Adhesive intestinal obstruction is the most common type of ileus, and conserva-tive treatment serves as its preferred treatment option. In the course of conservative treatment, gastrointestinal decompression will relieve symptoms, prevent ileus progression and promote gas-trointestinal function recovery, which has significant clinical effects. Currently, decompression effects of nasointestinal tubes and nasogastric tubes are controversial. There is a previous Meta-analysis evaluating decompression effects of these two methods, but this analysis includes non-randomized controlled trial and lacks research about Chinese patients. Therefore, the authors con-duct a Meta-analysis to evaluate decompression effects of nasointestinal tubes versus nasogastric tubes for adhesive intestinal obstruction.

临床资料 患者,男,56岁.因"腹胀、肛门无解便排气1周"于2018年5月2日入院.专科检查:腹隆,可见肠型蠕动波,腹软,无压痛、反跳痛,叩诊鼓音,肠鸣音活跃,移动性浊音.9个月前行肺癌根治术,左肺全切术(左肺上叶鳞癌,pT4N0M0,ⅢA期),术后TP方案化疗(紫杉醇135 mg/m2d1+顺铂60 mg/m2 d1).吸烟史.辅助检查指标:Hb80 g/L,CRP 65 mg/L, CEA 6.31 ng/mL,鳞状上皮细胞癌抗原(SCC)9.8 ng/mL,神经烯醇化酶(NSE) 35.96 ng/mL,CYFRA21-19.57 ng/mL.外院腹部 X线平片示小肠扩张,有气液平,考虑小肠梗阻.诊断:小肠梗阻,肺癌术后.

结直肠癌常以肠梗阻为首发症状,为外科急症,急诊手术由于创伤大、并发症多等并非临床最佳选择.我们诊治了1例以广泛小肠粘连梗阻为首发表现的结肠癌患者,使用经鼻肠梗阻导管减压联合区域动脉灌注化疗后,最终获得肿瘤的根治性切除,术后病理显示病理完全缓解,随访至今肿瘤未复发.

目的 研究与分析对于经鼻肠梗阻导管治疗术后粘连性肠梗阻的患者采取经胃镜联合DSA引导放置治疗的临床效果.方法 随机选取自2014年9月～2017年9月来我院进行治疗的患有术后粘连性肠梗阻的患者53例,对这53例患者采取经胃镜联合.DSA引导下放置经鼻肠梗阻导管治疗,对这些患者的治疗情况进行回顾性分析.结果 采取经胃镜联合DSA引导下放置经鼻肠梗阻导管治疗术对这53例患者进行术后粘连性肠梗阻治疗,所有的患者均在进行了一次性插管后,均成功,成功率高达100.0％,同时患者在进行手术后没有出现任何的并发症.有51例患者的导管前进良好,有2例患者的导管未出现明显前进.导管造影结果显示4例见肠管狭窄以及有49例肠管通畅.治愈49例,好转2例,来愈2例.结论 经胃镜联合DSA引导下放置经鼻肠梗阻导管治疗术后粘连性肠梗阻的临床效果显著,可以有效地解除患者的术后粘连性肠梗阻的临床症状.而对于该痰病的患者采取经鼻肠梗阻导管治疗,可以有效地减少X线的摄入,方便快捷,省时省力.

Objective To investigate the feasibility and efficacy of endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus. Methods From August 2015 to August 2017,27 cases of elderly patients with acute sigmoid volvulus received treatment of endoscopic placement of ileus tube combined enterectomy in Pudong New Area Gongli Hospital.Retrospectively collected clin-ic parameters of pre-catheterization,post-catheterization,enterectomy and postoperative follow-up;the success rate of catheterization and enterectomy,compression efficiency,post-operative complications,and efficacy of the com-bined therapy were analyzed. Results Emergency catheterizations of anorectal ileus tube were succeeded in 27 (100%)patients;one patient who developed intestinal gangrene received emergency enterectomy,the hemogram and internal environmental disturbance of the 26 cases were significantly relieved,and the efficacy rate of decom-pression was 96.3%. The success rate of was enterectomy was 100%;the incidence of severe complications and mortality were 22.2% and 3.7%,respectively. During the follow-up,2(7.4%)patients developed ileus,and the efficacy rate of the combined therapy was 85.2%. Conclusions The catheterization of ileus tube could effectively depress intestinal pressure. The success rate of enterectomy was significantly improved and postoperative mortality was reduced. The therapy of endoscopic ileus tube catheterization combined enterectomy is a safe and effective method for the treatment of acute sigmoid volvulus in the elderly.

目的 探讨经皮肝穿刺球囊扩张十二指肠乳头括约肌取石术治疗胆总管结石的临床价值.方法 对3例胃切除毕Ⅱ式手术和胆总管切开取石术后复发,经十二指肠镜取石失败的患者行经皮肝穿刺扩张胆管,用球囊扩张十二指肠乳头括约肌后将结石推入十二指肠的取石术治疗胆总管结石.结果 3例患者均一次性手术成功,术后放置内外引流管,1周内再次造影未见胆管残余结石影.结论 经皮肝穿刺球囊扩张十二指肠乳头括约肌取石术治疗胆总管结石安全可行,对不宜手术且内镜取石失败的胆管结石治疗有重要价值.

Objective To investigate the clinical application of nasal-insertion type ileus-tube in the treatment of adhesive small intestinal obstruction. Methods A total of 221 patients with simple adhesive small intestinal obstruction, who were admitted to authors’ hospital during the period from January 2010 to Aug. 2014, were enrolled in this study. The patients were randomly divided into nasal-insertion type ileus-tube group (n=111) and nasogastric tube group (n=110). After the procedure, the patients were kept under close observation, focusing on the abdominal distention, gastrointestinal decompression amount, the recovery time of anal exhaustion and defecation, the vanishing time of intestinal air-liquid plane on erect abdominal X-ray film, etc. The cure rate, effective rate and transit-operation rate were calculated. The results were compared between the two groups. Results The tube placement operation was successfully performed in all patients. Compared with the nasogastric tube group, in the nasal-insertion type ileus-tube group the recovery time of abdominal distention, anal exhaustion and defecation and the vanishing time of intestinal air-liquid plane on erect abdominal X-ray film were obviously shorter, and the gastrointestinal decompression amount was larger. In the nasal-insertion type ileus-tube group the cure rate and effective rate were significantly increased, while the transit-operation rate was decreased; the differences between the two groups were statistically significant (P<0.05). Conclusion For the treatment of adhesive small intestinal obstruction, the placement of nasal-insertion type ileus-tube is effective and reliable. This technique can strikingly improve the clinical symptoms, therefore, it is worthy of promotion and application in clinical practice.

目的 评价DSA导引下经窦道α-氰基丙烯酸正丁酯改良胶(Glubran 2)封堵术在治疗胃肠术后肠外瘘中的疗效.方法 回顾2012年9月至2014年9月胃肠手术后肠外瘘患者15例,分析应用DSA导引下经窦道Glubran 2封堵术治疗肠外瘘的愈合情况.结果 15例胃肠术后肠外瘘患者中,14例一次封堵成功,1例3个月后复发,再次封堵后治愈;13例胃肠术后出现吻合口瘘或肠瘘,经过3～4周保守治疗及通畅引流后,经窦道造影确诊为肠外瘘,予以Glubran 2封堵成功,2例造影后放置引流管,2～5d后封堵成功,1周内治愈出院.结论 DSA导引下经窦道Glubran 2封堵术治疗胃肠术后肠外瘘可以有效促进肠外瘘的愈合,可在肠外瘘形成早期使用,疗效可靠,对高龄患者更有优势.

[Objective] To evaluate the efficacy and safety of oxycodone controlled-release tablets in patients with advanced non-small cell lung cancer( NSCLC) who suffered from cancer pain and needed the treatment of docetaxel as second-line drug. [Methods] Data from 40 patients with NSCLC who suffered from moderate and severe cancer pain and were treated with oxycodone controlled- release tablets and docetaxel 75mg / m2 on d1 every 3 weeks from Feb 2007 to July 2011. The analgesic effects,karnofsky performance status scales( KPS) and adverse effects were observed. [Results] A group of 40 patients were available for evaluation,of whom the response rate was 27. 5%,the disease control rate 60%,and the median survival of all 9. 35 months,with one-year survival rate being 37. 5%. Compared with the condition before treatment,pain in patients was greatly relieved,and the total pain relief rate was 97. 5%,with the NRS score decreased significantly,and KPS score significantly raised,whose differences were statistically significant( P < 0. 05). The main side effect was hematologic toxicity and constipation,which could be solved after treatment. [Conclusion] Oxycodone combined with Docetaxel has satisfactory efficacy for the patients with moderate to severe pain in NSCLC,thus markedly improving the quality of life of the patients.

Objective To evaluate the effect of bronchial arterial infusion in patients with advanced lung cancer.Methods A total of 64 patients with advanced lung cancer were randomized into two groups:32 cases were treated with bronchial arterial infusion therapy(treatment group) and 32 cases received vein infusion therapy(control group).The clinical effects,survival rate and life quality were evaluated.Results The remission rate in the treatment group was 65.63%,and the median survival period was 10 months.The percentage of patients with a survival period of more than 1 year was 52.13%.The remission rate in the control group was 28.13% and the median survival period was 6 months.The percentage of patients with a survival period of more than 1 year was 28.13%.The rate of nausea and vomiting in the treatment group was significantly decreased(P0.05).Conclusion The clinical effect of bronchial arterial infusion with DDP and Gem is superior to the vein infusion therapy.Bronchial arterial infusion therapy is effective in stabilizing the tumor foci.This method can not only improve the life quality and prolong the life span,but also lighten the side effect of chemotherapeutics.

<正>肺癌是我国最常见的恶性肿瘤之一,其中非小细胞肺癌(non-small cell lung cancer,NSCLC)约占85%,5年生存率<15%。因此,目前临床上通常采用多学科综合治疗策略,结合局部与全身系统性治疗非转移性NSCLC。随着介入放射学的不断发展,超选择支气管动脉栓塞化疗治疗支气管肺癌显示出较好的效果,成为治疗中、晚期肺癌的有效方法之一。栓塞微球是介入化疗中使用的栓塞剂,在肝癌及脾功能亢进等栓塞治疗中的应用多见,但是在肺

Background and purpose:Oxaliplatin(L-OHP) combined with fluorouracil(5-FU) and calcium folinatc(CF) as the standard adjuvant chemotherapy for the patients with stage Ⅲ colorectal cancer.But it leads to many adverse effects.So we look for different methods to get low rates of it.The purpose of this study was to evaluate the effect and toxicity of interventional or hyperthermia therapy combined with FOLFOX regimen used in the postoperative adjuvant treatment of stage Ⅲ colorectal cancer.Methods:We retrospective analyzed 123 patients with stage Ⅲ colorectal cancer,all patients were randomized into 3 groups,57 cases in FOLFOX chemotherapy group(group A),35 cases in chemotherapy plus interventional therapy(group B)and 31 cases in chemotherapy plus hyperthermia therapy(group C).Group A patients were treated with L-OHP plus 5-FU/CF.L-OHP 130 mg/m2 was administered,iv infusion 3.5 h,d 1;CF 200 mg/m2,iv infusion for 2 h,d 1-5;followed by 5-FU 300 mg/m2,iv infusion over a period of 6 h,d 1-5.Group B patients were treated with continuous mesenteric arterial infusion L-OHP plus 5-FU/CF,d 1;the same FL regimen was used in group B.Patients of group C were treated with L-OHP 130 mg/m2 was administered,iv infusion 3.5 h,d 1,received hyperthermia therapy for 1 h at the same time.These treatments were repeated every 3 weeks to a total of 8 cycles.Results:Among 123 patients,the 3 years disease-free survival rates of group A,B and C were 71.9%,77.1% and 77.4% respectively(P=0.793,no statistically significant).The 5 years overall survival rates of group A,B and C were 56.1%,57.1% and 58.1% respectively(P=0.984,no statistically significant).Among the side effects,the neutropenia and peripheral neurologic adverse event of group B and C were less than that of group A and which was significant.Conclusion:Choosing interventional or hyperthermia therapy combined with FOLFOX as an postoperative adjuvant treatment for stage Ⅲ colorectal cancer is safe,effective,and proved to have the similar curative effects as literature reported.

OBJECTIVE To study the current status of therapeutic methods and evaluate the therapeutic effect by investigating and analyzing the clinical information on advanced stage lung cancer in Shanghai during recent ten years.To explore the means and value of treatment in the area high incidence of lung cancer.METHODS To review clinical data of more than 70 literatures and 2 904 cases published in domestic medicine journal about the therapeutic methods and effect on advanced stage lung cancer in Shanghai area.The results were analyzed by SPSS software.RESULTS Single treatment was main method for advanced lung cancer.The first was Chinese traditional medicine then following interventional therapy and vein chemotherapy respectively.The main means was two methods combined in multidisciplinary therapy.The effective rate was up to 37.9% and 54.1% in single therapy and multidisciplinary therapy respectively.Both heteropathy and interventional therapy had the higher effective rate 57.7% in single therapy and 76.7% in multidisciplinary therapy respectively.CONCLUSION To combine appropriately different methods can enhance effective rate for advanced stage lunge cancer and make sure that multidisciplinary therapy is more excel single therapy.The clinical information on late stage lung cancer in shanghai has some representative meaning and will guide to such treatment.

目的 观察奈达铂联合其他化疗药物治疗头颈部肿瘤、非小细胞肺癌、食管癌、妇科癌症的近期疗效和不良反应.方法 人组共82例.奈达铂80～100 mg/m2,加入500 ml生理盐水中静脉滴注2h,每4周重复.结果 头颈部肿瘤治疗组15例,CR 4例(26.7%)PR 7例(46.6%),有效率73.3%.非小细胞肺癌观察组25例,CR 3例(12%),PR 5例(20%),SD 10例(40%),PD 7例(28%),有效率RR为32%(8/25).食管癌22例,CR 2例(9%)、PR 7例(31.8),RR 40.9%.妇科癌症20例,结合放疗,全组病例有效率35%.不良反应主要有骨髓抑制,胃肠道反应少见,肝肾功能损害轻微.结论 奈达铂对食管癌、头颈部肿瘤疗效优于顺铂.在非小细胞肺癌、妇科肿瘤疗效与顺铂相近,但是不良反应轻,主要为骨髓抑制,多数患者耐受良好。

Objective To evaluate the efficiency of percutaneous transhepatic variceal embolization(PTVE) combined with patial splenic embolization(PES)for portal hypertension. Methods 30 patients with critical portal hypertension were divided randomly into two groups,15 patients of A group underwent PSE PTVE combined with PSE and 15 of B group underwent PES only. The changes of collateral circulation of the two groups were compared via color Doppler ultrasonography pre-and postoperatively. Results The hypersplenism was well controlled in both groups after PTVE and PSE. The varices of A group were embolized completely,the flow rate and velocity of portal blood stream were significantly reduced(P < 0.05). In addition,the flow rate and velocity together with inner diameter of the azygous vein decreased(P < 0.01),but no change shown on portal vein diameter,only with decrease of blood flow and velocity postoperatively were shown in the two groups(P < 0.05). During 13 -16 months follow-up,gastroesophageal variceal bleeding appeared in 2 patients and formation of portal thrombi in 1 patients of B group. There was no gastroesophageal variceal bleeding in A group but 2 patients appeared portal hypertensive gastroenteropathy(PHG)under endoscopic confirmations. Conclusion PTVE combined PSE is very efficient for gastroesophageal variceal bleeding and hypersplenism due to portal hypertension,especially for patients with poor hepatic function,possessing simple,economic,less invasive properties and deserving to be recommended.(J Intervent Radiol,2007,16: 665-668)

Background and purpose:The regimen of FOLFOX(L-OHP/LV/5-FU)is regarded as second line or salvage treatments with encouraging response rates and acceptable toxicity in advanced gastric cancer.Hypertherima enhancement of L-OHP efficiency by increased DNA adduct formation has been demonstrated in vitro.To evaluate efficacy,toxicity and feasibility of whole-body hyperthermia(WBH) as an adjunct to L-OHP/LV/5-FU in advanced gastric cancer.Methods:Divided into two groups :trial group 21 patients and control group 18 patients with advanced gastric cancer,who had progressed after completion of chemotherapy regimen,were treated with L-OHP 135 mg/m~(2),2h intravenous(i.v.) infusion,followed by LV 200 mg/m~(2)/d,1h i.v.infusion,and 5-FU 400mg/ m~(2)/d× 5d infusion.L-OHP(2h infusion) was started at a whole body temperature of 39 degrees C.Whole-body hyperthermia was administered by UHR2000 radiant heat device.The target temperature of 41.8 degrees C was maintained for 1～2h.They were treated in two periods with 21 days interval.Results:The response rate was 57.12% in trial group,and 22.22%in control group.Which was significant(P(0.05)).The common side effects were symptoms of stomach,nerve toxicity and leucopenia,but these side effects were small WBH treatment combined with FOLFOX regimen showed no unexpected toxicities.WHO grade 3 toxicities were rare.Conclusions:This trial suggests some advantage of combining FOLFOX regimen with WBH.WBH combined with FOLFOX is an active treatment of advanced gastric cancer with acceptable toxicity.

[目的]分析中晚期原发性肺癌介入治疗疗效和费用的关系。[方法]回顾性分析无外科手术指征而有介入化疗适应证的90例中晚期原发性肺癌患者,介入治疗组（A组）45例,非介入治疗组（B组）45例,比较两组治疗临床疗效与成本-效果。[结果]A组1年、2年和3年生存率分别为57.7%、33.3%和13.3%;B组生存率分别为35.5%、15.5%和0,A组较B组提高了生活质量。行介入1次治疗与非介入治疗组相比较生存期无统计学差异;介入1次治疗的平均总诊治费用为8750元;而非介入治疗组的平均总费用为4768元;A组中介入2～3次治疗后1年、2年、3年的生存率分别为60%、45%、15%;与介入4～6次治疗的80%、40%、20%相比无统计学差异（P＞0.05）,而平均总费用分别为20105元、34508元。对各组平均总费用/中位生存期的费用增量分析表明介入2～3次组费用增加不明显,成本-效果较其它两组好。[结论]从经济学角度看,中晚期原发性肺癌经支气管动脉插管化疗、栓塞治疗2～3次的成本-效果较好。

1998年10月～2000年12月,我院对26例肝炎后肝硬化门静脉高压患者进行了部分脾动脉栓塞治疗,观察其术前1周及术后4周脾动脉、脾静脉、门静脉的内径、平均流速和血流量的变化,并对其临床意义进行初步探讨.