目的 探讨64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。方法 选择2023年7月—2024年5月在潜江市中心医院诊治的主动脉夹层疑似患者96例为研究对象,所有患者均进行64层螺旋CT三维重建技术检查, 记录成像参数。所有患者在64层螺旋CT三维重建后进行介入治疗, 以介入检查结果为金标准, 判断64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。结果 在96例患者中, 64层螺旋CT三维重建联合判断为主动脉夹层60例, 其中Ⅰ型32例、Ⅱ型20例、Ⅲ型8例,其中再现（VR）、最大密度投影（MIP）及多平面重建（MPR）分别判断为主动脉夹层56例、54例、56例。在96例患者中, 64层螺旋CT三维重建检查的破口层面主动脉平均直径（3.08±0.25）cm、破口至左锁骨下平均距离（4.05±0.26）cm, 与介入治疗检查（3.05±0.36）cm、（4.06±0.14）cm, 对比差异无统计学意义（t=0.671, P=0.503; t=0.332, P=0.740）。64层螺旋CT三维重建联合、VR、MIP、MPR对主动脉夹层的诊断灵敏度分别为98.33%、93.22%、89.83%、94.92%, 特异度分别为97.30%、97.30%、97.30%、100.00%, 准确率分别为98.96%、94.79%、92.71%、96.88%。结论 64层螺旋CT三维重建技术在主动脉夹层介入术前评估中具有很高的灵敏度、特异度与准确率。

Objective To explore and analyze the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection（AD）intervention．Methods From July 2023 to May 2024, 96 cases of patients suspected of aortic dissection treated in our hospital were selected as the research subjects．All patients underwent 64-slice spiral CT three-dimensional reconstruction technology examination, and imaging parameters were recorded．After the 64-slice spiral CT three-dimensional reconstruction, all patients were given interventional treatment, and the results of the interventional examination were used as the “gold standard” to evaluate the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection intervention．Results Among the 96 patients,64-slice spiral CT three-dimensional reconstruction combined diagnosis identified 60 cases of aortic dissection,including 32 type I, 20 type II, and 8 type III cases．volume rendering（VR）, maximum intensity projection（MIP）, and muhiplanar reconstrudion（MPR） identified 56, 54, and 56 cases of aortic dissection,respectively．In 96 patients, the mean aortic diameter at the lacerated level and the mean distance from the lacerated to the left subclavicular level were（3.08±0.25）cm and（4.05±0.26）cm respectively in 64-slice spiral CT three-dimensional reconstruction examination, compared with（3.05±0.36）cm and（4.06±0.14）cm in interventional examination．There was no difference in comparison（t=0.671, P=0.503; t=0.332, P=0.740）．The sensitivity, specificity, and accuracy of the 64-slice spiral CT three-dimensional reconstruction combined, VR, MIP, and MPR for the diagnosis of aortic dissection were 98.33%, 93.22%, 89.83%, 94.92%, specificity were 97.30%, 97.30%, 97.30%, 100%, accuracy were 98.96%, 94.79%, 92.71%, 96.88%．Conclusions Technology of 64-slice spiral CT three-dimensional reconstruction has high sensitivity, specificity, and accuracy in the preoperative assessment of aortic dissection intervention and is worth promoting and applying clinically．

目的 探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法 对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析,将其分为观察组,另选取82例肺部良性肿瘤患者作为对照组,收集其术前CT增强延迟扫描结果,以术后病理诊断结果为金标准,分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值,采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ²=26.560、24.680,P<0.05）,观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ²=43.330、64.600,P<0.05）;82例非小细胞肺癌通过CT增强延迟扫描共确诊79例,CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82）,与病理诊断结果100.00%对比差异无统计学意义（χ²=3.060,P=0.080）;82例非小细胞肺癌平均CT增强值为（39.14±7.31）,不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P>0.05）,不同病理类型[腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）]、细胞分化程度[中、低分化（45.71±7.21）vs 高分化（32.81±5.11）]、临床分期[Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）]患者、淋巴结转移[是（42.75±4.21）vs 否（35.77±8.13）]CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378,P<0.05）;Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008,P<0.05）。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值,其诊断准确率与病理诊断并无显著差异,且可通过CT增强延迟扫描技术确定患者CT增强值,从而为非小细胞肺癌患者术后病理特征判断提供参考。

Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer（NSCLC）．Methods A retrospective analysis was conducted on 82 patients with NSCLC who underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into an observation group and another 82 patients with benign lung tumors were included in the control group．The preoperative CT enhanced delayed scanning results were collected,and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared,and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs 39.29%）in the observation group was significantly lower than that in the control group（χ²=26.560,24.680,P<0.05）,while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ²=43.330,64.600,P<0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan,and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82）,with no significant difference from the pathological diagnosis result of 100.00%（χ²=3.060,P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders,ages,maximum tumor diameter,and lymph node infiltration（P>0.05）．Patients with different pathological types [adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）],degree of cell differentiation [moderate,and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）],clinical stage [I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）] and lymph node metastasis [yes（42.75±4.21）,vs no（35.77±8.13）] CT enhancement had significant difference（t/F=5.243,8.804,84.828,4.378,P<0.05）．The Spearman correlation analysis results showed that pathological type,degree of cell differentiation,clinical stage,lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008）．Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis,and the CT enhanced value of patients can be determined through CT enhanced delayed scanning,providing reference for postoperative pathological feature judgment of NSCLC patients．

胶质瘤是颅内最常见的原发性恶性肿瘤,其分级对患者治疗方式的选择和预后至关重要。尽管目前组织病理学仍是其最为可靠的分级手段,但需通过有创性手术以获取组织样本,存在一定的风险。相较之下,磁共振成像（MRI）作为一种非侵入性影像诊断工具,在胶质瘤分级中发挥着不可或缺的作用。然而,传统MRI评估受限于医师个体主观性强和可重复性差的问题,一定程度上影响了准确的分级结果。近年来,影像组学技术的崭露头角为解决上述难题开辟了新视角,通过高通量提取影像数据特征捕捉并量化肿瘤的影像学表现,避免因主观因素而导致的不确定性,协助医师更准确地评估肿瘤的恶性程度。本文对近五年来MRI影像组学在胶质瘤术前分级预测方面的相关研究进行了简要综述,旨在为相关领域研究者提供有益的参考和借鉴,以推动MRI影像组学在临床实践中的应用。

Glioma is the most common primary malignant brain tumor,and its grading is crucial for treatment decisions and prognosis．Currently,histopathology remains the gold standard for grading,but it requires invasive procedures and carries inherent risks．In contrast,magnetic resonance imaging（MRI）,a non-invasive diagnostic tool,plays an indispensable role in glioma grading．However,traditional MRI assessment is hampered by interobserver subjectivity and limited repeatability,which compromise grading accuracy．In recent years,radiomics,a burgeoning field,has offered a promising solution to address these challenges．By extracting high-dimensional imaging data features,radiomics enables the quantification of tumor radiological characteristics and elimination of subjectivity-related discrepancies．This technology assists clinicians in more precisely assessing the malignancy of gliomas．This article summarizes relevant studies in the past five years on the application of MRI radiomics in preoperative glioma grading,aiming to provide valuable insights and guidance to researchers in the field and promote the clinician implementation of MRI radiomics．

目的 调查与探讨高龄髋部骨折患者术后谵妄（POD）的发生因素,并提出相关处理对策。方法 选取2019年8月—2022年12月择在南阳市中医院独山院区进行手术治疗的高龄髋部骨折患者82例为研究对象,所有患者在术前1 d进行机械痛阈评定,在术后7 d判定患者的POD发生情况,进行POD与术前痛阈水平的相关性分析,并提出相关的处理对策。结果 术后7 d,82例患者中发生POD 12例（谵妄组）,占比14.6%,未发生POD 70例（非谵妄组）,占比85.37%。谵妄组的性别、体质指数、骨折类型、骨折至手术时间与非谵妄组对比差异无统计学意义（P>0.05）,谵妄组的年龄、术前血红蛋白水平、术前白蛋白水平与非谵妄组对比差异有统计学意义（P<0.05）。谵妄组的术前1 d的痛阈水平低于非谵妄组（P<0.05）。Spearman分析显示,POD与术前痛阈、年龄、术前血红蛋白、术前白蛋白均存在相关性（P<0.05）。Logistic回归分析显示,术前痛阈、年龄、术前血红蛋白、术前白蛋白等都为导致POD发生的影响因素（P<0.05）,要积极加强预防性护理干预。结论 高龄髋部骨折患者POD的发生率较高,患者的术前痛阈、年龄、术前血红蛋白、术前白蛋白等均为导致POD发生的影响因素,要积极加强预防性护理干预。

Objective To investigate and explore the factors leading to postoperative delirium（POD）in elderly patients with hip fractures,and to propose relevant handling measures．Methods From August 2019 to December 2022,82 cases of elderly patients with hip fractures who underwent surgical treatment in Nanyang Hospital of Traditional Chinese Medicine Dushan District were selected as the research subjects．All patients underwent mechanical pain threshold assessment 1 day before surgery,and their postoperative delirium were determined 7 days after surgery,followed by correlation analysis,and relevant handling measures were proposed．Results Seven days after surgery,there were 12 patients（delirium group）of POD,accounted for 14.6%,and 70 patients（non delirium group）without POD,accounted or 85.37%．There was no significant difference in genders,body mass index,fracture types and fracture to surgery time compared between the delirium group and the non delirium group（P>0.05）． However,there were significant differences in ages,preoperative hemoglobin levels and preoperative albumin levels compared between the delirium group and the non delirium group（P<0.05）．The pain threshold level of the delirium group on the first day before surgery was significantly lower than that of the non delirium group（P<0.05）．Spearman analysis showed that POD was associated with preoperative pain threshold,ages,preoperative hemoglobin and preoperative albumin levels（P<0.05）．Logistic regression analysis showed that the preoperative pain threshold level,ages,preoperative hemoglobin and preoperative albumin levels were all independent risk factors for the development of POD（P<0.05）,preventive nursing intervention should be actively strengthened．Conclusions The incidence of POD is high in elderly patients with hip fractures．Preoperative pain threshold level,age,preoperative hemoglobin and preoperative albumin levels are all factors that contribute to the occurrence of POD．It is necessary to actively strengthen preventive nursing interventions．

目的 探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

目的 探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ²检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果 单因素分析,术前超声指标:胆囊大小>50 cm²、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论 手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。

Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ² test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm², gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.

目的 分析术前血清鳞状细胞癌相关抗原(SCCA)对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值。方法 选取2018年1月—2021年1月于我院肿瘤科治疗的128例宫颈鳞癌患者作为研究对象,根据其是否发生盆腔淋巴结转移将其分为转移组(42例)和非转移组(86例)。对比2组宫颈鳞癌患者一般资料,采用多因素Logistic分析宫颈鳞癌患者发生盆腔淋巴结转移的高危因素,采用ROC曲线评估术前血清SCCA对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值,通过约登指数确定最佳截断值。结果 2组患者一般资料对比,宫颈鳞癌细胞分化程度、宫颈鳞癌临床分期、宫颈鳞癌肿瘤直径大小、是否出现宫旁转移现象、是否出现脉管浸润现象、浸润深度、SCCA水平的差异有统计学意义,P<0.05;多因素Logistic分析显示宫颈鳞癌细胞分化程度、脉管浸润阳性、浸润深度、SCCA水平是宫颈鳞癌患者发生盆腔淋巴结转移的危险因素;ROC曲线分析结果显示,SCCA水平曲线下面积为0.909,最佳截断值为0.597 5 μg/L。结论 术前血清SCCA水平对宫颈鳞癌患者发生盆腔淋巴结转移具有预测价值。

Objective To analyze the predictive value of preoperative serum squamous cell carcinoma antigen (SCCA) on pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.Methods A total of 128 patients with cervical squamous cell carcinoma treated in the oncology department of our hospital from January 2018 to January 2021 were selected as the research objects,and divided into metastatic group (42 cases) and non-metastatic group (86 cases) according to whether pelvic lymph node metastasis occurred.The general data of the two groups of patients with cervical squamous cell carcinoma were compared.Multivariate logistic analysis was used to analyze the risk factors for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.ROC curve was used to evaluate the predictive value of preoperative serum SCCA for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma,and the optimal cut-off value was determined by Yoden index.Results When comparing the general data of the two groups of patients,the differences in the degree of cervical squamous carcinoma cell differentiation,clinical stage of cervical squamous carcinoma,tumor diameter of cervical squamous carcinoma,whether the phenomenon of parametastasis was present,whether the phenomenon of choroidal infiltration was present,depth of infiltration,and SCCA level were statistically significant,P<0.05; multi-factor logistic analysis showed that the degree of cervical squamous carcinoma cell differentiation,positive vascular invasion,depth of invasion and SCCA level were risk factors for pelvic lymph node metastasis in cervical squamous cell carcinoma patients.The results of ROC curve analysis showed that the area under the curve of SCCA level was 0.909 and the optimal cut-off value was 0.597 5 μg/L.Conclusions Preoperative serum SCCA level had good predictive value for the occurrence of pelvic lymph node metastasis in patients with cervical squamous carcinoma.

目的 研究对比胃癌患者术前胃镜活检病理与外科术后病理的异同并进行观察。方法 选取我院消化科于2016年7月—2017年12月收治的64例胃癌患者作为此次研究对象,术前均展开胃镜活检,术后展开外科病理检查,判断两种诊断方法的异同。结果 胃癌确诊率对比,术前胃镜活检后确诊胃癌患者占比85.9%(55/64),疑似胃癌患者占比10.9%(7/64),排除胃癌患者占比3.1%(2/64),术前胃镜活检确诊率85.9%,低于术后病理诊断95.3%,组间比较差异无统计学意义(P>0.05);胃镜活检病理结果对比,术前胃镜检查黏液腺癌占比35.9%,乳头状腺癌占比51.6%,均高于术后病理检查的25.0%、28.1%,组间比较差异具有统计学意义(P＜0.05);胃镜活检分化程度结果对比,胃镜病理与术后病理检查结果对比有明显差异,具有统计学意义(P＜0.05)。结论 对胃癌进行诊断时,尽管术前胃镜活检病理检查与外科术后病理检查结果存在差异,但术前胃镜活检对胃癌确诊率较为理想,可作为术前诊断参考,外科术后病理检查对全面评估胃癌病情具有较高应用价值,值得在临床中应用。

目的 观察比较术中及术前化疗干预对进展期胃恶性肿瘤手术患者p53、ki-67表达及预后的影响,为临床化疗时间的选择提供理论依据。方法 自2014年8月—2015年5月,我院共收入胃恶性肿瘤患者40例,将40例患者随机分为两组,每组各20例,保证两组患者在性别、年龄、胃癌分期等方面可比,无统计学差异(P＞0.05),标记为Ⅰ组和Ⅱ组。Ⅰ组20例患者于术前进行化疗干预,Ⅱ组在术中给予化疗干预。观察比较两组患者p53、ki-67表达状况及预后。结果 Ⅰ组及Ⅱ组治疗后p53及ki-67均比治疗前升高,差异有统计学意义(P<0.05)。但是治疗后,Ⅰ组和Ⅱ组的p53表达状况组间差异不明显,无统计学意义(P>0.05)。治疗前后,AI差异有统计学意义(P<0.05)。Ⅰ组效果明显好于Ⅱ组,两者差异有统计学意义(P <0.05)。术后六个月、一年随访时发现两组复发率、死亡率差别不大,无统计学意义(P>0.05),术后两年随访发现Ⅱ组复发率、死亡率明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论 术中化疗的疗效优于术前化疗,患者预后较术前化疗好。

Objective To observe the effect of intraoperative and preoperative chemotherapy on the expression of p53, Ki-67 and prognosis in patients with advanced gastric cancer. Methods 40 cases of advanced gastric cancer in our hospital from Aug 2014 to May 2015 were enrolled in the study, and were divide into 2 groups randomly. In group I, 20 patients received chemotherapy intervention befoerer operation, and the other group received chemotherapy intervention during operation. The expressions and prognosis of p53 and Ki-67 were observed and compared between the two groups. Results Group Ⅰ and group Ⅱ after treatment, p53 and Ki-67 were higher than that before treatment, with statistical significance(P<0.05). However, there was no significant difference in the expression of p53 between group Ⅰ and group Ⅱ after treatment, and there was no significant difference(P>0.05). Before and after treatment, the difference of AI was significant, with statistical significance (P<0.05). The effect of group Ⅰ was obviously better than that of group Ⅱ, the difference was statistically significant(P<0.05). Six monthse after the operation and one year follow-up found two groups of recurrence rate and mortality rate had no significant difference(P>0.05). After two years follow-up found the group Ⅱ recurrence rate, mortality was lower than in group Ⅰ (P<0.05). Conclusion The effect of intraoperative chemotherapy is better than that of preoperative chemotherapy, and the prognosis is better than that of preoperative chemotherapy.

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.