经胸乳径路腔镜甲状腺切除术91例

目的：探讨经胸乳径路腔镜甲状腺手术的临床效果。方法：全麻下行胸乳径路腔镜甲状腺切除术91例,其中结节性甲状腺肿48例,甲状腺腺瘤38例,甲状腺乳头状癌5例。结果：91例均顺利完成手术,手术时间50～195min,平均（120.5±29.6）min;术后发生颈部皮下积液和一过性声音嘶哑各1例。随访2～44个月,中位数21个月,无复发,患者对手术及美容效果均表满意。结论：胸乳径路腔镜甲状腺切除术是安全可行的,具有很好的美容效果。     

经胸乳径路腔镜甲状腺手术180例的临床研究

目的探讨经胸乳径路腔镜甲状腺手术技巧及其并发症的防治。方法回顾分析2005年3月至2009年12月经胸乳径路腔镜甲状腺手术180例患者的临床资料。结果本组178例腔镜甲状腺手术顺利完成,2例中转开放手术,其中1例为结节性甲状腺肿,因甲状腺体积大,空间狭小中转开放手术,另1例为原发性甲状腺功能亢进,因粘连严重、创面广泛渗血中转开放手术。全组手术时间70～190 min,平均110 min。术中出血量5～75 ml。术后出现皮肤瘀斑2例,抽搐1例,均于2周后恢复正常。声音嘶哑1例,1个月后恢复正常。住院时间3～6 d,平均4.5 d。结论经胸乳径路腔镜甲状腺手术是一种极富技巧性的手术,甲状旁腺损伤和喉返神经损伤是其严重并发症,规范手术操作能有效减少并发症的发生。     

甲状腺良性肿瘤腔镜手术50例分析

目的探讨腔镜手术治疗甲状腺良性疾病的临床应用价值。方法回顾性分析2年间采用胸乳径路完成的腔镜手术治疗甲状腺良性疾病50例的临床资料,着重分析手术相关技巧、并发症及效果。结果 50例腔镜手术均顺利完成,无中转开放病例,均达到完整肿瘤切除的目的、无肿瘤残留,且手术创伤小、美学效果肯定,无明显并发症发生。结论经胸乳径路行甲状腺腔镜手术较开放手术具有微创、美学等优势,且无明显并发症发生,成功率高。     

胸乳途径腔镜甲状腺手术影响因素及对策

经胸乳途径是目前最常用的完全腔镜下甲状腺手术径路,因颈部切口瘢痕小而隐蔽,受到广大患者的欢迎。但腔镜下甲状腺手术需人工建立手术空间、甲状腺血运丰富且局部解剖复杂、手指不能直接接触甲状腺组织等因素,使腔镜下甲状腺手术较为困难。     

经胸乳径路腔镜甲状腺切除术350例体会

目的探讨经胸乳径路腔镜甲状腺切除术的方法及其可行性。方法 2008年3月至2011年5月行经胸乳径路腔镜甲状腺切除术350例,回顾性分析350例患者的临床资料。其中甲状腺瘤142例,结节性甲状腺肿180例,原发性甲状腺机能亢进23例,甲状腺乳头状微小癌5例。行甲状腺瘤摘除术16例,单侧甲状腺次全切除130例,双侧甲状腺次全切除134例,单侧甲状腺腺叶切除42例,甲状腺全切除28例。结果手术过程顺利,平均手术时间（72.0±30.4）min,平均术中出血量（45.0±15.8）ml,无中转开放手术,无声嘶或甲状旁腺损伤等并发症发生,平均住院时间（7.0±4.5）d,术后随访3～30个月,无复发病例。结论经胸乳径路腔镜甲状腺切除术是安全可行的,且具有良好的美容效果。     

胸前入路完全腔镜甲状腺癌手术经验与技巧

<正>完全腔镜甲状腺手术(totally endoscopic thyroidectomy,TET)将传统颈部手术切口转移至隐蔽部位,具备卓越的美容效果及一定程度的微创特征,又称为颈部无疤痕腔镜甲状腺手术(scarless endoscopic thyroidectomy,SET)[1]。SET可选择不同的手术径路,如经腋窝、胸乳、腋乳等,近年还增加了经口入路     

腔镜甲状腺手术径路的研究进展

随着术者操作水平的提高及腔镜器械、超声刀等辅助工具的发展,腔镜甲状腺手术越来越得到人们的青睐,尤其年轻爱美女性。我国目前应用较多的是经胸乳入路腔镜甲状腺手术,其颈部无瘢痕,切口可被内衣遮盖,具有良好的美容效果。腔镜甲状腺手术还有其他入路,如颈部入路、锁骨下入路、全乳晕入路、口腔入路等。笔者结合国内外相关文献报道,现就腔镜甲状腺手术径路作一综述。     

非颈部切口腔镜甲状腺手术的技巧

目的:探讨非颈部切口腔镜甲状腺手术的技术难点及处理技巧。方法:回顾分析2006年10月至2009年12月为332例患者行经胸乳径路腔镜甲状腺手术的临床资料。结果:324例成功完成腔镜手术,8例中转开放手术。手术时间40～240min,平均80min。术中平均出血20ml。术后2～3d拔除颈部引流管,术后3～5d出院。手术未损伤喉上神经、喉返神经及甲状旁腺。随访310例6～18个月,术后无一例肿瘤复发。患者对术后美容效果非常满意。结论:非颈部切口腔镜甲状腺手术安全可行,创伤不大,兼具美容效果,且可同时处理双侧甲状腺肿瘤,不仅可作为治疗良性甲状腺肿瘤的首选方法,而且可有选择地用于治疗早期甲状腺乳头状癌和Ⅱ度肿大甲亢。     

胸乳入路腔镜甲状腺手术的临床应用

目的探讨胸乳入路腔镜甲状腺手术的临床应用价值。方法回顾分析2008年11月—2009年3月15例经胸乳入路腔镜甲状腺手术的临床资料。结果15例手术均成功,其中甲状腺腺瘤切除术11例,单侧甲状腺部分切除术4例。平均手术时间94 min(75~130 min),术中出血量25 mL(15~40 mL),术后住院时间4.5 d(3~7 d)。术后无严重并发症。15例随访1~6个月,无复发,所有患者对美体效果满意。结论胸乳入路腔镜甲状腺手术安全、可行、美体效果好,值得临床     

全乳晕入路与胸乳入路腔镜手术治疗甲状腺微灶癌的临床比较

目的:比较全乳晕入路和经胸乳入路腔镜甲状腺微灶癌手术的临床效果。方法:回顾性分析2014年1月—2015年6月甲状腺微灶癌患者行腔镜下甲状腺腺叶+峡部切除与中央组淋巴结清扫术50例,其中行全乳晕入路21例(全乳晕组),胸乳区入路29例(胸乳组),比较两组患者的相关临床指标。结果:两组患者年龄、肿瘤最大直径差异无统计学意义(均P0.05)。两组患者均在腔镜下顺利完成手术,全乳晕组与胸乳组比较,平均淋巴结清扫数目(5.90枚vs.6.07枚)、手术时间(99.95 min vs.99.17 min)、术中出血量(23.81 m L vs.28.21 m L)、住院时间(5.19 d vs.6.07 d)、术后疼痛评分及术后并发症发生率差异均无统计学意义(均P0.05);全乳晕组患者对手术切口满意度明显高于胸乳组(8.81vs.6.59,P0.0001)。结论:全乳晕入路腔镜甲状腺手术与胸乳入路腔镜甲状腺手术在治疗甲状腺微灶癌方面疗效相当,全乳晕入路具有更好的美容效果,是一种安全理想的手术方式。     

Sagittal plane analysis of the open and closed methods in children with displaced supracondylar fractures of the humerus (a radiological study)

OBJECTIVES: The aim of this study was to compare the radiological outcome of open and close reduction and osteosynthesis methods in the treatment of type II and III supracondylar humerus fractures in childhood with respect to the immediate post-operative reduction quality in sagittal plane. METHOD: One hundred and forty four-pediatric patients with type IIb and III supracondylar humerus fractures treated at two centers between 1995 and 2005 were evaluated radiologically within a retrospective study. Seventy-six patients (54 boys, 22 girls, mean age 7.6, range 2-12) were treated by closed reduction and cross percutaneous pinning while 68 (49 boys, 19 girls, mean age 7.3, range 2-13) were treated by open reduction. The reduction quality of the open and closed groups was compared on immediate post-operative lateral radiographs by measuring of lateral humerocapitellar angle, anterior humeral line and anterior coronoid line criteria. The reduction quality was classified excellent, good, fair and poor according to the achievement of three, two, one or none of the criteria, respectively. Reductions classified as excellent and good were introduced as acceptable results. RESULTS: At least one criterion was achieved in all the patients of both the groups. The mean humerocapitellar angle was 30.1 degrees in closed reduction group while the mean of it was 29.8 degrees in open reduced group. Radiograph of 48 (63.1%) patients with closed reduction were found to display the anterior humeral line intersecting the middle one-third of capitellum while this criteria was 45 (66%) in open reduction group. The anterior coronoid line was disturbed in three patients in each of both the groups. The reduction quality was evaluated to be excellent in 32 patients, good in 31, fair in 13 at the closed reduction group while these evaluations were 31, 20 and 17 in open reduction group, respectively. Successful reduction was achieved in 74.9% of the patients in closed reduction group and 75% of the patients in open reduction group. CONCLUSION: It is concluded that there was no significant difference between closed and open reductions of pediatric displaced supracondylar fractures with regard to the radiological criteria of reduction quality in sagittal plane.     

Comprehensive review of post–organ transplant hematologic cancers

A higher risk for a variety of cancers is among the major complications of posttransplantation immunosuppression. In this part of a continuing series on cancers posttransplantation, this review focuses on the hematologic cancers after solid organ transplantation. Posttransplantation lymphoproliferative disorders (PTLDs), which comprise the great majority of hematologic cancers, represent a spectrum of conditions that include, but are not limited to, the Hodgkin and non‐Hodgkin lymphomas. The oncogenic Epstein‐Barr virus is a key pathogenic driver in many PTLD cases, through known and unknown mechanisms. The other hematologic cancers include leukemias and plasma cell neoplasms (multiple myeloma and plasmacytoma). Clinical features vary across malignancies and location. Preventive screening strategies have been attempted mainly for PTLDs. Treatments include the chemotherapy regimens for the specific cancers, but also include reduction of immunosuppression, rituximab, and other therapies.     

胆囊炎患者胆汁中内皮素浓度的意义

目的探讨胆囊炎患者胆汁中内皮素浓度及其意义。方法采用放射免疫分析法测定了４０４例单纯型、４８例化脓型和２７例坏疽型结石性胆囊炎患者胆汁中内皮素浓度。结果三型胆囊炎患者胆汁内皮素浓度分别为２７４±８３ｐｇ／ｍｌ,４２３±１１１ｐｇ／ｍｌ和６７５±１３８ｐｇ／ｍｌ,与对照组测值１９４±４７ｐｇ／ｍｌ比较,具有显著性差异（Ｐ＜０．０５～０．０１）。结论胆汁中内皮素参与了胆囊炎的病理过程,其作用机制尚需深入研究。     

肾脏黏液样小管状和梭形细胞癌(附2例报道及文献复习)

目的 探讨肾脏黏液样小管状和梭形细胞癌(Mucinous tubular and spindle cell carcinoma,MTSCC)的临床及病理学特点.方法 对本院收治的2例肾脏黏液样小管状和梭形细胞癌患者临床及病理特点进行观察和讨论并结合相关文献复习.结果 2例患者术后诊断:肾脏黏液样小管状和梭形细胞癌.临床及病理特征符合相关文献对该型肾癌的报道,术后长期严密随访无复发.结论 MTSCC是罕见的肾癌分型,症状隐匿,具有独特的病理学特征,早期手术是最佳治疗方法,预后良好,罕见预后较差报道.     

胰腺素腺瘤和囊腺癌的诊治

目的 探讨胰腺囊性肿瘤的诊断和治疗。方法 对1978-1998年收治的均经手术和病理检查证实为胰腺囊性肿瘤的11例临床资料进行回顾性分析。结果 胰腺囊性肿瘤好发于中青年女性,临床表现为病程较长的上腹部肿物和胀痛。钡餐、B超、CT及ER-CP能协助诊断,本组11例中行胰十二指肠切除2例,胰体尾加脾切除6例,肿瘤单纯切除2例,囊肿-空肠袢式吻合1例,手术切除率为90.9%,术后1例死于腹内感染并峰主血症术后存活的10例均获随访（100%）。1例胰腺囊腺瘤手术后3个月死于心肌梗死,1例胰腺囊腺癌术后4年3个月死于癌转移,其余均健在,结论 凡中青年女性,上腹或左上腹出现较大肿块,且病程较长。结合B超和CT检查可对本病的诊断,胰腺囊腺瘤或囊腺癌,癌体虽较大,均有完整的包膜,而易于分离切除,首选手术方式为包括部分胰腺组织的全肿瘤切除术,疗效满意。     

Risk of lip cancer after solid organ transplantation in the United States

Solid organ transplant recipients have an increased risk of lip cancer, but the reasons are uncertain. Using data from the Transplant Cancer Match Study, we describe the epidemiology of lip cancer among 261 500 transplant recipients in the United States. Two hundred thirty‐one lip cancers were identified, corresponding to elevated risks for both invasive and in situ lip cancers (standardized incidence ratios of 15.3 and 26.2, respectively). Invasive lip cancer incidence was associated with male sex (adjusted incidence rate ratio [aIRR] 2.01, 95% CI 1.44‐2.82), transplanted organ (0.33, 0.20‐0.57, for liver transplants and 3.07, 1.96‐4.81, for lung transplants, compared with kidney transplants), and racial/ethnic groups other than non‐Hispanic whites (0.09, 0.04‐0.2). In addition, incidence increased with age and during the first 3 years following transplant, and was higher in recipients prescribed cyclosporine/azathioprine maintenance therapy (aIRR 1.79, 95% CI 1.09‐2.93, compared with use of tacrolimus/mycophenolate mofetil) and following a diagnosis of cutaneous squamous cell carcinoma (4.21, 2.69‐0.94). The elevation in lip cancer incidence is consistent with an effect of immunosuppression. Notably, the very strong associations with white race and history of prior skin cancer point to an important role for ultraviolet radiation exposure, and cyclosporine and azathioprine may contribute as photosensitizing or DNA damaging agents.     

胆石性重症胰腺炎的治疗对策及疗效分析

目的　探讨胆石性重症胰腺炎 (GSP)的合理治疗方法和疗效。方法　回顾性分析治疗的97例GSP临床资料。结果　 97例中 ,重症I级 5 4例 ,II级 43例 ;治愈 77例 ( 79.4% ) ,病死 2 0例( 2 0 .6% )。内镜治疗组 (EST)、延期手术组和早期手术组的并发率分别为 2 4.1% ,2 5 .0 %和 65 .5 % ;病死率分别为 10 .3 % ,13 .9%和 3 7.5 % ,前两组均明显低于早期手术组 (P <0 .0 5 )。结论　GSP治疗应根据“个体化方案” ,无胆石梗阻者应延期手术 ;有胆石嵌顿梗阻者应及早施行EST治疗或开腹手术 ,对重症II级患者首选EST治疗     

胆汁中氨肽酶N的分离、提纯及其促成核作用的初步研究

目的　观察氨肽酶N(APN )在胆石形成中的成核活性。方法　应用伴刀豆凝集素A亲和层析、羟基磷灰石柱层析及高压液相法从胆石症患者胆汁中分离、提纯胆汁中的APN ,并用模拟胆汁观察APN的成核活性。结果　最终APN纯化倍数达 2 94倍 ,酶的活性为12 .9nM·min-1·μg-1,分子量为 130kDa。随后在模拟胆汁观察到APN有明显的促成核活性。结论　APN在胆固醇结石形成中具有促成核作用。     

Epidemiologic perspectives on immunosuppressed populations and the immunosurveillance and immunocontainment of cancer

The advent in the last several years of effective immunotherapy for cancer has renewed interest in the role of the immune system in controlling cancer. The idea that the immune system can help control cancer has a long history. Solid organ transplant recipients (SOTRs) as well as human immunodeficiency virus (HIV)–infected people are affected by cell‐mediated immune dysfunction. Epidemiologic studies of these populations reveal a pattern characterized by a strongly increased incidence of virus‐related cancers (eg, Kaposi sarcoma, non‐Hodgkin lymphoma, and anogenital cancers). In addition, recent epidemiologic studies have evaluated cancer‐specific mortality among SOTRs and HIV‐infected people following a cancer diagnosis. For a wider range of cancers—not limited to those caused by viruses, and including melanoma and cancers of the colorectum, lung, and breast— these immunosuppressed cancer patients have higher cancer‐specific mortality than other cancer patients. This latter group of cancers somewhat mirrors those for which immunotherapy with checkpoint inhibitors is approved. These epidemiologic observations suggest that there are 2 distinct immune selection processes in humans: immunosurveillance directed against premalignant cells before cancer diagnosis (most relevant for preventing virus‐related cancers), and “immunocontainment” directed against established cancers. These processes thus appear relevant for different groups of malignancies and may have different mechanisms.     

异搏定对急性胰腺炎大鼠磷脂酶A2影响的研究

目的探讨急性胰腺炎(AP)时胰组织磷脂酶A2(PLA2)的变化,以及钙通道阻滞剂异搏定对其的治疗作用.方法采用"十二指肠闭袢法”诱发AP大鼠模型,随机分组,观测AP组和异搏定治疗组PAL2活性变化,同期行胰腺组织进行光镜和电镜检查.结果诱发AP16h和24h,异搏定治疗组胰腺组织PLA2活性(32.34±3.87,35.26±4.52)较AP组(44.83±5.31,47.77±5.86)明显降低(P<0.01),病理改变明显减轻.结论大鼠AP时存在PLA2的活化,钙通道阻滞剂异搏定可通过抑制PLA2的活化而起到治疗AP的良好作用.