腹腔镜下规则性肝切除与肝肿瘤剥除术治疗肝血管瘤的临床疗效比较

目的 比较腹腔镜下规则性肝切除与肝肿瘤剥除术治疗肝血管瘤的临床效果.方法 回顾性分析60例肝血管瘤患者的临床资料,其中31例在腹腔镜下行规则性肝切除术为A组,29例腹腔镜下行肝肿瘤剥除术为B组.比较两组手术时间、术中出血量、住院时间、术后并发症及复发率.结果 A组手术时间、术中出血量、住院时间分别为(153.96±37.13)min、(440.08±110.03)ml、(9.03±2.01)d,B组分别为(92.06±27.44)min、(327.21±130.51)ml、(7.17±3.14)d,B组手术时间、术中出血量明显少于A组(P<0.05).两组术后多数出现谷丙转氨酶(ALT)、谷草转氨酶(AST)一过性升高,同时A组出现1例胆漏,均未见切口感染、脂肪液化及死亡等情况发生,术后并发症比较无统计学意义(P>0.05).两组术后随访(13.97±3.09)个月,A、B组复发率分别为6.5%、3.4%,两组比较无统计学意义(P>0.05).结论 治疗肝血管瘤倾向于选择腹腔镜下肝肿瘤剥除术,具有创伤小、恢复快、预后好的优点,但具体选择何种术式仍需根据肿瘤实际情况而定.     

腹腔镜直肠癌根治术44例体会

目的:探讨腹腔镜直肠癌根治术的可行性和手术方法。方法:回顾分析2008年9月至2011年5月94例直肠癌患者的临床资料,分别行腹腔镜直肠癌根治术和传统开腹直肠癌根治术,比较手术时间、出血量、并发症、清扫淋巴结数、术后排气时间、住院时间等。结果:腹腔镜组与传统开腹组患者手术时间分别为(2.5±0.3)h及(2.1±0.4)h(P>0.05);出血量分别为(120±8)ml及(220±10)ml(P<0.05);并发症分别为13%及20%(P<0.05);清扫淋巴结数分别为(16±2)枚及(17±3)枚(P>0.05);术后排气时间分别为(52.5±6.5)h及(81.2±9.0)h(P<0.05);住院时间分别为(8.3±1.6)d及(11.2±2.7)d(P<0.05)。结论:腹腔镜直肠癌根治术创伤小,术后恢复快,根治效果同开腹手术,术中Trocar位置的选择、Toldt间隙及骶前间隙的辨别、对肿瘤的包裹隔离,是进一步完善手术的必要步骤。     

腹腔镜直肠癌手术在基层医院中的运用观察

目的探讨腹腔镜直肠癌切除术在基层医院开展的可行性及近期临床疗效观察。方法以2013年1月至2015年1月南安市医院收诊的47例直肠癌患者为研究对象,其中27例施行腹腔镜直肠癌根治术(A组),20例施行传统开放式直肠癌根治术(B组)。比较两组患者手术时间,术中出血量,淋巴结清扫数目,术后胃肠功能恢复时间,恢复进食时间,住院时间,以及术后并发症等的差异。结果 A组术中出血量、术后胃肠功能恢复时间、住院时间、切口感染率均短(少)于B组,差异有统计学意义(P0.05),淋巴结清扫数两组差异无统计学意义(P0.05)。结论腹腔镜下直肠癌根治术创伤小,术后恢复快,安全可行,可在基层医院推广。     

腹腔镜与开腹结直肠癌根治术的近远期疗效比较

目的探讨分析腹腔镜下结直肠癌根治的安全性和可行性,对比其与开腹手术的近远期疗效。方法回顾性分析我院2006年1月至2011年12月间结肠及中上段直肠癌根治术患者的临床资料,其中开腹手术120例,腹腔镜下手术76例。分析比较两组患者的临床病理资料、围手术期情况及近远期生存情况。结果两组患者年龄、性别比较无统计学差异。腹腔镜组平均手术时间大于开腹组,分别为(226.28±61.09)min和(193.50±53.79)min;术中失血量腹腔镜组小于开腹组,分别为(84.00±28.41)ml和(187.60±37.27)ml;术后住院时间腹腔镜组小于开腹组,分别为(7.55±2.04)d和(8.40±3.39)d。两组患者肠管近端及远端切缘长度、清扫淋巴结数目以及术后感染性和非感染性并发症发生率比较,差异无统计学意义。开腹组与腹腔镜组结直肠癌患者术后3、5年生存率分别为76.8%、65.7%和76.6%、71.2%(P>0.05);Duke’s A、B、C各期两组患者生存率比较无统计学差异。结论腹腔镜结直肠癌根治手术安全可行,具有出血少、术后恢复快等优点,肿瘤安全性、并发症发生率及术后近远期疗效不亚于开腹手术。     

老年直肠癌患者腹腔镜根治术与开腹根治术比较

[目的]探讨应用腹腔镜技术治疗老年直肠癌患者的可行性和近期临床疗效.[方法]比较2004年1月至2005年4月,20例行腹腔镜手术的老年直肠癌患者(A组),与30例行开腹根治术的老年直肠癌患者(B组)围手术期的临床资料.[结果]两组术中失血量(A＜B)、手术后胃肠功能和排尿功能恢复时间及住院时间(A＜B),手术时间和住院费用(A＞B)均有显著差异(P＜0.05).两组清扫淋巴结数量无差异(P＞0.05).[结论]腹腔镜根治术和开腹根治术治疗老年直肠癌患者在技术上同样安全可靠.腹腔镜技术更具有创伤小、围手术期出血少、手术后恢复快等突出优点,因而对于老年直肠癌患者可能有更好的应用前景.     

超声刀在腹腔镜下子宫全切术中的应用

目的探讨超声刀在子宫全切腹腔镜手术中的临床应用效果。方法将89例子宫全切手术患者分为超声刀腹腔镜组与单纯腹腔镜组,对比分析两组手术情况、术后并发症、术后排气时间和术后住院天数。结果超声刀腹腔镜组在手术时间、术中出血、术后发热及恶心呕吐发生率等指标显著优于单纯腹腔镜组(P<0.01,P<0.05);术后排气时间和术后住院天数超声刀腹腔镜组为(25.5±5.0)h和(4.2±1.2)天,单纯腹腔镜组为(29.4±4.9)h和(5.5±1.4)天,差异亦有显著性(均P<0.01)。结论超声刀在腹腔镜子宫全切术中的应用具有更微创、出血更少、恢复更快、术后并发症更少及组织器官功能恢复更好等特点。     

腹腔镜直肠癌根治术与开腹手术对患者生活质量影响的比较

目的探讨采用腹腔镜行直肠癌根治术与开腹手术对患者生活质量的影响。方法选取2007年2月至2015年2月间收治的260例直肠癌根治术患者,根据随机数字表法分为观察组(132例)和对照组(128例)。观察组患者接受腹腔镜直肠癌根治术,对照组患者接受开腹手术,观察和比较两组患者的临床疗效、术后并发症及生活质量。结果与对照组相比,观察组患者淋巴结清扫数目、手术时间无明显变化(P>0.05),而术后排气时间、住院时间明显缩短(P<0.05);观察组患者切口感染、肠梗阻、吻合口出血、吻合口瘘、肺部感染等术后并发症发生率显著降低(P<0.05);观察组患者术后生活质量各维度及总分均明显增高(P<0.05)。结论腹腔镜直肠癌根治术具有损伤小、恢复快、并发症少等优点,较开腹手术可明显提高患者术后生活质量。     

超声刀在直肠癌超低位前切除术中的应用

目的探讨超声刀在直肠癌超低位前切除术中的应用效果。方法回顾性分析江苏省肿瘤医院2011年6月至2012年7月收治的行直肠癌超低位前切除术的64例临床资料。其中超声刀组36例,电刀组28例,两组均采用双吻合器法重建肠道。比较两组患者的手术时间、术中出血量、术中输血率、术后前3天引流量、术后肠功能恢复时间以及术后吻合口瘘发生率。结果超声刀组较电刀组手术时间、术中出血量、术后前3天引流量、引流时间均显著减少(均P<0.05);而术后肠功能恢复时间、术中输血率与术后吻合口瘘发生率则无统计学差异(均P>0.05)。结论超声刀在直肠癌超低位前切除术中应用效果较电刀更好。     

胸腔镜小切口手术对非小细胞肺癌患者CRP、TNF-α及IL-6等指标水平的影响

目的探讨胸腔镜小切口手术对非小细胞肺癌患者CRP、TNF-α及IL-6等指标水平的影响。方法选取115例非小细胞肺癌患者,按手术类型分为胸腔镜小切口组(观察组)57例和传统后外侧切口组(对照组)58例。以血清C-反应蛋白(CRP),白细胞介素-6(IL-6)和肿瘤坏死因子-a(TNF-a)浓度作为衡量手术对机体造成创伤的指标,分别比较2组患者术后常见临床指标、术前1 d及术后1 d、2 d、3 d,血清中CRP、TNF-α、IL-6的变化。并分析比较手术时间、术中失血量、术后止痛时间、术后住院时间等临床指标。结果 2组非小细胞肺癌患者术前CRP、TNF-α及IL-6等指标浓度大致相同,差异无统计学意义(P>0.05);而在术后第1,2,3天血清CRP、IL-6和TNF-a浓度观察组均低于对照组,差异有统计学意义(P<0.05)。观察组在术中出血量、术后止痛时间、术后住院时间等指标上明显少于对照组,差异有统计学意义(P<0.05)。结论与传统开胸手术比较,胸腔镜小切口手术对于非小细胞肺癌患者术后早期机体的炎症反应和应激程度较轻、手术创伤较小,具有微创,术中出血量低等优势,适合在临床上推广并应用。     

大肠恶性肿瘤不同术式治疗效果及对免疫功能的影响

目的探讨大肠恶性肿瘤不同术式的效果及对免疫功能的影响。方法选取收治的144例大肠恶性肿瘤患者,以数字表法随机分为观察组和对照组,每组72例。观察组患者行腹腔镜大肠癌根治手术,对照组患者行传统的开腹大肠癌根治手术。对比两组患者的手术时间、术中出血量、住院时间和术后并发症等,术前、术后3 d检测两组患者血清Ig A、Ig G、Ig M和C反应蛋白(CRP)水平。结果观察组患者的手术时间为(183.9±27.4)min,术中出血量为(196.3±41.5)ml,住院时间为(10.9±3.1)d,均少于对照组(P<0.05),术后排气时间和并发症总数均优于对照组(P<0.05)。两组患者术后3 d血清Ig A、Ig G和Ig M出现了小幅度下降,CRP含量上升,观察组患者Ig A、Ig G、Ig M和CRP水平较对照组变化幅度更小,差异均有统计学意义(均P<0.05)。结论腹腔镜大肠恶性肿瘤手术对患者的创伤小,对机体的免疫功能影响也更小。     

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.