目的 探讨二次谐波超声造影术前检查肝癌血管受侵及肿瘤可切除性评价的使用价值.方法 选取2018年8月—2019年11月间我院收治的肝癌患者共200例,分别于术前采取二次谐波超声造影及CT增强扫描对患者进行检查,对比观察不同检查方法对周围血管受侵及手术可切除性的灵敏度、特异度等指标.结果 二次谐波超声造影术前分析肝癌周围血管受侵灵敏度及特异度与CT增强扫描对比差异无统计学意义(P>0.05);二次谐波超声分析手术可行性准确率与CT增强扫描对比差异无统计学意义(P>0.05).结论 二次谐波超声造影可于肝癌患者术前做出准确评价,指导手术方案.

The administration of doxorubicin (DOX) is one of the first-line treatments of breast cancer. However, acquisition of resistance remains the major obstacle restricting the clinical application of DOX. MicroRNAs (miRNAs) are small, noncoding RNAs which play crucial role in epigenetic regulation. Recent studies have shown that miRNAs are associated with tumor chemoresistance. Here we aim to explore the role of miRNA-192-5p in resistance to DOX in breast cancer cells. Normal human breast epithelial cell line MCF-10A, breast cancer cell line Michigan Cancer Foundation-7 (MCF-7), and DOX-resistant breast cancer cell line MCF-7/ADR were used here. The expression of miR-192-5p was examined by qPCR, and the expression of peptidylprolyl isomerase A (PPIA) was examined by qPCR and Western blot. The effects of miR-192-5p overexpression on the sensitivity to DOX were confirmed by Methylthiazolyldiphenyl-tetrazolium bromide (MTT) and Annexin-V/PI assay. Downstream molecular mechanisms, including PPIA, BAD, CASP9, Bcl-2, and c-Jun N-terminal kinase (JNK) activation, were detected by Western blot and qPCR. Luciferase reporter assay was used to validate the association between miR-192-5p and PPIA. miR-192-5p was downregulated while PPIA was upregulated in MCF-7/ADR cells. Functionally, miR-192-5p overexpression increased sensitivity to DOX by promoting cell apoptosis. Mechanistically, miR-192-5p overexpression performed its function by activating JNK, augmenting BAD and caspase9 expression, and suppressing Bcl-2 and PPIA expression. Luciferase assay validated that PPIA was a direct target of miR-192-5p. miR-192-5p sensitizes breast cancer cells to DOX by targeting PPIA, suggesting that miR-192-5p might serve as a novel target for reversing DOX resistance and controlling breast tumor growth.

目的 探讨经皮超声造影联合BI-RADS分级在乳腺癌诊断中的应用价值.方法 选择2015年6月-2016年12月因乳腺肿块就诊的患者76例,应用经皮超声造影联合BI-RADS分级进行检查,对比二者单独及联合应用的灵敏度、特异度、准确率等.结果 患者76个肿块,其中良性31个,恶性45个.超声造影、BI-RADS分级以及二者联合应用检查疾病灵敏度81.36％、81.97％、95.24％,特异度为70.59％、66.67％、92.31％,准确率为78.95％、78.95％、94.74％,联合应用灵敏度、特异度、正确率高于单纯超声造影、BI-RADS分级(均P＜0.05).结论 经皮超声造影联合BI-RADS分级能够提高乳腺癌诊断的灵敏度、特异度和准确率,降低漏诊率.

目的 探讨MRI与彩超在评价局部晚期乳腺癌新辅助化疗临床效果中的作用. 方法 选取我院收治局部晚期乳腺癌患者63例为研究对象,患者采取新辅助化疗,化疗降期后采取手术治疗,依照手术方法不同分为保乳术组和改良根治术组,改良根治术组行全乳切片病理检查,保乳术组行乳腺切缘、乳头切缘及瘤床病理切片并与化疗前后影像学变化进行比较. 结果 MRI、彩超测得肿瘤最大径与病理误差较少,MRI与病理测得值关联性最好,MRI测得的肿瘤最大径与病理测得值误差小于彩超.患者术后病理体积大小为(9.65±2.84)mm3,与化疗后肿瘤MRI体积大小(9.62±2.37) mm3比较,无明显差异(P＞0.05),术后病理体积大小显著小于化疗前肿瘤MRI体积,(41.62 ±56.27)mm3(P＜0.05). 结论 局部晚期肿瘤乳腺癌患者采用MRI诊断能够较高地评估肿瘤形态,与彩超相比,能够更加准确地为新辅助化疗方案的疗效评价提供依据.

目的:探讨乳管镜在诊治未扪及肿块乳头溢液中的应用价值.方法:收集2015年1-10月笔者所在医院119例非哺乳期未扪及肿块的乳头溢液患者的临床资料,总结乳管镜在诊疗乳头溢液患者中的作用.结果:95例(79.8%)患者发现了乳管内肿物,其中诊断为导管内乳头状瘤50例,导管扩张并炎症23例,乳腺增生11例,导管内癌11例.结论:乳管镜检查为未扪及肿块乳头溢液病因诊断的首选方法,对乳腺癌的早期发现有重要价值.

目的 探讨腹腔镜下游离带蒂大网膜在保乳术中的应用效果. 方法 选择湖南省肿瘤医院(中南大学湘雅医学院附属肿瘤医院)乳腺外二科2013年5月至2014年5月收治的早期乳腺癌患者8例,行保乳术,术中行腹腔镜下游离带蒂大网膜修复乳房缺损. 结果 7例患者术后网膜瓣均全部成活,乳房自然柔软外观形态良好,患者十分满意;1例在行腔镜下网膜游离时,网膜与左下腹壁粘连,游离时损伤网膜血管弓,只保留下部分网膜组织,因网膜瓣组织量少修复乳房外形欠佳. 结论 早期乳腺癌保乳术中行腹腔镜下游离带蒂大网膜乳房成形术为一种安全、微创的手术,腹腔镜下获得大网膜瓣的并发症发生率较低,可作为有效的技术在临床中应用.

Objective To discuss the feasibility and effect of immediate breast reconstruction with pedicled greater omentum and gel prosthesis following nipple and areola complex sparing mastectomy. Methods From August 2013 to September 2015, after mastectomy with conservation of nipple and areola, twenty-three patients with stage 0,Ⅰ,Ⅱbreast cancer accepted immediate breast reconstruction with pedicled greater omentum and gel prosthesis. Results All the pedicled greater omentum was successfully inserted, and no prosthesis migration and rupture occurred 3 to 25 months after operations. The reconstructed breast was good in shape and with soft feeling. Nipple ischemia occurred in two patients with ductal carcinoma in situ, while skin necrosis was not found within 3 months. There was no recurrence of breast cancer during follow-up period. Conclusion Immediate breast reconstruction with pedicled greater omentum and gel prosthesis after mastectomy with conservation of nipple and areola is an effective and safe procedure.

目的：探讨麦默通微创旋切系统在临床诊断和治疗不可触及乳腺肿块中的应用。方法：收集我科自2014年9月～2015年9月麦默通手术患者的临床资料，总结其临床经验。结果：188例患者的乳腺肿块均被安全的切除，术后有13例患者出现血肿或硬结，有2例患者出现皮下瘀斑，术后随访均未出现肿瘤的残留与复发。结论：麦默通旋切系统在不可触及乳腺肿物的治疗中具有定位精准、创伤小、安全性高及术后美观等优点，值得临床广泛应用。

Objective To investigate the therapeutic effect of laparoscopic radical resection of rectal carcinoma via natural orificespecimen extraction(NOSE). Methods Laparoscopic resection of rec-tal carcinoma was performed using NOSE technique in 35 cases of rectal cancer from October 2013 to 2015 July. Analysis of clinical data,postoperative exhaust time,the number of resected lymph node,and anastomotic leakage rate was conducted. Results All 35 cases underwent laparoscopic radical resection of rectal cancer with successful anus preservation. There were no preventive transverse colostomy. Among them,the success rate of laparoscopic radical resection via NOSE for rectal cancer was 85. 71%(30 /35). The operation duration ranged from 105 to 186 min(mean 129. 50 min). Anal exhaust time was 22 to 80 h(average 38. 13 h). Postoperative hospital stay lasted for 9 ~ 21 days(mean 10. 27 d). Anas-tomotic leakage occurred in 1 case and puncture infection in 2 cases. Conclusion Laparoscopic radical resec-tion of rectal carcinoma in middle and low rectal cancer is safe and reliable,which is worthy of being spread.

目的 探讨超声引导下Mammotome微创旋切术(MMT)切除触诊阴性乳腺肿块的临床意义.方法 159例278个触诊阴性乳腺肿块在B超引导下行MMT.结果 159例均成功在超声引导下行MMT,诊断明确,无明显术后并发症.278个乳腺肿块直径3～ 15 mm(平均9.1 mm),术后病理2例导管内原位癌,1例导管内癌伴局灶浸润,5例中-重度非典型增生,1例交界性分叶状肿瘤,补行乳腺单纯切除术2例,保乳手术1例,改良根治术1例,肿块扩大切除术5例.269个肿块为良性病变.术后B超随防3 ～10个月,未发现乳腺残留肿块.结论 临床触诊阴性乳腺肿块B超引导下MMT安全、微创,病理诊断若为良性则美学效果理想,若为恶性则患者可早期诊断及治疗.

目的 比较TAC与TC新辅助化疗方案治疗局部晚期乳腺癌的临床疗效和不良反应.方法 经病理等检查确诊局部晚期乳腺癌患者257例,随机分为TAC组(130例)及TC组(127例),分别给予TAC方案、TC方案化疗4个周期.TAC组129例、TC组124例化疗结束2周后行乳腺癌改良根治术.比较TAC组、TC组疗效和不良反应,治疗前、后TNM分期变化及术后并发症.结果 临床疗效比较TAC组优于TC组,其差异有统计学意义(P＜0.05)；TNM分期较新辅助化疗前降低(P＜0.05),不良反应比较差异无统计学意义(P＞0.05)；术后并发症比较差异无统计学意义(P＞0.05).结论 TAC及TC新辅助化疗方案对局部晚期乳腺癌均有效,TAC方案优于TC方案.

Objective: To compare the impacts between breast-conserving surgery and modified radical treatment on clinical efficacy and quality of life in patients with early breast cancer. Methods: The clinical data of 95 patients with early breast cancer undergoing breast-conserving therapy(breast-conserving group) between July 2004 and July 2007 were analyzed,and were compared with those of 95 matched patients over the same period undergoing modified radical mastectomy(modified radical group). Results: There were no significant differences between the two group in recurrence,metastasis and survival rate(all P0.05).The rate of aesthetically excellent breast shape in breast-conserving group and modified radical group was 93.7% and 0,respectively(P0.05).The quality-of-life score of the 5-year survival patients in breast-conserving group was significantly higher than that in modified radical group(83.66±3.70 vs.73.07±4.85)(P0.05). Conclusion: In early breast cancer patients,breast-conserving surgery can achieve the same therapeutic efficacy as modified radical mastectomy,and meanwhile significantly improve their quality of life.Strict observation of the indications,standardized surgical resection and individualized,comprehensive postoperative management are critical to success of breast-conserving treatment.

Objective To observe the efficacy and toxicity of treatment of gastric cancer with combined sodium cantharidate vitamin B6 injection and postoperative chemotherapy. Methods The article reviewed the clinical observation of the fifty cases of gastric cancer with combined sodium cantharidate vitamin B6 injection and postoperative chemotherapy from March,2008 to September,2009.After chemotherapy,the level of the adverse reaction and toxicity was compared between the treatment group(sodium cantharidate vitamin B6 injection and chemotherapy) and control group(pure chemotherapy). Results The incidence rates of neutropenia,nausea and vomiting,abnormal liver function in treatment group were 48%,44%,and 4%,respectively,and those in control group were 76%,72%,and 20%,respectively,there were statistically significant differences between the two groups(P0.05).No statistically significant difference was found in other aspects of adverse reactions between the two groups. Conclusions The combined therapy of sodium cantharidate vitamin B6 parenteral solution and postoperative chemotherapy for gastric cancer can improve patient's disease-resistant ability,decrease toxic reaction rate,and improve the therapeutic effect,which is worthy of popularization.

目的:观察斑蝥酸钠维生素B6注射液对晚期结直肠癌患者的治疗效果。方法:选取有明确诊断和分期的晚期结肠癌患者52例,随机分为斑蝥酸钠维生素B6治疗组26例和常规化疗的对照组26例。治疗组用奥沙利铂联合LV、FU的FOLFOX4方案,并于化疗的第一天起即用5%葡萄糖液+斑蝥酸钠维生素B6注射液0.5mg,每天1次至化疗结束,为1疗程。对照组仅用奥沙利铂联合LV、FU的FOLFOX4方案。3个疗程后行疗效评估。结果:斑蝥酸钠维生索B6注射液对晚期结直肠癌疗效较对照组明显提高(P<0.05),治疗组总有效率45.7%(CR+PR),对照组总有效率32.8%(CR+PR)。治疗组治疗前后全身功能状况Karnofsky评分亦差异有显著性(P<0.05),对照组治疗前后Karnofsky分无差异。在毒副作用上治疗组明显低于对照组。结论:斑蟹酸钠维生素B6注射液对晚期结肠癌能提高有效率及稳定率,改善全身体力状态及降低不良反应。