目的 研究乳腺癌根治术中保留乳头乳晕对术后疗效、上肢功能及外观满意度的影响。方法 选取我院2013年3月—2018年5月40例早期乳腺癌的患者为研究对象,按照数字表随机分组的方案分为观察组和对照组各20例。观察组患者采用保留乳头乳晕的乳腺癌根治术治疗;对照组患者采用传统的根治性手术。比较两组手术时间、术中出血量、术后引流量、术后下床时间、住院时间。比较两组患者术后上肢功能情况,采用上肢功能评定量表(disabilities of arm,shoulder and hand scale,DASH)评估。比较两组术后乳房外观满意度及两组患者术后并发症发生率。结果 观察组手术时间、术中出血量、术后引流量及平均住院时间均低于对照组,差异有统计学意义(P＜0.05)。观察组与对照组患者术后患侧上肢水肿及活动受限发生率相当,差异无统计学意义(P＞0.05)。观察组皮瓣缺血发生率为10.0%低于对照组40.0%,差异有统计学意义(P＜0.05)。观察组术后乳房外观优良率为90.0%,高于对照组优良率60.0%,差异有统计学意义(P＜0.05)。观察组患者术后并发症发生率15.0%低于对照组35.0%,差异有统计学意义(P＜0.05)。结论 保留乳头、乳晕的乳腺癌根治术具有手术效果好、与传统根治术相比,对上肢功能损伤较小、美容效果更好,患者满意度较高等优点,值得临床应用和推广。

目的 回顾分析我院胆石症患者个体化治疗方案的效果。方法 2006年8月—2015年1月,我院治疗不同类型胆石症患者3176例,其中胆囊结石2987例,其他类型胆管结石患者189例,定期复查B超等影像检查并最长随访9年,从并发症和术后主观症状、残石率和结石复发率等情况,了解治疗效果。结果 全组患者均手术成功, 大部分自觉症状明显好转,胆囊结石患者平均手术时间(35.7±14.5)分钟, 平均住院时间(3.5±2.5)天;胆管结石平均手术时间(70.3±31.5)分钟,平均住院时间(9.5±4.7)天。胆囊结石残留率0.1%,保胆术式结石复发率8.1%;胆管结石残留率3.7%和复发率5.5%。结论 胆石症患者病情繁杂多样,尤其是肝内胆管结石,治疗需要个体化。

Objective To retrospective analyze the effect of individualization treatment of calculus of cholelithiasis patients. Methods 3176 patients with different kind of cholelithiasis were treated in our hospital during Aug 2006 to Jan, 2015, including 2987 gallstone patients and 189 calculus of bile duct patients. Periodic review of B ultrasound and follow-up was taken after the surgery for 9 years, recording and analyzing intraoperative and postoperative complications, symptoms, residual stones and stone recurrence rate and other, and to evaluate the therapeutic effect. Results Surgeries of all the patients were performed successfully. Postoperative follow-up indicated that symptoms were relieved. The operative duration of gallstone patients was (35.7 ± 14.5) min, and the average hospitalization time was (3.5±2.5) days. The operative duration of calculus of bile duct patients was (70.3± 31.5) min, and the average hospitalization time was (9.5±4.7) days. And the calculus residual rate and recurrence rate of gallstone patients was 0.1% and 8.1% individually. The calculus residual rate and recurrence rate of calculus of bile duct patients was 3.7% and 5.5%. Conclusion Conditions of calculus of cholelithiasis patients are complicated, especially calculus of intrahepatic duct patient. It is necessary to take individual treatment schedule for them.