DIAGNOSISAND THERAPEUTICS OFTUMORCOMPLICATION 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈 欈
(CIP) 2009 3 ISBN978 7 5091 2516 8 / - : Ⅰ Ⅱ 1 2 3 Ⅲ Ⅳ R730 6 CIP (2009) 012625 : : : : : : 100036 188 :100036 :(010)51927270;(010)51927283 :(010)51927252 :(010)51927286 :www.pmmp.com.cn : : :787mm 1092mm 1/16 :31 75 :992 :2009 3 1 1 :0001~3000 :138 00
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1 1!! (1) (19)!!! (1)!!! (1)!! (2)!!! (3)!!!! (4)!!!! (5)!!! (5)!!! (5)!!! (6)!!! (6)!! (7)!!! (7)!! (7) (8)! (8)! (8)!!! (28)!! (9)! (28)!! (9)!! (9)!!!! (10) (10)! (10)!!!!!! (10)!! (11)!! (12)!!! (17)!!!! (18)!!!! (19)!!! (19) (19)! (20)!! (21) (21)!!!! (22) (22)!!! (23)!!! (25)! (25)!! (26)!! (26)!!!! (29)!!! (30) MCUO!!!! (32) MCUO!!!! (36)!!! (37) (38)! (39)! (39)
2 櫦! (39) 2!!! (60)!!! (41)!!! (41)!!! (41)!! (42)! (42)!!! (67)!!!! (68) (43)!!!!! (68) (43)!!! (45)!! (46)! (47) (49) (50)! (51) 3 (52)!!!! (52) (NSAID)!!!! (53)!!! (76)! (53)!!! (79)!!!! (54)!!!! (79)!! (54)! (55)!!! (87)!!!! (55)!!!! (55) ( )!!! (55) ( ) (56) ( ) (57)!!!! (57)!!!! (58) ( )(58)!!!! ( )!!! (58) ( )!!! (59) ( )!! (59)!!! (59)!!!! (60)! (60)! (60)! (63)!!!! (66)!!!! (66)!!!! (69)!!! (72)!!! (74)!!!! (75)!!!! (75)! (75)!! (75)! (75)!! (77)!! (83)!!!! (85)!! (87)! (88)!!!! (88)!!!! (89)! (89)!!!! (89)!! (90)!!!! (93) ( ) (93) ( )!! (94)! (95)
櫦 3!!!! (95)! (95) 4 (98) CACS!!!! (98)! (113)!! (98)!!!! (99)!!!! (114)!!!! (100)!! (101) CACS!!!! (101) (102) (102)!!! (102) CACS! (102) 5 (102)!!! (104) CACS! (104)!!! (104)!!! (104) (124)!! (105)!!! (105)!! (106) ( )!! (106)! (106) (107)!!!! (126) (107)!!! (107)!! (108)!! (109) ( )! (109) ( )!!! (109) ( )!!!! (128)!! (109) ( ) (129)! (110) ( )!!!! (110) ( ) (111) ( )TPN!! (111)!! (112) (112)!!!! (113)!!! (114)!!! (115)!!! (116)!! (116) (117) (117)!! (121)!! (121)!!! (121)!!! (122) (123) ( )!! (124) ( )!! (124) (124)!!! (125)!!! (126) (126)!!! (127) (128)!!!! (128) (129)!!! (129)
4 櫦 (130)!! (131)!!! (131)!!! (131) (131) (132)!!!! (133)!! (133)!!! (133) (134) (135)! (137) (137)!!! (137)!!! (137)!! (138) (138)! (139) (139)!!! (140) (141) (143)!! (145) (145)!!! (145) (145)! (146) (146)!!! (146) (147) (147)!!!! (148) (148)!!! (148)!!! (149) (149) (149) (150) (150)!!! (150) (150) (151) 6!! (153) (153)!!! (153)!!! (153) (154) (154)!!!! (154) (154) (155) (157) (158)!! (160)! (160) (160) (161)!!! (161) (161)!!! (162) (162)! (164)!!!! (164) (164) (165)!! (166) (167)!!! (167) (167)!! (167)!!!! (167) (168) (169)! (170)
櫦 5 (170)!!! (171) (171) (171)!!! (172) (172)!!! (172)!!!! (173)!!! (174)!!!! (174) (175) (175)!!!! (202)! (177)!!! (177)!!! (177)!!! (177) (178)!! (178)!!! (178)!! (179)!!! (180) (180) ( )!!!! (180) ( ) (206)! (181)!! (182) 7 (189)! (189) (189)!!! (190) (191)!!! (191) (192) ( )!!!! (195)!!! (195)!! (195) (196) (196)! (197) (197)!!! (197)!! (198)! (198)!!! (199)!!!! (199)!! (199) (200)!!! (200)!!!! (200)!! (201) ( )!!!! (202)! (202) (202)!! (202)!!! (203)!!! (203) (204) (205)! (206) (206)!! (207)!!! (207) (208) (208)! (209) (209)!!! (209)!!! (210)!!! (210) (211) (212) 8!!!! (215)!!!! (215)!!! (215)
6 櫦!!! (215)!!! (215) (216)!!! (217) (217) (218) (238)!!!! (219)!! (220) ( ) ( )! (220)!!! (239) ( )! (220) ( )!! (223) ( )!!! (223)!! (224)!!!! (224)!! (224) (225)!!! (225) (226) (227) ( )!! (227) ( )!! (228) ( )! (228) ( )!! (228) ( ) ( )!! (246)! (228)!!!! (228) (229)!!! (230) (230) (231) (253)!!! (232)!!!! (232)!!! (233)!!! (233) (234)!!! (235)!!!! (235) 9 (237) (237)!!!! (237)!!! (237) ( )!! (238) ( )! (238) ( )! (239) (239)!! (240)!!!! (240)!!! (241) (241) (242) (243)!!!! (243)!!! (244)!!! (244) (245) (246) ( )!! (246)!!!! (248)!! (249)!!! (250)!!! (250)!! (250) (252)!!!! (253) (254)!!! (254)! (254) (255)!! (234)! (257)
櫦 7 (257)!!! (257)!! (258) (258) (259) 10 (262)!!!!! (262) (262)!!! (263)!!! (264) ( )CINV! (264) ( ) CINV! (265) (265) ( )!!!! (265) ( )!! (266) ( ) (266) (266) ( )! (267) ( )!! (267) ( )!! (267) (271) (271)!!! (272) (272) (273)!!!! (295)! (274) (274)!!! (275) (275)!! (275)! (277) (277)!!! (277) (277) (278)!! (278) (278)!!! (279)!!! (279) (279) ( )!! (279) ( )!!! (280) ( )!!! (280) ( )! (282) ( )! (282) ( )!! (282) (284)! (287)!!!! (287) (288)!!! (289) (290) (291)!!!! (292)!!!! (292)!! (292)!!! (293) (293) (294) (295) (295) (295)!!!! (297) (297)!!!! (298) (299) (300) (300) (301) (302)!!! (304) (305)!!!!
8 櫦 (305) (305)!!! (305) (306) (307) 11 (311)!!!!!!! (311) (311) ( ) 12! (331)! (311) ( )!!!! (331)! (312) ( ) (331)! (313) (314) ( )!!!! (315) ( )! (315) ( )! (315) (315) (336) (315)!!!! (316) (316) (317)!!! (317) (318) (318)!!! (319) (319) (320)!!! (320)!!! (321) (321) (321)!!! (322) (322) (323) (323) (324) (324)!!! (325) (325) (325) (325) (327)!!!! (327)!!! (327)!!! (328)! (331)!!! (331)!!! (332) (334)!! (334) ( )!! (334) ( )!!!! (335)! (336)!!! (337)!!! (337)!!! (338) (338) 13!!!! (342)! (342) (342)!!! (342) (343) (343)!! (343)!! (344)!! (345)!! (345)
櫦 9!!! (363)! (348)! (348)!! (364)!! (350)!!! (365)! (350)!! (366)!! (350)!!! (367)!! (350)!! (350) (350)!!! (351)!!! (351) (352)!!! (352) (352)!!! (353)!! (353) (354) (354) 14!! (356)!!!! (356)!!! (356) (357)!!! (358)!!! (358)!! (359)! (359)!!! (359)!!! (360)!!! (360) (361)!! (361) (362)!!! (376)!! (362)!!! (362)!!! (363) (364)! (365)!! (366) (366) (367)!! (367)!!!! (368)!!! (368)!! (369) (369)! (369)!!!! (370)!!!! (370)!!!! (370)!! (371) (372)!!!! (372) (373)!!! (373)!! (373) (374) (374)!!! (374) (374)!! (375) (376) (376)!! (377) (377) (377)
10 櫦 (377)!!!! (377)!!! (377)!!! (378)!!! (378) (378)!! (379)!! (379) (379)!!! (380)!!! (380) (381)!! (381) (382)!!!! (382) (382)!!! (383) (383)!! (384) (384)!!!! (384)!!! (385)!!! (385) (385) (386)!! (386)!!! (387)!!! (387) (388)!! (388) ( )!!!! (388) ( )!!!! (388)!! (403) (389)!! (389)!!!! (390)!!! (390) (391)!!!! (391)!!! (391)!!! (392) (392)!! (392) (393)!!!!!!! (393)!!! (393) (394)!! (394) (394)! (394)!!! (395)!!! (395) (396)!! (396)!! (397)!!! (397)!!! (397) (397)!!! (397)!! (398)! (398)!!! (399)!! (400) (401)!!! (401) (402)!! (402)!! (402)!!! (402)!!! (403)!!!! (404) (404) ( )! (404) ( )
櫦 11!!!! (404) (416) (405) ( )!!! (417)!!! (405) ( )!!! (418)!!!! (405)! (405) 15! (407) 17!! (421) IL 2 LAK TIL!!! (407)!!! (407)!!! (407)!! (408) ( ) (424)! (408)!!! (408)!!! (409) ( )!!! (426)!!!! (409) ( )! (409) (TNF)!!! (409)!!! (409)!!! (410)!!! (410)!!!! (411) 16! (413) ( )!!!! (413)!!! (430) ( )!! (431)!! (413)!!! (431)!! (414)!! (415)!! (415)!!! (416) ( )!!! (433)!! (416)!!! (417)!!! (417) ( )!! (418)!! (420)! (421)!! (421)! (424) ( )!! (424) ( )!! (425) (426) ( )! (427) ( )!!!! (428) ( )!!! (428) ( )!!!! (429) ( )! (430) (431)!! (432) ( )! (432) ( )!!! (434)
12 櫦 ( )! (435) ( )!!!! (435) ( )! (436) ( )!! (436)!!!! (437)!! (437)!!! (439)!! (440)!!! (440) (441)!!!! (455)! (442)!! (442) ( )! (442) ( )!!!! (443)!!! (444) (444) (444)! (445)!!!! (445) ( ) CIN!!! (446) ( ) CIN!! (447)!!! (448)!!! (448) (448) (448)!!! (451)!!!! (451)!! (451)!! (451)!! (452)! (453)! (454) (455)!!!! (455)!!!! (455)! (456)!!! (457)!! (458)!!! (459)!!! (460)!! (461)!! (461)!! (462)!! (462)!! (462)!! (462) 18!!!! (466)
1 1 2 B X CT ECT MRI PET PET CT 20 :1 45% : 2 22% 18% 5% 1 3 4
2 櫦 8 9 3 (2) : :1 2 3 4 ; (1) :1 1 1000 2 5 3 4 1 1000 ( ) 75% 5 2 ; 10min 6 7
3 1 櫦 1894 Halsted 1 30% Ⅱ Herr
4 櫦 py) 2 2~6 40% 60% 50% 100% ; ; 5 80% 5 30%~54 4% ( ) B CT ECT MRI PET PET CT ; 2 2 CT 20 70 5 20% 10 80% (neoadjuvantchemothera
5 1 櫦 : 1 85% ~90% B CT 2 3 : ( ) ( ) ( ) ( ( ) ( ) ( ) ( ) ( ) ( ) 4 ( )
6 櫦 1 5 20 John CT 2 : 3 : 4
7 1 櫦 ( ) (debulkyoperation) : : 1 (Burkit) 2cm :
8 櫦 ; ; ; : ; 5 ; ; ( ) 20 20 X (treatmentplanningsystemtps) TPS ( ) : : 1 1 2 : ; ; ; 3 0 10 9 /L 60g/L : 50 0 10 9 /L ; : ;
9 1 櫦 1 ; : ; : : ; ; : ; 1/2~1/3 ; 2 1 : ; ; : ; : ; ; : 30~40Gy/ 3~4 1 ; : 70 ; : ; : : 3 : : ; 2 : ; ; 2 ;
10 櫦 ; : 1/d 1 8~ 2 0Gy5/ : 10~25Gy 1 2 4 2 1 1~1 2Gy2/d 10% ~ ; 20% ; 5 1 5Gy 3/d 3 1d 0 8Gy 5% ~ 12% 2 3 ( ) 1865 Lissau er 1946 Gilman Philips
11 1 櫦 1957 Arnold Duschin shy 20 70 ( ) 20 90 ( ) X B CT : ( ) ; Ⅰ : ( ); :EGFR (STI 571 Iressa) : CD20 ( ) HER2 (Herceptin) : ; ; : ; (rhg CSF rhgm CSF EPO);5 (5 HT3) DNA ) DNA ( >30%) : DNA (Burkit) DNA RNA( ) RNA (Wilms) ; ( ) :1 DNA ( <30%) : ;2 RNA;3 ;4 ( ); DNA : DNA ; :M ( )G1 (DNA ( ) )S (DNA ) G2(DNA ) : G1 G2 S M S DNA DNA ( RNA G2 M ( ) 2 ; :1 (G0 ): G0 2 : G0
12 櫦 (mg/m 2 ) DI DI : DI : : DI : 0 ( ) 10 10~12 ; : (1) : 2~3 10 8~10 ; (2) : ; (3) 10 9 10 6 (4) : ; ( ) (5) : 1 : : (6) (doseintensitydi): :
13 1 櫦 (2) : (7) : ; ; ; (8) : (3) : (9) : : ; :1 ;2 ;3 ;4 ;5 3 ;6 ( ) ( ) (1) ( ):1 2 2 (1) : (ADM) (IFO) (VCR) (VP 16) ADM
14 櫦 (DDP) (STS) : 3 ( ) (TSPA) (MMC) (ADM) (HCPT) 1 8~12 1 1~2 4 (L OHP) : 10 4 ( )L OHP 4 1 (MTX) (Ara c) (TSPA) ADM (5 Fu) (DDP) (VCR) (2) ( ):1 4 1979 WHO 3 ( ): 4 : (1) (CR): 4 (PR): 50% 4 4 2 (SD) (NC): 50% 25% (PD): 25% (2) 3 (CR): 4 (PR): 50% 4 4 ; (SD) (NC): 4 50% 25% (PD): 25% (3) (CR): X
15 1 櫦 (PR): 10% ~15% (SD) (NC): 8 (PD): WHO :WHO ; :1 2 ; ;2 ; CT ;3 MRI ;4 1994 ; (EuropeanOrganiza tion for Research and Treatment of Cancer EORTC) (NationalCancer 6 InstituteNCI) NCI WHO (1) : (ResponseE valuationcriteriainsolidtumorsrecist) 1999 (CF ) (PALA) α (MTX) (1) (DDP) CF (CR): (PR): (2) : 30% (PD): 20% (SD) (NC): PR A PD (2) ( A ) (CR): / (IR/SDincompletere sponse): ( ) 5 2~4 5 : A (PD): ( ) 5 (3) : ( 30% 5%~20%
16 櫦 21 7 (4) : (1) :1 (adjuvantchemotherapy) 2 (neo adjuvantchemotherapy) 3 2 4 5 :1 ; HLA 2 ;3 ( ) (2) : :1 (5) : B ;2 CD20 ( ) ;3 BaxxarZevalin;EGFR : ( )Matuzumab(EMD7200) ( )Panitumumab(ABX EGF); ;4 / VEGFR : (Avastin) VEGFR 2 (3) (IMC 1C11) (6) : ras (4) : ; (PTK) C(PKC) (FTase)
17 1 櫦 1 : 1 : ( ) 2 : 3 : : 4 (WHO) : 5 : 6 : ; 7 ( ) ( : ) : : : : ; : ; 4 4 1 1 2~7d 7~14d 14~28d 1~6 5~6 1 1 2
18 櫦 ; 3 Karnofsky WHO WHO 5 ; : 90% ~100%; : 15%~90%; : 5% ~15%; : 1%~5%; : 1% 4 ; 2 ; - 1 (1) : 40 ; Ⅲ~Ⅳ 25% ~50%; Ⅲ~Ⅳ 25%~50% ( ) ( ) ;
19 1 櫦 (2) : 1 Ⅳ Ⅳ ( ) (interventionalradiology) : 20 1 (interventionalcardiology) (inter ventionalneuroradiology) (inter ventionalgastroeintestinalradiology) 2 : X CT B 3 1 Seldinger Seldinger 1953 Seldinger ( ) Seldinger
20 櫦 Seldinger 1974 Driscol Seldinger X ) 20 80 DSA :1 ;2 ;3 ;4 ;5 ;6 1 60% ;7 ( );8 :1 ( );9 ;2 ( ;3 ) ;4 2 20 ( ) X 20 70 B CT MRI 10 :1 100 ;2 ;3 ;4 ;5 ;6 ;7 ;8 ;9 ( :
21 1 櫦 ;6 ;7 1 : 2 : ;8 3 : 4 : ;9 ;10 1~7d 1~3d : :1 ;2 ;3 ;4 ;5 ( ) ; 1170 3500
22 櫦 3 : : : : ; : : 1 : : : 2 : : : : : 1 ; : : ( ) : : : : ;
23 1 櫦 : : : : : : 4 : ( ) : : : 2 : : : : : : ; : : 3 : :! : : : :
24 櫦 : : 1 : ; ; ; ; 4 2 ; ; : 5 3
25 1 櫦 2~10h ; 4mW 5~8min( 1 ) (3) : 1 ( ) B ( ) 3 B1 ( ) C ( ) 20~30mg 0 5~2h : (1) : (2) : 2 2~6mW 2 4 (
26 櫦 ) : 1 (1) : ; ; ; ; ; ; (2) : ( ) 3 (2) : ; ; ; ; 2 0 5~1 ; (1) : 5 1 (1) : ( ) ; ( )
27 1 櫦 (2) : 10~20/min : ; ( ) ; ( 4 : ) : : 2 ; : 5 : : : (1) : 6 : 1 : ; : ( ) 2 : : (2) : 3 : : ( )
28 櫦 150 ; ; ; 2 ; 3 ; 4 ; ; ; 5 ; 6 7 8 9 (3) : (2) : (3) : 3 (1) :1 ( ) MCUO : MCUO 0 5%~10% (metastaticcancerofunknownoriginmcuo MUO) MCUO :1 X B MCUO;2 MCUO ( ) :1 ( ) ; X CT MRI 2 MCUO ;3
29 1 櫦 MCUO 3 ; MCUO MCUO 1889 Paget ( ) ( Lucle 1952 ; MCUO MCUO MCUO 2 (1) : : 1 (2) : 80% E wing 1929 ; ;
30 櫦 ( ) (3) : ( ) MCUO : ; ; ; ; (4) : PAS MCUO 1 MCUO : ; X CT MRI MCUO X 40% ; 40% CT ; MCUO X B 13% X ; MCUO 4% 2 X 2cm ; CT MCUO 1% ~2% MRI 5mm X CT MRI 3
31 1 櫦 (4)EB : VCA IgA X (5) 125(CA125): 11 CT OC125 CA125 1cm (6) (CEA) CA19 9: MCUO 4 X 40% ~60% CEA CEA CA19 9 5 X CT MRI B CA19 9 CEA (7) (ER): ER ER (8) (ACP): ACP ACP ACP ( ) ACP 6 62 (14%) MCUO ACP (1) ( β HCG): 70% 40% β HCG HCG 10%~30% β HCG 34 MCUO 14 7 ; (2) (AFP):60% 1 ;2 ; Kaposi 5%~8% AFP 1 MCUO AFP 10% ~25% AFP 1~5 5 1 23% (3) CA19 9 444 ACP 15%~20% MCUO 3 11%5 6% : MCUO 5000ng/ml