目的:探讨经自然腔道(肛门)取标本三孔法腹腔镜乙状结肠及直肠癌根治术治疗乙状结肠癌、直肠癌的安全性、可行性.方法:2022年2月至2023年4月为10例乙状结肠癌、直肠癌患者行三孔法腹腔镜乙状结肠及直肠癌根治术,经肛门取标本,腹部无辅助切口.结果:10例手术均顺利完成,手术时间平均(275.0±58.1)min,术中出血量平均(28.5±14.9)mL,术后首次肛门排气时间(38.4±11.0)h,进流食时间(2.3±0.7)d,术后平均住院(9.2±1.5)d.1例患者于术后第2天晚上发热38.7℃,予以抗感染治疗,第4天体温恢复正常;均无其他术后并发症发生.术后TNM分期:0～Ⅰ期4例,Ⅱ期2例,Ⅲ期4例.住院总费用平均(35012.99±2458.68)元.术后随访1～14个月,中位随访时间6个月,其中4例术后行辅助化疗;均未发现肿瘤复发、转移.结论:经自然腔道(肛门)取标本三孔法腹腔镜乙状结肠及直肠癌根治术治疗乙状结肠癌、高位直肠癌在技术上安全、可行,近期疗效理想.

Objective:To analyze the feasibility and safety of laparoscopic totally extraperitoneal hernia repair in the treatment of the right inguinal hernia with history of appendectomy.Methods:From September 2020 to September 2022, the clinical data of 73 patients with right or bilateral inguinal hernia who underwent laparoscopic totally extraperitoneal hernia repair (TEP) at the General Surgery Department of the 991st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army was retrospectively analyzed. According to whether they had a history of appendectomy, they were divided into a study group (after appendectomy group) and a control group (without surgery history group). The operation-related indicators,, postoperative pain degree, postoperative recovery, total hospitalization cost, and incidence of complications were compared between the two groups.Results:All the patients in the two groups successfully underwent TEP with no perioperative death; the operative time, intraoperative blood loss, hernia sac diameter, incidence of intraoperative peritoneal injury, number of intraoperative peritoneal injuries, amount of plastic clamp used and incidence of medical glue used in the two groups were not statistically significant (P>0.05). No case in the study group was converted to the transabdominal preperitoneal hernia repair (TAPP) or open surgery, and 2 cases in the control group were converted to TAPP, but there was no significant difference in the convert rate between the two groups (P=0.504). There was no significant difference in the time to get out of bed, postoperative hospital stay, or total hospitalization cost between the two groups. There was no significant difference in the VAS score of the postoperative day, the VAS score of the next day, or the postoperative pain duration between the two groups. There were 2 cases of seroma and 1 case of bladder injury in the study group, and 5 cases of seroma and no bladder damage in the control group. In all cases, the follow-up time was 2 to 24 months, and the middle follow-up time was six months. There was no chronic pain in either group. There was no recurrence in the study group, but one recurrence in the control group. There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Conclusion:TEP is safe and feasible in the treatment of the right inguinal hernia with a history of appendectomy.

目的 比较Lichtenstein术与全腹膜外补片修补术(TEP)治疗复发性腹股沟疝的临床效果.方法 选择2018年7月至2020年7月于本院就诊的80例复发性腹股沟疝患者,按照时间顺序以1:1比例交叉分为对照组(n=40)与研究组(n=40).对照组予以Lichtenstein术治疗,研究组予以TEP术治疗.比较两组的手术指标、并发症发生情况、不同时间的疼痛评分、术前及术后的实验室指标.结果 两组的手术时间及术后并发症总发生率比较,差异无统计学意义(P>0.05);研究组的术中失血量显著少于对照组,首次下床活动时间、住院时间显著短于对照组,差异具有统计学意义(P<0.05).术后12、48 h,研究组的VAS评分均显著低于对照组,差异具有统计学意义(P<0.05).术后,两组的血清PⅠCP、T-AOC水平明显升高,血清β-EP水平明显降低,且研究组优于对照组,差异具有统计学意义(P<0.05).结论 与Lichtenstein术相比,TEP术治疗复发性腹股沟疝的效果更佳,可减轻患者术后疼痛,改善氧化应激反应,加快术后恢复速度,值得临床推广应用.

目的 探讨老年原发性肝癌患者血清miRNA-200c水平及其与临床病理特征和预后的关系.方法 选择老年原发性肝癌患者90例作为肝癌组,90例同期体检的健康老年人作为对照组.采用实时定量聚合酶链反应(RT-PCR)测定血清miRNA-200c水平.结果 肝癌组血清miRNA-200c水平明显低于对照组(P<0.05).肝癌组血清miRNA-200c水平与原发性肝癌的分化程度、TNM分期和淋巴结转移有关(P<0.05),其中低分化、TNM分期Ⅲ-Ⅳ 期、有淋巴结转移者血清miRNA-200c水平明显低于中-高分化、TNM分期Ⅰ～Ⅱ期、无淋巴结转移者;血清miRNA-200c水平与原发性肝癌患者的年龄、性别、乙型肝炎病毒(HBV)感染、肝硬化、肿瘤直径无关(P>0.05).血清miRNA-200c水平诊断原发性肝癌的受试者工作特征(ROC)曲线下面积为(AUC)为0.811,95％CI为0.808～0.814,诊断界值为0.51,灵敏度为91.02％,特异度为69.53％.血清miRNA-200c水平以ROC曲线诊断临界值0.51为界,分为高表达组和低表达组,高表达组患者总生存率和无病生存率均明显高于低表达组(P<0.05).结论 老年原发性肝癌患者血清miRNA-200c水平降低,血清miRNA-200c水平与老年原发性肝癌的分化程度、临床分期和淋巴结转移关系密切,在老年原发性肝癌的诊断和预后预测中具有重要价值.

Hippo通路是通过调控细胞增殖、凋亡和分化进而控制器官体积大小的信号通路;近年研究发现,Hippo通路在不同的局部微环境以及各信号分子相互影响下显示多样性作用,在肿瘤免疫应答中具有重要的调控作用.Hippo信号通路的核心蛋白YAP活化状态有助于肿瘤细胞免于免疫清除:YAP活化上调趋化因子CXCL5的分泌,促进免疫抑制细胞MDSCs的募集,调控PD-L1的转录与翻译,促进肿瘤细胞的免疫逃逸.全面了解Hippo信号通路,对于研究肿瘤潜在的分子治疗靶点具有重要意义.

目的:探讨呼吸机辅助呼吸法在抢救重症有机磷农药中毒呼吸衰竭患者方面的临床价值。方法:对2010~2012年我院收治的126例重症有机磷农药中毒呼吸衰竭患者的临床资料进行回顾性分析,探讨其临床疗效。结果:为126例重症有机磷农药中毒呼吸衰竭患者用呼吸机辅助呼吸法进行抢救后,有114例患者治愈,有12例患者死亡,治愈率为90.5%,死亡率为9.5%。结论:呼吸机辅助呼吸法在抢救重症有机磷农药中毒呼吸衰竭方面具有良好的临床疗效,可显著提高患者的治愈率,降低其死亡率。