金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

子宫内膜异位症的发病相关因素研究

目的探讨子宫内膜异位症（EMS）的发病相关因素。方法纳入301例因腹腔镜手术住院的患者,进行问卷调查,比较EMS组患者与非EMS组患者月经、疼痛症状、孕产史、既往病史、日常生活和工作等情况,对EMS发病相关危险因素行多因素Logistic回归分析。结果单因素分析显示,EMS与非EMS患者在月经行经时间、月经量、月经周期、痛经、经期排便痛、不孕史、卵巢囊肿病史、多囊卵巢综合征病史上比较差异有统计学意义（P均〈0．05）。两组患者在初潮年龄、月经规律性、性交痛、平时盆腔痛、怀孕次数、生产次数、流产次数、异位妊娠次数、剧烈运动史、吸烟史以及饮酒史上比较差异无统计学意义（P均〉0．05）。多因素Logistic回归分析显示,月经量多、痛经、卵巢囊肿病史与EMS发病呈正相关,月经周期延长与EMS发病呈负相关（P均〈0．05）。结论EMS危险因素包括月经量多、痛经、卵巢囊肿病史、月经周期缩短,临床医疗工作者遇到以上症状的患者。应注意排除EMS。     

六例直接性门腔静脉分流术的初步经验

目的　探讨B超引导穿刺 ,在肝后段下腔静脉 (RHSIVC)与肝内门静脉之间建立直接性门腔分流 (DIPS)的可行性及安全性。方法　在B超导引下为 6例门脉高压患者 (3例同时合并有肝癌 )实施DIPS术 ,对 1例合并有肝癌的患者同时行经肝动脉化疗栓塞术 (HACE)。所有患者术前均行上腹部增强CT检查 ,测量RHSIVC的直径、长度及周围肝实质包绕RHSIVC的范围 ,分别对术前、术后患者的红细胞计数、血红蛋白量、肝功能、血氨水平及门脉主干压力的改变进行比较 ,采用彩色多普勒对分流道的通畅情况进行随访。结果　 6例DIPS术均获成功 ,患者门脉主干压力由术前的 (3 0 83±3 19)mmHg(1mmHg =0 13 3kPa)降至分流后的 (18 50± 6 47)mmHg ,差异具有显著性意义 (t =17 19,P <0 0 5)。术后 3d ,1例肝癌患者 (同时行HACE术 )死于急性肝功能衰竭 ,其余 5例患者无严重的并发症发生 ,分流道保持通畅 3 0～ 150d ,中位通畅时间为 60d。结论　在肝后段下腔静脉及门静脉之间建立直接性门腔静脉分流通道安全、可行 ,在临床上推广有待于进一步的研究     

单侧肺动脉化疗性栓塞术在转移性肺癌模型中的应用

目的探讨选择性肺动脉化疗性栓塞治疗肺转移瘤的可行性和疗效,并通过碘油示踪阐明微小肺转移瘤的肺动脉供血情况。方法实验采用新西兰大白兔14只,建立血源转移性肺癌模型。分为3组,A组(4只)作为对照组,B组(4只)和C组(6只)为实验组。所有兔均在全麻下分离股静脉,采用3F微导管行选择性左肺动脉灌注治疗:A组灌注生理盐水5ml;B组灌注表阿霉素(2mg/kg)和卡铂(15mg/kg);C组灌注卡铂(15mg/kg),同时将超液态碘油1ml和表阿霉素(2mg/kg)混合配成碘油乳剂透视下缓慢注入行化疗性栓塞术。术后3周全麻下处死所有存活实验兔(12只),剖胸取肺组织,用4%甲醛溶液固定,取材后石蜡包埋,分别测量肿瘤最大直径并计算肿瘤体积,比较各组治疗后体积改变。同时,在C组标本中另外取材,冰冻切片下用苏丹Ⅲ染色监测治疗后肿瘤内部碘油沉积情况。结果A组转移瘤平均体积(130.56±9.41)mm3较经介入治疗后B组(69.47±10.00)mm3、C组(19.73±3.54)mm3左肺转移瘤平均体积明显大,而C组左肺转移瘤体积较B组小,差异具有统计学意义(P<0.05)。2只兔术中死亡,死亡兔肺转移瘤内均见碘油沉积。另外,化疗栓塞后3周C组转移瘤内仍然可见散在碘油沉积,部分碘油已进入肿瘤实质内。结论化疗性栓塞术治疗肺部转移瘤确实可行,有利于控制肺转移瘤。经过碘油脂质染色进一步证实肺动脉参与了转移性肺癌的血供,尤其是参与了早期肺内微小转移结节的供血。随肿瘤结节的不断增大,转移瘤的肺动脉血供也不断增多。     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

目的 研究金属内支架置入联合三维适形放射治疗对原发性肝癌合并门静脉癌栓的治疗效果. 方法回顾性分析22例肝癌伴门静脉癌栓患者,其中门静脉支架置入联合适型放射治疗组(A组)10例,门静脉支架置入和经动脉化疗柃塞组(B组)12例.比较两组患者治疗后的不良反应发生情况及治疗前后肝功能变化情况,随访4、6、12个月的支架通畅率和3、6、12个月的生存率.肝功能比较采用Wilcoxon符号秩检验,支架通畅率曲线和生存率曲线的比较采用Log rank检验. 结果两组患者均成功建成门静脉通路,并通过经皮肝穿刺门静脉分支路径成功置放支架,门静脉狭窄均得到开通.患者均未发生腹腔出血,但术后均有不同程度的腹痛、发热、恶心、呕吐、肠胀气等症状,通过对症处理均在l周内缓解.A组患者均完成治疗,Ⅰ～Ⅱ度胃肠反应3例,Ⅰ～Ⅱ度骨髓抑制2例,对症处理后完全缓解.A组患者的4、6、12个月支架通畅率分别为90%,70%、30%,B组分别为50%,25%.16.7%,两组的通畅率曲线差异有统计学意义(χ<'2>=4.33,P<0.05).A组患者的3、6、12个月生存率分别为100%、80%、30%,B组分别为91.7%、41.7%,16.7%,对两组的生存率曲线差异有统计学意义(χ<'2>=4.05,P<0.05). 结论采用支架置入并联合三维适形放射治疗对肝癌伴门静脉癌栓有较好的疗效,且对肝脏的损害相对较小.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

膀胱癌肺转移致上腔静脉综合征合并肺动脉狭窄1例

上腔静脉综合征（superior vena cava syndrome,SVCS）是各种原因引起的上腔静脉回流受阻所致的一组临床症候群。肺动脉狭窄（pulmonary artery stenosis,PS）属于肺或纵隔肿瘤的并发症之一。膀胱癌肺转移导致的SVCS合并PS极为罕见,目前尚未见文献报道。本文报道1例老年男性膀胱癌肺转移出现头颈部及双上肢浮肿,结合肺动脉CT血管成像（computedtomographyangiography,CTA）及数字减影血管造影（digitalsubtraction angiography,DSA）明确患者存在SVCS合并PS,内科治疗无效后,采取支架植入治疗SVCS。术中测压提示PS尚未引起肺动脉高压,遂暂未处理PS。患者接受介入治疗后浮肿症状好转出院。     

司徒仪教授对子宫内膜异位症中医证候的分析

司徒仪教授认为子宫内膜异位症是虚夹杂之病,血瘀和肾虚是其主要病机;本病术后使GnRH-a治疗,必处于"肾虚血瘀"的状态。肾虚为因,血瘀为果,二者相兼并存,治疗上应以补肾活血为主要治法。     

胰腺癌与凝血相关因素的研究进展

 目前广泛认为胰腺癌存在着一种内在的独特能力使大部分胰腺癌患者存在高凝状态,并易导致血栓形成。在下肢深静脉彩超检查时,超过50%的胰腺癌患者存在深静脉血栓。是什么导致了胰腺癌此种高凝状态,这种高凝状态与胰腺癌之间有何关系,对胰腺癌的侵袭、转移以及预后有何作用;如何应对这种高凝状态是值得研究的问题。本综述从胰腺癌的高凝状态产生的原因、机制,高凝状态对于胰腺癌发展和转移的作用,预防和治疗方面措施的研究进展进行讨论,并提出今后的研究方向。