Multimodal therapy with intravenous biweekly leucovorin, 5-fluorouracil and irinotecan combined with hepatic arterial infusion pirarubicin in non-resectable hepatic metastases from colorectal cancer (a European Association for Research in Oncology trial).

BACKGROUND: The purpose of this study was to evaluate the tolerance and efficacy of combining i.v. irinotecan, 5-fluorouracil (5-FU) and leucovorin (LV) with hepatic arterial infusion (HAI) of pirarubicin in non-resectable liver metastases from colorectal cancer. PATIENTS AND METHODS: Thirty-one patients were included in a phase II trial with i.v. irinotecan/5-FU/LV administered every 2 weeks, combined with HAI pirarubicin 60 mg/m(2) on day 1 every 4 weeks. In most cases HAI was administered via a percutaneous catheter. RESULTS: The main grade 3/4 toxicity was neutropenia, encountered in 78% of the patients. When all patients were considered in the analysis, tumour response rate was 15 out of 31 [48%; 95% confidence interval (CI) 32% to 65%]. Liver resection was made possible in 11 patients (35%; 95% CI 21% to 53%). There were no toxic death. Median overall survival was 20.5 months, and median progression-free survival was 9.1 months. In patients with completely resected metastases, median overall survival was not reached and median progression-free survival was 20.2 months. CONCLUSION: The multimodality approach used in the present study was well-tolerated and yielded dramatic responses. An aggressive approach combining i.v. and HAI chemotherapy deserves further investigation.     

食管癌放疗后复发再程治疗的疗效观察

目的　探讨食管癌放疗后复发再程治疗的价值。方法　 5 0例食管癌放疗后复发患者接受再程治疗。随机分成手术切除组和再程放疗组 ,2 5例手术切除组左侧进胸 ,行食管—胃吻合术 ;2 5例再程放疗组 ,采用超分割治疗。 1 2Gy/f,Bid ,6MV X线 ,相隔 6小时 ,剂量 44～ 60Gy。结果　 2 5例手术切除组 1、2、3年生存率分别为 80 %、3 6%、2 8% ;再程放疗组 1、2、3年生存率分别为 44 %、2 0 %、8 7%。结论　食管癌放疗后复发治疗应首选手术治疗 ,放射治疗亦可作为一种有效治疗手段。     

Clinical significance of interstitial collagen deposition at the invading edge in oral cancer: Immunohistochemistry for type I collagen

Background Changes in interstitial collagen in human oral cancer have not yet been fully studied. We examined the relationship between the degree of interstitial collagen deposition at the invading edge of the tumor, and the clinical and pathologic findings in oral squamous cell carcinoma. We also investigated the therapeutic implication of the changes in distribution patterns of collagen deposition by comparing biopsy specimens and surgical specimens. Methods Immunohistochemical staining was performed by the streptavidin-biotin method using antibody against human type I collagen for visualizing interstitial collagen in 50 biopsy and 45 surgical specimens. Results Carcinomas with scanty interstitial collagen in biopsy specimens tended to have highly malignant characteristics. Large carcinomas with scanty deposition both in biopsy and surgical specimens were likely to have positive resection margins in spite of radical surgery. Conclusion Immunostaining patterns for type I collagen of oral squamous cell carcinomas can provide information of importance in determining safe resection margins.     

恶性肿瘤累及颈动脉的外科处理

为探讨头颈部恶性肿瘤侵犯颈动脉的外科治疗，对５例喉癌或下咽癌颈淋巴结转移累及一侧颈动脉病人，术前经ＣＴ或Ｂ超检查，３例经术前体外颈动脉压迫训练合格后手术切除受累段颈总动脉，２例系术中损伤颈总动脉后紧急切除受轻动脉。其中１例即刻行断端吻合，５例术中，术后均无明显脑缺血表现，３例术后随访２年以上健在，２例尚在随访中。     

肺癌肺叶切除术后肺功能状态影像学评价

评价肺癌肺叶切除术后的胸部Ｘ线检查对肺功能状况估测的临床意义。方法６２例患者分别在肺叶切除术后３个月、１２个月拍摄胸部Ｘ光片，同时测定肺活量（ＶＣ）、最大通气量（ＭＶＶ）、１秒用力呼气容量（ＦＥＶ１）、动脉血氧分压（Ｐｏ２）对有关数据进行统计学处理。结果膈肌活动度＜０．５ｃｍ组肺功能检测指标明显低于膈肌活动度＞０．５ｃｍ组，两组之间有显著性差异（Ｐ＜０．０５）。结论胸部Ｘ线检查测定隔肌动度可间接估测其肺功能状况，为临床治疗、估测预后提供参考依据。     

食管腺癌单纯手术与合并术前化疗比较

[目的]比较食管腺癌单纯手术与合并术前化疗的预后。[方法]单纯手术组91例，术前DDP，5FU联合化疗组16例，术前VP16、ADM、DDP联合化疗组22例，比较3组的生存率。[结果]单纯手术组91例手术死亡率2％，2年生存率24％，4年生存率8％。术前DDP、5FU联合化疗组16例，化疗后完全缓解1例（16％），部分缓解5例（31％），无效10例（63％），12例手术切除，1例由于化疗有关死亡，1例手术死亡，2、4年生存率均为42％。术前DDP、ADM、VP16联合化疗组22例，化疗后1例完全缓解（5％），11例部分缓解（50％），10倒无效（45％），18例手术切除，无手术死亡，2年生存率58％。[结论]术前化疗能明显提高食管腺癌病人的生存率，同时治疗应个体化。     

腹腔镜手术治疗过大卵巢囊肿手术8例报告

目的探讨腹腔镜治疗过大卵巢囊肿手术的可行性和适应征。方法2004年6月～2005年4月，在腹腔镜下治疗8例过大卵巢囊肿，2例卵巢囊肿切除术，6例卵巢囊肿剥除术。结果8例均获成功，无中转开腹，无手术并发症。手术时间60～95min，术后2～3d出院。结论过大卵巢囊肿可行腹腔镜手术治疗。     

经尿道前列腺汽化电切术治疗前列腺增生56例报告

目的 为探讨经尿道前列腺汽化电切术治疗前列腺增生的治疗效果。方法 采用经尿道前列腺汽化切割术结合电切术治疗前列腺增生56例。结果 手术时间45～90分钟，平均60分钟；切除前列腺组织重量为15～80g，平均30g；术中输血5例。无发生经尿道电切综合征(TURS)，2～4天拔除尿管，均能自行排尿。随访2～22个月，IPSS评分由术前29．6分降至9．5分；QOL评分由术前4．7分降至2．05分；最大尿流率(Qmax)由术前7．3ml／s增加至18．5ml／s；短暂性尿失禁3例；尿道狭窄2例。结论 经尿道前列腺汽化电切术具有微创伤、安全有效、适应证相对较宽的特点。     

多点活组织检查在浅表性膀胱肿瘤治疗中的意义

目的 :观察随机活组织检查对浅表性膀胱癌的治疗影响。方法 :对 2 14例浅表性膀胱行经尿道膀胱肿瘤电切术 (TURBt) +多处随机活组织检查 ,活组织检查处包括膀胱左右侧壁、顶部、底部、三角区和异常黏膜。结果 :在 2 14份活组织检查标本中 ,病理检查异常的有 :移行细胞癌 11例 (5 .1% ) ,原位癌 14例 (6 .5 % ) ,鳞状化生 10例 (4 .7% ) ,膀胱炎 5 0例 (2 3.4 % ) ,不典型增生 10例 (4 .6 % )。其中 ,有 6例因膀胱活检而改变治疗方案。结论 :活组织检查有利于对肿瘤分级 ,确认高危患者 ,并为 TU RBt术后选择辅助治疗或膀胱根治切除提供依据     

老年人前列腺增生合并腹股沟疝的同期手术效果评价

目的评价70~89岁老年人前列腺增生合并腹股沟疝同期手术治疗的效果,总结临床经验。方法回顾性分析32例70~89岁患者行经尿道前列腺切除术(TURP),同时行无张力疝修补术的临床资料和随访结果。结果平均手术时间(85.0±12.8)min,平均术中出血(90.0±18.7)ml,术中、术后无死亡和危及生命的并发症发生。随访7~40个月,未见疝复发及尿失禁、尿道狭窄等并发症,国际前列腺症状评分(IPSS)、最大尿流率和残余尿量与术前比较,差异均有统计学意义。结论70~89岁老年人同期施行TURP和无张力疝修补术是安全的,效果满意。