提上睑肌离断联合额肌瓣悬吊治疗下颌瞬目综合征临床研究

目的：研究提上睑肌离断联合额肌瓣悬吊治疗下颌瞬目综合征临床疗效。方法：7例下颌瞬目综合征患者均采用提上睑肌离断联合额肌瓣悬吊手术治疗。结果：随访6个月～2年,全部患者术后颌动瞬目症状消除,上睑缘无遮盖瞳孔,双侧睑裂对称,睑缘弧度自然,其中1例伴有轻度的上下睑闭合困难及上睑迟滞现象。结论：提上睑肌离断联合额肌瓣悬吊术是治疗下颌瞬目综合征较理想的手术方法。     

Optimization of Wire-guided Technique With Bracketing Reduces Resection Volumes in Breast-conserving Surgery for Early Breast Cancer

BackgroundWire-guided localization (WGL) of early breast cancer can be facilitated using multiple wires, which is called bracketing wire-guided localization (BWL). The primary aim of this study is to compare BWL and conventional WGL regarding minimization of resection volumes without compromising margin status. Secondly, BWL is evaluated as an alternative method for intraoperative ultrasound (US) guidance in poorly definable breast tumors on US.Patients and MethodsIn this retrospective cohort study, patients with preoperatively diagnosed breast cancer undergoing wide local excision between January 2016 and December 2018 were analyzed. Patients with multifocal disease or neoadjuvant treatment were excluded from this study. Optimal resection with minimal healthy breast tissue removal was assessed using the calculated resection ratio (CRR).ResultsBWL was performed in 17 (9%) patients, WGL in 44 (22%), and US in 139 (70%). The rate of negative margins was comparable in all 3 groups. The CRR was significantly smaller for BWL (0.6) than WGL (1.3) in tumors larger than 1.5 cm. Additionally, BWL (0.8) led to smaller CRRs than US (1.7). This could be explained by the high number of small tumors (≤ 1.5 cm) in the US group for which greater CRRs are obtained than for large tumors (> 1.5 cm) (1.9 vs. 1.4; P = .005).ConclusionFor breast tumors larger than 1.5 cm, BWL achieves more optimal resection volumes without compromising margin status compared with WGL. Moreover, BWL seems a suitable alternative to US in patients with poorly ultrasound-visible breast tumors and patients with a small tumor in a (large) breast.     

Effect of inflammation on positive margins of basal cell carcinomas

Background/Objectives: The use of preparations such as imiquimod in the treatment of basal cell carcinoma is well accepted. Imiquimod induces interferon‐α, other cytokines, antigen‐presenting cells and innate immunity, against tumour cells. The current study investigated whether the inflammation induced from a surgical procedure could have a similar effect on removing residual tumour after an excision. Method: A retrospective audit was carried out on basal cell carcinoma removed in the Dermatology Clinic of the Royal Newcastle Centre in 2007. The end‐point focussed on the features of those tumours which initially had a positive margin, but were found to have no remaining tumour on subsequent excision. Result: A linear regression was carried out, revealing two significant predictors of outcome. These were the location of the basal cell carcinoma excision and the excision type. Punch biopsies and excisional biopsy had a greater number of histopathologically negative wider excisions despite initial positive margins. Facial lesions had a greater number of negative wider excisions. Conclusion: The study has shown the majority of negative re‐excisions were from lesions on the head which had had an initial surgical procedure. However, the evidence is not strong enough to advocate a protocol for dealing with positive margins. A larger sample size that encompassed all three factors that affect outcome, that is, the location of lesion, type of lesion and type of excision carried out, would be required in order to make a more definitive statement on protocol change for treatment of basal cell carcinoma.     

结肠癌患者采用完整结肠系膜切除手术治疗的临床效果

目的分析结肠癌患者采用完整结肠系膜切除手术治疗的临床效果。方法选取郑州市第七人民医院2016年5月—2017年5月收治的90例结肠癌患者进行观察,所有患者均行手术治疗。根据不同手术方式将患者分为常规组和研究组,每组各45例。常规组给予常规结肠癌根治术,研究组给予完整结肠系膜切除手术。术后随访3个月,观察两组手术情况、术后并发症、总有效率及复发率情况。结果研究组短期总有效率、淋巴结清扫数量明显优于常规组,差异有统计学意义(P0.05);研究组术中出血量、住院时间、术后排气排便时间、下床活动时间、引流管拔出时间、术后并发症及复发率均低于常规组(P0.05)。结论完整结肠系膜切除手术对结肠癌患者的创伤性小,淋巴结清除彻底,患者术后恢复速度快,并发症少,复发率低,疗效安全可靠,提升了患者的生存质量,值得临床上推广。     

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直肠癌全系膜切除(TME)概念的提出和应用显著改善了直肠癌外科治疗效果,"概念带来的进步"得到了充分体现。借鉴直肠癌治疗的经验,以外科、解剖和胚胎学理论为基础,德国学者Hohenberger总结大量的临床证据提出了完整结肠系膜切除(CME)。CME概念的提出为结肠癌治疗效果进一步改善带来了希望,有望成为结肠癌根治性手术的质量控制标准。     

胃癌术后复发转移的早期诊断与治疗

目的 探讨胃癌根治术后复发的早期诊断及治疗的有关问题。方法 回顾性分析了1989～1999年114例进展期胃癌根治术后复发的早期诊断及治疗。结果 复发病灶手术切除15例 ,其中残胃癌行全胃切除4例 ,卵巢转移性癌行卵巢切除5例 ,肝内转移行局部肝切除2例 ,因肠梗阻行横结肠切除4例 ;行化疗等治疗73例 ,CR :9例 ,PR :17例 ,有效率35.6 %。结论 胃癌术后复发的疗效 ,关键在于早期诊断及早期治疗 ;能作再次手术切除者效果最好 ,其次是化疗 ,二者比较 ,p值<0.01 ,有显著性差异。     

Correlation Between TS,MTHFR, and ERCC1 Gene Polymorphisms and the Efficacy of Platinum in Combination With Pemetrexed First-Line Chemotherapy in Mesothelioma Patients

IntroductionThe combination of pemetrexed and platinum compound represents the standard regimen for first-line chemotherapy in malignant pleural mesothelioma patients. Pemetrexed is a multitarget antifolate agent that inhibits folate-dependent enzymes (eg, thymidylate synthase [TS]) and thus synthesis of nucleotides and DNA. Expression of TS and folate availability, regulated by gene polymorphisms, have implications for effectiveness of chemotherapy and the outcome of mesothelioma patients. The aim of this retrospective multicenter study was to assess the correlation between TS, 5,10-methylenetetrahydrofolate reductase (MTHFR) and excision repair cross-complementing group 1 (ERCC1) gene polymorphisms and the efficacy of pemetrexed-based first-line chemotherapy of mesothelioma patients.Patients and MethodsFifty-nine mesothelioma patients (31 men with a median age of 62 years) treated in first-line chemotherapy with platinum in combination with pemetrexed or pemetrexed monotherapy were enrolled. Genomic DNA was isolated from peripheral blood. Using polymerase chain reaction and high resolution melt methods, the variable number of tandem repeat, the G>C single nucleotide polymorphism (SNP) in these repeats, and 6-base pair (bp) insertion/deletion polymorphism of the TS gene, the SNP of 677C>T in MTHFR, and 19007C>T in the ERCC1 gene were analyzed and correlated with disease control rate, progression-free survival (PFS), and overall survival (OS) of mesothelioma patients.ResultsGreater risk of early disease progression (PD), and shortening of PFS and OS were associated with several clinical factors (eg, anemia for early PD and OS), weight loss (for PFS and OS), and previous surgical treatment (for early PD, PFS, and OS). Insertion of 6-bp in both alleles of the TS gene (1494del6) was the only genetic factor that increased the incidence of early progression (P = .028) and shortening of median PFS (P = .06) in patients treated with pemetrexed-based chemotherapy. In multivariate analysis, the 1494del6 in the 3′ untranslated region (UTR) of the TS gene also had a predictive role for PFS (P = .0185; hazard ratio, 2.3258 for +6/+6 homozygotes) in analyzed mesothelioma patients.ConclusionMost analyzed polymorphisms in TS, MTHFR, and ERCC1 genes failed to predict outcome in mesothelioma patients treated with pemetrexed-based chemotherapy. However, different variants of 1494del6 in the 3′ UTR of the TS gene were associated with differences in disease control rate and PFS of our patients.