A Multicenter Phase II Trial of Gemcitabine Plus Oxaliplatin in Unresectable Gallbladder Cancer

Background/Aims

No standard chemotherapy has been established for advanced gallbladder cancer. The authors studied the activity and tolerability of a gemcitabine and oxaliplatin (GEMOX) combination in unresectable gallbladder cancer (GBC).

Methods

Adult patients with pathologically confirmed unresectable GBC were prospectively recruited at three centers. No patient had received prior chemotherapy or radiotherapy. Patients received cycles of gemcitabine at 1,000 mg/m² on day 1, followed by oxaliplatin at 100 mg/m² on day 2, every 2 weeks. The primary study endpoint was time to progression.

Results

Forty patients with unresectable GBC were enrolled. The median age was 60 years (range, 38 to 79 years). All patients showed good performance status. Of the 33 analyzable patients, 12 achieved partial response (36%), 17 stable disease (52%), and four progressive disease (12%). No patient achieved a complete response. The tumor control rate was 88%. At a median follow-up of 6.8 months, the median time to progression was 5.3 months (95% confidence interval [CI], 3.7 to 6.9), and median overall survival was 6.8 months (95% CI, 6.1 to 7.5). Nine of the 40 patients (23%) experienced at least a grade-3 adverse event, but no patient experienced a grade-4 adverse event.

Conclusions

GEMOX combination therapy is a feasible option and is well tolerated in unresectable GBC.     

集中式预约检查流程的干预研究

目的：探讨集中式预约检查流程的干预对预约质量的影响。方法改变预约流程中的操作人员培训方法、对操作环节及电子信息系统进行流程改造,将流程改造后的2013年1月预约检查患者8114例作为干预组,选取2012年1月预约检查的患者7466例作为对照组。比较两组检查日期、检查总人数、预约检查回执单信息、检查的特殊要求错误率。结果干预组检查日期、检查总人数、预约检查回执单信息、检查的特殊要求错误率明显低于对照组,准确率由98．18％提高至99．98％。两组比较有显著性差异（P＜0．01）。结论对预约检查的流程干预可提高预约检查的准确率,提升服务质量。     

胆囊疾病患者营养不良风险与人口学及饮食的关系分析

目的探讨胆囊疾病患者营养不良风险与人口学及饮食的关系,为营养指导提供依据。方法自行设计胆囊疾病患者营养风险与人口学及低脂饮食的关系调查表,对303例胆囊疾病患者进行调查。结果 303例患者中181例存在营养风险,经单因素及多元Logistic回归分析,胆囊疾病患者营养风险与性别、年龄、文化程度及是否低脂饮食等相关。结论胆囊疾病患者存在营养不良风险高,要根据患者个体特点进行营养指导。     

微创保胆取石术前后胆囊收缩功能的超声评价

目的超声评价微创保胆取石术前后胆囊收缩功能的变化,为临床提供重要手术参考依据。方法应用超声评价40例微创保胆取石术患者手术前后胆囊收缩功能的变化。结果本组病例中,术前胆囊收缩功能良好(A组)21例术后胆囊收缩率均恢复正常;术前收缩功能尚可(B组)12例66%恢复正常;术前收缩功能欠佳和差(C组)7例71%收缩功能恢复正常或改善。3组患者术后3个月胆囊收缩率比较术前均有统计学差异(P<0.05)。结论超声评价诊断胆囊结石疾病及胆囊功能具有重要的临床作用,为微创保胆取石术前后胆囊功能的评估提供了重要的依据,本组病例提示,微创保胆取石术患者术后胆囊收缩功能基本可恢复正常或接近正常。     

胆囊癌18例CT诊断分析

目的探讨胆囊癌的CT表现,旨在提高胆囊癌的诊断水平。方法回顾性分析经病理证实的18例胆囊癌的CT表现。结果胆囊壁增厚型3例,腔内结节型6例,肿块型9例,合并肝脏及其他脏器受侵、肝脏及淋巴结转移、肝内外胆管扩张、胆囊结石等间接征象。结论 CT在胆囊癌的诊断与鉴别诊断中有重要的作用,但存在一定的局限性;细心分析胆囊及其周围的结构、器官的改变,有助提高胆囊癌的CT诊断水平。     

多排CT多期增强扫描在胆囊癌诊断与鉴别诊断中的应用

目的探讨CT多期增强扫描在胆囊癌诊断与鉴别诊断中的应用价值。方法分析经过手术病理证实的36例胆囊癌患者的CT表现,术前均做CT平扫,其中33例进行了多期增强扫描,3例做薄层扫描。结果36例胆囊癌中腔内肿块型15例,占42％（15／36）,厚壁型11例,占31％（11／36）,胆囊区肿块型6例,占17％（6／36）,混合型4例,占11％（4／36）。结论cT多期增强扫描对胆囊癌的诊断及鉴别诊断有价值。     

基于排队论的医院放射科门诊设备配置

目的：运用排队论对军队医院门诊放射科设备配置进行量化分析,缓解患者排队等待时间长的矛盾。方法以某三级甲等军队医院为例,运用排队论M/M/C模型,计算放射科设备配置和患者就诊时间分布及其服务强度等运行指标。结果当前放射科CR和DR检查上午服务强度分别为1．14和1．09,下午仅为0．60和0．70,MRI检查的服务强度为1．25,存在设备配置和患者就诊时间安排不合理等问题,通过预约模式以及采取措施提高有效工作时间,可以使三个检查队列的服务强度均维持在0．82～0．92,患者排队时间控制在15．61～44．47 min。结论应用排队论的理论和方法分析放射科设备配置合理可行。     

Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis

Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.     

胆囊癌的临床特点及CT影像诊断分析

目的 分析胆囊癌的临床特点及CT影像诊断的价值.方法 将本院2012年5月至2014年5月收治的43例胆囊癌患者纳入研究组行回顾性分析,另随机抽取同期于本院就诊的胆囊结石、胆囊息肉、胆囊良性肿瘤患者共40例为对照组.比较两组患者的一般资料与CT诊断结果,统计分析两组性别、年龄、临床症状、不同期相的CT值差异.结果 胆囊癌组中女性比例、年龄段60～69岁之间的发病人数比例分别为79.07％、48.84％,均明显高于对照组的55.00％、27.50％ (P＜0.05);胆囊癌组的CT平扫、动脉期、门脉期CT值分别为(35.14±4.07) HU、(51.36±6.27) HU、(66.58±7.74) HU,均显著高于对照组的(29.14±3.30)HU、(42.61±5.24) HU、(57.69±5.49) HU (P＜0.05);在43例胆囊癌患者中,CT直接征象检出:肿块型18例,结节型13例,壁肥厚型12例.间接征象检出:合并胆囊结石22例,侵犯邻近组织16例,淋巴结转移13例,远处组织转移4例,腹水5例.结论 老年女性是胆囊癌的高发人群,虽然其临床特征不显著,但可以患者不同期相的CT值与影像学图片为参考基础,综合考虑一般资料与病史后进行胆囊癌的术前诊断.     

腹腔镜胆囊切除术治疗老年胆囊结石的围术期应激观察及影响因素

目的 观察腹腔镜胆囊切除术治疗老年胆囊结石的围术期应激并分析应激反应的影响因素.方法 选择本院2012年6月至2015年6月所收治老年胆囊结石患者107例进行回顾性分析,均行腹腔镜胆囊切除术.于麻醉开始前、手术结束时与术后1d、2d、3d、5d检测患者内皮素(ED与超氧化物岐化酶水平(SOD),根据107例患者手术时间的不同(≤60 min、＞60 min)、麻醉方式的不同[硬膜外麻醉复合全麻(GEA)、全麻(GA)]对患者ET与SOD指标进行分组统计并比较.结果 麻醉开始后患者ET与SOD均呈现下降趋势,术后1d及术后2d的ET水平分别为(35.2±7.0)pg/ml、(35.8±6.1)pg/ml,手术结束时、术后1d的SOD分别为(62.1±9.5)U/ml、(65.3±8.8)U/ml,均显著低于麻醉开始前(P＜0.05).手术时间≤60 min患者术后1d与术后2d的ET分别为(30.4±4.4)pg/ml、(35.5±3.2)pg/ml,均低于手术时间＞ 60 min患者(P＜0.05);手术结束与术后1d的SOD分别为(66.4±6.3)U/ml、(67.6±5.1)U/ml,均高于手术时间＞ 60 min患者(P＜0.05).GEA患者术后1d与术后2d的ET分别为(30.6±3.8)pg/ml、(35.3±4.1)pg/ml,均低于GA患者(P＜0.05);手术结束与术后1d的SOD分别为(66.1±5.0)U/ml、(67.8±4.5)U/ml,均高于GA患者(P＜0.05).提示手术时间≤60 min与GEA麻醉方式所引起围手术期应激反应更轻.结论 腹腔镜胆囊切除术治疗老年胆囊结石患者围术期往往存在明显应激,且手术时间及麻醉方式对应激程度有较大影响,可尽量缩短手术时间并采取GEA麻醉方式减轻患者应激反应.