目的 探讨重建贲门、胃底、His角预防食管癌术后胸内吻合口瘘的应用效果.方法 行食管癌手术患者80例按照不同方法分为两组各40例.对照组行管胃,观察组行管胃+重建贲门、胃底、His角.比较两组术后1个月内吻合口瘘发生,术后1、6、12个月反流症状、胃镜及消化道造影情况,随访记录患者无进展生存期(PFS)和总体生存期(OS).结果 观察组术后1个月吻合口瘘发生率显著低于对照组(P<0.05).两组术后1个月反流症状发生率无统计学差异(P>0.05);观察组术后6个月和12个月反流症状发生率显著低于对照组(P<0.05).两组术后1、6、12个月黏膜溃疡和黏膜糜烂发生率无统计学差异(P>0.05).观察组PFS和OS显著长于对照组(P<0.05).结论 重建贲门、胃底、His角可降低食管癌术后胸内吻合口瘘发生,降低反流症状发生,延长患者生存期.

Objective: To evaluate the feasibility, efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs) for neoadjuvant therapy. Methods: Eighty-six patients with stage ⅢA EGFR-mutant lung adenocarcinoma were assigned to 2 groups (n=43 in each group) according to the random number table method: neoadjuvant targeted therapy group (single oral dose of erlotinib 150 mg per day, for 9 weeks) and neoadjuvant chemotherapy group (2 cycles of pemetrexed combined with cisplatin chemotherapy followed by 3- week discontinuation). Surgical treatment was underwent after imaging efficacy evaluation. Results: In neoadjuvant targeted therapy group, 4 achieved complete response (CR), 25 achieved partial response (PR), giving an objective response rate (ORR) of 67.4%. In pathological response, 8 patients had grade Ⅰ, 20 patients had grade Ⅱ, giving a pathological response rate of 65.1%. The most frequent adverse events (AEs) were rash and diarrhea. In neoadjuvant chemotherapy group, 2 had CR and 17 had PR, giving an ORR of 44.2%. In pathological response, 3 patients had grade Ⅰ, 15 patients had grade Ⅱ, giving a pathological response rate of 41.9%. The main AEs were hematologic toxic effects. The ORR, histological efficacy and hematologic toxicity showed statistical significance between the two groups (P<0.05). The neoadjuvant targeted therapy group had 90.7% resection rate, (299.8±23.4) ml of hemorrhage volume during operation, (5.2±0.4) days of extubation time and 9.3% postoperative complication rate. Corresponding results were 83.7%, (308.9±22.7) ml, (5.4±0.6) days and 11.6% in neoadjuvant chemotherapy group, which showed no statistical significance (P>0.05). Conclusions: Neoadjuvant targeted treatment for stage ⅢA lung adenocarcinoma harboring EGFR mutations. The regimen could be considered as a choice of neoadjuvant treatment for patients with stage ⅢA EGFR-mutant lung adenocarcinoma.

Objective To explore the clinical effect of the reconstructive operation in preventing gastroesophageal re-flux after esophagectomy by reconstructing the cardia (artificial cardia) and gastric fundus (artificial gastric fundus) on the basis of the gastric tube. Method 73 patients with esophageal carcinoma were stratified as control group (with sim-ple gastric tube reconstruction, n=37) and study group (with gastric tube+anti-reflux surgery, n=36) as per respective sur-geries administered, of which the reflux symptoms, upper gastrointestinal radiograph and 24 h pH as well as gastroscopy findings in 1, 6 and 12 months after surgery were assessed. Result There was no death reported in the cohort. The post-operative reflux symptoms, upper gastrointestinal radiograph and gastroscopy findings were similar between the two groups (P>0.05); While significant differences were observed in aspect of incidence of total reflux in 1 month and 6 months, reflux>5 min in 1 and 6 months, time of pH<4 in 6 and 12 months after surgery for the two groups (P<0.05), sug-gesting a better overall response in study group than that that of the control group. The study group had no anastomotic leakage, but was of higher incidence of anastomotic stenosis than that of control group (19.4% vs 10.8%). Conclusion Gastric tube reconstruction of gastric cardia and fundus is superior than simple gastric tube recontruction in controlling the gastroesophageal reflux, which may reduce the risk of anastomotic leakage after reconstructive surgery.

目的 分析原发性中叶肺癌的临床特点与手术治疗.方法 选取吉林省肿瘤医院2009-01-2014-03诊治的32例原发性中叶肺癌患者,回顾分析其临床资料.结果 32例患者无围手术期死亡,3例发生右肺叶间包裹性积液,实施胸腔穿刺术后治愈.术后20例患者实施综合治疗,12例未实施综合治疗,两组患者1年、3年、5年生存率差异具有统计学意义(P＜0.05).结论 原发性中叶肺癌在临床有极高的误诊率,诊断时重视患者临床症状及病史结合辅助检查,可以提高诊断率,肺叶切除术为重要治疗手段,应同时结合淋巴结清扫.

目的:观察紫杉醇脂质体联合顺铂治疗Ⅲb、Ⅳ期的非小细胞肺癌的临床疗效及不良反应.方法:将60例晚期非小细胞肺癌患者随机分为两组,一组为顺铂治疗组,一组为紫杉醇脂质体和顺铂联合治疗组,比较两种方案的临床疗效及不良反应.结果:联合组的反应率和中位生存期高于顺铂组,且不良反应发生率低于顺铂组.结论:紫杉醇脂质体与顺铂联合治疗晚期非小细胞肺癌有较好的临床疗效,不良反应少.

目的探讨小细胞肺癌的治疗模式。方法 2008年以来收治的小细胞肺癌患者154例,对其临床特点和治疗情况进行分析,疗效评价依据实体瘤疗效反应评价标准。结果 68例广泛期患者1、2年生存率为57%和24%,中位生存期为14.4个月。86例局限期患者,1、2、5年生存率分别为81%、57%和19%;其中根治术后化疗8例,均存活,中位生存期41.7个月;根治术后化疗联合放疗,中位生存期为50.8个月;未手术患者化疗、未手术患者化疗联合放疗中位生存期为12.1个和27.6个月。结论多线治疗方案对于广泛期患者,可改善生存;放化疗联合治疗为局限期患者的首选治疗方案。

目的 观察吉非替尼联合化疗治疗老年中晚期肺腺癌的疗效及安全性.方法 27例患者化疗同时均口服吉非替尼250 mg,直到疾病缓解时停药,同时选择性配合营养支持疗法、降低颅内压、抗骨转移治疗和止痛等治疗.观察症状变化、近期疗效、肿瘤进展时间、生存期及不良反应.结果 治疗后27例患者CR 3例(11.11%),PR 16例(59.26%),SD 5例(18.52%),PD 3例(11.11%).有效率(RR)为70.4%,疾病控制率(DCR)88.9%.中位肿瘤进展时间(TTP)11.3个月.疗效以不吸烟者为好(P＜0.05);性别间疗效差异无统计学意义(P＞0.05).3例生存时间＞24个月,5例＞12个月,1年生存率29.6%,8例＞8个月,8例＞3个月.毒副作用主要为腹泻Ⅱ～Ⅲ度、胸面部丘疹、色素沉着等.结论 中晚期肺腺癌应用吉非替尼联合化疗疗效较好且安全,患者的耐受性及顺从性好.

目的评价靶向治疗药物(易瑞沙、特罗凯)联合化疗一线治疗晚期非小细胞肺癌(NSCLC)的临床价值。方法符合入组条件的晚期NSCLC患者38例,除针对患者病情给予常规NP或GP方案化疗外,同时给予易瑞沙,250 mg每日1次,口服,或特罗凯,150 mg每日1次,口服。与35例常规应用化疗药物治疗的晚期NSCLC患者疗效进行对比分析。结果联合用药组35例患者可评价疗效,用药1年余CR 6例(17%),PR 16例(46%),SD 11例(31%),PD 2例(6%),较对照组疗效明显提高,差异有统计学意义,且患者出现皮疹及腹泻等相关副作用可耐受。结论一线应用靶向药物联合常规化疗较单用化疗疗效更好,且副作用可耐受。

胸腔肿瘤手术治疗可由于患者的抵抗力下降,尤其是老年人,因肺顺应性差,易诱发和出现肺功能低下,咳痰无力,痰液阻塞气道,影响通气功能,而导致肺部感染经久不愈等并发症,我科自2002年8月至2005年8月,对24例老年肺癌患者施行肺减容手术,术后患者肺功能恢复良好,有效预防了术后心肺并发症,为术后肿瘤序贯治疗奠定了基础,提高了患者的生存期与生存质量.

2002年8月~2005年8月,对24例老年肺癌患者施行肺减容手术,术后病人肺功能恢复良好,有效预防了术后心肺并发症。通过总结该24例老年肺癌患者临床肺功能的针对性治疗,旨在寻求针对改善老年肺癌患者围手术期肺功能的有效的治疗方案及思路。

为探寻合并有胸腔积液的肺癌患者外科治疗的价值,1992～1998年我们对12例患者在手术的基础上结合生物制剂沙培林加白介素-2(rIL-2)胸内灌注行过继免疫治疗,达到了既切除原发病灶又控制胸膜病变和消除胸水的目的,现报告如下.

患者,男,50岁,病例号38370,因"进食哽噎感"6个月而来我院就诊,经检查确诊为:"胸下段食管鳞癌",而给予在全麻下行"胸下段食管癌切除、食管胃弓上吻合术",术后6天出现吻合口瘘,经保守治疗,于24天治愈;病人于27天突然出现左锁骨上及左颈部肿胀,触痛明显,伴有发热,体温最高达38.0℃,经彩超检查,确诊为左颈内静脉血栓,约4.5cm大小,完全阻塞管腔,给予病人溶栓治疗:低分子右旋糖酐500ml 1次/日;尿激酶80万单位/日;降纤酶10单位/日;速尿20mg 2次/日;路路通0.5,1次/日,地塞米松10mg/日,并注意补钾,第2天症状明显减轻,一周后痊愈.

患者女,54岁.因右乳房肿物10年,肿瘤破溃6年,进行性四肢肌肉无力半个月住院.患者于10年前发现右乳房外上象限2 cm×2 cm肿物,质地硬,患者拒绝检查治疗,肿瘤逐渐生长,6年前长至9 cm×7 cm,表面皮肤破溃坏死,范围逐渐扩大,经久不愈,肿瘤继续长大,至入院前约有19 cm×17 cm×12 cm,表面多处破溃坏死,中心部位发黑,并有大量分泌物,伴恶臭,因四肢肌肉无力并进行性加重半个月住入我院.

目的探讨非小细胞肺癌骨转移的患者切除肺原发肿瘤为主的综合治疗疗效.方法1995年～2002年间对15例非小细胞肺癌骨转移患者行肺叶切除术加术后综合治疗.结果手术切除肺原发肿瘤加术后综合治疗的15例患者与单纯内科治疗比较,提高了生存率,改善了生活质量.结论选择性的非小细胞肺癌骨转移手术切除肺原发肿瘤加术后综合治疗比单纯内科治疗疗效好.

Objective To study the application of high frequency electroscalpel in advanced lung carcinoma resection. To evalute the long term effect. Methods Fifty-eight patients were performed by electrogenerator Ⅱ, which were incomplete resection. Results Postoperative 36 patients whose mediastinal lymph nodes incompletely resected were conformed by pathological evidence, which were 62% (36/ 58). Postoperative 55 patients, chemotherapy and radiotherapy 17 patients, chemotherapy 38 patients. Two year survival rate is 63.6% (35/55). Conclusion Using high frequency electroscalpel to electrocoagulate remaining carcinoma tissues, to some extent, which reached the aim of relative resection. This method increase the survival time of Lung carcinoma patients.

原发性肺癌晚期多易经血行、淋巴道转移至骨、肝、脑及腹腔等部位,常出现多脏器同时转移,皮下转移是晚期肺癌远处转移少见部位之一,我院1997～2002年收治原发性肺癌伴皮下转移6例,现报告如下.

心律失常是开胸术后常见的并发症[1,2],我们自1991年1月～1998年12月,从食管癌贲门癌手术病人中随机选取598例,其中42例术后发生了心律失常.现探讨本组病人术后发生心律失常的危险因素,并将围术期治疗体会总结如下:

我科自1985～1999年对老年肺癌合并肺功能低下的患者行手术治疗,取得了较好疗效,现报告如下. 资料:本组共25例,男18例,女7例,年龄62岁～78岁,大于65岁者21例, 平均66.9岁.术前诊断为中心型肺癌19例(术后病理证实鳞癌16例,腺癌2例,未分化小细胞癌1例),周围型肺癌6例(腺癌4例,鳞癌2例).

目的探讨肺癌合并脑转移病人外科治疗疗效.方法比较合并脑转移肺癌病人保守疗法与外科治疗疗效.结果肺癌合并脑转移外科治疗疗效明显优于保守治疗.结论病人全身状况较好,无其他重要脏器转移情况下,采取放疗化疗综合治疗尤其是手术治疗,能明显改善病人生存质量,延长病人生存期.