肺癌原发灶FDG摄取预测转移的初步研究

目的:观察分析肺癌患者原发灶脱氧葡萄糖(fluorodeoxyglucose,FDG)摄取与诊断时的淋巴结及远处转移状态的关系.方法:共收集到确诊为肺癌并治疗前行FDG-PET/CT检查患者208例,确定其原发灶大小(CT测量的最大径)、FDG;摄取值(最大标准化摄取值,即SU-Vmax)和转移状态.并分为无转移组、仅淋巴结转移组和远处转移组,分析原发灶FDG摄取与原发灶大小和转移情况等的关系,采用Logistic回归分析影响转移的因素.结果:原发灶大小与SUVmax呈正相关性,r=0.613,P:0.000.3组的原发灶大小差异无统计学意义(P=0.078).而SUVtnax差异有统计学意义.P=0.008;其中无转移组SUVmax小于仅淋巴结转移组(P=0.041)和远处转移组(P=0.002),后两组间差异无统计学意义,P=0.298.Logistic回归分析表明,SUVmax是唯一影响转移的因素.SUV-max每增加1单位,发生转移的风险增加1.112倍,P=0.032.结论:肺癌原发灶SUVmax增高则发生淋巴结或远处转移的风险增加,提示FDG摄取值可能作为一个预测转移的指标.     

Correlations of 99Tcm-HL91 SPECT hypoxia imaging with HIF-1α and VEGF expression in non-small cell lung cancer

Objective 99Tcm-HL91(99Tcm labeled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime)is a potential noninvasive marker of tumor hypoxia.It has been reported that 99Tcm-HL91 has validity for hypoxia imaging in non-small cell lung cancer(NSCLC).The aim of this study was to evaluate the 99Tcm-HL91 SPECT hypoxia imaging of NSCLC,the expression of inducible hypoxia factor-1α (HIF-1α)and vascular endothelial growth factor(VEGF),and to analyze their correlations with clinicopathological characteristics.Methods Twenty NSCLC patients who underwent radical resection were enrolled into this study prospectively.99Tcm-HL91 SPECT scanning was performed in all patients at one or two days before surgery.After intravenous injection of approximately 740 MBq 99Tcm-HL91,anterior,posterior and lateral planar images were collected at 2,4 and 6 hours,respectively.Regions of interest (ROls)were drawn in the tumor and the contralateral normal lung tissue,and the radioactivity ratio of tumor to normal tissue(T/N)was calculated.Immunohistochemistry was used to detect the expression of HIF-1α and VEGF in sequential histological sections of specimens.Results Among the 20 NSCLC patients,13 showed positive expression of HIF-1α and 15 had positive expression of VEGF,with a positive rate of 65.0% and 75.0%,respectively.The uptake of 99Tcm-HL91 was strongly correlated with the expression status of HIF-1α.No correlation between HIF-1α and VEGF expression levels was observed.The HIF-1α expression level was not correlated with histological subtype,but with lymph node involvement.The expression levels of HIF-1α and VEGF were positively correlated with tumor stage.Conclusion The result of 99Tcm-HL91 SPECT hypoxia imaging is found to be positively correlated with expression of HIF-1α in the non-small cell lung cancer.HIF-1α expression is positively correlated with VEGF expression.Furthermore,both HIF-1α and VEGF expressions are increasing with the increase of tumor stage.     

新生儿HIE脑干听觉诱发电位变化及高压氧干预

目的：通过观察新生儿缺氧缺血性脑病（ＨＩＥ）的脑干听觉诱发电位（ＢＡＥＰ）的变化来指导高压氧治疗及预测预后,以期确立ＢＡＥＰ为预测预后及指导高压氧治疗的可靠的客观指标。方法：对６４例ＨＩＥ的患儿随机分为两组,治疗组３４例,对照组３０例,两组均采用相同的综合治疗。治疗组给予高压氧治疗,１０次为一疗程,一个疗程后两组同期检查ＢＡＥＰ。ＢＡＥＰ异常者治疗组再行第二疗程高压氧治疗,至ＢＡＥＰ恢复正常为止。结果：治疗前治疗组与对照组统计学分析ＢＡＥＰ异常率无差异,第一次复查及第二次复查其ＢＡＥＰ异常率有显著性差异。治疗组第二疗程高压氧后ＢＡＥＰ发现仍有２例异常,后继续做高压氧治疗,４个疗程后恢复正常。对照组３个月时随访仍有３例ＢＡＥＰ异常。结论：ＢＡＥＰ可作为ＨＩＥ预测预后及指导高压氧治疗的一个客观指标。     

电子鼻咽喉镜直视下环杓关节拨动复位术治疗环杓关节脱位的疗效分析

目的 探讨电子鼻咽喉镜直视下环杓关节拨动复位治疗的疗效,为环杓关节脱位的治疗提供参考。方法 回顾性分析2016年9月—2021年3月收治17例明确诊断为单侧环杓关节脱位并在局部麻醉下经电子鼻咽喉镜直视下环杓关节拨动复位术的患者临床资料,比较拨动复位前后电子鼻咽喉镜检查、发声障碍指数量表（VHI-10）及听觉感知（GRABS）评估总嘶哑度G。结果 治疗前17例患者均有发音疲劳、不同程度的声音嘶哑、声带运动障碍及声门闭合不良。17例患者经复位术后4周均诉发音嘶哑改善;电子鼻咽喉镜检查声带运动恢复正常15例（88.24%）;2例（11.76%）患侧声带动度较术前改善,但仍较健侧稍差,声门闭合较前改善。与复位前比较,复位后VHI-10功能、生理、情感三个维度及总分均降低（P<0.05）;G0为8例,G1为7例,G2为2例。结论 局部麻醉下电子鼻咽喉镜直视下杓状软骨拨动复位是治疗环杓关节脱位的安全、简便、有效的方法。     

CTP联合3D-ASL技术对高原红细胞增多症脑部血流动力学的探讨

目的 研究高原红细胞增多症（HAPC）CT脑灌注(CTP)的变化/核磁共振质子自旋标记技术（3D-ASL）的应用价值并进行对比研究。方法 用多层螺旋CT(MDCT)研究22例不同程度高原红细胞增多症患者的CT脑灌注的变化；CT全脑灌注技术与核磁共振质子自旋标记技术（3D-ASL）在高原红细胞增多症脑部血流动力学改变中的应用价值的比较。结果 HAPC随病情加重, 大脑皮质和白质均脑血流量（CBF）呈下降趋势, 除额叶白质和颞叶白质外, 余部位不同病情间差异均有统计学意义（P < 0.05）；随病情加重，大脑各部位皮质和白质脑血容量（CBV）增加，白质更为显著，且各部位不同病情间CBV差异均有统计学意义(P < 0.05)；随病情加重，大脑各部位皮质和白质平均通过时间（MTT）均显著增加，各部位不同病情间MTT差异均有统计学意义(P < 0.05)；不同程度HAPC患者随病情加重（P < 0.05），相对脑血流量（rCBF）降低，除顶叶皮质、颞叶白质和枕叶白质外，各部位不同病情间rCBF差异均有统计学意义；通过ROC曲线来评价CTP和ASL两者的诊断价值，两条曲线接近，CTP略优于ASL。结论 不同程度HAPC患者随着病情进展，脑血流减低；血容量增加；血流平均通过时间延长；CTP与ASL两种方法效果接近，前者价值略优。     

麻醉后恢复室病人常见并发症的原因分析及处理

目的 探讨麻醉后恢复室（PACU）病人常见并发症的原因及处理.方法 回顾性分析PACU记录完整的1575例次发生并发症的原因及处理.结果 PACU并发症发生率为31.63%,其中并发症以循环不稳定、心律失常、舌后坠、恶心呕吐、寒战、躁动发生率高,其原因主要与术前准备欠佳、麻醉操作管理不完善、恢复室处理欠妥等有关.结论 充分的术前准备、完善的麻醉管理、妥当的PACU处置,有利于降低PACU并发症的发生率及死亡率,对提高恢复室病人的安全性有重要意义.     

18F-FLT联合18F-FDG PET/CT显像对纵隔淋巴结良恶性的诊断价值

目的 评价18F-FLT联合18F-FDG PET/CT显像对肺部恶性肿瘤患者纵隔淋巴结良恶性的诊断价值.方法 回顾性分析2009年4月至2011年10月全国11个PET/CT中心18F-FLT与18 F-FDG PET/CT显像的患者资料,选择行肺部恶性肿瘤切除和纵隔淋巴结清扫、获得病理检查结果的患者共41例,其中男28例,女13例,年龄(56.1 ±12.2)岁.对18F-FLT与18F-FDG PET/CT淋巴结的显像结果分别进行视觉分析和半定量分析,采用,检验比较各方法的诊断效能.结果 (1)41例患者手术共检出533枚淋巴结,经病理检查证实恶性192枚,良性341枚(炎性增生淋巴结或正常淋巴结);(2)以18 F-FDG SUV≥2.5和18F-FLT SUV≥2.0为诊断恶性淋巴结的阈值,18F-FDG和18F-FLTPET/CT对纵隔淋巴结良恶性诊断的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为91.67％ (176/192)、80.94％ (276/341)、84.80％(452/533)、73.03％(176/241)、94.52％(276/292)和81.25％ (156/192)、92.96％(317/341)、88.74％ (473/533)、86.67％ (156/180)、89.80％ (317/353),两者灵敏度、特异性及阳性预测值差异均有统计学意义(x2=8.897、21.722和11.495,均P＜0.05),准确性和阴性预测值差异均无统计学意义(x2=3.604和3.712,均P＞0.05);18F-FDG联合18 F-FLT诊断纵隔淋巴结的灵敏度、特异性、准确性、阳性预测值及阴性预测值则分别提高至93.75％(180/192)、94.43％ (322/341)、94.18％ (502/533)、90.45％ (180/199)、96.41％(322/334).结论 18F-FDG诊断纵隔淋巴结良恶性的灵敏度高于18F-FLT,但特异性及阳性预测值明显低于FLT,两者联合诊断可明显提高诊断准确性.     

FDG PET／CT代谢体积对食管癌术后预后的预测价值

目的研究食管癌患者^18F-FDG PET／CTMTV与预后的关系。方法回顾性分析2004年3月至2008年3月行^18F—FDG PET／CT检查的49例Ⅰ—Ⅳa期的食管癌患者,均经病理检查证实,随访资料完整。患者均行食管癌切除术,随访截止至2009年11月,中位随访时间为29（8～57）个月。应用Kaplan—Meier法及Cox比例风险模型分析年龄、性别、肿瘤位置、肿瘤组织分化程度、PET／CT示肿瘤长径、美国肿瘤联合会（AJCC）分期、转移淋巴结个数、原发灶SUVmax及MTV与预后的关系。结果在单因素分析中,仅AJCC分期[χ^2=16．206,危险比（HR）=1．177,P〈0．001）,淋巴结分期（N）（χ^2=9．536,HR=10．833,P=0．002）,浸润深度（T）（χ^2=5．810,FIR=2．397,P=0．016）,淋巴结转移个数（χ^2=11．423,HR=1．567,P=0．001）、MTV（χ^2=3．872,HR=2．433,P=0．049）对预后存在预测作用。对以上变量行多因素分析,仅AJCC分期及MTV是独立的预后因子（r=4．525,HR=1．170,P=0．033;χ^2=4．875,HR=3．071,P=0．027）。Kaplan-Meier生存分析显示术前低MTV组比高MTV组的生存率高（Log—rank检验,χ^2=4．186,P=0．041）。结论MTV与食管癌术后患者的预后密切相关。对于高MTV患者,术后可能需要接受更加积极的治疗。     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.