目的 观察原发性肝癌放射治疗疗效和放射性肝损伤(RILD)的影响因素及不同放射剂量对生存率的影响.方法 选择2011―2018年中国人民解放军联勤保障部队第九〇一医院无法手术治疗的肝癌病人175例,放射治疗总剂量为30～60 Gy之间,单次剂量范围为1.8～4.0 Gy,每周3～5次.评价放疗疗效和放射性肝损伤,比较影响疗效的各因素之间的关系,分析不同剂量对生存率的影响.结果 治疗结束3个月,客观缓解率(CR+PR)为58.86％,单次剂量>3～4 Gy,而总剂量>50～60 Gy显示更好的近期疗效(P<0.05),但剂量对生存率的影响差异无统计学意义(P>0.05),性别、child-pugh分级、经肝动脉化疗栓塞术(TACE)、分期对近期疗效的影响差异有统计学意义(P<0.05),年龄、病毒感染、癌栓对近期疗效的影响差异无统计学意义(P>0.05).分割剂量、年龄、child-pugh分级、分期对放射性肝损伤的影响差异有统计学意义(P<0.05),总剂量对放射性肝损伤的影响差异无统计学意义(P>0.05).结论 性别、child-pugh分级、TACE术、分期、分次剂量及总剂量与肝癌近期疗效有关,剂量的差异与生存率无关,大分割RILD发生率高,年轻、child-pugh A级、分期早的病人放射性肝损伤发生率相对低.

目的 检测肝癌组织中M2型丙酮酸激酶(M2 pyruvate kinase,PKM2)的表达,并分析其与放疗敏感性的关系.方法 回顾性分析80例肝癌患者的临床资料,患者均实施肝脏穿刺活检,且均符合三维适形放疗指征.检测肝癌组织中PKM2蛋白的表达,对比不同PKM2蛋白表达患者放疗前后血清AFP水平,对比不同PKM2蛋白表达患者的放疗效果和敏感性.探讨肝癌组织中PKM2表达与放疗敏感性的关系.结果 肝癌组织中PKM2蛋白阳性率为87.50％;放疗前后肝癌组织中PKM2蛋白阳性者血清AFP水平均高于阴性者(P＜0.05),且放疗后肝癌组织中PKM2蛋白阳性和阴性者血清AFP水平均低于放疗前(P＜0.05);PKM2蛋白阳性者缓解率(放疗敏感率)低于阴性者(P＜0.05);临床分期Ⅲ期、Ⅳ期,低分化,PKM2蛋白阳性均是放疗不敏感的独立危险因素(OR=3.274、5.328、5.942、7.135,P＜0.05).结论 肝癌组织中PKM2阳性率高,且与血清AFP水平、放疗敏感性均密切相关,PKM2蛋白阳性等均是放疗不敏感的独立危险因素.

目的 探讨晚期复发性铂耐药型卵巢癌脂质体阿霉素与依托泊苷的疗效对比.方法 选取2016年1月至2017年6月中国人民解放军联勤保障部队第901医院收治的晚期复发性铂耐药型卵巢癌患者60例,按照随机数字表法分为对照组和研究组,每组30例.对照组应用依托泊苷治疗,100mg/次,口服,每日1次,持续14d,每3周为1个周期,6个周期为1个疗程;研究组给予脂质体阿霉素治疗,40～50mg/m2,静脉滴注,每4周给药1次且为1个周期,6个周期为1个疗程.对所有患者每2个周期进行1次疗效评估.比较两组患者总有效率、无进展生存期以及不良反应发生情况.结果 治疗后,研究组总有效率(40.0％)与对照组(36.6％)比较差异无显著性(P>0.05);研究组患者无进展生存期[(7.4±0.5)个月]与对照组[(7.1±0.6)个月]比较差异无显著性(P>0.05);对照组患者粒细胞缺乏(20.0％)及胃肠道不良反应(26.6％)的发生率均高于研究组(6.0％、6.0％),差异有显著性(P<0.05),其他不良反应差异无显著性(P>0.05).结论 对于晚期复发性铂耐药型卵巢癌的治疗,脂质体阿霉素与依托泊苷的疗效均较为理想,脂质体阿霉素不良反应发生率较低,在临床中可根据患者的具体情况予以应用.

1病例资料 患者,男性,31岁,因"确诊皮肤瘢痕癌7 个月,进一步治疗"入院. 20年前患者右颈部、右胸部及上背部不慎被沸水烫伤(深Ⅱ度) ,烫伤面积约15％,经烧伤科治疗后,烫伤部位留有挛缩瘢痕. 2016年1月患者出现右侧锁骨上瘢痕偶发瘙痒、溃烂,后自行愈合,2016年8月患者右锁骨上皮肤再次溃烂,当地医院门诊给予定期消毒换药,面积逐渐增大并伴局部疼痛,难以愈合,溃烂面积4 cm × 4 cm,伴血性渗出.

目的 探讨多西他赛联合卡培他滨姑息治疗在晚期乳腺癌患者中的疗效及对患者生存期的影响.方法 选取我院收治的晚期乳腺癌女性患者74例,随机分为对照组和研究组,对照组采用多西他赛姑息治疗,研究组采用多西他赛联合卡培他滨姑息治疗,对比观察两组患者的治疗效果、不良反应及生存情况.结果 研究组患者缓解率为75.7％、对照组为45.9％,研究组明显高于对照组(P<0.05);两组患者恶心呕吐、口腔溃疡、骨髓抑制、脱发等不良反应的发生率无显著差异(P>0.05);研究组患者生存时间、无疾病进展生存期以及1年生存率均明显高于对照组(P<0.05).结论 多西他赛联合卡培他滨姑息治疗晚期乳腺癌可缓解临床症状,提高临床疗效,延长生存期且副反应未明显增加.

Objective To explore the clinical efficacy of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiation therapy (3D-CRT) in the treatment of patients with massive primary liver cancer (PLC). Methods From January 2009 to January 2015,147 unresectable massive PLC(tumor size≥10 cm) patients in our hospital were divided into TACE plus 3D-CRT group (n=63) and TACE group(n=84) according to different treatment methods. Curative effects in the two groups were compared,and the adverse reaction during treatment period were recorded. Results The effective rate was 65.1% in the TACE plus 3D-CRT group,significantly higher than 40.5% in the TACE group (P<0.05);The 6-month,1-year and 2-year survival rates were 84.1%,55.6% and 27.0%,respectively,in the TACE plus 3D-CRT group,and 59.5% (P<0.05),38.1% (P<0.05) and 19.1% (P>0.05),respectively,in the TACE group;The adverse reactions in the two groups were not significantly different. Conclusion TACE combined with 3D-CRT therapy for unresectable massive PLC has good clinical efficacy.

Objective To explore the therapeutic effect of Chinese herbal medicine for prevention and treatment of acute toxicity reaction of concurrent chemoradiation in patients with locally advanced nasopharyngeal carcinoma.Methods 80 cases of locally advanced nasopharyngeal carcinoma were randomly divided into an observation group of 40 cases treated Chinese herbal medicine combined with concurrent chemoradiation and a control group of 40 cases with only concurrent chemoradiation.Two group received intensity modulated radiotherapy besides weekly cisplatin chemotherapy.Curative effects and acute toxicity reaction of the two groups were compared.Results All cases received over 95% of radical radiation dose.2 cases (5.0%) of observation group postponed the radiation,significantly lower than 22.5% in the control group(P<0.05).Of observation group,80.0% of patients could be treated according to the plan of chemotherapy,significantly higher than 40.48% in the in the control group(P<0.05).The overall response rats was 100.0% in the two groups.The complete response rat was 85.0% in the observation group,higher than 77.5% in the control group,but there was no significant differences.The Ⅲ~Ⅳrat of oral mucositis,dermatitia,gastrointestinal toxicity and bone marrow suppression were 12.5%,10.0%,7.5% and 10.0% in experiment group,significantly lower than 35.0%,32.5%,27.5% and 30.0% in the control group(P<0.05).Conclusions Chinese herbal medicine can relieve acute toxicity reaction of concurrent chemoradiation in patients with locally advanced nasopharyngeal carcinoma and improve patients compliance.

<正>横纹肌肉瘤(rhabdomyosarcoma,RMS)是儿童和青少年最常见的软组织肿瘤,但在成人中少见,且腺泡状横纹肌肉瘤(alveolar rhabdomyosarcoma,ARMS)更是多见于青少年。现将本院收治的1例全身多发性ARMS的临床表现、病理特征及治疗效果报告如下。1病案摘要患者女性,19岁。2010年12月发现背部及左乳皮下包