专业型硕士研究生住院医师规范化培训是国家实施医学教育的重要举措.乳腺外科不仅具有普外科的传统特征,还和肿瘤、影像、病理等多个学科有交集,乳腺外科可结合自身优势,在教学查房和多学科讨论中激发学生的学习潜力,提高临床教学能力和医疗质量.

同源盒基因Six1是一多基因家族的转录调节因子,与恶性肿瘤的发生发展相关. 异常表达的Six1基因可以通过多种信号通路导致正常细胞的凋亡与增殖失衡,上游调控因子的异常表达可以导致Six1的功能失调,而异常表达的Six1可以作用于其靶基因CyclinA1、TGF-β等,从而促进肿瘤的发生发展.

目的 探究神经纤毛蛋白(Neuropilin 1,NRP-1)在胃癌组织中的表达及其与患者病理特征以及预后之间的关系.方法 回顾性分析2009年4月—2010年4月在本科采取手术治疗的109例胃癌患者临床病理资料,采用免疫组化方法检测胃癌及癌旁组织中NRP-1的表达水平,进一步分析其与患者临床病理特征以及预后之间的关系.结果 109例患者,61例患者胃癌组织NRP-1高表达,48例低表达;NRP-1的高表达与肿瘤直径、原发灶情况、是否有淋巴结转移、淋巴结转移个数以及组织学分化程度相关(P<0.05);COX回归(比例风险模型)多因素分析结果显示NRP-1的表达情况是影响胃癌患者预后的独立危险因素(P<0.05).结论 一方面,NRP-1在胃癌的进展中对肿瘤起到促进作用,其高表达与胃癌的恶性生物学行为相关;另一方面,NRP-1的高表达与胃癌患者的生存率成负相关,NRP-1可能作为一种用于预测胃癌患者预后的肿瘤标记物.

Objective To investigate the pathological characteristics and prognosis of male breast cancer patients admitted to a single institution for a certain period of time.Methods A retrospective method was adopted in this study to analyze the clinicopathologic fea-tures and survival conditions of 39 cases of male breast cancer patients,who were diagnosed and treated in the first affiliated hospital of Bengbu medical college from January 1 st 2007 to January 1 st 2012.The Kaplan-Meier method was employed to estimate the survival rate.The Log-rank test was adopted to compare the survival between two groups,and the Cox regression model was used to analyze the prognostic factors.Results According to the univariate analysis,the factors affecting the 5-year disease-free survival rate of male pa-tients with breast cancer were age stratification (P =0.017),lymph node metastasis (P =0.006),estrogen receptor expression (P =0.002 ),Progesterone receptor expression (P =0.003)and tumor size (P =0.025).The factors affecting the total productivity of male breast cancer patients were age stratification (P =0.027),lymph node metastasis (P =0.022),estrogen receptor expression (P =0.001 ),progesterone receptor expression (P =0.001 )and tumor diameter (P =0.031 ).According to multivariate analysis,age strati-fication (HR =0.197,95.0％ confidence interval:0.057-0.680,P =0.010)was associated with disease-free productivity in male breast cancer patients.(HR =1 .841 ,95.0％ confidence interval:0.638 (P =0.011 )and lymph node metastasis (HR =1 .841 , 95.0％ confidence interval:0.638-5.308,P =0.049)were the factors affecting the overall productivity of male breast cancer patients. Conclusions Male breast cancer has a low incidence rate and poor prognosis.We can improve the prognosis by improving the positive rate of male breast cancer through early diagnosis and treatment.

结直肠是消化系统肿瘤常见发生部位,在我国结直肠肿瘤的发病率逐年增加.目前,结直肠肿瘤的首选治疗措施是以手术治疗为主的综合治疗.随着腹腔镜设备及技术的发展,腹腔镜下结直肠肿瘤切除术目前已经广泛应用于临床.本文就目前腹腔镜结直肠手术的方式,外科医生与腹腔镜手术之间的关系以及对部分复杂患者手术方式的选择做一概述.

目的:探讨2种食管中段癌根治术对患者术后总体情况的影响,同时比较2种手术方式的差别.方法:回顾性分析某院收治的72例食管中段癌患者临床资料,根据手术方式不同分成观察组和对照组,观察组采用腹腔镜游离胃开放进胸食管中段癌根治术,对照组采用传统胸腹两切口开放食管中段癌根治术.观察比较2组患者在手术时间、腹部手术时间、术中出血量、淋巴结清扫个数、术后引流量、术后疼痛程度、胸腔引流管拔出时间、术后并发症、胃肠恢复时间以及住院天数的差异.结果:观察组总手术时间、腹部手术时间、术后住院时间较对照组明显缩短(P<0.05);2组比较观察组术中出血量、术后引流量较对照组明显减少,差异有统计学意义(P<0.05);观察组疼痛程度减轻、胃肠功能恢复提前(P<0.05);2组患者术后吻合口漏的发生情况、淋巴结清扫个数、术后胸管拔出时间比较,差异无统计学意义(P>0.05);观察组术后切口感染率、肺部感染率较对照组低,2组比较差异有统计学意义(P<0.05).结论:与传统胸腹两切口手术方式相比,腹腔镜游离胃开放进胸食管中段癌根治可以明显减少手术时间及术中出血量,患者术后恢复更快且并发症明显降低.

The aim of the present meta-analysis compared left colic artery (LCA) preservation with non-preservation in laparoscopic resection of rectal cancer in terms of feasibility, efficacy and safety. The PubMed, Ovid, Embase, Web of Science, CBM, CNKI, VIP and WanFang Data databases were searched prior to June 2017 for studies comparing LCA preservation and non-preservation in laparoscopic resection for rectal cancer. Two researchers screened the literature independently, extracted the data and evaluated the risk of bias. The study was performed using RevMan 5.3 software for meta-analysis. A total of 10 studies comparing LCA preservation and non-preservation in laparoscopic resection for rectal cancer were selected for this meta-analysis, with a combined study population of 1,471 patients. The results of the meta-analysis demonstrated that, when comparing LCA preservation with non-preservation in laparoscopic resection for rectal cancer, there were significant differences between the two groups in terms of operative time (P<0.01), estimated blood loss (P<0.01), percentage of neostomy (P<0.01), the number of retrieved lymph nodes (P<0.01), time to first postoperative exhaust (P<0.01) and amount of anastomotic leakage (P<0.01). However, there were no significant differences in postoperative hospital stay (P=0.28), incidence of recurrence (P=0.73) and incidence of metastasis (P=0.52). Therefore, compared with LCA non-preservation, patients in whom the LCA was preserved during laparoscopic resection for rectal cancer had a better prognosis. However, there was no difference in recurrence or metastasis between the two groups. Although the operative time and estimated blood loss were increased with LCA preservation, these may be reduced with improving proficiency of the operating surgeons. The conclusions of the present study require verification by larger samples and high-quality randomized controlled trials.

Objective To compare the effect of breast conserving surgery and modified radical mastectomy on the clinical efficacy of patients with early breast cancer.Methods CNKI,Chinese Journal Full-text Database (CJFD),China Biology Medicine Disc (CBMdisc),China Dissertation Database (Chinese Dissertation Database,CDDB) google academic and other databases were comprehensive searched.And then the search time was limited to between January 1,2015 and September 1,2017.Key words can be locked for breast conserving surgery,improved surgery for breast surgery,case-control studies,etc.,and then meet the conditions of the literature into the study,for a retrospective analysis.The authors reviewed the literature independently,extracted data and evaluated the risk of bias,and used Review Manager 5.3 software for systematic analysis.Results A total of 1 093 patients with early breast cancer were enrolled in the study.The Meta-analysis showed:there was a significant difference in operation time between the two groups(MD =-30.71,95％ CI:-31.96--29.46,P ＜ 0.01);there was a significant difference in intraoperative blood loss between the two groups(MD =-53.30,95％ CI:-55.38--51.22,P ＜ 0.01);there was a significant difference in postoperative hospital stay (MD =-5.66,95％CI:-7.17--5.17,P ＜0.01) and the incidence of complications (OR =0.30,95％ CI:0.19-0.47,P ＜ 0.01)compared with modified radical mastectomy in early breast cancer patients.There was no significant difference between the two groups in the postoperative recurrence and metastasis (OR =0.78,95％ CI:0.54-1.13,P =0.19).Conclusions In the choice of surgical methods,breast-conserving therapy is better than modified radical surgery,and postoperative recurrence and metastasis rate has no significant difference.