进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

目的 探讨术前动脉灌注化疗对进展期结直肠癌的远期临床疗效.方法 选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为2组:试验组68例行术前动脉灌注化疗,方案为:奥沙利铂(艾恒)130mg/m2、羟基喜树碱20 mg/m2、氟脲苷600 mg/m2,经股动脉插管灌注化疗1、2次,8～14 d后接受手术治疗;对照组60例直接手术治疗.观察动脉灌注化疗不良反应及组织学疗效,比较2组手术切除率、手术并发症、术后病理分期及远期生存率.结果 试验组动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均属Ⅰ、Ⅱ度.试验组手术切除率为97.1%(66/68)、根治性切除率为96.9%,分别高于对照组的73.3%(44/60)和79.5%(x2=14.848、8.906,P均＜0.05);试验组组织学有效率达72.7%,病理分期均较术前降低,其中Ⅱ期病例明显较对照组增多(P＜0.05);试验组中位生存期为53.0个月,1、3、5年生存率分别为95.3%、85.9%、44.6%;对照组的中位生存期为42.0个月,1、3、5年生存率分别为92.6%、75.9%、22.0%,试验组生存率高于对照组,但只有5年生存率差异具有统计学意义(x2=6.385,P＜0.05).术后并发症2组比较差异无统计学意义(P＞0.05).结论 术前动脉灌注化疗对进展期结直肠癌降低临床分期、提高手术切除率尤其是根治性切除率作用和疗效确切,并能提高患者的远期生存率.

Abstract：

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

Hcc肿瘤标记物mRNA的检测与微转移关系的研究现状

原发性肝癌是世界范围内发病率最高的恶性肿瘤之一,每年约有100余万新发病例,其中我国每年新发病例约有10余万,现已成为我国居于第2位的恶性肿瘤致死原因。目前Hcc的治疗首选手术切除,辅以化疗、介入治疗及放射性治疗。而Hcc总5年生存率在5％,影响Hcc疗效的因素主要是：局部复发和转移,复发和转移率高达70％。     

胃肠道癌CEA、nm23-H1基因表达的临床意义

胃癌、大肠癌术后复发和转移仍是影响5年生存率的重要因素。本实验通过免疫组化Ｓ-Ｐ法测定胃肠道癌组织中ＣＥＡ、ｎｍ23-Ｈ1的表达,分析其对胃肠道癌淋巴结转移和预后的影响及其临床意义。1　材料及方法1.1　病例资料:选择2000-10～2001-06住院的胃、大肠癌患者62例,其中胃癌37例,结、直肠癌25例,男性43例,女性19例,年龄38～74岁,平均53.4岁。术后组织标本常规病理学检查,同时免疫组化测定癌组织中ＣＥＡ、ｎｍ23-Ｈ1的表达。并将所有病例行ｐＴＮＭ临床病理分期,胃癌、大肠癌病理分期按ＵＩＣＣ1997年[1]标准。1.2　试剂及实验方法:…     

靶向肝癌细胞自噬提高大黄素的毒性杀伤作用

背景与目的:大黄素处理肝癌细胞后能够诱导内质网应激和凋亡.鉴于内质网应激与自噬之间的关联及后者作为细胞对抗应激环境的一种自我防御机制,该研究拟探讨通过抑制肝癌细胞自噬信号通路的策略提高大黄素对肿瘤细胞的毒性杀伤作用.方法:大黄素处理肝癌细胞后,应用CYTO-ID自噬检测试剂盒和蛋白[质]印迹法(Western blot)分别检测大黄素诱发细胞自噬情况;利用细胞自噬抑制剂(氯喹)预先抑制肝癌细胞自噬的产生,然后用大黄素处理肝癌细胞,最后通过ATPlite试验和细胞克隆形成实验检测肿瘤细胞存活;通过流式细胞术检测氯喹和大黄素联合处理诱导肝癌细胞发生凋亡的凋亡率,采用Western blot检测凋亡效应蛋白caspase-3活化断裂后产生活性片段的水平.结果:大黄素处理肝癌细胞后能够诱导肝癌细胞自噬;利用氯喹抑制肝癌细胞自噬能够显著能够提高大黄素对肝癌细胞克隆存活的抑制作用;氯喹和大黄素联合处理肝癌细胞能够显著提高细胞周期sub-G1期和活化caspase-3蛋白的表达水平.结论:靶向肝癌细胞自噬能够提高大黄素的毒性杀伤作用.     

胃肠道癌外周血CEA-mRNA的表达及临床意义

目的　通过检测手术前、后胃肠道癌患者外周血癌胚抗原信使核糖核酸 (CEA mRNA)的表达 ,了解胃肠道癌血行播散转移情况及在围手术期综合治疗中的意义。方法　采用巢式逆转录 聚合酶链式反应 (Nest RT PCR)检测 6 2例胃肠道癌患者和 2 2例对照组外周血CEA mRNA的表达状况。结果　 6 2例癌患者样本中 ,术前 2 7例 (43.5 % )外周血CEA mRNA检测阳性 ,术后 2 6例阳性 (41.9% ) ,对照组 10例正常人及 12例良性胃肠病患者CEA mRNA测定均为阴性。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者外周血CEA mRNA阳性率依次为 37.5 %、2 7.3%、5 1.9%、80 .0 % ,各期间无显著性差异 (P >0 .0 5 )。Ⅰ +Ⅱ期与Ⅲ +Ⅳ期合并 ,两组患者间CEA mRNA的表达有显著性差异 (P <0 .0 5 )。胃肠道癌的分化程度及癌栓的形成与外周血CEA mRNA的表达无关。 35例伴局部淋巴结转移的患者的外周血CEA mRNA阳性率 (6 2 .9% )与 2 7例无淋巴结转移患者的阳性率 (18.5 % )有显著性差异 (P <0 .0 1)。手术前后外周血CEA mRNA阳性率差异无显著性 (P >0 .0 5 )。结论　外周血CEA mRNA检测可作为胃肠道癌复发、转移及预后的判断指标 ,对临床正确分期及综合治疗起指导作用。外周血CEA mRNA表达阳性的患者 ,应在围手术期辅以免疫治疗和 /或全身化疗 ,以遏止肿瘤复发、     

胃癌组织端粒酶活性表达的临床意义

目的通过检测胃癌组织中端粒酶活性的表达,评价端粒酶活性阳性率在胃癌诊断及预后判断方面的价值。方法用多聚酶链反应-酶联免疫吸附法(PCR-ELISA)测定28例胃癌和12例良性胃病组织的端粒酶活性表达,并分析其与临床病理因素之间的相关性。结果28例胃癌、12例良性胃病组织中端粒酶活性阳性率分别为85.7%(24/28)、16.7%(2/12),两者比较有极显著性差异(P<0.01)。端粒酶活性表达与胃癌组织的组织分化、淋巴结转移均无相关性(P>0.05)。随着浸润深度、临床病理分期的提高,端粒酶活性阳性率有升高的趋势。结论检测端粒酶活性有助于胃癌的诊断,是否作为预后判断指标尚需进一步研究证实。     

胃肠道癌外周血微转移的研究

目的通过检测手术前、后胃肠道癌患者外周血癌胚抗原信使核糖核酸(CEA-mRNA)及细胞角蛋白20信使核糖核酸(CK20-mRNA)的表达,了解胃肠道癌血行播散转移情况及在围手术期综合治疗中的意义。方法采用巢式逆转录-聚合酶链式反应(Nest-RT-PCR)检测62例胃肠道癌患者外周血CEA-mRNA及CK20-mRNA的表达状况。结果62例样本中,术前27例(43.5%)CEA-mRNA检测阳性,34例(54.8%)CK20-mRNA检测阳性,术后26例(41.9%)CEA-mRNA检测阳性,31例(50%)CK20-mRNA检测阳性,对照组10例正常人及12例良性胃肠病患者CEA-mRNA及CK20-mRNA测定均为阴性。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者外周血CEA-mRNA阳性率依次为37.5%、27.3%、51.9%、80%,CK20-mRNA阳性率依次为37.5%、36.3%、66.7%、100%。各期间无显著性差异(P>0.05)。Ⅰ Ⅱ期与Ⅲ Ⅳ期合并,2组患者间CEA-mRNA及CK20-mRNA的表达有显著性差异(P<0.05)。胃肠道癌的分化程度及癌栓的形成与外周血CEA-mRNA及CK20-mRNA表达无关。伴局部淋巴结转移的患者的外周血CEA-mRNA及CK20-mRNA阳性表达与无淋巴结转移患者的阳性表达有显著性差异(P<0.01)。手术前后外周血CEA-mRNA及CK20-mRNA阳性率差异无显著性(P>0.05)。结论外周血CEA-mRNA及CK20-mRNA联合检测,特异性较高,可作为胃肠道癌复发、转移及预后的判断     

进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

食管癌根治术后并发胃窦癌外科新术式探讨

目的探讨食管癌根治术后并发胃窦癌的根治性切除方法,避免全胃切除。方法 2006年3月至2017年6月食管鳞癌根治术后随访期间确诊异时胃窦癌12例,其中男性10例,女性2例,年龄52~78岁,胸上段食管癌术后1例,胸中、下段食管癌术后11例。其中,新术式组7例,上消化道重建方式为:保留胃网膜右血管,行胃远端大部切除,进行空肠—近端残胃吻合术,避免全胃切除;传统术式组5例,实施全胃切除。结果新术式组7例患者术后恢复较好,无死亡、吻合口瘘、胃壁穿孔等,无严重消化道功能紊乱(如胃瘫、腹泻等),术后两周Karnofsky评分均达80分以上。传统术式组5例患者中,发生吻合口瘘并死亡1例,其余4例术后均有不同程度的消化道功能紊乱表现,无一例患者术后两周Karnofsky评分达80分以上。结论食管癌根治术后并发胃窦癌行根治性胃远端大部切除术,通过保留胃网膜右血管,避免全胃切除,使残胃、空肠—近端残胃吻合口获得充足的血供,减少术后不良事件的发生,明显提高患者生活质量,在上消化道重建方面找到了一种新方法。