Advanced primary peritoneal carcinoma： clinicopathological and prognostic factor analyses

Objective: To investigate the factors favoring a positive prognosis for advanced primary peritoneal carcinoma (PPC). Methods: Twenty-four cases meeting the criteria for PPC were analyzed retrospectively for the clinicopathologic profiles. Immunohistochemistry was used to determine the expressions of p53, Top2α, Ki-67 and Her-2/neu. Then all these clinicopathological factors and molecular markers were correlated with the prognosis. Results: There were 15 cases of primary peritoneal serous papillary carcinoma (PPSPC), 6 cases of mixed epithelial carcinoma (MEC) and 3 cases of malignant mixed Mullerian tumor (MMMT). All patients underwent cytoreductive surgery with optimal debulking achieved in 3 cases. Among those receiving first-line chemotherapy, 13 patients received the TP regimen (paclitaxel-cisplatin or carboplatin) and 7 patients received the PAC regimen (cisplatin-doxorubicin-cyclophosphamide). The median overall survival of all patients was 42 months, while the breakdown for survival time for patients with PPSPC, MMT and MEC was 44, 13 and 19 months, respectively. The expressions of p53, Top2a and Ki-67 were all demonstrated in 11 cases respectively. None showed the expression of Her-2/neu. There were significant differences in the median survival between patients with PPSPC and those with MMMT (44 months vs 13 months, P<0.05), also between patients receiving TP combination and those receiving the PAC regimen (75 months vs 28 months, P<0.05). Another significant difference in the median progression-free survival (PFS) was identified between patients with positive p53 immunostaining and those with negative p53 immunostaining (15 months vs 47 months, P<0.05), whereas age, menopausal status, residual tumor size and the other molecular factors did not significantly impact survival. Conclusion: Patients with PPC should be treated with a comprehensive management plan including appropriate cytoreductive surgery and responsive chemotherapy. Overestimating an optimal debulking surgery may not benefit survival. The pathologic subtype, chemotherapy regimen and p53 overexpression were significant prognostic factors.     

鼻咽癌患者诊治过程中相关伦理问题与放疗效果的相关性研究

目的探讨伦理学视角下鼻咽癌患者诊疗过程中知情同意及隐私保护态度对治疗结果的影响。方法采用问卷调查法对92名鼻咽癌患者诊治过程相关伦理问题与放疗效果进行调查和多元线性回归分析。结果患者年龄、病情认知度、诊治知情度、性格取向、社交态度和康复自信心6个因素引入回归方程(F=37.840,P=0.000,R2=0.728),对放疗效果的影响从大到小依次为病情认知度、社交态度、性格取向、康复自信心、年龄、诊治知情度。结论鼻咽癌患者诊治过程中适时告知病情和诊治方案,引导患者持积极开朗的社交态度,树立康复自信心是提高鼻咽癌放疗效果的重要因素。     

介入治疗中晚期宫颈癌的临床观察及护理

目的探讨中晚期宫颈癌患者进行超选择性动脉输注化疗栓塞术（即介入治疗）后临床疗效的观察及护理对策。方法选择已确诊为宫颈癌,临床分期Ⅱb以上患者37例,进行介入治疗1-3次后,观察临床症状、肿瘤大小、毒副反应及并发症。结果经介入治疗后临床症状完全缓解17例、明显缓解7例、中度缓解4例,总缓解率为91.9%（34/37）;肿块消退情况：CR8例、PR24例、SD5例,总有效率为86.5%。28例经介入治疗后获得降期手术切除占75.7%（28/37）,主要毒副反应有疼痛、恶心、呕吐、发热等。结论介入治疗对中晚期患者有良好的近期疗效,是一种增加手术机会、提高疗效、减轻毒副反应、提高生存质量的有效方法。     

尿路上皮癌p53bax基因蛋白的表达及意义

目的:为了探讨细胞凋亡促进基因bax在尿路上皮癌中染色的表达及意义以及与p53蛋白表达的相互关系。方法:对65例尿路上皮癌石蜡标本进行免疫组化。结果:bax蛋白阳性率为50.77％,且与肿瘤病理分级有关,其阳性细胞主要分布于高分化癌及浅表性癌。分级间比较有显著性差异(P<0.05)。分期间比较差异无显著性。p53蛋白阳性率为46.15％,与bax相反,在低分化及浸润性癌组织阳性率明显高于高分化及浅表性癌(P<0.05)。结论:作为细胞凋亡促进基因bax丢失与p53基因突变一样与尿路上皮癌的发生发展有关。检测bax与D53基因蛋白可进一步了解尿路上皮癌生物学信息,也为临床提供更有价值的预后判断指标。     

三羧氨基喹啉对人舌鳞癌裸鼠移植瘤的抑瘤效应研究

目的　旨在观察三羧氨基喹啉 (L inomide)对人舌鳞状细胞癌裸鼠移植瘤生长的抑制效应 ,以明确 L inomide的抑瘤作用 ,为 L inomide用于人口腔鳞癌的治疗以及后续的进一步研究提供理论和实验依据 .方法　将人舌鳞癌细胞系 Tca8113接种至 BAL B/ C(nu/ nu)裸鼠 ,建立人舌癌裸鼠移植瘤模型 ,设立对照组、5 0 mg/ (kg· d)及 10 0 mg/ (kg· d) L inomide腹腔注射组 ,观察L inomide对肿瘤生长的抑制作用 .结果　与对照组相比 ,给予 Linomide治疗组的裸鼠皮下肿瘤体积明显缩小 (P<0 .0 1) ,肿瘤的生长明显受到抑制 ,10 0 mg/ (kg· d)组的瘤块体积要小于 5 0 mg/(kg· d)组的荷瘤裸鼠 (P<0 .0 1) ,说明 Linomide能抑制人舌癌裸鼠移植瘤的生长 ,且抑制程度与L inomide的剂量相关 .给予 L inomide治疗的荷瘤裸鼠其平均瘤重低于对照组 (P<0 .0 1) ,10 0mg/ (kg· d)组的荷瘤裸鼠的平均瘤重与 5 0 mg/ (kg· d)组的裸鼠比较 ,其瘤重的降低更为明显 (P<0 .0 1) .给药组裸鼠的存活时间与对照组相比明显延长 (P<0 .0 1) ,10 0 mg/ (kg· d)组的荷瘤裸鼠存活时间要长于 5 0 mg/ (kg· d)组的裸鼠 (P<0 .0 1) .结论　 L inomide对人舌鳞状细胞癌裸鼠移植瘤有明显的抑瘤效应 .     

绿茶多酚类化合物抗肿瘤作用研究

对荷瘤小鼠喂服一定剂量(每千克体重喂40mg、80mg和120mg)的绿茶多酚后,测定其对移植性肿瘤细胞的抑制作用,结果显示:对EAC重量的抑制率分别为65.3％、51.0％和48.7％;对S180的抑制率为66.3％、68.5％和59.8％;对EAC细胞增殖数抑制率为81.4％、77.0％和50.5％.同时测得三个试验组EAC鼠的胸腺细胞增加率为248.2％、69.6％和44.6％;脾细胞增殖率为13.5％、61.5％和22.9％;对S180鼠的胸腺细胞增加率为200.7％、73.9％和138.0％;脾细胞增加率为34.4％、31.1％和20.0％.实验结果表明:茶多酚抗肿瘤作用可能是通过增强机体免疫力来抑制体内肿瘤细胞的生长.     

老年梗阻性左半结肠癌的外科治疗

目的探讨老年梗阻性左半结肠癌患者的围手术期处理及手术方式的选择。方法对25例老年梗阻性左半结肠癌的临床资料进行回顾性分析。结果行一期切除吻合术20例,行Hartmann术2例,行姑息性结肠造口3例。术后无吻合口漏发生,无手术死亡病例,发生切口感染2例,肺部感染3例。结论在老年梗阻性左半结肠癌的患者治疗中,选择合适病例行一期肠切除吻合术是安全可行的,充分的围手术期处理、术中良好的肠道灌洗和仔细的手术操作是手术成功的关键。     

协同模式对分化型甲状腺癌术后~(131)I治疗患者情绪及生活质量的影响

目的分析分化型甲状腺癌术后~(131)I治疗患者应用协同模式对其心理状况及生活质量的影响。方法选取2018年10月~2020年10月在我院收治的甲状腺癌术后~(131)I治疗患者100例,采用随机数字表法将其分为两组,各50例。对照组患者采用常规模式干预,研究组采用协同护理模式,比较两组情绪、生活质量等改善情况。结果研究组干预后SAS评分,SDS评分,与对照组各评分比较差异明显(P<0.05)。干预后两组患者的自我效能评分均提升,且研究组干预后自我效能评分改善情况优于对照组(P<0.05)。两组干预后自护能力均较干预前改善,且研究组干预后自护能力总分及各项目评分均高于对照组(P<0.05)。研究组干预后癌因性评分低于对照组,组间差异明显(P<0.05)。且研究组干预后生活质量各维度评分高于对照组,研究组护理满意度为96.00%,与对照组的80.00%比较明显较高,P<0.05,差异有统计学意义。结论分化型甲状腺癌术后~(131)I治疗患者中应用协同护理模式,能够有效改善患者心理状况,减轻患者癌因性疲乏,增强患者自我效能感,从而提升患者自护能力,改善患者生活质量及满意度,在临床具有较高的应用价值。     

Leucine amino peptidase a better indicator of carcinoma of liver, biliary tract and pancreas

Serum levels of leucine amino peptidase (LAP) was studied along with bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) and the ratio of AST/ALT and GGT/AST in 25 healthy subjects and 52 patients with hepatobiliary malignancies of which 12 were with hepatocellular carcinoma, 12 with liver metastasis, 6 with obstructive jaundice, 9 with carcinoma of gall bladder, 6 with carcinoma of pancreas and 7 with periampullary carcinoma. 24 Of the 52 patients studied had jaundice and 28 were without jaundice. LAP as compared to the other enzymes AST, ALT, GGT, ALP and AST/ALT ratio and GGT/AST ratio showed 100% elevation in obstructive jaundice, carcinoma of gall bladder and pancreas and periampullary carcinoma, 91.7% elevation in hepatocellular carcinoma and 83.3% elevation in liver metastasis. On comparing the levels of these enzymes in non jaundiced and jaundiced groups, LAP was elevated in both jaundiced and non jaundiced groups in 95.8% and 92.9% cases respectively whereas the other enzymes AST showed increase from 67.9% to 100%, ALT from 21.4% to 83.3%, GGT from 71.4% to 95.4% and ALP from 82.1% to 100% in non jaundiced and jaundiced groups respectively indicating that LAP rises in hepatic dysfunction due to hepatobiliary malignancy whereas the other liver function enzymes showed increased hepatic dysfunction due to hepatobiliary malignancy with the onset of jaundice thereby indicating that LAP is a better indicator of hepatobiliary malignancy as compared to other enzymes. The quantitative methods used for determination are reliable, accurate, simple, rapid and cost effective and therefore have better application in a clinical setting.