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AIM To clarify the surgical strategy for patients with stage Ⅳa primary hepatic carcinoma (PHC).METHODS Twenty-seven patients with stage Ⅳ a PHC were retrospectively studied in 1989 - 1998,including resected group (19 cases) whose all tumor nodes were resected and cytoreductive group (8 cases)whose most tumor nodules were resected and remnant nodules treated by ethanol injection. B-ultrosoundshould be used intraoperation in order to prevent from missing any tumor nodule. All the tumor nodules inthe liver should be removed, and residual nodules should be treated by ethanol injection during operation ifall the tumor nodules can not be removed. Multidisciphinary therapies were undertaken perioperatively.RESULTS The 1-, 2- and 3-year survival rates were 71.4%, 55.6% and 7.7% respectively. The 1-, 2- and3-year survival rates of the resected and cytoreductive groups were 73.3%, 53.3%, 10.0% and 66.7%,50.0%, 0% (P>0.05) respectively. The rate of complications was 22.0%, without operative and in-hospital mortality.CONCLUSION The surgical treatment included resected or cytoreductive operation plus supplementarytherapy considered to be both useful and the first choise for stage Ⅳa PHC.
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卵巢癌二次手术的研究与进展
卵巢癌的二次手术包括二次剖腹探查手术(second-look laparotomy,SLL,下称二探)和二次肿瘤细胞减灭术(secondary cytoreductive surgery,SCR).二探主要用于诊断和治疗卵巢癌,虽然SLL是否作为卵巢癌的常规手术仍不明确,但它在卵巢癌疗效评价、诊断及治疗中占有重要的地位.SCR指卵巢癌患者在完成或部分完成系统的首次治疗后,再次手术切除盆腹腔病灶,SCR是卵巢癌二线治疗中一个实际且又棘手的问题.
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对晚期卵巢癌综合治疗模式的思考
卵巢癌(epithelial ovarian cancer)仍然是妇科恶性肿瘤中死亡率高的疾病.其原因主要在于缺乏早期诊断的手段与其对治疗的不敏感性.前者使患者自觉有症状而就诊时已届晚期,后者则包括晚期患者由于病变广泛扩展至腹腔而难以达到满意的初次肿瘤细胞减灭术(optimal primary cytoreductive surgery,OPCS)的程度与对化疗容易耐药等因素.单就治疗而言,满意的初次肿瘤细胞减灭术以及术后辅以紫杉醇+铂类药物的化疗是当今治疗晚期卵巢癌的首选模式.但此治疗模式也仅提高了晚期卵巢癌患者的近期缓解率,而5年生存率仍停滞在30%左右[1,2].因此,目前对于晚期卵巢癌患者的手术+化疗的治疗模式仍存在改进与完善的地方.