EVALUATION OF STAPLING TECHNIQUE IN SURGICAL TREATMENT OF ESOPHAGEAL AND CARDIAC CANCER

Objective: To investigate an effective method to prevent anastomotic leakage and stenosis, evaluating the role of stapling technique in surgical treatment of esophageal and cardiac cancer. Methods: The stapling technique was used in end-to-side esophagogastromosis in surgical treatment of esophageal and cardiac cancer. Results: 128 patients were so treated. One patient died of superior mesenteric artery embolism, and the operative mortality was 0.78%. No anastomotic leakage or stenosis was found in this series. The other complications included postoperative thoracic cavity bleeding in 1 (0.78%), myocardial infarction in 2 (1.56%), stress ulcer of stomach in 1 (0.78%), and gastroparsis in 4 (3.12%). The overall morbidity rate was 4.7%. Conclusion: Using stapler to perform end-to-side esophagogastromosis has the advantages of being simple and safe, cutting short the operation time, and preventing leakage and stenosis. It is an ideal technique in the treatment of esophageal and cardiac cancer.

Relationship of telomerase activity and p53 gene mutation in cardiac cancer

Objective： To study the relationship of the telomerase activity and the p53 gene mutation in cardiac cancer. Methods： Telomerase activity and the p53 gene mutation were detected in 46 case of cardiac cancer, peri-cancerous and 30 case of normal mucosa by TRAP-ELISA and PCR-SSCP. Results： The rate of expression of telomerase activity in cardiac cancer, peri-cancerous and normal mucosa were 82.61% （38/46）, 43.48% （20/46） and 13.33% （4/30） respectively. The rate of Exon5→,8 of p53 gene mutation were 39,13% （18/46）, 4.35% （2/46） and 0.00% respectively. There was significant difference between group cancer and without cancer （P 〈 0.01）. Mean of A^- value of telomerase is 1.89：1：0.41 in cancer group and were 1.49：1： 0.43, 0.54：1：0.45 respectively in peri-canvcerous and normal mucosa, there were significant differences in cancer group and group of without cancer （P 〈 0.05）. The rate of p53 gene mutations in group of expression of telomerase activity was 44.74% （17/38）, and 12.50% （1/8） in without expression of telomerase activity. There were significant differences between the two groups. Conclusion： The rate of expression of telomerase activity and mean of A^- value of telomerase in cardiac cancer were obviously higher than without cancer, which indicating telomerase activity was closely related with the occurrence of cardiac cancer. P53 gene mutation in cardiac cancer were higher than the tissue of without cancer, and the rate of p53 gene mutation in telomerase activity were obviously higher than the group of without cancer. This shows the p53 gene mutation can loss of function of suppressing cancer and prompt telomerase activity and cause the cardiac cancer.

Cost-benefit analysis of screening for esophageal and gastric cardiac cancer

In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC program in Linzhou of Henan Province between 2005 and 2008. Howerer, the cost-benefit of the EDETEC program is not very clear yet. We conducted herein a cost-benefit analysis of screening for esophageal and cardiac cancer. The assessed costs of the EDETEC program included screening costs for each subject, as well as direct and indirect treatment costs for esophageal and cardiac severe dysplasia and cancer detected by screening. The assessed benefits of this program included the saved treatment costs, both direct and indirect, on esophageal and cardiac cancer, as well as the value of prolonged life due to screening, as determined by the human capital approach. The results showed the screening cost of finding esophageal and cardiac severe dysplasia or cancer ranged from $2707 to $4512, and the total cost on screening and treatment was $13 115-$14 920. The cost benefit was $58 944-$155 110 (the saved treatment cost, $17 730, plus the value of prolonged life, $41 214-$137 380). The ratio of benefit-to-cost (BCR) was 3.95-11.83. Our results suggest that EDETEC has a high benefit-to-cost ratio in China and could be instituted into high risk areas of China.

Recent advances in breast cancer radiotherapy:Evolution or revolution,or how to decrease cardiac toxicity?

Radiation therapy has a major role in the management of breast cancers.However,there is no consensus on how to irradiate and on volume definitions,and there are strong differences in strategies according to different centers and physicians.New treatment protocols and techniques have been used with the principal purpose of decreasing lung and heart toxicity and adapting radiation treatment to patients' anatomy.There is evidence that indicates internal mammary chain radiotherapy should be used carefully and that high quality techniques should be used for decreasing the dose delivered to the heart.This review of the literature presents the state of the art on breast cancer radiotherapy,with special focus on the indications,techniques,and potential toxicity.

CARDIAC ARRHYTHMIA AFTER LUNG CANCER SURGERY －－ANALYSIS OF 140 PNEUMONECTTOMY CASES

Among 808 surgically resected lung cancer cases at Shanghai Chest Hospital during 1991 to 1992, 140 of them (17.3%) underwent Pneumonectomy. Of the 140 cases:124 male, 16 female; aged 27-74 yrs, 35.7% elder (60 and over), preoperative abnormal EKG was found in 38 cases, operative mortality was 4.3%. The histopathological diagnosis were: squamous 43.6%, adeno. 36.4%, small cell 8.6%, mixed type 11.4%. The pTNM stages: stage I 2.9%, II 17.1%, IIIa 55.0%, IIIb 21.4%, IV 3.6%.Postoperatively, arrhythmia occuried in 76 cases, with an incidence of 54.3%. Of the 76 arrhythmias, atrial fibrillation was seen in 7 patients, atrial premature beats in 2, supraventricular tachycardia in 1, and sinus tachycardia in 66. The incidences of cadiac arrhythmia during the postoperative day (DO), first day (D1), D2, D3,and D4 were 48.7%, 35.5%, 7.9%, 4.0%and 2.6%respectively. Conclusion: the cardiac arrhythmia is the most common complication after pneumonectomy for lung cancer surgery. The major causes were incisional pain, hypovolemia due to blood loss and respirative insufficiency due to anomia. The perioperative prevention and treatment for arrhythmia were also discussed.

Amiodarone Therapy for Cardiac Arrhythmias: Is It Associated with the Development of Cancers?

Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.

Cardiac mass in a patient with colorectal cancer:“Not all that glitters is gold!”

When performing echocardiography in a 74-year-old woman admitted with non ST elevation myocardial infarction and concomitant colorectal cancer(CC),a dense calcification of the mitral annulus was detected. Differential diagnosis between secondary metastasis and other etiologies of cardiac masses was essential for staging and therapeutic decision-making.Multimodality imaging with echocardiography alongside a computed tomography scan and cardiac magnetic resonance was crucial for the final diagnosis of caseous calcification of the mitral annulus(CCMA).CCMA is briefly reviewed and some possible explanations for the previously undescribed association of CC with CCMA are suggested.

Malignant cardiac metastasis from breast cancer: Imaging contribution to surgical attitude

Metastasic cardiac disease from the breast is rarely diagnosed in the lifetime. It has a poor prognosis and limited management. Both echocardiography and computerized tomography (CT) should be the first imaging studies in suspicion of this entity. Other diagnostic methods should be based on the possibilities of treatment although a histopathological analysis of the metastasic mass is needed to confirm the diagnosis. Magnetic resonance imaging (MRI) could be useful to complete a morphological and functional evaluation in case of surgical removal.

Impact of Cardiac Dose on Overall Survival in Lung Stereotactic Body Radiotherapy (SBRT) Compared to Conventionally Fractionated Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC)

Purpose: To examine possible association between heart irradiation and Overall Survival (OS) in lung SBRT patients and to compare observed associations with cardiac toxicity models previously derived in LA-NSCLC patient studies. Materials and Methods: 197 Patients treated with lung SBRT at Mayo Clinic Arizona were selected for this IRB-approved study. Multivariate Cox model with Akaike Information Criterion (AIC) was used to select patient specific covariates associated with OS. Heart dosimetry was represented by VD indices, which is a percentage of volume exposed to dose D or greater. Multivariate Cox models with patient specific covariates and single VD index per model was used to find a range of doses which were predictive for OS. A digital subdivision of the heart was further used to determine the spatial distribution of doses which were predictive for OS. A coarse subdivision divided heart into 4 segments, while the fine subdivision divided heart into 64 segments. Knowledge constrained Fused Lasso operator was used to derive a more complete model which correlated heart dosimetry with OS. Results of statistical analysis were compared to predictions of a model of cardiac toxicity in LA-NSCLC patients. Results: Higher age (p < 0.001), higher stage (p < 0.001) and squamous cell histology (p = 0.001) were associated with reduced OS. Whole heart DVH analysis did not reveal associations between heart irradiation and reduced OS. Coarse subdivision of the heart into four segments revealed that the irradiation of two inferior segments of the heart with low doses was associated with reduced OS, V2Gy in the right-inferior segment (HR = 1.012/1%, p = 0.02), and V1Gy in the left-inferior segment (HR = 1.01/1%, p = 0.04). Maximum dose in the right-inferior segment of the heart was also associated with reduced OS (HR = 1.02/Gy, p = 0.02). Fine subdivision of the heart into 64 segments revealed that approximately 25% of heart volume in the inferior part of the heart (15/64 segments), when irradiated to doses in the 1 Gy - 5 Gy range, were predictive for reduced OS (HR = 1.01/1%, p = 0.01). A previously derived model of cardiac toxicity in LA-NSCLC patients did not predict a reduction of OS due to heart irradiation in lung SBRT patients, because of relatively low doses to the heart in most lung SBRT patients. Conclusions: Doses lower than 5 Gy in the inferior segments of the heart may be associated with reduced overall survival in patients treated for lung lesions with SBRT. Stage and histology of the disease, as well as patients’ age, were also associated with overall survival. Comparisons of cardiac toxicity patterns in LA-NSCLC patients and lung SBRT patients suggest different etiology of cardiac toxicity in the two groups.

Cardiac Safety with High Cumulative Dose of Pegylated Liposomal Doxorubicin in Patients with Metastatic Breast Cancer Previously Treated with Conventional Anthracyclines

Introduction: The treatment of metastatic breast cancer (MBC) is still challenging. Many studies documented the efficacy of pegylated liposomal doxorubicin (PLD) in patients with MBC, but there is a limited data about the cardiac safety with high cumulative dose (HCD) of PLD. Aim of the work: We conducted this trial to outline the cardiac safety of HCD of PLD in patients with MBC who previously received conventional anthracyclines. Methods: During the period of nine years (January 2011 to December 2019). We extracted the data of the patients with MBC receiving PLD at Medical Oncology Department, South Egypt Cancer Institute, Assiut University. These included patients’ demographics and therapeutic data including the full data of PLD, prior conventional anthracyclines, prior trastuzumab, and prior radiotherapy. Also, data about comorbidities as well as cardiac and other toxicities of PLD were obtained. The data was analysed using SPSS v. 21. Results: For all 81 eligible patients, the mean age was 43.9 years (±standard deviation (SD) 13.2). The mean cumulative dose of PLD was 378.4 mg/m2 (± SD of 250.2) and a range of 100 - 1200 mg/m2. About thirty-one (38.3%) patients received high cumulative dose (400 mg/m2 or more), while the remaining 50 patients did not. The decline in left ventricular ejection fraction (LVEF) was relatively rare;and of low grade. Grade 2 decline in LVEF occurred in only two patients who received high cumulative dose of PLD, and only one patient who did not reach HCD (p = 0.555). Grade 3 or 4 decline in LVEF did not occur in patients either with or without HCD. Regarding other toxicities, there was a significant increase in incidence of all grades palmar plantar erythrodysesthesia (PPE) in patients who received HCD of PLD when compared to those who did not reach the HCD (38.7% versus 16% respectively;p = 0.021). Conclusion: Our study concluded that the use of PLD seems to be a justified agent in the treatment of MBC who previously treated by conventional anthracyclines in the adjuvant, metastatic or both settings, even in patients reaching the cumulative dose of conventional anthracycline.

miR-25a-5p促进乳腺癌蒽环类药物治疗所致的心肌损伤

目的:探讨蒽环类药物诱导心肌毒性的机制和新的治疗靶点。方法:106例乳腺癌患者根据超声心动图检查鉴别出肿瘤治疗相关心功能障碍,分为心功能障碍组及对照组。通过微阵列技术高通量筛选两组患者差异表达miRNA。体外构建蒽环类药物诱导H9C2心肌细胞损伤模型,通过调控miR-25a-5p的表达,观察miR-25a-5p在蒽环类药物诱导H9C2心肌细胞损伤中的作用。结果:乳腺癌患者中9例发生肿瘤治疗相关心功能障碍,并从两组患者中鉴定出9个差异表达的miRNA。其中8个miRNA在体外模型中进一步得到验证,尤其是miR-25a-5p。通过上调miR-25a-5p,可进一步加重蒽环类药物诱导心肌细胞氧化损伤。结论:miR-25a-5p促进蒽环类药物诱导的心肌损伤,可能是新的生物标志物及治疗靶点。

右美托咪定联合七氟烷吸入麻醉对肝癌患者根治术后心功能及胃肠道功能的影响

目的探究右美托咪定联合七氟烷吸入麻醉对肝癌患者根治术后心功能及胃肠道功能的影响。方法选取2021年1月至2022年7月海南医学院第二附属医院肿瘤科收治的行根治术和淋巴结清扫术治疗的肝癌患者共64例为研究对象,根据随机数字表法随机分为试验组(n=32)和对照组(n=32),对照组患者行丙泊酚麻醉,试验组患者采用右美托咪定联合七氟烷吸入麻醉。记录患者肠道恢复时间、血清肠型脂肪酸结合蛋白(I-FABP)水平等指标及患者不良反应发生情况。结果试验组患者肠鸣音恢复、首次肛门排气、首次自主排便、住院时间均早于对照组(P<0.05),术后2 h I-FABP水平均低于对照组(P<0.05);肠内营养开始时间晚于对照组(P<0.05);T1及T2时,两组患者心率(HR)、每搏输出量(SV)、心输出量(CO)、心脏指数(CI)、左心室舒张末期内径(LVEDD)均较T0降低,且试验组高于对照组(P<0.05),两组左心室射血分数(LVEF)均较T0升高,试验组低于对照组(P<0.05);T3时,两组肌酸磷化酶-同功酶MB(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)、凝血活酶时间(aPTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原浓度(Fbg)、血浆血栓素B2(TXB2)、血小板α颗粒膜蛋白(GMP)及血小板最大聚集率(PAGmax)水平均较T0时升高,且试验组患者除PAGmax水平高于对照组外,其余指标均低于对照组(P<0.05);试验组患者不良反应发生率低于对照组(P<0.05)。结论肝癌患者在行根除术治疗中,使用右美托咪定联合七氟烷吸入麻醉能够促进术后肠道功能康复,对心功能保护效果较好。

超声心动图联合血清cTnI、GDF-15检测对老年乳腺癌患者术后化疗心脏损伤的评估价值

目的探究超声心动图联合血清心肌肌钙蛋白I(cTnI)、生长分化因子-15(GDF-15)对老年乳腺癌(BC)患者术后化疗心脏损伤的评估价值。方法选取北京市大兴区人民医院2019年9月至2022年8月收治的112例老年BC术后应用表柔比星为主的化疗患者为研究对象,按照是否发生心脏损伤将其分为:心脏损伤组(40例)和心脏未损伤组(72例)。评估超声心动图对老年BC患者术后化疗心脏损伤的诊断价值;采用酶联免疫吸附法检测两组血清cTnI、GDF-15水平;采用受试者工作特征曲线评估血清cTnI、GDF-15对老年BC患者术后化疗心脏损伤的诊断价值;以心脏损伤判定标准为金标准,评价超声心动图、血清cTnI、GDF-15及三者联合对老年BC患者术后化疗心脏损伤的诊断价值。结果超声心动图诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为77.50%、88.89%、84.82%;心脏损伤组患者血清cTnI、GDF-15水平均明显高于心脏未损伤组(P<0.05);血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的曲线下面积分别为0.864、0.834,截断值分别为221.88 ng/L、8.06 ng/L,灵敏度分别为75.00%、80.00%,特异度分别为94.44%、87.50%,准确度分别为87.50%、84.82%;超声心动图联合血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为97.50%、86.11%、90.18%,优于单独诊断。结论超声心动图联合血清cTnI、GDF-15对老年BC患者术后化疗致心脏损伤有较高诊断价值,可有效提高灵敏度、准确度,具有较高特异度。

影像检查对早期检测及评估乳腺癌患者化疗后相关心功能障碍的价值

乳腺癌已发展为全球第一大癌,随着诊治手段的进步,乳腺癌患者生存时间不断延长,但抗肿瘤治疗会引发心脏相关并发症,出现癌症治疗相关心功能障碍(cancer therapy related cardiac dysfunction,CTRCD)。CTRCD始于亚临床心肌细胞损伤,最终发展为有症状的心力衰竭。因此,准确评估CTRCD的发生和严重程度对于肿瘤患者的治疗和康复至关重要。随着医疗技术的不断进步,心脏影像学成为评估和管理心脏健康的关键工具,包括超声心动图、心脏计算机断层扫描(cardiac computed tomography,CCT)、心脏磁共振成像(cardiac magnetic resonance imaging,CMRI)等,在提供心脏结构和功能信息的基础上,组织特定性成像、应变成像、灌注成像等在早期识别和评估CTRCD中发挥关键作用。本文就不同影像检查技术在乳腺癌患者化疗后心功能障碍研究中的进展进行文献综述,重点论述磁共振技术在此方面的进展,以期为早期检测CTRCD提供更为精确的影像生物信息。

贲门癌组织FOXC1、SOX11表达及与病人临床病理特征和预后的关系

目的 观察贲门癌病人癌组织中和癌旁正常组织叉头框C1(FOXC1)、性别决定区Y框蛋白11(SOX11)的表达变化,并探讨二者表达与临床病理特征和预后的关系。方法 收集本院2018年3月~2020年3月期间确诊的94例贲门癌病人,所有病人均行腹腔镜近端胃切除+胃食管吻合术,根据病人3年预后情况分为生存组(54例)和死亡组(40例)。采用免疫组化法检测组织FOXC1、SOX11表达水平,采用Kaplan-Meier法分析贲门癌病人癌组织FOXC1、SOX11表达水平与3年生存率的关系,采用Cox风险回归模型分析贲门癌病人3年预后的影响因素。结果 贲门癌病人癌组织中FOXC1阳性表达率高于正常组织,SOX11阳性表达率低于正常组织,差异有统计学意义(P<0.05)。病理分期Ⅲ+Ⅳ期、组织低分化、有淋巴结转移的贲门癌病人癌组织中FOXC1阳性表达率和SOX11阴性表达率显著高于病理分期Ⅰ+Ⅱ期、组织中/高分化、无淋巴结转移病人(P<0.05)。死亡组病理分期Ⅲ+Ⅳ期、有淋巴结转移、FOXC1阳性表达、SOX11阴性表达病人比例高于生存组(P<0.05)。贲门癌病人癌组织中FOXC1阳性表达病人3年生存率低于FOXC1阴性表达病人(P<0.05);贲门癌病人癌组织中SOX11阴性表达病人3年生存率低于SOX11阳性表达病人(P<0.05)。FOXC1是贲门癌病人3年随访期内死亡的独立危险因素,SOX11是贲门癌病人3年随访期内死亡的保护因素(P<0.05)。结论 FOXC1高表达、SOX11低表达可能参与贲门癌的发生发展,与病人不良预后有重要联系。

贝伐珠单抗联合化疗致晚期结直肠癌患者心脏毒性的真实世界研究

目的 探讨贝伐珠单抗联合化疗对晚期结直肠癌患者心脏指标的影响。方法 选取南昌大学第一附属医院2020年1月1日至2022年12月31日收治的215例晚期结直肠癌患者。根据是否使用贝伐珠单抗将患者分为联合贝伐珠单抗化疗组(A组,138例)和单纯化疗组(B组,77例)。对A组进行亚组分析:根据化疗周期次数划分为两个阶段,随后排除A、B两组中具有既往心血管危险因素的患者,分别记为C组和D组,对其进行亚组分析:比较患者特征、用药前后心肌酶谱、血压及心电图变化情况。结果 1.A、B两组患者临床特征差异无统计学意义(P>0.05)。2.心电图异常率比较:A组明显高于B组(P<0.05);亚组分析表明,C组较D组差异有统计学意义(P>0.05)。3.心肌酶谱变化:A组肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)水平均有所增加,而B组没有明显变化,且两组间CK-MB和LDH差异有统计学意义(P>0.05);亚组分析示:患者治疗第二阶段血压较第一阶段升高明显(P>0.05);C组CK、CK-MB、LDH较D组差异无统计学意义(P>0.05)。结论 贝伐珠单抗导致心脏损伤与使用次数相关,CK-MB、LDH、心电图可作为早期发现心脏损伤的重要检测手段。

血清miR-21、miR-30b对乳腺癌患者术后曲妥珠单抗靶向治疗心脏毒性的预测价值

目的探讨血清miR-21、miR-30b对乳腺癌患者术后曲妥珠单抗靶向治疗心脏毒性的预测价值。方法选取乳腺癌曲妥珠单抗靶向治疗患者138例为观察组,根据是否发生化疗相关心脏毒性事件分为非心脏毒性组和心脏毒性组2个亚组;另外选取同期体检健康女性150例为健康组。比较各组血清miR-21、miR-30b水平和临床资料。采用ROC评估血清miR-21、miR-30b对发生心脏毒性的预测价值,采用多因素Logistic回归分析发生心脏毒性的影响因素。结果观察组血清miR-21高于健康组,而miR-30b低于健康组;心脏毒性组血清miR-21和高血压占比高于非心脏毒性组,而miR-30b和左室射血分数(LVEF)低于非心脏毒性组(P<0.05)。LVEF、miR-21、miR-30b是乳腺癌术后化疗心脏毒性的影响因素(P<0.05)。血清miR-21、miR-30b联合预测乳腺癌术后化疗心脏毒性的诊断效能高于miR-21、miR-30b单独预测(P<0.05)。结论血清miR-21、miR-30b是乳腺癌术后化疗心脏毒性的影响因素,两者联合预测乳腺癌术后化疗心脏毒性的效能更高。

乳腺癌放疗中的心脏保护策略:从分割技术到剂量控制

乳腺癌是女性最常见的恶性肿瘤,其发病率位居女性恶性肿瘤之首。放射治疗作为乳腺癌的重要治疗手段,能够有效降低复发率和死亡率。然而,在放疗过程中,心脏不可避免地暴露于电离辐射中,从而增加心脏毒性的风险,尤其是缺血性心肌病等并发症。因此,在乳腺癌放疗中,如何有效保护心脏并降低其受照剂量成为治疗中的关键挑战。本文将从放疗对心脏的影响、心脏剂量限值、心脏区域自动分割技术以及降低心脏受照剂量的策略四个方面进行探讨,旨在通过多种技术手段实现心脏的有效保护,从而降低心脏并发症的风险,提升患者的长期生存质量。

沙库巴曲缬沙坦防治肿瘤治疗相关心功能不全的效果分析

目的:探讨沙库巴曲缬沙坦治疗肿瘤治疗相关心功能不全(cancer therapy-related cardiac dysfunction,CTRCD)的疗效。方法:汇总分析自建库至2023年3月发表于Pubmed、Web of Science、Cochrane Library、Medline、Embase五大数据库的沙库巴曲缬沙坦治疗CTRCD的所有文献,归纳总结用药时机、剂量、药物疗效等;梳理总结其预防CTRCD的临床研究。结果:使用沙库巴曲缬沙坦治疗CTRCD 3~12个月后,肿瘤患者NYHA心功能从Ⅱ~Ⅳ级改善为Ⅰ~Ⅱ级,LVEF上升幅度为3.0%~37.0%,NTproBNP下降幅度为280.0~65498.0 pg/mL。结论:沙库巴曲缬沙坦治疗CTRCD有效,在改善患者LVEF、GLS等指标方面具有较好的临床应用价值,使肿瘤患者抗肿瘤治疗得以继续、生存期得以延长。

经腹与经左胸贲门癌根治术治疗老年贲门癌的临床效果及对应激反应的影响

目的探究经腹与经左胸贲门癌根治术治疗老年贲门癌的临床效果及对应激反应的影响。方法选取2019年3月—2020年3月黄河科技学院附属医院收治的98例老年贲门癌患者为研究对象,运用随机数表法分为经左胸入路治疗组(经左胸组)和经腹入路治疗组(经腹组),各49例。比较两组患者手术指标、术后疼痛及应激反应情况、并发症发生率、术后1年生存率。结果经腹组手术时间、术后引流量、术中出血量、住院时间分别为(187.79±24.97)min、(299.97±89.97)mL、(65.89±9.15)mL和(11.13±2.98)d,均优于左胸组,差异有统计学意义(t=4.415、3.647、3.700、4.954,P均<0.05)。经腹组运动与静息时视觉模拟评分法评分均低于经左胸组,术后超氧化物歧化酶水平高于经左胸组,C反应蛋白和丙二醛水平低于经左胸组,差异有统计学意义(P均<0.05)。经腹组术后肺部并发症发生率为4.08%,低于经左胸组的16.33%,差异有统计学意义(χ^(2)=4.009,P<0.05);两组其他手术并发症和术后1年存活率对比,差异无统计学意义(P均>0.05)。结论经腹入路治疗可减轻老年贲门癌患者术后疼痛和氧化应激反应,减少并发症的发生。