Abstract: Objective To investigate the method of improving effect, by investigating and analyzing the possible risk factors affecting shortterm outcome after total correction of tetralogy of Fallot (TOF). Methods Data of 219 patients who received total correction of TOF were divided into two groups according to the length of postoperative stay in hospital and recovery of heart function in the near future. Group A(n=110): patients had good recovery of heart function classified as gradeⅠorⅡ（NYHA classification）, and could smoothly be discharged from the hospital within two weeks without serious complications. The left ventricular ejection fraction (LVEF) had to exceed to 0.50 during 6 months followup visit. Group B(n=109): patients had worse recovery of heart function classified as grade Ⅱ or Ⅲ, and could not be discharged within two weeks with severe complications. LVEF was less than 0.50 during 6 months followup visit. The clinical data of two groups were compared, and risk factors affecting shortterm outcome after total correction of TOF operation were analyzed by logistic regression and model selection. Results There were good recovery of heart function classified as gradeⅠorⅡ(NYHA classification）in discharge, no death, and LVEF all exceeded to 0.50 in group A; there were 8 deaths in group B (7.34 %), and recovery of heart function was worse classified as grade Ⅱ or Ⅲ, with LVEF being less than 0.50（Plt;0.01）. Amount of postoperative daily thoracic drainage, assisted respiration time, time of inotropic agent stabilizing circulation, and the average length of postoperative stay in group A were all less or short than those in group B（Plt;0.01）. But the bypass and clamping time of group B were exceeded group A. The ratio of patching astride annulus in group B was greater than that in group A, and Nakata index was less than that in group A(Plt;0.01). The results of logistic regression and model selection indicate: age at repair (OR=0.69), oxygen saturation(OR=0.98), haematocrit before operation (OR=0.94), and patching astride annulus (OR=46.86), Nakata index (OR=16.90), amount of postoperative daily thoracic drainage (OR=0.84), presence of arrhythmia(OR=0.87), and wound infection(OR=63.57) have significant effect with shortterm outcome after total correction of TOF operation. Conclusions The probable methods to improving effect of shortterm outcome after total correction of TOF are an earlier age at repair, decreasing haematocrit, rising oxygen saturation before surgery, performing a palliative operation facilitating development of arteriae pulmonalis in earlier time, improving the surgical technique, and strengthening the perioperative care.
目的 探讨乳腺癌改良根治术后影响局部复发与远处转移的相关因素。方法 对陕西省汉中市铁路中心医院略阳医院2000年3月至2007年3月期间行乳腺癌改良根治术且资料完整的637例原发性乳腺癌患者的临床资料进行回顾性分析。结果 66例（10.36%）患者术后发生局部复发和远处转移，其中局部复发50例（7.85%），远处转移16例（2.51%）；术后3～4年内发生复发与远处转移者47例（71.21%）。术后复发和远处转移与患者年龄、肿瘤大小、腋窝淋巴结转移情况、TNM分期、激素受体（ER/PR）表达情况及术后是否接受正规的辅助治疗有关，与患者有无家族史无关。结论 肿瘤大小、腋窝淋巴结转移情况、TNM分期、ER/PR表达情况及术后是否接受正规的辅助治疗是影响乳腺癌改良根治术后复发与远处转移的危险因素，重视乳腺癌术后随访，规范乳腺癌的手术方式，强化乳腺癌的综合治疗是降低乳腺癌改良根治术后复发与远处转移率的主要措施。
In perioperation period, the dynamic changes of solubla interleulcin-2 receptor (sIL-2R) in serum were determined by ELISA in 60 patients with gastric cancer (GC), and then was compared with those of 30 normal individuals and 40 selective patients who necieved common abdominal surgery. Results: At the day before and ten days after operation, the sIL-2R of patients with GC was higher than that of normal individual. But twenty days after operation, the sIL-2R reduced to as normal level. Conclusion: As a immunodepressive index, the sIL-2R of patients with GC was increased obviously, and after radical gastrectomy, it decreased gradually. So by determining sIL-2R, we can evaluate the immunologic function of patientswith GC.
【摘要】 目的 探讨乳突根治术后耳内窥镜换药与常规换药相比是否具有优势。 方法 2003年3月-2008年10月对89例共89只耳行开放式乳突根治术患者按随机数字表法随机分为试验组及对照组，试验组45例45只耳采用耳内窥镜换药，对照组44例44只耳常规换药；分别观察试验组和对照组的干耳人数及干耳的时间，计算干耳率及干耳的平均时间。 结果 试验组45只耳中42只干耳，干耳率93.3％；对照组44只耳中40只干耳，干耳率90.9％。两组比较差异无统计学意义（Pgt;0.05）。试验组42例干耳患者平均干耳时间为术后（50.8±13.4） d，对照组40例干耳患者平均干耳时间为术后（60.7±12.2） d；两组比较，差异有统计学意义（Plt;0.001）。 结论 中耳乳突根治术后耳内窥镜下换药与常规换药相比不能显著提高干耳率，但能有效缩短干耳时间。【Abstract】 Objective To evaluate the application of otoendoscope in dressing change after mastoidectomy. Method Between March 2003 and October 2008, 89 patients (89 ears) underwent mastoidectomy in Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University and in Department of Otolaryngology, Nuclear Industry 416 Hospital of Chengdu. The patients were randomly divided into two groups by simple randomization (trial group and control group). Forty-five patients in the trial group underwent the dressing change under otoendoscope, while 44 patients in the control group under the routine method. The ear drying rate and the ear drying time in the two groups were observed. Results The ear drying rate was 93.3% (42 dry ears)in the trial group, and was 90.9% (40 dry ears) in the control group; the difference between the two groups was not significant (Pgt;0.01). The ear drying time was (50.8±13.4) days in the trial group and was (60.7±12.2) days in the control groups; the difference between the two groups was significant (Plt;0.001). Conclusion Dressing change under the otoendoscope after mastoidectomy may not improve the ear drying rate but can shorten the ear drying time.
【摘要】 目的 探讨中晚期宫颈癌术前动脉灌注化疗栓塞的临床价值。 方法 选择2005年6月-2009年12月35例经阴道镜活检确诊为宫颈癌临床分期Ⅱa~Ⅲb期宫颈癌患者，术前行1次子宫动脉化疗栓塞，化疗药物为博莱霉素（BLM）+顺铂（DDP）+环磷酰胺（CTX），栓塞剂为超液化碘油加明胶海绵颗粒。介入治疗后14~20 d行子宫全切加淋巴结清扫术。观察动脉灌注化疗栓塞前后肿块的大小变化、术中肿块粘连状况及出血量的多少。 结果 经介入治疗后肿块缩小32例：完全缓解（CR）3例、部分缓解（PR）29例，肿块无变化（NC）2例，进展（PD）1例，治疗有效率为91.4%。31例选择了手术治疗，手术率为88.6%。术中肿块粘连状况：无粘连24例，轻度粘连6例，中度粘连1例。术中出血量：≤100 mL 7例，100~200 mL 18例，200~400 mL 6例。 结论 中晚期宫颈癌术前动脉灌注化疗栓塞能有效地提高肿瘤切除率，降低手术风险。【Abstract】 Objective To evaluate the clinical value of preoperative transarterial chemoembolization for advanced cervical cancer. Methods A total of 35 patients with pathologically proved cervical cancer (from stage Ⅱa to Ⅲb) from June 2005 to December 2009 received preoperative transarterial chemoembolization once. Bleomycin, cisplantin and cytoxan were infused via bilateral uterine arteries, followed by arterial emboliezation with super-liquefaction iodipin and gel foam particles as embolic agent. Radical surgery was performed on the patients after 14-20 days. Volume change of mass, accretion state and haemorrhagia amount during the operation were analyzed. Results The masses deflated in 32 cases: complete response (CR) in 3, and partial response (PR) in 29. No change (NC) was seen in 3 cases. The effective rate was 91.4%. In 31 cases who underwent the operation, the operability was 88.6%, in whom non-accretionin was in 24, light accretion was in 6 and medium accretion was in 1. Haemorrhagia amount was less than 100 mL in 11 cases, 100-200 mL in 21cases, and 200-1 400 mL in 3 cases. Conclusion Preoperative chemoembolization can elevate exairesis rate and depress the operative risk effectively.
ObjectiveTo explore the evaluation value of preoperative multislice spiral computed tomography angiography (MSCTA) for normative radical gastrectomy. MethodsThe anatomic distributions of celiac trunk and its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which compared with postoperative pathological results. ResultsThe accuracy rate of preoperative MSCTA evaluating the distribution of celiac trunk and its three branches and their tributaries was 100%. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25.58%. Abnormal right hepatic arteries were found in 11 cases (12.79%), abnormal left hepatic arteries in 7 cases (8.14%), both abnormal right and left hepatic arteries in 1 case (1.16%), and abnormal common hepatic arteries in 3 cases (3.49%). Straight splenic arteries were found in 24 cases (27.91%), slightly curved splenic arteries in 44 cases (51.16%), and significantly curved splenic arteries in 18 cases (20.93%). Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58%（65/86）, 74.42%(64/86), and 91.86%(79/86), respectively. ConclusionsPreoperative MSCTA is an objective way to assess the distributions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.
The conectration of cholecystokinin infasting serum was determined by radioimmunoessay in 30 patients with gastric antrum cancer before and after radical sbutotal gastrectomy.It was 119.6±142.2pmol/L before the operation and 78.5±149.2pmol/L after the operation,which was significantly lower than that before the operation,P=0.022. The result suggests that the reduction of cholecytokinin secretion after gastrectomy was one of the important causes in the bile stasis,the disturbance of gallbladder emptying funcion and the formation of gallstone.