Objective:To investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods:A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results:All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. Conclusion:The soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.

目的 探讨胸腔镜下亚肺叶切除术联合纵隔淋巴结采样治疗老年早期非小细胞肺癌(NSCLC)的临床效果.方法 选取2017年1月—2020年1月收治的老年早期NSCLC 138例,行传统开胸肺叶切除术69例作为对照组,行胸腔镜下亚肺叶切除术联合纵隔淋巴结采样69例作为观察组.比较2组围术期指标、肺功能评分及术后并发症发生情况,并分析2组术后1年生存情况.结果 观察组手术时间、术后引流天数及住院时间短于对照组,术中出血量、淋巴结清扫个数、纵隔淋巴结清扫个数、术后引流量少于对照组,术后疼痛评分低于对照组(P<0.05).2组术后用力肺活量(FVC)、最大通气量(MVV)均低于术前,但观察组术后FVC、MVV高于对照组(P<0.05).观察组术后并发症发生率低于对照组,术后1年生存率高于对照组(P<0.05).结论 胸腔镜下亚肺叶切除术联合纵隔淋巴结采样治疗老年早期NSCLC效果确切,并发症发生率低,可改善患者生存情况.

目的:探究同步放化疗后全胸镜根治术结合养肺控瘤方治疗非小细胞肺癌的质量控制及生存分析.方法:回顾性分析136例来我院就诊的非小细胞肺癌的患者,将其分为两组,其中研究组为同步放化疗后行全胸腔镜根治术;对照组为全胸腔镜根治术后联合养肺控瘤方治疗.根据肺癌诊疗规范手术质量控制标准分析两组患者质量控制达标情况,并采用Log-rank比较两组的生存差异,以及Kaplan-Meier法比较累计生存率及中位生存时间.结果:分析结果显示研究组患者质量控制达标水平明显高于对照组,P<0.05,差异具有统计学意义;用Kapl

目的 探讨吉非替尼联合三维适形放疗治疗老年晚期非小细胞肺癌(NSCLC)的近远期疗效及对血清肿瘤标志物的影响.方法 选择2013年5月—2014年11月我院收治的老年晚期NSCLC患者79例,根据治疗方法不同分为观察组42例和对照组37例;观察组给予三维适形放疗联合吉非替尼,对照组给予三维适形放疗.评价2组治疗后的近期疗效和远期疗效[5年无进展生存时间(PFS)和总生存时间(OS)].比较2组治疗前后癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)含量及毒副反应发生情况.结果 观察组近期总有效率高于对照组(P<0.05),观察组PFS、OS长于对照组(P<0.05,P<0.01).与治疗前比较,2组治疗后血清CEA、CYFRA21-1含量均显著降低,且观察组低于对照组(P<0.01).2组毒副反应总发生率比较差异无统计学意义(P>0.05).结论 吉非替尼联合三维适形放疗治疗老年晚期NSCLC能取得较单用三维适形放疗更为优越的近远期疗效,且有利于血清肿瘤标志物的降低,治疗安全性好.

目的 探讨康艾注射液联合DP方案治疗老年中晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的近期效果及对免疫功能的影响.方法 选取老年中晚期NSCLC 94例,根据治疗方法 不同将其分为观察组(49例)和对照组(45例)两组.观察组采用康艾注射液联合DP方案(顺铂联合吉西他滨)治疗,对照组采用DP方案治疗,均连续治疗4个周期.观察比较两组治疗后近期效果,治疗前后血清免疫指标和可溶性白细胞介素-2受体(SIL-2R),以及治疗期间毒副反应发生情况.结果 治疗后,观察组近期总有效率为85.71％高于对照组近期总有效率64.44％,差异有统计学意义(P<0.05).治疗前,两组血清免疫指标及SIL-2 R水平比较差异无统计学意义(P>0.05).治疗后,观察组血清IgG、IgA、IgM水平及两组血清CD3+、CD4+水平较治疗前升高,对照组血清IgG、IgA、IgM水平及两组血清CD8+、SIL-2 R水平较治疗前降低,差异有统计学意义(P<0.05或P<0.01).治疗后,观察组血清IgG、IgA、IgM及CD3+、CD4+水平高于对照组,血清CD8+和SIL-2 R水平低于对照组,差异有统计学意义(P<0.01).治疗期间,观察组肝损害和骨髓抑制发生率低于对照组,差异有统计学意义(P<0.05).结论 康艾注射液联合DP方案治疗老年中晚期NSCLC可提高近期效果,改善机体免疫功能,减轻化学治疗毒副反应.

目的:探讨微创手术治疗与养肺控瘤方对非小细胞肺癌患者的临床疗效评价.方法:选取我院2018年11月-2019年11月收治的120例非小细胞肺癌患者作为研究对象,将其分为对照组与中药组,各60例,对照组给予开放手术治疗,中药组给予胸腔镜肺叶切除术联合养肺控瘤方治疗,观察两组患者围术期相关指标、术后T淋巴细胞亚群以及生活质量.结果:中药组的肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、白介素-10(IL-10)水平以及并发症等情况均低于对照组,差异均具有统计学意义(P<0.05);术后,中药组的CD3+低于对照组,CD4+、CD8+、CD4+/CD8+均高于对照组;中药组的生活质量评分优于对照组,差异均具有统计学意义(P<0.05).结论:针对非小细胞肺癌患者应用微创手术与养肺控瘤方治疗,可有效降低患者炎症反应,提高患者生活质量,值得临床推广应用.

患者男,31 岁.主因"排便时肿物脱出肛门外伴便血 1 年余"入院.入院前 1 年余,患者因大便干结 、排出费力致排便时有肿物脱出肛门外,初期可自行还纳,后需用手推送才能还纳,偶伴便血,为鲜血,无明显疼痛,1 年多来持续发作,发作时无发热,无恶心 、呕吐,来我院就诊.查体可见环状外痔,指诊可触及环状内痔,质中等,直肠无明显肿块,指套无血染.入 院 后 给 予 相 应 检 查,于入院第 2 天行PPH.患者于术后第 4 天停止排便 、排气,出现腹胀症状,给予胃肠减压,并行结肠镜检查,结果显示直肠吻合口水肿,狭窄明显,镜身不能通过.遂于硬膜外麻醉下行吻合口狭窄扩张术,术中发现吻合口严重狭窄,未找到与肠腔相通的通道,若强行分离,出现大出血 、肠穿孔等的风险较大,遂中止手术.经北京多家三甲医院医师门诊会诊,均建议结肠造口.于第 1 次手术后第 5 天,硬膜外麻醉下经肛门再次探查吻合口并准备行经腹结肠造口术.术中发现截石位 5 点处有一直径约 0.3 cm 的通道,只能容止血钳钳尖通过,置入 10 号普通红色导尿管(直径 3.5 mm),经导尿管引流出绿色稀便.将普通扩张球囊(直径 1.5 cm)置入,注水扩张持续 5 min,撤出,自行排出大量稀便,食指能通过狭窄处,手术结束.未行造口术.

目的 观察大隐静脉曲张患者行大隐静脉主干次高位结扎加点式剥脱术并且保留大隐静脉属支的术后复发率.方法 选取2010—2015年河北衡水饶阳县人民医院收治的320例行手术治疗的大隐静脉曲张患者,随机分为对照组160例和实验组160例.对照组行传统手术,切断大隐静脉的所有属支并且高位结扎主干;实验组保留大隐静脉属支,行主干次高位结扎加剥脱术.对比2组的临床效果.结果 2组患者的复发率无明显差异.结论 保留大隐静脉属支并且行大隐静脉主干次高位结扎加点式剥脱术,疗效可靠,值得临床推广.

Objective To detect the immune function and safety of irradiated blood in lung cancer patients.Methods One hundred and five patients were divided into irradiated group,conventional group and non-transfusion group.Irradiation group used irradiated blood in the operation,conventional group used regular blood,while the non-transfusion group without transfusion.Then the immune function and transfusion associated graft versus host disease(TAGVHD) in three groups were observed.Results The T cell subsets (CD4+,CD8+,CD4+/CD8+),NK cell,immunoglobulins (IgM,IgG,IgA) and complement (C3,C4) were all first lowered and then increased,the irradiation group and non-transfusion group returned to normal seven days after surgery.The conventional group did not reach the preoperative level.The CD4+,CD8+,NK cells,immunoglobulin(IgM,IgG,IgA) and complement(C3,C4) betewwn the groups,time points,groups · time points interaction were statistically significant (P＜ 0.05).CD4+/CD8+ in time points was significant difference (P＜0.05),and there was no significant difference in interaction between groups and groups · time points(P＞0.05).No patients with TA-GVHD were found in the irradiated blood group and normal blood group in 1 month.Conclusion The irradiated blood had no significant effect on immune function of the lung cancer patients,which was a safe and reasonable and feasible way for blood transfusion.

目的：观察放射粒子125 I植入联合化疗治疗非小细胞肺癌的临床疗效。方法选取非小细胞肺癌患者患者72例，随机分为观察组与对照组，每组36例。对照组予替吉奥联合奥沙利铂（ SOX方案）化疗，观察组先予放射性125 I粒子植入，植入粒子后5d进行化疗，化疗方案同对照组。观察2组治疗总有效率、不良反应发生率及远期疗效（2年生存率）。结果观察组总有效率为81．4％，高于对照组的51．2％（P＜0．05）；观察组不良反应发生率虽高于对照组，但2组比较差异无统计学意义；随访结果显示观察组2年生存率为66．7％，显著高于对照组的41．5％（ P＜0．05）。结论放射粒子125 I植入联合化疗治疗非小细胞肺癌，可显著提高治疗总有效率，延长患者2年生存率，且不增加患者不良反应，值得临床推广应用。

目的比较结直肠癌患者体内、外前哨淋巴结( SLN)定位法各自的检出率、准确性和特异性,并分析各自在临床应用中的利弊。方法选取64例结直肠癌患者行前哨淋巴结定位( SLNM)检测,其中34例行体内法SLNM(体内组),30例行体外法SLNM(体外组)。所有获得的前哨淋巴结及非前哨淋巴结均给予连续切片并以CK20为标记物进行免疫组织化学分析。结果体内组和体外组的肿瘤大小、位置、分期及分化程度差异均无显著性(P>0.05)。体内组和体外组前哨淋巴结平均检出数分别为(2.35±1.03)个和(2.45±1.93)个,检出率分别为88.24%和86.67%,准确性分别为87.50%和90.05%,假阴性率分别为8.8%和6.7%,分期提高率分别为20.00%和17.65%,差异均无显著性(P>0.05)。结论结直肠癌前哨淋巴结体内外定位法具有相似的检出率和准确性,体外法技术含量要求相对低、操作相对简单易行,所以在此方面较体内法有一定优势。

目的：探讨对结直肠癌患者行体外法定位前哨淋巴结（ sentinel lymph node，SLN）技术的可靠性及其对肿瘤分期的临床应用价值。方法回顾性分析39例结直肠癌患者体外法定位的SLN，用10g/L异硫蓝染料对离体肿瘤染色并在5min内找出被蓝染的第1~4个淋巴结判定为SLN。组织病理学检查被HE染色蓝染的SLN；若检查结果为阴性，再对其行免疫组织化学染色，寻找染色为阳性的淋巴结；常规病理检查所获得的全部淋巴结，并计算体外法SLN 检出率及病理分期提高率。结果共检出淋巴结672枚，其中 SLN 102枚。SLN 患者36例（92.3%，36/39）；每例患者SLN为1~5枚，平均2.62枚。其中17例患者行常规HE染色联合免疫组织化学染色检测SLN微转移灶皆为阴性，于根治性切除术中获得的标本中非SLN的区域淋巴结也均为阴性，即假阴性率为0.0%；12例患者于常规HE染色中检测到SLN中存在微转移灶，检出率为30.8%（12/39），HE染色为阴性联合免疫组织化学染色被证实存在微转移灶患者7例，联合抗细胞角蛋白免疫组织化学染色法提高检出率为17.9%（7/39），病理分期提高率为20.5%（8/39）。结论结直肠癌体外SLN定位活组织检查法具有较高的准确性，联合应用免疫组织化学染色能提高检出率，使患者病理分期得到提高，并对应用辅助化疗及对患者预后的评估给予准确参考指标。

目的 评价酶组织化学双重染色法在肿瘤组织脉管新生研究中的作用.方法 对人结直肠腺瘤、结直肠癌、胃癌、喉癌、结直肠癌细胞系Colon-21和鳞状上皮癌Vx2细胞系种植瘤标本,通过5'-核苷酸酶-碱性磷酸酶组织化学双重染色,相邻切片的HE染色,进行了光镜观察.结果 在所用病理类型的肿瘤组织中,均可观察到5'-核苷酸酶阳性管道结构,HE染色切片观察显示其为淋巴管;肿瘤周围组织和血管平滑肌,也呈5'-核苷酸酶强阳性反应;在同一组织切片上,碱性磷酸酶阳性管道为血管,某些炎性细胞也呈现碱性磷酸酶阳性反应.结论 肿瘤组织与正常组织相似,5'-核苷酸酶阳性管道为淋巴管,碱性磷酸酶阳性管道为血管,5'-核苷酸酶-碱性磷酸酶组织化学双重染色法,在研究肿瘤组织脉管新生现象中,可用于血管和淋巴管的区分.

Objective To study the feasibility of sentinel lymph node(SLN)mapping during operation and the clinical value of analyzing lymph node metastasis of colon cancer. Methods SLN was mapped during operation by isosulfan stain in 44 cases with colon cancer. All lymph nodes were checked by routine pathological technique, while SLNs were checked by serial sectioning pathologic technique and immunohistochemistry. Results Twenty-eight of 44 cases were showed SLN. A total of 114 SLNs was positively inspected in 44 cases. The SLNs count in each case was 1-5, (2.6±2.1)SLNs in average. Seven hundred and ninety-two non-SLNs were inspected in these 44 cases. The non-SLNs count in each case was 9-35 (18.0 ±8.7 in average). In these 44 cases, 28(64%)had lymphatic metastasis and 16 (36%) didnt. Twenty-six cases of the 28 who had lymphatic metastasis were inspected metastasis of SLNs. Conclusion The SLN mapping during operation is feasible and helpful to the positive finding rate of the metastatic lymph node of colon cancer.

目的 探讨乳腺癌组织内淋巴管密度(lymphatic vessel density,LVD)及其与腋窝淋巴结癌细胞转移的相关性.方法 采用5-核苷酸酶和碱性磷酸酶组织化学双霞染色法,对50例乳腺组织标本(包括乳腺癌组织标本40例,乳腺纤维瘤组织标本5例,正常乳腺组织标本5例)中的LVD进行光镜观察和图像分析.结果 乳腺癌组织中的LVD值16.10±1.51,明显大于乳腺纤维瘤组织中的LVD值12.45±0.47,也大于正常乳腺组织中的LVD值12.37±0.45.在腋窝淋巴结出现癌转移组,其乳腺癌组织中的LVD值17.74±0.48,明显大于无腋窝淋巴结癌转移组的LVD值为14.88±0.49.结论 乳腺癌组织中的LVD与腋窝淋巴结癌转移状态密切相关,是预测乳腺癌腋窝淋巴结转移状态的有价值指标之一.

[病例] 男,69岁.因饮酒后6小时突发腹痛4小时急诊入院.6小时前狂饮白酒约一斤,回家途中有轻微外伤史,2小时后突发剧烈腹痛,为持续性,伴恶心、呕吐,呕吐数次均为胃内容物,曾排少量酱油色尿液.

Objective To investigate the prevention and treatment of complications inguinal hernia treated with mesh-plug tension-free hernia repair.Methods To select 116 patients of inguinal hernia underwent tension-free repair with mesh-plug(Company Bard of America)from may,1995 to Nov.2007.Results Following up visit for six months-one year,no death,The post operative complication,included infection 1 case(0.9%),the incision hematoma 1 case(0.9%),the intractable pain 1 case(0.9%),the local gelosis and foreign body sensation 2 cases(1.7%),the edema of scrotum and fluidify 2 cases(1.7%),the chorditis and orchiditis 1 case(0.9%).Conclusions To traditional hernia repair,mesh-plug tension-free hernia repair was demonstrated the advantages,good operative skills and appropriate post operative managements are the keys of prevention and cure for inguinal hernia post-operative complications.