全胸腔镜下胸腺扩大切除术治疗重症肌无力

目的 评价全胸腔镜下胸腺扩大切除术治疗重症肌无力的临床价值.方法 2005年3月～2009年10月,86例重症肌无力患者在全胸腔镜下行经右胸胸腺扩大切除术,男性39例,女性47例,平均年龄(33.5±7.5)岁.切除范围包括胸腺组织及前上纵隔的脂肪组织.结果 全组手术均获成功,无1例中转开胸,平均手术时间(96±25)min,术中平均出血量(62±26)mL,术后平均住院时间为(7.2±2.5)d,术后发生重症肌无力危象4例,经过机械通气和对症治疗后好转.术后病理示胸腺增生28例、胸腺瘤15例、胸腺囊肿3例、萎缩胸腺26例、正常胸腺14例.86例均获随访,随访时间6～60个月,完全缓解27例(31.4％),部分缓解45例(52.3％),稳定11例(12.8％),恶化3例(3.5％),总缓解率83.7％.结论 全胸腔镜下胸腺扩大切除术治疗重症肌无力技术可行、疗效可靠,具备微创和恢复迅速的优势.     

Single-Incision Laparoscopic Common Bile Duct Exploration with Conventional Instruments: an Innovative Technique and a Comparative Study

Background

Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed.

Methods

Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed.

Results

The stone clearance rate was 94.1 % (16 patients) in the standard LCBDE group and 100 % in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3 %; p?<?0.05). One procedure (5.9 %) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8 % (two patients) in the standard LCBDE group and 5.9 % (one patient) in the SILCBDE group. The average follow-up period was 4.2 months.

Conclusion

SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated.     

The impact of spleen volume on the survival of metastatic pancreatic adenocarcinoma patients receiving nanoliposomal irinotecan

Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (NalFL) comprises the current standard for gemcitabine-failed metastatic pancreatic ductal adenocarcinoma (PDAC). As liposomes generally accumulate in the spleen, we evaluated the impact of spleen volume on prognosis. We enrolled patients with metastatic PDAC who failed gemcitabine-based therapy and were initiated on NalFL between August 2018 and November 2020. The spleen volume before NalFL administration was evaluated. They were stratified into dose subgroups (i.e. low, < 48 mg/m²; intermediate, 48 - < 64 mg/m²; high, ≥ 64 mg/m²) by the average nal-IRI dose during the entire treatment, and multivariate analysis of overall survival (OS) was performed. We included 547 patients with a median age of 63 years (range, 27-89 years) and a median of 1 (range, 0-7) palliative chemotherapy regimen. The median spleen volume was 245 mL (range, 82-817 mL). Among patients with splenomegaly (≥ 245 mL), the low-dose subgroup had the worst median time to treatment failure (TTF, 1.8 months vs. 2.5 months vs. 2.5 months, P = 0.020) and OS (3.3 months vs. 5.9 months vs. 6.6 months, P = 0.018) as against no prognostic impact in patients without splenomegaly. In the multivariate analysis of patients with splenomegaly, performance status (PS) ≥ 2, body surface area (BSA) < 1.6 m², prior fluoropyrimidine use, liver metastasis, and low-dose subgroup were independent poor prognostic factors. A low average nal-IRI dose was significantly associated with poor prognosis, especially among patients with splenomegaly. Further pharmacological studies should validate the relevance of spleen volume on the treatment outcomes of nal-IRI.     

奥沙利铂联合卡培他滨与FOLFOX治疗晚期结直肠癌疗效比较

目的 比较奥沙利铂联合卡培他滨与FOLFOX方案治疗晚期结肠、直肠癌的近期疗效和毒副反应.方法 将64例经病理检查确诊的晚期结肠、直肠癌患者随机分为两组.治疗组采用奥沙利铂85 mg/m2静脉滴注2 h,第1天;卡培他滨1000 mg/m2口服,第1~14天;每3周为一个周期.对照组CF 200 mg/m2静脉滴注2 h,第1~5天;5-Fu 300 mg/m2静脉点滴5 h,第1~5天;每3周为一个周期.2个周期后按照WHO实体瘤近期客观疗效评定标准进行评价.结果 治疗组与对照组的总有效率分别为62 5% (20/32)和34 4% (11/32),差异有统计学意义(χ2=4 0,P<0 05);治疗组有2例患者CR;两组主要毒副反应为血液和神经毒性.结论 奥沙利铂联合卡培他滨方案治疗晚期结肠、直肠癌近期疗效较FOLFOX方案好,虽然其恶心、呕吐、神经毒性较重,但患者能耐受.     

某部新兵群体左侧精索静脉曲张的心理调查分析

【目的】新兵群体左侧精索静脉曲张发生率及与心理行为相关性研究。【方法】采用疲劳量表-14（FatigueSeale-14,FS-14）、流调中心用抑郁量表（CenterEpidemiologicalStudiesDepressionScale,CES—D）、汉密顿焦虑量表（HamiltonAnxietyScale,HAM—A）和家庭关怀度指数,对196名新兵群体进行左侧精索静脉曲张和心理状况的横断面调查及相关性评估。【结果】有效评估193名,精索静脉曲张检出率26．02％,抑郁症状在精索静脉曲张新兵群体分布明显不同,患病组脑疲劳与抑郁、体疲劳的相关系数明显高于正常组（P〈0．05）。【结论】新兵群体精索静脉曲张发病率高于正常群体,对战士身心健康有明显影响,严重影响部队战斗力,需引起有关各方高度重视。     

解剖钢板治疗锁骨中段骨折

目的 观察应用解剖钢板内固定治疗锁骨中段骨折的疗效。方法 对2005年6月～2006年11月我科共收治32例急性锁骨中段骨折进行切开复位采用锁骨解剖钢板内固定治疗。结果 随访5～17个月,骨折均愈合,时间2～3．5个月,平均2．5个月。术后32例肩关节功能优良率100％。结论 锁骨解剖钢板治疗锁骨中段骨折创伤小、固定牢固,安全陛高,能早期活动肩关节,是行之有效的治疗方法。     

化脓性脊柱炎的MRI表现分析(附22例报告)

目的评价化脓性脊柱炎的MRI影像学表现。方法回顾性分析22例脊柱椎体感染病例的MR表现,全部病例均经临床随访或手术病理证实。结果发生于颈椎2例,胸椎5例,腰骶椎15例。受累椎体和椎间盘在T1W1呈广泛的融合的低信号,椎体和椎间盘分界模糊不清;而在T2W1图像上,受累椎体与椎间盘的信号强度增高,椎间盘残留部分呈略低或略高的信号。去脂序列中呈等高信号。累及附件、椎体旁软组织肿块形成、硬膜脓肿形成局部硬膜囊受压,相应脊髓受压见于部分病例中。结论MRI影像学对化脓性脊柱炎有明确的诊断价值,MRI应作为怀疑化脓性脊柱炎的常规检查手段。     

重和林M30在新诊2型糖尿病中的应用

目的：观察重和林M 30（精蛋白重组人胰岛素30／70）在新诊2型糖尿病人中的临床作用。方法选取80例需胰岛素治疗的2型糖尿病人,随机分为重和林M 30组（试验组）与门冬胰岛素30组（对照组）,连续治疗8周,比较两组治疗前后空腹血糖（FBG）、餐后2 h血糖（PBG）、体重指数（BMI）、糖化血红蛋白（HbA1c）、空腹C肽（Fasting C peptide ,FCP）变化,评估低血糖、严重低血糖发生率及胰岛素用量和性价比。结果两组患者FBG、PBG、HbA1c、FCP较治疗前均有明显下降（P＜0.05）,两组患者治疗后的FBG、BMI、HbA1c、FCP比较无明显差异（P＞0.05）;两组患者低血糖发生率及胰岛素用量无明显差异（ P＞0.05 ）,两组治疗后均未见严重的低血糖反应,试验组性价比较高。结论重和林M 30与门冬胰岛素30治疗新诊2型糖尿病整体降糖疗效无明显差异,重和林M 30性价比较高,在基层医院具有广泛应用优势。     

超声心动图与球囊导管测量在房间隔缺损封堵术中测量相关性的研究

目的分析房间隔缺损(ASD)直径的经胸超声心动图(TTE)测量值与球囊导管测量的ASD直径的关系,评价ASD直径的各种测量方法在介入治疗中的应用价值。方法全组共32例,均于心导管检查前1周内接受TTE检查,以测量到的ASD直径的最大值作为该ASD直径的TTE测量值。32例均于心导管术中以球囊导管测量ASD直径并以此作为ASD直径的球囊测量值。结果ASD直径二维超声测量最大径(19.5±8.9)mm;球囊测量最大径为(21.3±8.8)mm,二者差异无统计学意义且相关性好。结论应用TTE可较准确地独立估测ASD直径。球囊测量并不优于TTE。     

插入式微波天线阵列诱导高温原位灭活治疗肢体恶性或侵袭性骨肿瘤

目的：评价插入式微波天线阵列诱导高温原位灭活治疗肢体恶性或侵袭性骨肿瘤保肢诉临床应用。方法：应用插入式微波天线阵列诱导高温原位灭活治疗肢体恶性或侵袭性骨肿瘤１９０例,从手术技术、肿瘤学、关节功能并发症等方面全面综合评价此方法的临床应用效果。结果：恶性骨肿瘤１３４例,术后平均随访４７ｍｏ,因远隔脏器转移死亡者３２例,另有３例虽有肺部转移,但经转移病灶切除后现仍无瘤存活;存活率为７４．２％;１０２例存