背景与目的:甲状腺结节的发病率逐年升高,手术切除为甲状腺小结节的病理诊断和治疗提供了理想方法,但是对小结节的定位成为手术过程中的一大难题。本研究的目的在于明确一种新型甲状腺结节定位装置在甲状腺手术中的可行性和安全性。方法...背景与目的:甲状腺结节的发病率逐年升高,手术切除为甲状腺小结节的病理诊断和治疗提供了理想方法,但是对小结节的定位成为手术过程中的一大难题。本研究的目的在于明确一种新型甲状腺结节定位装置在甲状腺手术中的可行性和安全性。方法:在超声引导下,运用该定位装置在术前对有强烈手术意愿的患者进行甲状腺结节精准定位。随后对该项技术进行回顾性研究,以评估该新型定位技术的安全性和可行性。主要结局指标包括探究该项定位技术的安全性(定位过程是否导致出血以及其他不良反应)和成功率(能否精准定位甲状腺微小结节并且将其成功切除);次要结局指标包括可行性(定位过程持续时间以及定位装置是否失败和损坏)。结果:共对29例甲状腺切除手术患者的29个甲状腺微小结节进行术前精准定位。总体而言,28例患者的甲状腺微小结节被成功精准定位并切除,未出现术中定位钩子断裂或者脱落的情况。1例患者出现了结节与定位针钩子之间存在距离偏差,最终扩大切除范围后才将结节切除。其中结节直径大小中位数为0.5 cm,定位过程的时间平均数为13 min。没有病人在手术过程中或术后出现明显的相关并发症。结论:在甲状腺手术中使用该定位装置安全可靠,具有较高的定位成功率,能提高对甲状腺疾病的诊断率,同时也方便临床手术医生操作。是一种具有一定临床应用价值的结节精准定位技术。Background & Objective: The incidence of thyroid nodules is increasing year by year. Surgical resection provides an ideal method for the pathologic diagnosis and treatment of thyroid nodules, but the localization of nodules is a major problem in the surgical process. The objective of this study was to determine the feasibility and safety of a novel thyroid nodule localization device in thyroid surgery. Methods: Under the guidance of ultrasound, the localization device was used to accurately locate thyroid nodules in patients with a strong desire for surgery. Subsequently, a retrospective study was conducted to evaluate the safety and feasibility of this novel positioning technology. Primary outcome measures included examining the safety of the localization technique (whether the localization process resulted in bleeding and other adverse effects) and success rate (whether the tiny thyroid nodules could be accurately located and successfully removed). Secondary outcome measures include feasibility (duration of the positioning process and whether the positioning device fails and is damaged). Results: A total of 29 thyroid micronodules in 29 patients undergoing thyroidectomy were accurately located before the operation. Overall, the thyroid micronodules were successfully located and removed in 28 patients without intraoperative location hook breakage or loss. In 1 patient, there was a distance deviation between the nodules and the positioning needle hook, and the nodules were removed only after the scope of resection was expanded. The median diameter of nodules was 0.5cm. The average time of the positioning process was 13 minutes. None of the patients had significant complications during or after the procedure. Conclusion: The localization device is safe and reliable in thyroid surgery, and has a high localization success rate, which can improve the diagnosis rate of thyroid diseases and facilitate the operation of clinical surgeons. It is an accurate nodule localization technique with a certain clinical application value.展开更多
目的探讨凋亡抑制基因Survivin的小干扰RNA(Small interfering RNA,si RNA)对甲状腺乳头状癌细胞株K1裸鼠移植瘤血管生成的影响。方法将表达特异性Survivin si RNA序列的质粒载体,与表达无关序列si RNA的质粒载体分别转染K1细胞;G418筛...目的探讨凋亡抑制基因Survivin的小干扰RNA(Small interfering RNA,si RNA)对甲状腺乳头状癌细胞株K1裸鼠移植瘤血管生成的影响。方法将表达特异性Survivin si RNA序列的质粒载体,与表达无关序列si RNA的质粒载体分别转染K1细胞;G418筛选出稳定表达Survivin si RNA和表达无关序列si RNA的K1细胞,与未转染的K1细胞分别注射于裸鼠皮下,观察三组移植瘤的生长速度。SP免疫组化法检测各组移植瘤中的微血管密度(MVD)。结果 Survivin si RNA组比无关序列si RNA组肿瘤平均质量减少56%,比未转染组肿瘤平均质量减少63%;Survivin si RNA组MVD明显低于无关序列si RNA组及未转染组(P<0.05);无关序列si RNA组与未转染组MVD值差异无统计学意义(P>0.05)。结论 Survivin si RNA可抑制甲状腺乳头状癌细胞K1裸鼠移植瘤的微血管生成及肿瘤生长。展开更多
目的探讨达芬奇机器人与腹腔镜辅助直肠癌Dixon术的近期临床疗效。方法回顾性分析2016年3月~2018年5月我科达芬奇机器人(机器人组,n=53)或腹腔镜辅助(腹腔镜组,n=58)直肠癌Dixon术的临床资料,比较2组手术时间、术中出血量、术后24 h C...目的探讨达芬奇机器人与腹腔镜辅助直肠癌Dixon术的近期临床疗效。方法回顾性分析2016年3月~2018年5月我科达芬奇机器人(机器人组,n=53)或腹腔镜辅助(腹腔镜组,n=58)直肠癌Dixon术的临床资料,比较2组手术时间、术中出血量、术后24 h C反应蛋白、术后肛门首次排气时间、术后尿管留置时间、腹腔引流管留置时间、术后并发症、术后住院时间、淋巴结清扫数目和术后男性性功能评分等。结果机器人组手术时间(136.7±11.4)min,明显长于腹腔镜组(124.1±21.5)min(t=3.827,P=0.000);术中出血量(69.7±12.0)ml,明显少于腹腔镜组(75.3±13.2)ml(t=-2.370,P=0.020);术后尿管留置时间中位数3 d(1~6 d),明显短于腹腔镜组4 d(2~6 d)(Z=-3.029,P=0.002);术后24 h C反应蛋白(53.3±7.9)mg/L,明显低于腹腔镜组(57.1±6.3)mg/L(t=-2.829,P=0.006);术后男性性功能评分(19.0±3.1)分,明显高于腹腔镜组(17.1±3.3)分(t=2.186,P=0.033)。机器人组和腹腔镜组淋巴结清扫数目分别为(16.9±3.8)、(16.5±3.7)枚,术后肛门首次排气时间分别为(54.7±6.7)、(55.6±7.4)h,术后腹腔引流管留置时间中位数分别为6(5~24)、6(4~28)d,术后住院时间中位数分别为7(6~26)、7.5(5~30)d,术后并发症分别为9、8例,均无统计学差异(P>0.05)。结论与腹腔镜辅助直肠癌Dixon术比较,达芬奇机器人手术安全可行,且术中出血更少、炎症反应轻、盆腔自主神经损伤更轻,值得推广应用。展开更多
目的分析术前血清总胆红素水平对行胰十二指肠切除术患者的影响,探索术前胆红素应控制的最佳水平,总结梗阻性黄疸患者行术前减黄的价值及临床意义,指导临床应对恶性梗阻性黄疸。方法对住院行胰十二指肠切除术患者各项资料进行统计学分...目的分析术前血清总胆红素水平对行胰十二指肠切除术患者的影响,探索术前胆红素应控制的最佳水平,总结梗阻性黄疸患者行术前减黄的价值及临床意义,指导临床应对恶性梗阻性黄疸。方法对住院行胰十二指肠切除术患者各项资料进行统计学分析。结果胆红素≥171μmol/L组与<171μmol/L组年龄、性别、体重分布比较,两组差异无统计学意义(P=0.455、0.909、0.174);两组术前谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(Alb)水平比较,差异有统计学意义(P=0.004、0.002、0.026);两组术前血红蛋白、术中出血、术后住院时间、手术时间、术中输血、肿瘤位置比较,组间差异均无统计学意义(P=0.960、0.459、0.796、0.189、0.580、0.494);两组肿瘤的大小比较,组间差异有统计学意义(P=0.005);两组术后总的并发症发生率差异有统计学意义(P=0.040);两组术后胰瘘发生率差异有统计学意义(P=0.047);两组术后其他各个并发症之间比较,组间差异均无统计学意义(P>0.05);术前减黄后,两组胰瘘、术中出血≥600m L与<600 m L比较,差异有统计学意义(P=0.007、0.035)。结论术前胆红素水平与肿瘤大小有关;术前高水平的胆红素严重影响肝功能;高水平胆红素增加术后总体并发症;有效的术前减黄可以减少术中出血量,减少胰瘘的发生。展开更多
文摘背景与目的:甲状腺结节的发病率逐年升高,手术切除为甲状腺小结节的病理诊断和治疗提供了理想方法,但是对小结节的定位成为手术过程中的一大难题。本研究的目的在于明确一种新型甲状腺结节定位装置在甲状腺手术中的可行性和安全性。方法:在超声引导下,运用该定位装置在术前对有强烈手术意愿的患者进行甲状腺结节精准定位。随后对该项技术进行回顾性研究,以评估该新型定位技术的安全性和可行性。主要结局指标包括探究该项定位技术的安全性(定位过程是否导致出血以及其他不良反应)和成功率(能否精准定位甲状腺微小结节并且将其成功切除);次要结局指标包括可行性(定位过程持续时间以及定位装置是否失败和损坏)。结果:共对29例甲状腺切除手术患者的29个甲状腺微小结节进行术前精准定位。总体而言,28例患者的甲状腺微小结节被成功精准定位并切除,未出现术中定位钩子断裂或者脱落的情况。1例患者出现了结节与定位针钩子之间存在距离偏差,最终扩大切除范围后才将结节切除。其中结节直径大小中位数为0.5 cm,定位过程的时间平均数为13 min。没有病人在手术过程中或术后出现明显的相关并发症。结论:在甲状腺手术中使用该定位装置安全可靠,具有较高的定位成功率,能提高对甲状腺疾病的诊断率,同时也方便临床手术医生操作。是一种具有一定临床应用价值的结节精准定位技术。Background & Objective: The incidence of thyroid nodules is increasing year by year. Surgical resection provides an ideal method for the pathologic diagnosis and treatment of thyroid nodules, but the localization of nodules is a major problem in the surgical process. The objective of this study was to determine the feasibility and safety of a novel thyroid nodule localization device in thyroid surgery. Methods: Under the guidance of ultrasound, the localization device was used to accurately locate thyroid nodules in patients with a strong desire for surgery. Subsequently, a retrospective study was conducted to evaluate the safety and feasibility of this novel positioning technology. Primary outcome measures included examining the safety of the localization technique (whether the localization process resulted in bleeding and other adverse effects) and success rate (whether the tiny thyroid nodules could be accurately located and successfully removed). Secondary outcome measures include feasibility (duration of the positioning process and whether the positioning device fails and is damaged). Results: A total of 29 thyroid micronodules in 29 patients undergoing thyroidectomy were accurately located before the operation. Overall, the thyroid micronodules were successfully located and removed in 28 patients without intraoperative location hook breakage or loss. In 1 patient, there was a distance deviation between the nodules and the positioning needle hook, and the nodules were removed only after the scope of resection was expanded. The median diameter of nodules was 0.5cm. The average time of the positioning process was 13 minutes. None of the patients had significant complications during or after the procedure. Conclusion: The localization device is safe and reliable in thyroid surgery, and has a high localization success rate, which can improve the diagnosis rate of thyroid diseases and facilitate the operation of clinical surgeons. It is an accurate nodule localization technique with a certain clinical application value.
文摘目的探讨凋亡抑制基因Survivin的小干扰RNA(Small interfering RNA,si RNA)对甲状腺乳头状癌细胞株K1裸鼠移植瘤血管生成的影响。方法将表达特异性Survivin si RNA序列的质粒载体,与表达无关序列si RNA的质粒载体分别转染K1细胞;G418筛选出稳定表达Survivin si RNA和表达无关序列si RNA的K1细胞,与未转染的K1细胞分别注射于裸鼠皮下,观察三组移植瘤的生长速度。SP免疫组化法检测各组移植瘤中的微血管密度(MVD)。结果 Survivin si RNA组比无关序列si RNA组肿瘤平均质量减少56%,比未转染组肿瘤平均质量减少63%;Survivin si RNA组MVD明显低于无关序列si RNA组及未转染组(P<0.05);无关序列si RNA组与未转染组MVD值差异无统计学意义(P>0.05)。结论 Survivin si RNA可抑制甲状腺乳头状癌细胞K1裸鼠移植瘤的微血管生成及肿瘤生长。
文摘目的探讨达芬奇机器人与腹腔镜辅助直肠癌Dixon术的近期临床疗效。方法回顾性分析2016年3月~2018年5月我科达芬奇机器人(机器人组,n=53)或腹腔镜辅助(腹腔镜组,n=58)直肠癌Dixon术的临床资料,比较2组手术时间、术中出血量、术后24 h C反应蛋白、术后肛门首次排气时间、术后尿管留置时间、腹腔引流管留置时间、术后并发症、术后住院时间、淋巴结清扫数目和术后男性性功能评分等。结果机器人组手术时间(136.7±11.4)min,明显长于腹腔镜组(124.1±21.5)min(t=3.827,P=0.000);术中出血量(69.7±12.0)ml,明显少于腹腔镜组(75.3±13.2)ml(t=-2.370,P=0.020);术后尿管留置时间中位数3 d(1~6 d),明显短于腹腔镜组4 d(2~6 d)(Z=-3.029,P=0.002);术后24 h C反应蛋白(53.3±7.9)mg/L,明显低于腹腔镜组(57.1±6.3)mg/L(t=-2.829,P=0.006);术后男性性功能评分(19.0±3.1)分,明显高于腹腔镜组(17.1±3.3)分(t=2.186,P=0.033)。机器人组和腹腔镜组淋巴结清扫数目分别为(16.9±3.8)、(16.5±3.7)枚,术后肛门首次排气时间分别为(54.7±6.7)、(55.6±7.4)h,术后腹腔引流管留置时间中位数分别为6(5~24)、6(4~28)d,术后住院时间中位数分别为7(6~26)、7.5(5~30)d,术后并发症分别为9、8例,均无统计学差异(P>0.05)。结论与腹腔镜辅助直肠癌Dixon术比较,达芬奇机器人手术安全可行,且术中出血更少、炎症反应轻、盆腔自主神经损伤更轻,值得推广应用。
文摘目的分析术前血清总胆红素水平对行胰十二指肠切除术患者的影响,探索术前胆红素应控制的最佳水平,总结梗阻性黄疸患者行术前减黄的价值及临床意义,指导临床应对恶性梗阻性黄疸。方法对住院行胰十二指肠切除术患者各项资料进行统计学分析。结果胆红素≥171μmol/L组与<171μmol/L组年龄、性别、体重分布比较,两组差异无统计学意义(P=0.455、0.909、0.174);两组术前谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(Alb)水平比较,差异有统计学意义(P=0.004、0.002、0.026);两组术前血红蛋白、术中出血、术后住院时间、手术时间、术中输血、肿瘤位置比较,组间差异均无统计学意义(P=0.960、0.459、0.796、0.189、0.580、0.494);两组肿瘤的大小比较,组间差异有统计学意义(P=0.005);两组术后总的并发症发生率差异有统计学意义(P=0.040);两组术后胰瘘发生率差异有统计学意义(P=0.047);两组术后其他各个并发症之间比较,组间差异均无统计学意义(P>0.05);术前减黄后,两组胰瘘、术中出血≥600m L与<600 m L比较,差异有统计学意义(P=0.007、0.035)。结论术前胆红素水平与肿瘤大小有关;术前高水平的胆红素严重影响肝功能;高水平胆红素增加术后总体并发症;有效的术前减黄可以减少术中出血量,减少胰瘘的发生。
