顶部连接后台

搜索
烟台市中医医院2019年第二批急需高层次短缺人才招聘公告

公告通知:

版权所有:烟台市中医医院    网站备案:鲁ICP备11026673号-1     总服务台咨询电话:0535—6597085
地址:山东省烟台市幸福路39号    乘车路线:乘2路、16路、26路、47路、48路、70路、80路、82路直达
网站建设:中企动力 烟台      后台管理
 
安卓手机APP扫码下载 手机二维码 微信服务号 微信公众号 支付宝公众号
>
微创技术典型病案 A typical case of minimally invasive technology

肿瘤科特色 Oncology Feature

微创技术典型病案 A typical case of minimally invasive technology

Green is the main color of the 21st century, "green food", "green clothing", "green environment", even to treat diseases "green." In the treatment of malignant tumors, chemotherapy on the human body is undoubtedly a big side effect, will form pollution, so how to take its effects, to get rid of the disease, to achieve the purpose of efficiency reduction?
 
Oncology Department of Yantai traditional Chinese medicine hospital adopts green treatment of tumor, which can effectively avoid the above-mentioned damage. The green treatment of tumors is aimed at the different stages of the development of malignant tumors. Minimally invasive surgery, Chinese medicine treatment, low-dose radiation chemotherapy, and bioimmunotherapy are used to ensure the quality of life of patients and prolong their lives. These treatments conform to the principles of minimally invasive or non-invasive, low injury, and sustainable.
 
The concept of "green treatment" guides clinical practice. The oncology Department of Yantai traditional Chinese medicine hospital integrates the theory innovation of traditional Chinese medicine tumor with advanced technology, and selects the appropriate treatment method according to the different stages of the patient. Local treatment is a part of green treatment. For some tumors, we carry out local differentiation of tumors. Using modern minimally invasive techniques and traditional traditional Chinese medicine, such as external treatment, we can quickly eliminate local lesions and achieve therapeutic results.
 
Modern minimally invasive techniques include local cryoablation, microwave ablation, radiofrequency ablation, ultrasound focusing, photodynamic technology, DSA angioplasty, thermal perfusion, intratumor chemical injection, and radioactive iodine-125 tumors Implantation, vacuum assisted rotation of breast nodules, etc.. The advantages of minimally invasive treatment are: 1 The patient has less pain and does not need surgery. The treatment process has less trauma, less bleeding, and no damage or low damage to the organs. 2 The effect is good, can destroy the tumor body directly, has a good success rate. It has good repeatability and can be tolerated by elderly and infirm patients. 4 It can be combined with radiotherapy, chemotherapy and other treatments. 5 can be applied widely and can be used in cases where surgery or other treatment fails.
Here are some of the cases that we have treated under the concept of green treatment in the oncology Department of Yantai Hospital:
Case 1(chemotherapy for lung cancer + internal implantation of radioactive particle iodine-125 tumor + external application of Chinese medicine):
Liang XX, male, 60 years old. 2015-9-9 patients with "dry cough for 1 week" checked the chest CT in our hospital to show that the upper right lung leaves can see massive high-density shadows, the size of about 3.8 * 6cm, its internal density is not clear with the pulmonary vein demarcation, mediastinal No enlarged lymph nodes. Percutaneous biopsy, immunohistochemical examination of lung adenocarcinoma, EGFR gene detection did not have mutations, anti-tumor and traditional Chinese medicine decoction combined chemotherapy treatment, 6 cycles of chemotherapy to review the progress of lung lesions, 2016-2017 -1 In my family hospitalization, CT guided lung tumor iodine-125 particle implantation, every 2 months after the operation in the hospital, proprietary Chinese medicine static drops, oral Chinese medicine soup, moxibustion and other maintenance treatment. Every February, the chest CT is reviewed, and the lesion is gradually reduced to almost disappeared. The patient is currently in good physical condition and has no loss of weight.
 
Pre-treatment CT:
Radioactive particle iodine-125 during implantation(it can be clearly seen that the tumor is closely linked to large blood vessels):
 
Recent review of the film
 
Case 2(Hepatic metastatic tumor chemotherapy + intra-tumor alcohol injection treatment + internal Chinese medicine external application):
Patient Liangxx, male, 57 years old. 2015-5-30 patients were admitted to Yuding Hospital for "fever, abdominal pain for more than 2 weeks". The colonoscopy: 2/3 weeks from the anus to the anus, the cystic masses are raised, the surface nodules are uneven, and the quality is brittle. Biopsy pathology shows: rectal adenocarcinoma(pathological number 20151802); Check liver B hypermanifestation: intrahepatic occupation, considering rectal cancer metastasis. In 2015-6-10 Yu Weiding Hospital, palliative resection of rectal cancer + liver occupied microwave ablation under general anesthesia. During the operation, B-ultrasound examination saw a liver right lobe uneven mass of 6.5 * 5.5 cm, and the resection of the rectum during surgery. 17.5 cm, The specimen saw a tumor size of about 6 * 5.5 * 5.0 cm, about 4cm from the anus. The postoperative pathology showed that:(rectum) ulceration in the bulge type differentiated adenocarcinoma, invasion of the subserous fiber tissue, and no cancer in the upper and lower incisors. There was no metastasis in 14 iliac lymph nodes. Immunogenicity showed: MLH1(+), PMS2(+), MSH2(+), MSH6(+), Ki-67 positive rate of about 50 %, postoperative patients did not perform further chemotherapy. 2015-9-12 Enhanced CT in the entire abdomen of our hospital showed that the original diagnosis of rectal fistula was reviewed after surgery, abdominal wall scar shadow, rectal anastomosis of the oral intestinal wall thickening, left abdominal wall fistula, abnormal strengthening of the liver, Consider transfer. The fourth cycle of Folfox4 chemotherapy was started at 9.13, respectively. In 2015.11.23, anhydrous alcohol perfusion was performed on tumors in the liver area guided by CT(10 % iodine oil Mark was added to anhydrous alcohol). After the operation, we were given a homemade analgesic powder. The external application of the tumor site promoted necrotic tissue dissipation. Two cycles of Folfox4 chemotherapy. Oral Chinese medicine reduces side effects of chemotherapy throughout the treatment process. After chemotherapy, give oral Chinese medicine maintenance treatment. The CT liver lesion was enhanced by 2016.2.29, 2016.23, 2016-11 and 2017-5 respectively. Tumor markers CEA, CA-199 are normal. The patient is currently living in good condition.
 
Before the treatment of liver tumor alcohol injection CT:
 
One year after the treatment of intrahepatic alcohol injection, the CT was reviewed:
 
Two years after the treatment of alcohol injection in liver tumors, the CT film was reviewed(the tumor was close to disappearance, leaving part of the iodine oil deposit):
 
Case 3(Cases after microwave ablation of premature lung cancer):
Patients 2015-10-4 were hospitalized in my department for "dizziness, abdominal pain for 1 week". They had coughs at the time. The chest CT showed that: the shadow of the lung in the lungs and the glass shadow of Yemo(1.3 X 1.4 cm) in the right lung, After half a month of antibiotic treatment, CT was reviewed: Yemo glass stove in the right lung, with little change compared to 2015.10.5; Under the guidance of 10.22 lines of CT, the biopsy of the upper right pulmonary grinding glass lesion was performed. Postoperative pathology: a few adenoid structures were found in the hyperplastic fibrous connective tissue. After consultation with the provincial hospital Binglikewangjiayao, the opinion was:(Right lung upper lobe puncture) Highly differentiated adenocarcinoma. CK7:(+); TTF-1:(+); NapsinA(+); Ki-67:(+) 20 %, CEA:(+); CollagenIV:(±). Family members and patients refused to perform surgical removal of the lesion. Under the guidance of CT on 11.5, the microwave ablation of the lung grinding glass lesion was performed. After the operation, the lesion was given local external application to relieve blood stasis, and oral Chinese medicine soup was treated. The patient was not discharged after 2 days. After discharge from the hospital, continue to use Chinese medicine for external application. At present, the patient's life is in good condition.
Chest CT before microwave ablation:
 
CT during microwave ablation:
 
Immediate CT after microwave ablation:
 
1 week review of CT after microwave ablation:
 
Forty days after ablation, the CT scan was reviewed(the enhanced lesion was not strengthened at all, completely ablated):
 
Case 4(Early liver cancer ultrasound guided percutaneous percutaneous microwave ablation)
When the patient was admitted to the hospital for treatment of "prostate hypertrophy" in October 2016, CT found that liver occupied position, abdominal ultrasound and nuclear magnetic examination were considered as cirrhosis and liver cancer. On November 18, 2016, liver biopsy and ultrasound guided percutaneous percutaneous liver tumor microwave ablation. Postoperative pathology: hepatocellular carcinoma. After the operation, the Chinese medicine decoction was given to prevent recurrence, and the external application of Chinese medicine was given to promote the absorption of necrotic substances. Since then, the review did not find symptoms of recurrence and metastasis, and the patient's life status is good.
Here are the contrast between the enhanced CT scan of the upper abdomen before liver ablation in 2016.11.14 and the three revisits after ablation in 2017.1.9, 2017.11.20 and 2018.2.24. After the ablation, the lesion was not strengthened at all, and it was completely ablated and gradually reduced.
 
 
 
        绿色是21世纪的主色调, "绿色食物", "绿色衣服", "绿色环境",连治疗疾病也要"绿色"。在恶性肿瘤的治疗上,放化疗对人体无疑副作用较大,会形成污染,那么如何取其效、去其害,达到增效减毒的目的呢?
烟台市中医医院肿瘤科采用肿瘤的绿色治疗,能够有效避免上述损害。肿瘤绿色治疗,就是针对恶性肿瘤发展的不同阶段,采用微创手术、中医药治疗、低剂量放化疗、生物免疫治疗等方法,保证患者生活质量,延长患者的生命。这些治疗方法符合微创或无创、低损伤、可持续原则。  
        “绿色治疗”理念指导着临床实践。烟台市中医医院肿瘤科将中医肿瘤理论创新与先进技术接轨,根据患者所处的不同阶段,选用合宜的治疗方法。局部治疗是绿色治疗中的一部分,对于有些肿瘤,我们进行肿瘤局部辨证,采用现代微创技术及传统中医外治等手段,便可快速消灭局部病灶,达到治疗效果。
        我们采用的现代微创技术包括:氩氦刀局部冷冻消融术、微波消融、射频消融、超声聚焦、光动力技术、DSA血管介入技术、椎体成形术、热灌注、肿瘤内化学药物注射术、放射性碘-125肿瘤内植入术、乳腺结节的真空辅助旋切术等。 微创治疗的优势为:①病人痛苦小、不需开刀,治疗过程创伤小、出血少,对脏器无损伤或低损伤。②效果好,能够直接摧毁肿瘤本体,具有良好的成功率。③具有很好的可重复性,年老体弱的患者也可耐受。④可与放疗、化疗等其他疗法结合应用。⑤适用范围广,可用于无法手术或其他治疗失败的病例。
 
        下面介绍部分我们烟台中医院肿瘤科秉承绿色治疗理念下治疗过的案例:
 
案例1(肺癌化疗+放射性粒子碘-125肿瘤内植入治疗+中药内服外敷):
        梁XX,男,60岁。2015-9-9患者因“干咳1周”于我院查胸部CT示:右肺上叶可见团块状高密度影,大小约3.8*6cm,其内密度不均与肺静脉分界不清,纵隔内未见肿大淋巴结。行穿刺活检,免疫组化示肺腺癌,EGFR基因检测未见突变,予中成药抗肿瘤及中药汤剂联合化疗治疗,6周期化疗后复查肺部病灶较前进展,2016-3-1于我科住院,行CT引导性肺部肿瘤碘-125粒子植入术,术后每2个月住院行中成药静滴、中药汤剂口服、艾灸等维持治疗。每2月复查胸部CT,病灶逐渐缩小至几乎消失,患者目前体力状况生活状况好,体重无下降。
 
治疗前CT片:
 
放射性粒子碘-125植入过程中片子(能够明显看到肿瘤与大血管紧密相连):
 
最近复查片子
 
 
案例2(肝转移瘤化疗+肿瘤内酒精注入治疗+中药内服外敷):
        患者梁XX,男,57岁。2015-5-30患者因“发热、腹痛2周余”入住毓璜顶医院,查肠镜:距离肛门2-5cm处见环腔2/3周肿物样隆起,表面结节不平,质脆,活检病理示:直肠腺癌(病理号201518002);查肝脏B超示:肝内占位,考虑为直肠癌转移。于2015-6-10于毓璜顶医院在全麻下行直肠癌姑息切除术+肝占位微波消融术,术中B超探查见肝右叶不均质肿块6.5*5.5cm,术中切除直结肠约17.5cm,标本见肿瘤大小约6*5.5*5.0cm,距肛门约4cm,术后病理示:(直肠)溃疡隆起型中分化腺癌,侵及浆膜下纤维组织,上、下切缘未见癌累及。肠周淋巴结14枚未见癌转移。免疫组化示:MLH1(+)、PMS2(+)、MSH2(+)、MSH6(+)、Ki-67阳性率约50%,术后患者未行进一步放化疗。2015-9-12于我院全腹部增强CT示:原诊断直肠Ca造瘘术后复查,腹壁瘢痕影,直肠吻合口肠壁增厚,左侧腹壁瘘口影,肝内异常强化灶,考虑转移。分别于9.13开始行4周期Folfox4方案化疗,2015.11.23在CT引导下行肝区肿瘤无水酒精灌注术(无水酒精内加入10%碘油标记),术后给予我科自制化瘀止痛散膏药肿瘤部位外敷,促进坏死组织消散。再行2周期Folfox4方案化疗。整个治疗过程中口服中药减轻化疗副反应。化疗结束后给予口服中药维持治疗。分别于2016.2.29、2016.6.23、2016-11、2017-5全腹部增强CT肝脏病灶缩小。肿瘤标志物CEA、CA-199正常。患者目前生活状态良好。
 
肝肿瘤酒精注入治疗前CT片:
 
肝肿瘤内酒精注入治疗后1年复查CT片:
 
肝肿瘤内酒精注入治疗后2年复查CT片(肿瘤接近消失,存留部分碘油沉积):
 
 
 
案例3(肺早癌微波消融术后案例):
        患者2015-10-4因“头晕、腹痛1周”于我科住院,时有咳嗽,查体胸部CT示:双肺内索条影并右肺上叶磨玻璃影(1.3x1.4cm),予抗生素治疗半月后复查CT:右肺上叶磨玻璃灶,较2015.10.5变化不大;于 10.22行CT引导下右上肺磨玻璃病灶穿刺活检术,术后病理:增生的纤维结缔组织内查见少许腺样结构,经省立医院病理科王家耀会诊,意见:(右肺上叶穿刺)高分化腺癌。CK7:(+);TTF-1:(+);NapsinA(+);Ki-67:(+)20%,CEA:(+);CollagenIV:(±)。家属及患者拒绝行手术切除病灶。于11.5日行CT引导下肺部磨玻璃病灶微波消融术,术后给予病灶局部外敷化瘀止痛散,口服中药汤剂治疗。术后2天患者物不适出院。出院后继续中药内服外敷。目前患者生活状态很好。
 
微波消融术前胸部CT:
 
微波消融术中CT片:
 
微波消融术后即刻CT片:
 
微波消融术后1周复查CT片:
 
消融术后40天复查CT片(增强后病灶完全没有强化,完全消融):
 
案例4(早期肝癌超声引导下经皮穿刺微波消融术治愈)
        患者缘于2016年10月因“前列腺肥大”住院诊治时,CT发现肝占位,行腹部超声及核磁等检查后,考虑为肝硬化、肝癌,2016年11月18日于我院行肝穿刺活检并超声引导下经皮穿刺肝肿瘤微波消融术,术后病理:肝细胞癌。术后给予中药汤剂内服防复发,给予中药外敷促进坏死物质吸收消散。此后复查未发现复发及转移征象,现患者生活状态好。
下面是肝消融术前2016.11.14上腹部增强CT片与消融术后2017.1.9、2017.11.20、2018.2.24三次复查上腹部增强CT对比。消融后的病灶增强后完全没有强化,达到了完全消融,并逐渐缩小。
 

主攻方向 Main attack direction

科室形象 Oncology Image