目的 分析胃癌术前淋巴结分期(N分期)不足的危险因素,建立术前评估模型,辅助预测术前N分期.方法 回顾性分析268例胃癌患者的临床病理资料.患者术前常规行薄层增强CT评估术前N分期,结合术后病理结果分析术前N分期不足的危险因素.Logistic回归分析筛选出的影响因素,Kaplan-Meier绘制术前N分期准确组与不足组的生存曲线,利用R软件包绘制Nomogram图、预测模型的ROC曲线,计算AUC、95％CI、敏感度和特异性.结果 年龄、BMI、低分化、Lauren分型为弥漫型是胃癌术前N分期不足的独立危险因素(P<0.05).术前N分期不足组预后生存显著差于准确组(P=0.041).预测模型的ROC曲线AUC为0.935,敏感度为85.9％,特异性为96.9％.结论 年龄越小、BMI越高、低分化、Lauren分型为弥漫型是术前N分期不足的独立危险因素.本研究基于年龄、BMI、分化程度、Lauren分型建立的术前N分期评估模型,具有较高的可信度.

目的 观察肥胖症患者行减重术后胆石症的发生情况,探讨其发生胆石症的影响因素.方法 258例肥胖症患者均行减重手术治疗,术后随访1年,记录术后6、12个月体质量、体质量指数(body mass index,BMI),计算体质量降低值、BMI降低值、体质量降低率、BMI降低率.末次随访时行超声检查,258例患者根据超声声像图是否有胆结石或胆泥淤积分为胆石症组59例和无胆石症组199例,比较2组术前高血压、糖尿病比率及体质量、BMI等,术后6、12个月体质量、BMI、体质量降低值、BMI降低值、体质量降低率、BMI降低率.采用多因素logistic回归分析肥胖症患者行减重术后发生胆石症的影响因素;绘制ROC曲线,评估术后12个月时体质量降低值、BMI降低值预测肥胖症患者行减重术后发生胆石症的效能.结果 2组术前体质量、术前BMI、手术类型及高血压、糖尿病、高脂血症、疼痛综合征、使用调脂药物比率比较差异均无统计学意义(P＞0.05).胆石症组、无胆石症组术后6个月时体质量[84.5(77.5,97.6)、85.9(79.4,95.4)kg)]、BMI[30.0(28.7,32.2)、30.8(29.3,32.6)kg/m2]及术后 12 个月时体质量[67.8(62.0,73.3)、67.7(62.1,73.9)kg]、BMI[23.8(22.1,25.4)、24.1(23.5,24.9)kg/m2]均低于术前[114.0(102.0,128.5)kg、40.7(37.6,43.3)kg/m2,110.0(100.0,125.0)kg、39.8(36.5,44.2)kg/m2](P＜0.05),术后 12 个月时体质量、BMI 均低于术后6个月时(P＜0.05);胆石症组、无胆石症组术后12个月时体质量降低值[46.8(39.2,53.7)、42.6(33.3,52.3)kg]、BMI 降低值[17.3(14.0,19.0)、15.3(11.8,18.4)kg/m2]、体质量降低率[(0.42±0.06)％、(0.38±0.09)％]、BMI 降低率[(0.42±0.06)％、(0.38±0.09)％]均高于术后 6 个月时[26.2(23.1,35.5)kg、24.5(18.9,29.9)kg,9.4(8.5,11.6)kg/m2、9.0(6.5,11.2)kg/m2,(0.24±0.06)％、(0.03±0.09)％,(0.25±0.05)％、(0.23±0.09)％](P＜0.05);胆石症组术后 6、12个月时体质量降低值、BMI降低值、体质量降低率、BMI降低率均高于无胆石症组(P＜0.05).术后12个月时体质量降低值(OR=0.662,95％CI:0.563～0.777,P=0.030)、BMI降低值(OR=4.808,95％CI:2.835～8.156,P＜0.001)是肥胖症患者行减重术后发生胆石症的影响因素.术后12个月时体质量降低值、BMI降低值分别以45.5 kg、15.95 kg/m2为最佳截断值,预测肥胖症患者行减重术后发生胆石症的 AUC 分别为 0.620(95％CI:0.546～0.694,P=0.005)、0.704(95％CI:0.638～0.771,P＜0.001),灵敏度分别为64.4％、72.9％,特异度分别为59.8％、62.3％;二者联合预测肥胖症患者行减重术后发生胆石症的AUC为0.827(95％CI:0.766～0.889,P＜0.001),灵敏度为84.7％,特异度为72.8％.结论 行减重术后体质量、BMI快速下降的肥胖症患者发生胆石症的风险较大,术后12个月时体质量降低值、BMI降低值对胆石症的发生有一定预测价值.

Objective To observe the occurrence of reflux esophagitis（RE）after proximal gastrectomy in patients with proximal gastric cancer,and to investigate its risk factors.Methods Totally 189patients with proximal gastric cancer underwent proximal gastrectomy+esophagostomy.The RE was diagnosed 6to 12months after surgery according to the symptoms and gastroscopical findings,and the Los Angeles grading was evaluated.RE group（n=39）and no-RE group（n=150）were compared the body mass index,operation lasting time,intraoperative blood loss and tumor site.Multivariate logistic regression was done to analyze the influencing factors of postoperative RE in patients with proximal gastric cancer.Mantel-Haenszel Chi-square test and Pearson’s correlation coefficient were used to analyze the correlation between the number of risk factors of postoperative RE and the Los Angeles grading.Results In 189patients,39（20.6%）developed RE after operation,including 2cases of Los Angeles grade A,7of grade B,17of grade C,and 13of grade D.The operation lasting time was longer in RE group[（259.49±22.47）min]than that in no-RE group[（248.80±22.40）min]（t=2.652,P=0.009）.The intraoperative blood loss was larger in RE group[（232.05±61.22）mL]than that in no-RE group[（203.00±55.93）mL]（t=2.833,P=0.005）.The percentages of patients with body mass index≥24kg/m~2,tumor locating at the cardiac,resected esophagus length≥2cm,gastric residual volume 1/2and stapler type 29were higher in RE group（74.4%,92.3%,71.8%,82.1%,71.8%）than those in no-RE group（52.7%,75.3%,50.7%,65.3%,52.0%）（P＜0.05）.There were no significant differences in the tumor diameter,differentiation degree,postoperative TNM stage and postoperative gastric tube indwelling time between two groups （P＞0.05）.Body mass index≥24kg/m~2（OR=3.644,95%CI:1.450-9.156,P=0.006）,resected esophagus length≥2cm （OR=4.374,95%CI:1.540-12.425,P=0.006）,gastric residual volume 1/2（OR=12.109,95%CI:3.717-39.445,P＜0.001）and stapler type 29 （OR=6.877,95%CI:2.467-19.169,P＜0.001）were the risk factors of postoperative RE.The number of risk factors of postoperative RE was linearly and positively correlated with the Los Angeles grading（χ~2=8.941,P=0.003;r=0.485,P=0.002）.Conclusion BMI≥24kg/m~2,resected esophagus length≥2cm,gastric residual volume 1/2and stapler type 29are the risk factors of postoperative RE in patients with proximal gastric cancer,and the more the number of risk factors is,the severer RE is.

目的 观察肥胖症伴抑郁症患者行减重代谢手术后体质量及体质量指数(body mass index,BMI)变化,探讨抑郁症对减重代谢手术效果的影响.方法 247例肥胖症患者(BMI≥28 kg/m2),其中86例合并抑郁症者为抑郁症组,161例无抑郁症者为无抑郁症组.2组减重代谢手术采用腹腔镜袖状胃切除术或腹腔镜袖状胃切除术+空肠旁路术.比较2组性别、年龄、合并症、手术方式及术前体质量、BMI;计算术后3、6、12、24、36个月体质量减少值和BMI减少值,并进行比较.结果 (1)抑郁症组年龄[(32.1±8.8)岁]小于无抑郁症组[(34.7±8.7)岁](t=-2.237,P=0.026),男性及合并高血压、糖尿病、高脂血症、高尿酸血症、多囊卵巢综合征、脂肪肝、脂肪胰比率、行胃袖状切除术比率与无抑郁症组比较差异均无统计学意义(P＞0.05).(2)抑郁症组术前BMI[41.2(37.8,44.3)kg/m2]大于无抑郁症组[37.3(34.0,40.5)kg/m2](U=-5.444,P=0.024),术前体质量与无抑郁症组比较差异无统计学意义(P＜0.05).抑郁症组术后3个月体质量减少值[19.9(14.3,25.0)kg]、BMI减少值[6.9(5.1,8.9)kg/m2]均低于无抑郁症组[21.8(16.1,28.3)kg、7.8(5.6,10.2)kg/m2](U=-1.969,P=0.049;U=-2.466,P=0.014),术后 6、12、24、36 个月体质量减少值和BMI减少值与无抑郁症组比较差异均无统计学意义(P＞0.05).结论 年轻、BMI大的肥胖症患者抑郁症发生率高,抑郁症可影响减重代谢手术的短期效果.

Objective To analyze the relationship between No.12a lymph node metastasis and clinicopathological features of upper gastric cancer and to discuss the indications and prognostic significance of lymph node dissection in this group. Methods A retrospective analysis was performed on the medical records of 377 patients with upper gastric cancer, to compare the relationship between No.12a lymph node metastasis and clinicopathological characteristics of patients with upper gastric cancer. Kaplan-Meier method was used to analyze the prognosis of patients with or without No.12a lymph node metastasis, and Cox regression analysis was performed to analyze the influencing factors of prognosis and survival of patients with upper gastric cancer. Results Tumor location (lesser curvature side), tumor diameter (≥5.5 cm), degree of differentiation, and T/N/TNM stage were significantly correlated with No.12a lymph node metastasis (P < 0.05). After excluding N staging, Cox regression results showed that the degree of differentiation (HR: 0.668, 95%CI: 0.48-0.931, P=0.017) and pTNM stage (HR: 6.319, 95%CI: 4.063-9.828, P < 0.001) were the independent risk factors, but No.12a lymph node metastasis (HR: 1.477, 95%CI: 0.71-3.075, P=0.297) was not an independent risk factor for survival of upper gastric cancer patients. Conclusion No.12a lymph node metastasis does not seem to be an independent risk factor for the prognosis of upper gastric cancer patients. However, the prognosis of patients with No.12a lymph node metastasis is worse than that of patients without No.12a lymph node metastasis. The No.12a lymph nodes should be actively dissected when the tumor is in the following situations: the tumor is located in the lesser curvature, the degree of differentiation is poorly differentiated, and the tumor stage is late (T4, N3, or Ⅱ-Ⅲ stage).

目的 观察儿童疣状血管瘤(VH)特征性超声、MRI及临床表现.方法 回顾性分析25例经术后病理证实的VH患儿,观察VH影像学及临床特征性表现.结果 25例VH患儿皮肤见不规则红色、青紫色斑块,斑块边缘皮肤呈暗红色,范围较广时呈"铠甲样"外观,周边见"卫星状"病灶.15例仅接受超声检查,体表疣状物多呈低回声、后方伴声影,深部皮下组织以高回声为主;其中10例病灶呈均匀高回声、4例高低混杂回声、1例均匀低回声;13例病灶边界不清,2例边界清晰;12例病灶内未见明显血流信号,3例见少量血流信号.10例仅接受MR检查;其中9例病灶T1WI呈低信号、脂肪抑制(FS)-T2WI呈不均匀稍高信号,1例病灶呈等TIWI信号、FS-T2WI高信号.结论 儿童VH皮肤病变多呈不规则红色、青紫色斑块,斑块边缘皮肤呈暗红色,可形成"铠甲样"外观,伴周边"卫星状"病灶;超声多表现为均匀高回声且边界不清;MRI多呈T1WI低信号、FS-T2WI不均匀稍高信号.

目的 观察腹腔镜下袖状胃切除术(LSG)治疗伴月经失调的重度肥胖的效果.方法 伴月经失调的重度肥胖患者107例[其中合并多囊卵巢综合征(PCOS)者56例],均采用LSG治疗,比较手术前后体质量、BMI、多余体质量减轻百分比、月经周期、月经失调改善率.结果 与术前比较,术后1、3、6、12个月体质量、BMI降低,月经周期减短(P均<0.05);与术后1个月比较,术后3、6、12个月体质量、BMI降低和多余体质量减轻百分比增加,术后6、12个月月经周期减短(P均<0.05);与术后3个月比较,术后6、12个月体质量、BMI降低和多余体质量减轻百分比增加(P均<0.05);与术后6个月比较,术后12个月体质量、BMI降低和多余体质量减轻百分比增加(P均<0.05).107例伴月经失调的重度肥胖患者中,术后有86例恢复正常月经周期,月经失调改善率80.4％;其中56例合并PCOS患者,通过LSG均得到有效治疗,月经周期均恢复正常水平,月经失调改善率达100％;51例不伴有PCOS患者,月经失调改善率为64.3％.随着BMI、体质量的减轻,月经周期明显缩短,但并不呈线性关系,月经周期的改善先于体质量的下降;当体质量下降约10％、BMI下降至37 kg/m2、多余体质量减轻约21％时,月经周期已明显缩短;术后约2个月,月经周期恢复正常.结论 LSG在有效减重的同时,可明显改善重度肥胖患者的月经周期失调症状,尤其是对于伴有PCOS的患者.

目的 探讨cN0 期胃癌患者腹腔镜辅助胃癌根治术中应用纳米炭示踪剂对微小淋巴结的检出价值.方法 术前影像学检查证实cN0 期胃癌患者80例,随机分为观察组和对照组各40例.对照组行常规腹腔镜辅助D2胃癌根治术;观察组术式同对照组,术中于肿瘤边缘注射纳米炭混悬液示踪淋巴结,并清扫所有染色淋巴结.比较2组手术时间、术中出血量、术后排气时间、术后住院时间;比较2组淋巴结清扫数目、微小淋巴结清扫数目、转移淋巴结数目、转移微小淋巴结数目;比较2组术后并发症发生情况.结果 观察组手术时间[(157.73±11.61)min]、术中出血量[(138.23±12.64)mL]、术后排气时间[(3.33±0.83)d]、术后住院时间[(11.03±0.97)d]与对照组[(161.33±9.76)min、(137.10±9.96)mL、(3.28±0.82)d、(11.13±0.94)d]比较差异均无统计学意义(P＞0.05).观察组共清扫1 464枚淋巴结,其中微小淋巴结189枚;对照组共清扫1 119枚淋巴结,其中微小淋巴结75枚.观察组淋巴结清扫数目[(36.60±3.14)枚]、微小淋巴结清扫数目[(4.75±0.87)枚]、转移微小淋巴结数目[0(0,1)枚]均多于对照组[(27.98±3.45)、(1.88±0.94)、0(0,0)枚](P＜0.05),微小淋巴结转移率(25.0％)高于对照组(7.5％)(P＜0.05),淋巴结转移数目[0(0,5.75)枚]、淋巴结转移率(30.0％)与对照组[0(0,3.75)枚、25.0％]比较差异均无统计学意义(P＞0.05).观察组术后吻合口瘘、切口感染、肠梗阻发生率(2.5％、5.0％、2.5％)与对照组(2.5％、5.0％、5.0％)比较差异均无统计学意义(P＞0.05).结论 cN0期胃癌患者腹腔镜辅助胃癌根治术中应用纳米炭示踪剂可提高淋巴结尤其是微小淋巴结检出率,且不增加术后并发症发生率.

目的 观察灰阶超声影像组学鉴别诊断皮下组织血管瘤(HE)与卡波西型血管内皮瘤(KHE)的价值.方法 回顾性分析143例皮下组织HE和70例KHE共252处病灶,按7:3比例将病灶随机分为训练集(n=176)和验证集(n=76);提取病灶灰阶超声影像组学特征,构建影像组学模型,结合临床资料建立联合模型,观察各模型鉴别诊断皮下组织HE与KHE的效能.结果 共选取22个系数非零的稳定特征.影像组学模型鉴别训练集皮下组织HE与KHE的曲线下面积(AUC)、准确率、敏感度、特异度、阳性预测值及阴性预测值分别为0.91[95％CI(0.89,0.93)]、91.41％、83.20％、93.92％、95.79％ 及89.00％;用于验证集分别为0.85[95％C I(0.83,0.87)]、90.78％、79.32％、97.90％、96.71％ 及88.68％.联合模型鉴别训练集皮下组织HE与KHE的AUC、准确率、敏感度、特异度、阳性预测值及阴性预测值分别为0.94[95％C I(0.92,0.96)]、94.33％、90.77％、96.38％、94.23％ 及94.90％;用于验证集分别为0.90[95％C I(0.88,0.92)]、92.14％、85.69％、95.76％、93.33％ 及92.30％.联合模型鉴别诊断皮下组织H E与K H E的A U C均大于影像组学模型(P均<0.05).结论 灰阶超声影像组学鉴别诊断皮下组织HE与KHE的效能较佳;联合临床特征可进一步提高其诊断效能.

Objective:To investigate the differential performance of ultrasound between fibro-adipose vascular anomaly (FAVA) and venous malformations(VMs).Methods:From January 2015 to December 2020, the patients diagnosed with lower extremity FAVA by pathology in Henan Provincial People’s Hospital were enrolled as FAVA group. The patients diagnosed with lower extremity VMs by pathology were enrolled as the control group. The clinical and ultrasound imaging data were retrospectively analyzed. Through the single factor analysis of the two groups’data, the ultrasonic imaging indicators which may be valuable for distinguishing FAVA from VMs were screened. Further, the indicators valuable for differential diagnosis were determined by multi-factor Logistic regression analysis, and a multi-factor joint diagnosis model was constructed. The diagnostic efficiency of the joint diagnosis model was evaluated by the receiver operator characteristic curve (ROC curve), sensitivity, and specificity of the subjects.Results:A total of 20 patients with FAVA were involved, including 11 males and 9 females. The mean age was (18.1±12.2) years. Forty-six patients with VMs were involved, including 20 males and 26 females. The mean age was (19.9±13.6) years. Results of the single-factor analysis were differences in the lesion echo, fascial tail, blood flow, extrusion test, and posterior echo enhance characteristics between groups ( P<0.05). Multivariate analysis showed significant differences between groups in three aspects: fascial tail, extrusion test, and posterior echo enhancement ( P=0.001, 0.008, 0.007). The sensitivity and specificity of the multi-factor combined diagnosis model were 90.0% (95% CI: 68.3%-98.8%) and 93.5%(95% CI: 82.1%-98.6%), indicating high diagnostic efficiency. The ROC(AUC) area was 0.964(95% CI: 0.886-0.994), indicating high diagnostic efficiency. Conclusions:The ultrasonic imaging features of FAVA and VMs were different. The combined diagnosis of the fascial tail, compression test, and posterior echo enhancement has a higher auxiliary diagnostic value.

目的 观察软组织静脉畸形(venous malformation,VM)患者的彩色多普勒成像技术(color Doppler flow imaging,CDFI)和超微血管成像技术(superb microvascular imaging,SMI)的声像学特征,探讨高频超声联合SMI对软组织VM的诊断价值.方法 软组织VM患者42例,术前均行超声检查,观察软组织VM病灶的二维超声声像图表现及CDFI和SMI血流显像模式的声像图表现和频谱特征,比较2种血流显像模式的血流分级;42例患者术前行MRI检查32例,行X线检查16例,以组织病理检查结果为金标准,比较高频超声联合SMI与MRI诊断软组织VM的准确率、高频超声与X线诊断邻近关节或骨组织受累的准确率.结果 42例软组织VM病灶位于头颈部19例,位于四肢16例,位于躯干7例;二维超声显示病灶累及肌层23例,未累及肌层19例;病灶二维超声声像图表现呈多条管样无回声结构为主的混昆合回声38例,呈低回声4例;边缘清晰36例,边缘不清晰6例;形态规则29例,形态不规则13例;有血栓形成8例;有静脉石形成6例;邻近骨组织受累4例.SMI模式血流分级中、高分级(Ⅱ、Ⅲ级)患者比率(83.3％)多于CDFI模式(61.9％)(P＜0.05),低分级(0、Ⅰ级)患者比率(16.7％)少于CDFI模式(38.1％)(P＜0.05);SMI与CDFI两种血流显像模式的病灶血流分级比较差异有统计学意义(P＜0.05);高频超声联合SMI诊断软组织VM的准确率(93.8％)高于MRI(65.6％)(P＜0.05),高频超声诊断邻近关节或骨组织受累的准确率(25.0％)高于X线(12.5％)(P＜0.05).结论 高频超声联合SMI可清晰显示软组织VM病灶内血流分布情况,可作为软组织VM的首选影像学检查,有助于明确诊断,为临床治疗和随访提供重要依据.

Objective:To investigate the effect of laparoscopic assisted sphincter preserving surgery on ultra-low rectal cancer.Methods:A total of 85 patients with rectal cancer in Affiliated Hospital of Jiyuan Health School, from October 2017 to October 2018 were enrolled, and divided into two groups by random number table methods. Group A ( n=42) received routine open surgery, while group B ( n=43) received laparoscopic assisted sphincter preserving surgery. Then various indexes including surgery related indicators, anal function of anal resting pressure (ARP), maximum tolerable volume (MTV), maximum contraction pressure (MSP), 2-year local recurrence rate and 2-year distant metastasis rate, postoperative complications were compared between groups. Results:The intraoperative blood loss, incision length, hospital stay length and postoperative intestinal function recovery time of group B were lower or shorter than those of group A ( P<0.05). The operation time of group B was longer than that of group A ( P<0.05). The number of lymph node dissection and the length of resected specimens showed no significant difference between the two groups ( P>0.05). ARR, MTV and MSP showed no significant difference between the two groups before surgery ( P>0.05), which were decreased in both groups at the postoperative 6 months ( P<0.05), and the decrease degree was greater in group A than that in group B ( P<0.05). The 2-year local recurrence rate and 2-year distant metastasis rate showed no significant difference between the two groups ( P<0.05). The complication rate of group B was significantly lower than that of group A, with statistic difference ( P<0.05). Conclusions:Application of laparoscopic assisted sphincter preserving surgery for patients with ultra-low rectal cancer can achieve better postoperative anal function retention and rehabilitation.

With the development of laparoscopic technology, surgeon's requirements for precise anatomy are gradually increasing. Laparoscopic system has great advantages in the selection of anatomical level, the protection of nerve and blood vessel in surgery. 4K laparoscopic system can provide high-definition vision of operative field, which is conducive to precise anatomical operation. The authors share the practical team cooperation experience of laparoscope left hemi-colectomy for colon cancer in order to provide references for surgical colleagues.

目的 观察肢体多发性血管球瘤的超声声像特征,探讨彩色多普勒超声诊断肢体多发性血管球瘤的价值.方法 回顾性分析行超声检查并经手术组织病理证实的6例肢体多发性瘤患者36个瘤体的超声声像图特征.结果 36个瘤体中,30个位于肌束及肌间隙,瘤体直径＜1 cm 24个;二维声像图显示,27个瘤体呈圆形或类圆形,30个瘤体边界清晰,36个瘤体均呈低回声,29个瘤体内部回声均匀;彩色多普勒血流显像显示,31个瘤体内部可录及血流信号,29个瘤体血流呈中央型或混合型分布,28个瘤体内可见动脉血流(血流丰富者27个),25个瘤体周边可见粗大滋养动脉;频谱多普勒显示瘤体内动脉峰值流速为(15.3±4.2)cm/s,阻力指数为0.48～0.81(0.71±0.13).结论 肢体多发性血管球瘤超声声像图多表现为边界清晰的圆形或类圆形低回声血液供应丰富的团块,周边粗大滋养动脉为其特征,彩色多普勒超声检查有助于肢体多发性血管球瘤的诊断.

目的 探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)与腹腔镜胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗单纯性肥胖症的疗效差异.方法 回顾性分析2014年1月-2017年1月河南省人民医院胃肠外科一病区行腹腔镜减肥手术患者48例,按1∶1配比同期收集LSG组病人共24例及LRYGB组病人共24例.比较两组术后并发症、排气时间、术后平均在院时间,统计术后3、6、9、12个月体重指数 (BMI)、血红蛋白(HGB)及Ca2+、Fe2、Mg2+、VitB12.结果 LSG组术后并发症、排气时间及术后平均在院时间均小于LRYGB组,有统计学意义(P＜0.05);而术后3、6、9、12个月BMI、HGB及微量元素差异无统计学意义(P＞0.05).结论 LSG能达到与LRYGB同等的近期减肥疗效,并且具有并发症少、康复快等优点,值得临床广泛应用.

目的 研究并对比非离断式Roux-en-Y(Uncut Roux-en-Y)吻合术与毕Ⅱ式吻合术在腹腔镜下远端胃癌根治术中的安全性及临床疗效.方法 回顾性收集2017年1月-2018年12月期间于河南省人民医院胃肠外科实施的腹腔镜下远端胃癌D2根治术100例患者的临床病例资料,按不同的消化道重建方式分为两个小组,毕Ⅱ式组(包含56例,行毕Ⅱ式吻合),Uncut组(包含44例,行Uncut Roux-en-Y吻合).研究探讨两组远端胃癌患者围术期相关指标、近期并发症、远期并发症等情况发生率,以评估两种消化道重建方式术后治疗效果.结果 所有参与研究的远端胃癌患者均顺利完成手术并治愈出院,两组远端胃癌患者围术期指标、近期并发症发生率相比较差异无统计学意义(P＞0.05);毕Ⅱ式吻合组患者胆汁反流、碱性反流性胃炎发生率分别为33.9％、21.24％,均高于Uncut Roux-en-Y吻合组的11.36％、4.54％,差异有统计学意义(P＜0.05).结论 腹腔镜下远端胃癌根治术后消化道重建方式选择Uncut Roux-en-Y吻合,患者手术后胆汁反流、碱性反流性胃炎、术后Roux滞留综合征(Roux stasis syndrome,RSS)发生率均较传统毕赋吻合有所降低,且未明显增加患者手术风险及术后近期并发症,临床治疗效果较为显著,安全性高,有益于提高远端胃癌患者术后远期生活质量.

目的 探讨超声及MELCHIORRE评分在儿童血友病性膝关节病诊断中的价值.方法 对35例临床确诊的血友病患儿的35个靶关节进行超声检查,观察受检关节的声像图特点,行MELCHIORRE评分,并同期行MRI增强检查,根据关节病变程度将患儿分为两组,并比较两种检查方法对两组患儿各阳性病变检出情况及评分的一致性.结果 早期软组织病变16例,另19例合并骨、软骨病变,随着出血次数增加,超声评分明显增加(F=0.824,P＜0.01).超声与MRI对16例早期软组织病变(关节积液、滑膜增厚、含铁血黄素沉积)检出的一致性好至优秀(K=0.636～0.818,P＜0.01),两种方法对关节病变评分的一致性好(K=0.747,P＜0.0l);对19例晚期骨软骨病变各阳性病变(关节积液、滑膜增厚、含铁血黄素沉积、软骨破坏)检出的一致性中等至好(K=0.441～0.642,P＜0.05);而对(骨侵蚀、关节下囊肿)检出的一致性差(K=0.224～0.313,P＜0.05),两种方法对关节病变评分的一致性差(K=0.272,P＜0.01).结论 超声与MRI在诊断儿童血友病性膝关节早期软组织病变方面有较好的一致性,超声能够动态监测疾病的活动性,应作为儿童血友病关节随访的首选检查,MELCHIORRE评分适用于早期软组织病变的评估,可作为临床治疗、随访提供依据.

Complete excision of the left gastroepiploic mesentery and complete dissection the No.4sb lymph nodes is the entrance and one of important steps of splenic hilar lymph node dissection. 4K laparoscopy has a higher level of surgical vision and more subtle degree of local anatomical recognition.Following the concept of mesentery anatomy and with the help of the unique advantages of 4K laparoscopy, the lymph node dissection of left gastroepiploic region is more thoroughly, the operation time is shorter, and there is no bleeding or micro-bleeding. At the same time, the maximum protection of the surrounding important organs and blood vessels, can further improve the radical and safety of the operation. The authors investigate the lymph node dissection along the left gastroepiploic vessels region from intermediate approach in 4K laparoscopic radical gastrectomy.

Objective: To investigate the clinic value of ultrasound 3-dimensional shear wave elastography (3D-SWE) in therapeutic effect evaluation of neoadjuvant chemotherapy (NAC) for HER-2 positive breast cancer patients. Methods: A total of 43 lesions from 43 HER-2 positive breast cancer patients were selected and all of the lesions were confirmed by biopsy. Ultrasound examination was performed routinely before each chemotherapy cycle. The interested regions were selected under the 3-dimensional (3D) elasticity and gray-scale mode, the relevant data such as shear waves in the transverse, longitudinal and coronal sections of the mass were generated automatically. According to the histopathological results, the patients were divided into the pathological complete remission (pCR) group and the incomplete remission (non-pCR) group. The maximum elastic hardness value (Emax) and the reduction degree (ΔEmax) of the lesions in the two groups were measured and compared in each cycle of NAC. The accuracy of 3D-SWE technique for predicting the efficacy of NAC was evaluated using indicators such as sensitivity, specificity and area under the receiver operating characteristic (ROC) curve. Results: The clinicopathologic features between pCR group (18 cases) and non-pCR Group (25 cases) were not significantly different (P>0.05). Compared with pre-chemotherapy, the Emax values of pCR group and non-pCR Group during chemotherapy were declined (P<0.05). Moreover, the Emax values of pCR group before and after chemotherapy were lower than those of non-pCR group (P<0.05). At the end of the first cycle of chemotherapy, the predictive specificity, sensitivity and area under the curve (AUC) of pCR group were 72.0%, 83.3% and 0.838 (95%CI=0.680~0.930) respectively when the cutoff value of Emax was 118 kPa. At the end of the second cycle, the predictive specificity, sensitivity and AUC of pCR group were 76.0%, 83.3% and 0.863 (95%CI=0.720~0.940) respectively when the cutoff value of Emax was 87 kPa. At the end of the third cycle, the predictive specificity and sensitivity and the AUC of the pCR group were 88.0%, 77.8% and 0.893 (95%CI=0.760~0.970) when the cutoff value of Emax was 57 kPa. At the end of the fourth cycle of chemotherapy, the predictive specificity, sensitivity and AUC of pCR group were 92.5%, 88.9% and 0.960 (95%CI=0.850~0.990) respectively when the cutoff value of Emax was 30 kPa. After one cycle of NAC, the predictive sensitivity and specificity and AUC of pCR group were 88.0%, 60.0%, and 0.719 (95%CI=0.620~0.890) when the cutoff value of ΔEmax was 16.8%. After two cycles, the predictive sensitivity, specificity and AUC of pCR group were 55.5%, 80.0% and 0.712 (95%CI=0.550~0.840) when the cutoff value of ΔEmax was 34.9%. After three cycles, the predictive sensitivity, specificity and AUC of pCR group were 67.4%, 81.2% and 0.779 (95%CI=0.680~0.930) when the cutoff value of ΔEmax was 55.2%. After four cycles, the predictive sensitivity, specificity and AUC of pCR group was 72.3%, 92.0% and 0.831 (95%CI=0.690~0.930) when the cutoff value of ΔEmax was 75.1%. Conclusion: The Emax and ΔEmax values measured by 3D-SWE technology can predict the curative effect of NAC for breast cancer.

Objective:To observe the effects of endoscopic clipping on anastomotic leakage after anterior resection of rectal cancer.Methods:The data of ten patients with anastomotic leakage after anterior resection of rectal cancer from March 2014 to November 2018 in Henan Provincial People’s Hospital and Shanghai Changhai Hospital were retrospectively analyzed. And the effects of endoscopic clipping were observed.Results:Ten patients underwent endoscopic flushing of the leakage, and the leakages were closed by titanium clip. The number of titanium clips used was 1-3 (1.70±0.68). Postoperative pyrexia syndrome was effectively relieved. On the 2nd and 4th day after operation, levels of white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were lower than those before operation, however, the level of prealbumin was higher than that before operation, and the difference was statistically significant ( P<0.05). All patients were healed 3 months after the clipping operation. Conclusions:Endoscopic clipping anastomotic leakage after anterior resection of rectal cancer has clear curative effects, small trauma, fast recovery, and it is safe and feasible.