目的 探索"互联网+"模式下构建肿瘤科普教育体系及其应用效果.方法 2019年1月7日至11月25日,采取整体抽样法,抽取该院的19个科室31个病区的3424例肿瘤住院患者作为研究对象,对照组采取传统的健康宣教形式,观察组采用构建的肿瘤科普教育体系,借助手机APP、微信、平台等互联网+应用于肿瘤患者及家属,对科普教育体系运行效果进行对比研究.结果 观察组健康教育考核平均分优于对照组;观察组患者肿瘤康复相关行为(遵医行为、服药依从、合理饮食、观察病情、康复锻炼、定期复查、心理护理)高于对照组;患者住院各阶段健康教育的满意度高于对照组,差异均有统计学的意义(P<0.05).结论 基于"互联网+"模式下的肿瘤科普教育体系具有补充和完善传统健康教育方式的不足、拓展患者健康教育新渠道、促进肿瘤康复等优点.

Decompression and curettage can result are effective as treatments for large jaw cysts, which are common diseases in the clinic. Based on a treatment used in a previous study, this paper proposes a "three-step method" to treat large jaw cyst and repair the bone defect by decompression, curettage, and autologous dental bone powder implantation. This paper introduces the processes and key points of the operation involved in the abovementioned method.

目的:探讨Calpain2在FN诱导的口腔鳞癌细胞上皮间质转化(EMT)中的作用.方法:以口腔鳞癌Tca8113细胞为研究模型,FN诱导模型细胞48 h;侵袭小室实验考察细胞的侵袭能力;siRNA转染沉默Calpain2蛋白表达;应用蛋白质印记法检测各蛋白表达水平.结果:FN(15 μg/ml)处理Tca8113细胞12、24、48 h发现,Calpain2和Twist蛋白表达逐渐增加(P＜0.05或P＜0.01);E-cadherin蛋白表达逐渐降低(P＜0.05或P＜0.01).与空白对照组相比,FN处理组细胞侵袭数增加了(116.7±5.1)％(P＜0.01).与siRNA-NC组相比,siRNA-Calpain2组Calpain2蛋白表达下调(90.3±3.3)％(P＜0.01).FN处理细胞48 h,与siRNA-NC组相比,siRNA-Calpain2组E-cadherin蛋白表达下调和Twist蛋白表达上调被逆转(P＜0.01);siRNA-Calpain2组细胞侵袭数下降(51.3±4.5)％(P＜0.01).结论:FN能诱导口腔鳞癌Tca8113细胞发生EMT,该作用可能与Calpain2蛋白表达上调相关.

Objective To explore the clinical effects of modified pedicled pectoralis major myocutaneous flaps(PMMFs) in repairing postoperative defects following head and neck malignant tumor radical operation.Methods Twenty-eight patients with surgical defects after head and neck malignant tumor operation in this hospital from September 2013 to January 2017 were selected and performed the repairing reconstruction by modified PMMFs,then observed and followed up for the survival of the flaps.Results All 28 cases were followed-up for 3-36 months,all modified PMMFs survived.Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation had the advantages of high survival rate and less trauma;meanwhile the swallow and language function could obtain the maximal recovery.Conclusion Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation has good clinical curative effect and is worth clinical application.

目的:通过生物信息学方法分析甲状腺癌预后相关的非编码RNA与mRNA及信号通路.方法:从癌症基因组图谱(TCGA)数据库中下载568例甲状腺癌患者的临床信息及其组织样本的非编码RNA(lncRNA、miRNA)与mRNA数据,筛选出差异表达的非编码RNA与mRNA,对差异表达的mRNA进行功能富集分析与通路分析;构建lncRNA-miRNA-mRNA的竞争性内源RNA(ceRNA)调控网络;结合临床信息进行生存分析获取与甲状腺癌预后相关的非编码RNA与mRNA.结果:共筛选出差异表达的lncRNA 497个(上调93个,下调404个),miRNA 72个(上调5个,下调67个),mRNA 1097个(上调233个,下调864个).功能富集分析结果显示差异表达的mRNA主要参与单组织过程、单组织细胞过程、刺激反应等生物学过程,受体结合、分子功能调节、钙离子调节等细胞功能以及细胞、细胞膜、细胞外组件等细胞构成过程.通路分析结果显示差异表达的mRNA主要参与神经反应受体-配体相互作用、细胞因子-细胞因子受体相互作用、肿瘤转录失调等信号通路的调节.构建的lncRNA-miRNA-mRNA ceRNA互作网络中,有2个差异表达lncRNA(MIR181A2HG、OPCML-IT1),1个差异表达miRNA(miRNA-184)和2个差异表达mRNA(E2F1、SALL3)与甲状腺癌的总体生存期明显有关(均P<0.05).结论:所筛选的非编码RNA与mRNA以及相关信号通路在甲状腺癌的预后密切相关,并为甲状腺癌发生、发展机制的研究提供了新的方向.

目的:探索开窗减压术联合刮治术治疗单囊型成釉细胞瘤的临床疗效及应用价值.方法:对2011～2014年重庆市肿瘤医院头颈外科收治的8例单囊型成釉细胞瘤患者进行开窗减压术及刮治术.术后长期随访并拍摄口腔全景片及MRI检查,观察瘤腔变化.结果:8例单囊型成釉细胞瘤开窗减压后瘤腔明显缩小,骨量增加.术后12～18个月连续随访,全景片示瘤腔缩小不明显甚至无变化,行刮治术并关闭开窗口.二次手术后随访6～12个月,瘤腔再次缩小甚至消失,成骨良好无复发.结论:开窗减压术联合刮治术是治疗单囊型成釉细胞瘤的一种有效方法,可以保留下颌骨骨质的连续性及相应功能;开窗减压术后瘤腔变化不明显时是进行二期刮治术的最佳时机.

Objective: To explore the effect of intravenous chemotherapy on the fall risk of the cancer patients. Methods: Using fall risk assessment scale of cancer patients to assess the fall risk in 343 cancer patients before chemotherapy, undergoing chemotherapy and after chemotherapy and to analyze the difference on fall risk score in three stages. Results: The distribution proportion of cancer patients which had different grade of fall risk in three stages of chemotherapy were significant different (χ2=260.753,P<0.001). The fall risk score before chemotherapy, undergoing chemotherapy and after chemotherapy were 1.08±1.93, 3.07±1.96 and 1.76±1.90 respectively, and they were statistically signiifcant (F=92.283,P<0.001). According to the days receiving chemotherapy, we divided the patients into four different groups. And there were no signiifcant difference of fall risk score in different groups (F=0.511,P>0.05). Conclusion: Intravenous chemotherapy could increase the fall risk in cancer patients. We should take high risk management model for the patients with intravenous chemotherapy and take measures to prevent the risk of fall before chemotherapy for increasing the work efifciency. After the patients discharged, we should also pay attention to the fall risk of the patients to ensure the patients' safety.

目的 为提高舌癌、口底癌患者术后生存质量,探讨保留完整的下颌骨及牙列的舌癌、口底癌联合根治方法,并评价其近期疗效.方法 收集随访2013年5月至2014年11月该科室采用保留完整的下颌骨和牙列的方式行舌癌、口底癌根治术的5例患者的临床资料,通过术后患者面形、语言、舌运动、咬合和进食等情况以及肿瘤有无复发和转移,来评价患者口腔功能状况和手术疗效.结果 随访3～18个月,未发现肿瘤局部复发和远处转移.全部患者术后均面部外形对称无畸形、咬合关系无错乱,咀嚼、语言和吞咽功能良好.结论 保留完整的下颌骨和牙列的舌癌、口底癌联合根治方法既能根治肿瘤,又使患者获得良好的生存质量.

Objective To investigate the expression of CD133 in human adenoid cystic carcinoma,and explore the potential role and mechanism of CD133 in the progress of adenoid cystic carcinoma. Methods Twenty-five paraffin cases of human adenoid cystic carcinoma tissues and 23 cases of human oral squamous cell carcinoma tissues and 11 fresh cases of normal salivary gland tissue were collected,and CD133 expression level in these three groups were detected using immunohistochemistry,then the relationship between CD133 expression and various clinical parameters was analyzed. Results An obvious higher CD133 protein expression in salivary gland adenoid cystic carcinoma was detected while it was not found in oral squamous cell carcinoma,and its expression level was related to tumor proliferation and differentia-tion. The difference was statistically significant. Conclusion CD133 may play an important role in the generation and development of human salivary adenoid cystic carcinoma.

Objective To discuss the prevention and management method for chylous fistula after neck lymph node dissec‐tion .Methods Totally 1 793 cases of neck lymph node dissection in this department from January 2005 to September 2014 were retrospectively analyzed .The clinical data in the cases of chylous fistula occurred after operation were summarized .Results Twenty one cases of chylous fistula occurred ,accounting for 1 .17% ,in which 13 cases were cured by the local compressed bandaging and continuous negative pressure drainage;5 cases adopted the conventional method for 2-3 d ,but under the ineffective condition ,then they were treated by combining with somatostatin pumping (somatostatin 6 mg+0 .9% normal saline 48 mL ,2 mL/h ,lasting for 24 h ,for successive 2-3 d) and finally cured;3 cases were cured after reoperation .Conclusion Prevention is the best treatment for chylous fistulas ,local compression bandage plus continuous negative pressure drainage is the main method for treatment of chylous fistulas after neck dissection .The combined therapy with somatostatin can increase the close rate of chylous fistulas;for the patients with long persistent time ,large drainage volume and invalid conservative therapy should adopt the remedial measure of operation .

目的 探讨鼻咽癌组织中血小板反应蛋白1(thrombospondin 1,THBS1)基因启动子甲基化对其mRNA及蛋白水平表达的影响及与鼻咽癌临床病理特征的相关性.方法 收集51例新鲜鼻咽癌标本及18例正常鼻咽黏膜标本.应用逆转录PCR检测THBS1 mRNA的表达,Western blot检测THBS1蛋白的表达,甲基化特异性PCR检测THBS1基因启动子区CpG岛甲基化.结果 鼻咽癌组织中THBS1 mRNA(0.309±0.162)及蛋白(0.214±0.127)表达下调,与正常鼻咽黏膜组织对照组[分别为(0.528±0.096)、(0.514±0.118)]相比差异均具有统计学意义(P＜0.01);鼻咽癌组织中基因启动子区高甲基化率显著高于其在正常鼻咽黏膜组织,差异有统计学意义(P＜0.01).鼻咽癌组织中THBS1 mRNA及蛋白表达下调均与THBS1基因启动子区高甲基化有关(P＜0.01).基因启动子区高甲基化率与鼻咽癌临床TNM分期、局部侵袭、淋巴结转移及远处转移呈正相关,差异均具有统计学意义(P＜0.05).结论 鼻咽癌组织中存在THBS1 mRNA及蛋白异常低表达及启动子区的高甲基化,THBS1基因高甲基化可能抑制THBS1 mRNA及蛋白的表达,在鼻咽癌发生、发展中发挥重要作用.

Objective To investigate the significance of the nano-carbon negative development for parathyroid localization and in situ protection role in thyroid surgery.Methods 107 cases of thyroid lobectomy and 43 cases of combined radical thyroid cancer re-section by conventional operation were selected as the control group;102 cases of thyroid lobectomy and 48 cases of combined radi-cal thyroid cancer resection from July to December 2013 adopted the nano-carbon negative development as the observation group. The situation of parathyroid mistaken resection and the change of the postoperative serum calcium and parathyroid hormone (PTH) were compared between the two groups.Results The pathological exmination confirmed 1 case of parathyroid mistaken resection occurred in the observation group and 7 cases occurred in the control group;9 cases of transient hypocalcemia occurred in the ob-servation group and 27 cases in the control group;0 cases of permanent hypocalcemia occurred in the observation group and 5 cases in the control group;7 cases of temporary parathyroid hormone decrease occurred in the observation group and 2 1 cases in the con-trol group;1 case of permanently parathyroid hormone decrease occurred in the observation group and 7 cases in the control group;the differences among them were statistically significant(P<0.05).Conclusion The lymphatic systems between thyroid and para-thyroid are different from each other.Nano-carbon negative development can accurately and negatively develop the parathyroid to reach the goal of intraoperative identification and localization,which can be used as a novel mean for intraoperative accurate identifi-cation of parathyroid gland to protect the parathyroid function.

Objective To investigate the primary repair methods and efficacy of island pedicled pectoralis major muscle flap in soft tissue defect after the operation of head and neck malignant tumors.Methods From April 2011 to September 2012,27patients from this hospital who underwent primary repair using island pedicled pectoralis major muscle flap after a head and neck extensive soft tissue defect were investigated,including 11 cases of tongue cancer defect,2 cases of parotid gland defect,3 cases of gum cancer defect,2 cases of oropharyngeal cancer defect,9 cases of floor of the mouth cancer defect.Results 27 patients were safety in perioperative,27 cases of island pectoralis major muscle flap survived,patients were satisfied with both the appearance and function.There was postoperative neck hematoma in 1 patient,it was eliminated through timely remove the hematoma and hemostasis completely; There was 1 case of removing the epidermal necrolysis skin as flap necrosis,while it was acceptable efficacy as the muscle flap survival and surface granulation repaired.Conclusion Island pectoralis major muscle flap obtains unique advantages in repairing a large area of soft tissue defect in head and neck cancer patients after operation,such as abundant of tissue,a constant arterial anatomy of thoracoacromial,easy to operate,rich blood supply,strong resistance to infection,high survival rate and so on.A fine surgery operation is the key of island pectoralis major muscle flap survival.

Objective To evaluate the impact of risk management of nursing on the clinical therapeutic efficiency and nursing quality in patients undergoing chemotherapy with malignant tumor and diabetes mellitus(DM).Methods Eighty-seven diabetic patients with malignant tumor hospitalized in our institute from February 2010 to January 2011 were enrolled as control group,and received routine nursing risk management,including education of diabetes knowledge and treatment.One hundred and nine patients with DM and malignant tumor recruited from February 2011 to February 2012 were test group,and received the risk management of nursing,with PDCA(Plan Do Check Action)cycling risk management,including individualized risk control,risk prevention program of chemotherapy,and nursing risk management during chemotherapy.The incidences of acute complications of diabetes or extravasation of chemotherapeutic drugs and patients satisfaction were recorded and analyzed.Results The incidence of acute complications of diabetes or(1.83% vs 9.19%),hypertonic ketoacidosis(0.91% vs 6.89%),non-ketoic acidosis(0.91% vs 5.74%) of extravasation of chemotherapeutic drugs(0 vs 3.45%) were significantly decreased,and patients satisfaction(98.16% vs 91.96%) was increased after implementation of nursing risk management.Conclusion Nursing risk management can implement the efficiency in patients undergoing chemotherapy with malignant tumor and DM.

Objective To appraise the clinical meaning of nursing risk management in chemotherapy of diabetes with malignant tumor.Methods 109 patients were enforced by nursing risk management(observe group),87 patients were not enforced by nursing risk management(control group).We compared the incidence of diabetes acute complication,chemotherapeutics exosmosis,and satisfaction degree of patient,and then discuss the exact measures of nursing risk management.Results The incidence of diabetes acute complication and chemotherapeutics exosmosis were all significantly lower in observe group than control group,satisfaction degree of patient was significantly higher in observe group than control group(P<0.05).Conclusion Nursing risk management was efficient in the chemotherapy of diabetes with malignant tumor and worth promotion.

This article analyzes the risk factors of malignant tumor chemotherapy induced diabetes and risk factors that may occur during chemotherapy for patients with malignant tumor combined with diabetes mellitus in order to investigate effective risk management strategies,such as enhancing nursing risk management and risk education for nurses,controlling quality for high risk patients and risk link of chemotherapy,paying attention to psychological intervention and dietary management to reduce the risks of acute complications of diabetes and risks of drug leakage,ensuring the smooth completion of the chemotherapy.

Objective To explore the effect of ultrasound knife aid with endoscope compare to traditional way on thyroid gland total resect surgery.Methods A total of 792 selected patients with thyroid adenoma were divided by random digits table into group A use scalpel(n=201)、group B use electrome(n=185)、group C use ultrasound knife(n=192)、and group D use ultrasound knife aid with endoscope(n=214).To compare the condition on prior-surgery and post-surgery of the four groups.Results The group D have the better effect than the other group in decreasing the volume of bleeding in surgery,which shewed statistical significance(P0.001);The group D have the better effect than the other group in shorting the time of surgery,which shewed statistical significance(P0.001);The group D have the better effect than the other group in shorting the length of operative incision,which shewed statistical significance(P0.001);The group D have the better effect than the other group in decreasing the volume of draining fluid on post-surgery,which shewed statistical significance(P0.001);The group D have the less number of laryngeal nerve injury than the other group,which shewed statistical significance(P0.001).Conclusion Compared with the traditional way on thyroid gland total resect surgery,to use ultrasound knife aid with endoscope have the better effect in the volume of bleeding in surgery、the time of surgery、the length of operative incision、the volume of draining fluid on post-surgery and the number of laryngeal nerve injury.

Objective:To study the diagnosis and therapy of cervical neuroqenic tumor.Methods:The diagnosis and therapy of 25 cases with cervical neuroqenic tumor were retrospectively analyzed,combined with review of the documents.Results:Twenty five patients consisted of 16 males and 9 females,whose age were from 16 to 74 years old.The masses were from(8×6×5)cm to(2×1.5×1.5)cm,all were examined by color-ultrasonic,diagnostic puncture and CT or MRI before operation,21 cases had definite diagnosis.All masses were resected and verified by pathology,in which 22 cases were benign tumor and the others were malignant.Conclusion:Most of cervical neuroqenic tumor were benign,such as fibroneuroma,only ten percents were malignant.The surgical therapy was the most effective means.It was most important to protect nerve cord and great vessels in order to prevent postoperative complications.It must be taken chemotherapy and radiotherapy for the malignant patients.

目的探讨利用超声刀及相关技术行甲状腺次全切除术的可行性及应用价值。方法200例病人使用超声刀及相关技术自颈部低位小切口行部分或次全甲状腺切除术。结果手术顺利完成,术中失血约5~30毫升,无喉返神经损伤、甲状旁腺损伤及其他副损伤表现。结论超声刀是新一代手术用切割止血器械,具有切割精确、不损伤周围组织、无(少)烟雾与焦痂、与病人无电流接通、不会电击与灼伤病人等优点;利用超声刀辅助下行甲状腺次全切除术能达到微创、美观、安全的手术效果,术中利用超声刀可以克服操作空间小的局限,因简化操作而降低了手术难度,是临床治疗甲状腺肿瘤的一种新选择。

咽旁区解剖区域隐蔽深在,解剖结构复杂,发生在该区的肿瘤早期不易被发现,诊断困难.临床多表现为颈部或咽侧包块,并伴有不同程度的吞咽、呼吸或语言功能障碍.