全膝关节置换术后恐动的相关因素

[目的]探讨全膝关节置换术后恐动症发生的相关因素。[方法] 2020年1月—2021年12月本院行全膝关节置换术患者205例纳入本研究，采用恐动症TSK (Tampa Scale of Kinesiophobia, TSK)评分评估患者状态，TSK>37分确定为恐动症，将患者分为两组行单因素比较。行TSK评分与临床指标行单项相关分析和多元逐步回归分析。[结果]205例患者中，36例确诊为恐动症，发生率为17.6%。单项因素比较表明，恐动症组患者术前疼痛持续时间、术前VAS评分、翻修手术比例以及一期双侧置换比例显著高于非恐动症组（P<0.05）；而恐动症组患者文化程度、术前HSS评分、术前KSS临床评分和功能评分、K-SES评分和社会支持评分显著低于非恐动症组（P<0.05）。单项相关分析结果显示，文化程度、术前HSS评分、KSS临床评分、K-SES评分及社会支持评分与TSK评分呈显著负相关（P<0.05）；而术前VAS评分及疼痛持续时间与TSK评分呈显著正相关（P<0.05）。多元逐步回归分析结果表明术前疼痛时间长和社会支持评分低是发生恐动症发生的主要相关...     

胸外科

连枷胸的机械通气治疗；兔胸部撞击伤后呼吸功能的改变；重组人生长激素在胸部外伤伴有呼吸困难老年病人中的应用；胸腔镜钛夹夹闭胸交感神经干治疗头面部多汗10例报告；电视胸腔镜辅助胸腺切除术；先天性食管闭锁及气管食管瘘16例临床分析；食管结核的电视胸腔镜诊断与治疗（附8例报告）；电视胸腔镜食管癌切除术；电视胸腔镜食管下段肌层切开术（改良Heller术）治疗贲门失弛缓症（附21例报告）；纵隔镜及腹腔镜下食管癌切除术（附两例报告）；腹腔镜食管裂孔疝修补7例分析；血管内皮生长因子反义核糖核酸对人肺癌的抗血管生成作用；肺癌相关基因LSCC-3的差异性表达及其与临床和病理的关系；多基因表达预测可手术ⅢA期非小细胞肺癌新辅助化疗疗效的探讨；126例Ⅲa期非小细胞肺癌的外科治疗；电视胸腔镜辅助胸壁小切口肺叶切除术；电视胸腔镜手术治疗转移性肺肿瘤；电视胸腔镜手术治疗自发性气胸150例；电视胸腔镜辅助胸部小切口在肺大疱切除中的应用；气管、支气管成形肺切除术治疗中央型肺癌；心包内处理肺血管全肺切除治疗中晚期肺癌；全肺切除术后围手术期并发症的临床分析；胸骨下段正中小切口在心脏外科的应用。[编者按]     

全膝关节置换术后患者被动锻炼下恐动症及相关因素的调查

目的调查全膝关节置换术（TKA）后患者的恐动情况，以明确全膝关节置换术后恐动症的发生率。并通过对患者焦虑及疼痛评估确定其影响因素，为恐动症的进一步研究提供参考依据。 方法便利抽样选取2018年9月至2019年4月在内蒙古医科大学第二附属医院行TKA治疗的患者300例作为研究对象。采用自编的一般资料调查问卷、恐动症TSK评分表、社会支持评定量表等问卷对其进行调查，并且通过单因素和Logistic回归分析其影响因素。 结果所有患者中男性143例，女性157例，年龄45~83岁，平均（62±9）岁；139例患者（46.33%）存在恐动症，其TSK得分平均为（36±11）分。多重线性回归分析结果表明：受教育程度（标准回归系数=-0.345，P<0.01）与疼痛年限（标准回归系数=-0.276，P<0.01）为主要影响因素。Logistic回归分析结果表明：疼痛年限（OR=5.576，95% CI：2.213，15.453）、文化程度（OR=0.165，95% CI：0.071，0.324）、疼痛（OR=5.417，95% CI：2.203，13.385）及社会支持度（OR=0.560，95% CI：0.376，0.659）是TKA患者有恐动症的主要影响因素。 结论全膝关节置换术患者的恐动症心理与患者的疼痛年限、文化程度、疼痛经历与社会支持密切相关，在患者康复锻炼中应对这些产生恐动心理的因素予以干预，提高康复锻炼的依从性。     

乳腺癌患者术后恐动症现状及影响因素研究

目的 调查乳腺癌患者术后恐动症现状,分析其影响因素。 方法 对169例乳腺癌术后患者,采用一般资料调查表、恐动症Tampa量表、简易应对方式问卷、视觉模拟评分法、焦虑自评量表进行调查,分析乳腺癌患者术后恐动症的影响因素。 结果 乳腺癌患者术后恐动症得分为（36.23±5.28）分,50例（29.59%）患者存在恐动症。多元线性回归分析显示,文化程度、家庭人均月收入、是否行淋巴结清扫、积极应对、疼痛程度、焦虑情绪是乳腺癌患者术后恐动症的影响因素（P＜0.05,P＜0.01）,可解释恐动症总变异的38.30%。 结论 乳腺癌患者术后恐动症发生率较高,医护人员需采取针对性干预措施帮助患者降低术后恐动症水平,使患者早期开展功能锻炼,促进身体康复。     

肺癌患者完全胸腔镜与开胸肺叶切除术后近期生活质量的比较

目的 探讨完全胸腔镜肺叶切除术对肺癌患者术后近期生活质量的影响。方法 2012年10月.2013年12月，40例早期非小细胞肺癌患者自行选择手术方式，19例行完全胸腔镜肺叶切除术（胸腔镜组），21例行传统开胸肺叶切除术（开胸组）。术后3个月利用肺癌患者癌症治疗功能性量表（Functional Assessment of Cancer Treatment-Lung，FACT-L）中文版对患者生活质量进行评价。结果 胸腔镜组在身体状况（19.90±1.30 vs.17.10±1.40，t=6.533，P=0.000），情感状况（16.95±1.25 vs.14.15±2.05，t=5.147，P=0.000），功能状况（18.50±2.35 vs.16.45±2.45，t=2.694，P=0.025）及附加状况（20.40±2.35 vs.18.45±1.25，t=3.321，P=0.009）方面评分均高于开胸组，在社会及家庭状况方面两组评分差异无显著性。胸腔镜组术后生活质量总体状况评分高于开胸组（89.50±6.54 vs.81.40±6.25，t=4.004，P=0.003）。结论 完全胸腔镜肺叶切除术对肺癌患者术后的生活质量影响明显小于传统开胸肺叶切除术。     

气管、肺

氨力农改善肺癌病人术后心脏功能的临床研究；电视胸腔镜辅助下小切口肺切除术；原发性气管支气管肿瘤的外科治疗方法；气管隆突部肿瘤的手术体会（附14例报告）；袖式肺叶切除术联合肺动脉成形术治疗中央型支气管肺癌。     

髋、膝关节置换术后患者恐动症发生现状及影响因素分析

目的：了解髋、膝关节置换术后患者恐动症发生情况,并探索恐动症形成机制。方法：通过便利抽样法,选取2023年2—5月行全髋或全膝关节置换术的173例患者,采用一般资料调查表、恐动症评分表、疼痛数字评分表、疾病感知简易问卷、医院焦虑抑郁量表和简明围手术期疲劳评测量表进行评估。结果：髋、膝关节置换术后患者恐动症得分为（39.3±4.7）分,恐动症发生率为50.9%(88/173),其中全髋关节置换术后患者恐动症得分为（40.8±5.1）分,恐动症发生率为58.7%(37/60),均高于全膝关节置换术后患者[（38.4±4.3）分,P=0.001;45.1%(51/113),P=0.038]。路径分析显示,疼痛程度通过术后疲劳及焦虑抑郁对恐动症产生间接效应,间接效应值为0.190;疾病感知对恐动症有直接影响（β=0.290,P<0.001）,并通过焦虑抑郁产生间接效应,间接效应值为0.114;焦虑抑郁对恐动症有直接影响（β=0.194,P<0.05）,并通过术后疲劳产生间接效应,间接效应值为0.146;术后疲劳对恐动症有直接正向影响（β=0.328,P<0.001）。结论：髋...     

单孔胸腔镜行早期肺癌切除术中迷走神经保护对术后恢复及并发症的影响

目的 本文旨在探索单孔胸腔镜行早期肺癌切除术中进行迷走神经保护对患者术后恢复及并发症的影响。方法 回顾性分析本院2017年3月至2022年3月行单孔胸腔镜早期肺癌切除术患者154例，分为迷走神经未保护组与保护组。比较两组围手术期指标；比较两组迷走神经损伤并发症，腹胀、肺部感染、心律失常与咳嗽反射低下等。比较两组手术满意度。结果 两组术中出血量、淋巴结清扫量差异均无统计学意义（P>0.05），未保护组的手术时间、肛门排气时间、住院时间均明显大于保护组（P<0.05）。未保护组术后迷走神经损伤并发症发生率为44.44%；保护组术后迷走神经损伤并发症发生率为19.78%，两组差异有统计学意义（P<0.05）。未保护组的手术满意度为68.25%，保护组的手术满意度为82.42%，未保护组的手术满意度明显高于保护组（P<0.05）。结论 单孔胸腔镜引导下早期肺癌切除术行迷走神经保护疗效可靠，能明显降低患者术后因迷走神经损伤导致的脏器功能失调，促进早期功能恢复，提高手术满意度。     

骨科手术患者运动康复恐惧现状及影响因素分析

目的 调查骨科手术患者运动康复恐惧现状，并分析其影响因素。方法 采用便利抽样法，选取2021年1月至2023年1月本院收治的206例术后患者作为研究对象。收集患者一般人口学资料、恐动症评估量表评分、疼痛评分、医院焦虑抑郁量表评分、医学应对方式评分、家庭关怀度评分，采用单因素和Logistic回归分析患者发生恐动症的影响因素。结果 恐动症的发生率为39.3%，家庭月收入、疼痛评分、焦虑、抑郁、回避、屈服、家庭关怀度是患者发生恐动症的影响因素（P<0.05）。结论 家庭月收入、疼痛评分、焦虑、抑郁、回避、屈服、家庭关怀度是患者发生恐动症的影响因素。     

胸腔镜肺叶切除术治疗I期肺癌

目的：探讨胸腔镜肺叶切除术的疗效。方法：对30例术前诊断为I期肺癌的患行胸腔镜肺叶切除术，男19例，女11例，年龄36岁－78岁，平均63．1岁。结果：无手术死亡。2例（6．67％）术后输血，发生并发症4例（13．3％）。随访时间12月－45月，平均28．7月，生存率83．3％（25／30），其中I期患生存率为90．9％（20／22）。结论：对于I期肺癌，胸腔镜肺叶切除术长期疗效与常规开胸手术相仿，而且具有安全性高，手术创伤小，术后恢复快等优点。     

Synchronous growth of triple lung cancer

The case of a 75-year-old man with three synchronous carcinomas of the lung (large cell carcinoma, adenocarcinoma, and small cell carcinoma) is reported. This is the eighth well-documented case report in the literature; however, our case is the first to be reported with the newly described histological combination.     

Outcome of patients with early stage lung cancer

A study was conducted to evaluate the outcomes of 79 patients with early stage lung cancer diagnosed according to the following criteria. Central tumors were located in the segmental bronchi, or more proximally, and tumor invasion was limited to the bronchial wall without lymph node or distant metastases. Peripheral tumors were located distal to the subsegmental bronchi and were less than 2 cm in greatest dimension, and invasion was limited to the visceral pleura, with no lymph node or distant metastases. The 5-year survival rate was 100% for patients with peripheral type early squamous cell carcinoma, 94.6% for those with central-type early squamous cell carcinoma, and 79.3% for those with early adenocarcinoma. The 5-year survival rate for patients with central-type squamous cell carcinoma without pericartilage layer invasion was 97.0%, and that for those with T1N0M0 peripheral squamous cell carcinoma was 100.0%. To define early stage lung cancer as curable, it should be defined as T1N0M0, peripheral squamous cell carcinoma, or central squamous cell carcinoma without pericartilage layer invasion. For other histologic types, some added parameters are needed. The rate of multiple lung cancers was 10.1% and that of multiple primary malignant disease was 13.9%. Thus, careful followup of patients with early stage lung cancer should be carried out, as second malignancies in the lung and elsewhere are commonly detected.     

生物芯片在肺癌中的运用现状及其进展

生物芯片在生命科学研究中已经成为一种特别重要的研究工具,在肿瘤的诊断、治疗、预后及肿瘤病因学研究中广泛使用。现就生物芯片中在肺癌的运用做简要综述。     

Survival after resection for primary lung cancer: a population based study of 3211 resected patients

BACKGROUND: Very few population based results have been presented for survival after resection for lung cancer. The purpose of this study was to present long term survival after resection and to quantify prognostic factors for survival. METHODS: All lung cancer patients diagnosed in Norway in 1993-2002 were reported to the Cancer Registry of Norway (n = 19 582). A total of 3211 patients underwent surgical resection and were included for analysis. Supplementary information from hospitals (including co-morbidity data) was collected for patients diagnosed in 1993-8. Five year observed and relative survival was analysed for patients diagnosed and operated in 1993-9. Factors believed to influence survival were analysed by a Cox proportional hazard regression model. RESULTS: Five year relative survival in the period 1993-9 was 46.4% (n = 2144): 58.4% for stage I disease (n = 1375), 28.4% for stage II (n = 532), 15.1% for IIIa (n = 133), 24.1% for IIIb (n = 63), and 21.1% for stage IV disease (n = 41). The high survival in stage IIIb and IV was due to the contribution of multiple tumours. Cox regression analysis identified male sex, higher age, procedures other than upper and middle lobectomy, histologies such as adenocarcinoma and large cell carcinoma, surgery on the right side, infiltration of resection margins, and larger tumour size as non-favourable prognostic factors. CONCLUSIONS: Survival was favourable for resected patients in a population based group including subgroups such as elderly patients, those with advanced stage, small cell lung cancer, tumours with nodal invasion, and patients with multiple tumours. These results question the validity of the current TNM system for lung cancer with regard to tumour size and categorization of multiple tumours.     

Progress in lung cancer: Non-oat cell (non-small cell lung cancer)

Lung cancer remains the greatest killing cancer in the United States with 149,000 new cases expected in 1987. The present expected mortality rate is 87 per cent. More women in the United States died of lung cancer than breast cancer in 1986. Asymptomatic, early and curable lung cancer in high risk individuals is usually found by routine chest X-ray. So-called Stage I lung cancer was reported to have a 83 per cent survival rate at three years by Martini and Beattie in 1977 and 70 per cent five year survival rate subsequently. When the more than 30,000 volunteer males were enrolled in the National Cancer Institute, national lung program for screening, 223 unsuspected lung cancers were found. 47 per cent were Stage I with a survival rate at five years of over 76 per cent. The PMI-Strang/Memorial Sloan Kettering Cancer Center study found 53 cancers in its first screen and 235 lung cancers over the next eight years of the study. Forty per cent were Stage I with a five year survival rate of 70 per cent. Sputum cytology as compared to chest X-ray was of little additional value. Studies (Martini) of N1 lung cancer was found to have a 49 per cent survival rate following resection. The N2 group of lung cancers where the mediastinal tumor was surgically removable and followed by external radiation therapy had a 27 per cent survival rate at five years. Those tumors with solitary brain metastases where the solitary brain metastasis could be resected and the primary tumor controlled, gave a 27 per cent survival rate at six years. The group of advanced N2 disease where the mediastinum could not be completely cleared were a serious group of cancers. A study of 100 patients treated from 1977 to 1980 with surgery plus internal radiotherapy followed by external radiotherapy had an overall 22 per cent survival rate for four to eight years with most of the deaths occurring because of metastases outside the chest. More recently chemotherapy has been used pre-operatively for those individuals with advanced lung cancer in the chest then followed by a combination of surgery, internal radiotherapy, external radiotherapy and more chemotherapy, if chemotherapy sensitive. This is the so-called multidisciplinary approach. In our present early studies it seems that those so treated who are chemotherapy sensitive have a 44 per cent, two year survival rate in a group of patients considered to have extremely poor prognosis. Director Kriser Lung Cancer Center, Chief Thoracic Surgery, Director Clinical Cancer Programs, Beth Israel Medical Center Chief Medical Officer Emeritus, Attending Surgeon, Member of Board of Overseers, Memorial-Sloan-Kettering Cancer Center This report is the gist of a paper read by E.J.B. at the 87th Annual Congress of the Japanese Surgical Society, Tokyo, Japan, 1987.