Objective:To investigate the clinical efficacy and safety of targeted Cryocare surgical system through percutaneous lung puncture in the treatment of primary pulmonary malignant tumors for senile patients.Methods: The 230 lesions from 227 patients (over 70 years) with primary pulmonary malignant tumor were treated by using targeted Cryocare surgical system through percutaneous lung puncture. The coverage situations of tumor ice ball of different diameter were immediately observed, and the curative effects were evaluated as response evaluation criteria in solid tumors (RECIST). Besides, the change, complication and survival rate of pulmonary malignant tumor before and after treatment were dynamic observed.Results: After the targeted cryocare surgery, the coverage rate of 90 ice balls (diameter of tumor was less than 4 cm) was (98.6±0.4)%, and the tumor diameters of 140 ice balls were larger than 4cm and their coverage rate was (90.3±5.4)%. The difference of the coverage rate of tumor ice ball between two kind diameters was significant (t=4.69,P<0.01). The effective remission rates (CP+PR) post-surgery 1 month, 3 months, 6 months and 12 months were 56.4%, 56.2%, 55.4% and 53.9%, respectively, and there were no significant difference among these groups (x2=3.705,x2=3.500,x2=1.604,x2=0.935,P>0.05). The whole process of treatment was safety and there was no death cases, while 81 cases were fever post-operation (35.7%), 31 cases were hemoptysis post-operation (13.7%), 18 cases were pneumothorax post-operation (7.9%), 14 cases were pleural effusion post-operation (6.2%) and 1 cases was cold shock post-operation. And all of them recovered to normal situation after were treated as their relative symptom. Follow-up of post-operation 6 months, 1 years, 2 years and 3 years, the survival rates of patients were 89%, 68%, 26% and 12%, and the median survival time was 14 months.Conclusion: CT guided percutaneous targeted cryocare surgical system for pulmonary malignant tumors of the elderly patient is an effective and safe treatment method.

Objective To study clinical efficacy of paclitaxel and cisplatin chemotherapy with synchronous radiotherapy to local stage small cell lung cancer patients who were not sensitive to two cycles of chemotherapy with cisplatin.Methods Patients who had no change(SD) or progressive disease(PD) were divided into group A and B after two cycles of chemotherapy with cisplatin and etoposide.There were sixteen patients in group A,and seventeen in group B,respectively.No differences were observed in the gender and age between group A and group B.Patients in group A were continuously given cisplatin and etoposide chemotherapy with synchronous radiotherapy,and in B group changed to giving paclitaxel and cisplatin chemotherapy with synchronous radiotherapy.The side effects were recorded when or after chemo-therapy with synchronous radiotherapy.The short-term responsiveness and progression-free survival(PFS) of these patients were assessed by follow-up.Results The response rate(CR+PR)of group A was 37.5%(6/16),which was higher than that of group B[76.5%(13/17)](χ2=5.125,P=0.037).The median PFS of group A was 6.0 months,which was higher than that of group B(12.0 months)(χ2=5.134,P=0.023).The adverse reactions(such as bone marrow suppression,radioactive esophagitis and radiation pneumonitis)between two groups had no statistical differences.Conclusions Paclitaxel and cisplatin chemotherapy with synchronous radiotherapy is a safe and effective treatment for local stage small cell lung cancer patients who are not sensitive to cisplatin and etoposide chemotherapy.

Objective To study the effect of sensitivity to two cycles of chemotherapy using cisplatin plus etoposide( EP) before synchronous radiotherapy on prognosis in limited-stage small cell lung cancer( LS-SCLC) .Methods After two cycles of EP chemotherapy, the patients who had complete response( CR) and partial response( PR) were assigned to group A,the others who had no change( SD) and progressive disease(PD) were assigned to group B.All patients were given synchronous thoracic radiotherapy(TRT)(60 Gy administered in 30 fractions) ,and followed by 2~4 cycles of EP chemotherapy.The side effects were recorded when or after chemotherapy with synchronous radiotherapy.The short-term responsiveness and progression-free survival( PFS) of these patients was assessed by follow-up.Results A total of 55 patients finished 4~6 cycles of EP chemotherapy with synchronous radiotherapy.There were 39 patients in group A,and 16 in group B, respectively.Group A comprised 19 male and 20 female cases with a median age of 58.0 years,and group B comprised 9 male and 7 female cases with a median age of 58.5 years.No differences were observed in gender and age between two groups.The objective response rate( CR+PR) was79.5%(31/39) in group A compared to 37.5%(6/16)in group B(χ2=5.125,P=0.004) .The median PFS of group A was 18. 0 months,which was different from that of group B(6.0 months)(χ2=5.212,P=0.022).The adverse reactions(such as bone marrow sup-pression,radioactive esophagitis and radiation pneumonitis) between two groups had no statistical differences.Conclusions The prognosis in LS-SCLC is affected by sensitivity to two cycles of EP chemotherapy before synchronous radiotherapy.

目的 评价非小细胞肺癌患者组织表皮生长因子受体(epithelial growth factor receptor,EGFR)突变与EGFR蛋白表达水平的相关性及临床应用价值.方法 采用突变富集液相芯片技术和免疫组织化学方法分别检测60例非小细胞肺癌组织中EGFR 19、18、21和20外显子基因突变和EGFR蛋白表达水平,对检测结果进行相关性分析.结果 突变富集液相芯片检测显示,EGFR外显子19和21的突变率为26.7％ (16/60);免疫组化检测EGFR蛋白表达为50.0％(30/60),两者呈正相关(r =0.676,P=0.0001).结论 突变富集液相芯片技术检测非小细胞肺癌组织EGFR突变与免疫组织化学检测的EGFR蛋白表达水平具有较好的相关性,两者互为补充,对于预测EGFR-TKI的生存获益具有更大的价值.

Objective In order to improve the safety of cryorecanalization technique via fle -xible bronchoscope, we modified the surgical mode and observed the effects and safety .Methods The improved cryorecanalization is that we pretreated the tumor in central airway by cryoablation and argon plasma coagulation before cryorecanalization .There were 105 patients who suffered from cen-tral airway tumor were observed.The effects evaluation was performed immediately after the surgery . The score of dyspnea and Karnofsky were recorded and bronchoscopy was performed .The surgical safety assessment was mainly used for observing the bleeding risk in the surgery .Results Dyspnea score improved by at least one class in 66(62.8%) patients and remained unchanged in 39(37.2%) patients.The Karnofsky score of preoperative was 60±8.7 and the postoperative was 75±9.2.The quantity of complete success patients were 23(21.9%), the number of patients with partial success were 69(65.7%), and invalid were 13(12.4%).Severe bleeding did not occur.moderate bleeding occurred in 18(17.1%) patients and mild bleeding in 87(82.9%) patients.Conclusion The im-proved cryorecanalizationg technique can immediately relieve central airway obstruction safely .

目的 对亚丁湾护航官兵体检时部分人员出现的微量蛋白尿现象加以分析,找出相关原因.方法 通过统计学方法,对尿蛋白阳性与尿常规正常两组人群相关因素进行对比,同时将蛋白尿与已知相关危险因素分析,找出相关人员出现微量蛋白尿原因.结果 提示体检蛋白尿阳性人员与其他人员在相关因素对比中无统计学差异,同时经单因素和多因素(OR)分析表明,与蛋白尿常见危险因素年龄、肥胖、高血压、血脂紊乱、高空腹血糖、高尿酸不相关.结论 此次体检出现的部分任务官兵微量蛋白尿考虑为生理性蛋白尿,与远洋航海特殊环境有关,同时存在假阳性结果可能.

目的：了解胸内结节病”氟-脱氧葡萄糖正电子发射断层显像／计算机断层扫描（18F-FDGPET／CT）检查与支气管肺泡灌洗液检查（BALF）相关性，探讨结节病摄取”F-FDG机制。方法：19例病理确诊胸内结节病患者行18F-FDGPET／CT检查及BALF，检测CD4＋／CD8＋T细胞比值和血清血管紧张素转化酶（sACE）、肿瘤坏死因子-d（TNF-α）及可溶性白细胞介素-2受体（slL-2R）含量，“F-FDGPET／CT用最大标准摄取值（SUVmax）和平均标准摄取值（SUVmean）半定量分析，并分别分析SUVmax和SUVmean与CD4’／CD8’T细胞比值和sACE、TNF-仪及slL-2R含量相关性。结果：SUVmax和SUVmean之间有显著相关关系（P〈0．01）；SUVmax与sACE及TNF-d之间均有显著相关关系（P〈0．01）；SUVmean与sACE及TNF-α之间也均有显著相关关系（P〈0．01）；SUVmean与CD4＋／CD8＋ T之间有相关关系（P〈0．05）。结论!结节病肉芽肿负荷高者，摄取”F．FDG能力也高；其摄取“F—FDG能力可能与T细胞活化相关。SUVmean判定结节病活动性可能优于SUVmax。

Objective:To study the correlation between 18fluorine deoxyglucose(18F-FDG) positron emission tomography/computerized tomography(PET/CT) scan and bronchoalveolar lavage fluid(BALF)in patients with thoracic sarcoidosis,and explore the mechanism of 18F-FDG uptake in sarcoidosis.Methods:Nineteen patients with thoracic sarcoidosis underwent 18F-FDG PET/CT scan and BALF.The CD4+/CD8+ T cell ratio and serum angiotensin converting enzyme(sACE),tumor necrosis factor-α(TNF-α) and soluble interleukin-2 receptor(sIL-2R) levels in bronchoalveolar lavage fluid were detected.18F-FDG PET/CT scan was semi-quantitatively analyzed by maximum standardized uptake value(SUVmax) and mean standardized uptake value(SUVmean).The correlation between SUVmax,SUVmean,CD4+/CD8+ T cell ratio,sACE,TNF-α and sIL-2R levels was also analyzed.Results:SUVmax was significantly correlated to SUVmean(P<0.01).SUVmax was significantly correlated to sACE(P<0.01) and TNF-α(P<0.01),respectively;SUVmean was also significantly correlated to sACE(P<0.01) and TNF-α(P<0.01),respectively.SUVmean was correlated to CD4+/CD8+ T cell ratio(P<0.05).Conclusions:The 18F-FDG uptake capacity is high in high load of sarcoidosis granuloma;its ability to 18F-FDG uptake may be associated with T cell activation.SUVmean may be superior to SUVmax in determining the activity of sarcoidosis.

目的观察米力农治疗慢性肺源性心脏病合并心力衰竭的临床疗效。方法 46例慢性肺源性心脏病合并心力衰竭患者,随机分为常规治疗组（CT,n=23）和米力农治疗组（MT,n=23）。CT组采用吸氧、抗感染、怯痰平喘等治疗,MT组在CT组治疗法方案的基础上加用米力农,7d为1疗程。观察治疗后两组6min步行试验（6MWT）距离、脑钠肽（BNP）水平,同时采用彩色多普勒超声心动图测定静息状态下平均肺动脉压（mPAP）、心输出量（CO）的变化。结果 MT组6MWT高于CT组[（299.3±89.5）mvs.（243.2±68.8）m,P＜0.05],CO也显著高于CT组[（4.1±0.9）L/minvs.（3.6±1.3）L/min,P＜0.05];同时,MT组BNP低于CT组[（332±136）ng/Lvs.（485±102）ng/L,P＜0.05],mPAP也低于CT组[（32.3±7.6）mmHgvs.（38.2±6.2）mmHg,P＜0.05]。结论米力农治疗可改善慢性肺源性心脏病合并心力衰竭患者的运动耐量及心功能,且可降低肺动脉压。

Objective To study the advantages and disadvantages of orotracheal and nasotracheal intubation mechanical ventilation used to treat 1332 elderly patients with type Ⅱrespiratory failure.Methods 697 patients underwent a fiberoptic bronchoscope-guided intubation through the nose while 635 patients were treated with orotracheal intubation.Then,intermittent positive pressure ventilation(IPPV) was given.Dynamic blood gas analysis was observed.Results The therapeutical effect in the two groups was satisfactory after three to seven days of rescue.Good compliance,few complications,and tolerance of long-term treatment were observed in the nasotracheal intubation group,compared with the orotracheal intubation group.Conclusion Nasotracheal intubation is a preferable treatment for elderly COPD patients with type Ⅱrespiratory failure who require a long-term invasive mechanical ventilation treatment while oral intubation is suited to emergency.

Objective To investigate the clinical efficacy of Ar-He cryoablation combined with recombinant human endostatin in treatment of advanced refractory non-small cell lung cancer.Methods Thirty stage Ⅲ and stage Ⅳ refractory non-small cell lung cancer patients were randomly divided into two groups.One group included eighteen patients who received recombinant human endostatin therapy one week after cryoablation.The other group consisted of twelve patients that received Ar-He cryoablation alone.The CT scan of the chest and survival time was followed up after the treatment.Results The clinical response rate was found to be pretty much the same one month after treatment in the two groups,but was significantly higher in the cryoablation+endorstar group than in the cryoablation group three months and six months after treatment.The median survival time was 279 days in the cryoablation + endorstar group and 258 days in the cryoablation group;the difference was significant between the two groups(P0.01).Conclusions Better clinical efficacy can be achieved in treating advanced refractory non-small cell lung by cryoablation combined with recombinant human endostatin.

In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope.

[目的]探讨氩氦刀联合靶向治疗药物对晚期非小细胞肺癌（NSCLC）患者生活质量及生存期的影响。[方法]2001年7月至2007年3月经氩氦刀治疗的肺部肿瘤患者725例中选取氩氦刀术后联合分子靶向药物治疗的NSCLC患者31例为研究组。同时随机抽取单独行氩氦刀治疗的101例NSCLC患者为对照组。两组患者均系晚期（Ⅲb期或Ⅳ期）NSCLC患者。应用SPSS13.0统计学软件进行统计分析,对比两组患者的生存情况。[结果]氩氦刀术后一周左右,影像检测显示肿瘤区域阴影增大,多呈蜂窝空洞样破坏,CT值较冷冻前明显降低。研究组NSCLC患者冷冻氩氦刀术后联合靶向药物治疗后0.5年、1年、2年和3年生存率分别为100%、87%、42%、23%。对照组分别为90%、71%、18%、8%。两组比较差异具有统计学意义（P＜0.05）。[结论]CT引导下经皮穿刺氩氦刀治疗肺部肿瘤是一种有效、安全的治疗方法,并发症少而轻微。氩氦刀术后联合靶向药物治疗较单纯行氩氦刀治疗能显著延长NSCLC患者的中位生存期,也提高了生存率。且这种物理靶向和生物靶向的联合治疗方法对于NSCLC患者的脑、肺转移病灶有较好疗效。

Objective To approach the influence of glucocorticoids on sarcoidosis and its prognosis. Methods Comparing the prognosis of 109 confirmed sarcoidosis patients involved in stage Ⅰ and Ⅱ either treated by glucocorticoids(GC) or not. Results Cough and chest distress were the primary complains in most of sarcoidosis patients. Symptoms and degree of pulmonary function damage of patients in stage Ⅱ were more significant than that in stage Ⅰ . There was no significant deviation in expression of SACE between two stage. The influence was similar on patients in stage Ⅰ if treated by GC or not but the self-healing rate was higher than that in stage Ⅱ (96.4% vs 76.9%, P ＜0.05). The effective rate of GC on patients in stage Ⅱ was higher than that of no therapy(87.0% vs 76.9%, P ＜0.05). Moreover, more patients had relapses in stage Ⅱ than that in stage Ⅰ (15.3% vs 6.0%, P＜0. 05). Conclusions It is not necessary to treat sarcoidosis in stage Ⅰ without symptoms. Different patients should be treated individualized. Reasonable therapy by GC would improve the prognosis.

<正>结节病(sarcoidosis)是一种多系统多器官受累的非干酪性肉芽肿性疾病,常侵犯肺和双侧肺门淋巴结,临床上90%以上的患者肺部受累。结节病典型的病理学特征是肉芽肿组织中可见上皮样细胞聚集,其中有多核巨噬细胞,周围有淋巴细胞,但无干酪样病变。本病是一种自限性疾病,有自然缓解的趋势,大部

OBJECTIVES:To investigate the impact of tracheal mucosa involvement on the clinical features of sarcoidosis.METHODS:The clinical data of sarcoidosis patients with (Group A, n = 26) and without (Group B, n = 61) tracheal mucosa involvement were evaluated retrospectively.RESULTS:The proportion of patients suffering from cough in Group A was 92.3%, which was significantly higher than that in Group B (49.2%). The level of serum angiotensin-converting enzyme I (SACE) in Group A (60.7 ± 27.8 IU/L) was significantly higher than that in Group B (44.5 ± 31.9 IU/L). The proportion of lymphocytes in the bronchoalveolar lavage fluid (BALF) in Group A was significantly higher than that of Group B (45.3 ± 16.8% and 36.7 ± 15.1%, respectively; P = 0.047). The ratio of CD4 to CD8 in Group A was significantly higher than that in Group B (7.6 ± 5.4 and 3.1 ± 3.2, respectively; P = 0.005). In Group A, 84.6% patients received drug treatment, with a spontaneous remission rate of 15.4%. In Group B, 50.2% patients received drug treatment and the spontaneous remission rate was as high as 49.2%.CONCLUSIONS:Sarcoidosis with tracheal mucosa involvement that can lead to cough and other respiratory symptoms, may be a manifestation of sarcoidosis activity, and usually requires drug treatment (including corticosteroid treatment).

Objective To investigate the application efficacy of implantation of domestic nitinol stent for the treatment of dyspnea induced by central airway stenosis caused by malignant tumors. Methods Twelve patients with dyspnea due to central airway stenosis caused by malignant tumor with bronchoscopy-assisted implantation of nitinol stents,blood gas analysis,KPS score value,bronchoscopy and radiologic imaging before and after treatment compared to observe the therapeutic effects. Results Twelve patients,stents were placed su-ccessfully,a remarkable expansion of central airway stenosis,dyspnea and limitation of activity markedly relieve,compared with preoperative and postoperative PaO2,KPS score were significantly improved,no severe complications and death. Conclusion Bronchoscope-assisted implantation of domestic nitinol stents for the treatment of dyspnea induced by central airway stenosis caused by malignant tumors is a effective and safe minimally invasive palliative treatment,saving lives of patients in the short term,significantly improve patient quality of life and create opportunities for further treatment.

目的:进一步探讨结节病的临床特征与诊断方法。方法:回顾性分析经病理确诊的92例结节病患者的临床资料。结果:本组结节病男∶女比为1∶1.48,年龄22～69岁,40～60岁占66.31%。以咳嗽、胸闷气短就诊者分别占55.43%,41.30%;肺外表现以皮肤损害、浅表淋巴结肿大多见。胸部影像学以双肺门及纵膈对称性淋巴结肿大为主要特征,52例患者伴不同程度肺浸润,8例合并单侧或双侧胸腔积液,影像学分期以Ⅰ,Ⅱ期为主。53例患者血清血管紧张素转化酶表达增高。约1/3患者经支气管镜活检确诊,余经浅表淋巴结、皮下结节、纵膈镜下或CT下纵膈淋巴结活检或开胸肺组织活检确诊。结论:结节病临床表现缺乏特异性,可应用胸部影像学、血管紧张素转化酶检测等相关辅助检查以及病理学检查确诊。

<正>1病例资料患者男性,15岁,因间断咯血4个月余入院,病案号10337932。患者于2009年5月下旬运动后出现干咳症状,有少量白色黏痰,痰中带有血丝,呈间

Objective To investigate the long-term effects and risk factors of percutaneous cryosurgery for ⅢB and Ⅳ non-small cell lung cancer(NSCLC)patients.Methods Two hundred fifty-three cases of ⅢB and Ⅳ NSCLC patients were underwent percutaneous cryosurgery guided by computer tomography(CT).The follow-up was preceded continuously every 3 months.The destination was the patient death or loss.The risk factors included patients age,tumor histology,staging,size,location and whether receiving combined chemotherapy.Results The median survival time was 11.98 months and 1-,2-year survival rate was 41.1%,27.59% in 253 patients with NSCLC.The Wald χ2 value of tumor staging,tumor size,location and combination chemotherapy was 3.064,4.054,2.822 and 5.329 with Cox model analysis(P0.1).Conclusion Percutaneous cryosurgery for advanced NSCLC guided by CT is effective.Tumor size,stage,location and combination chemotherapy are associated with prognosis of NSCLC.