快速康复外科在结直肠癌择期手术中的应用效果

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.     

浅析18F-FDG PET/CT肿瘤显像前应注意的几个问题

随着18F-FDG PET/CT显著的临床价值以及临床医生对18F-FDG PET/CT检查的认可,越来越多的肿瘤患者选择了18F-FDG PET/CT检查。为了尽可能使行18F-FDG PET/CT肿瘤显像的患者感到检查的舒适性和无创性,并最大限度获得准确和高质量的影像结果,本文就患者行18F-FDG PET/CT肿瘤显像前     

快速康复外科在结直肠癌择期手术中的应用效果

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.     

结直肠黏液腺癌的临床特点

者黏液腺癌和非黏液腺癌中位生存时间分别为125.1和151.0个月,差异也有统计学意义(P＝0.020);两组Ⅰ、Ⅳ期患者总生存率差异无统计学意义(P＞0.05);而Ⅱ、Ⅲ期患者非黏液腺癌中位生存时间149.0个月,明显长于黏液腺癌的67.7个月(P＝0.033).结论 黏液腺癌可能是具有独特生物学行为的肿瘤,其预后差与其独特的病理类型有关.     

中国南方结直肠黏液腺癌和印戒细胞癌、非黏液腺癌的临床病理特征和预后

Background Previous studies have shown conflicting results on the relation between clinicopathologic features and prognosis of patients with colorectal mucinous, signet-ring cell, or non-mucinous adenocarcinoma; only few such studies have been performed in China. This retrospective study analyzed data from our department to investigate clinicopathologic characteristics, prognosis and possible correlations of three histologic types - colorectal mucinous, signet-ring cell, and non-mucinous adenocarcinoma, to clarify the bases for observed differences which may lead to development of targeted therapies Methods Of 2079 patients diagnosed with colorectal cancer between 1994 and 2007, 144 had mucinous, 25 had signet-ring cell, and 1837 had non-mucinous adenocarcinoma. Their clinicopathologic parameters and survival were analyzed using established statistical methodologies. Results Mucinous and signet-ring cell adenocarcinomas were common in younger patients （P 〈0.001）. Location, size and disease stage differed significantly among the three types. Signet-ring cell tumors were more commonly found in the rectum than mucinous and non-mucinous adenocarcinoma （P 〈0.001）. Mucinous and signet-ring cell tumors presented in a later stage in life more often than non-mucinous adenocarcinoma, with lymph node involvement, serosal infiltration, peritoneal dissemination, and adjacent organ invasion （P 〈0.01）. The rate of radical resection, hepatic metastasis and local recurrence did not differ among types （P 〉0.05）. Compared with patients with non-mucinous adenocarcinoma, patients with mucinous and signet-ring cell tumors who underwent potentially curative resections or stage Ⅱ/Ⅲ disease had poorer long-term overall survival. Survival did not differ by type for patients with either stage Ⅰ or Ⅳ disease （P 〉0.05）. Conclusions Mucinous and signet-ring cell adenocarcinoma have unique carcinogenesis and similar biologic behavior. Our study confirms that both histologic types, especially signet-ring cell tumors, are independent, negative prognostic factors for patients with colorectal cancer. Type does not appear to have a significant effect on survival when disease is either stage Ⅰ or Ⅳ at presentation.     

ICMA与IRMA测定TSH的对比分析

随着分析技术的迅猛发展,促甲状腺激素(TSH)的检测方法不断更新,化学发光免疫分析(ICMA)在国内逐渐普及.传统的IRMA为第二代的检测方法,临床上仍然广泛应用,作者对上述两种方法测定血清TSH含量的精密度、准确度及相关性进行了对比分析,现报道如下.     

创伤结局的多因素分析

目的探讨影响创伤结局的各种因素,建立创伤结局预测模型,为提高创伤救治水平提供有用的信息。方法回顾性分析1131例创伤患者的资料,以创伤生存率为反应变量,对生理评分、SIRS评分和解剖损伤评分进行Logistic回归分析,并考虑年龄等因素,计算出各自的权重。结果 GCS、SIRS、年龄和收缩压进入Logistic回归方程,解剖损伤评分未进入回归方程。结论 GCS、SIRS、收缩压、年龄是影响创伤结局的重要因素。     

肿瘤乏氧与乏氧检测研究现状

乏氧是人和动物肿瘤共有的特征。实验观察与测定表明，几乎所有的实体肿瘤中均有乏氧细胞存在，乏氧细胞在实体瘤中是常见现象。分子生物学研究发现，乏氧不仅使肿瘤产生针对放、化疗的保护蛋白，增加对放、化疗的抵抗性，而且使肿瘤内氧调节蛋白（OPR）、血管内皮生长因子（VEGF）等表达增加，从而使肿瘤自身的侵袭性也增加。自Thomlison和Grayp发现在恶性肿瘤中存在低氧细胞以来，     

神经生长因子在新生大鼠耳蜗的定位及其意义

目的 观察神经生长因子在新生大鼠耳蜗中的定位,为进一步研究其在听觉通路中的作用机制提供依据.方法 出生后5～7 d健康SD大鼠20只,制备耳蜗石蜡切片,用兔抗小鼠神经生长因子(nerve growth factor,NGF)多克隆抗体行免疫组织化学染色(S-P法),检测NGF在耳蜗中的表达.结果 新生SD大鼠膜迷路呈类三角形结构,可清晰看见幼稚柯替器、螺旋神经节细胞、蜗轴中的细胞染色阳性,细胞核及细胞质内均有表达.结论 NGF对出生后5～7 d大鼠螺旋神经节细胞和毛细胞的存活、成熟密切相关.     

结直肠腺癌病理分型的临床意义及预后分析

目的 探讨结直肠黏液腺癌、印戒细胞癌与乳头状、管状腺癌临床病理的差异和预后.方法 收集1994年8月至2007年3月结直肠手术患者2089例,其中黏液腺癌144例,印戒细胞癌25例,乳头状腺癌和管状腺癌1837例,剔除其他类型肠道肿瘤83例.比较三组的临床病理特点.对影响结直肠预后的部分临床病理指标,如年龄、肿瘤部位、分期、腹膜、病理分型进行单因素和非条件Logistic回归分析.对三组进行总体生存分析.结果 黏液腺癌患者发病的中位年龄为(54.20±16.25)岁,印戒细胞癌患者为(40.43±12.88)岁,乳头状腺癌和管状腺癌患者为(58.73±13.62)岁,印戒细胞癌发病年龄最低(P<0.001).三组男女比例、肿瘤直径、肿瘤部位、TNM分期、腹膜转移、淋巴结转移和脏器侵犯差异均有统计学意义(P值均<0.05).经单因素和非条件Logistic回归分析发现,黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素,而印戒细胞癌是预示结直肠癌预后的独立因素.三组总体生存时间和生存率间差异有统计学意义(P<0.001).结论 结直肠黏液腺癌和印戒细胞癌预后较乳头状、管状腺癌差.黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素.