Objective:To explore the occurrence of radiation proctitis after-loading brachytherapy of cervical cancer patients byimproved vaginal packing technology. Methods: A retrospective analysis on 76 patients with cervical squamous cell carcinoma in our department from 2005 to 2008 were treated with IIb 192Ir high dose rate intracavitary after-loading radiotherapy process and improved vaginal packing method in which all patients were randomly divided into accordion-style vaginal packing group(40 cases) and the control group (36 cases conventional saline gauze packing 4~5 blocks) . Short-term effect was evaluated by RECIST criteria, and adverse events were evaluated by NCI CTC3.0 criteria. Results: All the patients were followed up for 36 months in which follow-up rate was more than 88.16%. In observation group (accordion-style vaginal packing group of 40 patients),complete remission was 20(50.00%) cases, partial remission was 17(42.50%) patients, stable disease was 2(5.00%) cases,disease progression was 1(2.50%) case, objective efficiency(RR) was 90.00%. In control group, RR was 88.89%, and there was no significant difference in short-term effect rate(P0.05). Proctitis incidence of the two groups was respectively 10.00% and 11.11% in grade I, II grade of 2.50% and 2.78% in the observation group. Proctitis of III and IV grade level did not occur in the observation group, III,IV levels was respectively 5.56 % and 2.78% in control group, and the overall incidence of proctitis in two groups was respectively 12.50% and 22.22%(P0.05). Conclusion: Accordion-style vaginal packing technology can ensures Yindao Yuan and intrauterine source of cloth source rationality, and can be worthy of wider application,which not only improves the gain ratio of tumor treatment, but also reduce the rectal dose .

Objective To investigate the radical feasibility and clinical advantages of three-dimensional conformal radiotherapy in treating cervical cancer.Methods 90 cases of cervical cancer were selected and they were divided into observation group with 46 cases for three-dimensional conformal radiotherapy and control group with 44 for conventional radiotherapy.A comprehensive evaluation was made to judge the clinical efficacy,treatment side effects,quality of life and etc for two treatment options.Results The 2-year survival and local control rates for both groups were 100%.But there were difference in adverse reactions:the observation group's response rates to the rectum,bladder reaction were lower than those of the control group,and the difference was statistically significant(P0.05).Conclusion Although the overall curative effect between three-dimensional conformal radiotherapy and conventional radiotherapy is similar and has no difference in statistically significance,the treatment of the former can reduce the incidence of rectal and severity of reaction,and can improve the patients' quality of life.

目的:宫颈癌腔内放疗时采用超分割的治疗模式,探讨其方法的可行性。方法:体外放疗+腔内放疗:体外照射采用西门子加速器6MV-X线,全盆腔前后2野等中心技术照射,DT=2Gy(/次·d),5次/周,总剂量DT:46-50Gy(/25次·5周),外照射全盆腔剂量DT=30Gy/15次时盆腔中央挡铅(中央遮挡铅块5HVL,4cm宽)并开始配合腔内近距离治疗,采用铱-192高剂量率后装治疗机,Ⅱb,Ⅲ期A点4Gy/次,2次/d,两次间隔≥6h,每5d重复治疗1次,总计10次/5d,在3-4周内完成,A点剂量DT=40Gy。腔内照射当天不做体外照射。结果:近期有效率(CR+PR)Ⅱ期、Ⅲ期均为100%。1年生存率Ⅱ期100%(12/12),Ⅲ期95%(19/20)。放射性直肠炎、膀胱炎的发生率分别为12.50%(4/32)和6.25%(2/32)。结论:该方法可行,近期疗效满意。HDR腔内后装治疗宫颈癌,应用足够的分割(包括次数及剂量)是提高疗效、减少晚期并发症的关键,但晚反应组织损伤、远期生存率尚有待进一步随访及评诂。

<正>颈部神经鞘瘤是发生于颈部的良性肿瘤之一,早期症状不易引起患者注意。本文介绍经细针穿刺细胞学诊断颈部神经鞘瘤1例。在穿刺时患者除有点眩晕外,无其他不适,可能进针刺到周围神经或晕针所致,立即拔针让患者平卧休息,很快缓解。穿刺细胞学检查诊断快速、安全可靠,与手术活检相比是一种微创检查,诊断准确,患者痛苦小,易接受,值得推广。

Objective:To explore the contrast-enhanced ultrasound evaluation of the clinical efficacy after radical radiotherapy of cervical cancer. Methods: More non-surgical phase IIb cervical cancer in 30 cases of squamous cell carcinoma patients given radical radiotherapy before and after ultrasound contrast set since June 2008 to August 2011 for the study group,the radical radiotherapy of 30 cases over the same period of cervical cancer before and after.The conventional ultrasound set control group,the study group and the control group in conjunction with cytology,cervical smears common residual tumor were compared cervix situation. Results:The results of the study group,tumor necrosis, liquefaction of 16( 53%) ,tumor inactivated 7( 23%) , cervical partial abnormal contrast agent Kuaijinkuaichu to show that the tumor residues in 7( 23%) . The same group of cervical smear cytology to see cancer 2( 6%) after radiotherapy two methods detected residual tumor more significant difference( P0.05) .Conclusion: Ultrasound Contrast-enhanced dynamic observed within the residual tumor and tumor number of peripheral vascular and its distribution,additional local intracavitary radiotherapy dose,location,as well as evaluating the prognosis objective theoretical basis.

目的观察加减八珍汤对巨块型宫颈癌放疗患者血红蛋白的影响。方法将我科2005年11月至2010年11月收治的120例宫颈癌(Ⅱb期,外生型)接受根治性放疗的患者随机分为3组,研究组(40例)为放疗+口服加减八珍汤煎剂,单纯放疗组(40例)为单纯使用放疗方法及放疗配合紫杉醇+顺铂化疗组(40例)。全部病例均电话随访,随访率达87%。结果研究组与对照组放疗前后血红蛋白浓度的比较有显著性差异(P<0.01),研究组肿瘤局部控制率为85%,而单纯放疗组和放疗配合紫杉醇+顺铂化疗组患者因毒副作用叠加,治疗中断,肿瘤局部控制率分别为72.50%和77.50%,具有显著性差异(P<0.05)。结论加减八珍汤可改善巨块型宫颈癌局部的血液供应,提高血红蛋白(Hb)浓度,增加乏氧细胞的携氧能力,使放疗局控率增加。

<正>近年来,越来越多的学者在关注妇科肿瘤放疗患者生活质量等问题。本文将传统中医中药应用于宫颈癌放疗中,探讨加减八珍汤减轻患者毒副反应,提高整体疗效,现总结报告如下。1临床资料收集甘肃省肿瘤医院2005年11月至2010年11月宫颈癌患者192例,全部病例均经病理学证实

目的:探讨直肠癌患者采用常规放疗和适形放疗使盆腔内正常组织发生并发症的差异。方法:70例直肠癌患者根据临床分期、病理分级及经济状况采用不同的放疗方式,常规组(30例)为普通盆腔外照射,对照组(40例)采用3D-CRT。放疗剂量均为45-50GY/4.5-5W,放疗设备均采用6MV医用直线加速器放疗,随访6月-36月,分别进行各种并发症的对比分析。结果:适形组并发症的发生率明显低于常规组,其中Ⅱ、Ⅲ、Ⅳ级毒副反应的发生率两组比较差异具有统计学意义(P<0.01)。结论:提高放疗精确性,减少正常组织放疗并发症,提高患者的生活质量。采取3D-CRT或IMRT是今后放疗的发展方向。

恶性肿瘤现已成为威胁人类健康,导致死亡的最主要疾病之一。现代西医治疗肿瘤公认的手术、放疗、化疗三大手段在抑制肿瘤细胞增殖的同时却损伤了正气,对机体正常组织细胞和免疫功能具有不同程度的破坏。临床实践表明,肿瘤的生长速度是可变的,有效的治疗不一定让肿瘤全部消失;以前医学界一味重视杀灭肿瘤细胞,试图通过扩大根治术,大剂量化疗来提高疗效,但事与愿违;过度的攻击性治疗不但没有起到延长生存期的作用,反而降低了患者的生活质量,个人和社会都未能从治疗中受益。本文简要阐述了扶正培本、补肾健脾及辨证施治等基础治疗在抗肿瘤治疗中发挥的独特作用。

目的:探讨局部晚期宫颈腺癌及磷癌放射治疗的临床疗效。方法:回顾性分析2002年1月至2008年12月本科收住62例宫颈腺癌(宫颈肿瘤Φ>4cm,Ⅰb期—Ⅳa期)接受根治性放射治疗,并随机选取同期治疗的62例局部晚期鳞癌患者作为对照组进行比较分析。结果:随访时间36月～60月,局部晚期宫颈腺癌总的5年生率为49.23%,而同期宫颈鳞癌5年生存率为68.90%(P<0.01);I期病例二者生存率无显著性差异;II期腺磷癌5年生存率为56.20%及84.5%(P=0.037);III、IV期腺磷癌5年生存率分别为36.2%及49.80%,统计学有显著性差异(P<0.01)。两组放疗的不良反应接近。结论:应进一步了解宫颈腺癌的生物学行为,提倡早期多学科协作的综合治疗,为临床诊疗实践提供更多的循证医学依据。

目的探讨鼻咽癌患者颈部放疗后纤维化防治措施。方法回顾性分析2002年—2006年64例被确诊为鼻咽癌(Ⅰ-Ⅳa期)的患者接受根治性放射治疗,采用primis医用直线加速器的混合线照射,用面颈联合野+中下颈垂直切线野,DT68-70Gy/6.8～7w,其中二程放疗者12例,随机分为单纯放疗组30例和放疗中、后期配合输注复方丹参注射液250ml+地塞米松5～20mg,1～2次/日34例两组,随访2～3年。结果单纯放疗组颈部呈木板样改变,活动受限19例(19/30);而放疗中、后期配合输注复方丹参注射液组颈部活动受限者仅1例(1/34),两组比较差异有显著性(P<0.05)。结论丹参注射液具有活血化淤,改善颈部微循环的功能,而地塞米松兼有消除水肿,减轻组织机化等功效,二者合用可以防治鼻咽癌患者颈部放疗后纤维化发生,更好地提高患者的生活质量,值得临床广泛推广使用。

目的:探讨中晚期宫颈癌同步放化疗的耐受性和毒副反应。方法:2004年2005年我院开展了中晚期宫颈癌同步放化疗治疗患者54例,组织学类型为鳞癌81.48%(44/54),腺癌18.51%(10/54),Ⅱb期34例,Ⅲ期18例,Ⅳ期2例。全部病例采用体外照射和腔内近距离照射的联合放疗方案,同步应用DF化疗方案。体外照射采用6MV-X线,前后野对穿照射,常规分割每周5次,每次2Gy,外照射全盆腔剂量24Gy~30Gy/2W~3W,盆腔野挡铅4×10 cm~17 cm,加腔内近距离治疗。腔内近距离治疗每次A点剂量5Gy~6Gy,腔内照射当日不作体外照射,共5次~7次,腔内照射A点总量25Gy~42Gy。体外和腔内照射A点总量为70Gy~82Gy,B点总剂量50Gy~70Gy,总疗程6周~8周。与放化疗开始之日常规应用升白胺3片,3次/天,至疗程结束。结果:达CR者49/54(90.74%),PR者5/54(9.25%)。放疗结束宫颈刮片阴性52/54(96.29%)。本组病例治疗后均满2年,2年总生存率77.78%。本组宫颈癌患者同步放化疗副反应主要为肠道反应、泌尿系统反应、血液学毒性。急性放射性直肠反应全组发生率为46.30%(25/54),其中18例(72%)为轻度,7例(24%)为中度,全组病例无直肠阴道瘘发生。血液学毒性主要表现为白细胞下降,RTO G1级9例(16.67%),RTO G2级5例(9.25%),无3级以上毒性反应。结论:中晚期宫颈癌同步放化疗具有较好的临床耐受性,两年生存率达77.78%。通过改进外照射方式(如IMRT),降低单次腔内治疗剂量(小于6Gy),将会减轻肠道副反应。

目的 探讨食管癌患者血清053抗体与临床病理特征和常规分割放疗疗效间关系,以及放疗前后p53抗体动态变化规律.方法 选择未行手术及化疗的食管癌患者46例为实验对象,并选30例健康人做对照.采集放疗前1 d、放疗20、40、60 Gy时患者血清标本,采用酶联免疫吸附法(ELISA)检测患者血清053抗体.结果 食管癌患者血清p53阳性率明显高于正常人(39%:0:P:0;000),放疗前、放疗20、40 Gy的相似(39%、39%、35%,P=1.000、0.666)),放疗前、放疗60 Gy的有差别(39%、15%,P:0.010),放疗40、60 Gy的有差别(35%、15%,P=0.030).食管癌患者血清053抗体检测的敏感性为39%,特异性为100%,符合率为63%,阳性预测值为100%,阴性预测值为52%(kappa:0.34).食管癌患者血清p53抗体阳性率与肿瘤病理分化程度、临床分期以及淋巴结转移密切相关(P=0.002、0.014、0.015),与患者性别、年龄、原发肿瘤长短、部位无关(P=0.918、0.870、0.102、0.953).放疗有效患者的血清p53抗体阳性率显著低于放疗无效者(61%、100%,P:0.000).结论 检测血清053抗体水平有助于食管癌的诊断;放疗前后动态测定食管癌患者血清p53抗体的变化规律,有助于判断疗效和预后.

目的观察中药加减八珍汤在宫颈癌放疗增敏方面的功效。方法将51例宫颈癌随机分为2组,一组为中药加放疗(观察组28例),另一组为单纯放疗(对照组23例)。2组外照射总剂量4.5～6周44～48Gy,每次180～200cGy,每周5次。192Ir腔内放疗总剂量4～8周24～30Gy。观察组自放疗开始服用加减八珍汤。了解2组肿瘤消退率及患者全身状况改善情况。结果观察组完全缓解+部分缓解(CR+PR)26例(93%),全身状况改善28例(100%);对照组CR+PR12例(52%),全身状况改善15例(65%)。2组比较有显著性差异(P<0.05)。结论中药加减八珍汤对宫颈癌放疗有增敏作用,值得进一步探讨其作用机理。

目的用BARD专用活检针及活检枪经皮肺肿物穿刺获取小组织学与印片及涂片细胞学的诊断价值.方法对有组织学对比的98例经皮肺BARD专用活检针及活检枪(18G)对周围型肺部肿块活检资料作小切片组织学与涂片、印片组织学比较分析.结果(1)小切片组诊断敏感性92%,特异性100%,总准确率93%;涂片及印片组分别为90%、94%和91%.(2)小切片组对恶性肿瘤分型准确率92%(60/65),比涂片组的90%(65/72)高(P＜0.01).(3)82%(80/98)的病例获取小组织切片,此方法获取小组织切片率要比细针吸取细胞学(FNAC)高,其免疫组织化学染色结果与术后病理组织切片的相同.结论小组织学和细胞学的诊断准确性均高,2者结合应用将提高诊断准确性,前者对组织学分型、分类诊断接近术后病理诊断,有很高的应用价值,但是后者与前者结合更能弥补前者不足.

目的探讨放射性食道黏膜反应的预防和治疗方法。方法将已经病理证实为食道癌患者65例随机分为治疗组32例和对照组33例。治疗组为放射治疗开始时配合口服庆大霉素混合液(生理盐水+地塞米松+vitB12+2%利多卡因俗称“开关液”)10～15ml/次,3～4次/日,缓慢下咽。对照组服用冷开水。结果治疗组食道黏膜炎出现的比对照组迟且症状轻,2组差异有显著性(P<0.05)。结论庆大霉素混合液对预防和治疗放射性食道黏膜反应效果良好,值得在临床上广泛应用。

患者男性,61岁,汉族,因胸背痛5个月,加重1个月,于1999年11月就诊,以"胸椎转移瘤"收住.患者于1999年6月感胸背疼痛,10月后疼痛加重伴上肢活动受限.此疼痛午后为重,呈束带样,同时伴肢体麻木,渐感行走无力.院外拍胸椎片示T7胸椎椎体破坏.既往有"甲状腺腺瘤"史8年.