乳腺癌术后皮瓣坏死的预防对策

皮瓣坏死是乳腺癌术后最常见的并发症之一。国外报道其发生率为10%—60%,国内报道51%—71%不等[1],我科1990~1994年施行乳腺癌手术35例,发生皮瓣坏死15例,坏死率43%;1995年以来,改进了操作和处理方法后施行乳腺癌手术38例,未发生皮瓣坏死。报告如下

肛瘘切开术与切除术治疗低位单纯性肛瘘中的价值

目的分析比较肛瘘切开术与切除术治疗低位单纯性肛瘘的价值。方法方便选择2014年7月—2016年7月该院所收治的120例明确诊断为低位单纯性肛瘘患者进行研究。按照随机数字表法分为肛瘘切开组(n=60)和肛瘘切除术组(n=60),两组采用相同的术前准备、麻醉方式和术后管理。对比两组手术操作时间和术中出血量,研究分析两组术后切口愈合时间、切口并发症(疼痛、出血及感染)、复发率、早期排便次数、大便失禁和狭窄并发症发生率。结果肛瘘切开术组手术操作时间为(16.1±2.3)min,肛瘘切除术组手术操作时间为(13.8±3.2)min,两组数据差异有统计学意义(t=4.520 8,P=0.013 1);肛瘘切开术组手术切开愈合时间为(22.5±4.5)d,肛瘘切除术组手术愈合时间为(28.8±4.6)d,两组数据差异有统计学意义(t=8.91,P=0.010 1);肛瘘切开术组早期排便次数为(1.5±0.5)次,肛瘘切除术组早期排便次数为(2.5±1.5)次,两组数据差异有统计学意义(t=3.167,P=0.002)。而两组在术中出血量、术后因切口疼痛导致的镇痛药使用率、切开疼痛评分方面差异无统计学意义(P>0.05)。术后随访1年,肛瘘切开术组患者术后复发率高于肛瘘切除术组,差异有统计学意义(P0.05)。结论肛瘘切除术与切除术在治疗低位单纯性肛瘘方面,操作简单,伤口较小,手术操作时间短、恢复快,但远期复发率高于肛瘘切除术

Expression of ALCAM in gastric carcinoma and its clinical significance

目的检测ALCAM在胃癌组织中表达的情况,探讨其与临床病理参数的关系及对胃癌预后的临床意义。方法应用免疫组织化学方法检测61例胃癌组织中ALCAM的表达情况并分析ALCAM与胃癌临床病理特征及预后的关系。结果 ALCAM在胃癌组织中的阳性表达率明显高于癌旁组织,癌旁组织未见表达。TNM分期Ⅲ+Ⅳ期、伴淋巴结转移者癌组织中ALCAM表达明显高于对应组,而与患者的年龄、性别、术前CEA水平、肿瘤部位、肿瘤大小无关。单因素分析显示术前TNM分期、淋巴结转移、分化程度、ALCAM与胃癌患者总生存期相关;COX风险模型提示TNM分期、淋巴结转移、ALCAM为胃癌总体生存时间预后的独立危险因素。结论 ALCAM可能参与胃癌发展的恶性进程,其高表达提示胃癌患者预后不良。Objective To investigate the expression of ALCAM in gastric carcinoma and its clinical significance.Methods The different expression levels of ALCAM protein in gastric carcinoma and peritumoral tissues in 61 gastric carcinoma patients were determined by the immunohistochemistry method,respectively.The clinical significance of ALCAM was further explored.Results The ALCAM protein expression was significantly higher in the gastric carcinoma tissues than that in the perfumoral tissues.No ALCAM expression was shown in the perfumoral tissues.Further more,the expression of ALCAM protein in the gastric carcinoma tissues was higher in gastric carcinoma patients with lymph node metastasis,and with TNM stage Ⅲ-Ⅳ and lymph node metastasis.The univariate analysis showed that preoperative TNM stage,lymph node metastasis,degree of differentiation,and the expression of ALCAM were significantly associated with the overall survival of patients with gastric carcinoma.The multivariate analysis showed that TNM stag,lymph node metastasis,and the expression of ALCAM were independent predictors of gastric cancer overall survival.Conclusion ALCAM may be involved in the malignant progression of gastric cancer,and the over-expression of ALCAM is associated with poor prognosis