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УСКОРЕННЫЕ РЕЖИМЫ АДЪЮВАНТНОЙ ЛУЧЕВОЙ ТЕРАПИИ В ЛЕЧЕНИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ 乳腺癌辅助辐射治疗的加速模式
Pub Date : 2017-09-20 DOI: 10.17709/2409-2231-2017-4-3-6
Г. В. Афонин, Ю. А. Рагулин, Игорь Гулидов
Treatment of breast cancer (BC) is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug therapy.
乳腺癌的治疗是一个复杂的多学科问题。通常,放射治疗是乳腺癌患者治疗的强制性组成部分。许多大型随机试验已经证明了辅助放疗在标准分割方案(单局剂量为2gy至总局剂量为50gy,分25个部分)和低分割模式(使用较大日剂量的辐射照射,减少总治疗时间)中的有效性。本综述总结了关于乳腺癌术后放射治疗低分割模式的最大研究数据。大多数比较术后放疗标准分割模式与低分割模式的研究结果显示,主要肿瘤参数相似,耐受性相似,并发症发生率相似,美容效果良好。它还显示了在日常实践中应用加速机制的经济可行性。尽管以低分割方式进行放射治疗已经成为治疗标准,并被欧洲和美国最大的癌症协会推荐使用,但其实施的适应症、研究中的选择标准和推荐的单灶剂量范围各不相同。获得的结果并没有给我们一个机会自信地判断一个或另一个制度的优势。有必要确定预后有利和不利的因素,明确使用各种放疗技术的适应症。因此,作为乳腺癌综合治疗的一部分,辅助放疗低分割的最佳模式、起始时间以及选择患者的标准等问题尚未完全解决。同样开放的是选择最佳的单次和总剂量的辐射,它与药物治疗的组合。
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引用次数: 4
ПОПУЛЯЦИОННАЯ ОЦЕНКА ДИНАМИКИ ЗАБОЛЕВАЕМОСТИ И СТАДИЙНОЙ СТРУКТУРЫ РАКА ПРЯМОЙ КИШКИ В УСЛОВИЯХ РЕАЛИЗАЦИИ МЕРОПРИЯТИЙ НАЦИОНАЛЬНОГО ПРОЕКТА «ЗДОРОВЬЕ» И ДИСПАНСЕРИЗАЦИИ ОПРЕДЕЛЕННЫХ ГРУПП ВЗРОСЛОГО НАСЕЛЕНИЯ В АРХАНГЕЛЬСКОЙ ОБЛАСТИ (ИТОГИ ПРЕДВАРИТЕЛЬНОГО ИССЛЕДОВАНИЯ) 在国家“健康”计划的实施和在大天使地区某些成人群体的扩张(初步研究结果)中,对直肠癌的发病率和阶段结构进行普及评估
Pub Date : 2017-09-20 DOI: 10.17709/2409-2231-2017-4-3-3
Д. М. Дубовиченко, М. Ю. Вальков, А. А. Карпунов, А. Ю. Панкратьева
Objective . Assessment of the rectal cancer (RC) incidence and stage structure trends in the Arkhangelsk region (AR), Russia before and after implementation of national programs for health system reforming based on population data of the Arkhangelsk Regional Cancer Registry (ARCR) over the period 2000–2015. Materials and methods . Anonymized data on all cases of RC (C19.0‑C21.0) in the AR in 2000–2015 were extracted from the database of the ARCR. Over the study period, 3721 cases of the RC were selected. Age-standardized (ASR) RC incidence rate was calculated. Population number and its age distribution were taken from the Regional Bureau of Statistics, Arkhangelskstat. Time trends were analyzed using segmented regression. Results . Over the period, an incidence (ASR) of RC in AR increased from 11.5 to 14.2 per 100000. The incidence rates in the male population were higher than in women: 20.3 vs 12.6 in 2015. The growing trend of male incidence was stable. The ASR of RC incidence in female increased significantly by 4.6% per year in 2011–2015. RC ASRs for both urban and rural populations were growing, 12.3 and 20.4 per 100000 in 2015, respectively. StagesI, II, III and IV were established in 14%, 50%, 9% and 21% of cases, however, the stage I in urban residents was detected 4% more often. The proportion of stage I non-significantly varied from 10.6% to 13.3% in 2000–2015. After the introduction of the National Project “Health”, the proportion of the stage IV non-significantly decreased by 5.4% per year, same after the introduction of the All-national Dispensarization it non-significantly increased by 5.4% per year. Conclusion . Implementation of national programs for health system reforming didn’t provide significant improvement in earlier detection of RC. Introduction of national screening programs is necessary. A higher incidence rates among males and rural population require detailed analysis.
目标。基于2000-2015年期间阿尔汉格尔斯克地区癌症登记处(ARCR)人口数据,评估俄罗斯阿尔汉格尔斯克地区(AR)实施国家卫生系统改革方案前后直肠癌(RC)发病率和分期结构趋势。材料和方法。从ARCR数据库中提取2000-2015年AR中所有RC病例(C19.0 - C21.0)的匿名数据。在研究期间,选取了3721例RC病例。计算年龄标准化(ASR) RC发病率。人口数量及其年龄分布数据来自阿尔汉格尔斯州地区统计局。采用分段回归分析时间趋势。结果。在此期间,AR地区的RC发病率(ASR)从11.5 / 100000增加到14.2 / 100000。男性人群的发病率高于女性:2015年为20.3 vs 12.6。男性发病率增长趋势稳定。2011-2015年,女性RC发病率的ASR每年显著增加4.6%。2015年,城乡居民的农村生活质量指数分别为12.3 / 10万和20.4 / 10万。I、II、III和IV阶段的检出率分别为14%、50%、9%和21%,而城市居民的I阶段检出率高出4%。2000-2015年,I期比例从10.6%到13.3%无显著变化。在实施国家"健康"项目后,第四阶段的比例以每年5.4%的幅度无显著下降,在实施全国统一分配后,这一比例以每年5.4%的幅度无显著上升。结论。国家卫生系统改革规划的实施并未在早期发现RC方面提供显著改善。引入国家筛查项目是必要的。男性和农村人口较高的发病率需要详细分析。
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引用次数: 3
ВЛИЯНИЕ МЕТРОНИДАЗОЛА НА БИОЛОГИЧЕСКОЕ ДЕЙСТВИЕ ДОКСОРУБИЦИНА
Pub Date : 2017-09-20 DOI: 10.17709/2409-2231-2017-4-3-2
С. А. Ягубов, Б. С. Аманджолов, Ф. В. Доненко, Ю. И. Должикова, Н. В. Малахова
Purpose . Investigation of the effect of the Metronizatol on the biological effect of Doxirubicin. Materials and methods . The studies were performed in the CBA/Lac males and C57Bl/6 females mice grafted with melanoma B16 and mucinous ovarian cancer CaO‑1. Metronidazole and Doxorubicin were used in the work. The antitumor effect was assessed by tumor volume and inhibition of tumor growth. Results . The data obtained indicate that Metronidazole used in oncologic practice for the treatment and prevention of infectious complications, and as a radiosensitizer, can enhance the antitumor effect of Doxorubicin, but this effect is accompanied by a significant increase of the cytostatic toxicity. These effects are leveled by increasing the interval between injections of Metronidazole and Doxorubicin up to 4 hours. Conclusion . The enhancement of the antitumor activity of Doxorubicin under the influence of Metronidazole depends on the interval between the administration of these drugs. When Metronidazole is used in cancer patients, the possibility of enhancing the toxic effect of cytostatics should be considered when they are simultaneously exposed. Patients receiving chemotherapy should be administered antitumor drugs no earlier than 4 hours after exposure to Metronidazole.
目的。甲硝化醇对多柔比星生物效应影响的研究。材料和方法。该研究在移植了黑色素瘤B16和粘液性卵巢癌CaO‑1的CBA/Lac雄性和C57Bl/6雌性小鼠中进行。工作中使用甲硝唑和阿霉素。通过肿瘤体积和抑制肿瘤生长来评价其抗肿瘤作用。结果。所获得的数据表明,甲硝唑在肿瘤学实践中用于治疗和预防感染并发症,并作为放射增敏剂,可增强阿霉素的抗肿瘤作用,但这种作用伴随着细胞抑制毒性的显著增加。通过将注射甲硝唑和阿霉素的间隔延长至4小时,这些影响得以消除。结论。阿霉素在甲硝唑作用下抗肿瘤活性的增强取决于给药间隔。在癌症患者中使用甲硝唑时,应考虑细胞抑制剂与甲硝唑同时暴露时是否有增强其毒性作用的可能。接受化疗的患者应在接触甲硝唑后不早于4小时给予抗肿瘤药物。
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引用次数: 0
Гипофракционирование при радиотерапевтическом лечении инфильтративных глиом низкой степени злокачественности who grade II 辐射疗法低恶性粘土的低分馏作用谁是grade II
Pub Date : 2017-09-11 DOI: 10.21294/1814-4861-2017-16-4-11-18
Г. А. Паньшин, Н. В. Харченко, С М Милюков, Тимур Раисович Измайлов
The purpose of the study was to develop more effective fractionation regimens and radiation therapy programs in the treatment of infiltrative low-grade gliomas (WHO grade II). Material and methods. The study included 53 patients with morphologically verified supratentorial infiltrative low-grade gliomas (WHO grade II). Diffuse astrocytoma was diagnosed in 35 (66 %) patients, oligoastrocytoma in 7 (13 %) patients and oligodendroglioma in 11 (21 %) patients. Results. The overall survival (OS) was influenced by fractionated radiotherapy regimens (conventionally fractionated versus hypofractionated radiotherapy) (p=0.000) and type of radiotherapy (3D conformal versus 2D radiotherapy) (p=0.023). Multivariate analysis showed a statistically significant difference between the equivalent total dose (LQ-model) and OS (p=0.068). Risk factors proposed by the Association of Russian oncologists (р=0.947) and the extent of surgical excision (р=0.423) had no significant impact on the overall survival. Conclusion. Conventionally fractionated radiation therapy (2 Gy per fraction daily) significantly improved the OS compared to hypofractionated radiotherapy (3 Gy per fraction daily). The value of α/β ratio=6.8 Gy can be used to calculate the total dose using a linear-quadratic model.
该研究的目的是为浸润性低级别胶质瘤(WHO分级II)的治疗制定更有效的分离方案和放射治疗方案。该研究纳入了53例经形态学证实的幕上浸润性低级别胶质瘤(WHO II级)患者,其中弥漫性星形细胞瘤35例(66%),少星形细胞瘤7例(13%),少突胶质细胞瘤11例(21%)。结果。总生存期(OS)受分割放疗方案(常规分割放疗与低分割放疗)(p=0.000)和放疗类型(3D适形放疗与2D放疗)(p=0.023)的影响。多因素分析显示,等效总剂量(LQ-model)与OS差异有统计学意义(p=0.068)。俄罗斯肿瘤学家协会提出的危险因素(χ =0.947)和手术切除程度(χ =0.423)对总生存率无显著影响。结论。与低分割放疗(每天3 Gy /次)相比,常规分割放疗(每天2 Gy /次)显著改善了OS。α/β比值=6.8 Gy可采用线性二次模型计算总剂量。
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引用次数: 0
ЛЕЧЕНИЕ ТРОЙНОГО НЕГАТИВНОГО ПОДТИПА РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ 乳腺癌三重负亚型治疗
Pub Date : 2017-06-28 DOI: 10.17650/1994-4098-2017-13-2-20-26
А. Д. Зикиряходжаев, Мария Александровна Фролова, Елена Александровна Рассказова, Е. В. Глазкова
The rate of triple-negative breast cancer is 10–24  %, and in recent years it’s one of the most studied subtypes of breast cancer due to its clinical aggressiveness and a small number of molecular targets. The study objective is to evaluate effectiveness of different NAPCT regimens including their dependence on the presence of mutations in the ВRСА 1, 2, СHEK2 genes. Materials and methods . The study included 40 female patients with triple-negative breast cancer. The patients were monitored from 2012 to 2016; surgical treatment was performed at the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia. Median patient age was 45.9 (31–69)  years. All patients received neoadjuvant polychemotherapy (NAPCT) per different regimens. Then the patients underwent surgery of different volume (from radical mastectomies to resections), and in 25 % of cases reconstructive breast surgery was performed. In 5 patients with BRCA1, – 2 mutations, prophylactic subcutaneous mastectomy with immediate reconstruction with an implant was performed; 2 patients refused prophylactic mastectomy; in 1 patient with СНЕК2 mutation, metachronous multiple primary breast cancer was diagnosed, previously she didn»t undergo prophylactic mastectomy, and 6 years later cancer in the second breast was diagnosed. Results. The study included 11 patients under 40 (27.5 %), 4 (50 %) of them in the group with mutations in ВRCA1, -2, CHEK2. The study demonstrated high effectiveness of NAPCT regimens per the АС + Т scheme and weekly injections of doxorubicin 25 mg/m 2 , cisplatin 30 mg/m 2 , and paclitaxel 100 mg/m 2 . Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases. Median follow-up duration for this patient group was 22.1 months, and during this time disease progression was observed in 3 patients: in the 1st patient continued growth on the thoracic wall and brain metastases were diagnosed, in the 2nd patient – lung and supraclavicular lymph nodes metastases, in the 3rd patient – metastases in the cerebellum. In all of these patients, grade IV treatment pathomorphosis wasn»t achieved. Conclusions. The study demonstrated high effectiveness of NAPCT in patients with triple-negative breast cancer of different stages: objective response rate was 90.0 ± 4.7 %, grade IV treatment pathomorphosis was 50.0 ± 7.9 %. Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases. Rate of grade IV treatment pathomorphosis was higher in patients with hereditary form of the disease (62.5 ± 18.3 %) compared to the group with sporadic breast cancer (46.9 ± 8.8 %), р >0.05. In all patients, 2-year disease-free survival was 92.5 %, 2-year overall survival was 95 %.
三阴性乳腺癌的发病率为10 - 24%,由于其临床侵袭性强,分子靶点较少,是近年来研究最多的乳腺癌亚型之一。该研究的目的是评估不同NAPCT治疗方案的有效性,包括它们对ВRСА 1,2, СHEK2基因突变存在的依赖性。材料和方法。该研究包括40名患有三阴性乳腺癌的女性患者。2012 - 2016年对患者进行监测;手术治疗在P.A. Hertzen莫斯科肿瘤研究所-俄罗斯卫生部国家医学研究放射中心分支进行。患者中位年龄为45.9岁(31-69岁)。所有患者均接受不同方案的新辅助多重化疗(NAPCT)。然后患者接受了不同体积的手术(从根治性乳房切除术到全切除术),25%的病例进行了乳房重建手术。在5例BRCA1, - 2突变患者中,进行了预防性皮下乳房切除术并立即用植入物重建;2例拒绝预防性乳房切除术;1例СНЕК2突变患者,诊断为异时性多发原发乳腺癌,此前未行预防性乳房切除术,6年后诊断为第二个乳房癌。结果。该研究包括11例40岁以下的患者(27.5%),其中4例(50%)属于ВRCA1, -2, CHEK2突变组。该研究表明,АС + Т方案和每周注射阿霉素25mg / m2、顺铂30mg / m2和紫杉醇100mg / m2的NAPCT方案具有很高的有效性。在АС + Т方案中,50.0±7.9%的患者达到了NAPCT的IV级治疗病理形态,在强化方案中,62.5±12.5%的患者达到了四级治疗病理形态。该患者组的中位随访时间为22.1个月,在此期间有3例患者出现疾病进展:1例患者胸壁持续生长并诊断为脑转移,2例患者肺和锁骨上淋巴结转移,3例患者小脑转移。在所有这些患者中,没有达到IV级病理形态治疗。结论。研究表明,NAPCT在不同分期的三阴性乳腺癌患者中具有较高的疗效:客观有效率为90.0±4.7%,IV级治疗病理形态学为50.0±7.9%。在АС + Т方案中,50.0±7.9%的患者达到了NAPCT的IV级治疗病理形态,在强化方案中,62.5±12.5%的患者达到了四级治疗病理形态。遗传型乳腺癌患者的IV级治疗性病变发生率(62.5±18.3%)高于散发型乳腺癌患者(46.9±8.8%),差异有统计学意义(p < 0.05)。所有患者2年无病生存率为92.5%,2年总生存率为95%。
{"title":"ЛЕЧЕНИЕ ТРОЙНОГО НЕГАТИВНОГО ПОДТИПА РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ","authors":"А. Д. Зикиряходжаев, Мария Александровна Фролова, Елена Александровна Рассказова, Е. В. Глазкова","doi":"10.17650/1994-4098-2017-13-2-20-26","DOIUrl":"https://doi.org/10.17650/1994-4098-2017-13-2-20-26","url":null,"abstract":"The rate of triple-negative breast cancer is 10–24  %, and in recent years it’s one of the most studied subtypes of breast cancer due to its clinical aggressiveness and a small number of molecular targets. The study objective is to evaluate effectiveness of different NAPCT regimens including their dependence on the presence of mutations in the ВRСА 1, 2, СHEK2 genes. Materials and methods . The study included 40 female patients with triple-negative breast cancer. The patients were monitored from 2012 to 2016; surgical treatment was performed at the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia. Median patient age was 45.9 (31–69)  years. All patients received neoadjuvant polychemotherapy (NAPCT) per different regimens. Then the patients underwent surgery of different volume (from radical mastectomies to resections), and in 25 % of cases reconstructive breast surgery was performed. In 5 patients with BRCA1, – 2 mutations, prophylactic subcutaneous mastectomy with immediate reconstruction with an implant was performed; 2 patients refused prophylactic mastectomy; in 1 patient with СНЕК2 mutation, metachronous multiple primary breast cancer was diagnosed, previously she didn»t undergo prophylactic mastectomy, and 6 years later cancer in the second breast was diagnosed. Results. The study included 11 patients under 40 (27.5 %), 4 (50 %) of them in the group with mutations in ВRCA1, -2, CHEK2. The study demonstrated high effectiveness of NAPCT regimens per the АС + Т scheme and weekly injections of doxorubicin 25 mg/m 2 , cisplatin 30 mg/m 2 , and paclitaxel 100 mg/m 2 . Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases. Median follow-up duration for this patient group was 22.1 months, and during this time disease progression was observed in 3 patients: in the 1st patient continued growth on the thoracic wall and brain metastases were diagnosed, in the 2nd patient – lung and supraclavicular lymph nodes metastases, in the 3rd patient – metastases in the cerebellum. In all of these patients, grade IV treatment pathomorphosis wasn»t achieved. Conclusions. The study demonstrated high effectiveness of NAPCT in patients with triple-negative breast cancer of different stages: objective response rate was 90.0 ± 4.7 %, grade IV treatment pathomorphosis was 50.0 ± 7.9 %. Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases. Rate of grade IV treatment pathomorphosis was higher in patients with hereditary form of the disease (62.5 ± 18.3 %) compared to the group with sporadic breast cancer (46.9 ± 8.8 %), р >0.05. In all patients, 2-year disease-free survival was 92.5 %, 2-year overall survival was 95 %.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127769685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ОНКОПЛАСТИЧЕСКАЯ РЕЗЕКЦИЯ МОЛОЧНОЙ ЖЕЛЕЗЫ СКОЛЬЗЯЩИМ ДЕРМОГЛАНДУЛЯРНЫМ ЛОСКУТОМ С Z-ОБРАЗНЫМ РАЗРЕЗОМ 肿瘤成形术切除乳房滑行皮质皮瓣Z形切口
Pub Date : 2017-06-18 DOI: 10.17709/2409-2231-2017-4-2-9
Array А. Рассказова, Array Д. Зикиряходжаев, Array К. Сарибекян
Oncoplastic resections are a radical surgical treatment for breast cancer, as well as a method for the rehabilitation of patients, since operations are classified as organ preserving. When the tumor node is localized in the upper-inner quadrant of the breast, it is difficult to achieve good aesthetic results. One of the solutions to the problem is the use of a sliding flap with a Z-shaped incision. In P. Hertsen MORI from 2014 to 2016, the operation with the use of a sliding flap was performed in 13 patients. The prevalence of the process, patients were distributed as follows: ТisN0 М0–1, Т1N0 М0–7, Т2N0 М0–3, Т1N1 М0–2 .Molecular subtypes distribution was the following — luminal type A— 8, luminal type B — 3, triple-negative subtype — 1 patient. Localization of the tumor site in the breast: the upper-internal quadrant — 9, upper — 1, lowerinner quadrant — 3 .The upper Zshaped flap was used in 10 patients, the lower Zshaped flap in 3 cases. Postoperative period in all patients was without com plications. The wound healed by primary intention in all patients. Cosmetic effect was good. The observation period is from 6 months to 2 years, the median is 1.1 years. Data for local recurrence and distant metastases were not detected. 2 patients had only surgical treatment, in the remaining 8 cases, radiation therapy with or without drug therapy. In all cases the operation is performed on one breast, correction of the second breast was not required.The article presents the clinical observation of patients with oncoplastic resection of the Zshaped flap, a detailed procedure of the operation.
肿瘤切除术是乳腺癌的一种根治性手术治疗方法,也是患者康复的一种方法,因为手术被归类为器官保留。当肿瘤淋巴结定位于乳房内上象限时,很难达到良好的美学效果。解决这个问题的方法之一是使用带z形切口的滑动皮瓣。2014 - 2016年,P. Hertsen MORI共13例患者行滑动皮瓣手术。发病过程中,患者分布如下:ТisN0 М0-1、Т1N0 М0-7、Т2N0 М0-3、Т1N1 М0-2 .分子亚型分布如下:A - 8型、B - 3型、三阴性亚型- 1型患者。乳腺肿瘤部位定位:内上象限- 9,上象限- 1,下象限- 3,上z型皮瓣10例,下z型皮瓣3例。所有患者术后无并发症。所有患者伤口均按原意向愈合。美容效果好。观察期6个月~ 2年,中位数1.1年。没有发现局部复发和远处转移的数据。单纯手术治疗2例,放疗加或不加药物治疗8例。在所有情况下,手术都是在一个乳房上进行的,第二个乳房不需要矫正。本文介绍了z型皮瓣肿瘤切除的临床观察,详细介绍了手术步骤。
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引用次数: 1
ОДНОМОМЕНТНАЯ ИМПЛАНТАЦИЯ ИСКУССТВЕННОГО СФИНКТЕРА МОЧЕВОГО ПУЗЫРЯ И ПЕНИЛЬНОГО ПРОТЕЗА КАК МЕТОД КОРРЕКЦИИ ЭРЕКТИЛЬНОЙ ДИСФУНКЦИИ И МОЧЕВОЙ ИНКОНТИНЕНЦИИ 一次人工括约肌植入膀胱和阴茎假体,作为纠正勃起功能障碍和膀胱内膜炎的一种方法。
Pub Date : 2017-06-18 DOI: 10.17709/2409-2231-2017-4-2-10
Array С. Кызласов, Array М. Сокольщик, Н. А. Гончаров, Array В. Поройский, В. А. Сергеев, Array И. Володин, Array А. Кисилева, М. Забелин
This article provides a clinical example of the simultaneous implantation of an artificial sphincter of the bladder and a triple-component prosthesis of the penis, which allows almost completely to rehabilitate a patient with total incontinence and erectile dysfunction after laparoscopic radical prostatectom y for prostate cancer. The urgency of writing this article was a high incidence of prostate cancer, which has no tendency to decrease.It should be noted that when choosing the optimal method for treating prostate cancer, it is necessary to take into account the stage of the disease development, the patient’s age, concomitant diseases, possible complications, test results, and the wishes of the patient. In the stages of prostate cancer T1T2, radical prostatectomy in any of its embodiments, openly laparoscopically or with the help of a robot is a routine operation, at stage T3, in order to achieve an acceptable result, it is necessary not only sufficient surgical technique, but the correct preoperative preparation (the use of hormone therapy).One of the frequent complications of radical prostatectomy at stage T3 is urinary incontinence and erectile dysfunction, which is caused by the need for more “aggressive” techniques, the frequency of which reaches, in the opinion of different authors, 30 to 90%. With incontinence after a radical prostatectomy of moderate and severe degree, the implantation of an artificial urethral sphincter remains the preferred method of treatment. Artificial sphincter allows you to fully control the process of retention of urine and urination. Note that the restoration of potency after surgery is a very difficult problem. After the operation, one of the methods of preserving the erectile function is the early administration of 5fosofodiesterase inhibitors, but their reception does not always allow to maintain the erectile function, in this case, patients can be rehabilitated by penile implantation. The installation of a three-component phalloprosthesis or artificial sphincter separately is already a routine operation, but simultaneous treatment of two com plications and sim ultaneous im plantation of two prostheses is a rarity.
本文提供了一个同时植入人工膀胱括约肌和三组份阴茎假体的临床实例,几乎完全恢复了腹腔镜根治性前列腺切除术后完全失禁和勃起功能障碍的患者。写这篇文章的紧迫性是前列腺癌的高发病率,没有下降的趋势。需要注意的是,在选择治疗前列腺癌的最佳方法时,必须考虑到疾病发展的阶段、患者的年龄、伴随疾病、可能的并发症、检查结果以及患者的意愿。在前列腺癌T1T2阶段,根治性前列腺切除术的任何表现形式,公开腹腔镜或在机器人的帮助下都是常规手术,在T3阶段,为了达到可接受的结果,不仅需要足够的手术技术,而且需要正确的术前准备(使用激素治疗)。根治性前列腺切除术T3期常见的并发症之一是尿失禁和勃起功能障碍,这是由于需要更“积极”的技术引起的,在不同作者看来,其频率达到30%至90%。对于中度和重度根治性前列腺切除术后尿失禁,人工尿道括约肌植入仍然是首选的治疗方法。人工括约肌可以让你完全控制尿潴留和排尿的过程。注意手术后效力的恢复是一个非常困难的问题。手术后,保留勃起功能的方法之一是早期给予5 fosofodi酯酶抑制剂,但它们的接受并不总是允许维持勃起功能,在这种情况下,患者可以通过阴茎植入来恢复。分别安装三组份阴茎假体或人工括约肌已经是一种常规手术,但同时治疗两种并发症并同时植入两种假体是罕见的。
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引用次数: 0
Новые технологии в криохирургии при эндоскопическом лечении опухолей дыхательных путей 低温手术的新技术用于内窥镜治疗气道肿瘤。
Pub Date : 2017-06-17 DOI: 10.17709/2409-2231-2017-4-2-4
В. В. Соколов, Дмитрий Викторович Соколов, Л. В. Телегина, Андрей Леонидович Николаев, Андрей Павлович Кирюхин, Ю. Л. Кудрявцева
The article presents the history of the development of the cryosurgery method from antiquity to the present day, materials of the clinical use of cryosurgery for endoscopic diagnosis and treatment of tumors of respiratory tract at the present stage, features of modern equipment for cryosurgery. Also the article presents the first clinical experience of using cryorecanalization in stenosing tumors of the tracheobronchial tree inRussiawith the help of the medical device of the latest generation ERBECRYO 2. Three clinical examples of cryorecanalization are given. Preliminary results of clinical studies show that, in comparison with cryosurgery on older devices, cryorecanalization using the latest generation of m edical eq uipment and a new cryosondond model is an effective method of recanalization to restore airway patency, which can be used in combination with electrodestruction, argon-plasma And laser coagulation.
本文介绍了冷冻手术方法从古至今的发展历史,现阶段临床应用冷冻内镜诊断和治疗呼吸道肿瘤的材料,以及现代冷冻手术设备的特点。本文还介绍了俄罗斯首次利用最新一代ERBECRYO 2医疗器械在气管支气管树狭窄性肿瘤中应用冷冻再通术的临床经验。本文给出了三个低温再通的临床实例。初步临床研究结果表明,与旧设备上的冷冻手术相比,采用最新一代医用eq设备和新型低温超声模型进行冷冻再通是一种有效的恢复气道通畅的再通方法,可与电破坏、氩等离子体和激光凝固联合使用。
{"title":"Новые технологии в криохирургии при эндоскопическом лечении опухолей дыхательных путей","authors":"В. В. Соколов, Дмитрий Викторович Соколов, Л. В. Телегина, Андрей Леонидович Николаев, Андрей Павлович Кирюхин, Ю. Л. Кудрявцева","doi":"10.17709/2409-2231-2017-4-2-4","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-2-4","url":null,"abstract":"The article presents the history of the development of the cryosurgery method from antiquity to the present day, materials of the clinical use of cryosurgery for endoscopic diagnosis and treatment of tumors of respiratory tract at the present stage, features of modern equipment for cryosurgery. Also the article presents the first clinical experience of using cryorecanalization in stenosing tumors of the tracheobronchial tree inRussiawith the help of the medical device of the latest generation ERBECRYO 2. Three clinical examples of cryorecanalization are given. Preliminary results of clinical studies show that, in comparison with cryosurgery on older devices, cryorecanalization using the latest generation of m edical eq uipment and a new cryosondond model is an effective method of recanalization to restore airway patency, which can be used in combination with electrodestruction, argon-plasma And laser coagulation.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130274164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
УЛУЧШЕНИЕ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ БОЛЬНЫХ С КОНКРЕМЕНТАМИ МОЧЕТОЧНИКА ПОСЛЕ КОНТАКТНОЙ УРЕТЕРОЛИТОТРИПСИИ 改善尿道接触尿道败血症患者的治疗结果
Pub Date : 2017-06-17 DOI: 10.17709/2409-2231-2017-4-2-1
Array М. Сольх, Array И. Андрюхин, О. А. Макаров, Array В. Федченков
Purpose. Im proving the results of treatment of patients with ureteral stones and reducing the dam aging effects of contact lithotripsy. Materials and methods . In this study, 48 patients were examined aged 20 to 63 years. All patients admitted to the urology department with diagnoses: urolithiasis, calculus of the ureter. In all cases contact ureterolithotripsy with stenting of the upper urinary tract were performed. The patients were divided into two groups: main and control. 25 patients (52 .1%) were included into the main group, which in the postoperative period, we used low-level laser therapy (L-therapy). 23 patients were included in a control group (47.9%) who did not receive low-laser therapy. Laboratory tests and ultrasound with Doppler renal blood vessels scan were performed on admission, on the first day after the operation and on the 5-th day of hospitalization. Low-intensity laser therapy was performed within 5 days after contact ureterolithotripsy on projection of placement of stone and kidney projection by series for 5 minutes. Results . All patients admitted to the hospital, were spared from ureteral stones. In the main group during the treatment with L-therapy a decrease in the level of beta-2 microglobulin to normal was observed. (4.8 ± 0.1 mg/l on the first day. On the 5th day 2 .3 + 0.1 mg/l). In the control group during the treatment without the use of L-therapy, the average level of beta-2 microglobulin decreased but did not reach normal levels. (5.5 ± 0.1 mg/l on the first day. On the 5th day 3,2 ±0, l mg/l).Resistance index in the study group decreased compared to the control. In the control group, cases of acute pyelonephritis were observed. The average hospital stay for patients of the main group (6 days) was less than in the control group (6 .5 + days). Conclusion. The use of laser therapy in the treatment of patients who did undergo ureterolithotripsy can reduce the length of stay of the patient in the hospital and reduce the risk of acute pyelonephritis in the postoperative period. Also it can reduce the damaging effect of lithotripsy on the renal tissues.
目的。目的:验证输尿管结石患者的治疗效果,减少接触式碎石术对大坝老化的影响。材料和方法。本研究对48例年龄在20 ~ 63岁的患者进行了检查。所有患者入院泌尿科诊断:尿石症,输尿管结石。所有病例均行接触输尿管碎石术及上尿路支架置入术。将患者分为两组:主要组和对照组。主组25例(52.1%),术后采用低水平激光治疗(L-therapy)。对照组23例(47.9%)未接受低激光治疗。入院时、术后第1天、住院第5天分别行实验室检查和多普勒肾血管超声扫描。接触性输尿管碎石术后5天内进行低强度激光治疗,投射放置结石,连续投射肾脏5分钟。结果。所有入院患者均未患输尿管结石。主组在l -治疗期间β -2微球蛋白水平降至正常。(4.8±0.1 mg/l第一天。第5天2 .3 + 0.1 mg/l)。对照组在不使用l疗法治疗期间,β -2微球蛋白的平均水平有所下降,但未达到正常水平。(5.5±0.1 mg/l,第一天。第5天3、2±0,l mg/l)。与对照组相比,研究组耐药指数下降。对照组观察急性肾盂肾炎病例。主组患者平均住院时间(6天)少于对照组(6.5天以上)。结论。使用激光治疗输尿管结石患者可以减少患者住院时间,降低术后急性肾盂肾炎的风险。也可减少碎石对肾组织的损害。
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引用次数: 1
НЕОАДЪЮВАНТНАЯ КОМБИНИРОВАННАЯ ХИМИОТЕРАПИЯ У БОЛЬНОЙ РАКОМ ШЕЙКИ МАТКИ IIIB СТАДИИ С ИСПОЛЬЗОВАНИЕМ ВНУТРИАРТЕРИАЛЬНОГО ВВЕДЕНИЯ ПРЕПАРАТОВ ПЛАТИНЫ 宫颈癌患者IIIB使用动脉内铂药物进行综合化疗
Pub Date : 2017-06-17 DOI: 10.17709/2409-2231-2017-4-2-8
А. A. Рерберг, А. А. Костин, А. А. Бойко, Е. А. Новикова, Н. Волченко, О. A. Чулкова, Л. A. Демидова, Г. A. Хохриков, Д. Сидоров, А. Геворкян
The main treatment for cervical cancer are surgery, radiation and combined (surgery + radiotherapy), the role of chemotherapy in this localization is studied less fully. In recent years the new possibilities of chemotherapy, including neoadjuvant intraarterial chemotherapy, are explored. Theoretical prerequisites for this are the best drug delivery to the tumor by blood vessels, undamaged due to radiation therapy and surgery. This paper describes a clinical case of a patient with primary inoperable cervical cancer. As an alternative to preoperativ e radiotherapy the patient was proposed neoadjuv ant com bination chemotherapy with the use of regional administration of platinum drugs and systemic administration of drugs of taxan series as a stage of preparation for further surgical treatment. According to the prevalence of the tumor process patient underwent 2 courses of neoadjuv ant chemotherapy by a method of superselective intra-arterial administration of cisplatin and paclitaxel intravenously. According to a comprehensive examination after treatment data for the presence of tumor was absent. During the second stage the patient underwent surgical treatment in the volume of nerve-sparing radical hysterectomy with appendages. The next step, according to the histological form of the tumor, stage of disease, was the radiotherapy in the postoperative period on the pelv ic area and routes of lym ph drainage. The patient underwent external beam radiotherapy to the pelvic area of FD = 20 Gr, intracavitary gamma-therapy and external beam radiation on the area of parametrial and lymphopenia FD = 50 Gr.The patient passed the control examinations every 3 months. According to a comprehensive survey a year after the start of treatment — there is no data for the presence of recurrence and spread of tumor process.
宫颈癌的主要治疗方法为手术、放疗及手术+放疗联合治疗,化疗在此定位中的作用研究较少。近年来,化疗的新可能性,包括新辅助动脉内化疗,被探索。这一理论的先决条件是最好的药物通过血管输送到肿瘤,不受放射治疗和手术的损害。本文介绍了一例原发性不能手术的宫颈癌患者的临床病例。作为术前放疗的替代方案,建议患者进行新辅助联合化疗,局部给药铂类药物,全身给药紫杉系列药物,为进一步手术治疗做准备。根据肿瘤进展情况,患者采用顺铂+紫杉醇动脉超选择性给药方式进行2个疗程的新辅助化疗。经综合检查治疗后无肿瘤存在的资料。在第二阶段,患者接受了保留神经的根治性子宫切除术。下一步,根据肿瘤的组织学形态、疾病分期,在术后对盆腔区及淋巴液引流路径进行放疗。患者行盆腔外束放疗FD = 20 Gr,腔内伽玛治疗和参数区及淋巴细胞减少区外束放疗FD = 50 Gr。患者每3个月进行一次对照检查。根据治疗开始一年后的综合调查-没有数据显示存在复发和肿瘤扩散的过程。
{"title":"НЕОАДЪЮВАНТНАЯ КОМБИНИРОВАННАЯ ХИМИОТЕРАПИЯ У БОЛЬНОЙ РАКОМ ШЕЙКИ МАТКИ IIIB СТАДИИ С ИСПОЛЬЗОВАНИЕМ ВНУТРИАРТЕРИАЛЬНОГО ВВЕДЕНИЯ ПРЕПАРАТОВ ПЛАТИНЫ","authors":"А. A. Рерберг, А. А. Костин, А. А. Бойко, Е. А. Новикова, Н. Волченко, О. A. Чулкова, Л. A. Демидова, Г. A. Хохриков, Д. Сидоров, А. Геворкян","doi":"10.17709/2409-2231-2017-4-2-8","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-2-8","url":null,"abstract":"The main treatment for cervical cancer are surgery, radiation and combined (surgery + radiotherapy), the role of chemotherapy in this localization is studied less fully. In recent years the new possibilities of chemotherapy, including neoadjuvant intraarterial chemotherapy, are explored. Theoretical prerequisites for this are the best drug delivery to the tumor by blood vessels, undamaged due to radiation therapy and surgery. This paper describes a clinical case of a patient with primary inoperable cervical cancer. As an alternative to preoperativ e radiotherapy the patient was proposed neoadjuv ant com bination chemotherapy with the use of regional administration of platinum drugs and systemic administration of drugs of taxan series as a stage of preparation for further surgical treatment. According to the prevalence of the tumor process patient underwent 2 courses of neoadjuv ant chemotherapy by a method of superselective intra-arterial administration of cisplatin and paclitaxel intravenously. According to a comprehensive examination after treatment data for the presence of tumor was absent. During the second stage the patient underwent surgical treatment in the volume of nerve-sparing radical hysterectomy with appendages. The next step, according to the histological form of the tumor, stage of disease, was the radiotherapy in the postoperative period on the pelv ic area and routes of lym ph drainage. The patient underwent external beam radiotherapy to the pelvic area of FD = 20 Gr, intracavitary gamma-therapy and external beam radiation on the area of parametrial and lymphopenia FD = 50 Gr.The patient passed the control examinations every 3 months. According to a comprehensive survey a year after the start of treatment — there is no data for the presence of recurrence and spread of tumor process.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"292 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117328323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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Research'n Practical Medicine Journal
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