奥曲肽联合泮托拉唑治疗胃十二指肠溃疡出血的临床疗效探讨

目的：研究分析奥曲肽联合泮托拉唑治疗胃十二指肠溃疡出血的临床疗效。方法回顾性分析该院于2012年12月-2014年2月收治的100例胃十二指肠溃疡出血患者的病历资料,随机的分为对照组和治疗组,对照组和治疗组各50例,对照组患者采取泮托拉唑治疗,治疗组患者采取奥曲肽联合泮托拉唑治疗,对比分析两组患者的止血效果、临床疗效和不良反应情况。结果治疗组患者治疗1 d后止血效果明显优于对照组,P<0.05,治疗2 d后的止血效果和对照组患者止血效果比较,P>0.05,差异无统计学意义。治疗组患者的临床总有效率明显大于对照组,P<0.05,治疗组患者不良反应发生率小于对照组,P<0.05。结论胃十二指肠溃疡出血患者实施奥曲肽联合泮托拉唑治疗,有较好的止血效果和较少的不良反应,临床疗效显著,有一定的安全性和可行性,值得临床推广应用。     

无张力疝修补术治疗腹股沟斜疝的临床效果探讨

目的：分析腹股沟斜疝治疗中应用无张力疝修补术的临床效果。方法采用回顾性方法分析,选取该院自2010年12月-2014年11月间收治的91例腹股沟斜疝患者,按照手术方案分为对照组（39例）和无张力组（52例）,比较两组手术相关指标、术后牵扯感、术后并发症发生率及近期复发率。结果无张力组患者手术时间、患者下床活动时间及住院时间均更短患者术后牵扯感、术后并发症发生率及随访6个月~1年复发率均低于对照组（P<0.05）。结论腹股沟斜疝治疗中应用无张力疝修补术可有效缩短患者康复时间,降低并发症发生率、复发率,临床应用价值显著。     

The BRAF mutation is not associated with poor prognostic factors in Korean patients with conventional papillary thyroid microcarcinoma

BACKGROUND: The BRAF(V600E) mutation, the most common genetic alteration reported in papillary thyroid carcinoma, has been associated with poor prognostic factors. AIM: To determine whether the presence of the BRAF(V600E) mutation is associated with poor prognosis in Korean patients with conventional papillary thyroid microcarcinoma (micro-PTC). PATIENTS AND METHODS: DNA was extracted from paraffin-embedded thyroid tumour specimens taken from 60 patients with conventional micro-PTC, as well as from nine patients with follicular variant papillary carcinoma, six with nodular hyperplasia, four with follicular carcinoma (including one with Hürthle cell carcinoma), four with follicular adenoma (including two with Hürthle cell adenoma) and one each with medullary carcinoma, poorly differentiated carcinoma and anaplastic carcinoma. The presence of the BRAF(V600E) mutation was determined by polymerase chain reaction (PCR) amplification of exon 15 followed by direct sequencing. RESULTS: The BRAF(V600E) mutation was detected in tumour samples from 31 of 60 conventional micro-PTC patients (52%), but was not detected in patients with other types of thyroid tumours. The age distribution, tumour size, extrathyroid extension, multifocality and staging did not differ significantly between patients with and without the BRAF(V600E) mutation. CONCLUSION: In Korean patients with conventional micro-PTC, the presence of the BRAF(V600E) mutation was not significantly associated with prognostic factors.     

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

BACKGROUND AND PURPOSE:Medullary thyroid carcinoma is an uncommon malignancy that is challenging to diagnose. Our aim was to present our experience using core needle biopsy for the diagnosis of medullary thyroid carcinoma compared with fine-needle aspiration.MATERIALS AND METHODS:Between January 2000 and March 2012, 202 thyroid nodules in 191 patients were diagnosed as medullary thyroid cancer by using sonography-guided fine-needle aspiration, core needle biopsy, or surgery. One hundred eighty-three thyroid nodules in 172 patients were included on the basis of the final diagnosis. We evaluated the sensitivity and positive predictive value of fine-needle aspiration and core needle biopsy for the diagnosis of medullary thyroid cancer. We compared the rate of a delayed diagnosis, a diagnostic surgery, and surgery with an incorrect diagnosis for fine-needle aspiration and core needle biopsy and investigated the factors related to the fine-needle aspiration misdiagnosis of medullary thyroid cancer.RESULTS:Fine-needle aspiration showed 43.8% sensitivity and 85.1% positive predictive value for the diagnosis of medullary thyroid cancer; 25.7% (44/171) of patients had a delayed diagnosis, while 18.7% (32/171) underwent an operation for accurate diagnosis, and 20.5% (35/171) underwent an operation with an incorrect diagnosis. Core needle biopsy achieved 100% sensitivity and positive predictive value without a delay in diagnosis (0/22), the need for a diagnostic operation (0/22), or an operation for an incorrect diagnosis (0/22). A calcitonin level of <100 pg/mL was the only significant factor for predicting the fine-needle aspiration misdiagnosis of medullary thyroid cancer (P = .034).CONCLUSIONS:Core needle biopsy showed a superior sensitivity and positive predictive value to fine-needle aspiration and could optimize the surgical management in patients with medullary thyroid cancer. Because the ability of fine-needle aspiration to diagnose medullary thyroid cancer significantly decreases in patients with serum calcitonin levels of <100 pg/mL, core needle biopsy could be indicated for these patients to optimize their surgical management.

Medullary thyroid carcinoma (MTC) is an uncommon malignancy that is challenging to diagnose. Although it accounts for only 3%–5% of thyroid cancer diagnoses, it causes 15% of thyroid cancer–related deaths due to its aggressiveness.¹ Due to a lack of good treatment options other than surgery, early diagnosis of MTC and complete surgical resection comprising at least total thyroidectomy with central lymph node dissection offers the best chance for a cure.^2–5 In that respect, accurate and timely diagnosis of MTC is essential to ensure the appropriate surgical procedure.^6–9An early presurgical diagnosis of MTC remains a diagnostic challenge in clinical practice, however. Although fine-needle aspiration (FNA) cytology is an important diagnostic tool for evaluating thyroid nodules, its low sensitivity for diagnosing MTC limits an optimal preoperative evaluation and an operation in approximately half of the patients.^10,11 Serum calcitonin level measurement in patients with thyroid nodules is a sensitive and specific marker with even better diagnostic accuracy than cytology in unsuspected MTC, though the routine measurement of serum calcitonin levels in nodular thyroid disease and the cutoff value for a diagnosis of MTC are still debatable.^11–13 Due to these diagnostic difficulties, some MTC is still incidentally discovered after a diagnostic operation or after an operation with an incorrect presurgical diagnosis—this situation presents the risk of an incomplete therapeutic approach and a less favorable prognosis.^10,14,15 Therefore, early and accurate diagnosis of MTC is of crucial importance for optimal management.We studied core needle biopsy (CNB) for the diagnosis of MTC at 3 medical institutions during a 10-year period. The study was designed to evaluate the following: 1) the diagnostic performance of CNB, 2) its impact on surgical management compared with FNA, and 3) factors related to the FNA misdiagnosis of MTC.     

High prevalence and little change in TSH receptor blocking antibody titres with thyroxine and antithyroid drug therapy in patients with non-goitrous autoimmune thyroiditis

OBJECTIVE We have reevaluated the prevalence and pathogenetic importance of TSH receptor blocking antibodies (TRBAb) in autoimmune hypothyroidism, and investigated the changes in TRBAb activities during thyroxine and antithyroid drug treatment. DESIGN Serum TSH binding inhibitor immunoglobulin (TBII) and thyroid stimulation blocking antibody (TSBAb) were measured serially in all patients with non-goitrous autoimmune thyroiditis (AT) and measured monthly during methimazole treatment in 6 patients. PATIENTS Ninety patients with non-goitrous AT and 95 patients with goitrous AT were entered consecutively into this study. All patients with non-goitrous AT were treated with thyroxine and followed at intervals of 6 months for 2 years initially and then yearly intervals. The duration of follow-up was 1–8 years. Six patients from the TRBAb-positive non-goitrous AT group who were treated with thyroxine were randomly selected and given additional treatments with methimazole (40 mg per day) for 6 months. MEASUREMENTS Serum TBII was measured by 8 radioreceptor assay, TSBAb by using FRTL-5 cells, and antithyroid peroxidase and antithyroglobulin antibodies by radioimmunoassay. RESULTS The prevalences of TBII and TSBAb in non-goitrous AT were 47–8 and 58.9%, respectively, which were significantly higher than those in goitrous AT (6.3% for TBII, 10.5% for TSBAb). All but one patient showed persistent TBII and TSBAb activities during the thyroxine treatment for up to 8 years. A high dose of methimazole (40 mg per day) did not affect the titres of TBII and TSBAb in 5 out of 6 patients with non-goitrous AT tested. However, antithyroid peroxidase and antithyroglobulin antibodies activities were significantly decreased during the methimazole treatment. CONCLUSION The high prevalence of TSH receptor blocking antibodies (TRBAb) suggests that TRBAb may play a major role in the development of hypothyroidism and thyroid atrophy in the vast majority of patients with non-goitrous autoimmune thyroiditis. Most TRBAb activities are stable for at least 8 years and are not affected by thyroxine and antithyroid drug treatment.     

探讨不同甲状腺扫描终止参数对甲状腺摄锝率的影响

目的 比较甲状腺静态扫描采用计时和计数两种不同扫描终止参数对SPECT/CT甲状腺摄锝率的影响。方法 随机抽取60例甲状腺摄锝功能检查的患者,根据SPECT系统中摄锝功能检查程序进行满针计数、甲状腺静态扫描、空针计数采集。其中甲状腺静态扫描均采集计数组、计时组两组数据,计数组采用常规甲状腺扫描的定计数采集,采集300 k,约2~6 min;计时组采用系统程序扫描时间,定时为10 min;根据摄锝率大小分为摄锝功能正常、摄锝功能增强、摄锝功能减弱3组分别进行比较。 结果 摄锝功能正常组(18例)中计数组平均摄锝率(1.22±0.66)%,计时组为(1.23±0.66)%;摄锝功能增强组(30例)中计数组平均摄锝率(13.72±4.85)%,计时组为(13.72±4.86)%;摄锝功能减弱组(12例)中计数组平均摄锝率(0.12±0.01)%,计时组为(0.09±0.01)%;以上三组摄锝率对比差异均无统计学意义(P均>0.05)。结论 甲状腺摄锝功能检查中采集300 k计数时间和采集10 min时间这两种不同显像终止时间测得的甲状腺摄锝率大小无明显差别。采用计数扫描法可明显缩短扫描时间。     

320排螺旋CT对多发性肋骨骨折的诊断价值

目的 收集整理2012年1月～2013年12月我院收治的重症多发性肋骨骨折患者临床资料,分析并探讨320排螺旋CT在多发性肋骨骨折诊断中的临床应用价值。方法 对86例多发性肋骨骨折的患者进行320排螺旋CT扫描,重建全肋骨三维图像,并与胸部X线检查和普通螺旋CT的三维重建图像进行分析比较。结果 所有患者均顺利完成320排螺旋CT扫描,扫描时间均在3~5 s以内。与普通螺旋CT相比,320排螺旋CT重建的三维图像更加清晰细腻,且在线性骨折、凹陷性骨折以及肋软骨骨折的显示上存在显著统计学差异(p < 0.01)。结论 相对于普通螺旋CT,320排螺旋CT具有扫描速度更快、放射剂量更低、图像质量更好等特点,在一定程度上提高了肋骨骨折检出率,使诊断的准确性更高,具有明显的优势。     

腹腔镜脾切除术术中术后临床观察

［摘要］　目的　探讨腹腔镜脾切除术（LS）的临床效果。方法　对12例行腹腔镜脾切除术患者的手术时间、术中出血量、禁食时间、术后切口疼痛评分、术后住院时间进行观察分析。结果　手术时间为155～182 min,平均为170 min;手术中出血量为85～100 ml,平均为94 ml;术后禁食时间为24～48 h,平均为40 h;术后第1天切口疼痛评分得分为2～4分,平均为3.1分;术后第3天切口疼痛评分为1～2分,平均为1.2分;术后住院时间为6～8 d,平均为7.3 d。结论　腹腔镜脾脏切除术具有创伤小、患者痛苦少、术中出血少、术后恢复快、并发症少、术后切口疼痛小,住院时间短、伤口小而美观等优点,是行脾切除术患者的最佳选择。