白介素-2、博来霉素、顺铂治疗恶性胸腔积液的疗效及毒副反应比较

[目的]探讨胸腔内分别注入白介素-2、博来霉素、顺铂治疗恶性胸腔积液的疗效与毒副反应。[方法]回顾性分析经胸水细胞学确诊为恶性胸腔积液的患者共216例:白介素-2组(A组)80例,胸腔内注入0.9%生理盐水20ml+白介素-2100万U;博来霉素组(B组)72例,胸腔内注入0.9%生理盐水20ml+博来霉素60mg;顺铂组(C组)64例,胸腔内注入0.9%生理盐水20ml+顺铂60mg;间隔1周重复上述治疗,其中白介素-2组每4～5d重复治疗,最多重复4次。观察3组疗效、毒副反应。[结果]A、B、C组总有效率分别为75.0%、70.8%和56.3%,3组比较差异无统计学意义(P>0.05)。治疗后A组寒战、骨髓抑制、消化道反应、胸痛发生率均明显低于B、C组,差异有显著性(P<0.01)。[结论]胸腔内注射白介素-2治疗恶性胸腔积液疗效较好,毒副反应较博来霉素组、顺铂组明显轻,局部刺激较轻,耐受性好,是治疗恶性胸腔积液较好的方法。     

鸦胆子油乳剂与顺铂治疗恶性胸腔积液的疗效比较

 目的 探讨胸腔闭式引流胸腔积液后用鸦胆子油乳剂与顺铂（DDP）治疗恶性胸腔积液的疗效。方法 92例恶性胸腔积液患者随机分成两组，治疗组 46例胸腔注入鸦胆子油乳剂50 ml+利多卡因10 ml+地塞米松10 mg，对照组 46例胸腔注入DDP 60 mg +利多卡因10 ml+地塞米松10 mg，间隔1周后重复1次，共2次，观察疗效及毒副反应。结果 治疗组总有效率86.9 %，对照组总有效率54.3 %；毒副反应主要为发热、胸痛、皮疹等，两组比较差异无统计学意义（P＞0.05）。结论 鸦胆子油乳剂胸腔内注射治疗恶性胸腔积液疗效佳，毒副反应小，值得临床推广应用。     

绿脓杆菌制剂联合顺铂治疗恶性胸腔积液的临床观察

目的:观察绿脓杆菌制剂联合顺铂治疗恶性胸腔积液的疗效.方法:选择52例合并有中等量以上胸腔积液的恶性肿瘤患者,均经X线、B超、CT及脱落细胞学检查诊断为恶性胸腔积液,随机分成治疗组和对照组,各26例.治疗组胸腔内注入生理盐水40.0ml+绿脓杆菌制剂4.0ml+顺铂40mg/m2+地塞米松5.0mg;对照组胸腔内注入生理盐水40.0ml+顺铂40.0mg/m2+地塞米松5.0mg.结果:治疗组完全缓解10例,部分缓解13例,总有效率为88.5%;对照组完全缓解3例,部分缓解9例,总有效率为46.2%(P<0.05).治疗组不良反应主要为发热和轻度胸痛,对症处理均缓解.结论:绿脓杆菌制剂联合顺铂治疗恶性胸腔积液疗效确切,耐受性好,值得进一步临床推广.     

白细胞介素-2与顺铂治疗肺癌胸腔积液的临床观察

目的观察白细胞介素-2胸腔内注射治疗肺癌恶性胸腔积液的疗效及副反应。方法 42例肺癌恶性胸腔积液患者,随机分为2组,每组21例。胸腔置中心静脉导管排尽胸腔积液后,治疗组腔内注入0.9%NS20ml+白细胞介素-2100万U;对照组胸腔内注入0.9%NS20ml+顺铂20mg/m2。每周2次,用药2周、休息1周为1疗程。2月后评价疗效及毒副反应。结果治疗组有效率为85.71%,较对照组57.14%有明显提高,差异有统计学意义(P<0.05);不良反应除发热两组相当以外,消化道反应、胸痛发生率治疗组较对照组明显降低。结论白细胞介素-2是治疗肺癌恶性胸腔积液的一种有效、不良反应小的方法之一,值得临床推广使用。     

甘露聚糖肽联合顺铂治疗恶性胸腔积液疗效观察

目的观察甘露聚糖肽联合顺铂治疗恶性胸腔积液的临床疗效和毒副反应。方法 48例恶性胸腔积液患者随机分为治疗组和对照组,每组24例。胸腔闭式引流胸腔积液后,治疗组胸腔注射甘露聚糖肽20 mg和顺铂60 mg,对照组单药顺铂60 mg胸腔注射。2组均每周1次,连续3周。1个月后观察2组疗效及毒副反应。结果治疗组缓解率83.3%,对照组缓解率62.5%(P<0.05);治疗组KPS评分改善率明显高于对照组(P<0.05);治疗组毒副反应明显低于对照组(P<0.05)。结论甘露聚糖肽联合顺铂治疗恶性胸腔积液疗效满意。     

得力生和IL-2联合顺铂治疗恶性胸腔积液的疗效

目的:观察得力生和白细胞介素Ⅱ(IL-2)联合顺铂(PDD)治疗恶性胸腔积液的近期疗效和毒副反应。方法:58例恶性胸腔积液患者,先采用一次性单腔中心静脉导管,进行胸腔穿刺置管闭式引流胸水,再给予胸腔内注药,其中A组(n=32)白细胞介素Ⅱ加顺铂,B组(n=26)得力生加顺铂。白细胞介素Ⅱ每次注入200万U～300万U,得力生每次注入30ml～50ml,顺铂每次注入60mg～100mg,每周注射1次,连续注射3周,1个月观察两组的疗效及不良反应。结果:A组有效率81.3%(26/32),B组有效率76.9%(20/26),无显著性统计学差异(P>0.05)。结论:胸腔闭式引流后注入白细胞介素Ⅱ或得力生加顺铂,治疗恶性胸腔积液,疗效肯定,是控制恶性胸腔积液的有效方法。     

凝血酶治疗恶性胸腔积液疗效观察

[目的]观察凝血酶治疗恶性胸腔积液的疗效.[方法]凝血酶治疗恶性胸腔积液32例,采用凝血酶2000U 生理盐水20ml胸腔内注入;对照组30例,单用顺铂100mg 生理盐水60ml胸腔内注入.[结果]治疗组CR PR为84.4%(27/32),其中CR50%(16/32),毒副反应轻,对照组CR PR为86.6%(26/30),其中CR为63.3%(19/32).[结论]凝血酶治疗恶性胸腔积液有效率高,毒副反应轻.     

博莱霉素联合白介素2治疗肺癌恶性胸腔积液疗效观察

目的观察博莱霉素联合白介素2(IL-2)治疗肺癌恶性胸腔积液的疗效和不良反应。方法将经病理或细胞学确诊的68例肺癌恶性胸腔积液患者随机分为两组,A组38例,胸腔内注入博莱霉素60 mg+IL-2 100万单位+生理盐水50 ml+地塞米松5 mg。B组30例,注入顺铂60 mg+生理盐水50 ml+地塞米松5 mg。每周1次,连续治疗2～3周后观察疗效、生活质量和不良反应。结果 A组的总有效率为84.0%,B组为53.0%(P<0.05);A组的病变进展率明显低于B组(P<0.05);A组Karnofsky评分≥70分的患者显著高于B组(P<0.05),而A组Karnofsky<50分的患者显著低于B组(P<0.05)。不良反应方面,两组患者在恶心、呕吐及白细胞减低的发生率上,A组明显低于B组(P<0.05)。结论博莱霉素联合IL-2胸腔注入治疗肺癌恶性胸腔积液的疗效确切且不良反应轻微,值得临床推广。     

白细胞介素Ⅱ联合顺铂治疗恶性胸腔积液

目的：观察白细胞介素Ⅱ联合顺铂(PDD)治疗恶性胸腔积液的近期疗效和毒副反应。方法：54例恶性胸腔积液患，先采用美国Arrow公司生产的一次性单腔中心静脉导管，进行胸腔穿刺置管和闭式引流胸水，再给予胸腔内注药，其中A组(n=32)白细胞介素Ⅱ加顺铂，B组(n=22)白细胞介素Ⅱ。白细胞介素Ⅱ每次注入200～300万U，顺铂每次注入80mg～100mg，每周注射1次，连续注射3周，一个月后观察两组的疗效及不良反应。结果：白细胞介素Ⅱ加顺铂对恶性胸腔积液的有效率为87．5％(28／32)，优于白细胞介素Ⅱ单药组。结论：胸腔闭式引流后注入白细胞介素Ⅱ加顺铂，治疗恶性胸腔积液，疗效肯定。是控制恶性胸腔积液的有效方法。     

胸腔内注入顺铂联合爱迪注射液治疗恶性胸腔积液疗效比较

目的探讨胸腔内注入顺铂(DDP)联合爱迪注射液治疗恶性胸腔积液的疗效。方法病理确诊的恶性胸腔积液62例,经胸腔插管引流术或胸腔穿刺术排尽胸液后,按随机化原则分为两组。治疗组(32例)在胸腔内注入DDP50mg/m2,1天后再注入爱迪注射液50mL;对照组(30例)在胸腔内注入DDP50mg/m2。1周后重复,连续3次,观察疗效、生活质量、生存期及毒副反应。结果治疗组总有效率81%,较对照组53%有显著差异(P<0.05),Karnofsky评分治疗组较对照组有显著提高(P<0.05),生存期差异有显著性(P<0.05),治疗组胸痛较对照组明显。结论胸腔内注入顺铂(DDP)联合爱迪注射液是治疗恶性胸腔积液的一种有效且毒副反应少的方法。     

仙人掌原液毒性的初步研究

背景与目的： 研究仙人掌原液的毒性。 材料与方法： 小鼠急性毒性试验、Ames试验、小鼠骨髓嗜多染红细胞微核试验、小鼠精子畸形试验、大鼠30 d喂养试验。 结果： 仙人掌原液雌、雄小鼠LD50均大于20.0 g/kg,属无毒物质;Ames试验、微核试验和精子畸形试验结果均为阴性;大鼠30 d喂养试验结果显示该样品30 d喂养对大鼠各项观察指标未见毒性作用。结论： 在本次实验条件下,仙人掌原液为无毒物质,未显示有遗传毒性和亚急性毒性作用。     

食管平滑肌瘤10例临床治疗体会

我院１９７５年６月～１９９０年７月共收治食管平滑肌瘤１０例，占同期食管肿瘤总数的０．１９２％（１０／１０９２）。位于食管上段２例，中段５例，下段３例。Ｘ线食管钡餐造影是诊断本病的主要方法。行食管粘膜外肿瘤摘除９例，食管部分切除１例，效果良好。本文就其诊断与手术治疗进行了讨论。     

中晚期贲门癌148例的外科治疗

目的　总结贲门癌手术治疗影响生存率的因素 ,提供今后工作参考。方法　对 14 8例经手术治疗的贲门癌患者进行术后并发症、绝对生存率的X2 检验。结果　本组切除率为 94.5 9% ,近半胃切除占 72 .14 % ,1、3、5年生存率分别为 67.9%、45 %和 2 4.3 %。病期、外侵程度和淋巴结转移等因素对 5年生存率有显著影响 (P <0 .0 1)。术后并发症以吻合口瘘及肺癌并发症为多见 ,其发生率为 3 .6% ,手术死亡率 1.4%。结论　提高生存率的关键在于早期诊断 ,根治手术和术后积极综合治疗。     

仙人掌原毒性的初步研究

背景与目的:研究仙人掌原液的毒性。材料与方法:小鼠急性毒性试验、Ames试验、小鼠骨髓嗜多染红细胞微核试验、小鼠精子畸形试验、大鼠30 d喂养试验。结果:仙人掌原液雌、雄小鼠LD50均大于20.0 g／kg,属无毒物质;Ames试验、微核试验和精子畸形试验结果均为阴性;大鼠30 d喂养试验结果显示该样品30 d喂养对大鼠各项观察指标未见毒性作用。结论:在本次实验条件下,仙人掌原液为无毒物质,未显示有遗传毒性和亚急性毒性作用。     

胆囊癌29例分析

目的探索胆囊癌的防治方法。方法分析29例胆囊癌病人临床资料、治疗方法及结果。结果术前诊断明确者21例，剖腹探查发现已属晚期，9例为Ⅳ期行根治术，12例为Ⅴ期未行根治术，均于术后1年内死亡。术前怀疑胆囊癌者5例，剖腹探查冰冻切片证实为Ⅴ期及Ⅳ期者各1例，Ⅴ期未行根治术，Ⅳ期行根治术，均于术后1年内死亡；Ⅲ期者3例，行胆囊癌根治术分别于术后10月、13月、17月死亡。2例术中冰冻切片发现的Ⅱ期胆囊癌，行胆囊癌根治术，分别于术后23月、26月死亡。1例意外胆囊癌属Ⅰ期胆囊癌，术后5年半死亡。结论要减少胆囊癌危害，重在及时治疗胆囊结石。     

恶性肿瘤肝转移假性肝硬化发生机制及诊疗的研究进展

随着对恶性肿瘤的深入研究,越来越多的肿瘤患者接受到更规范更多线的治疗.更多线的化疗及靶向治疗,使一部分恶性肿瘤肝转移患者的肝脏发生类似肝硬化的形态学及临床改变,称之为假性肝硬化.由于假性肝硬化罕见,对于它的认识多来自于个案报道.因此,本文通过综述国内外关于假性肝硬化的个案报道及相关研究,对其发生机制、影像学及临床表现和...     

Management of intracranial metastases of differentiated carcinoma of thyroid

Summary Brain metastases in differentiated carinoma of the thyroid is a rare occurrence. We treated five documented cases of carcinoma of thyroid with brain metastases out of 400 cases of thyroid cancer treated between 1972 to 1993. 4 were females out of which one was pregnant during the appearance of brain metastases. All cases were treated with thyroidectomy, and radioiodine as primary therapy. Brain metastases developed 6 months to 11 years following treatment of the primary and were treated with radiotherapy and suppressive levothyroxine. We observed the beneficial effect of suppressive thyroxine and the poor prognosis associated with pregnancy and withdrawl of thyroid replacement therapy. 3 of the 5 patients are alive 12–23 months after treatment for brain metastases, while 2 patients died at 4 months and 7 years post brain metastases due to pulmonary and hepatic failure, respectively.     

Clinico-Pathological Study of 50 Cases of Tumours of Larynx

Otoacoustic emissions have been advocated in the management of otitis media with effusion. However, otoacoustic emissions cannot differentiate different types of hearing loss. This study was conducted to find factor that can differentiate otitis media with effusion from other common causes of hearing loss in children. Children were enrolled in the study and divided in four groups consisting of 25 ears each after pure tone and impedance audiometry: (1) Otitis media with effusion group, (2) Normal ear group, (3) Sensory-neural hearing loss group, (4) Chronic suppurative otitis media group. Otoacoustic emissions were recorded and results were analyzed statistically. The normal hearing group had significant difference from other groups but total band reproducibility of transient evoked otoacoustic emissions did not show any statistical difference in the cases groups. In distortion product otoacoustic emissions, group 1 showed significant difference from group 3 and group 1 had significant difference from all other groups at 4 kHz. The study did not find any factor that differentiates otitis media with effusion from other diseases. Although, distortion product otoacoustic emissions can indicate otitis media with effusion but impedance audiometry should be the main tool in the management of otitis media with effusion.     

Predictors of malignant potential of cystic lesions of the pancreas

Background

Cystic lesions of the pancreas (CLP) are a diagnostic dilemma, the correct characterisation of which determines surgical management.

Methods

From 1995 to 2005, radiology and pathology records were reviewed for the presence of CLP. CLP were divided into three groups; Group 1: Benign, Group 2: Pre-malignant, and Group 3: Malignant.

Results

Seventy-nine of 121 patients were included [Group 1: n = 46, Group 2: n = 10, Group 3: n = 23], with a median age at diagnosis of 68 (31–92) years. The median follow-up period was 24 (14–84) months. On univariate analysis, female gender (p = 0.04), jaundice (p < 0.01), raised serum ALT concentration (p = 0.03), cyst size (≥2.5 cm) (p < 0.01), and biliary duct dilatation (p < 0.01) were associated with malignant potential. Benign cysts were more likely to present incidentally (p < 0.01). On multi-variate analysis, cyst size (≥2.5 cm) was an independent predictor of malignant potential. Sub-group analysis revealed that cysts < 2.5 cm in the head of the pancreas with evidence of biliary obstruction (either abnormal liver function; raised ALT [p = 0.01], ALP [p = 0.01], total bilirubin [p = 0.02], and/or biliary duct dilatation [p < 0.01]) were associated with malignant potential.

Conclusion

Cyst size ≥2.5 cm on computer tomography imaging was an independent predictor of pre-malignant and malignant pancreatic cysts. Cyst size and the presence of biliary obstruction predict potentially malignant cysts of the head of the pancreas, which require surgical management.