磁共振成像不同扫描方位及序列对肛瘘诊断的价值

<正>肛瘘(即肛管直肠瘘)是肛周软组织慢性炎性病变导致肛管直肠和肛周皮肤的异常沟通,是一种常见的直肠肛管疾病~[1]。好发于青壮年男性,初期是由于肛门腺体堵塞细菌大量繁殖,逐渐形成肛周脓肿,最终脓肿向外延伸破裂形成肛瘘~[2],复杂性肛瘘手术后复发率高达20%~40%,手术操作过程中隐匿性脓肿、遗漏瘘管为主要诱导复发因素。所以术前明确瘘管位置、走行、周围脓肿的情况很重要。目前,磁共振成像(MRI)是一种无创、方便、准确的诊断方法。

慢性鼻窦炎中医外治法研究概况

慢性鼻窦炎以鼻窦黏膜的慢性炎症为其主要特点,主要症状为鼻塞、黏性或黏脓性鼻涕,次要症状为嗅觉减退或丧失、头面部胀痛,症状持续12周及以上。根据有无鼻息肉,将其分为慢性鼻窦炎伴息肉和慢性鼻窦炎不伴息肉^([1-2])。症状严重、药物治疗效果不明显,手术后复发率高^([3]),常合并哮喘及慢性阻塞性肺疾病等下呼吸道疾病。

Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer

AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.RESULTSSixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.

肺肉瘤样癌免疫治疗的研究进展

肺肉瘤样癌(PSC)是一种罕见的含有肉瘤样成分或肉瘤样分化的低分化非小细胞肺癌(NSCLC),在所有肺部肿瘤中所占比例不足1%。PSC相较其他类型的NSCLC生物学行为更具侵袭性,极易转移,且早期手术后复发率较高。其对传统治疗模式耐药性更强,导致其预后较其他NSCLC更差。近年来,免疫治疗的广泛应用为PSC患者带来了长期生存的可能性。

我国腹膜后肿瘤外科治疗的新机遇

腹膜后肿瘤是指位于横膈以下和盆膈以上、脏层腹膜以后潜在间隙的肿瘤(除外腹膜后器官的肿瘤),发病率占全身各类肿瘤不足0.5%,但近年来其发病率明显上升,并呈年轻化趋势。腹膜后肿瘤病理类型约70种,良性、交界性及恶性类型繁多复杂,其中恶性腹膜后肉瘤(retroperitoneal sarcoma,RPS)约占80%。该类肿瘤位置深在、发病隐匿,常常在肿瘤巨大、侵犯或挤压周围脏器发生合并症时才被发现,对恶性者手术难以完全根治性切除,手术后复发率高,大多数对放疗、化疗又不敏感,成为当前肿瘤学领域全球共同面对的挑战。我国与西方国家对腹膜后肿瘤的重视均始于20世纪90年代,获得了突飞猛进的发展,当前我国外科界对该领域的研究现状仍不足,对其未来发展仍彷徨。本文重点从腹膜后肿瘤外科历史出发,对我国腹膜后肿瘤诊疗的未来发展做一讨论。