约10%~30%的新发结直肠癌患者会出现急性肠梗阻，传统急诊手术治疗存在术后并发症高、死亡率高、生存质量低等不足。肠道支架置入联合限期手术作为一种新型治疗策略，展现出显著优势。肠道支架可迅速解除梗阻，改善患者症状，降低手术风险，为肿瘤微创切除创造条件，同时为新辅助化疗提供可能，但其潜在并发症如出血、移位、再梗阻及肠穿孔等也不容忽视，且长期安全性及对肿瘤结局的影响尚不明确。文章综述了肠道支架治疗梗阻性结直肠癌的治疗现状、争议及研究进展，旨在为临床研究和实践提供参考依据。

    Approximately 10% to 30% of patients with newly diagnosed colorectal cancer present with acute intestinal obstruction．Traditional emergency surgical intervention is characterized by high rates of postoperative complications，elevated mortality，and diminished quality of life．Combined stent and curative elective surgery（CSCES）has emerged as a novel therapeutic strategy，exhibiting significant clinical benefits．Intestinal stenting can rapidly alleviate obstruction，thereby improving patient symptoms，reducing surgical risks，and facilitating minimally invasive tumor resection．Additionally，it provides an opportunity for neoadjuvant chemotherapy．However，potential complications，including bleeding，stent migration，recurrent obstruction，and intestinal perforation，must be carefully considered．Moreover，the long-term safety and impact on oncologic outcomes remain to be elucidated．This review aims to provide a comprehensive overview of the current status，controversies，and recent advancements in the use of intestinal stents for the treatment of obstructive colorectal cancer，with the goalof informing clinical research and practice．

      目的 探讨血清乳酸脱氢酶（LDH）在中晚期肝癌患者接受靶向联合免疫治疗后的预后预测价值。方法 选取2022年1月—2024年8月在莆田学院附属医院肿瘤内科经病理和影像学检查确诊的中晚期肝癌患者作为研究对象。从医院的电子病历系统中收集患者的基线资料，随访截止2025年8月，并记录随访结果，包括患者的疾病缓解情况和死亡情况，以及无疾病进展生存期（PFS）、总生存期（OS）。采用Kaplan-Meier方法绘制不同基线LDH水平患者的OS生存曲线，并通过Log-rank检验比较生存曲线。同时，运用多因素Cox比例风险回归分析探讨影响中晚期肝癌患者在接受靶向联合免疫治疗后OS的相关因素。结果 结果显示，在50例肝癌患者中，基线LDH低于200 U/L的有15例，而高于200 U/L的有35例。与基线LDH＜200 U/L组相比，基线 LDH≥200 U/L患者PFS、OS更短，差异均有统计学意义（χ²分别为5.51、15.6，P值分别为0.019、0.017）。治疗8周后，与LDH降低患者相比，LDH升高患者OS更短，差异有统计学意义（χ²=13.2，P=0.04）。多因素Cox比例风险回归分析结果表明，基线LDH水平超过200 U/L是中晚期肝癌患者接受靶向联合免疫治疗后OS的影响因素［P=0.035，HR（95%CI）=5.03（1.12，22.54）］。结论 基线LDH水平较低的患者表现出更好的OS。基线LDH水平可以作为预测中晚期肝癌患者在接受靶向联合免疫治疗时预后的指标。 

   Objective To evaluate the prognostic significance of serum lactate dehydrogenase（LDH）levels in patients with advanced hepatocellular carcinoma（HCC）undergoing targeted therapy combined immunotherapy．Methods Patients diagnosed with advanced HCC were selected in Putian College Affiliated Hospital from January 2022 to August 2024，diagnosed with pathological and imaging examinations results．Patient baseline data were collected from the hospital’s electronic medical records，with follow-up extending until August 2025．We documented outcomes such as disease response and mortality，along with progression-free survival（PFS）and overall survival（OS）．Kaplan-Meier survival curves were constructed based on baseline LDH levels，and the Log-rank test was employed for comparison．Additionally，multivariate Cox proportional hazards regression analysis was conducted to identify factors influencing OS in patients receiving targeted therapy combined immunotherapy．Results Among the 50 patients，15 had baseline LDH levels below 200 U/L，while 35 had levels above．Patients with baseline LDH≥200 U/L had significantly shorter PFS and OS than those with baseline LDH ＜200 U/L（χ²=5.51 and 15.6 for PFS and OS，respectively；P=0.019 and 0.017，respectively）．After 8 weeks of treatment，patients with increased LDH had significantly shorter OS compared with patients with decreased LDH（χ²=13.2，P=0.04）．Multivariate Cox proportional hazards regression analysis indicated that a baseline LDH level exceeding 200 U/L is an independent prognostic factor for OS in patients with intermediate to advanced HCC receiving targeted therapy combined with immunotherapy（P=0.035，HR 5.03［1.12，22.54］）．Conclusions Patients with lower baseline LDH levels demonstrated better OS，suggesting that baseline LDH can serve as an important prognostic indicator for advanced HCC patients undergoing targeted combined immunotherapy．

      目的 合并肺纤维化的慢性阻塞性肺疾病（COPD）是COPD的特殊亚型，患者兼具气流受限与肺组织纤维化病理特征，临床症状更严重、肺功能下降更快，且现有单一治疗方案难以同时改善气流受限与纤维化进展，预后较差。基于此，本研究旨在分析尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD患者的效果及对肺功能的影响，为优化临床治疗方案提供依据。方法 选取2022年3月—2024年12月收治的96例合并肺纤维化的COPD患者，采用前瞻性随机对照研究设计，应用随机数字表法分为试验组与对照组。所有患者均采取常规治疗，对照组48例采取尼达尼布治疗，试验组采取尼达尼布联合格隆溴铵治疗。两组均治疗24周后，比较治疗前后症状评分、肺功能、纤维化指标、炎症指标，并分析两组治疗安全性。结果 治疗后，两组CAT评分、mMRC评分及VAS降低（P＜0.05）；且与对照组比较，试验组CAT评分、mMRC评分及咳嗽VAS评分较低（P＜0.05）。治疗后，两组FVC、FEV₁、DLCO及FEV₁/FVC比值均较治疗前改善（P＜0.05）；且与对照组比较，试验组FVC、FEV₁、DLCO及FEV₁/FVC比值较优（P＜0.05）。治疗后，两组血清KL-6、SP-D水平及CT纤维化评分均降低（P＜0.05）；且与对照组比较，试验组血清KL-6、SP-D水平及CT纤维化评分较低（P＜0.05）。治疗后，两组血清IL-6、TNF-α及TGF-β1水平降低（P＜0.05）；且与对照组比较，试验组血清IL-6、TNF-α及TGF-β1水平较低（P＜0.05）。试验组总不良反应发生率为8.33%（4/48），对照组为10.42%（5/48），两组比较差异无统计学意义（P＞0.05）。结论 尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD效果良好，可减轻患者临床症状，改善肺功能与肺纤维化，降低机体炎症反应，安全性较高。

   Objective To analyze the effects of the combination of nintedanib and glycopyrrolate in treating chronic obstructive pulmonary disease（COPD）patients with associated pulmonary fibrosis and its impact on lung function，providing a basis for optimizing clinical treatment strategies．Methods Ninety-six COPD patients with pulmonary fibrosis admitted from March 2022 to December 2024 were selected，and divided into experimental group and control group using a random number table method．Using a prospective randomized controlled study design，all patients received conventional treatment，with 48 cases in the control group receiving treatment with nintedanib and the experimental group receiving treatment with nintedanib combined with glycopyrrolate bromide．After 24 weeks of treatment in both groups，the symptom scores，lung function，fibrosis indicators，and inflammation indicators were compared before and post-treatment，and the drug safety of the two groups was analyzed．Results Post-treatment，CAT score，mMRC score and VAS decreased in both groups（P＜0.05）．Compared with the control group，CAT score，mMRC score and cough VAS score were lower in the experimental group（P＜0.05）．Post-treatment，FVC，FEV₁，DLCO and FEV₁/FVC ratio of both groups improved compared with that before treatment（P＜0.05）．Compared with the control group，FVC，FEV₁，DLCO and FEV₁/FVC ratio of the experimental group were better（P＜0.05）．Post-treatment，serum KL-6，SP-D levels and CT fibrosis scores of both groups decreased（P＜0.05）．Compared with the control group，serum KL-6，SP-D levels and CT fibrosis scores of the experimental group were lower（P＜0.05）．Post-treatment，serum IL-6，TNF-α and TGF-β1 levels in both groups decreased（P＜0.05）．Compared with the control group，serum IL-6，TNF-α and TGF-β1 levels in the experimental group were lower（P＜0.05）．The incidence of total adverse reactions in the experimental group was 8.33%（4/48），and that in the control group was 10.42%（5/48）．There was no difference between the two groups（P＞0.05）．Conclusions The combination of nintedanib and glycopyrrolate has a significant effect on the treatment of COPD complicated with pulmonary fibrosis，which can alleviate its clinical symptoms，improve lung function and pulmonary fibrosis，reduce the body’s inflammatory response，which is relatively safe．

目的 探讨顺行输尿管软镜治疗特殊类型输尿管中下段梗阻的临床疗效。方法　分析2024年1月至2026年5月广东省中西医结合医院收治了20例特殊类型输尿管中下段梗阻患者的临床资料，对患者手术时间、术前和术后的血红蛋白、肾积水及随访情况进行分析。结果　所有患者均一期完成手术，手术时间为（75.5±16.4）分钟，术前与术后第一天血红蛋白对比，有一定差异（t=6.141，P＜0.05），术前与术后1个月患侧肾积液对比，肾积液明显改善（t=3.937，P＜0.05）。结论　经皮肾通道顺行输尿管软镜治疗特殊类型输尿管中下段梗阻具有微创、安全、有效、并发症少、术后恢复快等优点，值得临床推广应用。

Objective To evaluate the clinical efficacy of antegrade flexible ureteroscopy in treating special types of middle and lower ureteral obstruction. Methods From January 2024 to May 2026, clinical data of 20 patients with special types of middle and lower ureteral obstruction admitted to Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine were analyzed. The operation time, preoperative and postoperative hemoglobin levels, hydronephrosis, and follow-up conditions of the patients were analyzed. Results All patients underwent successful single-stage surgery, with an average operative time of (75.5 ± 16.4) minutes. There was a significant difference in hemoglobin levels between preoperatively and on the first postoperative day (t = 6.141, P < 0.05). Hydronephrosis on the affected side showed marked improvement when comparing preoperative and one-month postoperative conditions (t = 3.937, P < 0.05). Conclusions Antegrade flexible ureteroscopy via percutaneous nephrostomy tract is a minimally invasive, safe, effective, and well-tolerated approach for treating special types of middle and lower ureteral obstruction, with few complications and rapid postoperative recovery, making it worthy of clinical promotion and application.

目的 探讨顺行输尿管软镜治疗特殊类型输尿管中下段梗阻的临床疗效。方法　分析2024年1月至2026年5月广东省中西医结合医院收治了20例特殊类型输尿管中下段梗阻患者的临床资料，对患者手术时间、术前和术后的血红蛋白、肾积水及随访情况进行分析。结果　所有患者均一期完成手术，手术时间为（75.5±16.4）分钟，术前与术后第一天血红蛋白对比，有一定差异（t=6.141，P＜0.05），术前与术后1个月患侧肾积液对比，肾积液明显改善（t=3.937，P＜0.05）。结论　经皮肾通道顺行输尿管软镜治疗特殊类型输尿管中下段梗阻具有微创、安全、有效、并发症少、术后恢复快等优点，值得临床推广应用。

Objective To evaluate the clinical efficacy of antegrade flexible ureteroscopy in treating special types of middle and lower ureteral obstruction. Methods From January 2024 to May 2026, clinical data of 20 patients with special types of middle and lower ureteral obstruction admitted to Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine were analyzed. The operation time, preoperative and postoperative hemoglobin levels, hydronephrosis, and follow-up conditions of the patients were analyzed. Results All patients underwent successful single-stage surgery, with an average operative time of (75.5 ± 16.4) minutes. There was a significant difference in hemoglobin levels between preoperatively and on the first postoperative day (t = 6.141, P < 0.05). Hydronephrosis on the affected side showed marked improvement when comparing preoperative and one-month postoperative conditions (t = 3.937, P < 0.05). Conclusions Antegrade flexible ureteroscopy via percutaneous nephrostomy tract is a minimally invasive, safe, effective, and well-tolerated approach for treating special types of middle and lower ureteral obstruction, with few complications and rapid postoperative recovery, making it worthy of clinical promotion and application.

比较恩那度司他片与罗沙司他胶囊治疗肾性贫血的临床疗效与安全性。 方法 采用前瞻性队列研究设计，选取2025年1月-2025年12月就诊于我院肾内科使用恩那度司他片与罗沙司他胶囊的非透析肾性贫血患者，比较两者治疗4周后红细胞计数（RBC）、血红蛋白（Hb）、红细胞压积（HCT）水平。通过JADER数据库调取与恩那度司他和罗沙司他相关的药物不良事件（ADE）报告，采用报告比值比法（ROR）和比例报告比值法（PRR）进行信号挖掘，对比分析两者的不良事件信号。 结果 共纳入恩那度司他组18例、罗沙司他组27例。治疗4周后，恩那度司他组Hb、RBC、HCT水平均较治疗前显著升高（P＜0.05），两组间治疗后Hb、RBC、HCT水平比较差异无统计学意义（P＞0.05）。JADER数据库共提取恩那度司他相关ADE报告65例，挖掘得到13个阳性信号；罗沙司他相关ADE报告3542例，挖掘得到135个阳性信号。两组重叠信号11个，主要为血栓栓塞事件（深静脉血栓形成、肺栓塞、分流道阻塞等）和代谢异常（高钾血症）。恩那度司他组检出的高血压（5例，ROR=8.63）未在罗沙司他组中出现。 结论 恩那度司他治疗肾性贫血疗效确切，与罗沙司他疗效相当。安全性方面，恩那度司他相关的血栓事件、高钾血症等信号需引起关注，同时需动态监测血压水平。

To compare the clinical efficacy and safety of Enarodustat Tablets and Roxadustat Capsules in the treatment of renal anemia. METHODS A prospective cohort study design was used to select patients with non-dialysis renal anemia who were treated with Enarodustat Tablets and Roxadustat Capsules in the Department of Nephrology of our hospital from January 2025 to December 2025. The levels of Red Blood Cell count ( RBC ), Hemoglobin ( Hb ) and Hematocrit ( HCT ) were compared between the two groups after 4 weeks of treatment. The adverse drug events ( ADE ) reports related to Enarodustat and Roxadustat were retrieved from the JADER database. The report odds ratio method ( ROR ) and the proportional report ratio method ( PRR ) were used for signal mining, and the adverse event signals of the two were compared and analyzed.RESULTS A total of 18 cases in the Enarodustat group and 27 cases in the Roxadustat group were included. After 4 weeks of treatment, the levels of Hb, RBC and HCT in the Enarodustat group were significantly higher than those before treatment ( P < 0.05 ),and there was no significant difference in Hb, RBC and HCT levels between the two groups after treatment ( P > 0.05 ). A total of 65 ADE reports related to Enarodustat were extracted from JADER database, and 13 positive signals were mined. A total of 3542 cases of Roxadustat-related ADE were reported, and 135 positive signals were mined. There were 11 overlapping signals in the two groups, mainly thromboembolic events ( deep vein thrombosis, pulmonary embolism, shunt obstruction, etc. ) and metabolic abnormalities ( hyperkalemia ). Hypertension ( 5 cases, ROR = 8.63 ) was not detected in the Roxadustat group.CONCLUSION Enarodustat is effective in the treatment of renal anemia, which is equivalent to Roxadustat. In terms of safety, signals such as thrombotic events and hyperkalemia related to Enarodustat need to be paid attention to, and blood pressure levels need to be dynamically monitored.

探讨手术联合辅助放化疗治疗老年口腔颌面部肿瘤的疗效与安全性。方法：选取2023年1月至2025年9月收治的110例老年口腔颌面部肿瘤患者，采用随机分组分为联合治疗组与单纯手术组，各55例。单纯手术组行根治性肿瘤切除术；联合治疗组在相同手术后接受辅助放化疗。比较两组1年、2年总生存率（OS）与无进展生存率（PFS）、肿瘤控制情况（局部复发、区域淋巴结及远处转移）及治疗相关不良反应。结果：联合治疗组1年、2年OS及PFS均显著高于单纯手术组（均P<0.05）。联合治疗组局部复发率、区域淋巴结转移率及远处转移率均显著更低（均P<0.05）。在安全性方面，联合治疗组因接受了标准化的预防性止吐与支持治疗，其≥3级恶心（5.45% vs 14.55%）、呕吐（3.64% vs 12.73%）发生率显著低于单纯手术组（P<0.05），其他不良反应发生率组间无统计学差异；长期随访显示，联合治疗组张口受限（9.09% vs 21.82%）及吞咽功能异常（7.27% vs 18.18%）发生率亦显著更低（P<0.05）。结论：在精细化支持治疗与先进放疗技术支持下，手术联合辅助放化疗可提升老年口腔颌面部肿瘤患者生存率与肿瘤控制率，不增加治疗相关毒副反应，还能更好保留长期功能，表明该综合治疗方案兼具疗效与安全性。

目的?比较经心尖途径与股动脉途径经导管主动脉瓣植入术（TAVI）治疗重度主动脉瓣狭窄的围术期卒中发生率。方法?回顾性分析2024年1月至2026年1月于本院行TAVI治疗的98例重度主动脉瓣狭窄患者，根据手术入路分为经心尖组（n=46）和股动脉组（n=52）。比较两组患者围术期卒中发生率、30天死亡率及术后并发症。结果?经心尖组围术期卒中发生率为6.52%，高于股动脉组的1.92%（P=0.042）。多因素logistic回归分析显示，经心尖入路（OR=3.482，95%CI：1.124～10.786，P=0.030）和主动脉瓣钙化积分（OR=1.156，95%CI：1.023～1.307，P=0.020）是围术期卒中的独立危险因素。经心尖组30天死亡率（4.35% vs. 1.92%，P=0.594）与其他并发症发生率差异无统计学意义。结论?经心尖途径TAVI的围术期卒中发生率显著高于股动脉途径，术前应充分评估手术入路选择，对高危患者采取针对性预防策略。

目的?比较经心尖途径与股动脉途径经导管主动脉瓣植入术（TAVI）治疗重度主动脉瓣狭窄的围术期卒中发生率。方法?回顾性分析2024年1月至2026年1月于本院行TAVI治疗的98例重度主动脉瓣狭窄患者，根据手术入路分为经心尖组（n=46）和股动脉组（n=52）。比较两组患者围术期卒中发生率、30天死亡率及术后并发症。结果?经心尖组围术期卒中发生率为6.52%，高于股动脉组的1.92%（P=0.042）。多因素logistic回归分析显示，经心尖入路（OR=3.482，95%CI：1.124～10.786，P=0.030）和主动脉瓣钙化积分（OR=1.156，95%CI：1.023～1.307，P=0.020）是围术期卒中的独立危险因素。经心尖组30天死亡率（4.35% vs. 1.92%，P=0.594）与其他并发症发生率差异无统计学意义。结论?经心尖途径TAVI的围术期卒中发生率显著高于股动脉途径，术前应充分评估手术入路选择，对高危患者采取针对性预防策略。

目的 探讨胸腔镜辅助下经左胸小切口微创直接冠状动脉旁路移植术（MIDCAB）治疗前降支单支病变的临床效果及安全性。方法 回顾性分析2022年1月至2024年6月收治的86例前降支单支病变患者的临床资料，根据手术方式分为MIDCAB组（n=44）和经皮冠状动脉介入治疗（PCI）组（n=42）。比较两组围术期指标、并发症发生率及随访12个月的主要心脑血管不良事件（MACCE）发生率。结果 MIDCAB组手术时间长于PCI组［（178.35±25.42）min vs （72.18±15.36）min，P<0.001］，但术后靶血管再次血运重建率低于PCI组（2.27% vs 14.29%，P=0.042）。两组术后12个月MACCE发生率差异无统计学意义（4.55% vs 11.90%，P=0.213）。MIDCAB组术后24 h引流量为（285.63±98.47）mL，呼吸机使用时间为（16.35±8.42）h，住院时间为（9.23±3.18）d。结论 MIDCAB治疗前降支单支病变安全有效，具有创伤小、恢复快、远期再血运重建率低的优势，可作为前降支单支病变的优选治疗策略之一。

目的 探讨胸腔镜辅助下经左胸小切口微创直接冠状动脉旁路移植术（MIDCAB）治疗前降支单支病变的临床效果及安全性。方法 回顾性分析2022年1月至2024年6月收治的86例前降支单支病变患者的临床资料，根据手术方式分为MIDCAB组（n=44）和经皮冠状动脉介入治疗（PCI）组（n=42）。比较两组围术期指标、并发症发生率及随访12个月的主要心脑血管不良事件（MACCE）发生率。结果 MIDCAB组手术时间长于PCI组［（178.35±25.42）min vs （72.18±15.36）min，P<0.001］，但术后靶血管再次血运重建率低于PCI组（2.27% vs 14.29%，P=0.042）。两组术后12个月MACCE发生率差异无统计学意义（4.55% vs 11.90%，P=0.213）。MIDCAB组术后24 h引流量为（285.63±98.47）mL，呼吸机使用时间为（16.35±8.42）h，住院时间为（9.23±3.18）d。结论 MIDCAB治疗前降支单支病变安全有效，具有创伤小、恢复快、远期再血运重建率低的优势，可作为前降支单支病变的优选治疗策略之一。

目的 探讨入院时血清淀粉样蛋白A（SAA）、载脂蛋白A1（ApoA1）、C反应蛋白（CRP）水平联合检测对老年急性脑梗死（ACI）患者规范治疗后3个月内发生预后不良的早期预测效能。方法 前瞻性选取2023年1月～2025年1月于焦作市第五人民医院就诊的108例老年ACI患者作为ACI组，另选取同期健康志愿者108例作为对照组。比较两组血清SAA、ApoA1、CRP水平。老年ACI患者予以规范治疗，根据治疗后3个月内预后情况将其分为预后不良（46例）和预后良好（62例）亚组，比较不同预后ACI患者患者临床资料及入院时血清SAA、ApoA1、CRP水平；Logistic回归分析入院时血清SAA、ApoA1、CRP水平是否为老年ACI患者规范治疗后3个月内发生预后不良的独立影响因素；ROC曲线分析入院时血清SAA、ApoA1、CRP水平联合检测对ACI患者预后不良的预测效能。结果 ACI组入院时血清SAA、CRP水平高于对照组，血清ApoA1水平低于对照组（P＜0.05）；预后不良亚组高血压占比、入院NIHSS评分、梗死体积、入院时血清SAA、CRP水平高于预后良好亚组，血清ApoA1水平低于预后良好亚组（P＜0.05）；剔除存在多重共线性指标高血压、入院NIHSS评分、梗死体积后，入院时血清SAA、ApoA1、CRP水平仍是老年ACI患者规范治疗后3个月内发生预后不良的独立影响因素（P＜0.05）；入院时血清SAA、ApoA1、CRP水平联合预测ACI患者预后不良的AUC值为0.873，显高于各指标单独预测值0.738、0.768、0.749（P＜0.05）。结论 入院时血清SAA、ApoA1、CRP水平是老年ACI患者预后不良的独立影响因素，联合检测对预后不良具有较高的预测效能，可将其作为ACI患者血清敏感指标，协助临床医师早期制定针对性干预措施，减少ACI患者预后不良的发生。