Objective To investigate the clinical effect of transanal minimally invasive surgery（TAMIS） and traditional transanal regional anal resection（TAE） in the treatment of rectal tumors. Methods The rectal tumor patients from 2019-06 to 2021-06 were prospectively included and were divided into TAMIS group（32 patients） and TAE group（27 patients） according to different surgical methods. Baseline data, operation time, intraoperative blood loss, postoperative numerical score（NRS） score, mean length of stay, complication rate, and recurrence rate during the 3-month postoperative follow-up were compared in 2 groups. Results A total of 59 patients were included, and there were no significant differences in the baseline data, negative margin rate, complication rate, and recurrence rate of 2 group patients（P＞0.05）.The operation time, intraoperative blood loss, NRS score and hospital stay length of the patients in the TAMIS group were shorter（smaller） than those of TAE group. The differences were all statistically significant（P＜0.05）. Conclusion There was no significant difference in negative margin rate, complication rate and recurrence rate between TAMIS and TAE. However, TAMIS has the advantages of short operation time, less intraoperative bleeding, less postoperative pain, less complications and short hospital stay.

目的 探讨腹腔热灌注联合静脉化疗治疗进展期右半结肠癌的临床疗效.方法 选择2021年1月至2022年1月南阳市中心医院收治的进展期右半结肠癌患者70例为研究对象.随机将患者分为对照组(n=35)和观察组(n=35),对照组患者给予静脉化疗,观察组患者给予腹腔热灌注联合静脉化疗.分别于治疗前后采用流式细胞仪检测2组患者血清中CD3+、CD4+、CD8+淋巴细胞占比,并计算CD4+/CD8+水平;比较2组患者治疗过程中不良反应发生率;采用生活质量测定量表评估2组患者治疗后的生活质量;比较2组患者随访1～2 a的预后情况.结果 治疗前,2组患者血清中CD3+、CD4+、CD8+淋巴细胞占比及CD4+/CD8+比较差异无统计学意义(P＞0.05).2组患者治疗后血清中CD3+、CD4+淋巴细胞占比及CD4+/CD8+显著高于治疗前,CD8+淋巴细胞占比显著低于治疗前(P＜0.05).治疗后,观察组患者血清中CD3+、CD4+淋巴细胞占比及CD4+/CD8+显著高于对照组,CD8+淋巴细胞占比显著低于对照组(P＜0.05).对照组患者治疗过程中静脉炎、胃肠道反应、白细胞降低、肌酐轻度增高、肝功能异常发生率分别为 17.1％(6/35)、20.0％(7/35)、14.3％(5/35)、11.4％(4/35)、11.4％(4/35),观察组患者治疗过程中静脉炎、胃肠道反应、白细胞降低、肌酐轻度增高、肝功能异常发生率分别为2.9％(1/35)、2.9％(1/35)、0.0％(0/35)、0.0％(0/35)、0.0％(0/35);对照组患者治疗过程中静脉炎、胃肠道反应、白细胞降低、肌酐轻度增高、肝功能异常等不良反应发生率均显著高于观察组(x2=11.202、14.420、15.401、12.089、12.089,P＜0.05).观察组患者的躯体功能、角色功能、情绪功能、社会功能评分均显著高于对照组(P＜0.05).对照组患者治疗后1、2 a生存率分别为54.3％(19/35)、22.9％(8/35),复发率分别为20.0％(7/35)、34.3％(12/35);观察组患者治疗后1、2 a生存率分别为97.1％(34/35)、71.4％(25/35),复发率分别为2.9％(1/35)、14.3％(5/35);观察组患者治疗后1、2 a的生存率显著高于对照组(x2=49.792、47.198,P＜0.05),复发率显著低于对照组(x2=14.420、10.873,P＜0.05).观察组患者的平均生存时间长于对照组(t=7.995,P＜0.05).结论 腹腔热灌注联合静脉化疗治疗进展期右半结肠癌的效果优于单独静脉化疗,且能够有效改善患者身体免疫功能,降低不良反应发生率,进一步提高患者的生活质量.

目的 探讨利胆排石颗粒联合熊去氧胆酸片治疗肝内胆管结石的临床疗效.方法 选取2020年1月—2021年9月在南阳市中心医院就诊的100例肝内胆管结石患者,根据随机数字表法将所有患者分为对照组和治疗组,每组各50例.对照组患者口服熊去氧胆酸片,10 mg/kg,2次/d.治疗组在对照组基础上温水冲服利胆排石颗粒,2袋/次,2次/d.两组患者连续治疗6个月.观察两组的临床疗效,比较两组的症状改善情况、结石和血清中总胆红素(TBIL)、直接胆红素(DBIL)、天门冬氨酸氨基转氨酶(AST)、丙氨酸氨基转移酶(ALT)水平.结果 治疗后,治疗组的总有效率为96.00％,明显比对照组总有效率84.00％高,组间比较差异有统计学意义(P<0.05).治疗后,两组的发热、黄疸、腹痛发生率显著降低(P<0.05),且治疗组发热、黄疸、腹痛发生率较对照组降低更明显(P<0.05).治疗后,两组的最大结石直径显著减小(P<0.05),且治疗组最大结石直径明显小于对照组(P<0.05).治疗后,两组的血清TBIL、DBIL、AST、ALT水平均显著降低(P<0.05),且治疗组血清TBIL、DBIL、AST、ALT水平明显低于对照组(P<0.05).结论 利胆排石颗粒联合熊去氧胆酸片可提高肝内胆管结石的疗效,改善临床症状,促进结石缩小,改善肝胆功能,且安全性良好.

目的:分析腹腔镜右半结肠切除术对患者MDA、SOD水平及生活质量的影响.方法:选取南阳市中心医院2017-12～2019-10收治的未出现远处转移的右半结肠癌患者70例,采用简单随机方法,将合格受试者按1∶1原则分为对照组和观察组.对照组患者采用开腹右半结肠癌根治术治疗,观察组患者采用腹腔镜右半结肠切除术治疗,分析两组患者治疗后的临床效果.结果:观察组术中出血量(100.15±49.32)mL少于对照组,手术时间(172.41±48.83)min、首次排气时间(3.06±1.18)d、住院时间(7.32±2.36)d短于对照组(P＜0.05).术前,两组MDA、SOD、CCSA-2、VEGF比较,差异不显著(P＞0.05).术后,观察组MDA、CCSA-2、VEGF低于对照组,SOD高于对照组(P＜0.05).术前,两组生活质量评分比较,差异不显著(P＞0.05).术后,观察组躯体、认知、角色、情绪、社会等功能领域评分高于对照组(P＜0.05).观察组的并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论:腹腔镜右半结肠切除术根治右半结肠癌,出血量较少,并发症较低,安全性高,可改善患者生活质量.

目的:探讨术后渐进式聚焦访谈对永久性肠造口患者病耻感及应对方式的影响.方法:以2021年1～7月于我院接受永久性肠造口治疗的68例患者为研究对象,采用随机数字表法分为A、B两组,各34例,A组术后接受常规护理,B组术后在A组常规护理基础上进行渐进式聚焦访谈,访谈分6次于术后2个月内完成.比较2组患者干预前后病耻感及应对方式.病耻感采用中文版社会影响量表(SIS)评价,应对方式采用中文版医学应对问卷(MCMQ)评价.结果:干预后,B组SIS之内在羞耻、社会排斥、社会孤立及经济无保障维度评分及总分均明显降低(P<0.05),而A组无明显变化(P>0.05);组间比较,B组干预后各维度评分及总分均明显低于A组(P<0.05).干预后,B组"面对"评分明显升高(P<0.05),"回避""屈服"评分明显降低(P<0.05),A组各维度评分无明显变化(P>0.05);组间比较,B组"面对"评分高于A组,"回避""屈服"评分低于A组(P<0.05).结论:对永久性肠造口患者实施渐进式聚焦访谈可减轻其病耻感,改善对疾病的应对方式.

目的 探讨血清糖类抗原199(CA199)、可溶性细胞间黏附分子-1(sICAM-1)、C反应蛋白(CRP)水平及腹部增强CT对胰腺癌的早期筛查价值.方法 选择我院98例胰腺癌疑似患者为研究对象,其均进行腹部增强CT检查和血清CA199、sICAM-1及CRP检测,并以病理检查结果为"金标准",分析血清CA199、sICAM-1、CRP水平及腹部增强CT对胰腺癌的早期筛查价值.结果 病理检查显示98例患者中胰腺癌者36例,良性胰腺病变者62例.胰腺癌组血清CA199、sICAM-1和CRP水平均低于良性胰腺病变组(P<0.05);血清CA199、sICAM-1及CRP早期筛查胰腺癌截断点分别为87.16kU/L、331.52μg/L、55.65mg/L,曲线下面积分别为0.857、0.764、0.685.腹部增强CT对胰腺癌早期筛查的灵敏度、特异度、准确度分别为88.89％、90.32％、89.80％.血清CA199、sICAM-1、CRP及腹部增强CT联合检查对胰腺癌早期筛查的灵敏度、特异度、准确度分别为97.22％、96.77％和96.94％.血清CA199、sICAM-1、CRP和腹部增强CT联合检查的AUC值大于各单一检查(P<0.05).结论 血清CA199、sICAM-1、CRP水平及腹部增强CT对胰腺癌的早期筛查存在不同程度诊断效果,且相较于单独检查,血清CA199、sICAM-1、CRP及腹部增强CT联合检查更能够提高对胰腺癌的早期筛查效能.

目的:探讨复方天仙胶囊联合FOLFOX4双周标准化疗方案治疗中晚期胃癌患者的临床疗效.方法:选择2018年6月～2019年6月于本院首次住院治疗的98例中晚期胃癌患者作为研究对象,按照随机数字表法将其分为对照组和观察组,各49例.对照组采用FOLFOX4双周标准化疗方案进行治疗,观察组在对照组基础上口服复方天仙胶囊.比较两组临床疗效和不良反应发生率,采用卡氏功能状态评分(KPS)和视觉模拟评分(VAS)评估两组患者的生活质量和疼痛程度,并检测治疗前和治疗后血清白介素-6(IL-6)、白介素-17(IL-17)和白介素-33(IL-33)表达水平.结果:观察组总有效率(57.14％)高于对照组(32.65％,P<0.05).观察组生活质量改善率(69.39％)高于对照组(44.90％,P<0.05).治疗后,两组VAS评分低于治疗前,且观察组低于对照组(P<0.05).治疗后,两组血清IL-6、IL-17、IL-33表达水平低于治疗前,且观察组低于对照组(P<0.05).治疗期间,两组肝肾功能损伤、周围神经毒性及口腔黏膜炎等不良反应发生率比较无统计学差异(P>0.05),观察组恶心、呕吐和骨髓抑制发生率低于对照组(P<0.05).结论:复方天仙胶囊联合FOLFOX4双周标准化疗方案治疗中晚期胃癌,可以提高临床疗效,改善患者生活质量,降低疼痛程度和血清炎症因子水平,且安全性较高,具有良好的临床应用价值.

目的 探讨胰头十二指肠切除术联合替吉奥治疗胰腺癌对患者血清MIC-1、REG4水平的影响.方法 回顾性分析110例胰腺癌行胰头十二指肠切除术后患者的临床资料,按术后辅助化疗方式的不同,分为观察组和对照组,各55例.对照组用吉西他滨辅助化疗,观察组用替吉奥辅助化疗,2组均连续治疗2个疗程.比较2组化疗前后血清肿瘤标志物水平、血清MIC-1、REG4水平、生活质量评分;比较2组化疗期间不良反应发生情况;比较2组随访4、8、12个月的平均生存期及生存率.结果 与化疗前相比,化疗后2组血清肿瘤标志物CA19-9、CA50、CA125、CA242水平,血清MIC-1、REG4水平均降低,且观察组低于对照组.与化疗前相比,2组化疗后1、4、10周的生活质量评分逐渐升高,且观察组高于对照组.化疗期间,观察组不良反应总发生率(32.73％)低于对照组(52.73％).观察组患者随访4、8、12个月平均生存期长于对照组;观察组患者随访12个月的生存率高于对照组(P均<0.05).结论 胰头十二指肠切除术后替吉奥辅助化疗可降低胰腺癌患者血清MIC-1、REG4水平,抑制肿瘤细胞分化,有利于患者预后,可延长患者生存周期并提高生活质量.

目的 探讨医护一体化护理干预对住院保守治疗的急性胰腺炎患者住院时间、焦虑情绪的影响.方法 2019年05月～2020年05月,将本院接收的80例急性胰腺炎患者作为观察对象,根据双盲随机对照原则,予以分组探讨,其中一组名为常规组(常规护理),另一组名为研究组(医护一体化护理干预).每个小组分别40例.观察并对比两组胰腺炎治愈率、住院时间、症状体征缓解时间、焦虑心理评分、满意度.结果 研究组胰腺炎治愈率高于常规组(P＜0.05);研究组住院时间以及症状体征缓解时间均短于常规组(P＜0.05);研究组焦虑情绪评分低于常规组(P＜0.05);研究组满意度高于常规组(P＜0.05).结论 对于住院接受保守治疗的急性胰腺炎患者,给予医护一体化护理干预,可早日减轻患者症状体征,进一步缩短其住院时间,减轻其焦虑情绪.

目的 探讨多样性心理干预对乳腺癌患者负性情绪、心理弹性和生存质量的影响.方法 采用随机数字表法将120例乳腺癌患者分为干预组和对照组,各60例.两组患者均给予常规的健康教育及治疗指导,干预组同时给予多样性心理干预.比较两组患者干预前后的心理弹性水平、负性情绪和生存质量.结果 干预后,干预组患者的心理弹性水平总评分为(75.27±9.41)分,高于对照组患者的(71.04±9.06)分(P﹤0.05).干预后,干预组患者中文版乳腺癌患者生命质量测定量表(QLICP-BR)中社会能力、心理状态、特异模块、共性症状维度的评分及总分均高于对照组患者(P﹤0.05).干预后,干预组患者焦虑抑郁量表中的焦虑亚量表(HADS-A)和抑郁亚量表(HADS-D)评分均明显低于对照组患者(P﹤0.01).结论 多样心理干预对乳腺癌患者的心理功能、负性情绪均具有明显的调节作用,可改善患者的生命质量.

探讨早期胃癌和IL-33的相关性.2017年6月—2019年6月,50例早期胃癌患者、40例胃良性病变患者及35例健康体检者清晨空腹抽外周静脉血5ml,检测胃蛋白酶原Ⅰ(PGI)、胃蛋白酶原Ⅱ(PG Ⅱ)、胃蛋白酶原比值(PGR)及IL-33表达水平,分析早期胃癌患者血清IL-33表达水平与临床特征的关系;采用Western blot检测早期胃癌癌组织、癌旁组织、胃良性病变患者胃黏膜组织IL-33蛋白表达水平.利用受试者操作特征(ROC)曲线评估PGI、PGR及IL-33诊断早期胃癌临床效能.结果显示,与胃良性病变组和对照组相比,早期胃癌患者血清PG Ⅰ水平、PGR显著降低,而IL-33水平显著升高(P＜0. 05);而PGⅠ、PGⅡ、PGR和IL-33水平在胃良性病变组和对照组,差异均无统计学意义(P＞0.05).早期胃癌黏膜癌组织、癌旁组织和胃良性病变患者的胃粘膜组织中IL-33蛋白灰度值相对表达水平差异均有统计学意义(P＜0.05);早期胃癌患者癌旁组织中IL-33蛋白灰度值相对表达水平显著高于胃良性病变患者(P＜0.05).早期胃癌患者血清IL-33表达水平与年龄、肿瘤直径、肿瘤细胞分化程度、伴有溃疡形成及Hp感染史有关.IL-33、PGR、PG I诊断胃癌的ROC曲线下面积(AUC)分别为0.904、0.823和0.788,当IL-33截断值为250.24ng/ml时,此时敏感度和特异度可达到87.21%和97.01%.结果表明, IL-33可能参与了早期胃癌的发病机制,IL-33表达水平与早期胃癌的临床特征有关,有望成为诊断早期胃癌的血清肿瘤学指标之一.

目的 比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后同期行内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)与ERCP术后二期行LC治疗胆囊结石合并胆总管结石的疗效,探讨同期LC+ERCP治疗胆囊结石合并胆总管结石的临床价值.方法 62例胆囊结石合并胆总管结石患者,根据手术方式分为观察组28例和对照组34例,观察组行同期LC+ERCP治疗,对照组于ERCP术后二期行LC治疗,比较2组患者临床资料及术后住院时间、并发症发生率、术前及术后1个月血清前白蛋白和白蛋白水平.术后第3天行经鼻胆管造影,观察2组结石清除情况.结果 2组体质量指数、胆总管结石数量和直径、胆总管直径及谷丙转氨酶、总胆红素水平比较差异无统计学意义(P＞0.05).观察组术后住院时间[(7.0±1.5)d]短于对照组[(8.8±1.5)d](P＜0.05),术后并发症发生率(7.1％)与对照组(8.8％)比较差异无统计学意义(P＞0.05).观察组术前及术后1个月血清前白蛋白[(238.2士19.5)、(285.7±21.5)g/L]和白蛋白[(31.7±3.4)、(37.5士3.0)g/L]水平与对照组[(243.1±20.8)、(285.1士22.8)g/L,(32.5±3.4)、(37.2±2.7)g/L]比较差异均无统计学意义(P＞0.05);2组术后1个月血清前白蛋白及白蛋白水平均高于术前(P＜0.05).2组术后第3天经鼻胆管造影显示结石清除率均为100％.结论 同期LC+ERCP治疗胆囊结石合并胆总管结石安全、有效,住院时间短.

目的 比较腹腔镜下规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇(COR)和外周血T淋巴细胞亚群的变化.方法 2017年11月～2018年11月我院收治的85例复杂性肝内胆管结石患者,其中52例对照组患者接受开腹肝切除术,33例观察组患者接受腹腔镜下规则性肝段或肝叶切除术.结果 观察组手术时间为198.9±15.2 min,显著长于对照组(172.4±18.1 min,P＜0.05),术中出血量、术后肛门排气时间和术后住院时间分别为211.1±17.9 mL、18.3±3.1 h和7.8±1.5 d,显著少于或短于对照组[分别为(245.9±23.6 mL、27.5±4.3 h和10.0±2.2 d),P＜0.05];术后3d,观察组血清COR、C反应蛋白(CRP)、肾上腺素(EP)和白介素-6(IL-6)水平分别为232.5±27.9 nmol/L、15.8±1.6 m g/L、204.3±19.2 ng/mL和72.7±6.9 μg/L,均显著低于对照组[分别为(327.0±35.6 nmol/L、31.2±2.8 mg/L、352.8±31.5 ng/mL和111.6±10.3 μg/L),P＜0.05];观察组外周血CD3+、CD4+和CD8+细胞百分比分别为58.1±5.2％、37.1±4.1％和28.2±1.7％,与对照组比,差异显著(分别为53.2±4.9％、33.6±4.0％和37.6±3.4％,P＜0.05).结论 腹腔镜下规则性肝段或肝叶切除术较开腹肝切除术对患者的创伤更小,能够抑制应激反应,提高机体免疫力,可能更有利于患者术后恢复.

Objective:To observe the effects of probiotics and bioelement on intestinal flora in mice with severe acute pancreatitis.Methods:Eighty 6-8-week-old male C57BL/6J mice were randomly divided into four groups, each containing 20 mice. Group A was the blank control group, group B was the modeling control group, group C was the probiotics group, and group D was the symbiotic tuple group. The body weight, pathological score, serum serotonin oxidase (DAO), endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL)-6 concentrations of the mice in each group were compared, and the relative abundance of intestinal mucosa and fecal samples in each group was compared.Results:At first week, weight of mice in groups B, C and D was lower than that in group A [(35.11±0.70) g], and that in group C [(33.46±0.72) g] and group D [(33.50±0.89) g] than in group B [(30.35±0.89) g]. The pathological scores in group B (27.00±7.94), group C (5.40±2.79) and group D (7.25±2.85) were higher than in group A (0), and those in groups C and D were lower than in group B, with the difference being statistically significant ( F=7.586, 5.365, P< 0.05). Serum DAO [(1.13±0.21), (1.00±0.32), (0.98±0.21) U/L], endotoxin [(3.48±0.07), (2.56±0.10), (2.55±0.05) EU/L], TNF-α [(21.07±9.09), (16.24±2.52), (15.90±8.43) ng/L], and IL-6 [(24.96±8.89), (20.41±6.02) ng/L, (19.02±7.40) ng/L] were significantly higher groups B, D and D than those in group A, and those in groups C and D were significantly higher than those in group B ( F=8.427, 6.536, 4.151, 6.158, P< 0.05). Alpha diversity analysis showed that the fecal and intestinal mucosal flora biodiversity of mice in groups B, C and D was significantly less than that in group A ( F=2.084, 2.823, 2.557, 2.186, 2.573, 1.983, P< 0.05). Principal Component Analysis (Principal Component Analysis, PCA) showed that the fecal flora of mice in each group was compared, and the differences were statistically ( t=2.279, 2.559, 2.495, 1.975, 2.557, 2.084, P< 0.05). Conclusion:Probiotics and synbiotics can reduce the degree of intestinal inflammation in mice with severe acute pancreatitis, regulate the proportion of beneficial bacteria, maintain the balance of intestinal flora, and protect the intestinal barrier and absorption function.

Objective:To explore application values of action research practice in the out-of-hospital health management of patients with rectal cancer stoma.Methods:According to the convenience sampling method, 46 patients with rectal cancer stoma who were admitted to Nanyang Central Hospital of Henan Province from March 2017 to March 2018 before the implementation of the action research practice were selected as the control group and 46 patients with rectal cancer stoma who were admitted from April 2018 to April 2019 after the implementation of the action research practice were selected as the observation group. The control group was given routine nursing after surgery while the observation group was given action research practice nursing after surgery. Hamilton Anxiety Scale (HAMA) , Hamilton Depression Scale (HAMD) , Exercise of Self-Care Agency Scale (ESCA) and MOS 36-Item Short-Form Health Survey (SF-36) were used before and after implementation to compare the implementation effects between the two groups.Results:After nursing, scores of HAMA and HAMD in the observation group were respectively (15.65±10.31) points and (17.41±9.25) points, both lower than those in the control group and the differences were statistically significant ( t=2.181, 2.384; P<0.05) . After nursing, the total score of ESCA of the observation group and the control group were respectively (114.96±20.45) points and (100.28±16.80) points and the difference was statistically significant ( t=3.762, P<0.05) . After nursing, the overall health of SF-36 scale was (19.11.±5.08) points in the observation group and (17.11±4.12) points in the control group and the difference was statistically significant ( t=2.074, P<0.05) . Conclusions:Carrying out action research practice for out-of-hospital health management of patients with rectal cancer stoma can alleviate negative emotions and improve self-care ability and quality of life of patients, which has relatively high clinical application value.

目的 探讨高频热疗、腹腔热灌注化疗联合静脉化疗对局部复发直肠癌的疗效分析.方法 选取局部复发直肠癌89例,随机分为实验组及对照组,实验组给予高频热疗、腹腔热灌注化疗联合静脉化疗,对照组仅给予静脉化疗.结果 实验组有效率为91.11％,局部有效率为95.56％,与对照组(65.91％,79.55％)比较,差异均有统计学意义(P<0.05).实验组1年、3年无瘤生存率分别为80.00％,62.22％,与对照组(56.81％,38.64％)比较,差异均有统计学意义(P<0.05);实验组1年、3年总生存率分别为为95.56％,71.11％,与对照组(79.55％,47.73％)比较,差异均有统计学意义(P<0.05).两组组间无明显差别:腹痛症状实验组略高于对照组,腹泻、Ⅱ度及以上恶心呕吐、Ⅲ度及以上骨髓抑制、周围神经毒性实验组略低于对照组,但是差异无统计学意义(P>0.05).结论 高频热疗、腹腔热灌注化疗联合静脉化疗对局部复发直肠癌疗效显著,安全性好,值得临床推广使用.

目的 探讨预防性造瘘在低位直肠癌根治术中的临床应用价值.方法 回顾性分析76例老年低位直肠癌患者的临床资料,所有患者均接受直肠癌前切除术,根据是否进行预防性造瘘分为观察组(n=40)和对照组(n=36),观察组患者进行预防性造瘘,对照组患者未进行预防性造瘘,比较两组患者的术后相关指标(首次排气时间、住院时间和住院费用),术前和术后7天外周血C反应蛋白(CRP)水平及淋巴细胞总数,术前和术后5天外周血降钙素原(PCT)水平,术后吻合口瘘发生率.结果 观察组患者术后首次排气时间、住院时间均明显短于对照组,住院费用明显少于对照组,差异均有统计学意义(P﹤0.01).术前,两组患者的外周血CRP、PCT水平及淋巴细胞总数比较,差异均无统计学意义(P﹥0.05).观察组患者术后7天外周血CRP水平、术后5天外周血PCT水平均明显低于同时间点对照组患者,观察组患者术后7天外周血淋巴细胞总数明显多于同时间点对照组患者,差异均有统计学意义(P﹤0.01).术后,观察组患者的吻合口瘘发生率低于对照组(P﹤0.05).结论 对于老年低位直肠癌患者,在低位直肠癌根治术中进行预防性造瘘可缩短术后首次排气时间和住院时间,减少住院费用和炎性反应,降低吻合口瘘的发生率,是一种更加安全的选择.

目的:探讨乌司他丁联合Seldinger技术置腹腔双套管负压吸引治疗肠瘘的临床效果.方法 :选取我院2015年3月—2018年3月收治的肠瘘患者60例作为观察对象,按照随机数字表法分为对照组和观察组,各30例.对照组采用Seldinger技术置腹腔双套管负压吸引方法,观察组在此基础上给予乌司他丁(10万单位溶于10％的葡萄糖注射液250 mL静脉滴注,bid)治疗.比较两组临床效果、C反应蛋白(CRP)、白细胞介素(IL)-1、IL-6水平、置管时间、穿刺前后患者0～24 h最高体温变化情况.结果 :观察组总有效率高于对照组,差异有统计学意义(P<0.05);观察组置管时间短于对照组,穿刺前后最高体温变化大于对照组,差异有统计学意义(P<0.05);观察组CRP、IL-1、IL-6水平低于对照组,差异有统计学意义(P<0.05).结论 :乌司他丁联合Seldinger技术置腹腔双套管负压吸引治疗肠瘘的疗效理想,可作为一种推荐的治疗方案应用于临床.

Objective To investigate the clinical features and prognostic factors of extrahepatic biliary neuroendocrine neoplasms(EB-NENs).Methods The clinical data and survival of 21 patients with EB-NENs admitted from May 2014 to May 2018 were analyzed retrospectively.Results These 21 EB-NENs patients accounted for 1.6％ (21/1313) of all biliary tract neoplasms treated during the study period.Seven (33.3％) cases had lymph node metastasis.Five (23.8％) suffered from distant metastasis.The follow up time was (4 ～ 46.5) months with median survival time of (23.23 ± 4.17) months.Univariate analysis showed that the risk factors for survival were tumor TNM stage (x2 =9.066,P =0.003),lymph node metastasis(x2 =6.399,P=0.011) and distant metastasis (x2 =9.808,P=0.002).By multivariate analysis,independent risk factors were tumor TNM stage (P =0.008,RR =3.003,95％ CI:1.332 ～ 6.774),lyraph node metastasis (P =0.023,RR =5.382,95 ％ CI:1.261 ～ 22.971) and distant metastasis or not(P =0.007,RR =7.423,95％ CI:1.730 ～ 31.851).Conclusion EB-NENs was a rare malignant tumor with poor prognosis.Tumor TNM stage,lymph node metastasis and distant metastasis were independent prognostic factors for EB-NENs patients.

Objective To explore the effects of microRNA (miRNA,miR)-483-3p targeting G1S specific cyclin E1 (CCNE1) on the proliferation and migration of colon cancer cells and its mechanism.Methods From June 2015 to June 2019,samples of colorectal cancer and adjacent tissues were collected in our hospital and selected as research objects.The expression levels of miR-483-3p in tumor and adjacent tissues were analyzed by fluorescent quantitative polymerase chain reaction (PCR).Lentiviruses were used to establish control microRNA and miR-483-3p overexpression cell lines (miR-control group and miR-483-3p group) in colon cancer cell lines.The proliferation ability of two groups of cells was analyzed by cell counting kit-8 (CCK-8).The migration ability of two groups of cells were analyzed by Tranwell.bioinformatics and double luciferase reporter gene were used to analyze the target gene of miR-483-3p.The difference between the two groups was analyzed by t test.Results Compared with the adjacent tissues of colon cancer (1.12 ±0.21),the expression level of miR-483-3p (0.37 ±0.12) in colon cancer tissues was significantly decreased (t =3.001,P ＜ 0.05).Compared with the miR-control group,the cell proliferation in the miR-483-3p group decreased significantly (F =2.891,P ＜ 0.05).Compared with the miR-control group (86.32 ± 9.32) ％,the cell migration ability of the miR-483-3p group (32.65 ± 6.18) ％ significantly decreased (t =4.011,P ＜ 0.05).Bioinformatics and double luciferase gene confirmed that CCNE1 was the target gene of miR-483-3p.In the miR-control group,the proliferation ability of cells overexpressing CCNE1 protein was significantly higher than that of cells overexpressing empty vectors (F =3.193,P ＜ 0.05).The proliferation ability of cells overexpressing CCNE1 protein in the miR-483-3p group significantly increased compared with cells overexpressing empty vectors in the miR-483-3p group (F=0.132,P＞0.05).Conclusion The expression of miR-483-3p in colon cancer ignificantly down-regulated,which leads to the increase of CCNE1 expression and promotes the proliferation and migration of colon cancer.