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Radiation therapy for extrahepatic bile duct cancer: Current evidences and future perspectives 预览
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作者 Taeryool Koo Hae Jin Park Kyubo Kim 《世界临床病例杂志》 2019年第11期1242-1252,共11页
Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant ... Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit. Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy. The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC. 展开更多
关键词 EXTRAHEPATIC BILE duct cancer Patterns of failure ADJUVANT RADIOTHERAPY Definitive RADIOTHERAPY PALLIATIVE RADIOTHERAPY BILIARY stent
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Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review 预览
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作者 Giuseppe Vanella Chiara Coluccio +2 位作者 Emilio Di Giulio Daniela Assisi Rocco Lapenta 《世界胃肠内镜杂志:英文版(电子版)》 2019年第1期61-67,共7页
BACKGROUND Self-expandable metal stents(SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer(CRC). Among possible complications of SEMS positioning, re-obstruction is the... BACKGROUND Self-expandable metal stents(SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer(CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.CASE SUMMARY A 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors(splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents(1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.CONCLUSION Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction. 展开更多
关键词 BEVACIZUMAB Colorectal neoplasms Intestinal OBSTRUCTION PALLIATIVE care Self-expandable metallic STENTS Case report
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Palliative and/or Hospice Care for Elderly Patients being Considered for Device Therapy 预览
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作者 C.Richard Conti,MD,MACC 《心血管创新与应用》 2019年第B02期449-450,共2页
Palliative care is the relief of symptoms without dealing with the underlying cause,e.g.use of analgesia,to relieve pain.The use of such an agent alleviates the symptoms without curing the underlying disease.This is t... Palliative care is the relief of symptoms without dealing with the underlying cause,e.g.use of analgesia,to relieve pain.The use of such an agent alleviates the symptoms without curing the underlying disease.This is the type of care for patients with serious illnesses.It focuses on improving quality of life,not just in your body,but also in your mind and spirit.There is a thin line between palliative care and hospice care. 展开更多
关键词 PALLIATIVE CARE
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Acute abdominal obstruction:Colon stent or emergency surgery? An evidence-based review 预览
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作者 Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura +1 位作者 Christopher C Thompson Eduardo Guimaraes Hourneaux de Moura 《世界胃肠内镜杂志:英文版(电子版)》 2019年第3期193-208,共16页
According to the American Cancer Society and Colorectal Cancer Statistics 2017,colorectal cancer(CRC) is one of the most common malignancies in the United States and the second leading cause of cancer death in the wor... According to the American Cancer Society and Colorectal Cancer Statistics 2017,colorectal cancer(CRC) is one of the most common malignancies in the United States and the second leading cause of cancer death in the world in 2018.Previous studies demonstrated that 8%-29% of patients with primary CRC present malignant colonic obstruction(MCO). In the past, emergency surgery has been the primary treatment for MCO, although morbidity and surgical mortality rates are higher in these settings than in elective procedures. In the 1990 s, selfexpanding metal stents appeared and was a watershed in the treatment of patients in gastrointestinal surgical emergencies. The studies led to high expectations because the use of stents could prevent surgical intervention, such as colostomy, leading to lower morbidity and mortality, possibly resulting in higher quality of life. This review was designed to provide present evidence of the indication, technique, outcomes, benefits, and risks of these treatments in acute MCO through the analysis of previously published studies and current guidelines. 展开更多
关键词 Colorectal cancer ENDOSCOPY STENT Surgery PALLIATIVE
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姑息缓和治疗对32例终末期癌症患者睡眠质量的影响 预览
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作者 刘海波 丁乐 胡大勇 《临床医学研究与实践》 2018年第14期33-34,共2页
目的探讨姑息缓和治疗对终末期癌症患者睡眠质量的影响。方法将我院62例终末期癌症患者,按照治疗方法分为观察组(32例,采用姑息缓和治疗)与参考组(30例,采用常规抗肿瘤治疗),比较两组患者的生存时间及治疗前、后PSQI、QOL及Piper疲... 目的探讨姑息缓和治疗对终末期癌症患者睡眠质量的影响。方法将我院62例终末期癌症患者,按照治疗方法分为观察组(32例,采用姑息缓和治疗)与参考组(30例,采用常规抗肿瘤治疗),比较两组患者的生存时间及治疗前、后PSQI、QOL及Piper疲乏修正量表评分。结果治疗后,观察组患者的PSQI、QOL、行为、情感、躯体及认知疲乏评分均明显改善,且优于参考组(P〈0.05)。参考组治疗前、后各项评分比较,差异不显著(P〉0.05)。两组患者的生存时间比较,无显著差异(t=0.262,P=0.794)。结论姑息缓和治疗有助于改善终末期癌症患者的睡眠质量及生活质量。 展开更多
关键词 姑息缓和 终末期癌症 PSQI评分 QOL评分 Piper疲乏修正量表评分
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Recognition of Palliative Care in Chinese Clinicians:How They Feel and What They Know 预览
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作者 Yirong Xiang Xiaohong Ning 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期221-227,共7页
Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires we... Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires were delivered through a social networking platform to1500clinicians of different specialties in10proviences of China.It covered issues of background information,self-assessment of familiarity to palliative care,prior training history,emotional attitude toward end-stage patients,and the reflections on clinical practice.Logistic regression analysis and chi-square test were used to analyse the categorical variables.Results There were379clinicians who completed the questionnaires and submitted successfully.Among them,66.8%(253/379)had attended palliative care training courses more than twice;66.8%(253/379)clinicians percieved powerless feeling when facing end-stage patients.We found that the education on palliative medicine was significantly associated to doctors'better comprehension on the concept of palliative care(OR=6.923,P=0.002).Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings(χ^2=13.015,P<0.001),and would be more likely to concern about patients and their family members in their clinical work(χ^2=28.754,P<0.001,χ^2=24.406,P<0.001).Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients.Palliative care help them overcome the negative feelings and act more caring in clinic.More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors'cognition on palliative care. 展开更多
关键词 PALLIATIVE care RECOGNITION China ONCOLOGIST
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Physicians’Perception of Palliative Care Consultation Service in a Major General Hospital in China 预览
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作者 Xuan Qu Nan Jiang +1 位作者 Nan Ge Xiaohong Ning 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期228-233,共6页
Objectives The in-hosptial palliative care consultation(PCC)is emerging as a routine service in some medical center in China.The current study evaluated how physicians in primary care team and consultation team percei... Objectives The in-hosptial palliative care consultation(PCC)is emerging as a routine service in some medical center in China.The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team,and37consultations were completed in2016.A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team.Physicians who applied for consultation in2016formally(requested from the department other than the Geriatrics)and informally(by rotating residents and unemployed visiting doctors in geriatric department)were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were103physicians participated in the survey,including primary care physicians from the department of Internal Medicine(n=8),Gynaecology(n=16)and Surgery(n=13),rotating residents(n=30),visiting doctors(n=16)in Geriatric department,and PCC team members(n=20).94.0%of the non-PCC physicians agreed that PCC relieved the suffering of patients;89.2%thought PCC improved the quality of patients'life;there were91.6%,95.2%,90.4%physicians who felt it relieved the anxiety of patients,of family members and of care providers,respectively.There were96.4%physicians who felt it could ease the tension in physician-patient relationship;97.6%felt it lower the risk for medical negligence,and96.4%of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation.More primary-team physician agree"PCC service helps the physicians better understand palliative care"than PCC members(97.6%vs.80%,P<0.05),while both were interested in learning more on palliative medicine(100%vs.96.4%,P>0.05). 展开更多
关键词 PALLIATIVE CARE CONSULTATION MEDICAL SERVICE
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Individualized Aromatherapy in End-of-Life Cancer Patients Care:A Case Report 预览
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作者 Qian Liu Xiaohong Ning Lei Wang 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期234-239,共6页
As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical sy... As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical symptoms,but also spiritual relaxation and peace,thus have improved quality of life at the end stage.In this paper,we report in detail about how aromatherapy was applied for symptom control in a cancer patient with unknown primary malignancy and multiple metastasis and its effects on the terminal life of this patient. 展开更多
关键词 AROMATHERAPY ESSENTIAL oil PALLIATIVE CARE END-OF-LIFE cancer
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Hospice and Palliative Care in Mainland China:History,Current Status and Challenges 预览
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作者 Xiao hongNing 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期199-203,共5页
The concept of End-of-Life Care(EOLC)came into China in the late1980s.However,hospice and palliative care in medical practice develope slowly.In recent years,profesionals,patients and their families,as well as governm... The concept of End-of-Life Care(EOLC)came into China in the late1980s.However,hospice and palliative care in medical practice develope slowly.In recent years,profesionals,patients and their families,as well as government begin to attach importance to it.There is a hospice and palliative care movement now in China.This article gives an overview of the progress and the current status in multiple aspects of hospice and palliative care in mainland China,and points out the barriers and challenges for its further development in the future. 展开更多
关键词 PALLIATIVE CARE HOSPICE China HISTORY current STATUS
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Conversion surgery for gastric cancer patients:A review 预览
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作者 Tommaso Zurleni Elson Gjoni +1 位作者 Michele Altomare Stefano Rausei 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2018年第11期398-409,共12页
Gastric cancer(GC)is the third most common cancer-related cause of death worldwide.In locally advanced tumors,neoadjuvant chemotherapy has recently been introduced in most international Western guidelines.For metastat... Gastric cancer(GC)is the third most common cancer-related cause of death worldwide.In locally advanced tumors,neoadjuvant chemotherapy has recently been introduced in most international Western guidelines.For metastatic and unresectable disease,there is still debate regarding correct management and the role of surgery.The standard approach for stage IV GC is palliative chemotherapy.Over the last decade,an increasing number of M1 patients who responded to palliative regimens of induction chemotherapy have been subsequently undergone surgery with curative intent.The objective of the present review is to analyze the literature regarding this approach,known as“conversion surgery”,which has become one of the most commonly adopted therapeutic options.It is defined as a treatment aiming at an R0 resection after chemotherapy in initially unresectable tumors.The 13 retrospective studies analyzed,with a total of 411 patients treated with conversion therapy,clearly show that even if standardization of unresectable and metastatic criteria,post-chemotherapy resectability evaluation and timing of surgery has not yet been established,an R0 surgery after induction chemotherapy with partial or complete response seems to offer superior survival results than chemotherapy alone.Additional larger samplesize randomized control trials are needed to identify subgroups of well-stratified patients who could benefit from this multimodal approach. 展开更多
关键词 Metastatic GASTRIC CANCER GASTRIC CANCER CONVERSION SURGERY R0 resection Stage IV GASTRIC CANCER PALLIATIVE chemotherapy UNRESECTABLE GASTRIC CANCER
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Palliative care for acute kidney injury patients in the intensive care unit 预览
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作者 Vinod Krishnappa William Hein +2 位作者 Daniel DelloStritto Mona Gupta Rupesh Raina 《世界肾病学杂志:英文版》 2018年第8期148-154,共7页
Patients with acute kidney injury(AKI)in the intensive care unit(ICU)are often suitable for palliative care due to the high symptom burden.The role of palliative medicine in this patient population is not well defined... Patients with acute kidney injury(AKI)in the intensive care unit(ICU)are often suitable for palliative care due to the high symptom burden.The role of palliative medicine in this patient population is not well defined and there is a lack of established guidelines to address this issue.Because of this,patients in the ICU with AKI deprived of the most comprehensive or appropriate care.The reasons for this are multifactorial including lack of palliative care training among nephrologists.However,palliative care in these patients can help alleviate symptoms,improve quality of life,and decrease suffering.Palliative care physicians can determine the appropriateness and model of palliative care.In addition to shared decision-making,advance directives should be established with patients early on,with specific instructions regarding dialysis,and those advance directives should be respected. 展开更多
关键词 PALLIATIVE CARE Acute kidney injury INTENSIVE CARE unit DIALYSIS ADVANCE DIRECTIVES
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Palliative surgery for Krukenberg tumors– 12-year experience and review of the literature 预览
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作者 Isaac Seow-En Gwen Hwarng +2 位作者 Grace Hwei Ching Tan Leonard Ming Li Ho Melissa Ching Ching Teo 《世界临床肿瘤学杂志》 2018年第1期13-19,共7页
AIM To determine the clinical characteristics of patients undergoing palliative surgery for Krukenberg tumors,including disease presentation,outcomes,and prognostic factors.METHODS This was a retrospective clinical st... AIM To determine the clinical characteristics of patients undergoing palliative surgery for Krukenberg tumors,including disease presentation,outcomes,and prognostic factors.METHODS This was a retrospective clinical study of all patients who underwent palliative surgery for Krukenberg tumors between January 2004 and December 2015.Patient information was obtained from inpatient and outpatient case notes as well as the hospital electronic records.Patients who underwent potentially curative resection,and patients with Krukenberg tumors who did not undergo surgery were also excluded from the study.Palliative surgery was defined as those performed for either alleviation of symptoms or for asymptomatic patients for whom surgical removal of the tumors were deemed necessary following a multidisciplinary consensus.Tumors were diagnosed pre-operatively by computed tomography scans and all had histologic confirmation of the surgical specimens.RESULTS Over the study duration,38 female patients underwent palliative surgery for Krukenberg tumors at our institution.Mean age was 54.2±11.7 years.The colon was the most frequent primary source of metastases(n=21)followed by the stomach(n=4).Prophylactic palliative surgery was performed for eight(21.1%)asymptomatic patients.Median post-operative length of stay was 8 d(IQR 6-12 d).Five patients(13.2%)experienced postoperative complications,although high grade morbidity was only seen in one patient(2.6%).Median overall survival from surgery was 17 mo(95%CI:12.1-21.9)at a median follow-up duration of 12 mo(IQR 8-17 mo).The median survival was shorter for patients who underwent emergency surgery,younger patients,those with a colorectal primary,larger tumors,or synchronous peritoneal or hepatic metastases.CONCLUSION Palliative surgery for Krukenberg tumors can be performed safely with acceptable complication rates.Bilateral oophorectomy should be performed to prevent the risk of symptomatic contralateral tumors. 展开更多
关键词 Krukenberg TUMOR PALLIATIVE SURGERY
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Value-based Practice:Integration of Cancer Rehabilitation and Palliative Care in Oncology Services 预览
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作者 Yi Zhu 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期204-209,共6页
Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition.The full cycle of care model encompasses inpatient,outpatient,rehabil... Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition.The full cycle of care model encompasses inpatient,outpatient,rehabilitation as well as supportive care such as palliative care and nutrition support.Cancer rehabilitation and palliative care have emerged as two important parts of value-based practice for oncology patients.More clinical evidence suggests that early intervention of oncology rehabilitation program and palliative care are likely to improve the patient outcome and reduce the overall medical cost for the patient and his or her family as well as for medical service providers.Although interest has been raised in Chinese oncologists,but effectiveness of incorporating these two services in clinical practices has not been adequately demonstrated.An understanding of scope of cancer rehabilitation and palliative care may help facilitate the integration of both into the oncology care continuum in efforts to improve patients'physical,psychological,cognitive,functional health and quality of life. 展开更多
关键词 cancer REHABILITATION PALLIATIVE CARE HOSPICE DISABILITY quality of life
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Implement the Palliative Care in Medical Practice of a Tertiary Comprehensive Hospital in China 预览
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作者 Xiaohong Ning 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期210-215,共6页
The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully ... The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully applied to medical practice by care providers in mainland China,where the seriously ill or terminal patients mainly receive medical care in hospitals.The implementation of palliative care in medical practice has developed greatly in Peking Union Medical College hospital in terms of clinical patient care,education,and research.This article gives an overview of it,and the experiences in team building,promotion,support seaking and fund raising were also discussed in this article.We hope to explore an effective dilivering model of palliative care for end-stage patients that is adaptive to Chinese culture and social environment. 展开更多
关键词 PALLIATIVE CARE medical practice education TEAM building
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Running a Volunteer Program for Palliative Care in a Chinese Hospital:Our Practice and Experience 预览
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作者 Xiaohong Ning Jie Li Yirong Xiang 《中国医学科学杂志:英文版》 CAS CSCD 2018年第4期216-220,共5页
The establishment and development of volunteer team are very important in the whole process of palliative care.The concept and practice of palliative care have been developed in Peking Union Medical College Hospital(P... The establishment and development of volunteer team are very important in the whole process of palliative care.The concept and practice of palliative care have been developed in Peking Union Medical College Hospital(PUMCH)since the end of2012.Great progress has been made in different aspects.Volunteers play an extremely important role in the development of palliative care in PUMCH.The whole work began with the establishment of volunteer teams.This article introduces the process of the establishment and development of palliative care volunteer team in PUMCH,aiming to provide practical references for hospitals in mainland China to develop their own palliative care volunteer team. 展开更多
关键词 PALLIATIVE care HOSPICE PEKING UNION Medical College HOSPITAL VOLUNTEER
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Current role of palliative interventions in advanced pancreatic cancer 预览
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作者 Chelsey C Ciambella Rachel E Beard Thomas J Miner 《世界胃肠外科杂志:英文版(电子版)》 2018年第7期75-83,共9页
Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States.Unfortunately,at diagnosis,most patients are not candidates for curative resection.Surgical palliation,a procedure performed wi... Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States.Unfortunately,at diagnosis,most patients are not candidates for curative resection.Surgical palliation,a procedure performed with the intention of relieving symptoms or improving quality of life,comes to the forefront of management.This article reviews the palliative management of unresectable pancreatic cancer,including obstructive jaundice,duodenal obstruction and pain control with celiac plexus block.Although surgical bypasses for both biliary and duodenal obstructions usually achieve good technical success,they result in considerable perioperative morbidity and mortality,even when performed laparoscopically.The effectiveness of selfexpanding metal stents for biliary drainage is excellent with low morbidity.Surgical gastrojejunostomy for duodenal obstruction appears to be best for patients with a life expectancy of greater than 2 mo while endoscopic stenting has been shown to be feasible with good symptom relief in those with a shorter life expectancy.Regardless of the palliative procedure performed,all physicians involved must be adequately trained in end of life management to ensure the best possible care for patients. 展开更多
关键词 Surgical PALLIATION Duodenal obstruction Hepatojejunostomy GASTROJEJUNOSTOMY Endoscopic STENTING Malignant ascites CELIAC block PALLIATIVE triangle Pancreatic cancer Obstructive JAUNDICE
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应用COX模型分析Ⅳ期胃癌的预后因素 预览 被引量:2
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作者 孙晓卫 李威 +2 位作者 刘学超 詹友庆 周志伟 《重庆医学》 北大核心 2017年第18期2532-2534,共3页
目的探讨影响Ⅳ期胃癌预后的相关因素。方法回顾性总结中山大学肿瘤防治中心2000-2010年收治的有完整随访资料的Ⅳ期胃癌患者248例。选择年龄、性别、体质量减轻、血红蛋白、癌胚抗原(CEA)、糖蛋白抗原(CA19-9)、Borrmann分型、肿... 目的探讨影响Ⅳ期胃癌预后的相关因素。方法回顾性总结中山大学肿瘤防治中心2000-2010年收治的有完整随访资料的Ⅳ期胃癌患者248例。选择年龄、性别、体质量减轻、血红蛋白、癌胚抗原(CEA)、糖蛋白抗原(CA19-9)、Borrmann分型、肿瘤部位、肿瘤大小、病理类型、转移部位、治疗模式共12项临床病理参数作为观察指标。用Kaplan-Meier法绘制生存曲线,计算中位生存时间(MST),用Log-rank检验行单因素分析,Cox回归风险比例模型行预后的多因素分析。结果全组患者MST为254d,单因素分析表明,性别、Borrmann分型、治疗模式是影响Ⅳ期胃癌预后的相关因素,而Cox回归模型显示,上述3个指标也是影响本组Ⅳ期胃癌预后的独立因素(P〈0.05)。结论治疗模式是影响Ⅳ期胃癌生存的重要独立因素,姑息化疗联合姑息手术的转化医学模式有助于改善Ⅳ期胃癌患者的预后。 展开更多
关键词 胃肿瘤 Ⅳ期 姑息疗法方法
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始终无法切除的结直肠癌肝转移的原发肿瘤外科治疗 预览
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作者 吴钢 蔡端 《上海医药》 CAS 2017年第19期41-45,共5页
20%的结直肠癌(CRC)病人在初诊时即为Ⅳ期疾病,这些病人中75%~90%合并不可切除的肝转移(CRLM)。CRLM是CRC治疗的难点,也是其最主要的死亡原因。对于转化治疗失败,肝转移肿瘤始终无法切除的CRLM病人,原发灶出现出血、梗阻或... 20%的结直肠癌(CRC)病人在初诊时即为Ⅳ期疾病,这些病人中75%~90%合并不可切除的肝转移(CRLM)。CRLM是CRC治疗的难点,也是其最主要的死亡原因。对于转化治疗失败,肝转移肿瘤始终无法切除的CRLM病人,原发灶出现出血、梗阻或穿孔等并发症时,应姑息性手术治疗。但是,对于无症状或症状轻微的原发肿瘤,其治疗策略仍然存在争议。传统的治疗理念认为,对选择的始终无法切除的CRLM病人姑息性切除原发性肿瘤,然后进行全身化疗,可以使病人的生存受益,并可避免因并发症而急诊手术的必要性。但是,亦有研究认为随着联合化疗和靶向药物的联合使用,可以很好地控制肠道原发病灶,而无需手术治疗,除非出现与之相关的并发症。目前尚无针对该问题的RCT研究提供I级证据支持哪种方法对无症状的、始终无法切除的CRLM带来额外的生存受益。 展开更多
关键词 结直肠癌肝转移 姑息性 外科 化疗
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经内镜胆道支架置入术在肝门部胆管癌姑息性治疗中应用优劣势分析 被引量:2
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作者 黄磊 施兆发 +1 位作者 王路兵 黄侠 《湖南师范大学学报:医学版》 2016年第3期56-58,共3页
目的:探讨经内镜胆道支架置入术姑息性治疗肝门部胆管癌的临床优劣势。方法:回顾性分析我院2013年1月~2015年1月收治的68例经内镜胆道支架置入术姑息性治疗肝门部胆管癌患者临床资料,设为内镜组。同期将我院收治的62例行经皮经肝穿刺胆... 目的:探讨经内镜胆道支架置入术姑息性治疗肝门部胆管癌的临床优劣势。方法:回顾性分析我院2013年1月~2015年1月收治的68例经内镜胆道支架置入术姑息性治疗肝门部胆管癌患者临床资料,设为内镜组。同期将我院收治的62例行经皮经肝穿刺胆道支架置入术治疗肝门部胆管癌设为经肝组。比较两组患者置入成功率、术后并发症及肝功能方面的差异。结果:内镜组患者胆道支架置入成功率为82.4%低于经肝组95.2%;内镜组患者术后胆道感染、胰腺炎发生率分别为22.1%、8.8%高于经肝组4.8%、0%,胆道出血发生率为1.5%低于经肝组19.4%,而内镜组肝脓肿发生率无明显差异;治疗后内镜组患者ALT、TBil显著下降。结论:经内镜胆道支架置入术姑息性治疗肝门部胆管癌效果显著,其置入成功率高,胆道出血少,有效改善患者肝功能,但其胆道感染及胰腺炎的发生率较高,而经皮经肝穿刺胆道感染及胰腺炎发生较少。 展开更多
关键词 经内镜胆道支架置入术 姑息性 肝门部胆管癌 临床应用
EOX与FOLFIRI方案一线治疗晚期胃癌的疗效比较 预览
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作者 李建旺 黄春珍 +1 位作者 元建华 陈琼慧 《世界华人消化杂志》 CAS 2016年第12期1866-1873,共8页
目的:比较表柔比星、奥沙利铂和卡培他滨(mEOX)与伊立替康、5-氟尿嘧啶和亚叶酸钙(FOLFIRI)在晚期胃癌一线治疗中的疗效及不良反应.方法:将105例病理学诊断的进展期胃癌患者随机分为mEOX组及FOLFIRI组,mEOX组(n=55)给予表柔比星... 目的:比较表柔比星、奥沙利铂和卡培他滨(mEOX)与伊立替康、5-氟尿嘧啶和亚叶酸钙(FOLFIRI)在晚期胃癌一线治疗中的疗效及不良反应.方法:将105例病理学诊断的进展期胃癌患者随机分为mEOX组及FOLFIRI组,mEOX组(n=55)给予表柔比星50 mg/m^2静推,d1;奥沙利铂130 mg/m^2静脉滴注,d1;卡培他滨625 mg/m^2,2次/d,d1-14,21 d为1周期,至少完成2个周期.FOLFIRI组(n=50)给予伊立替康180 mg/m^2,静脉滴注,d1;亚叶酸钙400mg/m^2静脉滴入2 h,d1;5-氟尿嘧啶注射液400 mg/m^2静推,d1;5-氟尿嘧啶1200 mg/m^2,持续22 h静脉滴注或泵入,d1-2,每14 d为1个周期,至少用4个周期.进展后行二线单药化疗.观察两组的疗效和不良反应.结果:mEOX组及FOLFIRI组客观有效率(objective response rate,ORR)分别为40.0%和48.0%,差异无统计学意义(P=0.409);mEOX组及FOLFIRI组一线化疗后的无进展生存期(progression-free survival,PFS)分别为7.3 mo和8.4 mo(P=0.07),进展后二线单药化疗中位PFS分别为2.4 mo和3.4 mo(P=0.098),总生存期(overall survival,OS)分别为13.5 mo和14.3 mo(P=0.40),无统计学差异.风险比(risk ratio,HR)为0.810(95%CI:0.501-1.163).均小于1.25界值,非劣效性检验成立.mEOX组Ⅲ-Ⅳ度粒细胞减少、血小板减少、贫血及腹泻发生率均明显低于FOLFIRI组,差异有统计学意义(P〈0.05),mEOX组因不良反应至化疗药物减量或延期使用的发生率也明显低于FOLFIRI组,差异有统计学意义(P〈0.05).结论:mEOX方案方便易用安全有效,可以成为局部晚期胃癌的标准方案,值得进一步研究. 展开更多
关键词 胃癌 转移 FOLFIRI EOX 一线 姑息治疗
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