腹腔镜与开腹胃癌根治术后早期并发急性胰腺炎的临床回顾性分析

目的本研究分析腹腔镜手术和开腹手术在胃癌治疗中伴发急性胰腺炎(post--gastrectomy acute pancreatitis,PGAP)的优劣性。方法收集2011年6月至2015年9月施行胃癌根治术的病人1050例。分别统计腹腔镜组和开腹组术后PGAP病例,并做回顾性分析对比研究。结果1050例胃癌根治术中并发PGAP的16例,发生率为1.52%,腹腔镜组432例,PGAP 7例,发生率为1.62%;开腹组618例,PGAP 9例,发生率为1.46%。腹腔镜组与开腹组术后PGAP发生率比较差异无统计学意义(x~2=0.046,P0.05)。腹腔镜组中远端胃251例,PGAP 1例(0.40%);近端胃78例,PGAP 1例(1.28%);全胃83例,PGAP 2例(2.41%);联合脏器切除20例,PGAP 3例(15.00%)。远端胃、近端胃和全胃切除术后PGAP发生率比较差异无统计学意义(P0.05),但三者与联合脏器切除术后PGAP发生率比较差异有统计学意义(P0.05)。开腹组中远端胃213例,PGAP 3例(1.41%);近端胃182例,PGAP 1例(0.55%);全胃174例,PGAP 2例(1.15%);联合脏器切除49例,PGAP 3例(6.12%)。结果类似腹腔镜组,远端胃、近端胃和全胃切除术后PGAP发生率比较差异无统计学意义(P0.05),但三者与联合脏器切除术后PGAP发生率比较差异有统计学意义(.P0.05)。腹腔镜组与开腹组分别对远端胃、近端胃、全胃和联合脏器切除后PGAP的发生率比较,差异均无统计学意义(P0.05)。结论腹腔镜与传统开腹胃癌根治术对于PGAP具有同样安全性。     

术前白蛋白碱性磷酸酶比值对根治性膀胱切除术后总体生存期的影响

目的探讨术前白蛋白碱性磷酸酶比值(AAPR)与根治性膀胱切除术后患者总体生存期(OS)的关系。方法回顾性分析2007年1月至2015年12月青岛大学附属医院收治的166例膀胱癌患者的临床病理资料。男148例,女18例。年龄(65.1±9.4)岁。伴高血压病31例、糖尿病14例。体质指数(BMI)(24.00±3.32)kg/m^2。肿瘤单发92例,多发74例。肿瘤直径<3 cm者43例,≥3 cm者123例。合并肾积水33例,无肾积水133例。术前AAPR(0.62±0.23)。根据AAPR的三分位点将患者分为低AAPR组55例,AAPR(0.42±0.09);中AAPR组55例,AAPR(0.58±0.05);高AAPR组56例,AAPR(0.86±0.21)。美国麻醉医师协会(ASA)分级1级4例,2级65例,3级86例,4级11例。根治术前患者均行经尿道膀胱肿瘤切除术,病理诊断均为膀胱癌,高级别144例,低级别22例。166例均行根治性膀胱切除术,其中腹腔镜手术140例,开放手术26例。术中行输尿管皮肤造口55例,回肠代膀胱96例,回肠原位新膀胱15例。将AAPR连续性变量和AAPR分组作为原始模型,调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗的数据作为校准模型1,在校准模型1基础上增加BMI、肿瘤数目、病理等级的数据作为校准模型2。采用趋势性检验检测不同AAPR组间危险比(HR)变化趋势。分析不同因素分层的AAPR与OS的关系。采用Kaplan-Meier法绘制生存曲线。采用基于广义相加模型的曲线拟合表示AAPR与OS的关系。结果本组166例中位随访63个月,生存95例,死亡71例。3年生存率为61%,5年生存率为50%。术后病理分期:T1期27例,T2期82例,T3期48例,T4期9例;N0期145例,N1期14例,N2期6例,N3期1例。术后52例行辅助化疗。单因素Cox回归分析结果显示,AAPR(HR=0.09,95%CI 0.022~0.391,P=0.001)、高AAPR组(HR=0.40,95%CI 0.216~0.742,P=0.003)、年龄(HR=2.42,95%CI 1.294~4.531,P=0.006)、肿瘤大小(HR=2.11,95%CI 1.112~4.014,P=0.023)、肿瘤数目(HR=0.62,95%CI 0.378~1.022,P=0.061)、pT3期(HR=8.93,95%CI 3.173~25.114,P<0.001)、pT4期(HR=10.39,95%CI 3.110~34.707,P<0.001)、N1期(HR=2.80,95%CI 1.422~5.531,P=0.003)、N3期(HR=17.06,95%CI 2.192~132.863,P=0.007)、病理分级(HR=0.30,95%CI 0.113~0.817,P=0.019)、肾积水(HR=2.36,95%CI 1.406~3.939,P=0.001)、术后辅助化疗(HR=2.66,95%CI 1.674~4.247,P<0.001)均与术后OS相关。调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗、BMI、肿瘤数目、病理分级后,Cox回归分析结果显示,与低AAPR组相比,高AAPR组的死亡风险降低约59%(HR=0.406,95%CI 0.200~0.822,P=0.012),AAPR每升高1个单位,死亡风险下降约80%(HR=0.199,95%CI 0.051~0.779,P=0.020)。趋势性检验结果显示,原始模型和校准模型中,AAPR不同分组间OS的HR下降趋势均有统计学意义(P=0.016),提示两者呈线性关系。调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗、BMI、肿瘤数目、病理分级后,曲线拟合图显示,AAPR与OS呈线性相关,随AAPR升高,术后死亡风险下降,OS延长。结论AAPR与膀胱肿瘤患者根治性膀胱切除术后的OS成线性相关,随AAPR升高,患者术后死亡风险下降,OS延长。     

萨提亚团体干预模式在老年肺癌根治术后患者中的应用

目的探讨萨提亚团体干预模式在老年肺癌根治术后患者中的应用效果。方法采用便利抽样法,选择2017年6月—2018年6月郑州大学第一附属医院收治的老年肺癌根治术患者82例为研究对象。随机分为观察组和对照组,每组各41例。对照组术后接受常规护理,观察组采用萨提亚团体干预模式。干预前后采用社会回避与苦恼量表(SADS)、Rosenberg自尊量表(RSES)和欧洲癌症研究所癌症患者生命质量测定量表(EORTC QLQ-C30)比较干预效果。结果干预后观察组患者SADS评分低于对照组,RSES评分高于对照组,差异均有统计学意义(P<0.05)。干预后观察组患者躯体功能、角色功能、情绪功能、社会功能、疲乏感、恶心呕吐、疼痛、呼吸困难、睡眠障碍、食欲丧失、便秘、腹泻、经济困难及整体生活质量评分均高于对照组,差异有统计学意义(P<0.05)。结论萨提亚团体干预模式用于老年肺癌根治术患者,有助于提高患者自尊,纠正不良情绪,改善生活质量,值得推广应用。     

舌癌根治术后患者整体护理的效果观察

目的探讨舌癌患者根治术后实施整体护理的效果。方法将入住我院50例接受舌癌舌颌颈联合根治术的患者,按照随机数字表法分为观察组和对照组各25例,对照组患者应用常规护理方法,观察组患者应用整体护理方法,比较两组患者护理的口腔清洁度、术后语言表达效果及满意度。结果观察组患者的口腔清洁度优良率高于对照组,两组比较差异有统计学意义(χ~2=9.44,P0.05);观察组患者的术后语言效果优于对照组,两组比较差异有统计学意义(χ~2=5.09,P0.05);观察组患者满意度高于对照组,两组比较差异有统计学意义(χ~2=9.92,P0.05)。结论通过整体护理的实施,有助于增强舌癌患者术后治疗信心,促进康复及提高他们的生活质量,值得临床推广。     

Comparison of recurrence and survival rates after breast-conserving therapy and mastectomy in young women with breast cancer

Multiple randomized trials have demonstrated that breast-conserving therapy with partial mastectomy and radiotherapy provides survival equivalent to that seen with mastectomy for patients with early-stage breast cancer. Breast-conserving therapy has been associated with better quality of life relative to mastectomy and has become the standard of care for patients with early-stage breast cancer. Young age has been identified as a risk factor for recurrence and death from breast cancer. Some studies have suggested that young women (less than 35 or 40 years of age) have inferior outcomes with breast-conserving therapy, implying that such women may be better served by mastectomy. On review of the available literature, there is no definitive evidence that mastectomy provides a consistent, unequivocal recurrence-free or overall survival benefit over breast-conserving therapy. However, available meta-analyses have not compared outcomes in young women specifically, and such analyses should be performed. In the interim, breast-conserving therapy is not contraindicated in young women (less than 40 years of age) and can be used cautiously; however, such women should be advised of the lack of unequivocal data proving that survival is equivalent to that with mastectomy in their age group.     

不同入路治疗局限性前列腺癌的安全性及疗效对比

目的:探讨经耻骨后入路与经腹腔镜入路前列腺癌根治术治疗局限性前列腺癌的安全性与疗效对比。方法:选取2012年7月至2014年8月我院泌尿外科收治的局限性前列腺癌患者101例,随机分为观察组(51例)与对照组(50例)。观察组患者接受腹腔镜下前列腺癌根治术治疗,对照组患者接受开放性耻骨后前列腺癌根治术。记录并对比两组患者各项围手术期情况以及术后并发症情况,进行分析。结果:两组患者接受不同手术治疗后,观察组患者手术时间显著长于对照组患者(P0.01),术中出血量少于对照组(P0.05),住院时间短于对照组(P0.05),术后24h疼痛评分也低于对照组(P0.05),并发症发生率33.33%,与对照组并发症发生率36.00%相比,差异无统计学意义(P0.05)。观察组与对照组患者的生化复发率和完全控尿率在术后1年与术后2年时相比,差异无统计学意义(P0.05)。结论:与开放性经耻骨后前列腺癌根治术相比,经腹腔镜前列腺癌根治术治疗效果相近,但其创伤小,出血少,术后恢复快,能够减少患者术后并发症,在治疗局限性前列腺癌中具有一定优势。     

Midterm outcomes of four-port extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer within Asian population

ObjectiveAsian patients tend to have higher stage prostate cancer at diagnosis compared with patients of other races. This article aims to investigate the use of four-port extraperitoneal laparoscopic radical prostatectomy (EPLRP) as the first step in a multimodality treatment strategy for Asian patients with high-risk prostate cancer (HRPC).Materials and methodsA cohort of 202 patients underwent EPLRP between January 2006 to January 2016, of whom 122 (60.3%) had HRPC as defined by D'Amico classification: clinical T stage ≥ cT2c or PSA level ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). All patients underwent proper preoperative staging. The median age was 68 years (48–82), PSA level 17.8 ng/mL (3.3–191.1), and biopsy Gleason sum 7 (6–10). All patients underwent pelvic lymphadenectomy, and some underwent neurovascular bundle preservation according to their risk category.ResultsPerioperative outcomes included a median operative time of 185 min (65–380), total blood loss 150 ml (30–500), postoperative hospitalization 10 days (6–25), and urethral catheterization time 7 days (4–22). No patient was converted to open surgery. Median specimen weight was 42 g (19–124), lymph node yield was 10 (0–35) with 11.5% positivity and a positive surgical resection margin rate of 28.7%. The median follow-up period was 37 months (6–129). 96.7% of patients achieved continence and 53.8% of the 39 potent patients prior to surgery maintained their sexual potency at one year after EPLRP. The 5-year cancer-specific, overall, and biochemical recurrence-free survival rates were 98.8%, 92.2%, and 68.7%, respectively.ConclusionExtraperitoneal laparoscopic radical prostatectomy has low morbidity, and can provide fair functional and oncological outcomes as the first step of a multimodality treatment strategy for high-risk prostate cancer in Asian.