目的 回顾性分析因化疗需要行完全植入式输液港的乳腺癌患者相关血栓形成的因素。方法 收集广州市第一人民医院乳腺外科2018年5月—2019年4月期间行植入式输液港置入术的60例乳腺癌患者相关资料,采用SPSS 26.0软件进行统计学分析。结果 输液港相关血栓形成(catheter related thrombosis,CRT)发生率为21/60(35%)。BMI≤24的患者CRT发生率为30.3%,BMI＞24则为40.74%;行4、6、8次化疗的CRT发生率分别为20%、33.34%、44.12%,导管末端位于T5-T8的CRT发生分别为:66.67%, 26.09%, 28.57%, 50%;Ki-67高表达的血栓发生率为27.5%,低Ki-67表达则为50%;导管材质为聚氨酯的血栓发生率为47.62%,硅胶材质则为28.21%,但差异均无统计学意义(P＞0.05)。雌激素受体/孕激素受体(estragen receptor/progesterone receptor,ER/PR)阴性的CRT发生率为60%,ER/PR阳性则为23.8%(P＜0.05);人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)阳性CRT发生率为50%,HER-2阴性CRT发生率则为23.53%(P＜0.05)。多因素分析:相对于ER/PR阳性,ER/PR阴性将增加CRT的发生(OR=4.482, 95%CI:1.116～17.998, P＜0.05);Ki-67的表达对血栓形成的影响具有统计学意义(OR=7.051, 95%CI:1.513～32.858, P＜0.05);HER-2表达对CRT的形成均无统计学意义(OR=0.254,95%CI:0.058～1.115, P＞0.05)。结论 血栓形成是植入式输液港术后常见的并发症,与肿瘤ER/PR表达相关,临床上应得到重视。

Objective To analyse the factors that lead to venous thrombosis among breast cancer patients who need totally implantable access port(TIAP) for chemotherapy. Methods Collecting the clinical data of 60 breast patients admitted to Guanzhou First People's Hospital from May 2018 to April 2019, analysed with SPSS 26.0. Results Catheter-related thrombosis(CRT) occurred in 21 out of 60(35%) patients with TIAP. 30.3% patients with BMI≤24 and 40.74% patients with BMI＞24 had CRT, and incidences of CRT were 20%, 33.34%, 44.12% at the fourth, sixth, eighth therapy respectively. The access terminal position at T5-T8 had 66.67%, 26.09%, 28.57%, 50% of incidence for CRT respectively. 27.5% CRT was with high Ki-67 expression and 50% CRT was with low Ki-67 expression; 47.62% patients with polyurethane catheter and 28.21% patients with silicone catheter got CRT. There were no significant differences in the comparisons above. CRT incidence in ER/PR negative patients was 60%,while 23.08% in ER/PR positive patients (P＜0.05). In HER-2 positive and negative patients, the incidences of CRT were 50% and 23.53% (P＜0.05). Logistic regression noticed that ER/PR negative would increase the incidence of CRT(OR=4.482, 95%CI:1.116～17.998, P＜0.05), low Ki-67 expression would accelerate CRT(OR=7.051, 95%CI:1.513～32.858, P＜0.05). There was no significant difference in the formation of CRT with HER-2 expression(OR=0.254, 95%CI:0.058～1.115, P＞0.05). Conclusion CRT was a common complication of TIAP, which related with ER/PR expression, and should pay attention to during clinical practices.

目的 探讨激光心肌血运重建(Transmyocardial Laser revascularization, TMLR)辅助冠状动脉旁路移植术治疗严重冠心病的临床疗效及 11年随访结果。方法 25例严重冠心病患者行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass, OPCAB)并辅以激光心肌血运重建术(TMLR组),回顾性总结了其术前、术中、术后及 11年随访资料,并与同期进行的 95例单纯不停跳冠状动脉旁路移植术(OPCAB组)病人资料进行比较分析。结果 TMLR组在平均远端吻合口数比 OPCAB组少,而手术时间、术后硝普钠用量比OPCAB组多,其他如术后机械通气时间、ICU停留时间、术后住院天数和术后常见并发症,2组之间均无差异;平均 11年随访资料中,胸闷痛、心衰、新出现 ST-T改变发生率、再发急性心梗、再次 PCI处理、LVEF和血管桥闭塞率,2组间无明显区别;死亡率二者之间也没有区别。结论 TMLR术辅助冠状动脉旁路移植术虽然手术时间比较长,血管活性药物应用较多,但术后康复和 11年随访资料显示与单纯 OPCAB术有相似的结果,说明 TMLR术作为冠状动脉旁路移植术的补充,对那些冠脉血管细小且钙化狭窄严重而不适合冠状动脉旁路移植术的冠心病患者是获益的。

Objective To explore and analyze the clinical effect of off-pump coronary artery bypass (OPCAB) combined transmyocardial laser revascularization(TMLR) of severe coronary artery disease and 11 years follow-up. Methods 25 cases with sever coronary artery disease were treated through OPCAB and TMLR, and the clinical data and 11 years follow-up data were summarized and analyzed retrospectively, compared with the data of the patients treated by only OPCAB. Results There were less mean bypass graft numbers in TMLR group than in OPCAB group. Operation time and the amount of sodium nitroprusside in TMLR group were more than that in OPCAB group. But intubation time, ICU stay time, postoperative stay time and postoperative common complications were not different between two groups. 11 years postoperative follow-up results indicated that chest pain, heart disfunction, ST-T alteration, AMI, PCI treatment again, LVEF and bypass graft occlusion rate were not obviously between two groups. Conclusion TMLR combined OPCAB may result in good outcome and improve long term survival.