目的探讨自制双套管持续负压吸引对低位直肠癌经腹前切除术后吻合口漏的防治效果。 方法2006年1月至2012年12月期间笔者所在医院施行了106例低位直肠癌经腹前切除术，均采用自制双套管持续负压吸引，回顾性分析其预防和治疗吻合口漏的效果。 结果本组106例患者术后发生吻合口漏6例（5.66%），给予双套管持续滴注冲洗结合持续低负压吸引，同时给予全身抗感染、禁食、肠外营养或后期肠内营养处理。12～16 d（平均14 d）后患者的大便成型、冲洗液清亮，遂拔除引流管。其中1例为直肠阴道瘘，经保守治疗失败后行横结肠双腔造瘘术，于术后6周恢复，3个月后行造瘘口关闭术。 结论低位直肠癌保肛手术应用自制双套管持续负压吸引技术后，吻合口漏的发生率较低；其还能有效控制盆腔感染，从而促进漏口愈合。
【Abstract】ObjectiveTo explore the effects of p38 mitogenactivated protein kinase (MAPK) on apoptosis of small intestinal epithelial cells after transplantation in rats. MethodsSmall intestinal transplantation was performed in SD and Wistar rats. The recipients were divided into three groups: isograft group (Wistar→Wistar group), allograft group (SD→Wistar group) and allograft+cyclosporine A group (SD→Wistar+CsA group). The grafts were harvested on day 1, 3, 5 and 7 after operation. All graft samples were subjected to histological examination. The apoptosis of graft epithelial cells was detected by TUNEL method. p38 MAPK was measured by Westernblotting method and serum TNFα was determined by ELISA. ResultsMild, moderate and severe rejection reaction occurred in the SD→Wistar group, it was showed that the number of apoptotic cells increased with the severity of the rejection reaction by TUNEL. In SD→Wistar group, the numbers of apoptotic cells were significantly higher than those of the other two groups （P＜0.01）. The severity of rejection reaction in SD→Wistar+CsA group was less than that of SD→Wistar group and the number of apoptotic cells increased with the severity of the rejection reaction (P＜0.01). The level of serum TNFα varied with the apoptotic degree of small intestinal epithelial cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）. The expression of p38 MAPK increased with the number of the apoptotic cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）, but there was no evident change in Wistar→Wistar group （Pgt;0.05）. The expression of p38 MAPK and the level of serum TNFα were positively correlated with apoptosis in small intestinal rejection after transplantation （r=0.875， P＜0.01； r=0.837， P＜0.01）. p38 MAPK and TNFα were also positively correlated （r=0.826，P＜0.01）. ConclusionApoptosis plays an important role in small intestinal rejection. p38 MAPK is involved in apoptosis and is an important regulator in signal pathway of cell apoptosis.
ObjectiveTo summarize the current status and the management and prophylaxis of complications in laparoscopic gastrectomy. MethodsThe literatures on laparoscopic gastrectomy in domestic and abroad were reviewed and analyzed combined with our experiences. ResultsThe complications of laparoscopic gastrectomy primary attributed to surgery itself and pneumoperitoneum. Limited field under laparoscopy, loss of threedimensional space and finger touch, new instrument and technology and working conditions increased the difficulty of operation and the possibility of surgical complications. Clear anatomical layer under laparoscopy, accurate dissection of lymph nodes, and digestive tract reconstruction were the basis to reduce the complications in laparoscopic gastrectomy. ConclusionCorrect surgical procedures may reduce the occurrence of complications in laparoscopic gastrectomy.
Sleep apnea causes cardiac arrest, sleep rhythm disorders, nocturnal hypoxia and abnormal blood pressure fluctuations in patients, which eventually lead to nocturnal target organ damage in hypertensive patients. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) is extremely high, which seriously affects the physical and mental health of patients. This study attempts to extract features associated with OSAHS from 24-hour ambulatory blood pressure data and identify OSAHS by machine learning models for the differential diagnosis of this disease. The study data were obtained from ambulatory blood pressure examination data of 339 patients collected in outpatient clinics of the Chinese PLA General Hospital from December 2018 to December 2019, including 115 patients with OSAHS diagnosed by polysomnography (PSG) and 224 patients with non-OSAHS. Based on the characteristics of clinical changes of blood pressure in OSAHS patients, feature extraction rules were defined and algorithms were developed to extract features, while logistic regression and lightGBM models were then used to classify and predict the disease. The results showed that the identification accuracy of the lightGBM model trained in this study was 80.0%, precision was 82.9%, recall was 72.5%, and the area under the working characteristic curve (AUC) of the subjects was 0.906. The defined ambulatory blood pressure features could be effectively used for identifying OSAHS. This study provides a new idea and method for OSAHS screening.
目的:探讨妊娠相关性宫颈癌的早期诊断、治疗和预后。方法:结合文献回顾分析我院2000年至2007年收治的13例妊娠相关性宫颈癌的诊治经过和预后。结果:妊娠相关性宫颈癌分化程度低，癌灶体积大，早期盆腔淋巴结转移率高，产褥期宫颈癌预后差。结论:宫颈细胞学检查应列为首次产检常规项目；妊娠期宫颈原位癌在密切随诊前提下可暂不予处理，待分娩后6~8周活检确认病变性质后，再采取相应治疗措施；新辅助化疗同样可为晚期别的妊娠相关性宫颈癌争取手术时机。
ObjectiveTo systematically review the implant survival and postoperative aesthetics of immediate versus delayed implant treatment in the anterior maxilla regions.MethodsWe searched databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI and WanFang Data from inception to April 2017, to collect randomized controlled trials (RCTs) and cohort studies on immediate implant and delayed implant in the anterior teeth areas. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 4 RCTs and 12 retrospective cohort studies involving 1 316 implants were finally included. The results of meta-analysis showed that: there was no significant difference between two groups in retention rate (RCT: RR=0.99, 95%CI 0.97 to 1.02, P=0.70; retrospective cohort study: RR=0.99, 95%CI 0.96 to 1.02, P=0.54), the implant stability of permanent restoration for 4 months (MD=0.82, 95%CI –0.11 to 1.76, P=0.08), alveolar bone resorption of long-term permanent crown restoration (12 months: RCT: MD=0.06, 95%CI –0.35 to 0.47, P=0.79; retrospective cohort study: MD=–0.27, 95%CI –0.57 to 0.03, P=0.07; 24 months: retrospective cohort study MD=–0.09, 95%CI –0.18 to 0.00, P=0.05), respectively. The immediate implant group was superior to the control group in alveolar bone resorption of short-term permanent crown restoration (3 months: MD=–0.08, 95%CI –0.13 to –0.04, P=0.000 1; 6 months: MD=–0.23, 95%CI –0.38 to –0.07, P=0.004). The PES score in the immediate implant group was higher than that in the delayed implant group(MD=1.12, 95%CI 0.11 to 2.13, P=0.03).ConclusionsCurrent evidence shows that both immediate and delayed implant procedures have similar outcomes in terms of implant retention, long-term stability and long-term alveolar bone resorption of the implants in the anterior maxilla regions, but the former procedure possesses better short-term reduction of alveolar bone absorption and postoperative gingival aesthetics. Furthermore, due to the limited quality and quantity of the included studies, more large-scale and high-quality studies are needed to verify the above conclusions.
ObjectiveTo systematically review the correlation between the expression of cytokeratin 19 (CK19) and oral squamous cell carcinoma (OSCC). MethodsPubMed, EMbase, CJFD, CBM, CNKI, VIP, WanFang Data and The Cochrane Library (Issue 1, 2015) were electronically searched from inception to January 1st 2015 to collect case-control studies about the correlation between CK19 expression and clinical pathogenic features in OSCC. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 studies were included, involving 612 OSCC cases and 564 normal controls. The results of meta-analysis showed that:The expression levels of CK19 were significantly different between the OSCC group and the control group, between OSCC groups with and without lymph node metastasis, between the high differentiation group and the middle/poor differentiation group, and between the clinical stage I group and the clinical stages Ⅱ to Ⅲ group (all P values≤0.05). However, there were no significant differences in expression levels of CK19 between the male OSCC group and the female OSCC group, and between the carcinoma size T1/T2 group and the T3/T4 group (all P values >0.05). ConclusionCurrent evidence shows that, CK19 expression may be associated with the occurrence, development and transfer of OSCC, and may be positively corrected with tumor malignance. It may be an indicator of poor prognosis and can be considered as a molecular marker of OSCC.
目的探讨超声引导经皮穿刺置管引流术在重症急性胰腺炎(SAP)治疗中的应用价值。方法对我院2001年 1 月至2009年12 月期间收治的35例腹腔渗液较多及合并胰腺周围积液、假性胰腺囊肿及脓肿的SAP患者采用了超声引导经皮穿刺置管引流术，观察其疗效。结果35例患者，置管引流45例次，置管成功率为100%。4例(11.4%)中转开腹手术，31例(88.6%)置管能有效引流。2例(5.7%)穿刺后并发少量出血。结论选择性应用超声引导经皮穿刺置管引流术对于腹腔积液较多及合并局部并发症的SAP患者，是一种有效的治疗手段。