舌癌颈淋巴清扫术不同术式的临床疗效

舌癌是最常见的口腔癌[1],由于早期临床症状不明显[2],往往被大家忽略,确诊的时候病情已经扩展到了中晚期,不仅增加了患者的治疗难度,同时为患者带来无尽痛苦.舌癌的颈淋巴结转移率较高[3],初诊病例约30％即发现有转移.舌癌的预后决定于原发癌的大小和颈部有无淋巴结转移[4].因此,对于早期舌癌来说颈淋巴清扫术显得格外重要.本文拟对比早期舌体鳞癌患者实施舌骨上颈淋巴清扫术及肩胛舌骨上颈淋巴清扫术的疗效.     

颈淋巴清扫术的术式选择

颈淋巴清扫术是治疗口腔颌面部恶性肿瘤的常规手术。按手术的性质，颈淋巴清扫术分为治疗性颈淋巴清除术和选择性颈淋巴清除术。     

颈淋巴清扫术治疗老年舌癌患者的疗效及对CD44V6和MMP-9表达的影响

目的探讨老年舌癌实施颈淋巴清扫术的治疗效果,并观察CD44V6和MMP-9在舌癌组织中的表达。方法采用骨上颈淋巴清扫术治疗老年舌癌患者,并通过免疫组织化学PV9000法观察舌癌和癌旁正常组织中CD44V6和MMP-9的临床表达。结果舌癌中CD44V6的阳性表达率略低于癌旁组织,但无统计学意义(P>0.05);舌癌中MMP-9的阳性表达率明显高于癌旁正常组织(P<0.05);且有颈淋巴结转移组中的舌癌组织CD44V6和MMP-9阳性表达率明显高于无颈淋巴结转移组(P<0.05)。结论采用肩胛舌骨上颈淋巴清扫术治疗舌癌的疗效好,复发率低,舌癌组织中CD44V6和MMP-9的表达和颈淋巴结转移密切相关,可作为评价舌癌颈淋巴结转移和预后的生物学指标。     

分区性颈淋巴结清扫术在治疗甲状腺癌颈淋巴结转移中的应用

目的 探讨分区性颈清术在治疗甲状腺癌颈淋巴结转移中的价值。方法 选择35例甲状腺癌颈淋巴结转移患者实施分区性颈淋巴结清扫术，同时选择实施传统清扫术的相同诊断的患者38例做对照组，对实施两种不同手术后的患者的生存率、复发情况、生存质量进行3年随访观察。结果 两组患者术后3年生存率无明显差别，而分区性清扫术后患者的生存质量明显优于行传统颈清扫术的患者。结论 应用分区性颈淋巴结清扫术可以在很大程度上取代传统的颈淋巴结清扫术，达到与传统手术相同的临床效果，同时又能最大限度地减少手术创伤，提高生存质量。     

乳腺癌腋窝淋巴结清扫术中保留肋间臂神经78例临床分析

既往乳腺癌腋窝淋巴结清扫术中,经常将肋间臂神经（ICBN）连同腋窝组织整块切除,以致术后患者出现上臂内侧麻木、疼痛等并发症。2004年1月～2008年2月,我们在78例乳腺癌腋窝清扫术中实施保留ICBN的手术方案,取得满意效果。现报告如下。     

腹部术后功能性胃排空障碍24例临床分析

功能性胃排空障碍（FDGE）又名胃瘫综合征,是指腹部术后继发的以胃排空障碍为主要征象、因胃流出道非机械性梗阻引起的胃动力紊乱。1997～2007年,本院发生腹部术后FDGE24例。现将其临床资料分析如下。     

腹膜透析三种装置的临床应用比较

1981～2007年,我们应用三种不同的腹膜透析装置开展膜透析患者245例.现报告如下. 临床资料:同期住院及家庭腹膜透析患者245例,按透析装置分为三组.Ⅰ组74例,男59例、女19例,年龄(43±9)岁;     

先天性唇裂功能性修复术的临床应用(附36例报告)

为重建先天性唇裂患者的口轮匝肌功能，减少术后畸形，对36例唇裂患者于唇裂修复术中将裂隙两侧迷走的口轮匝肌剥离、切断、复位，于前唇皮肤下方对位缝合(功能性修复术)。结果全部病例刀口均I期愈合，口轮匝肌运动时上唇各部分协调一致，上唇及鼻外形满意。认为功能性修复术可获得满意的外形及功能效果。     

食管扩张术临床应用指南

食管扩张术因其并发症发生率和死亡率相对较低，在临床上的应用越来越广泛。但到目前为止，有关食管扩张术应用的对照研究资料很少。以下指南为更好应用这一技术和推广标准草案的使用提供参考。     

颈淋巴结清扫术治疗颈淋巴结结核

目的探讨混合型颈淋巴结结核的外科治疗途径。方法采用颈淋巴结清扫术治疗１２２例混合型颈淋巴结结核。并对脓肿、窦道，肿大淋巴结大小、个数、发生部位、病理类型进行分析。结果１２２例颈淋巴结结核全部治愈，随访１～７年无复发。广泛性、顺行性感染、慢性迁延性是混合型颈淋巴结结核的特征。结论颈淋巴结清扫术是治疗混合型颈淋巴结结核的理想术式，具有治疗时间短、疗效确切、切口隐蔽、无功能障碍、并发症少等优点     

Clinical features of spontaneous coronary artery dissection

BackgroundSpontaneous coronary artery dissection (SCAD) is an infrequent but increasingly recognized cause of acute coronary syndrome (ACS). Previous case reports demonstrated that this condition occurs in young females with a low atherosclerotic risk factor burden and may be associated with peripartum or postpartum status. The purpose of this study was to review patients with angiographically confirmed SCAD to provide additional insight into the diagnosis and treatment of this condition.Methods and resultsWe screened medical records of all patients with ACS from March 2001 to November 2012. From these patients, we selected patients with SCAD based on coronary angiographic review. Of a total of 1159 ACS patients, 10 patients (0.86%) were diagnosed with SCAD. The mean age of these patients was 46 years, and 9 were female. ST-elevation myocardial infarction (STEMI) was observed in 9 patients and 5 patients had no coronary risk factors. One patient was treated conservatively with medication alone and 3 patients underwent thrombectomy. Balloon angioplasty was performed in 2 patients, and a bare metal stent was placed in one of these patients later. In the remaining 4 patients, bare metal stents were implanted emergently. Follow-up coronary angiography showed appropriate repair of SCAD in all 10 patients.ConclusionsIn our experience, the clinical features of SCAD appear to be similar to those reported previously. SCAD appears to be rare, but it should be considered in ACS patients, especially in younger females.     

Clinical experience of using a novel self‐help inflatable balloon to prevent esophageal stricture after circumferential endoscopic submucosal dissection

Although endoscopic submucosal dissection (ESD) is gradually becoming a first‐line treatment for superficial esophageal neoplasms (SEN), strictures occur in almost 100% of cases after circumferential ESD. A standard method to prevent stricture has not been established. Thus, we propose a novel self‐help inflatable balloon to prevent stricture. The new balloon was used by the patients themselves at home (4–5 times a day, duration of each procedure was approximately 15–20 min), and was removed when the defects were almost healed. From January 2018 to September 2018, eight patients who received circumferential ESD for SEN and underwent a novel self‐help inflatable balloon to prevent stricture were enrolled. Median size of the mucosal defects was 76.3 mm (range: 50–90 mm). Median time for removing the self‐help inflatable balloon was 94.6 days (range, 71–119 days). Only one (12.5%) patient experienced stricture, and three endoscopic balloon dilation sessions were carried out for this patient. All patients tolerated the balloon well, and none experienced perforation or delayed bleeding. The self‐help inflatable balloon seems to show a high preventive effect against stricture in patients whose mucosal defect was no longer than 100 mm in length after esophageal circumferential ESD. This method is economic, feasible, and safe.