胃癌前哨淋巴结术中定位和病理学检查

目的探讨肿瘤前哨淋巴结(SLN)活检技术在胃癌诊疗中应用的可行性。方法将38例胃癌患者,按肿瘤浸润深度分组,用术中注射美蓝的方法定位前哨淋巴结,用细胞角蛋白(CK-19)免疫组织化学染色判断淋巴结转移情况。结果38例患者全部检出SLN(100%)。出现淋巴结转移的有18例,其中SLN出现转移的有15例。SLN预测淋巴结癌转移的敏感性、假阴性率和准确率分别为83.3%、16.7%和92.1%;胃癌T1组无SLN假阴性者,准确率100%;T2组有1例假阴性者,准确率94.1%;T3组假阴性2例,准确率6/8例。结论采用肿瘤周围注射亚甲蓝的方法术中定位淋巴结为可行的SLN术中定位方法。     

胃癌前哨淋巴结的临床研究胃癌前哨淋巴结的临床研究

目的：探讨胃癌前哨淋巴结（SLN）对预测各期胃癌淋巴结转移情况的意义。方法：使用美蓝-抗胃癌单克隆抗体MAb 3H11，对120例胃癌术中及术后前哨淋巴结定位和活检。结果：119例找到胃癌SLN为转移淋巴结，其中8例为唯一转移部位；55例SLN为非转移淋巴结，其中5例非前哨淋巴结存在转移。SLN预测胃周淋巴结转移的敏感性为92．8％，假阴性率为7．3％，准确率为95．8％。T1期敏感性100％，准确率100％；T2期敏感性96．3％，准确率97．9％；T3期敏感性为89．7％，准确率92．3％，假阴性率10．3％。结论：胃癌SLN定位及活检技术能较准确反映早期胃癌的淋巴结转移状况。     

胃癌根治术中前哨淋巴结活检的可行性研究

目的研究前哨淋巴结活检(SLNB)技术是否可以应用于胃癌根治术中。方法筛选符合实施SLNB条件的胃癌患者;实施SLNB;标记前哨淋巴结(SLN);行规范性胃癌根治术;对SLN、非前哨淋巴结(n-SLN)和切除的胃癌组织采用常规HE染色法进行病理检查。结果76例胃癌患者行SLNB,有66例检到SLN,成功率为86.84%(66/76)。在66例SLNB成功的胃癌患者中有35例常规病理检查阳性,31例阴性。在31例阴性患者中,有13例区域淋巴结检测为阳性即假阴性,假阴性率为27.10%(13/48),余18例区域淋巴结检测也呈阴性即真阴性,SLNB对于区域淋巴结预测的准确性是80.30%(53/66),敏感性是72.90%(35/48),特异性为100.00%(18/18)。结论SLNB技术可以应用于T1、T2期胃癌根治术中。     

前哨淋巴结导航手术在早期胃癌治疗中的初步应用

目的 探讨早期胃癌(EGC)在前哨淋巴结(SLN)导航下行缩小手术的可行性和临床意义.方法 将确诊的39例EGC患者随机分为SLN导航组(20例)和常规手术组(19例).导航组联用专利蓝和99m>Tc标记的硫胶体进行SLN活检,对17例SLN术中冰冻病理阴性的EGC行缩小的D0-D1病灶局部切除或胃部分切除术,余3例因SLN阳性行常规D2根治术.传统手术组19例均行D2根治术.计算SLN诊断EGC淋巴结转移情况的准确率和假阴性率,比较两组的手术情况、术后康复和1、3年无瘤生存率.结果 SLN检测成功率为100%(20/20),平均检出SLN 2.2个/例,由SLN诊断胃癌区域淋巴结转移状况的准确性为95%(19/20),假阴性率为5%(1/20).与22例传统手术相比,17例缩小手术在不降低术后无瘤生存率的前提下,显著缩短了手术时间,减少了术中出血量,加快了术后康复的速度,减少了手术并发症.结论 SLN活检可准确判断EGC的区域淋巴结转移情况,对SLN转移阴性的EGC病例行缩小的限制性手术既可保证根治效果又能获得微创益处.     

术前超声造影联合细胞学检查判断乳腺癌前哨淋巴结状态122例分析

目的探讨使用超声造影联合细针穿刺细胞学检查(contrast-enhanced ultrasound-fine needle aspiration cytology,CEUS-FNAC),于术前评估乳腺癌前哨淋巴结(sentinel lymph node,SLN)状态的诊断价值。方法早期乳腺癌122例,术前行经皮超声造影联合细针穿刺SLN,并行细胞学检查,术中行单纯染料法或联合同位素方法定位、定性SLN,术后以石蜡病理为标准,对比术前细胞学结果。结果 122例病人术后SLN石蜡病理结果:转移28例,未转移94例;CEUS-FNAC方法检测到SLN转移20例,未转移103例;CEUS-FNAC的检出率为100%,判断SLN是否转移的灵敏度71.43%,特异性100%,准确度93.44%,阳性预测值100%,阴性预测值92.16%,P值为0.000,Kappa值为0.794。结论术前超声造影联合细针穿刺SLN获得的细胞病理学结果,和术后SLN石蜡病理结果一致性较好,表明CEUS-FNAC方法可以用于术前乳腺癌前哨淋巴结状态的评估。     

乳腺癌前哨淋巴结中hMAM的表达及其临床意义

目的探讨乳腺癌前哨淋巴结(SLN)组织中人乳腺珠蛋白(hMAM)的表达及其临床意义。方法 32例可手术的原发性乳腺癌患者,在乳腺癌根治性手术中均行肿块周围或乳晕周围注射亚甲蓝成功定位SLN,按常规行腋窝淋巴结清扫,术后对SLN和非SLN行常规病理学检查,并进一步采用RT-PCR和Western Blot检测SLN冷冻组织中hMAM的表达。结果 32例SLN常规病理检查结果6例阳性SLN,阳性率为18.75%,1例假阴性,假阴性率为14.28%。RT-PCR和Western Blot检测hMAM,阳性SLN分别为12例和9例,阳性率分别为37.50%和28.13%,无假阴性。两者与病理检查结果相比差异均有显著性(P0.05)。结论 SLN定位后检测SLN中hMAMmRNA的阳性表达,相对于SLN定位后仅行常规病理检查,明显提高了乳腺癌阳性SLN的准确率,降低假阴性率。故hMAMmRNA可单独作为标志物来检测乳腺癌SLN微转移。     

可切除胃癌的前哨淋巴结示踪研究

目的 探讨前哨淋巴结活检在胃癌中的临床价值.方法 回顾性分析2003年1月至2006年6月46例行D2根治术的胃癌患者进行亚甲蓝前哨淋巴结活检的临床资料.结果 38例成功识别前哨淋巴结.前哨淋巴结敏感性、假阴性、准确性、特异性、阴性预测值及阳性预测值分别为69%(18/26)、31%(8/26)、79%(30/38)、100%(12/12)、60%(12/20)、100%(12/12).pT1期、TNM Ⅰ期和肿瘤直径<4 cm的患者,敏感性、准确性和阴性预测值均高达100%.肿瘤部位和淋巴结转移程度影响活检成功率,而肿瘤浸润深度、临床分期、淋巴结转移程度影响活检的敏感性、准确性和阴性预测值.结论 亚甲蓝前哨淋巴结活检在胃癌中的应用是可行的,早期患者的敏感性、准确性和可靠性高.     

不同示踪法在胃癌前哨淋巴结检测中的应用比较

目的 探讨理想的胃癌前哨淋巴结(SLN)检测方法.方法 前瞻性分析2004年1月至2008年8月广州军区广州总医院确诊的59例胃癌患者的临床资料,按随机数字表法将患者分为染料法组(20例)、核素法组(20例)和联合法组(19例),分别或联合注射专利蓝和99Tcm进行SLN检测.采用t检验和x2检验分析SLM的检出情况及SLN判断胃癌区域淋巴结转移的准确率和假阴性率.结果 染料法组共检出SLN 38枚,平均1.9枚/例;核素法组共检出SLN 31枚,平均1.6枚/例;联合法组共检出SLN56枚,平均2.9枚/例.联合法组中同时被染料和核素标记的SLN为46枚,单独被染料和核素标记的SLN分别为6枚和4枚.3组SLN检测数目比较,差异有统计学意义(t=4.35,P<0.05).其中联合法组SLN的检出数目明显多于染料法组和核素法组(t=4.21,3.54,P<0.05).染料法组、核素法组和联合法组诊断胃癌淋巴结转移的准确率和假阴性率分别为95%(19/20)和5%(1/20)、90%(18/20)和10%(2/20)、100%(19/19)和0,其中联合法组的准确率最高(x2=163.01,P<0.05),假阴性率最低(x2=170.14,P<0.05).结论 联合染料和核素标记物示踪法是检测胃癌SLN的理想方法.     

乳腺癌前哨淋巴结检测的临床研究

目的通过前哨淋巴结(sentinel lymph node,SLN)活检,了解前哨淋巴结是否能反映乳腺癌腋窝淋巴结转移情况,从而决定是否行腋窝淋巴结清扫(axillary lymph node dissection,ALND). 方法 47例T1、T2、T3临床检查腋窝淋巴结无肿大的乳腺癌患者,术前30 min于乳腺肿块周围腺体注射蓝色染料,术中取蓝染的SLN病理检查,术后将病理检查结果与腋窝淋巴结转移情况进行比较分析. 结果 47例中5例未见淋巴结及淋巴管蓝染,其余42例找到腋窝淋巴结608个,阳性18例168个,阴性24例440个;SLN共78个,阳性16例29个,阴性26例49个.SLN的检出率89.4%,准确性95.2% ,特异性100%,敏感性88.9%,假阴性率11.1%,假阳性率0. 结论 SLN活检反应腋窝淋巴结的肿瘤转移状况,可以用于术中确定是否行ALND.     

乳腺癌患者腋窝前哨淋巴结微转移及孤立癌细胞的评价

目的 评价连续切片及免疫组化技术在乳腺癌前哨淋巴结(SLN)转移诊断中的价值,探讨微转移和孤立癌细胞的临床意义.方法 对80例腋窝淋巴结阴性的乳腺癌患者,用99mTc-SC和异硫蓝联合法进行前哨淋巴结活检(SLNB),对所有SLN和非SLN进行常规HE染色及免疫组织化学分析.结果 78例(97.5%)成功检出SLN,其中76.5%的SLN同位素和染料检查均为阳性.32例(41%)SLN转移阳性,其中13例(40.6%)为微转移.共有14例(43.8%)患者SLN是惟一阳性的淋巴结.SLN预测腋窝状态的敏感性、特异性和准确性分别为96.9%,100%和98.7%.SLN转移的患者,其SLN之外的转移率明显高于仅有微转移的患者(78.9%vs.23.1%).结论 连续切片及免疫组化技术是乳腺癌SLN转移诊断的敏感方法.仅有SLN微转移患者的SLN之外的腋窝淋巴结转移率低,但其预后意义及对手术方案的影响尚待进一步研究.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.