������ҽѧʵ��̸ת��ҽѧ����——��ͨ�ٴ�ҽ�������ʶ�Լ�������ҽѧT1��T2��T3�׶εĽ�ɫ

转化医学的理念已在临床广泛推广,数字医学也在近几年取得快速发展。国内数字医学领域优秀团队的成功元素为:创新的攻关理念、明确的攻关目标、多元的攻关团队、坚韧的攻关精神、精诚团结的攻关核心领导。在此基础上,分析在数字医学的不同阶段,临床医生如何认识自己的角色和任务,树立转化医学理念,从而更好地发挥主观能动性,实现数字医学在临床的跨越发展。     

T型管堵塞胆道1例

患者男，５９岁。１月前因“胆石症、胆道感染”在外院行胆囊切除、总胆管探查Ｔ管引流术，术后病情一度改善。但术后２周出现上腹部胀痛，Ｔ管引出胆汁由每日４００ｍｌ减至每日３０ｍｌ，颜色浑浊，伴恶心、呕吐、低热及黄疸，食欲不振。体查：急性病容，巩膜、皮肤重度...     

T1和T2期直肠癌术后复发转移分析

目的 探讨T1和T2期直肠癌根治术后复发转移相关的临床病理因素.方法 回顾性分析1990年至1999年146例行根治术的T1和T2期直肠癌病例的临床病理资料.结果 T1和T2期直肠癌术后复发转移率为25.3%(37/146).T1期直肠癌复发转移率(0.0%,0/12)明显低于T2期(27.6%,37/134)(P＜0.05).肿瘤占肠腔周径≤50%复发率(17.9%,15/84),明显低于肿瘤占肠腔周径＞50%(35.5%,22/62)(P＜0.05).低位直肠癌复发率(29.3%,34/116)明显高于中高位直肠癌(10.0%,3/30)(P＜0.05).而性别、年龄、病程、大体类型、组织学类型、肿瘤大小与术后复发转移无关.结论 T2期、低位、周径大于50%可能是T1和T2期直肠癌术后发生复发转移的高危因素.     

大肠癌患者外周血T1和T2淋巴细胞变化规律的研究

目的探讨不同临床分期的大肠癌患者外周血T1和T2淋巴细胞的变化规律。方法连续采集20例大肠癌患者初诊时外周血,以20例良性疾病患者外周血作为对照。应用胞内因子检测法检测T1及T2的比率。结果大肠癌患者外周血T1比率为(36±11)%,T2比率为3·3(1·9)%,均明显低于对照组[(46±12)%、4·1(3·1)%](P<0·05)。肿瘤直径≥5cm患者的T1低于肿瘤直径<5cm患者[(31±11)%比(40±10)%,P=0·064];低分化癌患者的T1低于高、中分化癌患者[(28±10)%比(38±11)%,P=0·072];有淋巴结转移患者的T1明显低于无淋巴结转移患者[(31±10)%比(41±10)%,P<0·05];Ⅲ、Ⅳ期患者的T1明显低于Ⅰ、Ⅱ期患者[(31±10)%比(41±10)%,P<0·05]。结论大肠癌患者外周血T1和T2比率显著降低。T1可能是判断大肠癌转移和预后的新指标。     

甲状腺T系恶性淋巴瘤1例

患者女性 ,6 7岁。发现左侧甲状腺肿块 2个月 ,伴有怕冷、食欲差、无力等症状。检查 :左侧甲状腺有 4ｃｍ× 4ｃｍ结节 ,质硬 ,边界不清 ,表面尚光滑 ,无触痛 ,随吞咽活动。体温36 .5℃、血压 16 / 12ｋＰａ ,脉搏 6 8次 /ｍｉｎ。吸13 1Ｉ率 3ｈ 4 .33% ,6ｈ 3.16 % ,2 4ｈ 5 .76 %。甲状腺功能 6项不正常 ;Ｔ3 <0 .5ｎｇ/ｍｌ,Ｔ4<2 0ｎｇ/ｍｌ,ＦＴ42 .8ｐｇ/Ｌ ,ＦＴ3 1.5 ｐｇ/ｍｌ,ＴＳＨ 6 1ｍＵ/Ｌ ,ＴＧＡＢ>30 % ,ＴＭＡＢ>15 %。血沉 2 7ｍｍ/ｈ。肝功能正常。Ｂ超 :甲状腺左叶 6 .3ｃｍ× 3.9ｃｍ× 3.0ｃｍ ,形态失常 ,包膜完…     

T3a前列腺癌报告1例

2012年11月中华医学会泌尿外科学分会（CUA）与欧洲泌尿外科学会（EAU）国际学术交流项目“Rising Star中国行”在广州启动，由EAU奖学金委员会主席，法国C—C．Abbou教授带领3位欧洲青年学者S．Gudjonsson、F．Farag和M．A．Cerruto于11月22日来我院观摩学习期间，就1例前列腺癌患者的诊断和治疗计划进行了讨论，具体如下：     

T2N1前列腺癌的治疗

前列腺癌是威胁男性健康的常见肿瘤之一,近30年来,针对前列腺癌涌现出多种治疗方法,如根治性前列腺切除术、放射治疗及内分泌治疗等。一般认为局限前列腺癌以根治性手术和放射治疗为主,而晚期前列腺癌则以内分泌治疗为主。     

Health-related quality-of-life outcomes after thoracic (T1–T10) fractures

Background contextThe thoracic spine exhibits a unique response to trauma as the result of recognized anatomical and biomechanical differences. Despite this response, clinical studies often group thoracic fractures (T1–T10) with more caudal thoracolumbar injuries. Subsequently, there is a paucity of literature on the functional outcomes of this distinct group of injuries.PurposeTo describe and identify predictors of health-related quality-of-life outcomes and re-employment status in patients with thoracic fractures who present to a spine injury tertiary referral center.Study designAn ambispective cohort study with cross-sectional outcome assessment.Patient sampleA prospectively collected fully relational spine database was searched to identify all adult (>16 years) patients treated with traumatic thoracic (T1–T10) fractures with and without neurologic deficits, treated between 1995 and 2008.Outcome measuresThe Short-Form-36, Oswestry Disability Index, and Prolo Economic Scale outcome instruments were completed at a minimum follow-up of 12 months. Preoperative and minimum 1-year postinjury X-rays were evaluated.MethodUnivariate and multivariate regression analysis was used to identify predictors of outcomes from a range of demographic, injury, treatment, and radiographic variables.ResultsOne hundred twenty-six patients, age 36±15 years (mean±SD), with 135 fractures were assessed at a mean follow-up of 6 years (range 1–15.5 years). Traffic accidents (45%) and translational injuries (54%) were the most common mechanism and dominant fracture pattern, respectively. Neurologic deficits were frequent—53% had complete (American Spinal Injury Association impairment scale [AIS] A) spinal cord deficits on admission. Operative management was performed in 78%. Patients who sustain thoracic fractures, but escaped significant neurologic injury (AIS D or E on admission) had SF-36 scores that did not differ significantly from population norms at a mean follow-up of 6 years. Eighty-eight percent of this cohort was re-employed. Interestingly, Oswestry Disability Index scores remained inferior to healthy subjects. In contrast, SF-36 scores in those with more profound neurologic deficits at presentation (AIS A, B, or C) remained inferior to normative data. Fifty-seven percent were re-employed, 25% in their previous job type. Using multiple regression analysis, we found that comorbidity status (measured by the Charlson Comorbidity index) was the only independent predictor of SF-36 scores. Neurologic impairment (AIS) and adverse events were independent predictors of the SF-36 physical functioning subscale. Sagittal alignment and number of fused levels were not independent predictors.ConclusionsAt a mean follow-up of 6 years, patients who presented with thoracic fractures and AIS D or E neurologic status recovered a general health status not significantly inferior to population norms. Compared with other neurologic intact spinal injuries, patients with thoracic injuries have a favorable generic health-related quality-of-life prognosis. Inferior outcomes and re-employment prospects were noted in those with more significant neurologic deficits.     

原发性T10脊椎平滑肌肉瘤1例

平滑肌肉瘤是多见于腹膜后隙、腹腔内脏器以及肢体皮下组织的恶性肿瘤,原发于骨的平滑肌肉瘤少见,而原发于脊往的平滑肌肉瘤更少见,笔者只检索到2例报道。本院收治1例原发于T10的骨原发平滑肌肉瘤．报道如下。     

T管长臂引起十二指肠瘘1例

Ｔ管长臂压迫引起十二指肠瘘实属罕见,我院经治１例,报告如下。１　病例摘要患者女性,７２岁,以急性胆囊炎、胆石症、胆源性胰腺炎行胆囊切除、胆总管Ｔ管引流、胰包膜切开、胰床引流术,术中见腹腔内有中等量淡黄色液体,大网膜皂化灶,胆囊约１０ｃｍ×６ｃｍ,胆总管直径１．０ｃｍ,胰头肿胀,质偏硬。于小网膜孔置腹腔引流管１根,与Ｔ管在右腹壁另戳孔一并引出固定,另置胰床引流管２根于左腹壁引出。术后４日腹腔引流量各为４０ｍｌ、５ｍｌ、１０ｍｌ、０ｍｌ,拔除腹腔引流管及胃管,患者无腹胀腹痛。术后第９日Ｔ管旁有少量淡…     

T1G3膀胱肿瘤的处理

对局限的T1aG3和T1bG3表浅膀胱肿瘤 ,没有前列腺浸润或伴发的Tis适合保守性治疗和严密监测证实。经过一个疗程的BCG治疗早期复发T1G3是不详之兆 ,对这种患者膀胱切除或化疗 免疫预防序联疗法应当被考虑 ,两个疗程后没有缓解 ,则必须行膀胱切除 ,经常有一些T1G3患者行膀胱切除时已经太晚。     

T1G3膀胱肿瘤的处理

对局限的T1aG3和T1bG3表浅膀胱肿瘤，没有前列腺浸润或伴发的Tis适合保守性治疗和严密监测证实。经过一个疗程的BCG台疗早期复发T1G3是不详之兆，对这种患者膀胱切除或化疗-免疫预防序联疗法应当被考虑，两个疗程后没有缓解，则必须行膀胱切除，经常有一些T1G3患者行膀胱切除时已经太晚。     

pDC1抑制T细胞增殖的实验研究

目的　研究 pDC1体外对T细胞增殖的抑制作用。方法　采集健康恒河猴外周血 ,用Ficoll Hypaque梯度离心法和三色流式细胞仪分离 pDC1,经混合淋巴细胞培养 (MLR)研究其免疫调整功能。结果　新鲜分离的 pDC1具有较弱的刺激T细胞增殖能力 ;在经CD40L培养后 pDC1即成熟DC1成为有效的T细胞刺激增殖者。结论　本实验用MLR方法成功地研究了恒河猴外周血pDC1体外抑制T细胞增殖的作用 ,为阐明pDC1诱导免疫耐受的作用机制奠定了基础。     

T1G3期膀胱癌诊治策略

膀胱癌是我国泌尿系统最常见的恶性肿瘤，新发病例中75％的病变局限于黏膜和固有层，临床分期属于T1期。其中10％的肿瘤病理分级属于G3级。把临床分期T1、病理分级G3的膀胱移行上皮癌统称为T1G3期膀胱癌。研究发现，T1G3期膀胱癌患者疾病进展和死亡的风险比其他T1期肿瘤患者高出10倍，其生物学行为复杂、临床预后较差，临床诊治相对较为棘手。目前国际上对于这类疾病多采取经尿道膀胱肿瘤电切联合膀胱灌注BCG保留膀胱、或根治性膀胱切除术的方式进行治疗。但何时选择保留膀胱的治疗方案、何时选择根治性膀胱切除术，还需要根据患者的具体临床风险因素进行综合分析，并制定最佳的治疗方案。作者在认真学习并总结国际上关于T1G3期膀胱癌最新治疗指南的基础上，对这类疾病的诊断与治疗的最新理念及方法进行综合分析，供广大泌尿外科同道参考。