GP方案化疗联合恩度治疗老年非小细胞肺癌的效果及对预后的影响研究

目的探究GP方案化疗联合恩度治疗老年非小细胞肺癌(NSCLC)的效果及对表皮生长因子受体(EGFR)与肿瘤异常蛋白(TAP)水平的影响。方法回顾性分析2015年1月至2017年1月的中晚期老年NSCLC病人76例,对照组使用GP化疗方案(吉西他滨+顺铂)(37例);观察组使用GP化疗联合恩度方案(39例)。比较2组病人化疗后的临床疗效、肿瘤进展情况,并比较化疗前后的卡氏行为状态评分(KPS)、生活质量评分(QOL)、血清EGFR和末梢血TAP阳性率以及不良反应发生情况。结果观察组疾病控制率(DCR)显著高于对照组(P0. 05)。观察组中位生存时间显著高于对照组(P0. 05)。治疗后观察组KPS、QOL评分均显著高于对照组(P0. 05)。2组血清EGFR和末梢血TAP阳性率均显著低于对照组(P0. 05)。2组间3～4级不良反应发生率差异无统计学意义(P0. 05)。结论使用GP化疗方案联合恩度治疗中晚期老年NSCLC病人,具有更好的临床效果,值得临床推广。     

自制推簧远中直立近中阻生磨牙的力学分析及临床应用

本文将结合1例上颌第一、第二磨牙近中阻生病例，介绍一种椅旁自制的螺旋推簧，用于近中阻生磨牙的远中直立移动，并探讨该螺旋推簧的力学原理及临床应用，为竖直近中阻生的磨牙提供一种新的治疗方法。     

正畸拔牙后Bolton指数不调的多因素分析

目的　探讨安氏分类、术前前牙比、全牙比及不同拔牙模式对前磨牙拔除后Bolton指数的影响。方法　随机选择166副安氏错患者的模型,测量术前Bolton指数的前牙比、全牙比及拔牙后的Bolton指数值,以错安氏分类、术前前牙比、全牙比及拔牙模式建立Logistic回归模型,对拔牙后Bolton指数不调的发生进行多因素分析。结果　当术前前牙比、全牙比较小时,前磨牙拔除后Bolton指数趋于协调;而当术前前牙比、全牙比较大时, 前磨牙拔除后Bolton指数更趋于不调。不同的拔牙模式对Bolton指数的影响并不一致,当术前Bolton指数的前牙比、全牙比正常时,上下颌均拔除第一前磨牙,或上颌拔除第一前磨牙,下颌拔除第二前磨牙后,其Bolton指数值则明显高于正常。结论　矫治设计时,不仅要计算完整牙列Bolton指数的全牙比、前牙比,还要对所选择的拔牙模式后的Bolton指数进行分析,并多因素综合考虑,选择合适的拔牙模式。     

腰椎间盘突出症健侧旁正中入路硬膜外穿刺置管注射胶原酶的疗效分析

腰椎间盘突出症为常见多发病,硬膜外注射胶原酶疗法具有微创、无痛、疗效好、经济和患者易接受等优点。1999年以来,我们在影像学研究的基础上,用健侧旁正中入路硬膜外穿刺向患侧置管注射胶原酶治疗腰椎间盘突出症260例,收到良好的效果,现报告如下。1资料与方法1.1一般资料选择ASAI—II级患者260例,男188例,女72例;年龄23—67岁,病史4个月—6年,平均2年7个月。患者均有典型腰椎间盘突出的临床症状,并经CT、椎管造影或MRI检查证实。临床诊断按Mcculloch[1]标准。其中突出部位L3—4者19例,L4—5突出者106例,L5—S1突出者88例,L4—5和L5…     

培哚普利联合左旋氨氯地平对高血压合并左心室肥厚患者的临床价值分析

目的 探究培哚普利联合左旋氨氯地平对高血压合并左心室肥厚(left ventricular hypertrophy,LVH)患者血浆脑钠肽(BNP B-type natriuretic peptide)等生化指标、临床疗效的影响。方法 选取于2018年1~12月来笔者医院接受治疗的高血压合并左心室肥厚患者91例作为研究对象。通过倾向评分匹配后,随机数字法将其分为两组,对照组32例和实验组32例。两组患者均进行常规治疗,包括合理膳食、适当运动、戒烟、戒酒等。对照组在常规治疗基础上口服左旋氨氯地平片治疗,实验组在规治疗基础上上口服培哚普利、左旋氨氯地平片治疗。通过血浆同型半胱氨酸(Hcy homocysteine)、心钠肽(ANP atrial natriuretic peptide)、脑钠肽(BNP B-type natriuretic peptide)水平;临床疗效两方面进行对比。结果 治疗后,实验组和对照组血浆Hcy、ANP、BNP水平均低于治疗前,实验组低于对照组,差异有统计学意义(P＜0.05)。治疗后,对照组高血压合并LVH患者临床总有效率分别为78.13%,实验组为93.75%,实验组高于对照组,差异有统计学意义(P＜0.05)。结论 培哚普利联合左旋氨氯地平治疗高血压合并左心室肥厚疗效显著,可有效降低血浆BNP等生化指标水平、改善左室收缩和舒张功能,提高临床疗效,具有一定临床推广价值。     

造血干细胞移植后输尿管狭窄1例

Ureteral stenosis is a comparatively rare complication following hematopoietic stem cell transplantation (HSCT). The etiology is still unclear and most believe that this may be due to the reactivation of BK virus in a state of immunodeficiency. In the later stages of ureteral stenosis with scarring, invasive interventions must be taken to relieve the hydronephrosis. Common treatments, such as D-J stent placement and permanent nephrostomy may not only entail the risk of infection, but also seriously affect the quality of life. Few cases of surgical intervention have been reported. In this article, a 25-year-old female was admitted to Peking University First Hospital suffering from recurrent flank pain. Seven years before, she developed hemorrhagic cystitis and bilateral urethritis 40 days after allogeneic HSCT. After continuous bladder irrigation and antiviral therapy, the left-sided hydronephrosis gradually alleviated while the right-sided one did not improve. D-J stents were used for urine drainage for 7 years before percuta-neous nephrostomy. Preoperative antegrade pyelography revealed significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter. After comprehensive decision, she underwent ileal ureter replacement. The operation was successful. The segmental lesion was dissected and the scar tissue was removed. A 25 cm intestinal tube was isolated to connect the pelvis and bladder. An anti-reflux nipple was created at the distal end of ileal ureter to prevent the potential infection. The blood loss was minimal. After surgery, the drainage tube was removed in 2 weeks, the nephrostomy tube and the D-J stent was removed in 3 months. Follow-up mainly included clinical assessment, serologic testing, renal ultrasonography, blood gas analysis and radiological examination. During the follow-up of 6 years, she was symptom-free and no postoperative complications occurred. The serum creatinine level was stable. No hydronephrosis was observed under ultrasonography. Obvious peristaltic waves and ureteral jets of the ileal ureter was confirmed on cine magnetic resonance urography. To sum up, ureteral stenosis after HSCT is relatively rare. Obstruction caused by scarring is usually irreversible and surgical intervention should be designed according to the location and length of the lesion. Ileal ureter replacement can be a safe, feasible and effective method to solve this kind of complex stricture.     

肠梗阻导管治疗结核性腹膜炎并发肠梗阻的临床观察

目的:探讨肠梗阻导管治疗结核性腹膜炎并发肠梗阻的临床价值。方法:收集入院诊断为结核性腹膜炎并发肠梗阻患者48例,随机分为经鼻型肠梗阻导管治疗组(观察组)24例,传统鼻胃管治疗组(对照组)24例,记录两组患者腹痛、腹胀缓解时间、肛门自主排气排便时间、立位腹平片气液平面消失时间、中转手术情况、平均住院日等数据,并进行统计分析。结果:对照组患者的腹痛、腹胀缓解时间为(2.6±1.80)d,观察组为(1.2±0.24)d;对照组自主排气排便时间为(5.4±2.1)d,观察组为(2.2±1.50)d;对照组立位腹平片气液平面消失时间为(6.7±2.15)d,观察组为(2.4±1.40)d;对照组中转手术率为8.3%,观察组无中转手术病例;对照组住院时间平均为(10.2±3.7)d,观察组为(5.6±1.67)d,两组比较差异有统计学意义(P0.05)。结论:肠梗阻导管在结核性腹膜炎并发肠梗阻的患者中较传统鼻胃管疗效更显著,值得推广。     

解毒愈溃汤结合西医疗法治疗糜烂型口腔扁平苔藓40例

目的:探讨解毒愈溃汤联合西医常规疗法治疗糜烂型口腔扁平苔藓(OLP)的近期和远期疗效及对血清肿瘤坏死因子α(TNF-α)、白介素-2,4,10(IL-2,4,10)的影响。方法:将80例符合条件的患者随机按就诊前后分为对照组和中西医结合组各40例。对照组采用复方氯己定含漱液,3次/d,连续使用2周;醋酸曲安奈德1 m L+2%利多卡因2 m L,糜烂区黏膜下局部注射,连续使用4周;口服维生素A,C,连续服用12周。中西医结合组在对照组治疗的基础上加服解毒愈溃汤加减治疗,1剂/d,疗程12周。客观指标体征、主观症状和生活质量于治疗前及治疗后4周进行评价;血清TNF-α,IL-2,4,10水平在治疗前、后进行检测。结果:经Ridit分析,中西医结合组临床疗效优于对照组(P0.05);治疗4周后两组客观指标征记分、疼痛评分及生活质量评分均较治疗前下降,中西医结合组下降更为显著(P0.01);治疗后12周,中西医结合组TNF-α,IL-2,IL-4和IL-10水平均低于对照组(P0.01);中西医结合组复发率为22.5%,低于对照组的45.0%(P0.05)。结论:解毒愈溃汤配合西医常规疗法治疗糜烂型口腔扁平苔藓近期能减轻患者的症状、提高患者生活质量,提高临床疗效,远期能降低复发率。其作用可能通过调节T细胞介导的炎性反应来实现的。     

甲状腺微小乳头状癌105例诊治分析

目的探讨甲状腺微小乳头状癌的临床诊治特点。方法回顾性分析我院自2006年2月~2013年6月期间收治并经过病理证实为PTMC的105例患者的病例资料。结果术前甲状腺彩超敏感率为85.7%,细针穿刺针吸细胞学活检阳性率66.9%,65例行患侧甲状腺+峡部甲状腺全切除,30例行患侧甲状腺全切除+对侧甲状腺次全切除,10例行甲状腺全切除,全部患者均行中央区淋巴结清扫术。所有患者随访1~8年,仅1例复发。结论甲状腺彩超在甲状腺微小癌的术前诊断中起重要作用,腺叶切除+中央区淋巴结清扫术可作为主要的手术方式,术后内分泌治疗不容忽视。