乳癌根治术后并发臂丛神经损伤

乳癌根治术是治疗乳腺癌的主要手段,但并发臂丛神经损伤的报道却很少,总结从1989年10月～1991年2月华山医院诊治的9例,3例门诊治疗,6例住院治疗。其中5例行神经松解后,皮瓣或肌皮瓣转移覆盖神经瘢痕区。随访到8例,疼痛改善3例,感觉和运动改善2例,疗效不理想,认为寻找预防措施是减少乳癌根治术后臂丛损伤的根本办法。     

Screening of the antiradical action of vegetable oils

Information on radical scavenging activity (RSA) and antioxidant potential of vegetable oils are not reported, or reporting has been rather limited. Such data is of importance for the evaluation of nutritional and health impact of these oils. The main objective of this short study was to compare the antiradical performance of some common and unusual vegetable oils. The described arrangement for our simple experiment uses the addition of stable radicals 1,1-diphenyl-2-picrylhydrazyl (DPPH) to vegetable oils, which are decomposed by components having antioxidant properties. The order of effectiveness of oils in inhibiting free radicals was as follows: coriander>blackcumin>cottonseed>peanut>sunflower>walnut>hemp seed>linseed>olive>niger seed. This initial survey might serve as a springboard for future research into this area.     

Bone disorders following total gastrectomy

Bone disorders following gastrectomy were studied by measuring absolute and relative bone mineral density of the Wards triangle, serum 1,25-(OH)₂-D, alkaline phosphatase, and total serum calcium. The subjects were 20 males who had undergone total gastrectomy not more than three months previously (group A₁). Seventeen of these patients were reviewed three years later (group A₂). Absolute and relative bone density were significantly lower in group A₂ than in A₁ (0.52 ± 0.011 g/cm² versus 0.6 ± 0.014 g/cm²,P<0.01 and 85.5 ± 1.4% age-matched control versus 95 ± 1.3%,P<0.01). 1,25-(OH)₂-D was significantly lower in group A₂ than in group A₁ (14.3 ± 0.97 pg/ml versus 20.6 ± 1.02 pg/ml,P<0.01). There was no difference in alkaline phosphatase and calcium serum concentration. The mean weight loss was 6.26 ± 0.57% over the follow-up period, and weight loss correlated with absolute and relative bone density (r=–0.74,P<0.01). There was a positive correlation between 1,25-(OH)₂-D and absolute or relative bone density (r=0.67,r=0.62 andP<0.01). These data suggest that bone density decrease has already occurred three years after total gastrectomy and is positively correlated to 1,25-(OH)₂-D deficiency. As no differences in serum alkaline phosphatase and serum calcium concentration were found, these factors are of little value for the early detection of postgastrectomy bone disorders, whereas weight loss is a valuable screening parameter.     

围手术期肠外营养支持在胃癌根治术的应用

1986～1988年的胃癌扩大根治术221例及根治性全胃切除术19例非肠外营养(N-TPN)支持为对照组,与1991～1993年的198例及61例施行TPN治疗为实验组进行对比。N-TPN组术后并发症总发生率为7.2％,TPN组则为2.0％;全胃切除术并发症发生率分别为31.6％和4.9％(P<0.01)。吻合口瘘发生率N-TPN组分别为2.7％和10.5％,而TPN组则均为0.0％(P<0.01)。膈下脓肿发生率N-TPN组为31.6％和15.8％,而TPN组则为1.5％和3.3％(P<0.05)。但本研究是回顾性的,所以要有待进行前瞻性的、对照的、随机的大范围研究。     

根治性切除治疗胰头癌的手术体会

目的 总结提高胰头癌手术根治率和降低术后并发症发生率的经验。方法 回顾性分析我院1996年1月至2005年3月期间的55例胰头癌根治术患者的临床资料。结果 本组55例胰头癌根治性切除术患者中男31例，女24例，均为胰腺导管癌。2002年前、后根治率分别为25．9％（29／112）和34．7％（26／75），并发症发生率分别为48．3％（14／29）和19．2％（5／26）。提高根治性手术技巧包括胰周淋巴结及神经丛清扫、联合血管切除、综合无血术野技术等。结论 提高胰头癌手术根治率和降低术后并发症发生率有赖于对胰头癌病理生理特点的深入了解和手术技巧的成熟。     

腹腔镜辅助远端胃癌根治术的临床应用

目的探讨腹腔镜远端胃癌根治术的可行性及手术方法。方法行腹腔镜远端胃癌根治术15例,D1清扫3例,D2/D2 12例。全部病例均行毕Ⅱ式胃空肠吻合。结果15例成功进行腹腔镜手术。手术时间平均(218.6±31.6)min,术中出血量平均(132.4±21.3)ml,清扫淋巴结平均(33.4±13.6)个。肿瘤近端切缘(6.6±0.9)cm,远端切缘(5.4±0.6)cm,术后肛门排气时间平均(3.5±0.6)d,无手术死亡,无吻合口漏,术后并发肺部感染1例,经治疗后痊愈。术后随访1~10个月,无肿瘤复发或转移。结论腹腔镜远端胃癌根治术能达到与开腹胃癌标准根治术(D2)的淋巴结清扫范围及肿瘤切缘,且具有创伤小、出血少、术后恢复快等优点。     

Prophylactic laparoscopic-assisted total gastrectomy for hereditary diffuse gastric cancer.

BACKGROUND: Ten percent of gastric cancer (GC) cases are familial, with one third resulting from a mutation in the tumor suppressor gene CDH1. Loss of this important structure can result in hereditary diffuse gastric cancer (HDGC), which carries a high mortality if early diagnosis is not made. Despite its clear genetic origin, optimal management of HDGC family members is controversial, as the utility and efficacy of current cancer screening programs for mutation carriers are unproven. METHODS: A 53-year-old Caucasian woman was initially seen for genetic screening because multiple family members had mutations of the CDH1 gene. Her pedigree analysis demonstrated 4 generations of gastric cancer, and 2 of the generations carried the CDH1 germline mutation, consistent with HDGC. At endoscopy, the patient's gastric mucosa was normal and random biopsies were also normal. The patient underwent a laparoscopic total gastrectomy. RESULTS: The gross examination of her stomach appeared normal. On histologic examination, however, the stomach was found to have diffuse (signet ring cell) adenocarcinoma in-situ with 11 microscopic foci of invasive adenocarcinoma limited to the lamina propria. CONCLUSION: Our case is the first reported prophylactic total gastrectomy utilizing a laparoscopic approach, and it highlights the importance of taking a thorough family history and obtaining a pedigree analysis. Endoscopic screening in HDGC cannot rule out diffuse GC, because the stomach and biopsies can be normal despite the presence of adenocarcinoma. Therefore, our case supports the recommendation for prophylactic gastrectomy in HDGC.     

肛旁脓肿行Ⅰ期根治性手术疗效的探讨

目的：探讨肛旁脓肿行Ⅰ期根治性手术的疗效。方法：对78例肛旁脓肿患者交叉设计分成两组。分别行Ⅰ期根治性手术（RS）和单纯脓肿切开引流（ID），比较术后疗效。结果：RS组病人术后形成肛瘘的发生率远低于ID组。而并发症却无升高趋势，且明显缩短了伤口愈合时间。结论：Ⅰ期根治性手术治疗肛旁脓肿疗效满意，临床使用价值高，值得推广。     

Transition from open to robotic-assisted radical prostatectomy is associated with a reduction of positive surgical margins amongst private-practice-based urologists

Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has not been determined if this phenomenon exists amongst non-fellowship-trained urologists in private practice. Herein, we describe the positive margin rates of two non-fellowship-trained private-practice urologists who converted from open radical retropubic prostatectomy to robot-assisted radical prostatectomy. The margin positivity data from two non-fellowship-trained private-practice urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy from each surgeon were compared with the first 50 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive surgical margin was defined as tumor present at the inked margin of the prostate. There was a significant decrease in the overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for surgeon 1 dropped from 44 to 20% and from 37 to 5.7%, respectively, after changing from open to robotic prostatectomy. For surgeon 2, the overall positive margin rate changed from 26 to 18% and the pT2 positive margin rate changed from 27.5 to 7% after converting. Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain negative surgical margins. With proper training this phenomenon does seem to apply to non-fellowship-trained urologists in private practice and can be realized within the first 50 cases performed.     

全胃切除消化道重建术中空肠储袋的临床研究进展

全胃切除术是常见的胃癌根治术之一。尽管消化道重建的方式繁多，但何种最好尚无定论。经检索近年来有关全胃切除后的消化道重建临床研究报道，主要介绍不同空肠肠袋、Roux-en-Y重建术式的优劣。结果表明，空肠肠袋、Roux—en—Y重建术式并不显著增加手术病死率和并发症发生率，能够改善术后早期食物摄入和体重增加。多数报道认为有利于提高术后生活质量。肠袋重建并未增加手术的风险，而且在早期能改善食物摄入，增加体重，有利于患者术后恢复，一定程度上提高患者生活质量。而患者术后长期效果，由于其影响因素涉及范围广，如地区差异和经济条件等，故要得出一精确结论还有待于进一步的探索。现就非十二指肠径路的主要方式及效果作一简述。