胸部肿瘤术后发生心律失常的危险因素

目的 分析胸部肿瘤术后发生心律失常的危险因素。方法 对679例胸部肿瘤患术后心电监护72小时以上，发生心律失常l14例。分析心律失常与无心律失常组间8项指标，用t检验和χ^2检验，分析组间差异。结果 年龄≥60岁、术前心电图异常、合并高血压、肺功能中度以上减退、糖尿病患以及手术时间＞5小时以上，术后发生心律失常的危险显增加；同时具二项以上合并症较一项合并症术后发生率差异显(P＜0．01)；肺、食管、贲门肿瘤术后的发生率无显差异(P＞0．05)。结论 高龄、肺功能较差、术前合并心血管疾病、糖尿病及手术时间长，均可使术后发生心律失常的机会增加，而与不同肿瘤即肺、食管、贲门癌及其术式无密切关系。     

胸部肿瘤术后近期心电图表现

目的：为了及时发现和处理胸部肿瘤手术后出现的各种心律失常及心肌供血情况。方法：对４３０ 例胸部肿瘤病人术后１ ～３ 天进行１２ 导联心电图检查。结果：术前心电图异常３０７ 例，约占７１ ％ 。术后心电图异常３４５ 例，约占８０ ％ 。慢性冠状动脉供血不足、心肌劳累、低血钾三种心电图异常发生率手术前后无明显变化。各种心律失常、急性心梗、急性心肌缺血、 Ｑ Ｒ Ｓ 低电压、完全性右束支传导阻滞的发生率术后明显增加。结论：上述情况发生的原因与术前心脏疾患的治疗和预防措施、术中和术后的不良刺激以及低氧血症有关。     

老年冠心病患者非心脏胸部肿瘤术后心律失常临床分析

总结我院1991-1998年60岁以上冠心病患者实施胸部肿瘤手术后出现的49例各种类型的心律失常,对同期冠心病与非冠心病患者围术期心律失常发生率进行对比分析,经统计学处理,两者差异有极显著性(P<0.005)。老年冠心病是开胸术后发生心律失常的基础,术后应严密监护。     

60岁以上胸部肿瘤术后心律失常

６０岁以上胸部肿瘤术后心律失常申佃京临朐县人民医院（临朐２６２６００）胸部肿瘤开胸术后心律失常是常见心血管并发症。我院１９８９年６月～１９９５年６月期间，对２２４例６０岁以上胸部肿瘤患者开胸术后心电监测，发生心律失常８４例，占３７．１％。其中室早２９...     

食管癌、贲门癌术后心律失常的原因分析

目的 探讨食管癌、贲门癌术后心律失常的原因.方法 对我科收治的600例食管癌、贲门癌患者临床资料进行回顾性分析.结果 600例食管癌、贲门癌患者术后共发生心律失常136例.不同年龄、术前心电图表现、肿瘤部位的患者术后心律失常的发生率:＜60岁者和≥60岁者分别为10.4％、25.0％;术前心电图检查正常者和异常者分别为6.3％、87.6％;食管癌、贲门癌患者分别为24.5％、14.4％,各组比较差异均有统计学意义(P均＜0.05).结论 高龄、术前心电图异常、手术方式、术后并发症与术后心律失常的发生密切相关.     

老年冠心病患者非心脏胸部肿瘤术后心律失常临床分析

总结我院1991－998年60岁以上冠心病患者实施胸部肿瘤手术后出现的49例各种类型的心律失常，对同期冠心病与非冠心病患者术期心律失常发生率进行对比分析，经统计学处理，两者差异有极显著性（P＜0．005）。老年冠心病是开胸术后发生心律失常的基础，术后应严密监护。     

食管癌贲门癌患者术后心律失常187例临床分析

目的 探讨食管癌贲门癌患者术后心律失常的发生原因及预防措施。方法 对625例食管癌责门癌患者的临床资料进行回顾性分析。结果术后共发生心律失常187例。＜60岁者术后心律失常的发生率为24．6％，≥60岁者为36．6％；术前合并心血管疾病者术后心律失常发生率为87．2％；食管癌患者术后心律失常发生率为37．7％，贲门癌为22．1％；颈部吻合者术后心律失常发生率为33．0％，弓下吻合者为22．3％；各组间均有显著性差异。结论 年龄、术前合并心血管疾病、吻合部位与术后心律失常的发生密切相关。充分的术前准备，加强术后监护，纠正缺氧可以预防或减少心律失常的发生。     

围手术期高血压对胸部肿瘤患者术后心血管并发症的影响

背景与目的:围手术期高血压发病率逐年增多,高血压增加麻醉、手术的风险,影响患者的术后转归.本研究主要探讨围手术期高血压对胸部肿瘤患者术后心血管并发症的影响.方法:回顾性分析2005年8月至12月中山大学肿瘤防治中心胸科行开胸手术治疗的胸部肿瘤患者464例的临床资料.全组患者分为两组,其中围手术期高血压患者组152例,非高血压患者组312例.分析这两组患者的术后心血管并发症,然后进行卡方检验.结果:两组患者在年龄、性别、肿瘤种类、术前合并慢性疾病及术前心血管疾病分布相似(P＞0.05).围手术期高血压患者组术后心血管并发症54例,发生率为35.53%,其中心律失常41例,低血压8例,心衰3例,心肌缺血2例.围手术期非高血压患者组术后心血管并发症53例,发生率为16.99%,其中心律失常41例,低血压9例,心衰2例,心肌缺血1例.两组患者术后心血管并发症发生率的差异有统计学意义(P＜0.05).结论:围手术期高血压明显增加了胸部肿瘤患者开胸术后心血管并发症的发生率.     

高龄癌症患者普胸手术后快速型心律失常23例

 目的　分析高龄癌症患者普胸外科手术后快速型心律失常的病因及其处理方法。方法　对23例高龄癌症术后心律失常患者肿瘤部位、伴随疾病、手术方法及术后治疗作回顾性分析。结果　23例术后并发快速型心律失常患者经过及时有效的治疗，均能缓解。结论　重视术前准备，尽早治疗并发症，术中、术后加强心电监护，维持水电解质和酸碱平衡，对防止术后心律失常的发生有重要作用，尽早处理严重心律失常是治疗成功的关键。     

胸部肿瘤术后近期心电图表现

目的：为了及时发现和处理胸部肿瘤手术后出现的各种心律失常及心肌供血情况。方法；对４３０例胸部肿瘤病人术后１－３天进行１２导联心电图检查。结果；术前心电图异常３０７例，约占７１％。术后心电图异常３４５例，约占８０％，慢性冠状动脉供血不足，心肌劳累，低血钾三种心电图异常发生率手术前后无明显变化。     

乳腺癌患者血清CYFRA21-1检测的临床价值

目的 :检测乳腺癌患者血清中CYFRA2 1 1水平 ,探讨其在乳腺癌的术前诊断和术后随访监测中的应用价值。方法 :采用放免法测定 34例乳腺良性疾病患者术前、4 7例乳腺癌患者术前和术后 4周及 56例乳腺癌术后随访患者的血清CYFRA2 1 1水平 ,进行对照分析。结果 :乳腺良性疾病无 1例阳性 ;乳腺癌术前阳性率仅 2 1% ,但两者血清CYFRA2 1 1水平有明显差异 ;4 7例乳腺癌患者手术前与术后 4周血清CYFRA2 1 1水平相比有显著差异 ;56例乳腺癌患者术后随访 8例转移复发者中 6例阳性 ,无转移复发者均阴性 ,转移复发者血清CYFRA2 1 1水平较无转移复发者明显增高 ,两者相比差异有极显著性。结论 :血清CYFRA2 1 1检测对乳腺癌特异性高 ,但对乳腺癌术前诊断价值不大 ,对乳腺癌转移复发的监测有非常重要意义。     

Transhiatal distal esophagectomy for Siewert type II cardia cancer can be a treatment option in selected patients

BackgroundWhile surgical treatment of Siewert I and III (S1,S3) Esophagogastric Junction (EGJ) cancer is codified, the efficay of transhiatal procedure with anastomosis in the lower mediastinum for Siewert II (S2) still remains a dibated topic.MethodsThis is a large multicenter retrospective study. The results of 598 consecutive patients submitted to resection with curative intent from January 2000 to January 2017 were reported. Clinical and oncological outcomes of different procedures performed in S2 tumor were analyzed to investigate the efficacy of transhiatal approach.ResultsThe 5-year overall survival rate (OS) was poor (32%) for all Siewert types. The most performed operations in S2 cancer were proximal gastrectomy + transthoracic esophagectomy (TTE or Ivor-Lewis procedure, 60%), total gastrectomy + transhiatal distal esophagectomy with anastomosis in the chest (THE, 24%) and total gastrectomy + transthoracic esophagectomy (TGTTE, 15%). Cardiovascular and pulmonary complications were higher after TTE. On the contrary, surgical complications were significantly higher after THE. Postoperative mortality was similar. The distribution of TNM stages was different in the 3 types of procedures: patients submitted to THE had an earlier stage disease. With this bias, OS after THE was higher than after TTE but the difference was not significant (49.85% vs 28.42%, p = 0.0587).ConclusionsDespite a higher rate of postoperative surgical complications, OS after total gastrectomy and transhiatal distal esophagectomy was at least comparable to that of transthoracic approach in less advanced S2 tumors. Therefore, THE with anastomosis in the chest could be a treatmen option in earlier S2 tumors.     

Timing of chest radiotherapy in patients with limited stage small cell lung cancer: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND: We undertook a systematic review and literature-based meta-analysis to determine whether the timing of chest radiotherapy may influence the survival of patients with limited stage small cell lung cancer (LS-SCLC). OBJECTIVES: To establish the most effective way of combining chest radiotherapy with chemotherapy for patients with limited-stage small cell lung cancer in order to improve long-term survival. MATERIALS: Eligible studies were identified according to the Cochrane Collaboration Guidelines and were randomised controlled clinical trials comparing different timing of chest radiotherapy in patients with LS-SCLC. Early chest irradiation was defined as beginning within 30 days after the start of chemotherapy. RESULTS: Seven randomised trials were eligible. The overall survival at 2 years or at 5 years was not significantly different between early or late chest radiotherapy. When only trials were considered that used platinum chemotherapy concurrent with chest radiotherapy, significantly higher 2 and 5-year survival rates were observed when chest radiotherapy (RT) was started within 30 days after the start of chemotherapy (2-year survival: HR: 0.73, 95% CI 0.57-0.94, p=0.01; 5-year survival: HR: 0.65, 95% CI 0.45-0.93, p=0.02). This was even more pronounced when the overall treatment time of chest radiotherapy was less than 30 days. In studies that did not show a survival advantage by early chest radiation, a lower dose-intensity of chemotherapy in the early vs. late arm was observed. CONCLUSIONS: When platinum-based chemotherapy concurrently with chest RT is used, the 2- and 5-year survival rates of patients with LS-SCLC may be in favour of early chest radiotherapy, with a significant difference if the overall treatment time of chest radiation is less than 30 days.     

Original Article

BACKGROUND: The prolongation of the post-operative life of cancer patients brings new medical demands. The purpose of this paper is to estimate the total number of women patients with breast cancer who will have disability resulting from surgical treatment from 2000 to 2020 in Japan. METHODS: The estimation was carried out using four indices: the number of cases of women diagnosed with breast cancer, the proportion of surgical operations, the frequency of disability from surgical treatment, and the crude survival rate of the patient group. The crude survival rates of surgically-treated breast cancer patients were estimated by the Weibull model. The frequencies of iatrogenic disabilities were calculated from several reports of complaints of pain in the chest wall or axilla and lymphedema of the arm, and 95% confidence intervals were calculated by the Monte Carlo simulation. RESULTS AND DISCUSSION: The number of women patients with disability from breast cancer treatment from 2000 to 2020 was estimated to be 42,016 (95% CI: 41,236, 42,796) people in 2000 and 72,514 (95% CI: 71,196, 73,832) people in 2020 for pain in the chest wall or axilla, and 22,486 (95% CI: 22,148, 22,823) people in 2000 and 38,692 (95% CI: 38,094, 39,290) people in 2020 for lymphedema of the arm. Treatment supports required for the disability are medication and social support. Cancer patients with disability after treatment need long-term support in their daily life.     

食管癌99mTc-HL91乏氧显像和HIF-1α表达水平的相关性研究

目的:研究食管癌99mTc-HL91乏氧显像以及与乏氧诱导因子-1α(HIF-1α)表达水平的相关性。方法:50例食管癌患者行SPECT99mTc-HL91乏氧显像,利用感兴趣区技术分别勾画各时相肿瘤(T)和相应正常食管部位(N)放射性计数比值,即T/N值,免疫组化方法检测肿瘤组织HIF-1α表达水平。结果:50例病灶对99mTc-HL91的摄取均高于相应正常组织,99mTc-HL91摄取程度与肿瘤病理分级无相关关系(P>0.05);注射99mTc-HL91 4小时后SPECT显像颈段和胸上段食管癌T/N值为2.04±0.38,胸中段食管癌T/N值为2.16±0.32,胸下段食管癌T/N值为2.18±0.41,三者无显著性差异(P>0.05);病灶的T/N值为1.36-4.43(中位值2.45),免疫组化结果显示表达HIF-1α的细胞数为23.1%-76.9%(中位数52.9%),两者之间呈正相关(P<0.05)。结论:食管癌组织对乏氧显像剂99mTc-HL91有显著摄取,摄取值与肿瘤病理分级及病变部位无相关性,但与HIF-1α的表达正相关。     

Decentralization of breast cancer surgery in the United States

BACKGROUND: Physician volume of at least 15-30 annual breast cancer operations has been associated with higher 5-year survival rates. The authors sought to determine whether surgical volumes for breast cancer in the United States frequently reach this threshold. METHODS: The authors conducted a retrospective cohort study of 987 surgeons who operated on 8105 Medicare patients with breast cancer during 1994-1995 in 6 areas in the Surveillance, Epidemiology and End Results tumor registry. The 2-year physician volume of breast cancer operations was estimated among Medicare patients (approximating the on-average annual volumes for patients of all ages) and its association was examined with physician characteristics and with 3 measures of surgical care. RESULTS: The median 2-year Medicare volume for breast cancer surgeons was 6, and 79% of physicians performed < or = 12 operations. Approximately 50% of patients were cared for by physicians who performed < or = 12 operations over 2 years, and 10% of patients were cared for by physicians who performed > or = 30 operations. Surgeon characteristics of age, female gender, general surgery board certification, and academic affiliation were associated with modestly higher volumes of breast cancer surgery. Higher surgeon volumes were associated with higher patient receipt of breast-conserving surgery, testing for hormone receptors, and lymph node dissection during mastectomy. CONCLUSIONS: Most physicians who perform breast cancer surgery perform few annual operations in Medicare patients, and lower volumes are associated with differences in surgical processes of care. Because patients in the Medicare age group comprise almost 50% of all incident breast cancer cases, surgical volumes for patients of all ages also are likely to be low. It is likely that only approximately 10% of patients in the United States are treated by surgeons who performing at least 30 annual operations.     

胸腔镜肺叶切除术及淋巴清扫术对不同病理类型肺癌患者肺功能、生存率的影响

目的 探讨胸腔镜肺叶切除术及淋巴清扫术对不同病理类型肺癌患者肺功能、生存率的影响。方法 选取2009年6月—2011年9月在我院接受胸腔镜肺叶切除术及纵隔淋巴清扫术的125例肺癌患者作为研究对象,根据病理类型分为腺癌组(AG)、鳞癌组(SG)、大细胞癌组(LG),观察手术前后临床效果、肺功能指标及生存率等。结果 LG组在手术时间、术中出血量、术后胸管引流量方面均高于SG组、AG组(P＜0.05);AG组在术中出血量、术后胸管引流量及术后恢复时间方面均高于SG组(P＜0.05);LG组在FVC%方面高于AG组(P＜0.05);LG组、AG组在FVC%、FEF50%、FEF75%方面与SG组有统计学差异(P＜0.05);18个月后各组患者生存率均低于第12个月的随访结果(P＜0.05),SG组在12、18个月的生存率均高于AG组、LG组(P＜0.05)。结论 胸腔镜肺叶切除术联合淋巴结清扫术治疗不同病理类型肺癌患者时,大细胞癌手术治疗时手术时间、术中出血量、术后胸管引流量方面均高于腺癌、鳞癌患者;鳞癌患者生存率及身体评价均高于其他各组。     

Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer.

BACKGROUND: We undertook a systematic review and literature-based meta-analysis to determine whether the timing of chest radiotherapy may influence the survival of patients with limited-stage small-cell lung cancer (LS-SCLC). MATERIALS: Eligible randomised controlled clinical trials were identified according to the Cochrane Collaboration Guidelines, comparing different timing of chest radiotherapy in patients with LS-SCLC. Early chest irradiation was defined as beginning within 30 days after the start of chemotherapy. RESULTS: Considering all seven eligible trials, the overall survival at 2 or 5 years was not significantly different between early or late chest radiotherapy. When only trials were considered that used platinum chemotherapy concurrent with chest radiotherapy, a significantly higher 5-year survival was observed when chest radiotherapy was started within 30 days after the start of chemotherapy (2-year survival: OR: 0.73, 95% CI 0.51-1.03, P = 0.07; 5-year survival: OR: 0.64, 95% CI 0.44-0.92, P = 0.02). This was even more pronounced when the overall treatment time of chest radiotherapy was less than 30 days. CONCLUSIONS: There are indications that the 5-year survival rates of patients with LS-SCLC are in favour of early chest radiotherapy, with a significant difference if the overall treatment time of chest radiation is less than 30 days.     

Concurrent twice-a-week docetaxel and radiotherapy: a dose escalation trial with immunological toxicity evaluation

Purpose: In vitro studies show that docetaxel (Taxotere) is potent radiosensitizer. In a previous study we observed a 27% complete response rate after radiotherapy and weekly docetaxel for non–small-cell lung cancer. In this dose escalation study we investigated the feasibility of a twice-a-week docetaxel regimen together with conventionally fractionated radiotherapy for brain, chest, and pelvic tumors.Methods and Materials: Nine patients with stage IIIb lung cancer, 9 with stage IVa pelvic tumors, and 9 with brain glioblastoma were recruited. The starting dose was 15 mg/m² (twice a week) and was escalated by 4 mg/m² increments every 3 patients with chest, pelvic, and brain tumors.Results: The maximum tolerated dose of docetaxel was 15 mg/m² (twice a week) for chest and pelvic cancer patients. The dose-limiting toxicity (DLT) was asthenia and mucosal toxicity (esophagitis or diarrhea in chest and pelvic tumors, respectively). Patients with glioblastomas received 23 mg/m² (twice a week) without toxicity. Complete response of the chest disease was observed in 3/9 (33%) patients and partial response in 4/9 (44%). Three patients with glioblastoma had a partial response. In pelvic malignancies a high complete response rate was observed (4/9; 45%). Severe monocytopenia and lymphocytopenia were observed during the fourth week of treatment. IgG and IgA immunoglobulins were also reduced. This coincided with the onset of asthenia and severe mucosal toxicity. Asthenia was absent in patients treated for brain tumors, and lymphocyte toxicity was less pronounced.Conclusions: Docetaxel radiochemotherapy is a promising therapeutic approach for locally advanced cancer. The recommended dose of docetaxel for chest and pelvic cancer patients is 15 mg/m² twice a week. Patients with brain tumors can be safely treated with higher doses of docetaxel (23 mg/m² twice a week) without toxicity. The severe immunologic toxicity observed suggests that granulocyte–macrophage colony-stimulating factor (GM-CSF) and immunoglobulin administration may be important in the efficacy and tolerance of taxane-based radiochemotherapy. Randomized trials are required to assess whether the efficacy of docetaxel radiochemotherapy depends on the frequency of docetaxel administration during radiation treatment.     

Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients

Purpose: Long-term outcome after radiation therapy for local–regional recurrence of breast cancer after mastectomy is generally poor. This study was performed to evaluate the long-term outcome for a potentially favorable subgroup of patients with chest wall recurrence.Methods and Materials: Of 71 patients with an isolated local–regional recurrence of breast cancer after mastectomy, 18 were identified who met the following favorable selection criteria: 1) a disease-free interval after mastectomy of 2 years or more, 2) an isolated chest wall recurrence, and 3) tumor size < 3 cm or complete excision of the recurrent disease. All 18 patients were treated with local–regional irradiation between 1967 and 1988. Radiotherapy (RT) was delivered to the chest wall to a median total dose of 60 Gy (range 30–66 Gy). Four patients received adjuvant chemotherapy and six patients received adjuvant hormonal therapy.Results: With a median follow-up of 8.4 years, nine of 18 patients were alive and free of disease. The 10-year actuarial overall and cause-specific survivals were 72% and 77%, respectively. The 10-year actuarial relapse-free survival and local control were 42% and 86%, respectively.Conclusion: Treatment for a local–regional recurrence of breast cancer after mastectomy in a favorable subgroup of patients results in a high rate of long-term survival as well as excellent local control. Aggressive treatment is warranted in this favorable subgroup of patients. 1998 Elsevier Science Inc.