Life Time Attributable Cancer Risk Estimated Using Scanner Reported Dose Length Product during Chest Computed Tomography Imaging in Young Children

This study aims to estimate the lifetime attributable cancer risk (LAR) for pediatric chest computed tomography (CT) examinations in five age groups using recently published age and region-specific conversion coefficients multiplying the widely available scanner registered dose length products (DLP) displayed on the CT console and hence calculating the Effective Dose (ED). The ED is then multiplied by the International Commission on Radiological Protection (ICRP) published risk factor for LAR. The obtained LAR values are compared with the international literature. Factors that may affect the LAR value are reported and discussed. The study included one hundred twenty five chest CT examinations for both males and females aged from less than one year to fifteen years. The patients reported data are from one single medical institution and using two CT scanners from June 2022 to December 2023. The results of this study may serve as benchmark for institutional radiation dose reference levels and risk estimation.

The Role of Chest Computed Tomography in the Work-up of Patients with Cervical or Endometrial Cancer

Background and Objectives: To determine whether chest CT-scan in patients with cervical or endometrial cancer is of additional value for planning initial treatment and work-up. Methods: A retrospective analysis was performed of 465 patients diagnosed with cervical or endometrial cancer between January 2003 and December 2007. All patients who underwent a chest CT-scan before treatment were included for analysis. Results: Out of 465 patients 74 patients underwent a pre-treatment chest CT-scan (cervical cancer, n = 58, and endometrial cancer, n = 26). Abnormalities were detected in 53.4% (31/58) and 73.1% (19/26) of patients with cervical and endometrial cancer, respectively. The majority of abnormalities were presumed to be benign, yet work-up was adjusted in 28.6% (13/58 and 11/26), and therapy was adjusted in 17.6% (6/58, and 7/26) of patients with cervical and endometrial cancer. Pulmonary metastasis were observed in 10.3% (6/58) and 24.1% (7/26) of patients with cervical cancer, and endometrial cancer, respectively. Most patients with pulmonary metastasis presented with extended disease based on clinical examination. Conclusions: Chest CT scans in patients with cervical and endometrial cancer frequently demonstrate abnormalities that are most likely benign, yet work-up is adjusted in a substantial number of cases. Therefore, chest CT-scan is only recommended for those patients with a clinical suspicion of extended disease.

Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (-0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Prevalence of unsuspected thyroid nodules in adults on contrast enhanced 16-and 64-MDCT of the chest

AIM: To determine the prevalence of unsuspected thyroid nodules on contrast enhanced 16and 64-modified discrete cosine transform (MDCT) of the chest, in a population of adult outpatients imaged for indications other than thyroid disease. METHODS: This retrospective study involved review of intravascular contrast-enhanced MDCT scans of the chest from 3077 consecutive adult outpatients, to identify unsuspected thyroid nodules. Exclusion criteria included history of thyroid cancer, known thyroid nodules or thyroid disease and risk factors for thyroid cancer, as evidenced by their medical records. One of 9 radiologists recorded number of nodules, location and bidirectional measurement of largest nodule, as well as amount of thyroid visualized on the chest computed tomography (CT). Presence of nodule was correlated with age, gender, race and percentage of thyroid imaged. RESULTS: A total of 2510 (2510/3077 or 81.6%) study subjects were included in the data analysis; among them,one or more nodules were identified in 629 subjects (629/2510 or 25.1%), with 242 (242/629 or 38.5%) having multiple nodules. Patients with nodule(s) were significantly older than those without (64 ± 13 years vs 58 ± 14 years, P < 0.0001), and female gender was associated with presence of nodule(s) (373/1222 or 30.5% vs 256/1288 or 19.9%, P < 0.0001). Women were also more likely having multiple nodules (167/373 or 44.8%) compared to men (75/256 or 29.3%, P < 0.0001). The majority of nodules (427/629 or 67.9%) were less than 1 cm. CONCLUSION: This retrospective review revealed a prevalence of 25.1% for unsuspected thyroid nodules on contrast-enhanced chest CT.

Recurrent and Invasive Primary Squamous Cell Carcinoma of the Chest Wall: A Case Report

Squamous cell carcinoma is a type of skin cancer with abnormal proliferation of keratinocytes. Its incidence reaches approximately 20% of cases of non-melanoma skin cancer, which has increased in recent decades due to growth in life expectancy, increased sun exposure, the use of tanning beds and improved detection of this type of tumors. We present a patient who was diagnosed with a squamous cell skin carcinoma in the chest wall, treated initially with surgical resection. A few years recurred in the same place, so the patient received radiotherapy with poor response. Ultimately a new surgical approach was performed with a wide margin resection by a multidisciplinary surgical team. Multidisciplinary management in this type of procedure is important so that the long-term result is optimal for the patient.

Reirradiation of recurrent breast cancer with proton beam therapy:A case report and literature review

BACKGROUND Locoregional recurrence of breast cancer is challenging for clinicians,due to the various former treatments patients have undergone.However,treatment of the recurrence with systemic therapy and subsequent reirradiation of chest wall is accompanied by increased toxicities,particularly radiation-induced cardiovascular disease.Reirradiation by proton beam therapy(PBT)enables superior preservation of adjacent organs at risk as well as concurrent dose escalation for delivery to the gross tumor.This technology is expected to improve the overall outcome of recurrent breast cancer.CASE SUMMARY A 47-year-old female presented with an extensive locoregional recurrence at 10 yr after primary treatment of a luminal A breast cancer.Because of tumor progression despite having undergone bilateral ovarectomy and systemic therapy,the patient was treated with PBT BE total dose of 64.40 Gy to each gross tumor and 56.00 Gy to the upper mediastinal and retrosternal lymphatics including the entire sternum in 28 fractions.Follow-up computed tomography showed a partial remission,without evidence of newly emerging metastasis.At 19 mo after the PBT,the patient developed a radiation-induced pericardial disease and pleural effusions with clinical burden of dyspnea,which were successfully treated by drainage and corticosteroid.Cytological analysis of the puncture fluid showed no malignancy,and the subsequent computed tomography scan indicated stable disease as well as significantly decreased pericardial and pleural effusions.The patient remains free of progression to date.CONCLUSION PBT was a safe and effective method of reirradiation for locoregionally recurrent breast cancer in our patient.

探讨胸部低剂量CT在老年体检人群肺癌早期筛查中的应用价值

目的探究胸部低剂量CT在老年体检人群肺癌早期筛查中的应用价值。方法回顾性分析本院自2020年2月至2022年4月收治的248例老年肺癌患者的临床资料,全部患者均接受了胸部低剂量CT诊断,该组患者在实施病理学诊断后按照病理类型分为肺腺癌(n=221)及肺鳞癌(n=27),对比不同病理类型下肺癌患者的螺旋CT征象。结果该组患者实施胸部低剂量CT检查所显示的异常病变征象如下:胸膜病变82例(33.06%)、肺门肿块45例(18.15%)、空洞和空腔病变42例(16.94%)、肺内多发性结节22例(8.87%)、弥漫性肺间质性病变35例(14.11%)、孤立结节肿块影12例(4.84%)、气管狭窄和梗阻10例(4.03%)。实施胸部低剂量CT检查时,肺腺癌与肺鳞癌相比,毛刺/棘突、胸膜凹陷征、血管连接征所占比例较高,差异有统计学意义(P<0.05)。肺腺癌与肺鳞癌相比,分叶征、空泡/空洞征所占比例比较,差异无统计学意义(P>0.05)。低剂量胸部CT与常规剂量胸部CT比较CTDI、DLP、ED较低,差异有统计学意义(P<0.05)。常规剂量胸部CT与低剂量胸部CT比较主动脉弓上缘分层、支气管分叉层面、膈顶上缘层面的噪声值较低,差异有统计学意义(P<0.05)。结论采用胸部低剂量CT应用在老年体检人群中进行肺癌早期筛查时具有较好的应用价值,同时可发现不同病理类型肺癌在征象上存在明显的差异性,为疾病的诊断及治疗提供可靠依据,同时胸部低剂量CT与常规剂量胸部CT比较的辐射剂量更低,安全性有保障。

基于胸部薄层CT扫描的肺磨玻璃影病变“四分型法”在临床中的应用研究

目的探讨基于胸部薄层CT扫描(TSCT)的肺磨玻璃影(GGO)病变“四分型法”在临床中的应用价值。方法回顾性分析2020年1月至2022年12月于首都医科大学宣武医院接受胸腔镜手术治疗的1541例患者的临床资料,共包含肺GGO病变2005例次。采用“四分型法”对肺GGO病变进行分型:Ⅰ型,无空泡征和(或)细支气管征的纯GGO(p-GGO);Ⅱ型,有空泡征和(或)细支气管征的p-GGO;Ⅲ型,仅在肺窗可见实性成分的异质性磨玻璃影(h-GGO);Ⅳ型,在肺窗和纵隔窗均可见实性成分的部分实性磨玻璃影(ps-GGO)。分析肺GGO病变影像学特征[最大径、病变类型、发生部位、分型、肿瘤实性成分占比(CTR)等]与术后病理检查结果的关联性。结果1541例患者自发现肺GGO至接受手术治疗的时间为0.10~156.00个月,平均11.23个月,其间肺GGO病变变化不明显1255例次(62.59%),最大径增大536例次(26.73%),密度增高45例次(2.24%),最大径增大伴密度增高169例次(8.43%)。术前肺GGO最大径为(13.21±7.90)mm;主要为单发病变[1098例次(54.76%)];多分布于右肺上叶[757例次(37.76%)]。肺GGO类型:Ⅰ型248例次(12.37%),Ⅱ型682例次(34.01%),Ⅲ型862例次(42.99%),Ⅳ型213例次(10.62%)。CTR≤25%有950例次(47.38%),25%<CTR≤50%有616例次(30.72%)、50%<CTR≤75%有314例次(15.66%),CTR>75%有125例次(6.23%)。肺GGO病变中,良性病变186例次(9.28%),恶性病变1819例次(90.72%),其中包括腺体前驱病变744例次,浸润期病变1075例次。分析结果显示,肺GGO病变术后病理检查结果与GGO最大径、病变类型、发生部位、分型、CTR及随访变化情况均存在关联性(P<0.05)。对应分析结果显示,与肺GGO病变CTR相比,肺GGO病变分型散点与术后病理恶性变[不典型腺瘤样增生(AAH)、原位腺癌(AIS)、微浸润腺癌(MIA)、浸润期腺癌(IA)]散点在二维分布图中更为接近,提示基于“四分型法”的肺GGO影像学特征与术后病理恶性变有更好的对应关系。结论基于TSCT的肺GGO病变“四分型法”有助于临床医师更好地评估以GGO为主要影像学表现的早期肺癌的风险度。

胸壁补偿膜厚度及患者体型特征对乳腺癌调强放疗摆位误差和剂量学的影响

目的:探讨胸壁补偿膜厚度及患者体型特征对乳腺癌患者手术后接受调强放疗治疗的摆位误差及放疗剂量的影响。方法:采用前瞻性研究方法,选取2021年1月至2023年6月阜阳市肿瘤医院肿瘤放疗中心治疗的103例乳腺癌患者,对患者进行锥形束CT检查,分析患者的体质量指数(BMI)、肿瘤位置、胸围、患侧乳腺体积对其摆位误差的影响,分析不同厚度的补偿膜对患者靶区、肺部、心脏、脊髓的放射剂量的影响。结果:不同BMI、不同患侧分布的乳腺癌患者在左右方向上的摆位误差无统计学意义(P>0.05);胸围≥89.0 cm、患侧乳腺体积≥650 cm^(3)患者的左右方向摆位误差大于胸围<89.0 cm、患侧乳腺体积<650 cm^(3)患者(P<0.05)。不同患侧分布的乳腺癌患者在上下方向上的摆位误差无统计学意义(P>0.05);BMI≥23.1 kg/m^(2)、胸围≥89.0 cm、患侧乳腺体积≥650 cm^(3)患者的上下方向摆位误差大于BMI<23.1 kg/m^(2)、胸围<89.0 cm、患侧乳腺体积<650 cm^(3)患者(P<0.05);不同BMI水平、不同胸围、不同乳腺体积、不同患侧分布的乳腺癌患者在前后方向上的摆位误差无统计学意义(P>0.05)。左侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的放射治疗计划靶区(PTV)D_(95%)、PTV靶区D_(5%)、左侧肺部V_(20%)、心脏V_(30%)、心脏平均剂量(D_(mean))、脊髓最大剂量(D_(max))、机器跳数(MU)、均匀性指数(HI)测定值比较,差异无统计学意义(P>0.05);采用0.5 cm补偿膜患者的适形度指数(CI)值低于采用1.0 cm补偿膜的乳腺癌患者(P<0.05),右侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的PTV靶区D_(95%)、PTV靶区D_(5%)、右侧肺部V_(20%)、脊髓D_(max)、MU、CI、HI测定值比较,差异无统计学意义(P>0.05)。结论:对于乳腺癌调强放疗患者,BMI、胸围、患侧乳腺体积均与摆位误差有关,采用0.5 cm和采用1.0 cm胸壁补偿膜均可以用于术后放疗,对放疗剂量和加速器跳数影响不大。

胸部低剂量螺旋CT联合肺癌自身抗体在肺癌早期筛查中的价值

目的评估胸部低剂量螺旋CT与7种自身抗体联合应用在肺癌早期筛查中的价值。方法本研究纳入2021年6月至2023年6月于河南省肿瘤医院健康管理中心体检的152例疑似肺癌患者,所有研究对象接受胸部低剂量螺旋CT检查,其中147例接受肺癌7种自身抗体检测。以病理检查结果为金标准,分析胸部低剂量螺旋CT、肺癌自身抗体检测单独及联合筛查的灵敏度、特异度,及3种筛查方式对肺癌的早期筛查价值。结果根据病理诊断结果,152例疑似肺癌患者中确诊肺癌138例,肺部良性病变14例。胸部低剂量螺旋CT单独用于肺癌早期筛查具有较高的灵敏度(0.919)和特异度(0.862),但准确率(0.783)和阴性预测值(0.194)相对较低。而肺癌自身抗体单独筛查的灵敏度范围为0.639~0.848,特异度范围为0.638~0.836,准确率范围为0.609~0.801,阳性预测值范围为0.162~0.434,阴性预测值范围为0.101~0.126。将胸部低剂量螺旋CT与肺癌自身抗体联合应用后,灵敏度为0.923,特异度为0.882,准确率为0.901,阳性预测值为0.984,阴性预测值为0.483,均高于单独筛查。结论联合应用胸部低剂量螺旋CT和肺癌自身抗体在肺癌早期筛查中表现出更高的诊断性能,特别是在提高灵敏度、特异度和准确率方面明显优于单独应用。

人工智能辅助胸部低剂量CT在肺部结节良、恶性诊断中的准确率研究

目的探讨人工智能辅助胸部低剂量CT在肺部结节良、恶性诊断中的应用。方法选取2020年3月至2021年7月在新乡同盟医院行胸部低剂量CT检查患者83例,根据阅片方式不同分为人工阅片组和人工智能辅助阅片组,观察两组肺部结节的诊断结果。结果人工智能辅助阅片诊断肺部结节的阳性率为86.75%,高于人工阅片的阳性率68.67%,差异具有统计学意义(x2=6.549,P=0.013);Kappa检验两种阅片方式的一致性较弱(Kappa值=0.196),P>0.05;人工智能辅助阅片对3~7mm直径肺部结节的检出率为93.44%,明显高于人工阅片的检出率85.25%,差异具有统计学意义(P<0.05),而两种阅片方式对0~3mm、7~20mm直径肺部结节的检出率差异无统计学意义(P>0.05);以病理结果为“金标准”绘制ROC曲线,结果显示,人工阅片、人工智能辅助阅片诊断恶性肺部结节的AUC分别为0.742(95%CI:0.514,0.921)、0.830(95%CI:0.701,1.00),且两种阅片方式的特异度、灵敏度、阳性预测值、阴性预测值差异均无统计学意义(P>0.05)。结论人工智能辅助胸部低剂量CT能提高肺部结节良、恶性诊断的准确率,并能提高3~7mm直径肺部结节的检出率,但与人工阅片对肺部结节诊断的特异度、灵敏度、阳性预测值、阴性预测值基本一致。

高分辨率胸部CT在肺炎型肺癌诊断中的应用价值

目的:探究高分辨率胸部CT在肺炎型肺癌诊断中的应用价值。方法:选择甘肃省第二人民医院放射影像科2022年1—12月收治的60例患者为研究对象,以病理检验结果为金标准,进行高分辨率胸部CT检查,对检查结果进行分析。结果:60例患者病理检查结果显示肺炎型肺癌35例,大叶性肺炎25例,分别占比58.33%,41.67%。高分辨率胸部CT检查肺炎型肺癌34例,大叶性肺炎24例,诊断符合率96.67%(58/60)。肺炎型肺癌单纯肺叶、段实变及肺叶肺段实变、单纯磨玻璃密度影、伴实性成分的混合磨玻璃结节、混合阴影检出率高于大叶性肺炎(P<0.05)。肺炎型肺癌局限性分布,边缘清晰性低于大叶性肺炎,弥散性分布,边缘模糊性高于大叶性肺炎,肺炎型肺癌瘤体检出率高于大叶性肺炎(P<0.05)。两组病灶容度、强化特征、血管集束征检出率比较,差异无统计学意义(P>0.05)。肺炎型肺癌患者空泡征、枯枝征、支气管充气征、蜂窝征、胸腔积液检出率高于大叶性肺炎(P<0.05)。结论:肺炎型肺癌与大叶性肺炎在疾病鉴别诊断过程中利用高分辨率胸部CT检查,能够通过科学的影像学特征对疾病实施鉴别,为患者临床疾病治疗方案的制定提供依据。

非小细胞肺癌病人竖脊肌面积与肺功能之间的相关性

目的:探讨非小细胞肺癌(NSCLC)病人竖脊肌横截面积与肺功能之间的相关性。方法:回顾性分析NSCLC病人92例临床资料,所有病人术前均进行肺功能测定和胸部CT检查,收集病人肺功能各项指标及相关临床信息,在病人术前胸部CT图像上,识别并手动勾画竖脊肌的肌肉轮廓,记录竖脊肌横截面积数值。结果:不同病灶直径的NSCLC病人肺功能指标间差异均无统计学意义(P>0.05)。NSCLC病人竖脊肌横截面积与年龄呈明显负相关关系(P<0.01),与身高和体质量均呈明显正相关关系(P<0.01);且竖脊肌横截面积与肺功能指标中第一秒用力呼气量、用力肺活量、呼气峰值流量、剩余肺活量75%时呼气流速均呈明显正相关关系(P<0.01),而与剩余肺活量50%时呼气流速和剩余肺活量25%时呼气流速均无明显相关关系(P>0.05)。结论:NSCLC病人竖脊肌横截面积与肺功能间存在相关性。

乳腺癌术后调强放疗患者体质情况与摆位误差的关系研究

目的探讨乳腺癌术后调强放疗患者体质量指数(BMI)、胸围、乳腺体积与摆位误差的关系。方法选取2019年1月至2022年10月在南通市第三人民医院接受调强放疗的乳腺癌患者63例,比较不同BMI、胸围、乳腺体积等患者摆位误差差异。结果63例乳腺癌患者中,左右方向(X轴)摆位误差为(2.61±0.72)mm,头脚方向(Y轴)摆位误差为(2.84±0.80)mm,前后方向(Z轴)摆位误差为(2.89±0.78)mm。随着BMI增加,X轴、Y轴和Z轴摆位误差逐渐增加(P<0.05),其中BMI≥24.0 kg/m^(2)患者X轴、Y轴和Z轴摆位误差分别为(3.13±0.53)mm、(3.60±0.63)mm和(3.88±0.66)mm,明显高于BMI<18.5 kg/m^(2)和18.5~23.9 kg/m^(2)患者(P<0.05)。胸围≥89 cm患者X轴和Y轴摆位误差分别为(2.84±0.52)mm和(3.07±0.56)mm,明显高于胸围<89 cm患者。随着乳腺体积增加,X轴摆位误差逐渐增加(P<0.05),其中乳腺体积>800 cm^(3)患者X轴摆位误差为(3.16±0.68)mm,明显高于乳腺体积<500 cm^(3)和500~800 cm^(3)患者(P<0.05)。不同年龄患者X轴、Y轴和Z轴摆位误差比较差异无统计学意义(P>0.05)。结论乳腺癌术后调强放疗摆位误差受患者BMI、胸围及乳腺体积的影响,与患者年龄无明显关系。

胸部X线与多层螺旋CT单独及联合检查对中央型肺癌的诊断价值

目的 探讨胸部X线与多层螺旋CT单独及联合检查对中央型肺癌的诊断价值。方法 135例疑似中央型肺癌患者均行胸部X线及多层螺旋CT检查,以病理检查结果为金标准,比较胸部X线和多层螺旋CT单独及联合检查诊断中央型肺癌的结果与病理检查结果的一致性以及对中央型肺癌的诊断价值,比较胸部X线和多层螺旋CT检查诊断中央型肺癌TNM分期结果与病理分期的符合率,比较不同病理类型中央型肺癌患者多层螺旋CT检查的图像特征。结果 病理检查结果显示,135例疑似中央型肺癌患者中,阳性96例,阴性39例。胸部X线和多层螺旋CT联合检查(Kappa=0.563)诊断中央型肺癌的结果与病理检查结果的一致性高于二者单独检查(Kappa=0.491、0.558)。胸部X线和多层螺旋CT联合检查诊断中央型肺癌的准确度、灵敏度、特异度、阳性预测值及阴性预测值均高于二者单独检查。以病理检查结果为金标准,多层螺旋CT和胸部X线检查诊断中央型肺癌Ⅰ、Ⅱ、Ⅲ期的符合率比较,差异均无统计学意义(P﹥0.05)。结论 胸部X线和多层螺旋CT联合检查对中央型肺癌患者的诊断价值较高。多层螺旋CT检查能区分和鉴别不同病理类型的中央型肺癌。

信息-动机-行为技巧理念的干预措施对肺癌患者心理状态及睡眠质量的影响

目的:探讨信息-动机-行为技巧理念的干预对肺癌患者心理状态及睡眠质量的影响。方法:选取2024年4月至2024年7月福建省肿瘤医院收治的肺癌患者50例作为研究对象,按照随机数字表法分为对照组和观察组,每组25例。对照组采用常规临床干预措施,观察组在对照组的基础上,给予患者信息-动机-行为技巧的干预,观察2组患者的心理状态、睡眠质量以及临床症状的缓解情况。结果:1)干预后,观察组患者的心理焦虑程度减轻、睡眠质量改善较对照组明显,差异有统计学意义(P<0.05);2)干预后,2组患者出现临床症状的占比比较,差异无统计学意义(P>0.05),但观察组数据稍低。结论:信息-动机-行为技巧理念能够有效改善患者的心理状态,减轻患者的焦虑情绪及紧张心理,缓解临床症状,保证患者的睡眠质量。

品管圈活动在提高ICU胸部肿瘤患者术后有效咳痰中的应用

目的:探讨品管圈活动在提高胸部肿瘤术后入住重症监护室(ICU)患者有效咳痰中的应用价值。方法:我院ICU于2014年2月14日成立品管圈小组,以提高胸部肿瘤术后患者有效咳痰为活动主题,根据病区现状进行调查及随访,总结分析影响咳痰的原因;通过PDCA循环法探讨质量改进方法有效性,对比分析改进措施实施前后患者有效咳痰情况。结果:患者有效咳痰的原因有切口疼痛、痰液黏稠不易咳出、未掌握有效咳嗽咳痰方法、护士宣教不到位四个方面;通过实施品管圈活动后,患者咳痰有效率提高了19.37%,明显优于实施前(P<0.05)。结论:实施品管圈活动可促进胸部肿瘤患者术后有效咳嗽、咳痰,促进患者康复。

腋下微创小切口治疗58例胸部肿瘤的临床应用

目的探讨腋下微创小切口术治疗胸部肿瘤的手术方法以及应用价值。方法利用腋下微创小切口术治疗58例胸部肿瘤患者,其中肺癌32例,肺部良性肿瘤11例,食管癌9例,纵隔肿瘤6例。结果所有患者手术无死亡病例。平均手术时间为3.5 h;清除淋巴结6.5枚/例;开胸时间平均6.8 min;关胸平均17.4 min;胸腔引流管平均放置时间3.75 d;术后平均住院时间为8.32 d。术后疼痛分级:1级56例,2级1例,3级1例。3例患者出现术后并发症,经治疗后全部治愈。结论腋下微创小切口术治疗胸部肿瘤损伤小,术后恢复快,疼痛程度轻,可作为临床治疗胸部肿瘤的方法推广使用。

电视胸腔镜辅助行小切口手术治疗胸部肿瘤疗效分析

目的探讨电视胸腔镜辅助下行小切口手术(VAMT)治疗胸部肿瘤的有效性。方法回顾分析我院2009年至2011年间行电视胸腔镜辅助小切口手术的52例患者(VAMT组)和常规开胸手术48例患者(常规组)的临床资料。比较两组的手术时间、术中出血量、淋巴结的清扫数量、术后引流量、住院时间以及并发症发生率,同时分析两组术前12 h和术后6 h、12 h和24 h的血清C反应蛋白(CRP)以及白细胞介素6(IL-6)和白细胞介素8(IL-8)的浓度变化。结果 VAMT组手术时间、术中出血量、术后引流量、住院时间以及并发症发生率等指标均低于常规组,差异具有统计学意义(P<0.05)。VAMT组和常规组的淋巴结清扫数量比较无差异,无统计学意义(P>0.05)。VAMT组和常规组患者在术后6 h、12 h和24 h血清中CRP、IL-6和IL-8浓度均显著性高于术前12 h,差异具有统计学意义(P<0.05)。与常规组比较,VAMT组术后6 h、12 h和24 h血清中CRP、IL-6和IL-8浓度明显降低(P<0.05)。结论 VAMT治疗胸部肿瘤术后急性炎症程度较轻,且安全可靠,值得临床推广使用。

胸部CT平扫联合灌注成像在中央型肺癌患者肺部病变形态观察及早期诊断中的应用价值

目的:探讨胸部CT平扫联合灌注成像在中央型肺癌患者肺部病变形态观察及早期诊断中的应用价值。方法:对笔者所在医院80例确诊的肺癌患者于放疗前及放疗后进行胸部CT平扫联合灌注扫描,测量相应参数值比较肺癌治疗前后的灌注参数变化及肺癌胸部CT表现。结果:放疗后两组患者BF和BV值比较差异有统计学意义(P<0.05),放疗后两组患者PS值比较差异有统计学意义(P<0.05)。结论:胸部CT平扫联合灌注成像对中央型肺癌患者肺部病变的形态变化具有很好的诊断价值和临床意义,有利于早期的诊断和分型。