肌肉减少症对食管癌术后并发症影响的Meta分析

目的:Meta分析术前肌肉减少症对食管癌术后并发症的影响。方法:检索PubMed、Embase、中国生物医学文献服务系统、中国期刊全文数据库、维普和万方数据库,收集建库至2017年4月公开发表的相关研究。应用RevMan 5.3软件进行Meta分析。结果:纳入6个队列研究共1 158例食管癌手术患者,合并术前肌肉减少症547例(47.2%),BMI(MD=-2.48,95％CI:-3.36~-1.60,P<0.000 01)、VC%(MD=-5.88,95％CI:-8.76~-3.00,P<0.000 1)和FEV1.0%(MD=-3.33,95％CI:-5.89~-0.77,P=0.01)低于无肌肉减少症者,肺部并发症（RR=1.77,95％CI:1.10~2.84,P=0.02）和吻合口瘘（RR=1.47,95％CI:1.10~1.98,P=0.010）的发生风险增高。结论:术前存在肌肉减少症的食管癌患者BMI较低,同时肺功能低下,术后发生肺部感染、吻合口瘘的风险增加。     

Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden

Objective:Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes.European randomized controlled trials with recruitment in the 1990's reported increased morbidity and mortality for D2 compared to D 1.Here,we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study.Methods:A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer.All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included.Patients were categorized into D0,D 1,or D 1 +/D2,and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression.Results:In total,349 (31.7％) patients had a D0,494 (44.9％) D1,and 258 (23.4％) D1+/D2 lymphadenectomy.The 30-d postoperative complication rates were 25.5％,25.1％ and 32.2％ (D0,D1 and D1+/D2,respectively),and 90-d mortality rates were 8.3％,4.3％ and 5.8％.After adjustment for confounders,in multivariable analysis,there were no significant differences in risk for postoperative complications between the lymphadenectomy groups.For 90-d mortality,there was a lower risk for D1 vs.D0.Conclusions:The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1).More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.     

Role of lymphadenectomy for ovarian cancer

Japan Society of Gynecologic Oncology (JSGO) recently revised its Ovarian Cancer Treatment Guidelines and the 4th edition will be released next year. This Guidelines state that lymphadenectomy is essential to allow accurate assessment of the clinical stage in early ovarian cancer, but there is no randomized controlled trial that shows any therapeutic efficacy of lymphadenectomy. In patients with advanced stage tumors, lymphadenectomy should be considered if optimal debulking has been performed. I fully agree with this recommendation of the JSGO and I would like to discuss the role of lymphadenectomy in the management of ovarian cancer.     

Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

No randomised trials have addressed the value of systematic aortic and pelvic lymphadenectomy (SL) in ovarian cancer macroscopically confined to the pelvis. This study was conducted to investigate the role of SL compared with lymph nodes sampling (CONTROL) in the management of early stage ovarian cancer. A total of 268 eligible patients with macroscopically intrapelvic ovarian carcinoma were randomised to SL (N=138) or CONTROL (N=130). The primary objective was to compare the proportion of patients with retroperitoneal nodal involvement between the two groups. Median operating time was longer and more patients required blood transfusions in the SL arm than the CONTROL arm (240 vs 150 min, P<0.001, and 36 vs 22%, P=0.012, respectively). More patients in the SL group had positive nodes at histologic examination than patients on CONTROL (9 vs 22%, P=0.007). Postoperative chemotherapy was delivered in 66% and 51% of patients with negative nodes on CONTROL and SL, respectively (P=0.03). At a median follow-up of 87.8 months, the adjusted risks for progression (hazard ratio [HR]=0.72, 95%CI=0.46-1.21, P=0.16) and death (HR=0.85, 95%CI=0.49-1.47, P=0.56) were lower, but not statistically significant, in the SL than the CONTROL arm. Five-year progression-free survival was 71.3 and 78.3% (difference=7.0%, 95% CI=-3.4-14.3%) and 5-year overall survival was 81.3 and 84.2% (difference=2.9%, 95% CI=-7.0-9.2%) respectively for CONTROL and SL. SL detects a higher proportion of patients with metastatic lymph nodes. This trial may have lacked power to exclude clinically important effects of SL on progression free and overall survival.     

卵巢癌二次探查手术中淋巴结清扫的意义

背景与目的：盆腹腔淋巴结清扫是国际妇产联盟（FIGO）卵巢癌手术病理分期的主要内容之一,但在卵巢癌的二次探查手术中,盆腔和腹主动脉旁淋巴结清扫的价值还存在争议。本文拟分析有关资料,以对卵巢癌二次探查手术中淋巴结清扫的价值进行探讨。方法;收集中国医学科学院肿瘤医院1994年7月1日至1996年10月1日收治的15例Ⅲ期和Ⅳ期卵巢癌患者的临床资料并进行回顾性分析。结果：15例患者的组织病理类型均为卵巢浆液性乳头状囊腺癌;组织分化程度分别为：高分化2例、中分化7例、低分化6例。15例患者在初次细胞减灭术时均没有进行淋巴结清扫,“二探术”时患者的盆腔和腹主动脉旁淋巴结均为阴性。“二探术”阴性的10例患者中有4例（40％）发生肿瘤复发,复发部位为盆腔腹膜、腹腔和肝脏,盆腔和腹主动脉淋巴结均没有复发。结论：初次减灭术时淋巴结阴性的卵巢癌患者,在进行“二探术”时可不必进行淋巴结清扫。     

70岁以上老年肺癌术后并发症分析

目的:分析70岁以上老年患者肺癌术后并发症的原因.方法:回顾性分析30例老年肺癌患者手术的临床资料.结果: 全组住院期间死亡2例,术后发生呼吸衰竭16例,心律失常8例,1年生存率为76.6%,3年生存率38.6%.结论: 生理年龄和心肺功能是影响高龄肺癌患者外科治疗的重要因素, 围术期处理是手术成功的关键.     

肺癌患者手术后肺部并发症发生的良好预测指标分析

目的探讨肺癌患者手术前肺功能指标对肺切除术后肺部并发症的预测能力。方法收集698例进行开胸肺切除手术患者术前肺功能检查的详细资料,回顾性分析常规肺功能检查指标与术后肺部并发症(PPC)的关系。结果在698例手术治疗的肺癌患者中,有86例(12.3%)患者术后发生肺部并发症(PPC)。PPC组与无PPC组中第一秒用力呼气容积(FEV1)、第一秒用力呼气容积占预计值百分比(FEV1%)、最大分钟通气量(MVV)、最大分钟通气量占预计值百分比(MVV%)、一次呼吸法测定肺一氧化碳弥散量(TLCOSB)、肺一氧化碳弥散量占预计值百分比(TLCOSB%)、肺泡一氧化碳弥散量占预计值百分比(TLCOVA%)、PpoFEV1和PpoFEV1%指标经t检验差异有统计学意义(P<0.05);而FVC和TLCOVA指标差异无统计学意义(P>0.05)。将698例患者分别根据通气和弥散功能障碍分组,PPC的发生率在FEV1%<70%、PpoFEV1%<40%和TLCOSB%<60%组明显升高,各组间差异有统计学意义(P<0.05);而不同PpoFEV1组间差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,FEV1%(OR=0.868,P<0.05)和TLCOSB%(OR=0.937,P<0.05)是预测术后PPC的独立保护因素,手术时间(OR=1.021,P<0.05)是预测术后PPC的独立危险因素。结论术前肺功能可以预测肺癌患者肺切除术后肺部并发症的发生,FEV1%和TLCOSB%是预测肺部并发症发生的良好指标。     

Prognostic evaluation of lymphadenectomy for epithelial ovarian cancer

Between 1989 and 1991, 150 patients with ovarian cancer were treated with chemotherapy, including cisplatin, in the Tokai Ovarian Tumor Study Group. Of these patients, 25 underwent cytoreductive surgery with lymphadenectomy, including removal of either pelvic or para-aortic lymph nodes, and 36 underwent both lymphadenectomies. A significant difference was observed between survival curves of the groups with positive and negative lymph nodes, respectively (P = 0.0049). The overall survival was longer in the lymphadenectomy group than in the nonlymphadenectomy group (P = 0.0842), and a significantly longer survival time was noted for stage III patients who underwent lymphadenectomy compared to those who did not (P = 0.0185). Multivariate analysis demonstrated that lymphadenectomy is a positive prognostic factor. The authors conclude that both pelvic and para-aortic lymph nodes should be resected to improve survival as well as to assess exact staging in patients with ovarian cancer. © 1995 Wiley-Liss, Inc.     

Evaluation of radical lymphadenectomy in breast cancer

The study was concerned with establishing parallel clinico-roentgeno-morphological features in diagnosis of lesions in axillary lymph nodes in 128 breast cancer patients. Complex evaluation of lymphographic and palpation evidence proved valuable because its application allows to avoid diagnostic errors for a certain stage of the disease. Also the results of X-ray postoperative evaluation of radicality of lymphadenectomies carried out in 100 mastectomies after Halsted, 22 mastectomies after Patey and 15 axillary lymphadenectomies are presented. Relatively less extent of excision for breast cancer was shown to involve higher risk of incomplete removal of apical nodes. It is emphasized that diagnosis improvement still remains a major aspect of small-scale surgical intervention.     

肺切除术后并发症与肺功能相关危险因素分析

目的:评估肺切除术后并发症与术前肺功能及手术方式的相关危险因素.方法: 回顾总结517例肺切除患者的临床资料,分析术后并发症与术前肺功能和手术方式的关系. 结果: 术后并发症总发生率为21.3%(110/517);术前肺功能正常者肺功能与并发症发生率14.0%,轻度障碍者发生率17.4%,中度障碍者发生率22.8%,重度障碍者发生率60.4%;全肺切除并发症发生率49.4%,双叶肺切除发生率18.7%,单叶肺切除发生率14.2%.结论:术后并发症与术前肺功能和手术切除范围相关,术前肺功能越差、手术范围越大,术后并发症发生率越高.     

老年胃癌患者术后并发症的临床分析

目的 探讨75岁以上老年胃癌患者术前合并疾病、临床病理情况以及术后并发症发生情况及其危险因素.方法 回顾性分析2009年1月至2009年12月间我院施行胃癌根治手术的337例患者,其中年龄≥75岁的患者40例,占11.87％,其余小于75岁的患者297例作为对照组,分析比较两组患者术前合并症等临床病理资料及术后并发症情...     

腹腔镜辅助直肠癌根治术后并发症及其相关因素分析

目的 分析腹腔镜辅助直肠癌根治术后并发症及其相关因素.方法 回顾分析2010年11月至2013年8月接受腹腔镜辅助直肠癌根治术310例患者的临床资料,比较有并发症组与无并发症组临床资料的差异.对发生术后并发症的危险因素进行单因素和多因素Logisitic回归分析.结果 310例患者中80例出现并发症.单因素分析显示：性别、发病年龄、术前合并疾病、体质量指数、肿瘤位置、分期、术者手术经验及手术时间与腹腔镜辅助直肠癌根治术后并发症相关（均P＜ 0.05）.多因素回归分析显示：性别、体质量指数、肿瘤位置、术前分期、术前合并疾病和术者手术经验是术后并发症发生的独立危险因素（均P＜0.05）.260例患者获得3～30个月（中位数18个月）的随访,有并发症组与无并发症组的生存曲线差异无统计学意义（x2=1.201,P=0.273）.结论 腹腔镜辅助直肠癌根治术后并发症发生的独立危险因素为性别、体质量指数、肿瘤位置、术前分期、术前合并疾病和术者手术经验.有无并发症患者的近期和中期生存情况相似.     

聚焦解决模式干预预防卵巢癌术后并发症的效果分析

目的 探讨聚焦解决模式干预预防卵巢癌术后并发症的效果.方法 将90例卵巢癌患者根据是否实施聚焦解决模式干预分为观察组(给予聚焦解决模式护理,45例)和对照组(给予常规护理,45例).比较两组患者心理状态、疾病认知水平、术后并发症发生情况以及护理满意度.结果 干预前,两组患者医院焦虑抑郁量表(HADS)中焦虑、抑郁维度评...     

Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients

Objective

To investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients.

Methods

We retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses.

Results

Following IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized <1 cm (optimal), and 11 had residual disease sized ≥1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS.

Conclusion

NGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.     

胃癌患者术前贫血与术后并发症及预后的相关性

目的:探讨术前贫血和贫血程度与胃癌并发症及预后的关系.方法:对2008年10月至2016年11月期间空军军医大学西京医院消化外科3692例行胃癌根治术患者的临床资料进行分析.探索术前贫血和贫血程度对胃癌术后并发症和预后的影响.结果:3692例患者中,男性2889例(78.3％),女性803例(21.7％).贫血患者14...