结扎速血管闭合切割系统在巨大神经纤维瘤手术中的应用效果

目的：探讨结扎速血管闭合切割系统(LigaSure vessel sealing system, LVSS)在巨大神经纤维瘤手术中的应用效果。方法：选取2013年10月至2020年5月行巨大神经纤维瘤手术的患者22例纳入本研究。传统手术组12例采用常规缝扎电凝止血手术方式,LigaSure组10例采用LigaSure血管闭合切割的手术方式,对比两组患者切除瘤体大小、手术时间、术中出血量、术后引流量、术后拔管时间及术后并发症情况。结果：两组间患者的一般资料具有可比性。LigaSure组术中出血量、术后引流量、术后拔管时间均较传统手术组显著降低(P＜0.05)。两组间切除瘤体大小、手术时间及术前术后血红蛋白差值无统计学差异。传统手术组出现1例术后皮下积液,予再次引流后伤口愈合良好。结论：LigaSure在手术治疗巨大神经纤维瘤方面的应用安全有效,能显著地减少出血量,简化手术操作,缩短术后恢复时间,值得在临床上进一步推广。     

多种放射性肺损伤动物模型的建立和效应评价研究

放射性肺损伤是胸部肿瘤放疗后常见并发症,随着对放射性肺炎研究不断深入,如何为基础研究和药物干预寻求最佳的动物模型和效应评价已成为当前亟待解决的难题之一。通过检索近10年文献,对不同放射性肺损伤模型动物及放射部位的选择、照射剂量的确定、照射方法的比较和动物模型效应评价进行了对比研究,以期寻找建立放射性肺损伤动物模型的稳定方法和较为明确的效应机制,为防护和减缓放射性肺损伤的发生发展而进行的基础研究和药物研制提供可靠的方法。     

两种不同放疗技术治疗鼻咽癌的疗效及计量学差异比较

目的:分析探讨两种不同放疗技术治疗鼻咽癌的疗效及计量学差异。方法:选取我院于2016年4月至2019年4月期间收治的63例鼻咽癌患者，根据鼻咽癌2008分期，其中T4期鼻咽癌患者有21例，T3期鼻咽癌患者有21例，T1-2期鼻咽癌患者有21例；所有入选患者均根据其具体情况制定固定野IMRT计划和旋转容积调强放疗计划，分别比较各期患者两套计划的计量学参数；分析两套计划的治疗时间和跳数、危及器官剂量、靶区覆盖等差异。结果:两种不同放疗技术均具备较好的靶区剂量分布，其中PTV1和PGTV的适行性和均匀性相当，两者剂量分布差异并没有统计学意义（均P>0.05）。IMRT组的PTV2剂量显著高于RapidArc组，并且前者的均匀性显著优于后者（均P<0.05），但是RapidArc组的剂量分布也能够满足临床需要。在按照患者T分期进行分层比较时，T3期患者和T1-2期患者的两种不同放疗技术靶区剂量分布相似，并且适形性和均匀性均相当。对于T4期患者而言，RapidArc组的PTV2、PTV1、PGTV靶区剂量均显著高于IMRT组（均P<0.05）；RapidArc组T4期患者的PGVT均匀指数优于IMRT组，两组数据比较差异虽无统计学意义（P=0.059），但P值接近0.05。RapidArc组治疗时间和治疗跳数分别为（185.92±32.19）s和（651.29±112.20）MUs，分别低于IMRT组的（522.29±73.39）s和（1 891.28±253.39）MUs，两组数据比较差异具有统计学意义（t=13.283，t=22.192，均P<0.05）。结论:对鼻咽癌患者采用9野IMRT和RapidArc治疗均能够达到临床要求，但是后者的治疗时间和治疗跳数更短，可以显著降低正常器官的剂量，在T4期鼻咽癌患者的治疗方面可以将高剂量区集中在靶区，从而大大减少正常器官的受照剂量，值得在临床上加以推广运用。     

Estimating returns to hospital volume: Evidence from advanced cancer surgery

High-volume hospitals typically perform better than low-volume hospitals. In this paper, we study whether such patterns reflect a causal effect of case volume on patient outcomes. To this end, we exploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp and arguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treatment episodes of advanced cancer surgery, our results suggest substantial positive effects of operation volume on survival. Complementary analyses point to learning-by-doing as an important explanation.     

Effect of body position on qualitative and quantitative ultrasound assessment of gastric fluid contents

We assessed the impact of raising the upper section of the bed, and patient positioning, on ultrasound assessment of gastric fluid contents. We performed ultrasound examinations in 25 subjects lying on their back, left and right sides at bed angles of 0°, 30°, 45° and 90°; this was carried out while the subjects were fasted, and repeated 10 min after drinking ≥ 50 ml water. After drinking, gastric contents were detected more frequently in the 45° semirecumbent position compared with the supine and 30° positions. The diagnostic performance of the Perlas qualitative grading scale to detect gastric fluid volume > 1.5 ml.kg⁻¹ was improved at 45°, compared with 0° and 30° angles. The use of a composite ultrasound grading scale at a 45° angle was associated with the best performance, with a sensitivity and specificity of 82%. Antral cross-sectional area was significantly increased when measured in the right lateral position, but there was no effect of raising the bed. In conclusion, raising the upper section of the bed significantly affected qualitative assessment of gastric fluid contents. Further studies are required to determine the most appropriate composite ultrasound grading scale and bed angle for fast and reliable qualitative ultrasound detection of fluid volumes > 1.5 ml.kg⁻¹.