This randomized controlled trial evaluated the efficacy of an amino acid-based enteral nutrition (AAEN) formula within an Enhanced Recovery After Surgery (ERAS) protocol for colorectal cancer surgery patients. Sixty patients were randomized to an AAEN group (n = 20), a short-peptide-based enteral nutrition (SP) group (n = 20), or a conventional nutrition (CON) group (n = 20). Primary outcomes were nutritional status, recovery indicators, complications, and inflammatory markers. On postoperative day 7, the AAEN group had significantly higher serum albumin (35.5 ± 2.9 g/L) and prealbumin (225 ± 38 mg/L) than the SP and CON groups (p < 0.01). Time to first flatus was shorter in the AAEN group (38.2 ± 5.8 h) than the SP (43.5 ± 6.9) and CON (52.1 ± 7.8) groups (p < 0.01). The AAEN group also had a shorter hospital stay (7.6 ± 1.3 days), lower complication rate (15.0%), and more favorable inflammatory and immune markers (p < 0.01). Perioperative AAEN enhances recovery, improves nutritional status, reduces complications, and modulates inflammatory and immune responses, supporting its integration as a preferred nutritional strategy within ERAS protocols.

Background:Papillary thyroid microcarcinoma (PTMC) generally exhibits an excellent prognosis. However, a subset of patients develops high-volume (>5 nodes) central lymph node metastasis (CLNM), which is associated with increased recurrence risk and may influence surgical decision-making. Reliable preoperative risk stratification for high-volume CLNM in clinically node-negative (cN0) PTMC remains challenging. Therefore, this study aimed to develop and validate a nomogram for predicting high-volume CLNM in unilateral cN0 PTMC. Methods:In this retrospective study conducted at a single center, 1,500 patients with unilateral cN0 PTMC who received surgical treatment were included. Patients were randomly allocated to training cohort and validation cohort at a 7:3 ratio. Independent predictors of high-volume CLNM were identified using multivariate logistic regression analysis. A nomogram was constructed using the training cohort and subsequently validated. Results:Multivariate logistic analysis identified male sex, age ≤50 years, maximal tumor diameter >8 mm, and tumor multifocality as independent predictors for high-volume CLNM. The nomogram showed good discrimination performance, with a concordance index (C-index) exceeding 0.70 in both the training and validation cohorts. Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis indicated favorable clinical applicability. Conclusions:A practical nomogram was developed to predict high-volume CLNM in patients with unilateral cN0 PTMC. This model may facilitate individualized preoperative risk stratification and assist clinicians in optimizing surgical strategies, particularly in the context of increasingly conservative management of PTMC.

Background:The TOPAZ-1 study results represented significant advancement in the treatment of advanced biliary tract cancer (BTC) by combining durvalumab with gemcitabine-cisplatin (DGC). However, the highly selected patient population may not reflect the real-world scenarios. To gain deeper insights into this combination regimen, we conducted an evidence collection and a mimic survival comparative analysis. Methods:Records were identified through a formal search of PubMed and Web of Science. Six retrospective cohort studies with real-world evidence were definitively included. The individual patient data for OS and PFS were reconstructed and analyzed. The outcomes different from TOPAZ-1 were summarized and compared. Results:Whether Asia or non-Asia group, the mOS was similar to the TOPAZ-1 (Asian group: 12.57 months vs. TOPAZ-1, HR = 0.91, 95% CI: 0.69-1.21, log rank P = 0.53; non-Asian group: 13.61 months vs. TOPAZ-1, HR = 1.10, 95% CI: 0.91-1.31, log rank P = 0.323). The mPFS for the Asian group did not show significant differences compared with TOPAZ-1 (5.63 months vs. TOPAZ-1, HR = 1.09, 95% CI: 0.88-1.35, log rank P = 0.422), whereas for the non-Asian group differences exist (6.58 months vs. TOPAZ-1, HR = 0.80, 95% CI: 0.70-0.92, log rank P = 0.002), but potentially influenced by patient ethnicity. The disease control rate in the real world was not so favorable as that in TOPAZ-1. The most common adverse events (AEs) in real-world scenarios were fatigue (26.01%), leukopenia (24.64%), anemia (24.30%), and thrombocytopenia (21.14%). The incidence of immune-related AEs of grades 3-4 was slightly higher in the real world compared with TOPAZ-1 (4.0% vs. 2.4%). Factors such as ECOG-PS, age, alternative doses of durvalumab, neutrophil-to-lymphocyte ratio (NLR), baseline CEA levels, baseline CA19-9 levels, and metastatic disease could be prognostic factors under DGC regimen, with NLR showing a potential as a predictive marker for survival benefit. Conclusions:The efficacy and safety of the DGC regimen for patients with advanced BTC are confirmed through a comparative analysis and aggregation of real-world evidence in this study. Further real-world investigations are still warranted to determine if the DGC regimen has a broader therapeutic indication and to identify predictive markers for survival benefit. Efforts are required to improve the cost-effectiveness of the DGC regimen to facilitate its wider and standardized use.

Objective:Type 2 diabetes mellitus (T2DM) is strongly associated with obesity, a significant risk factor for the occurrence and progression of chronic kidney disease. In recent years, weight loss surgery has become an important treatment option for diabetes. This study examined whether Roux-en-Y gastric bypass surgery, a new metabolic bariatric surgery approach, can effectively reduce the risk of long-term renal impairment in individuals with type 2 diabetes. Methods:In a cohort study, 60 individuals suffering from both obesity and type 2 diabetes were stratified and randomly divided into 2 groups based on gender and weight. The control group (30 cases) received internal medicine treatment; the observation group (30 cases) received Roux-en-Y gastric bypass surgery. The study compared the changes in glycated hemoglobin, fasting blood glucose, fasting insulin, fasting C-peptide, postprandial 2-hour blood glucose, postprandial 2-hour insulin, postprandial 2-hour C-peptide, weight, waist circumference, and BMI before and at 6, 12, and 18 months after treatment. Kidney function-related indicators such as urinary protein excretion, microalbuminuria, and creatinine clearance were also compared. Results:There were no significant differences in the above indicators between the 2 groups before treatment (P > .05). After 6, 12, and 18 months of treatment, the levels of glycated hemoglobin, fasting blood glucose, fasting insulin, fasting C-peptide, postprandial 2-hour blood glucose, postprandial 2-hour insulin, postprandial 2-hour C-peptide, weight, waist circumference, and BMI were significantly decreased compared to before treatment (P < .05). Urinary protein excretion and microalbuminuria decreased, while creatinine clearance increased after 6, 12, and 18 months of surgery (P < .05). The differences in indicators between the 2 groups at each point after surgery were statistically significant (P < .05). Conclusion:Roux-en-Y gastric bypass surgery was more effective than medical treatment in treating type 2 diabetes and mitigating long-term kidney function damage. These findings confirm the clinical utility of Roux-en-Y gastric bypass surgery in these conditions, indicating its potential for generalization and reference.

The CHOP combined chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) is commonly used to treat non-Hodgkin Lymphoma (NHL). While these drugs are effective for cancer treatment, they may have side effects on the reproductive system that are poorly studied. This study used a mouse model to investigate the mechanisms of reproductive function impairment induced by the CHOP regimen and developed a predictive model for assessing reproductive damage with a non-invasive procedure. From 2022 to 2023, we statistically analyzed the changes of reproductive function of NHL patients before and after receiving CHOP regimen in the First Affiliated Hospital of Xiamen University. The NHL mouse model was established and divided into CHOP treatment group and control group. The weight of testis and epididymis, sperm quality and motility were compared between the two groups. Histopathological examination of testicular tissue was performed to determine pathological changes. ELISA was used to measure the expression of cytokines and cytokine pathways in serum, protein expression was analyzed by immunohistochemistry, and protein and mRNA levels of cytokines and pathways were evaluated by Western blotting and qPCR. Using stepwise regression method to select important factors, a prediction model of reproductive system damage was constructed. Fifty-two NHL patients included in the questionnaire showed significant reproductive system damage after CHOP regimen treatment. The weight of testis and epididymis, as well as the number and vitality of sperm in the mouse model treatment group were significantly lower than those in the control group. Serum LH, FSH, estradiol and progesterone levels decreased significantly, while inhibin B levels increased significantly. There was no significant change in testosterone or prolactin levels. Inflammatory markers such as CSF-1, IL-1, IL-6, TGF-β1 and GDNF increased significantly, while the level of SOD1 decreased significantly. Immunohistochemical staining analysis showed that CAMP, Caspase3, CSF-1, GDNF, IL-1, IL-6, PRKACB, TGF-β1 and TXNDC5 were all expressed in spermatocytes, and the expression of therapeutic histones was significantly higher than that of the control group. Western blot analysis further detected the protein expression, and QPCR detected the mRNA content. The results showed that the expression of histone and mRNA in the treatment group was significantly higher than that in the control group. Stepwise regression method determined that estradiol (E2) was the most important variable in the prediction model, and the AUC for predicting reproductive damage was 1. The CHOP regimen induces male reproductive toxicity, potentially mediated through alterations in hormone levels and increased expression of inflammatory cytokines and oxidative stress. Using E2 as the sole predictor in the model accurately predicts the extent of reproductive damage, offering a non-invasive method for detecting reproductive system damage.

PURPOSE:The advent of circulating tumor DNA (ctDNA) technology has provided a convenient and noninvasive means to continuously monitor cancer genomic data, facilitating personalized cancer treatment. This study aimed to evaluate the supplementary benefits of plasma ctDNA alongside traditional tissue-based next-generation sequencing (NGS) in identifying targetable mutations and tumor mutational burden (TMB) in colorectal cancers (CRC). METHODS:Our study involved 76 CRC patients, collecting both tissue and plasma samples for NGS. We assessed the concordance of gene mutational status between ctDNA and tissue, focusing on actionable genes such as KRAS, NRAS, PIK3CA, BRAF, and ERBB2. Logistic regression analysis was used to explore variables associated with discordance and positive mutation rates. RESULTS:In total, 26 cancer-related genes were identified. The most common variants in tumor tissues and plasma samples were in APC (57.9% vs 19.7%), TP53 (55.3% vs 22.4%) and KRAS (47.4% vs 43.4%). Tissue and ctDNA showed an overall concordance of 73.53% in detecting actionable gene mutations. Notably, plasma ctDNA improved detection for certain genes and gene pools. Variables significantly associated with discordance included gender and peritoneal metastases. TMB analysis revealed a higher detection rate in tissues compared to plasma, but combining both increased detection. CONCLUSIONS:Our study highlights the importance of analyzing both tissue and plasma for detecting actionable mutations in CRC, with plasma ctDNA offering added value. Discordance is associated with gender and peritoneal metastases, and TMB analysis can benefit from a combination of tissue and plasma data. This approach provides valuable insights for personalized CRC treatment.

最新全球疾病负担报告表明,创伤是影响10～24岁及25～49岁人群伤残调整寿命年的首要因素[1].89％的创伤相关死亡发生于中低收入国家,每年死亡人数超过600万,占世界死亡人数的10％[2].急性创伤性凝血病(acute traumatic coagulopathy,ATC)是在创伤后发生的机体凝血、纤溶系统及抗凝系统发生的急性凝血障碍性疾病[3-4],其可作为独立影响因素使创伤患者死亡风险增高[5].

BackgroundThe safety of mastectomy (MT) with immediate reconstruction (IR) in breast cancer patients who have completed neoadjuvant chemotherapy (NAC) is not apparent. This meta-analysis aims to systematically evaluate the differences in surgical complications and postoperative survival rates between MT with IR (MT+IR) and MT alone in post-NAC breast cancer patients.MethodsThe PubMed, Embase, Cochrane Library, WanFang Data, and CNKI databases were systematically searched, and cohort studies of post-NAC breast cancer patients with MT+IR or MT surgery were collected from databases inception to May 25, 2023. Two researchers independently executed literature screening, data extraction, and bias risk assessment, and meta-analysis was performed using Revman 5.3 software.ResultsA total of 12 studies involving 7378 cases who have accepted NAC were collected for this study. The results showed that compared with the MT group, the relative risk of surgical complications in the MT+IR group was increased by 44%, with no statistical significant [RR=1.44, 95% CI (0.99, 2.09), P=0.06]. While among study subgroups with a median follow-up of less than one year, more surgical complications occurred in the MT+IR group by 23% [RR=1.23, 95% CI (1.00, 1.52), P=0.05]. There was no significant differences in overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival between the two groups.ConclusionsCompared with the MT, MT+IR does not affect the postoperative survival rate in post-NAC breast cancer patients, accompanied by a mild increase in short-term surgical complications, but no significant difference in long-term complications.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42023421150.

目的:探讨西妥昔单抗联合奥沙利铂、卡培他滨治疗晚期结肠癌的临床疗效.方法:选取107例晚期结肠癌患者作为研究对象,根据治疗方式不同将患者分为对照组(n=52)和试验组(n=55).对照组予以奥沙利铂联合卡培他滨化疗方案治疗;试验组在对照组基础上予以西妥昔单抗治疗,21 d为1个疗程,两组患者均治疗两个疗程.比较两组治疗前后karnofsky评分(KPS)、血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)]和细胞免疫功能指标.记录并比较两组患者临床疗效和不良反应.结果:与对照组比较,试验组总有效率更高(63.64％vs.38.46％,P<0.05).治疗后,试验组KPS评分高于对照组(P<0.05);血清CEA、CA199水平低于对照组(P<0.05).治疗后,两组CD3+、CD4+和CD4+/CD8+T细胞水平相比治疗前均降低(P<0.05),但试验组高于对照组(P<0.05).两组患者不良反应发生率比较,差异无统计学意义(P>0.05).结论:西妥昔单抗联合奥沙利铂与卡培他滨治疗晚期结肠癌能够提高临床疗效,降低患者血清肿瘤标志物水平,改善免疫功能.

Objective To explore the value of multidisciplinary team（MDT） nursing in elderly patients with diabetes mellitus and acute cholecystitis（AC）. Methods From December 2020 to December 2021, 68 elderly patients with diabetes and AC who were admitted to the 73rd Army Group Hospital of the Army were selected as the study objects. 34patients were included in the control group（according to routine care） and 34 patients were included in the observation group（MDT nursing intervention）. The blood glucose index, self-care ability and quality of life scores before and after the intervention were compared between the two groups. Results Before intervention, there was no statistically significant difference in blood glucose level between the two groups（P＞0.05）. After intervention, the blood glucose level in the observation group was lower than that in the control group, the difference was statistically significant（P＜0.05）. Before intervention, there was no statistically significant difference in the scores of self-care ability and quality of life between the two groups（P＞0.05）. After intervention, the self-care ability and quality of life of the observation group were higher than those of the control group, the difference was statistically significant（P＜0.05）. Conclusion MDT nursing intervention in elderly patients with diabetes mellitus and AC has an ideal effect, which can better control their blood glucose, improve their self-care ability and quality of life.

Purpose Recently developed circulating tumor DNA (ctDNA) technique is convenient and noninvasive for dynamically monitoring cancer genomic information to instruct personalized treatment. We assessed the additional value of plasma ctDNA to routine tissue next generation sequencing (NGS) of therapeutically targetable mutations and tumor mutational burden (TMB) in colorectal cancers (CRC). Methods Tissue and plasma ctDNA sequencing data from 76 colorectal cancer patients were retrospectively analyzed using 556 or 105 cancer-related gene panels. The concordance of plasma-based NGS assays with solid tumor-based NGS assays was compared. Results In total, 26 cancer-related genes were identified. The most common variants in tumor tissues and plasma samples were in APC (57.9% vs 19.7%), TP53 (55.3% vs 22.4%) and KRAS (47.4% vs 43.4%). For the detection of therapeutically targetable mutations, the overall concordance of KRAS , PIK3CA , BRAF, NRAS and ERBB2 between plasma- and tissue-based analyses was 75% (57/76), 90.79% (69/76), 96.05% (73/76), 100% (76/76) and 94.74% (72/76), respectively. Moreover, the positive mutation rate of these genes by plasma plus tissue was significantly higher than that by single assay, both for individual genes and for gene combinations. Similar result was also observed for the detection of TMB-H. The increased positive mutation rate of combined tissue and plasma testing was independent of the clinical characteristics of the patients. Conclusion In conclusion, plasma ctDNA additionally increases the positive detection rate of tissue NGS only. Tissue NGS and plasma ctDNA results should be mutually complementary in clinical detection to comprehensively capture important clinically relevant genomic information for CRCs.

目的:观察四君子汤方加减联合肠内营养对促进D2 胃癌术后快速康复的临床疗效.方法:回顾性分析厦门大学附属成功医院普外二区 2019 年 11 月至 2021 年 2 月收治的 101 例行D2 胃癌根治术患者的临床资料,根据术后是否服用中药汤剂四君子汤分为联合组(51例)及对照组(50 例).对照组从术后第 2～9 天服用肠内营养制剂,联合组在对照组基础上加用四君子汤.比较两组患者术后康复情况:排气时间、拔尿管时间、拔引流管时间、下床时间、住院时间、住院费用、术后疼痛评分及术后并发症情况;比较两组患者术后 10 d中医证候积分、血清白蛋白、前白蛋白、转铁蛋白,免疫球蛋白(Ig)G、IgA、IgM、CD3+、CD4+、CD4+/CD8+水平.结果:与对照组比较,联合组中医证候积分降低、排气时间提前、拔引流管时间提前、下床活动提前、术后住院时间缩短、住院费用减少,差异有统计学意义(P＜0.05);两组患者术后 36 h、48 h及 60 h疼痛评分对比,差异有统计学意义(P＜0.05);两组患者术后尿管拔除时间比较,差异无统计学意义(P＞0.05);术后 10 d,联合组血清白蛋白、前白蛋白、转铁蛋白、IgG、IgA、IgM及CD3+、CD4+、CD4+/CD8+水平均比对照组显著提升(P＜0.05);联合组和对照组并发症发生率分别为 3.9%、8.0%.术后 1 个月门诊随访复查,均恢复较好.结论:胃癌根治术后四君子汤加减联合肠内营养可以显著降低术后中医证候积分,改善免疫功能及营养状态,减轻术后疼痛,促进肠道功能早期恢复,减少住院时间及住院费用,促进胃癌术后快速康复,安全可行.

Immune checkpoint inhibitor-associated adverse reactions (irAEs) are a clinical treatment issue that requires additional attention when ICIs have significant survival benefits in patients with advanced hepatocellular carcinoma (HCC). Among them, ICIs-associated myocarditis (ICIAM) is a kind of severe irAE with a high mortality rate (17%–50%). Despite its low incidence (PD1/PD-L1 related: 0.41%–0.8%), ICIAM can significantly disturb the decision making of therapeutic schemes and even the survival outcomes of patients. ICIAM induced by sintilimab has not been reported in any complete clinical studies yet and understanding the clinical characteristics involved may inform better practices for the management. Here, we reported a 78 y/o patient with advanced HCC, who experienced ICIAM induced by sintilimab within a short course from treatment onset and found that adequate baseline examination before the implementation of the therapeutic scheme, regular monitoring of myocardial enzymonram and cardiac imaging were measures for the early detection, while glucocorticoid pulse therapy is still the best choice with timely and sufficient application. Simultaneously, the combination of other immunosuppressants may lead to better results. New-predictive markers and examination methods are still required to facilitate the early detection.

目的 探讨中低位直肠癌前切除(low anterior resection,LAR)术后发生吻合口漏的危险因素.方法 回顾性对照研究方法,分析中国人民解放军南部战区总医院普通外科2015—2019年行LAR术505例患者的临床资料,按照国际直肠癌研究小组(International Study Group of Rectal Cancer,ISREC)对术后吻合口漏(anastomotic leakage,AL)进行确诊.观察指标有性别、年龄、糖尿病、高血压、吸烟史、体质量指数(body mass index,BMI)、肠梗阻、新辅助治疗、肿瘤直径、手术方式、术中出血量、手术时间、吻合口与肛缘距离、预防性肠造口、术后白蛋白及血红蛋白.采用χ2检验对吻合口漏的影响因素进行单因素分析,对比组间差异具有统计学意义的变量纳入多因素Logistic回归分析,确定吻合口漏发生的独立危险因素.结果 男309例,女196例,平均年龄61(36～73)岁.吻合口漏43例(8.5％),A/B级漏37例(86.0％),C级漏6例(14.0％).单因素分析显示,性别(P=0.029)、糖尿病(P=0.002)、吸烟史(P=0.027)、BMI≥28 kg/m2(P=0.002)、肠梗阻(P=0.004)、新辅助治疗(P=0.002)、肿瘤直径≥5 cm(P=0.017)、吻合口与肛缘距离≤5 cm(P=0.021)、预防性肠造口(P=0.020)、术后白蛋白<35 g/L(P=0.030)、术后血红蛋白<100 g/L(P=0.029)在观察组与对照组的差异具有统计学意义(P<0.05).多因素Logistic回归分析显示,性别(OR=0.217,95％CI:0.070～0.669,P=0.008)、糖尿病(OR=4.617,95％CI:1.391～15.332,P=0.012)、BMI≥28 kg/m2(OR=1.292,95％CI:1.036～1.612,P=0.023)、肠梗阻(OR=8.588,95％CI:1.432～51.511,P=0.019)、新辅助治疗(OR=13.971,95％CI:2.974～65.624,P=0.001)、肿瘤直径≥5 cm(OR=2.46,95％CI:1.377～4.393,P=0.002)、吻合口与肛缘距离≤5 cm(OR=0.171,95％CI:0.100～0.294,P<0.001)、术后血红蛋白<100 g/L(OR=0.91,95％CI:0.875～0.947,P<0.001)是吻合口漏发生的独立危险因素,而预防性肠造口(OR=0.001,95％CI:0.001～0.011,P<0.001)是吻合口漏发生的保护因素.结论 吻合口漏病理是多因素共同作用的结果.了解吻合口漏危险因素,在于采取更好的防治措施.

下腔静脉畸形罕见,主要包括双下腔静脉、左下腔静脉、下腔静脉后段缺失等.双下腔静脉畸形是指在肾静脉以下有左右两条对称的下腔静脉,其发生与在胚胎期发育过程中双侧上主静脉持续存在而未退化有关[1].Trigaux等[2]研究发现双下腔静脉变异发生率为0.3％,此类畸形由于多无临床症状和体征,以往多在尸检或其他器官疾病行相关辅助检查时偶然发现,目前多为个案报道或小样本临床研究[3-8].我院2019年8月22日收治1例双下腔静脉畸形并双下肢深静脉血栓形成患者,手术置入肾上下腔静脉滤器,总结报道如下.

目的:探讨肺动脉置管溶栓在中危急性肺栓塞患者中的临床疗效.方法:回顾性分析2017年6月至2019年10月,16例行肺动脉置管溶栓治疗中危急性PTE患者的临床资料,对比溶栓前后患者呼吸频率、血氧饱和度、动脉血氧分压、心率、D-二聚体及肺动脉DSA、CTA结果,评估治疗效果.结果:16例肺栓塞患者均顺利完成肺动脉置管溶栓治疗.其中14例患者因合并下肢DVT同期行下腔静脉滤器置入,术后1周内14例患者临床症状均消失,呼吸频率、血氧饱和度、动脉血氧分压、心率、D-二聚体较术前明显改善;肺动脉DSA复查未见血栓残留,术后无严重并发症发生,治愈率87.5％.术后3个月16例患者肺动脉CTA复查未见血栓残留,治愈率达100％.结论:肺动脉置管溶栓可有效缓解中危急性肺栓塞患者临床症状,临床疗效确切.

目的:建立结直肠癌病人来源的异种移植(PDX)模型,探讨氟尿嘧啶(5-fluorouracil,5-Fu)的药效、毒性与给药剂量之间的关系.方法:将新鲜的结直肠癌手术标本移植至免疫缺陷小鼠皮下,建立PDX模型并稳定传代,检测模型的溯源性;分别给予5、10、20、40、60 mg/kg浓度的5-Fu,测量肿瘤体积、小鼠体质量变化和死亡情况等.结果:成功建立PDX模型,溯源性高达99.96％.5-Fu 5、10、20、40、60 mg/kg剂量组对应的肿瘤抑制率分别为33％、49％、68％、92％、100％.其中,40 mg/kg剂量组小鼠体质量剧减,60 mg/kg剂量组死亡率达100％.结论:5-Fu的体内抑瘤效果及毒性与剂量密切相关,10～20 mg/kg剂量的5-Fu较适合PDX模型的药效评价.

Objective To investigate the risk factors for anastomotic leakage (AL) after laparoscopic intersphincteric resection (Lap-ISR) for patients with low-lying rectal cancer.Methods This retrospective study was conducted in the Characteristic Medical Center of PLA Rocket Force from Jun 2011 to Nov 2018.151 patients undergoing Lap-ISR were enrolled for this study.Results All patients in this series had a defunctioning ileostomy.The overall leakage rate was 17.2％ (26/151),including peri-operative AL (n =20) and delayed AL (n =6).In accordance with the grading system of the International Study Group of Rectal Cancer,there were 24 patients (15.9％) with AL Grade B (requiring active therapeutic intervention) and two patients (1.3％) with AL Grade C (requiring re-laparotomy).Univariate analysis showed that BMI (≥ 25 kg/m2),tumor annularity (≥ 3/4) and operation time (≥ 240 min) were associated with AL (P ＜ 0.05).Multivariate analysis showed that operation time (≥ 240 min,OR =7.390,95％ CI:2.483-21.988,P =0.000),tumor annularity (≥ 3/4,OR =6.233,95％ CI:1.932-20.107,P=0.002) and higher BMI (≥ 25 kg/m2,OR=3.523,95％ CI:1.275-9.738,P=0.015)were independently predictive of AL Conclusion Tumor annularity,operation time and higher BMI are independently associated with symptomatic AL after Lap-ISR.

目的 探讨三维可视化技术在胆囊癌根治术中的应用价值.方法 回顾性分析2014年1月至2016年12月东方肝胆外科医院收治的56例胆囊癌患者的临床资料,应用三维可视化影像系统将患者术前二维CT图像进行三维可视化重建,通过观察肿瘤与临近肝脏、血管、胆管、淋巴管之间的关系,评估根治的可能性,模拟手术规划,预估手术风险.通过对患者实施根治性手术,比较重建结果与实际手术的区别,统计分析手术时间、术中出血量、术中输血量、并发症发生情况.结果 56例患者三维可视化重建后图像清晰立体地显示胆囊肿瘤及侵犯的肝组织,转移的淋巴结以及与第一肝门的解剖结构及毗邻关系,均顺利完成胆囊癌根治术,三维重建肿瘤的解剖关系与术中情况大致相符.结论 采用三维可视化技术能够对胆囊癌患者术前进行精准手术规划评估,提高手术根治率,降低围手术期风险,具有一定的临床应用价值.

目的 探讨腹腔镜直肠癌术后排尿功能障碍的危险因素.方法 回顾性分析火箭军特色医学中心肛肠外科2014年1月至2016年5月收治的196例腹腔镜直肠癌手术患者的临床资料,将术后出现排尿困难或排尿不尽等排尿障碍症状且B超检查结果 显示膀胱残余尿量超过100 mL定义为排尿功能障碍,采用单因素和多因素Logistic回归分析探讨患者术后排尿功能障碍的危险因素.结果196例患者中有35例(17.9％)发生排尿功能障碍.单因素分析发现,男性较女性(22.4％vs.9.9％,OR=2.639,P=0.032)、APR手术较AR+ISR手术(33.3％vs.15.7％,OR=2.685,P=0.040)、糖尿病患者较非糖尿病患者(31.0％vs.14.3％,OR=2.690,P=0.015)术后排尿功能障碍的发生率更高,且差异均有统计学意义.中低位直肠癌患者发生术后排尿功能障碍的例数多于高位直肠癌患者,但差异无统计学意义(P=0.113).多因素分析结果显示,男性(P=0.023,OR=2.893,95％CI 1.158～7.227),APR手术(P=0.031,OR=2.977,95％CI 1.106～8.011),合并糖尿病(P=0.010,OR=2.954,95％CI 1.291～6.761)是腹腔镜直肠癌术后排尿功能障的独立危险因素.结论 男性、行腹会阴联合根治术和患有糖尿病的直肠癌患者行腹腔镜根治性手术易发生术后排尿功能障,临床上应予以重视,围术期控制好血糖,术中注重保护神经功能,以减少术后排尿功能障碍的发生.