CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用

摘要 目的：探讨电子计算机断层扫描(Computed Tomography,CT)与磁共振成像(Magnetic resonance imaging,MRI)扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用。方法：2016年9月到2019年10月选择在本院诊治的下拟诊为四肢骨关节隐匿性骨折118例,所有患者都给予CT与MRI扫描三维重建诊断,记录影像学特征与判断诊断价值。结果：在118例患者中,最终确诊为四肢骨关节隐匿性骨折98例,无骨折20例,其中腕关节骨折34例,踝关节骨折22例,膝关节骨折15例,肘关节骨折15例,肩关节骨折8例,髋关节骨折4例。在98例确诊的四肢骨关节隐匿性骨折中,MRI三维重建显示双边征、骨质破坏、充气征、软组织影等比例显著都高于CT (P<0.05)。CT与MRI三维重建诊断四肢骨关节隐匿性骨折的敏感性为89.8 %和99.0 %,特异性为95.0 %和100.0 %,误诊率分别为9.3 %和0.8 %,MRI三维重建诊断的敏感性高于CT ,漏诊率低于CT。结论：CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用都有很好的价值,特别是MRI三维重建能清晰显示骨折特征,具有更高的诊断敏感性,能减少漏诊率,可作为四肢骨关节隐匿性骨折的首选检查方法。     

Multimodality treatment of locally advanced soft-tissue sarcomas of the extremities

Background

Adjuvant radiotherapy (RTE) still has a fundamental role as a post-operative treatment of locally advanced soft tissues sarcomas of the extremities. Moreover the employment of combined modalities in locally advanced soft tissues sarcomas of the extremities allow to maximize the chance of local cure even in difficult presentation cases, and possibly improve survival, especially in high-risk disease patients. In patients with sarcomas of the extremities in which definitive surgery has not been radical (with positive or “close” margins) radiotherapy can improve the results in terms of Disease Free Survival (DFS) and, together with chemotherapy, of Overall Survival (OS). We recommend radiotherapy in case of deep tumor location, inadequate surgical margins and grade 3 tumour; for positive or “marginal (or close)” excision (that means inadequate surgery) or in selected patients with a bad prognosis, we believe that a multidisciplinary approach can be preferable.

Introduction

Adjuvant radiotherapy (RTE) still has a fundamental role as a post-operative treatment. In patients with sarcomas of the extremities in whom definitive surgery has been or not radical (positive or “close” margins), radiotherapy with chemotherapy can improve the results in terms of Disease Free Survival (DFS) and Overall Survival (OS), while RTE alone seems to improve local control.

Materials and methods

From 1/2000 to 12/2005 we treated 34 patients affected by locally advanced sarcomas of the upper or lower extremities with radiotherapy (doses ranging from 54 to 66 Gy) and chemotherapy in 18/34 with an adjuvant scheme that consisted in Epirubicine (120 mg/m²) plus Ifosfamide (7000–9000 mg/m²).

Results

Disease Free Survival (DFS) and the Overall Survival (OS) rates were 76% and 82%, respectively. Eighteen patients developed one or more long-term side effects. Most of these complications were mild: all patients experienced only erithema, edema, local sclerosis or moderate pain.

Conclusion

Radiotherapy has an important role as a post-operative treatment also when surgery was non-radical. It improves local control more in patients with high-grade sarcomas of the extremity with positive or close margins. It is still difficult to assess the role of adjuvant chemotherapy.     

The versatility of the free osteocutaneous fibula flap in the reconstruction of extremities after sarcoma resection

Background

An understanding of the biology of bone and soft-tissue sarcomas, knowledge of adjuvant therapies and refinement in techniques of reconstructive surgery have allowed limb-sparing and limb salvage surgery to become a reality in the management of malignant tumors of the extremities. Functional limb salvage following radical resection has become a possibility in many resectable tumors by the use of alloplastic prostheses, homograft or autogenous bone for skeletal reconstitution combined with vascularized soft tissue coverage. Although the free fibula flap has been well described for reconstructions of the mandible and oral cavity, it has not been widely presented as an ideal tool to preserve extremities and to circumvent amputation.

Patients and methods

We describe the complex surgical reconstruction in four patients with primary sarcomas of the extremities. The sarcomas (Ewing's sarcoma, osteosarcoma and epitheloid sarcoma) were resected radically and the massive bone and soft tissue defect was replaced by vascularized free fibula transfer.

Results

We present our experience with versatility of this osteocutaneous flap to allow reconstruction and salvage of extremitity sarcomas. There were no operative or postoperative complication and all the four patients had good limb function. The flap was found to be versatile as it could be used for either upper limb or lower limb and for large defects. The results were better in upper limb than in lower limb.

Conclusions

Free fibular graft was found to be effective for salvaging limb function where a massive bone defect resulted from wide tumor resection in the extremities.     

关节镜下前交叉韧带重建中保留残端对膝关节功能及本体感觉恢复的影响研究

目的:探讨关节镜下前交叉韧带(ACL)重建术中保留韧带残端对ACL损伤患者膝关节功能及本体感觉恢复的影响。方法:回顾性分析2010年1月~2016年3月解放军第174医院收治的ACL损伤患者266例,所有患者均行关节镜下ACL重建,其中保留韧带残端的163例为保留残端组,术中完全清理韧带残端的103例为非保留残端组,所有患者术后随访12个月以上,评价两组患者的膝关节功能及本体感觉恢复情况。结果:术前、术后9个月、术后12个月两组膝关节患侧Lysholm评分、国际膝关节文献委员会膝关节评估表(IKDC)评分、被动活动察觉阀值、被动角度再生试验结果比较差异无统计学意义(P0.05);两组术后各检测时间点的Lysholm评分、IKDC评分较术前均显著提高,被动活动察觉阀值、被动角度再生试验结果较术前明显降低(P0.05);保留残端组术后3个月、6个月的Lysholm评分、IKDC评分高于非保留残端组,被动活动察觉阀值、被动角度再生试验结果低于非保留残端组,差异有统计学意义(P0.05)。结论:关节镜下ACL重建中保留残端可加快膝关节功能及本体感觉恢复速度,获得满意的临床疗效,值得推广应用。     

Effect of Implant vs. Tissue Reconstruction on Cancer Specific Survival Varies by Axillary Lymph Node Status in Breast Cancer Patients

BackgroundTo compare the breast cancer-specific survival (BCSS) between patients who underwent tissue or implant reconstruction after mastectomy.MethodWe used the database from Surveillance, Epidemiology, and End Results (SEER) registries and compared the BCSS between patients who underwent tissue and implant reconstruction after mastectomy. Cox-regression models were fitted, adjusting for known clinicopathological features. The interaction between the reconstruction types (tissue/implant) and nodal status (N-stage) was investigated.ResultsA total of 6,426 patients with a median age of 50 years were included. With a median follow up of 100 months, the 10-year cumulative BCSS and non-BCSS were 85.1% and 95.4%, respectively. Patients who underwent tissue reconstruction had tumors with a higher T-stage, N-stage, and tumor grade and tended to be ER/PR-negative compared to those who received implant reconstruction. In univariate analysis, implant-reconstruction was associated with a 2.4% increase (P = 0.003) in the BCSS compared with tissue-reconstruction. After adjusting for significant risk factors of the BCSS (suggested by univariate analysis) and stratifying based on the N-stage, there was only an association between the reconstruction type and the BCSS for the N2-3 patients (10-year BCSS of implant vs. tissue-reconstruction: 68.7% and 59.0%, P = 0.004). The 10-year BCSS rates of implant vs. tissue-reconstruction were 91.7% and 91.8% in N0 patients (P>0.05) and 84.5% and 84.4% in N1 patients (P>0.05), respectively.ConclusionsThe implant (vs. tissue) reconstruction after mastectomy was associated with an improved BCSS in N2-3 breast cancer patients but not in N0-1 patients. A well-designed, prospective study is needed to further confirm these findings.     

主动保温与常规保温对食管癌根治术患者术中体温、应激反应和术后苏醒质量的影响

摘要 目的：探讨主动保温与常规保温对食管癌根治术患者术中体温、应激反应和术后苏醒质量的影响。方法：纳入我院2018年7月~2020年8月期间接收的食管癌根治术患者100例,采用随机数字表法将患者分为对照组（50例,常规保温）和观察组（50例,主动保温）。对比两组患者术中体温、应激反应和术后苏醒质量,观察两组并发症的发生率。结果：与对照组比较,观察组术后苏醒时间、拔除气管导管时间、手术时间、麻醉苏醒室滞留时间、住院时间均较短（P<0.05）。对照组手术开始时（T2）~术毕(T6)时间点体温逐渐下降（P<0.05）。观察组T2~T6时间点体温较T1时间点未见明显变化（P>0.05）。观察组T2~T6时间点体温高于对照组（P<0.05）。两组术后3 d肾上腺素（E）、内皮素（ET）以及C反应蛋白（CRP）均较术前升高,但观察组低于对照组（P<0.05）。观察组的并发症总发生率明显低于对照组（P<0.05）。结论：食管癌根治术患者术中进行主动保温干预,可维持体温,减轻围术期应激反应,改善术后苏醒质量,同时还可降低并发症发生率。     

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

AimTo review key studies evaluating stereotactic radiotherapy in the setting of early-stage non-small cell lung cancer (NSCLC) for inoperable or high-risk patients, and discuss areas of ongoing research and clinical trials.BackgroundThe use of stereotactic radiotherapy for the treatment of early stage non-small cell lung cancer (NSCLC) has increased rapidly over the past decade. Numerous studies have reported outcomes for patients treated with SBRT who are unfit for surgical resection, or at high risk of surgical complications.Materials and methodsA narrative review.ResultsThe preponderance of evidence suggests that SBRT is associated with excellent local control (∼90% at 3 years) and a favorable toxicity profile. In patients with higher operative risks, such as the elderly and patients with severe COPD, SBRT may provide a less-toxic treatment than surgery with similar oncologic outcomes. Ongoing studies are evaluating the use of SBRT for locally advanced or oligometastatic NSCLC.ConclusionsA large body of evidence now exists to support the use of SBRT for early-stage NSCLC. Decisions regarding the optimal choice of treatment should be individualized, and made in the context of a multidisciplinary team.     

Retroperitoneal soft-tissue sarcomas: Radiotherapy experience from a tertiary cancer center and review of current evidence

BackgroundSurgery remains to be the main therapeutic approach for retroperitoneal sarcomas (RPS) although evidence supports that complementary radiotherapy increases local-control and survival. We present a multidisciplinary management and experience of a tertiary cancer center in the treatment of RPS and analyze current evidence of radiotherapy efficacy.Patients and methodsWe retrospectively reviewed 19 patients with primary or relapsed RPS treated between November 2009 and October 2018. Multidisciplinary approach comprised complete resection in 15 patients (79%) achieving resection R0 in 11 patients (58%), R1 in 4 patients (21%) and R2 in 2 patients (10%). Seven patients (37%) underwent a preoperative radiation (PRORT), 10 patients (53%), post-operative radiation (PORT) and 2 patients (10%), received radiotherapy exclusively. Ten patients (53%) received adjuvant chemotherapy.ResultsWith a median follow-up of 24 months (2–114 months), actuarial rates of loco-regional relapse free survival (LRFS) at 1, 2 and 3 years were 77%, 77% and 67%, respectively. Actuarial rates of distant-metastases-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) at 1, 2 and 3 years were 100%, 100% and 80% for DMFS; 94%, 77% and 67% for DFS and 100%, 91% and 91% for OS, respectively. Only surgical margins (negative vs. positive) showed significance for 3y-LRFS: 100% vs. 34.3%, p = 0.018. Treatment tolerance was acceptable with no acute or late toxicity higher than grade 2.ConclusionsComplementary radiotherapy appears to be useful and well tolerated for the multidisciplinary management of RPS. Presence of positive surgical margins seems to be the most relevant prognostic factor through the follow-up.     

Repeat single-fraction stereotactic radiosurgery for recurrent vestibular schwannoma

BackgroundData are scarce on the efficacy of a second radiosurgery (SRS) treatment of vestibular schwannoma that has progressed following initial treatment with SRS. We sought to report the outcome of our repeat SRS series with long-term imaging follow-up.Materials and methodsWe retrospectively analyzed 6 patients who met the following criteria: Repeat SRS at our institution between 1995 and 2018; solitary unilateral tumor; no evidence of neurofibromatosis; and magnetic resonance (MR) planning for both SRS treatments. All treatments were delivered with a linear accelerator-based system using head frame immobilization. The prescribed dose to the periphery of the tumor was 12.5 Gy in all initial and repeat SRS treatments, except for one repeat treatment to 10 Gy.ResultsFollow-up with MR scan following the second SRS treatment was a median 8.4 years. The tumor control rate (lack of progression) following the second SRS treatment was 83% (5/6). Actuarial 10-year outcomes following repeat SRS were: tumor control, 80%; absolute survival, 80%; and cause-specific survival, 100%. Of the patients with at least minimal hearing retention before initial SRS, none had ipsilateral hearing preservation after initial radiation treatment. Improvement in any pretreatment cranial nerve deficits was not seen. The only permanent grade ≥ 3 toxicity from repeat SRS was a case of infraorbital nerve deficit. No patient developed a stroke, malignant transformation, induced second tumor, or facial nerve deficit.ConclusionThere was excellent overall survival, tumor control, and low morbidity in our series for recurrent vestibular schwannoma submitted to repeat single-fraction SRS, supporting additional studies of this treatment strategy.     

Intraoperative electron radiation therapy after salvage surgery in gynecological cancers and retroperitoneal sarcomas: outcomes and adverse effects

BackgroundSalvage surgery is considered an option for isolated recurrences of retroperitoneal and pelvic tumors, in patients who have undergone previous radiotherapy. In order to increase local control intra operative electron radiation therapy (IOERT) can be used in these patients to administer additional radiation dose. We evaluated the outcomes and adverse effects in patients with retroperitoneal sarcoma and gynecologic tumors after salvage surgery and IOERT.Materials and methodsTwenty patients were retrospectively analyzed. Twenty-three IOERT treatments were performed after surgery. Six (30%) were sarcoma and 14 (70%) were gynecological carcinoma. Administered dose depended on previous dose received with external beam radiotherapy (EBRT) and proximity to critical structures. The toxicities were scored using the Common Terminology Criteria for Adverse Events version 4.0.ResultsThe median age of the patients was 51 years (range 34–70). After a median follow-up of 32 months (range 1–68), in the sarcoma group the local control rate was 66.6%; while in the gynecological group the local control rate was 64.3%. In relation to late toxicity, one patient had a Grade 2 vesicovaginal fistula, and one patient presented Grade 4 enterocolitis and enteric intestinal fistula.ConclusionsIOERT could have a role in the treatment of retroperitoneal sarcomas in primary tumors after EBRT, as it may suggest a benefit in local control or recurrences after surgical resection in those at high risk of microscopic residual disease. The addition of IOERT to salvage resection for isolated recurrence of gynecologic cancers suggest favorable local control in cases with concern for residual microscopic disease.     

中医正骨手法改善桡骨远端伸直型骨折患者腕关节功能的临床研究及疗效的影响因素分析

摘要 目的：观察中医正骨手法在桡骨远端伸直型骨折中的临床应用价值,并分析疗效的影响因素。方法：选择四川省骨科医院2020年1月~2022年1月期间收治的桡骨远端伸直型骨折患者152例,按照治疗方式的不同将患者分为对照组（给予石膏固定）和研究组（应用中医正骨手法治疗）,例数分别为77例和75例。对比两组优良率、临床指标、腕关节活动度和X线相关影像学指标。同时采用多因素Logistic回归分析影响研究组腕关节功能疗效的相关因素。结果：治疗后,研究组的优良率明显高于对照组（P<0.05）。研究组手背消肿时间、疼痛缓解时间、骨折愈合时间均短于对照组（P<0.05）。两组治疗后12周掌屈、背伸、桡偏、尺偏、旋前、旋后活动度均扩大,且研究组均大于对照组（P<0.05）。两组治疗后12周掌倾角、尺偏角、桡骨高度均增加,且研究组均大于对照组（P<0.05）。单因素分析显示,研究组腕关节功能优良率与年龄、性别、骨质疏松、功能锻炼、掌倾角、尺偏角、桡骨高度、骨折端稳定性、受伤能量、利手情况有关（P<0.05）,而与体质量指数、就诊时间、基础疾病、骨折类型、固定时间无关（P>0.05）。多因素Logistic回归分析显示：性别为女、骨质疏松、无功能锻炼、掌倾角偏小、桡骨高度偏短、骨折端不稳定、受伤能量为高能量、利手是影响腕关节功能优良率的危险因素（P<0.05）。结论：中医正骨手法可有效改善桡骨远端伸直型骨折患者腕关节功能,减少骨折愈合及疼痛缓解时间。此外,患者腕关节功能的优良率还受到性别、骨质疏松、功能锻炼、掌倾角、桡骨高度、骨折端稳定性、受伤能量、利手情况的影响,值得引起临床重视。     

股神经阻滞和收肌管阻滞对全膝关节置换术后下肢静脉血栓形成的影响

目的:探究股神经阻滞(femoral nerve block,FNB)和收肌管阻滞(adductor canal block,ACB)对全膝关节置换术(total knee arthroplasty,TKA)后下肢静脉血栓形成的影响。方法:将2019年3月-2019年4月拟在全身麻醉下行全膝关节置换术的40例患者随机分为FNB组和ACB组,所有患者均给予超声引导下单次注射,术后均给予标准化抗凝治疗。术后评估两组患者不同时间节点的疼痛评分、股四头肌肌力及术后下肢静脉血栓形成情况。结果:两组患者术后2、6、12、24、48、72 h患肢术区局部疼痛的VAS评分差异无统计学意义(P0.05)。ACB组患者术后2、6、12、24、48 h股四头肌肌力均明显高于FNB组(P0.05),术后72 h两组患者股四头肌肌力无明显差异(P0.05)。ACB组在术后患者首次直腿抬高时间(4.5±4.6)h,显著低于FNB组在术后患者首次直腿抬高时间(25.6±12.6)h,两组对比差异有统计学意义(P0.05)。术后72 h给予两组患者复查双下肢血管超声,复查结果显示,FNB组19例患者中共有2例出现下肢静脉血栓,均为肌间隙静脉血栓形成;ACB组20例患者中无患者出现下肢静脉血栓形成,差异无有统计学意义(P0.05)。结论:FNB与ACB在全膝关节置换术后镇痛方面无明显差异,但ACB组较好的保留患者术后早期股四头肌肌力,对于术后功能锻炼和快速康复有较积极的作用,两种神经阻滞方式对患者VTE风险的影响相同。     

The treatment of lower extremity sarcomas with wide excision, radiotherapy, and free-flap reconstruction.

Treatment of extremity sarcomas has evolved into a multidisciplinary approach utilizing surgery, radiotherapy, and, in some cases, chemotherapy. Limb-sparing surgery has maintained low rates of local recurrence when supplemented with early postoperative radiotherapy (brachytherapy). Leg defects that result from resection resemble those caused by trauma and appear ideally suited to free-flap reconstruction. However, the resection site is subjected to 4500 cGy of radiation given within 2 weeks of surgery. It has not been demonstrated that free flaps can endure early postoperative radiation without adverse effects. Three patients are presented with locally recurrent leg sarcomas treated by wide excision, brachytherapy, and free-flap reconstruction. All flaps survived, and the wounds healed uneventfully. This study reviews the current multidisciplinary approach to the treatment of lower extremity sarcomas and demonstrates the durability of free-flap reconstruction in the presence of early postoperative radiation therapy.     

Specific Management of Post-Chikungunya Rheumatic Disorders: A Retrospective Study of 159 Cases in Reunion Island from 2006-2012

BackgroundSince 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients.ResultsWe reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy.ConclusionRheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials.     

锁骨远端解剖锁定钢板结合Nice结环扎与锁骨钩钢板治疗Neer Ⅱ型锁骨远端骨折的疗效比较研究

摘要 目的：以锁骨钩钢板为对照,探讨锁骨远端解剖锁定钢板结合Nice结环扎治疗Neer Ⅱ型锁骨远端骨折的临床疗效,为临床Neer Ⅱ型锁骨远端骨折的治疗提供合理方案。方法：回顾性分析自2017年1月~2020年1月宿迁市第一人民医院收治的38例Neer Ⅱ型锁骨远端骨折患者的临床资料,按内固定方式不同进行分组,其中18例采用锁骨远端解剖锁定板结合Nice结环扎固定（观察组）,20例采用锁骨钩钢板内固定（对照组）。记录两组手术时间、术中出血量、骨折愈合时间、术后并发症,并于术后3个月和6个月时进行视觉模拟评分法（VAS）评分及肩关节功能Constant-Murley和UCLA评分。结果：38例患者手术均顺利完成,两组手术时间及术中出血量比较无差异（P>0.05）。38例患者手术均获得随访,两组骨折愈合时间比较无差异（P>0.05）;观察组并发症发生率（11.11%）低于对照组（40.00%）（P<0.05）。观察组术后3个月和6个月的VAS评分均低于对照组,而Constant- Murley和UCLA评分均高于对照组（P<0.05）。结论：Neer Ⅱ型锁骨远端骨折采用锁骨远端解剖锁定钢板结合Nice结环扎治疗固定效果确切,患者术后肩关节功能恢复良好,并发症少,痛疼程度轻,相较于锁骨钩钢板治疗,其优势明显,可作为临床治疗Neer Ⅱ型锁骨远端骨折的推荐方案。     

下肢深静脉血栓形成的危险因素及导管接触性溶栓的临床疗效研究

目的:分析下肢深静脉血栓形成(DVT)的危险因素,并探讨导管接触性溶栓治疗下肢DVT的临床疗效。方法:选取2015年12月～2018年12月间在北京积水潭医院治疗的126例下肢DVT患者作为病例组,另外选取同期在我院健康体检的志愿者60例作为对照组,采用多因素Logistic回归分析下肢DVT的危险因素。将病例组按随机数表法分为系统溶栓组(采用系统性溶栓治疗)和导管溶栓组(采用导管接触性溶栓治疗)两个亚组,各63例。评价两组疗效,观察两组患者治疗前及治疗1个月后的双下肢周径差和静脉通畅度评分,记录并比较两组患者治疗时间、住院时间、尿激酶用量以及不良反应发生情况。结果:病例组与对照组年龄、体质量指数(BMI)、红细胞计数(RBC)、手术外伤史比较,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,年龄、BMI、RBC、手术外伤史均是下肢DVT的独立危险因素(P0.05)。导管溶栓组痊愈率为57.14%(36/63),高于系统溶栓组的33.33%(21/63)(P0.05);治疗1个月后,两组双侧大腿周径差、双侧小腿周径差以及静脉通畅度评分均明显减小,且导管溶栓组上述指标均明显小于系统溶栓组(P0.05)。导管溶栓组治疗时间和尿激酶用量明显少于系统溶栓组,但住院时间明显长于系统溶栓组(P0.05)。两组患者不良反应发生率比较差异无统计学意义(P0.05)。结论:年龄、BMI、RBC、手术外伤史均是下肢DVT的独立危险因素,导管接触性溶栓治疗下肢DVT的疗效显著,具有较好的安全性。     

苓桂术甘汤对老年脾胃气虚型功能型消化不良患者胃蛋白酶原、胃泌素及血液流变学的影响

摘要 目的：研究苓桂术甘汤对老年脾胃气虚型功能型消化不良患者的临床治疗效果,并探讨治疗对患者胃蛋白酶原、胃泌素和血液流变学的影响。方法：选取2020年1月到2021年10月在我院接受治疗的老年脾胃气虚型功能型消化不良患者120例,按治疗方式分为对照组以及研究组,对照组患者给予常规药物治疗,研究组患者在对照组基础上加用苓桂术甘汤进行治疗,比较两组患者临床治疗疗效和治疗前后生活质量评分、中医症候积分、血清胃蛋白酶I和II、血清胃泌素-17、血液流变学。结果：（1）研究组患者临床治疗总有效率显著高于对照组（93.33 % vs 75.00 %,P<0.05）;（2）治疗后,两组患者的生活质量评分升高,而中医症候积分降低,且研究组优于对照组（P<0.05）;（3）两组患者治疗后血胃蛋白酶I和II、血清胃泌素-17均显著降低,并且治疗后研究组低于对照组（P<0.05）;（4）两组患者治疗后血液流变学指标（高切全血黏度、低切全血黏度和血浆黏度）均显著降低,并且研究组降低程度显著高于对照组（P<0.05）。结论：加用苓桂术甘汤治疗老年脾胃气虚型功能型消化不良可显著提高临床治疗疗效,改善患者生活质量,降低患者血清胃蛋白酶原、胃泌素以及血流变学指标表达。     

雌激素替代疗法对内分泌失调女性内分泌轴功能的影响

目的:探讨雌激素替代疗法对内分泌失调女性内分泌轴功能的影响。方法:选取2014年9月至2018年2月到本院就诊的186例内分泌失调女性患者当作研究对象,根据治疗方法的不同将其分为观察组(给予雌激素替代疗法)100例与对照组(给予常规药物)86例,两组均治疗3个月,比较两组治疗前TC、TG、LDL-C、HDL-C水平、黄体生成素(LH)和雌二醇(E2)水平的变化、疗效与不良反应的发生情况。结果:观察组与对照组治疗后的总有效率分别为98.0%和88.4%,观察组明显高于对照组(P0.05)。观察组治疗后的血清HDL-C、E2值较对照组显著增加,血清TC、TG与LDL-C、FSH水平均较对照组明显降低(P0.05)。观察组与对照组治疗期间的主要不良反应为乳房胀痛、乳房包块、肝功能异常、下肢水肿等,组间对比差异无统计学意义(P0.05),所有不良反应经过对症处理后好转。结论:雌激素替代疗法治疗内分泌失调女性能调节内分泌轴功能,提高治疗效果,改善临床症状,促使血脂分泌平衡,且安全性好。     

急性肠系膜缺血性疾病36例治疗体会

摘要 目的：探讨急性肠系膜缺血(acute mesenteric ischemia,AMI)的诊断和治疗方法。方法：回顾性收集并分析36 例AMI患者的临床资料,均术前行MDT讨论,血管外科及胃肠外科联合手术治疗。所有治疗病例均行手术探查。其中3例病人术中使用荧光内镜判断肠道血供。统计诊治过程中腹部CT、白细胞计数、D-二聚体相关数据,应用SPSS软件分析其与肠道坏死的相关性。结果：腹部CT特异表现、白细胞计数升高与肠道坏死有相关性关系。治疗病例有11例行肠切除、 8例为外院行手术治疗后,在我院行术后康复治疗。术后8例发生短肠综合证。1例病人自动出院。1例死亡。1例病人术后出现肠道坏死、肠瘘,3个月后行肠瘘切除术,术后恢复良好。5例病人术后6个月行造口还纳。荧光内镜判断肠道血供及生机效果良好。结论：AMI 病情凶险,提高对疾病的认识,早期诊断,尽早重建小肠血运是提高疗效、改善预后的关键。多学科讨论后精准治疗,可提高治疗效果。术前腹部CTA对AMI的诊断及判断肠道坏死有重要意义。术中使用吲哚箐绿荧光显影剂、配合荧光导航内镜,判断肠道缺血范围,值得进一步探讨。临时性肠道双造瘘有利于及时发现肠管血运恢复情况,远端造瘘可早期进行肠内营养,值得推广。