) for the chemotherapy-induced thrombocytopenia in patients with gastrointestinal cancer. Methods: It was an opened and non-randomized controlled clinical study. When the platelet counts was under 75 × 109/L after chemotherapy, rhIL-11 was administered 25six patients were enrolled into this study. The treatment group and the control group had thirty-eight cases, respectively. The mean recovery time to PLT ≥ 100 × 109/L was 8.1 days in treatment group, while in control group was 12.2 days (P ＜ 0.01).Moreover, the mean recovery time from PLT ≤ 50 × 109/L to ≥ 100 × 109/L was 8.9 days in treatment group, while in control group was 12.9 days (P ＜ 0.05). There was a statistical difference between the two groups. Major side effects included edema,fever, articular muscle soreness, but they were all mild and well tolerable. Conclusion: rhIL-11 can be safely and effectively used for the treatment of chemotherapy-induced thrombocytopenia in patients with gastrointestinal cancer.     

全胸腔镜联合腹腔镜食管癌根治术与常规手术的临床对比研究(英文)

Objective: The aim was to evaluate the best intra-thoracoscopic surgery technique between video-assisted thoracic surgery (VATS) combined with laparoscopy and right open transthoracic esophagectomy, in patients with esophageal cancer. Methods: From November 2006 to May 2008, 221 patients with esophageal cancer were enrolled in this study, prospective randomized in two groups. 111 patients were performed the VATS technique (Experimental group), whereas in the other 110 patients esophagectomy was adopted by thoracotomy (Control group). Results: The time consuming of Experimental group was 272.3 min in average with a standard deviation(std) of 57.9, and it was 218.7 min in average with std of 91.0 in the control group (P=0.000). The operative blood loss was 219.7±194.4 mL in the Experimental group, compared with 590.0±324.4 mL in the control group, with significant difference (P=0.000). Postoperative hospital stay of Experimental group was 9.6±1.7d, and it was 11.4±2.3d in the control group (P=0.000). There was no-delayed union of incision in the Experimental group, but 6.36% in the control group (P=0.007). The disorder of gastric emptying occurred 0.9% in the Experimental group, whereas 6.4% in the Control group. There was no significant difference in survival curves and rates (P=0.555). Conclusion: There were several advantages of VATS technique, such as reduced hemorrhage, better recovery, few complications, and great number of lymph node dissection, although there was no significant difference in long-term survival rate. Thus the VATS combined with laparoscopy technique was worthy of generalization in esophageal surgery with good prospects.     

Evaluation of the safety and efficacy of glucocorticoid therapy for hyperbilirubinemia in patients with hepatocellular carcinoma who have undergone transcatheter arterial chemoembolization

Objective The aim of this study was to analyze the safety and efficacy of glucocorticoid treatment for hyperbilirubinemia in patients with hepatocellular carcinoma(HCC)who have undergone transcatheter arterial chemoembolization(TACE).Methods We conducted a retrospective analysis of the clinical data of 198 patients with HCC who were admitted to The Fifth Medical Center of PLA General Hospital from June 2014 to August 2019 and underwent TACE therapy.The patients were divided into glucocorticoid(GCC)treatment group and control group.Standard liver-protecting procedures were used in both groups.The treatment group also received intravenous injections of methylprednisolone sodium succinate for 3–5 days.Reduction in bilirubin concentration,mean duration of hospitalization,and complications were compared between the two groups to investigate the safety and efficacy of GCCs for treatment of hyperbilirubinemia after TACE treatment.Results Bilirubin concentrations were significantly lower in the treatment group than in control group on days 3 and 5 after GCC/conventional liver-protecting treatment(P<0.05).The treatment group had significantly shorter durations of total post-surgery hospitalization,and recovery time than the control group(14.5±4.6 days vs.17.5±6.6 days,P<0.001;9.2±3.3 days vs.11.8±5.4 days,P=0.001;7.0±3.3 days vs.9.3±4.6 days,P<0.001).No GCC-associated complications were detected in the treatment group.Conclusion Short-term use of GCCs to treat hyperbilirubinemia in patients with HCC who have undergone TACE is safe and associated with rapid decline in bilirubin concentration and shorter hospital stay compared with patients who did not receive GCCs.     

立即全切与保留膀胱治疗初发T1G3膀胱癌总生存率的Meta分析(英文)

Objective:The aim of this study was to compare the therapeutic effects of bladder preserving approach transurethral resection (TURBT) with additional intravesical instillation versus immediate cystectomy in patients with newly diagnosed stage T 1 G 3 bladder cancer. Methods:Clinical data of patients with newly diagnosed T 1 G 3 bladder cancer underwent immediate cystectomy (Group A) or TURBT with additional intravesical instillation (Group B) was collected from online databases. Meta-analysis that recommended by Cochrane Collaboration was done for the data obtained. Publication bias was examined using a funnel plot. Results:Four trails, including 434 patients, were eligible for this study. The general mortality rate of group A (74/149 = 49.7%) and group B (102/285 = 35.8%) was calculated and compared in RevMan 4.2, which showed the difference on general mortality rate between the two groups was not statistical significant, with the pooled RR = 1.23 (95% CI 1.10-1.70, P > 0.05). Conclusion:Compared with TURBT, immediate cystectomy may not reduce the general mortality rate to improve the forward survival rate.     

Tumor markers of bladder cancer: the schistosomal bladder tumors versus non-schistosomal bladder tumors

Recent data have redefined the concept of inflammation as a critical component of tumor progression. However, there has been little development on cases where inflammation on or near a wound and a tumor exist simultaneously. Therefore, this pilot study aims to observe the impact of a wound on a tumor, to build a new mouse tumor model with a manufactured surgical wound representing acute inflammation, and to evaluate the relationship between acute inflammation or wound healing and the process of tumor growth. We focus on the two phases that are present when acute inflammation influences tumor. In the early phase, inhibitory effects are present. The process that produces these effects is the functional reaction of IFN-γ secretions from a wound inflammation. In the latter phase, the inhibited tumor is made resistant to IFN-γ through the release of TGF-β to balance the inflammatory factor effect on the tumor cells. A pair of cytokines IFN-γ/TGF-β established a new balance to protect the tumor from the interference effect of the inflammation. The tumor was made resistant to IFN-γ through the release of TGF-β to balance the inflammatory effect on the tumor cells. This balance mechanism that occurred in the tumor cells increased proliferation and invasion. In vitro and in vivo experiments have confirmed a new view of clinical surgery that will provide more detailed information on the evaluation of tumors after surgery. This study also provides a better understanding of the relationship between tumor and inflammation, as well as tumor cell attacks on inflammatory factors.     

Characteristics of bladder microcirculation in women with overactive bladder

We studied microcirculation and a blood nitric oxide level in 30 females aged 23-63 years with overactive bladder (OAB) before and after administration of oxibutinin. We found that OAB patients have microcirculation disorders accompanied with elevation of nitric oxide in the blood. Oxibutin improved bladder microcirculation, normalized blood nitric oxide with resultant positive changes in clinical symptoms with less frequent voiding and alleviation of imperative disorders.     

肌层浸润性膀胱癌保留膀胱手术的临床观察

目的　探讨肌层浸润性膀胱尿路上皮癌保留膀胱手术的有效性及安全性。方法　收集２００３年６月至２００７年６月行保留膀胱手术的４１例肌层浸润性膀胱癌患者的临床资料,其中行膀胱部分切除术（ＰＣ）２９例,行根治性经尿道膀胱肿瘤电切术（ＴＵＲＢＴ）１２例。采用吡柔比星３０ｍｇ／次膀胱灌注化疗,每周１次,共８次,继而每月１次,共持续１年。每３个月行膀胱镜检查１次,持续２年。结果　ＰＣ组术后１、３年无瘤生存率分别为８２８％（２４／２９）和５５.２％（１６／２９）,ＴＵＲＢＴ组分别为７５％（９／１２）和５０％（６／１２）,两组差异均无统计学意义（Ｐ＞０.０５）。ＰＣ组术后肿瘤复发率为３４.５％（１０／２９）,首次肿瘤中位复发时间为９.５个月;ＴＵＲＢＴ组术后肿瘤复发率为４１.７％（５／１２）,首次肿瘤中位复发时间为８.０个月,两组差异均无统计学意义（Ｐ＞０.０５）。结论　对于身体条件不能耐受或不愿接受根治性膀胱全切术的肌层浸润性膀胱癌患者,行保留膀胱手术联合术后化疗是一种可行的治疗方案。     

Multimodality bladder preservation therapy for muscle-invasive bladder tumors

The standard treatment for muscle-invasive bladder cancer in the United States is still radical cystectomy with pelvic lymph node dissection. An alternative to cystectomy is multimodality bladder preservation with thorough transurethral resection, chemotherapy, and radiation therapy. This report addresses several key issues to be considered when selecting patients for a multimodality treatment for invasive bladder cancer. Recent protocols incorporating various fractionation schemes for radiation and alternative chemotherapeutic agents are reviewed. Quality of life associated with bladder preservation after a multimodality approach is also discussed.     

羟基喜树碱膀胱灌注化疗预防膀胱癌术后复发

目的 探讨羟基喜树碱在膀胱癌术后膀胱灌注化疗预防肿瘤复发的效果。方法 52例膀胱恶性肿瘤患行膀胱部分切除术或羟尿道膀胱肿瘤电气化切除术后，采用羟基喜树碱20mg 生理盐水20mg膀胱灌注20次预防膀胱肿瘤复发。结果 随访1～6年，术后2年无复发，2年后复发6例，复发率11．5％。结论 膀胱癌术后羟基喜树碱膀胱灌注化疗预防肿瘤复发，疗效肯定副作用小。     

肌层浸润性膀胱癌保留膀胱综合治疗的疗效评价研究

目的 评价髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗综合治疗肌层浸润性膀胱癌的临床疗效.方法 比较64例采用髂内动脉灌注化疗(吡柔比星40 mg/m2、5-FU 1000 mg/m2、羟喜树碱30 mg/m2)+经尿道膀胱肿瘤电切术+膀胱内灌注化疗(综合治疗组)和62例采用经尿道膀胱肿瘤电切术+膀胱内灌注化疗(对照组)的肌层浸润性膀胱癌(T2N0M0期)患者经治疗后的肿瘤复发/转移率、死亡率及治疗相关不良反应的发生情况.结果 至随访截至日期,综合治疗组的无复发/转移率为93.75%(60/64),明显高于对照组的45.16%(28/62),差异有统计学意义(P=0);转移死亡率为3.13%(2/64),低于对照组的16.13%(10/62),差异有统计学意义(P=0.015);非膀胱癌死亡率为10.94%(7/64),与对照组的12.90%(8/62)相比,差异无统计学意义(P﹥0.05).结论 髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗的综合治疗方案,能够降低肌层浸润性膀胱癌(T2N0M0)患者肿瘤复发率和死亡率,不增加非癌性死亡风险,值得进一步探讨.     

Management of bladder cancer

Bladder cancer is a paradigm of malignancy, representing the spectrum from localized to metastatic disease, and manifesting varied histologic types, including transitional cell carcinoma, squamous cell carcinoma, and adenocarcinoma. Preclinical and clinical data suggest that a common stem cell of origin gives rise to the different histologic types and that these patterns are of clonal origin. Localized bladder cancer is managed optimally by transurethral resection, with or without adjuvant intravesical chemotherapy. Invasive cancer or relapsed superficial disease may require more radical surgery or radical radiotherapy. In recent years, the evolution of techniques of continent urinary diversion or of bladder replacement has revolutionized the management of invasive disease. However, the 5-year survival for invasive bladder cancer is still approximately 50%, and innovative strategies have been developed, combining definitive local treatment and systemic chemotherapy, in an attempt to improve survival. For patients with metastatic disease, the combination of methotrexate, vinblastine, doxorubicin, and cisplatin (the MVAC regimen) has achieved response rates as high as 70% but with a median survival of only 12 months. Until cure rates are improved, one of the hallmarks of effective management of metastatic disease will remain the provision of thorough and well-structured palliative treatment programs. Recently, the introduction of new agents (such as paclitaxel, gallium, ifosfamide, and gemcitabine) has led to promising response rates, and further clinical trials of these agents alone and in combination are in progress. In addition, an improved understanding of the mechanisms of resistance to treatment, including the implications of the expression of p-glycoprotein, p53 proteins, and other biochemical predictors of outcome, and of strategies to overcome such resistance, may lead to more effective management of advanced disease. Furthermore, real progress will be made only through the application of well-designed clinical trials to test the efficacy and toxicity of the new strategies of treatment.