Functional outcomes of soft palate free flap reconstruction following oropharyngeal cancer surgery

IntroductionThe objective of this study was to assess the impact of surgical resection and free flap reconstruction of soft palate cancer on speech, swallowing and quality of life, and to identify the factors influencing functional outcomes and quality of life.Material and methodsPatients treated with surgical resection of squamous cell carcinoma and free-flap reconstruction of the soft palate were reviewed at least 12 months after surgery. Speech was assessed using the Hirose intelligibility scoring system, nasalance scoring, GRBAS scoring and the Voice Handicap Index 30 (VHI30) questionnaire. Swallowing was assessed by fiberoptic endoscopy and the Deglutition Handicap Index (DHI). Quality of life was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires.Results29 patients were included. Speech outcomes were satisfactory, demonstrating normal or slightly below normal speech intelligibility in 75.9% of the patients, moderate or no rhinolalia in 72.4% of the patients and mean overall VHI30 scores indicative of slight or no handicap in 86.2% of the patients. Swallowing outcomes were satisfactory, with mean overall DHI scores indicative of slight or no handicap in 82.8% of the patients. Patient quality of life was preserved as demonstrated by mean quality of life and functioning scales scores all superior to 80%.ConclusionThe sequelae arising from surgical resection and free-flap reconstruction of soft palate cancer are tolerable, involving slight handicap in terms of speech and swallowing and relatively little impact on quality of life.     

胸腔镜根治术对老年食管癌患者术后肺部感染与呼吸功能及炎症因子的影响

目的探讨胸腔镜根治术对老年食管癌患者术后肺部感染与呼吸功能及炎症因子的影响。方法选择100例行手术治疗的食管癌患者的临床资料进行回顾性分析,根据手术方法分为胸腔镜组60例与开胸组40例。比较2组术后肺功能、外周炎症因子水平以及肺部感染发生率。结果(1)2组术后24 h外周血炎症因子IL-6、IL-8、IL-10以及TNF-α均显著升高(P<0.05),但开胸组显著高于胸腔镜组(P<0.05);术后1周,2组外周血炎症因子水平均显著下降,2组间比较差异无统计学意义(P>0.05)。(2)术后1个月,开胸组患者FEV1、FEV1/FVC FVC均显著低于胸腔镜组,差异有统计学意义(P<0.05)。(3)术后3天开胸组CRP水平、WBC水平、体温以及呼吸频率均显著高于胸腔镜组,差异有统计学意义(P<0.05)。(4)胸腔镜组术后无肺部感染,开胸组有4例(10.0%)发生肺部感染,2组比较差异有统计学意义(P<0.05)。结论与传统开胸手术比较,胸腔镜食管癌根治术对老年患者呼吸功能、外周血炎症因子的影响相对较小,术后患者肺部感染发生率更低。     

Thinned-out skin paddle versus collagen matrix as an optimized peri-implant soft tissue following fibula osteoseptocutaneous free flap: 3-year retrospective study

The objective of this study was to compare the implant longevity following two methods of peri-implant soft tissue optimization following free fibula flap (FFF): thinning of skin paddle (SP) and collagen matrix (CM). All patients who underwent rehabilitation with dental implants after mandibular reconstruction with FFF between June 2009 to May 2014 were retrospectively reviewed. Two methods of peri-implant soft tissue optimization were applied: (1) SP group, (2) CM group. Outcome measurements were: modified plaque index (mPI), modified sulcus bleeding index (mSBI), probing depth (PD), marginal bone loss (MBL), implant success rate and complication rates. A total of 24 patients with 69 implants were included in the study, with 8.7% (n = 6) of implants lost in 3 years. No statistically significant difference was found regarding the outcome measurements in both groups. Failed implants presented with statistically significant higher mPI, mSBI, PD and MBL scores during prosthesis delivery and subsequent follow-ups (P<0.03). In the SP group, one patient experienced SP necrosis which later underwent soft tissue optimization using CM. CM is an alternative peri-implant soft tissue, while thinning of SP is feasible if thickness is well controlled.     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象，随机分为观察组和对照组，各45例。对照组采用传统腰麻联合丙泊酚麻醉，观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉，比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分），以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组麻醉后上述指标波动较对照组小（P<0.05）；麻醉前，两组患者皮质醇、肾上腺素水平无显著差异（P>0.05），麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）；两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）；观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）；观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果，可有效缓解患者疼痛，减少术后不良反应发生。     

经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响

目的探讨经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响。 方法选择2016年1月至2017年6月，广元市中心医院行经腹-会阴联合直肠癌根治术78例患者的临床资料。其中经腹膜外造口者40例为观察组，经腹膜内造口者38例为对照组，2组患者均于围手术期接受全程护理。比较2组手术指标、术后并发症发生情况及排便功能。 结果观察组术中出血量、住院时间分别为（104.24±39.08）ml和（15.62±3.10）d，与对照组（120.46±47.35）ml和（17.20±2.95）d，差异有统计学意义（P<0.05）；观察组手术时间、造口时间、术后切口愈合时间分别为（233.12±40.50）min、（21.87±9.23）min和（7.31±0.28）d，与对照组（231.38±39.04）min、（20.95±9.14）min和（7.05±0.34）d，差异无统计学意义（P>0.05）。观察组排便功能优良率显著高于对照组，差异有统计学意义（67.50% vs 34.21%，P<0.05）。观察组造口旁疝的发生率显著低于对照组，差异有统计学意义（2.50% vs 18.42%，P<0.05）；但2组间造口出血、造口水肿、造口回缩或脱垂等发生率比较，差异无统计学意义（P>0.05）。 结论经腹-会阴联合直肠癌根治术后经腹膜外造口可显著降低术后造口旁疝的发生率，促进其排便功能的恢复，整体疗效优于经腹膜内造口。     

形觉剥夺性高度近视豚鼠巩膜形态改变及缺氧诱导因子-1α和氧自由基在高度近视中的作用

目的　观察形觉剥夺性高度近视（form deprivation high myopia，FDHM）豚鼠巩膜形态变化，探讨缺氧诱导因子-1α（hypoxia-inducible factor-1α，HIF-1α）及氧自由基在高度近视中的作用。方法　将豚鼠适应性饲养1周后，随机分为空白对照组（25只）和模型组（25只）。模型组豚鼠右眼行眼睑缝合，所有模型组豚鼠均选择右眼作为FDHM组，对侧眼为自身对照组。空白对照组豚鼠不做任何处理。于造模前及造模后8周采用检影镜测量屈光度，A超进行生物测量。形觉剥夺8周以后处死豚鼠，观察巩膜形态和超微结构的变化，测定巩膜HIF-1α相对表达量，超氧化物歧化酶（superoxide dismutase，SOD）活力及丙二醛（malondialdehyde，MDA）的含量。结果　豚鼠形觉剥夺8周以后，FDHM组屈光度从（+3.59±0.33）D变为（-7.96±0.55）D，明显高于空白对照组（+0.89±0.32）D、自身对照组（-0.55±0.49）D（均为P<0.05）；玻璃体腔深度为（4.12±0.13）mm明显高于空白对照组（3.71±0.23）mm和自身对照组（3.93±0.04）mm（均为P<0.05）；眼轴长度为（8.93±0.22）mm明显长于空白对照组（7.95±0.37）mm和自身对照组（8.01±0.15）mm（均为P<0.05）。巩膜组织明显变薄，细胞外基质增多，成纤维细胞密度降低，胶原纤维平均直径减小。FDHM组巩膜中HIF-1α相对表达量、MDA含量明显高于空白对照组和自身对照组，SOD活力明显低于空白对照组和自身对照组（均为P<0.05）。结论　形觉剥夺8周后，豚鼠FDHM眼近视度数明显增加，玻璃体腔深度增加，眼轴延长，巩膜形态发生病理性变化；HIF-1α、SOD、MDA可能参与了FDHM的形成。     

New era of research on cancer‐associated glycosphingolipids

Cancer‐associated glycosphingolipids have been used as markers for diagnosis and targets for immunotherapy of malignant tumors. Recent progress in the analysis of their implications in the malignant properties of cancer cells revealed that cancer‐associated glycosphingolipids are not only tumor markers, but also functional molecules regulating various signals introduced by membrane microdomains, lipid rafts. In particular, a novel approach, enzyme‐mediated activation of radical sources combined with mass spectrometry, has enabled us to clarify the mechanisms by which cancer‐associated glycosphingolipids regulate cell signals based on the interaction with membrane molecules and formation of molecular complexes on the cell surface. Novel findings obtained from these approaches are now providing us with insights into the development of new anticancer therapies targeting membrane molecular complexes consisting of cancer‐associated glycolipids and their associated membrane molecules. Thus, a new era of cancer‐associated glycosphingolipids has now begun.     

高流量吸氧与面罩吸氧在胸腔镜辅助食管癌根治术后氧疗效果对比

目的观察高流量湿化吸氧与常规面罩吸氧在食管癌患者行胸腔镜辅助食管癌根治术后治疗的临床效果。方法将36例择期行胸腔镜辅助下食管癌根治术后患者随机分为常规面罩吸氧对照组(A组)和高流量湿化吸氧治疗组(B组),对两组患者治疗2 h、6 h和24 h后的呼吸频率、动脉血气分析等指标进行比较,了解两种吸氧方式在食管癌患者行胸腔镜辅助食管癌根治术后治疗上的优劣。结果两组患者治疗2 h、6 h和24 h的呼吸频率、动脉血气分析发现,A组动脉氧饱和度、动脉血氧分压较B组降低,动脉血二氧化碳分压、呼吸频率较B组增高,两组比较差异有统计学意义(均P0.01)。结论与常规面罩吸氧比较,高流量湿化面罩吸氧可以使胸腔镜辅助食管癌根治术后患者有更满意的氧合效果,值得在临床上推广。