目的 研究卡培他滨维持治疗复发转移三阴性乳腺癌化疗有效患者的价值.方法 选择本院 2019 年 1 月至 2019年 12 月诊治的 132 例复发转移三阴性乳腺癌患者作为研究对象,按非随机临床同期对照研究及患者自愿原则分为维持组(67 例)和对照组(65 例),其中对照组给予化疗,维持组在化疗有效后给予卡培他滨维持治疗.比较两组患者治疗前后肿瘤标志物、炎症因子水平变化和肿瘤转移浸润相关因子,并评估疗效和安全性.结果 维持组患者客观缓解率显著高于对照组(P＜0.05);治疗后两组肿瘤标志物水平均有所降低,且维持组显著低于对照组(P＜0.05);维持组患者治疗后免疫功能指标水平有所上升,且高于对照组(P＜0.05);治疗后两组肿瘤转移浸润相关因子水平均有所降低,但维持组低于对照组(P＜0.05);维持组患者出现血小板减少、胃肠道反应、肝功能损伤、骨髓抑制以及手足综合征,均为Ⅲ级及以下,可耐受或经对症处理后好转.结论 卡培他滨作为复发转移三阴性乳腺癌化疗有效患者的维持治疗药物,可有效调节机体免疫应答,抑制癌细胞生长,从而提高治疗效果,且具有毒性低、安全耐受的优点.

Objective:To explore the significance of exposing the circummammary ligament under endoscopy and the effect of membrane anatomy in breast reconstruction.Methods:The case data of 49 breast cancer patients who underwent endoscopic nipple-sparing mastectomy combined with one-stage breast reconstruction with prosthesis implantation in Beijing Friendship Hospital, Capital Medical University from February 2014 to December 2021 were retrospectively analyzed, there were 44 cases of posterior pectoralis prosthesis implantation, 5 cases of anterior pectoralis prosthesis implantation. The anatomical structure of the circummammary ligament was observed under endoscopy during operation, and the annular mammary ligament was used as an anatomical marker to complete subcutaneous glandectomy and prosthesis implantation for breast reconstruction, the BREAST-Q scales were used to evaluate the postoperative effect.Results:The medial sternal ligament, sub clavicular ligament, lateral confluence ligament and triangular ligament condensation could be clearly exposed in all 49 cases. Breast reconstruction module of BREAST-Q were used to evaluate the surgery effect after breast cancer surgery, the scores of postoperative breast satisfaction, chest wall status, psychosocial status and sexual health status were 81.43±12.57, 88.39±10.61, 88.04±13.70, 74.82±15.93.Conclusion:The endoscopic technique is beneficial to expose the circummammary ligament during operation, and surgical resection and reconstruction can better restore the appearance of the breast and improve postoperative satisfaction according to the principle of membrane anatomy.

目的 探讨两步法单孔腔镜乳房重建手术在早期乳腺癌治疗中的临床应用价值.方法 21例早期乳腺癌患者于乳房皮下腺体切除术即刻行两步法单孔腔镜乳房重建手术;记录手术情况、术后并发症及美容效果;术后6个月,应用BREAST Q乳腺癌患者结局量表评价患者对外观满意度和生活质量.结果 21例均顺利完成两步法单孔腔镜乳房重建手术,无中转开放手术病例;术后无假体取出、包膜挛缩发生,2例发生乳头、乳晕缺血坏死,发生率为9.5％.术后6个月,BREAST Q量表评分乳房满意度为(75.3±2.2)分,胸壁状态评分为(90.4±1.5)分,社会心理状态评分为(86.1±2.0)分,性健康程度评分为(71.4±2.6)分.结论 两步法单孔腔镜乳房重建手术在早期乳腺癌治疗中应用效果良好,患者可获较好的外观满意度和生活质量.

目的 观察乳腺癌患者病理组织中Cath-D、c-erbB-2的表达情况,并分析其与淋巴结转移、肿瘤标志物水平的相关性.方法 选取接受手术治疗的乳腺癌患者为研究对象,同时选取同期接受手术治疗的乳腺纤维腺瘤患者为对照.观察乳腺癌(有、无淋巴转移组)、乳腺纤维腺瘤患者组织切片Cath-D、c-erbB-2阳性表达情况,比较乳腺癌(有、无淋巴转移组)、乳腺纤维腺瘤患者血清肿瘤标志物水平的差异,分析淋巴结转移的乳腺癌患者Cath-D、c-erbB-2阳性表达与肿瘤标志物水平的相关性.结果 乳腺癌组患者的组织切片Cath-D、c-erbB-2阳性表达率均高于乳腺纤维腺瘤组(χ2=51.796、70.090,P均<0.001);有淋巴结转移的乳腺癌患者组织切片Cath-D、c-erbB-2阳性表达率高于无淋巴结转移组.乳腺癌组患者血清CEA、CA15-3、CA125水平高于乳腺纤维腺瘤组(t=52.270、58.784、76.349,P<0.001);乳腺癌组有淋巴结转移组患者血清CEA、CA15-3、CA125水平高于无淋巴结转移组(t=16.681、27.880、23.216,P<0.001).有淋巴结转移的乳腺癌患者Cath-D、c-erbB-2阳性表达率与血清CEA、CA15-3、CA125水平正相关.结论 乳腺癌患者病理组织中Cath-D、c-erbB-2阳性表达率较高,且与淋巴结转移和肿瘤标志物水平相关.

目的 探讨血单核细胞趋化蛋白-1(MCP-1)、降钙素原(PCT)、免疫球蛋白在甲状腺癌患者术后感染并发症预测中的应用价值.方法 选取甲状腺癌手术患者95例为研究对象,测定术前、术后1 d、术后3 d血MCP-1、PCT、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)水平,并依据患者术后有无感染并发症分为感染组(n=14)、未感染组(n=81),比较2组患者一般资料与术前、术后1 d、术后3 d血MCP-1、PCT、IgM、IgG、IgA水平,以受试者工作特征曲线(ROC)探讨其对患者术后是否发生感染并发症的预测价值,分析术后感染并发症影响因素.结果 患者术后1 d、3 d血MCP-1、PCT水平较术前增高,血IgM、IgG、IgA水平较术前降低(P<0.05);组内比较,感染组与未感染组术后1 d、3 d血MCP-1、PCT高于术前,血IgM、IgG、IgA水平低于术前;组间比较,感染组术后1 d、3 d血MCP-1、PCT高于未感染组,血IgM、IgG、IgA水平低于未感染组(P<0.05).术后3 d IgM预测甲状腺癌患者术后发生感染并发症AUC最大,为0.940,截断值为0.55 g/l,诊断敏感度为92.86％、特异度为86.42％;血MCP-1、PCT、IgM、IgG、IgA均为患者术后发生感染并发症的重要影响因素(P<0.05).结论 血清MCP-1、PCT、免疫球蛋白是引起甲状腺癌患者术后感染并发症的影响因素,监测其水平变化能早期预测术后感染并发症.

目的 探讨单独使用蓝染料法示踪行早期浸润性乳腺癌前哨淋巴结活检(SLNB)的可行性.方法 回顾性分析2015-01—2015-06新乡医学院第一附属医院SLNB学习曲线时的60例早期浸润性乳腺癌患者的临床资料.将沿蓝染淋巴管示踪找到蓝染淋巴结或蓝染淋巴管指向的第一个淋巴结的方法作为单蓝染料法.将术中γ探测仪检测超过淋巴结最高计数10％的淋巴结,加蓝染料法示踪淋巴结的方法作为蓝染料联合核素法.比较两种方法前哨淋巴结(SLN)的检出数目、成功率和假阴性率.结果 单蓝染料法检出SLN 85枚(0～3枚,中位数2枚),蓝染料联合核素法为194枚(0～6枚,中位数4枚).单蓝染料法成功率为96.7％、假阴性率为9.3％,蓝染料联合核素法成功率为98.3％、假阴性率为6.3％.检出1枚SLN时,单蓝染料法假阴性率为7.7％,蓝染料联合核素法假阴性率为0.0％.检出≥2枚SLN时,单蓝染料法假阴性率为11.1％,蓝染料联合核素法假阴性率为7.1％.差异均无统计学意义(P>0.05).结论 经过详细的术前评估和严格的学习曲线,单蓝染料法行前哨淋巴结活检是可行的.

Objective: To investigate the effect of Toll-like receptor 7 (TLR7) in CD8(+) T cells activity from patients with breast cancer. Methods: Thirty-three patients with breast cancer, twenty-three patients with benign breast tumor, and twenty healthy individuals were collected from The First Affiliated Hospital of Xinxiang Medical University between December 2017 and March 2018. Peripheral blood mononuclear cells (PBMCs) were isolated, and CD8(+) T cells were purified. TLR7 protein and mRNA relative expression in CD8(+) T cells was measured using flow cytometry and real-time PCR, respectively. mRNA relative expressions corresponding to perforin, granzyme B, and FasL in CD8(+) T cells were measured in response to TLR7 agonist stimulation. Direct/indirect contact co-culture system of CD8(+) T cells and breast cancer cell line MCF-7 was also used to assess cytolytic and noncytolytic function in response to TLR7 agonist CL097 stimulation. Results: The mean fluorescence intensity corresponding to TLR7 protein in CD8(+) T cells from breast cancer patients was 124.0±15.32, which was significantly down-regulated in comparison with benign breast tumor patients (255.5±54.91) and healthy individuals (261.9±68.65) (P<0.000 1). TLR7 mRNA relative level was also remarkably reduced in CD8(+) T cells from breast cancer patients (1.97±1.18) in comparison with benign breast tumor patients (4.84±1.01) and healthy individuals (4.75±1.40) (P<0.000 1). TLR7 agonist CL097 stimulation notably increased mRNA relative levels of perforin and granzyme B mRNA in CD8(+) T cells (P<0.01), but not elevated FasL mRNA (P>0.05).Furthermore, TLR7 agonist CL097 stimulation enhanced the cytolytic and noncytolytic function of CD8(+) T cells to MCF-7 cells, which presented as the elevation of target cell death and increase of interferon-γ production in direct and indirect contact co-culture system. Conclusion: TLR7 agonist promoted CD8(+) T cells function from breast cancer patients.

比较甲状腺乳头状癌行传统开放手术与经胸-乳入路内镜手术的效果.收集201 4年1 0月-2017年10月行手术治疗PTC患者573例,其中457例行开放甲状腺切除手术(开放手术组),116例行经胸-乳入路腔镜下甲状腺切除手术(内镜手术组).对两组临床病理特征、并发症、手术完成情况进行分析.开放手术组平均年龄为47.53岁,内镜手术组为28.33岁(P＜0.01);开放手术组手术范围较内镜手术组广泛,但是内镜手术组的手术时间较长(P＜0.01);开放手术组平均术后住院时间为9.77 d,内镜手术组为7.31 d(P＜0.05);开放手术组的肿瘤直径大于内镜手术组(P＜0.05),内镜手术组清除的淋巴结数目较开放手术组少(P＜0.01);术后并发症发生率及甲状腺球蛋白水平两组间无显著差异(P＞0.05).内镜手术组的手术切口明显小于开放手术组,且位于隐蔽的部位.经胸-乳入路内镜手术与开放手术治疗PTC手术效果相似,美容效果更好.因此,对选择性的PTC患者行经胸-乳入路腔镜甲状腺切除手术是合适的选择.

Objective:To discuss the operatiug skill of endoscopic thyroidectomy through areola.Methods:Fifty-nine patients underwent endoscopic thyroidectomy through areola (endoscopic group) and 209 patients underwent open thyroid surgery (open group)from Jan.2016 to Dec.2016 in the first affiliated hospital of Xinxiang medical university.The operation time,blood loss,incidence of postoperative complications such as face subcutaneous emphysema,hoarseness,suffocation,Homer syndrome,drinking choke,mediastinal emphysema,Trocar tunnel infection and infection of surgery area were compared between the two groups.Results:There was no statistical difference in operation time between two groups [(76.58-± 29.12) min vs.(73.21 ± 28.14) min].Blood loss of endoscopic group was statistically less than open group [(20.71 ± 14.32) ml vs.(33.28 ± 12.19) ml].There was no obvious difference in incidence of postoperative complications,including drinking choke,subcutaneous emphysema,red and swollen drainage entrance,hoarseness,peri-oral and extremity numbness.In 7 d after surgery,endoscopic group was better than open group in cosmetic results.Conclusions:Injecting appropriate air to decrease smog and compounding practice of ultrasound knife and dissecting forceps are the key to success in endoscopic thyroidectomy through areola.Complete endoscopic thyroidectomy through areola could be regarded as better scheme for thyroid benign tumor.

OBJECTIVE To investigate the clinical infection status and risk factors of breast cancer patients after op-eration .METHODS The treatment of 1080 patients with breast cancer treated from Jun .2013 to Jun .2016 was retrospectively analyzed .The clinical infection status after operation ,distribution of pathogens and the risk factors of infection were analyzed .RESULTS Among the 1080 patients ,37 cases were infected and the infection rate was 4 .3% .Among the 37 patients ,49 strains of pathogens were isolated from the specimens .Among them ,18 strains were gram-positive bacteria ,accounting for 36 .7% ,23 strains were gram-negative bacteria ,accounting for 46 .9% ,and 8 strains were fungi ,accounting for 16 .3% .The 37 patients were mainly infected with respiratory tract infection .The drug resistance experiments of gram-positive bacteria showed that Staphylococcus aureus and Staphylococcus haemolyticus had the lowest resistant rates to vancomycin ,which were 0 .00% ,The drug resist-ance experiments gram-negative bacteria showed that Pseudomonas aeruginosa had the lowest resistant rates to ceftazidime and meropenem ,which were 0 .00% ,Acinetobacter baumannii had the lowest resistant rates to ampi-cillin and meropenem ,Escherichia coli had the lowest resistant rates to ampicillin ,sulbactam ,ciprofloxacin and meropenem ,which were 0 .00% ,and Klebsiella pneumoniae had the lowest resistant rate to meropenem ,which was 0 .00% .The age ,length of stay ,and whether radiotherapy and chemotherapy were the risk factors of infec-tions (P<0 .05) .CONCLUSION The postoperative infections of breast cancer patients is mainly respiratory tract infection ,and most of the pathogens have various degrees of drug resistance ,and it should be away from the risk factors that may cause infections in the course of treatment of patients .

OBJECTIVE To explore the correlation between the changes of high‐sensitivity C‐reactive protein (h‐CRP) and procalcitonin (PCT ) and the prognosis of the splenectomy ,pericardial devascularization patients with postoperative infection so as to provide guidance for clinical control of the postoperative infections .METHODS A total of 68 patients who received the splenectomy ,pericardial devascularization from Dec 2014 to 2015 and had postoperative infections were enrolled in the study and assigned as the experimental group ,meanwhile ,68 patients who received the splenectomy ,pericardial devascularization but did not have infection were set as the control group .The PCT level of the two groups of patients was determined by using electrochemiluminescence immunoas‐say ,and the h‐CRP level was determined with the use of immunoturbidimetric assay .The levels of h‐CRP and PCT were compared between the two groups of patients ,and their correlation with the prognosis was observed . RESULTS The PCT level of the experimental group was (16 .38 ± 4 .47)ng/ml ,significantly higher than (6 .86 ± 3 .13)ng/ml of the control group;the h‐CRP level of the experimental group was (45 .30 ± 19 .70)mg/L ,signifi‐cantly higher than (22 .10 ± 5 .30)mg/L of the control group;the WBC counts of the experimental group were (17 .40 ± 3 .40) × 109/L ,significantly more than (11 .30 ± 2 .60) × 109/L of the control group;the APCHEⅡscore of the experimental group was (24 .56 ± 7 .79) ,significantly higher than (13 .12 ± 6 .21) of the control group (P<0 .05) .The PCT and h‐CRP of the patients with postoperative infection in the experimental group were posi‐tively correlated with the APCHEⅡ score after the admission to the hospital (r=0 .642 and 0 .547);the WBC was&nbsp;not correlated with the APCHEⅡ .The levels of PCT and h‐CRP of the experimental group were significantly higher than those of the control group on Day 1 ,3 ,and 5 (P<0 .05);the levels of PCT and h‐CRP of the experi‐mental group reached the peak on Day 3 and then showed downwards .CONCLUSION The h‐CRP and PCT of the splenectomy , pericardial devascularization patients with postoperative infection are closely associated with the prognosis .It is necessary to strengthen the monitoring of the h‐CRP and PCT levels so as to reduce the infection rate .

目的 探讨腹腔镜全直肠系膜切除在低位、超低位直肠癌手术中的安全性、肿瘤根治疗效和术后恢复情况.方法 低位、超低位直肠癌患者136例行腹腔镜全直肠系膜切除64例(腹腔镜组),开腹全直肠系膜切除72例(开腹组),比较手术学指标、肿瘤根治疗效.结果 腹腔镜组手术时间为(162.4 ±42.0)min,开腹组为(146.1±31.2)min;腹腔镜组出血量为(87.6 ±52.2) ml,开腹组为(199.4 ±95.8)ml,两组比较差异有统计学意义(P＜0.01).两组保肛率、清除淋巴结数目和远切端距肿瘤的距离比较,差异无统计学意义(P＞0.05).腹腔镜组直肠系膜完整性优于开腹组,两组比较差异有统计学意义(P＜0.05).腹腔镜组对吗啡类镇痛药物的需要、肠功能恢复时间、住院时间均更少,差异有统计学意义[15.6％和30.6％,P＜0.05;(66.7 ±12.2)h和(99.9±19.1)h,P＜0.01;(7.7±1.0)d和(9.2±1.6)d,P＜0.01].术后并发症发生率、随访局部复发率、总复发率、不同TNM分期的总复发率比较,差异均无统计学意义(P＞0.05).结论 腹腔镜全直肠系膜切除手术出血量少,更完整地直肠系膜切除,术后肠功能恢复快,镇痛的需要率低,住院时间短.

<正>目前,超低位直肠癌的治疗已经由单纯的根治性治疗转变为根治性治疗及功能保留〔1〕。尽管吻合器已被广泛应用,但由于有些直肠癌在盆腔位置较深,在狭小的骨盆腔很难安全可靠地全切肿瘤,为解决这个难题,我院采用了吻合器法和免吻合

胰腺癌是常见的消化道肿瘤之一,其恶性程度高,预后极差,5年生存率1％～4％,手术切除仍是目前最有效的治疗手段.但该病早期诊断率低,确诊时大多已属晚期,手术切除率仅为10％ ～ 15％.对失去手术机会的局部晚期胰腺癌,化疗联合同步放疗已成为主要治疗手段.5-氟尿嘧啶及吉西他滨是治疗胰腺癌的常用有效药物,但两者都有缺点,患者对以5-氟尿嘧啶及吉西他滨为基础的同步放化疗耐受性差,因此寻找更合适的化放疗方案尤为重要.