Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

The impact of metabolic dysfunction-associated fatty liver disease on the prognosis of patients with hepatocellular carcinoma after radical resection

Background:Metabolic dysfunction-associated fatty liver disease(MAFLD)is recently proposed an entity by a group of international experts.However,the impact of MAFLD on the prognosis of patients with hepatocellular carcinoma(HCC)is not clear.The aim of this study was to explore the influence of MAFLD for the prognosis of HCC after radical resection.Methods:HCC patients who received radical resection were enrolled.The recurrence-free survival(RFS)and overall survival(OS)were compared between MAFLD and non-MAFLD.Results:A total of 576 HCC patients were included,and among them 114(19.8%)met the diagnostic criteria of MAFLD.The median RFS was 34.0 months in the MAFLD group and 19.0 months in the non-MAFLD group.The 1-,3-,and 5-year RFS rates were 64.9%,49.1%and 36.1%in the MAFLD group,which were higher than those of the non-MAFLD group(59.4%,35.3%and 26.5%,respectively,P=0.01).The mean OS was 57.0 months in the MAFLD group and 52.2 months in the non-MAFLD group.There was no statistical difference in OS rate between the MAFLD group and non-MAFLD group.Similar results were found in HBV-related HCC patients in the subgroup analysis.Univariate analysis revealed that MAFLD was a protective factor for RFS in HCC patients after radical resection(P<0.05),and there was no association between MAFLD and OS rate(P>0.05).Multivariate analysis demonstrated that MAFLD was not an independent protective factor for HCC patients with radical resection.Conclusions:MAFLD improves RFS rate in HCC patients with radical resection,but is not an independent protective factor and not associated with OS rate.

Laparoscopic vs open radical resection in management of gallbladder carcinoma:A systematic review and meta-analysis

BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still controversial.AIM To compare laparoscopic radical resection(LRR)with traditional open radical resection(ORR)in managing GBC.METHODS A comprehensive search of online databases,including Medline(PubMed),Cochrane Library,and Web of Science,was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023.A meta-analysis was subsequently performed.RESULTS A total of 18 retrospective studies were identified.In the long-term prognosis,the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival(TFS).LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis(TNM)Ⅱstage subgroup vs the ORR group(P=0.04).In the short-term prognosis,the LRR group had superiority over the ORR group in the postoperative length of stay(POLS)(P<0.001).The sensitivity analysis showed that all pooled results were robust.CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNMⅡdisease and POLS.Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.

Effect of immune-enhancing enteral nutrition application before radical resection of rectal carcinoma on postoperative immune response level and trauma endurance capacity

Objective:To study the effect of immune-enhancing enteral nutrition application before radical resection of rectal carcinoma on postoperative immune response level and trauma endurance capacity.Methods:A total of 94 patients who received radical resection of rectal carcinoma in our hospital between May 2013 and October 2015 were selected and randomly divided into EN group and control group, the EN group received preoperative immune-enhancing enteral nutrition preparations, and the control group received routine preoperative nutrition intervention. The same day after operation, peripheral blood mononuclear cells were collected to determine CD69 and HLA-DR levels, and serum was collected to determine the levels of IgM, IgG, inflammatory response indexes and stress response indexes.Results:CD69 and HLA-DR levels in peripheral blood mononuclear cells as well as IgM, IgG, TP, ALB, PA and TF levels in serum of EN group were significantly higher than those of control group, and serum CRP, YKL-40, IL-1β, TNF-α, IL-6, HSP70, ACTH, Cor and HO-1 levels of EN group were significantly lower than those of control group.Conclusion:Immune-enhancing enteral nutrition application before radical resection of rectal carcinoma can improve the immune function and nutritional status, strengthen trauma endurance capacity and relieve postoperative inflammatory response and stress response.

GLI1 and PTTG1 expression in colorectal carcinoma patients undergoing radical surgery and their correlation with lymph node metastasis

BACKGROUND Few studies have investigated the expression of GLI1 and PTTG1 in patients undergoing radical surgery for colorectal carcinoma(CRC)and their association with lymph node metastasis(LNM).Therefore,more relevant studies and analyses need to be conducted.AIM To explore GLI1 and PTTG1 expression in patients undergoing radical surgery for CRC and their correlation with LNM.METHODS This study selected 103 patients with CRC admitted to our hospital between April 2020 and April 2023.Sample specimens of CRC and adjacent tissues were collected to determine the positive rates and expression levels of GLI1 and PTTG1.The correlation of the two genes with patients’clinicopathological data(e.g.,LNM)was explored,and differences in GLI1 and PTTG1 expression between patients with LNM and those without were analyzed.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive potential of the two genes for LNM in patients with CRC.RESULTS Significantly higher positive rates and expression levels of GLI1 and PTTG1 wereobserved in CRC tissue samples compared with adjacent tissues.GLI1 and PTTG1 were strongly linked to LNM in patients undergoing radical surgery for CRC,with higher GLI1 and PTTG1 levels found in patients with LNM than in those without.The areas under the ROC curve of GLI1 and PTTG1 in assessing LNM in patients with CRC were 0.824 and 0.811,respectively.CONCLUSION GLI1 and PTTG1 expression was upregulated in patients undergoing radical surgery for CRC and are significantly related to LNM in these patients.Moreover,high GLI1 and PTTG1 expression can indicate LNM in patients with CRC undergoing radical surgery.The expression of both genes has certain diagnostic and therapeutic significance.

Risk factors for residual tumor after resection of hepatocellular carcinoma

AIM:To identify the clinicopathological risk factors correlated with residual tumor in hepatocellular carcinoma (HCC) patients after resection. METHODS:From January 2001 to April 2007,766 HCC patients who had undergone resection were included in this research. Lipiodol angiography was performed within 2 mo after surgery and followed by post-Lipiodol computed tomography (CT) 4 wk later for all 766 patients to monitor tumor in the remnant liver. Tumor detected within the first 3-mo postoperative period was defined as residual tumor. Patients were divided into 2 groups:disease or disease-free within the first 3 mo after surgery. Risk factors for residual tumor were investigated among various clinicopathological variables. RESULTS:A total of 63 (8.22%) patients were found to have residual tumor after surgery. Three independent factors associated with residual tumor were identified by multivariate analysis:preoperative serum α-fetoprotein (AFP) level [odds ratio (OR) = 1.68 (95% confidence interval (CI):1.20-2.36)],tumor size [OR = 1.73 (95% CI:1.29-2.31)] and microvascular invasion [OR = 1.91 (95% CI:1.12-3.24)]. CONCLUSION:Residual tumor is related to AFP level,tumor size and microvascular invasion. Patients at high risk should undergo closer follow-up and could be candidates for multimodality therapy.

Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report

BACKGROUND Hepatic cystic echinococcosis(CE)is an infectious zoonotic parasitic disease,and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment.Hepatocellular carcinoma(HCC)is the fourth most common malignant tumor.Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized.We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about.CASE SUMMARY A 70-year-old man presented with upper abdominal pain.On admission,laboratory data showed that,except for hepatitis B surface antigen positivity,other indicators were normal,including alpha-fetoprotein.Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe,without reinforcement after enhanced scanning and sized about 16.9 cm×12.2 cm,which was considered a type II hydatid cyst.Multiple small solid lesions were also found adjacent to it,and thus it was highly suspected as a malignant tumor.After a multidisciplinary team discussion,the diagnosis of co-occurrence of hepatic CE and HCC was made.According to Romic classification,the case belongs to type IIb,and radical left hemi-hepatectomy was performed.Postoperative pathological examination revealed CE co-existence with welldifferentiated HCC,consistent with the preoperative diagnosis.CONCLUSION With the combination of hepatitis B and obvious extrusion by large hydatid,the HCC risk of a patient might be higher.

Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas

Multivisceral surgical resection for cure was successfully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma(HCC)associated with direct invasion to the stomach and pancreas.The patient presented with gastric outlet obstruction,upper abdominal pain and a history of chronic liver disease due to hepatitis B virus(HBV)infection.Upper gastro-intestinal(GI)endoscopy revealed an infiltrating tumor protruding through the gastric wall and obliterating the lumen.Computer tomograghy(CT)and magnetic resonance imaging(MRI)scan demonstrated a 15-cm tumor in the left lateral segment of the liver with invasion to the stomach and pancreas.Alpha-foetoprotein (AFP)levels and liver function tests were normal.The patient underwent an en bloc left hepatectomy,total gastrectomy,distal pancreatectomy with splenectomy and radical lymphadenectomy.Pathology revealed a poorly differentiated,giant cell HCC involving the stom-ach and pancreas.Disease-free margins of resection were achieved.The patient's postoperative course was uneventful.Sixteen months after surgery,he has norecurrence or distal metastasis.Direct invasion of HCC into the GI tract is rarely encountered.Complete surgical resection should be considered in selected patients with an appropriate hepatic functional reserve.

RISK FACTORS FOR RECURRENCE IN PATIENTS WITH HEPATOCELLULAR CARCINOMA AFTER RADICAL RESECTION

Three hundred and eight patients with hepatocellular carcinoma underwent radical resection during 1975- 1991.The 1-,2-, 3-,4-,5-,and 10-year recurrent rates were 12.7%,28.7%,41.2%, 47.5%,54.1% and 64.4% respectively.By the end of March 1992,recurrence had occurred in 134 patients.Risk factors for recurrence were analyzed.Cox univariate analysts identified the following five factors to be correlated with increasing risk: high γ-GT,discovery by clinical,macronodular cirrhosis,minor resection and portal vein embolus.However,only high γ-GT,macronodular cirrhosis,and minor resection have been proved significant risk factors for recurrence in Cox multivariate analysis.Larger hepatic resection might reduce recurrence,intra-andlor post-operation comprehensive treatments are adevocated.

Laparoscopic radical resection for situs inversus totalis with colonic splenic flexure carcinoma:A case report

BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions.Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT,and it is considered difficult even for an experienced surgeon because of the mirror positioning.We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma,and computed tomography showed that all the organs in the chest and abdomen were inverted.Laparoscopic hemicolectomy with complete mesocolic excision was safely performed.The operating surgeon stood on the patient’s left side,which is opposite of the normal location.CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas.Laparoscopic radical resection is difficult,but it is well established and safe.The surgeon should stand in the opposite position and perform backhand operations.

OVERVIEW FOR THE DIAGNOSIS AND TREATMENT OF GALLBLADDER CARCINOMA

Objective. To improve the recognition of diagnosis and treatment of gallbladder cancer. Methods. Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. Results. Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. Conclution.The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of gallbladder: (1) Age over 50 have recurrent cholecystitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder wall; (4) Polypoid lesion larger than 1cm inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement.

Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure

AIM:To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer. METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center, South Korea. Clinicopathologic data, including age, sex, operative findings, pathologic results, adjuvant therapy, postop-erative clinical course and follow-up data were retro-spectively collected and analyzed for this study. RESULTS:Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS. Nine patients (37.5%) underwent combined vessel resection, including 8 superior mesenteric-portal vein resections and 1 celiac axis resection. Two patients (8.3%) underwent combined resection of other organs, including the colon, stomach or duodenum. Negative tangential margins were achieved in 22 patients (91.7%). The mean tumor diameter for all patients was 4.09 ± 2.15 cm. The 2 patients with positive margins had a mean diameter of 7.25 cm. The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%. The median survival of the 24 patients was 18.23 ± 6.02 mo. Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P = 0.021). Nine patients (37.5%) had postoperative complications, but there were no postoperative mortalities. Pancreatic fistula occurred in 4 patients (16.7%):2 patients had a grade A fistula and 2 had a grade B fistula. On univariate analysis, histologic grade, positive tangential margin, pancreatic fistula and adjuvant therapy were significant prognostic factors for survival. CONCLUSION:RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.

D1 versus Modified D2 Gastrectomy for Ca Stomach—A Prospective and Comparative Study

Background: Carcinoma stomach remains a major malignancy and accounts for 10.4% of cancer related deaths globally. Despite improvement in chemo-radiotherapy, surgery remains the primary curative modality with special emphasis on lymphadenectomy. However the extent of lymphadenectomy performed by surgeons all over the world differs. Generally speaking, in Japan and Korea, the standard curative protocol would entail a “D2” lymphadenectomy whereas in the western world it would be considered unnecessary and the standard protocol would entail a standard “D1” lymphadenectomy. Thus prompting a newer surgical therapy of modified D2 in dissection in which pancreas and spleen are preserved. Lymph nodes surrounding stomach are divided into 20 stations and these are classified into three groups depending upon the location of the primary tumour. Aims & Objectives: The aims and objectives are to compare: 1) operative time of modified D2 gastrectomy with that of D1 gastrectomy;2) operative morbidity and mortality of modified D2 gastrectomy with that of D1 gastrectomy;3) the disease recurrence between modified D2 & D1 gastrectomy. Materials & Method: The study entitled D1 versus modified D2 gastrectomy for Ca stomach—a prospective, comparative study was conducted in the Postgraduate Department of General Surgery, Government Medical College, Srinagar as a prospective, comparative study over a period of three years 2012-2014. Patients with resectable gastric cancer were taken as subjects for the study and were divided in 2 groups that were closely matched to avoid any bias. Assessment of both the groups was done in identical fashion as per standard protocol. One group underwent gastrectomy with D1 lymph node dissection whereas the other group underwent gastrectomy with a modified D2 lymph node dissection (spleen and pancreas preservation). The type of lymphadenectomy was decided on randomization (simple random sampling). Results: After comparing the two procedures, it was noted that: 1) modified D2 lymphadenectomy took on an average 2 hours more than D1 gastrectomy;2) operative mortality was same in both the procedures. Operative morbidity was seen more in modified D2 group than D1 group however this difference was statistically insignificant;3) number of recurrence was quite significant in D1 group but no recurrence was seen in modified D2 group. Conclusion: On the basis of the study, we recommend that modified D2 gastrectomy is a better procedure than D1 gastrectomy for patients of carcinoma stomach undergoing curative resection.

优化护理理念在肾癌根治术患者围术期治疗中的应用及满意度分析

目的探究肾癌根治术患者围术期治疗中,采用优化护理理念的效果。方法随机选取2021年1月—2022年12月吉林省肿瘤医院接诊的100例肾癌根治术患者为研究对象,以随机数表法分为对照组(常规护理干预)和研究组(优化护理理念干预),每组50例,分析两组患者生活质量评分、疼痛评分、遵医行为、情绪评分和满意度。结果研究组患者生活质量评分高于对照组,差异有统计学意义(P<0.05)。研究组患者疼痛评分低于对照组,差异有统计学意义(P<0.05)。研究组患者遵医行为优于对照组,差异有统计学意义(P<0.05)。研究组患者情绪评分比对照组低,差异有统计学意义(P<0.05)。研究组的护理服务满意度(98.00%)高于对照组(86.00%),差异有统计学意义(χ^(2)=4.891,P<0.05)。结论以优化护理理念干预肾癌根治术患者的效果优异,能提高围术期治疗效果,减少不良并发症发生,提高患者生活质量,满意度等和缓解患者肢体疼痛。

直肠癌围手术期患者症状群的纵向研究

目的明确直肠癌根治术患者在围手术期所经历的症状群类型、组成及动态变化,为手术前后症状群的管理提供参考。方法采用便利抽样法,选取2023年2-7月新疆医科大学肿瘤医院胃肠外科的直肠癌根治术患者140例为研究对象,采用一般资料调查问卷、安德森症状评估量表+大肠癌模块,收集患者手术前(T1)、手术后1 d(T2)、手术后3 d(T3)、手术后7 d(T4)4个时间点进行纵向调查并通过探索性因子确定症状群。结果最后有121例患者完成调查。4个时间点症状发生率>20%的症状个数分别11、11、10和10。术前直肠癌患者存在消化道症状群、能量不足症状群以及情绪相关症状群;术后1 d、3 d、7 d存在消化道症状群、能量不足症状群、情绪相关症状群以及疲乏-疼痛-口干症状群,共4个症状群,这4个时间节点群内症状组成不同。结论直肠癌根治术患者在围手术期间存在稳定且动态变化的症状群,应密切关注症状变化,开展相应的症状群管理。

右美托咪定复合瑞芬太尼对食管癌根治术患者应激反应的影响

目的探讨右美托咪定复合瑞芬太尼对食管癌根治术患者应激反应的影响。方法选择2021年3月至2023年3月周口市中心医院接诊的行食管癌根治术的患者90例,随机均分为对照组和观察组2组,每组45例。对照组采取瑞芬太尼静脉麻醉,观察组采用右美托咪定复合瑞芬太尼静脉麻醉。比较2组患者麻醉相关指标、应激反应相关指标及不良反应发生情况。结果与对照组比较,观察组瑞芬太尼使用剂量减少,苏醒时间、拔管时间均缩短(t=35.240,P<0.001;t=11.810,P<0.001;t=10.340,P<0.001)。观察组患者术后3 d血清促肾上腺皮质激素、皮质醇水平均低于对照组(t=7.622,P<0.001;t=4.467,P<0.001)。观察组不良反应发生率低于对照组( χ^( 2)=4.406,P=0.036)。结论右美托咪定复合瑞芬太尼减少了食管癌根治术患者麻醉药物的剂量,减轻了应激反应,且安全性高,具有较高的临床推广价值。

右美托咪定联合七氟烷对食管癌根治术患者应激指标、认知功能及HMGB1水平的影响

目的探讨右美托咪定联合七氟烷对食管癌根治术患者应激指标、脑氧代谢指标、认知功能及高迁移率族蛋白B1(high mobility group protein B1,HMGB1)水平的影响。方法选取2020年1月至2022年12月周口市中心医院收治的124例食管癌患者,随机分为对照组及观察组各62例。观察组麻醉诱导前给予右美托咪定,对照组麻醉诱导后给予生理盐水,两组采用相同的麻醉诱导及麻醉维持方案。比较两组患者应激反应指标、脑氧代谢指标、术后认知功能障碍发生情况及外周血HMGB1含量。结果在T_(0)时两组皮质醇(Cor)、丙二醛(MDA)水平、脑氧摄取率(CERO_(2))及动脉—颈内静脉血氧含量差(Da-jvO_(2))无显著差异(P>0.05);T_(1)及T_(2)时观察组患者Cor及MDA水平、CERO_(2)及Da-jvO_(2)水平均显著低于对照组患者(P<0.05)。观察组术后认知功能障碍发生率(6.45%)与对照组(22.58%)相比显著降低(P<0.05)。观察组术后1 d及3 d外周血HMGB_(1)水平显著下降(P<0.05)。结论麻醉诱导前输注右美托咪定应用于食管癌根治术可缓解患者应激反应、调节脑氧代谢并降低术后认知功能障碍的发生率。

超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞在老年胸腔镜肺癌根治术中的应用效果

目的探讨超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞在老年胸腔镜肺癌根治术患者中的应用效果。方法选择2020年10月至2022年10月在河南理工大学第一附属医院行胸腔镜下肺癌根治术的肺癌患者119例为研究对象。将患者随机分为观察组(n=59)和对照组(n=60),观察组剔除3例,对照组剔除4例,2组最终各纳入56例患者。对照组患者采用超声引导下罗哌卡因竖脊肌平面阻滞麻醉,观察组患者采用超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞麻醉,2组患者麻醉前准备、麻醉诱导和麻醉维持相同,术后均使用静脉自控镇痛泵止痛。记录2组患者入室后(T_(1))、阻滞成功后(T_(2))、切皮时(T_(3))、手术结束(T_(4))的心率(HR)和平均动脉压(MAP),术后6、12、24、48 h行静息及活动状态下视觉模拟评分法(VAS)评分。比较2组患者术后48 h镇痛药物使用量和镇痛泵按压次数、谵妄和不良反应发生率。结果2组患者T_(2)、T_(3)时MAP、HR显著高于T_(1)和T_(4)时(P<0.05);2组患者T_(4)时与T_(1)时MAP、HR比较差异无统计学意义(P>0.05);2组患者T_(2)与T_(3)时MAP、HR比较差异无统计学意义(P>0.05)。2组患者T_(1)时MAP、HR比较差异无统计学意义(P>0.05);T_(2)、T_(3)、T_(4)时,观察组患者的MAP、HR显著低于对照组(P<0.05)。2组患者术后12、24、48 h时静息状态和活动状态下VAS评分均显著低于术后6 h(P<0.05);2组患者术后24、48 h时静息状态和活动状态下VAS评分均显著低于术后12 h(P<0.05);2组患者术后48 h时静息状态和活动状态下VAS评分均显著低于术后24 h(P<0.05)。术后6 h,2组患者静息状态和活动状态下VAS评分比较差异无统计学意义(P>0.05);术后12、24、48 h,观察组患者静息状态和活动状态下VAS评分均显著低于对照组(P<0.05)。观察组患者术后48 h镇痛药物使用量和镇痛泵按压次数显著少于对照组(P<0.05)。对照组和观察组患者术后48 h内总不良反应发生率分别为5.36%(3/56)、8.93%(5/56);2组患者总不良反应发生率比较差异无统计学意义(χ^(2)=0.135,P>0.05)。对照组和观察组患者术后48 h内谵妄发生率分别为14.29%(8/56)、3.57(2/56),观察组患者谵妄发生率显著低于对照组(χ^(2)=3.953,P<0.05)。结论老年胸腔镜肺癌根治术患者采用超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞,可维持围手术期血流动力学稳定、提高镇痛效果,且能减少镇痛药物使用量和镇痛泵按压次数,降低术后谵妄发生率。

PA-TACE的时机选择对肝细胞癌患者根治性切除术后近期预后的影响

目的探讨肝癌根治性切除术后辅助性肝动脉化疗栓塞(PA-TACE)治疗的时机选择对肝细胞癌(HCC)患者近期预后的影响。方法回顾性分析南京医科大学附属无锡人民医院2015年1月至2021年12月收治的103例肝癌根治性切除术后半年内接受TACE治疗的HCC患者的临床资料,根据术后接受TACE治疗的时间不同,分为观察组(n=53)和对照组(n=50)。观察组患者在术后4~8周接受TACE治疗,对照组患者在术后9~26周接受TACE治疗。肝癌根治性切除术后随访2年。对两组患者术后2年复发率、2年生存率进行比较,同时比较TACE治疗期间两组患者不良反应的发生率,以及术后2年两组患者在各项评估量表指标上的差异。结果与对照组相比,观察组患者肝癌根治性切除术后2年复发率较低[20.8%(11/53)vs 48.0%(24/50),χ^(2)=7.429,P=0.006],术后2年生存率较高[88.7%(47/53)vs 78.0%(39/50),χ^(2)=5.316,P=0.021],差异具有统计学意义(P<0.05);TACE治疗期间,两组患者不良反应的总发生率差异无统计学意义(χ^(2)=0.160,P>0.05);肝癌根治性切除术后2年,与对照组相比,观察组患者的PS评分、Child-Pugh评分、PS-SGA评分、FPS-R评分均较低,但差异均无统计学意义(P>0.05);观察组患者生活质量评分较对照组高,差异具有统计学意义(t=7.236,P<0.05)。结论HCC患者在肝癌根治性切除术后4~8周内接受PA-TACE治疗,能减少术后早期肿瘤复发率,提高生存率,提高患者手术后的生活质量。

老年食管癌患者术后反流性食管炎的影响因素

目的探讨老年食管癌患者术后发生反流性食管炎的影响因素。方法选取医院2018年7月至2021年5月收治的154例老年食管癌根治术患者为研究对象,根据是否并发反流性食管炎分组,采用单因素及logistic回归模型分析相关指标与老年食管癌根治术后发生反流性食管炎关系,并制定针对性干预措施。结果154例老年食管癌根治术患者有44例(28.57%)发生反流性食管炎。两组吸烟史、体重指数(BMI)、饮酒史、血糖水平、白蛋白水平、消化道重建方式、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分差异有统计学意义(P<0.05)。BMI、吸烟史、血糖水平、消化道重建方式、HAMA评分、HAMD评分是诱发反流性食管炎影响因素。结论老年食管癌根治术后反流性食管炎发生风险较高,主要与BMI、吸烟史、血糖水平、消化道重建方式、HAMA评分、HAMD评分有关,临床应重视具有上述风险因素患者的早期合理干预,以降低反流性食管炎发生风险,改善预后。