Comprehensive treatment of malignant mesothelioma patients after the failure of systemic chemotherapy

Malignant mesothelioma (MM) is an aggressive neoplasm usually arising from the mesothelial surfaces of the pleural or peritoneal cavity. Currently, no standard therapy is available. The most commonly used therapy is cytoreductive surgery combined with systematic chemotherapy, but the median overall survival (OS) is less than 12 months; moreover, treatments are lacking for patients in whom chemotherapy has failed and/or who cannot withstand surgery. We investigated multiple minimally invasive therapies (cryosurgery, photodynamic therapy and intracavity chemotherapy) for the treatment of MM patients in whom systemic chemotherapy had failed. Twenty-seven patients were divided into comprehensive (combination of the three therapies) and palliative (intracavity chemotherapy only) treatment groups. The OS of patients who received comprehensive treatment was significantly longer than that of those who received palliative treatment (median OS: 64 vs. 9 months, P < 0.001). This interesting result was not associated with treatment timing, but was closely associated with repeated treatments.     

Human malignant mesothelioma: molecular mechanisms of pathogenesis and progression

The continuing identification and elucidation of the molecular defects involved in mesothelioma pathogenesis and progression should lead to better disease control and greater therapeutic options in the near future. Goal of this review article is to summarize the most recent advances in molecular pathogenesis of mesothelioma and discuss possible therapeutic implications of these findings.     

Expression profile and function of Wnt signaling mechanisms in malignant mesothelioma cells

Malignant mesothelioma (MM) is an uncommon and particularly aggressive cancer associated with asbestos exposure, which currently presents an intractable clinical challenge. Wnt signaling has been reported to play a role in the neoplastic properties of mesothelioma cells but has not been investigated in detail in this cancer. We surveyed expression of Wnts, their receptors, and other key molecules in this pathway in well established in vitro mesothelioma models in comparison with primary mesothelial cultures. We also tested the biological response of MM cell lines to exogenous Wnt and secreted regulators, as well as targeting β-catenin. We detected frequent expression of Wnt3 and Wnt5a, as well as Fzd 2, 4 and 6. The mRNA of Wnt4, Fzd3, sFRP4, APC and axin2 were downregulated in MM relative to mesothelial cells while LEF1 was overexpressed in MM. Functionally, we observed that Wnt3a stimulated MM proliferation while sFRP4 was inhibitory. Furthermore, directly targeting β-catenin expression could sensitise MM cells to cytotoxic drugs. These results provide evidence for altered expression of a number of Wnt/Fzd signaling molecules in MM. Modulation of Wnt signaling in MM may prove a means of targeting proliferation and drug resistance in this cancer.     

Epidemiology of malignant peritoneal mesothelioma: A population-based study

BackgroundMalignant peritoneal mesothelioma (MPeM) is a rare cancer of the mesothelial cells in the peritoneum with poor prognosis. Earlier reports from other countries indicate an incidence of 0.2–3 new cases per million per year. No previous studies have examined the national epidemiology of MPeM in Nordic countries. This study aimed to clarify the epidemiology of MPeM in Finland over a 12-year period.MethodsThe data consisted of cancer notifications, laboratory notifications, and death certificate information in the Finnish Cancer Registry (FCR) and Statistics Finland (SF) of all MPeM patients from 2000 to 2012 in Finland. We also collected data on occupational disease compensations from the Workers’ Compensation Center (WCC) of Finland. Any missing information was collected from the respective patient’s file of every patient obtained from health institutions that had treated the patients.ResultsBetween January 1, 2000 and December 31, 2012, 90 new MPeM cases (56 males, 34 females) occurred in Finland. Median annual incidence was four new cases, which corresponded to 0.74 new cases per million per year. MPeM was deemed an occupational disease in 21 patients (23.3%). 71 patients (78.9%) of whom had a known cause of death, with a median survival of 4 months. The number of deaths linked to other disease than mesothelioma was 28/74 (37.8%).ConclusionsOur study indicates that MPeM in Finland is rare and fatal, which is in accordance with previous reports from other countries. MPeM is also a fatal disease, since most of the patients died due to MPeM.     

微创血肿抽吸术治疗脑出血并肾功能不全患者的临床研究

目的：评价微创血肿抽吸引流术在脑出血合并肾功能不全患者中的治疗效果。方法：回顾性分析2000年1月至2009年3月间我院收治的15例脑出血合并肾功能不全进行微创抽吸引流术患者的临床资料,并与同期22例保守治疗的患者进行比较。结果：微创手术组显效率为66.67%,总有效率为86.67%,明显高于保守治疗组的22.73%和40.91%（P〈0.01）;治疗后微创组血肌酐值为107.65±22.06μmol/L,显著低于保守组139.45±22.8μmol/L,P〈0.001。结论：早期应用微创血肿穿刺抽吸术能迅速有效地解除脑室内高压,阻断恶性循坏而使病情得到缓解,同时也能明显改善肾功能。     

腔镜微创食管癌根治术治疗Siewert I型胃食管结合部鳞癌的短期疗效评估

目的：探讨腔镜微创食管癌根治术治疗Siewert I型胃食管结合部鳞癌患者的短期临床疗效及安全性。方法：选取我科2009 年1 月1 日至2012 年3 月1 日收治的Seiwert I型胃食管结合部鳞癌患者114 例,并将其随机分为开胸食管切除术组(59 例)和 腔镜微创食管切除术组(55 例),评估并比较两组的短期临床疗效及并发症的发生情况。结果：微创食管切除术组患者术后生存质 量评分评分均显著高于开胸食管切除术组(P<0.05),患者2 年生存率为83.6%(46/55),高于开胸食管切除术组(47/59,79.7%)。此 外,微创食管切除术组肺部并发症(9.09%vs 28.81%)和声带麻痹(0%vs 15.25%)的发生率均显著低于开胸食管切除术组(P<0.05)。 结论：腔镜微创食管癌根治术可显著提高Siewert I型胃食管结合部鳞癌短期疗效。     

微创后入路治疗肩胛骨骨折的临床研究

目的:探讨微创后入路手术治疗肩胛骨骨折的临床疗效。方法:选取2009年6月~2014年1月在我院接受后路内固定手术治疗的40例肩胛骨骨折,治疗组20例,行微创后入路内固定术,对照组20例,行Judet入路内固定术。比较两组间手术时间、术中出血量、切口总长度及术后肩关节功能Constant评分。结果:40例患者均获随访,随访时间12~36个月,平均16.5个月。治疗组手术时间、术中出血量、切口总长度均优于对照组(均P0.05),术后6个月肩关节功能:治疗组优15例,良3例,可1例,差1例,优良率90%,对照组优14例,良2例,可3例,差1例,优良率80%。两组优良率比较,差异有统计学意义(P0.05)。两组均无感染、骨折延迟愈合或不愈合。对照组1例发生肩胛上神经卡压。结论:微创后入路手术操作简单,创伤小,恢复快,是一种安全有效的肩胛骨骨折手术入路。     

微创经椎间孔入路与传统后路手术治疗单节段腰椎结核的疗效比较

目的：对比微创经椎间孔入路与传统后路手术治疗腰椎结核的临床疗效,评价微创经椎间孔入路治疗腰椎结核的安全性及 有效性。方法：回顾性分析本院2012 年10 月-2013 年3 月收治的单节段腰椎结核患者73 例,所有患者均为单节段病变,以腰痛 为主,无神经压迫症状,死骨和脓肿范围不大。其中43 例采用传统开放手术,30 例采用微创手术,于围术期分别记录两组患者的 手术时间、术中出血量及术后引流量,术后1、3、6 和12 月时采用疼痛视觉模拟评分(VAS)和Oswestry 功能障碍指数(ODI)进行疗 效评估,末次随访时记录并比较两组患者的融合率。结果：所有患者术后腰痛明显减轻,发热患者体温在2 周内恢复正常。微创手 术组的手术时间、术中出血量及术后引流量分别为240± 30 min、520± 50 mL 和630± 110 mL,均明显少于传统手术组的180± 35 min、350± 50 mL和320± 80 mL (P<0.05)。在术前、术后1 月、3 月、6 月、12 月和末次随访时,微创手术组腰痛VAS评分分别 为8.7± 1.2 分、4.5± 1.1 分、3.5± 1.1 分、2.0± 1.4 分、1.3± 0.5 分和1.2± 0.5 分,ODI 评分分别为（77± 6）%、（31± 5）%、（23± 8）%、（14± 6）%、（8± 4）%和（7± 3）%;传统手术组VAS评分分别为8.5± 1.1 分、2.7± 0.7 分、2.1± 0.6 分、1.9± 0.7 分、1.1± 0.4 分 和1.1± 0.4 分,ODI 评分分别为（78± 5）%、（23± 6）%、（14± 7）%、（12± 5）%、（7± 2）%和（7± 2）%。其中,术后1 个月和3个月, 微创组腰痛VAS 评分和ODI评分均明显低于开放组(P<0.05)。术后6 个月、12 个月和末次随访时,两组患者腰痛VAS 评分和 ODI评分差异无统计学意义(P>0.05)。末次随访时所有病例均获得骨性融合。结论：微创经椎间孔入路手术治疗单节段腰骶椎结 核,可获得与传统后路手术相同的临床疗效,且手术时间短,术中出血量及术后引流量较少,具有较高的安全性。     

高血压脑出血的微创治疗

目的：探讨微创清除颅内血肿技术的手术效果。方法：将42例高血压脑出血的患者,都采用YL-1型一次性使用颅内血肿粉碎穿刺针,进行钻颅手术。结果：16例术后次日即拔针,10例第二日拔针,其余全部患者均在一周内拔针。术后一个月意识恢复良好者27例,重残者10例,死亡5例。结论：谊术式操作时间短,血块及时有效地清除,减轻了副损伤,大大提高了救治成功率。适合广大基层医院使用。     

小切口微创手术治疗新鲜跟腱断裂的临床价值

目的：探讨小切口微创手术治疗新鲜跟腱断裂的一晦床价值。方法：选取我院新鲜闭合性跟腱断裂患者50例,随机分为实验组和对照组各25例。实验组行小切口手术,对照组行常规切口手术。术后对患者进行随访,采用美国足踝协会（AOFAS）推荐的评分标准对患者术后功能恢复情况进行评价,观察并记录完全恢复患者例数、完全恢复时间、小腿最大周长差和术后并发症发生情况。结果：实验组AOFAS评分为（98．6±9．7）分,痊愈率96．00％,痊愈时间（20．2±3．2）周,两侧小腿最大周长差为（0．79＋0．68）cm,共有1例患者出现并发症,并发症发生率8％;而对照组的AOFAS评分为（91．4±11．5）分,痊愈率92．00％,痊愈时间（22．4±3．8）周,两侧小腿最大周长差为（0．91~0．76）cm;共有6例患者出现并发症,并发症的发生率为24％。两组患者的痊愈率、两侧小腿最大周长差比较差异无统计学意义（痊愈率：x2=-0．355,P=0．552;侧小腿最大周长差：t=O．588,P=0．559）;而与对照组比较,实验组AOFAS评分明显升高,完全恢复时间明显缩短,术后并发症的发生率显著降低,差异均有统计学意义（AOFAS评：t=2．393,P=0．021;恢复时间：t=2．150,P=0．037;并发症发生率：xⅫ．153,P=0．042）。结论：小切口手术与常规切口手术治疗新鲜跟腱断裂的疗效相当,但小切口手术术后恢童时间曼短．并发症更少．临床价值相对更高．     

老年高血压脑出血的微创治疗分析

目的：探讨微创手术与传统开颅手术治疗高血压脑出血的手术效果。方法：回顾性分析自2005年5月至2009年7月期间开颅手术39例和微创手术治疗44例高血压脑出血的疗效,比较两种方式的优劣。结果：开颅手术组和微创手术组均获得了较好的疗效,两者相比未见有明显的差剐。结论：微创手术组和开颅手术比较未见明显的疗效差异,微创手术手术简单,创伤面积小,费用较低,患者耐受性好,值得推广。     

经肛门微创手术治疗小儿先天性巨结肠症40例临床疗效分析

目的:探讨经肛门微创手术治疗小儿先天性巨结肠症的临床效果.方法:将我院收治的40例先天性巨结肠患儿,随机分为对照组和试验组,对照组采用经腹会阴联合手术治疗,试验组采用经肛门微创手术治疗.分析两组手术时间、术中出血量、恢复肠道排气时间、住院时间,并发症发生情况等.结果:组术中出血量、肠道恢复排气时间、住院时间均显著优于对照组,差异有统计学意义(P＜0.05).试验组手术时间与对照组差异无统计学意义(P＞0.05).试验组并发症发生率低于对照组,差异有统计学意义(P＜0.05).试验组术后排便控制功能显著优于对照组,差异有统计学意义(P＜0.05).结论:采用经肛门微创手术治疗小儿先天性巨结肠症,术后患者排便功能恢复好,手术情况佳,并发症少,疗效优于经腹会阴联合手术,值得临床推广应用.     

通道辅助微创缝合与两种常用跟腱缝合方式的生物力学研究

目的:通过对比通道辅助跟腱微创缝合方式(CAMIR)与2种临床最常用的跟腱缝合方式的生物力学强度,验证CAMIR微创缝合方式同样能够达到常规缝合方式的力学强度,为临床推广应用提供可靠的理论依据。方法:将27支跟腱样本随机分为3组(每组9支),分别是CAMIR组、经典微创Ma-Griffith组、标准切开Krackow组。所有跟腱样本首先预加载50N,2min。然后以20N-100N,1Hz,循环1000次。如果缝合未失效,则以20 mm/s的速度将样本拉伸至失效。通过实验仪上的传感器自动记录循环1000次时整个缝合结构的伸长量,记录拉伸失效时整个缝合结构的伸长量以及最大负荷,并计算单纯拉伸阶段缝合结构的抗拉伸硬度。结果:CAMIR的循环1000次结束时伸长量(P=0.581)、缝合失效时伸长量(P=0.799)、缝合失效时最大负荷(P=0.278)、单纯拉伸过程中抗应变硬度(P=0.935)与常用的Ma-Griffith、Krackow缝合方式均无明显差异。结论:CAMIR缝合方式强度可靠,为术后进行早期功能康复训练提供力学保障,同时能够有效避免腓肠神经损伤,是临床上值得推荐的微创缝合方式。     

X射线测量延边朝鲜族正常成年人下腰椎间孔参数的临床意义

本文以延边朝鲜族正常成年人下腰椎椎间孔X射线测量数值为研究对象,行测量及对比,为不同民族人种经椎间孔入路脊柱内镜手术治疗提供相关数据。选取符合测量标准的腰椎X光片,对下腰椎椎间孔参数进行测量,结果行统计学分析并与国内外相关数据对比。延边朝鲜族正常成年男性和女性下腰椎椎间孔形态无明显差异,延边朝鲜族正常成年人下腰椎椎间孔测量数据与国内外学者测量的下腰椎椎间孔数据比较均存在差异。对不同地区民族人群施行腰椎微创手术,术前下腰椎椎间孔形态的个体化测量是必要的。     

The clinical efficacy study of treatment to Chiari malformation type I with syringomyelia under the minimally invasive surgery of resection of Submeningeal cerebellar Tonsillar Herniation and reconstruction of Cisterna magna

PurposeDiscuss the clinical efficacy of treatment to Chiari malformation type I with syringomyelia under the minimally invasive surgery of resection of Submeningeal Cerebellar Tonsillar Herniation and reconstruction of Cisterna magna.Methods130 Chiari malformation type I with syringomyelia patients, divided into treatment group, literature group and control group, were collected to be treated under the monitoring of ultrasound in the surgery.Results6 months after operation, the lesions were decreased or disappeared, the symptoms were relieved obviously. According to MRI and Mimics 17.0 software, the volumes of Cisterna magna increased distinctly (P < 0.001), the proportions of brain in foramen magnum region were decreased (P < 0.001). Assessed by CCOS scale and Tator methods, the improvement rates of treatment group were 97.7% and 94.6%, the literature group and control group were 82.2% and 77.8%, respectively.ConclusionThe efficacy of Chiari malformation type I with syringomyelia under the minimally invasive surgery of resection of Submeningeal Cerebellar Tonsillar Herniation and reconstruction of Cisterna magna is remarkable, and the complications are fewer. This surgery emphasizes recovery of tonsil of cerebellum and reconstruction of Cisterna magna and the circulation path of cerebrospinal fluid, which is a safe and efficient treatment.     

微创旋切术用于老年乳腺良性肿块患者对手术指标、应激反应和免疫功能的影响

摘要 目的：对比分析微创旋切术和传统开放手术对老年乳腺良性肿块患者手术指标、应激反应、免疫功能的影响及安全性。方法：收集我院2015年4月~2019年2月因乳腺良性肿块需手术治疗的老年患者148例,按不同手术方式分为观察组和对照组,每组74例。观察组予以微创旋切术,对照组予以传统开放手术,比较两组手术指标,手术前后应激反应、免疫功能,术后乳房美观性和并发症的发生情况。结果：观察组切口长度、手术时间、出血量、住院时间和术后疼痛评分分别为(2.35±1.45)cm、(18.27±4.51)min、(5.07±1.02)mL、(4.98±1.20)d和(2.88±1.13)分,均低于或短于对照组(P<0.05);术后血清去甲肾上腺素(NE)、肾上腺素(E)和皮质醇(Cor)水平分别为(71.03±3.02)ng/mL、(68.22±7.23)ng/mL和(101.82±13.29)mmol/L,均明显低于对照组(P<0.05);手术后免疫功能中CD4⁺、CD3⁺和CD4⁺/CD8⁺分别为(27.27±3.70)%、(44.87±6.13)%和(1.22±0.07),均显著高于对照组(P<0.05);术后乳房美观性优良率为98.6%,明显高于对照组(P<0.05),总并发症发生率为2.7%,显著低于对照组(P<0.05)。结论：与传统开放手术相比,微创旋切术用于老年乳腺良性肿块患者的效果较好,手术时间短,出血少,患者术后疼痛较轻,住院时间短,可有效保护患者的免疫功能,降低应激反应,安全性高。     

鼻内镜手术治疗鼻窦炎、鼻息肉临床分析

目的:分析鼻内镜治疗慢性鼻窦炎、鼻息肉的临床效果.方法:回顾性分析本院采用鼻内镜手术治疗鼻窦炎、鼻息肉110例患者资料,对比不同分型患者的手术疗效.结果:Ⅰ型的治愈率和总有效率明显高于Ⅱ型和Ⅲ型,具有统计学明显差异性(P＜0.05);Ⅱ型的治愈率和总有效率明显高于Ⅲ型,具有统计学明显差异性(P＜0.05).结论:慢性鼻窦炎、鼻息肉采用鼻内镜手术治疗具有创伤小、术中及术后痛苦小等优点,其微创有效的优势在该术式中更值得推广.     

膝关节镜辅助微创手术治疗复杂性胫骨平台骨折的疗效分析

目的:探讨膝关节镜辅助微创手术治疗复杂性胫骨平台骨折的疗效。方法:搜集2013年2月-2015年1月期间我院收治的确诊为复杂性胫骨平台骨折患者104例,按照随机数字表法分为微创组和对照组,每组各52例。对照组采用传统切开复位钢板内固定术治疗,微创组采用膝关节镜辅助微创手术治疗;观察两组患者临床各项指标、膝关节功能HSS评分以及术后并发症发生率。结果:术后微创组下床活动时间、完全负重下地时间和骨折愈合时间显著低于对照组(P0.05);三个月后的关节活动度、一年后的膝关节功能优良率显著高于对照组(P0.05);术后微创组并发症发生率为9.62%(5/52),显著低于对照组的23.08%(12/52),差异具有统计学意义(P0.05)。结论:膝关节镜辅助微创手术治疗复杂性胫骨平台骨折,临床疗效显著,术后膝关节功能恢复好,并发症发生率低,值得临床推广应用。     

微创经皮椎体成形术治疗脊柱转移性肿瘤的临床疗效分析

目的:探讨微创经皮椎体成形术治疗脊柱转移瘤的临床疗效及安全性。方法:选取我院收治的60例脊柱转移瘤患者并随机分为两组,观察组(30例)行微创经皮椎体成形术治疗,对照组(30例)行开放性手术治疗。比较两组患者术后12、24、48 h的VAS评分、镇痛次数,术前及术后24、48 h的血清C-反应蛋白(CRP)水平,术前及术后3、6个月的Prolo评分。结果:术后12、24、48 h,两组患者的视觉模拟评分法(VAS)评分逐渐下降,且观察组VAS评分均显著低于对照组(P0.05),术后镇痛次数也明显少于对照组(P0.05)。术后24、48 h,两组患者血清CRP水平均明显低于术前,且观察组血清CRP水平显著低于对照组(P0.05)。术后3、6个月,两组患者的Prolo评分均较术前明显提高,且观察组Prolo评分显著高于对照组(P0.05);随访3个月期间,两组并发症的发生情况相比差异无统计学意义(P0.05)。结论:微创经皮椎体成形术可以明显减轻脊柱转移性瘤的疼痛,患者日常生活能力恢复较好,且安全性高。