Ⅲ期贲门癌胃左动脉灌注化疗后围手术期处理

目的 :探讨 期贲门癌胃左动脉灌注化疗的方法及围手术期处理的注意事项。方法 :对 2 8例 期贲门癌经胃左动脉灌注化疗后围手术期处理进行回顾性分析。结果 :采用该方法后 ,术中分离容易、出血少、切除率和远期生存率高。经严密的围手术期处理后 ,全组无一例死亡。 期贲门癌术前胃左动脉灌注化疗 ,间隔 2周后再限期手术治疗是一种实用而有效的方法。     

动脉灌注四联化疗治疗高龄胃底贲门癌的临床疗效分析

目的：评价动脉灌注四联化疗对高龄胃底贲门癌治疗的临床疗效价值。方法选择89例高龄胃底贲门癌患者行超选性胃左动脉灌注化疗。结果89例症状明显改善,65例体重较前增3~5 kg,76例胃镜：癌灶不同程度缩小,13例钡餐造影示：癌灶缩小。0.5、1、2年生存率92.13%、76.4%、29.2%。36例无明显不良反应,53例上腹胀饱、恶心、呕吐等不良反应,42例有不同程度骨髓抑制。结论氟尿嘧啶、丝裂霉素、表阿霉素、卡铂四联药物动脉灌注治疗胃底贲门癌,是一种有效的、安全的治疗方法,尤其对于高龄患者。     

胃左动脉介入化疗栓塞联合根治术治疗贲门癌

目的探讨贲门癌术前介入化疗栓塞的临床疗效。方法对39例贲门癌患者行胃左动脉介入化疗栓塞后手术,并与对照组43例贲门癌患者单纯根治手术的切除率及生存率比较。结果化疗栓塞后手术切除,不仅可提高手术切除率,还可以减少手术时间及术中出血量,延长生存时间。结论贲门癌术前行胃左动脉介入化疗栓塞创伤小,不良反应轻微,疗效显著,应将其立为治疗进展期贲门癌手术前的一项常规治疗方法。     

动脉化疗栓塞治疗晚期贲门癌临床观察

目的:探讨动脉灌注化疗联合栓塞治疗晚期贲门癌的临床疗效。方法:60例晚期贲门癌患者随机分为2组,即动脉灌注化疗联合栓塞组(治疗组,n=30)和静脉化疗组(对照组,n=30)。两组均采用相同化疗方案分别行动脉灌注化疗联合栓塞或静脉化疗,按WHO疗效评定标准评价近期疗效及观察患者临床症状改善情况。结果:治疗组和对照组相比较,近期有效率显著增加(P<0.01),且临床症状改善明显。结论:动脉化疗联合栓塞治疗可以提高晚期贲门癌患者近期疗效并改善患者临床症状,可作为晚期贲门癌的一种有效治疗方法。     

可手术的Ⅲ期贲门癌术前选择性动脉灌注化疗

目的探讨可手术的Ⅲ期贲门癌术前选择性动脉灌注化疗的疗效。方法可手术的Ⅲ期贲门癌选择性胃左动脉灌注化疗一次。结果76例经胃肠双重造影、腹部CT和B超检查均有不同程度的改善,临床症状明显好转,参照全国胃癌协作组第二次会议制定的进展期胃癌全身化疗判定标准,完全缓解(CR)4%(3/76),部分缓解(PR)86%(65/76),稳定(S)11%(8/76)。结论可手术的Ⅲ期贲门癌术前接受选择性动脉介入化疗近期疗效明显。     

腹腔热灌注辅助化疗治疗进展期胃癌术后患者的临床疗效观察

目的探讨腹腔热灌注辅助化疗治疗进展期胃癌术后患者的临床疗效。方法将60例进展期胃癌患者随机分为研究组与对照组各30例,两组术后均予以静脉化疗,研究组加用腹腔热灌注化疗。结果研究组腹膜刺激发生率明显高于对照组(P<0.05),其余不良反应无明显差异(P>0.05)。研究组中位生存时间为25.8个月,明显长于对照组的21.5个月(P<0.05)。结论进展期胃癌患者肿瘤根治术后积极行腹腔热灌注辅助化疗,可一定程度地延长生存期。     

介入治疗晚期贲门癌20例报告

我科 1996年 3月至 1997年 10月 ,对 2 0例晚期贲门癌患者行动脉插管化疗介入治疗 ,取得了较为满意的疗效 ,现总结如下。1　资料与方法1.1　一般资料 :本组 2 0例患者 ,男 14例 ,女 6例 ;年龄 46～ 76岁 ,平均 5 5岁。本组患者病灶均经内窥镜活检病理证实为贲门癌。其中尚有 7例患者经 AFP及 B超或 CT检查证实伴有肝脏转移。1.2　治疗方法 :2 0例患者均采用 Seldinger技术 ,经皮穿刺股动脉插管至胃左动脉 ,行血管造影 ,而后灌注化疗药物。本组有 5例导管无法进一步插入胃左动脉 ,则直接在腹腔干灌注化疗药物。术中药物均为 DDP10 0 mg、…     

改良体外循环体腔热灌注技术在肿瘤化疗中的应用

目的 探讨改良体外循环体腔热灌注技术在肿瘤化疗中的应用效果。方法 选取2015年1月至2022年3月在首都医科大学附属北京安贞医院进行热灌注化疗的患者21例,其中行改良体外循环单侧胸腔热灌注化疗(E-HITEC)12例(E-HITEC组),行改良体外循环腹腔热灌注化疗(E-HIPEC)9例(E-HIPEC组)。比较2组患者术中生命体征,以及灌注流速、预充液体总量和体腔温度变化。术后观察患者有无胸腔积液或腹腔积液复发,并记录院内结局。结果 E-HIPEC组灌注流速、预充液体总量、出入体腔温差均大于E-HITEC组[(2 585±308)ml/min比(1 910±381)ml/min、3 000(3 000,3 100)ml比2 400(2 125,2 500)ml、(0.8±0.3)℃比(0.4±0.1)℃](均P<0.05)。除1例患者接受E-HITEC后仍有胸腔积液生成外,其余患者住院期间均未出现胸腔积液或腹腔积液复发现象。住院期间患者死亡2例,其余19例患者均病情好转,存活出院。结论 改良体外循环体腔内热灌注化疗可结合手术或单独使用,能快速达到目标温度,对患者生命体征影响小...     

热疗联合肝动脉化疗栓塞治疗中晚期肝癌的疗效分析

目的探讨深部热疗联合肝动脉灌注栓塞术治疗中晚期原发性肝癌的疗效及副反应。方法将72例原发性肝癌患者随机分为2组,A组为综合治疗组,37例;B组为对照组,35例。A组采用热疗联合肝动脉化疗栓塞术,B组行单独肝动脉化疗栓塞术。结果 A组在近期疗效及生活质量均明显优于B组(P<0.05),两组毒性反应、AFP下降无明显差异。结论热疗联合肝动脉栓塞术联合热疗治疗失去手术治疗机会的中晚期原发性肝癌疗效较好,可改善临床症状,提高生活质量。     

经皮动脉化疗栓塞术治疗中晚期胃癌的临床分析

目的 观察经皮动脉化疗栓塞术治疗中晚期胃癌的临床疗效。方法 15例中晚期胃癌患者,均进行经皮动脉化疗栓塞术治疗。分析治疗及随访情况、临床症状改善情况、肿瘤标志物、临床疗效、近期不良反应发生情况。结果 15例患者全部手术成功,平均介入手术时间为(118±45)min。化疗栓塞血管中胃左动脉6例,胃左+胃网膜右动脉2例,胃左+胃网膜右动脉+肝动脉1例,胃左+胃网膜左动脉+肝动脉2例,胃左+胃十二指肠动脉3例,胃左+胃右+胃网膜右动脉1例。平均住院时间为(3.9±0.96)d。随访结束后, 15例患者中死亡5例,中位生存期为9个月,其中1例患者最长存活13个月;现存活患者10例,平均生存期已超过15.6个月。12例上腹饱胀不适、上腹痛患者中8例得到改善, 2例黑便患者均得到改善, 1例便潜血阳性患者转阴, 2例反酸烧心患者改善, 1例吞咽困难患者得到明显改善, 4例恶心、纳差患者中1例得到改善。多数患者治疗后食欲增加,腹痛减轻。术前癌胚抗原(CEA)升高者5例,其中4例术后下降;术前糖类抗原724(CA-724)升高者5例,其中4例术后下降;术前糖类抗原125(CA-125)升高者3例,术后...     

进展期胃癌术中区域灌注化疗预防胃癌术后肝脏转移的观察

目的研究进展期胃癌术中肝固有动脉灌注化疗对预防术后胃癌肝转移的作用。方法将2007~2009年医院收治的80例进展期胃癌患者随机分为实验组(n=40,术中区域灌注化疗+D2根治手术)和对照组(n=40,单纯D2根治手术),术后常规相同化疗治疗。治疗后随访3年,比较两组患者术后并发症和肝脏转移率。结果两组患者术后并发症的发生率比较差异无统计学意义(P>0.05);肝脏转移率实验组明显低于对照组,差异有统计学意义(P<0.05)。结论进展期胃癌术中区域性动脉灌注化疗可明显降低术后肝脏转移发生率,且不良反应轻,安全可行。     

Protective effect of gangliosides on myocardial hypoxic damage in the rat.

The size of the infarct produced by ligation of the left coronary artery in the rat was decreased significantly in animals treated i.p. with 40 mg/kg per day of a ganglioside mixture (GMIX) for 7 days after surgery. Rats treated with GMIX had lower ventricular myeloperoxidase activity, indicating a lower leukocyte infiltration after infarction. The underperfused zone was also smaller in animals treated daily with GMIX 30 days after surgery. Control hearts, but not hearts obtained from animals pretreated for 15 days with 40 mg/kg per day of GMIX, released lactate dehydrogenase (LDH) during perfusion in a Langerdorff apparatus after ligation and reperfusion of the left coronary artery in vitro. Hearts made hypoxic in vitro by changing the perfusion gas to nitrogen for 20 min and later reoxygenating with 95% O2 -5% CO2 released LDH in the perfusate, but did not do so in the presence of 10 microM monosialotetraesosylganglioside. Gangliosides, therefore, seem to protect the rat heart against hypoxic damage.     

Effects of acute hexarelin administration on cardiac performance in patients with coronary artery disease during by-pass surgery

Growth hormone (GH) secretagogues are synthetic molecules with neuroendocrine but also cardiovascular activities mediated by specific GH secretagogue-receptors. The acute administration of hexarelin, a peptidyl GH secretagogue, increases left ventricular ejection fraction in normal subjects and even in patients with severe GH deficiency. We evaluated cardiac performances in patients with coronary artery disease after acute administration of hexarelin (2.0 microg/kg, i.v.) compared to that in patients given with GH-releasing hormone (GHRH; 2.0 microg/kg, i.v.), recombinant human (rh)-GH (10.0 microg/kg, i.v.) or placebo. Cardiac performance was studied in 24 male patients (age [mean +/- S.E.M.]: 59.5 +/- 1.1 years; body mass index: 24.6 +/- 0.9 kg/m(2); left ventricular ejection fraction: 57.2 +/- 1.4%) with coronary artery disease undergoing by-pass surgery during general anesthesia. Left ventricular ejection fraction, left ventricular end diastolic volume, cardiac index and cardiac output were evaluated by intraoperative omniplane transoesophageal echocardiography while wedge pressure, central venous pressure, mean arterial pressure and systemic vascular resistance index were evaluated by systemic and pulmonary arterial catheterization. RhGH, GHRH and placebo did not exert any hemodynamic effect while hexarelin induced a prompt (after +10 min) increase in left ventricular ejection fraction (P < 0.001), cardiac index (P < 0.001) and cardiac output (P < 0.001) lasting up to +90 min without any variation in left ventricular end diastolic volume. Accordingly, hexarelin induced a reduction of wedge pressure (P < 0.01). These changes occurred in the presence of increased mean arterial pressure (P < 0.05) and transient decrease of central venous pressure (P < 0.05 at +30 min only) but no change in systemic vascular resistance index. Heart rate after hexarelin was similar to that after placebo. Hexarelin induced a slight increase in GH levels which was similar to that after GHRH but far lower (P < 0.01) than that after rhGH. Thus, in patients with coronary artery disease undergoing by-pass surgery, the acute administration of hexarelin clearly improves cardiac performance without any relevant variation in systemic vascular resistance. The cardiotropic effect of hexarelin is not shared by GHRH or by rhGH, indicating that it is not mediated by the increase in circulating GH levels but more likely reflects activation of specific cardiovascular GH secretagogue receptors.     

Actions of two new bradycardic agents, AQ-AH 208 and UL-FS 49, on ischemic myocardial perfusion and function

The effects of continuous infusions (30 min) of two new bradycardic agents, AQ-AH 208 (3,4-dihydro-6,7-dimethoxy-2-(3-((2-(3,4 dimethoxyphenyl) ethyl)-amino methyl) propyl)-1(2H)-isochinolinon) (10 and 25 micrograms/kg/min) and UL-FS 49 (1,3,4,5-tetrahydro-7,8-dimethoxy-3(3((2-(3,4-dimethoxyphenyl) ethyl) methylimino) propyl)-2H-3-benzazepin-2 on) (1.0 and 2.5 micrograms/kg/min) on ischemic myocardial perfusion and function were studied in anesthetized open chest dogs. Coronary stenosis was induced by narrowing an extracorporeal shunt between the carotid and left anterior descending coronary artery. Regional perfusion was measured by use of radioactive microspheres and regional myocardial function (% segment shortening) was assessed by sonomicrometry. AQ-AH 208 and UL-FS 49 produced dose-dependent reductions in heart rate of 13 to 55 beats/min without prominent effects on left ventricular dP/dt, aortic blood pressure, and % segment shortening of the normally perfused area. In nonischemic myocardium, AQ-AH 208 did not change transmural blood flow in spite of the bradycardia, whereas UL-FS 49 decreased flow. At the high infusion rate, ischemic subendocardial perfusion increased from 0.43 to 0.58 ml/min/g following UL-FS 49 and from 0.57 to 0.84 ml/min/g after treatment with AQ-AH 208. Consequently, endo/epi rose from 0.52 to 0.80 and 0.62 to 0.96, respectively. Atrial pacing abolished the effects of UL-FS 49 on ischemic myocardium whereas the effects of AQ-AH 208 were only partially reduced. Ischemic myocardial function deteriorated less during treatment with UL-FS 49 and was significantly improved following AQ-AH 208 as compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of the anti-ulcer agents ecabet sodium,cimetidine and sucralfate on acetylsalicylic acid-induced gastric mucosal damage deteriorated by renal failure in rats

Renal failure including post-renal transplantation increases the susceptibility of the upper gastrointestinal mucosa to injury. The aim of this study was to confirm the influence of renal failure on gastric mucosal barrier and the protective effect of various anti-ulcer agents in rats. Renal failure (RF) was induced by 45-min left renal artery clamping and right-uninephrectomy. Four days after surgery, gastric mucosal lesions were induced by intragastric administration of acetylsalicylic acid (ASA, CAS 50-78-2) (100 mg/kg). Anti-ulcer agents were given orally 30 min before ASA administration. RF induced moderate gastric mucosal damages, but significantly worsened the ASA-induced gastric lesions. Ecabet sodium (CAS 86408-72-2) and cimetidine (CAS 51481-61-9) significantly inhibited ASA-induced gastric lesions in RF rats, whereas sucralfate (CAS 54182-58-0) tended to inhibit it. ASA and all of these anti-ulcer agents had no effect on the serum creatinine and blood urea nitrogen levels increased by RF. The gastric mucosa of RF rats is more susceptible to damage induced by ASA. Ecabet and cimetidine potently inhibited gastric lesions in RF rats suggesting its utility for the gastric mucosal damage in patients with RF including post-renal transplant.     

紫杉醇类联合氟尿嘧啶和顺铂双途径化疗42例晚期胃癌的临床观察

目的观察紫杉醇类联合氟尿嘧啶和顺铂动静脉双途径给药治疗晚期胃癌的临床疗效和不良反应。方法选取42例晚期胃癌患者，首日接受氟尿嘧啶和顺铂经腹腔干动脉，肠系膜上动脉、下动脉和肝动脉的灌注化疗，次日起接受TCF或DCF方案静脉化疗，其中6例肝转移者联合肝动脉栓塞化疗术。结果总有效率为61．9％（26例／42例），中位疾病进展时间（TTP）为6．2月，生存时间为5～32月，中位生存时间（MST）为13．2月，17例生存时间达1年以上（40．5％），6例生存时间达2年（14.3％），23例症状改善，临床获益率为82．1％。不良反应主要有恶心、呕吐，口腔炎，腹泻，Ⅲ、Ⅳ度白细胞及血小板抑制，关节肌肉疼痛及轻度肝功能损害，未发生出血、发热、腹痛等动脉介入相关的并发症。结论紫杉醇类联合氟尿嘧啶和顺铂双途径给药治疗晚期胃癌的临床疗效较好，不良反应可耐受。     

Endothelium-dependent vasodilation in the isolated rabbit kidney following in vivo and in vitro ischaemia and reperfusion: effects of antagonizing platelet activating factor (PAF)

Renal ischaemia-reperfusion (I/R) is a pathological condition occurring frequently after transplantation and acute renal failure. A mediator thought to play a role in the disturbed haemodynamics of I/R is platelet activating factor (PAF). We studied endothelium-dependent (acetylcholine, ACh) and -independent (sodium nitroprusside, SNP) vasorelaxant responses and the effect of BN 52021, a PAF antagonist, in the isolated perfused rabbit kidney after in vivo and in vitro I/R. Anaesthetized rabbits underwent right nephrectomy and 1 h left renal artery clamping followed by 30min reperfusion with blood. In another group, kidneys were isolated and, after transferral to the perfusion system, the perfusion pump was turned off for 1 h, followed by 30min reperfusion with Krebs' solution. BN 52021 or its vehicle dimethylsulphoxide (DMSO) was administered 20min before left renal artery occlusion or turning off the pump. Although in vitro I/R did not influence ACh-induced responses, in vivo I/R caused a decrease which was prevented by BN 52021. SNP-induced responses did not change in in vitro I/R and decreased only at lower concentrations in in vivo I/R, whereby pretreatment with BN 52021 did not offer any protection. It is concluded that in vivo I/R diminishes ACh-induced endothelium-dependent vasodilation, possibly via PAF and blood components, whereas SNP-induced endothelium-independent vasodilation was not altered by in vivo and in vitro ischaemia in the isolated rabbit kidney.     

进展期胃癌术中行区域性缓释化疗的安全性评价

目的探讨进展期胃癌术中腹腔内行区域性植入5-氟尿嘧啶缓释化疗的临床疗效及用药安全进行分析评价。方法将60例进展期胃癌患者均进行手术根治切除术后并随机分为两组,治疗组:30例患者给予术中行区域性缓释化疗;对照组30例患者与治疗组患者术后均进行常规全身化疗,并对其两组患者治疗后临床疗效进行疗效评价及安全性评价。结果疗效判定治疗组:完全缓解8例占26.7%、部分缓解11例占36.7%、疾病稳定7例占23.3%、疾病进展4例占13.3%。对照组:完全缓解5例占1.7%、部分缓解9例占30.0%、疾病稳定11例占36.7%、疾病进展5例占16.7%。两组患者在治疗后腹腔相关并发症与化疗毒副作用无显著差异。结论进展期胃癌术中腹腔内行区域性植入5-氟尿嘧啶缓释化疗,患者耐受性良好,用药后临床疗效增加而未见明显的全身、局部不良反应。     

三维适形放疗联合支气管动脉灌注化疗治疗局部晚期非小细胞肺癌的疗效观察

目的探讨三维适形放疗联合支气管动脉灌注化疗治疗局部晚期非小细胞肺癌的临床效果。方法对60例诊断明确的局部晚期非小细胞肺癌患者先行支气管动脉灌注化疗：盐酸吉西他滨1000mg／m2,奈达铂50mg／m2;1周后复查血常规,指标正常即开始行三维适形放疗DT：46GY／23f-50GY／25f;1个月后行第2次BAI,方案同前;后再次行CT定位,根据肿瘤缩小情况,调整放疗计划,给予缩野后肿瘤局部二程加量放疗20GY／10f～24GY／12f。2次计划放疗均按照单次计量2GY,每周5次进行。放疗总剂量至60—70Gy／30—35f／6—7周。结果放疗结束1个月后评价疗效,CR23例（21．6％）,PP,37例（61．6％）,SD7例（11．6％）,PD3例（5％）。总有效率CR＋PR为83．3％,1年及2年生存率分别为77．1％（44／57）、26．3％（15／57）。结论三维适形放疗二程加量联合支气管动脉灌注化疗治疗局部晚期非小细胞肺癌近期疗效较好,明显提高生存率,未增加放疗不良反应,是目前治疗局部晚期非小细胞肺癌安全有效的治疗方法。     

中晚期胃癌腹腔热灌注化疗的护理

目的探讨中晚期胃癌患者腹腔热灌注化疗的术后护理。方法总结2009年4月至2011年12月收治胃癌患者中26例中晚期胃癌患者在腹腔热灌注化疗术后护理,术后严密观察病情,及早发现及处理如恶心,呕吐,腹胀,腹痛,胸闷,气促等症状。结果术后发生6例腹胀,腹痛,3例恶心,呕吐,1例胸闷,气促,对这些患者给予对症处理后,取得良好的效果。结论中晚期胃癌患者行腹腔热灌注化疗与护理延长和提高了患者的生存期。