食管癌和肺癌术后乳糜胸的分析及比较

目的分析食管癌和肺癌术后乳糜胸的发生率、成因、治疗方法及预后并加以比较.方法回顾性研究1993年1月1日～2003年10月31日接受手术治疗的食管癌和肺癌1 32例和2 87例.结果食管癌术后乳糜胸为13例(发生率0.85%),肺癌术后为12例(发生率0.42％);乳糜胸每日的中位引流量,食管癌为1 00 l/天,肺癌为650 l／天.食管癌术后乳糜胸的临床症状有呼吸困难、心悸、呼吸窘迫和休克,肺癌术后乳糜胸无特殊临床表现.食管癌术后乳糜胸保守治疗8例,死亡2例.再手术治疗5例,死亡1例.肺癌术后乳糜胸经保守治疗均痊愈.结论食管癌术后乳糜胸的发生率高于肺癌,食管癌术后乳糜胸的量及临床表现比肺癌严重,食管癌术后乳糜胸预后差.食管癌术后乳糜胸应推荐早期手术治疗,肺癌术后乳糜胸经保守治疗可痊愈.     

食管癌术后乳糜胸的诊治及教训——附17例分析

本院1975—1985年间共施行食管癌切除手术846例,发生乳糜胸17例,发生率为2.01％。乳糜胸发生于左侧7例,右侧6例,双侧4例。16例于术后3天内发生,仅1例于术后7天发生。本组17例均先行保守治疗,8例中转手术,保守治疗死亡1例,中转手术后死亡1例。作者认为在主动脉弓上下这一区域分离食管或肿瘤时,对所分离切断的组织,必须不厌其烦地一一结扎,一旦疑有损伤胸导管,应直视下将胸导管低位双重缝扎,是防止发生乳糜胸的重要措施。保守治疗有一定的试探性,对部分病例,长期保守治疗,将贻误病情。乳糜液引流日量多于500ml者应及时中转手术,是提高治愈率的关键。本组手术8例9次,全部由右胸入路,有简单快捷、效果确实的特点。本文并介绍了这一手术方法和注意事项。     

食管癌切除术后乳糜胸

从1975年到1989年共行食管癌切除术1616例,术后发生乳糜胸25例,占1.5％。治愈123例,死亡2例,死亡率8％。作者提出乳糜胸应根据其每日引流量分为轻、中和重三度,按度进行治疗,轻度者积极保守治疗,避免不必要的手术;中度者首先保守治疗,同时密切观察,必要时改行手术治疗;重度者应及早手术,防止盲目保守治疗,造成严重后果。并对保守和手术治疗有关问题及预防措施进行了讨论。     

食管癌术后乳糜胸的治疗体会——附26例分析

目的　总结食管癌切除术后发生乳糜胸的原因及其治疗经验。方法　本组２６ 例乳糜胸患者,采用保守治疗１２ 例;经左胸或右胸行膈上胸导管手术结扎１４ 例,其中１ 例因胸导管变异,先后２ 次行胸导管手术结扎。结果　保守治疗患者中,９ 例治愈,３ 例死亡。手术结扎胸导管患者中,１３ 例治愈,死亡１ 例。结论食管癌术后乳糜胸多发生于中晚期食管中段癌切除术后,因肿瘤组织与周围组织粘连或浸润,分离肿瘤时,即有伤及胸导管及分支的可能。乳糜胸患者是否需行手术结扎胸导管,主要根据每日乳糜液排出量的多少,若每日引流量超过８００ ～１０００ ｍｌ,经保守治疗３～５ 天,乳糜量有增无减,应果断及早手术结扎胸导管。     

肺癌术后乳糜胸的治疗对策

目的：回顾肺癌肺切除和淋巴结清扫术后并发乳糜胸的病例，分析其治疗对策方法：1997年7月～2003年12月，共1546例肺癌患者行肺切除术(至少是肺叶切除术)并行系统的淋巴结清扫其中16例术后并发乳糜胸，均以保守治疗(闭式引流，胸腔内注药，全胃肠外营养或低脂饮食)。结果：全部16例均经保守治疗治愈该组患者在乳糜胸确诊后经6-2l天治疗，平均于9．8天后可进正常饮食胸引流量最多2100ml／天。结论：由于解剖及生理的原因，以及各种营养支持治疗的进展使其保守；台疗的成功率不断提高，我们认为该类术后乳糜胸如果处理得当，完全可以保守治疗治愈。     

胸腔镜治疗食管癌术后乳糜胸

目的：探讨胸腔镜手术在食管癌手术后乳糜胸治疗中的作用。方法2012年1月至2013年12月,应用胸腔镜经右胸入路行胸导管结扎治疗食管癌术后并发乳糜胸16例。结果16例患者均在胸腔镜下完成手术。手术时间40～90 min,平均65 min。术后引流时间4～9天,平均引流时间5．5天。术后无严重并发症,随访6个月无复发。结论胸腔镜治疗食管癌术后乳糜胸是一种安全、有效的治疗方法。手术后并发乳糜胸应尽早行胸腔镜手术干预,有助于患者的早日康复,减少住院时间。     

食管癌手术后并发乳糜胸23例报告

目的：分析食管癌手术后并发乳糜胸的原因，诊断，治疗方法。方法：对3041食管癌切除术后23例乳糜胸患进行回顾性分析。结果：手术 扎胸导管15例，保守治疗8例，治愈率95．4％，结论：食管癌癌切除后乳糜胸是一种严重并发症，胸腔闭式引流量是诊断的主要依据，明确诊断后胸导管结扎术。     

食管癌切除术后乳糜胸(附8例报告)

本文报告了1979年4月至1985年5月期间行食管癌切除术670例,术后发生乳糜胸7例,发生率1.0％。加上作者在外院处理1例共8例。全部采用2次开胸手术,6例行左侧切口,2例行右侧切口。治愈7例,死亡1例。作者的经验是诊断乳糜胸的主要依据是术后胸腔引流量的多少,如连续几日在1,000ml以上者,应尽快手术,以左侧开胸切口为佳。     

食管癌术后并发乳糜胸的诊断及治疗

目的：探讨乳糜胸的成因、诊断、治疗及再次手术的有关问题。方法：回顾分析１９９２年２月～１９９８年１１月,我院行食管癌手术１２０３例,并发乳糜胸１１例,采取保守治疗３例、手术治疗８例。结果：１０例痊愈、１例同时并发乳糜腹和胸内吻合口瘘,术后第３０天死亡。结论：乳糜胸应根据胸腔引流量合理选择保守治疗或手术治疗。     

食管癌手术后并发乳糜胸23例报告

目的　分析食管癌术后并发乳糜胸的原因、诊断、治疗方法。方法　对 3 0 41例食管癌切除术后 2 3例乳糜胸患者进行回顾性分析。结果　手术结扎胸导管 15例 ,保守治疗 8例 ,治愈率 95 4%。结论　食管癌切除术后乳糜胸是一种严重并发症。胸腔闭式引流量是诊断的主要依据 ,明确诊断后行胸导管结扎术     

食管癌切除术后乳糜胸11例治疗体会

目的:探讨食管癌乳糜胸的临床处理经验.方法:对11例食管癌术后乳糜胸患者的诊断及治疗进行讨论,其中6例大量乳糜胸(引流量≥1200ml)者,行再次手术胸导管低位结扎,5例中小量乳糜胸(引流量<1200ml)采取胸腔闭式引流或胸膜腔穿刺,并胸膜腔内注入10%福尔马林治疗.结果:胸导管结扎者中5例治愈,1例因拖延手术死亡;10%福尔马林胸膜腔内注射者全部治愈.结论:对于食管癌术后乳糜胸患者应根据乳糜液漏出量的多少选择有效治疗措施,大量乳糜胸应及早再次手术胸导管结扎;中小量乳糜胸取10%福尔马林胸膜腔内注射是一种有效的治疗方法.     

预防性胸导管结扎术在食管癌根治术中应用的评价

背景与目的:胸导管结扎术是食管癌切除术中预防和治疗乳糜胸的常用方法,但对于其预防乳糜胸的作用存在争议,且有关胸导管结扎术对食管癌术后其它并发症及预后的影响的研究很少,本研究目的是评价预防性胸导管结扎术对预防乳糜胸的作用及其对并发症和预后的影响。方法:回顾性分析1991年1月至1996年5月在中山大学肿瘤防治中心行食管癌根治术,并有明确记载是否行预防性胸导管结扎术的病例共389例,分为未结扎组218例和结扎组171例,对比两组乳糜胸和其它并发症的发生率及患者生存率,评价预防性胸导管结扎术的临床价值。结果:未结扎组和结扎组乳糜胸发生率分别为0.46%(1/218)和1.17%(2/171)(P<0.001)。未结扎组和结扎组并发症发生率分别为11.5%(25/218)和18.1%(31/171)(P=0.063);围手术期死亡率分别为0.92%(2/218)和1.75%(3/171)(P=0.658)。结扎组和未结扎组1、2、3、5年生存率分别为75.2%、52.2%、42.2%、29.2%和74.2%、53.2%、43.2%、29.8%,P值分别为0.992、0.819、0.841、0.902;两组生存曲线采用log-rank检验,P=0.464。结论:预防性胸导管结扎术不能有效预防乳糜胸,且对食管癌根治术后并发症发生率和患者预后无明显影响。     

局部不良型宫颈癌的综合治疗

目的：探讨局部不良型宫颈癌的综合治疗。方法：40例宫颈癌术前行常规综合放疗,A点剂量＞70Gy30例,60－70Gy7例,50－59Gy2例,44Gy1例,放疗后1－8周行筋膜外子宫切除术15例,次广泛子宫切除术23例,广泛性子宫切除加盆腔淋巴结清扫术2例,结果：2例死于夹杂症,12例死于肿瘤未控或复发。3年生存率为74．9％,5年生存率为66．8％,50％治疗失败发生于治疗后1年内,2年内死亡率为9／12（75．0％）,3例发生术后并发症,均经保守治疗痊愈。结论：放疗后辅以近期子宫切除的综合治疗,对治疗局部不良型宫颈癌有其合理性及可行性。     

Treatment of Acute Promyelocytic Leukemia in Patients Presenting at Vancouver General Hospital from 1983 to 1992

Between 6/83 and 8/92, 23 of 361 patients (6.4%) presenting at Vancouver General Hospital with acute myelogenous leukemia had acute promyelocytic leukemia (APL). Treatment plan was: 1) induction with high-dose cytosine arabinoside and an intercalator; and 2) consolidation with allogeneic bone marrow transplantation (BMT) for those aged ≤ 50 years with a sibling donor or repeat of induction for the others. Complete remission (CR) was achieved in 20 patients (87%). Eleven patients in CR were eligible for allogeneic BMT; 4 were considered unsuitable, 2 refused, and 5 underwent this treatment-1 died of acute graft-versus-host disease, 1 relapsed and 3 are leukemia-free and well 1.6, 3.3 and 3.9 years after diagnosis. Fifteen patients did not undergo allogeneic BMT in CR; 4 received no further treatment and all died, 2 relapsed before consolidation therapy and both died, 1 underwent autologous BMT and died of complications, and 8 received consolidation treatment as planned--1 died of sepsis, 2 relapsed and 5 are leukemia-free and well 1.0, 3.8, 4.5, 4.9 and 8.5 years after diagnosis. The actuarial overall survival for all 23 patients was 38% (95% confidence interval [CI] 18-57%). The actuarial 2-year leukemia-free survival was 60% (95% CI 20-85%) for the 8 patients who underwent consolidation chemotherapy as planned and 53% (95% CI 68-86%) for the 5 patients who underwent allogeneic BMT in CR. These results suggest that patients with APL who are able to undergo consolidation chemotherapy have a relatively good prognosis and allogeneic BMT may reasonably be held in reserve for salvage therapy.     

Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor

Chyloperitoneum is an extremely rare complication of abdominal surgery in children and a combined occurrence of chylothorax and chyloperitoneum after abdominal surgery has never been reported in children. Chylous ascites usually occurs as a result of operative trauma to the thoracic duct, cisterna chyli, or its tributaries. About one third of all patients with chylous ascites after retroperitoneal lymph node dissection also develop secondary chylothorax. Diaphragmatic defects have been shown to be responsible for the occurrence of chylothorax secondary to chyloperitoneum. Congenital diaphragmatic weakness may result in evagination of the peritoneum causing diaphragmatic blebs, the rupture of which results in the movement of the peritoneal fluid into the pleural cavity. In the authors' patient, the rent in the diaphragm that occurred during surgery was probably responsible for the chylothorax. The role of chemotherapy, if any, in the pathophysiology of this complication is unknown. Total parenteral nutrition (TPN) is a simple and effective treatment for postoperative chylous effusions. Surgical treatments such as abdominal exploration for the repair of leaking lymphatics and peritoneovenous shunt should be reserved for patients who fail TPN.     

肺癌术后乳糜胸17例诊疗体会

背景与目的随着肺癌手术的进展,肺癌术后乳糜胸的发生率有逐年增加的趋势。本文通过对近7年我科1472例肺癌手术进行分析,探讨肺癌术后并发乳糜胸的诊断和处理。方法回顾分析17例肺癌术后并发乳糜胸病人的临床资料。结果17例病人行保守治疗,16例治愈,1例未愈者沿原切口行手术治疗后治愈。结论乳糜胸的发生与肺癌TNM分期和手术部位有一定的关系,发生乳糜胸后采取及时正确的治疗也可以取得良好的效果。     

Bladder carcinoma--a 20-year review of radical irradiation therapy

Between 1967 and 1986, 319 patients, judged unsuitable for cystectomy, were scheduled to receive curative radiation treatment for transitional cell cancer of the urinary bladder. Crude and corrected 5-year survival for all stages were 18% and 28%, respectively. Corrected 5-year survival by stage was: T1-57%, T2-31%, T3-16% and T4-6%. Fifty-seven patients (18%) never completed the scheduled treatment and all but two of them died in a short time from tumour progression. Local response could be evaluated in 179 of the 262 patients, who completed the radiation treatment. In 130 patients (73%) complete local response was observed and 49 patients (27%) had persistent tumour. Corrected 5-year survival in the responder group was 53% compared to 8% in the non-responder group. Intestinal complications occurred in 51 patients, of whom 24 were operated upon and another four died before operation from radiation-induced intestinal complications. More than 80% of all intestinal and/or urinary tract complications were observed within 3 years after irradiation. During this period, special attention should be paid to detect and treat radiation complications to prevent fistula formation or perforation, with poor prognosis. The dose per radiation fraction and the radiation technique appeared to be the most important factors for the development of intestinal complications.     

An open-label pilot study of pentostatin, mitoxantrone, and rituximab in patients with previously untreated, Stage III or IV, low-grade non-Hodgkin lymphoma

BACKGROUND: In a previous study, the authors demonstrated that the combination of pentostatin (P) and rituximab (R) was well tolerated and was active in patients with low-grade non-Hodgkin lymphoma (NHL). In the current study, mitoxantrone (M) was added to P + R to evaluate the toxicity and efficacy of this three-drug combination (PMR). METHODS: Twenty-four previously untreated patients with histologically proven, Stage III or IV, low-grade NHL were registered between April and September, 2002. Patients received P (4 mg/m2), M (10 mg/m2), and R (375 mg/m2) every 28 days (M on Day 1; P and R on Days 1 and 8; in Cycle 1, R was given on Day 8 only). Eighty-three percent of patients had Stage IV disease, the median patient age was 62 years (range, 4-81 years), and the performance status was 0-2. RESULTS: Responses included 9 patients who achieved complete remission (CR) (38%), 3 patients with unconfirmed CR (CRu) (12%), 8 patients who achieved partial remission (33%), and 4 patients who achieved stable disease (17%); the overall response rate (CR + CRu + PR) was 83%. PMR appeared to result in comparable activity in all histologies. The median response duration was 10.0 months (range, 3.5-15.1 months). Patients received a median of 5 cycles (range, 1-10 cycles). Eighteen patients (75%) required dose reduction or delay due to toxicity, mainly neutropenia (the administration of growth factors was not permitted). Three patients died (two patients died of disease progression, and one patient died from unrelated cardiopulmonary arrest). Grade > or = 3 drug-related toxicities included neutropenia (67%), leukopenia and febrile neutropenia (17% each), and sepsis (8%), and 38% of neutropenic episodes occurred in Cycles 1 and 2. CONCLUSIONS: In this study, PMR was active and well-tolerated in patients with low-grade NHL, and the combination is deserving of further study.