不同腹腔镜手术入路切除巨大肾上腺肿瘤临床效果评价

目的比较腹腔镜下经腹腔入路和经腹膜后入路切除巨大肾上腺肿瘤的临床效果。方法回顾性分析郑州大学第一附属医院诊治的105例巨大肾上腺肿瘤患者的手术治疗资料,根据腹腔镜入路不同分为经腹腔入路组和经腹膜后入路组。比较2组患者手术时间、术中出血量、术后转重症监护室(ICU)比例、术后通气时间、术后发热(≥38.5℃)比例、术后引流时间、术后住院时间等。结果经腹腔入路组和经腹膜后入路组在术后转ICU比例、术后发热比例,术后引流时间以及术后住院时间比较差异均无统计学意义(χ²=1.463,P=0.229;χ²=0.026,P=0.873;t=1.554,P=0.123;t=1.260,P=0.221)。经腹膜后入路组手术时间、术中出血量及术后通气时间均少于经腹腔入路组,差异均有统计学意义(t=3.179,P=0.002;t=3.149,P=0.002;t=3.260,P=0.002)。结论经腹腔入路和经腹膜后入路腹腔镜手术均可安全切除巨大肾上腺肿瘤,且各有优势,应根据患者具体情况及施术者经验选择手术入路。     

不同入路腹腔镜手术与开放手术治疗大体积肾上腺肿瘤疗效比较研究

目的比较不同入路腹腔镜手术与开放手术治疗6 cm肾上腺肿瘤的临床疗效及安全性。方法收集2008年1月至2017年12月,中国医科大学附属盛京医院泌尿外科收治的88例6 cm肾上腺肿瘤患者的临床资料,根据手术方式不同分为腹腔镜组(65例)、开放手术组(23例),其中腹腔镜组依手术入路不同分为经腹腔组(39例)与经腹膜后组(26例)。比较3组患者术中失血量、术中输血例数、手术时间、术后镇痛时间、术后住院天数、术后保留引流管天数、术后并发症等指标间的差异。结果经腹腔组和经腹膜后组在术中出血量、术中输血例数、术后镇痛时间、术后住院天数、术后并发症等方面少于开放手术组(均P0.05),但经腹腔组与经腹膜后组间比较差异无统计学意义(均P0.05)。3组患者在手术时间和术后保留引流管天数比较,差异无统计学意义(均P 0.05)。结论无论是经腹还是经腹膜后的腹腔镜手术治疗6 cm肾上腺肿瘤均安全有效,其疗效明显优于开放手术。     

经口腔前庭和全乳晕入路腔镜治疗甲状腺乳头状癌的近期疗效分析#br#

目的探究经口腔前庭入路腔镜甲状腺手术和经全乳晕入路腔镜甲状腺手术治疗甲状腺乳头状癌的近期疗效。方法选取青岛大学附属烟台毓璜顶医院2018年12月至2019年12月66例cT1N0期甲状腺乳头状癌患者,根据术式的不同分为经口腔前庭入路腔镜手术组（口腔组）和全乳晕入路腔镜手术组（全乳晕组）,各33例,对比2组近期疗效。结果口腔组与全乳晕组性别、年龄、病程、肿瘤位置、肿瘤直径比较,差异无统计学意义（P>005）。两组术中出血量、手术时间、中央区淋巴结清扫数、术后引流量、住院时间、颈部恢复活动时间比较差异无统计学意义（P>005）,口腔组中央区淋巴结清扫时间短于全乳晕组,差异具有统计学意义（P<005）。两组术前及术后2 d红细胞沉降率（ESR）、白细胞计数（WBC）、C反应蛋白（CRP）、血钙、甲状旁腺素（PTH）水平比较,差异无统计学意义（P>005）。两组术后1 d、7 d的视觉模拟疼痛评分（VAS）比较,差异无统计学意义（P>005）,术后2 d的VAS评分、温哥华瘢痕评定量表（VSS）评分及患者满意度评分比较,差异具有统计学意义（P<005）。两组术后CO2气体栓塞、喉返神经损伤、声嘶、感染、手足麻木、呛咳并发症的发生率比较,差异无统计学意义（P>005）。术后1年随访,两组是否需要接受I131治疗及局部复发率比较,差异无统计学意义（P>005）。结论经口腔前庭和全乳晕入路腔镜治疗cT1N0期甲状腺乳头状癌均安全有效,但前者术式清扫淋巴结数目用时更短,患者术后疼痛轻,美容效果更好,尤其对于有美容需求的患者可作为优先选择手术方式。     

经腹与经腹膜后腹腔镜肾输尿管全长切除治疗上尿路尿路上皮癌的临床研究

目的探讨经腹膜后入路腹腔镜肾输尿管全长切除联合膀胱袖状切除术治疗上尿路尿路上皮癌的可行性和安全性。方法将62例尿路上皮癌患者分为经腹腔入路组和经腹膜后入路组。经腹腔入路组患者均接受经腹腔入路腹腔镜肾输尿管全长切除联合膀胱袖状切除术治疗;而经腹膜后入路组患者则接受经腹膜后入路肾输尿管全长切除联合下腹部小切口膀胱袖状切除术治疗。观察并记录2组患者手术时间、术中出血量和住院时间等手术相关指标。术后观察2组患者术后并发症、肿瘤复发和转移情况,并于术前和术后3个月采用SF-36量表对患者的生活质量进行评分。结果经腹膜后入路组患者的手术时间、术中出血量和住院时间分别为(118.74±22.68)min、(124.69±43.78)mL和(8.12±2.21)d,均显著低于经腹腔入路组的,组间差异有统计学意义(P<0.05);经腹膜后入路组患者术后3个月的生理功能、生理职能、躯体疼痛、总体健康、社会功能、活力、情感职能和精神健康共8个维度的评分均高于经腹腔入路组(P<0.05);经腹膜后入路组患者术后的并发症发生率为3.12%,显著低于经腹腔入路组的13.33%(P<0.05)。2组患者术后彩超和膀胱镜检查均未发现肿瘤复发情况;2组患者术后远处转移发生率比较,差异无统计学意义(P>0.05)。结论经腹膜后入路肾输尿管全长切除联合下腹部小切口膀胱袖状切除术治疗上尿路尿路上皮癌,创伤小,利于患者的康复,同时可提高患者的生活质量,安全有效,值得应用于临床。     

腹腔镜下电凝钩与超声刀治疗低位直肠癌根治术的疗效对比#br#

【摘要】目的对比腹腔镜下电凝钩与超声刀治疗低位直肠癌根治术的疗效。方法对青岛市立医院2015年5月至2018年5月就诊的低位直肠癌患者150例进行回顾性分析,按照腹腔镜下不同手术方法分为电凝钩组（n=80）和超声刀组（n=70）。观察两组手术一般情况、近期疗效、术后并发症、复发及生存情况。结果电凝钩组手术时间短于超声刀组（P<005）,出血量、淋巴结切除个数、切除肿瘤直径两组差异无统计学意义（P>005）;两组术后肛门排气时间、下床活动时间、排便时间、进食时间及住院时间,差异无统计学意义（P>005）;超声刀组排尿困难发生率高于电凝钩组（P＜005）,两组术后肠梗阻、吻合口瘘和切口感染发生率,差异无统计学意义（P>005）。结论腹腔镜下电凝钩相较于超声刀手术用时更短,并发症发生更少,更加便捷。     

免腹部辅助切口经自然腔道取标本完全腹腔镜下直肠癌根治术对第三间隙效应的影响

目的探讨免腹部辅助切口经自然腔道取标本(NOSE)法完全腹腔镜下直肠癌根治术对第三间隙效应的影响。方法选取2016年1月至2018年6月在东南大学附属中大医院江北院区普外科住院并行根治性切除术的直肠癌患者120例,随机分为观察组与对照组,每组60例。对照组行常规腹腔镜直肠癌根治术,观察组行免腹部辅助切口NOSE法完全腹腔镜下直肠癌根治术,比较两组手术相关指标,分别于术前及术后24、48、72 h测定血清白蛋白(ALB)、前白蛋白(PAB)、总蛋白(TP)、Na+、K+、Ca2+、一氧化氮(NO)、超氧化物歧化酶(SOD)、丙二醛(MDA)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF α)及白介素 6(IL 6)水平。结果两组患者的手术时间、淋巴结清扫数及术后并发症发生率比较差异均无统计学意义(P>005),但观察组的切口长度、术中出血量、术后首次排气时间、术后首次下床时间、术后住院时间均低于对照组,差异有统计学意义(P<005)。两组术后血清ALB、PAB、TP、Na+、K+、Ca2+水平比较差异无统计学意义(P>005);观察组术后24、48、72 h的血清SOD水平高于对照组,血清MDA、CRP、TNF α、IL 6水平低于对照组,差异均有统计学意义(P<005)。结论免腹部辅助切口NOSE法完全腹腔镜下直肠癌根治术安全可行,可减轻手术创伤及对第三间隙效应的影响,有利于术后康复。     

腹腔镜下三角吻合联合经自然腔道取标本用于近端胃癌根治术的效果分析#br#

目的探讨全腹腔镜下三角吻合联合经自然腔道取标本（NOSES）用于近端胃癌根治术的效果。方法选取安徽医科大学第二附属医院2019年10月至2020年10月收治的62例近端胃癌患者,按照治疗方法的不同分为研究组与对照组,各31例。研究组行近端胃部分切除腹腔镜下三角吻合消化道重建联合NOSES治疗,对照组行食管残胃吻合术联合经腹部切口取标本治疗。比较两组的手术效果、手术前后炎症反应及免疫功能指标,以及并发症发生情况。结果两组患者的性别、年龄、体质指数（BMI）、美国东部肿瘤协作组（ECOG）评分、肿瘤直径、美国麻醉医师协会（ASA）分级及病理分期比较差异无统计学意义（P>005）。研究组的手术时间、吻合时间、淋巴结清扫数大于对照组,术中出血量、术后首次排气时间、流质饮食时间、术后下床时间小于对照组,差异有统计学意义（P<005）,两组术后住院时间比较差异无统计学意义（P>005）。两组手术前后炎症反应指标[白细胞计数（WBC）、C反应蛋白（CRP）]及免疫功能指标[CD3+、CD4+、CD8+、CD4+/CD8+]比较差异无统计学意义（P>005）。两组术后并发症发生率比较差异无统计学意义（194% vs. 258%,P>005）。随访6个月,两组均无肿瘤复发、转移及死亡患者。结论近端胃癌患者采用全腹腔镜下三角吻合消化道重建联合NOSES治疗比食管残胃吻合术联合经腹部切口取标本治疗的效果更优,术后恢复更快,安全可靠。     

胸腔镜剑突下入路对纵隔肿瘤术后感染和疼痛应激相关指标的影响

目的比较剑突下入路和胸壁入路方式行胸腔镜纵隔肿瘤切除对患者术后感染和疼痛应激水平的影响。方法选取2014年8月至2017年7月在深圳市第九人民医院胸心外科接受胸腔镜纵隔肿瘤切除术的患者56例,25例自剑突下入路(剑突组),31例自胸壁入路(胸壁组)。比较两组患者术后1个月内发生感染的情况,分别于术后1 d和7 d检测并比较两组患者血清5 羟色胺(5 HT)、前列腺素E2(PGE2)、促肾上腺皮质激素(ATCH)和神经肽Y(NPY)水平。结果术后1个月内,剑突组总感染率为160％(4／25),胸壁组为161％(5／31),差异无统计学意义(P>005)。术后1 d,剑突组的5 HT、PGE2、ATCH水平显著低于胸壁组,差异有统计学意义(P<005),但两组NPY水平差异无统计学意义(P>005);术后7 d,两组的5 HT、PGE2、ATCH和NPY水平差异均无统计学意义(P>005)。结论与经胸壁入路胸腔镜手术相比,经剑突下入路胸腔镜纵隔肿瘤切除手术能够有效降低患者术后的疼痛应激水平,且不增加术后感染的风险,安全性高,具有临床推广价值。     

快速康复外科理念对腹腔镜下胰十二指肠切除术患者术后应激因子及预后的影响

目的探讨快速康复外科理念对腹腔镜下行胰十二指肠切除术胰头癌患者术后应激因子及预后的影响。方法选取2016年10月至2019年10月在淮南新华医疗集团新华医院接受治疗的60例胰头癌患者,随机分为对照组和观察组,每组30例。两组均接受腹腔镜下胰十二指肠切除术,在手术期间及术后,对照组给予临床常规治疗措施,观察组采用快速康复外科理念指导围手术期诊疗,观察并比较两组患者治疗前后的皮质醇(CO)、肾上腺素(AD)、白细胞介素 6(IL 6)、肿瘤坏死因子 α(TNF α)应激因子水平,比较两组患者汉密顿焦虑量表(HAMA)评分,比较两组患者的临床疗效(术后肛门排气时间、引流管拔除时间、住院时间)及术后并发症发生情况,并于术后随访6个月,记录并比较随访期间两组患者的二次手术率及病死情况,行统计学分析。结果术前两组患者的应激因子(CO、AD、IL 6及TNF α)比较差异无统计学意义(P>005),术后2 d,观察组的血清CO、AD、IL 6、TNF α水平及HAMA评分均低于对照组(P<005);观察组的并发症发生率(3333％)低于对照组(7333％),且观察组患者的术后肛门排气时间、引流管拔除时间和住院时间较对照组均明显缩短(P<005),观察组的二次手术率及病死率均明显低于对照组(P<005)。结论快速康复外科理念应用于腹腔镜下胰十二指肠切除术患者具有较好的临床疗效,可大幅度减轻患者术后的应激反应,降低并发症的发生率,同时还起到缩短治疗时间、减轻患者创伤的效果,利于患者术后快速恢复。     

腹腔镜手术治疗原发性胃间质瘤对患者胃功能恢复速度和消化功能的影响

目的分析腹腔镜手术治疗原发性胃间质瘤对患者胃功能恢复速度和消化功能的影响。方法选取大连医科大学附属大连市中心医院于2016年2月至2018年10月收治的100例原发性胃间质瘤患者的临床资料进行分析,对照组50例采用开腹手术,观察组50例采用腹腔镜手术,分析两组患者的临床疗效。结果两组患者危险度比较,差异无统计学意义(P>005)。观察组和对照组术中出血量为(693±1572)ml比(1779±3211)ml,手术时间为(8251±3625)min比(10314±3514)min、术后胃肠功能恢复时间为(460±176)d比(523±162)d、术后引流管拔除时间(154±029)d比(308±042)d,差异均有统计学意义(P<005)。观察组术后前白蛋白、转铁蛋白、T淋巴细胞亚群(CD3+、CD4+、CD4+／CD8+)水平高于对照组(P<005),两组术后白蛋白水平比较,差异无统计学意义(P>005)。观察组并发症发生率为600％低于对照组的2400％(P<005);观察组复发率600％与对照组2％相比,差异无统计学意义(P>005)。结论腹腔镜手术治疗原发性胃间质瘤,术中出血量少,术后胃肠功能恢复快,并发症少,可改善患者免疫功能,安全性高。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

Quality of life and care in leukemia, myeloma and non-malignant disease. Opinions of patients and relatives, and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P less than 0.05). Similarly, relatives of decreased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P less than 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P less than 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P less than 0.001). The opinions of patients were similar to those of their relatives. However, the relatives of leukemia patients were even more satisfied with the contact with the medical staff than the patients themselves (P less than 0.05). As many as 10-30% of the relatives never gave up hope for their relative's survival. Only two out of 27 deaths were considered not dignified. The lung carcinoma patients reported a less good quality of life (P less than 0.001), and less satisfaction with the information given (P less than 0.01), than the hematological patients from the same year. Similarly, their attitude to the medical care improved less (P less than 0.01), and they were less content with the general care than the leukemia group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)