紫杉类药物所致周围神经病变作为乳腺癌化疗的常见不良反应之一,表现为肢体末端为主或可累及全身的感觉、运动和自主神经等损害,具有剂量限制性和累积效应,严重时改变治疗结局、降低患者生命质量.该文通过分析近年来国内外相关文献,对该病变的疾病概况、诊断评估、中西医防治手段等方面的研究进展作一综述,以期为临床治疗及相关研究提供参考.

目的:探讨扶正固本法对乳腺癌骨转移后骨破坏的抑制作用及可能的分子机制.方法:通过胫骨内注射乳腺癌细胞建立乳腺癌骨转移动物模型,给予扶正固本方药干预,给药后采用IVIS检测乳腺癌在骨环境中的生长情况,X-ray和TRAP染色分析骨破坏及破骨细胞活性情况,并采用ELISA检测小鼠血清中的TNF-α、IL-1β、IL-6、IL-17、PTHrP、RANKL、OPG、TGF-β、IGF、PDGF细胞因子的表达改变.结果:IVIS结果显示扶正固本方药可减缓乳腺癌在骨环境中的生长,X-ray和TRAP染色表明扶正固本方药可以减少乳腺癌骨转移引起的骨破坏及破骨细胞活性,ELISA结果显示扶正固本方药可以降低血清中TNF-α、IL-1β、IL-6、IL-17、PTHrP、RANKL、TGF-β、IGF、PDGF的表达水平,提高血清中OPG的表达水平.结论:扶正固本方药可通过调节多种细胞因子的表达,从而减缓乳腺癌细胞在骨环境中的生长,以及减轻乳腺癌细胞所引起的骨破坏.

目的 探讨乳腔镜腺体切除联合脂肪抽吸术治疗男性乳房发育的临床应用价值;方法 回顾性分析并方便选取2014年1月—2017年1月期间行乳腔镜腺体切除联合脂肪抽吸术治疗的25例(42侧)男性乳房发育患者的临床资料,观察手术情况、术后并发症及美容效果.结果 所有患者均顺利完成手术;术中出血少,无中转开放手术,术后引流量少、疼痛小、住院时间短;1例患者出现皮下积液,2例出现轻度皮下气肿,2例出现皮肤瘀斑,术后并发症发生率低;随访半年未发现局部复发;除1例SimonⅢ 型患者出现皮肤松弛稍下垂,其余患者基本达到正常的男性胸部外观,胸壁表面无瘢痕,中心区与周围区过渡平顺,胸廓平坦,乳头对称,无明显硬结,效果满意.结论 乳腔镜腺体切除联合脂肪抽吸术安全、有效,是治疗男性乳房发育的理想术式.

目的 评价喉罩或单腔气管内插管在胸腔镜下胸交感神经链切断术的应用效果.方法 选择80例行胸腔镜下胸交感神经链切断术的手汗症患者,采用计算机随机法将患者分为A、B两组,每组各40例.其中A组男20例、女20例,平均年龄24岁;B组男21例、女19例,平均年龄23岁.A组使用喉罩通气,B组使用单腔气管内导管,均应用小潮气量较快频率正压通气及间歇人工气胸.观察两组麻醉期间各时点心率(HR)、平均动脉压(MAP)、呼气末二氧化碳分压(PetCO2)、动脉血氧饱和度(SpO2)、心电图(ECG)的变化.同时记录喉罩/单腔导管置入时间、CO2充气时间、手术时间、术中术后不良反应和并发症.结果 两组患者手术顺利,无并发症.A组喉罩/插管置入时间和喉罩/单腔管呛咳、术后咽喉疼痛发生率低于B组,差异有统计学意义(P＜0.05).B组MAP、HR水平在T2(喉罩/单腔管置入后)和T7(苏醒后拨喉罩/单腔管时)明显高于T1(麻醉诱导完成),差异有统计学意义(P＜0.05);A组MAP、HR水平在T2和T7时亦明显低于B组,差异有统计学意义(P＜0.05).所有患者术中ECG、SpO2和PetCO2无明显变化.结论 喉罩或单腔气管内插管结合间歇的人工气胸都能满足胸交感神经切断术的操作需要,喉罩具有更稳定的血流动力学状态和更高的安全性.

原发性手汗症是指无明显器质性病因，手掌部汗腺分泌亢进的状态，是外分泌腺过度分泌的功能性疾病，常合并足底及腋窝多汗。胸腔镜下胸交感神经干切断术是治疗手汗症的有效方法［1］。如何在保证疗效的同时尽可能减少术后并发症，是目前研究手汗症治疗的热点。笔者医院于2011年12月－2013年4月行胸腔镜下双侧 T 4交感神经干切断术治疗手汗症80例，取得满意效果，现报道如下。

To assess the feasibility of totally implantable access port(TIAP)for long - term transfusion in patients with chest cancer. Methods:From December 2009 to May 2012,we used TIAP for long term transfusion in 50 cases of chest cancer. Under local anesthesia or general anesthesia,with subclavian vein or internal jugular vein puncture,we inserted TIAP with over the wire(OTW)technique. Peri - operation and long term complications were observed. Results:TIAP was inserted successfully at a rate of 98% in all cases. All cases had no serious complica-tion. Among the patients,the tip point of the wire reaching internal jugular vein occurred in two cases,puncture insert-ed subclavian artery improperly in one case. All of them had to receive inserted again and successful. Two patients had the catheter occlusion:Both of them were cured by arm exercise or moving the port. One patient got out the TIAP be-cause the access port leaked. 35 cases had been removed TIAP in plan. Conclusion:TIAP is effective and safe for pa-tients of chest cancer. Operation can achieve success safely with design formulas of catheter depth and OTW tech-nique.

乳腺浸润性筛状癌(invasive cribriform carcinoma,ICC)是一种罕见的乳腺浸润性癌,占所有乳腺癌的0.8％ ～3.5％.2003年,世界卫生组织(WHO)乳腺肿瘤组织学分类在上皮性肿瘤中将其列为一种新的肿瘤亚型[1].现就福建中医药大学附属厦门市中医院外二科1例乳腺混合型ICC,结合文献分析如下.

目的:探讨榄香烯乳(elemene,ELE)逆转人肺腺癌A549/DDP细胞株耐药性及其机制.方法:采用MTT法检测榄香烯乳单用的细胞毒作用及与顺铂(cisplatin,DDP)合用时耐药逆转作用;采用流式细胞术检测榄香烯乳对A549/DDP细胞内罗丹明-123(rhodamine-123,Rh123)蓄积的影响;采用Western blot检测榄香烯乳对耐药细胞A549/DDP细胞膜上P-gp蛋白表达的影响.结果:不同浓度榄香烯对A549/DDP细胞均有一定的抑制作用,呈时间-剂量依赖性效应.单用DDP的IC50为15.46μg/ml,合用20μg/ml榄香烯24h,IC50为4.15μg/ml,逆转耐药倍数为3.63.同时,榄香烯增加A549/DDP细胞内Rh123的蓄集,降低细胞膜上p-gP的表达,且呈剂量依赖性,表明榄香烯能减少A549/DDP细胞对药物的外排和抑制P-gp蛋白的表达.结论:榄香烯在体外逆转肿瘤细胞耐药性可能与其抑制P-gp的功能和表达有关.

报告1例刀刺伤致患者心、左肺、肝、右侧膈肌破裂的成功诊治经验,讨论心脏刀刺伤合并其他脏器损伤的诊断、救治方法及注意事项。

Objective To investigate the effects of matrine on the proliferation and apoptosis of human esophageal carcinoma Eca-109 cell line.Methods Different concentrations of matrine were used in the culture of esophageal carcinoma cells.Proliferation,apoptosis,and cell cycle arrest of esophagus carcinoma Eca-109 cells line were observed by MTT assay,Hoechst33342 staining,and flow cytometry quantitative analysis.Results showes that matrine significantly induced apoptosis of the Eca-109 cell line;The cell cycles measurement by flow cytometry quantitative analysis showed an increase in G2 phase cells,and S phase cells were significantly reduced.Conclusions Matrine can inhibit proliferation and promote apoptosis of the Eca-109 cell line,and the mechanism may be correlated to the cell cycle arrest at G2 phase.

目的评价手汗症患者临床路径实施的实际效果及应用价值。方法随机选择40例手汗症患者为实验组,实施临床路径;另外选择40例手汗症患者为对照组,比较2组住院时间、住院费用、满意度等指标。结果 2组患者的住院时间、住院费用和患者满意度比较均有显著性差异(P<0.05)。结论临床路径在保证医疗质量的同时,为手汗症患者提供了优质服务,可以缩短住院时间,降低住院费用,提高患者的满意度。

目的:研究分化诱导剂黄芪(Astragalus)在体外对人肺腺癌SPC-A-1细胞生长抑制的影响.方法:用不同浓度的黄芪分别处理肺腺癌SPC-A-1细胞后,镜下观察癌细胞的生长情况;测定软琼脂克隆形成率;MTT(噻唑蓝)法测定生长抑制率.结果:不同浓度黄芪处理后细胞的生长明显受到抑制,细胞生长抑制率随黄芪的浓度增加而增加.结论:黄芪对肺腺癌SPC-A-1细胞的生长有明显的抑制作用.

恶性肿瘤在无转移的情况下影响全身远隔器官功能,即肿瘤的远隔效应,当神经系统受其影响时,可出现一些各不相同的病征,即副肿瘤综合征(paraneoplastic neurological syndrome,PNS).因PNS常在恶性肿瘤临床症状出现之前出现,故误诊率极高.现就1例乳腺癌并发副肿瘤小脑变性报道如下.

目的:探讨中药提取物黄芪（Astragalus）对人肺腺癌（lung adenocarcinoma）细胞系SPC-A-1的凋亡诱导作用及其发生机制。方法:体外培养SPC-A-1细胞,用不同浓度黄芪对体外培养的SPC-A-1细胞进行干预。分别采用MTT、免疫细胞化学染色、流式细胞仪法检测其对SPC-A-1细胞的增殖抑制和凋亡诱导作用;并对凋亡相关Bcl-2与Bax蛋白表达的变化进行定性检测。结果:经不同浓度黄芪处理后的SPC-A-1细胞,其生长受到明显的抑制,细胞凋亡指数随药物浓度增加而明显增加;黄芪作用Bax表达明显高于对照组。结论:一定浓度的黄芪能抑制SPC-A-1细胞的增殖,促进其凋亡;其机制可能与调控Bcl-2、Bax表达有关。

Objective To investigate the etiologies of spontaneous pneumothorax in flat chest teenagers.Methods 30 teenagers with flat chest and spontaneous pneumothorax were designed as the study group,while 20 teenagers without spontaneous pneumothorax during the same period were taken as control.The ratio of thoracic transverse diameters to anterior-posterior diameters,and the ratio of tracheal length to transverse diameters were measured respectively by CT scan.The resected pulmonary tissues in 30 cases with spontaneous pneumonthorax and in 20 cases without spontaneous pneumonthorax underwent Pathology examinations.Student t-test was employed to perform tIle statistical analysis.Results The ratios of thoracic transverse diameters to anteriorposterior diameters and the ratios of tracheal length to transverse diameters in the study group were remarkably higher than those in the control group.with significant statistical difference(P

目的 探讨气管镜下覆膜内支架置入治疗胸腔胃-气道瘘的可行性与疗效. 方法 根据胸腔胃-气道瘘口的位置、大小、数目选择内支架,气管镜直视下,对5例患者6处瘘在气管内置入6枚气管覆膜内支架封堵瘘口.结果 5例内支架均置入成功,瘘口完全封闭,即刻消除呛咳症状;5例均被有效控制肺部感染,生活质量提高;1例支架置入2个月后呼吸衰竭死亡.随访5～15个月,3例死于恶病质,1例死于呼吸衰竭,1例正常生活至今. 结论 气管覆膜内支架能有效封堵胸腔胃-气道瘘,操作简单、安全、近期疗效可靠.

AIM:To investigate the mutative law of the serum S100-B protein in patients undergone coronary artery bypass grafting with or without cardiopulmonary bypass(CPB-CABG or non-CPB CABG),and to compare the degree of cerebral injury in patients during CABG between the two different surgical manipulations.METHODS:30 patients were divided into two groups:CPB-CABG group(group A) and non-CPB CABG group(group B).Every group included 15 patients.Blood from jugular vein was phlebotomized in every patients at the following 8 time points:before operation(OP),after anaesthesia,end of grafting,end of OP,2 h after OP,6 h after OP,12 h after OP and 24 h after OP.The serum concentrations of S100-B protein in the samples were measured.RESULTS:The level of serum S100-B protein increased markedly at the beginning of CABG,and the peak value of group A(2.32 μg/L±0.26 μg/L) was treble higher than that in the patients in group B(0.71 μg/L±0.14 μg/L).The levels of S100-B protein tend to normal level in both groups 24 h after OP.The level of S100-B protein had notable relation with the time of CABG in group A and the manipulative time on the heart in group B.CONCLUSION:The degree of cerebral damage can be valued by investigating the mutative law of the serum S100-B protein in patients undergone CPB-CABG and non-CPB CABG.The non-CPB CABG reduces the degree of cerebral damage and avoids the functional disorder of central nerve.