联合肝叶及入肝血管切除和重建治疗肝门部胆管癌的临床研究

目的探讨侵犯血管的肝门部胆管癌(HCCA)根治术同时联合肝叶及入肝血管切除和重建的临床意义。方法选取徐州医学院附属宿迁医院/南京鼓楼医院集团宿迁市人民医院普外科2006年1月至2014年1月期间收治的62例同时侵犯肝门部肝动脉和门静脉的HCCA患者,根据对患者手术创伤耐受程度的评估、营养状况及家属的意愿,其中33例行HCCA根治术+肝叶切除+肝动脉和门静脉联合切除重建术即R0切除(简称联合切除组),29例仅行姑息性胆管肿瘤切除和(或)内引流减黄手术即R1~2切除(简称姑息手术组)。结果联合切除组和姑息手术组患者的中位生存期分别为26.3个月和9.6个月,1、2、3年生存率分别为84.85%比26.32%、66.67%比15.79%和42.42%比0,联合切除组患者的中位生存时间和1、2、3年生存率长于或高于姑息手术组(t=4.470、P=0.000。χ2值分别为28.338、20.348和15.891,均P=0.000)。联合切除组33例患者中,术后出现并发症9例(27.27%),姑息手术组术后出现并发症5例(17.24%),2组间的差异无统计学意义(χ2=0.888,P=0.346)。联合切除组术后第12天有1例死于肝功能衰竭,围手术期死亡率为3.03%,姑息手术组围手术期无死亡者,围手术期死亡率为0,2组间的差异无统计学意义(χ2=0.893,P=0.345)。结论联合肝叶切除及血管切除重建可明显提高HCCA根治性(R0)切除率,并能提高HCCA患者的1、2、3年生存率。联合血管切除重建和联合肝叶切除的并发症是可控的,不增加围手术期死亡率。     

A Comparison of Single-, Two- and Three-Port Laparoscopic Myomectomy

Background and Objective:

A recent FDA safety communication has discouraged the use of a power morcellator for myoma extraction and has called for a change in surgical techniques for myomectomy. The objective of this study was to compare surgical outcomes of laparoscopic single-, two-, and conventional three-port myomectomy and to evaluate the feasibility of contained manual morcellation for uterine myoma.

Methods:

This retrospective study was a review and analysis of data from 191 consecutive women who underwent single-, two-, or three-port myomectomy for the management of uterine myoma from January 1, 2009, through December 31, 2014.

Results:

The 3 study groups did not differ demographically. Apart from operative time, the single- and two-port groups showed operative outcomes comparable to those of the multiport group. The single-port group had significantly longer operative times (P = .0053) than the two- and three-port groups. However, in the latter half of the single-port cases, the operative time was similar to those in the three-port group. The two-port surgery group showed a consistent operative time without a learning period.

Conclusion:

Single- or two-port myomectomy with transumbilical myoma morcellation is feasible and safe, with outcomes comparable to those of three-port myomectomy. These results suggest the potential for minimally invasive management of symptomatic uterine myoma, without the use of a power morcellator.     

新城疫病毒治疗乳腺癌的研究进展

乳腺癌是发病率最高的女性恶性肿瘤,是不容忽视的女性健康杀手.近年来,乳腺癌的发病率持续呈上升趋势和年轻化趋势.随着乳腺癌治疗的越来越多元化、细致化,乳腺癌患者的预后得到了显著的改善.当Csatary发现新城疫病毒能够抑制晚期胃癌转移的现象后,新城疫病毒便作为一种新型的抗肿瘤生物制剂得以广泛研究.新城疫病毒治疗乳腺癌也就成为一种较好的新的辅助治疗方法.本文简要地从新城疫病毒的概况、作用机制、研究意义等方面进行阐述.     

针刺抗炎研究进展

背景 创伤、烧伤、手术等容易导致机体发生全身炎性反应综合征、脓毒症、多器官功能不全综合征(multiple organ disfunction syndrome,MODS),甚至死亡.调控过度的炎症反应是防治脓毒症和MODS的重要手段之一. 目的 阐释针刺抗炎的作用及机制. 内容 针刺对多种炎性疾病有良好的治疗作用,对脓毒症和MODS亦有一定的防治作用.针刺可通过对免疫细胞、免疫球蛋白、神经递质和细胞因子等的调节,发挥抗炎作用.此外,下丘脑-垂体-肾上腺轴、胆碱能抗炎通路和内源性大麻素系统参与了针刺的抗炎机制. 趋向 针刺抗炎的确切机制尚不清楚,是否还有其他机制参与针刺的抗炎作用还有待阐明.     

The Parameters Affecting the Success of Irrigation and Debridement with Component Retention in the Treatment of Acutely Infected Total Knee Arthroplasty

BackgroundThe aims of our study were to evaluate the success rate of irrigation and debridement with component retention (IDCR) for acutely infected total knee arthroplasty (TKA) (< 4 weeks of symptom duration) and to analyze the factors affecting prognosis of IDCR.MethodsWe retrospectively reviewed 28 knees treated by IDCR for acutely infected TKA from 2003 to 2012. We evaluated the success rate of IDCR. All variables were compared between the success and failure groups. Multivariable logistic regression analysis was also used to examine the relative contribution of these parameters to the success of IDCR.ResultsSeventeen knees (60.7%) were successfully treated. Between the success and failure groups, there were significant differences in the time from primary TKA to IDCR (p = 0.021), the preoperative erythrocyte sedimentation rate (ESR; p = 0.021), microorganism (p = 0.006), and polyethylene liner exchange (p = 0.017). Multivariable logistic regression analysis of parameters affecting the success of IDCR demonstrated that preoperative ESR (odds ratio [OR], 1.02; p = 0.041), microorganism (OR, 12.4; p = 0.006), and polyethylene liner exchange (OR, 0.07; p = 0.021) were significant parameters.ConclusionsThe results show that 60.7% of the cases were successfully treated by IDCR for acutely infected TKA. The preoperative ESR, microorganism, and polyethylene liner exchange were factors that affected the success of IDCR in acutely infected TKA.