咪唑安定＼恩丹西酮用于硬膜外麻醉抗内脏牵拉反应的效果观察

硬膜外阻滞麻醉下施行腹部手术，当手术牵拉内脏器官时病人常出现“内脏牵引痛”，为解除这类牵引痛，我院自2002年8月-2004年2月期间对80例硬膜外腔麻醉腹腔手术病人，采用咪唑安定和恩丹西酮做为辅助药，以求解除牵引痛症状，效果尚称满意，今介绍如下。     

带蒂横形岛状包皮瓣一期手术治疗先天性尿道下裂

先天性尿道下裂是泌尿外科常见病，男婴中发病率约为0．3％。治疗方法唯有行尿道成形术，矫止阴茎下曲畸形及重建尿道，以满足正常排尿及成年后婚育需求。尿道成形术式多达200余种，各种术式均存在各种各样的并发症，目前仍难以找出一种完美的术式。近3年来我们应用Duckett术一期治疗先天性尿道下裂6例，手术方式相对简单，并发症少，疗效满意，现报告如下。     

剂量调整的EPOCH方案治疗初治血管免疫母T细胞淋巴瘤的前瞻性研究

  目的  前瞻性研究剂量调整的EPOCH方案对初治血管免疫母T细胞淋巴瘤（AITL）患者的疗效及不良反应。   方法  选择2008年9月至2012年9月中国军事医学科学院附属307医院确诊的初治AITL患者9例。全组患者均接受剂量调整的EPOCH方案一线化疗。   结果  全组患者发病中位年龄54岁,男:女为2:1,88.9%为Ann-Arbor stage Ⅲ~Ⅳ期,77.8%合并B症状。初诊时伴有贫血的患者占66.7%,LDH或β2微球蛋白升高占55.6%。EPOCH方案近期疗效CR率22.2%,总反应率66.7%。中位随访20个月,4年PFS和OS分别为11.1%和33.3%,中位生存时间19个月。EPOCH方案化疗主要不良反应为血液学毒性,3~4度粒细胞减少和血小板减少分别为77.8%和33.3%,44.4%的患者出现粒细胞缺乏伴发热。   结论  剂量调整的EPOCH方案一线治疗AITL患者较传统CHOP方案未见明显生存获益。主要不良反应为血液学毒性,并可以耐受。      

甲状腺手术引流的改进

甲状腺手术引流的改进云南省保山地医院外科（６７８０００）张家璋，何联华，杨国富，鲁云我们对于甲状腺术后病人切口下放置胶管，行负压引流袋引流，效果较好。方法：取内径０．６ｃｍ或１．０ｃｍ乳胶管，长１０～２０ｃｍ，其一尖端剪１～２个侧孔，剪孔按创口大小、...     

塞来昔布对SK-N-SH细胞增殖和凋亡影响的研究

目的:探讨特异性环氧化酶-2(COX-2)抑制剂塞来昔布(celecoxib)对人神经母细胞瘤细胞系SK-N-SH细胞生长的影响及其分子生物学作用机制。方法:不同浓度塞来昔布(12.5、25、50和75μmol/L)用不同时间(24、48和72h)处理SK-N-SH细胞,MTT法检测细胞增殖,DNA ladder法及AO/EB染色法分析细胞凋亡,Western blot检测COX-2、Bcl-2蛋白表达。结果:MTT法显示,12.5、25、50和75μmol/L组在3个时间点对细胞的抑制率分别为(7.38±1.12)%、(10.33±1.97)%和(25.16±5.58)%;(34.46±6.76)%、(30.12±6.71)%和(57.54±3.06)%;(61.85±4.01)%、(50.78±2.85)%和(85.67±2.17)%;(83.85±5.56)%、(90.06±5.71)%和(98.04±4.43)%。组间差异均有统计学意义,P<0.05。结论:塞来昔布抑制SK-N-SH细胞的生长并诱导其凋亡,其机制除了抑制COX-2外还可能与抑制Bcl-2有关,有一定的临床应用价值。     

43例淋巴母细胞淋巴瘤患者临床特点及疗效分析

Objective To investigate the clinical features and treatment outcomes of different regimens in Chinese patients with lymphoblastic lymphoma(LBL). Methods Forty-three patients with LBL were retrospectively analysed, of which 30 were T-LBL, and 13 B-LBL. Results ①Most patients were young men with a median age of 21, and 63.0％ of the T-LBL patients had mediastinal masses. ② Treatment outcome could be assessed in 37 cases, of which the response rate (RR) was 81.1％ and complete remission (CR) rate was 67.6％. The RR and CR rates in patients treated with regimens for ALL (ALL-like group) and those treated with regimens for NHL(NHL-like group) were 94.4％ , 68.4％ and 83.3％ , 52.6％ , respectively. ③The estimated median overal survival(OS) and progression free survival (PFS) of hematopoietic stem cell transplantation (HSCT) group were significant longer than those of ALL-like group(P =0.018, P=0.025) and NHL-like group(P = 0. 016, P = 0. 011). The OS at 5 years in NHL-like group, ALL-like group and HSCT group were (14.4 ± 9.4) ％ , (20.2 ± 12.7) ％ and (79.5 ± 13.1) ％, respectively. Conclusion ①LBL is more common in young men, with less involvement of peripheral blood. Compared with B-LBL, T-LBL often has a mediastinal mass and serious cavity effusion. ② Intensive treatment regimens for ALL should be used in LBL. HSCT at CR1 can improve outcome obviously.     

43例淋巴母细胞淋巴瘤患者临床特点及疗效分析

Objective To investigate the clinical features and treatment outcomes of different regimens in Chinese patients with lymphoblastic lymphoma(LBL). Methods Forty-three patients with LBL were retrospectively analysed, of which 30 were T-LBL, and 13 B-LBL. Results ①Most patients were young men with a median age of 21, and 63.0％ of the T-LBL patients had mediastinal masses. ② Treatment outcome could be assessed in 37 cases, of which the response rate (RR) was 81.1％ and complete remission (CR) rate was 67.6％. The RR and CR rates in patients treated with regimens for ALL (ALL-like group) and those treated with regimens for NHL(NHL-like group) were 94.4％ , 68.4％ and 83.3％ , 52.6％ , respectively. ③The estimated median overal survival(OS) and progression free survival (PFS) of hematopoietic stem cell transplantation (HSCT) group were significant longer than those of ALL-like group(P =0.018, P=0.025) and NHL-like group(P = 0. 016, P = 0. 011). The OS at 5 years in NHL-like group, ALL-like group and HSCT group were (14.4 ± 9.4) ％ , (20.2 ± 12.7) ％ and (79.5 ± 13.1) ％, respectively. Conclusion ①LBL is more common in young men, with less involvement of peripheral blood. Compared with B-LBL, T-LBL often has a mediastinal mass and serious cavity effusion. ② Intensive treatment regimens for ALL should be used in LBL. HSCT at CR1 can improve outcome obviously.     

早期霍奇金淋巴瘤不同治疗模式104例回顾性分析

本研究探讨早期霍奇金淋巴瘤(HL)综合治疗模式与扩大野放疗模式的疗效。回顾性分析解放军307医院1987年1月至2010年12月确诊的104例早期HL患者临床资料,分为综合治疗组76例与扩大野放疗组28例,比较两种治疗模式对疗效、生存状况及不良反应的影响。结果表明,104例早期HL患者中位生存85.42个月,综合治疗组与扩大野放疗组的完全缓解率(72.4%vs 71.4%,P=0.924)、总有效率(97.4%vs 96.4%,P=0.779)、5年总生存率(OS,89.5%vs 89.1%,P=0.528)和8年OS(81.3%vs 70.6%,P=0.528)无统计学差异,但两组的5年无进展生存率(PFS,84.2%vs 69.0%,P=0.040)、8年PFS(80.0%vs 55.5%,P=0.040)和5年复发率(28.1%vs 45.6%,P=0.023)有差异。结论:早期HL的综合治疗模式较扩大野放疗模式可提高PFS及降低复发率,但两组OS未见差异。     

浅谈医源性胆道损伤的原因及防治

目的：探讨医源性胆道损伤的原因及防治。方法：回顾性分析我1995年6月-2012年12月收治的17例胆道损伤的诊治资料。结果：本院发生2例;外院转入15例。肝总管部分损伤8例,肝总管横断伤4例,胆总管部分损伤3例,胆总管横断1例,右肝管部分损伤1例。予不同处理,包括腹腔及胆管引流、胆总管修补,胆管对端吻合,胆（肝）管空肠Roux-en-Y吻合等。结论：除熟悉病理解剖关系外、经验和谨慎对预防胆囊切除致胆管损伤至关重要。对于胆道损伤应力争术中及时发现、早期正确处理。     

43例淋巴母细胞淋巴瘤患者临床特点及疗效分析

Objective To investigate the clinical features and treatment outcomes of different regimens in Chinese patients with lymphoblastic lymphoma(LBL). Methods Forty-three patients with LBL were retrospectively analysed, of which 30 were T-LBL, and 13 B-LBL. Results ①Most patients were young men with a median age of 21, and 63.0％ of the T-LBL patients had mediastinal masses. ② Treatment outcome could be assessed in 37 cases, of which the response rate (RR) was 81.1％ and complete remission (CR) rate was 67.6％. The RR and CR rates in patients treated with regimens for ALL (ALL-like group) and those treated with regimens for NHL(NHL-like group) were 94.4％ , 68.4％ and 83.3％ , 52.6％ , respectively. ③The estimated median overal survival(OS) and progression free survival (PFS) of hematopoietic stem cell transplantation (HSCT) group were significant longer than those of ALL-like group(P =0.018, P=0.025) and NHL-like group(P = 0. 016, P = 0. 011). The OS at 5 years in NHL-like group, ALL-like group and HSCT group were (14.4 ± 9.4) ％ , (20.2 ± 12.7) ％ and (79.5 ± 13.1) ％, respectively. Conclusion ①LBL is more common in young men, with less involvement of peripheral blood. Compared with B-LBL, T-LBL often has a mediastinal mass and serious cavity effusion. ② Intensive treatment regimens for ALL should be used in LBL. HSCT at CR1 can improve outcome obviously.