早期乳腺癌保留乳腺的综合治疗

目的探讨早期乳腺癌保留乳腺的治疗方法。方法1994年3月～2002年12月,共13例早期乳腺癌患者接受保留乳房手术为主的综合治疗。其中Ⅰ期6例,Ⅱ期7例。T均≤3cm。所有患者均采用象限或区段切除;11例行中下组腋窝淋巴结清扫。术后采用6MV-X线外照射,DT46～50Gy;瘤床局部采用组织间插植放疗8～12Gy,共1～2次。除1例导管内癌外,均接受了同期化疗6疗程。ER、PR阳性者服用三苯氧胺5年。结果全部病例均存活,无局部复发病例;中位生存时间51个月,4年生存率69%。1例患者治疗7年后出现骨转移。美容效果满意。结论采用合理的综合治疗早期乳腺癌患者保乳手术可获得根治术同样的疗效,且美容效果良好,应积极推广。     

乳腺癌保乳术后切线照射17例疗效分析

目的 观察早期乳腺癌保乳术后全乳腺切线照射治疗的临床毒副反应及近期疗效.方法 对2005年9月～2010年9月本院收治的17例早期乳腺癌接受保乳手术的患者,实行全乳腺切线照射至60 Gy,瘤床电子线推量6 Gy,随访其局部复发及远处转移,并按RTOG标准评估放疗反应.结果 保乳术后放疗后患者中位随访30.5个月,无局部...     

局麻在早期乳腺癌保乳手术中的应用

目的 探讨局麻下完成早期乳腺癌保乳手术的治疗效果.方法 2003年10月2006年3月对我院14例乳腺肿块平均直径在2.5 cm及腋均无扪肿大淋巴结的患者,在局麻下行区域或肿块切除及腋淋巴结清扫术.结果 所有患者麻醉疗效均满意.术后当天可进食及下床活动,无一例发生皮下积液或切口感染等并发症.结论 局麻下施行保乳手术具有创伤小、操作简单、麻醉满意、恢复快、费用低及对患者生理干扰小等特点.     

早期乳腺癌保乳手术术后配合放疗与改良根治术的疗效对比

目的 对比分析早期乳腺癌保乳手术术后配合放疗与改良根治术的临床效果.方法 将本院2009年2月～2012年10月收治的180例Ⅰ期和Ⅱ期乳腺癌患者,根据患者手术方式不同分成改良根治术组125例和保乳手术组55例,保乳手术组11例术后行全乳适型调强放疗和瘤床加量放疗,改良根治术组有26例采取放疗.其他两组患者在手术后采取以CEF方案为主的化疗,而雌激素受体（ER）或孕激素受体（PR）阴性患者则采取内分泌治疗.结果 保乳手术组术后3年的生存率为90.9％,远处转移率为3.6％,局部复发率为5.4％;改良根治术组术后3年的生存率为95.2％,远处转移率和局部复发率分别为6.4％和4.8％,两组比较,差异无统计学意义（P＞0.05）.结论 保乳手术＋术后放射治疗早期乳腺癌的创伤小、痛苦少、恢复快,且可达到与改良根治术相同的效果,对于早期乳腺癌可推广应用.     

乳腺癌保留乳房手术的近期疗效观察

目的探讨早期乳腺癌保留乳房手术的近期疗效。方法对我院2004年1月至2007年10月收治的25例早期乳腺癌行保留乳房手术,并于术后进行随访。结果未见局部复发和远处转移,乳房外形保持良好。结论保留乳房手术治疗早期乳腺癌的近期疗效满意,术前严格掌握适应证,术后给予规范的综合治疗是保留乳房手术获得成功的关键.     

Pathophysiology and pharmacokinetics following burn injury

Therapy for inpatient burn victims is a clear challenge for the clinician, since directly following injury the pharmacokinetic parameters of many drugs will change drastically. Blood flow to the tissues is decreased; the rate of distribution and elimination of intravenous drugs administered during this time is reduced, and absorption of oral drugs may be slowed. Approximately 48 hours after injury, the blood flow increases, as does internal core temperature; the rates may increase as a result. Immediately after injury, plasma albumin level rapidly decreases and remains significantly depressed even at 60 days post-burn. Thus, the protein binding of acidic and neutral drugs will decrease and higher amounts of free fraction will be available at the biophase. On the other hand, alpha 1-acid glycoprotein increases in concentration and remains elevated at least 20 days post-burn. Basic drugs exhibit increased protein binding and will most probably need an increased dosage to achieve the appropriate pharmacological effect. Hepatic metabolism is also affected: the rate of phase I metabolism will decrease while phase II metabolism is unimpaired and may possibly increase. Other liver functions, such as protein synthesis, are also impaired. The effect on phase I drug metabolism is believed to be due to oxygen-derived free radicals released during the course of injury. In those patients with full-thickness burns, the epidermal layer is destroyed. Topical drugs have less of a barrier to cross and, consequently, less drug is needed to achieve effectiveness. In addition, the stomach has been found to secrete excess protons which will eventually lead to ulcers in the majority of patients. Hyperchlorhydria may affect the dissolution and disintegration of orally administered drugs in tablet form, as well as the partitioning of the neutral un-ionised species between the stomach and bloodstream. In the small intestine decreased nutrient absorption and DNA synthesis occurs, but the effect this may have on drug absorption is questionable. This paper focuses on the epidemiology of burn injuries and the way in which the pathophysiology following such injury alters the pharmacokinetics of a drug. Specific examples are provided. Some mention is made of burn management, therapeutic drug monitoring in burn patients, experimental design considerations, and future research topics.     

Recent patents on topical application of honey in wound and burn management

Topical application of honey to burn and wounds has been found to be effective in controlling infection and producing a clean granulating bed. It is suggested that the wound healing effect of honey may in part be related to the release of inflammatory cytokines from surrounding tissue cells, mainly monocytes and macrophages. It has been reported that honey hastens wound healing by accelerating wound contractions. Microscopic evaluation demonstrated that there was a significant acceleration of dermal repair in wound treated with honey. Macroscopic and microscopic observations under in vivo assessment suggested that the topical application of honey might have favourable influences on the various phases of burn and wound healing hence accelerating the healing process. The regulatory effects of honey are related to components other than the sugars. However, the mechanisms by which honey affects the release of anti inflammatory agents and growth factors from monocytic cells are as yet unclear. Whether honey affects other cell types, particularly endothelial cells and fibroblasts, involved in wound healing also needs to be clarified. The present article is a short review of recent patents on the healing effect of honey in wound and burn management.     

创伤性脾损伤的保守手术与根除治疗对比分析

目的：探讨创伤性脾损伤的保守手术与根除治疗的对比效果。方法：将40例创伤性脾损伤患者平分为两组,对照组采用开腹全脾切除术,治疗组采用保守手术治疗。结果：经过治疗后,治疗组的有效率为95.0%,对照组的有效率为75.0%,治疗组的有效率明显好于对照组（P〈0.05）。对照组发生并发症8例,其中肺部感染7例,粘连性肠梗阻1例;治疗组发生并发症2例,其中肺部感染1例,粘连性肠梗阻1例。两组并发症经对症治疗后均获得治愈,两组并发症对比差异有统计学意义（P〈0.05）。结论：相对于根除治疗,保守手术治疗创伤性脾损伤能提高治疗疗效,降低并发症,值得推广应用。     

乳腺癌保乳术后放射治疗技术概述

乳腺癌是危害妇女健康的常见肿瘤之一,随着放疗设备的发展,临床使用的放疗技术种类也在不断增加。笔者通过简要介绍乳腺癌保乳术后应用到的几种放疗技术的含义,并阐述各种放疗技术剂量学的利弊,来探讨在临床实践中如何更好地选择放疗技术。     

保守性手术和药物治疗输卵管妊娠分析

目的探讨不同保守性方式治疗输卵管妊娠的血B-HCG下降幅度及妊娠结局方法回顾性分析保守性治疗输卵管妊娠322例,其中药物治疗组90例(A组),保守性手术治疗组232例(B组),治疗后定期监测血B-HCG下降幅度及宫内妊娠率、再次异位妊娠率。结果A组血B-HCG降至正常时间为19.9±6.17天,B组血B-HCG降至正常时间为10.68±5.90天;A组宫内妊娠率为45%,B组宫内妊娠率为67.3%;B组6例发生持续性异位妊娠,均为输卵管伞端胚囊挤出术。结论监测血B-HCG是判断保守治疗成功的指标,保守性手术具有术后宫内妊娠率高的优点,是保守治疗的首选,但应尽量避免行输卵管伞端胚囊挤出术.     

乳腺癌术后行调强放疗与三维适形放疗的效果观察

目的探讨调强放疗(IMRT)与三维适形放疗(3D-CRT)在乳腺癌术后患者中的应用效果。方法选取解放军989中心医院2015年1月—2017年12月期间行保乳术治疗的乳腺癌患者92例,随机分为对照组、观察组,每组46例。两组均行乳腺癌保乳术及化疗,化疗2～3个疗程后,对照组行3D-CRT,观察组行IMRT,比较两组的照射剂量、放疗前后的基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶组织抑制剂-1(TIMP-1)水平及不良反应发生情况。结果该研究92例患者均完成放疗,观察组左侧病灶及患侧肺脏照射剂量明显低于对照组(P<0.05);观察组PTV的V105%、V110%及V115%也均低于对照组(P<0.05);观察组CI高于对照组、HI低于对照组,差异有统计学意义(P<0.05);两组放疗后MMP-9水平均较本组放疗前降低,差异有统计学意义(P<0.05);放疗前、放疗后两组TIMP-1水平对比,差异无统计学意义(P>0.05);观察组皮肤反应、骨髓抑制、放射性肺损伤、胸骨后疼痛及消化障碍等不良反应发生率均低于对照组,差异有统计学意义(P<0.05)。结论 IMRT与3D-CRT相比,前者的PVT剂量均匀性及适形度均较好,危及器官的受照射剂量低,利于降低乳腺癌术后患者不良反应发生率。     

乳腺癌早期行保乳手术治疗的体会

目的:总结早期乳腺癌行保留乳房根治术的治疗效果.方法:分析2005年1月～2009年12月我科开展的保乳手术的42例患者的近期治疗效果.结果:本组患者均行保留乳房的乳腺癌根治术,术后联合化疗、放疗、内分泌治疗均获得较满意的效果.结论:早期乳腺癌行保乳手术联合放、化疗可达到与传统根治手术相同的近期效果,并具有患者心理打击小、美容效果好的优点.     

子宫内膜异位症保守性术后应用GnRH-a治疗对复发的影响

目的 探讨子宫内膜异位症保守性术后应用GnRH-a治疗对复发的影响.方法 选取笔者收治的腹腔镜保守性术后108例子宫内膜异位症不孕症患者,将其随机分为观察组以及对照组;对照组单纯进行手术治疗,观察组在术后予以GnRH-a治疗,比较两组治疗效果、复发率、疼痛缓解率以及不孕妊娠率.结果 观察组完全缓解率与对照组相比明显升高,复发率明显降低,P＜ 0.05.观察组术后疼痛缓解率(85.19％)明显高于对照组(62.96％),P＜0.05.其中41例不孕症患者,观察组术后2年妊娠率(64.81％)明显高于单纯手术组(31.48％),P＜ 0.05.结论 腹腔镜保守手术术后联合药物GnRH-a对中重度子宫内膜异位症进行治疗可明显降低患者术后复发率,提高术后妊娠率,值得临床上推广应用.     

Metronidazole and Pentoxifylline films for the local treatment of chronic periodontal pockets: preparation,in vitro evaluation and clinical assessment

Objective: Periodontitis is one of the most important chronic inflammatory dental diseases arising from the destructive actions caused by a variety of pathogenic organisms presented in the oral cavity. The aim of this study is the preparation and in vitro evaluation of films for the local treatment of periodontal pockets.

Methods: The prepared films contained either metronidazole (Mtr), for its antimicrobial effect in periodontal diseases, using a mixture of polymers namely hydroxypropyl methyl cellulose, Carbopol 934 or locally applied Pentoxifylline (PTX), for its anti-inflammatory activity, using chitosan. All films were prepared using solvent casting technique and were evaluated for their physical characteristics, drug content uniformity, surface pH, swelling behavior, mechanical properties and in vitro release. Further characterization was done on the selected formulations using differential scanning calorimetry and scanning electron microscopy for surface structure. Clinical evaluation tests were also performed.

Result: Appropriate physical characteristics and mechanical properties for most formulations and their suitability for periodontal application were observed. In vitro drug release from most films showed a burst release rate for both Mtr and PTX during the first 2 h after which the release rate was markedly decreased. Clinical trials on patients revealed the advantageous use of Mtr and PTX as an adjunct treatment with traditionally used dental techniques.

Conclusion: The effectiveness of the co-therapy of either drug could add benefit in the eradication of chronic periodontal hazards.     

剖腹保守性手术和半根治手术治疗不同类型子宫内膜异位症的临床观察

目的观察剖腹保守性手术及半根治手术治疗子宫内膜异位症的临床疗效。方法根据异位部位将77例子宫内膜异位症患者分为腹膜组（27例）和卵巢组（50例）。据患者要求行剖腹保守性手术或半根治手术,观察2组临床疗效。结果 2组临床疗效均较好。卵巢组手术时间短于腹膜组,出血量少于腹膜组,差异均有统计学意义（P〈0.05）。结论剖腹保守性手术可满足患者的分娩需求,半根治手术可减少复发。2种方法均手术时间短、恢复快、患者痛苦轻,且并发症少,值得临床推广应用。     

腹腔镜手术联合GnRHa治疗卵巢子宫内膜异位症的预后分析摘要

目的分析卵巢子宫内膜异位囊肿接受腹腔镜保守治疗,术后辅助使用与不用促性腺激素释放激素激动剂（gonadotropin-releasing-hormoneagonist,GnRHa）的近期、远期复发率和妊娠率。方法收集2008年1月一2011年7月在我院妇科行腹腔镜保守手术治疗并经病理证实为卵巢子宫内膜异位囊肿症的患者,按术后辅助使用GnRHa与否,分为单纯手术组和联合用药组。随访截止到2012年12月,比较两组患者的复发率和妊娠率。结果共有195例患者接受治疗,最后183例患者纳入分组,为单纯手术组59例,联合用药组124例。单纯手术组总妊娠率、6月和1年妊娠率分别为45．8％、22．0％和39．0％;联合用药组为55．6％、9．7％和29．0％,两组6月妊娠率差异有统计学意义,其余差异无统计学意义。单纯手术组总复发率、6月和1年复发率分别为10．2％、5．1％和6．8％;联合周药组为11．3％、1．6％和6．5％,两组差异无统计学意义。结论对于卵巢子宫内膜异位囊肿症患者,在腹腔镜手术治疗以及术后辅助GnRHa相比较能降低复发率和有益于妊娠率的提高。     

对乳腺癌新辅助化疗的理解与遵循原则

乳腺癌新辅助化疗始于20世纪70年代,研究证实新辅助化疗可以使不可手术的局部晚期乳腺癌患者获得手术治疗的机会,并且提高肿瘤体积较大患者的保乳率,从而明显改善患者的生活质量。对于新辅助化疗在可手术早期乳腺癌中的应用,虽然循证医学证据表明新辅助化疗的生存率与辅助化疗相同,但是仍有许多问题存在争议。本文对国内会议上经常讨论的10个有关新辅助化疗的热点问题以及临床指南进行探讨。     

腹腔镜下手术和经腹保守性手术治疗卵巢肿瘤蒂扭转的优劣差异

目的研究腹腔镜下手术和经腹保守性手术治疗卵巢肿瘤蒂扭转的优劣差异。方法选取我院2014年9月~2016年10月间收治的卵巢肿瘤蒂扭转96例患者,采用随机数字法将其分为对照组和观察组,每组各48例。所有患者行手术治疗,对照组采取经腹保守措施,观察组采取腹腔镜措施,比较两组患者手术时间、术中出血量、首次肛门排气时间、住院时间差异;比较术后切口感染、出血、发热等并发症发生情况;所有患者随访1年,比较患者子宫缩小、卵巢血供异常、卵巢功能障碍等发生情况。结果观察组患者术中出血量、手术时间、首次肛门排气时间、住院时间显著优于对照组(P<0.05);两组患者的切口感染、出血、发热等并发症发生率比较,观察组显著优于对照组(P<0.05);术后1年随访结果比较,观察组子宫缩小、卵巢血供异常、卵巢功能障碍发生率显著优于对照组(P<0.05)。结论使用腹腔镜下手术治疗卵巢囊肿蒂扭转,疗效显著、术后并发症发生率低,远期疗效良好,应在临床广泛推广。