肺癌发病率、死亡率位居癌症首位,全球每年有近180万新发病例[1-3],我国每年新发73万[4].预计到2025年,我国肺癌患者每年将达到100万,成为世界肺癌大国.肺癌中非小细胞肺癌(non small cell lung cancer, NSCLC)约占85％,其中约70％的患者在诊断明确时已为晚期,失去手术治疗机会[5-7].晚期NSCLC化疗有效率为21.80％～28.10％,中位生存期为11个月[8],可见化疗益处有限.而同步放化疗不良反应较重,但综合介入治疗是一种新模式,疗效显著、安全性高,故本文对NSCLC的综合介入治疗现状作一综述.

临床资料 患者,女,67岁.因“间歇腹胀5年余,黑便3h”于2015年1月4日入院.查体:慢性肝病面容,腹膨隆,脾肋下3 cm,移动性浊音(+).肝脏血管+三维成像:提示肝硬化、脾肿大、腹水,门脉高压、食管胃底静脉曲张;肝病胆囊,胆囊结石.腹部彩色超声:肝脏弥漫性病变(肝纤维化分期F1 ～F2期),门静脉轻度增宽;胆囊炎症并多发结石;脾肿大,脾静脉轻度增宽.胃镜检查见食管静脉曲张(重度);胃底静脉曲张.血清生化示:总蛋白40.81 g/L,胆碱酯酶1.82 kU/L,三酰甘油0.45 mmol/L.血常规示:WBC 1.27× 109/L,中性粒细胞百分比0.669,淋巴细胞百分比0.181.腹水检查:外观呈乳白色,浑浊,无味,比重1.014,不凝固,黏蛋白试验阳性,蛋白定量15 g/L,RBC 450×106,WBC 80×106,中性粒细胞0.2,淋巴细胞0.8,总蛋白14.44 g/L,碱性磷酸酶21 U/L,谷氨酰转肽酶3.5 U/L,腺苷脱氨酶5 U/L,葡萄糖5.53 mmol/L,乳酸脱氢酶53 U/L.结合患者临床表现及相关辅助检查,诊断为:肝硬化失代偿期(乙型)并门脉高压症,食管胃底静脉曲张,乳糜腹水,脾功能亢进,消化道出血;胆囊结石.

Objective To compare the efficacy of Xelox and Sox neoadjuvant chemotherapies in the treatment of gastric cancer in order to explore a therapy with better clinical outcomes for patients. Methods A total of 86 gastric cancer cases in the Department of Oncological Surgery in First Hospital of Lanzhou University were randomly selected and divided into two groups according to different chemotherapies. And after being treated with 3 periods of neoadjuvant chemotherapies, the Xelox and Sox groups were observed and compared in terms of recent efficacy, tumor stages and radical gastrectomy rates. Prognosis follow-ups were also carried out for efficacy comparison. Results Among the 40 cases of Xelox neoadjuvant chemotherapy, there were 12 cases (30.0%) of RR, 25 cases (62.5%) of radical gastrectomy and 15 cases (37.5%) of non-radical gastrectomy;5 cases (12.5%) were in postoperative phaseⅠ, 3 cases (7.5%) in phaseⅡ,12 cases (30.0%) in phaseⅢ, and 20 cases (50.0%) in phaseⅣ;the overall survival time for the 40 cases was 6-23 months and median survival time was 18 months;time to tumor progression was from 1 to 23 months, with a median value of 15 months. Among the 46 cases of Sox neoadjuvant chemotherapy, there were 27 cases (59.0%) of RR, 38 cases (82.6%) of radical gastrectomy and 8 cases (17.4%) of non-radical gastrectomy;17 cases (37%) were in postoperative phaseⅠ,11 cases (24%) in phaseⅡ, 5 cases (11.0%) in phaseⅢ, and 13 cases (28.0%) in phaseⅣ;the overall survival time for the 46 cases was 8-24 months and median survival time 23 months;time to tumor progression was from 5 to 24 months, with a median value of 20 months. Conclusions Sox neoadjuvant chemotherapy in the treatment of gastric cancer is significantly better than xelox in terms of short-term effect, prognosis and clinical benefits, thus it is preferable for clinical application.