The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases

Sixty consecutive patients in whom a free radial forearm flap was used to reconstruct an intraoral defect have been reviewed. The ages ranged from 54 to 85 years, the majority of patients presenting with intraoral carcinoma. There were 6 microvascular failures, and the remaining 54 patients (90 percent) healed uneventfully, with no incidence of fistula. Intraoral healing time was reduced to 11 days on average, and hospitalization was similarly reduced to 17.8 days. A slower postoperative recovery did not appear to be related to age or to the site of the defect within the oral cavity but closely paralleled the extent of excisional surgery. The postoperative mortality was less than 2 percent, but the overall prognosis remained poor, with a 21.6 percent mortality at follow-up (minimum 15 months). Thirty-nine patients (72 percent) underwent early postoperative radical radiotherapy without any evidence of intraoral wound breakdown or problems with flap viability. The results demonstrate the effectiveness of this method of intraoral reconstruction and indicate that such complicated and prolonged surgical techniques do not increase the risks associated with major head and neck surgery.     

Infraorbital rim augmentation

In patients with recessive infraorbital rims, alloplastic augmentation of the infraorbital rims makes the eyes appear less prominent and improves appearance. Ten patients (seven women and three men) with an average age of 30 years (range, 23 to 45 years) underwent augmentation of the infraorbital rim with alloplastic implants over a 9-year period. With an average follow-up of 3 years (range, 6 months to 6 years), reconstructions have remained stable and satisfactory, with no incidence of infection, infraorbital nerve damage, or palpebral fissure distortion. One patient underwent additional surgery to correct contour irregularities, and one patient requested implant removal 1 month after surgery.     

Capsule injection for the prevention of contracture

From 1990 through 1999, 164 patients with prior augmentation mammaplasty underwent implant removal by the author, and 128 of the patients had the implants replaced. Of that group, 86 were noted on preoperative examination to have capsule contracture of grade III or IV. Patients with preoperative capsule contracture were offered the option of a postoperative injection of triamcinolone intended to prevent recurrent contracture. Patients who elected to have replacement with gel-filled implants were excluded. A total of 48 patients underwent injection of triamcinolone 4 to 6 weeks after surgery. Of the remaining 38 patients, 12 were not offered injection because they selected gel-filled implants and 26 declined injection. Follow-up ranged from 8 months to 10 years (mean, 46 months), and no patient was followed up for less than 8 months. Of the 48 patients who received injections, two developed recurrent contracture, one at 3 years and one at 4.5 years. Of the 26 patients who declined injection, eight had recurrent contracture (three bilateral) within 12 months. These data suggest that in this high-risk group of patients, a postoperative injection of triamcinolone can reduce the risk of recurrent contracture.     

保乳手术与改良根治术治疗Ⅰ-Ⅱ期乳腺癌患者的疗效及生存状况比较研究

目的:比较分析乳腺癌保乳手术和根治术的临床疗效及患者生存状况。方法:回顾性分析2012年6月至2015年6月在我院乳腺外科行手术治疗的乳腺癌患者92例的临床资料,其中行保乳手术患者24例(保乳组),行根治手术患者68例(根治组),两组患者术后均采用个性化综合治疗巩固疗效,对比观察两组疗效及预后状况;通过乳腺癌生命质量测定量表(FACT-B)检测对比两组患者术后1、2年的生存质量;并对比两组患者术后乳房美容效果。结果:保乳组患者手术时间、术中出血量、引流量以及引流时间均明显较根治组少,差异有统计学意义(P0.05),而淋巴结清扫数则无明显差异(P0.05);两组患者上肢水肿发生率无明显差异(P0.05),而保乳组切缘皮瓣缺血发生率低于根治组(P0.05);两组患者术后2年生存率、复发率以及远处转移率无统计学差异(P0.05)。保乳组患者术后1、2年生理状况、情感状况、社会状况、功能状况、其他因素及生活质量综合评分均显著高于根治组,差异有统计学意义(P0.05);保乳组术后乳房美容效果的优良率显著高于根治组,差异有统计学意义(P0.05)。结论:相比于根治术,保乳手术不仅具有创伤小、术后恢复快的优势,患者预后状况与根治术相当,同时可更好的改善患者生存质量,术后乳房美容效果较好,临床应用价值更高。     

The utility of superficial abdominal reflex in the initial diagnosis of scoliosis: a retrospective review of clinical characteristics of scoliosis with syringomyelia

Background

The incidence of spinal deformity in children with Prader-Willi syndrome (PWS) is high, with 86% of these patients found to have a significant structural scoliosis; however, there are very few case reports describing surgical treatment for this deformity.

Methods

The authors reviewed a case series consisting of 6 patients who underwent spine surgery for scoliosis. Children's mean age at index surgery was 12 years and 10 months (range, 10 to 15 yrs). Clinical evaluation revealed the typical phenotypic features of the PWS in all of the patients; 4 subjects had a karyotype confirmation of PWS. Major structural curves showed preoperative mean Cobb angles of 80.8° (range, 65° to 96°). Hybrid instrumentation with sublaminar wires, hooks and screws was used in the first 2 patients, while the remaining 4 were treated with titanium pedicle screw constructs.

Results

The mean clinical and radiological follow-up was 3 years and 10 months (range, 2 years to 9 years). Major complication rate was 50%. One patient who developed a major intraoperative complication (paraparesis) prevented spinal fusion to be obtained: the neurologic deficit resolved completely after instrumentation removal. Solid arthrodesis and deformity correction in both coronal and sagittal plane was, however, achieved in the other 5 cases and no significant curve progression was observed at follow-up. Another major short-term complication was encountered 3 months after surgery in a patient who experienced the detachment of a distally located rod and required correction through revision surgery and caudal extension by one level. Cervico-thoracic kyphosis was seen in 1 patient who did not require revision surgery.

Conclusions

Spine reconstructive surgery in patients with PWS is rare and highly demanding. The best method of reconstruction is posterior multilevel pedicle screw fixation. Moreover, even with modern techniques, the risk of complications is still high. These new techniques, however, have shown to improve the postoperative course by allowing for immediate mobilization without any brace or cast. The use of the growing rod techniques, requiring repeated surgeries, should be carefully evaluated in each single case.     

Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results.

A review was performed on 170 patients who underwent 173 consecutive latissimus dorsi myocutaneous flap breast reconstructions between 1978 and 1989. The majority of the patients had modified radical mastectomies, and reconstruction was usually delayed for 3 to 18 months after mastectomy. Acceptable symmetry was obtained in the majority of patients without the need for surgery on the opposite breast. Perioperative and long-term complications are reviewed. Patients were followed for an average of 4.7 years after reconstruction. Ninety-four percent of patients demonstrated little or no change in the reconstructed breast after the first year. This method of reconstruction has met patient expectations with a minimum number of procedures and low morbidity.     

Surgical management of the anophthalmic orbit, part 2: post-tumoral

Ablative surgery for tumors of the globe and its adnexal structures is frequently the cause of major orbitofacial deformity. Radiotherapy compounds the problem because it suppresses skeletal growth in the growing patient and induces a contraction of the remaining soft tissues in the orbit. Goals for reconstruction in these patients include the restoration of orbital structures to allow the fitting of an ocular prosthesis and the correction of distorted orbitofacial relationships. The authors present a series of 53 patients (mean age, 29 years; 28 male) who were treated over the past 18 years by composite reconstruction of the post-tumoral anophthalmic orbit. The follow-up ranged from 5 months to 18 years (mean, 7.75 years). Four patients were treated primarily (immediate reconstruction after tumor ablation), and 49 were treated secondarily (mean oncological follow-up since ablative surgery, 14.8 years). Twenty-eight patients underwent orbital enucleation (including three bilateral cases), 23 underwent orbital exenteration, and two underwent evisceration. Forty-two patients received radiotherapy, including 20 enucleation patients, 15 exenteration patients, and seven others in whom details of primary therapy were incomplete. A staged reconstruction was undertaken in each case; it considered, in turn, the bony orbital volume (orbital remodeling and cranial bone grafts), orbital contents (implant, temporalis muscle transposition, cranial bone grafts, and dermafat grafts), conjunctival sac (mucosal and skin grafts), ocular prosthesis, eyelids (local flaps and skin grafts), and additional procedures to restore orbitofacial symmetry. The authors conclude that the long-term results of post-tumoral orbital reconstruction are favorable, and they particularly recommend the use of autogenous tissues in irradiated orbits.     

Intraductal papillary neoplasms of bile duct. A distinct entity like its counterpart in pancreas

To recognize the new entity-intraductal papillary neoplasia of bile duct in liver, the authors reviewed the clinical records of sixteen patients, analyzed the microscopic features, and selected immunohistochemical reactivity (cytokeratins and mucins) that might correlate with classification. Ten patients were male and six were female, with a mean age of 58 years (range, 21-73 years). According to their cell phenotypes, these papillary tumors were classified as intestinal type (6 cases), pancratobiliary type (4 cases), gastric type (5 cases) and oncocytic type (1 case). Most were located in the left hepatic duct and accompanied with bile duct dilatation (10 cases). Eight showed minimal expansile invasion into the ductal wall and eight were noninvasive. Five patients were treated with a hepatectomy, three underwent segmental resections, and one underwent a left hepatic lobectomy. One patient died of unrelated causes 6 years after operation, and another died of postoperative complications. The remaining 7 patients are alive and disease free 1-5 years after surgery. Because of its distinct clinical, pathological features and a favorable prognosis can be expected after complete surgical resection, we suggested that intraductal papillary neoplasia should be distinguished from other types of peripheral cholangiocarcinoma, as a distinct entity, like its counterparts in the pancreas. Neoexpressed and overexpressed mucins are of clinical value as a marker for supportive diagnosis, prognosis or monitoring therapy.     

Survival among clinical stage I–III rectal cancer patients treated with different preoperative treatments: A population-based comparison

BackgroundRadical resection is regarded as the cornerstone of rectal cancer treatment. Preoperative (chemo)radiotherapy and adjuvant chemotherapy are often administered. This population-based study compares the survival in clinical stage I–III rectal cancer patients who received either preoperative radiotherapy, preoperative chemoradiotherapy or no preoperative therapy. As secondary research questions, the association of type of radical resection and adjuvant chemotherapy on survival is also investigated.MethodsPatients diagnosed between January 2006 and December 2011 with stage I–III rectal adenocarcinoma were retrieved from the Belgian Cancer Registry database. Multivariable Cox proportional hazards regression models were applied to evaluate the association of preoperative treatment, type of radical resection and use of adjuvant chemotherapy with survival, adjusting for the baseline characteristics age, gender, WHO performance status and clinical stage.ResultsA total of 5173 rectal cancer patients were identified. Preoperative treatment was as follows: none in 1354 (26.2%), radiotherapy in 797 (15.4%) and chemoradiotherapy in 3022 (58.4%) patients. The patient group who did not receive preoperative therapy or radiotherapy followed by radical resection had a lower observed survival compared to the patient group receiving preoperative chemoradiotherapy. The patient groups who underwent abdominoperineal excision and those receiving adjuvant chemotherapy had a worse observed survival compared to the patient group treated with sphincter-sparing surgery and no adjuvant therapy respectively. These effects were age-dependent. Multivariable analysis demonstrated similar findings for the observed survival conditional on surviving the first year since surgery.ConclusionIn this population-based study among clinical stage I–III rectal cancer patients treated with radical resection, a superior observed survival was noticed in the patient group receiving preoperative chemoradiotherapy compared to the patients groups receiving no or preoperative radiotherapy only, adjusting for case mix, type of radical resection and adjuvant chemotherapy. Additionally, higher adjusted observed survival was also detected for the patient groups with sphincter-sparing surgery or no adjuvant chemotherapy.     

Research: Is resection of tumours involving the pelvic ring justified? : A review of 49 consecutive cases

INTRODUCTION: Pelvic surgery is challenging and impacts significantly on limb and visceral function, thus, raising the question "is heroic surgery justifiable". This study assessed the functional, oncologic and surgical outcomes following pelvis tumour resections. METHODS: Between 1996-2003, 49 patients (mean age 43 years) underwent pelvic tumour resections- 38 primary malignant tumours, 5 secondary tumours and 6 benign tumours. Bone tumours comprised 5 osteosarcomas, 5 Ewings sarcomas, and 12 chondrosarcomas. Of the soft tumours, 9 were of neural origin. Tumours involved the ilium, acetabulum, pubic bones, sacrum or a combination of these. Functional assessment was performed and no patient had metastases at presentation. RESULTS: There were 41 limb sparing resections and 8 hindquarter amputations. Surgical margins were intralesional (1), marginal (13), wide (26), and radical (3). Of limb sparing surgery, prosthetic reconstructions were performed in 10 patients, biologic reconstructions in 6, a combination of these in 3 and no reconstruction in others. There was 1 intraoperative death, 7 local recurrences and 19 metastases. Death from disease occurred at a mean of 14.2 months with a mean followup of 27 (1-96) months. Amputation and periacetabular resections had worse functional outcomes. Emotional acceptance was surprisingly high. CONCLUSION: Pelvic resections are complex. Functional outcome is significantly affected by surgery. Disease control is similar to limb tumours. Emotional acceptance of surgery in survivors was surprisingly high. Major pelvic resection for malignancy appears justified.     

Reconstruction of concomitant lip and cheek through-and-through defects with combined free flap and an advancement flap from the remaining lip

Massive facial defects involving the oral sphincter are challenging to the reconstructive surgeon. This study presents the authors' approach to simultaneous reconstruction of complex defects with an advancement flap from the remaining lip and free flaps. From January of 1997 to December of 2001, 22 patients were studied following ablative oral cancer surgery. Their ages ranged from 32 to 66 years. Nineteen patients had buccal cancer, two patients had tongue cancer, and one patient had lip cancer. In all cases, the disease was advanced squamous cell carcinoma. Nine patients underwent composite resection of tumor with segmental mandibulectomy, and seven patients underwent marginal mandibulectomy. Cheek defects ranged from 15 x 12 cm to 4 x 3 cm, and intraoral defects ranged from 14 x 8 cm to 5 x 4 cm in size. One third of the lower lip was excised in nine patients, both the upper and lower lips were excised in 10 patients, and only commissure defects were excised in three patients. An advancement flap from the remaining upper lip was used for reconstruction of the oral commissure and oral sphincter. Then, the composite through-and-through defect of the cheek was reconstructed with radial forearm flaps in 13 patients, fibula osteocutaneous flaps in five patients, double flaps in three patients, and an anterolateral thigh flap in one patient. The free flap survival rate was 96 percent, and only one flap failed. With regard to complications, there were two patients with cheek hematoma, six patients with orocutaneous fistula or neck infection, and one patient with osteomyelitis of the mandible. All but one patient had adequate oral competence. All patients had an adequate oral stoma and could eat a regular or soft diet; two patients could eat only a liquid diet. For moderate lip defects, immediate reconstruction of complex defects took place using an advancement flap from the remaining lip to obtain a normal and functional oral sphincter; the free flap can be used to reconstruct through-and-through defects. This simple procedure can provide patients with a useful oral stoma and acceptable cosmesis.     

联合入路翻页式腹腔镜辅助右半结肠癌根治术与开腹根治术术后近期效果比较

摘要 目的：探讨联合入路翻页式腹腔镜辅助右半结肠癌根治术与开腹根治术术后近期效果比较。方法：选取2019年4月-2021年3月在南通大学附属肿瘤医院经CT和电子肠镜确诊的右伴结肠癌患者,所有患者均选择根治性右半结肠切除术（D2）。最后纳入研究对象77例,其中男性患者39例,女性患者38例,年龄37~75岁。根据手术方案将患者分为联合入路翻页式腹腔镜辅助手术40例,并命名为观察组,剩余37例行开放式根治术,为对照组。所有患者均提供了知情同意书。根据临床资料收集患者一般信息。记录围手术期结局为开腹手术或腹腔镜手术的手术时间,失血量,肛门排气时间,液体饮食时间,住院时间和30天之内的并发症和死亡率等。通过蛋白印迹分析患者术后7天血清内Polo样激酶（Polo-like Kinase 1,Plk1）、胸苷激酶1（Thymidine Kinase 1,TK1）、X连锁的凋亡蛋白抑制剂（X-linked inhibitor of apoptosis protein,XIAP）的活力。结果：两组患者一般资料比较无差异（P>0.05）。观察组较对照组的手术运行时间缩短,失血量减少,血管危险因素病发率降低（P<0.05）,淋巴结获得量两组比较无差异（P>0.05）。观察组较对照组的住院时间、第一次肛门排气时间、输液天数和胃肠功能恢复时间缩短（P<0.05）。观察组较对照组在吻合口漏、乳糜漏、术后腹腔出血和麻痹性肠梗阻等不良发生率比较无差异（P>0.05）,观察组较对照组的整体不良发生率升高（P<0.05）。观察组较对照组的Plk1、TK1、XIAP的蛋白表达降低（P<0.05）。结论：联合入路翻页式腹腔镜辅助右半结肠癌安全可行,且具有手术难度低,缩短手术时间,减少术中出血以及加快术后康复的优势。     

Cervical spine arthrodesis in rheumatoid arthritis: a long-term follow-up.

Forty-one patients with rheumatoid arthritis involving the cervical spine had a posterior cervical arthrodesis. They were followed for a minimum period of seven years. The diagnoses prior to surgery included cranial settling, atlantoaxial subluxation, subaxial subluxation, and any combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone graft. In addition, one patient had an anterior vertebrectomy, and two had transoral resection of the odontoid. Follow-up consisted of a subjective questionnaire, standard radiographs, and physical examination, including a neurologic exam. This information was compared to preoperative data available in the patient''s medical record, postoperative data, and the information obtained in a similar study undertaken in 1987. At the time of follow-up, thirteen patients were known to be dead. One patient could not be located. Of the remaining twenty-six patients, eighteen underwent the full examination, including physical exam and radiographs. The remaining nine patients were contacted and interviewed, but were unavailable for exam and radiographs. All patients considered the operation a success. Only one patient at follow-up had a non-union. This was stable over time. No patient had a deterioration in neurologic function. There was no significant degeneration or instability seen at levels adjacent to the fused segments as compared to the rest of the cervical spine. Posterior cervical spine arthrodesis for rheumatoid involvement of the neck is a safe, efficacious procedure with no significant deterioration of effects over time.     

核心蛋白聚糖基因过表达对5/6肾切除大鼠肾间质纤维化的影响和机制

目的探讨腺相关病毒介导的核心蛋白聚糖(decorin,DCN)基因过表达对5/6肾切除大鼠肾间质纤维化的影响和机制。方法将DCN基因和绿色荧光蛋白基因(GFP)基因克隆入重组腺相关病毒(rAAV)载体中,在HEK293细胞中包装成rAAV-GFP和rAAV-DCN病毒。健康雄性wistar大鼠32只,随机分为假手术组(sham,n=8),手术组(operation,n=8),手术+rAAV-GFP病毒尾静脉注射组(GFP组),手术+rAAV-DCN基因尾静脉注射组(DCN组)。携带相应基因的病毒注射后3周行5/6肾切除术构建肾间质纤维化模型。术后第12周处死动物,肾组织切片行HE染色,天狼星红(Sirius red)染色和Masson染色。免疫组化方法检测TGFβ1和α-SMA。Western Blot检测肾组织TGFβ1、α-SMA、E-cadherin、p-smad2、smad2、samd7和p-P38 MAPK表达水平。结果DCN基因过表达显著抑制了5/6肾切除术所致血压升高和肾功能下降(P<0.05),明显减轻了5/6肾切除大鼠肾小球萎缩与代偿性肥大,肾小管扩张及管型形成。Sirius red和Masson染色表明DCN过表达明显抑制了5/6肾切除大鼠肾脏胶原沉积(P<0.05)。免疫组化结果显示DCN过表达明显减少了肾组织TGFβ1和α-SMA的表达(P<0.05)。Western blot结果显示DCN过表达明显下调了TGFβ1、α-SMA、p-smad2、p-P38 MAPK的表达,显著上调了E-cadherin and samd7的表达(P<0.05)。结论腺相关病毒介导的DCN基因过表达显著抑制5/6肾切除大鼠肾间质纤维化而保护肾功能,其机制与下调TGFβ1、α-SMA、p-smad2、p-P38 MAPK表达和上调E-cadherin和samd7表达有关。     

肝泡状棘球蚴病不同手术疗效及预后的分析研究

目的:比较肝泡状棘球蚴病(HAE)不同手术方式的疗效,并分析影响HAE手术患者预后的相关因素。方法:回顾性分析2003年9月-2015年2月期间在我院进行手术治疗的HAE病人的诊疗记录。根据手术方式的不同,将病人分为非移植性根治性切除组(A组)、术中病灶绝大部分切除(90%以上)组(B组)、术中不能90%以上切除或仅引流组(C组)、肝移植组(D组)。结合随访资料,评价四组的疗效,并分析影响患者预后的相关因素。结果:A组死亡率低于其他三组,差异具有统计学意义(P0.001)。生存曲线结果显示,A组预后生存状况优于其他三组,差异具有统计学意义(P=0.001)。多因素分析结果表明,非移植性根治性切除、术中出血量是影响患者生存的独立危险因素(均P0.05)。结论:在早期发现早期诊断的前提下,对HAE病人行非移植性根治性切除术治疗效果最好,且非移植性根治性切除是患者预后的独立危险因素。     

Long term management of duodenal ulcer in general practice: How best to use cimetidine?

Two hundred and sixty seven patients with duodenal ulceration were entered into a five year study of two strategies of treatment with cimetidine. Two thirds were treated continuously with 400 mg at bedtime supplemented by temporary increases in dosage if they had symptomatic relapses (group 1), and the remaining third were given intermittent “healing” doses for four to eight weeks if a symptomatic recurrence was judged to have occurred (group 2). Life table analysis showed that the probability of remaining free of clinically important symptoms five years after the start of treatment was 24% (95% confidence interval (CI) 15·5% to 32·6%) in group 1 compared with nil in group 2 (p<0·0001). The median values for the longest periods free from relapse for each patient were 108 weeks in group 1 and 32 weeks in group 2, respectively (p<0·0001; 95% CI of the median difference 36 to 76). Over the five years 10 patients suffered major complications, two requiring emergency surgery, while a further nine had elective surgery because of the failure of medical treatment. There were no deaths that could be attributed either to ulceration or to treatment with cimetidine.Medical management was therefore very satisfactory for most patients, though those treated continuously with cimetidine suffered considerably less from their ulcer symptoms. As 80% of patients studied relapsed during the two years after a healing course of cimetidine, continuous treatment will benefit many patients treated in general practice.     

腹腔镜与开腹手术对胃癌根治术患者TNF-alpha和IL-6 水平的影响研究

目的:探讨腹腔镜与开腹手术对胃癌根治术患者肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平的影响.方法:选取自2011年3月至2013年5月期间来我院就医并行胃癌根治术的72例胃癌患者作为研究对象.并将所有患者随机平均分成腹腔镜组和传统开腹组各36例.其中,腹腔镜组行腹腔镜辅助下胃癌根治术,传统开腹组行传统开腹胃癌根治术.比较两组手术时间、术中出血量、肛门排气时间及住院时间;比较两组患者术前及术后血清TNF-α和IL-6水平.结果:腹腔镜组术中出血量、肛门排气时间及住院时间均明显低于对照组(P＜0.05)腹腔镜组术后TNF-α和IL-6水平明显低于开腹组(P＜0.05),两组比较有显著性差异(P＜0.05).结论:腹腔镜辅助下胃癌根治术较传统开腹胃癌根治术术后血清TNF-α和IL-6水平低,对机体免疫功能影响较小,可减少患者术后感染机会,值得在临床中推广应用.     

Can Active Surveillance Management be Developed for Patients With Low-Risk Papillary Thyroid Microcarcinoma? A Preliminary Investigation in a Chinese Population

ObjectiveActive surveillance (AS) has been shown to be a safe approach that can effectively block transition from overdiagnosis to overtreatment in patients with low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to determine whether the AS approach can be implemented in China and investigate the population characteristics of Chinese patients who underwent AS.MethodsThe epidemiologic and clinical characteristics as well as patient adherence were evaluated in 115 patients who underwent AS management as an alternative to immediate surgery for low-risk (or highly suspected) PTMC.ResultsThe mean patient age was 41.8 ± 10.3 years, with 41.7% and 4.4% of the patients aged <40 and ≥60 years, respectively. The median baseline diameter of index tumors was 4 (range, 3-6) mm, with 73.0% of the tumors being ≤5 mm. A total of 84.4% of the patients had a junior college, college, or graduate degree, and 83.5% were employed by the government, public institutions, companies, or technical posts. After a median 25-month follow-up, a tumor growth of ≥3 mm occurred in 3 patients (2.6%), and no new lymph node metastasis occurred. Surgery was performed in 4 patients because of patient preferences rather than because of disease progression. There was satisfactory adherence in 109 patients (94.8%) in a simulated ideal medical environment.ConclusionThe AS approach can be used as an alternative to low-risk PTMC management in China. Given the difference in epidemiologic and clinical characteristics, Chinese institutions should fully consider the features of the Chinese population while developing candidate criteria, surveillance intervals, and follow-up strategies for AS.     

食管癌切除术患者运动能力、肌肉力量和生活质量的相关性分析

摘要 目的：探讨食管癌患者术前功能锻炼能力、肌力、焦虑、抑郁和健康相关生活质量（QOL）的特点,并评估食管癌根治术对这些参数的影响。方法：我们对2019年1-12月36例新诊断的可切除食管癌患者进行回顾性分析,这些患者接受了食管切除术并进行了术后康复治疗。术前、术后2周分别进行6 min步行距离（6MWD）、膝伸肌肌力、握力、医院焦虑抑郁量表（HADS）和慢性阻塞性肺疾病（COPD）评定量表（CAT）测试。术前进行肺功能测试,并对MOS 36项目健康问卷（SF-36）的组成部分进行一般健康评定。结果：患者平均年龄66.1±9.2岁。患者以男性为主（75.0%）,有较高的吸烟史（80.6%）,鳞状细胞癌（94.4%）。COPD 15例。临床分期：0-I期11例,II期6例,III期15例,IV期4例。29例行开腹手术。SF-36评分的组成部分与CAT和HADS评分显著相关,COPD患者的身体状况明显差于非COPD患者（P<0.05）。比较术前和术后的数值,发现术后6MWD、握力、等长膝伸肌肌力显著降低,CAT评分显著升高（P<0.05）,HADS评分无明显升高（P>0.05）。在多元回归分析中,术后6MWD的下降与术前SF-36的生理成分总结显著相关。结论：从微创手术和围手术期处理的角度来看,有必要进一步改进围手术期的康复。在手术后两周,食管切除术对健康相关的QOL和身体健康有害,需建立围手术期康复策略,以改善术后结果。     

肥厚梗阻性心肌病的外科治疗

目的:总结肥厚室间隔切除术治疗肥厚梗阻性心肌病的手术效果,探讨外科治疗策略。方法:2002年3月至2010年10月,外科手术治疗33例肥厚梗阻性心肌病病人。其中男16例,女17例;年龄13～59岁,平均(42.7±13.6)岁;左室流出道压差(LVOTGP)70～120 mmHg(1 mmHg=0.133Kpa),平均(95.0±22.6)mmHg。其中合并二尖瓣关闭不全24例,主动脉瓣关闭不全7例,升主动脉增宽3例,冠心病2例。手术在全麻低温体外循环下完成,按常规经主动脉切口行室间隔心肌切除术,同期完成二尖瓣置换术(MVR)7例,二尖瓣成形术(MVP)7例,二尖瓣、主动脉瓣成形术(MVP+AVP)5例,二尖瓣、升主动脉成形术3例,二尖瓣、主动脉瓣成形、冠状动脉旁路移植术(MVP+AVP+CABG)2例。分析比较病人术前超声心动图(UCG),术中经食管心脏超声(TEE),以及术后1周、3月、6月、1年超声心动图结果。结果:手术死亡1例(3.0%,1/33例),主要死因为严重低心排综合症以及多脏器功能衰竭。二次开胸止血1例(3.0%,1/33例)。术中经食管心脏超声示所有病人二尖瓣前叶收缩期前向运动现象(SAM征)消失。存活病人手术效果良好,解剖狭窄解除,峰值压差降低,SAM现象基本消失。远期随访生存病人症状消失,生活质量明显改善,心功能I～II级,无远期死亡、并发症或再次手术。结论:外科治疗肥厚梗阻型心肌病具有良好的手术效果。了解病生理过程、术中仔细探察、手术切除彻底是手术成功的关键。