NRS 2002和PG-SGA在胃肠道恶性肿瘤患者中的应用

背景：目前国内指南共识推荐对于围手术期胃肠道恶性肿瘤患者,需使用营养风险筛查2002(NRS 2002)和患者主观整体评估（PG-SGA）量表分别进行营养风险筛查和评估。但PG-SGA量表筛查专业要求更高,内容复杂,耗时长,在目前医务人员工作繁忙的情况下,仅使用NRS 2002量表进行筛查。目的：探索NRS 2002与PG-SGA对胃肠道恶性肿瘤患者营养状况和临床结局评估的相关性和一致性,探索仅使用NRS 2002进行筛查的准确性,为临床营养筛查与评估工作规范的建立提供指导。方法：回顾性分析2020年1月—2022年10月中南大学湘雅医院胃肠外科行胃肠道恶性肿瘤根治术的患者157例,采用NRS 2002和PG-SGA量表进行营养筛查与评估,收集人口学资料、营养相关实验室指标和术后短期临床结局资料。结果：存在营养风险或营养不良的患者的术前体质指数（BMI）、淋巴细胞、前白蛋白显著低于不存在营养风险或营养不良的患者（P<0.05）;NRS 2002与PG-SGA的相关性（r=0.728）和一致性（κ=0.460）较好,预测术后并发症的曲线下面积（AUC）分别为0.691和0.702。...     

Expression and significance of HIF-1α and ET-1 in gastrointestinal stromal tumors

Objective To explore the expression and the value of HIF-1α,and ET-1 in judging the prognosis of gastrointestinal stromal tumors (GISTs). Methods The expression of HIF-1α, and ET-1 protein was examined in 76 GISTs by immunohistochemistry S -P methods. Results There was a positive correlation between the expression of HIF-1 α and ET-1 ( P < 0.05 ). The positive expression rate of HIF-1 α and ET-1 was 73.68% (50/76) ,and 65.79% (50/76) respectively,which was related with histologicial grade, tumor diameter, infiltration and metastasis, nuclear division rating of GISTs ( P < 0.05 ), but had no relationship with patients' age, gender, initial position of the tumor ( P > 0.05 ). There was statistically sig-nificant difference in the expression of HIF-1 α and ET-1 in the following groups:among the three classes of very low-risk and low-risk, middle-risk, high-risk, bewteen the diameter < 2 cm and > 5 cm (P < 0.05). The more malignant degree and larger diameter, the more highly positive expression rate ( P < 0.05 ). The positive expression in the groups with infiltration and metastasis, and nuclear division ≥5/50 HP was sig-nificantly higher than the groups without infiltration and metastasis, and nuclear division < 5/50 HP (P < 0.05). Conclusion The expression of HIF-1α had a significant correlation with ET-1. HIF-1α,and ET-1 expression was closely related with the prognosis of GISTs,and can serve as important predictors for survival.     

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甲状腺素在外科中一直用来治疗慢性淋巴细胞性甲状腺炎 ,还作为甲状腺全切术后的替代治疗或甲状腺癌术后抗复发的重要药物。近年来有许多关于甲状腺素在治疗非甲状腺疾病 (ｎｏｎｔｈｙｒｏｉｄａｌｉｌｌｎｅｓｓ ,ＮＴＩ)中作用的报道 ,如治疗心衰、高脂血症等。本文就甲状腺素在外科中一些新的应用作一总结。1　甲状腺素在外科危重病人中的应用　　我们于 1987年发现急性梗阻性化脓性胆管炎病人Ｔ3水平明显低于胆管结石和胆囊结石病人 ,并且随病情改善而恢复正常[1] 。众所周知 ,老年病人行急症手术的并发症及病死率均高 ,而那些存在低Ｔ…     

卡培他滨用于Dukes B,C期大肠癌患者术后化疗的临床观察

目的 评估卡培他滨用于可切除的结直肠癌患者术后辅助化疗的疗效及毒副作用.方法 回顾分析2004～2005年Dukes B,C期大肠癌根治术病例,按其术后化疗方案分为卡培他滨组,5-FU/LV组,未化疗组.比较两化疗方案出现的毒副反应.并根据随访资料比较3组1,2,3年生存率.结果 毒副反应方面,卡培他滨组手足综合征和皮肤色素沉着较明显,发生率均为48.6%,5-FU/LV组为7%,2.1%,两组相比有差异有显著性(P＜0.05);5-FU/LV组毒副反应主要表现在胃肠道反应,以恶心呕吐最为明显,发生率为69.8%,而卡培他滨组则为27%,两组比较有差异有显著性(P=0.001),其余副反应两者比较无统计学差异.1,2,3年的生存率卡培他滨组为97%,89%,83%,5-FU/LV组为95%,83%,73%,未化疗组为88%,71%,53%,3组比较差异有显著性(P＜0.05).结论 卡培他滨用于可切除的结直肠癌术后患者疗效好,其毒副反应小,患者耐受性好,有可能成为大肠癌辅助化疗的基础治疗方案.     

VEGF、HIF-1 alpha、EGF在肝细胞癌中的表达及其临床意义

目的研究肝细胞癌 (HCC)中血管内皮生长因子 (VEGF)、缺氧诱生因子 1alpha(HIF 1α)和表皮生长因子 (EGF)的表达情况及其临床意义。方法采用免疫组织化学SABC法检测 36例HCC组织及其癌旁肝组织和 6例正常肝组织中VEGF、HIF 1α和EGF的表达情况 ,研究这 3个因子与HCC临床病理学资料、新生血管生成以及预后的关系。结果 36例HCC中VEGF、HIF 1α和EGF表达的阳性率分别为 89% (32 / 36 ) ,6 7% (2 4 / 36 )和 75 % (2 7/ 36 ) ,均高于相应的癌旁肝组织和正常肝组织 (P <0 0 5 )。光学显微镜下有静脉浸润的HCC组织中VEGF和HIF 1α的表达率分别为 96 % (2 3/ 2 4 )和 88% (2 1 / 2 4 ) ,高于光学显微镜下无静脉浸润者 (75 %和 2 5 % ) ,差异有显著意义 (P <0 0 5 )。VEGF阴性组术后 1、2年生存率均为 1 0 0 % ,弱阳性组分别为 87%和 2 2 % ,强阳性组分别为 5 4 %和 0 ,三组存活率的差异具有显著意义 (P <0 0 5 )。EGF阴性组术后 1、2年存活率分别为 1 0 0 %和 6 0 % ,弱阳性组均为 70 % ,强阳性组分别为 2 7%和 0。三组之间存活率的差异亦具有显著意义 (P <0 0 5 )。结论HCC组织中VEGF、HIF 1α和EGF呈过量表达。HCC组织中VEGF、EGF和HIF 1α的表达与HCC中新生血管生成以及预后不良有密切关系     

Expression and significance of HIF-1α and ET-1 in gastrointestinal stromal tumors

Objective To explore the expression and the value of HIF-1α,and ET-1 in judging the prognosis of gastrointestinal stromal tumors (GISTs). Methods The expression of HIF-1α, and ET-1 protein was examined in 76 GISTs by immunohistochemistry S -P methods. Results There was a positive correlation between the expression of HIF-1 α and ET-1 ( P < 0.05 ). The positive expression rate of HIF-1 α and ET-1 was 73.68% (50/76) ,and 65.79% (50/76) respectively,which was related with histologicial grade, tumor diameter, infiltration and metastasis, nuclear division rating of GISTs ( P < 0.05 ), but had no relationship with patients' age, gender, initial position of the tumor ( P > 0.05 ). There was statistically sig-nificant difference in the expression of HIF-1 α and ET-1 in the following groups:among the three classes of very low-risk and low-risk, middle-risk, high-risk, bewteen the diameter < 2 cm and > 5 cm (P < 0.05). The more malignant degree and larger diameter, the more highly positive expression rate ( P < 0.05 ). The positive expression in the groups with infiltration and metastasis, and nuclear division ≥5/50 HP was sig-nificantly higher than the groups without infiltration and metastasis, and nuclear division < 5/50 HP (P < 0.05). Conclusion The expression of HIF-1α had a significant correlation with ET-1. HIF-1α,and ET-1 expression was closely related with the prognosis of GISTs,and can serve as important predictors for survival.     

乳腺癌保乳手术治疗的临床疗效观察

目的探讨乳腺癌保乳手术治疗的适应证、治疗方法和疗效。方法对246例Ⅰ-Ⅱ期乳腺癌施行保乳手术加术后放疗、化疗及内分泌治疗等综合治疗（保乳组）;并与同期施行乳房切除手术组加综合治疗的295例Ⅰ-Ⅱ期乳腺癌（对照组）进行对比。结果保乳组、对照组的平均手术时间分别为（92±37.3）min,（156±23.2）min;术中平均出血量分别为（182±86）mL,（276±52）mL;手术并发症率分别为14.2%,36.9%;保乳组均优于对照组（均P〈0.05）。保乳组3、5、10年期生存率分别为93.2%、86.7%、82.7%,总局部复发率是6.5%;对照组3、5、10年期生存率分别为94.1%、85.3%、84.9%,总局部复发率为4.4%。两组生存率和复发率比较差异无统计学意义（均P〉0.05）。保留乳房的美容效果满意率为81.3%。结论对临床Ⅰ、Ⅱ期乳腺癌行保乳手术与乳房切除手术的3年、5年和10年疗效相近,保乳手术后大部分患者乳房外形良好。