OBJECTIVE:To investigate the efficacy and safety of Venetoclax combined with CACAG regimen in treatment of patients with refractory/relapse acute myeloid leukemia(R/R AML).METHODS:The study was a singlecenter prospective clinical trial. The enrolled patients met the criteria for R/R AML. Treatment included Azacidine(75 mg/m2，d 1-7), Ara-C (75-100 mg/m2, q12h, d 1-5), Aclacinomycin(20 mg d1,d3,d5), Chidamide(30 mg d1,d4), Venetoclax(100 mg d1, 200 mg d2, 400 mg d3-d14, in combination with Triazole Drug, reduced to 100 mg/d), and granulocyte colony-stimulating factor (300 μg /d until neutrophil recovery). The primary endpoint of observation was overall response rate after 1 course of treatment.RESULTS:A total of 19 patients were enrolled from January 2022 to April 2023. After 1 course of treatmen, the overall response rate was 81.3%(13/16), the CR rate was 68.8%(11/16), and the PR was 12.5%(2/16). Among the 11 patients who got CR/CRi, 8 cases achieved CRm (minimal residual disease negative CR) and 3 cases did not. As of March 27, 2023, the median follow-up time was 111(19-406) days. The six-month overall survival and progression-free survival rates were both 55.7%, the 1-year overall survival and progression-free survival rates were 46.4% and 47.7%, respectively. In addition, compared with the non-CRm group, CRm patients had a better PFS (377 days vs 111 days, P =0.046). Treatment-related adverse events were mainly 3-4 degrees of bone marrow suppression, complicated by various degrees of infection(n=12), hypokalemia(n=12) and hypocalcemia (n=10) and elevated liver enzymes (n=8), of which 3/4 degrees accounted for 47.4%(9/19).CONCLUSION:The Venetoclax combined with CACAG regimen is an effective salvage therapy for patients with R/R AML, with high remission rate and safety profile.

特殊病理类型子宫内膜癌(special type endometrial carcinoma,STEC)是一类病死率较高的妇科恶性肿瘤,相较常见的子宫内膜样腺癌,STEC进展快、复发率高,且具有显著组织异型性,传统病理分型无法满足临床需要.近年来提出的TCGA等分子分型对STEC的诊治具有重要意义,本文就分子分型在浆液性癌、透明细胞癌、癌肉瘤、去/未分化癌和高级别不明确子宫内膜癌五类STEC中的研究进展进行综述,包括分子分型在STEC诊断和鉴别、靶向药物研发、疗效预测及预后中的应用,以期为临床合理应用分子分型提供参考.

目的 探究宫颈病变患者高危人乳头瘤病毒(HR-HPV)感染筛查方法及应用.方法 选择2018年6月-2020年12月解放军总医院第一医学中心妇产科诊治的1 405例宫颈病变患者为研究对象,分析不同程度宫颈病变患者的HR-HPV感染分布情况,单一型、混合型HR-HPV感染、DNA拷贝量情况,探讨各种筛查策略的有效性.结果 宫颈癌病变患者中炎症613例、低度鳞状上皮内病变(LSIL)461例、高度鳞状上皮内病变(HSIL)311例、宫颈癌(CC)20例.最易导致宫颈病变的HR-HPV感染分型为:82、31、16、68、39、33、35、18;宫颈癌与癌前病变患者易感的HR-HPV分型略有不同:CC组为HPV16、18,癌前病变组为HPV16、58、52、51、31、58、66.在单一型HR-HPV感染中,HPV31、16、52、58、56、18与宫颈病变发生的相关性更高;当DNA拷贝量≥10E4时宫颈病变发生风险升高.在混合HR-HPV感染中,含16、18任两种亚型混合感染组的HSIL及以上占比高于任两种亚型混合感染不含16、18组(P＜0.05).单独采用HR-HPV感染筛查的病理阳性率和病理HSIL+占比与单独采用TCT相当,二者联合筛查并未增加病理阳性检出的敏感度,而联合DNA拷贝量将增加筛查敏感度.结论 以HR-HPV分型感染联合DNA拷贝量检测为主的宫颈病变筛查策略是有效的,应注意将不同型别HR-HPV感染与病变的关系纳入临床建议参考.

Objective:To analyze the application value of da Vinci robot-assisted pelvic dissection in the treatment of some patients with advanced and recurrent cancer in gynecology.Methods:19 patients who received robot-assisted PE from the first medical center of the PLA General Hospital from Sep. 2014 to Dec. 2021 were selected as the study subjects. Analyze the general material of the cases, the relevant indicators in the perioperative period and the follow-up data. At the same time, review the literature and share relevant experience.Results:Among 19 cases of da Vinci robot-assisted PE, 21.05% were initially treated and 78.95% were relapsed. 17 patients received robotic MDT cooperative surgery, 70.59% of which were combined with two departments and 29.41% with three departments. The resection rate of R0 was 89.47%, the rate of neoadjuvant chemotherapy was 52.63%, and the rate of serious complications was 10.53%. Compared with different types of robot-assisted PE, anterior pelvic PE accounted for 52.63%, posterior pelvic PE accounted for 31.58%, and total pelvic PE accounted for 15.79%. There was no significant difference in average operation time, maximum diameter of tumor resection, blood transfusion rate, R0 resection rate and conversion rate among the three groups (P>0.05). The total pelvic PE group had the most surgical bleeding, the posterior pelvic PE group was slightly inferior, and the anterior pelvic PE group had the least [(700±444.41) mL vs (375±271.57) mL vs (147±86.16) mL, P=0.019]. The average postoperative hospital stay in the anteriorr pelvic PE group was less than that in the total pelvic PE group [(13.80±5.71) days vs (22.33±5.13) days, P=0.046]. The average follow-up time of all patients was (33.05±25.73) months, and the median follow-up time was 23 months; One-year and two-year OS were 84.21% and 63.16% respectively.Conclusions:Da Vinci robot-assisted pelvic dissection has a definite effect on the treatment of some patients with advanced and recurrent cancer in gynecology. Reasonable control of surgical indications, high-level robotic surgical MDT team, scientific perioperative management, and individualized comprehensive treatment plan can benefit more patients.

OBJECTIVE:To investigate an improved culturing method for karyotyping analysis, and increase the detection rate of cytogenetic abnormalities in patients with multiple myeloma (MM), so as to provide more powerful information for the clinical diagnosis, prognosis stratification, and individualized treatment of MM patients.METHODS:Eighty newly-diagnosed MM patients were enrolled and divided into two groups. In observation group, IL-6 (10 ng/ml) and GM-CSF (30 ng/ml) were supplemented in the culture medium, while no stimulating factor was added in control group. The samples from both groups were cultured for 72 hours under the same conditions, and their karyotypes were analyzed by G-banding. The detection rate of the cytogenetic abnormalities, as well as the corresponding characteristics were compared between the two groups.RESULTS:The detection rate of the chromosome aberrations was greatly increased in the observation group compared with the control group, the overall detection rate was 72.5% and 22.5%, respectively, as well as 80.0% and 19.2% in the subgroup of ≤60 years old, 68.0% and 28.6% in the subgroup of > 60 years old, which showed significant statistical differences (P<0.05).CONCLUSION:The modification of the culturing method with the addition of IL-6 (10 ng/ml) and GM-CSF (30 ng/ml) dual stimulating factors followed by incubation for 72 hours can effectively increase the detection rate of abnormal karyotypes in MM patients.

1 病例资料 患者女,39岁,因"不规则阴道出血 7个月、异常阴道排液2个月"于2019年11月9日收入我院妇产科.2019年4月患者无明显诱因出现阴道不规则出血,量多于月经量,色鲜红,伴下腹痛、腹胀,无大小便改变,未予重视.2019年9月出现异常阴道排液,经期延长达10余天,经血量多于以往,就诊于我院妇产科门诊,筛查宫颈人乳头瘤病毒(human papilloma virus,HPV)为阴性,液基薄层细胞学检查(thin-prep cytology test,TCT)未见上皮细胞病变.

目的 调查军队慢性病退休干部睡眠状况并了解其影响因素,为改善睡眠障碍干预方案提供参考.方法 2019年10月—2021年3月,以在解放军总医院第二医学中心保健科门诊进行健康检查的633名军队慢性病退休干部作为调查对象,通过睡眠状况自评量表、心理资本量表及电子健康素养量表进行调查分析.结果 军队慢性病退休干部睡眠状况得分为(21.22±3.04)分,其中48.82％(309/633)存在睡眠问题.不同性别、婚姻状况、经常饮酒情况、喝茶情况、休闲活动参加情况、慢性病种类与性格类型的军队慢性病退休干部睡眠状况得分比较,差异均有统计意义(均P＜0.01).多元线性逐步回归分析显示,性别、婚姻状况、经常饮酒情况、休闲活动参加情况、慢性病种类、电子健康评判能力及心理资本均是军队慢性病退休干部睡眠状况的影响因素(β=0.043、-0.090、0.060、-0.042、0.170、-0.556、-0.243,均P＜0.05).结论 军队慢性病退休干部的睡眠质量不佳,应关注女性、无配偶、经常饮酒、不经常参加休闲活动、多种慢性病、电子健康评判能力低、心理资本水平一般的军队慢性病退休干部睡眠状况.医疗保障单位应加强对军队慢性病退休干部睡眠问题的干预,改善其睡眠质量.

Background The receptor tyrosine kinase FLT3 with internal tandem duplications within the juxtamembrane domain ( FLT3 -ITD) is a poor prognostic factor; however, the prognostic significance of missense mutation in the tyrosine kinase domain ( FLT3 -TKD) is controversial. Furthermore, the accompanying mutations and fusion genes with FLT3 mutations are unclear in acute myeloid leukemia (AML). Methods We investigated FLT3 mutations and their correlation with other gene mutations and gene fusions through two RNA-seq based next-generation sequencing (NGS) method and prognostic impact in 207 de novo AML patients. Results FLT3 -ITD mutations were positive in 58 patients (28%), and FLT3 -TKD mutations were positive in 20 patients (9.7%). FLT 3-ITD was associated with a higher white blood cell count (WBC, mean 72.9 × 10 9 /L vs. 24.2 × 10 9 /L, P = 0.000), higher bone marrow blasts (mean 65.9% vs. 56.0%, P = 0.024), and NK-AML (normal karyotype) (64.8% vs. 48.4%, P = 0.043). NPM1 and DNMT3A mutations were enriched in FLT3 -ITD (53.5% vs. 15.3%, P = 0.000; 34.6% vs. 13%, P = 0.003). However, the mutations of CEBPA were excluded in FLT3 -AML (3.8% vs. 0% vs. 19.8%, P = 0.005). Mutations of Ras and TP53 were unlikely associated with FLT3 -ITD (1.9% vs. 20.6%, P = 0.006; 0% vs. 6.1%, P = 0.04). The common fusion genes (> 10%) in FLT3 -ITD had MLL- rearrangement and NUP98 -rearrangement, while the common fusion genes in FLT3 -TKD had AML1-ETO and MLL -rearrangement. Two novel fusion genes PRDM16-SKI and EFAN2-ZNF238 were identified in FLT3-ITD patients. Gene fusions and NPM1 mutation were mutually excluded in FLT3 -ITD and FLT3 -TKD patients. Their patterns of mutual exclusivity and cooperation among mutated genes suggest that additional driver genetic alterations are required and reveal two evolutionary patterns of FLT3 pathogenesis. Patients with FLT3 -ITD had a lower CR (complete remission) rate, lower 3-year OS (overall survival), DFS (disease-free survival), and EFS (event-free survival) compared to FLT3 wt AML. NK-AML with FLT3 -ITD had a lower 3-year OS, DFS, and EFS than those without, while FLT3 -TKD did not influence the survival in whole cohort and NK-AML. Besides, we found that FLT3 -ITD/ TET2 bimutation defined a poor prognostic subgroup. Conclusions Our study offers deep insights into the molecular pathogenesis and biology of AML with FLT3 -ITD and FLT3 -TKD by providing the profiles of concurrent molecular alterations and the clinical impact of FLT3 -ITD and FLT3 -TKD on AML patients.

背景 子宫内膜癌是最常见的女性生殖系统恶性肿瘤之一,与高血压、糖尿病、肥胖症等内分泌代谢紊乱紧密相关.尽管大量文献报道达芬奇机器人手术具有手术时间短、出血量少、生存预后优于传统手术的特点,但目前缺乏大样本量达芬奇机器人系统治疗子宫内膜癌(endometrial carcinoma,EC)患者的围术期结果和长期生存预后分析.目的 分析达芬奇机器人手术系统治疗子宫内膜癌患者的围术期结果、临床病理特征及预后,探讨达芬奇机器人手术治疗子宫内膜癌的特点和应用优势,为临床应用提供参考.方法 回顾性分析解放军总医院第一医学中心妇科2012年2月-2020年6月收治的333例采用机器人手术初治的子宫内膜癌患者临床资料,分析患者年龄、体质量指数(body mass index,BMI)、绝经年龄、婚育情况、代谢合并症情况、手术时间、术中出血量、淋巴结切除数目、术后肛门排气时间、住院时间、术后并发症情况、肿瘤病理特征及生存预后数据.结果 子宫内膜癌患者平均发病年龄(53.03±9.05)岁;平均体质量指数(26.04±4.00)kg/m2,肥胖患者(BMI>28 kg/m2)占27.63％;未生育患者占9％;绝经后患者占63％;合并代谢综合征患者占43.84％.机器人手术平均手术时间(184.91±49.78)min,平均术中出血量(135.29±62.68)mL,平均淋巴结清扫数量(28.00±11.47)枚.手术并发症38例(11.41％),包括淋巴漏23例、感染7例、下肢静脉血栓4例、肠梗阻2例、腹腔内出血1例、输尿管阴道瘘1例,经积极治疗均治愈.平均术后排气时间(1.90±0.63)d,平均术后住院时间(9.59±4.04)d.Ⅰ型子宫内膜癌占92.19％,Ⅱ型子宫内膜癌占7.81％;高分化内膜癌占41.19％,中低分化占58.81％;子宫内膜癌Ⅰ期患者占78.08％,Ⅱ期占10.51％,Ⅲ期占10.81％,Ⅳ期占0.60％;肥胖(BMI>28 kg/m2)和年龄(年龄>53岁)对子宫内膜癌患者接受达芬奇机器人系统治疗的围术期影响差异无统计学意义(P<0.05).333例达芬奇机器人手术治疗子宫内膜癌患者的3年累积生存率96.5％,5年累积生存率95.8％.结论 达芬奇机器人手术系统治疗子宫内膜癌稳定性强、精确度高,手术效果不受患者高龄、肥胖、复杂合并症等多元化临床特征影响.

对于临床早期宫颈癌患者,手术是主要治疗手段,其中淋巴结切除(盆腔淋巴结切除与腹主动脉旁淋巴结切除)是宫颈癌根治术的重要组成步骤[1].由于盆腔淋巴系统大抵与血管并行,淋巴组织存在于动静脉周围脂肪组织中,因此行腹主动脉旁淋巴结切除术时需将其从腹主动脉及下腔静脉血管鞘周围剥除,因此下腔静脉的解剖变异会使手术难度大大提升,并增加了血管损伤的风险[2-3].

卵巢癌是致死率最高的妇科恶性肿瘤[1].据统计我国每年新发卵巢癌病例约5万人,因该病死亡约2.25万人[2].卵巢癌的治疗方式主要为手术及化疗,而淋巴结切除术是卵巢癌患者手术的重要组成步骤.双下腔静脉畸形通常在尸体解中时发现[3-4],在活体病例手术中极难发现.本文回顾性分析解放军总医院第一医学中心妇产科收治的1例卵巢透明细胞癌Ⅳa期患者临床资料,术中偶然发现合并双下腔静脉畸形.该患者接受了手术治疗并经后续化疗及靶向治疗达到完全缓解.总结相关临床经验及手术要点,报告如下.

子宫内膜癌(EC)是女性生殖系统常见的恶性肿瘤,在全球范围内其发病率逐年升高.多数EC患者经手术治疗后预后较好,但对于晚期或复发、转移性EC来说,传统的治疗手段效果有限,患者预后较差.1983年Bokhman根据流行病学、内分泌及预后特点将EC分为I型(雌激素依赖型)和II型(非雌激素依赖型),然而在临床应用中该分型手段具有一定局限性.随着分子生物学及基因测序技术的发展,EC的研究深入分子水平.2013年美国TCGA第一次归纳提出EC的4种分子分型,由于其费用高昂、技术复杂,临床不易获得.2015年Talhouk等提出简易替代分型并在后续的研究中将其命名为ProMisE分子风险分型,包括:POLE突变型、MSI高突变型、p53野生型、p53突变型.EC分子分型的研究具有重要的临床指导意义.本文就EC传统分型到分子分型的转变做一回顾,并对分子分型与临床相关的研究做一总结与分析.EC分子分型的不断完善有助于实现临床诊疗中的精准化、规范化、个体化,在精准医学背景下有重要价值.

目的 探讨经机器人辅助腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂的效果及安全性.方法 收集2013年1月至2018年12月于解放军总医院第一医学中心妇产科采用经机器人辅助腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂13例患者的临床资料.比较手术前后盆腔器官脱垂治疗效果及安全性,盆腔器官脱垂术后患者采用整体印象改善评分量表(PGI-I)评估主观满意度.结果 13例患者中,平均术中出血量(86.9±98.3) ml(20～300 ml),手术时间(143.5±47.3) min (60～240 min),平均住院时间(10.4±2.1)d(8～16d),平均随访时间(40.8±22.0)个月(6～72个月).脱垂客观治愈率85％,主观治愈率100％,PGI-I评分非常好者9例(9/13),很好者4例(4/13).网片暴露4例(4/13),其中暴露直径小于1 cm且无症状者3例,暴露直径1～2 cm有症状者1例,暴露发生时间均在术后2～12个月,暴露位置均位于阴道缝合范围内.结论 机器人辅助腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂出血量少,住院时间短,术后效果良好,是治疗盆腔器官脱垂可选择的术式之一.

OBJECTIVE:To evaluate the clinical characteristics, genetic abnormalities, treatment efficacy and prognostic factors in patients with plasma cell leukemia(PCL).METHODS:30 patients diagnosed as PCL in our hospital from January 1993 to December 2019 were enrolled, and the clinical characteristics, laboratory findings, therapeutic regimes, and survival data of the patients were retrospectively analyzed.RESULTS:The median age of the 30 patients was 56.5 (28-80) years old, among them, 25 patients were primary plasma cell leukemia, and 5 patients were secondary plasma cell leukemia. Complex karyotypes and subdiploids were most common in cytogenetic abnormalities. Among the 20 cases of chromosome G banding, 11 (55%) cases were complex karyotypes and 8 (40%) cases were hypodiploid. Fluorescent in situ hybridization (FISH) test showed that among 11 cases, 6 cases showed 17p13 deletion, 8 cases showed at least two kinds of abnormalities, which including t (14; 16), t (8; 14), t (11;14), 17p13 deletion, and 13q14 deletion. The median overall survival (OS) time was 10.5 months for all patients. The median OS time of the patients in ECOG score ≤ 2 group was 21.5 months, which was significantly longer than those in the ECOG score>2 group(1.2 months) (P=0.017). The median OS time of the patients treated with novel agents (including proteasome inhibitor and/or immunomodulator) was 24.9 months, which was significantly longer than the patients treated with traditional chemotherapy group(10.5 months) (P＜0.001). For the patients treated with novel agents, the median OS time of patients accepted two novel agents combination was 30.9 months, which was longer than those of single novel agent(11.5 months) (P=0.021). The effect of genetic abnormolity to the OS of the patients showed no statistical difference. Multivariate statistical analysis showed that ECOG score>2 was the independent prognostic factor of plasma cell leukemia patients. There were two patients underwent allogeneic hematopoietic stem cell transplantation in the study,but died due to the pulmonary infection within 6 months after transplantation.CONCLUSION:In the era of novel agents, ECOG score is an independent prognostic factor of plasma cell leukemia. Multiple novel agents treatment should be underwent as soon as possible to improve the prognosis of the patients. Pulmonary infection is a common factor that cause the death of the patients after allogeneic hematopoietic stem cell transplantation.

目的:探讨采用机器人手术大子宫切除的相关临床经验和优势.方法:选取2017年1月至2018年12月解放军总医院第一医学中心妇产科收冶的大子宫(子宫体积≥12孕周)患者,将接受机器人手术大子宫切除者纳入机器人手术组(n=42),将接受腹腔镜(含腹腔镜辅助阴式)手术大子宫切除者纳入腹腔镜手术组(n=57),分析比较相关病例资料.结果:子宫体积＞16孕周者:机器人手术组的手术时间、出血量均显著少于腹腔镜手术组[手术时间:(91.7 ±27.8) min vs(126.1±44.9) min,P＜0.001;出血量:(97.3±41.4)ml vs (138.1±56.2)ml,P＜0.001];子宫体积12～16孕周者:两组的手术时间比较,差异无统计学意义(P＞0.05),机器人手术组的手术出血量显著少于腹腔镜手术组[(65.8±29.0)ml vs (80.4±26.5)ml,P=0.011].机器人手术组的住院天数显著少于腹腔镜手术组[(6.1±1.2)d vs(6.9±1.5)d,P=0.005].两组的输血率、术中转开腹情况,以及泌尿系损伤、感染、深静脉血栓和肠梗阻发生率比较,差异均无统计学意义(P＞0.05).结论:相比腹腔镜,机器人手术实施巨大子宫切除具有机械臂灵活性、3-D手术视野和操控稳定性等优势,手术时间更短、出血量更少且住院时间更短.

Objective To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.Methods From January 2013 to December 2017,the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment .The observation group(n=53) used LMWH plus LDA to prevent preeclampsia ,while the control group ( n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups .Results The incidence of severe preeclampsia in the observation group(5.7％) was lower than that in the control group (18.9％)(χ2 =4.296,P<0.05),and there was statistically significant difference in the delivery time between the two groups (χ2 =7.993,P<0.05).While the incidence of preeclampsia ,placental abruption,postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P >0.05).The proportion of NICU transferred fetus in the observation group(18.3％) was lower than that in the control group (30.7％)(χ2 =4.289,P<0.05).There were no statistically significant differences in perinatal mortality and neonatal asphyxia ( all P >0.05 ).Conclusion Compared with using the LDA alone , LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies;at the same time,it also can delay the delivery time and reduce the rate of NICU transferred.

Objective:To investigate the efficacy and safety of nano-particle albumin bound paclitaxel in the treatment of patients with advanced and relapsed cervical cancer.Methods:A retrospective cohort study was conducted. Among the cervical cancer patients who were diagnosed and treated in Affiliated Hospital of Yan'an University from January 2013 to January 2018, 52 advanced and relapsed cases were selected as the research objects. The chemotherapy protocol of nano-particle albumin bound paclitaxel and cisplatin was used, and the efficacy and toxicity of chemotherapy were analyzed.Results:The total objective remission rate of 52 patients with advanced or relapsed cervical cancer was 67.3% (35/52), the disease control rate was 88.5% (46/52), and the progression-free survival time was (11.7±3.6) months. The objective remission rate in patients who had received radiotherapy and with a time interval of > 12 months since their last chemotherapy was higher than that in patients who had not received radiotherapy and with a time interval of ≤ 12 months since their last chemotherapy [76.9% (30/39) vs. 46.2% (6/13), χ2 = 4.333, P = 0.037; 78.9% (15/19) vs. 43.8% (7/16), χ2 = 4.609, P = 0.032]. Late stage, relapse, whether received radiotherapy, whether received chemotherapy and the time from the previous chemotherapy had no effect on the disease control rate (all P > 0.05). The progression-free survival time in patients who underwent radiotherapy and with a time interval of > 12 months since their last chemotherapy was longer than that in patients who had not received radiotherapy and with a time interval of ≤12 months since their last chemotherapy [(13.0±4.4) months vs.(8.7±2.9) months, t = 3.029, P = 0.004; (12.8±3.1) months vs. (9.6±4.0) months, t = 2.665, P = 0.012]. The highest incidence rates of adverse reactions were myelosuppression (82.7%, 43/52) and gastrointestinal reaction (65.4%, 34/52), and the most common grade Ⅲ-Ⅳ adverse reaction was myelosuppression (20 cases). Conclusion:The efficacy and safety of nano-particle albumin bound paclitaxel combined with cisplatin in the treatment of advanced and relapsed cervical cancer are reliable.

目的 比较达芬奇机器人手术与腹腔镜手术在子宫内膜癌治疗中的应用效果.方法 选择行微创手术的子宫内膜癌患者390例,其中行达芬奇机器人手术者229例(机器人组),行腹腔镜手术者161例(腹腔镜组).记录两组围手术期相关指标(手术时间、术中出血量、引流量、术后排气时间)及住院时间、住院费用,淋巴结切除情况(腹主动脉旁淋巴结切除数、左盆腔及右盆腔淋巴结切除数和总淋巴结切除数),以及中转开腹率、输血率、并发症发生率.结果 机器人组手术时间、住院费用、总淋巴结切除数均高于腹腔镜组,术中出血量、输血率均低于腹腔镜组(P均<0.01).两组引流量、术后排气时间、住院时间、腹主动脉旁淋巴结切除数、左盆腔及右盆腔淋巴结切除数、中转开腹率、并发症发生率比较差异均无统计学意义(P均>0.05).结论 与腹腔镜手术相比,达芬奇机器人手术治疗子宫内膜癌的手术时间更长、住院费用更高,但是患者术中出血量更少、输血率更低、总淋巴结切除数更多.

目的 观察局部巨块型宫颈癌(locally advanced bulky cervical cancer,LABCC)患者手术治疗的疗效,并分析相关预后指标,为临床实践提供参考.方法 选取我中心妇产科2013年1月-2015年1月手术治疗的354例宫颈癌(ⅠA2-ⅡA2期)患者作为研究对象.根据国际妇产科联合会2009分期标准,将ⅠB2期(n=57)和ⅡA2期(n=34)局部病灶≥4 cm病例纳入LABCC组,将ⅠA2期(n=12)、ⅠB1期(n=189)和ⅡA1期(n=62)局部病灶<4 cm病例纳入对照组,比较两组围术期指标、并发症发生情况和生存指标.结果 LABCC组纳入91例,平均年龄(52.4±5.5)岁;对照组纳入263例患者,平均年龄(51.8±4.8)岁.LABCC组接受新辅助化疗比例高于对照组[69例(75.8％)vs 45例(17.1％),P<0.001],术中出血量[(598.1±135.3)ml vs(450.8±117.5)ml,P<0.001]和输血率[11例(12.1％)vs 14例(5.3％),P=0.030]高于对照组,术后住院时间长于对照组[(14.1±1.4)d vs(12.1±1.5)d,P<0.001],泌尿系损伤发生率高于对照组[5例(5.5％)vs 4例(1.5％),P=0.038];两组手术用时、淋巴结切除数以及其他并发症发生率无统计学差异(P>0.05).LABCC组的5年累积生存率低于对照组(64.8％vs 82.1％,P=0.001),死亡率高于对照组(9.9％vs 4.2％,P=0.042),两组复发率差异无统计学意义(14.3％vs 8.4％,P=0.103).结论 手术治疗LABCC疗效可靠,建议在新辅助化疗后进行手术,LABCC组较对照组5年生存率更低、死亡率更高.