吉林省军区某边防团——着眼部队特点 提高保障水平

吉林省军区某边防团担负着522.5公里边境线的巡逻执勤任务，由于点多线长，哨所分散，驻地偏远，给官兵就医带来许多不便。为解决这一实际问题，该团卫生队克服重重困难，定期派医疗小分队深入边防哨卡，为官兵送医送药。     

化疗与放疗综合治疗晚期食管癌64例

比较综合治疗与单纯放疗晚期食管癌的疗效。方法：取我院内科纂 １９９１年４月至１９９４年４月收治病理证实的晚期食管癌３２例。以ＤＤＰ为主的联合化疗与放疗综合治疗，并随机抽同同期单纯放疗的病例３２例作对照研究。结论：综合治疗优于单纯放疗，值得进一步研究。     

罗氟司特中间体3-环丙基甲氧基-4-二氟甲氧基苯甲醛的合成

目的研究罗氟司特中间体的合成。方法 3,4-二羟基苯甲醛依次与Boc酸酐和氯甲基环丙烷反应后得3-环丙基甲氧基-4-O-Boc-苯甲醛,脱掉Boc后再与二氟一氯甲烷醚化制得罗氟司特中间体3-环丙基甲氧基-4-二氟甲氧基苯甲醛。结果总收率约62%。结论本合成路线操作简单,成本低,有利于大规模制备。     

复方天麻颗粒质量标准研究

目的 建立复方天麻颗粒的质量控制方法.方法 采用薄层色谱(TLC)法对制剂中的天麻、五味子、麦冬进行定性鉴别;采用高效液相色谱(HPLC)法对天麻素及五味子醇甲进行含量测定.结果 定性鉴定出制剂中的天麻、五味子及麦冬;经HPLC测定,结果 显示天麻素在0.11～4.26 μg范围内线性关系良好,平均回收率为97.9%,重现性实验RSD为1.7%;五味子醇甲在0.07～4.50 μg范围内线性关系良好,平均回收率为96.7%,重现性实验RSD为1.3%.结论 该方法 可有效地控制复方天麻颗粒的质量.     

胸段食管癌淋巴结转移规律与放疗意义探讨

目的 了解胸段食管癌淋巴结转移规律，探讨胸段食管癌放疗临床靶区的设计。方法 对首程治疗行颈、胸、腹3个野根治术的胸段食管鳞癌患者621例，标记各部位清扫的淋巴结分别送检，进行临床病理资料分析，了解淋巴结转移规律，为食管癌放疗临床靶区的设计提供理论依据。结果 胸上、中、下段食管癌颈部淋巴结转移率分别为42．9％、27．9％和7．9％，上纵隔的分别为31．2％、24．0％和10．1％，中纵隔的分别为14．3％、29．7％和33．7％，下纵隔的分别为1．3％、4．0％和19．1％，腹部的分别为11．7％、25．1％和55．1％。胸部各段食管癌淋巴结转移部位比较差异有统计学意义（P〈0．05）。病变长度愈长、肿瘤分化越低、肿瘤浸润越深食管癌淋巴结转移率也愈高（P〈0．05）。结论 胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见，胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点，胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。建议胸上段食管癌临床靶区的范围上界包括颈段食管旁及锁骨上、下界包括隆突下的淋巴结引流区，胸下段食管癌临床靶区的范围上界至隆突水平、下界包括胃左血管旁的淋巴结引流区，胸中段食管癌临床靶区的范围应根据具体情况设定。     

食管癌束流调强放射治疗的临床疗效观察

目的探讨束流调强放射治疗（IMRT）食管癌的疗效及其不良反应。方法采用IMRT方法,治疗食管癌45例单次分割剂量2．0～2．5Cy／次,1次／天,5次／周,共25～33次,总剂量50～66Gy,中位处方剂量60Gy。结果总有效率（CR＋PR）为91．1％。1、2、3年局部控制率分别为91．1％、77．8％和62．2％,1、2、3年生存率分别为88．9％、68．9％、51．1％。中位生存期36．4个月。仅1例出现3级食管炎,余放射不良反应均为0～2级。结论IMRT能明显提高食管癌患者的局部控制率和生存率,同时能更好地保护正常组织。     

老年肺癌三维适形放疗疗效观察

目前我国人口老年化的问题日渐突出，肺癌患者中老年患者的比例存在上升趋势。2000年1月-2005年10月，我们对老年肺癌患者实施了三维适形放射治疗，以观察其对老年肺癌患者的疗效。     

食管癌病变长度不同检测方法的比较

Objective To compare accuracy of methods to measure lesion of thoracic segment esophageal carcinoma, and to provide the theory evidence for the precise sketch of irradiation targets.Methods A total of 598 patients with thoracic segment esophageal squamous cell carcinoma were enrolled in this retrospective study.Their lesion lengths were measured and compared respectively in intraoperative specimen,X-ray barium meal and CT.Results Measured mean lengths of lesion were respectively(6.70±2.52)cm,(5.13±1.91)cm and(5.23±1.93)cm in CT,X-ray barium meal and intraoperative specimen.There were significant differences in lesion lengths between intraoperative specimen and CT (P=0.000).There were no significant differences in lesion lengths between intraoperative specimen and X-ray barium meal(P=0.106).Lesion lengths were from top to bottom CT,intraoperative specimen and X-ray barium meal.There were no significant differences in lesion lengths between different pathological type,different T staging intraoperative specimen and X-ray barium meal(P＞0.05),but there were significant differences in lesion lengths between different pathological types(except intracavitary type),different T stagings intraoperative specimen and CT(P＜0.05). Conclusion Lesion length measured with CT is longer than that measured with intraoperative specimen,but it is shorter with X-ray barium meal than that with intraoperative specimen.It is suggested that X-ray barium meal and other examinations should be referred generally in using CT to depict esophageal carcinoma radiotherapy area.     

胸段食管鳞癌淋巴结转移个数与术后放疗疗效相关性的探讨

目的:对胸段食管鳞癌三野根治术患者的不同淋巴结转移个数与术后放疗的疗效进行分析,评价胸段食管鳞癌术后放疗价值。方法:收集1993-01-01-2007-03-30福建省肿瘤医院收治的胸段食管鳞癌三野淋巴结清除根治术患者1 715例,其中单纯手术1277例,术后放疗438例。术后3~4周开始放疗,中位总剂量50 Gy,2 Gy/次,5次/周,5周完成。结果:全组5年生存率为49.4%,其中淋巴结转移个数为0、1~2、3~5和>5枚的5年生存率分别为71.7%、45.0%、25.8%和11.8%,χ2=371.460,P=0.000。术后放疗与单纯手术比较可以提高淋巴结转移≥3枚患者的生存率,差异有统计学意义,χ2=10.388,P=0.001;淋巴结转移<3枚患者的生存率差异无统计学意义,χ2=1.970,P=0.160。结论:术后放疗能提高淋巴结转移≥3枚的生存率。     

淋巴结阳性胸段食管鳞癌术后放化疗临床研究

目的 对淋巴结阳性胸段食管鳞癌术后放化疗与术后放疗进行回顾性分析,观察其疗效和不良反应.方法 选择首程治疗行胸段食管鳞癌三野淋巴结清扫根治术,术后病理有淋巴结转移、无远处转移患者304例,其中术后放疗组140例,术后放化疗组164例.术后放疗剂量50 Gy,化疗方案为顺铂加紫杉醇,21 d为1个周期,平均2.35个周期/例.结果 术后放化疗组和术后放疗组3年总生存率、无瘤生存率分别为65.7%和52.8%(χ2=6.90,P=0.009)、62.5%和52.8%(χ2=4.75,P=0.029);锁骨上区淋巴结转移率、远处转移率、总复发转移率分别为1.8%和7.1%(χ2=5.21,P=0.022)、18.3%和27.9%(χ2=3.94,P=0.047)、27.4%和39.3%(χ2=4.80,P=0.028);早期不良反应的中性粒细胞减少、放射性食管炎、胃肠道反应分别为96.3%和32.1%(χ2=140.31,P=0.000)、37.2%和26.4%(χ2=4.01,P=0.045)、23.2%和5.0%(χ2=19.77,P=0.000);晚期不良反应分别为6.1%和5.0%(χ2=0.17,P=0.678).结论 淋巴结阳性胸段食管鳞癌术后放化疗能提高生存率和无瘤生存率,降低锁骨上区淋巴结转移率、远处转移率和总复发转移率,早期不良反应重于单纯术后放疗,但患者能耐受治疗.

Abstract：

Objective To retrospectively analyze the treatment results and side effects of postoperative chemoradiotherapy and postoperative radiotherapy of thoracic esophageal squamous cell carcinoma (EPC) with positive lymph nodes.Methods Three hundred and four patients of thoracic EPC were initially treated with three-field lymphadenectomy, with pathological positive lymph nodes and without distant metastases;and randomly divided into two groups:140 patients of the simple postoperative radiotherapy (RT) and 164 patients of postoperative chemoradiotherapy (CRT).The median total dose was 50 Gy.The regimen of concurrent chemotherapy included cisplatin and taxol, and the intermission was 21 days;the median cycles were 2.35.Results The 3-year overall survival rates were 65.7% of CRT and 52.8% of RT (χ2=6.90,P=0.009), and The 3-year disease-free survival rates were 62.5% of CRT and 52.8% of RT (χ2=4.75,P=0.029).The incidences of the supraclavicular lymph-node metastases were 1.8% and 7.1%(χ2=5.21,P=0.022), respectively;and the incidences of distant metastases were 18.3% and 27.9%(χ2=3.94,P=0.047), respectively;and the incidences of overall metastases and recurrences were 27.4% and 39.3%(χ2=4.80,P=0.028), respectively.Early side effects included granulopenia (96.3% and 32.1%,χ2=140.31,P=0.000), radiation-induced esophagitis (37.2% and 26.4%,χ2=4.01,P=0.045),and gastrointestinal toxicity (23.2% and 5.0%,χ2=19.77,P=0.000).Late side effects were 6.1% and 5.0%(χ2=0.17,P=0.678), respectively.Conclusions Postoperative chemoradiotherapy of thoracic EPC with positive lymph nodes can improve the overall survival and disease-free survival, decrease the incidence of the supraclavicular metastases, the distant metastases, the total metastases and recurrences.More severe early side effects were observed in chemoradiotherapy than in the radiotherapy group,but well tolerated.