腹腔镜辅助保留幽门胃切除术改善早期胃癌术后胆汁反流性胃炎前瞻性随机对照研究

目的比较腹腔镜辅助保留幽门胃切除术(LAPPG)与腹腔镜辅助远端胃大部切除术(LADG)(BillrothⅠ式吻合)对胃体中部早期胃癌病人术后继发性胆汁反流性胃炎(BRG)的影响。方法自2018年2月至2018年12月,对上海交通大学医学院附属仁济医院胃肠外科收治的69例早期胃体中部癌(cT1N0M0)病人进行1∶1前瞻性随机化入组,其中LAPPG组(行LAPPG)34例,LADG组(行LADG,BillrothⅠ式吻合)35例,进行6个月随访,比较两组术前、术中、术后及随访结果。结果两组病人在年龄、性别、BMI、术前合并症及术后病理诊断的基线水平差异无统计学意义(P>0.05)。两组淋巴结清扫数目、手术时间、术中出血量、术后首次排气时间、胃管拔除时间、Ⅱ级以上并发症差异无统计学意义(P>0.05)。术后6个月随访结果显示,BRG临床表现无特异性,在两组中差异无统计学意义(P>0.05);但内镜下诊断BRG比例LAPPG组显著低于LADG组,差异有统计学意义[3例(8.8%)vs.16例(45.7%),χ^2=11.763,P=0.001];LAPPG组中Kellosalofen分级Ⅱ度以上BRG的比例显著低于LADG组,差异有统计学意义[2例(5.7%)vs.9例(25.7%),χ^2=5.062,P=0.024];组织学活检发现LADG组胃小凹增生1例、腺体萎缩伴肠化3例,LAPPG组未观察到上述病理组织学异常,但两组差异无统计学意义(P>0.05)。结论LAPPG治疗早期胃体中部癌安全可行,该术式较LADG可改善术后BRG的发生率及严重程度。其对病人术后长期疗效及残胃癌发生率的影响仍有待大样本RCT研究的长期随访证实。     

孤立性髂动脉瘤介入治疗39例临床分析

目的 探讨孤立性髂动脉瘤介入治疗的临床经验。方法 回顾性分析2010年1月至2018年9月昆明医科大学附属延安医院血管介入科采用覆膜支架介入治疗孤立性髂动脉瘤39例,术后3个月、6个月及之后的每年对病人进行随访,探讨相关治疗方法。结果 39例病人分型有1A：Ⅰ型1例,1B：Ⅱ型8例,1D：Ⅳ型17例,2B：Ⅱ型2例,2D：Ⅳ型1例,2E：V型10例。平均瘤体最大直径为（42.4±11.2）mm（23.0～77.0 mm）。39例病人均顺利完成介入手术治疗,技术成功率100%,术中保留双侧髂内动脉1例,保留一侧髂内动脉29例,双侧髂内动脉均封闭9例,术中行一侧髂内动脉栓塞9例,行双侧髂内动脉均栓塞1例,手术时间为（49.0±17.0）min（35.0～87.0 min）,术后随访（31.9±17.7）个月（5～69个月）,术后除1例左髂动脉瘤破裂且合并肾衰竭的病人死亡,其余病人均好转出院,复查CTA示髂动脉瘤被完全封闭,支架形态位置良好,无内漏及其他并发症。结论 孤立性髂动脉瘤起病隐匿,早期多无症状,CT等检查能够早期诊断。介入治疗是安全有效的方法。应注意在术前根据髂动脉瘤的累及范围,近远端有无足够的锚定区进行分型,并对不同分型进行有差别的个体化治疗。     

应用皮下负压引流器预防下消化道开放手术切口愈合不良回顾性队列研究

目的 探讨应用皮下负压引流器预防下消化道开腹手术切口愈合不良的价值。方法 回顾性分析2018年10月至2020年1月首都医科大学附属北京友谊医院普外科收治的113例下消化道开放手术病人的临床资料。根据腹壁缝合时是否放置皮下引流器,分为皮下引流组（78例）和对照组（35例）。比较两组病人切口愈合情况,分析切口愈合不良与临床特征的关系以及开放手术切口愈合不良的影响因素。结果 113例病人中,切口愈合不良发生率为14.2%（16/113）,其中皮下引流组切口愈合不良发生率为5.1%（4/78）,对照组为34.3%（12/35）,两组差异具有统计学意义（P<0.05）。多因素分析提示,影响切口愈合不良发生的独立危险因素为未放置皮下引流器（OR=14.510,95%CI 3.411~61.735,P=0.001）、糖尿病（OR=7.064,95%CI 1.286~38.789,P=0.024）及吻合口漏/残端漏（OR=15.004,95%CI 1.876~119.996,P=0.011）。结论 下消化道开放手术切口愈合不良发生率较高,应用皮下负压引流器能有效减少其发生,且操作方便、价格低廉。     

经口腔前庭入路腔镜甲状腺全切除术治疗cN0甲状腺乳头状癌临床研究

目的 探讨经口腔前庭入路腔镜全甲状腺切除术（TOETVA）的有效性及安全性。方法 回顾性分析2017年7月至2019年7月浙江大学医学院附属第二医院甲状腺外科收治的行全甲状腺切除术且病理学检查确诊为甲状腺乳头状癌（PTC）的110例病人的临床资料,术前影像学检查提示无淋巴结转移（cN0）。其中51例行TOETVA（经口组）,59例行开放甲状腺手术（开放组）,对比两组临床病理学指标、手术效果以及随访情况。结果 两组病人术中喉返神经信号减弱比例、中央区淋巴结清扫数目、单双侧甲状腺清扫比例、淋巴结转移阳性率、阳性淋巴结数目及术后并发症（声音嘶哑、饮水呛咳、暂时性甲状旁腺功能减退及感染）差异均无统计学意义（P＞0.05）。术后随访6个月,经口组与开放组病人的Tg和PTH水平差异无统计学意义（P=0.560、0.206）,且均未发现两组有甲状腺残留及甲状腺癌复发转移征象。结论 TOETVA在有效性及安全性方面不劣于开放手术,且体表无手术瘢痕,尤其适合有美容要求的临床低危PTC病人。     

流入反转恢复序列在肝移植术后MR门静脉成像中的应用

目的 探讨流入反转恢复（IFIR）序列在肝移植术后门静脉成像中的应用价值。方法 对26例肝移植术后患者依次行上腹部IFIR序列成像和对比增强MRA（CE-MRA）,由2名医师采用盲法对门静脉显示质量进行评分,比较2组图像评分的差异并测量吻合口直径。比较2组图像测量值的差异,评价医师间图像质量评分和测量吻合口直径的一致性。结果 26例IFIR序列和CE-MRA均能显示门静脉主干及门静脉左、右支近端血管,图像质量≥ 3分者分别为92.31%（24/26）和96.15%（25/26）。2名医师对IFIR序列与CE-MRA图像质量评分差异均无统计学意义（医师1：Z=-1.077,P=0.282;医师2：Z=-0.629,P=0.529）。2组图像吻合口直径测量值间差异均无统计学意义（医师1：t=0.369,P=0.546;医师2：t=0.020,P=0.889）。2名医师图像质量评分和测量吻合口直径的一致性好。结论 IFIR序列可作为评估肝移植术后门静脉的有效方法之一。     

Maternal humoral factors associated with perinatal human immunodeficiency virus type-1 transmission in a cohort from Kigali, Rwanda, 1988-1994

OBJECTIVES: to study different parameters of humoral immunity responses in the serum of 39 human immunodeficiency virus type-1 infected pregnant women from Kigali, (Rwanda) in correlation with perinatal transmission. METHODS: this study was done between 1988 and 1994. Thirty nine HIV-1 infected women, 18 transmitting (T) and 21 non-transmitting (NT) mothers, have been chosen based on the quantity of sera available for analysis. Maternal data were collected at the time of delivery or during the preceding month. Quantification of viral load was performed by the signal amplification bDNA assay. Specific reactivity of antibody was tested against recombinant p24 protein and five different synthetic peptides from gp120 and gp41 based on HIV LAI-strain sequences. Neutralization assays were performed against laboratory (RII strain of the HIV-1 C subtype) and primary strains (two NSI and one SI of the HIV-1 A subtype). Antibody Dependent Cellular Cytotoxicity assay was performed with CEM.NK(R) cells against a laboratory HIV-1 strain. RESULTS: absence of correlation regarding maternal viral load, or viral subtype and vertical transmission was observed. By contrast, the CD4/CD8 ratio was significantly higher in non-transmitting mothers compared to transmitting mothers. Moreover, high anti-p24 antibody avidity was correlated with a lower risk of perinatal transmission. Furthermore, transmission risk appeared significantly higher with reactivity of serum samples to linear epitopes of gp41 (amino acids 566-582, 578-594), whereas risk appeared lower with reactivity to the immunodominant domain of gp41 (amino acids 597-609). No significant difference was observed in titres of antibody neutralizing primary isolates (two NSI (non syncitium inducer) and one SI (syncitium inducer) of the HIV-1 A subtype) and laboratory strain (RII strain, of the HIV-1 C subtype) between transmitting and non-transmitting mother's sera. In addition, titres of Antibody Dependent Cellular Cytotoxicity were similar in transmitting versus non-transmitting mothers. However, high Antibody Dependent Cellular Cytotoxicity titres were correlated with a good clinical status of children. CONCLUSIONS: three parameters such as high CD4/CD8 ratio, high anti-p24 antibody avidity and high reactivity against the immunodominant epitope of gp41 have been shown to be correlated with no perinatal transmission. High Antibody Dependent Cellular Cytotoxicity titres appeared to be linked to a good clinical status of children after birth. One parameter, reactivity against two linear epitopes of gp41, appeared to be correlated with vertical transmission.     

自适应统计迭代重建技术算法在头颅CT扫描降低噪声中的对比分析

目的：分析不同的ASIR（自适应统计迭代重建技术）值在降低头部图像噪声中的价值。方法：采用型号为Discovery CT750 HD的宝石CT,对32例受检者进行头部扫描。扫描结束后在双侧侧脑室最大层面重建图像,FOV25cm、层厚5mm、间隔20mm,共5层,分别将ASIR值设定为0％、20％、40％、60％、80％、100％重建图像,窗宽为100HU、窗位为35HU。在一侧侧脑室内选取圆形感兴趣区,测量不同的ASIR值时侧脑室脑脊液的CT值与标准差,应用医学统计软件SPSS13对数据进行统计分析。结果：各组间侧脑室脑脊液的CT值标准差有明显的统计学差异,随ASIR百分比的增加,图像噪声水平明显降低。结论：提高ASIR值能够降低图像噪声。扫描时,采用较高ASIR值具有降低射线剂量的作用。     

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??Efficacy of FOLFOX4 regimen systemic chemotherapy in treating advanced hepatocellular carcinoma: An analysis of 22 cases YIN Xiao-yu*??CHEN Jie??PENG Jian-xin??et al. *Department of Hepatobiliary Surgery??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080??China
Corresponding author??YIN Xiao-yu??E-mail??yinxy@21cn.com
Abstract Objective To evaluate the efficacy of FOLFOX4 regimen systemic chemotherapy in treating advanced hepatocellular carcinoma (HCC). Methods The clinical data of 22 cases of advanced HCC were treated by FOLFOX4 regimen systemic chemotherapy between July 2007 and July 2013 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The chemotherapy was given each two weeks??with a maximum of 8 cycles. The therapeutic responses were evaluated each 3 cycles and end of treatment. Results A total of 85 cycles were administered in 22 cases??with a mean of ??3.7±2.0?? cycles /case. There were no complete response??5 partial responses??5 static diseases and 12 progressive diseases. The objective response rate was 22.7% (5/22)??and disease control rate was 45.4% (10/22)??with a one-year survival rate of 12.1% and median survival time of 5.8 months in the follow up of 2-34 ??8.5±1.9??months . In 10 cases of disease control after chemotherapy??the median survival time reached up to 9.5 months. Conclusion FOLFOX4 regimen systemic chemotherapy is effective in part of advanced HCC??and represented as an effective modality.