Objective:To investigate the prognostic value of circulating tumor cells（CTCs）in patients with stage T1-2 breast cancer with 1~3 positive axillary lymph nodes（ALNS）.Methods:Clinical data of 120 patients with breast cancer who met the standards from January 2016 to December 2019 were retrospectively analyzed. SPSS24.0 statistical software. was used for analysis. Univariate and multivariate analysis of patient prognosis was performed by COX risk regression model. ROC curve is drawn to determine the optimal critical value of CTCS. Kaplan-Meier method was used to draw disease-free survival curves of patients with different CTCS levels，and log-rank test was used to analyze the difference in survival rates. P<0.05 was considered statistically significant.Results:The follow-up period was 27~63 months，with a median of 49 months. No patient died during the follow-up period，a total of 10 patients had local recurrence，5 patients had distant metastasis，and 1 of them had local recurrence with distant metastasis. The 5-year DFS was 88.3%.Cox univariate survival analysis showed that age，PT2 stage，triple negative molecular typing and CTCS number were the influential factors for postoperative prognosis（P<0.05）. ROC curve analysis of CTCS showed that the AUC was 0.807（95%CI：0.739-0.875），the optimal cut-off value was 3，the Youden index was 0.683，the sensitivity was 0.908，and the specificity was 0.775.During the follow-up period，10 of the 71 patients in the CTCS≥3 group had recurrence and metastasis，the 5-year disease-free survival rate was 85.9%，and 4 of the 49 patients in the CTCS<3 group had recurrence and metastasis，the 5-year DFS was 91.8%. The difference in DFS between the two groups was statistically significant（χ2=4.006，P=0.045）.Conclusion:CTCS can predict the prognosis of breast cancer patients with stage T1-2 and 1~3 p ALNs positive patients. When patients have CTCs≥3，PMRT should be considered in combination with other clinicopathological characteristics such as age，PT stage，molecular typing to improve the prognosis of patients.

目的:探讨不同类型镜下非活动期中心型气管支气管结核(简称"气管支气管结核")的特征.方法:回顾性分析2017年1月至2020年12月首都医科大学附属北京胸科医院收治的267例镜下非活动期气管支气管结核患者的临床表现、影像学特征及支气管镜下检查情况.结果:267例患者中,男性79例,女性188例,男女比例为1:2.38;年龄以20～40岁年龄组为主(55.43％,148/267).临床表现:胸闷、气促221例(82.77％),咳嗽、咳痰166例(62.17％),发热35例(13.11％),咯血15例(5.62％),无症状20例(7.49％).非活动期气管支气管结核主要累及部位:左主支气管124例(46.44％),右中间段支气管69例(25.84％),右主支气管48例(17.98％),气管26例(9.74％);左侧:右侧病变比为1:0.94(124:117).267例患者中,以管壁软化型为主者21例(7.87％),以瘢痕狭窄型为主者198例(74.16％),以管腔闭塞型为主者15例(5.62％),以反复回缩型为主者33例(12.36％);合并肺不张169例(63.30％),并发肺内空洞116例(43.45％),出现肺内多病灶195例(73.03％).支气管管腔狭窄的CT表现与支气管镜检查检出符合率为98.13％(262/267).结论:镜下非活动期气管支气管结核以女性、中青年人群多见,最常见症状为胸闷、气促,咳嗽、咳痰;CT检查与支气管镜检查检出符合率高,是镜检前的重要诊断手段.

目的 探讨局部晚期乳腺癌(LABC)根治切除联合自体全厚邮票植皮术一期创面修复的疗效.方法 回顾性分析2018年3月至2020年3月首都医科大学附属北京安贞医院收治的10例LABC女性患者的临床资料.9例原发肿瘤直径＞5 cm,在切除肿瘤后取下腹部皮肤行一期全厚邮票植皮术;1例为右侧改良根治术后2年局部复发4个月伴随对侧原发乳腺癌,切除右侧胸壁复发病灶后,取左侧改良根治术所切除乳房的正常皮肤行一期全厚邮票植皮术.记录术后7d植皮区成活、皮下积液情况.术后随访6～24个月,记录植皮区皮肤状态及复发情况.结果 10例患者行乳腺癌根治手术联合一期全厚邮票植皮术修复胸壁缺损创面,手术效果满意,供皮区无张力缝合,愈合良好,术后7d植皮区95％以上成活.随访6～24个月,植皮区皮肤弹性好,瘢痕轻,耐摩擦;9例患者无局部复发及远处转移;1例术后拒绝辅助化疗及放疗,术后1年同侧胸壁出现局部复发,未发现其他转移.术后患者生活质量明显改善.结论 乳腺癌根治术联合全厚邮票植皮术一期创面修复治疗LABC手术效果满意,并可有效地降低皮瓣坏死风险,促进切口I期愈合,为需要植皮治疗的LABC患者提供了安全、可靠的手术方法.

目的 探讨介入支架置入(percutaneous coronary intervention,PCI)术后4～6周实施乳腺癌手术的可行性和安全性.方法 2014年1月～2019年1月我们对18例乳腺癌合并重度冠状动脉狭窄先行PCI,PCI术后4～6周实施乳腺癌手术(3例完成PCI术后1个月确诊乳腺癌,15例乳腺癌术前准备发现冠状动脉重度狭窄,无法耐受手术及麻醉,先行冠状动脉PCI),重视围手术期管理,术前5 d开始停用阿司匹林及氯吡格雷,使用低分子肝素钙桥接抗凝,术中及术后使用心肌保护药物.结果 12例置入药物洗脱支架(drug eluting stent,DES),6例置入金属裸支架(bare metal stent,BMS).PCI术中支架置入后即刻血管造影显示血流通畅.乳腺癌手术包括改良根治术7例,乳腺全切术+前哨淋巴结活检4例,单纯乳房切除5例,保乳乳腺区段切除+前哨淋巴结活检2例,均顺利完成乳腺癌手术.手术时间50～145 min,(89.9±27.4)min;术中出血量30～200 ml,(98.3±59.5)ml.术中、术后血压、心率及血流动力学平稳,术前与术后3 d血小板、高敏C反应蛋白、脑钠肽、心肌肌钙蛋白Ⅰ及左心室射血分数差异无显著性(P>0.05),乳腺癌手术后无心脏相关事件发生.3例乳腺癌改良根治术后恢复抗凝后出现皮瓣下出血,通过加强负压引流及加压包扎控制,效果满意.住院时间5～8 d,(6.1±1.1)d.18例术后随访12～24个月,中位随访时间15个月,均无心脏相关事件发生,无肿瘤复发及转移.结论 通过加强围术期的管理,改善术中、术后心肌供血,选择恰当的手术方式,BMS与DES置入术后4周以上实施乳腺癌手术是安全的.

目的 比较金属支架联合腹腔镜与急诊开腹手术治疗结直肠癌并急性肠梗阻的近期疗效,寻求安全有效的治疗方法.方法 回顾性分析2017年1月至2019年3月120例结直肠癌并急性肠梗阻患者资料,根据手术方法分为两组,金属支架联合腹腔镜治疗的57例为联合组,63例行急诊开腹手术的患者为开腹组.应用SPSS19.0统计软件进行数据分析,围术期指标以(x±s)表示,独立t检验,并发症发生率、二期手术率等采用χ2检验,P<0.05为差异有统计学意义.结果 联合组手术时间为(179.8±17.3)min,术后排气时间为(2.3±0.5)d,术后住院时间为(7.3±1.9)d,均短于开腹组的(209.5±21.0)min、(4.6±0.8)d、(11.9±3.2)d;联合组淋巴结清扫数为(16.7±2.1)个,多于开腹组的(12.4±1.7)个,术中出血量为(27.9±4.1)ml,少于开腹组的(75.5±9.3)ml,差异均有统计学意义(P<0.05).联合组造口4例,二期行造口关闭术4例,开腹组造口17例,二期行造口关闭术17例,联合组并发症发生率为12.3％,二期手术率为7.0％,均低于开腹组的44.4％、27.0％,差异均有统计学意义(P<0.05).结论 金属支架联合腹腔镜治疗结直肠癌并急性肠梗阻安全、可行,且手术根治效果好,能有效降低二期手术率.

目的 探讨腹腔镜技术在急性肠系膜血管缺血性疾病(acute mesenteric ischemia,AMI)诊断中的应用价值.方法 回顾性分析我院2006年8月～2018年1月11例术前检查不能明确的可疑AMI患者资料,均行腹腔镜探查.结果 8例(72.7％)术中证实为急性肠缺血坏死,均中转开腹手术切除坏死段肠管,其中7例行Ⅰ期吻合,1例因缺血坏死肠管广泛,结肠内容物较多,腹腔污染严重而行远段小肠造瘘术,术后2天因腹痛剧烈不缓解再次行腹腔镜探查,发现部分残余小肠肠管呈渐进性缺血坏死,再次行坏死小肠切除+小肠造瘘术,平均手术时间110 min(78～185 min),平均出血量95 ml(40～210 ml),平均住院时间11 d(7～28 d),8例均痊愈出院,术后均于门诊定期复诊6个月,未再次出现明显腹痛、腹胀等症状,进食正常,大便良好,其中二次手术者术后3个月行小肠造瘘还纳,术后恢复良好.另3例探查术中见肠管远端存在不同程度粘连,血运、蠕动正常,无明显出血、坏死表现,行肠粘连松解术.结论 对于腹部症状和体征不相符,伴有急性肠梗阻的可疑AMI患者,在严格掌握探查指征以及手术时机情况下,腹腔镜技术可有效地用于AMI的诊断.

Objective To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis (TBTB). Methods From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT (computer tomography), bronchial reconstructions and bronchoscopy. All patients underwent routine anti-tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council (mMRC) dyspnea scale and complications. Results Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for (10 ± 4) times,and then these patients received balloon dilatation through bronchoscope for (7±3) times subsequently. The total effective rates were 76.53％and 72.45％after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses (t=-15.012,P<0.01). The average of mMRC score changed from (3.8±0.5) before the procedure, to (1.1 ± 0.7), (1.2 ± 0.7) and (1.2 ± 0.7) immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy (t=30.398-31.058, P<0.01), but not among the 3 scores after treatments. No serious complications were observed in all cases. Conclusions Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronchial tuberculosis. A shorter course of disease indicated more benefits for patients.

目的 探讨高频电凝联合冷冻消融治疗肉芽增殖型支气管结核的有效性及安全性.方法 选取2012年5月-2016年9月首都医科大学附属北京胸科医院收治的146例肉芽增殖型气管支气管结核患者,所有患者支气管镜下所见肉芽肿均超过正常支气管管径的1/2,均为初治患者.其中49例采用冷冻消融治疗,48例采用高频电凝治疗,49 例采用高频电凝联合冷冻消融治疗.所有患者均接受全身"2HRZE/10HRE"抗结核治疗及"H"雾化吸入治疗,介入治疗结束后镜下局部注药"HR"治疗.观察三组患者治疗次数、近远期疗效评估、并发症等情况.结果 高频电凝联合冷冻消融组共治疗(1.40 ± 0.59)次,少于冷冻消融组的(6.58 ± 1.72)次(P<0.0167),但与高频电凝组的(1.55 ± 0.59)次之间无显著统计学差异.治疗结束时高频电凝联合冷冻消融组总有效率为97.96% (48/49),高于冷冻消融组的总有效率81.63% (40/49),但与高频电凝组间无显著统计学差异(97.96% vs 95.83% ).治疗结束1个月及6个月后复查,高频电凝联合冷冻消融组总有效率均高于高频电凝组,但与冷冻消融组无显著统计学差异.并发症方面,治疗结束时、治疗结束后1个月及治疗结束后6个月高频电凝组肉芽肿再生率均高于冷冻消融组及高频电凝联合冷冻消融组,而冷冻消融组及高频电凝联合冷冻消融组间无统计学差异.高频电凝组1例患者出现气道管壁软化.三组均未见其他严重并发症.结论 针对肉芽肿超过正常管径1/2的肉芽增殖型支气管结核,高频电凝联合冷冻消融治疗具有较好的有效性和安全性.

Objecti To explore the clinical effect of laparoscopic right hemicolectomy by using three-hole method. Methods From November 2009 to December 2014, a retrospective analysis of laparoscopic right hemicolectomy of 95 patients were performed, including 47 cases in five holes group and 48 cases in three holes group.Clinical data were analyzed by using statistical software SPSS 19.0.Measurement data such as perioperative indicators were expressed as mean ±standard deviation(-x ±s), and were examined by using t test.Count data, such as postoperative complication rate and survival rate , were expressed as %, and were examined by using χ2 test.A P value <0.05 was considered as statistically significant difference. Results There were no significantly differenence between χ2 groups in terms of intraoperative blood loss and harvested lymph nodes.Compared with five holes group, operation time, exhaust time, feeding time and drainage time in three holes group were significantly decreased .There were postoperative increase of blood WBC、 CRP and IL-6 in both two groups (P <0.05), however five-hole group were significantly higher than that of the three-hole group (P <0.01).The 12-month survival rate (97.9%) of three holes group was higher than 93.6% of five holes group (χ2 =2.16, P <0.05).The 18-month survival rate (93.8%) of three holes group was higher than 89.4% of five holes group (χ2 =3.67, P <0.05).The 18-month survival rate (91.7%) of three holes group was higher than 82.9% of five holes group (χ2 =4.01, P <0.05).The total number of recurrence, metastasis and complication in the three -hole group was 75 (14.58%) lower than 14 (19.79%) in the five-hole group. Conclusion Minimally invasive surgical procedure by using three -hole method is superior to conventional five -hole method, with higher survival rate, lower recurrence and complication rate.it is worth clinical wider application .

Objective To evaluate the clinical efficacy of laparoscopy combined with colonoscopy for small colorectal space occupying lesions (equal or less than 3 cm). Methods From January 2010 to January 2015,a total of 41 cases of small colorectal space occupying lesions (equal or less than 3 cm)were treated under general anesthesia with laparoscopic surgery combined with colonoscopy.The patients were placed at the lithotomy position.After the establishment of pneumoperitoneum,injection of methylene blue for staining was carried out under colonoscopy. Laparoscopic titanium clipping positioning was conducted, and then the colonoscope was withdrawn.According to the intraoperative frozen pathological results,bowel resection surgery or colorectal surgical resection was selected. Results All the 41 cases of laparoscopic combined with colonoscopic surgery were successfully completed, with no conversion to laparotomy.There were 9 cases of preoperative diagnosis of precancerous lesions,6 of which were found neoplasia in the colon epithelium with intraoperative pathological diagnosis,with 3 cases of Tis adenocarcinoma.Among 32 cases of preoperative diagnosis of stage 0 -Ⅰ colorectal cancer,there were 29 cases of intraoperative and postoperative diagnosis of stage Ⅰ (23 cases of T1 N 0 M0 adenocarcinoma and 6 cases of T2 N 0 M0 adenocarcinoma)and 3 cases of stage Ⅲ (T2 N 1 M0 adenocarcinoma).Two cases were multiple lesions.Bowel resection was performed in colon intraepithelial neoplasia and Tis lesions of colorectal cancer,while resection of colorectal cancer was conducted in stage T1 -T2 colorectal cancer.Two patients with colonic epithelial neoplasia were followed up for 9 and 12 months,without recurrence.The remaining 39 cases were followed up for 24 -49 months,with a median of 38.6 months. Among the 35 cases of colorectal cancer,colonoscopy detected local recurrence in 1 case of T2 N 1 M0 adenocarcinoma (stage Ⅲ)after 34 postoperative months.No metastasis was found in all the patients. Conclusion Laparoscopy combined with colonoscopy for small diameter (equal or less than 3 cm)benign tumor or stage Tis -T2 malignant colorectal cancer has advantages of both endoscopy,especially suitable for difficultly located or removed lesions,which can improve the positioning precision and surgical safety.

目的 分析散发型淋巴管肌瘤病(S-LAM)的临床及病理特点,提高对该病的认识.方法 对11例经病理证实的S-LAM进行回顾性分析,采用SMA、vimentin、HMB45、Ki-67、CD34、D2-40、ER和PR等抗体进行免疫组化染色,并复习文献.结果 11例均为女性,表现为乳糜性胸或腹水,有胸闷、呼吸困难、气促等症状;病程中均有多个部位累及,包括肺、腹膜后、淋巴结.胸部CT示两肺散在或弥漫分布囊腔影,直径0.2 ～2cm,囊壁薄而清晰;腹膜后受累者CT显示囊性低密度影.11例均有月经不调,其中3例合并子宫肌瘤,1例合并卵巢畸胎瘤、肾血管平滑肌脂肪瘤及肝血管瘤,1例合并小肠胃肠间质瘤,2例合并肝囊肿.免疫组化显示11例HMB45均(+),5例ER灶性(+),8例PR局灶(+).随访5～ 60个月,患者均存活,且症状缓解.结论 LAM的临床表现无特异性,CT表现有一定的特异性,最终确诊依赖于组织病理,熟悉这些特点有助于早期诊断,但预后差.

目的 探讨胎儿心横纹肌瘤合并结节性硬化症的临床及病理特征、病理诊断、治疗与预后.方法 对1例胎儿进行尸检.标本采用常规石蜡包埋、切片、HE染色及免疫组化染色.结果 该例为心室多发结节样肿瘤,切面灰粉色、质细腻,镜下可见到“蜘蛛样”细胞,myoglobin和desmin(+);脑实质内可见体积较大的星形细胞弥漫聚集,胞质嗜伊红色,核偏位,GFAF(+);脾内可见组织细胞样细胞多灶状瘤样生长,CD68(+),诊断为胎儿心横纹肌瘤合并结节性硬化症.结论 心横纹肌瘤为良性错构性肿瘤,早发现及准确诊断对临床治疗非常有意义,合并结节性硬化症时预后较差.

目的 探讨黏液样脂肪肉瘤的影像学及病理学特征.方法 采用免疫组化法对15例黏液样脂肪肉瘤进行染色,观察其影像学特征,并复习相关文献.结果 15例患者术前CT显示肿物为界限清楚的低密度影,MRI显示SE T1WI上为低信号,而T2WI上为明显高信号,类似于水的密度或信号,影像学检查缺乏特异性诊断,不易分辨肿物性质.组织学形态:由不同成熟阶段的脂肪母细胞、黏液样基质及毛细血管网组成,部分区域具有“肺水肿样”特征.免疫表型:脂肪母细胞S-100阳性,免疫组化标记CD34可见“鸡爪样”的小血管.结论 黏液样脂肪肉瘤影像学特征往往表现为低密度水肿样影像,诊断无特异性,病理检查可明确诊断.

目的 探讨肺原发肌上皮癌与鳞状细胞癌共存的肺复合癌临床病理学特征.方法 采用HE及免疫组化EnVision法观察1例肺原发肌上皮癌与鳞状细胞癌共存病例的临床病理学特征,并复习相关文献.结果 该例为肺原发肌上皮癌与鳞状细胞癌共存.胸部CT及支气管镜均提示右肺下叶支气管处结节.癌组织呈实性片状及梁状结构排列,肿瘤细胞形态多样.免疫表型:CK、vimentin、p63、SMA、S-100和Calponin阳性.邻近支气管黏膜可见鳞状细胞癌,免疫表型:CK、CK5/6和p63阳性,vimentin、SMA阴性.结论 肺原发肌上皮癌与鳞状细胞癌共存的肺复合型恶性肿瘤罕见,确诊需结合影像学、病理组织学及免疫表型.治疗以手术切除为主,对放、化疗均不敏感.

Objective:To explore the clinical manifestations,treatment and particularity of patients with hemobilia taking anticoagulant in perioperative period.Method:The clinical manifestations,diagnosis and treatment process of 23 cases with hemobilia in our hospital from January 1998 to December 2012 were analyzed retrospectively.Result:Most of patients with biliary tract hemorrhage of upper gastrointestinal bleeding symptoms,there were 6 cases with cholangitis as the first symptom.Can generally be found by B-ultrasound and CT primary lesion,and the celiac artery through duodenoscopy angiography.12 cases were given surgery,4 cases selective arterial embolization,conservative treatment in 7 cases.For patients taking warfarin anticoagulation vitamin K1 was available,depending on the circumstances of aspirin treatment in patients with perioperative available low molecular weight heparin(LMWH) transition.19 cases cured,accounting for 82.6%,4 cases were deaths,accounting for 17.4%.Conclusion:The good results of hemilia patient could be achieved by accurate diagnosis,exact operation and active perioperative management or effective conservative therapy.

Purpose To investigate the significance of TKTL1 expression in invasive ductal carcinoma(IDC) of breast.Methods The expression of TKTL1 was detected in 54 cases of IDC and 10 cases of ductal carcinoma in situ(DCIS) by immunohistochemical staining.The relationship between the TKTL1 expression and pathologic features(ER,PR,histological grade,tumor size,vessel invasion,nerve invasion and lymph node metastasis) were also analyzed.Results(1) The expression of TKTL1 had no significant difference between IDC and DCIS(P0.05).(2) The expression of TKTL1 was positively correlated with lymph node metastasis(P=0.047),but had no relationship with ER,PR,tumor size,vessel invasion,nerve invasion and histological grade(P0.05).Conclusions Overexpression of TKTL1 may correlated with invasion and lymph node metastasis in IDC.