胸廓内血管蒂肋软骨瓣移植修复关节软骨缺损的研究

目的　为带血供肋软骨移植提供解剖学依据。方法　解剖观测 30侧成人胸廓内血管行程、分支、剑突血供及其形态学。结果　胸廓内动脉沿胸骨旁线下行 ,第 4肋骨之后走行于胸横肌的浅面 ,距正中线 (2 .7± 0 .7)cm ,在第 6肋或第 6肋间隙分为肌膈动脉和腹壁上动脉 ,其分支点距正中线 (2 .8± 0 .5 )cm ,剑突上 (4 .0± 1.3)cm。以上分支沿途分出肋间前动脉的肋软骨支和剑突支。胸廓内动脉外径 (2 .0± 0 .6 )mm、静脉 (2 .2± 0 .9)mm和 (1.5± 0 .8)cm ,剑突支 (0 .9± 0 .1)cm剑突中部长 (2 .1± 2 .3)cm ,中部宽 (1.1± 1.2 )cm ,中部厚 (0 .5± 0 .8)cm。结论　设计以胸廓内血管蒂的第 6肋软骨瓣 (单根 )、第 6、7肋软骨瓣 (双根 )和剑突瓣移植术 3种 ,可用于关节软骨缺损修复。     

内乳淋巴结活检在乳腺癌分期与辅助治疗中的价值

目的分析乳腺癌经肋间隙内乳淋巴结切除活检在乳腺癌分期与辅助治疗中的价值。方法回顾性分析济南军区总医院甲状腺乳腺外科2003年5月至2014年1月期间305例（根据是否行新辅助化疗分为新辅助化疗组和无新辅助化疗组）行乳腺癌各式改良根治术与经肋间隙内乳淋巴结切除活检患者的相关临床与病理资料,包括患者年龄、腋窝淋巴结、内乳淋巴结转移状况等信息,分析内乳淋巴结对乳腺癌分期与治疗的影响。结果新辅助化疗组共收集乳腺癌患者67例,发生腋窝淋巴结转移者45例（67．2％）,内乳淋巴结转移者23例（34．3％）;乳腺癌淋巴结病理（pN）分期改变者23例（34．3％）,乳腺癌肿瘤病理（pTNM）分期改变者8例（11．9％）。无新辅助化疗组共收集乳腺癌患者238例,发生腋窝淋巴结转移者155例（65．1％）,内乳淋巴结转移者30例（12．6％）;乳腺癌pN分期改变者30例（12．6％）,pTNM分期改变者23例（9。66％）。新辅助化疗组的内乳淋巴结转移率明显高于无新辅助化疗组（χ2=15．7,P〈0．05）,pTNM分期改变率也明显高于无新辅助化疗组贸（χ2=5．3,P〈0．05）。结论经肋间隙内乳淋巴结活检对乳腺癌pN分期、pTNM分期有一定的影响。新辅助化疗不能使所有内乳淋巴结转移癌达到病理完全缓解。经肋间隙内乳淋巴结活检不仅可完善乳腺癌pN和pTNM分期,而且能够指导乳腺癌术后辅助治疗,减少内乳区局部过度治疗,有助于乳腺癌患者个体化治疗。     

经肋间隙探查定位于内乳区的前哨淋巴结对乳腺癌淋巴分期的影响

目的 探讨乳腺癌前哨淋巴结在内乳区时对其探查与否对淋巴结分期的影响。方法 2006-01—2016-01间,对501例c T1-4N0-1M0期乳腺癌患者进行前哨淋巴结探查术,发现有蓝染淋巴管通向内乳区的患者,经肋间隙入路行内乳区前哨淋巴结活检术(IM-SLNB)+腋窝前哨淋巴结探查+改良根治术100例为A组;行腋窝前哨淋巴结探查+改良根治术401例为B组。观察A组经肋间隙入路IM-SLNB的病理结果与假设该组病例不探查相对比,了解探查对其淋巴分期的影响。观察经肋间隙入路的IMSLNB对手术时间、出血、并发症及恢复等的影响。结果 A组探查发现内乳区淋巴结癌转移19例相对于假设不探查为0例,其淋巴结分期修正率19.0%,(P0.05)有统计学意义;经肋间隙入路IM-SLNB阶段所用时间(23.93±5.89)min;仅1例术中胸廓内动脉出血,切断肋软骨显露血管后结扎止血,出血量约10~20 m L,其余99例均5 m L;胸膜破损0例、气胸0例;术后并发症和愈合时间与B组无统计学差异(P0.05)。结论 选择乳腺癌前哨淋巴结在内乳区时对其进行探查其阳性率高,有助于淋巴结准确分期;经肋间隙入路的内乳区淋巴结探查,创伤小、风险小、不增加并发症。     

经肋间隙取内乳区前哨淋巴结活检术的临床意义(附51例报告)

目的探讨内乳区前哨淋巴结活检的方法及意义。方法于2003年6月至2004年11月,选择内乳区淋巴结显像的51例乳腺癌病人并确定内乳前哨淋巴结,术中再次用γ探测仪、蓝色染料确认前哨淋巴结的位置,切开肋间肌,经肋间隙胸膜外切除内乳区前哨淋巴结及其他内乳淋巴结。结果51例病人检出内乳前哨淋巴结共54枚,手术时间(31±7)min。检出1枚前哨淋巴结48例,2枚3例,其中发生癌转移18例,共19枚。前哨淋巴结位于第2、3肋间隙者分别为13枚和20枚。用3种方法联合定位内乳前哨淋巴结,其敏感性和特异性均为100%,总准确率为100%。51例共检出内乳淋巴结118枚,其中发生癌转移25枚。无前哨淋巴结转移者未见内乳区其他淋巴结转移。无并发症发生。结论经肋间隙取内乳区前哨淋巴结活检为明确内乳淋巴结转移状况提供了有效的方法。     

踝前血管的解剖特点及临床意义

目的　为小腿中下段皮瓣移植与踝前血管吻合提供解剖学基础。　方法　在 3 0侧成人下肢标本解剖观测了踝前血管的长度、外径、走行。　结果　内、外踝前动脉起于胫前动脉或足背动脉。内、外踝动脉长度分别为 (4 9± 0 5 )mm和 (2 5± 0 7)mm。内、外踝动脉外径分别为 (1 5± 0 2 )mm和 (1 6± 0 3 )mm。　结论　踝前血管解剖位置恒定、管径粗 ,蒂较长 ,进行吻合可作受区血管     

可降解壳聚糖血管外周支持与静脉移植物早期结构的变化

目的　探讨可降解壳聚糖血管外周支持 (CES)对静脉移植物 (VG)早期结构变化的影响 ,为临床提高VG通畅率提供新的治疗方法。　方法　将兔右颈内静脉端 端吻合于同侧颈总动脉建立静脉移植模型 ,以有无CES干预分为支架组与无支架组 (每组 2 4只兔 )。术后 1、2、4周分别切除移植静脉 ,计算机图像分析系统测量和计算内膜、中膜厚度和面积 ,免疫组织化学法检测增殖细胞核抗原 (PCNA)指数观察平滑肌细胞增殖程度。　结果　CES在术后 2周开始降解。支架组VG ,术后 1～ 2周内膜、中膜的厚度和面积、PCNA指数在术后 1周轻度增加 ,1～ 2周维持稳定 ,术后 2周分别为(2 6 3± 3 7) μm、(2 6 0± 1 9) μm、(0 5 6± 0 0 8)mm2 、(0 34± 0 0 5 )mm2 与 (11 5± 2 1) % ,明显低于无支架组的 (5 6 4± 9 4 ) μm、(47 6± 4 9) μm、(1 17± 0 0 8)mm2 、(1 2 0± 0 4 3)mm2 与 (36 6± 2 9) % (P <0 0 1) ;术后 4周虽然又增加 ,分别为 (31 7± 1 6 ) μm、(31 7± 1 6 ) μm、(0 72± 0 12 )mm2 、(0 4 2± 0 0 6 )mm2 与 (13 4± 1 2 ) % ,但仍低于无支架组的 (76 8± 8 0 ) μm、(5 7 4± 9 5 ) μm、(1 2 7± 0 17)mm2 、(1 2 7± 0 0 9)mm2 与 (16 8± 2 2 ) % (P <0 0 5 )。结论　CES     

手辅助电视胸腔镜行食管癌切除术

目的　探讨手辅助电视胸腔镜行食管癌切除术的可行性及优缺点。方法　对 45例术前判断分期T3N1MO以下食管癌患者行手辅助电视胸腔镜食管癌切除术 (研究组),同期施行常规开胸手术 45例(对照组),比较两组患者术中淋巴结清扫情况及围手术期情况。结果　研究组手术效果满意。研究组和对照组手术清扫的食管旁淋巴结分别为(3 .6±1. 0)和 (3 .3±1 .5)个,贲门旁淋巴结分别为(1 .3±1 .1)和(1. 6±1 .1)个,胃左动脉周围淋巴结分别为 (4 .3±1 .4)和 (4. 7±2. 1)个,两组差异无统计学意义(P>0 .05);隆突下淋巴结分别为(6 .6±3. 7)和(3 .8±2 .5)个,研究组好于对照组(χ2 =2 95,P<0 05)。研究组与对照组手术时间分别为 (29±5)和 (60±6)min,胸部失血量分别为(93±19)和(145±35)ml,术后第 1天引流量分别为(201±45)和(295±57)ml,差异均有统计学意义(χ2 =18. 69, 6. 13, 6 .08,P均<0 .001)。结论　手辅助电视胸腔镜食管癌切除术能够达到常规开胸手术相同的切除效果,且具有手术时间短、创伤小、恢复快等优点。     

乳腺癌内乳区前哨淋巴结活检术研究进展

内乳区淋巴结的转移状况是乳腺癌的独立预后指标,也：是乳腺癌淋巴分期的重要依据之一。内乳区淋巴结转移的患者预后较差。随着前哨淋巴结活检技术的不断发展和新型注射技术的出现,内乳区前哨淋巴结活检的显像率显著提高,经肋间行内乳区前哨淋巴结活检术可以最小的风险评估内乳区淋巴结状况,并进一步完善乳腺癌的淋巴结分期．有助于为患者制定更为准确的个体化治疗方案。     

乳腺癌表现为肋软骨胸骨增厚:长期存在的假象

腋淋巴结是乳腺癌首先转移的部位,其中0.4%病例以腋淋巴结转移灶为唯一的临床发现。乳内动脉周围淋巴结则是第二位的转移部位,惜临床上不能扪及。作者报道一例乳腺癌伴乳内动脉周围淋巴链转移,引起肋软骨胸骨增厚,体检、X线和乳腺摄片均未能发现达3年多之久。一55性妇女主诉左第3胸肋软骨(胸骨旁增厚史3年,来Sloan-Kettering癌肿中心诊治,在这以前由很多医生作了检查,包括4次乳腺摄片,2年前肺部和胸骨X线片提示隆凹的软骨影,未作活检。1月前发现左乳内下象限有一结节,切除活检示管内和浸     

乳腺内乳淋巴结在乳腺癌诊治中的临床意义

目的探讨乳腺内乳淋巴结在乳腺癌诊治中的临床意义.方法通过分析国内、外关于内乳淋巴结的相关研究,总结乳腺癌中乳腺内乳淋巴结的分布、转移、检测及临床治疗的效果. 结果乳腺内乳淋巴结主要分布在胸骨附近,沿胸内乳动、静脉走行,在乳腺癌中能够发生早期转移且转移率随腋淋巴结转移数目的增多而增加,对内乳淋巴结的活检和治疗能影响乳腺癌患者的预后.结论内乳淋巴结的活检和治疗有助于乳腺癌的精确分期、治疗和预后判断, 同时也是防止乳腺癌复发的有效手段.     

右美托咪定对家兔窦房结和房室结功能的影响

目的研究不同剂量右美托咪定对家兔窦房结和房室结功能的影响。方法健康雄性新西兰大白兔24只,体重1.5~2.8kg,按随机数字表分为三组(n=8):对照组(C组),以12ml/kg速度持续泵注生理盐水;造成心动过缓最低剂量组(D1组),负荷量10μg/kg,持续泵注量5μg·kg-1·h-1;6倍剂量组(D2组),负荷量60μg/kg,持续泵注量30μg·kg-1·h-1。麻醉家兔,分离右侧股动脉并置管,实时监测MAP和HR。右侧颈外静脉置入起搏电极,深度位于上腔静脉下段和右心房交界处,通过程控刺激的方法获取窦房结、房室结的功能指标。于右美托咪定泵注前(T0)、右美托咪定持续泵注后20~30min(T1)、50~60min(T2)测量窦房结恢复时间(SNRT)、校正窦房结恢复时间(CSNRT)、窦房结总恢复时间(TRT),和房室结前传功能2∶1点。结果 C组各时点SNRT、CSNRT、TRT和2∶1点差异均无统计学意义。与T0时比较,T1、T2时D1组和D2组SNRT、CSNRT和TRT明显延长,T1时D1组和D2组2∶1点明显缩短,T2时D2组2∶1点明显缩短(P0.05)。与T1时比较,T2时D1组SNRT、CSNRT和TRT明显缩短,2∶1点明显延长(P0.05)。与C组比较,T1、T2时D1组和D2组SNRT、CSNRT和TRT明显延长,T1时D1组和D2组2∶1点明显缩短,T2时D2组2∶1点明显缩短(P0.05)。与D1组比较,T1、T2时D2组SNRT、CSNRT和TRT明显延长,2∶1点明显缩短(P0.05)。结论 10μg/kg负荷剂量右美托咪定泵注结束后对家兔窦房结和房室结功能抑制较显著,并在短时间内有所恢复(≤1h),而60μg/kg负荷量抑制效应更明显,并持续抑制窦房结和房室结功能。     

Patients with sentinel lymph node positive melanoma: Who needs completion lymph node dissection?

Introduction

Completion lymph node dissection (CLND) for melanoma after positive sentinel lymph node biopsy (SLNB) was recently shown to improve regional but not overall survival, likely due to the majority of patients harboring no further nodal disease. We sought to determine predictors of non-sentinel node (NSN) positivity.

Value of pre-operative carotid sinus massage

The usefulness of carotid sinus massage in pre-operative assessment is discussed with case examples. The technique and risks of carotid sinus massage are described. Carotid sinus massage is of particular value in the demonstration of sino-atrial and atrioventricular node disease in the absence of definitive abnormalities on the routine resting electrocardiogram, and in the identification of patients who show a hypersensitive response to vagal stimulation. These patients should be identified prior to procedures that involve marked vagal activity, since prolonged sinus arrest may occur.     

Predicting residual lymph node basin disease in melanoma patients with sentinel lymph node metastases

BACKGROUND: The incidence of residual occult disease in nonsentinel lymph nodes (NSLN) after a positive sentinel lymph node (SLN) biopsy in patients with melanoma is relatively low. The purpose of this study is to identify factors that may be predictive of occult NSLN metastases after positive SLN biopsy. METHODS: Fifty-six consecutive melanoma patients with positive sentinel nodes who subsequently underwent complete lymph node dissection (CLND) were evaluated. RESULTS: Only the number of positive SLN predicted the status on NSLN by univariate (P = 0.008) and multivariate (P = 0.028) analyses. None of the other variables (characteristics of SLN metastases, number of draining nodal basins, age, sex, thickness, Clark level, ulceration, number of mitoses/mm(2), histological subtype, and location of the primary) significantly predicted CLND results. CONCLUSIONS: Identifying patients with residual lymph node basin disease remains difficult. Thus, lymph node dissection should be performed in all patients after positive sentinel node biopsy.     

Intramammary sentinel lymph node in patients with breast cancer: Report of four cases

To analyze breast cancer patients with intramammary sentinel lymph node, we reviewed T1-T2N0 breast cancer patients who underwent sentinel lymph node mapping using radioisotope methods. Intramammary sentinel lymph (ISN) nodes were detected in 4 of 166 patients. Three of four ISNs were present in completely different quadrants of the breast from those of primary lesions. Although two patients had no involved nodes, including ISNs, the remaining two with T2 tumor had metastasis of ISNs alone with resulting upstaging. We should keep in mind the presence of intramammary SN in regions apart from the primary tumor, particularly when performing breast conservative surgery.     

Breast Cancer in an Intramammary Sentinel Node

Abstract: A palpable 3.2 cm infiltrating ductal carcinoma was removed from a 27-year-old woman. Radiologic evaluation of the breasts with mammography and sonography identified an intramammary node between the carcinoma and the axilla. This was localized and removed at the time of axillary dissection. Isosulfan blue, which had been injected into the walls of the lumpectomy cavity to facilitate identification of the sentinel node in the axilla, stained the intramammary node. It contained several foci of carcinoma. Excision of the intramammary nodes may be indicated in breast cancer patients treated with breast conservation.     

Development of Sentinel Node Targeting Technique in Breast Cancer Patients

Abstract: The goals of this clinical study were to develop a clinically relevant technique of targeting the sentinel lymph nodes for surgical removal in breast cancer patients and to determine the accuracy of the sentinel node for predicting whether regional metastases have occurred. One hundred fifty-seven patients with breast cancer and clinically negative lymph nodes had 0.2 to 1.0 mCi of a radiopharmaceutical injected into the breast around the primary cancer. All patients underwent completion lymphadenectomy immediately following sentinel node resection. The nodes were analyzed pathologically to determine which nodes contained metastases. A considerable variation was observed in the ability of different radiopharmaceutical agents to selectively label the sentinel node. Of those evaluated, 1 mCi technetium sulfur colloid in a volume of 8 ml provided the best labeling rate (29/29 = 100%). Of 119 patients in which a sentinel node was identified, 41 had pathologically positive nodes and in only 2 cases was the sentinel node not one of the pathologically positive nodes (false-negative rate 4.9%). The mean number of sentinel nodes was 3. There was considerable variation in the ability of lymphoscintigraphic agents to selectvely label the sentinel lymph node in breast cancer agents. Technetium sulfur colloid appears to successfully label the sentinel nodes in >90% breast cancer patients and was the best agent of the group evaluated. The pathology of the sentinel lymph node has a high accuracy for predicting whether regional lymph node metastases have occurred.     

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目的 探讨早期胃癌的淋巴结转移规律及其对预后的影响。方法 对161例有癌病人术后进行长期随访，对24例伴有淋巴结转移的早期胃癌与137例无淋巴结转移的早期胃癌的临床病理特征及3、5年生存率进行比较。结果 早期胃癌的淋巴结转移与肿瘤大小、浸润深度及淋巴、静脉侵犯有关，伴有淋巴结转移的早期胃癌3、5年生存率分别为82.8%和80.5%，明显低于无淋巴结转移者，后者分别为96.1%和92.4%。结论 术前或术中正确评估早期胃癌的淋巴结转移状态是选择合理的治疗方案和改善预后的重要条件。     

肺癌淋巴结转移规律的临床研究

目的 探讨原发性肺癌淋巴结转移频率,分布范围及特点,为广泛廓清提供依据。方法 按Ｎａｒｕｋｅ肺癌淋巴结分布图对３８６例肺癌病人施行了手术切除及广泛肺门、叶间及纵隔淋巴结廓清术。结果 清除淋巴结２６０３组,Ｎ１淋巴结转移率２０．１％,Ｎ２淋巴结转移率１６．２％。Ｔ１,Ｔ２,Ｔ３间淋巴结经差异非常显著。     

Role of Combined Sentinel Lymph Node Biopsy and Axillary Node Sampling in Clinically Node-Negative Breast Cancer

Axillary lymph node status is a prognostic marker in breast cancer management, and axillary surgery plays an important role in staging and local control. This study aims to assess whether a combination of sentinel lymph node biopsy (SLNB) using patent blue dye and axillary node sampling (ANS) offers equivalent identification rate to dual tracer technique. Furthermore, we aim to investigate whether there are any potential benefits to this combined technique. Retrospective study of 230 clinically node-negative patients undergoing breast-conserving surgery for single T1–T3 tumours between 2006 and 2011. Axillae were staged using a combined blue dye SLNB/ANS technique. SLNs were localized in 226/230 (identification rate 98.3 %). Three of one hundred ninety-two patients with a negative SLN were found to have positive ANS nodes and 1/4 failed SLNB patients had positive ANS nodes. Thirty-four of two hundred twenty-six patients had SLN metastases and 11/34 (32.4 %) also had a positive non-sentinel lymph node on ANS. Twenty-one of twenty-four (87.5 %) node-positive T1 tumours had single node involvement. Nine of thirty-eight node-positive patients progressed to completion axillary clearance (cALND), and the rest were treated with axillary radiotherapy. Axillary recurrence was nil at median 5 year follow-up. Complementing SLNB with axillary node sampling (ANS) decreases the unavoidable false-negative rate associated with SLNB. Appropriate operator experience and technique can result in an SLN localization rate of 98 %, rivalling a dual tracer technique. The additional insight offered by ANS into the status of non-sentinel nodes has potential applications in an era of less frequent cALND.