保留肋间臂神经的乳腺癌改良根治术46例临床研究

目的:探讨乳腺癌患者行乳腺癌改良根治术中保留肋间臂神经(Intercostobrachial nerve,ICBN)的可行性及临床意义。方法:在86例Ⅰ、Ⅱ期乳腺癌患者中,行改良根治术时完整保留ICBN 46例,切除40例。比较两组患者术后上臂内侧及腋窝部皮肤感觉功能。结果:保留ICBN组46例,腋窝及上臂内侧皮肤感觉异常6例(13.04%)。切除ICBN组40,腋窝及上臂内侧皮肤感觉异常30例(75.00%)。两组间差异有统计学意义(P<0.05)。随访3～72个月,两组均无肿瘤局部复发和远处转移。结论:保留肋间臂神经在Ⅰ、Ⅱ期乳腺癌改良根治术中是安全可行的,能有效保留患者上臂内侧及腋窝皮肤感觉功能,提高患者术后生活质量。     

保留肋间臂神经在乳腺癌改良根治术中的可行性及临床意义

[目的]探讨乳腺癌患者行乳腺癌改良根治术中保留肋间臂神经的可行性及临床意义：[方法]30例乳腺癌改良根治术保留肋间臂神经,32例切除肋间臂神经。保留肋间臂神经组用双极电凝显露保留肋间臂神经,术后随访比较两组患者术后上臂内侧及腋窝部皮肤感觉功能。肿瘤局部复发情况。[结果]保留肋间臂神经组30例,腋窝及上臂内侧皮肤感觉正常28例（占85％）：切除肋闻臂神经纽均有不同程度的皮肤感觉异常,严重者疼痛或烧灼感。两组间差异有统计学意义（P〈0．001）。随访3～5年,两组均无肿瘤局部复发和远处转移。手术时间两组差异无显著性意义。[结论]保留肋间臂神经在Ⅰ、Ⅱ期乳腺癌改良根治术中是安全可行的,能有效保留患者上臂内侧及腋窝皮肤感觉功能．提高患者术后生活质量．、     

保留肋间臂神经在乳腺癌改良根治术中的临床意义

目的研究保留肋间臂神经在乳腺癌改良根治术中的价值。方法将于我院2002年1月至2008年1月行乳腺癌改良根治术的患者124例分为保留肋间臂神经组（实验组）42例及切除肋间臂神经组（对照组）82例，对比术后两组患者上臂内侧感觉功能。结果实验组患者术后上臂感觉障碍发生率约11．9％，对照组约48．8％，差异有统计学意义，而两组术后复发率及并发症无明显差别。结论对早期乳腺癌（Ⅰ、Ⅱ期）需行腋淋巴结清扫术的患者，术中保留肋间臂神经可显著减少术后患者上臂内侧感觉障碍，且不增加手术并发症的发生率及复发率。     

乳腺癌改良根治术中保留肋间臂神经的临床意义

目的研究在乳腺癌改良根治术中保留肋间臂神经的临床价值。方法将我院2003年9月至2009年9月行改良根治术的Ⅰ、Ⅱ期乳腺癌患者61例分为保留肋间臂神经组（实验组）37例及切除肋间臂神经组（对照组）24例,术后测试患者患侧上臂内后侧及腋部的皮肤感觉功能变化。结果实验组患者术后感觉障碍发生率约16.2%,对照组约75%,差异有统计学意义,而两组术后并发症及局部复发无明显差别。结论对Ⅰ、Ⅱ期乳腺癌患者行改良根治术时术中保留肋间臂神经可显著减少术后患者患侧上臂内后侧及腋部皮肤感觉障碍,且手术并发症及术后局部复发无明显差别。     

乳腺癌改良根治术中保留肋间臂神经的临床意义

目的探讨Ⅰ、Ⅱ期乳腺癌改良根治术中保留肋间臂神经的临床价值。方法85例行Ⅰ、Ⅱ期乳腺癌改良根治术,保留肋间臂神经61例,切除24例,术后对患者进行随访观察。结果保留肋间臂神经61例中,术后患者上臂内侧及腋部皮肤感觉正常58例（95.08%）、感觉异常3例（4.92%）;切除肋间臂神经24例均有感觉异常,2组比较差异有显著性（χ2=17.71,P〈0.001）。随访1-5年,85例均无肿瘤局部复发。结论在乳腺癌腋窝淋巴结清除术中,保留肋间臂神经是可行的,既保存了上臂内侧及腋部皮肤感觉功能,又改善患者术后生活质量,具有一定临床价值。     

乳腺癌改良根治术中保留肋间臂神经的价值

目的:探讨乳腺癌改良根治术中保留肋间臂神经的方法及临床价值.方法:将2003-2008年间368例Ⅰ～Ⅱ期乳腺癌患者随机分为两组,观察组184例,其中176例成功实施肋间臂神经保留,8例无法保留肋间臂神经或保留肋间臂神经失败,切除肋间臂神经;对照组184例均切除肋间臂神经,术后对两组患者进行观察和随访.结果:术后随访1～5年,观察组和对照组术后患侧上肢感觉异常发生率分别为6.8 %和91.8 %,差异有统计学意义(P＜0.05).两组均未见局部复发.结论:在Ⅰ～Ⅱ期乳腺癌改良根治术中保留肋间臂神经是可行的,它显著减少了患侧上臂内侧及腋部皮肤感觉异常的发生率,有利于改善病人术后的生活质量,具有一定的临床应用价值.     

乳腺癌腋淋巴结清扫术中保留肋间臂神经的应用研究

目的:探讨Ⅰ、Ⅱ期乳腺癌改良根治术中保留肋间臂神经的临床价值。方法:选择行Ⅰ、Ⅱ期乳腺癌改良根治术患者65例,保留肋间臂神经50例,切除15例,术后对患者进行随访观察。结果:保留肋间臂神经50例中,术后患者上臂内侧及腋部皮肤感觉正常46例(92.0%),感觉异常4例(8.0%);切断肋间臂神经15例均有感觉障碍,两组比较差异有显著性。随访1年,50例均无肿瘤局部复发。结论:在乳腺癌腋窝淋巴结清扫术中,保留肋间臂神经对改善患者术后生活质量具有一定的临床价值。     

保留肋间臂神经在乳腺癌改良根治术中的临床意义

目的: 探讨乳腺癌改良根治术中保留肋间臂神经(intercostobrachial nerve, ICBN)的临床意义.方法: 在60例Ⅰ、Ⅱ期乳腺癌患者中,行改良根治术时完整保留ICBN 32例,切除28例.术后对两组患者患侧上臂内侧和腋窝区的皮肤感觉功能进行检查.结果: 保留ICBN的32例中,术后患侧上臂内侧及腋窝区皮肤感觉正常30例(93.8%),感觉异常2例(6.2%);而切除ICBN的28例中术后感觉正常10例(35.7%),感觉异常18例(64.3%).两组上臂内侧和腋窝区的皮肤感觉异常比较,差异有统计学意义(P<0.005).经随访无1例出现肿瘤局部复发.结论: 乳腺癌改良根治术中保留肋间臂神经可以预防术后上臂及腋窝感觉障碍的发生,不增加局部复发的风险,应成为乳腺癌改良根治手术的标准组成部分.     

乳腺癌改良根治术保留胸前神经及肋前臂神经的近期治疗效果的对照研究

目的 评价保留胸前神经及肋间臂神经的临床价值.方法 将2006年3月～2007年3月在笔者所在医院乳腺外科收治的Ⅰ期、Ⅱ期乳腺癌患者80例,行常规改良根治术进行游离并保留胸前神经和肋间臂神经,并回顾性选取前期2005～2006年于笔者所在医院行改良根治术未保留胸前神经和肋间臂神经的Ⅰ期、Ⅱ期乳腺癌患者80例进行对照研究.结果 术后通过测试胸大小肌厚度和功能情况和患侧上臂内后侧的感觉和运动功能,发现研究组患者术后6月内胸肌厚度与对照组相比较差异无统计学意义,于6月后两组比较开始具有统计学意义,功能对比在术后早期差异性就较明显;研究组上臂后内侧感觉障碍及疼痛较对照组低,两者比较差异有统计学意义(P＜0.01);随访期内两者的局部复发及远处转移率无统计学意义.结论 Ⅰ期、Ⅱ期乳腺癌患者行改良根治术同时保留胸前和肋间臂神经,改善了患者术后局部感觉运动功能,提高了患者术后生活质量,与未保留胸前和肋间臂患者相比近期肿瘤根治效果相似.     

保留肋间臂神经在乳腺癌腋窝淋巴结清扫术中的意义

目的:探讨保留肋间臂神经在早期乳腺癌腋窝淋巴结清扫术中的可行性及临床应用价值.方法:70例Ⅰ、Ⅱ期乳腺癌行腋窝淋巴结清扫术病人被分为两组,其中肋间臂神经保留组32例,肋间臂神经切除组38例.术后对病人上臂内侧感觉功能进行对比分析.结果:保留肋间臂神经与不保留肋间臂神经两组患者术后2周时,切除ICBN者36例均有上臂内侧和腋部皮肤麻木,其中12例有持续疼痛;而32例保留ICBN者中仅4例产生麻木,2例疼痛.结论:在早期乳腺癌(Ⅰ、Ⅱ期)改良根治术中施行保留肋间臂神经是可行的,它保存了患侧上臂内侧及腋部皮肤感觉功能,改善病人的生活质量,具有一定临床价值.     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.