APACHEⅡ对老年胸科危重病人预后评估的护理学意义

采用APACHEⅡ评分系统对 6 0例年龄≥ 6 5岁开胸手术病人进行回顾性评分。结果 6 0例病人APACHEⅡ评分均值为 14 .6 0± 7.14 ;死亡组 (7例 )评分为 2 2 .14± 8.11,存活组 (5 3例 )为 13.80± 6 .4 7,死亡组评分显著高于存活组(P <0 .0 1)。随着APACHEⅡ评分的增高 ,并发症增多 ,实际病死率与预测病死率均呈上升趋势 ,两者之间呈显著相关性 (r=0 .80 ,P <0 .0 1)。提示APACHEⅡ评分系统对预测老年胸科危重病人的术后并发症及病死率有重要的临床护理意义。     

腹部外科危重病人APACHEⅡ应用和救治体会

目的　探讨APACHEⅡ评分系统在腹部外科危重病人中的应用价值 ,总结腹部外科继发MODS危重病人的救治经验。方法　回顾性分析 86例APACHEⅡ评分 >2 0分的腹部外科病人的病历资料 ,评定入选病人的脏器衰竭情况 ,计算全组病人MODS的发生率 ,比较继发和未继发MODS病人的死亡率。结果　全组病人死亡率 6 3.95 % ;继发MODS病人死亡率 70 .1 5 % ;未继发MODS病人死亡率 4 2 .1 1 % ;两者相比有显著性差异 (P <0 .0 5 )。结论　APACHEⅡ评分 >2 0分病人属危、重病人 ,预防和治疗MODS是改善腹部外科危重病病人预后的关键。肺脏是MODS发生最早和最常见器官 ,适时的机械通气可望改善危重病人的预后 ,合理营养支持可巩固前期治疗效果     

原发性输尿管癌影响预后因素分析

目的　探讨原发性输尿管癌影响预后因素及术后发生膀胱癌的危险因素。　方法　16 0例输尿管癌中男 93例 ,女 6 7例 ,平均年龄 6 3.7岁。左侧 81例 ,右侧 79例 ;上段 30例 ,中段 2 1例 ,下段 96例 ,单侧多发 13例。病理分期Ta9例 ,T15 8例 ,T2 4 6例 ,T3 4 1例 ,T46例 ;分级G14例 ,G2 119例 ,G3 37例。 16 0例均行手术治疗 ,其中肾、输尿管全长加膀胱袖状切除 12 4例 (77.5 % )。总结临床病理学资料 ,对随访结果进行统计学分析。　结果　患者 5年生存率 5 3.0 % ,其中Ta、T1、T2 患者 5年生存率 (83.3%、71.9%、5 9.1% )与T3 和T45年生存率 (37.5 %、16 .7% )比较差异有统计学意义 (P <0 .0 0 0 1) ;G1、G2 患者的 5年生存率 (10 0 .0 %、6 3.5 % )与G3 (19.0 % )比较差异有统计学意义 (P =0 .0 0 1)。肿瘤分期分级是影响预后的因素。 16 0例输尿管癌术后发生膀胱癌者 38例 (2 3.8% )。多因素分析结果显示 ,伴有同发膀胱癌和下段输尿管癌是术后发生膀胱癌的危险因素 (P =0 .0 0 1,P =0 .0 0 5 )。　结论　原发性输尿管癌分期分级是影响预后因素 ;伴有同发膀胱癌和下段输尿管癌是术后发生膀胱癌的危险因素。     

肝细胞肝癌中p15基因产物的表达及其意义

用免疫组织化学方法 (SABC法 )检测p15基因在 5 3例肝细胞肝癌 (HCC )标本中的表达。p15基因阳性表达率为 64 .2 % ( 3 4/5 3 )。病理I ,II级p15阳性率明显高于III级 (均为P <0 .0 5 ) ;临床分期T1 ,T2 期p15阳性率均明显高于T3期 (均为P <0 .0 5 )与T4 期 (均为P <0 .0 1)。提示p15基因的异常表达在HCC的发生、发展中可能起重要作用 ;p15基因表达可以作为病程、预后判断的候选检测指标 ,对HCC的基因治疗有潜在的价值和意义。     

上皮钙粘蛋白/连接素复合体在膀胱癌中表达及对预后的判断价值

目的 :探讨上皮钙粘蛋白 /连接素 (E cd/cat)复合体在膀胱癌中的表达及对判断膀胱癌的复发及预后的价值。方法 :应用免疫组织化学法 (SP法 )检测 72例膀胱移行细胞癌和 10例正常泌尿系移行上皮石蜡包埋标本中E cd/cat复合体的表达情况。结果 :10例正常泌尿系移行上皮E cd/cat复合体各组成成分均正常表达。膀胱移行细胞癌中E cd、α cat、β cat、γ cat异常表达率分别为5 6 .9% (4 1/ 72 )、4 4 .4 % (32 / 72 )、5 6 .9% (4 1/ 72 )、4 3.1% (31/ 72 )。E cd和cat表达具有显著相关性 (P<0 .0 1)。E cd/cat复合体异常表达率与膀胱癌的病理分级和临床分期密切相关 (P <0 .0 5 )。β cat的异常表达与所有肿瘤的复发相关 (P <0 .0 5 )。α cat异常表达与表浅肿瘤 (Tis～T1期 )的复发密切相关 (P <0 .0 1)。γ cat异常表达与肿瘤的生存预后密切相关 (P <0 .0 1)。结论 :E cd/cat复合体的异常表达与膀胱癌的分化和侵袭程度密切相关。β cat是膀胱肿瘤复发预后的较好指标。α cat是表浅肿瘤复发预后的较好指标。γ cat是膀胱癌生存预后的有价值指标。     

p53,CD34,E-钙粘蛋白在膀胱癌中的表达及判断预后的价值

目的　探讨 p5 3、CD3 4 、E 钙粘蛋白 (E cadherin)在膀胱移行细胞癌中的表达及判断膀胱癌预后的价值。　方法　采用免疫组化方法检测 4 6例膀胱移行细胞癌和 8例正常膀胱粘膜标本p5 3、CD3 4 、E cadherin的表达情况。　结果　 4 6例膀胱癌标本中p5 3、E cadherin的异常表达率分别为2 1.7%和 4 5 .6 %。p5 3异常表达在表浅型膀胱癌为 9.1% ,浸润型为 33.3% ,差别有显著性意义 (P <0 .0 5 ) ;病理Ⅰ～Ⅱ级异常表达 7.1% ,Ⅲ级 4 4 .4 % ,差别有显著性意义 (P <0 .0 0 5 ) ;复发组异常表达89 % ,未复发组 15 % ,差别有显著性意义 (P <0 .0 0 5 )。E Cadherin的异常表达率在浅表型膀胱癌为77.3% ,浸润型为 33.3% ,差别有显著性意义 (P <0 .0 0 5 ) ;在Ⅰ、Ⅱ级膀胱癌为 71.4 % ,Ⅲ级为2 7.8% ,差别有显著性意义 (P <0 .0 0 5 ) ;在复发组与未复发组分别为 18.0 %和 6 1.0 % ,差别有显著性意义 (P <0 .0 1)。CD3 4 在膀胱癌中的异常表达率为 4 1.3% ,在不同分期分级及复发与未复发组之间的表达差别均无显著性意义。　结论　p5 3和E Cadherin的异常表达与膀胱癌的恶性程度及复发密切相关 ,可作为判定肿瘤预后和复发的分子生物学指标     

肝门部胆管癌的外科治疗和预后相关因素分析

目的 探讨肝门部胆管癌的外科治疗策略及预后相关因素.方法 对1990年1月至2005年12月144例行手术切除治疗的肝门部胆管癌患者的临床资料进行回顾性分析.144例患者中,男性102例,女性42例;年龄36～74岁,平均63岁.根治性切除(R0组)86例(59.7%),镜下切缘阳性(R1组)34例(23.6%),肉眼切缘阳性(R2组)24例(16.7%).R0组和R1组的120例患者中,Bismuth-Corlette分型Ⅰ型28例(23.3%),Ⅱ型49例(40.8%),ⅢA型10例(8.3%),ⅢB型19例(15.8%),Ⅳ型14例(11.7%);TNM分期Ⅰ期19例(15.8%),Ⅱ期80例(66.7%),Ⅲ期16例(13.3%),Ⅳ期5例(4.2%);组织病理学分级:高分化(G1)41例(34.2%),中低分化(G2、G3、G4)79例(65.8%);无淋巴结转移者(N0)62例(51.7%),有淋巴结转移者(N1、N2)58例(48.3%);T1分期42例,T2～3分期78例;无血管侵犯者86例,有血管侵犯者34例.R0组和R1组120例患者均施行伴部分肝切除+区域淋巴结清扫术.结果 中位生存期:R0组46.8个月,R1组18.3个月,R2组11.2个月.生存率:R0组和R1组的120例患者术后1、3、5年总生存率分别为60.2%、36.1%、29.4%,R0组预后好于R1组(P<0.01),R1组预后好于R2组(P=0.031);高分化癌患者预后较好(P=0.003);有淋巴结转移患者预后极差(P<0.01);T1期患者的预后好于T2～3分期患者(P=0.030).有血管侵犯者预后较差(P=0.047).结论 肝门部胆管癌的病理类型、临床分期以及是否行根治性切除是影响预后的主要因素.联合不同范围的肝切除及淋巴结清扫术对提高肝门部胆管癌的根治率和生存率有重要的意义.     

p53, p21/WAF1, pRb的表达与T1G3膀胱癌预后的关系

目的　探讨p5 3,p2 1/WAF1和pRb的异常表达在T1G3 膀胱癌预后判断中的价值。　方法　对 4 7例T1G3 膀胱癌患者进行术后随访 ,采用p5 3,p2 1/WAF1和pRb单克隆抗体对手术标本行免疫组化染色。将肿瘤进展情况与染色结果和与预后相关的临床指标进行分析。　结果　 39例手术保留膀胱的患者总进展率为 5 9% ,其中 9例发生远处转移。 8例行膀胱全切术的患者 1例于术后 2年发现肺转移。肿瘤细胞核p5 3,p2 1/WAF1和pRb蛋白的异常表达率分别为 6 6 .7%、5 1.4 %和 71.8%。多因素分析显示 ,p5 3、pRb同时异常表达 (P <0 .0 5 )和p5 3、p2 1/WAF1、pRb三者同时异常表达(P <0 .0 1)与肿瘤进展显著相关。　结论　p5 3,p2 1/WAF1和pRb的表达与T1G3 膀胱癌患者的预后密切相关     

老年人肝门部胆管癌的外科治疗(附91例临床回顾分析)

目的报道老年肝门胆管癌病人的手术治疗结果。方法对1996年1月至2010年12月15年间收治老年肝门胆管癌病人91例(年龄65~83岁)的资料并进行分析。按照Bismuth分型:I型17例,Ⅱ型24例,Ⅲa型19例,Ⅲb型22例,Ⅳ型9例。其中外科手术治疗75例;胆道引流16例。根据治疗情况及手术类型分为三组:第1组:根治性切除术(R0切除组)44例;第2组:姑息切除(R1切除组)31例;第3组:胆道引流组(开腹经胆总管胆道内支架置入7例,行经皮肝穿刺引流9例)16例。围手术期死亡3例。死亡原因:肝衰竭2例,肺部感染1例。结果术后1年、2年、3年、5年生存率:R0切除组分别为68.18%、40.90%、31.81%、15.91%,中位生存期为(20±3)个月;R1切除组分别为64.52%、35.48%、22.58%、6.45%,中位生存期为(18±2)个月;胆道引流组分别为56.25%、6.25%、0%、0%,中位生存期为(13±1)个月。R0组与R1组术后生存率相仿(x~2=7.39,P=0.0582);R0组术后生存率优于胆道引流组(x~2=34.45,P=0.0016);R1组术后生存率也优于胆道引流组(x~2=26.18,P=0.0037)。结论认真、仔细、严格的术前准备,合理手术方式,积极处理合并症,老年肝门胆管癌病人可获得良好的手术疗效;手术治疗是老年肝门胆管癌病人的首选方法。本组R0切除组与R1切除组治疗效果明显优于胆道引流组。即便是R1切除,也能获得与R0切除相似的疗效。     

啰哌卡因切口浸润联合静注氟比洛芬酯对老年髋关节手术后镇痛的作用

目的:研究0.75%啰哌卡因切口浸润联合静注氟比洛芬酯用于老年髋关节手术后镇痛和其对应激反应的影响.方法:选择ASA Ⅰ~Ⅱ级老年髋关节手术患者60例,随机分为氟比洛芬酯组(F组),啰哌卡因组(R组),联合组(F+R组),对照组各15例.分别于麻醉前(T0),术毕30 min(T1)、2 h(T2)、6 h(T3)和24 h(T4)采肘静脉血,行放免法测血浆白细胞介素6(IL-6)、皮质醇(Cor)水平,观察T1、T2、T3、T4各时间点各组VAS评分.结果:F+R组VAS评分在T1~T4各时间点均低于F组、R组、对照组(P＜ 0.05).F+R组T1~T3与T0时IL-6水平比较差异无统计学意义(P＞ 0.05),在T2~T4各时间点的IL-6水平与对照组相比较均低于对照组(P＜ 0.05).F+R组在T1~T4时的Cor水平均上升,但与T0时比较(P＞ 0.05);对照组的Cor水平在T2~T4时高于T0也高于F+R组(P＜ 0.05).结论:0.75%啰哌卡因切口浸润联合术前静注氟比洛芬酯用于老年髋关节手术后镇痛,可以增强镇痛效果,抑制过度应激反应,缓解炎症反应和免疫损伤.     

老年患者肝移植的临床分析

目的 探讨年龄≥60岁的老年患者肝移植的临床特点,总结临床诊治经验.方法 36例年龄≥60岁者接受肝移植治疗(老年组),术前其Child-Pugh评分为(7.86±2.06)分,其中34例采用非转流原位经典肝移植,2例为背驮式肝移植.术后采用他克莫司与糖皮质激素联用预防排斥反应,并辅以达利珠单抗诱导治疗.以同期施行肝移植、年龄小于60岁的214例患者作为对照.结果 老年组女性比例以及术前合并丙型肝炎、糖尿病的患者比例明显高于对照组,差异有统计学意义(P＜0.05,P＜0.05,P＜0.01),而合并乙型肝炎的患者比例则明显低于对照组(P＜0.01).两组在手术方式、供肝缺血时间以及术中情况等方面的差异均无统计学意义.老年患者术后气管插管时间为(9.0±12.1)h,明显长于对照组的(5.8±6.8)h(P＜0.05),36.1%的患者术后插管超过12 h,明显高于对照组的17.8%(P＜0.05).老年组术后心血管并发症和细菌感染的发生率分别为13.9%和77.8%,明显高于对照组的1.9%(P＜0.01)和59.3%(P＜0.05),而急性排斥反应发生率为5.6%,明显低于对照组的19.6%(P＜0.05).老年组患者术后1、2及3年存活率分别为77.8%、71.8 %和61.6 %,对照组分别为85.5 %、72.2 %和65.5 %,两组间各存活率的差异均无统计学意义;老年组中超出米兰标准者肝移植后的1、2及3年存活率分别为56.3%、56.3%和36.5%,对照组分别为78.0%、62.8%和62.8%,两组比较,各存活率的差异均有统计学意义(P<0.05).老年组患者的死亡原因,肺部感染占第一位(41.7%),明显高于对照组的14.9%(P＜0.05).结论 老年患者肝移植术后易并发感染和心血管疾病,肺部感染是老年患者术后死亡的主要原因;超出米兰标准的老年肝癌患者行肝移植需慎重.     

高通量血液滤过治疗脓毒症的疗效分析

目的 分析脓毒症预后的影响因素,以及探讨高通量血液滤过（HVHF）治疗脓毒症的疗效和治疗脓毒症并发急性肾损伤（AKI）的开始时机。 方法 回顾性分析接受HVHF治疗的152例脓毒症患者的临床资料。对治疗前和治疗后24、48、72 h进行急性生理与慢性健康状况评分（APACHE）Ⅱ、APACHEⅢ、简化急性生理学评分（SAPS）。根据第28天存活情况,将患者分为存活组和死亡组,组内比较治疗前、治疗后24、48、72 h临床指标变化;组间比较治疗前临床资料差异。多元回归分析影响患者预后的危险因素。分析AKI不同分期对患者预后的影响。 结果 肺部和消化道是脓毒症常见感染部位。HVHF治疗后第28天,152例患者中存活74例(48.68%),死亡78例(51.32%),其中4例(2.63%)需继续肾脏替代治疗。第28天病死率明显低于根据APACHEⅢ预测的病死率（88.78±17.72）%。HVHF治疗24 h后APACHEⅡ、APACHEⅢ、SAPSⅡ评分显著降低（均P < 0.01）。年龄、衰竭器官数目、APACHEⅡ、APACHEⅢ、SAPSⅡ评分、基础疾病、休克、AKI、急性重症胰腺炎、消化道出血、昏迷及使用升压药物与28 d存活率密切相关,其中基础疾病、APACHEⅢ是独立危险因素。AKI 1期的肾功能恢复率高于AKI 2、3期（均P < 0.05）;无AKI患者28 d病死率低于AKI 1、2、3期（均P < 0.05）,但AKI 1、2、3期间28 d病死率差异无统计学意义。 结论 脓毒症患者预后差。HVHF能有效改善脓毒症的临床和生化指标,减轻病情,提高存活率。基础疾病、APACHEⅢ是影响脓毒症患者28 d死亡的独立危险因素。无AKI患者的28 d病死率显著低于AKI 1、2、3期的患者。AKI分期与28 d肾功能恢复率相关,与28 d病死率无相关。     

肾移植术后肺部感染状态下免疫抑制剂的调整

目的 探讨肾移植术后肺部感染患者免疫抑制剂的应用与预后的关系.方法 对肾移植术后合并肺部感染的98例患者临床资料进行回顾性分析.将患者分为维持应用免疫抑制剂组(维持剂量组,45例)与免疫抑制剂减量或停用组(调整剂量组,53例).按与感染相关的器官衰竭估计评分(SOFA)标准,在肾移植术后肺部感染较重(SOFA≥12分)和感染较轻(SOFA＜12分)的情况下,分别分析两组患者的死亡率、感染恢复时间和排斥反应发生率的差异.结果 当SOFA≥12分时,调整剂量组死亡率和感染恢复时间明显低于维持剂量组(P＜0.05),而排斥反应发生率在两组之间的差异则无统计学意义(P＞0.05);当SOFA＜12分时,死亡率和感染恢复时间在两组之间差异无统计学意义(P＞0.05),但调整剂量组患者排斥反应发生率明显高于维持剂量组(P＜0.05).结论 在肾移植术后肺部感染较重(SOFA≥12分)时,减量和停用免疫抑制剂有利于降低患者的死亡率和缩短抗感染疗程;但感染较轻(SOFA＜12分)时,建议维持免疫抑制剂原剂量不变.     

Significance of serum troponin T and C-reactive protein in the long?term prognosis of hemodialysis patients

Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T (cTnT) and C-reactive protein (CRP) in maintenance hemodialysis (MHD) patients. Methods Clinical data of 76 MHD patients in our hospital from January 2002 to January 2003 were retrospectively analyzed. Time and cause of death in the next 10 years were recorded. Survival rate was calculated by Kaplan?Meier and impact factors of long-term prognosis were explored. Significance of cTnT and CRP was elucidated by COX regression analysis. Results CRP was positive in 28 cases (36.8%) and cTnT was positive in 22 cases (28.9%) among 76 patients. The median survival time was 37.9 months, 2-year survival rate was 65.9% and 10-year survival rate was 24.2%. Univariate analysis found positive CRP, positive cTnT, old age, diabetes, cardiocerebrovascular disease, anemia, low serum albumin, Kt/V decline were associated with long-term prognosis. Multivariate analysis showed that increased age (P＝0.010), cardiocerebrovascular disease (P＝0.048), positive cTnT (P＝0.036), positive CRP (P＝0.009) were independent risk factors of the 10-year survival of MHD patients. Ten-year mortality of cardiocerebrovascular diseases in positive cTnT group was not significantly different as compared with negative cTnT group (50.0% vs 35.4%, P＝0.248). But the positive cTnT group had higher 2-year mortality than negative cTnT group (40.9% vs 14.6%, P＝0.015). Mortality of cardiocerebrovascular disease was higher in positive CRP group as compared to negative CRP group at both 2-year and 10-year time (48.1% vs 7.0%, P＝0.000; 66.7% vs 23.3%, P＝0.000). Compared with both negative cTnT and CRP group, both positive cTnT and CRP group had much higher all-cause mortality (92.9% vs 55.6%, P＝0.030), higher mortality of cardiocerebrovascular disease at 10-year (64.3% vs 25.0%, P＝0.009), and higher mortality of cardiocerebrovascular disease at 2-year (57.1% vs 5.6%, P＝0.000). Conclusions Aging, cardiocerebrovascular disease, positive cTnT and positive CRP are independent risk factors of long-term prognosis for MHD patients. Positive cTnT can predict cardiocerebrovascular mortality of MHD patients in 2 years, while positive CRP can predict short- and long-term cardiocerebrovascular mortality. Positive cTnT combined with positive CRP may be more valuable in predicting the poor prognosis of MHD patients.     

生长抑素受体和雌激素受体在原发性乳腺癌中的表达及其意义

目的研究生长抑素受体(SSTR)与雌激素受体(ER)、孕激素受体(PR)在原发性乳腺癌中的表达及其意义。方法 采用免疫组织化学链霉菌抗生物素蛋白-过氧化酶(SP)法检测SSTR和ER、PR在68例乳腺癌中的表达。结果 在68例乳腺癌中,SSTR阳性表达44例(64.70％),ER、PR阳性表达51例(75.70％),ER、PR和SSTR同时阳性表达阳性41例(60.29％)。ER、PR和SSTR两者表达呈正相关(r=0.651 6,P<0.05)。SSTR阳性患者复发率和死亡率低于SSTR阴性者(P<0.05);SSTR阳性且ER、PR阳性患者复发率和死亡率明显低于SSTR阴性ER、PR阴性患者(P<0.01)。病理分化低的有47例,SSTR阳性表达36例(P>0.05)。结论SSTR表达与ER、PR表达有明显相关性,有可能作为判断乳腺癌预后的指标。     

Results of surgical resection of squamous cells carcinoma of the oesophagus with or without preoperative radiochemotherapy: comparative and retrospective study

AIM OF THE STUDY: The aim of the study was to assess preoperative radio-chemotherapy for squamous cell carcinoma of the esophagus. MATERIAL AND METHODS: This study was a retrospective comparison between radio-chemotherapy followed by surgical resection (RCPO) and surgery alone. The RCPO group included patients with tumor located in the middle or lower third of the esophagus, staged T2 or T3 tumors without distant metastases by pretherapeutic assessment. These patients were matched with patients who underwent immediate surgery, who constituted the surgical group (CHIR). Both groups were matched for gender, age, tumor localization (middle or lower third), T stage, and surgical procedure. Each group included 77 men and 9 women, 50 tumors of the middle third and 36 of the lower third of the oesophagus, and 19 tumors T2 and 67 T3 ones. RESULTS: Morbidity of both groups was not significantly different. The mortality was 4% in the group CHIR and 12% in the group RCPO (P =0.07). The rate of radical resection (R0) was significantly higher in the RCPO group (74% vs. 51%; P =0.001). The overall 5-year survival rate was 38% after R0 surgery and 11% after R1 or R2 surgery (P <0.0001). After R0 surgery, the 5-year survival rate was 47% in the CHIR group and 32% in the RCPO group (P =0.06). CONCLUSION: Preoperative radiochemotherapy increases the rate of radical surgical resection without significant increase in postoperative morbidity and mortality.     

麦吉尔布里斯班症状评分对胰头癌预后预测价值的临床研究

目的探讨麦吉尔布里斯班症状评分(McGill Brisbane symptom score,MBSS)对胰头癌预后的预测价值。方法回顾性地收集于2006年6月至2015年6月就诊并接受手术治疗的83例胰头癌病人的临床资料。记录病人的性别、年龄、合并基础疾病、入院近期的体重改变情况、是否腹痛、黄疽、吸烟史、手术情况(R0、非R0)、是否合并淋巴结、局部神经和血管侵犯、随访2年时的生存率等指标。单因素分析法比较组间上述指标的差异,进一步选取单因素分析结果中的组间差异指标进行多因素分析,以确定胰头癌病人术后预后不良的相关危险因素。结果本组83例病人共分为低MBSS组37例,高MBSS组46例,病人平均年龄、性别构成、合并基础疾病情况、肿瘤分化程度、周围神经、血管及淋巴结侵犯情况相比,组间差异无统计学意义(P0.05);而高MBSS组病人肿瘤相对较大,分期相对较晚,非R0切除率及平均MBSS评分较高,组间差异有统计学意义(P0.05);肿瘤大小、分期、手术方式及MBSS评分4项指标均为胰腺癌病人术后早期预后不良的独立危险因子(OR均1.0,P值均0.05);MBSS=9.0时,其预测病人术后早期预后不良的敏感性、特异性分别为80.44%和85.23%。结论 MBSS与胰头癌病人术后预后有关,高MBSS评分是胰头癌病人术后预后不良的独立危险因子,MBSS评分9时,其预测胰头癌病人术后早期预后不良的敏感性和特异性均较高,值得临床进一步深入研究。     

Relationship between renal phospholipase A2 receptor expression and clinical characteristics,prognosis in idiopathic membranous nephropathy patients

Objective To explore the relationship of phospholipase A2 receptor (PLA2R) expression in renal tissue with clinical characteristics, prognosis of idiopathic membranous nephropathy(IMN) patients. Methods 134 patients diagnosed as nephropathy proven by biopsy was selected as subjects of this research, including 98 patients with IMN patients, 10 patients with secondary membranous nephropathy and 26 patients with other renal glomerular diseases. The expression of PLA2R antigen in renal tissue was detected by immuno-fluorescence chemistry staining. Results The positive rate of renal PLA2R expression in IMN patients was higher than that in SMN patients (91.84% vs 40.00%, P＜0.01), whereas there is no expression in other glomerular diseases. The PLA2R negative group were mainly stage I membranous nephropathy, and positive group was mainly in stage II. The distribution of pathological stage between the two groups was statistically significant (P＜0.01). Compared with the positive group, the negative group was manifested with higher eGFR[(115.91±23.32) ml?min-1?(1.73 m2)-1 vs (94.06±27.38) ml?min-1?(1.73 m2)-1, P=0.031], associated with the higher 12-month complete remission rate (87.50% vs 44.07%, P=0.021). Conclusions The expression of PLA2R antigen in renal tissue plays an important role in the diagnosis, disease evaluation and prognosis of IMN. The negative PLA2R in kidney tissue of IMN may indicate a good clinical prognosis.     

Assessment of extensive surgery for locally advanced lung cancer. Safety and efficacy of induction therapy.

OBJECTIVE: Locally advanced lung cancer has a poor prognosis, despite extensive surgery conducted in an effort to improve survival. We evaluated the safety and efficacy of induction therapy prior to extensive surgery for locally advanced lung cancer. METHODS: Primary resection for lung cancer was done in 549 consecutive patients divided into three groups; 446 undergoing standard pulmonary resection (no extensive surgery), 87 undergoing extensive surgery without induction therapy, and 16 undergoing surgery after induction therapy. RESULTS: Morbidity was 23.5%, 28.6%, and 43.8%, respectively. The rate was significantly higher in the induction group compared with the no extensive surgery group (P < 0.05). Surgical mortality was 0.67%, 3.4%, and 6.3%, respectively. The difference was statistically significant between the no extensive surgery and extensive surgery groups (P < 0.02), and between the no extensive surgery and induction groups (P < 0.02). Hospital mortality was 2.2%, 9.2%, and 6.3%, respectively. The rates were significantly higher in the extensive surgery (P < 0.01) and induction (P < 0.05) groups compared to the no extensive surgery group. Five-year survival was 50.3% for the patients who received induction therapy, and 14.7% for the patients who did not receive induction therapy. CONCLUSIONS: Survival differences between the induction and non induction groups were not significant, but some patients with T3 or T4 disease may benefit from induction therapy. The high morbidity of induction treatment should be recognized, and strict candidate selection and careful postoperative care used to help prevent increased mortality.     

腹腔镜和胆道镜治疗高龄胆囊合并胆总管结石分析

目的探讨腹腔镜联合纤维胆道镜对高龄胆总管结石合并胆囊结石患者的临床疗效。方法选取2010年2月至2013年2月收治的48例高龄胆总管结石合并胆囊结石患者,按照入院顺序分别纳入胆道镜组及十二指肠镜组,各24例。分别实施腹腔镜胆囊切除(LC)联合胆总管探查取石(LCBDE)及联合内镜下乳头括约肌切开(EST)。数据采用SPSS18.0软件进行分析,并发症发生率采用χ2检验;术中术后计量资料以(x珋±s)表示,采用t检验,以P0.05有统计学意义。结果胆道镜组手术时间(185.20±52.47)min、术中出血量(35.9±12.8)ml、住院时间(10.26±3.15)d均显著少于十二指肠镜组(t=11.905、13.226、4.198,P0.05);十二指肠镜组胆管炎发生率为25.0%(6/24),显著高于胆道镜组的4.2%(1/24)(χ2=10.853,P0.05);差异均有统计学意义。两组患者术后疼痛均处于轻微疼痛范围内,术后下床活动时间、胃肠功能恢复时间、并发症发生率、结石复发率、胆管积气发生率比较差异均未见明显统计学意义(P0.05)。结论 LC联合LCBDE具有良好的结石清除能力,并可降低术后胆管炎发生率与结石复发率,有利于降低高龄患者手术应激,保证其预后。