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慢传输型便秘的诊疗进展

Advances in diagnosis and treatment of slow transit constipation

:790-797
 
       作为胃肠道的常见疾病,慢传输型便秘近年来患病率逐年上升。关于该病的具体病因和病理机制目前仍未完全明确,部分患者保守治疗效果欠佳,症状难以彻底缓解。随着病程的延长,患者的生活质量受到显著影响。若长期治疗无效,还可能诱发胃肠道肿瘤、心脑血管疾病等疾病,进一步加重患者的经济与心理负担。在此背景下,外科手术为慢传输型便秘缓解症状提供了新的选择。多数就诊于外科门诊的患者已有数年的便秘病史,曾尝试口服泻药、开塞露刺激或灌肠等常规治疗,但效果均不理想,最终转向手术干预。目前的标准术式以全结肠切除或次全结肠切除为主。近年来,次全结肠切除联合盲乙状结肠吻合术的应用取得了良好疗效,而针对混合型便秘设计的金陵术式也展现出独特的优势。文章通过系统梳理近年来的相关文献,从病因学、发病机制、诊断方法、治疗现状及手术疗效等方面,对慢传输型便秘进行了全面阐述,旨在增进对该疾病的深入理解,从而为临床诊疗策略提供新的理论思路。
      As a prevalent gastrointestinal disorder,slow transit constipation(STC) has demonstrated a steadily increasing incidence in recent years.The precise etiology and underlying pathological mechanisms of STC remain incompletely elucidated,with conservative management often proving inadequate for achieving complete symptom resolution in a subset of patients.Chronic disease progression significantly compromises patients’ quality of life,and prolonged ineffective treatment may predispose individuals to serious complications including gastrointestinal neoplasms and cardiovascular disorders,thereby imposing substantial economic and psychological burdens.Within this clinical context,surgical intervention has emerged as a viable therapeutic alternative for refractory STC.The majority of surgical candidates typically present with a multi-year history of constipation refractory to conventional therapies such as oral laxatives,rectal stimulants,and enema administration.Current standard surgical approaches predominantly involve total or subtotal colectomy.Notably,subtotal colectomy with cecosigmoid anastomosis has demonstrated particularly favorable outcomes in recent clinical practice,while the Jinling procedure,a novel surgical technique specifically designed for mixed-type constipation,has shown distinctive therapeutic advantages.This comprehensive review systematically evaluates contemporary literature to provide an integrated perspective on STC,encompassing its etiological factors,pathogenic mechanisms,diagnostic modalities,current treatment paradigms,and surgical outcomes.Through this scholarly synthesis,we aim to deepen the clinical understanding of this condition and propose innovative theoretical frameworks to inform future therapeutic strategies.

论著

CT征象在预测亚实性肺腺癌结节侵袭风险中的价值

Value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules

:46-51
 
目的 探讨亚实性肺腺癌结节CT征象在预测侵袭风险中的价值。方法 选取经胸部CT检查发现并经病理证实为肺腺癌的亚实性结节共76个病灶,病灶分为侵袭前组与侵袭组2组,分析结节CT征象,行统计学分析,明确亚实性肺腺癌结节侵袭性的预测因素。结果 侵袭前组(包括原位腺癌、微浸润性腺癌)共31例;侵袭组[浸润性腺癌(IAC)]共45例。2组在最大平均直径、结节平均CT值、结节形状、分叶、毛刺、胸膜牵拉征、有无实性成分、肿瘤微血管CT成像征间比较差异有统计学意义(P<0.05),而在空泡征、空气支气管征方面比较差异无统计学意义(P>0.05)。结节最大直径预测浸润性腺癌侵袭性界值为13.63 mm,敏感度、特异度分别为68.9%、96.8%,AUC为0.885;平均CT值预测IAC侵袭性界值为-528 HU,敏感度、特异度分别为84.4%、83.9%,AUC为0.867。回归分析显示病灶最大平均直径(OR=2.015、P=0.01)可以作为浸润性肺腺癌结节的独立预测因子。结论 亚实性肺腺癌结节侵袭前组和侵袭组在最大直径、平均CT值、形状、分叶、毛刺、微血管征存在差异;结节的最大平均直径是IAC的独立预测因子。
Objective To investigate the value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules.Methods A total of 76 subsolid pulmonary adenocarcinoma nodules detected by chest CT and pathologically confirmed were selected,and the lesions were divided into pre-invasion group and invasion group.CT signs of nodules were analyzed and statistical analysis was performed to determine the predictive factors of invasion of subsolid pulmonary adenocarcinoma nodules.Results There were 31 cases in the pre-invasion group(including adenocarcinoma in situ and minimally invasive adenocarcinoma)and 45 cases ininvasion group[invasive adenocarcinoma(IAC)].There were significant differences in maximum mean diameter,mean CT value of nodule,nodule shape,lobule,burr,pleural stretch sign,solid component and microvascular CT imaging signs between the two groups(P<0.05),but there were no significant differences in vacuole sign and air bronchial sign between the two groups(P>0.05).The maximum diameter of nodules predicted the invasion boundary of invasive adenocarcinoma was 13.63 mm,the sensitivity and specificity were 68.9% and 96.8%,respectively,and the AUC was 0.885.The mean CT value predicted the invasive boundary of IAC was -528 HU,the sensitivity and specificity were 84.4% and 83.9%,respectively,and the AUC was 0.867.Regression analysis showed that the maximum mean lesion diameter(OR=2.015,P=0.01)was an independent predictor of infiltrating lung adenocarcinoma nodules.Conclusions There were differences in the maximum diameter,mean CT value,shape,lobed,burr and microvascular signs between the pre-invasion group and the invasion group.The maximum mean diameter of nodules was an independent predictor of IAC.
论著

不同起源神经母细胞瘤N-myc基因扩增情况研究

A Study of the status of N-myc amplification in neuroblastoma originating from different sites

:16-18
 
目的 了解不同类型神经母细胞瘤的生物学特性。方法 在本研究中,对新诊断神经母细胞瘤患者的生物学特点(N-myc基因扩增)与临床特点进行了比较。结果 共49例神经母细胞瘤,起源于腹膜后35例,其他14例。两个组呈现出不同的N-myc基因扩增情况(P<0.05)。结论 不同临床类型的神经母细胞瘤存在有不同的生物学特性发布情况。
Objective To investigate the biological characteristics of neuroblastomas originating from different sites. Methods Fluorescent in situ hybridization (FISH) was employed to detect the status of N-myc amplification in patients with newly diagnosed neuroblastoma originating from different sites from July 2011 to June 2013. Results A total of 49 cases of patients with newly diagnosed neuroblastoma were identified in the study, 35 cases of neuroblastoma originating from retroperitoneal site, 14 cases from other primary sites. There were significant differences in the N-myc amplification between the two groups(P<0.05). Conclusion Patients with neuroblastomas originating from extra-retroperitoneal sites might show a more favorable biological characteristics than from retroperitoneal site.
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