雷替曲塞联合奥沙利铂治疗老年晚期结直肠癌患者的临床疗效

目的观察雷替曲塞联合奥沙利铂治疗老年晚期结直肠癌患者的临床疗效。方法选取2020—2021年南华大学附属长沙中心医院收治的老年晚期结直肠癌患者60例,依据入院编号的奇偶数分为对照组与观察组,各30例。对照组给予氟尿嘧啶联合奥沙利铂治疗,观察组给予雷替曲赛联合奥沙利铂治疗,2组均以21 d为1个化疗周期,持续治疗2个周期。比较2组临床疗效,治疗前与治疗2个周期后肿瘤标志物[血清糖类抗原(CA)19-9、CA125、CA242、癌胚抗原(CEA)]水平,预期生存期、疾病无进展时间及化疗相关不良反应。结果观察组客观缓解率与对照组比较,差异无统计学意义(63.33%vs.43.33%,χ^(2)=2.411,P=0.121)。治疗2个周期后,观察组血清CA19-9、CA125水平低于治疗前,且观察组血清CA19-9、CA125、CEA水平低于对照组(P<0.01)。观察组预期生存期、疾病无进展时间长于对照组(P<0.01)。观察组营养不良发生率低于对照组(6.67%vs.26.67%,χ^(2)=4.320,P=0.038),2组转氨酶升高、周围神经毒性、中性粒细胞减少、尿素氮升高、感染、血小板减少、贫血、腹泻发生率比较,差异无统计学意义(P>0.05)。结论雷替曲塞联合奥沙利铂治疗老年晚期结直肠癌患者可更有效地降低血清肿瘤标志物,延缓病情进展,进而延长患者生存期,降低药物毒性,安全性较高。

内镜或手术解除恶性消化道口梗阻的差别

Background: The treatment of gastroduodenal outflow obstruction(GOO) caused by malignant diseases represents a significant challenge. Open surgical gastrojeju nostomy (GJ)has been the treatment of choice, but it has high morbidity and mort ality rates. More recently, endoscopic placement of self-expanding metallic ste nts (SEMS) has been proposed and the results of small, preliminary studies are e ncouraging. This study compared technical and clinical success, morbidity, morta lity,and hospital stay in patients undergoing endoscopic and surgical treatment of GOO. Methods: Medical records of 60 consecutive patients with GOO seen betwee n April 1997 and November 2002 were retrospectively reviewed. Because of extreme ly short life expectancy, 13 patients were treated by insertion of a double-lum en nasogastric-jejunal tube. The remaining 47 patients (28 men, 19 women; mean age 73.5 years,range 48-92 years) with unresectable pancreatic (33), gastric(7) , metastatic lymph nodal (4), papillary (2), and biliary (1) tumors were treated by placement of a SEMS(24) or open surgical GJ (23). Results: The technical suc cess rates were similar, but clinical success was lower in the GJ group (92%vs. 56%, p= 0.0067). The SEMS group had a shorter length of hospital stay (3.0 [1. 4] days vs. 24.1 [10.3], p < 0.001). Thirty-day mortality was 30%in the GJ gro up, and 0%in the SEMS group(p = 0.004). Morbidity was higher in the GJ compared with the SEMS group (61%vs. 17%, p= 0.0021). Mean survival was longer in the SEMS group (96.1 [9.6] days vs. 70.2 [36.2] days,p = 0.0165 for a single test of hypothesis; Bonferroni correction for a multiple testing removes this significa nce), consequently,out-of-hospital survival was longer for the SEMS group (93. 2[9.3] days vs. 46.0 [31.5] days, p < 0.001). None of the endoscopic procedures required the assistance of an anesthesiologist or the use of an operating room. Conclusions: The results of this retrospective study suggest that SEMS insertion is better than surgical GJ for palliation of patients with GOO in terms of clin ical success, morbidity, and mortality. Technical success rates were similar. SE MS placement should be proposed as the first-line treatment for relief of GOO. However, a randomized,comparative, prospective study of SEMS vs. laparoscopic GJ is needed.

癌症医疗损害责任鉴定案件50例分析

恶性肿瘤已成为威胁我国乃至全世界人民健康的重大疾病,由于病情复杂,疾病负担大,治疗效果不佳等因素,一直是产生纠纷较多的病种。医疗纠纷发生后,因涉及医学专业问题,往往需要进行鉴定来判定医疗机构是否存在过错,过错与损害后果之间是否存在因果关系等。鉴于鉴定结论在医疗损害赔偿判决中的重要作用,本文通过对50例经过鉴定的司法判例进行回顾性分析,总结恶性肿瘤医疗损害赔偿鉴定及司法判决中存在的问题,探讨进一步完善建议,以期为恶性肿瘤的鉴定和司法判决提供一定参考。

癌症晚期患者主要照顾者的需求调查

目的了解癌症晚期患者的主要照顾者的需求,探讨癌症晚期患者的不同生存期对照顾者需求的影响。方法采用横断面研究设计,通过方便抽样法,将2021年3月至2021年9月四川大学华西第四医院姑息医学科的99例癌症晚期患者的主要照顾者纳入研究,采用主要照顾者一般情况调查表、晚期癌症住院患者家属需求调查表和生存期评价为调查工具进行调查。结果预期生存期<7 d的患者有42例,预期生存期7~30 d的患者有12例,预期生存期30~90 d的患者有16例,预期生存期90~180 d的患者有11例,预期生存期180 d以上的患者有18例。主要照顾者总需求得分(3.6±0.8)分,各维度中以患者症状控制需求得分(4.4±0.9)最高,其次为疾病知识(4.2±0.9)、医护相关行为(4.1±0.9)、临终关怀知识(3.7±1.2)、家属自身健康(3.2±1.2)、丧葬支持(3.1±1.2),以患者心理支持需求得分(2.9±1.3)最低。对于不同预期生存期患者对主要照顾者的需求中,丧葬支持、临终关怀知识、患者心理支持3个维度的需求差异具有统计学意义(P均<0.05)。多重线性回归结果显示预期生存期为90~180 d时,主要照顾者对家属自身健康、疾病知识、丧葬支持、患者心理支持以及患者症状控制的几个维度的需求更大。结论癌症晚期患者的不同生存期对主要照顾者的需求不同。提示医护人员应重视癌症晚期患者照顾者群体,根据患者的不同生存期,有针对性地满足对照顾者各方面需求,提高照顾质量,从而提高患者的生活品质。