Evaluation the effect of fertility-preserving surgery on young patients with malignant ovarian tumors

Objection:To evaluate the impact of fertility-preserving surgery and adjuvant chemotherapy on survival and fertility of young patients with ovarian malignant tumors.Methods:Retrospective analysis of 39 patients with ovarian malignant germ cell tumors,23 patients with malignant epithelial tumors and 4 patients with sexual cord mesenchymal tumors receiving conser-vative treatments.Results:Two patients lost follow-up(we do not statistics them).Fifty-nine among 64 patients were alive up to now(92.19%).The overall survival rate for ovarian epithelial malignancies,malignant germ cell tumors and sexual cord mes-enchymal tumors were 95.45%,89.47% and 100% respectively.Fifteen patients received second operation and recurrence was found in 6 patients.Among the 59 surviving patients,53 patients have normal menstruation.Thirteen patients among 20 patients who want to pregnant have 15 pregnancies and 9 successful deliveries.Conclusion:The management of fertility-preserving surgery on patients with ovarian malignant germ cell tumors,whatever the FIGO staging is,is a safe option.For patients with ovarian epithelial carcinomas,fertility-preserving surgery only confined to low-stage(stage I),low-grade(G1),and patients who want keep fertility function seriously.Cisplatinum-based combination chemotherapy is necessary.Standardized chemotherapy has no affection on fertility function.

Clinical Application Significance of Nutritional Support Therapy in Patients with End-stage Malignant Tumor

To analyze the effect of nutritional support on clinical efficacy in patients with end-stage malignant tumors.Sample data collection was conducted from April 2015 to July 2017.54 patients with end-stage malignant tumors were enrolled in the study.They were divided into reference group(n=27)and experimental group(n=27)by double-blind method.Conventional treatment was used in the reference group,while nutritional support therapy was used in the experimental group.The treatment effects of the two groups were compared.Post-treatment effect of the experimental group and the reference group was compared using the parameters including total adverse reaction value,cancer-related fatigue score,quality of life,A/G,AS:AL,alkaline phosphatase(ALP),blood urea nitrogen(BUN),anorexia score,ALB,and uric acid(UA).The parameters such as A/G,AS:AL,ALP,BUN,anorexia score,ALB,and UA were also used to compare between pre-and post-treatment.The value of P<0.05 was used to indicate the statistical significance of the test.Conclusion:Nutritional support therapy had a superior effect in patients with end-stage malignant tumors.

Safety and efficacy of metallic stent for unresectable distal malignant biliary obstruction in elderly patients

AIM To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.METHODS Of 272 patients with unresectable distal malignant biliary obstruction, 184 patients under the age of 80 were classified into Group A, and 88 subjects aged 80 years or more were classified into Group B. The safety of metallic stent insertion, metal stent patency period, and the obstruction rate were examined in each group.RESULTS In Group B, patients had a significantly worse per-formance status, high blood pressure, heart disease, cerebrovascular disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher(P < 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779(1-965) d; 252.000 ± 35.998(1-618) d in Group A and 269.000 ± 47.885(1-965) d in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 82 of the 272(30.15%) patients; in 53/184(28.80%) patients in Group A and in 29/88(32.95%) of those in Group B, showing no significant difference between the two groups. Procedural accidents due to metal stent insertion occurred in 24/272(8.8%) patients; in 17/184(9.2%) of patients in Group A and in 7/88(8.0%) of those in Group B, with no significant difference between the two groups, either.CONCLUSION These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.

Microsatellite instability and expression of DNA mismatch repair genes in malignant astrocytic tumors from adult and pediatric patients

Microsatellite instability (MSI) is used as a molecular marker for defective DNA mismatch repair (MMR) genes.We report here alterations of MSI in 15 malignant astrocytomas (WHO grade Ⅲ) and glioblastomas (GBM; WHO grade Ⅳ) of pediatric patients (2-21 years) and 12 GBM from adults (44-68 years) by comparative analysis of BAT25/BAT26 loci and 10 other microsatellite markers. High-level microsatellite instability (MSI-H) occurred in 4 of the 15 pediatric cases (26.7%) and in 1 of the 12 adult GBM cases (8.3%). Low-level mi-

Huge pelvi-abdominal malignant inflammatory myofibroblastic tumor with rapid recurrence in a 14-year-old boy

Inflammatory myofibroblastic tumor(IMT) is an uncommon benign neoplasm with locally aggressive behavior but malignant change is rare.We report an unusual case of pelvic-abdominal inflammatory myofibroblastic tumor with malignant transformation in a 14-year-old boy presenting with abdominal pain and 9 kg body weight loss in one month.Computed tomography revealed a huge pelvi-abdominal mass(30 cm),possibly originating from the pelvic extraperitoneal space,protruding into the abdomen leading to upward displacement of the bowel loops,downward displacement of the urinary bladder,massive central necrosis,a well-enhanced peripheral solid component with prominent peritumoral vascularity.Subsequent examination confirmed the computed tomographic findings.Histopathologic examination revealed proliferative epitheloid and spindle cells,inflammatory cell infiltration and high mitotic counts.Immunohistochemistry was strongly positive for anaplastic lymphoma kinase and revealed a high proliferative index(ki-67 = 40%).DNA sequencing and electronic microscopy further confirmed the primitive fibroblastic cell phenotype of the tumor and a final diagnosis of inflammatory myofibroblastic tumor with malignant transformation was established.Rapid tumor recurrence was noted 20 d after radical tumor resection.To our knowledge,this is the largest documented case of IMT in a pediatric patient and the first report of IMT with malignant transformation originating from the pelvic extraperitoneal space.

Effect of kanglaite injection and docetaxel in treating advanced stage esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients

Objective:To investigate the effect of Kanglaite injection combined with docetaxel in advanced esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients.Method:A total of 130 patients with advanced esophageal cancer admitted in our hospital from October 2014 to July 2017were selected and divided into two groups according to the time of admission, 65 cases in each group, set as observation group and control group, all patients were treated with conventional radiotherapy (cisplatin combined with 5-fluorouracil), the observation group was given Kanglaite injection combined with docetaxel on the basis of this, while the control group only was given docetaxel treatment, the treatment period was 6 weeks, tumor markers, VEGF and immune function of both group after treatment were compared.Result: After treatment, the levels of carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9) and carcino-embryonic antigen (CEA) in the observation group were lower than those in the control group, the difference was statistically significant;VEGF level in the observation group after treatment was lower than the control group, the difference was statistically significant;After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group, while the levels of CD8+ in the observation group was lower than those in the control group, the difference was statistically significant.Conclusion: Kanglaite injection combined with docetaxel in the treatment of elderly patients with advanced esophageal cancer is better, effectively reducing the level of tumor markers and vascular endothelial growth factor, improve immune function, it isworthy of clinical application.

低分子肝素钙联合逐级加压弹力袜预防妇科恶性肿瘤患者术后下肢深静脉血栓的临床研究

目的探讨低分子肝素钙联合逐级加压弹力袜预防妇科恶性肿瘤患者术后下肢深静脉血栓(DVT)的临床效果。方法选取2022年1—12月于赣南医学院第一附属医院经外科手术治疗的180例妇科肿瘤患者作为研究对象,按照随机数字表法分为对照组与研究组,每组90例。对照组予低分子肝素钙进行常规治疗,研究组在对照组基础上联合逐级加压弹力袜治疗。比较两组血清学指标、凝血功能指标、血流速度、下肢周径及术后DVT发生情况。结果干预后,研究组血小板计数、纤维蛋白原、D-二聚体水平均低于对照组,差异有统计学意义(P<0.05)。干预后,研究组活化部分凝血活酶时间、凝血酶原时间、凝血酶时间均长于对照组,下肢血流峰速、血流平均速度均快于对照组,差异有统计学意义(P<0.05)。干预后,研究组下肢周径短于对照组,术后下肢DVT发生率低于对照组,差异有统计学意义(P<0.05)。结论低分子肝素钙联合逐级加压弹力袜治疗经外科手术的妇科肿瘤患者,有助于预防术后DVT形成,改善机体血流状态,值得临床推广应用。

恶性肿瘤病人人文护理质量评价体系的构建

目的:构建恶性肿瘤病人人文护理质量评价体系。方法:通过查阅文献,结合文献筛选结果及专家小组讨论结果形成恶性肿瘤病人人文护理质量评价体系初稿,采用改良后的德尔菲法对初稿内容进行修订并形成恶性肿瘤病人人文护理质量评价体系终稿,运用层次分析法进行一致性检验。结果:2轮专家函询问卷回收率分别为76%和97%,专家权威系数为0.893,2轮专家函询肯德尔和谐系数为0.090~0.095(P<0.05),第1轮专家函询重要性均分为4.21~4.92分,变异系数为0.05~0.20,满分比为42%~92%。第2轮专家函询重要性均分为4.30~4.92分,变异系数为0.06~0.18,满分比为43%~92%。最终形成包括4个一级指标、17个二级指标、67个三级指标的恶性肿瘤病人人文护理质量评价体系,层次分析结果表明各层次指标矩阵均通过一致性检验。结论:恶性肿瘤病人人文护理质量评价体系的构建具有科学性,为提高恶性肿瘤病人人文护理质量,需强化非技术性人文关怀技能,建立家庭友好型长期护理保险制度,倡导病人自我护理,突出政府责任。

肺癌恶性胸腔积液来源肿瘤细胞的小鼠PDX模型构建及实验验证

目的·构建肺癌患者恶性胸腔积液(malignant pleural effusion,MPE)肿瘤细胞来源的肿瘤异种移植(patientderived tumor xenograft,PDX)模型,并进行实验验证。方法·从基因表达综合数据集(Gene Expression Omnibus,GEO)下载人肺癌伴MPE单细胞转录组测序公共数据GSE131907和人肺癌实体瘤单细胞转录组测序公共数据GSE203360,对数据进行聚类、差异基因本体功能富集分析,明确应用MPE建模的可行性。同时收集肺癌患者的MPE样本,经离心、裂解红细胞等富集细胞操作后,将其植入非肥胖型糖尿病重症联合免疫缺陷(non-obese diabetic/severe combined immunodeficient,NOD/SCID)小鼠皮下,待移植瘤生长至1000 mm³时进行瘤体传代及保存。对稳定传代移植瘤进行组织病理学检测,通过苏木精-伊红染色(hematoxylin-eosin staining,H-E染色)观察细胞组织形态,免疫组织化学法(immunohistochemistry,IHC)检测肺癌标志物表达情况。结果·经单细胞数据分析发现MPE中肿瘤细胞的增殖功能更强,提示MPE中肿瘤细胞PDX建模或具备更佳成瘤效果;共收集35例肺癌MPE样本,成功构建13例PDX模型,成功率达37.14%;在组织病理学检测中,H-E染色可见移植瘤组织细胞异型性明显,IHC检测显示细胞角蛋白7(cytokeratin 7,CK7)、甲状腺转录因子1(thyroid transcription factor-1,TTF1)和天冬氨酸蛋白酶A(Napsin A)等肺癌标志物均呈阳性表达。结论·通过富集肺癌患者MPE中的肿瘤细胞,成功构建了更为简便高效、可实时动态建模的PDX模型。该模型保留了肺癌患者肿瘤细胞的恶性特征及蛋白表达特性,为肺癌伴MPE患者的基础研究和临床用药指导提供了重要的实验模型工具。

持续气道正压通气在老年妇科恶性肿瘤手术患者中的应用效果

目的探讨持续气道正压通气(CPAP)在老年妇科恶性肿瘤手术患者中的应用效果。方法将75例老年妇科恶性肿瘤手术患者根据术后治疗方式的不同分为对照组(n=39,鼻导管联合面罩氧疗)和研究组(n=36,CPAP治疗),比较两组患者的生命体征[平均动脉压(MAP)、心率(HR)、动脉血氧饱和度(SaO_(2))]、炎症因子指标[白细胞介素(IL)-8、IL-10及肿瘤坏死因子(TNF)-α]及并发症发生情况。结果治疗后,两组患者MAP、HR均明显低于本组治疗前,SaO_(2)均明显高于本组治疗前,研究组患者MAP、HR均明显低于对照组,SaO_(2)明显高于对照组,差异均有统计学意义(P﹤0.01)。治疗后,两组患者IL-8、TNF-α水平均明显低于本组治疗前,IL-10水平均明显高于本组治疗前,研究组患者IL-8、TNF-α水平均明显低于对照组,IL-10水平明显高于对照组,差异均有统计学意义(P﹤0.01)。研究组的并发症总发生率为5.56%,低于对照组患者的20.51%,差异有统计学意义(P﹤0.05)。结论老年妇科恶性肿瘤患者术后采用CPAP治疗,能稳定患者的生命体征,减轻炎症反应,防止低氧血症,具有一定的临床应用价值。

恶性肿瘤临终病人生命末期尊严体验的质性研究

目的:了解恶性肿瘤临终病人生命末期的尊严体验,为改善照护质量提供参考依据。方法:采用目的抽样方法选取2022年7月—2023年8月在杭州市4所三级医院住院的18例恶性肿瘤临终病人,对其尊严体验进行半结构式访谈,采用内容分析法进行资料分析,提炼主题。结果:恶性肿瘤临终病人的尊严体验归纳为3个主题:对尊严的理解、尊严受损的因素、尊严得到维护的因素。结论:医护人员可通过改善工作态度、提升临床照护质量、多学科协作、实施个性化照护、建立良好的社会支持系统改善恶性肿瘤临终病人的尊严体验,提升生命末期的生存质量。

恶性肿瘤患者姑息治疗面临的生命伦理难题及破解之道

姑息治疗作为治疗恶性肿瘤最为特殊的方式,不仅有利于提高患者的生命质量和生命价值,缓解患者及其家属的身心痛苦,而且可以帮助患方减轻经济负担并有效避免医疗卫生资源的浪费。然而,在姑息治疗服务实际推进过程中却面临死亡尊严、心理照护需求、患者自主决策权利等多方面的伦理问题。从生命伦理角度出发,通过剖析不同类型的现实争端,揭示其内在伦理问题,并从捍卫患者尊严、打破传统认知局限、建立医患共同决策的场域模式等方面为构建符合国情的姑息治疗服务模式,维护恶性肿瘤患者的生命权益,提出具体的解决对策。

NRS-2002与PG-SGA在中晚期肿瘤患者营养筛查及评估中的应用

目的 研究欧洲营养风险筛查工具(NRS-2002)与主观整体评估量表(PG-SGA)在中晚期肿瘤患者营养筛查及评估中的应用效果。方法 回顾性分析2020年1月至2022年1月长安医院收治的116例中晚期肿瘤患者的临床资料,根据其在入院后接受的营养状况筛查和评估结果的不同分为营养正常组72例和营养不良组44例。比较两组患者的NRS-2002与PG-SGA评分情况、NRS-2002与PG-SGA不同分组患者的营养指标水平、应用NRS-2002与PG-SGA评分分组后两组患者近期的疗效及远期生存情况;采用Spearman秩相关分析法分析NRS-2002与PG-SGA评分与中晚期肿瘤患者营养指标的相关性。结果 营养正常组患者的NRS-2002与PG-SGA评分分别为(2.07±0.79)分、(3.52±1.01)分,明显低于营养不良组的(4.69±0.74)分、(5.22±1.14)分,差异均有统计学意义(P<0.05);NRS-2002评分中营养正常组患者的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平明显高于营养不良组,PG-SGA评分中营养正常组的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平也明显高于营养不良组,差异均有统计学意义(P<0.05);经Spearman秩相关分析法分析结果显示,NRS-2002和PG-SGA评分均与患者体质量指数、红细胞计数、血红蛋白、白蛋白、前白蛋白呈负相关(P<0.05);营养正常组患者的近期总有效率为94.44%,明显高于营养不良组的70.45%,差异有统计学意义(P<0.05);营养正常组患者的中位生存时间为(12.86±2.27)个月,明显长于营养不良组的(8.26±1.41)个月,生存率为93.06%,明显高于营养不良组的65.91%,而局部复发和远处转移率分别为16.67%、6.94%,明显低于营养不良组患者的34.09%、34.09%,差异均具有统计学意义(P<0.05)。结论 NRS-2002与PG-SGA均是筛查和评估中晚期肿瘤患者营养状态的有效方法,能及时发现患者的营养风险,以便及时对患者营养不良状况进行纠正,值得临床推广应用。

周红光教授运用温滋解毒法辨治肾癌术后经验撷菁

肾癌是泌尿外科发病率及死亡率较高的恶性肿瘤,手术后患者在临床治疗中易出现肾功能不全、心血管疾病等并发症。中医药治疗具有阴阳并调、扶正驱邪、动态调整的特点。文章总结了周红光教授运用温滋解毒法治疗肾癌术后阴阳俱损、痰湿互结证型患者的临证经验。周红光教授认为在治疗中应将温法、滋法和解毒法三法同用,既要帮扶正气,也不忘祛除痰、湿、毒、瘀、热、寒等邪实,文章附验案一则。

GLIM标准在胃肠道恶性肿瘤患者营养不良诊断中的应用研究

探讨全球领导人营养不良倡议(GLIM)标准下胃肠道恶性肿瘤患者营养不良发生情况,并比较其与患者主观整体评估(PG-SGA)在营养不良诊断中的一致性,以期为GLIM标准的临床应用提供依据。方法 选取2021年10月至2022年7月安徽医科大学第一附属医院普外科收治的220例胃肠道恶性肿瘤患者,运用GLIM标准及PG-SGA量表对患者进行营养评估,采用生物电阻抗技术测量患者的人体组成成分,通过Kappa一致性检验分析GLIM标准与PG-SGA量表评估结果的一致性。结果 GLIM诊断出营养不良患者112例(50.9%),其中中度营养不良85例,重度营养不良27例。营养不良的严重程度在不同年龄、体重、体质指数、右上臂围、右小腿围、手握力、体脂、体脂百分比、去脂体重、去脂体质指数、肌肉含量以及骨骼肌方面具有显著差异(P<0.05)。PG-SGA诊断出营养不良患者158例(71.8%),其中85例为中度营养不良,73例为重度营养不良。GLIM标准和PG-SGA量表在诊断营养不良时表现出中等程度的一致性(Kappa=0.548,P<0.001),其受试者操作特征曲线下面积为0.821(95%CI=0.745~0.877);但在区分不同严重程度的营养不良患者时,二者一致性水平相对较低(Kappa=0.344,P<0.001)。结论 GLIM标准与PG-SGA在诊断营养不良时一致性尚可,而在区分中度和重度营养不良时一致性较差,但这并不影响GLIM标准的临床适用性。

160例恶性肿瘤患者疼痛负担及其影响因素研究

目的:探索中医药治疗恶性肿瘤患者的疼痛负担及其影响因素。方法:选取2019年9月至2021年12月中国中医科学院广安门医院等10家中医药三甲医院初次就诊的恶性肿瘤患者临床数据,运用简明疼痛调查量表(BPI)进行疼痛评估,采用多因素回归分析方法探讨疼痛负担的影响因素。结果:160例近期未进行抗肿瘤治疗的恶性肿瘤患者中,62.5%为男性患者,65岁以上的患者为55.6%,75.6%临床分期为Ⅳ期,80.6%患者正在使用阿片类药物;癌症患者在过去24 h疼痛平均程度为4分,疼痛最剧烈程度为6分;在疼痛对功能的干扰方面,总体干扰平均得分为4.94分,活动干扰及情感干扰得分分别为5.11分、4.69分;多因素分析中,正在服用阿片类药物的患者具有更高的疼痛最剧烈程度(β=0.239,95%CI为0.267~1.285,P=0.003)。结论:寻求中医药治疗的恶性肿瘤患者疼痛负担总体处于轻至中度水平,疼痛对患者总体功能、活动、情感干扰产生中度影响;正在服用阿片类药物的患者出现爆发痛时疼痛程度更高。

恶性肿瘤病人希望水平与社会支持的相关性探讨

目的:探究恶性肿瘤病人希望水平现状及其影响因素。方法:选取2021年7月—8月在襄阳市某三级甲等医院肿瘤科的149例病人为研究对象,采用一般资料调查表、Herth希望量表(HHI)、社会支持评定量表(SSRS)对其进行调查,并采用相关性分析、多元线性回归分析恶性肿瘤病人希望水平的影响因素。结果:恶性肿瘤病人的Herth希望量表总分为(35.77±5.27)分、社会支持总分为(40.72±7.68)分;148例(99.33%)恶性肿瘤病人希望水平总体处于中高等水平;Pearson相关分析显示,恶性肿瘤病人的希望水平与社会支持呈正相关(r=0.47,P<0.001);多元线性回归分析结果显示,社会支持是恶性肿瘤病人希望水平的影响因素。结论:恶性肿瘤病人的希望水平处于中高等水平,医护人员需注重提升病人的社会支持程度,为其制定合理的护理措施,提升其希望水平。

2010—2020年广西某三甲医院恶性肿瘤住院死亡病例分析

目的分析广西某三甲医院恶性肿瘤住院死亡病例的分布特征及死因构成情况,为医院管理和学科建设提供参考。方法基于广西医科大学附属肿瘤医院2010年1月1日—2020年12月31日期间收集的1834例恶性肿瘤住院死亡病例的相关临床信息数据,对恶性肿瘤住院患者的病死率趋势、性别及年龄分布、死因顺位等情况进行分析。结果恶性肿瘤住院患者的病死率呈下降趋势,男性病死率高于女性(χ^(2)=141.487,P<0.001),不同年龄组恶性肿瘤住院患者病死率差异有统计学意义(χ^(2)=389.637,P<0.001),且随年龄的增加而升高。死因顺位前10位依次为肺癌、肝癌、结直肠癌、乳腺癌、胃癌、淋巴瘤、食管癌、鼻咽癌、卵巢癌、胰腺癌。结论医院恶性肿瘤住院患者的病死率逐步下降,其中肺癌、肝癌是主要死亡病种。医院可进一步优化医疗资源配置和加强相关学科建设,以持续提升医疗质量,降低肿瘤病死率。

攀枝花市某三甲医院2017—2021年恶性肿瘤病例分析

目的分析攀枝花市某三甲综合医院2017—2021年恶性肿瘤出院患者信息,了解恶性肿瘤的构成及死亡相关情况,为恶性肿瘤防治、医疗资源合理配置提供数据依据。方法使用Excel 2010、SPSS26.0进行数据整理,对2017—2021年所有恶性肿瘤出院患者及恶性肿瘤死亡患者的构成比、增长率及性别等进行统计分析。结果近5年前10顺位恶性肿瘤的收治类型较稳定,2021年分别为肺恶性肿瘤、肝恶性肿瘤、甲状腺恶性肿瘤、直肠恶性肿瘤、胃恶性肿瘤、乳腺恶性肿瘤、白血病、结肠恶性肿瘤、前列腺恶性肿瘤、淋巴癌。近5年除女性特有的乳房和卵巢恶性肿瘤外,不同性别的恶性肿瘤死亡例数前10位构成不同(P<0.05)。结论恶性肿瘤住院患者逐年增加,病死率逐年下降,并存在性别差异,应结合地区特征进行重点恶性肿瘤防治。

妇科恶性肿瘤根治术后病人早期活动证据总结

目的:检索并总结妇科恶性肿瘤根治术后病人早期活动的最佳证据,为临床实践提供参考。方法:按照“6S”证据模型,检索数据库及网站中妇科恶性肿瘤根治术后病人早期活动的相关文献,检索时间为2017年1月-2022年10月。结果:共纳入12篇文献,其中指南6篇、临床决策1篇、专家共识2篇、文献综述3篇。从术前宣教、术后镇痛、术后恶心呕吐、管路管理、早期活动5个方面总结了21条证据。结论:证据应用时应结合临床实际情况及妇科恶性肿瘤病人意愿,选择性运用最佳证据,促进妇科恶性肿瘤根治术病人术后康复。