目的 分析早期三阴性乳腺癌(TNBC)患者采取保乳手术治疗的临床效果.方法 回顾性分析2010年1月-2015年1月解放军总医院第八医学中心普通外科收治的56例早期(Ⅰ期+Ⅱ期)TNBC患者的临床资料.其中采用保乳手术治疗27例(保乳手术组),同期因自身意愿、经济因素等原因选择改良根治术29例(改良根治术组).术后均进行辅助放化疗,5年随访,比较两组患者术后局部复发率、远处转移率、5年生存率、手术时间、术中出血量、住院时间、术后并发症、生活质量情况等.结果 两组患者术后局部复发率、远处转移率、5年生存率、手术时间比较,差异无统计学意义(P>0.05);保乳手术组患者术中出血量明显少于改良根治术组,术后并发症发生率明显低于改良根治术组,住院时间明显短于改良根治术组,症状自评量表SCL90评分总分、总症状指数、阳性项目数、阳性项目均分明显低于改良根治术组(P<0.05).结论 早期TNBC患者采取保乳手术治疗安全有效,与改良根治术相比,保乳手术可明显缩短术后恢复时间,减少手术并发症,提高患者术后生活质量.

BACKGROUND Serum alkaline phosphatase (ALP) has been proved to be a negative prognostic factor for several malignancies, but its clinical significance in gastric cancer (GC) patients has not been sufficiently studied. In the present retrospective study, we investigated the effect of serum ALP on disease-free survival (DFS) after radical gastrectomy. MATERIAL AND METHODS We included 491 GC patients receiving radical gastrectomy at the Chinese People's Liberation Army 309th Hospital. Univariate and multivariate analyses were performed to determine factors influencing serum ALP and DFS. The changes in serum ALP and its clinical relevance were also analyzed using the log-rank test and Cox proportional hazards model. RESULTS There were 491 patients who met our inclusion and exclusion criteria. Pre-treatment serum ALP was elevated in 87 of these patients and was normal in the other 404 patients. Elevation of pre-treatment serum ALP was correlated with the tumor diameter (OR=2.642, P=0.017), TNM stage (OR=4.592, P=0.005), and T classification (OR=1.746, P=0.043). DFS was significantly different between patients with normal or elevated pre-treatment serum ALP (median 42.1 vs. 32.8 months, P=0.001) and multivariate analysis suggested pre-treatment serum ALP is an independent risk factor for poor DFS after radical gastrectomy (HR=2.035, P=0.021). In addition, removal of the primary tumor lesion led to an obvious decline in serum ALP activity (median 262 U/L vs. 152 U/L, P<0.001), and monitoring changes in serum ALP can help evaluate the risk of tumor relapse in GC patients (χ²=17.814, P<0.001). CONCLUSIONS Serum ALP is a good predictor of GC patient DFS after radical gastrectomy, and patients with elevated serum ALP have shorter relapse times.

Objective: To investigate the association between chemotherapy-induced leucopenia and patients' disease-free survival in gastric cancer patients who received radical gastrectomy. Methods: The clinical data of 273 gastric cancer patients who received radical gastrectomy and postoperative adjuvant chemotherapy between January, 2010 and December, 2015 in PLA 309(th) hospital was reviewed retrospectively. Results: A total of 195 (71.4%) patients experienced at least one time of leucopenia, while it was absent in the other 78 (28.6%) patients. The median disease-free survival of patients with or without leucopenia was 49.7 and 44.0 months respectively (P=0.009), leucopenia was an independent factor influencing patients' disease-free survival (HR=2.758, P=0.022), but there was no statistical difference between the disease-free survival of patients with different degrees and frequency of leucopenia (P=0.446, 0.123). Conclusion: Chemotherapy-induced leucopenia is a predictor of good prognosis for gastric cancer patients who receive radical gastrectomy.

目的 观察腹腔镜辅助微创根治术治疗进展期胃癌的近远期疗效,以及对免疫功能、缺氧诱导因子-1α(HIF-1α)水平的影响.方法 选择2010年2月至2012年3月解放军第309医院普通外科收治的胃癌患者90例为研究对象,其中微创组48例,行腹腔镜辅助微创根治术(简称微刨根治术),开腹组42例,行常规开腹手术.对比分析两组患者的近期疗效,包括各项临床指标(术中出血量,进食、排气、手术、住院时间,淋巴结清扫数),术后并发症发生率以及免疫功能指标(C3、C4,IgG、IgA、IgM),血清C反应蛋白(CRP)和HIF-1α水平变化;远期疗效为5年存活率指标.结果 两组均成功手术,无围术期死亡.微创组出血量、进食流质时长、排气时间、并发症发生率、术后CRP水平和HIF-1α值均小于开腹组(P＜0.05);两组5年存活率比较差异无统计学意义(P＞0.05).结论 对于进展期胃癌的治疗,近期疗效微创根治术优于常规开腹手术,但远期疗效在两组间无差异.

Objective To explore the potential function of miR-181a-5p in regulating cell proliferation and apoptosis in the breast cancer cell line MDA-MB-231 by targeting Kras. Methods The expressions of miR-181a-5p and Kras in MDA-MB-231 (a human breast cancer cell line) and HBL-100 (a human breast cell line) were detected by RT-PCR and Western blotting, respectively. The MDA-MB-231 cells were transfected with miR-181a-5p mimics. Cells that were transfected with the negative control mimics were served as control. To verify the upregulation of miR-181a-5p using its mimics, the expression of miR-181a-5p was detected using RT-PCR and the expression of its target, Kras, was detected using Western blotting. Cell proliferation was measured by MTT assay. Cell apoptosis and cell cycle were detected with flow cytometer. To confirm that Kras is a real target of miR-181a-5p in MDA-MB-231 cells, wild-type Kras 3'-UTR plasmid (Kras-wt) or mutant Kras 3'-UTR plasmid (Kras-Mut) were co-transfected with miR-181a-5p mimic or control mimics. Dual luciferase reporter gene assay was conducted. Results Compared to HBL-100 cells, the expression of miR-181a-5p significantly lower (P<0.05) in MDA-MB-231 cells, while the expression of its target, Kras, was significantly higher (P<0.05). Compared to cells transfected with negative control mimics, cells transfected with miR-181a-5p mimics showed an upregulation of miR-181a-5p (P<0.05), a reduction of its target Kras (P<0.05), a significant reduction in proliferative capacity (P<0.05), a higher rate of apoptosis (P<0.05), and a greater number of cells arrested in G2/M phase as well as a dramatic decline in the number of cells arrested in S phase (P<0.05). Compared to control cells, cells co-transfected with miR-181a-5p mimics and Kras-wt showed the lowest luciferase activity (P<0.05). Conclusions In MDA-MB-231 cells, miR-181a-5p was lowly expressed but its target Kras was highly expressed. Upregulated miR-181a-5p in MDA-MB-231 cell inhibited cell proliferation and induced apoptosis by targeting Kras. DOI: 10.11855/j.issn.0577-7402.2018.09.03

Objective To identify the influence of chemotherapy-induced serum alkaline phosphatase (ALP) elevation on the tumor-free survival (TFS) in patients of gastric carcinoma after radical gastrectomy.Methods The clinical data of 189 gastric carcinoma patients receiving radical surgery and postoperative adjuvant chemotherapy between Jan,2010 and Dec,2015 were reviewed and statistically analyzed.Results The TFS of patients with serum ALP elevation was obviously inferior than those without ALP elevation (x2 =5.717,P =0.017),serum ALP elevation was an independent risk factor influencing patients' TFS (HR =2.178,P =0.032),the degree of serum ALP elevation was associated with patients' TFS (x2 =4.627,P =0.031).Conclusion Serum ALP elevation during postoperative chemotherapy indicates the increases of recurrence or metastasis rate of gastric cancer patients after radical gastrectomy.

Objective:To explore and identify the influence of dendritic cell-cytokine induced killer cell (DC-CIK) on the number of blood circulating tumor cell (CTC),therapeutic efficacy and prognosis of patients with liver metastasis after radical resection of colorectal cancer.Methods:We retrospectively analyzed the clinical data of patients developing liver metastasis after radical resection of colorectal cancer (CRC) and treated in PLA 309th Hospital between July,2009 and December,2015,among whom 62 patients were administered DC-CIK plus conventional treatment (DC-CIK group) and 70 received only conventional treatment (conventional group).In addition,peripheral venous blood of 21 patients in DC-CIK group and 24 patients in conventional group were examined to clarify CTC number via CellSearch(R) immunomagnetic technology.The therapeutic efficacy was compared between the two groups.Results:The CTC number of patients in DC-CIK group decreased significantly after treatment (1.0± 1.1 vs 2.7±2.0,P＜0.01),while that in conventional group did not alter obviously (P＞0.05).The resection rate of liver metastasis,objective response rate to treatment,patients' progression-free survival and overall survival of DC-CIK group were all superior than those of conventional group (P＜0.05 or P＜0.01).Conclusion:DC-CIK can decrease the number of CTC in CRC patients with liver metastasis after radical operation and prolong their survival;it has reliable anti-tumor effect under the precondition of standard execution.

Objective To summarize the experiences in surgical treatment of abdominal tuberculosis and intestinal obstruction. Methods The clinical data were retrospectively analyzed of surgically treated 112 cases of abdominal tuberculosis and intestinal obstruction from Jan. 2010 to Dec. 2015. Results Of the 112 cases, 96 were diagnosed with complete intestinal obstruction, including 29 cases of ileocecal tuberculosis (12 cases of ileum perforation), 39 cases of severe adhesions, and 28 cases of strangulated ileus caused by adhesive band; 16 cases were incomplete ileus, including 6 cases of ileocecal tuberculosis, 6 cases of part adhesions caused by mesenteric lymph node tuberculosis, and 4 cases of angulation adhesion. A hundred and six cases were cured surgically. Six cases were obstructed again and cured after antituberculotic treatment. Five cases were with intestinal fistula after surgery, of whom 2 cases died of MODS induced by aggravation of infection, and 3 cases were cured and recovered after antituberculotic and nutritional support treatment through thorough drainage. Conclusions The surgical treatment as early as possible is recommended for the patients with abdominal tuberculosis and intestinal obstruction. Preoperative formulation through full multidisciplinary team (MDT) consultation of reasonable anti-tuberculosis treatment and nutritional support scheme is the key to complete recovery and reduce of postoperative complications. DOI: 10.11855/j.issn.0577-7402.2016.12.16

目的 探讨甲状腺微小癌的手术方式及减少喉返神经损伤的方法.方法 回顾性分析解放军309医院普外科2006年1月—2013年12月收治的238例甲状腺微小癌患者的临床资料,总结其术前检查方法、手术方式及喉返神经损伤情况.238例患者均为查体时超声检查发现,超声显示结节直径均≤1.0cm,其中术前行甲状腺结节细针穿刺(FNA)检查84例,明确为微小癌72例,假阴性12例,其余均为术后病理证实.所有病例中单侧单发甲状腺微小癌144例,单侧多发甲状腺微小癌46例,双侧多发甲状腺微小癌48例.结果 238例患者中采用患侧+峡部切除+对侧腺叶次全切除97例,患侧+峡部腺叶切除56例,双侧甲状腺切除23例,双侧甲状腺次全切除62例;行颈部淋巴结清扫132例,未行颈部淋巴结清扫106例;其中术中行喉返神经显露122例,共显露喉返神经182条,未显露喉返神经116例.术后随访1～7年,局部复发6例,无远处转移和死亡病例.238例患者中发生喉返神经损伤6例,其中显露喉返神经组1例,未显露喉返神经组5例,均为单侧损伤.结论 高频超声检查是发现甲状腺微小癌的重要手段,术前FNA检查是及时判定结节性质的可靠方法,手术切除是治疗甲状腺微小癌的有效方式.选择合理的手术方式是提升甲状腺微小癌远期疗效的关键;术中显露并保护喉返神经能最大限度地减少喉返神经损伤.

Objective To explore the relationship of serum hepatocyte growth factor ( HGF) with the efficacy of neoadjuvant chemotherapy ( NAC) and clinicopathological characteristics in patients with stageⅡ/Ⅲbreast cancer. Methods Totally 168 patients with stage Ⅱ/Ⅲ breast cancer who underwent neoadjuvant therapy between January 2010 and January 2015 in No. 309 Hospital of PLA were enrolled for a retrospective study. They were divided into 2 groups, including low HGF level (L) group (n=84) and high HGF level ( H) group ( n=84 ) according to the median value of serum HGF, which was detected by ELISA and calculated by statistical analysis. The efficacy of NAC was assessed according to the RECIST criteria. The patients were followed up for 2-68 months and the survival curves were drawn. The differences in clinical stage, tumor size, lympho node metastasis, ER, PR and HER-2 expression between two groups were analyzed&nbsp;by χ2 test. The differences in tissue polypeptide specific antigen (TPSA), carbohydrate antigen (CA) 15-3, Ki67 were analyzed by t test. Kaplan-Meier method was used to analyze the relationship of serum HGF level with efficacy of NAC, 5-year DFS and 5-year cumulative survival. Risk factors associated with 5-year cumulative survival were processed in Cox’ s proportional hazards regression model. Results Serum HGF level had a median value of 825 pg/ml. The rate of lympho node metastasis in H group was 48. 8% ( 41/84 ) , significantly higher than 30. 9% (26/84) in L group (χ2=5. 586,P=0. 018). Serum TPSA level in H group was (60. 6±26. 8) U/L, significantly higher than (49. 8±20. 9) U/L in L group (t=-2. 93, P=0. 004). The efficacy of NAC, 5-year DFS and 5-year cumulative survival in H group was 69. 0%( 58/84 ) , 65. 5% and 69. 0% respectively, significantly lower than 84. 5%(71/84), 81. 9% and 89. 9% in L group (χ2=5. 643, P=0. 018;χ2 =4. 957, P=0. 046;χ2 =4. 849, P=0. 044). Serum HGF level, clinical stage and NAC response were risk factors of 5-year cumulative survival (HR=7. 0, 95%CI=1. 28-47. 62, P=0. 037; HR=8. 5, 95%CI=3. 55-29. 79, P=0. 006; HR=4. 8, 95%CI=1. 84-7. 99, P=0. 024). Conclusion Serum HGF level is closely associated with lymph node metastasis, response to NAC and prognosis in patients with breast cancer, which can be used as a predictive index for NAC efficacy and patients’ prognosis.

Objective To explore perioperative risk factors for postoperative pancreatic fistu?la. Methods Six hundred and forty?three cases patients who underwent radical gastrectomy for gastric cancer from January 2010 to June 2015 in the NO. 309 Hospital of Chinese People’ s Liberation Army were selected and divided into Postoperative Pancreatic Fistula( POPF) group with 53 cases and Non?Postoperative Pancreatic Fis?tula( NPOPF) group with 590 cases. Preoperative,intraoperative and postoperative data were analyzed by statisti?cal analysis of two groups. Results POPF rate was 8. 24%(53/643). There were no significanct differences in terms of gender,age,preoperation with disease,preoperative serum albumin,TNM stage,abdominal surgery,sur?gical procedure,lymph node dissection,digestive tract reconstruction,surgical approach,blood loss and length of time between the POPF group and NPOP group(P>0. 05). The level of BMI of POPF group was higher than that of NPOPF group,the difference was statistically significant((25. 63±2. 54) kg/m2 vs. (21. 11±2. 44) kg/m2,t=2. 245,P=0. 025). The number of lymph node dissection in POPF group was (32. 25±5. 82),in NPOPF group was (27. 06±6. 79),there was significant difference between the two groups(t=2. 093,P=0. 037). The operation time in POPF group was (242. 50±52. 30) min,in NPOPF group was (229. 51±59. 21) min,the difference was statistically significant between the two groups( t=2. 398,P=0. 017) . The serum CRP of 1 d in POPF group was (85. 72±12. 05) mg/L,in NPOPF group was (76. 41±12. 52) mg/L,and there was significant difference between the two groups( t=1. 979,P=0. 048) . The serum albumin of 2?4 d after operation in POPF group was (26. 0±5. 9) g/L,in NPOPF group was (32. 6±6. 8) g/L,the difference between the two groups was statistically significant(t=-10. 185,P=0. 000). The drainage fluid amylase of 1 and 2 d after operation in POPF group was (2094+1444) U/L,in NPOPF group was (746+486) U/L,and there was significant difference be?tween the two groups( t=10. 400,P=0. 000) . Logistic regression analysis results showed that body mass index ( BMI) ,lymph node dissection number,time of operation,postoperative 1,2 d drainage fluid amylase and serum albumin of 2?4 d after operation were postoperative occurred pancreatic fistula risk factors( OR=1. 972,183. 6, 2. 004,0. 150,9. 809,P>0. 05). Conclusion BMI,number of dissected lymph node,duration of surgery,serum albumin of 2?4 d after operation and postoperative 1,2 d drainage fluid amylase have important clinical values for predicted POPF.

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with breast-conserving surgery for locally advanced breast cancer. Methods Eighty-one patients with locally advanced breast cancer were selected from those who were admitted into 309 Hospital of PLA from January 2009 to October 2013, consisting of 65 patients in stage Ⅲa and 16 in stage Ⅲb, and they were treated with neoadjuvant chemotherapy combined with breast-conserving surgery. The clinical efficacy [complete response (CR), partial response (PR), stable disease (SD) and progress disease (PD)] was observed during follow-up. Results All the patients were followed-up for 12-60 months with a median of 34 months. There were 12 CR patients (14.8%), including 4 with pathological complete response (4.9%), and 52 PR patients (64.2%), 17 SD patients (21.0%). No PD was observed. The overall response rate(ORR) was 79.0%(64/81). After follow-up for 12-60 months (median 34 months), distant metastasis to the lung, liver, meninges and bone occurred in 3 patients (3.7%, 3/81) and 1 of them died. Forty-eight patients received breastconserving surgery. The local recurrence rate was 6.3% (3/48). Assessment of cosmetic result was carried out in 48 patients who received breast-conserving surgery and comprehensive treatment for one year, and excellent results were obtained in 14.6% (7/48), good in 43.8% (21/48), and poor in 41.7% (20/48). Conclusions The therapeutic efficacy of locally advanced breast cancer is satisfactory by neoadjuvant chemotherapy and breast-conserving surgery. Standardization of excision and postoperative radiotherapy, systemic comprehensive treatment is the key to the success of the treatment. DOI: 10.11855/j.issn.0577-7402.2015.06.14

Objective To evaluate the clinical effects of chemotherapy combined with cytokine-induced killer (CIK) cells and dendritic cells (DC) on advanced gastric cancer. Methods Seventy-two cases with advanced gastric cancer (stage Ⅳ) treated in 309 Hospital of PLA from Jan. 2011 to Jan. 2013 were randomly divided into chemotherapy group and combined therapeutic group. Chemotherapy group consisted of 35 cases, received 6 to 10 cycles of chemotherapy with the protocol of FOLFOX 4. Combined therapeutic group consisted of 37 cases, beside receiving the same chemotherapeutical protocol, they were given autologous CIK cells combined with subcutaneous injection of DC near inguinal and axillary lymph nodes. The changes in tumor burden, cellular immune responses (CD3+, CD4+, CD8+, CD3+CD56+, CD3–CD56+ and CD4+/CD8+) and the Karnofsky's grade were determined, and the 2-year survival rate of both groups was recorded. Results All patients were followed up for 9~30 months (average 22 months). The disease control rate (DCR) was significantly higher in combined therapeutic group (70.3%, 26/37) than in chemotherapy group (54.3%, 19/35, P 0.05). The 2-year survival rates in the chemotherapy group and the combined therapeutic group were 57.1% and 64.9%, respectively, with no significant difference between two groups (P>0.05). Conclusion Chemotherapy combined with autologous CIK cells transfusion and DC injection may improve the treatment result in patients with advanced gastric cancer, by enhancing the autoimmune function, thus it improves the life quality, and it is found to be safe in treatment of patients suffering from advanced gastric cancer. DOI: 10.11855/j.issn.0577-7402.2015.06.11

Objective To evaluate the clinical efficacy of imatinib mesylate as an adjuvant therapy in combination with surgery for advanced gastrointestinal stromal tumors. Methods A total of 92 patients with advanced gastrointestinal stromal tumors, which were confirmed by pathological examination, were enrolled in this study from Jan. 2007 to Jan. 2012. There were 57 male and 35 female patients with age range of 21-85 years, and disease courses from one month to 2.5 years. The lesion was located in the stomach in 41 patients, jejunum in 11, ileum in 9, colon in 17, and rectum in 14. All of them received imatinib mesylate at a dose of 400mg/d for 3-9 months. According to Choi's efficacy evaluation criteria, therapeutic efficacy and adverse reactions were recorded. Results All of the patients were followed up for 9-50 months. Two patients achieved complete response (CR), 45 partial response (PR), 31 stable disease (SD) and 14 had disease progression (PD). Six patients died. The overall response rate (ORR) was 51.1% and disease control rate(DCR) was 84.6%. The adverse reactions were mainly facial and lower extremity edema to varying degrees, neutropenia, nausea and vomiting. Fifty-four patients received surgery after adjuvant therapy, the resection rate was 58.7%. The overall survival rates at 1 and 3 years were 100% and 93.4% respectively. Conclusions Imatinib mesylate as adjuvant therapy has good therapeutic efficacy for middle-late gastrointestinal stromal tumor. It can prolong patient life and improve the resection rate. Only mild adverse reactions occur and its toxicity is acceptable. DOI: 10.11855/j.issn.0577-7402.2015.05.16

Objective To evaluate the clinical effects of cytoukine-induced killer (CIK)cells in combination with dendritic cells(DC) on advanced rectal cancer.Methods 89 cases with advanced rectal cancer(stage Ⅳ)treated in our hospital from August 2007 to August 2009 were divided randomly into two groups:(1) Chemotherapy group consisted of 48 cases,obtained 6 to 12 cycles of chemotherapy with the protocol of FOLFOX4 ; (2) Therapeutic alliance group consisted of 48 cases,besides the same chemotherapeutical protocol,were transfused of autologous CIK cells and were injected with DC into inguinal lymph nodes,axillary lymph nodes and near site.We detected the changes of tumor burden,carcinoembryonic antigen (CEA),cellular immune responses (CD3+、CD4+、CD8+、CD4+/CD8+、CD3+ CD56+、CD3-CD56+),the Karnofsky's grade and 2-year cumulative survival rate.Results The effective rate of the chemotherapy group consisted of 5 partial remission (PR) and 20 minor remission (MR) was 52.1％,and the effective rate of the therapeutic alliance group consisted of 1 complete remission(CR),8 partial remission(PR) and 19 minor remission(MR) was 68.3％.The proportions of CD3+ 、CD4+ 、CD3+ CD56+ 、CD3-CD56+ and the ratio of CD4+/CD8+ were significantly increased in the therapeutic alliance group,but the proportions of CD8+ was deceased.Karnofsky's grade was also increased in the therapeutic alliance group.The 2-year cumulative survival rate in the chemotherapy group and the therapeutic alliance group were 54.2％ and 70.7％,respectively.There was significant difference between two groups (P ＜ 0.05).Conclusion Co-treatment with CIK cells and dendritic cells,which could increase clinical effects,immunity and improve life quality,was effective and safe to sdvanced rectal cancer.

Objective To investigate the diagnosis and surgical intervention for small papillary thyroid microcarnoma(PTMC).Methods A retrospective study was conducted.One hundred and thirty-eight patients with small PTMC were enroll in this study who were hospitalized from Jan.2008 to Dec.2012 in the No.309th Hospital of Chinese People Liberation of Army.Results All of the 138 patients have no clinical was diagnosed by thyroid ultrasound symptoms before operation,which exhibited very small nodules(≤ 1 cm).Among the 138 cases,122 cases has calcified thyroid nodules and 88 cases showed rich blood flow in nodules as well as 53 cases the boundary was not clear.Pre-operation,54 cases were implemented by fine needle aspiration(FNA).Among 54 cases,46 cases were diagnosed as small papillary thyroid cancers and 8 cases were not diagnosed by FNA.The remaining was proved by postoperative pathological examination.All of these 138 cases,96 cases were unilateral and solitary,20 cases were solitary and multiple,and the remained 22 cases were multiple unilateral.Sixty-four cases were operated by side lobe resection plus isthmus resection and contralateral subtotal resection,35 cases were operated by side lobe resection plus isthmus resection,18 cases were operated by bilateral thyroid resection and 25 cases were operated by bilateral thyroid subtotal resection.Seventy-six cases were operated with cervical lymph node dissection and the remaining 62 cases were not.Twenty-six cases have lymph node metastasis and the remained 112 were not.In the postoperative period (1-6 years),there were 4 cases of recurrent laryngeal nerve injury,2 cases of laryngeal nerve injury and 2 cases with transit parathyroid gland injury.During the postoperative period,there were 4 cases with local recurrence and no distant metastases and dead.Conclusion High-intensity focused ultrasound is an important method for diagnosis the small papillary thyroid cancers.FNA is the most reliable method to preoperative determination of the nature of the thyroid nodule.Meanwhile,the reasonable and effective surgery is the key to optimize the therapeutic effect and reduce side-effects.

Background Roux-en-Y gastric bypass (GBP) is the main surgical procedure used in type 2 diabetes. The objective of this study was to evaluate the different types of GBP in treatment of type 2 diabetes.Methods Patients with type 2 diabetes were randomly divided into two groups: those who underwent gastrojejunal loop anastomosis bypass and those who underwent gastrojejunal Roux-en-Y bypass. Blood glucose alterations, operation time, and operation complications were observed.Results Gastrojejunal loop anastomosis bypass and gastrojejunal Roux-en-Y bypass were both effective in the treatment of selected patients with type 2 diabetes. Compared with gastrojejunal Roux-en-Y bypass, gastrojejunal loop anastomosis bypass had the advantages of easier implementation, shorter operation time, and fewer operation complications.Conclusions Gastrojejunal loop anastomosis is effective in treatment of type 2 diabetes. It is safe, easy to implement, and worthy of clinical popularization. Chin Med J 2012;125(11):1899-1902

Objective To evaluate the effects and practicability of radical resection for low rectal carcinoma with infusion pump chemotherapy via internal iliac artery,and explore the correlation factors influencing the therapeutic effects.Methods Data of 316 patients with low rectal carcinoma,admitted from Oct.1997 to Mar.2008,were retrospectively analyzed and assigned into 2 groups according to the treatment: Patients received infusion pump chemotherapy via internal iliac artery to target area combined with intravenous systemic chemotherapy were assigned into group A(n=249),and those receiving systemic chemotherapy alone following radical resection were assigned to group B(n=67).The timing of pump chemotherapy to target area in group A was set at day 12 after recovery of digestive function,with regimen of 5-FU at 0.5g per dose plus hydroxycamptothecin at 10-15mg per dose,twice a week,four times as a treatment course for a total of 6 courses,and it was followed by intravenously systemic chemotherapy with a regimen of FOLFIRI or FOLFOX.In group B,at day 12 right after recovery of digestive function,the intravenous sytemic chemotherapy was started with the same regimen as in group A.The local recurrence rate,metastasis rate and survival rate after 1,3 and 5 years in the two groups were respectively observed and compared,and the correlation between the clinicopathological features and the 5 year local recurrence rates and survival rates was analyzed in patients of group A.Results In group A,the local recurrence rate at year 1,3 and 5 was 0,1.68%(4/238) and 3.79%(8/211),respectively,the metastasis rate was 0.80%(2/249),4.62%(11/238) and 10.90%(23/211),respectively,and the survival rate was 100%,77.73%(185/238) and 72.04%(152/211),respectively.In group B,the local recurrence rate at year 1,3 and 5 was 0,9.52%(6/63) and 16.36%(9/55),respectively,the metastasis rate was 1.49%(1/67),15.87%(10/63) and 27.27%(15/55),respectively,and the survival rate was 100%(67/67),58.73%(37/63) and 52.73%(29/55),respectively.There was no significant difference between the two groups(P>0.05) for 1-year local recurrence rate,metastasis rate and survival rate.The 3-and 5-year local recurrence rates and metastasis rates were lower and the survival rate was higher in group A than in group B(P < 0.05).The degree of differentiation of the tumor and Duke’s stage of cancer may be the factors influencing the 5-year local recurrence rate,metastasis rate and survival rate.Conclusions The chemotherapy via internal iliac artery with an implanted pump following radical resection for low rectal carcinoma may give a satisfactory effect on the cure rate for low rectal cancer by lowering the 5-year local recurrence rate and metastasis rate and raising the survival rate.Degree of differentiation of the tumor and Duke’s stage may play an important role in therapeutic effectiveness-and survival of the patients.

目的明确颈淋巴结结核性脓肿不同疗法的优劣。方法 2008年7月至2010年7月共53例颈淋巴结核脓肿患者,分别行切开引流脓腔搔刮术和脓肿切除术,对两组治愈率、复发率、住院天数、美观效果和并发症等指标进行比较。结果切开组并发症较切除组低,切除组住院天数、美观效果优于切开组,两组治愈率、复发率无显著差异。结论对颈淋巴结核脓肿应具体情况具体分析,如脓肿较小(直径≤3 cm)首选脓肿切除术,若脓肿较大行切开引流更为安全,对患者而言创伤也更小,也可考虑两者结合的办法。

Objective To evaluate the effect of selective regional chemoinfusion on prognosis after radical gastrectomy for gastric cancer.Methods The present study selects 127 cases of gastric cancer treated by the General Surgery Department of 309 Hospital of PLA from January 2003 to December 2005.Patients with distant metastasis identified through pre-operative examination after being hospitalized are excluded.Patients are divided into two groups: those with a chemotherapy pump implanted(pump-implanted group) and those without(control group) during gastrectomy operation.The pump-implanted group comprises 63 patients,including 51 males and 12 females [(50.7±6.2) years];the control group comprises 64 patients,including 54 males and 10 females [(53.3±7.5) years].No statistical difference is observed in terms of gender,age,TNM stage,tumor site,and pathological type between the two groups(P>0.05).All patients have received radical gastrectomy.Patients in the pump-implanted group are implanted with chemotherapy pumps at the right gastroepiploic artery,vein,and abdominal cavity and receive general chemotherapy with regional chemoinfusion after operation.Patients in the control group receive only vein chemotherapy.The occurrence rate of complications,as well as the local reoccurrence,liver metastasis,abdominal cavity metastasis,one-year survival,three-year survival,and five-year survival rates of two groups are observed and compared.Results The operation has been successfully performed on all patients.Post-operative complications are primarily gastroplegia and wound infection.Most patients have accomplished six-week chemotherapy after the operation,and the adverse reactions primarily include mild to moderate nausea or hypoleukemia.No death related to the operation or chemotherapy is recorded.Six patients in the pump-implanted group and nine patients in the control group are unable to accomplish the chemotherapy because of intolerance for or obstruction of chemotherapy pumps.The visiting period for the pump-implanted group is 11.7 to 60 months,and two patients lost contact.The visiting period for the control group is 10.5 to 60 months,and four patients lost contact.The difference between the pump-implanted and control groups in terms of local recurrence(17.5% vs 32.8%),liver metastasis(27.0% vs 43.8%),abdominal cavity metastasis(14.3% vs 29.7%),three-year survival rate(71.4% vs 53.1%),and five-year survival rate(46.0% vs 28.1%) has statistical significance(P 0.05).Conclusion Selective regional chemoinfusion after radical gastrectomy is currently a useful supplement to the treatment of gastric cancer and is suitable for extensive application.