目的 探讨内镜下治疗胆管乳头状瘤的价值。方法 6例经病理学检查证实的胆管乳头状瘤患者在行“胆道探查+ T管引流术”后6～8周行胆道镜下高频电刀烧灼术，对术后治疗效果进行评估。结果 6例患者术后胆汁引流量逐渐增多至100～400 ml/d(平均250 ml/d)，胆汁黏稠度明显减轻，黄疸减退。术后随访1～3年，平均2年，3例患者术后黄疸、腹痛明显减轻，至今无复发； 2例在继续治疗中； 1例患者随访半年，T管引流通畅，但因严重肺部感染并发多器官功能衰竭死亡。结论 内镜下高频电刀烧灼治疗胆管乳头状瘤能有效缓解患者的临床症状，明显提高患者的生存质量。
ObjectiveTo explore the clinical manifestations, pathogenesis, prognosis and the therapeutic modalities of the patients with solid tumors combined with remarkable hematologic abnormalities. MethodsGastric cancer in a paitnet was diagnosed by endoscopy as well as pathological biopsy and myeloproliferative neoplasms (MPNs) were excluded through bone marrow examinations. Therefore, the primary and metastatic malignancies were excised. ResultsAlthough surgical operation improved the hematologic changes, the high tumor load caused the poor prognosis. ConclusionThe solid tumors may present with hematologic manifestations which is similar to the symptoms of MPNs; it belongs to the para-neoplastic phenomenon and may be an independent poor prognostic factors.
目的 增加对治疗相关性继发白血病的认识。 方法 报道非霍奇金淋巴瘤治疗后2年继发急性髓细胞白血病M6型1例，结合文献讨论治疗相关性白血病的发病机制、治疗、预后。 结果 1例73岁非霍奇金淋巴瘤患者接受R（Rituxmab，利妥昔单抗）－CHOP环磷酰胺+多柔比星+长春新碱+泼尼松方案规律化学治疗。治疗结束24+个月后，经骨髓涂片及细胞免疫分型诊断为急性髓细胞白血病M6型，染色体检查为：44～48，XY，del（5）（q12q33），-8，-10，der（12）t（4；12）（q11-q12；p13），其一般情况急剧恶化并死亡。 结论 治疗相关性白血病的发生可能与烷化剂等化疗药物使用和免疫受损等有关，利妥昔单抗导致第二肿瘤的发生暂时不能除外。治疗相关性白血病常伴有复杂染色体核型，其病情发展迅速，治疗效果差，生存期明显缩短。Objective To improve the understanding of secondary therapy-related leukemia. Methods The clinical data of one patient with non-Hodgkin lymphoma which transformed into acute myeloid leukemia M6 2 years after chemotherapy were studied. We discussed the pathogenesis, treatment and prognosis of therapy-related leukemia with literature review. Results A 73-year-old patient diagnosed to have non-Hodgkin’s lymphoma accepted R-CHOP chemotherapy.Two years after the treatment, the disease finally developed into acute myeloid leukemia M6 confirmed by cytogenetics, bone marrow morphology and flowcytometry analysis. The chromosome analysis demonstrated complex karyotypes as 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13). His general status deteriorated rapidly and soon after the patient died. Conclusions Occurrence of therapy-related leukemia may be due to the administration of alkylating agents, topoisomerase inhibitors and damage of immune function. Therapy-related leukemia often occurs with complex karyotypes and progresses rapidly with poor treatment response.