单中心近10年腹主动脉瘤1246例流行病学研究

目的 回顾性分析近10年中国医科大学附属第一医院收治的腹主动脉瘤（AAA）病人的流行病学特点,为研究近10年AAA流行病学变化趋势,以及为AAA的进一步预防和诊治提供依据。方法 纳入自2011年1月至2020年12月中国医科大学附属第一医院诊治的1246例AAA病人的病案资料,回顾性分析包括病人年龄、性别、就诊时间、就诊科室、首发症状、住院时间、住院费用、术式选择等信息,分析近10年AAA流行病学变化特点。结果 入院病人平均年龄为（66.9±10.5）岁,男女占比约为4∶1。男性AAA病人以同型半胱氨酸升高为主,女性以血脂升高为主。AAA病人的主要合并症为3级高血压（41.9%）、冠心病（31.1%）和合并髂动脉瘤（25.8%）。男性AAA合并髂动脉瘤比率明显高于女性（27.8% vs.17.8%,P＜0.01）。72.7%的AAA病人首诊原因为体检发现,其次是AAA破裂（18.7%）。AAA病人急诊与门诊就诊例数呈逐年升高态势,急诊与门诊就诊占比约为2∶3。65~69岁为现阶段住院病人主要年龄段。各年份男性占比约为80%,年龄段65~69岁为男性占比可达近90%。各年份腔内修复术（EVAR）是AAA的主要治疗方式,行EVAR治疗病人的例数和比例总体趋势逐年增加,行EVAR治疗的占比随病人年龄增加而逐渐增大。近10年AAA病人的病死率呈降低趋势,2015年后病死率总体维持在2%～3%,以男性为主,年龄段70~74岁的病死率最高为5.8%。AAA病人平均住院（17.0±16.4）d,平均住院费用为（11.3±10.7）万元。结论 近10年AAA住院病人有逐年增高趋势,主要患病人群为年龄＞60岁男性,男女临床特点有较大差异。采用EVAR治疗的占比逐年增加。对于老年AAA人群,尤其是年龄段65~69岁男性AAA病人,在AAA的防治过程中应给予更多关注。     

Effect of methylprednisolone, tirilazad mesylate and vitamin E on lipid peroxidation after experimental spinal cord injury

Effect of methylprednisolone (MP), tirilazad mesylate (TM) and vitamin E on lipid peroxidation (LP) was evaluated in an experimental model of spinal cord compression injury in anesthetized rats. Forty rats, divided randomly into four groups, were injured by compressing on the spinal cord at Th 3 for 1 min. Bolus injections of saline solution, MP (30 mg/kg bolus and 5.4 mg/kg/h), TM (10 mg/kg four times per day), or vitamin E (30 mg/ kg four times per day) were begun 1 h after the spinal cord injury (SCI). Twenty-four hours after treatment, the rats were killed, and malondialdehyde (MDA), a LP product, was measured in the spinal cord tissues. Rats treated with MP, TM and vitamin E had significantly decreased MDA levels (P<0.01) than rats in the control group. The lowest MDA levels were found in the TM group. These results suggest that MP, TM and vitamin E may have a protective effect against SCI in rats by its antioxidant effect.     

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??Case analysis of conversion therapy by laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy for gastric cancer peritoneal metastasis XUE Kan*??LI Zi-yu??LI Shuang-xi??et al. * Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author??LI Zi-yu??E-mail??ligregory@outlook.com
Abstract Objective To investigate the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) combined intraperitoneal and systemic chemotherapy in gastric cancer patients with peritoneal metastasis. Methods A gastric cancer patient whose peritoneal cancer index was 39 during laparoscopic exploration was admitted at Peking University Cancer Hospital Gastrointestinal Center. The patient received laparoscopic HIPEC with docetaxel, followed by 6 courses of intraperitoneal and intravenous PTX??along with S-1 orally. Results CT scan showed distinct response during post-treatment evaluation. A second look by laparoscopy was suggested by MDT. No tumor cell was found in the lavage fluid through abdominocentesis and no metastasis can be seen by laparoscopic exploration. Then total gastrectomy plus D2 minus No.10 lymph node dissection was performed. The patient recovered smoothly after surgery. The pathology confirmed a ypT3N2M1, moderate to poor-differentiated adenocarcinoma, from gastric antrum to body. By September 2017, the patient was still in postoperative treatment. Conclusion Laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy showed effective interim results in gastric cancer peritoneal metastasis conversion therapy and is deserved for further researches.     

肝门部胆管癌外科治疗分析

目的　研究影响肝门部胆管癌疗效的因素。方法　回顾性分析 1997～ 2 0 0 2年收治的198例肝门部胆管癌的临床资料。结果　 198例的主要临床表现为黄疽 (94 5 % ,187例 )、瘙痒(5 6 6 % ,112例 )和腹痛 (33 8% ,6 7例 )。Bismuth CorletteⅠ型 14例 ,Ⅱ型 19例 ,Ⅲa型 12例 ,Ⅲb型 15例 ,Ⅳ型 112例 ,分型不清楚者 2 6例。手术切除 12 0例 (83 3% ) ,根治性切除 5 9例 (41 0 % ) ,姑息性切除 6 1例 ,剖腹探查胆道置管引流 2 4例 ,ERCP及PTCD内外引流 5 4例。 16例术后行放射治疗。术后生存时间与职业、术前最高血清总胆红素水平、手术方式和术后放疗四个因素显著相关。ENBD、ERBD或EMBE、胆道探查置管引流、肿瘤姑息切除、根治切除不同治疗方式的术后生存时间总体差异有显著意义 (χ2 =87 0 4 89,P <0 0 1)。结论　早期诊断和根治切除是提高肝门部胆管癌疗效的重要措施。     

56例胆囊癌的预后因素分析

目的：研究影响胆囊癌预后的因素，探讨提高胆囊癌疗效的途径。方法：回顾性分析了1995年6月至2001年6月收治的56例胆囊癌的临床资料。结果：56例中男20例，女36例，其中34例（61％）合并胆结石。腹痛（47／56，占84％）和黄疸（23／56，占41％），是主要临床症状。B超，CT，CA19－9有助于术前诊断。30例（包括Nevin Ⅱ5例，Ⅲ3例，Ⅳ4例，Ⅴ18例）获得根治性切除或扩大根治性切除，11例NevinⅤ期予以姑息性切除，剖腹探查行改善症状的各种引流术或／和活检术15例。统计学分析显示，生存时间与手术方式，Nevin分期，放疗，化疗，是否合并胆囊结石5个因素呈显著相关。结论：提高胆囊癌的早期诊断率，积极施行根治性切除术，辅以放疗，化疗，可望改善胆囊癌的疗效。     

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??Clinical study of insulin resistance for patients after selective abdominal surgery CHEN Hong*, LI Fei , JIA Jian-guo, et al. *Department of General Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China Corresponding author: CHEN Hong, E-mail: chenhong@medmail.com.cn Abstract Objective To investigate the risk factors of insulin resistance(IR) after selective abdominal surgery and the mechanism of IR induced by surgery. Methods Fourteen-patients including five male and nine female after selective abdominal surgery between March 2006 and June 2006 at Xuan Wu Hospital of Capital Medical University were studied. Fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 were tested for selective surgery patients on one day before, during and one day after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before and at the end of operation. Results Significant differences were found in fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 of pre-operative 1 day, during operation and post-operative 1 day (P <0.001). A significant elevation of HOMA-IR level was found on post-operative 1 day compared to that before surgery in all patients (P <0.001). However there was no significant difference in HOMA-β among the same two points of time (P=0.103). The result of RT-PCR showed that the expression of GLUT4 mRNA in muscle of patients at the end of operation reduced significantly compared with preoperation (P<0.001). ISI showed negative correlation with operative time(r=-0.736,P <0.001), blooding during operating (r=-0.594,P=0.032) and post-operative TNF-α(r=-0.641,P =0.018). R2 of the equation was 0.687. Conclusion Insulin resistance occurs in selective abdominal surgery patients. The defective site was at postreceptor, and the decrease of content and action of GLUT4 may play an important role in its mechanism. To control the intensity of surgery is helpful for decreasing IR.     

Carotid intima-media thickness in relation to macrovascular disease in patients with type 2 diabetes mellitus

BACKGROUND: Increased carotid intima-media thickness is regarded as a marker of atherosclerosis. Type 2 diabetes mellitus is associated with a high prevalence of macrovascular disease. MAIN PURPOSE: The present study aimed to examine the relationship between carotid intima-media thickness and the presence of macrovascular disease in patients with type 2 diabetes. METHODS: 71 patients with type 2 diabetes mellitus were studied. The distal common carotid artery and carotid bifurcation intima-media thickness were measured bilaterally with high-resolution ultrasonography. The relationship between the presence of coronary artery disease, cerebrovascular disease and peripheral arterial disease and carotid intima-media thickness was evaluated. RESULTS: Patients with coronary artery disease had significantly (p = 0.048) increased intima-media thickness of the distal common carotid artery. This difference ceased to be significant after adjustment for cardiovascular risk factors. Patients with peripheral arterial disease had a significantly higher bifurcation (p < 0.0001), distal common carotid (p = 0.03) and mean intima-media thickness (p = 0.0008) than did those without peripheral arterial disease. This difference remained significant even after adjustment for other cardiovascular risk factors. In the multiple linear regression analysis, the presence of peripheral arterial disease, age and male gender significantly predicted bifurcation intima-media thickness, while age and the presence of peripheral arterial disease significantly predicted mean intima-medial thickness. CONCLUSIONS: In the present study, the increased carotid intima-media thickness in patients with type 2 diabetes mellitus was related to the presence of peripheral arterial disease. This finding probably reflects morphologic and hemodynamic similarities between the two vascular beds and indicates that increased carotid intima-media thickness in patients with type 2 diabetes may be a marker of atherosclerosis in different locations.     

胰体尾癌的外科治疗

胰体尾癌早期诊断困难，多数就诊时肿瘤已明显增大，且多有淋巴结及周围脏器的浸润和转移，故手术切除率较低，约为5％-10％。我院8年来手术切除105例胰体尾癌，积累了一些诊治经验，现总结如下。     

Neonatal osteofibrous dysplasia associated with pathological tibia fracture: a case report and review of the literature

Osteofibrous dysplasia is a rare and benign disease that originates from the tibia or fibula. The symptoms of osteofibrous dysplasia include painless enlargement and bowing of the tibia and pain occurring in the presence of pathological fracture. Herein a male infant who was admitted with redness and swelling on the right leg and diagnosed as pathological tibia fracture due to left tibia osteofibrous dysplasia on the third day of life was presented. To our knowledge, this is the earliest presentation of osteofibrous dysplasia with a pathological fracture in a neonate. Therefore, it must be suspected in neonatal bone fractures.