恶性骨肿瘤介入化疗的护理问题及应对策略

随着对骨肿瘤认识的不断深入,术前、术后辅助化疗的规范化应用,使恶性骨肿瘤保肢率和生存率大幅提高,越来越多的患者得以保留有用的肢体。介入化疗是经导管把化疗药物注入肿瘤供养动脉内,通过栓塞肿瘤血管抑制肿瘤生长达到对肿瘤的治疗目的。具有肿瘤局部化疗药物浓度高、外周血液浓度低、疗效高、创伤小、全身毒副作用少、还可以重复使用的优点,是骨科恶性肿瘤患者通常采用的治疗方法。我院以1998年至今,共对28例恶性骨肿瘤患者实施了介入化疗,由于我们术前对患者进行全面的健康教育,制定对策调动患者积极参与治疗,收到了满意的临床效果。     

肢体恶性骨肿瘤化疗的护理

发生在肢体的恶性骨肿瘤 ,我院多采用瘤段切除加小腿旋转 180°,以膝代髋 ,以踝代膝的手术方式 ,在保命的基础上尽量保留肢体长度。为降低复发率和转移率 ,近年来应用抗癌化疗药物治疗效果显著 ,由于骨肿瘤化疗的药物强度大 ,浓度高 ,且持续时间长 ,毒副作用就更大 ,因此 ,对护理工作提出了更高的要求。1　临床资料我院 1998年至 2 0 0 0年共收治肢体恶性骨肿瘤 11例 ,骨肉瘤 7例 ,软骨肉瘤 2例 ,纤维肉瘤 2例 ,年龄 13～ 5 4岁 ,一般化疗 3～ 6个疗程 ,多则 6～ 8个疗程。2　护理措施2 1　心理护理　骨肿瘤患者中部分青少年心理欠稳定 ,…     

恶性骨肿瘤保肢术局部复发相关问题的研究

作者结合临床多方面材料．重点讨论保肢术后的局部复发问题。对３０例骨肿瘤病人的穿刺针道作全程分段多处病检，针道接种率６．６％；同期对１５例恶性骨肿瘤病人实施保肢术，作病变区首次冲洗液查瘤细胞及病灶邻旁组织随机多方向病检均未发现瘤细胞残留。检查肿瘤包膜的完整性，作术前平片、ＣＴ，术后标本和平片的对照测量。提出肿瘤的穿刺活检对局部复发无明显影响；有效的术前、后化疗和严格的广泛切除术是防止局部复发的主要条件，局部复发决定于手术的切除边界而不决定于是局部切除还是截肢治疗。     

恶性骨肿瘤的化疗进展

近 30年来 ,恶性骨肿瘤的治疗取得了很大进展 ,在很大程度上 ,是由于化疗的开展及逐渐完善 ,特别是新辅助化疗(ｎｅｏ ａｄｊｕｖａｎｔｃｈｅｍｏｔｈｅｒａｐｙ)概念的形成及其法则的应用。以骨肉瘤、尤文肉瘤为代表的恶性骨肿瘤 ,在开展化疗之前其主要治疗是截肢或局部广泛切除和足量的放疗 ,这些治疗常导致患者的终身残疾 ,且局部复发率很高 ,5年生存率不足2 0 %。新辅助化疗为恶性骨肿瘤患者保留肢体及功能带来了希望 ,国外的 5年生存率超过 80 % [1] ,国内报道的 5年生存率也达 5 0 %～ 6 0 % [2 ] 。肿瘤化疗的原则和方法来自于大量…     

恶性骨肿瘤的保肢手术52例

目的：研究恶性骨肿瘤的保肢手术治疗方法及其疗效。方法：总结本院自1983-2000年采用保肢手术治疗四肢恶性骨肿瘤52例，根据病灶的病理特性，部位，范围等条件分别采用病灶刮除骨水泥髓内支架堵塞术，瘤段切除灭活再植术，瘤段切除人工假体置换术，瘤段切除异体骨关节置换术等手术方法联合全身化疗，介人化疗或术中肿瘤供血动脉灌注化疗。结果：本组有36例获得1-16年随访。存活5年以上8例，2-5年25例，1-2年6例，1年内死亡7例，其中骨转移癌5例，根据Enneking骨肿瘤外科治疗后功能评定标准评本组患术后功能，效果满意，结论：恰当的手术方法联合完整的化疗方案保肢治疗四肢恶性骨肿瘤外科治疗后功能评定标准评价本组患术后功能，效果满意。结论：恰当的手术方法联合完整的化疗方案保肢治疗四肢恶性骨肿瘤提出了患的生存质量，减少了致残率，并未降低患的生存率。     

恶性骨肿瘤的保肢治疗

目的 探讨肢体恶性骨肿瘤保肢手术结合辅助化疗的临床疗效。方法 我科于2000年1月至2002年10月间，对平均年龄为18．5岁的29例四肢恶性骨肿瘤患进行保肢治疗，其中25例进行了辅助性化疗。29例中，骨肉瘤21例，尤氏瘤4例，软骨肉瘤4例。按Enneking分期，ⅡA期1例，ⅡB期28例。除软骨肉瘤外，均作术前化疗，3例骨肉瘤未作术后化疗。施行人工关节置换术14例，瘤骨灭活再植10例，异体骨关节移植3例，腓骨肿瘤切除2例。广泛切除15例，边缘性切除14例。结果 发生并发症8例，其中局部复发、皮肤坏死、骨不愈合各2例，皮下积液、切口感染各1例。随访4～31个月，平均14个月，局部复发2例，肺转移2例，按Enneking肢体肌肉骨骼系统肿瘤外科治疗重建术后功能评定标准，优良率为80％。结论 保肢手术结合辅助化疗是治疗肢体恶性骨肿瘤的比较理想的方法，有效的术前化疗是保肢成功的关键，坚持术后化疗是预防肺转移的有效措施。     

恶性骨肿瘤局部切除术中放疗灭活保肢的探讨

目的：探索一种既能延长生命、保住肢体，又能最大程度保留关节功能的四肢恶性骨肿瘤治疗方法。方法：1999年7月∽2003年6月对9例四肢恶性骨肿瘤患者，进行局部切除术中放疗灭活保肢术前后配合化疗的治疗。结果：局部无一例复发，关节稳定，活动度均在90∽135度，效果较好。结论：恶性骨肿瘤局部切除术中放疗灭活保肢的治疗方法不失为一种有效治疗方法，能较好地提高四肢恶性骨肿瘤患者的生存质量。     

恶性黑色素瘤化疗进展

目前,治疗早期恶性黑色素瘤仍以手术切除为主,术后辅以化疗可减少复发;对播散型黑色素瘤,化疗则是重要的治疗手段。本文就单用、联合应用化疗药物治疗恶性黑色素瘤的效果及其研究进展情况进行了综述。     

儿童恶性骨肿瘤保肢手术的进展

恶性骨肿瘤患者，病骨发育成熟(14～16岁)是选择保肢手术的适应证之一。因为儿童患者实施保肢手术后，骨骺的损伤迟早会导致肢体明显不等长，引起下腰部疼痛及代偿性脊柱侧弯，步态异常等，加上患儿一般难以配合术后的功能锻炼，所以保肢术效果多不佳。按照传统的方法，这部分患者常要选择截肢治疗。     

恶性肿瘤患者化疗前后的淋巴细胞亚群分析

目的：观察恶性肿瘤患者化疗前后淋巴细胞亚群的变化特征,探讨恶性肿瘤患者的机体免疫状况。方法：采用流式细胞术对100例住院恶性肿瘤患者的淋巴细胞亚群进行分析,观察患者化疗前后的淋巴细胞亚群的变化特征。同时收集30名健康体检者作为正常对照。结果：恶性肿瘤患者CD^8＋细胞、B细胞高于正常,而CD^3＋细胞、CD^4＋细胞、NK细胞及CD^4＋/CD^8＋比值显著低于正常水平（P〈0.05）;化疗后完全缓解组以上4项趋于正常（P〉0.05）;而未缓解组与完全缓解组及正常对照组相比有明显差异（P〈0.05）。结论：恶性肿瘤患者细胞免疫功能衰退,体液免疫功能略增高,化疗后缓解的病人各指标趋于正常,与病情发展一致,淋巴细胞亚群分析可作为监测恶性肿瘤患者免疫状态的指标。     

超声诊断恶性骨肿瘤的临床价值探讨

目的:探讨超声对恶性骨肿瘤的诊断价值.方法:将27例恶性骨肿瘤患者的超声诊断结果与病理结果对照并分析恶性骨肿瘤超声图像特征.结果:27例恶性骨肿瘤病例中,超声检出25例,灵敏度92.59%,特异度96.87%,对于骨肿瘤良恶性的鉴别超声检查与病理检查具有较高的一致性,Kappa值为0.897,良恶性骨肿瘤的血流分级和阻力指数(RI) 均存在显著差异(P<0.01).结论:对于恶性骨肿瘤的超声与病理诊断结果一致性较高,超声检查是一种简便有效的骨肿瘤的辅助检查方法.     

High dose chemotherapy for the treatment of malignant brain tumors

Conventional treatment of malignant high grade gliomas includes maximal resection followed by external beam radiotherapy. The addition of adjuvant chemotherapy has provided little improvement in the median duration of survival for these patients, particularly those patients with glioblastoma multiforme. The failure of conventional dose chemotherapy to improve the outcome of patients with high grade brain tumors has led several investigators to utilize high dose chemotherapy in order to overcome the limited benefit seen with conventional dose therapy which is due to intrinsic drug resistance as well as the impermeability of blood brain barrier. The majority of published studies utilizing this approach suggest that the addition of high dose chemotherapy with bone marrow transplant is of marginal benefit. However, most of these trials include small numbers of patients with advanced, refractory disease. A few trials have been reported utilizing high dose therapy in an adjuvant setting and the data from these studies are somewhat more promising. This review will analyze these studies and also discuss possible modifications of this approach in order to improve this aggressive treatment for patients who otherwise would have a dismal prognosis.     

超声诊断恶性骨肿瘤的临床价值探讨

目的：探讨超声对恶性骨肿瘤的诊断价值。方法：将27例恶性骨肿瘤患者的超声诊断结果与病理结果对照并分析恶性骨肿瘤超声图像特征。结果：27例恶性骨肿瘤病例中,超声检出25例,灵敏度92.59%,特异度96.87%,对于骨肿瘤良恶性的鉴别超声检查与病理检查具有较高的一致性,Kappa值为0.897,良恶性骨肿瘤的血流分级和阻力指数（RI）均存在显著差异（P〈0.01）。结论：对于恶性骨肿瘤的超声与病理诊断结果一致性较高,超声检查是一种简便有效的骨肿瘤的辅助检查方法。     

Neoadjuvant chemotherapy in malignant fibrous histiocytoma of bone and in osteosarcoma located in the extremities: Analogies and differences between the two tumors

Background: Malignant fibrous histiocytoma (MFH) is a rare bone tumor usually treated like osteosarcoma. Studies on analogies and differences between the two tumors have seldom been reported.Patients and methods: Between March 1982 and December 1994, 51 patients with high-grade MFH of bone and 390 with high-grade osteosarcoma were treated with the same regimen of neoadjuvant chemotherapy. All of the tumors in both groups were located in the limbs. Preoperative chemotherapy was performed according to three different, successively activated, regimens consisting of MTX/CDP intraarterially, MTX/CDP/ADM, and MTX/CDP/ADM//IFO.Results: The rate of limb salvage was the same in both the MFH (92%) and osteosarcoma (85%) patients. MFH showed a statistically significantly lower rate of good histologic response, 90% or more tumor necrosis (27% vs. 67%, P = 0.00001) for all three regimens. Despite this low chemosensitivity, the disease-free survivals of the two neoplasms were similar (67% vs. 65%).Conclusions: In terms of histologic response to primary chemotherapy, MFH has a lower chemosensitivity than osteosarcoma. Nevertheless, the two tumors have similar prognoses when treated with chemotherapy regimens based on MTX, CDP, ADM and IFO.     

High-dose multi-agent chemotherapy followed by bone marrow ‘rescue’ for malignant astrocytomas of childhood and adolescence

Between April 1986 and March 1989, ten patients under 21 years of age with histologically confirmed malignant astrocytoma, received marrow-ablative chemotherapy with either thiotepa and Etoposide (five patients) or thiotepa, Etoposide and BCNU (five patients), followed by bone marrow ‘rescue’. Nine patients had glioblastoma multiforme (GBM), and one patient had an intrinsic brain stem anaplastic astrocytoma (AA). Seven patients were treated for recurrent tumor. Two patients who developed GBM as second malignancies were treated directly following surgical resection. One patient had received irradiation only for recently diagnosed cervical spinal cord GBM. Thiotepa was administered at a total dose of 600–900 mg/M² over three days, Etoposide was administered at a total dose of 1500 mg/M² over three days, and BCNU was administered at a total dose of 600 mg/M² over four days. Non-hematopoietic toxicities have been mainly transient, predictable and acceptable, consisting of oropharyngeal mucositis, cutaneous hyperpigmentation, erythema and desquamation. Four patients achieved complete responses (CR), as determined by radiographic evaluation (CT and/or MRI) on day 28 post-marrow infusion. The mean remission duration of those with CR is 290 + days; two patients presently remain in remission. Two patients achieved partial responses (PR, greater than 50% tumor shrinkage) by day 28 post-marrow infusion; both developed disease progression, at day 61 and 94 post-marrow infusion, respectively. One patient, with a brain stem AA, had stable disease maintained for 13 months post-marrow infusion. With a total (CR + PR) response rate of 60%, these regimens merit evaluation in broader categories of recurrent brain tumor patients, as well as in patients with newly-diagnosed GBM.     

Study on the health-related quality of life in patients after surgery for malignant bone tumors

Aim: We conducted a study in China to assess the health-related quality of life (HRQoL) in patients treatedon for malignant bone tumors after surgery, and investigate the possible determinants. Methods: The subjectswere 120 patients surgically treated by amputation and limb-salvage for bone tumors during the period of June2008 to June 2010. The Medical Outcomes Study Short Form 36 (SF-36) was employed to measure the HRQoLof all the patients before and after surgery. Results: With regard to the results of the general quality of life tool(SF-36), we observed a significant improvement of all the indexes of HRQoL after 6 months (p<0.05). PF, RP andBP scores showed significant increase between surgery after 6 and 12 months (p<0.05). The means of the HRQoLof bone tumor patients in our study were still much lower than those of general population in every domain,even 12 months after surgery. Logistic regression showed that female patients were found to have lower scoresin physical component summary (PCS) than males (OR=0.64, 95% CI=0.35-0.89). Patients older than 15 yearshad lower scores in mental component summary (MCS) (OR=0.60, 95% CI=0.32-0.86). Ablative surgery wasrelated to both lower MCS and PCS scores (For MCS, OR=0.54, 95% CI=0.31-0.83; for PCS, OR=0.43, 95%CI=0.25-0.73). Conclusion: Our study showed the treatment for bone tumor could greatly alter the HRQoL ofpatients. Age, sex and type of surgery were associated with physical or mental HRQoL after surgery.     

恶性间皮瘤的化疗进展

本文对近20年来单药或联合化疗方案治疗恶性间皮瘤疗效的临床试验进行综述,但结果令人失望。罕有报告有效率>20%者,且均不能使中数生存期>10个月,新药培美曲赛类药物的出现使恶性间皮瘤治疗出现明显进展,与顺铂合用有效率可达45%,中数生存期超过12个月,以这2个药为基础的方案现已成为治疗恶性胸膜间皮瘤的标准一线方案。     

白蛋白结合型紫杉醇治疗晚期恶性肿瘤的临床观察

目的：观察白蛋白结合型紫杉醇治疗晚期恶性肿瘤的疗效及毒副作用.方法：对采用含白蛋白结合型紫杉醇方案化疗的晚期恶性肿瘤患者32例进行回顾性分析,每例患者接受1-6个周期化疗,中位化疗4个周期.每2个周期后按照RECIST实体瘤近期客观疗效评定标准进行疗效评价.观察疗效和不良反应.结果：30例可评价疗效,完全缓解（CR）1例,部分缓解（PR） 13例,稳定（SD）7例,疾病进展（PD）9例.客观有效率（RR=CR＋ PR）46.6％,临床获益率（CR＋PR ＋SD）为70.0％.不良反应主要为骨髓抑制、消化道反应、感觉神经毒性.结论：白蛋白结合型紫杉醇治疗晚期恶性肿瘤,疗效较好,毒副反应小,值得临床上进一步推广应用.     

盖诺为主的联合化疗方案治疗晚期恶性肿瘤

目的 观察以盖诺(国产长春瑞滨)为主的联合化疗方案治疗晚期恶性肿瘤的疗效及安全性。方法 经病理确诊的晚期恶性肿瘤患者104例，临床上采用以盖诺为主的联合化疗方案，每3～4周重复一次，连用3个周期为一疗程。结果 治疗后近期疗效cR6例(5．77％)PR51例(49．03％)有效率51．81％，中位缓解期为3个月，中位生存期为6个月。结论 盖诺毒副作用可以耐受，以盖诺为主的联合化疗方案疗效显著，值得推广为某些肿瘤治疗一线用药。