EGFR在肾癌中的研究进展

随着分子生物学技术的提高,针对细胞受体和调控分子为靶点的靶向治疗已成为国内外肿瘤治疗的热点。表皮生长因子受体(EGFR)与多种实体肿瘤的发生、发展及肿瘤的侵袭、转移有密不可分的关系,如在卵巢癌、肺癌、头颈部癌等肿瘤中,都检测到EGFR的高表达。表皮生长因子及其阻滞剂的研究在临床肿瘤的治疗中显示出了巨大的潜力。EGFR在肾癌细胞中高表达,本文就针对近年EGFR在肾癌中的研究进展作一综述。     

机器人解剖性右肝后叶切除术

目的探讨应用达芬奇机器人行解剖性右肝后叶切除术的可行性、安全性及优势。 方法选取南华大学附属第一医院于2020年12月收治的1例61岁男性肝肿瘤患者，腹部增强CT及MRI提示肝S6、S7段肝细胞癌可能，肿瘤大小约80 mm×60 mm。评估无明显手术禁忌证后，经充分术前准备，拟在全身麻醉下行机器人解剖性右肝后叶切除术，围手术期实施加速康复外科管理模式。 结果手术顺利，手术时间约150 min，术中出血量约100 mL，术后无肝衰竭、出血、感染等并发症，术后7 d出院。术后病理示肝细胞癌，切缘均为阴性，术后4个月和10个月复查CT未见肿瘤复发、转移征象。 结论机器人行解剖性右肝后叶切除术是安全、可行的。     

精益临床 教研共进——记空军军医大学(原第四军医大学)口腔医学院头颈肿瘤外科 张圃

正张圃男,医学博士,口腔临床医学博士后,空军军医大学(原第四军医大学)口腔医学院头颈肿瘤外科副教授、副主任医师、硕士研究生导师。从事口腔颌面外科临床、教学、科研工作20余年,擅长口腔颌面-头颈部良性肿瘤、恶性肿瘤的诊断与治疗,包括肿瘤根治手术、肿瘤微创治疗;肿瘤切除后面貌恢复手术中美容技术与理念的应用;近、远处组织转移修复肿瘤切除后缺损及口腔功能重建;口腔颌面-头颈部的多学科综合治疗。     

脊柱手术机器人在脊柱外科手术中的应用进展

过去十年间,智能医疗技术已经成为研究的热点方向,并衍生出图像辅助AI和肿瘤诊断辅助系统等一系列技术.在外科领域,外科机器人是最有吸引力的智能技术之一.经过近十年的发展,机器人在脊柱外科手术中显露出巨大优势,已有大量关于准确性和辐射量的研究报道.但是,文献查阅过程中亦暴露出机器人的一些不足,促使我们对脊柱机器人的综合评价进行了回顾.此综述总结了已发表文章中提到的结果和我们已总结而未发表的结论,希望这些总结有助于研究人员将来对机器人进行针对性的改进,并拓宽脊柱手术机器人的未来方向.脊柱手术机器人技术被认为在未来应用中前景光明,但是与其他现有的应用技术相比,亟须解决应用范围窄、应用深度浅和优势不突出的缺点.     

达芬奇机器人胃癌根治术淋巴结清扫的策略与效果

2000年7月,美国食品和药物管理局（food and drug administration,FDA）正式批准了Intuitive Surgical公司研发的达芬奇机器人手术系统应用于临床外科治疗,在此后几年中,应用达芬奇机器人手术系统相继开展了胆囊切除术、胃底反折术、Heller肌切除术、胃旁路术、结肠切除术等腹部外科手术[1-2]。     

吲哚菁绿在机器人肝脏FNH切除术中的应用

目的总结应用吲哚菁绿(indocyanine green,ICG)在机器人肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)切除术中荧光显影定位导航的方法。方法回顾性分析解放军总医院肝胆胰外科医学部2018年5月至2020年10月行ICG荧光显影术中导航机器人肝脏FNH切除患者的临床病理资料。根据肿瘤大小将患者分为肿瘤<5 cm组和肿瘤≥5 cm组。术前48 h,患者经肘正中静脉注射ICG,剂量0.25 mg/kg。术中在机器人荧光模式下实时定位肿瘤边界并联合应用术中超声完成FNH切除术。结果36例患者中,男17例、女19例,平均年龄28.7岁。35例完成机器人肿瘤切除术、1例中转开腹。肿瘤平均直径(5.9±4.4)cm,13例患者肿瘤<5 cm、23例患者肿瘤≥5 cm。机器人手术患者的中位手术时间120 min,中位术中出血量50 ml,术后平均住院时间3.9 d。两组的手术时间、术中出血量和术后平均住院时间比较,差异有统计学意义(P<0.05)。结论ICG荧光显影术中可实时显示肝脏FNH肿瘤边界,引导外科医师机器人下完整切除肿瘤。     

肝癌冷冻治疗86例报告

冷冻外科是一门外科新技术，近年来有报道冷冻治疗皮肤、直肠、前列腺、妇科及头颈部的肿瘤。我科于1994年11月～1997年2月应用LCS-2000型冷冻机治疗肝癌86例，现报告如下。     

从穿刺孔转移思考腹腔镜机器人胆道肿瘤外科

穿刺孔转移是腹腔镜或机器人肿瘤外科的少见事件,在腹腔镜结直肠癌或泌尿系肿瘤根治术后的发生率约为0.09％～ 0.73％,这和传统开放手术的切口转移率相当.但意外胆囊癌等胆道肿瘤实施腹腔镜或机器人手术后PSM发生率高达6.7％～30.0％,很可能和胆道肿瘤特殊的生物学行为、手术操作违反无瘤原则以及术中胆汁溢漏入腹腔污染切口直接相关.目前对腹腔镜和机器人胆道肿瘤外科技术的早期探索阶段,应在筛选合适的早期病例、提高外科经验、避免术中胆汁溢漏和严格遵守外科肿瘤原则操作等方面严格把关,从而降低PSM的发生率、提高肿瘤学效果.此外,应开展临床对照研究以获得开放手术和腹腔镜/机器人手术治疗胆道肿瘤的远期疗效的证据,明确胆道肿瘤是否可作为腹腔镜机器人技术的适应证.     

达芬奇机器人胃癌手术相关技术与应用前景

1994年经美国FDA批准,自动定位内镜系统作为机器人持镜手应用于普通外科临床,此后又开发了宙斯机器人系统,但FDA仅批准其作为外科手术助手而不能作为真正的手术者。2000年7月,美国FDA正式批准了Intuitive Surgical公司研发的达芬奇机器人手术系统应用于临床外科治疗，在此后几年中，应用达芬奇机器人手术系统相继开展了胆囊切除术、胃底折叠术、Heller肌切开术、胃旁路术、结肠切除术等腹部外科手术。     

达芬奇机器人辅助胃癌根治术的相关问题探讨

1994年经美国FDA批准,自动定位内镜系统作为机器人持镜手应用于普通外科临床,此后又开发了宙斯机器人系统,但FDA仅批准其作为外科手术助手而不能作为真正的手术者。2000年7月,美国FDA正式批准了IntuitiveSurgical公司研发的达芬奇机器人手术系统应用于临床外科治疗,在此后几年中,应用达芬奇机器人手术系统相继开展了胆囊切除术、胃底反折术、Heller肌切除术、胃旁路术、结肠切除术等腹部外科手术。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.