ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

目的 比较不同栓塞材料的门静脉栓塞术（PVE）与联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）对剩余肝体积（FLR）增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法 采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌（HCC）或肝内胆管癌（ICC）病人,将其分为4组：ALPPS组及分别采用氰基丙烯酸正丁酯（NBCA）、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果 各组的手术切除例数及二期手术切除率分别为：ALPPS组38例（99.4%）,NBCA组32例（76.2%）,明胶海绵组20例（60.6%）,微球组10例（83.3%）。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 mL/d和 8.5 mL/d,均高于明胶海绵组（3.7 mL/d）。结论 采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。     

Chemoprotective effect of plant phenolics against anthracycline-induced toxicity on rat cardiomyocytes. Part III. Apigenin, baicalelin, kaempherol, luteolin and quercetin

Flavonoids are found universally in plants and act as free radical scavenging and chelating agents with antiinflammatory, antiischemic, vasodilating and chemoprotective properties. In this study, the antilipoperoxidative and cytoprotective effects of apigenin, baicalein, kaempferol, luteolin and quercetin against doxorubicin-induced oxidative stress were investigated in isolated rat heart cardiac myocytes, mitochondria and microsomes. After preincubation of cardiomyocytes with the test compounds for 1 h the cardiomyocytes were treated with the toxic agent, doxorubicin (100 micro M for 8 h). Cardiomyocyte protection was assessed by extracellular LDH and cellular ADP and ATP production. Cytoprotection was concentration dependent for baicalein > luteolin congruent with apigenin > quercetin > kaempferol. All test compounds had signi fi cantly better protective effects than dexrazoxan, an agent currently used for adjuvant therapy during anthracycline antibiotic therapy. In microsomes/mitochondria the IC(50) values of lipid peroxidation inhibition for quercetin, baicalein, kaempferol, luteolin, and apigenin were 3.1 +/- 0.2/8.2 +/- 0.6, 3.3 +/- 0.3/9.6 +/- 0.5, 3.9 +/- 0.3/10.1 +/- 0.8, 22.9 +/- 1.7/18.2 +/- 0.7, and 338.8 +/- 23.1/73.1 +/- 6.4 mM, respectively. The antilipoperoxidative activity of apigenin differed from its cytoprotective effects, but correlated with the free radical scavenging of 2,2-diphenyl-1-picrylhydrazyl radical and half peak oxidation potential (E(p/2)). Apigenin was the least effective of the flavonoids studied in all models except the cardiomyocyte model where its cardiomyocyte cytoprotective effect was comparable to other compounds.     

80例成人肝移植的供肝动脉变异、损伤与植入前重建

目的研究供肝肝动脉变异、取修肝损伤与植入前重建的相互关系,对动脉并发症的影响。方法回顾分析2004年3月至2006年7月单个医疗组完成的80例成人肝移植资料。植入前供肝动脉重建方法:整形获得变异或受损动脉的根部袖片或斜面端口,与合适部位吻合成具有共同主干的动脉树,尽可能单次吻合。3mm以下吻合口采用8/0prolene线间断缝合,3mm及以上吻合口采用7/0prolene线四点连续锁边缝合。术后以彩色多普勒超声、CT或MRI动脉造影监测动脉血流情况,随访6～34个月。结果供肝动脉变异发生率25.0%(20/80),变异肝左动脉6.25%,变异肝右动脉12.50%,二者并存3.75%,变异肝总动脉2.50%。全组取修肝动脉损伤发生率7.5%(6/80),变异组与无变异组损伤发生率(25.0%vs1.7%)有统计学差异(P<0.01)。损伤部位以变异肝右动脉损伤最为常见,占42.9%(3/7),占变异组损伤部位的50.0%。损伤时间在取肝、修肝期各占一半(3/6),变异组损伤的60.0%(3/5)发生在修肝期,无变异组未发生修肝损伤。取肝期动脉损伤率,在变异组与无变异组间(10.0%vs1.7%)存在统计学差异(P<0.05)。全组植入前动脉重建率13.8%(11/80),变异组为55.0%(11/20),76.9%的变异肝右动脉接受了植入前重建,均来自肠系膜上动脉。无变异组未行重建。动脉重建组中,63.6%(7/11)的变异/损伤动脉与脾动脉吻合。随访期内,全组无肝动脉血栓形成,肝动脉狭窄发生率3.8%(3/80)。变异组与非变异组肝动脉狭窄发生率(5.0%vs3.3%)比较,植入前重建组与非重建组(9.1%vs2.9%)比较,均无统计学意义(P>0.05)。全组假性动脉瘤发生率1.25%,吻合口出血发生率1.25%,均在无变异组。结论肝右动脉变异是供肝动脉变异的最常见类型,常需要植入前整形重建。供肝动脉变异增加取肝、修肝过程的动脉损伤发生率,本组变异肝右动脉损伤最常见。供肝动脉变异、合适的植入前重建并不增加移植后肝动脉血栓形成、动脉狭窄的发生率。     

Analysis of vaginal recurrences in stage I endometrial adenocarcinoma

OBJECTIVE: To determine the risk of vaginal recurrence in Stage 1 endometrial cancer and treatment morbidity associated with different therapeutic approaches MATERIAL AND METHODS: Between 1995 and 2005, 341 patients with clinical Stage I endometrial cancer were treated at Istanbul Medical Faculty. One hundred and forty-four women were included in this study as the follow-ups and records were complete. The patients with no myometrial invasion received no further therapy following hysterectomy. When there was superficial myometrial invasion postoperative vaginal vault radiation was used, and if deep myometrial invasion was present, external pelvic radiation was given. RESULTS: Overall 5-year survival rate for all patients with Stage I disease was 80%. Nine patients (6.25%) developed recurrent disease, three of whom had vaginal recurrences. All three vaginal recurrences were small and diagnosed at routine follow-up exam within 51 months of primary therapy. CONCLUSION: This selective treatment protocol for patients with Stage I endometrial cancer avoided radiation entirely in 38% of the patients while achieving a very low rate of vaginal recurrence and good overall survival.     

肝门部胆管癌的计划性肝切除

肝门部胆管癌(hilar cholangiocarcinoma)是原发于左右肝管及肝总管黏膜上皮的恶性肿瘤,又称高位胆管癌、上段胆管癌或Klatskin肿瘤,2009年AJCC第7版的TNM分期[1]将其归为肝门周围胆管癌或近侧胆管癌.肝门部胆管癌仍然是胆管癌的最常见类型,占胆管癌的50%～70%.由于肝门部胆管癌容易向胆管周围侵犯,甚至累及肝门部血管和肝实质,这给我们的外科根治性切除带来了更多的困难和挑战.     

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??Multi-disciplinary team and conversion therapy for colorectal cancer with unresectable liver metastases??A report of 86 patients WEI-Ye*??YE Qing-hai??YU Yi-yi??et al. *Department of General Surgery, Zhongshan Hospital??Fudan University??Shanghai200032??China
Corresponding author??QIN Xin-yu??E-mail??qin.xinyu@zs-hospital.sh.cn
Abstract Objective To analyze safety and effect of the conversion therapy for initially unresectable colorectal liver metastases (CLMs) under the guidance of multi-disciplinary team (MDT). Methods The retrospective analysis was conducted for 86 patients with unresectable CLMs received MDT management and arrived conversion therapy successfully from January 2008 to December 2011 in Zhongshan Hospital of Fudan University. The perioperative and survival outcomes??prognostic factors were evaluated. Results During the mean follow-up of 41 months (24-68 months), according to the finding time of liver metastases of 86 patients??recurrence events were 73 patients??and 39 patients died. The 1 year??2 year and 3 year overall survival rate (OS) was 90.6%??75.6% and 65.1% respectively. The median OS time was ??47.5±3.1?? months. The 1 year??2 year and 3 year disease free survival rate (DFS) was 72.1%??48.8% and 31.4% respectively. The median DFS time was ??22.0±2.9?? months. The OS and DFS were no significant difference when compared 86 patients with initially unresectable CLMs successfully arrived conversion therapy with 99 patients with initial resectable CLMs??P >0.05??. The perioperative mortality rate was 1.5%??and operative complication rate was 24.4%. Tumor regression grade and early tumor shrink could predict the prognosis of CLM patients received conversion therapy. Conclusion The conversion therapy under the guidance of MDT mode is safe and effective for unresectable CLMs. The mid-term survival rate is similar with initially resectable CLMs??and long-term survival is expected.     

重度阻塞性睡眠呼吸暂停患儿临床预测模型研究

目的　建立习惯性打鼾患儿中重度阻塞性睡眠呼吸暂停（OSA）的临床预测模型,为临床诊疗提供依据。方法　选择2019年1月至12月就诊于首都医科大学附属北京儿童医院睡眠中心的3～12岁习惯性打鼾患儿。所有患儿完成一般资料收集、OSA-18问卷、PSQ-SRBD量表及多导睡眠监测。应用决策树方法构建重度OSA患儿的临床预测模型。结果　共纳入受试患儿1441例,根据PSG结果,重度OSA 1152例,非重度OSA 289例。重度OSA组年龄、男性比例、体重指数（BMI）、颈围/身高比、腹围/臀围比、SRBD量表呼吸维度、其他维度及总分均高于非重度OSA组（P均<0.01）。OSA-18问卷各个维度得分及总分在两组患儿间比较,差异无统计学意义（P均>0.05）。基于决策树构建的重度OSA患儿预测模型,对非重度OSA患儿预测精确率为90%,召回率76%,F1得分82%,对重度OSA患儿的预测精确率32%,召回率58%,F1得分41%,整体准确率为73%。 结论　该研究构建的重度OSA患儿临床预测模型整体准确率73%,有一定的预测价值,能为临床排除重度OSA患儿提供一定的依据,指导临床决策,但仍需更多的临床资料进一步优化模型。     

Electrogastrography in patients with Roux-en-Y reconstruction after previous Billroth gastrectomy

BACKGROUND/AIMS: The aim of this prospective study was to characterize gastric myoelectrical activity in patients with Roux-en-Y reconstruction after previous Billroth gastrectomy. METHODOLOGY: Thirteen patients entered the study (6 men and 7 women, aged 35-57). The mean time from Roux-en-Y reconstruction to electrogastrography (EGG) recording was 5 years. Surface cutaneous EGG was recorded using a Digitrapper EGG in the morning both fasting and after a standard solid test meal. All patients assessed their dyspeptic symptoms at the time of EGG in a semi-quantitative subjective scale. RESULTS: EGG was abnormal in all studied patients (but one postprandial recording). Dyspepsia was not meal-related and was not more severe in Helicobacter pylori positive patients. There was a significant negative correlation between time from Roux-en-Y reconstruction to EGG recording and bradygastria percent activity, both fasted and postprandial (r = -0.576; p = 0.0022). There was an inverse trend between severity of dyspepsia and normal slow-wave rhythm percent activity. Older patients tended to have more severe dyspepsia. CONCLUSIONS: The results of this study suggest that abnormal EGG recording is associated with dyspepsia in patients after Roux-en-Y reconstruction.