目的探討經胸鎖乳突肌前緣入路行甲狀腺良性腫瘤切除術的體會。方法2002年10月至2010年10月期間我院對128例甲狀腺良性腫瘤患者行經胸鎖乳突肌前緣入路甲狀腺手術，手術切口采取皮內縫合。結果所有患者均順利完成手術。手術時間45~130 min（平均65 min），術中出血10~100 ml（平均40 ml）； 引流管均在術后第2天拔除，引流量15~30 ml（平均20 ml）； 手術切口長3~7 cm（平均5 cm），均一期愈合； 住院時間3~6 d（平均4.5 d）。術后無出血，無神經、甲狀旁腺損傷及其他并發癥。術后隨訪0.5~8年（平均5.5年），12例患者（9%）復發，復發時間為術后1~3年（平均1.5年）; 8例患者結節lt;1 cm，給予臨床觀察; 其余4例患者經相同入路經二次手術治愈，隨訪無復發，未發現甲狀腺癌。結論經胸鎖乳突肌前緣入路行甲狀腺良性腫瘤切除術不損傷或橫斷舌骨下肌群，術中出血少，無頸部肌肉瘢痕粘連影響外觀之慮。
目的 探討不能手術治療的惡性梗阻性黃疸給予介入治療及術后行放射治療的效果。方法 對筆者所在單位2006年6月至2011年6月期間收治的68例不能手術治療的惡性梗阻性黃疸患者在X線導向下行經皮經肝膽道內外引流及金屬內支架引流術，對膽道金屬內支架置入術后行放射治療的臨床資料進行回顧性分析與總結。結果 行內外引流管引流28例次，金屬內支架置入63例次。55例膽管癌患者膽道金屬內支架置入后再行放射治療，13例患者單純行膽道內外引流管引流，全部患者的黃疸均得到改善。行膽管腫瘤組織活檢51例和膽汁脫落細胞學檢查68例，總陽性率為58.8% （40/68），術后0.5、1及3年存活率分別為95.6% （65/68），70.6% （48/68）和14.7% （10/68）。結論 惡性梗阻性黃疸在失去手術治療機會后采用介入治療解除膽管梗阻，減輕肝臟損害，膽道金屬內支架置入術后再行放射治療，有助于提高患者生存質量，延長患者生存時間。
Objective To investigate the effectiveness of LARS ligament and three-dimensional (3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection. Methods The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed. There were 7 males and 5 females with an average age of 41.8 years (range, 19-63 years). There were 8 cases on the left side and 4 cases on the right side, and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma. The disease duration ranged from 1 to 20 months, with an average of 8.1 months. The osteotomy length, operation time, and intraoperative blood loss were recorded, and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score before and after operation. The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb, and the range of motion (ROM) of the wrist joint was measured, including extension, flexion, radial deviation, and ulnar deviation; the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up; the possible wrist complications were recorded. ResultsAll 12 patients successfully completed the operation. The osteotomy length was 5.0-10.5 cm (mean, 6.8 cm), and the operation time was 180-250 minutes (mean, 213.8 minutes). The intraoperative blood loss was 30-150 mL (mean, 61.7 mL). All patients were followed up 11-52 months (mean, 30.8 months). Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients, and biological fixation was gradually achieved. During the follow-up, the stability, motor function, and ROM of the wrist joint were good. There was no complication such as arthritis, subluxation, prosthesis loosening, and infection, and no tumor recurrence and metastasis. At last follow-up, the Mayo score was 82.1±5.4, and MSTS score was 27.5±1.5, which were significantly improved when compared with those before operation (48.8±13.5, 16.4±1.4; t=?10.761, P<0.001; t=?26.600, P<0.001). The grip strength of the affected side was 59%-88% of that of the healthy side, with an average of 70.5%. The ROM of wrist joint were 55°-80° (mean, 65.42°) in extension, 35°-60° (mean, 44.58°) in flexion, 10°-25° (mean, 17.92°) in radial deviation, 10°-25° (mean, 18.33°) in ulnar deviation. Conclusion The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection. It can improve the function of wrist joint, reduce the incidence of complications, and improve the stability of wrist joint.