目的 探讨结直肠癌肿瘤组织中跨膜丝氨酸蛋白酶4(TMPRSS4)、间质表皮转化因子(c-Met)、驱动蛋白家族成员18A(KIF18A)表达水平与其病理特性和生存状态的关系.方法 选取该院于2015年3月至2017年6月确诊的102例结直肠癌患者作为研究对象,比较癌变组织和癌旁组织TMPRSS4、c-Met阳性率及KIF18A水平的差异,不同病理状态及生存状态患者的TMPRSS4、c-Met阳性率及KIF18A水平的差异,分析患者的病理状态及生存状态与TMPRSS4、c-Met阳性率和KIF18A水平的相关性.结果 癌变组织TM-PRSS4、c-Met阳性率及KIF18A水平明显高于癌旁组织(P<0.05);不同性别、年龄患者TMPRSS4、c-Met阳性率及KIF18A水平比较差异均无统计学意义(P>0.05),而不同病程、TNM分期、临床分型患者之间比较差异有统计学意义(P<0.05);通过对患者的随访,生存患者61例,死亡患者41例,生存组TMPRSS4、c-Met阳性率及KIF18A水平明显低于死亡组(P<0.05);患者的TNM分期、临床分型、病程及生存状态与TM-PRSS4、c-Met阳性率及KIF18A的水平呈正相关(r=0.165～0.998,P<0.05).结论 结直肠癌肿瘤组织中TMPRSS4、c-Met阳性率及KIF18A水平与其病理特性和生存状态存在一定的相关性,可作为结直肠癌患者诊断辅助参考之一.

Objective:To explore the clinicopathological characteristics and prognosis of colorectal cancer with liver and lung metastases according to different T stage.Methods:The information of 2 602 patients with colorectal cancer with liver and lung metastases registered in the surveillance, epidemiology and end results (SEER) database from 2010 to 2015 was collected. All the patients were divided into three groups according to T stage: T0/T1 group ( n=545), T2/T3 group ( n=1 138), and T4 group ( n=919). The clinicopathological characteristics (including age, sex, race, primary tumor site, histology, differential stage, T/N stage, distant metastatic site, carcinoembryonic antigen, surgery, and overall survival) were compared across the three groups and the impact of T stage on the overall survival was detected by Kaplan-Meier method and COX logistical analysis. Results:The proportion of N2 in T0/T1 group was significantly lower than those in T2/T3 group and T4 group [3.5% (19/545) vs. 29.3% (333/1 138), χ2=379.911, P<0.05; 3.5% (19/545) vs. 32.4% (298/919), χ2=379.911, P<0.05]. The proportion of rectum location in T4 group was significantly lower than those in T0/T1 group and T2/T3 group [18.6% (167/899) vs. 32.8% (165/503), χ2=64.569, P<0.05; 18.6% (167/899) vs. 33.9% (382/1 127), χ2=64.569, P<0.05]. Among the three groups, the proportion of grade Ⅳ in T0/T1 group was the lowest, and the proportion of grade Ⅲ and Ⅳ in T4 group was the highest. COX logistical analysis indicated that T0/T1 group [hazard ratio ( HR)=1.130, 95% confidence interval ( CI): 1.001-1.275, P<0.05] and T4 group [ HR=1.190, 95% CI: 1.085-1.305, P<0.01] showed a significantly poorer prognosis compared with T2/T3 group. Conclusion:Patients with colorectal cancer with liver and lung metastases in the different T stage presented significantly different clinicopathological characteristics and prognosis, especially for T0/T1 stage that has lower proportion of N2 and poorer prognosis.

Objective Investigate application of functional neck dissection with preservation of cervical plexus in differentiated thyroid cancer.Methods In the current hospital,39 cases of patients with differentiated thyroid cancer and lymph nodes metastases were treated with selective neck dissection through a low-collar incision while preserving cervical plexus.The distribution of the lymph nodes,complications,recurrence rate,and clinical effect are studied.Results In the 39 cases,the cervical lymph node metastases were mainly distributed at Level Ⅳ (76.9％),Level Ⅲ (64.1％),Level Ⅱ a (38.4％),Ⅱb(2.6％) and Ⅴb (12.8％).Three cases of complications were found after surgeries:one case of neck swelling,one case of bleeding,and one case of chyle leakage.No impairment in the sensation of ears,lower neck,shoulders,and the subclavian skin was found.No local relapse was found during the 5-60 months' follow-ups.Compared with L-shape incision,the Low-collar incision is cosmetically desirable.Conclusion Neck dissection through a low-collar incision with preservation of cervical plexus results in a small incision and preserves cervical plexus while not increasing the recurrence rate.

目的 探讨抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)两种指标的联合检测在甲状腺癌术后随访中诊断复发或转移的临床价值.方法 选择84例接受甲状腺癌切除术后怀疑复发或转移的患者为研究对象,检测血清TPOAb与TgAb水平,通过TgAb、TPOAb以及两者联合的检测结果与核素显像进行诊断性试验分析,比较上述指标诊断的敏感性、特异性和准确性等指标.结果 对甲状腺癌复发或转移诊断的敏感性、特异性和准确性:TGAb为60.3%、50%、58.3%;TPOAb为64.7%、56.2%、64.3%;两者联合为64.7%、87.5%、69.1%.结论 联合检测TGAb和TPOAb能显著提高甲状腺癌术后诊断复发或转移的特异性和准确性.

目的 对在右半结肠癌手术中完整结肠系膜切除术的临床效果进行分析和探讨.方法 方便选择2012年6月—2014年6月期间由于右半结肠癌而在该院治疗的60例患者作为研究对象,通过随机的方式对这些患者进行划分,其中30例为对照组,30例为观察组.采用传统根治术治疗对照组患者,采用完整结肠癌系膜切除术治疗观察组患者,对两组患者的相关手术指标、并发症发生率等进行比较,同时对其进行为期2年的随访,对两组患者的复发率和死亡率等进行统计和比较.结果 观察组的术中出血量为(178.27±12.43)mL、术后引流量为(58.43±2.49)mL、淋巴结清扫总数目为(21.03±1.29)个,对照组的术中出血量为(231.42±13.61)mL、术后引流量为(84.21±1.74)mL、淋巴结清扫总数目为(12.97±1.58)个;观察组的残端肿瘤残余率为3.3%、术后吻合口漏率为0.0%、并发症发生率6.7%、死亡率0.0%、复发率为3.3%,对照组的残端肿瘤残余率为6.7%、术后吻合口漏率为3.3%、并发症发生率20.0%、死亡率10.0%、复发率为13.3%.在上述指标方面,观察组与对照组相比差异有统计学意义(P<0.05).结论 在右半结肠癌的临床治疗中采用完整结肠系膜切除的方式具有十分显著的效果,能够将患者的肿瘤有效清除,并且具有较低的复发率和死亡率.

目的 对老年患者采用保乳联合前哨淋巴结活检手术治疗的临床价值进行研究.方法 方便选取该院2014年6月—2016年5月收治的64例老年乳腺癌患者,根据随机分组法原则将患者均分为两组.对照组患者采用传统根治手术治疗,观察组患者采用保乳联合前哨淋巴结活检手术治疗.对两组患者临床指标进行比较;术后随访6个月,比较两组患者术后美容效果.结果 观察组患者术中出血量为(69.3±11.8)mL、手术时间为(71.2±11.3)min、引流拔管时间为(5.0±1.1)d、总引流量为(100.6±12.6)mL,对照组患者分别为(131.7±14.6)mL、(93.8±13.4)min、(17.6±2.4)d、(185.4±16.7)mL,差异有统计学意义(P<0.05),且观察组患者满意率93.75%比对照组71.88%高(P<0.05).结论 保乳联合前哨淋巴结活检手术治疗老年乳腺癌临床效果显著,手术时间较短,术中患者出血量较少,且术后恢复较快,可大大缩短引流时间,值得在临床中推广应用.

目的 研究和分析采用开腹和腹腔镜手术来治疗老年人直肠癌的临床效果和疗效安全性.方法 方便选取该院2015年2月—2016年2月收治的直肠癌老年患者64例,将其分成各32例的治疗组和参照组,治疗组以腹腔镜直肠癌根治术治疗,参照组以开腹直肠癌根治术治疗,比较两组疗效和并发症发生情况.结果 治疗组患者术中出血量为(120.3±19.6)mL、术后排气时间为(2.7±0.3)d、和进食固体时间(4.0±0.3)d、导尿管留置天数为(3.1±0.4)d和淋巴结清除个数(13.6±3.0)个,参照组分别为(398.7±37.9)mL、(5.0±6.1)d、(5.3±0.4)d、(5.7±0.7)d和(5.0±3.4)个,两组间除手术时间外差异有统计学意义(P<0.05);两组并发症发生率分别为3.12%和12.50%,差异有统计学意义(P<0.05);治疗组局部复发率、 远处转移率、 切口疝发生率、 黏连性肠梗阻分别为15.62%、21.87%、0.00%和12.50%,而参照组分别为18.75%、25.00%和3.12%、25.00%,其中切口疝和黏连性肠梗阻发生率差异有统计学意义(P<0.05).结论 采用腹腔镜直肠癌根治术治疗的效果优于开腹手术,疗效安全.

Objective To compare with the effect of improved small incision and traditional thyroidectomy surgery treatment of thyroid adenoma. Methods 76 cases of thyroid adenoma patients treated in our hospital in July 2013- August 2014 were randomly divided into two groups, each of 38 cases. Observation group were given small incision surgery, control group were given traditional thyroidectomy surgery, hospital time, operation time, incision length, blood loss and postoperative compli-cations of two groups were compared. Results Hospitalization time, operation time, incision length blood loss intraoperative of observation group compared with control group significantly reduced (P﹤0.01);Postoperative complication rate of observa-tion group was 15.79%, compared with control group was significantly lower (P﹤0.05) . Conclusion Effect of small incision surgery in the treatment of thyroid adenoma is significant, with few complications,worthy of application.

目的:观察卡培他滨联合奥沙利铂治疗晚期结肠癌的疗效.方法:将我院2013年3月~2014年3月收治的42例晚期结肠癌患者,采用双色球分组法分为对照组和观察组.对照组单纯采用卡培他滨治疗,观察组在此基础上使用奥沙利铂治疗.对比两组治疗效果,并对所有患者随访两年,对比两组治疗后1年、2年的生存率.结果:观察组治疗有效率明显高于对照组,存在显著差异(P<0.05);治疗后随访2年,发现观察组1年、2年生存率均明显高于对照组,差异显著(P<0.05).结论:卡培他滨联合奥沙利铂治疗晚期结肠癌具有良好的效果,两年期生存率比单一使用卡培他滨治疗高,值得在临床推广.

为总结吻合器痔上黏膜环切术(PPH)治疗重度痔的经验,回顾2009年1月至2011年2月于我院接受PPH治疗的120例重度痔患者资料,对其手术时间、术后住院时间和术后出血、尿潴留、剧烈疼痛、复发等情况进行分析.结果显示,本组120例患者全部治愈.平均手术时间为(24.63±5.40) min；术后平均住院时间为(4.97±1.49)d.术后大出血(＞300ml)1例,尿潴留30例,剧烈疼痛6例,无肛门狭窄、大便失禁发生.术后随访1个月至2年,均无复发.结果表明,PPH治疗重度痔操作简单易行、手术时间短、患者痛苦小、恢复快,疗效肯定.但要严格掌握PPH适应症,加强术中操作及术后并发症的防治.