颈前肌群胸骨端离断入路在双侧巨大甲状腺肿物切除术中的应用

目的探讨胸骨端离断颈前肌群翻转固定在双侧巨大甲状腺肿物切除术中的应用优势。方法采用胸骨端离断颈前肌群翻转固定法完成甲状腺手术53例(观察组),采用颈白线切口行甲状腺手术44例(对照组),手术均由同一组医师完成。分别对2组患者的手术时间、手术野显露效果、术中出血量、术后并发症及术后引流量进行比较。结果 2组患者在性别、年龄、疾病构成以及肿瘤大小方面的差异均无统计学意义(P>0.05)。观察组的手术时间、术中出血量及术后引流量短(少)于对照组(P<0.01),术后并发症发生率低于对照组(P=0.04);手术野暴露效果优于对照组(P<0.01)。结论经胸骨端入路行双侧巨大甲状腺手术是可行的,手术操作简便,手术野显露优于颈白线切口,术后并发症少,值得临床推广。     

Diagnostic Ureteroscopy Independently Correlates with Intravesical Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Background

Little is known about the effects of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy.

Methods

This study was designed to determine the effect of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy. From 2004 to 2010, 446 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical center. We included 115 patients who underwent preoperative diagnostic ureteroscopy and 281 patients who did not. This study analyzed the impact of the reported risk factors and diagnostic ureteroscopy for intravesical recurrence after nephroureterectomy by multivariate Cox regression model.

Results

The rates of metastasis and cancer-specific mortality did not differ significantly between the two groups. Diagnostic ureteroscopy was associated with a higher incidence of intravesical recurrence in patients with (p = 0.02) and without (p = 0.016) a previous history of bladder cancer. Ureter tumor biopsy (p = 0.272) and ureter involvement (p = 0.743) were not associated with the rate of intravesical recurrence in this study. Multivariate Cox regression analysis showed that only bladder cancer history (p < 0.001), multifocal tumor (p = 0.05), and diagnostic ureteroscopy (p = 0.05) were independently associated with intravesical recurrence.

Conclusions

Diagnostic ureteroscopy for upper urinary tract cancer was not associated with metastasis and cancer-specific mortality. However, ureteroscopy was associated with an increased incidence of intravesical tumor recurrence. Methods of prevention should be considered to decrease intravesical recurrence and avoid repeated surgical interventions or the development of advanced bladder disease in patients at risk.     

脂质体递药系统与奥沙利铂脂质体对结直肠癌治疗的研究

奥沙利铂对晚期结直肠癌的临床治疗有较好效果,但有剂量限制性毒性.脂质体作为药物载体,具有缓释性、靶向性和降低药物毒副作用的特点.脂质体的主动靶向修饰对改变抗肿瘤药物的生物分布,减少或逆转肿瘤细胞的多药耐药性,提高抗肿瘤药物的作用也具有意义.利用脂质体的特性,将奥沙利铂制成脂质体治疗结直肠癌有一定意义.