腹腔脂肪量与胃癌病人术中淋巴结清扫的关系

目的:探讨腹腔脂肪分布的CT测量与胃癌病人术中淋巴结清扫的关系。方法:回顾性收集2008年5月至2009年9月在我院外科胃切除加D2淋巴结清扫术的226例胃癌病人。手术前通过CT扫描及重建分别测量了腹腔脂肪面积(IFA)及腹腔脂肪体积(IFV)。将IFA分为高IFA组(IFA≥85 cm2)和低IFA组(IFA<0.001)。结论:病人腹腔脂肪面积影响胃癌的术中淋巴结清扫个数。     

Laparoscopic total mesorectal excision with natural orifice specimen extraction

AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications.     

Alternatives to commonly used pelvic reconstruction procedures in gynecologic oncology

Objectives

The objective of this review is to discuss alternatives to commonly used methods of soft tissue reconstruction in patients with gynecologic malignancies, and in particular alternatives to skin grafts, local skin flaps, and rectus abdominis/gracilis flaps.

Methods

A review of the literature was performed on soft tissue reconstruction in patients with gynecologic malignancies.

Results

Soft tissue reconstruction is often necessary to achieve successful wound healing, minimize complications, and to restore anatomic form and function. Commonly used methods such as skin grafts, local skin flaps, and rectus abdominis/gracilis flaps are effective, but many scenarios exist where they may be suboptimal or unavailable for use. Situations faced by the gynecologic oncologist where this may be the case include patients in whom prior treatments and/or tumor involvement have affected the vascular supply and tissues of commonly used options, those with disease recurrence who have previously undergone tumor extirpation and reconstruction, and patients undergoing radical surgery where commonly used options alone are inadequate. Under these circumstances, there are several alternative options, and an understanding of the full spectrum of reconstructive techniques is essential.

Conclusions

Many clinical scenarios exist where commonly used options for soft tissue reconstruction are suboptimal or unavailable. Current evidence supports use of alternative methods of reconstruction in these situations. However, further larger scale and comparative studies are needed to refine surgical decision-making.     

腹腔镜技术在食管裂孔疝修补手术中的初步体会(附3例报告)

目的探讨腹腔镜技术在修补食管裂孔疝手术中的应用。 方法回顾性分析武汉市第一医院2013年3月至2014年3月,3例行腹腔镜食管裂孔疝手术患者的临床资料。 结果3例腹腔镜手术均顺利完成,无中转开腹手术。2例同时行Nissen胃底折叠术,1例仅行裂孔修补术,平均手术时间120 min,平均住院5 d,无术后并发症。术后平均随访时间6月,无复发病例。 结论腹腔镜修补食管裂孔疝手术具有微创,安全,有效的特点,符合快速康复外科的要求。     

上皮钙黏蛋白启动子-160 C/A位点单核苷酸多态性与鼻咽癌的相关性

背景与目的：上皮钙黏蛋白(E-cadherin,E-cad)作为一种关键的结构蛋白对正常的细胞极性、上皮形态和细胞分化非常重要。最近有研究表明E-cad基因启动子区域-160 C/A基因多态性与鼻咽癌(nasopharyngeal carcinoma,NPC)的易感性有关。本研究旨在评价中国汉族人群中NPC危险性和E-cad基因启动子-160 C/A位点多态性的关系。方法：选取303例明确诊断为NPC的患者为实验组,同时选取318位健康志愿者为对照组。采用TaqMan探针技术检测启动子区域-160 C/A位点的单核苷酸多态性。结果：按性别和年龄调整后,实验组E-cad基因启动子-160 C/A位点A/A基因型危险性显著高于对照组(调整后OR=2.09,95%CI：1.03~4.22,P=0.04)。按性别分层后,女性NPC患者中A/A基因型危险性显著高于对照组(OR=7.57,95%CI：1.57~36.47,P=0.012)。此外,与NPC患者中男性A/A基因型比对,女性A/A基因型具有更高的患病风险(OR=2.66,95%CI：1.14~6.20,P=0.024)。结论：E-cad基因启动子-160 C/A位点的A/A基因型是中国汉族人群患NPC的危险因素之一,尤其对于女性患者尤为显著。     

舌体骨软骨迷离瘤1例

舌体骨软骨迷离瘤是在舌体组织内发现分化正常的骨、软骨成分的疾病,临床上罕见。本文报道 1例舌体骨软骨迷离瘤。     

婴幼儿合并轻度上呼吸道感染择期手术全麻的安全性

【摘要】目的评估合并轻度上呼吸道感染（URI）的婴幼儿实施全身麻醉的可行性与安全性。 方法择期手术插管全身麻醉婴幼儿 169 例, 年龄 20 d～ 36 个月 、性别不限、ASA 分级Ⅰ 或Ⅱ 级。 根据术前是否出现上感症状, 将其分为 URI 组（n=41）和非 URI 组（n=128）。 观察并记录患儿一般情况, 手术期、术后呼吸系统相关并发症发生情况。 结果 （1）2 组间比较： 与非 URI 组相比, URI 组在手术期屏气的发生率较高, 咳嗽、多痰、血氧饱和度（SpO2）＜0.95、发热、舌后坠发生率差异无统计学意义, 2 组手术期均无发热。 URI 组术后多痰的发生率较高, 咳嗽、SpO2＜0.95、发热、舌后坠、屏气发生率差异无统计学意义, 2 组在手术期和术后均未发生喉痉挛与支气管痉挛。（2）手术期-术后比较： 与手术期相比, 非 URI 组术后咳嗽、发热的发生率增高, SpO2＜ 0.95、舌后坠的发生率降低; URI 组术后发热的发生率增高, SpO2＜ 0.95、屏气发生率降低, 其余并发症发生率差异无统计学意义。 结论 合并轻度 URI 的婴幼儿在周密的术前评估与谨慎的术中管理下实施气管插管全身麻醉是可行并且相对安全的。     

纳米粒子对蛋白质结构影响的原子力显微镜研究

目的 研究不同粒径、不同材料、不同形状的纳米粒子对蛋白质分子结构的影响。方法 通过原子力显微镜表征纳米 粒子吸附蛋白质前后的粒径变化,研究其对蛋白质结构的影响。 结果 从粒径大小来看,纳米粒子的粒径越小对蛋白质的 结构造成的影响越小;从纳米粒子的材料来看,半导体材料的纳米粒子对蛋白质结构造成的影响大于金纳米粒子;从纳 米材料的形状来看,球形纳米颗粒对蛋白质结构造成的影响小于片状石墨烯。结论 纳米粒子的粒径、材料和形状对蛋白 质的分子结构有着显著的影响。     

肾移植后环孢素A浓度监测及其影响因素

背景：对使用环孢素A的患者进行长期、定期的血药浓度监测以做到个体化给药具有非常重要的临床意义。 目的：总结肾移植后环孢素A血药浓度监测方法及影响其血药浓度的因素,以期为临床安全有效地使用环孢素A提供参考。 方法：以“环孢素A、肾移植、血药浓度、影响因素”及“Cyclosporin A,Renal Transplantation,blood drug level”为关键词,采用计算机检索2000-01/2012-01相关文章。纳入肾移植后应用环孢素A进行免疫抑制治疗,并对其血药浓度进行检测的文章及有关环孢素A检测方法及影响环孢素A血药浓度因素的文章;排除重复研究或Meta分析类文章。共纳入30篇相关文献进行综述。 结果与结论：由于环孢素A的治疗窗较窄,生物利用度相差较大,一般的给药方案是首次剂量依据体质量给予,此后则参考环孢素A的测定浓度及时进行剂量调整。目前主要采用荧光偏振免疫法及高效液相色谱法对其血药浓度进行检测,同时可应用人工神经网络对其进行预测。当然在调整给药剂量的同时还要考虑一些药物相互作用及患者自身病理生理因素的影响。肾移植后患者必须在其治疗过程中常规性监测环孢素A血药浓度,避免出现环孢素A血药浓度过大或不足,同时综合考虑临床各方面的因素,及时调整患者的用药情况,实施个体化用药方案,使肾移植后患者能获得最佳治疗效果。