乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用

Objective To study the immediate conservative breast surgical reconstruction by trans-ferring the same lateral latissimus dorsal myocutaneous flap (LDM) for the treatment of stage Ⅱ and stage Ⅲ breast cancer, combined with neoadjuvant chemotherapy. Methods Breast cancer patients in stage Ⅱ and Ⅲ with pathological diagnosis by core needle biopsy, had undergone immediate conservative breast reconstruction surgery with transferring the latissimus dorsal myocutaneous (LDM). We scored the reconstructed breast twice at one month after operation and completion of radiation. The final score was decided using the mean value of the twice evaluating score. Kaplan-Meier survival was used to analyze the survival of 18 cases with traditional mastectomy. Results The tumor size ranged from 30 mm to 55 mm before neoadjuvant chemotherapy, and ranged from 25mm to 45 mm after neoadjuvant chemotherapy. The median weight of the tumor specimens in breast conservative operation was 140 g (90 g to 220 g). A-mong the 18 patients, 16 cases had more than 3 scores with satisfied cosmetics (93.33 % ). Dorsal subcu-taneous seroma in donation area was observed in 5 of 18 patients (27.78 %) and dorsal incision dehiscence was observed in 2 of 18 patients (11.11%). None of the patients developed recurrence except that 1 pa-tient (5.55 %) had distance metastasis (bone metastasis} in a mean 22-months follow-up. The Kaplan-Meier survival curve in breast conservation reconstruction patients had no different from that of traditional mastectomy patients at the same time. Conclusions Immediate conservative breast surgical reconstruction by using the same lateral latissimus dorsal myocutaneous flap is an effective method for stage Ⅱ and stage Ⅲ breast cancer patients combined with neoadjuvant chemotherapy, which can increase satisfactory breast so that cosmetic outcome can be reached.     

椎间盘内射频电刺激定位椎间盘源性腰痛责任椎间盘

目的探讨椎间盘内射频电刺激定位椎间盘源性腰痛责任椎间盘的有效性。方法对78例椎间盘源性腰痛患者,在CT引导下通过椎间盘内射频电刺激定位责任椎间盘,根据椎间盘电刺激诱发试验结果分为A组(椎间盘电刺激试验诱发阳性)及B组(椎间盘电刺激试验诱发阴性)。行椎间盘低温等离子纤维环成形术。以疼痛数字评分法(NRS)评价患者疼痛程度,以改良MacNab评分评价术后患者主观满意度,并进行统计学分析。结果 78例中,A组67例,B组11例。2组患者术前NRS评分差异无统计学意义(P0.05),A组术后1周、1个月及6个月NRS评分均较B组减低(P均0.05)。术后1、3、6个月,A组患者MacNab评分优良率均明显高于B组(P均0.05)。术后无严重并发症发生,仅6例出现穿刺点皮下淤血、14例穿刺点局部疼痛,均在术后2周内自行消失。结论椎间盘电刺激诱发试验阳性患者椎间盘低温等离子纤维环成形术后疼痛缓解程度和患者主观满意度更优;椎间盘内射频电刺激有助于准确定位椎间盘源性腰痛责任椎间盘。     

卡维地洛治疗老年轻中度高血压的降压疗效和安全性研究

目的评价卡维地洛治疗老年轻中度原发性高血压的降压疗效和安全性。方法46例老年轻中度高血压患者经过清洗期后，每日口服卡维地洛片12．5mg，如血压不达标，增加剂量12．5mg／2周，直至8周结束观察。结果46例患者服药2周末舒张压即明显下降，治疗8周末平均剂量为25mg／d，收缩压和舒张压分别降低19．66mmHg和14．31mmHg，总有效率为76．41％，总显效率为65．2％，服药后心率在正常范围内下降2．76次／min，血清总胆固醇和甘油三酯无明显改变，血糖在正常范围内轻度升高。不良反应主要是头晕，头疼，困倦，但均较轻微，停药后消失。结论老年轻中度原发性高血压患者每日口服卡维地洛片12．5～37．5mg安全有效。     

乳腺癌中ErbB原癌基因家族的蛋白表达与临床病理特征的关系

目的探讨原癌基因erbB一1、erbB．2、erbB-3、erbB-4在乳腺癌组织中的蛋白表达及其预后意义。方法对81例乳腺癌石蜡切片采用免疫组织化学方法分析其erbB-1、erbB-2、erbB一3、erbB-4基因的蛋白表达情况。结果81例乳腺癌分别以组织学类型、组织学分级、淋巴结转移和术后生存期为分组标准进行结果分析。erbB一2、3阳性表达在组织学分级、术后生存期和淋巴结转移组差异有统计学意义（P〈0．05或P〈0．01）,在组织学分型中差异无统计学意义（P〉0．05）;erbB．1、4表达在上述4组中差异无统计学意义（P〉0．05）;但erbB一1、3、4与erbB-2间比较差异有统计学意义（P〈0．05或P〈0．01）。结论erbB-2、3与乳腺癌生长、增殖和转移密切相关,可作为独立性的预后指标;erbB一1、4在乳腺癌发生中具有协同作用,同时检测erbB一1和erbB-4对临床诊断和治疗具有一定的参考价值。     

支持性心理干预在介入治疗中的应用

近年来,介入治疗已成为与传统的内科药物治疗、外科手术治疗并列的三大现代医学治疗手段之一[1].介入治疗(interventionaltreatment)是介于外科、内科治疗之间的新兴治疗方法 ,包括血管内介入和非血管内介入治疗.介入治疗是指不开刀暴露病灶的情况下,在血管、皮肤上做直径几毫米的微小通道,或经人体原有的管道,在影像设备(血管造影机、透视机、CT、MRI、B超)的引导下对病灶局部进行的创伤最小的治疗方法 .支持性心理治疗,又称支持疗法,是指在执行医疗护理过程中,医护人员针对患者的病情,心理状态合理地采用劝导、鼓励、同情、安慰、支持以及解释和保证等方法 ,帮助患者认识问题[2].实施支持性心理干预的目的 在于减轻患者的紧张、消除焦虑心理和不良情绪,使患者能保持接受治疗的最佳心理状态,从而促进治疗护理过程的顺利进行,促进患者康复.2009年1月,我院开始在介入治疗中引入支持性心理干预,经过1年的实践取得较好的效果,本文将实施支持性心理干预对改善介入治疗患者的心理状态的效果进行观察,现报道如下.     

进行性色素性紫癜性皮肤病1例

色素性紫癜性皮肤病是临床常见的毛细血管炎类疾病,经典表现为对称发生于小腿及踝之周围,一般无自觉症状。笔者门诊遇到1例患者皮损全身泛发,临床较为少见,现报道如下。临床资料　患者,女,5 3岁,家庭妇女。全身皮疹伴微痒4～5个月。病初先于双小腿及踝之周围出现紫红色瘀点,斑片,微痒。曾在外院按皮炎治疗(用药不详)效果不明显,以后皮损逐渐累及大腿躯干、双上肢、颈部。发疹前无服药史,否认化学品接触史,饮食无特殊;发疹前后无发热、咽痛、咳嗽,否认外伤,平素体健,既往无类似病史。体检:系统检查无异常,皮肤科情况:颈部、躯干、四肢均匀散…     

卡维地洛治疗老年轻中度高血压疗效观察

 目的 本研究以观察每日口服一次卡维地洛12.5～50 mg 治疗老年轻中度原发性高血压的临床疗效及安全性.方法 选择轻中度老年原发性高血压患者46例,给予卡维地洛口服治疗.结果 (1)在治疗2周时诊室血压均有所下降,在治疗6～8周末下降最明显,并维持至24周;(2)24周末卡维地洛组诊室SBP/DBP降低幅度为19.7/11.4 mmHg,治疗前后相比有显著的差别;(3)卡维地洛降压总有效率分别为93.3%,总显效率分别为70%;(4)卡维地洛对老年人血糖、血脂、血电解质、血尿酸肝肾功能等均无明显影响,心电图检查治疗前后也无明显变化;(5)卡维地洛主要的不良反应:头晕(13%)、乏力(2%)、嗜睡(2%).在服药过程中逐渐减轻,无因药物不良反应而终止试验者.结论 本研究中的原发性高血压患者每日口服一次卡维地洛12.5～5 0 mg,降压疗效幅度显著,疗效明显,耐受性及安全性好.卡维地洛是老年轻中度高血压患者首选降压药物.     

全内镜大通道单侧入路双侧减压治疗老年单节段腰椎管狭窄症的早期疗效

【摘要】 目的：评估脊柱全内镜大通道下单侧入路双侧减压（unilateral laminotomy for bilateral decompression,ULBD）治疗老年单节段腰椎管狭窄症的早期临床效果。方法：回顾性分析我院2018年7月~2020年7月采用全内镜大通道下ULBD治疗的37例单节段腰椎管狭窄症患者。其中男17例,女20例;年龄60~78岁（66.8±4.9岁）;手术节段：L3-4 7例,L4-5 20例,L5-S1 10例。收集患者手术资料及术中并发症情况。术前及术后1周、3个月、1年采用疼痛视觉模拟评分（visual analog scale,VAS）评价腰腿痛,Oswestry功能障碍指数（Oswestry disability index,ODI）评价下肢功能。术后1年采用MacNab标准对临床疗效进行评价。结果：所有患者手术顺利,手术时间75~155min（113.7±19.4min）,术中出血量10~50ml（26.5±9.4ml）,住院天数5~7d（5.5±0.7d）。术中发生1例硬膜囊撕裂,行胶原蛋白海绵封闭后严格卧床休息1周,患者未出现明显临床症状,伤口愈合良好。术前、术后1周、3个月、1年的腰痛VAS评分分别为5.4±0.5分、2.4±0.6分、1.0±0.5分、0.4±0.5分,腿痛VAS评分分别为7.3±0.5分、2.7±0.5分、1.3±0.5分、0.7±0.6分,ODI分别为（78.6±2.3）%、（26.0±4.1）%、（17.4±2.2）%、（10.7±2.0）%。术后各时间点腰腿痛VAS评分、ODI均较术前显著改善,差异具有统计学意（P<0.001）。术后各时间点间两两比较差异均有统计学意义（P<0.001）。术后1年MacNab标准优21例,良13例,可3例,优良率91.89%。结论：脊柱全内镜大通道下ULBD治疗老年单节段腰椎管狭窄症的早期临床效果较好,但远期疗效需进一步随访。     

乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用

Objective To study the immediate conservative breast surgical reconstruction by trans-ferring the same lateral latissimus dorsal myocutaneous flap (LDM) for the treatment of stage Ⅱ and stage Ⅲ breast cancer, combined with neoadjuvant chemotherapy. Methods Breast cancer patients in stage Ⅱ and Ⅲ with pathological diagnosis by core needle biopsy, had undergone immediate conservative breast reconstruction surgery with transferring the latissimus dorsal myocutaneous (LDM). We scored the reconstructed breast twice at one month after operation and completion of radiation. The final score was decided using the mean value of the twice evaluating score. Kaplan-Meier survival was used to analyze the survival of 18 cases with traditional mastectomy. Results The tumor size ranged from 30 mm to 55 mm before neoadjuvant chemotherapy, and ranged from 25mm to 45 mm after neoadjuvant chemotherapy. The median weight of the tumor specimens in breast conservative operation was 140 g (90 g to 220 g). A-mong the 18 patients, 16 cases had more than 3 scores with satisfied cosmetics (93.33 % ). Dorsal subcu-taneous seroma in donation area was observed in 5 of 18 patients (27.78 %) and dorsal incision dehiscence was observed in 2 of 18 patients (11.11%). None of the patients developed recurrence except that 1 pa-tient (5.55 %) had distance metastasis (bone metastasis} in a mean 22-months follow-up. The Kaplan-Meier survival curve in breast conservation reconstruction patients had no different from that of traditional mastectomy patients at the same time. Conclusions Immediate conservative breast surgical reconstruction by using the same lateral latissimus dorsal myocutaneous flap is an effective method for stage Ⅱ and stage Ⅲ breast cancer patients combined with neoadjuvant chemotherapy, which can increase satisfactory breast so that cosmetic outcome can be reached.