摘要:目的：探讨高频电刀在乳腺癌手术皮瓣游离中的临床应用及其功率大小对术后皮瓣坏死的影响。方法：回顾性分析2003年1月至2008年9月,在我院154例行乳腺癌改良根治术患者的临床资料,其中乳腺刀组（A组）37例,小功率电刀组（B组）60例,大功率电刀组（C组）57例,对比分析各组皮瓣坏死情况。结果：共发生皮瓣坏死35例,其中A组用乳腺刀游离皮瓣6例（6/37）,B组用小功率电刀（18～22W）游离皮瓣9例（9/60）,C组用大功率（≥28W）电刀游离皮瓣20例(20/57),B组与A组比较差异无显著意义(Ｐ＞005),C组与A、B组比较差异有显著意义(Ｐ＜005);而B、C组与A组比较,游离皮瓣时出血量明显减少,差异有显著性意义（Ｐ＜005）。结论：合理应用高频电刀游离皮瓣具有术中出血少,术后恢复快的优势,但若功率过高,则会增加皮瓣坏死率。Abstract: Objective: To Analyse influence of Skin Flap Necrosis after Operation of Breast Cancer with different power of radioknife. Methods：The clinical data of 154 breast cancer patients received surgery operation trea tment was analysed retrospectively, among them there are 37 patients operation with lancet (group A), there were 60 patients operation with littlepower radioknife (group B) and there were 57 patients operation with highpower radioknife (group C). Results：There were 35 cases (22.73％) suffured from skin flap necrosis among 154 breast cancer cases received surgery operation. There were 6 cases（6/37）in group A, 9 cases（9/60）in group B and 20 cases（20/57）in group C. Group B and group C has littler hemorrhage in operation compare with group C (Ｐ＜005) . Conclusion： Radioknife for skin flap decoherence in operation of breast cancer can decrease hemorrhage but highpower radioknife will increase necrosis of skin flap.
ObjectiveTo observe the accuracy of magnetic resonance imaging (MRI) for predicting pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer, and to analyze the cause of the prediction error.MethodsData from 157 breast cancer patients who underwent NAC before surgery in Mianyang Central Hospital from January 2017 to January 2019 were analyzed. MRI parameters before and after NAC and pCR conditions were collected to analyze the parameters that produced false positives and false negatives.ResultsOf the 157 patients, 37 (23.6%) achieved pCR after NAC, and 33 (21.0%) achieved radiation complete remission (rCR) after NAC. The accuracy of MRI prediction was 70.7% (111/157), the sensitivity was 82.5% (99/120), and the specificity was 32.4% (12/37). A total of 25 cases did not achieve rCR, but postoperative evaluation achieved pCR (false positive), 21 cases achieved rCR, but postoperative evaluation did not achieve pCR (false negative). Diameter of tumor, peritumoral oedema, and background parenchymal enhancement were associated with MRI false positive prediction (P<0.05); gland density and tumor rim enhancement were associated with MRI false negative prediction (P<0.05).ConclusionMRI can be used as an important method to predict pCR after NAC in breast cancer patients, and its accuracy may be related to diameter of tumor, peritumoral oedema, background parenchymal enhancement, gland density, and tumor rim enhancement.
Objective To explore the risk factors of female’s breast cancer in secondary cities of the west and establish a risk prediction model to identify high-risk groups， and provide the basis for the primary and secondary preve-ntion of breast cancer. Methods Random sampling （method of random digits table） 1 700 women in secondary cities of the west （including 1 020 outpatient cases and 680 physical examination cases） were routinely accept the questionnaire survey. Sixty-two patients were confirmed breast cancer with pathologically. Based on the X-image of the mammary gland patients and questionnaire survey to put mammographic density which classificated into high- and low-density groups. The relationships between the mammographic density， age， body mass index （BMI）， family history of breast cancer， socio-economic status （SES）， lifestyle， reproductive fertility situation， and breast cancer were analyzed， then a risk prediction model of breast cancer which fitting related risk factors was established. Results Univariate analysis showed that risk factors for breast cancer were age （P=0.006）， BMI （P=0.007）， age at menarche （P=0.039）， occupation （P=0.001）， domicile place （P=0.000）， educational level （P=0.001）， health status compared to the previous year （P=0.046）， age at first birth （P=0.014）， whether menopause （P=0.003）， and age at menopause （P=0.006）. The unconditional logistic regr-ession analysis showed that the significant risk factors were age （P=0.003）， age at first birth （P=0.000）， occupation （P=0.010）， and domicile place （P=0.000）， and the protective factor was age at menarche （P=0.000）. The initially established risk prediction model in the region which fitting related risk factors was y=-5.557＋0.042x1-0.375x2＋1.206x3＋0.509x4＋2.135x5. The fitting coefficient （R square）=0.170， it could reflect 17% of the actual situation. Conclusions The breast cancer risk prediction model which established by using related risk factors analysis and epidemiological investigation could guide the future clinical work，but there is still need the validation studies of large populations for the model.
Objective To investigate the clinical outcomes of total knee arthroplasty (TKA) by using the condylar constrained knee prosthesis in the treatment of destructive hemophilic arthritis. Methods Between September 2007 and July 2015, 8 cases (8 knees) of destructive hemophilic arthritis accepted TKA by using condylar constrained knee prosthesis. All patients were male, aged 22 to 56 years, with an average age of 35 years. The disease course of hemophilia A was 3-30 years (mean, 17.3 years). Preoperative range of motion (ROM) was (68.1±32.6)°; the flexion deformity was (14.38±16.13)°. Six patients had valgus of 7-35° (mean, 17.3°), of whom, one had fixed dislocation of patella; and one had varus of 15°. Hospital for Special Surgery (HSS) knee score was 52.5±12.9. Pre-operative X-ray film examination demonstrated narrowing of the knee gap and cystic degeneration of articular cartilage and subchondral bone. Results All patients achieved primary wound healing, and were followed up 1-9 years (mean, 5 years). Tense blister with common peroneal nerve damage and extension penetrating into distal tibial cortex occurred in 1 case respectively, which were cured corresponding treatment. At last follow-up, the knee ROM and the flexion deformity were significantly improved to (98.1±8.9)° and (0.63±1.77)° (t=–2.527,P=0.036;t=2.396,P=0.047). At 2 weeks after operation and last follow-up, the HSS scores were significantly increased to 77.3±11.0 and 85.0±9.0 (P<0.05). X-ray film showed that lower extremity alignment returned to normal in patients with varus and valgus. Conclusion Good curative effect can be get by using condylar constrained knee prosthesis in TKA for the treatment of destructive hemophilic arthritis.
ObjectiveTo investigate the strategy adjustment of breast cancer surgery management process during the outbreak of novel coronavirus pneumonia (NCP), and to summarize the experience.MethodsBased on "Pneumonitis Diagnosis and Treatment Plan for Novel Coronavirus Infection (Fifth Trial Version)" and "Surgery Work System During the Prevention and Control of Novel Coronavirus Infection in Mianyang Central Hospital (Second Edition)", the breast surgery department adjusted strategies and plans for breast cancer surgery during the epidemic.ResultsFrom January 25, 2020 to February 11, 2020, 8 cases of breast cancer surgery were performed in our hospital. They were all females, with an average age of 45 years. Five patients underwent modified radical mastectomy, 2 patients underwent breast-conserving surgery plus sentinel lymph nodes biopsy, and 1 case underwent breast-conserving surgery plus axillary lymph node dissection. All 8 patients were diagnosed as invasive ductal carcinoma of breast by hollow needle biopsy. All patients recovered smoothly after surgery, no complications occurred, and they were discharged as planned. No patients or medical staff showed NCP exposure and infection.ConclusionDuring the NCP epidemic, breast cancer surgery can be performed and the epidemic can be effectively prevented and controlled by adjusting the work flow and strategy.
Objective To identify risk factors for death in patients with rhabdomyolysis-induced acute kidney injury (RI-AKI) treated with continuous renal replacement therapy (CRRT), then to develop and validate the efficacy of prediction models based on these risk factors. Methods Clinical data and prognostic information of patients with RI-AKI requiring CRRT from 2008 to 2019 were extracted from the MIMIC-IV 2.2 database. The enrolled patients were divided into a training set and a test set at a ratio of 7∶3. LASSO regression, random forest (RF) and extreme gradient boosting (XGBoost) were used to identify the risk factors affecting patients’ 28-day survival in the training set, then to develop logistic model, RF model, support vector machine (SVM) model and XGBoost model. The accuracy of above prediction models and the area under the receiver operating characteristic curve (AUC) were calculated in the test set. Results A total of 175 patients were included. Lactic acid, age, Acute Physiology Score Ⅲ, hemoglobin, mean arterial pressure and body mass index measured at intensive care unit admission were identified as the six risk factors affecting 28-day survival of enrolled patients by LASSO regression, RF and XGBoost. The accuracy of the logistic model, RF model, SVM model and XGBoost model in the test set was 0.75, 0.79, 0.79 and 0.81, with the AUC of 0.82, 0.85, 0.87 and 0.87, respectively. Conclusion The XGBoost model, incorporating six risk factors including lactic acid, age, Acute Physiology Score Ⅲ, hemoglobin, mean arterial pressure, and body mass index assessed at the time of admission to the intensive care unit, demonstrates superior clinical predictive performance, thereby enhancing the clinical decision-making process for healthcare professionals.