选择性动脉化疗灌注联合微量泵输注治疗大肠癌

目的：对选择性动脉化疗灌注联合微量泵输注治疗大肠癌的价值进行探讨。方法：用Seldinger技术对31例大肠癌病例行选择性动脉灌注化疗药物（Mitomycin,Cisplatin)，保留导管，联合微量泵连续输注药物（Cisplatin Floxuridine)。结果：治疗后，患者临床症状改善明显，完全缓解1例，部分缓解23例，无变化6例，恶化1例，有效率77.4%,1,2,3年生存率分别为74.2%,54.8%与35.5%，其中9例于治疗2次后行根治性切除。结论：选择性动脉化疗灌注联合微量泵输注治疗大肠癌是一种安全有效的治疗方法。     

老年人肝癌介入治疗50例体会

老年肝癌患者因各组织、器官的解剖、生理状况不同于中青年人 ,故在介入治疗上有其特殊性。我们选择 1995年2月至 1998年 2月 5 0例资料完整者进行分析 ,就治疗中的体会报告如下 :　　一、材料方法　　 1.对象 :老年肝癌患者 (老年组 ) 5 0例 ,男 42例 ,女 8例 ,年龄 6 0～ 88岁 ,平均年龄 78岁 ;其中右肝巨块型 2 2例、弥散型 8例、结节型 8例、左肝巨块型 7例、结节型 5例 ,门静脉右支癌栓 6例、左支癌栓 1例 ;肝功能Ｃｈｉｌｄ分级 :Ａ级8例、Ｂ级 32例、Ｃ级 10例 ,中青年肝癌患者 (中青年组 ) 32例 ,男 2 6例 ,女 6例 ,年龄 32～ 5 8岁…     

Combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I in treating stage Ⅲ non-small cell lung cancer

Objective To assess the therapeutic effect of combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I implantation in treating stage Ⅲ non-small cell lung cancer. Methods Sixty cases with stage Ⅲ non-small cell lung cancer were randomly divided into two groups with random number table. In group A (in interventional treatment group, n = 30),the gemcitabine 1000 mg/m2 and one third of the cisplatin 100 mg/m2 was given using seldinger technique for transcatheter bronchial arterial infusion chemotherapy on day 1. Two-thirds of the cisplatin 100 mg/m2 was infused in veins on day 2 and 3. The gemcitabine 1000 mg/m2 was infused in veins on day 8, 21 days for a period. In group B (interventional - 125I groups), the method of combination chemotherapy of gemcitabine and cisplatin was the same as in Group A. After ten days of arterial perfusion, 125I seeds were implantated, 21 days for a period. All patients received at least 2 cycles. The imaging evaluation of patients after treatment standards included complete remission (CR), partial remission (PR), stable (SD),progressive disease (PD), effective rate (CR + PR)/30 and clinical benefit rate (CR + PR + SD)/30.Non-parametric rank sum test was used to compare short-term effect of the two groups treatment of two cycles.x2 test was used to compare year survival, Kaplan-Meier method was used to calculate median survival,log-rank test method was used to difference between the groups. Results In group A, there were 17 PR,9SD and 4 PD. The overall response rate was 56. 7% (17/30) and clinical beneficial rate was 86. 7% (26/30). In Group B, there were 2 CR, 21 PR, 7 SD. The overall response rate was 76.7% (23/30) and clinical beneficial rate was 100% (30/30). There was significant difference between the two groups (P =0. 036). In group A, the 1 year survival rate was 46. 7% (14/30) and the 2 year survival rate was 36. 7%(11/30), median survival time (MST) was 10 months . In group B, the 1 year survival rate was 76. 7%(23/30) and the 2 year survival rate was 63. 3% (19/30) , median survival time (MST) was 27 months.There was a significant difference between two group in 1 year survival rate (P = 0. 017), 2 year survival rate (P = 0. 039) and median survival time (P = 0. 006). Conclusion The treatment effects of Ⅲ stage non-small cell lung cancer by gemcitabine and cisplatin combination chemotherapy with double way plus radioactive seed 125I implantation was better than gemcitabine and cisplatin combination chemotherapy with double way.     

肝动脉热灌注化疗栓塞联合射频消融治疗原发性肝癌的对照研究

目的 探讨经肝动脉热灌注化疗栓塞(TACE)联合射频消融(RFA)治疗原发性肝癌的价值.方法 回顾性分析80例Ⅰ～Ⅱ期的原发性肝癌患者.A组(热灌注TACE联合RFA)36例,采用Seldinger法插管入肝内肿瘤供血动脉,将吉西他滨1000 mg溶于1200 ml生理盐水,以设定温度51℃,0.8～1.0 ml/s的流速进行热化疗灌注,然后用吉西他滨200 mg+卡铂200 mg+超液化碘油进行化疗栓塞.B组(热灌注TACE)44例,与A组相同方案行热灌注TACE.每4周为一周期,A组连续2周期后间隔2周,对原病灶行全麻下RFA治疗,B组连续4周期治疗.治疗后按mRECIST标准行影像评价有效率,比较卡氏评分、近期疗效、甲胎蛋白(AFP)转阴率、生存率、中位生存期.结果 A组卡氏评分改善、AFP转阴率、近期有效率均优于B组(Z=-2.080,P=0.038;P=0.037;Z=-6.756,P＜0.001).1、2、3年生存率:A组分别为97％、92％、78％,B组分别为80％、70％、36％;中位生存期:A组43个月,B组29个月,差异均有统计学意义(P＜0.05).结论 热灌注TACE联合RFA可进一步提高原发性肝癌治疗效果.     

吉西他滨、顺铂双路径用药联合125Ⅰ粒子植入治疗Ⅲ期非小细胞肺癌的临床对照研究

目的 探讨吉西他滨、顺铂双路径用药联合125I粒子植入治疗Ⅲ期非小细胞肺癌的价值.方法 60例Ⅲ期非小细胞肺癌患者应用随机数字表法随机分为两组.A组(血管介入组)30例,第1天采用Seldinger法插管进行支气管动脉化疗灌注.用药剂量:吉西他滨1000 mg/m2;顺铂100 mg/m2,第1天灌注时取总量的1/3.余量顺铂于第2天和第3大静脉滴注.第8天吉西他滨1000 mg/m2静脉滴注,21 d为1个疗程.B组(血管介入+125I粒子植入组)30例,双路径用药同A组,于动脉灌注后第10天行局麻下125I粒子植入术,21 d为1个疗程.两组均至少完成2个疗程评价.患者治疗后的影像评价标准为完全缓解(CR)、部分缓解(PR)、稳定(SD)、进展(PD).有效率为(CR+PR)/30,临床获益率为(CR+PR+SD)/30.采用非参数秩和检验比较A、B组的近期疗效(治疗2个疗程),x2检验比较年生存率,Kaplan-Meier法计算中位生存期、log-rank法检验组间中位生存期差异.结果 近期疗效.A组:PR 17例,SD稳定9例,PD 4例,有效率为56.7%(17/30),临床获益率为86.7%(26/30);B组:CR 2例,PR 21例,SD 7例,有效率为76.7%(23/30),临床获益率为100%(30/30).B组效果优于A组,差异有统计学意义(P=0.036).1年生存率B组(76.7%,23/30)高于A组(46.7%,14/30),差异有统计学意义(P=0.017).2年生存率B组(63.3%,19/30)高于A组(36.7%,11/30),差开有统计学意义(P=0.039).B组中位生存期(27个月)高于A组(10个月),组间差异有统计学意义(P=0.006).结论 吉西他滨、顺铂双路径用药联合125I粒子植入治疗Ⅲ期非小细胞肺癌的疗效明显优于单纯同方案双路径用药的疗效.

Abstract：

Objective To assess the therapeutic effect of combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I implantation in treating stage Ⅲ non-small cell lung cancer. Methods Sixty cases with stage Ⅲ non-small cell lung cancer were randomly divided into two groups with random number table. In group A (in interventional treatment group, n = 30),the gemcitabine 1000 mg/m2 and one third of the cisplatin 100 mg/m2 was given using seldinger technique for transcatheter bronchial arterial infusion chemotherapy on day 1. Two-thirds of the cisplatin 100 mg/m2 was infused in veins on day 2 and 3. The gemcitabine 1000 mg/m2 was infused in veins on day 8, 21 days for a period. In group B (interventional - 125I groups), the method of combination chemotherapy of gemcitabine and cisplatin was the same as in Group A. After ten days of arterial perfusion, 125I seeds were implantated, 21 days for a period. All patients received at least 2 cycles. The imaging evaluation of patients after treatment standards included complete remission (CR), partial remission (PR), stable (SD),progressive disease (PD), effective rate (CR + PR)/30 and clinical benefit rate (CR + PR + SD)/30.Non-parametric rank sum test was used to compare short-term effect of the two groups treatment of two cycles.x2 test was used to compare year survival, Kaplan-Meier method was used to calculate median survival,log-rank test method was used to difference between the groups. Results In group A, there were 17 PR,9SD and 4 PD. The overall response rate was 56. 7% (17/30) and clinical beneficial rate was 86. 7% (26/30). In Group B, there were 2 CR, 21 PR, 7 SD. The overall response rate was 76.7% (23/30) and clinical beneficial rate was 100% (30/30). There was significant difference between the two groups (P =0. 036). In group A, the 1 year survival rate was 46. 7% (14/30) and the 2 year survival rate was 36. 7%(11/30), median survival time (MST) was 10 months . In group B, the 1 year survival rate was 76. 7%(23/30) and the 2 year survival rate was 63. 3% (19/30) , median survival time (MST) was 27 months.There was a significant difference between two group in 1 year survival rate (P = 0. 017), 2 year survival rate (P = 0. 039) and median survival time (P = 0. 006). Conclusion The treatment effects of Ⅲ stage non-small cell lung cancer by gemcitabine and cisplatin combination chemotherapy with double way plus radioactive seed 125I implantation was better than gemcitabine and cisplatin combination chemotherapy with double way.     

球囊暂时阻断颈内动脉在头颈部肿瘤切除中的应用

目的 探讨暂时性颈内动脉球囊阻断试验在头颈部肿瘤切除的术前价值.方法 32例头颈部肿瘤患者术前行肿瘤侧颈内动脉暂时性球囊阻断试验,阻断30 min,观察并记录球囊阻断前后神经系统的变化.球囊阻断后监测残端动脉压力;计算残端动脉压力与患者平均动脉压比值.阻断时无神经系统相关症状或残端压≥阻断前50％为阴性,出现神经系统相关症状或残端压＜阻断前50％为阳性.结果 32例患者中,30例阴性,2例阳性.2例阳性中,1例阻塞后患者出现神经症状,立即终止试验后患者症状消失;1例无神经相关症状,残端压40 mmHg.30例阴性患者中,2例行部分颈内动脉切除,7例结扎颈内动脉,21例保留颈内动脉,肿瘤均完整切除,患者无术后神经系统相关并发症.2例阳性患者均放弃手术切除:1例行粒子植入结合动脉内药物灌注治疗,1例行氩氦刀结合动脉药物灌注治疗.结论 暂时性球囊阻断颈内动脉试验简便易行.通过评价患者闭塞颈内动脉后有无神经系统症状及监测残端动脉压,有助于选择头颈部肿瘤治疗方式,可有效避免出现神经系统相关并发症.