乳腺癌保乳手术术中射频治疗的临床疗效

目的:比较单纯行乳腺癌保乳术与乳腺癌保乳术合并术中射频治疗(RFA)的治疗效果。方法:对2009年6月~2012年6月收治的符合保乳条件的345例0~Ⅲa期乳腺癌患者进行保乳手术,其中98例行术中射频治疗(RFA组),247例未行术中射频治疗(对照组)。比较2组的术后并发症、局部复发率、远处转移率、病死率、乳腺外观的差异。结果:RFA组随访患者90例,中位随访时间36个月,局部复发率2.2%,远处转移率7.7%,病死率3.3%;对照组随访患者219例,中位随访时间33个月,局部复发率7.7%,远处转移率7.3%,病死率3.2%。RFA组的局部复发率低于对照组(P<0.05),转移率、病死率的差异均无统计学意义(P>0.05)。乳腺外观评价,RFA组的外观评分好于对照组(P<0.05)。RFA组皮肤烧伤(4.4%)的并发症高于对照组(P<0.01)。结论 :术中射频治疗可以降低保乳术后的局部复发率,增加术后乳腺外观美感。     

MMP-7蛋白在肺癌患者和正常人外周血中的表达水平及临床意义

背景与目的基质金属蛋白酶7(matrix metalloproteinase7,MMP-7)又称基质溶解素,是MMPs家族成员之一,本研究旨在检测MMP-7在肺癌患者和正常人外周血血浆中的蛋白水平,并探讨其临床意义。方法采用酶联接免疫吸附试验(enzyme-linked immunosorbnent assay,ELISA)检测114例肺癌患者和100名正常人外周血血浆标本中的MMP-7浓度。结果肺癌患者外周血血浆中的MMP-7蛋白浓度(n=114,median=0.72ng/mL)明显高于正常人外周血血浆中的MMP-7蛋白浓度(n=100,median=0.30ng/mL,P<0.001),当cuto值为0.56ng/mL时,MMP-7检测肺癌的敏感性为62.3%,特异性为76.0%。但是,肺癌患者外周血血浆中MMP-7的蛋白水平与患者的年龄、性别、吸烟史、肿瘤大小、病理类型、淋巴结转移及分期均无关(P>0.05)。结论外周血血浆中MMP-7可以作为辅助肺癌诊断的一种肿瘤标志物,但其与肺癌的各项临床参数之间无明显联系,需要进一步扩大样本进行分析。     

24例甲型H1N1流行性感冒病例报告

Objective To study the clinical characteristics and laboratory results of 24 confirmed HI NI influenza cases. Methods The characters of clinical, laboratory, iconography and etiology of 24 patients with A/H1N1 were studied,and the changes of T-lymphocyte subsets that between the pre-and post-treatment were evaluated. Results The ages of patients were ranged from 6 to 65 years old; average age was 26 years old. 15 patients were under 25 years old. 22(22/24,91.7%) patients had recently traveled to USA or Canada. The most common presenting symptoms were: fever(22/24, 91.7%); sore throat (22/24, 91.7%); cough(20/24, 83.3%); dry cough (14/24, 58. 3%); expectoration (6/24, 25.0%); nasal discharge(6/24,25.0%). Six had pneumonia in sixteen patients (6/16,37.5%)who took CT scan; seven (7/24,29. 2%) had headache and four(4/24, 16. 7%) had muscular soreness; two(2/24,8. 3%) had sneeze and nasal obstruction; only one(1/24,4.2%) had diarrhea; one(1/24,4. 2%)had conjunctivitis.The result of 23 patients about T-Lymphocyte subsets: most of CD4 and CD8 were decreased (18/23, 78.3%), ranging from 122 to 691 cells/μl (normal was 706-1125 cells/μl),with the average of 408 cells/ μl,but ratios of CD4/CD8 were normal. Fourteen patients were detected CD4 and CD8 after received the treatment during 5 to 7 days. The results of CD4 (cells/μl) were different between the pre-and post-treatment: 436. 29±189. 06,976. 71±332. 96 (paired-samples t test: t=-5. 416, P < 0. 05) while the results of CD8 (cells/μl) were: 323. 64±176. 47,703.14±211.77 (t=-5.319, P < 0.05); the results of leukocytes in 22 patients were different between pre-and post-treatmet: (5.13±1.47)×109/L, (6. 25±1.37)×109/L(t=-2. 900, P < 0.05) while the results of lymphocytes were: (1.16±0. 43)×109/L, (2.30±0.37)×109/L (t=-6.819,P<0.05); but the ratios of CD4/CD8 were:1.44±0.41,1.40±0. 26 (t=0.507,P>0.05). All the patients were received antivirus treatment (Oseltamivir) and the virus conversed during 1-10 days(average 4. 5 days). The temperature was normal after onset during 3-4 days and the patients were recovered during 3-13 days(with the average of 7.3 days). Conclusion Influenza A virus H1N1 subtype was identified as the cause of outbreaks of febrile respiratory infection which was self-limited. There was no evidence to show that the changes of T-Lymphocyte subsets could indicate the prognosis of patients.     

茵栀黄口服液联合布拉氏酵母散治疗新生儿黄疸疗效观察

目的:探讨茵栀黄口服液联合布拉氏酵母散治疗新生儿黄疸的临床疗效。方法:120例病理性黄疸的新生儿随机分两组,对照组60例,治疗组60例。对照组采用常规蓝光治疗并服用布拉氏酵母散;治疗组在对照组的基础上,联合服用茵栀黄口服液。结果:治疗组的治疗时间明显短于对照组,治疗组在治疗后第2~6天的血清胆红素下降明显比对照组快,日均下降值显著高于对照组,差距具有统计学差异(P0.05)。结论:茵栀黄口服液联合布拉氏酵母散在新生儿黄疸治疗中疗效确切、安全,起效快且可以明显缩短病程。     

外科手术在继发性甲状旁腺功能亢进症中的地位

<正>近年来,慢性肾脏病(chronic kidney disease, CKD)已成为影响我国公共卫生健康的重大问题之一。目前,我国CKD的患病率约为10.8%(11.7%～15.1%)[1-2]。继发性甲状旁腺功能亢进(secondary hyperparathyroidism, SHPT)是CKD 最常见的并发症之一,SHPT病人钙磷代谢紊乱刺激甲状旁腺过度分泌甲状旁腺激素(parathyroid hormone, PTH),     

近十年甘肃省庆阳市人群包虫病流行病学分析

目的分析2008—2017年甘肃省庆阳市包虫病疫情分布和流行病学特征,为调整防治策略提供依据。方法采用描述流行病学方法分析中国疾病监测信息系统上报的2008—2017年庆阳市的包虫病疫情资料。结果 2008—2017年庆阳市累计报告病例601例,年均报告发病率2.32/10万,各年发病率差异有统计学意义(χ2=161.785,P0.01),呈先上升后下降趋势,发病季节性不明显,各地区差异有统计学意义(χ2=3 547.504,P0.01),主要分布于环县、占97.00%,年均发病率16.49/10万;女性(2.87/10万)高于男性(1.81/10万),差异有统计学意义(χ2=31.491,P0.01),男女性别比为1∶1.46,病人最小4岁、最大88岁,平均54岁,发病率随着年龄的增长而逐渐上升(χ2=876.925,P0.01),且主要集中在40岁以上人群、占87.85%,以农民为主、占95.67%;从发病到明确诊断时间间隔1~2 334 d不等、平均159 d;县、乡级诊断538例、占89.52%,医疗机构诊断480例、占79.87%,以县、乡级医疗机构诊断为主。结论近十年来庆阳市包虫病疫情呈先上升后下降趋势,发病率随着年龄的增长而逐渐上升,以农村中老年人群发病为主,环县等个别地区发病率仍然很高,防治形势不容乐观;应继续加强包虫病联合防控力度,落实综合防治措施,有效控制流行,遏制包虫病的危害。     

茵栀黄口服液辅助袋鼠疗法治疗新生儿黄疸的疗效分析

目的:分析茵栀黄口服液辅助袋鼠疗法治疗新生儿黄疸的疗效。方法:选择本院2012年1月—2014年4月收治的40例黄疸患儿为研究对象,随机将其分为两组,均接受蓝光照射、液体补充等常规治疗,对照组在此基础上加以茵栀黄口服液治疗,实验组则给予茵栀黄口服液辅袋鼠疗法治疗,对两组治疗效果、黄疸消失时间及平均住院时间进行比较。结果:实验组患儿黄疸消失时间(6.01±1.26)d,对照组患儿黄疸消失时间(5.03±0.90)d,两组比较差异有统计学意义。另外,两组患儿治疗总有效率比较差异无统计学意义,(P>0.05)。结论:茵栀黄口服液辅助袋鼠疗法能有效改善黄疸症状,缩短住院时间,安全有效,值得在新生儿黄疸治疗中进一步应用。     

无自体移植的甲状旁腺全切除术在难治性继发性甲状旁腺功能亢进中的应用

目的:分析继发性甲状旁腺功能亢进症(SHPT)患者行无自体移植的甲状旁腺全切除术(TPTX)的临床效果和可行性。方法:回顾性分析2012年4月—2015年12月中日友好医院乳腺甲状腺外科行TPTX治疗的220例SHPT患者的临床资料,观察其疗效及并发症。结果:220例均为长期透析患者,透析时间为(7.93±3.75)年,术前甲状旁腺激素(PTH)、钙、磷明显升高,术后明显降低,分别为(73.65±181.46)pg/mL、(1.82±0.31)mmol/L、(1.51±0.59)mmol/L(P<0.01),平均住院日(7.8±2.8)d,症状缓解明显,无喉返神经损伤、大出血等严重并发症出现,低钙血症发生率为73.64%,经积极加强补钙后都可缓解,无低动力性骨病出现,20例术后呈甲状旁腺功能亢进持续状态(PTH≥300pg/mL),占9.1%,围手术期1例因感染性休克死亡,占0.45%。结论:TPTX治疗SHPT临床疗效安全可靠,手术方式易于统一规范,值得推广应用,减少术中甲状旁腺遗漏是手术成功的关键,加强监测和保持血钙稳定是减少术后并发症的关键。     

先天性肝囊肿合并胆总管内囊肿一例

患者女,43岁,主因“右上腹痛6个月,加重伴腹胀1个月,彩色超声发现肝囊肿10d”南门诊以“肝囊肿”收入院。患者6个月前无明显诱因出现间断性右上腹痛,自服止痛药物后好转;1个月前,患者诉右上腹痛较前加重,不伴有寒战、发热、恶心、呕吐、黄疸等其他不适,来北京地坛医院行彩色超声检查,结果提示：左肝囊性占位（9．1cm×8．3cm）。