We have performed guided chemoembolization on 84 patients of moderate and advanced carcinoma of liver using adriamycin lipiodol emulsion (A/L) since 1986. Result showed that the rate of improvement of symptoms was 86.1%, in 75% cases the AFP were decreased and in 79.2% the size of tumor were reduced. The mean survival time was 10.3 months which was much higher than that of the control group (5.6 months,Plt;0.001). THe survival rates of 1/2,1,2,3 year were 89.3%,43.4%,13.5% and 3.8% respctively that were significantly higher than those of the control group (51.2%, 11.5%,0) (Plt;0.01). Three patients underwent secondary resection after using A/L chemoembolization ans gelatin spinge central embolization with a longer survival rate. This may be a good method of treatment to the nonresectable liver cancers and may also be an easy way for postoperative observation.
Objective To evaluate the short-term cl inical outcomes of metal-on-metal total hi p resurfacing arthroplasty in treating osteonecrosis of the femoral head (ONFH) in young and middle-aged patients and to compare with patients of hip osteoarthritis at the same period. Methods From July 2006 to October 2008, 33 patients (45 hips) with ONFH (ONFH group) and 39 patients (45 hips) with osteoarthritis (osteoarthritis group) were treated with metal-on-metal total hipresurfacing arthroplasty. In ONFH group, there were 18 males (27 hips) and 15 females (18 hips) with an average age of 42.7 years (range 19-58 years), including 22 left hips and 23 right hips. The causes were trauma (4 cases), glucocorticoid (25 cases), drugs (2 cases), alcohol (1 case), and psoriasis (1 case). According to Steinberg classification, there were 10 hips at stage III, 18 hips at stage IV a, 13 hips at stage IV b, and 4 hips at stage IV c. The Harris score was 52.0 ± 4.6. The disease course was 1-12 years. In osteoarthritis group, there were 26 males (30 hips) and 13 females (15 hips) with an average age of 47.1 years (range 42-65 years), including 17 left hips and 28 right hips. The causes were degenerative arthritis (23 cases), trauma (11 cases), and ankylosing spondyl itis (5 cases). The Harris score was 57.0 ± 3.8. The disease course was 3-17 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention without compl ications of infection and thrombosis of deep vein of lower extremities. The patients were followed up for 26 months in ONFH group and 28 months in osteoarthritis group. Femoral neck fracture occurred in 1 case of osteoarthritis group after 4 months, who received total hip arthroplasty; no compl ication of prosthesis loosening, dislocation, incision infection, osteonecrosis, and bone absorption occurred in other patients. At last follow-up, the Harris scores were 93.0 ± 5.5 in ONFH group and 94.0 ± 2.4 in osteoarthritis group, showing no significant difference between two groups (P gt; 0.05); but there were significant differences between pre- and post-operation (P lt; 0.01). Conclusion The cl inical short-term outcomes ofmetal-on-metal total hip resurfacing arthroplasty to treat ONFH are satisfactory. It can achieve similar outcomes to that ofosteoarthritis group. More cases and long-term follow-up are needed to investigate long-term cl inical outcomes.
Objective To assess the efficacy and safety of neoadjuvant intraarterial chemotherapy in the treatment of advanced cervical cancer. Methods We searched databases including PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBMdisc, conference articles, and Ongoing Controlled Trial for Random Controlled Trials and quasi-Random Controlled Trials up to October 2009. For homogeneous studies, we performed meta-analysis. Results Fifteen studies involving 1 331 participants with advanced cervical cancer were included. Twelve studies showed that the efficacy of the NIC group was 6.72 times than that of the traditional group. Several studies showed that the survival rate of the NIC group was better than that of the traditional group. Meanwhile, the adverse events of the NIC group were fewer than those of the traditional group. Conclusions The results of this system review show that, NIC which is more effective than conventional treatments with less adverse reactions provides a new adjunct for clinical treatment of advanced cervical cancer . However, due to the current clinical treatment for the disease is the coexistence of multiple chemotherapy program status, the higher quality and more focused clinical research which will compare NIC with a variety of conventional chemotherapy are needed in the further.
目的 应用联合微创介入方法治疗中晚期肝癌并探讨其疗效。方法 我院自1998年4月至2008年11月期间采用联合介入治疗的方法，即行经皮股动脉插管肝动脉化疗栓塞术，同期行B超引导下经皮穿刺瘤内乙醇注射(PEI)治疗中晚期肝癌175例。结果 左肝动脉行肝动脉化疗栓塞7例，右肝动脉行125例，单行化疗而未栓塞43例； 175例均行B超引导下PEI。随访6～28个月，平均19.3个月，死亡15例，其中8例死于肝功能衰竭，7例死于上消化道大出血伴肝癌广泛转移。29例存活6～12个月； 146例存活13～28个月，其中27例存活已超过26个月。结论 对于不能切除的中晚期肝癌采用联合介入治疗，因其具有操作简单、疗效可靠、经济、安全等优点，值得临床推广应用。
ObjectiveTo systematically review the effects of Liujunzi decoction on improving the quality of life (QOL) of patients with advanced primary liver cancer. MethodsDatabases including MEDLINE, EMbase, SCI, The Cochrane Library (Issue 2, 2014), CBM, CNKI, VIP and WanFang Data were searched electronically from inception to July 2014 to collect randomized controlled trials (RCTs) about Liujunzi Decoction for advanced primary liver cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 7 RCTs involving 458 patients were included. The results of meta-analysis showed that the Liujunzi decoction group had significantly higher stability of QOL (RR=0.76, 95%CI 0.64 to 0.91, P=0.002), Karnofsky Performance Score (KPS) (MD=4.47, 95%CI 2.74 to 6.21, P<0.00001) and effective rate of TCM syndrome (RR=0.73, 95%CI 0.62 to 0.86, P=0.0001) than those of the control group. ConclusionCurrent evidence shows that Liujunzi decoction could improve the QOL and KPS, and relieve TCM syndromes of patients with advanced primary liver cancer, especially for those with spleen deficiency-syndrome. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
ObjectiveTo investigate strategies and efficacy of surgical treatment of advanced hepatic alveolar echinococcosis. MethodsThirty-six patients with advanced hepatic alveolar echinococcosis who underwent surgical treatment in our hospital from August 2014 to March 2016 were selected, who were divided into three groups:radical hepatectomy group (15 cases), quasi-radical hepatectomy group (17 cases), and palliative surgery group (4 cases). The operative time, intraoperative blood loss, postoperative complications, and metastasis were analyzed among these three groups. ResultsThe operative time, intraoperative blood loss, and rate of postoperative complications had no significant differences between the radical hepatectomy group and the quasi-radical hepatectomy group. No patient had postoperative recurrence in the radical hepatectomy group. The hepatic portal residual lesion was enlarged for 1 case and the intrahepatic and extrahepatic lesions were stable for the other patients in the quasi-radical hepatectomy group. In the palliative surgery group,the retroperitoneal lesions enlargement was seen in 2 cases and the lesions around the abcess grew progressively in 1 case. ConclusionIndividualized treatment accompanied with multiple-disciplinary treatment and damage-control surgery concept could benefit optimally to patients with advanced hepatic alveolar echinococcosis.
ObjectiveTo evaluate the prognostic value of preoperative inflammatory indexes in patients with local-advanced esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical and prognostic data of 150 local-advanced esophageal squamous cell carcinoma patients who were treated by esophagectomy in Guangyuan Central Hospital from July 2014 to July 2015. There were 128 males and 22 females with average age of 62.23±8.48 years. The optimal cutoff value was determined by receiver operation characteristics (ROC) curve analysis. Patients were grouped according to the optimal cutoff values (NLR=3.49, PLR=152.28, MLR=0.36). Log-rank test, and multivariate Cox logistic regression modelling were used to assess the simultaneous influences of prognostic factors for survival outcomes after esophagectomy.ResultsThe patients with higher ratio (NLR>3.49, PLR>152.28, MLR>0.36) had significantly shorter median progression free survival (PFS) and lower postoperative recurrent rate than those of the patients with lower ratio. The stratified analyses found that thelymph node staging and postoperative recurrent rate were positively correlated with the higher ratio. However, the tumor differentiation was negatively correlated with it. In univariate analyses, patients with preoperative NLR>3.49, PLR>152.28 and MLR>0.36 had a poorer prognosis. Furthermore, in multivariate analyses we found MLR>0.36 was also significantly associated with a decreased postoperative recurrent rate (HR=12.945, 95%CI 2.31 to 72.548, P=0.00).ConclusionsThe preoperative NLR, PLR and MLR are useful prognostic markers in patients with stage ⅢA-ⅣA esophageal squamous cell carcinoma who conducted esophagectomy.
ObjectiveTo explore the safety and effectiveness of transarterial chemoembolization (TACE) combined with lenvatinib and programmed cell death protein-1 (PD-1) antibody in the conversion resection for intermediate and advanced unresectable hepatocellular carcinoma (HCC), and to provide new treatment strategies for the treatment of intermediate and advanced unresectable HCC. MethodThirty-eight intermediate and advanced unresectable HCC patients treated at West China Hospital of Sichuan University from October 2020 to June 2021 were prospectively included in our study, all patients treated with TACE + lenvatinib + PD-1 antibody, and the clinical data of these 38 patients were summarized. ResultsThe last evaluation time for the 38 patients was October 20, 2021. According to the mRECIST standard for tumor efficacy evaluation, the objective response rate was 84.2% (32/38), the disease control rate was 94.7% (36/38); the conversion success rate based on imaging was 55.3% (21/38), the actual conversion resection rate was 52.6% (20/38). The incidence of adverse events was 100%, of which 22 patients had grade 3 adverse events, and there was no ≥ grade 4 adverse events. All patients were followed up, the follow-up time was 16–52 weeks, and the median follow-up time was 33.5 weeks. During the follow-up period, only two patients had tumor progression, of which one patient died due to disease progression, and there was no postoperative recurrence. ConclusionsLenvatinib combined with TACE and PD-1 antibody is safe for the treatment of intermediate and advanced unresectable HCC. Triple therapy can achieve satisfactory conversion resection rate of intermediate and advanced unresectable HCC, which will provide a new treatment strategy for it.