局部晚期喉癌颈部淋巴结转移规律及相关因素分析

目的 分析局部晚期(T3、T4期)喉癌颈部淋巴结转移(LNM)规律,为喉癌放疗颈部靶区勾画提供参考。方法 回顾分析2000-2017年中国医学科学院肿瘤医院初治局部晚期喉癌患者,所有患者至少行双颈Ⅱ-Ⅳ区淋巴结清扫,计算颈部各区LNM率。采用Logistic回归分析LNM相关因素。结果 共272例患者纳入研究,全组患者LNM率为57.1%(156/272)。根据原发病变部位分3个组:A组(72例),原发灶局限于一侧;B组(86例),原发灶主体偏于一侧但侵犯过中线;C组(114例),原发灶为巨大或中央型病变。各组不同颈部分区LNM率:A组同侧颈部Ⅱ区36.3%、Ⅲ区26.4%、Ⅳ区6.9%,对侧分别为13.9%、8.3%、1.4%;B组:同侧颈部Ⅱ区41.9%、Ⅲ区29.1%、Ⅳ区11.6%,对侧分别为18.6%、14.0%、1.2%;C组:左侧Ⅱ区24.6%、Ⅲ区 23.7%、Ⅳ区2.6%,右侧分别为21.9%、26.3%、6.1%。局限单侧(A组)与中线受侵(B、C组)双侧LNM率相近(15.3%、25.0%,P=0.093)。同侧Ⅲ区是否转移和临床淋巴结分期与对侧颈是否LNM相关(OR=2.929,95%CI为1.041~8.245,P=0.042)和OR=0.082,95%CI为0.018~0.373,P=0.001)。同侧Ⅱ区、Ⅲ区转移是同侧Ⅳ区转移的危险因素(P=0.043、0.009)。结论 双侧颈部Ⅱ、Ⅲ区是高危LNM区,Ⅳ、Ⅴ区转移较少见;同侧Ⅱ、Ⅲ区转移是同侧Ⅳ区及对侧颈LNM的相关因素,cN0期患者少见对侧颈LNM。     

肝硬化腹水简易皮下转流术

肝硬化腹水简易皮下转流术西安医科大学附属第二医院肝胆外科（７１０００４）李国成，刘清峰，李宗芳门静脉高压症有明显腹水病人，一旦发生食管、胃底曲张静脉出血，其手术死亡率高达６０％～７０％［１］，是治疗上的难题．我院自１９８５年以来，对３例病西人采用术中...     

肝癌瘤周纤维化过程中α1(Ⅰ)、α1(Ⅳ)型前胶原mRNA的原位杂交特点

目的：为解决中晚期肝癌临床切除率低、手术创伤大、转移率高等问题，设计了选择性胆管支、门静脉支联合结扎的方法，对大鼠移植性肝癌模型进行了治疗性研究，并观察了瘤周纤维增生特点。方法：应用R—35大鼠肝癌瘤株制备Wister大鼠移植性肝癌模型，分组实施含瘤肝叶的门静脉支胆管支联合结扎术及对照手术。对比观察大鼠病死率、转移率、治疗成功率；原位杂交检测α1(Ⅰ)、α1(Ⅳ)型前胶原mRNA表达及定位情况。结果：手术组瘤周纤维包裹紧密与对照组相比病死率31．3％：68．8％、腹腔转移率31．3％：62．5％、肝内转移率12．5％：43．8％、腹腔转移合并肝内转移率6．3％：37．5％、肺转移率0：18．8％、治疗成功率为43．8％；癌周纤维化早期，Ito细胞及MF主要对α1(Ⅳ)前胶原mRNA做出表达，中期α1(Ⅰ)前肢原mRNA杂交信号开始出现并增多，后期二者趋于稳定。结论：联合结扎法可使肝癌团块周围发生广泛的肝纤维化，有效的包裹和限制了肝癌细胞团的膨胀性生长，显著地降低了肝癌病死率、腹腔和肝内转移率及肺转移率；Ito细胞是癌周纤维化过程中胶原生成的先驱细胞，激活后的Ito细胞可进一步转变为MF和Fb，成为癌周纤维化过程中的主要胶原生成细胞，纤维条束及其中的胶原生成细胞对癌细胞的生长和生物活动有反应能力。     

前列腺癌大分割调强放疗副反应初步分析

Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly significantly associat-ed with grade ≥1 acute GI toxicity. Grade 1,2 and 3 acute genitourinary (GU) toxicity occurred in 68%, 0% and 3% of the patients, respectively. The bladder V50> 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5%, respectively. The rectal V65> 10% was highly significantly associated with grade ≥1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49%, 11% and 3%, respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.     

局部晚期喉癌颈部淋巴结转移规律及相关因素分析

目的 分析局部晚期(T3、T4期)喉癌颈部淋巴结转移(LNM)规律,为喉癌放疗颈部靶区勾画提供参考。方法 回顾分析2000-2017年中国医学科学院肿瘤医院初治局部晚期喉癌患者,所有患者至少行双颈Ⅱ-Ⅳ区淋巴结清扫,计算颈部各区LNM率。采用Logistic回归分析LNM相关因素。结果 共272例患者纳入研究,全组患者LNM率为57.1%(156/272)。根据原发病变部位分3个组:A组(72例),原发灶局限于一侧;B组(86例),原发灶主体偏于一侧但侵犯过中线;C组(114例),原发灶为巨大或中央型病变。各组不同颈部分区LNM率:A组同侧颈部Ⅱ区36.3%、Ⅲ区26.4%、Ⅳ区6.9%,对侧分别为13.9%、8.3%、1.4%;B组:同侧颈部Ⅱ区41.9%、Ⅲ区29.1%、Ⅳ区11.6%,对侧分别为18.6%、14.0%、1.2%;C组:左侧Ⅱ区24.6%、Ⅲ区 23.7%、Ⅳ区2.6%,右侧分别为21.9%、26.3%、6.1%。局限单侧(A组)与中线受侵(B、C组)双侧LNM率相近(15.3%、25.0%,P=0.093)。同侧Ⅲ区是否转移和临床淋巴结分期与对侧颈是否LNM相关(OR=2.929,95%CI为1.041~8.245,P=0.042)和OR=0.082,95%CI为0.018~0.373,P=0.001)。同侧Ⅱ区、Ⅲ区转移是同侧Ⅳ区转移的危险因素(P=0.043、0.009)。结论 双侧颈部Ⅱ、Ⅲ区是高危LNM区,Ⅳ、Ⅴ区转移较少见;同侧Ⅱ、Ⅲ区转移是同侧Ⅳ区及对侧颈LNM的相关因素,cN0期患者少见对侧颈LNM。     

韦氏环和结内弥漫性大B细胞淋巴瘤的临床特征与预后

目的 回顾性分析韦氏环与结内弥漫性大B细胞淋巴瘤的临床特征和预后.方法 分析病理确诊的韦氏环和结内弥漫性大B细胞淋巴瘤181例资料,其中韦氏环80例,结内101例.Ann Arbor分期1期57例,Ⅱ期83期,Ⅲ期26例,Ⅳ期15例.Ⅰ-Ⅱ期接受化疗加受累野照射,Ⅲ-Ⅳ期以化疗为主.结果 与结内弥漫性大B细胞淋巴瘤相比,韦氏环弥漫性大B细胞淋巴瘤多表现为临床Ⅱ期和邻近器官受侵,少见全身症状、脾受侵、乳酸脱氢酶和β2微球蛋白升高.韦氏环和结内弥漫性大B细胞淋巴瘤的5年总生存率分别为76%和56%(x2=2.43,P=0.119),Ⅰ～Ⅱ期韦氏环和结内弥漫性大B细胞淋巴瘤的5年总生存率分别为78%和58%(x2=76,P=0.097).单因素分析显示乳酸脱氢酶升高、国际预后指数评分≥1、β2微球蛋白升高是韦氏环弥漫性大B细胞淋巴瘤患者的预后不良因素,而β2微球蛋白升高、大肿块和国际预后指数评分≥1与结内弥漫性大B细胞淋巴瘤患者的预后差有关.多因素分析显示只有乳酸脱氧酶升高、β2微球蛋白值升高与伞组患者预后差有关.结论 与结内病变相比,韦氏环弥漫性大B细胞淋巴瘤具有某些不同的临床特征.     

前列腺癌大分割调强放疗副反应初步分析

Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly significantly associat-ed with grade ≥1 acute GI toxicity. Grade 1,2 and 3 acute genitourinary (GU) toxicity occurred in 68%, 0% and 3% of the patients, respectively. The bladder V50> 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5%, respectively. The rectal V65> 10% was highly significantly associated with grade ≥1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49%, 11% and 3%, respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.     

搏动性门脉血泵治疗门脉高压症的实验研究

目的为解决门脉高压症向肝血流减少、肝代谢功能下降及侧支循环压力过高、静脉曲张等问题,我们研制了搏动性门脉血泵,对丝线栓塞性门脉高压模型犬进行门脉外动力泵血的研究.观察入肝血量、肝代谢变化及侧支压力等一系列指标.方法对杂种犬进行门脉左右支丝线栓塞术制备门脉高压动物模型;应用高弹力硅胶球囊连接单流向硅胶瓣"T"型管,制作搏动性门脉血泵;应用强磁场磁极片及低频振荡交流线圈体外提供动力.将血泵"T"管安置于门脉主干前壁侧支平面上,测定血泵工作前后的入肝血流量、侧支静脉压力及吲哚氰绿排泄的变化.结果模型犬血泵平面以上的门脉压力在泵工作后由(30.3±4.2)cm H2O升至(49.0±7.1)cm H2O;入肝血流量由(270±28)ml/min升至(396±25)ml/min;血泵平面以下门脉压由(31.4±3.1)cm H2O降至(18.0±4.3)cm H2O;脾静脉压由(36.2±4.0)cmH2O降至(20.5±3.4)cm H2O;胃底静脉压由(35.3±3.3)cm H2O降至(19.3±4.7)cm H2O;吲哚氰绿排泄率由(0.092±0.009)升至(0.151±0.013);15min滞留率由(19.03±8.50)降至(9.04±2.50).结论搏动性门脉血泵对增加门脉入肝血流,改善肝代谢功能状态及降低侧支压力具有显著作用.血泵结构设计新颖,安置方法合理.动力装置体外固定,易于检修和更换电池,可长期工作.体内部分的长期维护方案正在进一步研究之中.     

胃十二指肠溃疡穿孔行急诊胃大部切除术64例体会

目的:探讨胃十二指肠溃疡穿孔行急诊胃大部切除术的安全性和可行性。方法:对64例胃十二指肠溃疡穿孔行急诊胃大部分切除术患者的临床资料进行回顾性分析。结果:64例全部临床治愈,无十二指肠残端破裂,吻合口漏,腹腔脓肿等严重并发症发生。结论:胃十二指肠溃疡穿孔行急诊胃大部分切除术,即便穿孔时间超过8h,只要无严重的心肺疾病,通过术中术后严格的处理也是安全可行的。     

头颈部肿瘤病人放疗期间营养支持的效果观察

[目的]探讨头颈部肿瘤放疗期间不同的肠内营养方式对病人整体健康状况的影响.[方法]对2007年4月-10月我院住院放疗头颈部肿瘤病人71例进行回顾性分析,全部病人出现由于放射性黏膜炎引起的进食困难,其中34例(管饲组)接受了鼻饲或胃造瘘;37例(对照组)经口进食,比较两组放疗前后体重、卡氏评分(KPS)及营养指标的变化.[结果]两组病人放疗期间均有不同程度的体重减少,管饲组体重减少幅度明显低于对照组(P<0.05).KPS评分在放疗第4周(仅置管几天或置管前)管饲组低于对照组(P<0.05), 治疗结束两组比较差异无统计学意义;放疗前管饲组血清白蛋白和前白蛋白均低于对照组(P<0.05),治疗结束时两组间比较差异无统计学意义.[结论]头颈部肿瘤病人放疗期间采用管饲肠内营养,对于改善病人整体健康状况效果显著.