目的 探讨干扰素α-2b栓联合宫颈环形电切术治疗宫颈炎合并高危型人乳头状瘤病毒(HPV)感染的疗效.方法 选择宫颈炎合并高危型HPV感染患者164例,均行阴道镜下宫颈活检和液基薄层细胞学检查,随机均分为对照组82例,联合治疗组82例.对照组接受宫颈环形电切术治疗,联合治疗组接受干扰素α-2b栓联合宫颈环形电切术治疗.术后6月,比较两组患者的整体疗效、HPV病毒载量、HPV转阴率和宫颈炎症指标,比较两组宫颈愈合时间、药物相关不良反应的发生情况.结果 术后6月,联合治疗组疗效分级、总有效率均优于对照组(P<0.05);联合治疗组HPV病毒载量低于对照组,HPV转阴率均高于对照组(P<0.05).联合治疗组阴道灌洗液中白细胞介素-2、白细胞介素-10、肿瘤坏死因子-α水平低于对照组(P<0.05).联合治疗组创面愈合时间、阴道流血时间、排液时间均短于对照组(P<0.05).两组间阴道局部红肿、干涩、瘙痒等不良反应发生率差异无统计学意义(P>0.05).结论 干扰素α-2b栓治疗能够促进宫颈炎合并高危型HPV感染的术后恢复,提升疗效,且在治疗安全性方面较为可靠.

目的 探讨干扰素阴道胶囊联合微波治疗宫颈炎合并高危型人乳头瘤病毒(HPV)感染对外周血Th17和Treg细胞及炎症因子的影响.方法 随机选择2015年1月—2018年1月在本院就诊的慢性宫颈炎合并高危型HPV感染患者90例,按随机数字表法分为观察组和对照组,每组45例.对照组给予重组人干扰素α2b栓,观察组给予重组人干扰素α2b栓联合微波治疗,治疗3个月后,观察两组患者的症状改善情况、HPV转阴率、血清炎性因子水平以及Th17和Treg细胞水平.结果 观察组总有效为41例,占91.1％,对照组为73.3％,观察组显著高于对照组(P＜0.05).治疗后观察组的白带量改善率、白带脓性改善率、高危型HPV转阴率均显著高于对照组(P＜0.05).治疗前两组患者的白介素-17(IL-17)、肿瘤坏死因子-β(TNF-β)、白介素-23(IL-23)水平比较,差异无统计学意义(P＞0.05);治疗后两组患者的IL-17、TNF-β、IL-23水平均显著下降,且观察组下降更加显著(P＜0.05).治疗后观察组的Treg细胞、Th17细胞水平,Th17/Treg比值均较对照组低(P＜0.05).治疗前两组患者的滴虫、真菌、细菌性阴道炎、衣原体、解脲支原体感染人数比较差异无统计学意义(P＞0.05),治疗后观察组的细菌性阴道炎、衣原体、解脲支原体感染显著降低,与对照组比较差异有统计学意义(P＜0.05).结论 干扰素阴道胶囊联合微波治疗宫颈炎患者的治疗效果好,可显著改善患者症状,减轻体内炎症反应,增加HPV转阴率,调节Th17和Treg细胞,对预防宫颈癌有重要作用.

目的 探讨人乳头瘤病毒(HPV)DNA分型联合v-Ki-ras2 Kirsten大鼠肉瘤病毒癌基因同源物(KRAS)、Ki-67检测对宫颈癌的诊断价值.方法 选择86例宫颈癌患者为观察组,以同期体检的90例宫颈炎患者为对照组.分别检测两组患者的HPV DNA分型及KRAS、Ki-67表达情况,分析HPV DNA分型联合KRAS、Ki-67检测在宫颈癌中的诊断价值.结果 观察组患者的HPV-DNA阳性率为97.67％,高于对照组的14.44％(P﹤0.05).观察组患者的HPV DNA分型以高危型病毒HPV16、HPV18为主,宫颈炎患者的HPV DNA分型以低危型病毒HPV6、HPV11为主.观察组患者的KRAS、Ki-67阳性率均高于对照组(P﹤0.05).HPV DNA分型联合KRAS、Ki-67检测诊断宫颈癌的特异度和准确度均高于任一单独检测方法.结论 宫颈癌患者的HPV阳性率及KRAS、Ki-67阳性率均较高,宫颈癌患者感染HPV以高危型HPV16和HPV18为主,HPV DNA分型联合KRAS、Ki-67检测对宫颈癌的诊断效能较高.

目的 探讨胰岛素样生长因子-1受体(IGF-1R)、表皮生长因子受体(EGFR)、p53蛋白在胸腺上皮瘤组织中的表达情况及临床意义.方法 采用免疫组织化学染色法检测82例胸腺上皮瘤患者的胸腺上皮瘤组织和60例胸腺滤泡性增生患者的胸腺滤泡性增生组织中IGF-1R、EGFR、p53蛋白的阳性表达情况,并分析其阳性表达情况与胸腺上皮瘤患者临床特征及预后的关系.将76例获得随访的胸腺上皮瘤患者分为生存组与死亡组,比较IGF-1R、EGFR、p53蛋白在两组中的阳性表达率.结果 IGF-1R、EGFR、p53蛋白在胸腺上皮瘤组织中的阳性表达率均明显高于胸腺滤泡性增生组织(P﹤0.01).不同性别、年龄、世界卫生组织(WHO)分型、肿瘤直径胸腺上皮瘤患者胸腺上皮瘤组织中IGF-1R、EGFR、p53蛋白的阳性表达率比较,差异均无统计学意义(P﹥0.05).Masaoka分期为Ⅲ～Ⅳ期、有淋巴结转移胸腺上皮瘤患者胸腺上皮瘤组织中,IGF-1R、EGFR、p53蛋白的阳性表达率均高于Masaoka分期为Ⅰ～Ⅱ期、无淋巴结转移的胸腺上皮瘤患者(P﹤0.05).死亡组中IGF-1R、EGFR、p53蛋白的阳性表达率均明显高于生存组(P﹤0.01).Pearson相关性分析结果显示,EGFR与IGF-1R、p53蛋白的阳性表达均呈正相关(r=0.270、0.443,P﹤0.05),IGF-1R与p53蛋白的阳性表达无相关性(r=-0.121,P﹥0.05).结论IGF-1R、EGFR、p53蛋白在胸腺上皮瘤组织中表达异常,且与胸腺上皮瘤的进展有关,对肿瘤的恶性程度和预后评估具有重要意义.

目的 探讨免疫细胞及肿瘤标志物与有高危型人乳头瘤病毒(HPV)感染的宫颈癌患者HPV水平的相关性及与预后的关系.方法 选取有HPV感染的72例宫颈癌患者(宫颈癌组)、83例宫颈上皮内瘤变(CIN)患者(CIN组)和50例慢性宫颈炎患者(慢性宫颈炎组).比较不同宫颈疾病患者外周血免疫细胞(CD4+、CD8+、CD4+/CD8+、CD56+、Treg)水平和肿瘤标志物(K-ras、Ki-67)的阳性表达情况,高危型HPV宫颈癌患者HPV水平与免疫细胞及肿瘤标志物的相关性,以及有无淋巴结转移的高危型HPV感染宫颈癌患者的免疫细胞水平及肿瘤标志物阳性表达情况,宫颈癌死亡患者与生存患者的免疫细胞水平及肿瘤标志物阳性表达情况.结果 宫颈癌组患者的CD4+、CD56+、CD4+/CD8+水平均低于CIN组患者和慢性宫颈炎组患者(P﹤0.05),CD8+、Treg的水平均高于CIN组患者和慢性宫颈炎组患者(P﹤0.05);3组患者的K-ras、Ki-67的阳性表达率比较,差异均有统计学意义(P﹤0.05);宫颈癌组患者的CD8+、Treg水平及K-ras、Ki-67阳性表达情况与HPV-DNA水平呈正相关(r=0.546、0.402、0.645、0.713,P﹤0.05),而CD4+、CD56+水平与HPV-DNA水平呈负相关(r=-0.478、-0.463,P﹤0.05);宫颈癌组有淋巴结转移的患者CD4+、CD56+、CD4+/CD8+水平均明显低于无淋巴结转移的患者(P﹤0.01),而CD8+、Treg的水平及K-ras(+++)、Ki-67(+++)的比例均高于无淋巴结转移的患者(P﹤0.05);宫颈癌组死亡患者的CD4+、CD4+/CD8+、CD56+水平均明显低于生存患者(P﹤0.01),而CD8+、Treg的水平及K-ras(+++)、Ki-67(+++)的比例均明显高于生存患者(P﹤0.01).结论 与有高危型HPV感染的CIN患者和慢性宫颈炎患者比较,有高危型HPV感染的宫颈癌患者的免疫功能降低,而其肿瘤标志物K-ras、Ki-67表达升高,免疫细胞和肿瘤标志物的检测有助于高危型HPV感染宫颈癌患者的早期预防、诊断及预后评估.

目的 观察同期肋骨内固定手术在胸外伤合并多发肋骨骨折治疗中的应用效果.方法 选取医院收治的合并多发肋骨骨折的胸外伤患者142例,随机分为观察组和对照组,每组71例.对照组采用常规开胸术治疗,观察组采用同期肋骨内固定术治疗.观察比较2组临床疗效、不良并发症、手术情况.结果 观察组治疗总有效率为93.0％,高于对照组的77.5％ (P ＜0.01);观察组不良并发症发生率为8.5％,低于对照组的28.2％ (P＜0.01);观察组手术时间、通气时间、呼吸机使用时间、住院时间短于对照组,手术出血量少于对照组(P均＜0.01).结论 同期肋骨内固定手术治疗合并肋骨骨折的胸外伤患者手术时间短,可减少术后出现的各种不良并发症,疗效更为理想,值得临床推广应用.

目的 观察比较电视胸腔镜与常规开胸肺叶切除手术治疗非小细胞肺癌患者的临床效果.方法 选取医院收治的非小细胞肺癌患者80例,随机分为观察组和对照组,每组40例.2组均采用双腔气管插管以及静脉复合麻醉,观察组采用电视胸腔镜肺叶切除手术,对照组采用常规开胸肺叶切除手术.观察比较2组手术指标、免疫功能指标、VAS评分及不良反应发生情况.结果 观察组术中出血量少于对照组,引流时间、住院时间短于对照组(P均＜0.01);治疗后,2组VAS评分较治疗前均降低,且观察组VAS评分低于对照组(P均＜0.01);治疗后,2组CD3、CD4水平较治疗前升高,CD8水平较治疗前降低,且观察组上述指标改善程度更明显(P均＜0.01);观察组不良反应发生率为7.50％,低于对照组的25.00％(P＜0.05).结论 在电视胸腔镜辅助下进行肺叶切除术治疗非小细胞肺癌,可减轻并发症及术后疼痛,调节免疫功能,有利于患者预后,较常规开胸手术治疗更佳.

Objective To investigate magnetic resonance imaging ( MRI )-guided argon-helium cryoablation combined with chemotherapy in treatment of elderly patients with advanced lung cancer. Methods A total of 215 elderly patients with advanced lung cancer were admitted during June 2012 and June 2015 were divided into observation group (n=112) and control group (n =113) according to treatment methods. Control group received chemotherapy only, while observation group was treated with MRI-guided argon-helium cryoablation on the basis of treatment for control group. The short-term efficacy, changes of T lymphocyte subsets levels and survival time were observed in two groups. Results Tumor control and clinical benefit rates in observation group were significantly higher than those in control group (P<0. 05). After treatment, CD3+, CD4+ and CD4+/CD8+ levels were significantly higher, while CD8+ levels were significantly lower than those before treatment in two groups (P<0. 05);in observation group, the CD3+, CD4+ and CD4+/CD8+ levels were significantly higher, while CD8+ level was significantly lower than those in control group (P<0. 05). Survival time in observation group was significantly longer than that in control group (P<0. 05). Conclu-sion MRI-guided argon-helium cryoablation combined with chemotherapy in treatment of elderly patients with advanced lung cancer can improve clinical effect, prolong survival time and enhance the immunity.

目的：通过磁共振( MR)导引的方法，利用氩氦刀对肺癌进行消融治疗，评价该方式治疗肺癌的有效性及安全性。方法收治的180例肺癌患者，中央型肺癌67例，周围型肺癌113例。通过MR引导下利用氩氦刀对肺癌进行消融治疗。结果 MR导引下氩氦刀消融肺癌，所有患者均顺利完成治疗。本组病例中，肿瘤被冰球完全覆盖43例(23.9%)，冰球覆盖病灶80%以上110例(61.1%)，低于80%27例(15.0%)。消融后CT扫描肿瘤CT值明显降低，部分患者肿块直径明显缩小或消失。结论 MR具有较高软组织分辨率，可任意方位断层成像，无电离辐射，对温度敏感，故引导氩氦刀消融肺癌疗效确切，手术过程简单，安全性好，术后并发症较少。

Objective To evaluate the feasibility of magnetic resonance ( MR) guided biopsy, and to evaluate the advantages of it. Methods 53 patients with biopsy were enrolled, among these patients, 31 male, 22 female, age range from 17 to 82 years old, median age was 48. 3 years;pulmonary lesion of 18 cases, vertebral lesions of 4 cases (1 case of thoracic, and 3 cases of lumbar spine) , hepatic lesions of 13 cases, renal space lesion of 7 cases, pelvic lesion of 11 cases ( uterine rectum space of 1 case, seminal vesicle lesion of 1 case, prostate of 9 cases) . Using optical guidance equipment and magnetic resonance imaging to complete the needle biopsy. Results 53 patients received successfully MR guided biopsy,identified as lung, vertebral body, liver, kidney and pelvic tumor respectively. All patients were well tolerated, and no complications oc-curred. Conclusion MR has high soft tissue resolution and no ionizing radiation, arbitrary slice imaging and puncture from multiple directions, so biopsy success rate is high and risk is low.

目的：探讨艾迪注射液联合多西他赛治疗老年人复发性非小细胞肺癌的临床疗效。方法采用前瞻性随机对照的方式将120例老年复发性非小细胞肺癌患者随机分为研究组和对照组，每组各60例，其中研究组采用艾迪注射液联合多西他赛治疗，而对照组则单纯采用多西他赛治疗，对比两组的临床疗效及安全性。结果研究组CR率、PR率及有效率均高于单纯对照组，但差异均无统计学意义（χ2＝0．06、0．20、0.32，P＝0．800、0．660、0．570）。研究组血小板减少发生率为18．33％，明显低于对照组的35．00％（χ2＝4.31，P＝0．039）。研究组Ⅲ～Ⅳ级白细胞减少发生率为21．67％，亦明显低于对照组的63．33％（χ2＝25．11， P＝0．01）。研究组生活质量有效率为88．33％，明显高于对照组的66．67％（χ2＝8．08，P＝0．005）。结论艾迪注射液联合多西他赛治疗老年人复发性非小细胞肺癌可以明显降低患者的血小板减少发生率和Ⅲ～Ⅳ级白细胞减少发生率，毒副反应较轻，患者可以耐受，改善生活质量，值得临床推广应用。

Objective To observe the clinical efficacy of GnRH-α and gestrinone in consolidation therapy after operation of endometriosis. Methods Eighty cases undergoing conservative surgery and diagnosed as pelvic endometriosis by pathological examination from January 2005 to January 2008 were divided into 2 groups randomly. 45 cases in GnRH- α group were injected GnRH -α 3.75 mg each time per 28 days from the first -fifth day of menstruation. 35 cases in gestrinone group took gestrinone 2.5 mg per day, twice a week from the first day of menstruation. Results The rates of dysmenorrhea and other painful systems in two groups after treatment were significantly lower than those before treatment (P < 0.05). Followed up results showed that complete remission rates in GnRH-α group and gestrinone group were 88.9% and 85.7%, respectively. The relapse rates in GnRH-α group and gestrinone group were 4.4% and 5.7%, respectively. There was no significant difference ( P > 0.05). The incidence of adverse reaction in GnRH- α group was significantly lower than that in gestrinone group. Conclusion Application of GnRH-α and gestrinone in consolidation therapy after operation of endometriosis is safe and effective, without serve adverse reactions.

Objective:To study the genetic damage induced by radiotherapy in cervical cancer patients.Methods: Blood samples were collected from 15 cervical cancer patients exposed to radiation at accumulated dose of 0Gy,10Gy,20Gy,30Gy,40Gy,50Gy,60Gy.To study DNA damage by comet assay.To study hprt gene mutation by multinucleated cell assay.Results:All the accumulated dose groups increased significantly according to 0Gy(P0.01).The increase of the comet frequency was linear from 0-60Gy.The tail length showed significant increase at all the accumulated dose groups(P0.01).At the accumulated dose of 30Gy,the tail length achieved the max value.There was no dose-effect manner between the tail length and the accumulated dose.Mutation frequency of hprt gene increased after radiation.The mutation frequency increased significantly at dose 30Gy,40Gy and 50Gy compared to 0Gy(P0.05).There was a good dose-effect manner between mutation frequency of hprt gene and accumulated dose.Conclusion: Radiotherapy induced DNA damage and hprt gene mutation in cervical cancer patients.To assess the radiation-damage by comet assay and hprt gene mutation has a high sensitivity.

目的评价培美曲塞联合奥沙利铂治疗晚期非小细胞肺癌的疗效及安全性。方法选择经病理学确诊,接受2个周期以上的化疗及失败的复发晚期非小细胞肺癌患者24例,给予培美曲塞500 mg/m2第1天+奥沙利铂120 mg/m2第1天静滴,每3周重复治疗1次,至少应用2个周期评价疗效及不良反应。结果 24例患者中,完全缓解2例,部分缓解4例,稳定10例,进展8例,有效率25%,疾病控制率67%。不良反应主要为轻中度的胃肠道反应和骨髓抑制。结论培美曲塞联合奥沙利铂治疗晚期复发性非小细胞肺癌疗效确切,不良反应轻,安全性好。

OBJECTIVE:To assess the radiotherapy damage using hprt gene mutation in cervical cancer patients.METHOD:Blood samples were collected from 15 cervical cancer patients exposed to radiation at the accumulated dose of 0-60 Gy.hprt gene mutation was studied by multinucleated cell assay.RESULT:Mutation frequency of hprt gene increased after radiation.The frequency increased significantly at dose 30,40 and 50 Gy compared to 0 Gy(P0.05).At the accumulated dose of 60 Gy,the mutation frequency was also higher than 0 Gy,but not statistically significant.The increase of hprt gene mutation frequency was linear from 0-40 Gy.There was a good dose-response effect between mutation frequency of hprt gene and accumulated dose(r=0.900,P0.05).Analysis showed a linear dose-response with an equation of y=0.459+0.014x(r=0.900,P0.05).CONCLUSION:Mutation frequency of hprt gene increased after radiation from 0-40 Gy.There was a good dose-response relationship between mutation frequency and accumulated dose.Mutation frequency of hprt gene could be a valuable biodosimeter.

One hundred and ninety one patients with esophageal carcinoma underwent surgical resection from January 2004 to January 2009. The gastroesophageal anastomosis was performed with auto suture instrument at superior aperture of the thorax in 107 cases (group A) and the instrument anastomosis was performed above or below the aorta arch in 84 cases ( group B ). The electron gastroscopy was performed and biopsy of mucosa at 3cm above the anastomosis was taken during the postoperative follow-up in all patients. Results showed that the incidence rate of reflux esophagitis in group A ( 5% ) was much lower than that in group B (51% ).

目的 探讨食管癌切除食管胃胸廓上口器械吻合的技术及较食管胃颈部吻合、食管胃弓上吻合的优势.方法 100例食管癌患者均经左胸切口食管癌切除食管胃胸廓上口器械吻合,通过术后病理了解上残阳性率,术后2个月胃镜检查,了解吻合口距门齿长度,吻合口大小,追问有无声音嘶哑及胃镜检查观察喉返神经有无损伤.结果 本组100例,食管上残阳性率6例,术后2个月胃镜检查,吻合口距门齿长度16～18 cm 82例(82%),18.1～21 cm 18例(18%),有声音嘶哑及胃镜检查证实喉返神经损伤者6例,吻合口中度狭窄10例(10%),重度狭窄4例(4%).结论 食管癌切除食管胃胸阔上口器械吻合术与传统的食管胃弓上或颈部吻合术相比具有手术损伤小、食管上残率低的优点且吻合口狭窄、声音嘶哑等并发症少.

目的 探讨改进器械吻合方法 对预防食管贲门癌切除术后并发症作用.方法 食管贲门癌患者324例,随机分为观察组和对照组各162例,对照组应用器械常规吻合方法 ,观察组应用改进后的器械吻合方法 .术后随访3～6个月,观察两组吻合口并发症发生情况.结果 观察组吻合口漏、吻合口狭窄分别为0.62%(1例)、2.46%(4例),与对照组的1.85%(3例)、4.32%(7例)相比较,差异有统计学意义(P＜0.05);两组吻合口出血发生率比较,差异无统计学意义(P＞0.05).结论 改进器械吻合方法 ,可以降低吻合口出血、吻合口漏及吻合口狭窄的发生率,提高术后患者生活质量.

例1,男,16岁,主因发热、乏力、胸痛1个月于2008年8月10日入院.体温最高40℃,无咳嗽、咯痰、咯血.查体无阳性体征.查WBC 10.03×109/L,N 71%.胸片:右中肺野内带可见一直径5 cm块状影,与右上纵隔无明显分界.中上纵隔增宽.