Iatrogenic Tumor Implantation

Iatrogenic tumor implantation is a condition that results from various medical procedures used during diagnosis or treatment of a malignancy.It involves desquamation and dissemination of tumor cells that develop into a local recurrence or distant metastasis from the tumor under treatment.The main clinical feature of the condition is nodules at the operation's porous channel or incision,which is easily diagnosed in accordance with the case history.Final diagnosis can be made based on pathological examination.Tumor implantation may occur in various puncturing porous channels,including a laparoscopic port,abdominal wall incision,and perineal incision,etc.Besides a malignant tumor, implantation potential exists with diseases,such as a borderline tumor and endometriosis etc.Once a tumor implantation is diagnosed,or suspected,surgical resection is usually conducted. During the diagnosis and treatment of diseases,avoiding and reducing iatrogenic implantation and dissemination has been regarded as an important principle for surgical treatment of tumors.In a clinical practice setting,if possible,excisional biopsy should be employed,if a biopsy is needed.Repeated puncturing should be avoided during a paracentesis.In a laparoscopic procedure,the tissue is first put into a sample bag and then is taken out from the point of incision.After a laparoscopic procedure,the peritoneum,abdominal muscular fasciae,and skin should be carefully closed,and/or the punctured porous channel be excised.In addition,the sample/tissue should be rinsed with distilled water before surgical closure of the abdominal cavity, allowing the exfoliated tumor cells to swell and rupture in the hypo-osmolar solution.Then surgical closure can be conducted following a change of gloves and equipment.The extent of hysteromyomectomy should as far as possible be away from the uterine cavity.The purpose of this study is to make clinicians aware of the possibility of tumor implantation and to give special attention to avoid,or reduce iatrogenic implantation during a surgical procedure.

Isolated subcutaneous implantation of a borderline ovarian tumor:A case report and review of the literature

Laparoscopy-related tumor implantations of gynecological malignancies into the subcutaneous tissue are rarely diagnosed.We report an interesting case of a 46-year-old female who presented with an abdominal subcutaneous metastasis of a borderline ovarian tumor.The patient received a laparoscopic unilateral adnexectomy for a solid-cystic tumor of the right ovary.Histopathological workup showed a papillary borderline tumor of mucinous type.Nine days later she underwent a hysterectomy,left adnexectomy,appendectomy and omentectomy.Exploration of the peritoneum revealed no intraperitoneal implants.Further exploration showed a non-invasive implant of a borderline tumor in the subcutaneous tissue above the fascia that had no contact to the peritoneum.It is hypothesized that tumor cells may have been implanted during a previous laparoscopy,the most recent of which had been fourteen years prior to her current presentation.Various risk factors for port-site malignancies have been identified.Tumor manipulation and extraction of tumor tissue without a protective bag may contribute to development of trocarsite metastasis.

Inhibitory activity of polysaccharide extracts from three kinds of edible fungi on proliferation of human hepatoma SMMC-7721 cell and mouse implanted S180 tumor

AIM To determine the activities ofpolysaccharide extracts from Flammulina velutipes (Curt. ex Fr. ) Sing (FV), Lentinusedodes (LE) and Agaricus bisporus Sing (AB)on the proliferation of human hepatoma SMMC-7721 cells in vitro and on mouse implanted S-180tumors in vivo.METHODS The polysaccharide extracts were isolated from the fruit bodies of FV, LE and AB by the methods of hot-water extraction, Sevag’sremoval of proteins, ethanol precipitation,trypsin digestion and ethanol fractionalprecipitation. Human hepatoma SMMC-7721 cells were treated with 50 mg/L Polysaccharide extracts, and the mitosis index, mitochondria activity and cell proliferation were detected at different times in both control and experimental groups. The mice with S-180 implanted tumors were injected with the polysaccharide extracts at 24 mg/ kg body weight for 9 d and the tumorweight was measured on the 15th day.RESULTS The mitosis index of hepatoma cells in vitro could be significantly decreased by treatment with the polysaccharide extracts fromthe three kinds of edible fungi (P < 0 .005 ). Thecell numbers and mitochondria activity of SMMC7721 cells treated with polysaccharide extracts were lower than those in control groups (P <0.005). The inhibition rates of polysaccharide extracts against implanted S-180 tumors in mice were 52.8%, 56.6% and 51 .9% respectivelycompared with that in c0ntrol gr0ups.CONCLUSI0N The POIysaccharide extractsfrom the three kinds of edible fungi could inhibitnot only the Cultured malignant cells in vitfO butalso impIanted Sl80 tum0r i0 vivo.

Investigation of Peri-implant Status and Risk Variables for Implant Failure in Body of Maxilla after Oral Tumor Surgery

The aim of this study was to assess the peri-implant parameters and evaluate the clinical status with the survival of dental implants in body of maxilla after treatments of oral tumor. A follow-up examination included 27 patients who underwent the ablative tumor and （or） reconstructive surgery during a 5-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The reasons related to implant failure were studied by comparing the amount of failure with the value of marginal bone resorption, probing pocket depth, and plaque index using statistical t-test. The relationship between smoking and implant failure was analyzed statistically by chi-square test. The results showed among the 112 implants observed after implant loading, 29 have failed with the failure rate being 22.14 %. There was no significant correlation between the peri-implant status and the implant failure （P〉0.05）, however, the association of smoking and implant failure was statistically tested （P〈0.05）. It was suggested that the association of peri-implant status and implant failure in the maxilla after tumor surgery can＇t be statistically tested, however smoking was still a mainly significant factor.

Analysis and Prevention of Failure Causes of Percutaneous Implantable Port for Tumor Chemotherapy

The failure causes of percutaneous implantable port (PIP) for tumor chemotherapy were analyzed and the appropriate preventing measures were put forward. During Feb. 1995 to Feb. 1999, 10 patients with tumor undergoing failure insertion of PIP were retrospectively studied. We placed the PIP in the hepatic artery in 3 patients with liver carcinoma after operation, in the internal iliac artery in 5 patients with colonic or rectal carcinoma after operation and in the left gastric artery in 2 patients with stomach carcinoma after operation. The results showed that in the 10 patients, chemotherapeutic agent effusion around the PIP and local tissue necrosis in 5 cases, infection and ab- scess formation around the PIP in 3 cases, PIP body rupture in one case and the catheter sliding into the internal iliac artery occurred. It was concluded that taking measures during PIP insertion could prevent the occurrence of complications and is beneficial to the implementation of scheduled chemotherapeutic protocol for the patients.

A Totally Absorbable Multilayer PLGA Implant Device Containing Doxorubicin Inhibited Tumor Growth and Metastasis without Systemic Toxicity in Murine Breast Cancer and an Ideal Pharmacological Paradigm for Regional Chemotherapy

We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STID100 that released doxorubicin for 3 weeks in an orthotopic 4T1 breast cancer model in Balb/C mice. This implant starts as a thin doxorubicin-embedded PLGA membrane, and is then rolled into a cylinder containing an air gap between the membrane layers. Its controlled sustained release delivered 2× the amount of the intravenous (IV) equivalent of doxorubicin, inhibited the primary tumor, and prevented lung metastasis. Importantly it did not cause weight loss, splenomegaly, or cardiac toxicity vs systemically administrated doxorubicin. This favorable safety profile is further substantiated by the finding of no detectable plasma doxorubicin in multiple time points during the 3-week period, and low tumor doxorubicin concentration. The implant system delivered to the specification of an ideal pharmacological paradigm might offer a better coverage of the local tumor, significantly preventing metastatic spread with less drug toxicity to many vital organs, compared to the traditional pharmacology of IV route. The profile of STID made it an attractive therapeutic alternative in metastatic tumor prevention, pain management and many other diverse clinical scenarios.

肌骨超声在恶性肿瘤患者行静脉输液港植入术及术后监测中的应用

目的研究肌骨超声在静脉输液港(IVAP)植入术及术后监测中的应用效果。方法选取2020年2月至2022年1月于深圳市龙岗中心医院接受IVAP植入术的216例恶性肿瘤化疗患者作为研究对象,按随机数表法分为观察组和对照组各108例。对照组患者采用传统检测方式进行IVAP植入术的引导及术后监测,观察组患者采用肌骨超声进行IVAP植入术的引导及术后监测。比较两组患者的手术成功率、前期并发症及后期并发症发生情况,同时比较两组患者的满意度和舒适度。结果观察组患者的手术成功率为99.07%,明显高于对照组的91.67%,差异有统计学意义(P<0.05);观察组患者的前期并发症与后期并发症发生率分别为2.78%、4.63%,明显低于对照组的10.19%、14.81%,差异均有统计学意义(P<0.05);观察组患者的满意度和总舒适度分别为98.15%,97.22%,明显高于对照组的91.67%,89.81%,差异均有统计学意义(P<0.05)。结论肌骨超声应用于IVAP植入术及术后监测可提高患者的手术成功率,避免和减少相关并发症发生、发展,提升患者的满意度和舒适度。

恶性肿瘤患儿完全植入式静脉输液港导管相关血栓的发生率及危险因素分析

目的描述恶性肿瘤患儿使用完全植入式静脉输液港过程中导管相关血栓的发生率并分析危险因素。方法用回顾性研究设计,通过便利抽样法,选择2013年2月—2018年11月在广州市某三甲医院儿童肿瘤科接受静脉输液港植入术的419例恶性肿瘤患儿,查阅病历获取患儿的一般资料、疾病资料、手术资料,并从静脉输液港植入术随访至患儿死亡、拔港或至2022年12月期间导管相关血栓发生情况。描述导管相关血栓的发生率和导管使用情况并用χ^(2)检验分析其差异性,采用Kaplan-Meier曲线和Cox风险比例模型分析影响无导管相关血栓时间的危险因素。结果19例患儿完全植入式静脉输液港的中位使用天数为644 d(1~2629 d),导管相关血栓的总体发生率为25.5%。年龄≤3岁、身高≤98 cm、体重≤14 kg、手术时长>30 min、中性粒细胞百分比≤20%的患儿导管相关血栓发生率更高(P<0.05)。单因素分析时,年龄≤3岁、体重≤14 kg、手术时长>30 min、中性粒细胞百分比≤20%是无导管相关血栓时间的危险因素(P<0.05)。多因素分析时,体重≤14 kg(HR=0.676,P=0.051)、手术时长>30 min(HR=2.075,P<0.001)、中性粒细胞百分比≤20%(HR=0.498,P=0.025)是无血栓时间的独立危险因素。结论导管相关血栓是静脉输液港使用过程中常见的并发症,发生率较高但较少影响输液港使用。体重≤14 kg、手术时长>30 min、中性粒细胞百分比≤20%是恶性肿瘤患儿静脉输液港导管相关血栓的独立危险因素,未来需重点关注血栓高风险患儿并缩短手术操作时间,降低血栓发生率。

IL-6对种植体周围炎大鼠牙龈组织中TNF-α表达的影响

目的 探究白细介素(IL-6)对种植体周围炎大鼠牙龈组织中肿瘤坏死因子-α(TNF-α)表达的机制。方法 按照随机数字表法将40只大鼠分为假手术组(sham组)、种植体周围炎大鼠模型组(PI组)、种植体周围炎大鼠模型给予IL-6抑制剂Tocilizumab组(Tocilizumab组)、在Tocilizumab组的基础上给予NF-κB/p65激活剂LPS组(LPS组),每组10只。观察种植体周围软组织袋深度(PPD)、探诊出血(BOP)、出血指数(BI)和牙龈指数(GI)。测量种植体周围骨高度和骨密度(Micro-CT法);检测种植体周围牙龈组织炎症浸润(HE染色);RT-PCR检测种植体周围牙龈组织中IL-6、TNF-α mRNA表达;检测牙龈组织中p-p65蛋白表达(蛋白质印迹法)。结果 与sham组比较,PI组大鼠种植体软组织中PPD(近颊、远颊、近舌、远舌)、BOP、BI和GI均明显增加(P<0.05);与PI组比较,Tocilizumab组大鼠种植体软组织中PPD(近颊、远颊、近舌、远舌)、BOP、BI和GI均明显降低(P<0.05);与Tocilizumab组比较,种植体软组织中PPD(近颊、远颊、近舌、远舌)、BOP、BI和GI均明显增加(P<0.05)。与sham组比较,PI组大鼠种植体骨高度、牙槽骨密度明显降低,IL-6、TNF-α mRNA和p-p65蛋白表达增加(P<0.05);与PI组比较,Tocilizumab组大鼠种植体骨高度、牙槽骨密度明显升高,IL-6、TNF-α mRNA和p-p65蛋白表达低于(P<0.05);LPS组大鼠种植体骨高度、牙槽骨密度低于Tocilizumab组,IL-6、TNF-α mRNA和p-p65蛋白表达高于Tocilizumab组(P<0.05)。结论 IL-6抑制剂可通过抑制牙髓组织中NF-κB通路激活,进而抑制种植体周围炎大鼠牙龈组织中TNF-α释放,从而减轻大鼠种植体周围炎发展。

肿瘤患者植入式静脉输液港非计划性拔管的预防护理专案应用研究

目的探讨实施护理专案降低肿瘤患者植入式静脉输液港非计划性拔管的效果。方法选取2021年11月至2022年4月植入式静脉输液港肿瘤患者65例为对照组,2022年5月至2022年10月植入式静脉输液港肿瘤患者55例为观察组,运用护理专案的方法分析输液港非计划性拔管各类导管相关并发症的原因,实施多学科协作护理专案活动。结果观察组植入式静脉输液港导管相关并发症减少,非计划性拔管发生率低于对照组(P<0.01或P<0.05);观察组植入式静脉输液港自我管理能力低于对照组(P<0.01)。结论多学科协作护理专案能够有效降低肿瘤患者植入式静脉输液港非计划性拔管发生率,提高肿瘤患者对植入式静脉输液港的自我管理能力。

正念减压联合纽曼护理模式在恶性肿瘤粒子植入术患者中的应用

目的探讨正念减压理论联合纽曼护理模式在恶性肿瘤粒子植入术患者中的应用。方法选择2021年8月—2022年8月在医院进行恶性肿瘤粒子植入术治疗的140例患者为研究对象,按照组间基线资料均衡可比的原则分为观察组和对照组,每组70例,对照组采用常规护理干预,观察组采用正念减压联合纽曼护理模式干预,比较两组患者的心理弹性[心理弹性量表(CD-RISC)]、尿失禁程度[尿失禁问卷简表(ICIQ-SF)]、术后引流时间、胃肠功能恢复时间、尿失禁持续时间、住院时间、生活质量[癌症患者生活质量量表(EORTC QLQ-C30)]、并发症发生率。结果干预后观察组CD-RISC评分高于对照组,差异有统计学意义(P<0.05)。干预后观察组ICIQ-SF各维度评分均低于对照组,差异有统计学意义(P<0.05)。干预后观察组患者术后引流时间、胃肠功能恢复时间、尿失禁持续时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。干预后观察组EORTC QLQ-C30中功能领域及总体健康领域评分高于对照组,差异有统计学意义(P<0.05),EORTC QLQ-C30中症状领域评分均低于对照组,差异有统计学意义(P<0.05)。干预后观察组患者并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论将正念减压联合纽曼护理模式应用于恶性肿瘤粒子植入术患者的护理中可改善其心理健康,同时降低尿失禁程度,加快术后恢复,并提高其生活质量,减少并发症的发生。

植入式肿瘤电场治疗胶质母细胞瘤的建模与仿真研究

目的 研究植入式肿瘤电场治疗胶质母细胞瘤的可行性。方法 通过COMSOL有限元仿真,探索相位差、触点设置、电极数量和电压等参数对电场的分布的影响,逐步优化参数,探索电场覆盖范围的影响因素。结果 合理地设置相位差在相同电压下可以扩大电场覆盖的范围,并提出了一种双层环绕递增相差设置方法。以5根电极5 V电压为例,对比了不同数量的触点激活的电场分布范围,阐明了双层触点激活的优势及触点选择的方式。仿真了使1 V/cm的有效治疗电场覆盖不同大小残腔切除边缘所需的最少电极数量和最小整数电压,3根电极6 V的电压即可覆盖直径2 cm残腔的切除边缘,而直径5 cm的残腔需要5根电极和10 V的电压。针对直径3.5 cm的残腔探究了电极数量与电压的相互替代关系。结论 脑肿瘤切除术后通过植入式电极可以将中频交变电场聚焦在切除边缘附近,优化参数可以覆盖残腔表面,场强超过1 V/cm,表明植入式肿瘤电场治疗是一种潜在可行的治疗方案。该治疗方案的安全性、器械小型化和供能则仍需进一步的研究。

Preparation of Adriamycin Magnetic Albumin Microspheres and Their Experimental Antitumor Effects in vitro and in vivo

The adriamycin magnetic microspheres (ADM-MAMs) were prepared by the heat-stabilized protein methods. Their physico-chemical properties were examined; their cytotoxicities against tumor cells in vitro were assayed by a modi-fied MTT method, and their effects were observed on the implanted gastric tumor in Wistar rats given ADM-MAMs via alimentary canal at the presence of the ex-ternal magnetic fields. The results showed that the ADM-MAMs were successful-ly prepared and had cytotoxic effect on tumor cells in vitro similar to the free ADM (P>0. 05). The inhibitory effects of ADM-MAMs on the implanted gastric tumor in vivo were significantly increased as compared with the controls (P<0.01). Our results suggested that ADM-MAMs were a new type of adriamycin (ADM) preparation and its form alteration did not affect its anticancer effects.

Extrathyroidal Implantation of Thyroid Hyperplastic/neoplastic Cells after Endoscopic Thyroid Surgery

Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies. Methods A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery. Results Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review. Conclusions Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.

督灸结合助气解麻汤对肿瘤患者输液港并发症的预防效果分析

目的:探讨督灸结合助气解麻汤对气虚血瘀型肿瘤患者输液港并发症的预防效果。方法:将100例进行化疗治疗的恶性肿瘤患者按随机数字表法分为对照组和观察组各50例。两组患者由相同医生执行完全植入式输液港(totally implantable venous access port,TIAP)。对照组术后第1天进行常规护理,观察组在对照组基础上予督灸结合助气解麻汤干预,两组疗程均为2周。比较两组患者静脉炎、置管感染发生情况及气虚血瘀证主症评分。结果:观察组静脉炎发生率为4.00%(2/50),低于对照组的20.00%(10/50)(P<0.05);观察组导管尖端异位、导管渗漏、导管堵塞、感染的总发生率为8.00%(4/50),低于对照组的26.00%(13/50)(P<0.05);治疗后两组患者气虚血瘀证主症评分均降低(P<0.01),观察组降低程度高于对照组(P<0.01)。结论:对于肿瘤进行输液港患者在西医常规护理措施的基础上,采取督灸结合助气解麻汤有助于降低患者静脉炎,预防置管感染,并促进中医证候的改善。

胰腺癌性疼痛介入治疗的研究进展

胰腺癌是一种具有高度侵袭性的肿瘤,嗜神经生长是胰腺癌的重要生物学特点,其对神经的侵犯给患者带来极大的疼痛负担,严重影响患者生存质量和生存意志。世界卫生组织(World Health Organization,WHO)癌痛“三阶梯镇痛原则”是传统治疗癌性疼痛的治疗方案,但由于其毒副作用明显、疗效差、易成瘾、易耐药以及医师临床用药不规范等因素,无法满足患者病情需要。近年来,随着介人技术的发展以及广泛的临床试验的开展,介入作为癌痛管理的“第四阶梯”,其治疗手段以及各种影像引导方式的发展与应用,如神经毁损术、^(125)I粒子植入术、患者自控镇痛泵技术、鞘内药物输注系统植入术等,临床疗效得到了有力证明,为癌痛患者提供了方便、安全、有效的治疗方式。

标准化护理在碘125放射性粒子植入术治疗恶性肿瘤中的应用效果

目的:分析对接受碘125放射性粒子植入术治疗的恶性肿瘤患者应用标准化护理的效果。方法:选取2022年1月至2023年12月间蚌埠医科大学第一附属医院收治的72例恶性肿瘤患者,均接受碘125放射性粒子植入术治疗,随机均分为两组,参照组36例采取常规护理,观察组36例采取标准化护理干预,分析患者护理满意度、心理状态与生存质量等指标。结果:护理后,观察组的护理满意度更高,心理状态与生存质量等较优,与参照组相比,结果存在显著差异(P<0.05)。结论:对接受碘125放射性粒子植入术治疗的恶性肿瘤患者进行标准化护理,可以减轻患者的心理压力,提升生存质量,提高护理满意度。

Primary research on neoplasm needle track implantation metastasis after radioactive seeds implantation and preventive measures

Objective:To observe the possibility of neoplasm needle track implantation after radioactive seeds implantation and seek preventive measures to avoid it.Methods:Superficial tissue of 250 seeding needle cores and 250 stylophores employed in neoplasm radioactive seeds implantation was smeared on slides to search for tumor cells.All patients received chemotherapy or endocrine therapy after operations.Ultrasound B-mode or computer tomography(CT)was performed at 10th day,30th day,60th day,and 180th day post operation to detect neoplasm implantation metastasis through needle tracks. Results:Positive cells were found on 13 of 250(5.20%)cores,and 7 of 250(2.80%)stylophores.The difference was not sta- tistically significant(P>0.05).The positive cells frequency of needles those traversed distance less than 3 cm in normal tissue was 6.19%(13/210),while the frequency of the others those traversed longer distance in normal tissue was 2.41%(7/290). The positive cells frequency of needles traversing different distances in normal tissues is significantly different(P<0.05).No neoplasm was detected through needle tracks by ultrasound B-mode or CT in 180 days after operation.Conclusion:Tumor cells could ablate into the needle track during radioactive seed implantation.Some preventive measures,such as optimization of pre-operation and intra-operation treatment plan,chemotherapy or endocrine therapy after operation,may be beneficial to avoid the implantation metastasis of neoplasm in seeding needle tracks.

Investigation of Maxillary Preprosthetic Situations after Oral Tumor Treatment

In order to investigate the maxillary preprosthetic situation after oral tumor treatment and/or reconstructive surgery, based on the review of case history and the clinical records 47 cases were analyzed after oral tumor treatment and/or reconstruction, including residual maxillary bone, intermaxillary relationships, defection of maxilla and oral situation after radiation therapy. The results showed that the residual maxillary bone was useful for implantation in the front alveolar bone and zygoma area. The maxillary preprosthetic situation after tumor treatment and/or reconstructive surgery was difficult due to maxillary resection, intermaxillary relationships, unsuitable soft and hard tissue transfer and the irradiation. It is suggested that the maxillary preprosthetic situation after oral tumor treatment is getting worse not only due to maxillary resection and/or irradiation, but surprisingly also due to mandibular resection and/or irradiation.

THE ESTABLISHMENT OF A NEW ANIMAL MODEL FOR GASTRIC CANCER STUDY BY ORTHOTO PIC IMPLANTATION OF GASTRIC CANCER CELLS INTO ATHYMIC NUDE MICE

An animal model mimicking human gastric cancer by gastric wall implantation technique in athymic nude mice was reported. Two human gastric cancer cell lines. MKN-45 and MKN-28, were used in this study. All animals with gastric wall implantation of cancer cells of these two cell lines developed grossly visible gastric tumors after 3-4 weeks of implantation. Histopathological examination showed that tumors prirnarily grew at serosal side of stomach, and progressively invaded the gastric mucosa, but none showed metastasis in this study. All tumor-bearing animals died within 5-8 weeks after implantation. These results indicated that gastric wall of nude mice provided a good soil for growth and propagation of human gastric cancer cells. The model was useful for in vivo study on biological behavior of various types of human gastric cancers.