简易显微摄影装置的制作和应用

简易显微摄影装置可通过显微镜对细菌及其芽胞、鞭毛和某些寄生虫的图象摄制成片。这种设备制作简单,操作方便,一般生物显微镜都可采用这种方法开展显微摄影。器具一、复式光学显微镜一台(直筒、斜筒均可)。本装置采用日产 NIKON 斜筒双目显     

腹腔镜诊断治疗盆腔脓肿的探讨

目的:使盆腔脓肿患者得以早期诊断、早期有效治疗,防止近期、远期并发症,寻找最佳治疗方法。方法:对29例入院诊断为盆腔脓肿的患者进行腹腔镜探查术,对术中证实为盆腔脓肿的患者实施盆腔分离粘连、病灶切除、冲洗等操作,术后应用抗生素,辅以中药治疗。结果:29例中有27例证实为盆腔脓肿,2例为陈旧性宫外孕;盆腔脓肿手术顺利,术后均未安放腹腔引流,未出现并发症,术后症状迅速消失,均痊愈出院。结论:腹腔镜手术是目前盆腔脓肿最佳诊断、治疗方法。     

宫颈癌腹腔镜下广泛子宫切除及盆腔淋巴结清扫术中应用可溶性止血纱布的疗效分析

目的：评价可溶性止血纱布在早期宫颈癌腹腔镜下广泛子宫切除及盆腔淋巴结清扫术中的应用价值。方法：选择40例行腹腔镜下广泛子宫切除及盆腔淋巴结清扫术的宫颈癌患者术中应用可溶性止血纱布作为实验组,选择同期行腹腔镜下广泛子宫切除及盆腔淋巴结清扫术的宫颈癌患者56例,术中未放置可溶性止血纱布作为对照组,比较两组术后24h凝血功能、术后放置腹腔引流管时间、腹腔引流量、术后产生盆腔淋巴囊肿的患者比例。结果：实验组的术后引流量和留置引流管时间均小于对照组,但两组术后24h的凝血功能、术后1周、2周、4周累计产生盆腔淋巴囊肿的例数比较,差异无统计学意义。结论：可溶性止血纱布可减少腹腔镜下广泛子宫切除及盆腔淋巴结清扫术术后腹腔引流,为妇科腹腔镜手术止血提供了一个有效措施。     

术中盆腔冲洗液细胞学检查在中上段直肠癌的临床应用价值

目的探讨术中盆腔冲洗液细胞学检查在中上段直肠癌的临床应用价值。方法选择46例手术治疗的中上段直肠肿瘤已侵及浆膜、肉眼未发现转移的患者,开腹后用100—200ml生理盐水行盆腔冲洗,通过将盆腔冲洗液离心后作脱落细胞涂片检查,来帮助术中判断肿瘤的分期、术式的选择、及对术后复发和转移的初步评估。结果行盆腔冲洗的46例中38例找到肿瘤细胞,阳性率为82．6％（38／46）。结论直肠癌术中行盆腔冲洗液细胞学检查是术中简便而实用的判断直肠癌术式及预后的方法。     

高压缓冲式结肠双重造影灌肠器的设计与研制

目的：设计并研制一款适用于结肠气钡双对比造影的灌肠器。方法：在灌肠器筒体上设计有硫酸钡混悬液输出管、气体输出管及三通控制减压阀;在筒盖上设计有高压注气装置、排气阀及压力表。结果：通过预先向灌肠筒内装入适量硫酸钡混悬液和气体,在灌肠筒内形成一定压力,灌肠检查时,转动三通控制开关至硫酸钡混悬液输出位置,灌肠器则按照先硫酸钡混悬液后气体输出的顺序使灌肠自动完成。结论：高压缓冲式结肠双重造影灌肠器结构简单、操作方便、安全可靠,减少了工作人员近台操作的辐射损害,提高了结肠双对比造影的图像质量。     

阴肛指诊辅助腹腔镜治疗子宫内异症临床观察

目的研究阴肛指诊辅助腹腔镜手术治疗中重度盆腔子宫内膜异位症的临床效果。方法回顾我院2006年4月．2007年4月收治的53例中重度盆腔子宫内膜异位症患者的临床资料，从手术并发症、术后症状改善、术后复发率、受孕率等方面进行综合分析。结果53例手术均在腹腔镜下顺利完成，无并发症发生；术后症状缓解率达90．57％；术后复发率6．25％；受孕率18．78％。结论妇科腹腔镜手术配合阴肛指诊，可提高腹腔镜盆腔操作的治疗效果，尤其对重度阴道直肠型子宫内膜异位病灶的切除，方便、安全、有效，值得临床推广。     

宫腔镜术后盆腔感染的危险因素及应对措施研究

目的分析引起宫腔镜术后盆腔感染的危险因素,对实施针对性的护理措施提供依据。方法回顾性分析医院2016年2月-2017年4月行宫腔镜手术的99例患者,采用单因素及Logistic多因素回归分析宫腔镜术后盆腔感染的危险因素,并根据宫腔镜术后盆腔感染危险因素实施有针对性的护理措施。结果 99例宫腔镜手术患者中,术后发生盆腔感染10例,感染率为10.10%;手术时间≥1h、不良卫生习惯、贫血及糖尿病为术后盆腔感染的相关危险因素;手术时间、不良卫生习惯、贫血以及糖尿病是宫腔镜术后盆腔感染的独立危险因素(P<0.05)。结论引起宫腔镜术后盆腔感染的危险因素较多,给予患者针对性的护理措施,可有效降低宫腔镜术后盆腔感染率。     

宫腔镜术后盆腔感染的危险因素及应对措施研究北大核心CSCD

目的分析引起宫腔镜术后盆腔感染的危险因素,对实施针对性的护理措施提供依据。方法回顾性分析医院2016年2月-2017年4月行宫腔镜手术的99例患者,采用单因素及Logistic多因素回归分析宫腔镜术后盆腔感染的危险因素,并根据宫腔镜术后盆腔感染危险因素实施有针对性的护理措施。结果 99例宫腔镜手术患者中,术后发生盆腔感染10例,感染率为10.10%;手术时间≥1h、不良卫生习惯、贫血及糖尿病为术后盆腔感染的相关危险因素;手术时间、不良卫生习惯、贫血以及糖尿病是宫腔镜术后盆腔感染的独立危险因素(P<0.05)。结论引起宫腔镜术后盆腔感染的危险因素较多,给予患者针对性的护理措施,可有效降低宫腔镜术后盆腔感染率。     

盆腔淋巴结切除术中结扎淋巴管与电凝闭合淋巴管的比较

目的:比较盆腔淋巴结切除术中丝线结扎和电凝闭合盆腔淋巴管断端术后盆腔淋巴囊肿形成的情况,从而找到更有效预防盆腔淋巴囊肿的方法。方法:选取南阳市中心医院妇产科2008年6月～2010年12月接受盆腔淋巴结切除术的宫颈癌患者。研究组42例,术中用4号丝线结扎双侧腹股沟深淋巴管、闭孔近端淋巴管、闭孔远端淋巴管、髂总淋巴管、髂内外静脉交叉处淋巴管共5处;对照组36例,术中用电凝闭合相应淋巴管。于手术后第1周、第4周、第12周和第24周对患者进行体格检查和B超检查,了解盆腔有无淋巴囊肿形成以及有无其他相关并发症的发生。结果:丝线结扎组与电凝闭合组患者基本情况、术后住院天数、手术时间、术中出血量、术后排气时间、卵巢移位、淋巴结转移,术后引流量比较,无统计学差异。电凝闭合组术后第1周、术后第4周、第12周淋巴囊肿形成率高于结扎组;术后第24周电凝闭合组与结扎组淋巴囊肿形成率无统计学差异。结论:盆腔淋巴结切除术中丝线结扎腹股沟深淋巴管、闭孔近端淋巴管、闭孔远端淋巴管、髂总淋巴管、髂内外静脉交叉处淋巴管比电凝闭合相应淋巴管在术后近期内可以有效地减少盆腔淋巴囊肿的发生率。     

介入热化疗治疗腹腔盆腔恶性肿瘤围手术期的护理

目的总结经过导管动脉内灌注高热化疗药液治疗腹腔和盆腔恶性肿瘤围手术期的护理经验。方法112例腹腔和盆腔恶性肿瘤患者经股动脉穿刺选择肿瘤供血动脉灌注高热化疗药液治疗。术前、术中和术后对患者进行精心护理，强化专科护理和心理护理。结果112例腹腔和盆腔恶性肿瘤患者经精心护理，取得了患者良好的配合，术中、术后未发生因护理原因产生的并发症。结论加强经导管动脉灌注热化疗治疗腹腔和盆腔恶性肿瘤患者围手术期的护理，对提高患者治疗效果和预防并发症发生具有积极的意义。     

Efficacy of intraoperative radiotherapy targeted to the abdominal lymph node area in patients with esophageal carcinoma

We investigated whether intraoperative radiotherapy (IORT) during curative surgery for esophageal carcinoma is useful or not. The cases of 117 patients diagnosed with thoracoabdominal esophageal carcinoma who underwent curative surgery between 1986 and 2007 were reviewed: 72 patients received IORT (IORT group) and 45 did not (non-IORT group). Upper abdominal lymphadenectomy was performed in 115 patients (98.5%). Seventy patients (59.8%) received chemotherapy and 80 patients (68.4%) received external radiotherapy. IORT encompassed the upper abdominal lymph node area. A single-fraction dose of 20–30 Gy was delivered using high-energy electrons. Median follow-up duration for patients was 7.4 years. The 5-year overall survival rate did not significantly differ between the IORT and non-IORT groups. However, the 5-year abdominal control rate was significantly higher in the IORT group (89.2%) than in the non-IORT group (72.9%; P = 0.022). We next focused on a patient subgroup with a primary lesion in the lower thoracic or abdominal esophagus or measuring >6 cm in length since this subgroup is probably at high risk of upper abdominal lymph node metastasis. Of the 117 patients, 75 belonged to this subgroup, and among them 45 received IORT. Both univariate and multivariate analysis revealed the survival rate was significantly higher in patients who received IORT than in those who did not (P = 0.033 univariate; 0.026 multivariate). There were no obvious perioperative complications solely attributed to IORT. IORT for esophageal carcinoma will likely be effective for patients with a primary lesion in the lower thoracic or abdominal esophagus, or with a long lesion.     

Lifetime cost-effectiveness analysis of intraoperative radiation therapy versus external beam radiation therapy for early stage breast cancer

Background

To date no one has examined the quality of life and direct costs of care in treating early stage breast cancer with adjunct intraoperative radiation therapy (IORT) versus external beam radiation therapy (EBRT) over the life of the patient. As well no one has examined the effects of radiation exposure with both therapies on the longer term sequelae. The purpose of this analysis was to examine the cost-effectiveness of IORT vs. EBRT over the life of the patient.

Methods

A Markov decision-analytic model evaluated these treatment strategies in terms of the direct costs in treating patients over their lifetime (including the downstream costs associated with radiation exposure) and the resultant quality of life of these patients. Medicare reimbursement amounts in treating patients were used for acute, steady state, recurrent cancer(s), and complications associated with radiation exposure. Quality adjusted life years (QALYs) derived from the medical literature were assessed with each of these states. Life expectancies as well were derived from the medical literature. Cost-effectiveness was evaluated for dominance and net monetary benefit [at a willingness to pay (WTP)] of $50,000/QALY. Sensitivity analysis was also performed.

Results

IORT was the dominant (least costly with greater QALYs) versus EBRT: total costs over the life of the patient = $53,179 (IORT) vs. $63,828 (EBRT) and total QALYs: 17.86 (IORT) vs. 17.06 (EBRT). At a willingness to pay of $50,000 for each additional QALY, the net monetary benefit demonstrated that IORT was the most cost effective option: $839,815 vs. $789,092. The model was most sensitive to the probabilities of recurrent cancer and death for both IORT and EBRT.

Conclusion

IORT is the more valuable (lower cost with improved QALYs) strategy for use in patients presenting with early stage ER+ breast cancer. It should be used preferentially in these patients.

     

移动式加速器术中放射治疗的辐射防护与安全评价

目的 评估移动式加速器术中放射治疗(IORT)的辐射防护与安全状况,为IORT临床应用中的辐射安全提供指导.方法 以某医院拟用的1台MOBETRON移动式加速器及其场所为研究目标,确定IORT的工作负荷及场所外围人员的年剂量管理目标值,估算极端情况下IORT室外围的辐射水平和人员所受的剂量,核算IORT治疗场所的辐射屏蔽.结果 该IORT治疗室在仅采用相当于普通X射线诊断装置的屏蔽条件下,治疗室外与靶不同距离关注位置的剂量率为:东墙外35～78 μSv/h;南墙外89 μSv/h,西墙外70 ～ 84 μSv/h,北墙外75～106 μSv/h; IORT室楼下普通治疗室64 μSv/h,室顶外围空间为45μSv/h.估算出年累积出束5h时场所外围职业人员的年剂量最高为0.53 mSv,公众所受年剂量低于0.1 mSv,均满足剂量管理目标值的要求.加速器IORT设备及场所设置有相应的安全联锁、防护设施与管理措施,可有效制约设备运行照射时人员误入和误留IORT室的风险.结论 在普通手术室中施行移动式加速器IORT时,在工作负荷极小的条件下采取针对低能辐射的屏蔽防护可达到剂量管理目标要求,但应相对固定IORT场所,并根据工作负荷和剂量率控制要求对治疗室增设相应的屏蔽.     

An assessment of intraoperative radiotherapy

An assessment of intraoperative radiotherapy (IORT) was undertaken to inform a decision on whether this technology should be introduced into the state of New South Wales. On the basis of a literature review, IORT appeared to be essentially an experimental technology, with limited data to demonstrate its comparative advantage over other treatments. Introduction of a dedicated IORT facility was technically feasible, but there appeared to be major uncertainties regarding selection and referral of suitable patients on a state-wide basis. The results of the assessment suggested that introduction of an IORT facility might have limited advantage for routine health services. A decision was subsequently taken not to support the introduction of this technology.     

基于蒙卡算法的乳腺癌术中放疗模型的剂量学优化

目的：探讨蒙特卡罗算法在乳腺癌术中放疗（IORT）模型剂量学优化中的应用价值。方法采用MCTP的MCBEAM程序建立乳腺癌术中放疗模型，利用MCSIM程序对患者术前CT模拟术中影像模型进行剂量计算，分析其剂量学特点，并对靶区剂量进行优化。结果通过蒙卡计算，优化的乳腺癌术中放疗模型方案为：靶区表面添加2-3 mm等效材料，靶区后缘添加5 mm等效材料再加2 mm铅板，这可以使90%以上等剂量线包绕整个靶区，同时可以消除＞110%的热点区域，肺最大剂量＜1 Gy。结论蒙特卡罗算法在乳腺癌IORT模型剂量学优化中的应用能显著提高IORT靶区剂量的计算精度，优化剂量分布，值得临床推广。     

移动式术中放射治疗技术及进展

术中放射治疗技术是一种既古老又新生的放疗技术,本文简要介绍了其发展历程,并以世界术中放射治疗设备的最新设备Mobetron为代表,简述了其优点和应用.     

移动式加速器术中放射治疗辐射场剂量水平的测量与分析

目的掌握移动式加速器(简称加速器)术中放射治疗时在手术室及其外围产生的辐射水平,制订手术室可行的屏蔽设计方案,加强术中放射治疗的防护管理。方法以某医院设置的1台Mobetron移动式加速器和术中放射治疗场所为研究对象,采用12MeV电子束、输出量率1000cGy/min进行模拟术中放射治疗,分别使用LiF(Mg,Cu,P)热释光剂量计(TLD)和6150-AD型环境剂量率仪对术中放射治疗手术室内及其外围的辐射水平进行测量。结果 (1)术中放射治疗手术室内的辐射场剂量水平及其分布:Z=75cm平面(治疗床平面)内,加速器前方100cm处的剂量率为40.8～62.8mGy/h,后方100cm处的剂量率为0.13～11.2mGy/h;加速器前方和侧向300cm处的剂量率为2.05～6.35mGy/h。(2)术中放射治疗辐射安全设置状况及手术室外围的辐射水平:术中放射治疗手术室及其准备间设为控制区,防护门均与出束联锁;照射时东墙外走廊(中间隔有准备间)最高剂量率为9.0μGy/h,北墙外控制室内最高剂量率为19.5μGy/h,西墙外清洁走廊和南墙外、楼下场所最高剂量率分别为24.2、14.5和23.0μGy/h。结论加速器在手术室内产生的辐射主要为轫致辐射的杂散辐射,但应相对固定术中放射治疗场所并结合实测辐射值制订并优化场所的屏蔽设计方案。     

Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer

A detailed understanding of the interactions and the best dose-fractionation scheme of radiation to maximize antitumor immunity have not been fully established. In this study, the effect on the host immune system of a single dose of 20 Gy through intraoperative radiation therapy (IORT) on the surgical bed in low-risk breast cancer patients undergoing conserving breast cancer has been assessed. Peripheral blood samples from 13 patients were collected preoperatively and at 48 h and 3 and 10 weeks after the administration of radiation. We performed a flow cytometry analysis for lymphocyte subpopulations, natural killer cells (NK), regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSCs). We observed that the subpopulation of NK CD56^+high CD16⁺ increased significantly at 3 weeks after IORT (0.30–0.42%, P < 0.001), while no changes were found in immunosuppressive profile, CD4⁺CD25⁺Foxp3⁺Helios⁺ Treg cells, granulocytic MDSCs (G-MDSCs) and monocytic MDSCs (Mo-MDSCs). A single dose of IORT may be an effective approach to improve antitumor immunity based on the increase in NK cells and the non-stimulation of immunosuppressive cells involved in immune escape. These findings support future combinations of IORT with immunotherapy, if they are confirmed in a large cohort of breast cancer patients.     

术中照射野新型遮挡材料的研制与效果评析

本文介绍一种复合放射线遮挡材料,用于术中放射治疗照射野内重要组织器官的保护。     

Intraoperative Radiotherapy

IORT is a promising tool for improving cancer treatment in patients with tumors that cannot be locally controlled by conventional surgery or radiotherapy. Results of clinical trials in progress should clarify its clinical merits and limitations in the treatment of locally advanced gastric, pancreatic, and retroperitoneal tumors. Principles and techniques are discussed.