小儿肝母细胞瘤29例诊治分析

２９例小儿肝母细胞瘤依时间和治疗原则不同分为早期（１９６５～１９８０年行手术切除）、中期（１９８０～１９９１年行手术切除＋术后化疗）、后期（１９９１～１９９５年行术前化疗＋手术＋术后化疗）。早、中期总体手术切除率分别为３７．５％、３０％，总体１年无瘤生存率２５％和３０％。后期总体切除率６２．５％，１年无瘤生存率５０％。统计学分析表明，后期生存率提高是由于采用术前化疗，使进展期肿瘤切除病例增多。认为加强对Ⅲ、Ⅳ期肿瘤的术前化疗，是提高其切除率、改善本病总体预后的关键     

中叶肺癌的外科治疗

作者自１９６５年２月至１９９３年４月，手术治疗８８例中叶肺癌，占同期肺癌手术总例数的７．７％。主要临床症状为发热、咳嗽、血痰和胸痛。本组有８４例行肺楔形切除、肺叶切除及全肺切除，４例开胸探查。随访７８例，１、３、５和１０年生存率分别为８７．１８％、４３．０８％、３８．１８％和２４．１３％。作者认为：中叶肺癌的发病率低、易误诊，因而往往拖延了手术治疗时机，若能尽早手术，远期疗效较好。     

Ⅲ期胃癌治疗的探讨

１９７５年至１９８９年作者共收治Ⅲ期胃窦、体部癌患者２３８例，随访９０．７％，总５年生存率为４５．４％，１０年生存率为３３．７％。扩大根治组（选择性Ｒ＿３或Ｒ＿３）术后５年和１０年生存率分别为５６．３％和４７．５％，显著高于普通根治组（Ｒ＿２）的３５．７％和２３．３％。术后辅助化疗组５年生存率和１０年生存率分别为３６．４％和１２．１％。显著高于未用化疗组（９．５％和３．６％）。化疗加中药组术后生存率（７８，１％和４５％）显著高于单用化疗组。腹腔冲洗、化疗组和腹腔化疗组的腹膜转移率分别为１８．７％和２０．６％，显著低于腹腔未治疗组（３１．９％）。作者认为Ⅲ期胃癌最佳治疗方案为切除足够的胃和淋巴结，防治腹膜和血行转移。     

同时支气管肺动脉成形治疗中心型肺癌

自１９８７年至１９９５年，对２３例中心型肺癌病人采用同时行支气管、肺动脉成形术治疗。其中支气管完全袖式切除２０例，楔形袖式切除３例；肺动脉干侧壁切除１８例，袖式切除５例。术后１、３、５年生存率分别为７．３％、４５．５％、３３．３％。采用同时支气管肺动脉成形术治疗中心型肺癌进一步减少了全肺切除术的比率，扩大了手术适应证，取得了满意的治疗效果。     

肝癌切除加免疫化疗对术后复发的影响

作者将１２１例原发性肝癌患者分成４组：（１）单纯手术切除组（ＯＰ组），３０例；（２）手术切除加化疗组（ＯＣ组），２７组；（３）手术切除加免疫疗组（ＯＩ组），３１例；（４）手术切除加免疫化疗组（ＯＩＣ组），３３例，结果显示４组术后１年复发率分别为５６．７％、４０．７％、３２．３％及２７．３％，ＯＩ组及ＯＩＣ组术后复发率明显低于ＯＰ组及ＯＣ组，结果提示手术加免疫治疗有助于降低原发性肝癌的术后复发率。     

气管,支气管成形术40例

作者报告了４０例气管、支气管成形术的治疗体会。其中气管成形术３例,隆凸成形术２例,支气管成形肺切除术３４例,肺动脉成形术１例。术后并发症４例（１０％）,手术死亡２例（５％）。恶性肿瘤３０例,随访１～１０年,术后１年、３年、５年、１０年生存率分别为８３．３％、５３．３％、４０％、２３．３％。作者对手术适应证及麻醉的处理、手术方法及结果进行了讨论。这种手术能最大限度地清除病灶和保留健肺,但其手术并发症和死亡率均高于肺癌常规手术。因此要严格掌握手术适应证。     

肺癌病人Ki－ras基因点突变与术后长期生存关系的研究

本研究应用ＰＣＲ及寡核苷酸探针杂交技术，研究肺癌组织Ｋｉ－ｒａｓ基因点突变与肺癌病人术后长期生存的关系。结果显示：（１）６０例肺癌中Ｋｉ－ｒａｓ点突变率为４１．６７％。（２）小细胞肺癌Ｋｉ－ｒａｓ突变率较鳞癌、腺癌高，分别为５０％、４３．４８％和４０．７４％。（３）有Ｋｉ－ｒａｓ点突变组肺癌病人，其术后１、３、５年生存率分别为６４．０％、３６．０％和２４．０％；而无点突变组肺癌病人术后１、３、５年生存率分别为７４．２９％、５１．４３％和４０．０％。本研究结果表明：研究肺癌的Ｋｉ－ｒａｓ基因点突变，对判断肺癌病人的预后，指导术后的综合治疗，具有重要的临床意义。     

III期非小细胞肺癌的综合治疗

４１０例ＩＩＩ期非小细胞肺癌，３００例综合治疗，其中手术前后结合化疗或放疗５７例，术后化疗２０２例、术后放疗１９例，术后放疗及化疗２２例；与单纯手术组１１０例比较。术后１、３、５年生存率分别为６３．００％、２２．８２％、２１．５２％和４０．００％、８．２５％、８．６２％，前者明显高于后者，其中以术后结合化疗、放疗组最佳，５年生存率分别为２２．７２％和３０．００％。Ｎ０组最优，Ｎ２、３组最差。术中主     

肝切除治疗原发性肝癌156例体会

我科采用常温下病侧肝血流阻断施行非规则性肝切除术治疗原发性肝癌１５６例，均经手术治疗，病检证实。患者年龄１７￣６８岁，平均年龄为４３．５岁。Ｉ期肝切除１５４例，Ⅱ期肝切除２例。手术并发症５例，全组无手术死亡。切除标本最重３．５ｋｇ。１、３、５年生存率分别为６２．１％、３０．８％、２０．５％，５年以上仍存活者５例。此种手术只需游离所需切除肝脏的所属韧带，毋需解剖肝门，简化手术步骤，既能完成肝切除，又     

40例胸腺肿瘤合并重症肌无力的手术治疗

报告４０例胸腺肿瘤合并重症肌无力（ＭＧ）的手术治疗效果。本组包括完全切除肿瘤和胸腺２６例，次全切除肿瘤１０例，组织活检４例。结果手术死亡１例（２．５％），术后１年内死亡８例（２０．５％）。３１例术后随访３～１２年，５年生存率为６１．３％，１０年生存率２７．７％；其中非浸润型胸腺瘤分别为７６．９％和３０．０％，浸润型胸腺瘤则为５０．０％和２５．０％。ＭＧ术后缓解改善率为８０．６％，术后肌无力危象发生率为４０．０％，抢救成功率为９３．８％，结论显示手术治疗胸腺肿瘤合并ＭＧ，如严格掌握手术指征，可获得较好的疗效和预后。     

膝关节后交叉韧带断裂治疗临床分析

目的 对35例膝关节后交叉韧带断裂治疗进行临床分析,重点探讨了有关交叉韧带断裂的治疗问题。方法 经明确诊断后,分析采用胫骨附着处撕脱骨折复位固定手术治疗26例、早期髌韧带中1／3移植重建3例、单纯长腿石膏固定6例。结果 本组病例全部进行随访,随访时间13个月－5年,胫骨附着处撕脱骨折复位固定及髋韧带中1／3移植重建29例为优良、单纯长腿石膏固定6例为差。结论 后交叉韧带断裂后应该及时给予手术修复;膝后外侧手术入路,操作简单,暴露充分;少于3个月的陈旧性病例仍适应手术治疗。     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

Surgical correction of rupture of aneurysm of the sinus of Valsalva

Operations were performed on 48 patients with aneurysms of the thoracic aorta, one of them had a rupture of aneurysm of the noncoronary sinus followed by the formation of a fistula between the aorta and the right atrium. The fistula was ligated by an access through the right atrium with good nearest and long-term results.     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Evaluation of systems of grading of neurological deficit in tuberculosis of spine

STUDY DESIGN: Prospective comparative study. OBJECTIVE: To compare the efficacy of the ASIA scoring system and Tuli's classification for assessment of neurological status in a typical case of Pott's paraplegia/tetraplegia and suggest a suitable classification. SETTING: Department of Orthopaedics of University College of Medical Sciences and GTB Hospital, Delhi, India. METHODS: A total of 33 cases of tuberculosis of the spine with paraplegia were evaluated serially for the severity of the neurological deficit by grading systems as suggested by Tuli and ASIA score, during the course of treatment. A total of 111 readings of neurological status were recorded and analysed. RESULTS: Tuli's grading was found to be sensitive for detection of early stage (grade I) of neurological deficit. The rest of the grades (grade II, III, IV) of Tuli's classification have a wide range of sensory-motor deficit and hence are insensitive to early detection of any deterioration/improvement in the neurological status. The ASIA score failed to grade all types of neurological deficit associated with the Pott's spine. The sensory-motor score obtained by the ASIA scale depends on the level of involvement of the spinal cord. The higher the level of the cord damage, the poorer is the score. CONCLUSION: Neither Tuli's grading nor the ASIA scale alone can effectively grade all stages of neurological deficit in tuberculosis of the spine. The neurological deficit in tuberculosis of the spine should be described in stages and each stage should have sensory and motor scoring. A new staging system of Pott's tetraplegia/paraplegia is suggested.     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

人工关节松动病因的研究

目的：探讨人工关节松动的病因。方法：选择７例松动人工髋关节，翻修手术时取松动关节周围的界膜组织；同时选择１０例骨折内固定患者，拆除内固定物时取内固定物周围瘢痕组织。标本做组织学检查和肿瘤坏死因子（ＴＮＦ）测定。选择１０只成年兔，将２０只模拟假体分别置入双侧股骨远端。分别于术后第６、８、１０、１２、１４周向右侧膝关节腔注射聚乙烯微粒悬液，作为实验侧；左侧膝关节腔注射生理盐水，作为对照侧。第１６周取股骨远端标本，做组织学检查。结果：松动人工髋关节周围的界膜组织主要含大量的组织细胞和聚乙烯微粒，而骨折内固定物周围的瘢痕组织主要为纤维成分，无聚乙烯微粒。松动关节周围界膜组织中的ＴＮＦ浓度明显高于骨折内固定物周围的瘢痕组织（Ｐ＜０．０１）。动物实验发现，实验侧模拟假体周围有一层充满组织细胞的纤维结缔组织界膜，并有明显骨吸收和骨溶解现象，而对照侧无明显纤维结缔组织界膜，也无骨破坏现象。结论：人工关节磨损后，产生大量的磨损微粒，微粒刺激组织细胞分泌ＴＮＦ等溶骨性因子，这些溶骨性因子直接或间接地激活破骨细胞，从而引起假体周围骨吸收、骨溶解，最终导致假体松动。假体松动后又可加重磨损，产生更多的微粒，形成恶性循环     

Sonographic evaluation of hypertrophy of septum of Bertin

Sonography was utilized to evaluate 12 patients with hypertrophy of the septum of Bertin. To confirm the diagnosis, angiography was used in 7 patients and radionuclide imaging in 2. Three sonographic characteristics were found: (1) an isoechogenic, ellipsoid mass with an echogenic linear rim of renal sinus fat; (2) contiguity of the mass with a normal-placed septum of Bertin; and (3) the occurrence of the mass effect always at the level of the emergence of the renal vein. The sonographic findings could be divided into two definite types. Type I showed moderate hypertrophy with a mass effect ranging from 1.1 by 2.3 cm to 2.0 by 3.2 cm in diameter, usually presenting with a smooth contour and discrete mass effect on the intravenous pyelogram (IVP). Type II showed severe hypertrophy with a mass effect ranging from 3.2 by 4.0 cm to 3.5 by 4.5 cm in diameter, usually presenting with a lobulated contour and irregular stretching of the calyceal system on IVP. The differential diagnosis is discussed. In conclusion, we found that sonography associated with excretory urography is an accurate method for the diagnosis of hypertrophy of the septum of Bertin.     

Substantiation of the selection of a method of surgical treatment of varicose veins of the legs

An examination and operative treatment of 207 patients have shown that findings of plethysmometry and plethysmography reflecting the state of the direct and retrograde blood flow in the veins of lower extremities help to the correct selection of the method of surgery without phlebography. Long-term results of the operation confirm this conclusion.     

食管穿孔83例分析

８３例不同原因引起的食管穿孔，保守治疗５７例；手术２６例，行单纯食管修补术２０例、开胸行纵隔和／或胸腔引流２例、切除贲门肿物行胃食管吻合１例、颈部食管外置２例（其中１例并行二期结肠代食管手术）、１例开胸取异物形成食管瘘后，行二期修补瘘术。全组死亡８例，其中死于纵隔胸腔感染和主动脉破裂出血各４例。总治愈率８５％。并指出异物假牙造成食管穿孔的重要性，对严重的腐蚀性食管灼伤应早期行食管镜检，并针对食管穿孔部位、种类、间隔期、纵隔与胸腔的感染程度及病人具体情况采取相应的治疗措施。