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1.
艾晓光 《中国现代药物应用》2022,(1)
目的分析前列腺癌根治术患者采用围术期康复干预对尿失禁的预防效果。方法 42例行前列腺癌根治术的患者,随机分为研究组与对照组,每组21例。对照组患者给予常规干预,研究组患者采取围术期康复干预。对比两组患者的尿失禁发生率,下尿路症状改善情况,生活质量。结果研究组患者的尿失禁发病率14.29%明显低于对照组的47.62%,差异具有统计学意义(P<0.05)。干预后,两组患者的下尿路症状评估量表(LUTS)评分均低于本组干预前,且研究组患者的LUTS评分(10.25±2.02)分明显低于对照组的(15.63±2.59)分,差异具有统计学意义(P<0.05)。研究组患者的生理功能、情感职能、社会功能、总体健康评分分别为(75.14±4.28)、(76.67±4.31)、(74.98±4.25)、(75.87±4.26)分,均高于对照组的67.21±4.35)、(68.22±4.39)、(66.58±4.37)、(68.01±4.36)分,差异具有统计学意义(P<0.05)。结论前列腺癌根治术患者采用围术期康复干预可以有效降低术后并发症发生率,改善患者临床症状,提高患者生活质量,效果显著,值得在临床上进一步推广应用。 相似文献
2.
3.
BackgroundTo investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.Materials and methodsWe ascertained perioperative complication rates within the National Inpatient Sample database (2016–2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.ResultsOf 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97–3.44), transfusions (OR:2.40; 95%-CI: 1.72–3.36), cardiac (OR:2.27; 95%-CI: 1.49–3.47), thromboembolic (OR:9.07; 95%-CI: 5.21–16.58) and other medical complications (OR:2.01; 95%-CI: 1.52–2.66).ConclusionsThe current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates. 相似文献
4.
Nicolas Mottet Roderick C.N. van den Bergh Erik Briers Thomas Van den Broeck Marcus G. Cumberbatch Maria De Santis Stefano Fanti Nicola Fossati Giorgio Gandaglia Silke Gillessen Nikos Grivas Jeremy Grummet Ann M. Henry Theodorus H. van der Kwast Thomas B. Lam Michael Lardas Matthew Liew Malcolm D. Mason Philip Cornford 《European urology》2021,79(2):243-262
ObjectiveTo present a summary of the 2020 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and local treatment of clinically localised prostate cancer (PCa).Evidence acquisitionThe panel performed a literature review of new data, covering the time frame between 2016 and 2020. The guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence.Evidence synthesisA risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. Risk-adapted screening should be offered to men at increased risk from the age of 45 yr and to breast cancer susceptibility gene (BRCA) mutation carriers, who have been confirmed to be at risk of early and aggressive disease (mainly BRAC2), from around 40 yr of age. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is performed, a combination of targeted and systematic biopsies must be offered. There is currently no place for the routine use of tissue-based biomarkers. Whilst prostate-specific membrane antigen positron emission tomography computed tomography is the most sensitive staging procedure, the lack of outcome benefit remains a major limitation. Active surveillance (AS) should always be discussed with low-risk patients, as well as with selected intermediate-risk patients with favourable International Society of Urological Pathology (ISUP) 2 lesions. Local therapies are addressed, as well as the AS journey and the management of persistent prostate-specific antigen after surgery. A strong recommendation to consider moderate hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term hormonal treatment.ConclusionsThe evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for their use in clinical practice. These PCa guidelines reflect the multidisciplinary nature of PCa management.Patient summaryUpdated prostate cancer guidelines are presented, addressing screening, diagnosis, and local treatment with curative intent. These guidelines rely on the available scientific evidence, and new insights will need to be considered and included on a regular basis. In some cases, the supporting evidence for new treatment options is not yet strong enough to provide a recommendation, which is why continuous updating is important. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them. 相似文献
5.
《European journal of surgical oncology》2022,48(9):2045-2052
IntroductionThe aims of this study were to analyze the pathological response, and survival outcomes of adenocarcinoma/adenosquamous (AC/ASC) versus squamous cell carcinoma (SCC) in patients with locally advanced cervical cancer (LACC) managed by chemoradiotherapy followed by radical surgery.MethodsRetrospective, multicenter, observational study, including patients with SCC and AC/ACS LACC patients treated with preoperative CT/RT followed by tailored radical surgery (RS) between 06/2002 and 05/2017. Clinical-pathological characteristics were compared between patients with SCC versus AC/ASC. A 1:3 ratio propensity score (PS) matching was applied to remove the variables imbalance between the two groups.ResultsAfter PS, 320 patients were included, of which 240 (75.0%) in the SCC group, and 80 (25.0%) in the AC/ASC group. Clinico-pathological and surgical baseline characteristics were balanced between the two study groups. Percentage of pathologic complete response was 47.5% in SCC patients versus 22.4% of AC/ASC ones (p < 0.001). With a median follow-up of 51 months (range:1–199), there were 54/240 (22.5%) recurrences in SCC versus 28/80 (35.0%) in AC/ASC patients (p = 0.027). AC/ASC patients experienced worse disease free (DFS), and overall survival (OS) compared to SCC patients (p = 0.019, and p = 0.048, respectively). In multivariate analysis, AC/ACS histotype, and FIGO stage were associated with worse DFS and OS.ConclusionIn LACC patients treated with CT/RT followed by RS, AC/ASC histology was associated with lower pathological complete response to CT/RT, and higher risk of recurrence and death compared with SCC patients. This highlights the need for specific therapeutic strategies based on molecular characterization to identify targets and develop novel treatments. 相似文献
6.
手术治疗特别是中耳病变切除联合鼓室成形术是目前根治中耳胆脂瘤最主要的方法,依据2012年版的中耳炎手术分型指南内容,按照手术对外耳道后壁和鼓窦上鼓室侧壁处理方式不同,中耳病变切除具体类型和对应ICD-9-CM-3编码为:完壁式乳突根治术20.4900x009、开放式乳突根治术20.4900x008、完桥式乳突根治术20.49和上鼓室鼓窦切开术20.4900x007等,为避免上述手术编码的混淆,编码员应掌握每种术式的具体内涵。同时对于重要的其它手术操作如鼓室成形术19.4~19.5、耳甲腔成形术18.79、外耳道后壁重建术18.6和乳突缩窄术20.92等也不能漏编和多编。编码员应加强中耳结构和手术知识的学习,当不能确定手术具体类型时,应与耳鼻喉医师沟通,确定正确手术类型和内容时方可编码。 相似文献
7.
Won Kyung Cho Won Park Doo Ho Choi Yong Bae Kim Jin Ho Kim Su Ssan Kim Kyubo Kim Jin Hee Kim Sung Ja Ahn Sun Young Lee Jeongshim Lee Sang-Won Kim Jeanny Kwon Ki Jung Ahn 《Clinical breast cancer》2019,19(1):78-86
Background
Given the lack of established indications for elective nodal irradiation (ENI) in ypN0 patients after neoadjuvant chemotherapy (NAC) and breast-conserving surgery (BCS), we set out to investigate the role of ENI in ypN0 patients according to subtype and pathologic complete remission (pCR) status.Patients and Methods
We analyzed 261 patients who received NAC followed by BCS and adjuvant radiotherapy in 13 institutions of the Korean Radiation Oncology Group from 2005 to 2011. The tumors were classified into one of 3 subtypes: luminal (estrogen receptor positive or progesterone receptor positive and HER2 negative), HER2 (HER2 positive), or triple negative (estrogen receptor, progesterone receptor, and HER2 negative). We compared locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) according to ENI in different subgroups generated by the subtype and pCR statuses.Results
In all patients, the 5-year LRC, DFS, and OS rates were 96.0%, 91.0%, and 96.8%, respectively. In all patients, axillary lymph node dissection was found to be the only favorable factor for LRC (P = .023) and DFS (P = .001). Age ≥ 50 years (P = .027), negative resection margin (P = .002), and axillary lymph node dissection (P = .002) were all favorable factors for OS. ENI did not affect LRC, DFS, or OS. Subgroup analysis by tumor subtype and pCR showed that ENI was not associated with greater LRC or DFS in any subgroups.Conclusion
In ypN0 patients after NAC and BCS, ENI did not improve LRC or survival, regardless of subtype or primary tumor response. This result should be verified through larger prospective trials. 相似文献8.
《European journal of surgical oncology》2019,45(8):1373-1377
IntroductionNipple-sparing mastectomy (NSM) is considered an oncologically sound procedure but necrosis of the nipple-areola complex (NAC) or skin flaps is a concern, particularly in the presence of risk factors. To increase the indications for NSM and decrease such complications, different procedures of “surgical delay” (SD) have been described.Materials and methodsA retrospective analysis of patients who underwent SD for NSM at four Italian Breast Centers from 2014 to 2017 was performed. SD generally consisted of a periareolar or “hemi-batwing” incision, dissecting the skin and the NAC from the underlying breast tissue. NSM was scheduled after 2–3 weeks.ResultsEighty-eight procedures were analyzed. Mild complications of SD were registered in 7.9% of cases. NSM was performed in 85 cases, whereas in three cases (3.4%) a “skin-sparing” mastectomy was necessary due to positivity of the retroareolar biopsy for cancer at SD.A direct-to- implant (DTI) reconstruction was performed in 42 cases (49.4%), while in 43 (50.6%) a tissue-expander (TE) was inserted. After NSM, eight complications (9.4%) were recorded: one total necrosis (1.2%), one partial necrosis (1.2%) and four minimal ischemia (4.7%) of NAC, one skin flap necrosis (1.2%), one haematoma (1.2%). In only two cases (2.3%) prosthesis removal was needed. Aesthetic outcome was evaluated excellent or good in 92.9% of cases.At a median follow-up of 24 months no local recurrences were seen.ConclusionThis is the largest series of SD with NSM presented so far in the literature. In our experience, SD extends indications for NSM in high-risk women. 相似文献
9.
《Clinical breast cancer》2020,20(4):e458-e468
PurposeThe eligibility for nipple-sparing mastectomy (NSM) regarding subareolar non-mass enhancement (NME) on breast magnetic resonance imaging (MRI) was not clear. This study aimed to evaluate the eligibility for NSM according to the NME-to-nipple distance on preoperative breast MRI.MethodsWe identified patients with breast cancer who underwent mastectomy with NME suspected of malignancy in the subareolar region on preoperative breast MRI. The incidence of nipple invasion was pathologically evaluated according to the NME-to-nipple distance on breast MRI, and the clinicopathologic factors related to pathologic nipple invasion were analyzed.ResultsOf 137 patients, 55 (40.1%) had NME extension to the nipple, 53 (38.7%) had radiologic distance less than 2 cm, and 29 (21.2%) had radiologic distance of 2 cm or more. The rate of pathologic nipple invasion was 52.7% (29 of 55) in patients with NME extension to nipple, 7.5% (4 of 53) in patients with NME-to-nipple distance less than 2 cm, and 3.4% (1 of 29) in patients with NME-to-nipple distance of 2 cm or more (P < .001). NME extension to the nipple was an independent risk factor for pathologic nipple invasion (odds ratio 21.702; 95% confidence interval, 2.613–180.225; P = .004). The survival outcome was not different between NSM and conventional total mastectomy/skin-sparing mastectomy in patients with radiologic distance less than 2 cm, but without NME extension to the nipple.ConclusionsNSM is an acceptable procedure in patients with breast cancer with a low incidence of pathologic nipple invasion when there is no evidence of NME extension to the nipple on preoperative breast MRI. 相似文献
10.
AimBoth skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have been widely adopted. Although postmastectomy radiation therapy (PMRT) can improve clinical outcomes, it can worsen cosmesis following reconstruction. Therefore, identifying risk factors of ipsilateral breast tumor recurrence (IBTR) could help de-escalate PMRT after NSM/SSM in patients with pT1-2 disease.MethodsWe retrospectively reviewed patients treated with SSM (N = 400) and NSM (N = 156) in patients with pT1-2N0-1 disease between 2009 and 2016. Seventy-four patients received PMRT with 50–50.4 Gy in 25–28 fractions. The Cox proportional hazards model was used to analyze the prognostic factors of IBTR.ResultsWith a median follow-up of 66.2 months, 17 IBTR events were observed, with 5-year IBTR-free rate of 97.2%. Although only one IBTR was observed after PMRT, there was no statistical difference in the 5-year IBTR-free rate (PMRT vs. no PMRT, 98.6% vs. 97.0%, p = 0.360). Multivariable analyses demonstrated that age ≤45 years and lymphovascular invasion (LVI) were adverse features of IBTR. The low-risk group (0 risk factor) showed a better 5-year IBTR-free rate than the high-risk group (≥1 risk factor) (100.0% vs. 95.8%, p = 0.003). In the high-risk group, PMRT slightly improved 5-year IBTR-free rate compared with no PMRT (98.6% vs. 95.2%, p = 0.166). In addition, PMRT increased 5-year cumulative incidence of reconstruction failure (10.0% vs. 2.8%, p = 0.001).ConclusionWe identified risk factors (age and LVI) related to IBTR following upfront SSM/NSM with pT1-2 disease. As a hypothesis-generating study, de-escalation of PMRT by omitting chest wall irradiation in selective patients could improve reconstruction-related complications without compromising oncologic outcomes. 相似文献