鑵庢瘝绱�(x矛)鑳炵槫鏄厭绔ユ檪鏈熸渶甯歌鐨勮厧鑷熸儭鎬ц叓鐦�锛屽湪鎵€鏈夊厭绔ユ儭鎬ц叓鐦や腑绱勫崰6%;15姝蹭互涓嬪厭绔ヤ腑锛岀櫦(f膩)鐥呯巼绱勭偤7.1/100,000(缇庡湅)锛屼絾浜炴床浜虹兢涓櫦(f膩)鐥呯巼鐣ヤ綆;鍠伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫鎮ｅ厭涓�锛岀敺锛氬コ=0.92:1锛屽钩鍧囪ê鏂峰勾榻＄偤44鍊嬫湀锛屽ぇ绱�10%鐨勮厧姣嶇窗(x矛)鑳炵槫浼存湁鍏堝ぉ鐧�(f膩)鑲茬暩褰�銆�

闅ㄨ憲鍖栫檪銆佹墜琛�(sh霉)銆佹斁鐧傜瓑澶氱ó娌荤檪鎵嬫鐨勭稖鍚堟噳(y墨ng)鐢�锛岀附楂旂敓瀛樼巼宸茬稉(j墨ng)閬�(d谩)鍒�85%浠ヤ笂銆傜洰鍓�锛屼笘鐣岃寖鍦嶅収(n猫i)鑵庢瘝绱�(x矛)鑳炵槫鐨勬不鐧傚彲鍒嗙偤鍏╁€嬮鍒ワ紝涓€鏄互鍖楃編鍦板崁(q奴)鐐洪鐨凜OG锛屾帹钖︾洿鎺ユ墜琛�(sh霉)娌荤檪锛屾牴鎿�(j霉)琛�(sh霉)鍚庣梾鐞嗗拰鍒嗘湡閲囧彇閫�(j矛n)涓€姝ユ不鐧�;浜屾槸浠ユ瓙娲插湴鍗€(q奴)鐐洪鐨凷IOP锛屾帹钖﹁(sh霉)鍓嶅寲鐧�锛屽緟鑵槫绺皬鍚庡啀琛屾墜琛�(sh霉)鍒囬櫎锛屾牴鎿�(j霉)涓嶅悓鍗遍毆搴︿締娌荤檪;姝ゅ叐绋不鐧傛柟寮忓悓妯ｆ櫘閬嶅瓨鍦ㄤ簬鍦嬪収(n猫i)锛屾晠鏈(gu墨)鑼冨皣鍏╄€呭垎鍒ヤ簣浠ョ緟鍒�锛屾牴鎿�(j霉)閲囩敤鐨勫垵濮嬫不鐧傛柟寮忎笉鍚岋紝鍚勯伕鎿囦娇鐢ㄦ不鐧傛柟妗�銆�

浜�銆侀仼鐢ㄨ寖鍦�

鏍规摎(j霉)鐥呭彶銆侀珨鏍兼鏌�銆佸奖鍍忓(xu茅)妾㈡煡鍜�/鎴栫祫绻旂梾鐞嗗(xu茅)妾㈡煡纰哄畾鐨勮厧鑷熷崰浣�锛岃€冩叜鐐鸿厧姣嶇窗(x矛)鑳炵槫(涓嶅寘鍚腑鑳氳憠鑵庣槫锛岃厧鑷熼€忔槑绱�(x矛)鑳炶倝鐦�锛屾儭鎬ф┇绱嬭倢妯ｇ槫)銆�

涓�銆佽ê鏂�

(涓€)鑷ㄥ簥琛ㄧ従(xi脿n)

甯歌鑷ㄥ簥琛ㄧ従(xi脿n)鐐虹劇鐧ョ媭鐨勮吂閮ㄥ寘濉�銆佽吂鐥涘拰鑵硅劰锛岀磩40%鎮ｅ厭浼存湁鑵圭棝琛ㄧ従(xi脿n);鑵庢瘝绱�(x矛)鑳炵槫鎮ｅ厭涓�锛岀磩鏈�18%琛ㄧ従(xi脿n)鐐鸿倝鐪艰灏匡紝24%鐐洪彙涓嬭灏�;澶х磩鏈�25%鎮ｅ厭鏈夐珮琛€澹撹〃鐝�(xi脿n)銆�

鍦�10%鐨勬偅鍏掍腑鍙兘鏈冧即鏈夌櫦(f膩)鐔便€佸幁椋�銆侀珨閲嶆笡杓�;鑲鸿綁(zhu菐n)绉绘偅鍏掑彲鍑虹従(xi脿n)鍛煎惛绯荤当(t菕ng)鐧ョ媭銆佽倽杞�(zhu菐n)绉诲彲寮曡捣涓婅吂閮ㄧ柤鐥�锛屼笅鑵旈潨鑴堟闃诲彲琛ㄧ従(xi脿n)鐐鸿吂澹侀潨鑴堟洸寮垫垨绮剧储闈滆剤鏇插嫉銆傝偤鏍撳缃曡銆�

(浜�)杓斿姪妾㈡煡銆�

1.琛€銆佸翱甯歌(gu墨)銆佺敓鍖栨鏌ワ細鍖呮嫭鑲濊厧鍔�銆侀浕瑙ｈ唱(zh矛)銆佷钩閰歌劔姘叾绛夈€�

2.鑵槫妯�(bi膩o)瑷樼墿鑵庢瘝绱�(x矛)鑳炵槫鐩墠缂轰箯鐗圭暟鎬х槫妯�(bi膩o)锛屼竴浜涙寚妯�(bi膩o)濡侼SE鍙互鐢ㄤ簬閼掑垾鑵槫鐮磋/鑵庤嚐绁炵稉(j墨ng)姣嶇窗(x矛)鑳炵槫銆侫FP鍙簣浠ラ憭鍒ョ暩鑳庣槫鍨嬭厧姣�銆�

3.鑵归儴褰卞儚瀛�(xu茅)妾㈡煡

(1)鑵归儴瓒呰伈锛氬垵姝ュ垽鏂疯叓鐦や綅缃�锛屽ぇ灏忥紝鑸囧懆鍦嶇祫绻旈棞(gu膩n)绯�锛岃绠″収(n猫i)鏈夌劇鐦ゆ爴绛�;

(2)鑵归儴澧炲挤(qi谩ng)CT(鏈夎厧鍔熻兘涓嶅叏鏅傜鐢ㄩ€犲奖鍔�)鎴朚RI锛�銆傝厧姣嶇窗(x矛)鑳炵槫涓ぇ绱�4%鐨勬偅鍏掍即鏈変笅鑵旈潨鑴堟垨蹇冩埧鐦ゆ爴锛�11%鎮ｅ厭浼存湁鑵庨潨鑴堢槫鏍擄紝鑲烘爴濉炲崄鍒嗙綍瑕�锛屼絾甯稿父鏄嚧鍛界殑;

鍥犳锛岃(sh霉)鍓嶅寮�(qi谩ng)CT鍜孧RI涓嶅儏鍙互纰哄畾鑵庤嚐鑵槫鐨勮捣婧�锛岀⒑瀹氬皪鍋�(c猫)鑵庤嚐鏈夌劇鐥呰畩锛岃瀵熻吂閮ㄨ嚐鍣ㄦ湁鐒¤綁(zhu菐n)绉伙紝鍚屾ǎ鍙互纰哄畾鑵旈潨鑴堢槫鏍�;鑵庢瘝绱�(x矛)鑳炵槫涓儴鍒嗘偅鍏掍即鏈夎厧姣嶇窗(x矛)鑳炵槫鐥咃紝

澧炲挤(qi谩ng)MRI鍙互杓冨ソ鐨勪簣浠ュ崁(q奴)鍒嗛憭鍒�;

(3)鑳搁儴CT锛氳倽鑷熷拰鑲洪儴鏄厧姣嶇窗(x矛)鑳炵槫鏈€甯歌鐨勮綁(zhu菐n)绉婚儴浣�锛屽叾涓ぇ绱�15%鐨勬偅鍏掍即鏈夎偤杞�(zhu菐n)绉伙紝鑳搁儴CT妾㈡煡鍙互寰堝ソ鐨勫垽鏂疯偤鍏�(n猫i)杞�(zhu菐n)绉荤梾鐏舵儏娉�;

(4)PET-CT锛氬苟涓嶆帹钖︿綔鐐哄父瑕�(gu墨)妾㈡煡锛屼絾濡傛灉鎮ｅ厭楂樺害鎳风枒澶氱櫦(f膩)杞�(zhu菐n)绉绘垨寰�(f霉)鐧�(f膩)锛屽彲浜堜互妾㈡煡;

(5)娲绘锛氬鏋滆嚚搴婁笂鑰冩叜鐐鸿厧姣嶇窗(x矛)鑳炵槫1鏈熸垨2鏈�锛屾牴鎿�(j霉)鍖楃編鍦板崁(q奴)COG缍�(j墨ng)椹楋紝琛�(sh霉)鍓嶇┛鍒烘椿妾㈡渻鎻愬崌鑵槫鍒嗘湡锛屽洜姝ゅ苟涓嶆帹钖﹂€�(j矛n)琛屽父瑕�(gu墨)绌垮埡娲绘锛屽彲鐩存帴鎵嬭(sh霉)鍒囬櫎;浠ユ瓙娲茬偤涓荤殑SIOP鎺ㄨ枽閫�(j矛n)琛岃(sh霉)鍓嶅寲鐧傦紝闆栫劧瑾�(r猫n)鐐虹┛鍒烘椿妾㈠苟涓嶆渻褰遍熆鑵槫鍒嗘湡锛屼絾涔熶笉浣滅偤甯歌(gu墨)鎿嶄綔銆傚皪浜庝竴浜涜嚚搴婁笂闆ｄ互纰哄畾鐨勭梾璁�锛屽彲浠ヨ绌垮埡娲绘;

(6)闁撹畩鍨嬭厧姣嶇窗(x矛)鑳炵槫锛氶牠椤盡RI銆佸叏韬鎺冩弿銆侀楂撶窗(x矛)鑳炲(xu茅)妾㈡煡銆�

鍥涖€佽嚚搴婂垎鏈�

鐩墠锛屽湅闅涗笂閫氱敤鐨勮嚚搴婂垎鏈熶富瑕佸弮鐓т互鍖楃編鍦板崁(q奴)鐐洪鐨凜OG鍜屼互姝愭床鐐轰富鐨凷IOP锛岀洰鍓嶅湅鍏�(n猫i)鐨勫垎鏈熺郴绲�(t菕ng)涓昏鍙冭€僀OG銆�

(涓€)COG鍒嗘湡

鈪犳湡锛氳叓鐦ゅ眬闄愪簬鑵庡収(n猫i)锛屽彲瀹屾暣鍒囬櫎锛岃厧琚啘瀹屾暣锛岃(sh霉)鍓嶇槫楂旂劇鐮磋鎴栨椿妾�锛岃厧绔囪绠℃湭渚电姱锛屽垏绶ｉ櫚鎬�锛屾穻宸寸祼(ji茅)闄版€�銆�

鈪℃湡锛氬彲瀹屾暣鍒囬櫎锛屽垏绶ｉ櫚鎬э紝鑵槫灞€閮ㄤ镜娼�(鑵庤鑶�銆佽厧绔�)锛岃厧绔囪绠′镜鐘紝鍒囩罚闄版€�锛屽鏋滆绠＄槫鏍�锛岃兘闅ㄧ槫鑵庝竴骞跺垏闄ゅ墖鑰冩叜鐐篒I鏈熴€�

鈪㈡湡锛氳吂鐩嗚厰娣嬪反绲�(ji茅)鍙楃疮锛岃叓鐦ょ┛閫忚吂鑶滆〃闈㈡垨鑵硅啘绋锛岃倝鐪兼垨閺′笅娈樼暀锛岃叓鐦や镜鐘噸瑕佽嚐鍣�锛岃倝鐪肩劇娉曞畬鏁村垏闄�锛岃(sh霉)鍓嶆垨琛�(sh霉)涓叓鐦ょ牬瑁�锛岃(sh霉)鍓嶆椿妾紝鑵槫鍒嗗鍒囬櫎銆�

鈪ｆ湡锛氳琛岃綁(zhu菐n)绉�(鑲�銆佽倽銆侀銆佽叇)锛岃吂鐩嗚厰澶栨穻宸寸祼(ji茅)杞�(zhu菐n)绉�銆�

鈪ゆ湡锛氶洐鍋�(c猫)鑵庢瘝绱�(x矛)鑳炵槫銆�

(浜�)SIOP鍒嗘湡

鈪犳湡锛氳叓鐦ゅ眬闄愬湪鑵庤嚐鎴栬厧鍛ㄧ簴缍亣鍖呰啘鍏�(n猫i)锛屾湭渚电姱澶栬啘锛屽彲瀹屾暣鍒囬櫎锛屽垏绶ｉ櫚鎬�;鑵槫绲勭箶鍙獊鍏ヨ厧鐩傜郴绲�(t菕ng)锛屼絾鍛ㄥ湇绠″鏈彈绱�;鑵庣珖琛€绠℃湭鍙楃疮;鑵庡収(n猫i)琛€绠″彲鍙楃疮;缍�(j墨ng)鐨┛鍒烘椿妾�;鑵庡懆鑴傝偑/鑵庣珖鍙嚭鐝�(xi脿n)澹炴銆�

鈪℃湡锛氳叓鐦ゅ欢浼歌嚦鑵庤嚐鎴栬厧鍛ㄧ簴缍亣鍖呰啘澶栵紝渚电姱鑵庡懆鑴傝偑锛屽彲瀹屾暣鍒囬櫎锛屽垏绶ｉ櫚鎬�;鑵槫渚电姱鑵庣珖琛€绠�銆佹穻宸寸锛屽彲瀹屾暣鍒囬櫎;鑵槫渚电姱鑷ㄨ繎鑷熷櫒鎴栦笅鑵旈潨鑴堬紝浣嗗彲瀹屾暣鍒囬櫎;鍙┛鍒烘椿妾�銆�

鈪㈡湡锛氳叓鐦ょ劇娉曞畬鏁村垏闄�锛屽垏绶ｆ畼鐣�(鑲夌溂鎴栭彙涓嬫畼鐣�);鑵归儴娣嬪反绲�(ji茅)鍙楃疮;琛�(sh霉)鍓嶈叓鐦ょ牬瑁�;鑵槫渚电姱鑵硅啘绲勭箶;鑵硅啘绋杞�(zhu菐n)绉�;琛€绠℃垨杓稿翱绠″垏绶ｆ湁鐦ゆ爴娈樼暀锛屽垎濉婂垏闄�;琛�(sh霉)鍓嶆椿妾㈡墜琛�(sh霉);濡傛灉鍖栫檪鍚庢穻宸寸祼(ji茅)鎴栧垏绶ｇ偤澹炴锛岃獚(r猫n)瀹氱偤III鏈�銆�

鈪ｆ湡锛氳琛岃綁(zhu菐n)绉�(鑲恒€佽倽銆侀銆佽叇)锛岃吂鐩嗚厰澶栨穻宸寸祼(ji茅)杞�(zhu菐n)绉汇€�

鈪ゆ湡锛氶洐鍋�(c猫)鑵庢瘝绱�(x矛)鑳炵槫銆�

浜斻€佺梾鐞嗗垎鍨�

鍏稿瀷鐨勮厧姣嶇窗(x矛)鑳炵槫鍖呮嫭鍘熷鑵庤儦鑺�銆佷笂鐨拰闁撹憠鎴愬垎锛岃绋辩偤“涓夌浉绲�(ji茅)妲�(g貌u)”锛屾槸鑵庢瘝绱�(x矛)鑳炵槫鏈€鏈夌壒寰佹€х殑绲勭箶瀛�(xu茅)鐗归粸(di菐n)銆備笁绋垚鍒嗗湪鍚勮叓鐦ら枔姣斾緥涓嶇浉鍚�锛岀窗(x矛)鑳炲垎鍖栫▼搴︿篃涓嶇浉鍚�锛屽儏鍖呭惈涓€绋垨鍏╃ó鎴愬垎鐨勫柈鐩搞€侀洐鐩哥梾璁婁篃鍙湅鍒�銆�

鍘熷鑵庤儦鑺芥垚鍒嗭細绱�(x矛)鑳炲皬锛屽湏褰㈡垨鐭褰�锛岃優璩�(zh矛)灏�锛岀窗(x矛)鑳炴牳鐩稿皪灏�銆佷笉瑕�(gu墨)鍓�锛屾煋鑹茶唱(zh矛)鍒嗗竷鍧囧嫽锛岀◢绮楃硻銆傛牳浠佸皬銆傝叓鐦ょ窗(x矛)鑳炴帓鍒楃穵瀵�锛屽彲鍛堝绋祼(ji茅)妲�(g貌u)锛屽铔囧舰銆佺祼(ji茅)绡€(ji茅)鎬у強鍩哄簳绱�(x矛)鑳炴ǎ銆佸綄婕€х瓑銆傛牳鍒嗚娲昏簫銆傝儦鑺藉瓨鍦ㄤ簬绲曞ぇ澶氭暩(sh霉)鑵庢瘝绱�(x矛)鑳炵槫涓�锛屼篃鍙偤鑵槫鐨勫敮涓€鎴愬垎锛屾噳(y墨ng)瑭茶鏄庢墍鍗犳瘮渚�銆�

涓婄毊鎴愬垎锛氬ぇ澶氭暩(sh霉)鑵庢瘝绱�(x矛)鑳炴湁涓婄毊鎴愬垎鐨勫垎鍖�锛屾帓鍒楁垚鑿婂舰鍦�(tu谩n)妯�銆佸師濮嬪皬绠℃ǎ鎴栦钩闋ǎ銆傜暟婧愭€х殑涓婄毊鍒嗗寲涔熷彲瑕嬪埌锛屾渶澶氱殑鏄粡娑插拰楸楃媭涓婄毊锛岀簴姣涗笂鐨伓鍙嚭鐝�(xi脿n)銆�

闁撹憠鎴愬垎锛氶粡娑叉€у拰姊舰绱�(x矛)鑳為€欎簺鎴愬垎骞句箮鍦ㄦ墍鏈夌殑妯�(bi膩o)鏈腑鍙锛屽彲鍑虹従(xi脿n)鑲岀簴缍拰绾栫董姣嶇窗(x矛)鑳�锛屽苟鍛堝悇绋▼搴︾殑鍒嗗寲銆傚咕涔庢墍鏈夌殑闁撹憠鍒嗗寲褰㈠紡锛屽寘鎷剛鑲祫绻�锛岃粺楠�锛岄锛屾垚鐔熺缍�(j墨ng)绡€(ji茅)绱�(x矛)鑳炲拰绁炵稉(j墨ng)鑶犺唱(zh矛)绲勭箶鍙互鐪嬪埌銆傛湁鏅傞€欎簺鐣版簮鎬ф垚鍒嗗崄鍒嗘槑椤€傛牳闁撹畩锛氶枔璁婂畾缇╃偤绱�(x矛)鑳炴牳鐨勯’钁楀澶т即鏌撹壊璩�(zh矛)澧炲锛屽苟涓斿嚭鐝�(xi脿n)澶氭サ澶氬€嶉珨鎬ф牳鍒嗚銆�

鏍搁’钁楀澶т即鏌撹壊璩�(zh矛)澧炲锛氶枔璁婄殑鏍稿繀闋堣嚦灏戞瘮鍒囩墖涓劇闁撹畩鍗€(q奴)鍩熺槫绱�(x矛)鑳炵殑鏍稿ぇ3鍊�銆傛牳澧炲ぇ鎳�(y墨ng)鏄牳鎵€鏈夊昂瀵哥殑澧炲ぇ锛屽柈绱旂殑澧為暦鏄笉澶犵殑銆傚澶х殑鏍镐篃蹇呴爤鏌撹壊璩�(zh矛)澧炲姞锛岄’绀篋NA鐨勬槑纰虹殑澧炲姞銆�

澶氭サ澶氬€嶉珨鎬ф牳鍒嗚锛氱暟甯告牳鍒嗚蹇呴爤鍙嶆槧鏁村€婦NA鏁�(sh霉)閲忔槑纰哄鍔犮€傚妤�銆佸鍊嶉珨鏍稿垎瑁傝薄蹇呴爤绛変簬鎴栧ぇ浜庢甯稿垎瑁備腑鏈熺殑绱�(x矛)鑳炴牳銆傚柈绱�?n猫i)鏃ь偘w鍦ㄥ垎瑁傚悗鏈熺础閷橀珨鐨勫欢閬�锛岄洊鐒剁偤“鐣板父鍒嗚”锛屼絾鏄笉鎳�(y墨ng)瑾�(r猫n)鐐烘牳闁撹畩銆�

鐣�(d膩ng)妯�(bi膩o)鏈湁闄愬鐐烘椿妾㈡(bi膩o)鏈檪锛屾槑椤殑鏍稿澶т即鏌撹壊璩�(zh矛)澧炲鎴栬€呭嚭鐝�(xi脿n)涓€鍊嬪妤垫牳鍒嗚鍙兘瓒充互鎻愮ず闁撹畩銆傛牳闁撹畩鐨勭櫦(f膩)鐢熺巼鐐�5%锛岃垏骞撮健鐩搁棞(gu膩n)锛�2姝蹭箣鍏�(n猫i)灏戣锛岃嚦5姝叉檪鐐�13%锛屼互鍚庝竴鐩寸董鎸佸湪閫欎竴姘村钩銆傛牳闁撹畩鐨勯噸瑕佹€у湪浜庡皪鑵槫娌荤檪鐨勫弽鎳�(y墨ng)锛岃€屼笉鏄爯(y霉)娓叾閫�(j矛n)灞曟€с€�

鐩墠鐮旂┒椤ず闁撹畩鐨勮叓鐦ょ窗(x矛)鑳炲皪鍖栫檪鐒″弽鎳�(y墨ng)锛屽洜鑰屽湪琛�(sh霉)鍓嶅寲鐧傞亷鐨勬墜琛�(sh霉)鍒囬櫎妯�(bi膩o)鏈腑妾㈠嚭鐜囪純楂�銆係IOP鎺ㄨ枽鐨勮厧姣嶇窗(x矛)鑳炵槫浜炲瀷鐨勭祫绻斿(xu茅)妯�(bi膩o)婧�(zh菙n)锛�

completelynecrotic锛氬畬鍏ㄥ姝诲瀷;regressive锛氭秷閫€鍨�;Mixed锛氭贩鍚堝瀷;Epithelial锛氫笂鐨瀷;Stromal锛氶枔钁夊瀷;Blastemal锛氳儦鑺藉瀷

鍏€佸嵄闅害鍒嗙祫锛�

(涓€)COG鎺ㄨ枽鐩存帴鎵嬭(sh霉)锛岃(sh霉)鍚庢牴鎿�(j霉)鐥呯悊椤炲瀷鍙垎鐐洪爯(y霉)鍚庤壇濂藉瀷(FH)鍜岄爯(y霉)鍚庝笉鑹瀷(UFH)锛欶H锛氫笉鍚湁闁撹畩鐨勮厧姣嶇窗(x矛)鑳炵槫;UFH锛氬眬鐏跺拰褰屾极闁撹畩鍨嬭厧姣嶇窗(x矛)鑳炵槫;

(浜�)SIOP鎺ㄨ枽琛�(sh霉)鍓嶅寲鐧�锛岃(sh霉)鍚庢牴鎿�(j霉)鐥呯悊椤炲瀷鍒嗙偤涓嶅悓鍗遍毆绲勶細

浣庡嵄绲勶細涓儦钁夎厧鐦わ紝閮ㄥ垎鍥婃€у垎鍖栧瀷鑵庢瘝绱�(x矛)鑳炵槫鍜屽畬鍏ㄥ姝诲瀷鑵庢瘝绱�(x矛)鑳炵槫;

涓嵄绲勶細闁撹憠鐐轰富鍨�锛屼笂鐨偤涓诲瀷锛屾贩鍚堝瀷锛岄€€琛屾€ц畩鍜屽眬鐏堕枔璁婂瀷;

楂樺嵄绲勶細鑳氳娊鐐轰富鍨嬶紝褰屾极闁撹畩鍨�锛岄€忔槑绱�(x矛)鑳炶倝鐦ゅ拰鎯℃€ф┇绱嬭倢妯ｇ槫銆�

涓�銆佹不鐧�

鑵庢瘝绱�(x矛)鑳炵槫鐨勬不鐧傚師鍓囦粛鐒舵槸浠ユ墜琛�(sh霉)銆佸寲鐧傚拰鏀剧檪鐩哥祼(ji茅)鍚堢殑缍滃悎娌荤檪锛屼絾鎵嬭(sh霉)鍒囬櫎鏄暣楂旀不鐧傜殑鍩虹煶;鏍规摎(j霉)COG鏂规娌荤檪鐨勫劒(y艒u)榛�(di菐n)鏄彲浠ュ緱鍒版渶鍘熷銆佹渶婧�(zh菙n)纰虹殑鐥呯悊绲�(ji茅)鏋�锛屼絾濡傛灉鐦ら珨杓冨ぇ锛岃(sh霉)涓嚭琛€銆佺槫楂旂牬瑁�銆佹墜琛�(sh霉)闆ｅ害澧炲ぇ浠ュ強琛€琛岃綁(zhu菐n)绉婚ⅷ(f膿ng)闅澶�;

渚濇摎(j霉)SIOP鏂规娌荤檪鐨勫劒(y艒u)榛�(di菐n)鏄寲鐧傚悗鑵槫楂旂⿳绺皬锛屼究浜庢墜琛�(sh霉)鍒囬櫎锛岃(sh霉)涓嚭琛€灏�锛屽寲鐧傛湁鐦ら珨鍛ㄥ湇绾栫董鍋囧寘鑶滃舰鎴�锛岃(sh霉)涓槫楂旂牬瑁傛鐜囦綆锛屼絾缂洪粸(di菐n)鏄彲鑳芥渻鍑虹従(xi脿n)鐥呯悊椤炲瀷涓嶆簴(zh菙n)纰哄強瑾よê銆�

(涓€)娌荤檪鍘熷墖

鏈(gu墨)鑼冮噸榛�(di菐n)鍙冭€僀OG銆丼IOP鏂规鍜孋CCG鏂规锛屾彁渚涚殑浠ヤ笅娌荤檪鏂规鍚勯啱(y墨)闄㈡牴鎿�(j霉)鍚勮嚜鎯呮硜閬告搰鎳�(y墨ng)鐢�?锛涱媱璐慜G鍜孲IOP鐨勬不鐧傚師鍓囧拰绱�(x矛)鍓囨湁鎵€涓嶅悓锛屽缓璀板悇瀹堕啱(y墨)闄㈤厡鎯呴伕鎿嘋OG鎴朣IOP涓€绋柟妗堢郴绲�(t菕ng)娌荤檪锛岄儴鍒嗙梾浜哄彲绲�(ji茅)鍚堟墍鍦ㄩ啱(y墨)闄㈠闅涙儏娉侀仼鐣�(d膩ng)鏀硅壇銆傚湪涓€浜涚壒娈婃不鐧�锛屼緥濡傛斁鐧傜瓑娌荤檪绱�(x矛)鍓囧缓璀伴鍏堣€冩叜鍙冭€冦€婂厭绔ヨ厧姣嶇窗(x矛)鑳炵槫瑷烘柗娌荤檪寤鸿CCCG-WT-2016銆嬨€愪腑鑿厭绉戦洔蹇�2017骞寸55鍗风2鏈熴€戙€�

1.COG/CCCG鏂规锛欳OG/CCCG鎺ㄨ枽鐩存帴鎵嬭(sh霉)鍒囬櫎锛屼絾灏嶄簬涓€浜涚壒娈婇鍨嬭厧姣嶇窗(x矛)鑳炵槫锛屾帹钖﹁(sh霉)鍓嶅寲鐧�锛屽锛氬绔嬭厧鑵庢瘝绱�(x矛)鑳炵槫銆佷笅鑵旈潨鑴堢槫鏍撲綅缃珮浜庤倽闈滆剤姘村钩鑰�銆佽叓鐦や镜鐘懆鍦嶈嚐鍣�(鑴捐嚐锛岃儼鑵�锛岀祼(ji茅)鑵�)锛岃厧涓婅吅闄ゅ銆佺劇娉曟墜琛�(sh霉)鐨勮厧姣嶇窗(x矛)鑳炵槫銆佸綄婕€ц偤杞�(zhu菐n)绉�銆侀洐鍋�(c猫)鑵庢瘝绱�(x矛)鑳炵槫銆�

琛�(sh霉)鍚庢牴鎿�(j霉)鍒嗘湡鍜岀梾鐞嗗垎鍨�锛岄噰鍙栭€�(j矛n)涓€姝ユ不鐧傛帾鏂�锛屽鍖栫檪鏂规鍙婃斁鐧傜瓑;闆欏伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫娌荤檪涓婁互鍠伌(c猫)鏈€楂樺垎鏈熺偤婧�(zh菙n)?锛涚磾鎾艰窂瀛ｉ┊\鏅�锛屽鑰冩叜鍙洿鎺ユ墜琛�(sh霉)锛岃(sh霉)鍚庢噳(y墨ng)绲�(ji茅)鍚堝垎鏈�銆�

鐥呯悊銆�1p/16q闆滃悎鎬х己澶辨儏娉佺瓑缍滃悎鑰冩叜锛屽弮鐓OG妯�(bi膩o)婧�(zh菙n)閫�(j矛n)琛岃(gu墨)鑼冨寲娌荤檪銆�

2.SIOP鏂规锛�

鑷ㄥ簥瑷烘柗鐐鸿厧姣嶇窗(x矛)鑳炵槫鍚�锛屽彲鏍规摎(j霉)鍒嗘湡閫�(j矛n)琛岃(sh霉)鍓嶅寲鐧�(闆栫劧绌垮埡娲绘骞朵笉鏈冩彁鍗囧垎鏈�锛屼絾涓嶄綔鐐哄父瑕�(gu墨))锛�4鍛�/6鍛ㄨ⿻浼�锛岃(sh霉)鍚庢牴鎿�(j霉)鍒嗘湡鍙婄梾鐞嗗垎鍨嬶紝閲囧彇閫�(j矛n)涓€姝ユ不鐧傛柟妗�;闆欏伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫娌荤檪涓婁互鍠伌(c猫)鏈€楂樺垎鏈熺偤婧�(zh菙n)銆�

鐢变簬琛�(sh霉)鍚庨彙涓嬫墍瑕嬬偤鍖栫檪鍚庣祫绻旈鍨嬶紝鏁呯梾鐞嗙祼(ji茅)鏋滃牨鍛婃檪鎳�(y墨ng)鍤�(y谩n)鏍兼寜鐓IOP鎺ㄨ枽鐨勮厧姣嶇窗(x矛)鑳炵槫浜炲瀷鐨勭祫绻斿(xu茅)妯�(bi膩o)婧�(zh菙n)閫�(j矛n)琛屽垎椤�锛屽悓鏅傜祼(ji茅)鍚堝垎鏈�锛岄€�(j矛n)琛屽嵄闅害鍒嗙祫锛岄嚌灏嶆€х殑閫�(j矛n)琛屽€嬮珨鍖栨不鐧�銆�

(浜�)鎵嬭(sh霉)

1.鍠伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫鏍规不鎬у垏闄�(閬╃敤浜庡ぇ澶氭暩(sh霉)鍠伌(c猫)鐥呰畩)

(1)鎵嬭(sh霉)鍒囧彛鐨勯伕鎿囷細鐐轰簡寰楀埌鑹ソ鐨勬墜琛�(sh霉)閲�锛屾帹钖︾稉(j墨ng)鑵归儴姗垏鍙ｏ紝鍒囧彛蹇呴爤瓒冲澶т互閬垮厤琛�(sh霉)涓亷澶氱殑鎿犲鑵槫锛屽繀瑕佹檪鍙互浣滆兏鑵硅伅(li谩n)鍚堝垏鍙ｃ€�

(2)濡傜槫楂旂梾璁婅純灏�锛岃厧钂傝绠¤檿瀹规槗鏆撮湶锛屽彲棣栧厛铏曠悊鑵庤拏鍕曢潨鑴�锛屾笡灏戞墜琛�(sh霉)鎿嶄綔鎿犲鑵槫閫犳垚鑵槫绱�(x矛)鑳炶婧愭€ф挱鏁ｈ綁(zhu菐n)绉荤殑姗�(j墨)鏈冦€傚鏋滆叓鐦ゅ法澶�锛岃厧闁€鐒℃硶椤湶锛屽彲鍏堟父闆㈢槫楂斿懆鍦嶏紝鏈€鍚庤檿鐞嗚厧钂傝绠�锛岃(sh霉)涓伩鍏嶉亷搴︽摖澹撶槫楂斻€�

(3)绲�(ji茅)鍚堣(sh霉)鍓嶅奖鍍忓(xu茅)妾㈡煡锛屼粩绱�(x矛)鎺㈡煡鑵庨潨鑴堜互鍙婁笅鑵旈潨鑴堝収(n猫i)鏈夌劇鐦ゆ爴鐨勫瓨鍦�锛屽鏋滅槫鏍撳眬闄愪簬鑵庨潨鑴堜笅鑵旈潨鑴堣倽闈滆剤浠ヤ笅姘村钩锛屽彲浠ユ墜琛�(sh霉)鍒囬櫎銆傛墜琛�(sh霉)閬庣▼涓紝鍙湪鐦ゆ爴涓婃涓嬭厰闈滆剤闋�(y霉)缃樆鏂峰付锛岄仼鐣�(d膩ng)鏀剁穵锛岄槻姝㈢槫鏍撹劔钀�锛屽垏闄ょ槫鏅傦紝鍙皣涓嬭厰闈滆剤鐦ゆ爴鐨勮繎蹇冪銆佸皪鍋�(c猫)鐨勮厧闈滆剤鍙婁笅鑵旈潨鑴堥仩(yu菐n)绔毇鏅傞樆鏂�锛屽眬閮ㄦ贰鑲濈礌楣芥按娌栨礂锛岄槻姝㈢┖姘ｆ爴濉炲強灞€閮ㄨ鏍撳舰鎴�;

濡傛灉鐦ゆ爴鑼冨湇寤�锛岄珮浜庤倽涓嬩笅鑵旈潨鑴堬紝鍖栫檪鍚庝粛鐒℃硶绺皬鑷崇浜岃倽闁€涓嬫柟锛屾噳(y墨ng)鑰冩叜鑸囧績鑷熷绉戣伅(li谩n)鍚�锛岃(sh霉)涓閬撹秴鑱插鏅傜洠(ji膩n)娓紝蹇呰鏅傞珨澶栧惊鐠�(hu谩n)杓斿姪涓嬭绠＄槫鏍撳彇鍑�锛岃(sh霉)涓搷浣滆紩鏌旓紝閬垮厤鐦ゆ爴鑴惤銆�

(4)鐐轰簡鑷ㄥ簥姝ｇ⒑鍒嗘湡锛屽繀闋堜粩绱�(x矛)鎺㈡煡娣嬪反绲�(ji茅)鐨勬儏娉侊紝娓呴櫎娣嬪反绲�(ji茅)鑼冨湇渚濇摎(j霉)鐥呰畩閮ㄤ綅鑰屼笉鍚岋紝閲嶉粸(di菐n)鍦ㄤ簬鑵庨杸姘村钩鐨勮吂涓诲嫊鑴堟垨涓嬭厰闈滆剤闄勮繎銆�

(5)鍚屽伌(c猫)鑵庝笂鑵烘噳(y墨ng)鐩￠噺浜堜互淇濈暀锛屽鏋滆厧涓婅吅鑸囪叓鐦ゅ垎鐣屼笉娓�锛屽彲鑰冩叜浜堜互鍒囬櫎銆傚琛�(sh霉)鍓嶅奖鍍忓(xu茅)鎻愮ず鐦ら珨宸ㄥぇ锛屼镜鐘懆鍦嶈嚐鍣ㄥ彲鑳芥€уぇ锛屽彲鑰冩叜浜堜互琛�(sh霉)鍓嶅寲鐧�锛屽緟鐦ら珨绺皬鍚庡啀琛屾墜琛�(sh霉)鍒囬櫎锛岄伩鍏嶈(sh霉)涓噸瑕佽嚐鍣�(濡傝劸鑷�銆佽儼鑵�銆佽吀绠＄瓑)鐨勫け鑳藉拰琛�(sh霉)鍚庡苟鐧�(f膩)鐧ョ殑澧炲姞锛岃几灏跨鍒嗛洟鑷崇洝鍙兘浣庣殑閮ㄤ綅浜堜互鍒囬櫎銆�

(6)濡傛灉琛�(sh霉)涓槫楂旂牬瑁傛垨鑰冩叜鑵槫娈樼暀锛屽眬閮ㄦ噳(y墨ng)浜堜互閵€澶�/閳﹀ぞ妯�(bi膩o)瑷�锛屼究浜庤(sh霉)鍚庢斁鐧傚畾浣嶃€�

(7)鎵嬭(sh霉)閬庣▼涓挤(qi谩ng)瑾�(di脿o)鐒＄槫瑙€蹇�锛屾帰鏌ョ敱閬�(yu菐n)鑰岃繎锛屽嫊浣滆杓曟煍锛岄伩鍏嶅皣鑵槫绱�(x矛)鑳炲付鑷冲叾瀹冮儴浣嶄互鍙婅叓鐦ゆ挱鏁�銆傚皪琛�(sh霉)涓櫦(f膩)鐢熻叓鐦ゆ桨鐮存噳(y墨ng)鐢ㄧ礂甯冭钃嬪寘瑁逛互鍏嶈叓鐦ょ窗(x矛)鑳炶劔钀界ó妞�銆�

(8)鑵槫鍒囬櫎鍚庤姹傛洿鎻涙墜濂椼€傚壍(chu脿ng)闈㈢敤澶ч噺钂搁ぞ姘存矕娲楁蹈娉�锛屾秷婊呭彲鑳借劔钀界殑鑵槫绱�(x矛)鑳�銆�

(9)鐦ら珨琛�(sh霉)鍚庣ū閲嶏紝鎵嬭(sh霉)瑷橀寗涓姹傝┏绱�(x矛)鎻忚堪鑵槫鐨勯噸閲�銆佸ぇ灏忥紝鑸囧懆鍦嶇祫绻斾镜娼ょ殑鎯呮硜锛岃(sh霉)涓叓鐦ゆ湁鐒＄牬娼帮紝琛�(sh霉)鍚庤叓鐦ゆ湁鐒℃畼鐣�锛屾穻宸寸祼(ji茅)娓呮巸鎯呮硜銆�

2.鍠伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫淇濈暀鑵庡柈浣嶈叓鐦ゅ墲闄�(NSS)銆傜洰鍓嶅柈鍋�(c猫)鑵庢瘝绱�(x矛)鑳炵槫NSS鎵嬭(sh霉)浠嶇劧瀛樻湁鐖锛屽鏋滆€冩叜琛孨SS锛屽墖闇€瑕佺稖鍚堣€冩叜锛岀梾渚嬬洝閲忛伕鎿嘔鏈燂紝鐦ら珨浣嶄簬鑵庤嚐涓€妤�锛屾湭渚电姱闆嗗悎绯荤当(t菕ng)锛屾墜琛�(sh霉)鍒囬櫎涓彲閬╃暥(d膩ng)澶氬垏鍙栦竴浜涚槫鍛ㄨ厧鑷熺祫绻旓紝淇濊瓑鍒囩罚闄版€�锛岄伩鍏嶆畼鐣�銆�

3.闆欏伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫淇濈暀鑵庡柈浣嶈叓鐦ゅ墲闄�(NSS)銆傜洰鍓嶅凡鐭ョ梾渚嬩腑锛岄洐鍋�(c猫)鑵庤嚐瀵︽€у崰浣嶅熀鏈笂閮借€冩叜鐐鸿厧姣嶇窗(x矛)鑳炵槫锛岀劇璜栨槸COG閭勬槸SIOP锛岄洐鍋�(c猫)鑵庢瘝绱�(x矛)鑳炵槫鎺ㄨ枽閫�(j矛n)琛岄洐鍋�(c猫)鐨凬SS锛屽父瑕�(gu墨)琛�(sh霉)鍓嶅寲鐧�锛屽寲鐧傚悗瑭曚及闆欏伌(c猫)鑵庤嚐鎯呮硜锛屽彲鍒嗘琛孨SS鎵嬭(sh霉)锛屾牴鎿�(j霉)鐦ら珨澶у皬鍙婅寖鍦�锛屽彲閬告搰鍓滈櫎琛�(sh霉)鎴栫槫楂斿姞閮ㄥ垎鑵庤嚐鍒囬櫎锛屽鍏╁伌(c猫)鐦ら珨鍧囪純灏�锛屽彲琛屼竴鏈熷垏闄�銆�

涔熷彲琛屼竴鍋�(c猫)鑵庡垏闄よ(sh霉)锛屼竴鍋�(c猫)NSS琛�(sh霉)銆傛墜琛�(sh霉)鍏ヨ矾鏂归潰锛屾湰绲勫潎閲囩敤涓婅吂姗垏鍙�锛岀稉(j墨ng)鑵硅厰鍏ヨ矾锛屾墦闁嬪伌(c猫)鑵硅啘锛屽皣绲�(ji茅)鑵稿強鍛ㄥ湇绲勭箶缈诲悜?q奴)顩�?c猫)锛屾墦闁嬭厧鍛ㄨ剛鑲泭锛屽厖鍒嗘父闆㈣厧鑷�锛屾毚闇茶厧钂傝绠★紝骞堕爯(y霉)缃樆鏂峰付銆�

閫欑ó鏂瑰紡鐩稿皪浜庤吂鑶滃悗鍏ヨ矾鍙互寰堝ソ鍦版帶鍒惰厧钂傝绠�锛屾笡灏戣(sh霉)涓嚭琛€;灏囪叓鐦ゅ懆鍦嶈剛鑲祫绻斿墧闄わ紝瑕栭噹鐩稿皪闁嬮棅;鍙互鎺㈡煡琛€绠″懆鍦嶆穻宸寸祼(ji茅)鎯呮硜锛屼究浜庡垏闄ゅ強娲绘銆�

(涓�)鍖栫檪

1.COG鍖栫檪鍘熷墖锛�

鍖栫檪鏂规锛�

(1)EE4A鏂规锛�

(2)DD4A鏂规锛�

(3)M鏂规锛�

(4)I鏂规锛�

(5)闆欏伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫娌荤檪娴佺▼锛�

2.SIOP:

鍖栫檪鍘熷墖锛�

鍖栫檪鏂规锛�

(1)鈪犳湡涓嵄

(2)鈪�銆佲參鏈熶綆鍗辩祫

(3)鈪犳湡楂樺嵄銆佲叀銆佲參鏈熶腑鍗辩祫

(4)鈪�銆佲參鏈熼珮鍗辩祫-4钘ユ柟妗�

(5)鈪ｆ湡鏀硅壇AVD鏂规

(6)鈪ｆ湡鏀硅壇4钘ユ柟妗�

(7)闆欏伌(c猫)鑵庢瘝绱�(x矛)鑳炵槫

鑸嘋OG涓嶅悓锛孲IOP鎺ㄨ枽渚濇摎(j霉)鍊嬮珨宸暟閫�(j矛n)琛岃(sh霉)鍓嶅寲鐧傦紝鏂规鐐篈V/AVD,鎵嬭(sh霉)鎳�(y墨ng)瑭�12鍛ㄥ収(n猫i)瀹屾垚锛岃(sh霉)鍚庢牴鎿�(j霉)鍠伌(c猫)鏈€楂樺垎鏈熷強鐥呯悊鍒嗗瀷鍒跺畾娌荤檪鏂规銆�

(鍥�)鏀剧檪

娌荤檪鏂规鐨勯伕鎿囦笉鍚�锛屾斁鐧傜殑鍔戦噺涔熺浉鎳�(y墨ng)鏈冩湁宸垾锛屼絾鏄疌OG鍜孲IOP鍧囨帹钖︽斁鐧傚湪琛�(sh霉)鍚庡叐鍛ㄥ収(n猫i)閫�(j矛n)琛�銆傛斁鐧備竴鑸噰鐢ㄤ綆鍔戦噺鍒嗘鐓у皠锛�10锝�20Gy銆�

鍏�銆佸苟鐧�(f膩)鐧ュ強鍓綔鐢�

(涓€)鎵嬭(sh霉)骞剁櫦(f膩)鐧�

鍦嬪鐨勬枃鐛�(xi脿n)涓牨鍛�锛岃厧姣嶇窗(x矛)鑳炵槫鎵嬭(sh霉)骞剁櫦(f膩)鐧ヤ富瑕佸寘鎷�锛岃吀姊楅樆(5.1%)锛屽嚭琛€鍜屾劅鏌�(1.9%)锛岃绠℃悕鍌�(1.5%)銆備富瑕佽垏鐦ら珨鐨勫ぇ灏�銆佽垏鍛ㄥ湇绲勭箶闂�(gu膩n)绯诲拰鎵嬭(sh霉)閱�(y墨)甯妧琛�(sh霉)鐩搁棞(gu膩n)銆傞洐鍋�(c猫)鑵庢瘝绱�(x矛)鑳炵槫濡傝NSS锛岃(sh霉)鍚庡彲鑳芥渻鍑虹従(xi脿n)鐭毇鑵庡姛鑳戒笉鍏�銆佸翱鐦�銆佹硨灏跨郴鎰熸煋銆佽吀濂楃枈銆�

(浜�)钘ョ墿姣掑壇浣滅敤

1.蹇冭嚐姣掓€э細钂界挵(hu谩n)椤炶棩鐗╋細姣忎竴鍊嬫湁钂界挵(hu谩n)椤炶棩鐗╃殑鐧傜▼鍓嶆鏌ュ績闆诲湒銆備竴鏃︾櫦(f膩)鐝�(xi脿n)2搴︿互涓婂偝灏�(d菐o)闃绘化銆佹槑椤殑ST-T鏀硅畩銆丵T闁撴湡寤堕暦銆佸強鍏跺畠缍�(j墨ng)蹇冨収(n猫i)绉戠⒑瑾�(r猫n)鏈夊紩鐧�(f膩)鍤�(y谩n)閲嶅績寰嬪け?锛涜洂澧撐存嚳铦楊伈婕犳儞锛扮⒕濡禗锛屽彲鑰冩叜鍚堢敤鍙充笝浜炶兒銆備竴鏃﹀績鍔熻兘涓嶅叏(蹇冭嚐灏勮鍒�?j菒n)?sh霉)<55%鎴栬桓绺煭鍒�?j菒n)?sh霉)<28%)鎳�(y墨ng)瑭茬鐢ㄨ捊鐠�(hu谩n)椤炶棩鐗╋紝骞堕個璜嬪績鍏�(n猫i)绉戞渻瑷哄崝(xi茅)鍔╂不鐧�銆�

2.鑲濊嚐姣掓€э細杞�(zhu菐n)姘ㄩ叾鍗囬珮锛氭不鐧傚墠鍠磾ALT鍗囬珮涓嶈秴閬庢甯搁珮闄愮殑10鍊嶈€呮不鐧傚彲涓嶄綔浠讳綍瑾�(di脿o)鏁�銆侫LT鍗囬珮瓒呴亷姝ｅ父楂橀檺鐨�10鍊嶈€呮噳(y墨ng)寤堕伈鍖栫檪1鍛ㄥ京(f霉)鏌ヨ倽鍔熻兘锛孉LT鎸佺簩(x霉)瓒呴亷10鍊嶈€呮噳(y墨ng)绌嶆サ灏嬫壘鍜屾不鐧傝倽鍔熻兘鎼嶅偡鍘熷洜锛屽悓鏅傚彲浠ュ湪鍤�(y谩n)瀵嗚瀵熶笅绻肩簩(x霉)娌荤檪銆傛不鐧傛湡闁撶殑鍠磾ALT鍗囬珮锛岄櫎闈炴槑纰虹偤闈炴不鐧傜浉闂�(gu膩n)鎬х殑鍗囬珮锛屽儏闇€瑙€瀵熶笉瑾�(di脿o)鏁存不鐧傘€�

3.琛€娑插壇浣滅敤

(1)璨ц锛氫竴鑸彲浠ラ€氶亷杓告敞绱呯窗(x矛)鑳炵珐瑙ｈ钵琛€锛岃鑹茬礌60g/L浠ヤ笅蹇呴爤杓告敞銆�

(2)琛€灏忔澘娓涘皯锛氳灏忔澘瑷堟暩(sh霉)灏忎簬20×10⁹/L鏅傛噳(y墨ng)杓告敞琛€灏忔澘锛屼即鏈夋槑椤嚭琛€鐧ョ媭鎴栨劅鏌撹〃鐝�(xi脿n)鏅傝几娉ㄦ寚寰佸彲閬╃暥(d膩ng)鏀惧銆�

(3)涓€х矑绱�(x矛)鑳炵己涔忥細灏嶉爯(y霉)鏈熸渻鍑虹従(xi脿n)杓冮暦鏅傞枔绮掔窗(x矛)鑳炵己涔忚€呭彲浠ヤ娇鐢ㄧ矑绱�(x矛)鑳為泦钀藉埡婵€鍥犲瓙銆�

4.娉屽翱绯诲弽鎳�(y墨ng)锛氬鐠�(hu谩n)纾烽叞鑳�锛岀暟鐠�(hu谩n)纾烽叞鑳虹瓑锛氱暥(d膩ng)澶у姂閲忛潨婊�锛岃€岀己涔忔湁鏁堥爯(y霉)闃叉帾鏂芥檪锛屽彲鑷村嚭琛€鎬ц唨鑳辩値锛岃〃鐝�(xi脿n)鐐鸿唨鑳卞埡婵€鐧ョ媭銆佸皯灏�銆佽灏垮強铔嬬櫧灏�锛岀郴鍏朵唬璎濈敘(ch菐n)鐗╀笝鐑啗鍒烘縺鑶€鑳辨墍鑷�锛屼絾鐠�(hu谩n)纾烽叞鑳哄父瑕�(gu墨)鍔戦噺鎳�(y墨ng)鐢ㄦ檪锛屽叾鐧�(f膩)鐢熺巼杓冧綆锛屼娇鐢ㄦ湡闁撳彲浜堜互姘村寲锛屼繚璀�(h霉)鑶€鑳辩瓑灏嶇櫏娌荤檪;

5.鑵庢瘨鎬э細濡傚崱閴�銆侀爢閴�锛屽彲鑳藉紩璧疯厧姣掓€�銆備富瑕佺偤鑵庡皬绠℃悕鍌�銆傛€ユ€ф悕瀹充竴鑸浜庣敤钘ュ悗10锝�15澶╋紝琛€灏跨礌姘�(BUN)鍙婅倢閰�(Cr)澧為珮锛岃倢閰愭竻闄ょ巼闄嶄綆锛屽鐐哄彲閫嗘€�锛屽弽寰�(f霉)楂樺姂閲忔不鐧傚彲鑷存寔涔呮€ц紩鑷充腑搴﹁厧鎼嶅銆傜洰鍓嶉櫎姘村寲澶栧皻鐒℃湁鏁堥爯(y霉)闃叉湰鍝佹墍鑷寸殑鑵庢瘨鎬х殑鎵嬫銆�

6.绁炵稉(j墨ng)姣掓€э細濡傞暦鏄ユ柊鍫裤€侀暦鏄ュ湴杈�锛屼富瑕佸紩璧峰鍛ㄧ缍�(j墨ng)鐧ョ媭锛屽鎵嬫寚銆佺缍�(j墨ng)姣掓€х瓑锛岃垏绱⿳閲忔湁闂�(gu膩n)銆傝冻瓒鹃夯鏈ㄣ€佽叡鍙嶅皠閬查垗鎴栨秷澶�锛屽鍛ㄧ缍�(j墨ng)鐐�銆傝吂鐥�銆佷究绉橈紝楹荤椆鎬ц吀姊楅樆鍋惰銆傞亱(y霉n)鍕曠缍�(j墨ng)銆佹劅瑕虹缍�(j墨ng)鍜岃叇绁炵稉(j墨ng)涔熷彲鍙楀埌鐮寸挵(hu谩n)锛屽苟鐢�(ch菐n)鐢熺浉鎳�(y墨ng)鐧ョ媭;涓€鑸槸鍙€嗘€э紝鍏掔鑰愬彈杓冩垚浜哄ソ銆傚閴戦鍙紩璧疯伣鍔涗笅闄�锛岃€抽炒绛夋瘮杓冨父瑕�銆�

娉細浠ヤ笂鍖栫檪钘ョ墿姣掓€у垎绱氭(bi膩o)婧�(zh菙n)瑭宠闄勮〃銆�

涔濄€侀毃瑷�

(涓€)闅ㄨí鏅傞枔

琛�(sh霉)鍚�2骞村収(n猫i)锛�3鍊嬫湀寰�(f霉)鏌ヤ竴娆★紝2锝�5骞村崐骞村京(f霉)鏌ヤ竴娆�锛�5骞翠箣鍚庢帹钖︽瘡骞翠竴娆°€�

(浜�)闅ㄨí鍏�(n猫i)瀹�

琛€甯歌(gu墨)锛岀敓鍖�锛岃吂閮ㄨ秴鑱�锛岃兏鐗�/鑳搁儴CT浜ゆ浛銆傚鏈夊彲鐤戠梾鐏�锛屽缓璀拌灞€閮ㄥ寮�(qi谩ng)CT鎴朚RI閫�(j矛n)涓€姝ユ鏌ャ€�

鍗�銆佽綁(zhu菐n)瑷烘浠�

(涓€)閬╃敤灏嶈薄

1.瀛樺湪鑵归儴鍖呭銆佽吂鐥�銆佽灏挎垨褰卞儚瀛�(xu茅)妾㈡煡鍙枒鑵庢瘝绱�(x矛)鑳炵槫鎴栬(gu墨)鑼冨寲娌荤檪鍚庤€冩叜寰�(f霉)鐧�(f膩);

2.鐥呯悊鎴栬嚚搴婅ê鏂风偤鑵庢瘝绱�(x矛)鑳炵槫銆�

(浜�)杞�(zhu菐n)瑷烘(bi膩o)婧�(zh菙n)

1.鈪犵礆杞�(zhu菐n)瑷猴細鐧ョ媭鍙婂奖鍍忓(xu茅)鎳风枒鑵庢瘝绱�(x矛)鑳炵槫锛屽鍏锋湁浠ヤ笅姊濅欢涔嬩竴锛屽墖寤鸿鐢辩福绱氶啱(y墨)闄㈣綁(zhu菐n)鑷充笂绱氶啱(y墨)闄�銆�

(1)閱�(y墨)闄笉鍏峰倷閫�(j矛n)琛孊瓒�銆丮RI銆丆T绛夊奖鍍忔鏌ユ浠惰€�;

(2)閱�(y墨)闄笉鍏峰倷鐥呯悊瑷烘柗姊濅欢鑰�;

(3)閱�(y墨)闄㈢劇鍏掔鑵槫娌荤檪缍�(j墨ng)椹楄€�銆�

2.鈪＄礆杞�(zhu菐n)瑷猴細绗﹀悎浠ヤ笅姊濅欢涔嬩竴鑰呭缓璀拌綁(zhu菐n)瑷鸿嚦鍏锋湁鍏掔鑵槫?锛熼姘�?銆佸競绱氶啱(y墨)闄�銆�

(1)缍�(j墨ng)灏辫ê閱�(y墨)闄㈠畬鎴愬奖鍍忔鏌ャ€佹椿妾㈢瓑閫�(j矛n)涓€姝ユ鏌ヤ粛鐒℃硶鏄庣⒑瑷烘柗鑰�(濡傜暥(d膩ng)?sh霉)鍥熷棄瑁攖(y墨)闄㈢梾鐞嗘渻瑷轰笉涓€鑷存垨鐣�(d膩ng)?sh霉)澶辩牅鑼籵娉曠⒑瀹氳ê鏂�);

(2)鐣�(d膩ng)?sh霉)钂痶(y墨)闄㈢劇娉曞畬鎴愯叓鐦ゅ垏闄ゅ京(f霉)闆滄墜琛�(sh霉)鑰�;

(3)鍑虹従(xi脿n)鑵槫鎴栨不鐧傜浉闂�(gu膩n)鍤�(y谩n)閲嶅苟鐧�(f膩)鐧�锛岃€岀暥(d膩ng)?sh霉)钂痶(y墨)闄㈢劇鐩搁棞(gu膩n)娌荤檪缍�(j墨ng)椹楄€�銆�

3.濡傚叿鏈変互涓嬫浠朵箣涓€锛屽墖寤鸿鐢辩渷銆佸競绱氶啱(y墨)闄㈣綁(zhu菐n)瑷鸿嚦鍏锋湁鍏掔鑵槫瑷虹檪姊濅欢鐨勭暥(d膩ng)?sh霉)钂痶(y墨)闄�銆�

(1)宸插湪鐪佸競绱氶啱(y墨)闄㈡槑纰鸿ê鏂�銆佸垎鏈熴€佸垎绲�锛屽強鍒跺畾鍑烘不鐧傛柟妗堟偅鑰�锛屼絾鏄�锛屽洜鐒″厭绔ユ偅鑰呮墜琛�(sh霉)鎴栧寲鐧傛浠讹紝涓嶈兘瀵︽柦鍚庣簩(x霉)娌荤檪锛屽彲杞�(zhu菐n)瑷鸿嚦鍏锋湁鍏掔鑵槫瑷虹檪姊濅欢鐨勭暥(d膩ng)?sh霉)钂痶(y墨)闄㈢辜绾�(x霉)瀹屾垚鍚庣簩(x霉)娌荤檪銆佽⿻浼�銆侀毃瑷�銆�

(2)宸插湪鐪佸競绱氶啱(y墨)闄㈠畬鎴愬京(f霉)闆滆叓鐦ゅ垏闄ゆ墜琛�(sh霉)銆佹斁鐧�銆佸毚(y谩n)閲嶅苟鐧�(f膩)鐧ュ緱鍒版帶鍒�锛屼絾鏄�锛屽洜鐒″厭绔ユ偅鑰呭寲鐧傛浠�锛屼笉鑳藉鏂藉悗绾�(x霉)娌荤檪锛屽彲杞�(zhu菐n)瑷鸿嚦鍏锋湁鍏掔鑵槫瑷虹檪姊濅欢鐨勭暥(d膩ng)?sh霉)钂痶(y墨)闄㈢辜绾�(x霉)瀹屾垚鍚庣簩(x霉)娌荤檪銆佽⿻浼�銆侀毃瑷�銆�

(涓�)涓嶇磵鍏ヨ綁(zhu菐n)瑷烘(bi膩o)婧�(zh菙n)

1.宸叉槑纰鸿ê鏂�锛屼笖绗﹀悎杞�(zhu菐n)瑷烘(bi膩o)婧�(zh菙n)锛屼絾宸插弮鍔犺厧姣嶇窗(x矛)鑳炵槫鐩搁棞(gu膩n)鑷ㄥ簥鐮旂┒鑰�;

2.鎮ｅ厭绗﹀悎杞�(zhu菐n)瑷烘(bi膩o)婧�(zh菙n)锛屼絾宸插洜鑵槫閫�(j矛n)灞�銆佸京(f霉)鐧�(f膩)銆佽叓鐦ゅ拰/鎴栨不鐧傜浉闂�(gu膩n)骞剁櫦(f膩)鐧ョ瓑鍘熷洜鍑虹従(xi脿n)鐢熷懡楂斿緛涓嶇┅(w臎n)瀹�锛岄暦閫旇綁(zhu菐n)閬�(y霉n)瀛樺湪鐢熷懡鍗遍毆鑰�;

3.灏辫ê鐨勯啱(y墨)闄笉鍏峰倷褰卞儚妾㈡煡銆佺梾鐞嗚ê鏂枫€佹墜琛�(sh霉)銆佸寲鐧傜瓑鎶€琛�(sh霉)姊濅欢锛屼絾鍚岀礆鍏跺畠閱�(y墨)闄㈠彲閫�(j矛n)琛岃€�;

4.缍�(j墨ng)杞�(zhu菐n)瑷虹殑闆欐柟閱�(y墨)闄㈣⿻浼帮紝鐒℃硶鎺ュ彈杞�(zhu菐n)瑷烘偅鍏掗€�(j矛n)涓€姝ヨê鐧傝€�銆�