目的 探讨盐酸埃克替尼治疗晚期复发非小细胞肺癌患者的临床疗效.方法 选取2015年4月至2017年9月间青岛市肿瘤医院收治的68例晚期复发非小细胞肺癌患者,采用随机数表法分为观察组和对照组,每组34例.对照组患者采用常规临床化疗治疗,观察组患者在对照组基础上加用盐酸埃克替尼片联合治疗,比较两组患者的临床有效率.结果 观察组患者临床有效率为73.5％,高于对照组的61.8％,差异有统计学意义(P＜0.05).两组患者不良反应发生情况比较,差异无统计学意义(P＞0.05).结论 盐酸埃克替尼治疗晚期复发非小细胞肺癌患者,可提高临床疗效,有一定的安全性,值得临床运用.

Objective To investigate the clinical value and effect of combined detection of carcinoembryonic antigen (CEA),serum keratin 19 fragment(CYFRA21-1)and neuron specific enolase(NSE)in the early diagnosis of lung cancer, to provide a scientific basis for the early diagnosis.Method A retrospective study concerning 200 cases of lung disease was conducted,in which 100 lung cancer patients were assigned as the study group,and another 100 patients with benign lung disease were control group.The general demographic characteristics of patients,such as age,sex,and BMI,were col-lected,and all subjects were administered with laboratory electrochemical luminescence detection of CEA,CYFRA21-1 and NSE.Result The mean age of the subjects was 54.68±4.89,of which 127 cases(63.5%)were male and 73 cases (36.5%)were female.In ROC analysis,for CEA,the cutoff point was 3.52,with sensitivity being 81.8% and the specifici-ty was 80.2%;for CYFRA21-1,the AUC was 0.746,the sensitivity was 79.8%,and the specificity was 80.7%;for NSE, the AUC was 0.789,the sensitivity was 79.2%,and the specificity was 80.4%.Combined detection of CEA,CYFRA21-1, and NSE was observed with an AUC of 0.934,of which the sensitivity and specificity were 91.25% and 94.34%,respec-tively.Conclusion The combined detection of CEA,CYFRA21-1 and NSE is of higher diagnostic value for early diag-nosis of lung cancer,and can significantly improve the sensitivity and specificity of early diagnosis.

目的:探讨适形调强放疗联合多西他赛与顺铂化疗(TP方案)治疗晚期食管癌的临床疗效及不良反应.方法:将68例晚期食管癌患者随机分为两组,即单纯接受调强放疗治疗的放疗组和接受联合调强放疗及TP化疗的联合组,每组34例.对比两组临床治疗效果.结果:联合组治疗有效率为76.64％,优于放疗组的44.11％,差异有统计学意义(P＜0.05);两组治疗放射性肺炎、乏力并发症发生率比较差异无统计学意义(P＞0.05).两组恶心呕吐、骨髓抑制并发症发生率比较差异有统计学意义(P＜0.05).联合组随访3年的死亡率及肿瘤转移率分别为64.70％及14.71％,明显低于放疗组的88.23％及35.29％(均P＜0.05).结论:对晚期食管癌患者行调强放疗联合TP方案化疗可有效地提高临床治疗效果和改善患者的预后.

目的:探讨晚期食管癌放疗联合化疗与放疗联合靶向治疗的安全性及有效性.方法:随机选取晚期食管癌患者80例,分为治疗组和对照组,各40例.治疗组予放疗联合盐酸厄洛替尼治疗,对照组予放疗联合化疗,比较两组患者治疗的不良反应、死亡率、有效率、生存率.结果:治疗组和对照组消化道反应发生率分别为2.5％和92.5％,骨髓抑制发生率分别为32.5％和47.5％,放射性食管炎发生率分别为90％和95％,放射性肺炎发生率分别为5％和7.5％,皮疹发生率分别为62.5％和7.5％.治疗组完全缓解(CR)+部分缓解(PR)38例,总有效率95％,高于对照组总有效率87.5％,但差异无统计学意义(P＞0.05).治疗组和对照组中位生存期分别为(21.3±1.7)、(15.6±1.3)个月,1年生存率分别为75％、67.5％,2年生存率分别为52.5％、47.5％,3年生存率分别为37.5％、17.5％.两组患者中位生存时间比较治疗组优于对照组(P＜0.05);两组患者1年生存率比较差异无统计学意义(P＞0.05),2、3年生存率比较治疗组优于对照组(P＜0.05).结论:对晚期食管癌行放疗联合靶向治疗安全性高,毒副作用小,患者中位生存期长,值得临床推广.

目的 观察在局部晚期下咽癌治疗中单药多西他赛同期放化疗的临床疗效.方法 2005.01.11-2013.01.26间就诊青岛市中心(肿瘤)医院的99例局部晚期下咽癌患者,根据治疗方法进行分组:同期放化疗组38例,诱导化疗后放疗组31例,单纯放疗组30例,同期放化疗采用的化疗方案为单药多西他赛,每周1次,共5-7个周期;诱导化疗采用氟尿嘧啶+顺铂+亚叶酸钙,3-4周1次,共2-3个周期.放疗50-54Gy后,原发灶和(或)颈部转移淋巴结未达到完全缓解者或者淋巴结转移为N3无论是否达到完全缓解,且愿意接受手术者,放化疗4-5周后予以原发灶的手术切除和(或)颈部淋巴结的清除,达到或者几乎达到完全缓解者或者不愿手术的患者继续放疗至66-74Gy.结果 3年总生存率,局部控制率及无病生存率,同期放化疗组(71.1％、77.8％、66.7％)明显高于诱导化疗后放疗组(38.7％、41.7％、16.7％)及单纯放疗组(43.3％、30.8％、30.8％)(P＜0.05),单纯放疗组与诱导化疗后放疗组之间的差异无统计学意义(P＞0.05).无远处转移生存率,同期放化疗组(74.1％)及诱导化疗后放疗组(91.7％)明显高于单纯放疗组(38.5％)(P＜0.05),前两者之间的无远处转移生存率的差异无统计学意义(P＞0.05).结论 单药多西他赛同期放化疗明显提高了患者3年总生存率,局部控制率、无病生存率及无远处转移生存率.

Objective:To study the action of paclitaxel nanoparticle(TAX - NLC)on KB cells. Methods:F - ac-tin and apoptosis of KB cells after being exposed to TAX - NLC were observed by laser confocal microscopy. Cytomor-phology of KB cells after being exposed to TAX - NLC was observed by light microscope. Results:After KB cells were exposed to TAX - NLC,F - actin of KB cells was gathered into a mass,punctate,the microfilament function was inhib-ited. The apoptosis of KB cells were induced by TAX - NLC. Many multinucleated cells of KB cells were induced by TAX - NLC. Conclusion:TAX - NLC destroyed microfilament function,induced apoptosis and multinucleated cells, finally tumor cells were killed.

目的:探究调强放疗(IMRT)联合厄洛替尼治疗晚期食管癌的疗效和安全性,为临床晚期食管癌的治疗提供参考.方法:选择晚期食管癌患者87例作为研究对象,对照组41例采用单纯IMRT,试验组46例采用IMRT配合厄洛替尼治疗,观察分析两组患者的临床疗效和不良反应发生情况,并随访第1、2年的生存状况.结果:试验组患者有效率(86.96％)明显高于对照组(43.90％)(x2=18.083,P＜0.05),放射性食管炎、口腔黏膜炎、放射性肺炎、骨髓抑制、消化道反应等不良反应发生率两组间差异均有统计学意义(P＜0.05),虽然第1、2年的生存率对照组(68.29％、48.78％)略高于试验组(65.22％、47.83％),但两组间生存状况的差异无统计学意义(x2 =0.092、x2=0.008,P=0.761、P=0.929).结论:调强放疗联合厄洛替尼对晚期食管癌治疗效果显著,且并发症少,临床可以作为晚期食管癌治疗的一种参考方法.

Objective:To compare the inhibitory effect of paclitaxel lipid nanoparticles(TAX-NLC)on KB,SKOV3 cells. Method:The affection of TAX-NLC on Ca2+in KB,SKOV3 cells by using Laser confocal microscope were observed.MTT method was used to determine the inhibition rate of TAX-NLC action in KB,SKOV3 cell.The cell morphological changes of TAX-NLC role in KB,SKOV3 cells were observed by Laser confocal microscope.Result:After the TAX-NLC acting on KB,SKOV3 cells,the concentration of Ca2+of KB cells was higher than that of SKOV3 cells.And the inhibition rate of KB cell was higher than that of SKOV3 cells,the production of KB multinucleated cells was more than that of SKOV3 cells.Conclusion:TAX-NLC is more sensitive to KB cells,Ca2+concentration,the inhibition rate,multinucleated cells are closely associated.

Objective To analyze curative effect and adverse reactions of icotinib combined with whole brain radiotherapy in the treatment of senile lung adenocarcinoma with brain metastases patients. Methods A total of 57 senile lung adenocarcinoma with brain metastases patients, without receiving chemotherapy, were divided by different treatment methods into targeted combined radiotherapy group (27 cases) and single radiotherapy group (30 cases). Effective rate, median survival time, survivorship curve, and adverse reactions of the two groups were observed and compared. Results There were statistically significant differences of effective rate (81.5%VS 40.0%) and disease control rate (96.3%VS 73.3%) between the targeted combined radiotherapy group and the single radiotherapy group (P<0.05). The targeted combined radiotherapy group had median survival time as 11 months and 1 year survival rate as 51.9%, and those in the single radiotherapy group were 7 months and 23.3%. The difference of 1 year survival rate between the two groups had statistical significance (P=0.02<0.05). Main adverse reactions in the targeted combined radiotherapy group was rash, with the occurrence rate as 63.0%. There were 2 cases with grade 4 rash, and they received continuous targeted drug by oral administration after symptomatic treatment. Conclusion Implement of icotinib combined with radiotherapy provides good curative effect and few adverse reactions in treating senile lung adenocarcinoma with brain metastases patients. It is worth clinical promotion and application.

目的 研究鼻咽癌患者放射治疗后的颈髓损伤状况.方法 选择2013年1月至2014年10月间青岛市肿瘤医院收治的鼻咽癌放疗后出现放射性颈髓损伤(RICCI)的30例患者为研究组,以同期门诊随访的鼻咽癌放疗后经影像学检查及体格检查未发现RICCI的31例患者作为对照组,对两组患者进行MRI检查.结果 放疗前两组患者感觉运动评分差异无统计学意义(P＞0.05);放疗后研究组患者感觉运动评分低于对照组,差异有统计学意义(P＜0.05).研究组患者颈髓囊变的长度、横截面、体积明显大于对照组,美国脊柱损伤学会(ASIA)评分小于对照组(P＜0.05).放疗后,研究组B、C等级患者数明显高于对照组,D、E等级患者数低于对照组,差异均有统计学意义(均P＜0.05).结论 鼻咽癌放疗可诱发RICCI,对患者的感觉运动、颈髓囊变的长度、横截面、体积均具有负面作用,加重患者的颈髓神经损伤,引起Frankle等级变化.

我国是世界上肺癌的高发地区,我国肺癌的发生率已高达61.4/10万,近年来肺癌发病率呈逐年上升的趋势,目前肺癌发病率已占到恶性肿瘤的第一位[1-3]。随着人们生活水平的提高,人民群众的防癌控病意识也逐渐增强。恶性肿瘤的发病机制及影响因素是人们特别关注的问题,而微量元素与恶性肿瘤的关系近年来越来越引起医学界的重视。为了解肺癌病人血液中微量元素含量与肺癌发病之间的关系,我们对青岛地区部分医院2011年1月-2012年10月的125例肺癌病人全血中微量元素含量进

Objective To analyze the pathogen distribution and drug resistant pattern in lung cancer patients with hospital infection so as to provide basis for the clinical rational use of antibiotics and control of hospital infection.Methods From January 2010 to December 2011,a total of 536 strains of pathogenic bacteria were isolated from 311 cases of lung cancer patients with hospital infection.The clinical data were reviewed to understand the pathogen distribution and antibiotic resistance.Results Pathogenic gram negative bacilli accounted for 64.6%,fungi 25.0%,gram positive cocci 10.4%.More than 85% of the gram negative bacilli were resistant to ampicillin.And more than 30% of these strains were resistant to gentamicin,tobramycin or cotrimoxazole.Of the gram-positive cocci,as high as 80% of S.aureus isolates were resistant to penicillin or erythromycin.More than 85% of the S.pneumoniae isolates were resistant to erythromycin,tetracycline,or trimethoprim-sulfamethoxazole.Not more than 10% of the common fungal strains were resistant to 5-flucytosine,voriconazole,fluconazole,or amphotericin B,but itraconazole was an exception.Conclusions It is important for lung cancer patients to receive appropriate microbiological tests to identify hospital infection and the causative pathogens in time,which may facilitate the rational use of antimicrobial therapies and control of hospital infections.

<正>放射性口腔黏膜炎是头颈部肿瘤放疗的常见并发症,轻者使患者疼痛,影响进食,降低生活质量,重者使放疗无法进行,影响治疗效果,因此放射性口腔黏膜炎的治疗显得尤为重要。我们采用金因肽治疗放射性口腔黏膜炎取得较好的疗效,现总结

OBJECTIVE: To evaluate the effect of intensity modulated radiation therapy(IMRT) combined with Docetaxl chemotherapy for locally late stage non-small cell lung cancer.METHODS:Totally 65 NSCLC patients were involved.Group A consisted of 35 patients,treated with IMRT combined Docetaxel and Cisplatin chemotherapy,and after radiation therapy,they received Docetaxel and Cisplatin chemotherapy for two therapy cycles.Group B consisted of 30 patients,receiving IMRT,then Docetaxel and Cisplatin chemotherapy for 4-6 therapy cycle.RESULTS: The overall response rate(CR+PR)was 82.9% in Group A,and 60.0% in Group B.The overall response rate of Group A was higher than Group A(P=0.04);The one-year and two-year survival rate of Group A were 77.1% and 48.6%,and that of Group B were 73.3% and 43.3% respectively.There were no significant differences between Group A and Group B in one-year and two-year survival rate(P=0.63).The incidence of leucopenia was 77.1% in Group A,and 53.3% in Group B(P=0.123);The incidence of radiation-induced esophagitis was 65.7% in Group A,and 53.3% in Group B(P=0.582).The incidence of radiation-induced pulmonitis was 45.7% in Group A,and 40.0% in Group B(P=0.898).CONCLUSION: The short-term effect of intensity modulated radiation therapy(IMRT) combined with Docetaxl is better than sequential radiotherapy and chemotherapy,while there are no significant differences in adverse reactions between the two treatment.

PET/CT是解剖影像和生物影像于一体的影像技术,在临床的应用越来越广泛,对指导非小细胞肺癌的精确放疗有重要的价值,笔者就PET/CT在非小细胞肺癌几何靶区、生物靶区、评价非小细胞肺癌的治疗效果、检测复发等方面的作用进行分析和探讨。

The objective of this study was to compare the efficacy of different radiation options in non-small cell lung cancer(NSCLC) patients with brain metastasis,and study its prognostic factor.Retrospective analysis of 97 NSCLC patients with brain metastases was carried out.Group A including 23 cases received whole brain radiotherapy 30 Gy/10 f while Group B 45 cases receiving whole brain radiotherapy 40 Gy/20 f.Group C including 29 patients received whole brain radiotherapy 40 Gy/20 f,and then increased by 10 Gy/5 f to partially reduced field.The median survival time was 8.7 months,and 1-year local control rate was 23% in Group A while in Group B 8.8 months and 63%,in Group C 9.2 months,and 84% respectively.There was no significant difference in median survival time among three groups(P0.05).However,the 1-year local control rate of Group C was significantly higher than that of Group A.Univariate analysis showed that metastasis outside of the brain and the number of metastases in the brain were the prognostic factors.Multivariate Cox model analysis showed that metastasis outside of the brain was independent prognostic factor.In conclusion,in NSCLC patients with brain metastases,both metastasis outside of the brain and number of metastases in the brain have correlation with prognosis.Metastasis outside of the brain is independent prognostic factor.

Objective: To compare short-term curative effect and adverse reaction of intensity-modulated radiation therapy(IMRT) positioned by PET/CT and conventional radiotheraphy in advanced non-small cell lung cancer(NSCLC) patients,who accepted chemical-treatment at the same time.Methods: Clinical trail study was carried out in our hospital.The patients who attended the study were divided to two groups,IMRT(experiment group) and conventional radiotheraphy(control group).There were 30 patients in experiment group and 38 patients in control group.The total dose of radiation were 60 Gy in 6 weeks.Results: There was a significant difference between the curative effect ratio of experiment group(90.0%) and control group(57.9%)(χ2=8.583,P0.05).The 1,2 years survival rate of experiment group were 76.6% and 53.3%,and the 1,2 years survival rate of control group were 44.7% and 65.8% respectively,there were no significant differences in two groups(P0.05).There were significant differences between the two groups in some adverse reactions such as radioactive skin reactions,radioactive esophagitis and radioactive pneumonia(P0.01).Conclusion: Experiment group has obvious advantages in short-term curative effect and less adverse reactions.As to the survival rate,we need more time to follow-up the results of two groups.

BACKGROUND:PET is a sensitive and special method of determining malignant degree of the lung cancer. This study investigates the correlation between (18)F-deoxyglucose (FDG) uptake and various biological markers in clinical stage I non-small cell lung cancer (NSCLC).METHODS:The non-small cell lung cancer specimens of 23 patients were examined by flow cytometry and immunohistochemistry, the relationship between the max standard uptake value (SUV) of FDG and the expression of the biological markers p53, Ki-67, proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF), glucose transporter-1 (GLUT-1), S-phase fraction (SPF) were studied.RESULTS:The max SUV was correlated with the expression of p53 (P <0.05), Ki-67 (P <0.05), PCNA (P <0.05), VEGF (P <0.05) and SPF (P <0.05) in stage I NSCLC. Glut-1 expression showed significant correlation with FDG uptake (P =0.001), however the max SUV showed no correlation with tumor pathology.CONCLUSIONS:Our study indicates that (18)F-FDG uptake in NSCLC correlates well with the expression of p53, Ki-67, PCNA, VEGF, GLUT-1, SPF.

目的探讨放射性核素血流显像对甲状腺肿瘤良恶性鉴别诊断的价值.方法对125例静态显像为冷节结的患者进行了放射性核素血流现象的回顾性分析.结果125例患者中,血流显像阳性者37例,包括31例恶性病变,6例良性病变,假阳性率为4.8%;血流显像阴性者88例,84例良性病变,4例恶性病变,假阴性率为3.2%.恶性诊断符合率为88.6%,良性诊断符合率为93.3%,总符合率为92.6%.结论放射性核素血流显像对甲状腺肿瘤良恶性判断有较高的价值,可有效的提高术前诊断符合率.

恶性腹腔积液是腹部恶性肿瘤或转移瘤的严重并发症之一.一般患者出现恶性腹水时多为癌症中、晚期,患者体质较差,全身化疗和放射治疗有时难以完成,部分患者腹腔化疗后多次复发.Cr32PO4胶体腹腔灌注治疗,若使用恰当,吸收剂量合理,对提高病人的生活质量、延长生存期,有着十分重要的意义.自2002年10月以来,笔者采用Cr32PO4胶体腹腔灌注治疗恶性肿瘤腹腔内化疗后再复发的恶性腹水病人30例,效果满意,现报道如下.