目的 探讨乳腺癌术后疼痛综合征（PMPS）的发生率及影响因素。方法 选择2021年1月—2023年2月医院收治的82例乳腺癌患者为研究对象,采取手术治疗,统计PMPS发生率,分析PMPS的特征,比较PMPS患者和非PMPS患者的临床资料,采用 Logistic 逐步回归分析。结果 82例中有20例患者术后发生PMPS,发生率为24.39%,其中患侧腋窝45.00%、麻木样疼痛35.00%、中度疼痛60.00%、术后即刻疼痛50.00%、每日发作疼痛50.00%占比较高。PMPS患者和非PMPS患者的体质指数、教育程度、病理分期、肿瘤占位、手术方式、术前使用非甾体抗炎药、术前化学治疗、术后化学治疗比较差异均无统计学意义（P>0.05）。PMPS患者年龄低于非PMPS患者,负性情绪率30.00%高于非PMPS患者8.06%,清扫腋窝淋巴结率95.00%高于非PMPS患者72.58%,术后放射治疗率30.00%高于非PMPS患者6.45%（P<0.05）。年龄、负性情绪、清扫腋窝淋巴结、术后放射疗为PMPS发生的危险因素（P<0.05）。结论 乳腺癌术后较容易发生PMPS,主要表现为术后即刻腋窝疼痛、麻木,发作频率较高,疼痛较重,其中年龄小、术前焦虑、清扫腋窝淋巴结、术后放疗为引发PMPS的危险因素,需加强监测和针对性处理,研究价值较高。

Objective To investigate the incidence and influencing factors of post-mastectomy pain syndrome（PMPS）in breast cancer patients．Methods A total of 82 patients with breast cancer admitted to our hospital from January 2021 to February 2023 were selected as the research objects,and underwent surgical treatment．The incidence of PMPS was counted,the characteristics of PMPS were analyzed,and the clinical data of PMPS patients and non-PMPS patients were compared．Results Among the 82 patients,20 patients had PMPS after surgery,with an incidence of 24.39%．Among them,the affected axilla accounted for 45.00%,numbness pain 35.00%,moderate pain 60.00%,immediate postoperative pain 50.00%,and daily pain 50.00%．There were no significant differences in body mass index,education level,pathological stage of disease,tumor location,surgical method,preoperative use of non-steroid anti-inflammatory drugs,preoperative chemotherapy and postoperative chemotherapy between PMPS patients and non-PMPS patients（P>0.05）．The age of PMPS patients was significantly higher than that of non-PMPS patients,the rate of negative emotion was 30.00%,the rate of axillary lymph node dissection was 95.00%,and the rate of postoperative radiotherapy was 30.00%,which was significantly higher than that of non-PMPS patients（P<0.05）．Age,negative emotion,axillary lymph node dissection and postoperative radiotherapy were independent risk factors for PMPS（P<0.05）．Conclusions PMPS is prone to occur after breast cancer surgery,mainly characterized by immediate postoperative axillary pain and numbness,with a high frequency and severe pain．Young age,preoperative anxiety,axillary lymph node dissection,and postoperative radiotherapy are independent risk factors for PMPS,which need to be strengthened monitoring and targeted treatment．

目的 探讨风险防范护理干预对颅内动脉瘤介入术后患者血管并发症的应用。方法 选取天津市人民医院2020年6月—2023年10月收治的80例颅内动脉瘤患者,应用随机数字表法将其分为观察组与对照组,各40例。所有患者均采取血管内介入栓塞术治疗,对照组患者实施常规护理,观察组患者在对照组基础上增加风险防范护理干预。对比两组患者干预前后负面情绪变化、术后并发症发生率、干预前后生活质量变化以及护理满意度。结果 干预后,两组焦虑、抑郁评分降低,观察组分别为（39.78±1.80）（44.73±3.78）分,低于对照组的（54.63±3.91）（49.23±4.14）分,对比差异有统计学意义（t=21.823、5.078,P<0.05）;观察组术后并发症发生率低于对照组（7.50% vs 27.50%,χ²=5.541,P=0.019）;干预后两组中文版明尼苏达心功能不全生命质量（MLHFQ）相关维度评分均升高,且观察组分别为（30.73±3.82]（21.13±2.70）（27.08±4.28）分,高于对照组的（26.20±3.50）（17.20±2.79）（23.20±2.35）分,对比差异有统计学意义（t=5.530、6.389、5.021,P<0.05）;观察组护理满意度高于对照组（92.50% vs 72.50%,χ²=5.541,P=0.019）。结论 颅内动脉瘤介入术后采取风险防范护理干预可改善患者焦虑、抑郁情绪,降低术后并发症,改善患者术后生活质量,患者护理满意度较高。

Objective To investigate the application effect of risk prevention nursing intervention on vascular complications in patients with intracranial aneurysms after interventional surgery．Methods Eighty patients with intracranial aneurysm admitted in Tianjin People’s Hospital from June 2020 to October 2023 were selected and divided into observation group and control group with 40 cases each．All the patients were treated with endovascular interventional embolization,the control group patients underwent routine care,and the observation group patients added risk prevention nursing intervention on the basis of the control group．The negative mood changes before and after the intervention,the incidence of postoperative complications,the quality of life before and after the intervention,and nursing satisfaction were compared between the two groups．Results After the intervention,the anxiety and depression scores in both groups decreased,and the observation group[（39.78±1.80）and （44.73±3.78）] scores were lower than the control group[（54.63±3.91）and（49.23±4.14）] scores,significantly（t=21.823,5.078,P<0.05）．The postoperative complication rate was significantly lower than the control group（7.50% vs 27.50%,χ²=5.541,P=0.019）．After the intervention,MLHFQ related dimension scores were increased in both groups,and the observation group（30.73±3.82,21.13±2.70 and 27.08±4.28）scores were higher than the control group（26.20±2.50,17.20±2.79 and 23.20±2.35）scores,statistically significant（t=5.530,6.389,5.021,P<0.05）．The nursing satisfaction was higher than the control group（92.50% vs 72.50%,χ²=5.541,P=0.019）．Conclusion sRisk prevention nursing intervention after intracranial aneurysm intervention can improve patient anxiety and depression,assist in reducing the incidence of postoperative complications,improve patient quality of life,and increase patient satisfaction with nursing．

目的 观察椎间孔镜下腰椎间盘突出症的近期疗效,分析不同年龄段对手术疗效的影响。方法 收集120例腰椎间盘突出患者,分成A、B、C三个研究小组:A青年组(年龄≤44岁)、B中年组(44岁<年龄<65岁)、C老年组(年龄≥65岁)。以术前、术后1天、术后3月、术后6月为界限,分析患者的疼痛视觉模拟量表(VAS)评分,并计算相对应的腰椎Oswestry功能障碍指数;术后1年用改良Macnab标准评价疗效优良率。结果 针对不同试验小组的VAS评分、ODI指数等进行对比分析:术后1天的对比差异不存在统计学意义(P>0.05);术后3个月、6个月比较差异有统计学意义(P<0.05),其中C组术后3月、6月VAS评分、ODI指数高于A、B组,差异有统计学意义(均P<0.05),A、B组间比较无统计学差异(P>0.05)。术后1年三组间疗效优良率比较无统计学差异(P>0.05)。结论 不同年龄段患者椎间孔镜的近期疗效显著,中青年患者恢复快,中期疗效好。

Objective To observe the short-term curative effect of transforaminal endoscopy for lumbar disc herniation, and to analyze the influence of different age on the curative effect. Methods 120 patients with lumbar disc herniation were collected, the study was divided into three groups: group A, group B and group C: group A (young adults, 44 years or older), group B (44 years or older) and group C (65 years or older). The visual analogue scale (Vas) scores of the patients were analyzed and the corresponding Oswestry index of the lumbar spine was calculated according to the preoperative, 1 day, 3 months and 6 months postoperatively. A modified Macnab was used to evaluate the rate of excellency and good results 1 year after operation. Results The Vas score and Odi index of different groups were compared. There was no statistically difference at 1 day after operation (P > 0.05). After 3 months and 6 months, there was statistically difference (P<0.05), among them, the VAS scores and Odi index of group C were higher than those of group B, the difference was statistically significant (P<0.05), there was no statistically difference between group A and group B (P > 0.05). There was no statistically difference between the three groups in the first year after operation (P > 0.05). Comparison of VAS score and ODI index among the three groups: there was no statistically difference at 1 day after operation (P>0.05); there was statistically difference at 3 months and 6 months after operation (P<0.05), among which VAS score and ODI index of group C were higher than those of group A and group B (all P<0.05), but there was no statistically difference between group A and group B (P>0.05). There was no statistically difference in the excellent and good rate among the three groups one year after operation (P>0.05). Conclusion The short-term curative effect of intervertebral foramina in patients of different ages is remarkable, the young and middle-aged patients recover quickly, and the medium-term curative effect is good.

目的 比较唑来膦酸对 PVP(椎体成形术)治疗OVCF(骨质疏松椎体压缩性骨折)术后再发骨折的影响。方法 收集2016年12月—2018年6月在我院骨科接受PVP治疗患者共70例,其中40人在术后接受了唑来膦酸治疗(观察组),30人在术后接受了安慰剂治疗(对照组),两组患者均给予维生素D和钙剂基础治疗。记录术后6个月、1年、2年腰椎骨密度;术后2年内伤椎及邻近椎体再发骨折情况。结果 观察组伤椎再发骨折率(1/40,2.5%)低于对照组(2/30,6.67%)(P＜0.05);观察组邻椎再发骨折率(2/40,5%)低于对照组(7/30,23.33%)(P＜0.05)。结论 唑来膦酸能较好地预防PVP术后再发骨折。

Objective To compare the effect of zoledronic acid on the treatment of osteoporotic vertebral compression fracture after percutaneous vertebroplasty PVP. Methods From December 2017 to June 2019, a total of 70 patients who received PVP in the hospital medical plastic surgery clinic, 40 patients were collected received zoledronic acid (group A) and 30 patients received placebo (group B) after operation. Both groups received basic treatment of vitamin D and calcium. The bone mineral densits (BMD) of lumbar vertebrae were recorded at 6 months, 1 year and 2 years after operation, and the recurrent fractures of injured vertebrae and adjacent vertebrae were recorded at 2 years after operation. Results The rate of recurrent fracture of vertebrae in group A (1/40, 2.5%) was lower than that in group B (2/30, 6.67%); the rate of recurrent fracture of adjacent vertebrae in group A (2/40, 5%) was grcartly lower than that in group B (7/30, 23.33%). Conclusion Zoledronic acid can prevent recurrent fracture after PVP.

目的 探究椎间孔镜下治疗腰椎间盘突出症切除黄韧带对腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度的影响。方法 选择120例腰椎间盘突出症患者,随机分为观察组与对照组各60例。观察组患者椎间孔镜术中切除部分黄韧带;对照组患者保留黄韧带。比较两组患者术后半年、1年及2年的腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度。结果 观察组术后半年、1年腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度与对照组比较(P＞0.05)。观察组术后2年与对照组比较(P＜0.05)。结论 椎间孔镜下治疗腰椎间盘突出症保留黄韧带术后腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度远期效果优于切除黄韧带。

Objective To explore the effects of ligamentum flavum resection on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space. Methods 120 patients with lumbar disc herniation were randomly divided into observation group and control group. In the observation group, part of the ligamentum flavum was excised by endoscope and in the control group, the ligamentum flavum was preserved. The lumbar lordosis angle, sacral inclination angle, lumbar curve index and intervertebral space height of the two groups were compared at 6 months, 1 year and 2 year after operation. Results At 6 months, 1 year after operation, the lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space in the observation group were compared with those in the control group(P＞0.05). 2 years after operation, the observation group was compared with the control group(P<0.05). Conclusion The long-term effect of ligamentum flavum preserving on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space is better than that of ligamentum flavum resection.

目的 探讨Reversine对人肝星状细胞系LX-2凋亡的影响。方法 设对照组和Reversine干预组,其中Reversine干预组分为7个浓度,分别为1,5,10,20,40,80,120 μg/mL,CCK-8法检测Reversine对LX-2增殖的影响,选取最佳浓度。将细胞重悬在加入5 μL FITC-Annexin V和5 μL PI,用流式细胞仪进行了凋亡率分析,免疫荧光检测凋亡蛋白bcl-2及caspase 3。结果 Reversine可促进LX-2细胞凋亡,随着Reversine浓度增加,LX-2的凋亡可呈剂量依赖关系,其中10 μg/mL为最佳浓度,LX-2细胞的bcl-2蛋白的表达显著下降而cleaved-caspase 3的表达显著上升。结论 Reversine可通过促进caspase-3蛋白活化、抑制bcl-2蛋白表达的方式诱导LX-2凋亡。

目的 构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型。方法 采用低浓度加量持续诱导法,诱导吉西他滨耐药乳腺癌细胞4T1耐药株,命名为4T1/Gem;CCK-8法测定4T1与4T1/Gem细胞的增殖抑制率,计算耐药指数; Western blot法检测细胞P-gp蛋白表达;B超引导下注射4T1/Gem细胞悬液诱导裸鼠肝脏成瘤;HE染色观察肿瘤组织病理情况,免疫组化法检测瘤组织ER、PR、HER2、Ki-67和P-gp蛋白的表达。结果 经过14个月的诱导成功建立4T1/Gem细胞株,可在含40 μg/mL的Gem培养液中稳定生长。4T1/Gem细胞耐药指数为4T1细胞的788.547倍。与亲代相比,4T1/Gem处于G1期和G2期的细胞增加,S期细胞减少;上调P-gp蛋白的表达。4T1/Gem细胞成功建立裸鼠乳腺癌肝转移模型,瘤组织中ER、PR、HER2蛋白阴性表达,Ki-67阳性10％和P-gp蛋白阳性表达。结论 成功构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型,为开发治疗乳腺癌肝转移化疗耐药的药物提供实验基础。

Objective To construct a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem) and establish a nude mouse model of breast cancer with hepatic metastatic. Methods A gemcitabine-resistant variant of the breast cancer 4T1 cell line was induced by gradually increasing the concentration of gemcitabine; this variant is referred to in this study as 4T1/Gem. The proliferation suppression rates of 4T1 and 4T1/Gem cells were determined by using the CCK-8 essay to evaluate the drug resistance indices of the cell lines. Western blot analysis was used to detect P-gp protein expression. Under ultrasonography, a 4T1/Gem cell suspension was injected into nude mice to induce liver tumors. H&E staining was used to observe tumor pathology, and immunohistochemistry was used to detect the expression of ER, PR, HER-2, Ki-67, and P-gp. Results After 14 months of induction, a 4T1/Gem cell line is established successfully. The cell line can grow stably in culture liquid containing 40 μg/ml gemcitabine. The drug resistance index of 4T1/Gem is 788.547. Compared with the 4T1 cell line, the 4T1/Gem cell line can upregulate P-gp protein expression and successfully establish a nude mouse model of breast cancer with hepatic metastatic. ER, PR, and HER-2 proteins exhibit negative expression in the tumor tissue. The positive expression of P-gp and 10% of Ki-67 proteins is also observed. Conclusion This study successfully constructs a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem)and establishes a nude mouse model of breast cancer with hepatic metastatic, thereby providing an experimental basis for developing and treating a drug-resistant variant of breast cancer.

目的 探讨胰腺神经鞘瘤的临床特点和诊治方法。方法 总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果 共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁(范围17～89岁),其中女性40例(56%)。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6.1 cm(1～20 cm)。肿瘤位于胰头部29例(40%)、胰体/尾部32例(44%),沟突部6例(8%)。肿瘤表现为实性肿物27例(38%)、囊性28例(39%)、囊实性10例(14%)。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例 (7%) 患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[(13.8±6.2)cm vs (5.6±4.1)cm,P=0.0004)]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论 胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。

Objective To analyze clinical presentation, diagnosis, treatment options, and outcome of pancreatic schwannoma. Methods A retrospective study of clinical data of a case in our hospital and 71 cases reported in literature with pancreatic schwannoma. Results 72 cases were analysed. The mean age was 54 years (range 17-89 years), with 56 % of patients being female. Mean tumor size was 6.1 cm (range 1-20 cm). Tumor location was the head (29 cases), body and tail (32 cases), and uncinate process (6 cases). 27 cases exhibited solid tumors and 28 cases exhibited cystic tumors. Treatment included pancreaticoduodenectomy (23 cases), distal pancreatectomy (15 cases), enucleation (16 cases). 5 cases (7%) were malignant schwannoma. Tumor size of malignant group was significant larger than benign group (13.8±6.2 cm vs 5.6±4.1 cm,P=0.0004). There was no local recurrence metastasis,or death at the follow-up after operation (range 3-65 months). Conclusion The clinical manifestations of pancreatic schwannoma are lack of specificity and preoperative diagnosis remains difficulty. The tumor size was significantly related to classification of malignant or benign. Pancreatic schwannoma has satisfactory prognosis with surgical treatment.

目的 探讨生理情况下高龄肝脏与低龄肝脏的区别,寻找可以区分高龄肝脏与低龄肝脏的指标。方法 取6周龄SD大鼠和9月龄以上退役SD大鼠各5只,采用超声弹性成像检测肝脏硬度、全自动生化检测仪检测血清学指标、H&E染色观察肝脏形态结构、Sirius Red染色及Masson染色检测胶原纤维的沉积、免疫组化SP法检测TGF-β1、p16^INK4a、SMP-30蛋白的表达。结果 高龄组和低龄组之间血清学指标、胶原纤维沉积及TGF-β蛋白、p16^INK4a蛋白的表达无差异;超声弹性成像检测低龄组Vs值为(1.21±0.09)m/s,高龄组为(1.32±0.05)m/s(P=0.033);SMP-30蛋白低龄组IOD值为138244.988±51286.257,高龄组为116240.170±35017.936(P=0.007)。结论 高龄大鼠与低龄大鼠肝脏的硬度及SMP-30蛋白的表达存在差异,随着年龄的增加肝脏硬度增大,SMP-30蛋白表达下降。肝脏硬度与SMP-30蛋白可作为区分高龄肝脏与低龄肝脏的指标。

Objective To investigate the differences between elderly and younger liver. Methods In accordance with the age of the SD rats into two groups: younger group (Group Y, 6 weeks, n=5) and elderly group (Group O, 40 weeks or more, n=5). Data were compared by using ultrasound elasticity imaging to detect liver stiffness, automatic biochemical detector to gauge serum indexes, H&E staining to observe the liver morphological structure, Sirius Red staining and Masson staining to assay the collagen fibers deposition, Immunohistochemistry to identify the expression of TGF-β₁, p16^INK4a and SMP-30 protein. Results Serum indexes, collagen deposition, TGF-β₁ and p16^INK4a protein expression were no statistically significant difference between two groups. The Vs value was (1.21±0.09) m/s in Group Y and (1.32±0.05) m/s in Group O (P=0.033). and the IOD value of SMP-30 protein between Group Y and Group O were 138244.988±51286.257 and 116240.170±35017.936 (P=0.007). Conclusion The degree of liver stiffnessnd and SMP-30 protein in elderly and younger liver are different.Increased the degree of liver stiffness and decreased the expression of SMP-30 protein in the elderly SD rats. Liver stiffness and SMP-30 protein could be used as indicators to distinguish between elderly and younger liver.

目的 动态观察乳腺癌患者辅助内分泌治疗5年后的血脂及肝功能水平的变化,探求辅助内分泌治疗与高脂血症及脂肪肝发病率的关系。方法 56例乳腺癌患者实行辅助内分泌治疗,术后随访5年动态抽血测定其总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)及谷草转氨酶(AST)、谷丙转氨酶(ALT)、直接胆红素(DBIL)、总胆红素(TBIL)等参数的变化,B超监测其肝脏变化。结果 经过2年内分泌治疗TG由(1.203±0.723)mmol/L上升至(1.701±1.271)mmol/L,5年内分泌治疗后TG降至(1.389±0.706)mmol/L。经过2年内分泌治疗LDL由(2.497±0.990)mmol/L上升至(2.950±0.984)mmol/L,5年内分泌治疗后LDL为(2.867±0.886)mmol/L。结论 辅助内分泌治疗2年会导致其TG和LDL的升高,5年随访仅发现LDL升高,辅助内分泌治疗会增加乳腺癌患者诱发心血管疾病的风险。