脑转移瘤治疗方案的比较

脑转移瘤是成人最常见的颅内肿瘤之一,也是肿瘤患者致残与死亡的主要原因,然而目前还没有完全统一的治疗策略.本文利用比较治疗学相关原理和方法,从治疗方式、疗效、费用等方面对脑转移瘤的不同治疗方法进行比较和分析,为患者进行治疗上的选择提供帮助,同时指导和规范该类疾病治疗的临床决策,为临床治疗思路提供借鉴.     

脑转移瘤的综合治疗策略及最新进展

脑转移瘤,亦称颅内转移瘤,是成人最常见的颅内肿瘤。随着人口老龄化,影像学检查发现微小病灶能力的提高及系统治疗的改善,脑转移瘤的发病率呈逐渐升高趋势。然而,脑转移瘤患者的预后却不容乐观,目前对于脑转移瘤、特别是多发脑转移瘤仍无规范的治疗方法。因此,本文将综合近年来国内外手术、放疗、化疗、分子靶向治疗、免疫治疗等治疗脑转移瘤相关的临床研究及2015年版最新美国国立癌症综合网络(NCCN)指南,对脑转移瘤、特别是多发脑转移瘤的规范化治疗进行探讨。     

如何规范脑转移瘤不同治疗方法的适应证及治疗时机

脑转移瘤(又称颅内转移廇)系指原发于身体其他部位组织的肿瘤细胞转移至颅内形成的占位性病变,压迫脑神经组织,引起相应的临床症状和体征的一类疾病。脑转移的肿瘤原发部位以肺、乳腺、消化道肿瘤等常见,多发为主,预后不佳。临床表现归纳起来有三大特征:颅内压增高;局限性病灶症状;进行性病程。诊断上应结合病史、体格检查及影像学手段综合考虑。在治疗方面需把握一定的原则。主要治疗方法有手术治疗、放射治疗及化疗。以上三种方法各有其适应证及禁忌证,在临床上需谨慎选择。颅内转移瘤目前尚无最佳治疗手段,只有通过各学科的密切合作和积极努力,在建立不同原发肿瘤的高危预警体系基础上,把握治疗时机,采取规范化多学科综合治疗新策略,以改善脑转移瘤患者的生存和生活质量,使患者真正获益。根据患者治疗目的不同可选择不同的实施方案。     

导言:脑转移瘤的诊治现状

正脑转移瘤是一类原发于中枢神经系统以外,通过不同途径播散进入脑组织的肿瘤,其发病率正随着全身肿瘤治疗的进展与肿瘤患者生存期的延长而不断增长,此次圆桌会议主要探讨脑转移瘤治疗方法规范化、治疗方案的选择及目前所需要解决的问题等。目前对脑转移瘤的主要治疗手段包括全脑放疗、开颅肿瘤手术切除及立体定向放射外科治疗(SRS),而全身性     

放射治疗后复发性脑转移瘤的治疗抉择

立体定向放射外科(SRS)已经成为治疗脑转移瘤的一线选择,它既可用于全脑放射治疗(WBRT)后效果的提高,也可作为独立的治疗方案。当使用SRS作为一个单一的治疗方案,局部和远端的大脑复发率从73.0%到76.4%不等;当与WBRT联合使用时,复发率从27.0%到46.8%。作为系统性疗法改善,SRS治疗后,新发或复发脑转移瘤的患者有可能增加。关于补救治疗的安全性和有效性的证据是有限的,治疗方案的选择仍有争议。在本文中,笔者分析有关SRS治疗后复发和SRS治疗后新发脑转移瘤的发展,将对患者的每一个建议性方案及潜在的治疗策略进行讨论,其中包括再次SRS,手术切除,WBRT,分次立体定向放射治疗,化疗和支持治疗。     

脑转移瘤不同治疗方案的选择及比较

脑转移瘤是指起源于中枢神经系统以外组织的肿瘤发生扩散累及脑组织而形成的肿瘤,是高致残率与死亡率的恶性疾病,近年来其发病率日益增高,已超过原发颅内肿瘤成为颅内最常见的肿瘤。多数威胁脑转移瘤患者生命的是由于颅高压,而外科手术是解决颅高压最快捷有效的方法。面对全脑放疗、立体定向放疗、化疗、分子靶向等其他多样性的治疗手段,如何个体化选择手术与不同治疗方式的治疗时机及联合方式,以达到最佳的治疗效果,仍需进一步探讨。     

口腔颌面部脉管畸形两种非手术治疗方案比较

在治疗口腔颌面部脉管畸形的众多治疗方法中,激光治疗和瘤腔内药物注射是两种最为常用而且有效的非手术治疗手段。本文通过结合两者各自的优缺点,利用比较治疗学相关原理和方法,从治疗方法、治疗效果、治疗费用等方面对两者进行比较,以便获得一些启发,为临床治疗提供一定的借鉴。     

口腔颌面部脉管畸形两种非手术治疗方案比较

在治疗口腔颌面部脉管畸形的众多治疗方法中,激光治疗和瘤腔内药物注射是两种最为常用而且有效的非手术治疗手段.本文通过结合两者各自的优缺点,利用比较治疗学相关原理和方法,从治疗方法、治疗效果、治疗费用等方面对两者进行比较,以便获得一些启发,为临床治疗提供一定的借鉴.     

三种方式治疗椎体转移瘤的近期疗效评价

探讨椎体转移瘤的治疗方式选择,评价不同治疗方式的近期疗效。回顾性分析笔者所在医院治疗的75例单椎体转移瘤患者,按治疗方式分为三组,即单纯手术组25例,手术联合放疗组22例和单纯放疗组28例。照射剂量为40Gy~60Gy,2Gy/次,5次/周。分析三组患者半年内治疗疗效。1个月时三组患者的疼痛缓解率差异无统计学意义(P0.05);半年内肿瘤局部复发率单纯手术组单纯放疗组手术联合放疗组(P0.05);手术联合放疗组照射剂量为(57.27±4.56)Gy,单纯放疗组照射剂量为(43.93±4.97)Gy(P0.05)。调强放疗可以有效地对椎体肿瘤实施精准放疗,同时减少脊髓的放射损伤。手术联合放疗效果优于单纯放疗及单纯手术。椎体转移瘤肿瘤切除术可以有效地减少肿瘤负荷、缓解脊髓压迫,提高了肿瘤的放疗剂量,为椎体转移瘤的根治性放疗提供了空间。     

榄香烯联合替莫唑胺与单药替莫唑胺在 NSCLC 脑转移放疗后维持治疗中的比较研究

探讨榄香烯注射液联合替莫唑胺在非小细胞肺癌（NSCLC）脑转移患者放疗后维持治疗的疗效,将46例NSCLC脑转移放疗后患者,随机分为联合治疗组和对照组,分别采用榄香烯联合替莫唑胺和单药替莫唑胺维持化疗,观察两组疗效、免疫指标、不良反应及生存分析。结果显示两组无进展生存期（PFS）、总生存期（OS）差异无统计学意义（P＞0．05）。总缓解率及卡氏功能状态评分（KPS）两组比较差异有统计学意义（P＜0．05）。联合治疗组免疫功能提高,化疗不良反应减轻。榄香烯联合替莫唑胺维持治疗可以提高NSCLC脑转移患者放疗后的总缓解率,改善生活质量,减轻化疗的不良反应,应用安全。     

颅内动脉瘤治疗方案选择的多维思考

针对颅内动脉瘤手术治疗和血管内治疗的优缺点,分析不同治疗方式的疗效与经济费用比较,就如何选择治疗方法提出医疗原则,并对医疗原则进行伦理学思考,认为治疗应该体现安全、有效、经济的原则.     

侵袭性垂体腺瘤的个性化治疗

垂体腺瘤是颅内常见的良性肿瘤,但部分垂体腺瘤却呈现恶性生物学行为,呈侵袭性生长,导致手术全切困难,或是虽然手术切除满意,但却存在较高的复发率,使得临床治疗效果不满意。基于此,Jefferson1940年提出侵袭性垂体腺瘤的概念,随后人们对其诊断和治疗进行了深入系统的研究,取得了明显进展,特别是近年来有人提出垂体腺瘤的个性化治疗,使得侵袭性垂体腺瘤的治疗效果大为改观。     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

颅内动脉瘤治疗方案的比较

手术和血管内介入是目前临床上治疗颅内动脉瘤的有效方法,针对两者的优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴。     

In vitro studies to elucidate the fibrinolytic activity in cerebrospinal fluid altered by inflammation and hemorrhage and having pathologic protein values]

Using selectively immunological methods, it was possible, through FSP determination, for plasmin activities and plasminogen concentrations to be occasionally and exclusively detected in inflammatorily altered liquores and in bloody liquores, respectively. Thus, bloody cerebrospinal fluid, in contrast with inflammatorily altered liquor, usually shows free fibrinolytic activity, so that antifibrinolytic therapy of intracranial aneurysmal hemorrhage is pathophysiologically justifiable.     

超声心动图与心血管造影X线引导下先心病介入封堵治疗的比较

目前先天性心脏病介入治疗已成为介入心脏病学的新热点,而先心病介入治疗离不开影像学引导,目前临床上常用的影像学引导方式主要有超声心动图和心血管造影两种,本文针对两者优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴。     

Turning differences into possibilities: Using discourse analysis to investigate change in therapy with adolescents and their families

Discourse analysis affords researchers and practitioners improved understandings regarding how positive outcomes are accomplished in the conversations of family therapy. By investigating how change is constructed or ‘performed’ in therapeutic interactions, its analyses conceptually parallel those of the social constructionist approaches to family therapy. In this respect, discourse analysis offers empirical methods to examine claims about the constructive aspects of therapeutic conversations. These conceptual and research parallels are examined in how impasses in family therapy were transcended, rhetorically, between an adolescent, his parents and the therapist. We conclude that the research methods of discourse analysis can directly enhance the conversational skills and methods of therapists.     

运用比较治疗学的方法促进T2DM胰岛素治疗决策的最优化

2型糖尿病（T2DM）为内分泌科常见疾病,胰岛素是最主要的治疗药物之一,但胰岛素治疗方法诸多,各种方案的疗效参差不齐。为了促进2型糖尿病治疗决策的最优化,本文通过利用检索国内报道的相关文献,对文献中2型糖尿病的胰岛素治疗方法进行归纳总结,并且运用比较治疗学的研究方法进行比较分析,旨在寻求最有效的治疗方案。     

Some Historical Conditions of Narrative Work

Written to honor the immense contribution of Michael White as a leader in the development of narrative therapy, this historical essay contrasts the origins of psychoanalysis, family therapy and narrative therapy. Changes in the understanding of therapeutic strategies, methods of training and supervision, styles of leadership, the involvement of audiences in the therapeutic and training processes, and conceptions of the nature of the mind are described. A style of direct demonstration of methods, especially of the formulation of questions, is important in narrative work. The central master-role of the therapist in analysis and family therapy is replaced in narrative work by eliciting local knowledge, and the recruitment of audiences to the work. This is consistent with narrative therapy's "de-centered" image of the therapist.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.