目的:探讨生活事件与胃癌患者的躯体化症状及应对方式间的关系,并分析应对方式的调节效应.方法:采用随机方便抽样方法,抽取某院收治的胃癌患者167例作为研究组,同时抽取166例健康人群作为对照组,采用生活事件量表、躯体化症状自评量表、简易应对方式问卷进行调查.结果:研究组的负性生活事件刺激量显著大于对照组(t=7.278,P＜0.01);研究组在躯体化症状的躯体化障碍、抑郁症状、焦虑症状以及焦虑抑郁症状4个因子上均显著大于对照组(P＜0.01);此外,研究组在积极应对得分上显著小于对照组(t=-13.212,P＜0.01),在消极应对得分上则显著大于对照组(t=16.458,P＜0.01).积极应对以及消极应对在负性生活事件影响胃癌患者躯体化症状中具有调节的效应.结论:胃癌患者与健康人群相比躯体化症状明显,经历更多的负性生活事件且采用更消极的应对方式,应对方式在生活事件对胃癌患者躯体化症状的影响中扮演着调节的角色.

目的 探讨5-氨基酮戊酸光动力疗法(ALA-PDT)治疗子宫颈低级别鳞状上皮内病变(LSIL)合并高危型人乳头瘤病毒(HR-HPV)感染患者的有效性和安全性.方法 选取LSIL合并HR-HPV感染的60例女性患者为研究对象,按照随机数字表法分为观察组和对照组,每组30例.对照组给予常规药物治疗,观察组给予ALA-PDT治疗.比较2组治疗效果、HR-HPV转阴率、焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分.结果 治疗后6个月,观察组治疗总有效率为83.33％,高于对照组的53.33％,差异有统计学意义(P＜0.05).观察组HR-HPV转阴率高于对照组,差异有统计学意义(P＜0.05).治疗前,2组SAS和SDS评分差异无统计学意义(P＞0.05);治疗后,观察组SAS和SDS评分低于对照组,差异有统计学意义(P＜0.05).2组均未发生明显不良反应.结论 ALA-PDT治疗LSIL合并HR-HPV感染的患者临床疗效显著,安全性良好,有利于改善患者焦虑、抑郁状态.

目的 研究癌症住院患者及其家属心理痛苦程度的影响因素,探讨两者之间的相关性,为患者及家属的心理疏导提供理论依据.方法 采用问卷调查表、心理痛苦温度计(Distress Thermometer,DT)的方法,随机抽取癌症患者及其直系家属各248例,采集问卷调查信息并进行统计学分析.结果 目前癌症患者心理痛苦得分为(3.39±2.58)分,其家属为(2.95 ±2.46)分,显著痛苦检出率分别为41.93％及35.48％,差异无统计学意义(P =0.190).在不同的家庭经济情况下,患者与家属心理痛苦平均分差异有统计学意义(P＜0.05).在患者不同病程长短分组中,患者病程≥6个月的家属DT评分(2.54±2.71)分,而病程＜6个月的,家属DT评分(2.36±2.15)分,差异具有统计学意义(P =0.042).结论 心理痛苦在癌症患者及家属中普遍存在,显著痛苦检出率均较高,且家属与患者本人心理痛苦程度相当,均与家庭经济情况相关.患者病程长短影响患者及家属心理痛苦程度,在医疗及护理过程中,需要同时关注患者及家属心理痛苦.

目的:检测EZH2和SMYD3蛋白在结直肠癌组织中的表达,分析EZH2和SMYD3蛋白的表达情况与结直肠癌不同病理特征及预后的相关性,探讨EZH2和SMYD3蛋白在结直肠癌发生发展中作用相关性,为结直肠癌的诊断、治疗及预后判断提供全新的分子标志及靶点.方法:结直肠癌组织(实验组)及癌旁组织(对照组)标本取自郑州大学附属肿瘤医院普外科结直肠癌患者根治术后石蜡包埋标本,共60例.采用免疫组织化学方法检测结直肠癌组织及癌旁组织中EZH2和SMYD3蛋白表达情况,结合结直肠癌患者的术后病理,根据2017版NCCN指南完成TNM分期,用X2检验分析EZH2和SMYD3蛋白在结直肠癌组织及癌旁组织中的表达差异,分析EZH2和SMYD3蛋白表达情况与结直肠癌术后病理参数之间的关系;用Kaplan-Meier法、Log-rank检验分析EZH2和SMYD3蛋白与结直肠癌患者根治术后无病生存期(DFS)及总生存期(OS)之间的关系,采用Pearson相关性分析EZH2和SMYD3蛋白在结直肠癌组织中表达的相关性.结果:EZH2及SMYD3蛋白在结直肠癌组织中的阳性率明显高于癌旁组织,表明两者均在结直肠癌的发展中表达上调.EZH2蛋白表达情况与肿瘤TNM分期、有无淋巴结转移有显著相关性,SMYD3蛋白表达情况与肿瘤TNM分期、有无淋巴结转移、肿瘤发生部位有显著相关性,表明两者的表达可能与结直肠癌的侵袭和转移有关.EZH2、SMYD3蛋白表达阳性结直肠癌患者术后DFS较短,表明两者的表达可能提示结直肠癌患者预后不良.在结直肠癌组织中,EZH2、SMYD3蛋白的表达情况呈正相关关系,表明两者在结直肠癌的发生发展过程中可能呈协同作用.结论:EZH2、SMYD3蛋白在结直肠癌组织中的表达上调,在结直肠癌组织表达中呈明显正相关,并且与结直肠癌的不良预后相关,可能会是结直肠癌患者重要的预后因子及治疗靶点.

患者男,64 岁,直肠腺癌术后 4 年经综合治疗后,于2017年3 月 20 日入院.诊断: ( 1)直肠腺癌术后肝转移pTxNxM1期,Ⅳ期;(2)肝转移瘤射频消融术后;(3)左肾切除术后;(4)胆囊炎. 2011年4月8日,患者因良性肿瘤行左肾切除术,术后肾功能检查恢复正常.4年前,患者因间断便后带血2个月余就诊于河南省人民医院,排除手术禁忌后,于2015年1月行直肠癌根治术.术中探查,腹腔内无腹水,腹腔、网膜、腹主动脉旁等未见转移结节,术后病理分期pT4N0M0期.基因检测示,N?ras突变型,K?ras、BRAF 野生型.行奥沙利铂+替吉奥方案化疗 4 个周期,定期复查.2016年9月,复查PET?CT提示肝转移,行射频消融术,后定期复查提示肿瘤标志物升高. 2017年3月18日,增强MRI提示肝S5转移,大小约31 mm×26 mm×31 mm,患者肝转移病灶进展.遂于2017年3月21日在我院行肝脏射频消融术,术后肝内转移灶较术前缩小但未达到无疾病状态,行FOLFIRI(伊立替康+氟尿嘧啶+左亚叶酸钙)方案+贝伐珠单抗化疗4个周期.化疗期间复查血常规和肝肾功能,均正常.2017年5月12日,复查增强CT提示病情稳定. 2017年5月31日,复查肾功能轻微异常(肌酐 121 μmol／L,尿酸 429 μmol／L),停止化疗并给予护肾等对症支持治疗后肾功能恢复正常.患者停止化疗和靶向治疗后予以中药调理. 2017年8月19日,复查增强CT示,左肾上腺区结节较前增大,考虑转移;右肺上叶脊柱旁微小结节,较前稍增大;肝内散在稍低密度结节,部分较前稍减少.患者拒绝使用化疗药物和靶向治疗,继续中药调理治疗. 2018年6月12日,复查CT提示肝转移病灶较前进展,患者仍拒绝化疗,予以口服替吉奥+阿帕替尼治疗8个周期(替吉奥40 mg,2次／d,第1～14天;阿帕替尼250 mg,1次／d),阿帕替尼使用1个月后复查CT(图1).服用阿帕替尼期间复查肝肾功能未见明显异常. 2018年12月27日复查CT示,肝转移病灶较前进展,遂改为口服瑞戈非

Objective To explore the clinical characteristics, treatment strategy and prognosis of adenoid cystic carcinoma of the head and neck (ACCHN).Methods A retrospective analysis of the clinical and follow?up treatment of 79 patients with ACCHN from June 2008 to July 2017 was conducted in the Cancer Hospital of Zhengzhou University. Results A total of 79 ACCHN cases, including 31 males and 48 females. The age ranged from 19 to 77 (median, 52). The clinical manifestations of ACC were related to the locations of primary tumor.The mean size of the tumor was 2.6 cm ( range from 1.5 to 7.7 cm). 50 of 79 patients with a definitive pathological diagnosis received surgical resection. 59 cases received chemotherapy and 62 cases received radiotherapy. With a median follow?up of 55 months, the 5?year, 10?year survival rate of these patients were 69.6% and 54.4%, respectively. Conclusions ACCHN is an uncommon neoplasm with the characteristics of epithelial nerve growth, being inclined to distant metastasis, and high early misdiagnosis rate. The clinical manifestation, imaging and pathological result are need to be combined together to diagnose ACCHN.

目的 探讨胃癌术后化疗患者的营养状况,并探讨其对患者生活质量及化疗不良反应的影响.方法 选取2016年4月至2018年4月郑州大学附属肿瘤医院内科接受化疗的55例胃癌术后患者.采用营养风险筛查表(NRS 2002)评估患者营养状况,采用癌症生活质量测定量表(EORTC－QLQ－C30)评估患者生活质量,采用WHO标准评估患者化疗不良反应.比较有营养风险组与无营养风险组患者的生活质量及化疗不良反应.结果 无营养风险者占27. 27%(15／55),有营养风险者占72. 73%(40／55).无营养风险组患者EORTC－QLQ－C30评分中躯体功能、角色功能、情绪功能、整体健康状况／生活质量评分高于有营养风险组,疲乏症状评分低于有营养风险组患者,差异有统计学意义(P＜0. 05);两组患者EORTC－QLQ－C30评分中其他各领域评分比较,差异无统计学意义(P＞0. 05).两组患者化疗不良反应发生率比较,差异无统计学意义(P＞0. 05).结论 多数胃癌术后患者存在营养风险,营养状态可能影响患者生活质量,但营养状态可能与化疗不良反应的发生无关.

目的 探讨基于患者主观整体评估(PG-SGA)的个性化饮食指导在接受新辅助化疗的局部进展期胃癌患者中的应用价值.方法 选取2015年3月至2018年3月于郑州大学附属肿瘤医院接受"奥沙利铂+替吉奥"方案新辅助化疗的59例局部进展期胃癌患者为研究对象,采用信封法将患者随机分为对照组(30例)和观察组(29例).采用PG-SGA对患者营养状况进行评估,对照组患者接受常规饮食指导,观察组患者接受基于PG-SGA的个性化饮食指导.比较两组患者新辅助化疗前后淋巴细胞计数、血红蛋白浓度、血清白蛋白水平、血清前白蛋白水平和新辅助化疗后毒副反应发生情况.结果 新辅助化疗后,两组患者各营养指标水平均较化疗前降低,观察组患者各营养指标水平均高于对照组,差异有统计学意义(均P<0.05).观察组患者食欲下降、恶心呕吐、血红蛋白降低、白细胞降低发生情况均较对照组轻,差异有统计学意义(均P<0.05),腹泻及血小板降低发生情况与对照组比较,差异无统计学意义(均P>0.05).结论 基于PG-SGA的个性化饮食指导可改善局部进展期胃癌患者新辅助化疗后营养状况,减轻或减少新辅助化疗毒副反应的发生,为手术的实施奠定基础.

目的 探讨阿帕替尼递增剂量治疗晚期胃癌的效果.方法 选取2014年5月至2017年5月西峡县人民医院接诊的86例晚期胃癌患者,按随机数表法分为对照组和观察组,各43例.对照组患者接受阿帕替尼恒定剂量治疗,观察组患者接受阿帕替尼递增剂量治疗.比较两组患者治疗1个疗程后的临床效果,治疗前后癌胚抗原(CEA)水平以及服药期间不良反应发生率.结果 观察组患者RR高于对照组,差异有统计学意义(P<0.05).治疗后,两组患者CEA水平低于治疗前,观察组患者CEA水平低于对照组,差异有统计学意义(P<0.05).观察组患者服药期间胃肠道反应发生率和手足综合征发生率均低于对照组,差异有统计学意义(均P<0.05).观察组患者骨髓抑制发生率、蛋白尿发生率、高血压发生率、出血发生率、肝功能异常发生率与对照组比较,差异无统计学意义(P>0.05).结论 采用阿帕替尼递增剂量治疗晚期胃癌能够提升治疗效果,减少不良反应.

Objective:To investigate the relationship between the expression of Survivin in breast cancer (BC) and the efficacy of chemotherapy using paclitaxel. And further study the effect of compound matrine injection on the curative effect of chemotherapy. Methods:119 patients with BC were selected and analyzed retrospectively. The pa-tients were divided into two groups:Paclitaxel chemotherapy group (group A)and chemotherapy combined with ma-trine injection group (group B). The expression of Survivin was studied immunohistochemically in tumor tissues,then the patients were divided into positive expression group and negative expression group. The progression-free survival rates (PFS)and overall survival (OS)were calculated by the Kaplan-Meier method. The response rate (RR)was assessed by χ2 . Results:Group A:The RR in negative group was 83 . 3 ％ ,higher than the positive group (P =0. 031). In negative group,the PFS and OS both were longer than the other,and the difference of PFS was significant (P = 0. 046). Group B:There was no significant diversity in RR,PFS and OS between positive and negative expres-sion group. Comparison between group A and group B:The RR was improved by using matrine in positive patients (P= 0. 026). In combination with matrine,PFS of the positive expression patients was increased from 12. 761 to 16. 197 months,with obvious difference (P = 0. 027). OS was increased from 30. 789 months to 36. 570 months,but the difference was not statistically significant (P > 0. 05). Conclusion:The detection of the expression level of Survivin was expected to be the predictive index of paclitaxel chemotherapy in breast cancer. For patients with high expression of Survivin,combining with matrine may improve the efficiency of chemotherapy,and even extend PFS.

目的 观察树突状细胞诱导的杀伤细胞(DC-CIK)联合化疗对老年结直肠癌患者外周血T细胞亚群及细胞因子的影响,探讨DC-CIK联合化疗对老年结直肠癌的临床疗效及作用机制.方法 68例老年结直肠癌患者随机分为对照组和试验组,每组34例.对照组第1天静脉滴注奥沙利铂100 mg·m-2,静脉滴注2h,第2～6天静脉滴注亚叶酸钙200 mg·m-2,静脉滴注5-氟尿嘧啶500 mg·m-2.试验组于化疗前2d单采外周血单个核细胞,培养树突状细胞诱导的杀伤细胞,于第14～16天连续回输3d,每天1次,每次1.5h内回输完毕.2组均21 d为1个疗程,根据患者情况术后辅助化疗4～6个疗程,试验组接受2个疗程树突状细胞诱导的杀伤细胞治疗.比较2组患者治疗前后外周血T细胞亚群及血清血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及干扰素-γ(IFN-)水平,比较2组患者的临床疗效及治疗过程中出现的药物不良反应情况.结果 治疗后,试验组CD3+、CD4+、CD4+/CD8+,CD4+ CD25+分别为(59.61±5.95)％,(38.97±6.58)％,(1.28±0.07),(4.31±1.07)％;对照组CD3+为(53.64±5.25)％,CD4+为(34.64±6.36)％,CD4+/CD8+为1.10±0.06,CD4+ CD25+为(8.17±1.19)％,差异有统计学意义(P＜0.05).治疗后,对照组和试验组的VEGF分别为(216.51±26.82),(136.73±27.56) ng·L-1,TNF-α分别为(3.12±0.81),(4.57±0.79)μg·L-1,差异有统计学意义(P＜0.05).试验组治疗前IFN-γ为(23.41±2.29)ng·L-1,治疗后为(32.63±2.58)ng·L-1(P＜0.05).对照组的客观缓解率为41.18％(14/34例),疾病控制率为73.53％(25/34例);试验组客观缓解率为55.88％(19/34例),疾病控制率为94.12％(32/34例),2组疾病控制率差异有统计学意义(P＜0.05).2组患者的胃肠道反应和周围神经毒性的发生率差异无统计学意义(P＞0.05),试验组的骨髓抑制发生率低于对照组(P＜0.05).结论 DC-CIK联合化疗可改善老年结直肠癌患者的免疫功能,提高患者的临床疗效,且安全性较高.

Objective: To explore the clinical characteristics, surgical procedures and prognosis of solid pseudopapillary tumor of the pancreas(SPTP). Methods: The clinical and follow-up data of 55 cases with SPTP in Henan Tumor Hospital from June 2005 to April 2015 were retrospectively analyzed. Results: There were 55 SPTP cases, including 7 males and 48 females. The age ranged from 16 to 76 (median, 33). Clinical presentations of SPTP were not specific. The mean size of the tumor was 7.6 cm (range from 2 to 25cm). Pancreatic head and tail were the most common locations of SPTP. All the patients received surgical resection with a definitive pathological diagnosis. Some immunohistochemical markers were mostly positive, including β-catenin, Vim, Syn, CD10, CD56, PR, etc. With a median follow-up of 53 months, the 1-year, 2-year and 5-year survival rate were 98.1%, 96.1% and 94.0%, respectively. Conclusions: SPTP is an uncommon exocrine pancreatic neoplasm with low malignant potential, which frequently occurs in young women. Preoperative imaging can provide evidence for the selection of treatment modalities among which surgical resection ispreferred. Diagnosis still relies on pathology and immunohistochemistry.

Objective:To understand the current situation and influence factors of psychological pain of patients and their families in malignant tumors,to investigate the relationship between the patient and family members psychological pain,and to find ways of coping with reasonable psychological pressure,to provide guidance in the process of clinical treatment.Methods:According to the psychological distress thermometer (DT),Medical Coping Questionnaire (MCMQ) and self-designed general situation questionnaire,124 patients and their families were investigated by a questionnaire,establishing a database.IBM SPSS statistics 21 was used for statistical analysis.Results:The psychological pain score of patients with malignant tumor inpatients was (3.29 ± 2.58),and families was (2.85 ± 2.46),with no statistically significant difference (P ＞0.05).In comparison of different family economic conditions,there was statistical significance of patients and their families suffering psychological differences (P ＜ 0.05).Facing and avoiding had negative correlation with psychological pain,while yielding had positive correlation with psychological distress.Conclusion:The inpatients and their families generally have psychological pain,which is related to the annual household income.Families psychological pain degree is the same with the patients themselves,encouraging patients to face disease,to reduce the heart physical pain.

目的:探析肿瘤标志物在常见肿瘤中的应用及临床研究.方法:选择2013年2月-2014年2月期间我院收治的肺癌患者120例作为观察组,再选择同期的100例体检者作为对照组,分别对其进行血清肿瘤标志物检测,比较两组检测结果.结果:相比较对照组而言,观察组的各项临床指标改善明显,组间比较差异有统计学意义(P＜0.05).结论:临床上在对肺癌进行诊断时,采用联合检测肿瘤标志物的方法,不仅可以提高诊断准确性,还能为临床上制定针对性治疗方案提供有效依据.

目的 探讨消癌平注射液联合紫杉醇与顺铂联合化疗(TP)方案治疗晚期胃癌的临床疗效.方法 30例晚期胃癌患者随机分为试验组和对照组,各15例,试验组采用消癌平注射液联合TP方案,对照组采用TP方案,2个周期后评估2组临床疗效、生活质量改善情况及毒副反应.结果 试验组临床有效率为66.7%,明显高于对照组的26.7%,差异有统计学意义(P<0.05),试验组生活质量改善率明显高于对照组,差异有统计学意义(P<0.05),试验组毒副反应发生率明显低于对照组,差异无统计学意义(P>0.05).结论 消癌平注射液联合TP方案治疗晚期胃癌可提高治疗疗效,改善患者生活质量.

目的 观察重组人内皮抑素恩度(endostar)持续静脉泵入和静脉滴注两种方式联合TP方案治疗进展期卵巢癌的疗效和不良反应.方法 32例经病理组织学和(或)细胞学证实的进展期卵巢癌患者,随机分为试验组(恩度持续静脉泵+TP方案联合治疗)和对照组(恩度静脉滴注+TP方案联合治疗),每组各16例,比较治疗前、治疗2周期、4周期后肿瘤大小、血清VEGF水平的变化,评价临床疗效和安全性.结果 2周期后试验组有效率和疾病控制率分别为37.5％和62.5％,对照组分别为25.0％和62.5％,两组差异无统计学意义(P＞0.05).4周期后试验组有效率和疾病控制率分别为50.0％和81.3％,对照组分别为31.3％和75.0％,两组有效率差异无统计学意义(P＞0.05).治疗后试验组血清中VEGF的表达量低于对照组(P＜0.05),且4周期后VEGF的表达量显著低于2周期(P＜0.01).试验组心脏不良反应、骨髓抑制发生率低于对照组,差异有统计学意义(P＜0.05).结论 恩度持续静脉泵入近期疗效较好,并可有效下调晚期卵巢癌血清中VEGF的表达,且不良反应轻微.

ObjectiveAnalysis of intravenous chemotherapy and intraperitoneal chemotherapy adjuvant in treatment of colon cancer.Methods In our hospital, 60 patients with colon cancer surgery were randomly divided into two groups,the control group administered intravenous chemotherapy,while the observation group using intravenous chemotherapy intraperitoneal chemotherapy,two groups of effect were compared.ResultsComparison of the two groups after 3,5-year survival rates of the patients,the difference was statisticaly significant(P<0.05).Conclusion Clinical give colon cancer postoperative adjuvant chemotherapy combined with intraperitoneal chemotherapy has good effect.

Objective To explore the breast cancer using ginseng and astragalus righting the clinical effect of injection chemotherapy treatment. MethodsSelected 88 patients with breast cancer were divided into two groups randomly, the control group routine chemotherapy treatment, and on the basis of the observation group, shenqifuzheng injection combined treatment, compared the therapeutic effect of two groups.Results After treatment, two groups of the total remission rate and incidence of adverse reactions compared with statistical signiifcance (P<0.05).Conclusion The clinical use of ginseng and astragalus righting injection and chemotherapy for breast cancer can achieve good curative effect.

Ohjeetive To observe the short-term efficacy and toxic reaction of compound sophora flavescens injection in the treatment of advanced colorectal carcinoma.Methods From January 2012 to April 2014,78 patients with advanced colorectal carcinoma were randomly divided into observation group and control group,with 39 cases in each group.The patients in the observation group were given compound sophora flavescens injection and XELOX chemotherapy,and the patients in the control group were given XELOX chemotherapy alone.Twenty-one days was as one cycle and the treatment course lasted for four cycles.Toxic reaction,quality of life,therapeutic efficiency,and clinical symptom were observed after the treatment.Results There was no significant difference in the tumor response rate and the level of CEA between the two groups (P ＞0.05).The KPS scores were significantly improved in chemotherapy group compared with chemotherapy control group (P ＜ 0.05).In addition,the incidences of gastrointestinal reaction and myelosuppression were lower than those in the control group (P ＜ 0.05).Conclusions Compound sophora flavescens injection combined with chemotherapy in the treatment of advanced colorectal carcinoma can reduce toxic reaction of chemotherapy and improve the quality of life in patients with advanced colorectal carcinoma,so it is worthy to be popularized.

Objective To study the expression and clinical significance of Bcl-2 and Caspase-3 in esophageal squamous carcinoma.Methods SP immunohistochemical technique was used to examine the expression of Bcl-2 and Caspase-3 in 70 cases of esophageal squamous carcinoma and 20 cases of normal esophageal mucosa,the relationship between expression and clinical pathological features of esophageal carcinoma and the correlations of them were analyzed.Results The expression of Bcl-2 and Caspase-3 were significantly different in normal esophageal mucosa and esophageal squamous carcinoma tissue (P ＜ 0.05);the expression of Bcl-2 were connected with classification,lymphnode metastasis and clinical stages (P ＜ 0.05),but there was no significance in gender and age(P ＞ 0.05).The expression of Caspase-3 were connected with classification and lymphnode metastasis (P ＜ 0.05);but there was no significance in gend,age and clinical stages(P ＞0.05).And the expression of Bcl-2 was negatively correlated with the expression of Caspase-3 in ESCC (r =-0.55,P ＜ 0.05).Conclusions The expression of Bcl-2 and Caspase-3 may participate in the occurrence and development of esophageal cancer,the expression of Bcl-2 may has a certain inhibitory effect on the expression of Caspase-3,simultaneous detection of the expression of Bcl-2 and Caspase-3 in esophageal carcinoma can improve the early diagnosis of esophageal carcinoma and evaluate the prognosis.