妊娠合并子宫肌瘤235例临床分析

[目的]探讨刮宫产术中子宫肌瘤剔除的可行性。[方法]回顾性分析235例妊娠合并子宫肌瘤产妇，在剖宫产同时行子宫肌瘤剔除，并与170例单纯剖宫产的无合并子宫肌瘤产妇的临床资料作对照。[结果]观察组与对照组对象年龄、孕次、孕周等方面无统计学意义（P〉0．05）。两组出血量、外周血血红蛋白下降值、手术时间、切口愈合情况均无统计学意义（P〉0.05）。[结论]妊娠合并子宫肌瘤患者剖宫产率高．大部分病例可在剖宫产同时仃子宫肌瘤剔除术，但对于直径〉5cm的肌壁间或黏膜下肌瘤．需做好充分的术前准备，保证手术的安全。     

剖宫产术中子宫肌瘤的处理及结局分析

目的：探讨剖宫产术中剔除子宫肌瘤的安全性.方法：对56例妊娠合并子宫肌瘤病例剖宫产子宫肌瘤剔除方法进行分析,正常剖官产术做对照比较预后.结果：单纯子宫肌瘤剔除组（剔除I组）与对照组比较,术中出血量增加,手术时间延长,差异有统计学意义（P〈0.01）.先结扎子宫动脉后剔除子宫肌瘤组（剔除Ⅱ组）与对照组比较,手术时间延长（t=3.71,P〈0.01、）,术中出血量无差异（t=1.49,P〉0.05）,三组产后出血发生率、产科子宫切除、术后病率、住院时间两两比较差异无统计学意义.结论：剖宫产术中剔除子宫肌瘤术中出血量增加,应加强对出血预测,必要时行子宫动脉结扎,减少术中出血量.     

剖宫产术中行子宫肌瘤剔除术160例临床分析

目的：探讨剖宫产同时行子宫肌瘤剔除术的可行性。方法：回顾性分析160例剖宫产术中同时行子宫肌瘤剔除术的产妇,与同期100例行单纯剖宫产术的产妇作为对照,比较两组的手术时间、出血量、住院天数。按肌瘤大小分为〉8cm肌瘤组与≤8cm肌瘤组,对其术中出血量、手术时间及术后住院天数进行比较。结果：研究组手术操作时间较对照组延长,差异有统计学意义（P〈0.05）;但两组的术中出血量和术后住院天数比较,差异均无统计学意义（P〉0.05）。〉8cm肌瘤组与≤8cm肌瘤组相比较,手术时间明显延长,术中出血量显著增多（P〈0.05）。结论：根据患者的具体情况,选择性地行剖宫产同时子宫肌瘤剥除术是安全可行的,对部位特殊的子宫肌瘤及大型子宫肌瘤的处理须谨慎。     

妊娠合并卵巢肿瘤和子宫肌瘤的临床诊断及治疗

目的:分析妊娠合并卵巢肿瘤和子宫肌瘤的临床特征、诊断及其治疗。方法:回顾性分析2010年1月-2012年8月我院产科妊娠合并卵巢肿瘤59例、妊娠合并子宫肌瘤（肌瘤直径大于4cm）患者265例临床资料,分析妊娠合并卵巢肿瘤、妊娠合并子宫肌瘤患者的临床资料、诊断时间、治疗等。结果:妊娠合并卵巢肿瘤患者平均孕次以及无临床自觉症状百分率显著高于妊娠合并子宫肌瘤患者（P＜0.05）;妊娠合并卵巢肿瘤患者彩超诊断准确率89.83%,妊娠合并子宫肌瘤患者彩超诊断准确率为85.28%,两组比较,差异无统计学意义（P＞0.05）;在59例妊娠合并卵巢肿瘤患者中,53例行剖宫产,剖宫产术中同时实施手术患者53例,占剖宫产人数的100.00%,实施卵巢肿瘤剥除加卵巢成形术患者43例（81.13%）、行患侧附件切除术患者10例（18.87%）;在265例妊娠合并子宫肌瘤患者中,164例行剖宫产,剖宫产术中同时行肌瘤剔除术患者135例,占剖宫产人数的82.32%。结论:妊娠合并卵巢肿瘤患者无明显的临床症状;彩超诊断对与妊娠合并卵巢肿瘤、妊娠合并子宫肌瘤具有着重要的应用价值;在严格控制患者病情、掌握手术指征的情况下,剖宫产同时行手术治疗是一种良好的治疗方式。     

子宫肌瘤在晚期妊娠的合理治疗

目的探讨子宫肌瘤在晚期妊娠的合理治疗方法。方法回顾性分析2007--2008年98例晚期妊娠合并子宫肌瘤的处理方法以及产科结局。并随机选取同期100例单纯剖宫产病例的临床资料与剖宫产同时行子宫肌瘤剔除病例比较,评价其预后。结果98例中经阴道分娩28例,剖宫产70例。剖宫产同时行肌瘤剔除术64例,剖宫产并子宫次全切除术1例,另5例因肌瘤生长部位原因仅行单纯剖宫产术。肌瘤剔除组与对照组在出血量、术后外周血血红蛋白值、切口愈合情况、住院时间等方面的差异均无统计学意义（P〉0．05）。结论子宫肌瘤患者在妊娠晚期应根据肌瘤大小、生长部位等条件选择合理的治疗方案,多数患者在行刮宫产术的同时行子宫肌瘤剔除术是安全、可行的。     

妊娠合并子宫肌瘤剖宫产术中行子宫肌瘤剔除术的安全性与可行性分析

目的 探讨妊娠合并子宫肌瘤的孕妇,在剖宫产手术中同时行子宫肌瘤剔除术的安全性和可行性。方法 回顾性分析郑州市妇幼保健院2018年1月至2019年12月收治的妊娠合并子宫肌瘤孕妇520例,按照剖宫产手术中是否同时行子宫肌瘤剔除术分为观察组和对照组,并对2组孕妇围手术期相关指标、术后恢复相关指标以及术后并发症情况进行比较。结果 观察组孕妇手术时间长于对照组,差异有统计学意义(t=2.145,P=0.034)。2组孕妇术中出血量、肛门排气时间、恶露排净时间、住院时间比较差异均无统计学意义(t=1.393,P=0.166;t=1.120,P=0.397;t=1.619,P=0.170;t=1.337,P=0.183)。2组孕妇并发症总发生率比较差异无统计学意义(χ²=0.203,P=0.652)。结论 妊娠合并子宫肌瘤孕妇,在慎重的综合评估后,选择剖宫产术中同时行子宫肌瘤剔除术安全可行,值得临床应用和推广。     

剖宫产手术同期行子宫肌瘤剔除术对产妇的影响

目的 探讨妊娠合并子宫肌瘤的孕妇,在剖宫产手术同期行子宫肌瘤剔除术对其自身的影响。方法 回顾性分析2018年1月至2019年12月郑州市妇幼保健院收治的520例妊娠合并子宫肌瘤孕妇,按照剖宫产手术中是否同期行子宫肌瘤剔除术分为A组(剖宫产手术同期行子宫肌瘤剔除术)和B组(单纯行剖宫产手术),将A组、B组中有妊娠要求的分为C组、D组,分别对A组、B组产妇的血红蛋白下降水平、产后心理状况,C组、D组的再次妊娠成功率、早产率及其他并发症情况进行比较。结果 A组产妇产后焦虑发生率、产后抑郁发生率明显低于B组,差异均有统计学意义(χ²=14.822,P<0.001;χ²=14.919,P<0.001);2组产妇术后血红蛋白下降水平、产后焦虑自评量表评分、爱丁堡抑郁量表评分比较均无统计学意义(t=1.449,P=0.074;t=-0.442,P=0.659;t=-1.506,P=0.066);C组与D组再次妊娠成功率、早产率比较差异均无统计学意义(χ²=0.199,P=0.656;χ²=0.043,...     

腹腔镜在子宫肌瘤剔除术中的临床应用价值

[目的]探讨腹腔镜子宫肌瘤剔除术的临床应用价值。[方法]选择腹腔镜下子宫肌瘤剔除术112例患者作为观察组（腔镜组），取同期具有可比性的开腹子宫肌瘤剔除术患者75例为对照组（开腹组），比较两组病人术中、术后情况。[结果]腔镜组平均手术时间比开腹组长（P=0．001），腔镜组术中平均出血量与开腹组相比无明显差异（P=0．261），腔镜组术后使用镇痛剂、肠功能恢复时间、住院天数、恢复生活自理时间、恢复工作时间及术后病率均低于开腹组，差异有统计学意义（P〈0．05）。无严重手术并发症发生。[结论]腹腔镜子宫肌瘤剔除术是一种微创、安全、有效的手术方法，合理选择适应证和熟练掌握镜下缝合技术是保证手术成功的关键。     

剖宫产术中行子宫肌瘤剔除术的临床应用

目的探讨临床剖宫产术中同时行子宫肌瘤剔除术的临床疗效和安全性。方法选取2011年月至2011年12月期间收治的剖宫产术中同时行子宫肌瘤剔除术的80例妊娠合并子宫肌瘤患者为研究组,并选取同期仅进行剖宫产术的80例妊娠合并子宫肌瘤患者为对照组,观察两组的应用效果。结果研究组手术时间明显高于对照组,差异有统计学意义(P<0.05)。研究组和对照组的术中出血量、产后出血量、缩宫素用量比较,差异无统计学意义(P>0.05)。研究组和对照组术后血红蛋白、住院时间、肛门排气时间比较,差异无统计学意义(P>0.05)。研究组的并发症发生率为2.5%,对照组的并发症发生率为3.8%,差异无统计学意义(P>0.05)。结论临床中妊娠合并有子宫肌瘤的患者在实施剖宫产术中同时行子宫肌瘤剔除术是可行的,值得临床应用与推广。     

妊娠伴子宫肌瘤51例临床分析

:[目的]探讨妊娠合并子宫肌瘤对妊娠期、分娩期及产褥期的影响及处理。[方法]对51例妊娠合并子宫肌瘤进行了回顾性分析。[结果]妊娠合并子宫肌瘤占住院产科病人的0 31% ,合并症发生率为78 43%。子宫肌瘤使剖宫产率提高。剖宫产术中行肌瘤剔除 ,未明显增加整个手术出血量。[结论]妊娠合并子宫肌瘤使妊娠合并症发生率明显提高 ,剖宫产术中行肌瘤剔除是可行的     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.