交互式教学方法在肿瘤科护理实习教学中的应用

探讨交互式教学方法在肿瘤科护理实习教学中的应用效果。方法:选取医院肿瘤科临床实习的63名护生,随机将其分为甲乙组,分别实施传统教学模式与交互式教学方法,比较两组护生的实习效果。结果:乙组的实习效果明显优于甲组,两组间差异均具有统计学意义(P<0.05)。结论:交互式教学方法在肿瘤科护理实习教学中的应用效果显著,能拉近师生之间的关系,提高护生的健康教育能力和满意度,从而提升其综合素质水平,值得在临床上推广和应用。

Management of neuroendocrine carcinomas of the pancreas (WHO G3): A tailored approach between proliferation and morphology

Neuroendocrine carcinomas(NEC) of the pancreas are defined by a mitotic count > 20 mitoses/10 high power fields and/or Ki67 index > 20%, and included all the tumors previously classified as poorly differentiated endocrine carcinomas. These latter are aggressive malignancies with a high propensity for distant metastases and poor prognosis, and they can be further divided into small- and large-cell subtypes. However in the NEC category are included also neuroendocrine tumors with a well differentiated morphology but ki67 index > 20%. This category is associated with better prognosis and does not significantly respond to cisplatin-based chemotherapy, which represents the gold standard therapeutic approach for poorly differentiated NEC. In this review, the differences between well differentiated and poorly differentiated NEC are discussed considering both pathology, imaging features, treatment and prognostic implications. Diagnostic and therapeutic flowcharts are proposed. The need for a revision of current classification system is stressed being well differentiated NEC a more indolent disease compared to poorly differentiated tumors.

SURGICAL TREATMENT OF SPINAL TUMOR(ANALYSIS OF 32 CASES)

With the advance of spinal surgery in the last decade,surgical treatment of spinal tumors has been no longer limited to simple laminectomy.The principles of surgical treatment of spinal tumors include:(1) anterior approach for the anterior lesion and posterior approach for the posterior lesion;(2) combined anterior and posterior approach for extensive lesions and(3) internal fixation for spinal stability.32 cases of spinal tumors were treated on the basis of the above guiding principles and 84%(27/32) showed excellent or good results.

An Overview of CyberKnife Radiosurgery

Stereotactic radiosurgery is a non-invasive procedure that utilizes precisely targeted radiation as an ablative surgical tool. Conventional radiosurgery devices, such as the Gamma Knife, rely upon skeletally attached Stereotactic frames to immobilize the patient and precisely determine the 3D spatial position of a tumor. A relatively new instrument, the CyberKnife (Accuray, Inc., Sunnyvale, CA), makes it possible to administer radiosurgery without a frame. The CyberKnife localizes clinical targets using a very accurate image-to-image correlation algorithm, and precisely cross-fires high-energy radiation from a lightweight linear accelerator by means of a highly manipulable robotic arm. CyberKnife radiosurgery is an effective alternative to conventional surgery or radiation therapy for a range of tumors and some non-neoplastic disorders. This report will describe CyberKnife technology and oncologic applications in neurosurgery and throughout the body.

SURGICAL TREATMENT AND PROGNOSIS OF BRONCHIAL CARCINOID TUMOR

In order to understand the effect of surgery in the treatment of the bronchial carcinoid tumor and the factors affecting prognosis, 18 cases of bronchial carcinoid tumor are presented, including 5 cases with Cushing's syndrome. There were lobectomy in 10, lung wedge resection in 3, excision of intraluminal tumor of bronchus in 3, exploratory thoracotomy in 2 cases. No operation death. Pathological examination revealed 14 cases were typical carcinoid tumor and 4 cases were atypical carcinoid tumor. By 2-13 years follow-up . 3 , 5 and 10 years survival rate were 82% , 78%and 70% respectively. Bronchial carcinoid tumor is often confused with small cell carcinoma of lung, the correct diagnosis can be obtained by light microscopic, electron microscopic and immunohistochemistry studies. Those patients accompanied with ectopic-ACTH secretion always have Cushing,s syndrome , resection of tumor can produce gho result. Proper operation method depends on the location of the tumor and patient's extent of cardiac and pulmonary reserve.Atypical carcinoid tumor had high malignancy and poor prognosis. The size of tumor, lymph node involvement and adjuvant therapy seem no definite effect on the patients' survival rate.

Appendiceal mucocoeles and pseudomyxoma peritonei

Mucocoele of the appendix occurs when obstruction of the appendiceal lumen results in mucus accumulation and consequent abnormal dilatation. The most impor- tant aetiology, from a surgical perspective, is either mucinous cystadenoma or cystadenocarcinoma. In the latter, a spontaneous or iatrogenic rupture of the mucocoele can lead to mucinous intraperitoneal ascites, a syndrome known as pseudomyxoma peritonei. Optimal management of mucoceles is achieved through accurate preoperative identification and subsequent careful resection. We report two cases and subsequently discuss the clinical presentation of mucocoeles, their association with pseudomyxoma peritonei and an optimal management of both conditions.

Clinical analysis of abdominal aorta block in operation of gynecologic tumor

Objective:To evaluate the clinical effects of the abdominal aorta block in controlling haemorrhage during operations of the gynecologic tumor. Methods: From July 1965 to January 2005. we collected patients (n = 49) of gynecologic tumor complicated with haemorrhage during operations, who were divided into 3 groups: preventive blocking group (PG, n=12), treatment blocking group (TG, n = 20) used abdominal aorta block technique with sterilized cotton band and silica gel tube, and control group (CG, n = 17) which were used the regular haemostatic methods, such as ligature, suture and ribbon gauze packing. During operations, the vital signs including the amount of bleeding and transfusion were measured. Results: Compared with the CG, the amount of bleeding and transfusion in the PG and TG decreased significantly (P<0. 01). After using the technique, 32 cases of haemorrhage were controlled completely. All patients finished operation smoothly in the end and the vital signs were stable. The vision field of operation was clear and the operating time was shortened dramatically (3. 0 h vs 5. 7 h and 3. 8 h vs 5. 7 h, P< 0. 01). No complications caused by the block occurred in the post-operation. Conclusion: Lower abdominal aorta block is safe and effective in controlling haemorrhage during operations of the gynecologic tumor.

Transthoracic En-bloc Esophagectomy

In patients with esophageal carcinoma surgical resection remains the standard of curative treatment. For locally advanced tumors (pT1sm–pT3) transthoracic esophagectomy with extended lym- phadenectomy is the standard surgical procedure since it o?ers a complete removal of the primary tumor and possible lymph node metastases. This surgical resection is appropriate for squamous cell but also adenocarcinoma of the esophagus because both histological entities demonstrate a lymphatic spread to the abdominal compartment and the upper mediastinum. In-hospital mortality rates are between 6% and 9%; anastomotic leakage and pulmonary complications mainly contribute to postoperative morbidity. In terms of 5-year survival the transthoracic procedure o?ers a better prognosis compared to the transhiatal resection. 五笔字型计算机汉字输入技术

RESPONSE OF EARLY STAGE BULKY CERVICAL SQUAMOUS CARCINOMA TO PREOPERATIVE ADJUVANT CHEMOTHERAPY

Objective To investigate the potential role of preoperative adjuvant chemotherapy on early stage cervical squamous carcinoma with bulky tumor. Methods One hundred and forty-five patients with cervical squamous cancer stagesⅠb-Ⅱa were investigated, among which17 patients with bulky tumors (≥4 cm) were managed by cisplatin-based chemotherapy for 1-2 courses followed by radical hysterectomy and pelvic lymphadenectomy (BC group). The change of tumor size, pelvic lymph nodes metastasis, cervical wall invasion, the involvement of surgical specimen margin, and the blood loss during operation were assessed after opera-tion and compared with those in 51 patients with bulky tumors (BN group) and 77 patients with small local tumors (S group) who underwent surgery directly. Results (1) The tumor size of 17 patients in BC group were decreased in various degrees after chemotherapy, with 13 pati-ents of clinical effectiveness (76.47%). And the responsiveness pertained to neither histological differentiation nor size of local tumors. (2) Post-operative histology has showed that patients in BC and BN group have higher incidence of lymph node metastasis and deep cervical infiltration (5/68 and 3/68, respectively) than in S group (1/77 and 1/77, respectively) while with no statistical significance. (3) Blood loss during operation in BC group was less than BN and S group. (4) Seventeen patients, including those underwent surgeries of vaginal prolongation and/or ovarian transposition, appeared disease-free survival within the follow-up time. Conclusions Most of patients with bulky early stage cervical squamous carcinoma are sensitive to cisplatin-based chem-otherapy, which could greatly reduce local tumor size and in turn facilitate the following operation by well controlling blood loss.

Surgical management of gallbladder sarcomatoid carcinoma

AIM:To study the behavior as well as optimal treatment of gallbladder sarcomatoid carcinoma, we reviewed the results of treatment of gallbladder sarcomatoid carcinoma from Chang Gung Memorial Hospital. METHODS:From 1987 to 2005,six patients were diagnosed with gallbladder sarcomatoid carcinoma and treated at our institution.Tumor staging was based on 2002 revised tumor-node-metastasis(TNM)staging for gall bladder cancer from the American Joint Committee on Cancer.The clinical presentation,laboratory data and preoperative workup were reviewed retrospectively. RESULTS:Five patients were female and one was male.The age ranged from 51 to 66 years(median, 58 years).Surgical procedures included three curative resections,two palliative resections and one biopsy. There were two surgical complications(33.3%)and one case of surgical mortality(16.7%).The followup time ranged from 30 d to 5 mo.The median survival was 2.5 mo.The prognosis was extremely poor,even after curative resection and postoperative chemotherapy. CONCLUSION:The prognosis of gallbladder sarcomatoid carcinoma was not dependent on TNM stage and was always dismal.The clinicopathological features were different from those of gall bladder cancer.

SURGICAL TREATMENT OF GYNECOLOGIC MALIGNANCES IN PATIENTS 70 YEARS OF AGE AND OLDER

Objective.T o assess the viability of surgical procedures on gynecologic malignant patients o f70years age and older.Methods.Between September1,1983to June30,1 999,57gynecologic malignant patients aged70years and older were treated by surgical procedures.A retrospective study was perf ormed.All patients were analyzed for preexisting medical conditions,length of hospital stay,morbidi-ty,and mortality.Results.Thirty-four patients had a n extensive surgical procedure,while a local surgical procedure was done in23 patients.Forty-one patientshad one or more preexisting medical i llnesses.Minor surgical morbidity occurred in24patientsand majo r surgical morbidity occurred in6patients.There were no differen ces in the types of surgical procedures,mean hospital stay,preexisting medical illness and postoperative complications between the two groups of patients70 to75year older and over age75.The major postoperative complications all occ urred in the extensive surgical procedure group that were higher as compared wit h local operation and postoperative mean stay was also significant-ly length in former group.Conclusions.The extensive surgical procedure can be performed fo r elderly patients with gynecologic malignances.Careful preoperative evaluatio n,monitoring,and meticulous postoperative care are vital to the success.

Surgical salvage therapy of anal cancer

AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively.Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments.RESULTS:Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation.Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5-245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5-27) months. Six patients had a long-term survival.CONCLUSION:Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N2-3 tumors.

Colorectal cancer in geriatric patients: Endoscopic diagnosis and surgical treatment

AIM: To investigate the prevalence of colorectal cancer in geriatrie patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatrie patiente with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatrie patients is demonstrated.

Clinical Research of a Modified Midfacial Degloving in a Maxillectomy (with a Report of a Typical Case)

OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows： 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report： 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery

PARAPETROSAL PRESIGMOID APPROACH FOR PETROCLIVAL TUMORS

Objective To discuss the operative technique of parapetrosal presigmoid approach for patients with petroclival tumors and its outcome. Methods 16 petroclival tumors have been microsurgical treated with parapetrosal presigmoid approach and the clinical data were analysed retrospectively. Results In all patients, 9 had meningiomas, 3 epidermoid cysts, 2 pontine gliomas, and 2 schwannomas. Total resection was performed in 12 patients, subtotal resection in 3, and near subtotal resection in 1. Temporary post-operative cranial nerve paresis occurred in 3 patients but no CSF leakage and mortality ever occurred. Conclusion This approach is simpler and safer than other more extensive transpetrosal approaches. It can expose sufficiently the petroclival regions and facilitate tumor removal and provides good clinical outcome.

Analysis of the therapeutic effect of surgical treatment for the gastrointestinal tumor

The gastrointestinal tumor is a disease with the high incidence in our country, and the researches in our country currently on the treatment of the disease are increasingly deep-going. The disease has gradually received widespread attention in the medical field, and the treatment program of the disease and the operational program also made a lot of experts devoted into the relevant researches. This paper cites some practical examples to briefly elaborate the curative effect of the surgical operations on the gastrointestinal tumors and has carried out the summary, hoping to provide certain references for the related researches.

Criticalities in randomized controlled trials on HIPEC for ovarian cancer

Since the 1990 s, many oncological surgery groups around the world started to apply hyperthermic intraperitoneal chemotherapy(HIPEC) to the different peritoneal spread cancers. The rationale of the application of HIPEC after surgery is to complete the cytoreductive procedure. This combined treatment has now been successfully applied to many different intra-abdominal neoplasms. However, the treatment of peritoneal surface malignancies and the administration of HIPEC still lack high graded evidence data, especially in ovarian cancer. Experimental data exists about every step of the treatment of peritoneal spread ovarian cancer but unfortunately they have not yet been translated into phase Ⅲ clinical randomized trials. Moreover, treatment protocols differ between different centers. A systematic review of published randomized trial protocols was performed. HIPEC techniques are miscellaneous and not yet standardized. Well structured phase Ⅲ randomized trials among specialized centers are needed to investi-gate the effi cacy of this therapeutic approach, as well as technical details that may contribute to the standardization of the procedure and limit morbidity and mortality. In particular, new criteria are mandatory to uniformly stage the disease, to objectively evaluate the extension of cytoreduction and consequently the residual disease, to decide the best method of performing hyperthermia and to perfuse drugs. Moreover, pharmacokinetic and pharmacodynamic studies are urgently needed to assess the best type and dose of anticancer drugs.

The clinical features of thoracic stomach cancer after surgical treatment for esophageal carcinoma

Objective:Postoperative recurrence of esophageal carcinoma was the main factor that affect the patients' survival and quality of life.This study mainly investigated the clinical features of thoracic stomach cancer (TSC) after surgical treatment for esophageal carcinoma.Methods:We retrospectively reviewed 51 cases of postoperative TSC in our hospital (Henan Province Tumor Hospital,Zhengzhou,China).Results:The 51 (10.97%) of all 465 cases that underwent endoscope after surgical treatment for esophageal carcinoma in our hospital were TSCs.There were 13 cases with complicating anastomotic recurrence.The locations of 46 cases (90.2%) were the same as the primary cancer.The 48 cases were squamous cell carcinomas and 3 cases were adenocarcinomas after esophagectomy for esophageal carcinoma.Endoscopic manifestations were puffiness-infiltrating type at 39.2% (20/51),massive type at 15.7% (8/51),ulcerative type at 7.8% (4/51) and ulcerative infiltrating type at 3.9% (2/51) and stenotic type etc.Conclusion:The incidence of TSC after surgical treatment for esophageal carcinoma is high.The main cause was that the local residual cancer invaded gastric wall.The gastroscopic features of TSC are different from those of gastric cancer.Regular review with endoscopy in postoperative esophageal carcinoma patients was a major way to diagnose TSC.

Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018

Objectives:To investigate the focuses and trends of the studies on pediatric palliative care(PPC)and provide directions for future research.Methods:Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods,including co-word analysis,biclustering analysis,and strategic diagram analysis.The included papers were divided into three groups based on the publication time,including 2004-2008,2009-2013,and 2014-2018.Results:A total of 1132 papers were published between 2004 and 2018,and there were 293 papers published between 2004 and 2008,396 between 2009 and 2013,and 443 between 2014 and 2018.There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018,including 12 between 2004 and 2008,13 between 2009 and 2013,and 17 between 2014 and 2018.Conclusion:Studies on PPC were making progress,with the increasing number,expanding scope,and uneven global distribution.Integration palliative care into pediatrics,cancer treatments in pediatric oncology,education methods on PPC,and establishment of professional teams were the major themes during 2004e2008,then the themes changed into establishing interventions to enhance the quality of life of the patients and parents,building professional-family relationship,and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills,end-oflife decision making,and guidelines making on PPC during 2014-2018.Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas,training programs on communication skills,family support and guideline making are worth studying in the future.

The Microscopic Surgical Treatment for Tumor of Posterior Cranial Fossa in Children

OBJECTIVE To analyze and discuss about the clinicalcharacteristics, pathological types, surgical modalities andtechniques, and postoperative complications in children withtumor of posterior cranial fossa .METHODS Retrospective study was conducted on 102 cases ofpediatric tumor of posterior cranial fossa, admitted and treated inour hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment. Fifty-eight were male and 44 cases were female. The age ranged from 9months to 14 years old, with an average of 6.1 ± 0.5 of age. CranialCT or MRI examination was conducted before and after thesurgery on all patients.RESULTS The primary manifestations for this group of patientswere increased intracranial pressure and/or ataxia. Postoperativepathological diagnoses showed: 46 cases of medulloblastoma, 43cases of astrocytoma, 11 cases of ependymoma (including 1 caseof degenerative ependymoma), 1 case of dermoid cyst, and 1 caseof teratoma. In this group of the patients, radical surgery wasused in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large section was performed on 3 cases.There were no deaths from surgery reported. Ninety-one casesshowed significant symptomatic improvement when comparedwith preoperative conditions, while 11 cases showed either noimprovement or more severely affected afterward. For 6 cases,postoperative ventriculoperitoneal shunt was performed within7 days to 2 months after the surgery. Sixty-three patients gainedfollow-up for 3 to 60 months in duration. Thirty-nine patientsregained normal life and were able to learn well, while there were7 patients who could not live normally on their own. During thefollow-up period, there were 17 cases of recurrence and 7 casesof death. In 23 cases of medulloblastoma in children with age of3 years old or above, 2 cases who underwent surgical removal ofintracranial ependymoma received small dosage of postoperativeX-ray radiotherapy on the the brain and spinal cord. Nine casesof medulloblastoma in children under age of 3 and 17 cases ofastrocytoma diagnosed after the surgery received chemotherapyof Carmustine.CONCLUSION Medulloblastomas and astrocytomas werethe most common types of pediatric tumor of posterior cranialfossa, right followed by ependymoma, and dermoid cysts andteratomas were rare. Early correct diagnosis, proper selection ofappropriate surgical modality and the surgical margin, propertreatment of postoperative complications, and the selecting rightradiotherapy or chemotherapy were the key factors in influencingthe prognostic outcome of children with tumor of posterior cranialfossa.