ObjectiveTo explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection(ESD) for patients with early gastric cancer(EGC). MethodsThe clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node(SLN) biopsy. If frozen sectioning examination suggested there was lymph node metastasis, laparoscopic D2 radical gastrectomy would be operated. However, the ESD would be operated if the frozen sectioning examination was negative. ResultsThe total numbers of SLN were 95, and mean numbers of SLN were 3.7±1.4(range from 1 to 6). Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival(DFS) and local recurrence rate after ESD for EGC was 91.7%(22/24) and 4.2%(1/24), respectively. And the total DFS for all patients was 96.2% (25/26). ConclusionESD for EGC is a safe and feasible procedure, combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.
目的 總結我院35歲以下青年人胃癌43例的診治經驗。方法 對43例患者臨床特征、診斷及治療進行回顧性分析。結果 手術40例，根治性切除14例，姑息性切除9例，胃空腸吻合6例，單純探查11例，切除率57.50%。術后3個月內死亡5例，4～12個月內死亡18例，12～24個月內死亡8例，生存2年以上9例，5年以上3例。誤診26例，誤診率60.46%。結論 青年人胃癌發病率低，惡性程度高，病程短，轉移早，早期診斷率低，誤診率高，治療關鍵是提高早期診斷率。
ObjectiveTo investigate the safety and feasibility of early mobilization in critically ill patients with femoral catheters, and to provide reference for guiding clinical rehabilitation training. MethodsThe literature on the safety and feasibility of early mobilization in critically ill patients with femoral catheters included in PubMed, EMbase, OVID, Springer-link, Wiley Online Library, and Web of Science up to June 2021 was searched, and relevant data were extracted for analysis. ResultsSeventy-two papers were initially screened, and 12 papers that met the criteria were finally included, covering 1 056 patients, and 489 patients had femoral catheters. Patients underwent 6 495 sessions of physical therapy, and a total of 62 patients had adverse events, including 14 (2.86%, 14/489) patients with catheter-related adverse events. ConclusionAlthough early mobilization in critically ill patients with femoral catheters may lead to adverse catheter-related events, the incidence is low. Therefore, the associated risks and benefits should be weighed in clinical practice, and femoral catheter is not recommended as a contraindication for early mobilization in critically ill patients.
目的 探討應用雙吻合器低位直腸癌前切除術后吻合口漏的早期診斷和防治措施。方法 回顧性分析 2005～2011年期間筆者所在醫院收治的160例應用雙吻合器行低位直腸癌前切除患者的臨床資料。結果 本組患者術后發生吻合口漏13例（8.1%），發生吻合口漏的時間為術后 3～12d，平均7d；8例經保守治療后治愈，4 例經二次手術行結腸或回盲部造瘺后好轉，1 例于術后12d死亡。結論 直腸癌前切除術后吻合口漏的早期正確診斷和合理治療是降低患者死亡率的關鍵；早期的造瘺手術和通暢引流是治愈吻合口漏的必要措施。
ObjectiveTo investigate the association between preoperative systemic immune-inflammation index (SII) and early allograft dysfunction (EAD) in liver transplant recipients. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria in the West China Hospital of Sichuan University from January 2015 to December 2019 were collected. The postoperative EAD was analyzed. The generalized propensity score weighting (GPSW) were used to balance the confounding factors affecting the occurrence of EAD. ResultsA total of 390 patients who met the inclusion and exclusion criteria were enrolled in this study, 93 cases of EAD occurred, the incidence of EAD was 23.8%. The recipient’s model for endstage liver disease score and Child-Pugh grade, the donor’s body mass index, age, and graft weight, and the intraoperative cold ischemia time, liver transplantation time, intraoperative blood loss, total infusion, red blood cell transfusion, autologous blood reinfusion, fresh frozen plasma transfusion, concentrated platelet transfusion, total red blood cell and autologous blood transfusions were balanced by GPSW, then the overall mean correlation coefficient of the 14 covariables and SII decreased from 0.049 to 0.039, and each covariable reached the standard of less than 0.1. The binary logistic regression analysis based on GPSW showed that there was no significant association between SII and EAD (P=0.371). ConclusionFrom preliminary result of this study, it is not found that preoperative SII of liver transplantation patients is related to occurrence of postoperative EAD.
Objective To investigate pattern of lymph node metastasis (LNM) in patient with early gastric cancer (EGC) and it’s relation to clinicopathologic features so as to providing evidence for proper clinical management for EGC. Method The clinical and pathologic data of 101 EGC patients who were diagnosed and treated in the West China Hospital of Sichuan University from January 2011 to December 2012 were retrospectively analyzed. Results The LNM was found in the 28 patients, the rate of the LNM was 27.7% (28/101). In the univariate analysis, the LNM was associated with the macroscopic type (P=0.013), depth of invasion (P<0.001), differentiation type (P=0.044), and lymphovascular invasion (P=0.020); In the multivariate logistic regression analysis, the factors including of the macroscopic type (RR=4.742, P=0.009), differentiation type (RR=6.369, P=0.011), and depth of invasion (RR=15.218, P<0.001) were the independent risk factors for the LNM. Twenty-eight patients with LNM had only 1 positive lymph node, 4 patients had more than 7 positive lymph nodes. The No.6 lymph node was the most frequently involved station (35.7%, 10/28). The LNMs in the 69.7% (19/28) patients were restricted in the extent of the D1 lymphadenectomy, 3 (10.7%) patients without the perigastric lymph node involvement had the No.8a or No.9 LNM. Conclusion LNM in patient with EGC is correlated with clinicopathologic features such as macroscopic type, depth of invasion, differentiation type, and lymphovascular, further investigation is warranted to clarify risk factors of LNM in patient with EGC.
ObjectiveTo investigate the methods and significance of early orthodontic treatment for class Ⅱ malocclusion with molars scissors bite. MethodsTen patients with classⅡ malocclusion with molars scissors bite from 2011 and 2014 were selected. Study models and clinical data of them were retrospectively analyzed. Cephalometric radiographs taken before and after treatment were traced and measured. Student's t-test was used to analyze whether there was a significant difference before and after treatment. ResultsAfter treatment, the change of SNA, S-Go/N-Me, and soft tissue facial angle was not significant(P>0.05). SNB, N-ANS, ANS-Me, and S-Go increased significantly. ANB, Y axis, H angle, lower lip to H-line, and inferior sulcus to H-line decreased significantly(P<0.05). The treatment duration was 12 months on average. ConclusionEarly treatment of molars scissors bite and class Ⅱmalocclusion can keep the mandible and tempromandibular joint function well through occlusion guidance and muscle balance, which may prevent the exacerbation of facial deformity effectively.
目的 探討影響急性腹痛早期確診的原因，以提高急性腹痛早期確診的正確率及治愈率。 方法 2006年9月－2012年3月在川北醫學院附屬醫院急診科就診的主訴為急性腹痛的21例患者，回顧性分析其未早期確診的原因。并進一步將原因分類歸納，進行原因與結果的歸因分析，以及時效性分析。 結果 “先入為主，主觀臆斷”、“知識面窄，臨床經驗不足”、“過分依賴輔助檢查”、“對疾病的自然演變過程認識不足”、“患者對病史的隱瞞”等原因都可能影響急性腹痛患者的早期確診。 結論 盡量避免主觀臆斷，拓展知識面，詳細詢問病史及查體，重點檢查，密切觀察病情變化，認真分析，選擇陽性指標進行針對性檢查，對提高急性腹痛的早期確診有重要作用。