目的 总结一种新的技术在心脏术后纵隔感染的应用经验。方法 回顾性分析2017年2月—2019年6月15日心脏术后发生纵膈感染成人患者,共有5例(1.2%),其中男性4例,女性1例,平均年龄(49±19)岁,平均体质量(70±15)kg,2例为急性A型主动脉夹层,2例为冠心病,1例为感染性心内膜炎合并白塞氏病,患者确诊后出现创面感染重、分泌物多,行VSD(负压封闭引流)进行过渡治疗,待创面清洁、肉芽新鲜后入手术室行清创术,术中4例采用SternaLock胸骨固定系统进行固定,1例因未累及至胸骨后,仅在胸骨前方行清创缝合。结果 4例完全治愈并顺利出院,1例因出现多器官功能衰竭死亡,但伤口愈合良好。结论 通过VSD引流增加了胸骨血流,加速肉芽组织形成,防止感染进一步加重,稳定胸骨,为进一步清创创造了良好的基础,同时运用SternaLock^®胸骨固定系统(8孔型钛板及2.4 mm自钻锁螺钉)进行固定,明显增加了胸骨的稳定性,进一步改善患者预后。

Objective To summarize the application experience of a new technique in mediastinal infection after cardiac operation. Methods A retrospective analysis of adult patients with mediastinal infection after cardiac surgery from February 2017 to June 15, 2019 were taken including a total of 5 cases (1.2%), of which 4 were male and 1 was female, with an average age (49±19) years old, average weight (70±15) kg;2 cases had acute type A aortic dissection, 2 cases had coronary heart disease, 1 case had infective endocarditis with Behcet's disease. After diagnosed, the patients developed severe wound infection and excessive secretion. VSD (vacuum sealing drainage) was performed for transitional treatment. After the wounds were cleaned and the granulation were still fresh, the wounds were for debridement in the operating room. During the operation, 4 cases were fixed with the SternaLock^® plating system, and 1 case was only treated with debridement and suture in front of the sternum because it did not involve the sternum. Results Four cases were cured and discharged smoothly, and 1 case died due to multiple organ failure, but the wound healed well. Conclusion The VSD increased sternum blood flow, which accelerated the granulation tissue formation, further to prevent infection and stable sternum, create a good foundation for further debridement, meanwhile the SternaLock ^® plating system(consists of eight pass since the titanium plate and 2.4 mm drill lock screw) was used for fixation, which significantly increased the stability of the sternum, further improved the prognosis of patients.

目的 分析芳香化酶(CYP19)基因多态性与子宫内膜异位症(endometriosis,EMs)术后复发的关系。方法 回顾性分析2019年2月—2020年2月于我院接受手术的110例EMs患者临床资料,按照术后12个月是否复发分为未复发组(62例)、复发组(48例),通过聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术测定两组CYP19基因115T/C、240A/G、1531C/T位点的单核苷酸多态性(single nucletide polymorphism,SNP),并分析不同位点对应VAS评分、r-AFS评分的差异。结果 复发组CYP19基因115T/C、1531C/T位点不同基因型及等位基因频率与未复发组相比,差异均无统计学意义(P＞0.05);复发组CYP19基因240A/G位点AG基因型频率比未复发组高(P＜0.05),AA基因型频率比未复发组低(P＜0.05);两组240A/G位点等位基因频率相比,差异有统计学意义(P＜0.05);CYP19基因240A/G位点AG 型VAS评分、r-AFS评分＞GG型＞AA型,差异有统计学意义(P＜0.05);CYP19基因115T/C、1531C/T位点不同基因型的VAS评分、r-AFS评分相比,差异均无统计学意义(P＞0.05)。结论 CYP19基因240A/G位点多态性与EMs术后复发、疼痛程度及病情密切相关,且携带G等位基因的基因型(AG+GG)可能是术后复发的风险因素。

Objective To analyze the relationship between aromatase (CYP19) gene polymorphism and recurrence of endometriosis (EMs) after surgery. Methods The clinical data of 110 patients with EMs who underwent the operation in our hospital from February 2019 to February 2020 were analyzed retrospectively. The patients were divided into non-relapsing group (62 cases) and relapsing group (48 cases) by 12 months followed-up outcomes. The single nucleotide polymorphism (SNP) of 115T/C, 240A/G and 1531C/T sites of CYP19 gene were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and the differences of VAS and r-AFS scores between the two groups were analyzed. Results The genotypes and allele frequencies of 115T/C and 1531C/T of CYP19 gene in relapsing group were not significantly different from those in non-relapsing group (P>0.05). The AG genotype frequency of 240A/G site of CYP19 gene in relapsing group was higher than that in non-relapsing group (P<0.05), while the AA genotype frequency was significantly lower than that in non-relapsing group (P<0.05). There were significant differences in the allele frequencies of 240A/G site (P<0.05). The scores of VAS and r-AFS of AG＞GG＞AA, with significant differences (P<0.05). There were no significant differences in the VAS and r-AFS scores of CYP19 gene at 115T/C and 1531C/T site (P>0.05). Conclusion The 240A/G polymorphism of the CYP19 gene is closely related to postoperative recurrence, pain degree and condition of EMs, and the genotypes carrying the G allele (AG+GG) may be the risk factor of postoperative recurrence.

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 探讨分析30岁及以下青年乳腺癌患者术后首次复发转移特点,以期指导术后随访,早期发现转移病灶。方法 回顾性分析2003年1月—2018年8月在梅州市人民医院收治的年龄≤30岁乳腺癌患者73例,所有患者均行根治性手术治疗,分析临床病理特点及术后首次复发转移特点。结果 共纳入23例三阴性(31.5%)、20例luminal B(HER2-)型(27.4%)、12例HER-2阳性型(16.4%)、10例 Luminal B(HER2+)型(13.7%)、4例Luminal A型(5.5%)和4例分型不明(5.5%)。中位随访28.4个月,7例三阴性(7/23, 30.4%)、 6例HER-2阳性型(6/12, 50.0%)、 4例Luminal B(HER2-)型(4/20, 20.0%) 和3例 Luminal B(HER2+)型(3/10, 30.0%)出现复发转移。复发转移患者中,90.0%合并远处转移,75.0%合并内脏转移,其中HER-2阳性型均合并内脏转移;92.3%(12/13)激素受体阴性患者复发转移发生在术后2年内。三阴性患者最常见远处转移部位是远处淋巴结,HER-2阳性型患者最常见远处转移部位是肝,luminal B(HER2+)型患者最常见远处转移部位是肺和骨,luminal B(HER2-)型患者最常见远处转移部位是肺和远处淋巴结。结论 ≤30岁青年乳腺癌患者术后首次复发转移多合并远处转移,激素受体阴性患者容易早期复发,不同分子分型患者具有不同的好发远处转移部位。

Objective We retrospectively investigated the first recurrent pattern after radical surgery in breast cancer patients aged ≤30 years, so as to guide postoperative follow-up and early detection of recurrent lesions. Methods A total of 73 consecutive early breast cancer patients aged ≤30years admitted to Meizhou People's Hospital from January 2003 to August 2018 were included. Retrospective analysis was conducted to analyze the clinicpathologic characteristics and characteristics of first recurrent pattern. Results 23 triple negative(31.5%), 20 Luminal B(27.4%), 12 HER2 enriched (16.4%), 10 Luminal/HER2+(13.7%), 4 Luminal A(5.5%) and 4 undifined subtypes(5.5%) were included. After a median follow-up of 28.4 months, 20 patients relapsed, which included 7 triple-negative(7/23, 30.4%), 6 HER2-enriched (6/12, 50.0%), 4 luminal B(4/20, 20.0%) and 3 luminal/HER2+(3/10, 30.0%) subtypes. 90.0% of patients combined with distant metastasis. 75.0% of patients had visceral metastasis, which included all the recurrent HER-2 enriched patients. 92.3% of hormone receptor negative(HR-) patients had a RFS less than 2 years. The most common metastatic sites in triple-negative, HER-2-enriched, luminal/HER2+ and luminal B subtypes were distant nodes, liver, lung and bone, distant nodes and lung, respectively. Conclusion The first recurrent pattern mainly presented as distant metastasis in breast cancer patients aged≤30 years, with early relapse in patients with HR- diseases. Different molecular subtypes of breast cancer favor different distant metastatic sites.

目的 回顾分析我医院近8年混合痔行Milligan-Morgan术式治疗的患者的临床病历资料,探索术后出现胃肠道症状的危险因素。方法 选取我医院2012年1月—2019年6年期间行Milligan-Morgan术式治疗的混合痔患者1 221例,分成术后胃肠道症状组和未出现胃肠道症状组,比较两组间的差异,分析其相关危险因素。结果 1 221例混合痔患者中出现胃肠道症状的为168例,发生率为13.8%(168/1 221);单因素分析结果显示,高血压、全麻麻醉方式是术后出现胃肠道症状的相关因素,差异有统计学意义;多因素Logistic回归分析结果显示,高血压、全麻麻醉方式是术后出现胃肠道症状的独立危险因素。结论 混合痔患者行Milligan-Morgan术式治疗出现胃肠道症状率较高;围手术期控制患者血压,以及慎重选择全麻麻醉方式可能有效减少胃肠道症状发生率。

Objective To explored the risk factors of gastrointestinal symptoms after operation by retrospectively analyzing the clinical records of patients with mixed hemorrhoids treated by Milligan-Morgan operation in our hospital in recent 8 years. Methods 1 221 patients with mixed hemorrhoids treated by Milligan-Morgan operation in our hospital from January 2012 to June 2016 were divided into two groups: the group with digestive tract symptoms after operation and the group without digestive tract symptoms. The differences between the two groups were compared and the related risk factors were analyzed. Results Among 1 221 patients with mixed hemorrhoids, 168 had gastrointestinal symptoms, whose incidence was 13.8%(168/1 221). Univariate analysis showed that hypertension and general anesthesia were the related factors of gastrointestinal symptoms after operation, and the difference was statistically significant. Multivariate logistic regression analysis showed that hypertension and general anesthesia were the independent risk factors. Conclusion Milligan-Morgan operation for mixed hemorrhoids has a high incidence of digestive tract symptoms. Perioperative blood pressure control and careful selection of general anesthesia may effectively reduce the incidence of digestive tract symptoms.

目的 探究五加生化胶囊联合热电复合治疗仪对人流术后子宫复旧影响的临床效果。方法 选择2018年4月—2019年8月我院收治的人流术后子宫复旧患者240例,随机分成两组,对照组进行常规术后处理,研究组则在常规术后处理的基础上进行五加生化胶囊联合热电复合治疗仪治疗。结果 研究组的术后疼痛症状评分低于对照组(P＜0.05);研究组的平均流血量、持续流血天数以及术后月经复潮天数均少于对照组(P＜0.05);研究组的子宫内膜厚度高于对照组(P＜0.05),且子宫纵径和横径短于对照组(P＜0.05)。结论 五加生化胶囊联合热电复合治疗仪对人流术后子宫复旧进行治疗具有良好效果,值得推广。

Objective To investigate the clinical effect of Wujia biochemical capsule combined with thermoelectric complex therapy instrument on uterine retroplasia after abortion. Methods 240 cases of uterine rehabilitation after abortion from April 2018 to August 2019 were selected and randomly divided into two groups. The control group were performed routine postoperative treatment, while the research group were performed five plus biochemical capsules combined with thermoelectric complex therapy instruments on the basis of routine postoperative treatment. Results The postoperative pain symptom scores were lower than that of control group(P<0.05). The average blood flow, duration of bleeding and post-operative menarche were all less than that of control group(P<0.05). The thickness of endometrium in the study group was higher than that of the control group(P<0.05), and the longitudinal and transverse diameters of the uterus were shorter than those of the control group(P<0.05). Conclusion Wujia biochemical capsule combined with thermoelectric complex therapy instrument has a good effect on the treatment of involution of uterus after abortion and is worth promoting.

目的 检测外周血循环肿瘤细胞(circulating tumor cell, CTC)在原发性肝癌患者中的表达情况,并探讨CTC动态变化及其相对于甲胎蛋白(Alpha fetoprotein AFP)对原发性癌患者术后复发转移的预测作用。方法 收集原发性肝癌患者134例,肝脏良性病变患者72例,检测外周血 CTC 数目,同时检测AFP的表达水平,分析 CTC 与 AFP 的相关性。然后在134名原发性肝癌患者中筛选出成功行肝癌根治术的患者,共86例,检测这86名患者术前、术后外周血CTC和AFP,分析CTC和AFP对原发性肝癌术后复发转移的评估价值。结果 原发性肝癌患者外周血CTC阳性率高于肝脏良性病变患者,差异有统计学意义(P＜0.05);原发性肝癌患者CTC水平与AFP水平、淋巴结转移、肿瘤结节多少有关,与年龄、性别、肿瘤直径、分化程度、肝硬化有无、TNM分期无关;原发性肝癌患者CTC和AFP生存分析显示,原发性肝癌根治术后早期复发转移与CTC和AFP密切相关;CTC较阳性对术后复发转移具有更好的诊断价值,二者联合对复发转移预测价值最高。结论 CTC可以做为一个比传统肿瘤标志物更好的对原发性肝癌术后复发转移进行监测的指标,与肿瘤标志物联合检测预测价值更高。

Objective To detect the expression of peripheral blood circulating tumor cells CTC in patients with primary liver cancer and to explore the dynamic changes of CTC and its predictive effect on postoperative recurrence and metastasis of primary cancer. Methods The number of CTC in peripheral blood was measured in 134 patients with primary liver cancer and 72 patients with benign liver disease, the expression of AFP was detected, and the correlation between CTC and AFP was analyzed. Then 86 patients with primary liver cancer were selected from 134 patients with primary liver cancer who underwent radical hepatectomy. The values of CTC and AFP in evaluating recurrence and metastasis of primary liver cancer before and after operation were analyzed by CTC and AFP, in peripheral blood of these 86 patients. Results The positive rates of CTC in peripheral blood of patients with primary liver cancer were higher than that of patients with benign liver disease(P< 0.05). The levels of CTC in patients with primary liver cancer were related to AFP level, lymph node metastasis and the number of tumor nodules, but not to age, sex, tumor diameter, differentiation degree, liver cirrhosis and TNM stage. The survival analysis of CTC and AFP in patients with primary liver cancer showed that the early recurrence and metastasis of primary liver cancer after radical resection were closely related to the positive rate of CTC and AFP, and the positive rate of CTC was more effective than that of AFP positive in the diagnosis of recurrence and metastasis after operation, and the combination of the two had the highest predictive value for recurrence and metastasis. Conclusion CTC may be used as a better index to monitor postoperative recurrence and metastasis of primary liver cancer than traditional tumor markers. The combined detection prediction value of tumor markers is higher.

目的 回顾分析我医院近9年产妇行剖宫产术治疗的患者的住院病历资料,探索术后出现切口脂肪液化的危险因素。方法 选取我医院2011年1月—2019年8月期间行剖宫产术治疗的产妇患者1 018例,分成术后切口脂肪液化组和甲级愈合组,比较2组间的差异,分析其相关危险因素。结果 1 018例产妇患者中出现切口脂肪液化的为34例,发生率为3.34%(34/1 018);单因素分析结果显示,糖尿病、体质指数超重、7 cm以上切口长度是术后出现切口脂肪液化的相关因素,差异有统计学意义;多因素Logistic回归分析结果显示,糖尿病、体质指数超重、7 cm以上切口长度是术后出现切口脂肪液化的独立危险因素。结论 产妇患者行剖宫产术治疗出现切口脂肪液化率较高;围手术期控制患者血糖,以及孕期控制体质指数、缩小剖宫产手术切口长度可能有效地减少切口脂肪液化发生率。

Objective To retrospectively analyze the medical records of patients undergoing cesarean section in our hospital in recent 9 years, and explore the risk factors of incision fat liquefaction after operation. Methods 1 018 patients undergoing cesarean section in our hospital from January 2011 to August 2019 were divided into two groups: incision fat liquefaction group and grade A healing group. The differences between the two groups were compared and the risk factors were analyzed. Results Among 1 018 parturients, 34 had incision fat liquefaction, and the incidence was 3.34% (34/1018). Univariate analysis showed that diabetes mellitus, overweight body mass index and incision length of more than 7 cm were risk factors for incision fat liquefaction after operation, and the difference was statistically significant. Multivariate logistic regression analysis showed that diabetes mellitus, overweight body mass index and incision length over 7 cm were independent risk factors for incision fat liquefaction. Conclusion The incision fat liquefaction rate is higher in patients undergoing cesarean section. Controlling blood sugar level, body mass index during pregnancy and shortening the length of incision during perioperative period may effectively reduce the incidence of incision fat liquefaction.

目的 观察普瑞巴林联合甲钴胺对腰椎手术术后急性疼痛的影响。方法 按照纳入排除标准选择2019年1月—2019年12月在我院行单一节段的腰椎手术患者共60例,缝皮时常规予0.375%罗哌卡因20 mL切口周围浸润,术后使用病人静脉自控镇痛(Patient-Controlled Intravenous Analgesia, PCIA)。患者随机分为2组,实验组:术前1天开始口服普瑞巴林75 mg bid和静脉注射甲钴胺注射液 0.5 mg qd,共5天;对照组:术前1天开始口服普瑞巴林 75 mg bid和注射等体积的生理盐水,共5天。观察术前和术后6、12、24、48 h的VAS评分,在术前、术后24 h和术后48 h进行JOA评分,记录术后24 h和48 h阿片类药物用量、PCIA按压次数、补救用药量和不良反应。结果 两组患者术后12 h内的VAS评分无差异,但是在12～48 h这段时间里实验组的静息VAS和运动VAS评分均低于对照组(P<0.05)。实验组在术后24 h和48 h舒芬太尼消耗量、PCIA按压次数和平均补救用药剂量少于对照组(P<0.05),两组患者的JOA评分和不良反应均无差异(P>0.05)。结论 普瑞巴林联合甲钴胺应用于腰椎手术患者术后镇痛效果良好,药物不良反应发生率低,但仍需进行更大规模的随机对照研究证实该镇痛方案的安全性和有效性。

Objective To observe the effect of pregabalin combined with mecobalamin on acute pain after lumbar surgery. Methods A total of 60 patients underwent single lumbar spine surgery in our hospital from January 2019 to December 2019. The incisions of patients were routinely infiltrated around the incision with 0.375% ropivacaine 20 mL. Patient-controlled intravenous analgesia (PCIA) was used. The patients were randomly divided into two groups. The experimental group: oral pregabalin 75mg bid and intravenous mecobalamin injection 0.5mg qd 1 day before surgery, five days in total. Control group: oral pregabalin 75mg bid and intravenous injection of equal volume of saline 1 day before surgery, five days in total. The VAS scores of preoperative and postoperative 6, 12, 24, and 48 h were observed. JOA scores were performed before surgery, 24 h after surgery, and 48 h after surgery. The doses of opioids, PCIA pressing times, remedial medications and adverse reactions were recorded at 24 h and 48 h after surgery. Results There was no significant difference in VAS scores between the two groups within 12 h after surgery, but the resting VAS and exercise VAS scores in the experimental group were lower than those in the control group during the period of 12～48 h (P<0.05). The amount of sufentanil, the pressing times of PCIA and the average remedial medication in the experimental group were lower than those in the control group at 24 h and 48 h after operation (P<0.05). There were no significant differences in JOA scores and adverse reactions between the two groups (P>0.05). Conclusion Pregabalin combined with mecobalamin in patients with lumbar spine surgery has good postoperative analgesia and low incidence of adverse drug reactions, but more randomized controlled trials are needed to confirm the safety and efficacy.

目的 分析融合功能训练在大龄人群行斜视矫正术后建立双眼三级视功能及巩固术后效果的可能性。方法 回顾性研究2008年10月—2016年12月在广州爱尔眼科医院被诊断为共同性斜视并进行手术矫正的患者174例,术后进行融合功能训练。根据术前诊断斜视的类型分成共同性内斜视组、共同性外斜视组、间歇性外斜视组,根据两眼最佳矫正视力差别分为＞2行、≤2行组,训练时对单眼抑制及交叉抑制者先采用脱抑制训练再扩大融合功能训练,具有较小融合范围的矫正术后的患者直接从扩大融合功能开始训练,对比观察斜视手术矫正前和矫正后进行融合训练后融合功能及双眼视情况。结果 斜视矫正术后128例建立了正常的融合范围,随访1年斜视无复发,无视疲劳症状发生。其中共同性外斜视组、共同性内斜视组、间歇性外斜视组进行训练后治疗的有效率分别为32.35%、28.57%、100%,两眼最佳矫正视力相差＞2行和≤2行的有效率分别为11.54%、100%。结论 大龄斜视患者尤其是间歇性外斜视或双眼最佳矫正视力相差在2行以内的患者,经过融合训练均获得良好的双眼视,视疲劳得到改善,斜视手术效果得到巩固。

Objective To analyze the possibility of fusion function training to establish binocular tertiary vision function and consolidate the effect of postoperative strabismus correction in elderly people. Methods Conduct a retrospective study about 174 patients who were diagnosed with common strabismus and had corrective surgery at Guangzhou Aier Eye Hospital from October 2008 to December 2016, and those patients was performed after the fusion function training. According to the type of preoperative diagnosis of strabismus, they were divided into common esotropia group, common exotropia group, intermittent exotropia group. According to the difference of the best corrected visual acuity between the two eyes, they were divided into>2 lines group and ≤2 lines group. Monocular-suppression and cross-suppression patients firstly used de-inhibition training and then expand the fusion-range training. Patients with a smaller fusion range started training directly by expanding the fusion function. We compared and observed the fusion function and binocular condition between before and after strabismus surgery. Results The normal fusion range was established in 128 cases after strabismus correction, and there was no recurrence of strabismus and visual fatigue symptoms after 1 year of follow-up. Among them, the effective treatment rates of the common exotropia group, the common esotropia group, and the intermittent exotropia group after training are 32.35%, 28.57%, and 100%, respectively. The two groups which are divided into>2 lines group and ≤2 lines group are 11.54% and 100%, respectively. Conclusion Elderly patients with strabismus, especially those with intermittent exotropia or within two lines of best corrected visual acuity, have achieved good binocular vision after fusion training, have been improved visual fatigue, and the effect of strabismus surgery is consolidated.