乳腺癌内乳淋巴结病理状态的再认识：附229例内乳淋巴结活检报告

目的探索内乳淋巴结活检对乳腺癌分期、治疗和预后的价值。方法对229例乳腺癌行各式根治术时,经肋间隙行内乳淋巴结定位及活检。结果220例经肋间隙内乳淋巴结活检成功,内乳淋巴结转移者24．45（56／229）,腋窝淋巴结转移55．02％（126／229）;腋窝淋巴结转移伴内乳淋巴结转移率为34．13％（43／126）,仅内乳淋巴结癌转移率为12．62％（13／107）。腋窝淋巴结癌转移数≥4枚时,内乳淋巴结转移率49．32％（36／73）,56例内乳淋巴结转移的淋巴结病理分期（pN）均升高。乳腺癌内乳淋巴结转移与肿瘤部位无显著相关性（x^2=0．661,P=0．719）。内乳淋巴结活检可使70．7％肿瘤位于中央区或内象限的患者避免内乳区照射,使50．7％腋窝淋巴结转移≥4枚者避免内乳区照射。无气胸及出血等与内乳淋巴结活检相关的并发症。结论经肋间隙行内乳淋巴结活检方法简单可行,可提高部分乳腺癌患者pN分期,避免内乳区过度治疗,治疗更具个体化。     

乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床应用分析

目的探讨乳腔镜下前哨淋巴结活检及腋窝淋巴结清扫在乳腺癌患者临床诊疗中的可行性及较常规开放手术的优劣势。方法随机选取2005年12月—2012年3月肿瘤外科经针吸活检或术中快速冰冻病理诊断为乳腺癌且分期为Ⅰ、Ⅱ期的患者40例,通过术中美兰示踪及术前B超定位在乳腔镜下对40例乳腺癌患者行前哨淋巴结活检术(ESLNB)及腋窝淋巴结清扫术(EALND),根据蓝染及术前B超定位寻找SLN,乳腔镜下切除SLN并清扫Ⅰ、Ⅱ组淋巴结,如Ⅱ组淋巴结有明显肿大者则一并清扫Ⅲ组淋巴结,对切除淋巴结行HE染色病理分析。结果两术式每位患者切除淋巴结数目范围为:ESLNB为1~5枚,平均3.1枚;EALND为11~29枚,平均12.8枚。ESLNB检出率为95.0%(38/40),准确率92.1%(35/38),假阴性率15.0%(3/20),灵敏度85.0%(17/20);SLN多位于胸肌组,其中37例位于胸肌组,1例位于胸肌间组;40例患者均顺利完成乳腔镜,无中转开放手术,术中无重要血管神经损伤;术后无明显并发症,但有3例患者术后发生肢体疼痛、感觉异常。结论乳腺癌患者乳腔镜下前哨淋巴结活检及腋窝淋巴结清扫术具有较好可行性,美容效果好,并发症低,可对腋窝淋巴结准确分期。     

乳腺癌患者保乳手术腔镜腋窝淋巴结清扫术中的病理生理变化

目的 探讨乳腺癌患者保乳手术腔镜腋窝淋巴结清扫术中机体相应的循环、呼吸、血气等病理生理变化.方法 选择符合保乳条件的Ⅰ～Ⅱ期浸润性乳腺癌患者20例(维吾尔族),经患者要求择期行保乳手术开放切除病灶并进行乳腔镜下腋窝淋巴结清扫术,对比术时CO2充气前、充气后及放气后心率(HR)、脉搏血氧饱和度(SpO2)、平均动脉压(M...     

乳腔镜在乳腺癌根治术中的应用

目的：探讨乳腔镜在乳腺癌腋窝淋巴结清扫术中的价值和手术技巧。方法：2009年3月～2011年3月收治乳腺癌患者136例,其中66例应用乳腔镜行乳腺癌改良根治术（ MALND）,70例行常规乳腺癌腋窝淋巴结清扫术（ TALND）,对2组患者术中出血量、手术时间、清扫淋巴结及阳性淋巴结数量、术后功能相关并发症进行对比研究。结果：MALND组术中出血量、手术时间少于TALND,差异有统计学意义（P＜0．05）。清扫淋巴结及阳性淋巴结数量,2组组间差异无统计学意义（P＞0．05）。术后功能相关并发症如感觉异常、淋巴水肿、皮下积液,皮瓣愈合等,MALND组明显优于TALND,差异有统计学意义（P＜0．05）。随访6～12个月,2组均未出现腋窝复发患者。结论：通过乳腔镜游离皮瓣和清扫腋窝淋巴结及内乳淋巴结清扫,出血少,对机体干扰少,可明显减少常规开放手术的并发症和有突出的美容效果。用乳腔镜行乳腺癌改良根治术,可有效降低乳腺癌手术中的并发症的发生率。     

应用乳腔镜行保乳手术治疗乳腺癌的手术配合

目的总结在乳腔镜辅助下行腋窝淋巴结清扫+乳腺癌保乳手术的手术配合。方法对36例肿瘤直径≤2 cm、距离乳晕≥3 cm的乳腺癌患者在全麻下经腋窝脂肪抽吸后在乳腔镜辅助下行腋窝淋巴结清扫+乳腺癌保乳手术,对手术配合的护理经验进行总结。结果全部患者手术均获成功。手术时间2～3 h;出血量100～250 ml;与常规手术相比手术时间、出血量未见明显增加;全部患者未发生皮下气肿、出血、再手术等情况。结论乳腔镜辅助下的乳腺外科手术具有微创、美观的优势。手术切口相对较小,患者比较满意。吸脂法腔镜腋窝淋巴结清扫可以达到常规手术的清扫范围。     

乳腔镜微创乳腺癌根治术的进展

腔镜在乳腺癌外科的应用起始于1997年,Yamagata等[1]采用经乳晕入路,在腔镜辅助下采用外部牵拉法建立操作空间,对1例乳腺癌病人成功进行了乳房部分切除术.1999年Ishiguro等[2]进一步证明了该方法在乳腺癌保乳手术中的可行性及美容优势.此后,乳腔镜手术和乳腔镜辅助手术得到较快发展.随着广视角腔镜和超声刀等手术器械的完善以及相应技术的成熟,腔镜辅助乳腺癌根治性切除术、保留乳房的乳腺癌切除术和腋窝淋巴结清扫术在临床广泛开展.     

乳腺癌保乳手术65例近期疗效观察

目的评价乳腺癌保乳综合治疗的疗效。方法乳腺癌行保留乳房的肿瘤切除加腋窝淋巴结清扫;前哨淋巴结活检阴性则替代腋窝淋巴结清扫。结果随访1～61月,中位随访24月,保乳组中1例锁骨上淋巴结转移(1/65);死亡2例,死亡率3.07%(2/54)。结论乳腺癌采用保乳手术综合疗法,近期疗效满意,远期生存率尚待进一步随访观察。     

乳腔镜辅助乳腺癌腋窝淋巴结清扫术25例临床分析

目的 探讨腔镜技术用于乳腺癌腋窝淋巴结清扫术的可行性.方法 24例乳腺癌患者行腔镜下腋窝淋巴结清扫术,记录淋巴结清扫数目,了解清扫效果.结果 24例腔镜,平均取出腋窝淋巴结15.5枚;所有患者术中均未出现腋静脉、胸长神经、胸背神经损伤,未发生大出血、脂肪栓塞,1例出现皮下气肿.平均引流量350 ml,术后 4～5 d拔除引流管.结论 乳腔镜腋窝淋巴结清扫术已完全能够达到常规手术清扫腋窝淋巴结的技术要求,并在减少术后并发症、进一步改善患者术后生存质量上显示特有优势.     

胸腔镜下内乳淋巴结清扫术的手术配合

区域淋巴结转移是乳腺癌不良预后的一个重要标志 ,大量的研究资料表明 :除了腋窝淋巴结外 ,内乳淋巴结也是乳腺癌转移的第一站区域淋巴结 ,尤其是发生于内上象限或中央部位的乳腺癌 ,内乳淋巴结转移或复发是影响乳腺癌预后的重要因素[1] 。为了清扫第一至第五肋软骨水平的内乳淋巴链 ,传统的乳腺癌扩大根治术需在常规根治术的基础上切除第二和第四肋软骨各 2cm。但扩大根治术因创伤大、并发症多而逐渐被放疗所代替[2 ] 。不过 ,对内乳淋巴链行放疗可引起肺损伤、患侧上肢水肿和功能障碍及心脏方面的并发症等而使其应用受到限制[1] 。近年来 …     

32例腔镜下乳腺癌腋窝淋巴结清扫术临床分析

目的探讨腔镜下乳腺癌腋窝淋巴结清扫手术方法、可行性及临床效果。方法回顾性分析32例乳腺癌腔镜下腋窝淋巴结清扫手术（腔镜组）的临床资料,并与46例同期临床分期类似而行传统腋窝淋巴结清扫（传统组）资料比较。结果两组均为Ⅰ～Ⅱ期乳腺癌。腔镜组无中转开放手术,未发生大出血、皮下气肿、脂肪栓塞等并发症。腔镜组淋巴结数目（15．5枚）、平均手术时间（80min）与传统组比较差异均无统计学意义。但缩短了引流时间（3～5d）、减少了出血量（380ml）和术后并发症发生率（仅1例）。结论在选择性乳腺癌患者行腔镜下腋窝淋巴结清扫术能够达到传统腋窝淋巴清扫治疗效果,可在保证腋窝淋巴结清扫质量的同时降低手术并发症发生率,达到了生理、心理的微创化,提高了患者的生活质量。腔镜下腋窝淋巴结清扫术是可行的。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.