目的 探讨内镜黏膜下剥离术(ESD)治疗结直肠高级别上皮内瘤变(HGIN)的安全性及临床疗效。方法 回顾性分析2016年1月—2019年6月在南方医科大学附属小榄医院经肠镜活检诊断为结直肠HGIN并接受ESD治疗的56例患者的临床资料,记录每例病变的术后病理、整块切除率、治愈性切除率、手术并发症和随诊结果。结果 病灶平均直径为(2.28±0.76) cm。53例经ESD术完整切除,3例术中改用内镜下黏膜分片切除术切除,整块切除率为94.64％ (53/56)。术后病理51例HGIN,2例HGIN伴黏膜内癌,2例浸润性癌,术前活检与术后病理总符合率为92.86%(52/56),治愈性切除率为96.43%(54/56)。术中出血发生率为89.29%(50/56),术后迟发性出血发生率为3.57%(2/56)。术中穿孔发生率为5.36%(3/56),无术后迟发性穿孔病例。中位随访期为17个月,期间共1例患者复发。结论 ESD术治疗结直肠HGIN安全有效,但需警惕浸润性癌的可能。ESD术具有较高的术中出血和穿孔的风险,术者需具备熟练的操作技术及处理手术并发症的经验。

Objective To investigate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for colorectal high-grade intraepithelial neoplasia (HGIN). Methods Data of 29 patients diagnosed as colorectal HGIN and underwent endoscopic submucosal dissection (ESD) from January 2016 to June 2019 were retrospectively analyzed. Postoperative pathology, total en bloc resection rate, curative resection rate, complication and follow-up results were recorded. Results The mean diameter of the lesions was (2.28±0.76) cm. A total of 53 cases were successfully treated by ESD, 3 cases were changed using endoscopy piecemeal mucosal resection, the en bloc resection rate was 94.64% (53/56). Postoperative diagnosis confirmed 52 cases of HGIN, 2 cases of HGIN with intra-mucosal cancers and 2 case of invasive cancer,the overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 92.86% (52/56), the curative resection rate was 96.43% (54/56). The incidence of intro-operative bleeding and postoperative delayed bleeding was 89.29% (50/56) and 3.57% (2/56) respectively. The incidence of intro-operative perforation was 5.36% (3/56) and no delayed perforation occurred. The median follow-up period was 17 months and one case recurred. Conclusion ESD is a safe and effective treatment for colorectal HGIN, but invasive cancer must be cautioned. ESD has high risk of intro-operative bleeding and perforation, therefore, the surgeon must have skilled operation and treatment experience for complications.

目的 分析上消化道早癌与癌前病变内镜下治疗的效果。方法 将2017年10月—2020年10月接诊且行传统外科手术治疗的75例上消化道早癌与癌前病变患者作为对照组,将同期接诊且行内镜黏膜下剥离术(ESD)治疗的75例上消化道早癌与癌前病变患者作为观察组,对组间围手术期指标、生活质量、疼痛评分、病灶切除情况、治疗效果、并发症发生率展开分析。结果 (1)观察组术中出血量(17.66±2.25)mL、手术用时(96.79±9.25)min、住院时间(10.95±1.88)d、治疗费用(1.74±0.41)万元均少于对照组(87.73±5.63)mL、(190.52±10.68)min、(22.75±2.69)d、(4.96±0.37)万元(P<0.05);(2)组间生活质量、疼痛评分在术前无差异(P>0.05);观察组生活质量、疼痛评分在术后优于对照组(P<0.05);(3)观察组治愈性切除率(98.67%)、整块完整切除率(100.00%)与对照组(96.00%、98.67%)无差异(P>0.05);(4)观察组总有效率(96.00%)与对照组(97.33%)无明显差异(P>0.05);(5)观察组发生2例并发症(2.67%),对照组发生11例并发症(14.67%,P<0.05)。结论 对上消化道早癌与癌前病变患者行ESD治疗,疗效显著,可以减少并发症,减轻疼痛感与经济压力,改善生活质量,值得推广。

Objective To analyze the effect of endoscopic treatment of early upper gastrointestinal cancer and precancerous lesions. Methods From October 2017 to October 2020, 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by traditional surgery were selected as the control group, and 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by endoscopic submucosal dissection (ESD) were selected as the observation group. The therapeutic effect and the incidence of complications were analyzed. Results (1) The intraoperative blood loss was (17.66±2.25) mL, operation time was (96.79±9.25) min, hospitalization time was (10.95±1.88) d, treatment cost was(17.4±4.1)thousand yuan in the observation group, which were less than those in the control group [(87.73±5.63) mL, (190.52±10.68) min, (22.75±2.69) d, (49.6±3.7) thousand yuan, (P＜0.05)]. (2) There were no significant differences in quality of life and pain score between groups before operation. The quality of life and pain score of the observation group were better than those of the control group after operation (P<0.05). (3) The curative resection rate (98.67%) and complete resection rate (100.00%) of the observation group were not significantly different from those of the control group (96.00% and 98.67%,P＞0.05); (4) The total effective rate (96.00%) of the observation group was not significantly different from that of the control group (97.33%,P＞0.05); (5) The total effective rate of the observation group was significantly higher than that of the control group (97.33%). There were 2 cases of complications in the observation group (2.67%), and 11 cases in the control group (14.67%, P<0.05). Conclusion ESD treatment for patients with early upper gastrointestinal cancer and precancerous lesions has significant effect, can reduce complications, relieve pain and economic stress, and improve the quality of life, which is worthy of promotion.

目的 探讨超声引导下宫颈癌根治术的应用效果及对患者远期生存率的影响。方法 选取本院2015年1月—2017年12月共收治的70例宫颈癌患者作为研究对象,将2016年7月—2017年12月纳入的患者作为观察组,2015年1月—2016年6月纳入的患者作为对照组,各35例,给予对照组患者常规腹腔镜根治术,给予观察组患者超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗。对比两组患者的治疗效果、远期生存率与复发率以及术后6个月、1年、2年、3年的FACT-G评分情况。结果 两组疾病控制率对比无差异(97.14% vs 85.71%,P＞0.05);观察组的治疗总有效率为高于对照组的(85.71% vs 60.00%,P＜0.05);观察组和对照组患者1年生存率对比无差异(P＞0.05),观察组2年、3年生存率高于对照组(P＜0.05),观察组和对照组1年局部复发率对比无差异(P＞0.05),观察组的2年、3年局部复发率低于对照组(P＜0.05);观察组术后6个月、1年、2年、3年的FACT-G评分高于对照组(P＜0.05)。结论 应用超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗宫颈癌能够提升患者的治疗效果,减少疾病复发和提高远期生存率,提升患者的生存质量,值得临床应用推广。

Objective To investigate the application effect of ultrasound-guided radical hysterectomy for cervical cancer and its influence on the long-term survival rate of patients. Methods A total of 70 patients with cervical cancer admitted from January 2015 to December 2017 were selected as the research subjects, and the patients enrolled from July 2016 to December 2017 were selected as the observation group, patients from January 2015 to June 2016 as the control group, each with 35 cases. The control group was given conventional laparoscopic radical hysterectomy, and the observation group was given ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation technology. The treatment effect, long-term survival rate, recurrence rate and FACT-G scores 6 months, 1 year, 2 years and 3 years after operation were compared between the two groups. Results There were no significant differences in disease control rates between the two groups (97.14% vs 85.71%, P>0.05); the total effective rate of treatment in the observation group was higher than that in the control group (85.71% vs 60.00%, P<0.05). There was no significant difference in the 1-year survival rate between the observation and the control group (P>0.05). The 2-year and 3-year survival rate of the observation group were higher than that of the control group (P<0.05). There was no significant difference in comparison of 1-year local recurrence rate between the observation group and the control group (P>0.05). The 2-year and 3-year local recurrence rate of the observation group were lower than that of the control group (P<0.05). FACT-G scores in the observation group after surgery at 6 months, 1 year, 2 years, and 3 years were significantly higher than the control group (P<0.05). Conclusion The application of ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation in the treatment of cervical cancer can improve the treatment effect, reduce disease recurrence rate, increase long-term survival rate, and improve the quality of life of patients, which is worthy of clinical application and promotion.

目的 通过对不同受孕能力精子外显子的分析,寻找并验证特异性外显子作为精子受孕能力的生物标记物。 方法 基于二代测序数据进行生物信息学分析,寻找特异性外显子并设计引物。各取8份高、低受孕能力精液标本,提取精子RNA反转录后进行real time q-PCR验证外显子的表达效率,筛选表达差异恒定的精子外显子作为生物标记物。各取10份高、低受孕能力精子标本,用筛选后的外显子引物进行real time q-PCR验证。 结果 生物信息学分析得到31个候选精子外显子,从31个候选外显子中筛选出9个表达差异恒定的精子外显子GAPDHS、HSF2BP、HSPA1L、ADAM21、SPEM1、WBP2NL、DDX20、TSGA10、PGK2;real time q-PCR验证结果显示,在高、低受孕能力精液标本中这9种精子外显子表达差异明显。 结论 初步确定,差异表达恒定的九种外显子可作为评估精子质量的生物标记物。

Objective To find and verify specific exons as biomarkers of sperm fertility by analyzing sperm exons with different fertility ability.Methods Based on the second generation sequencing data, bioinformatics analysis was conducted to find specific exons and design primers. We obtained 16 semen samples, 8 of high and the other 8 of low fertilizing ability, after the sperm RNAs were extracted and reverse-transcribed, real time q-PCR was performed to verify the expression efficiency of exons, and the sperm exons with constant expression difference were selected as biomarkers. 10 high and 10 lowfertility ability sperm samples were taken for real time q-PCR verification with screened exon primers. Results Thirty-one sperm exons were obtained by bioinformatics analysis, and 9 sperm exons with constant expression differences were selected from the 31 candidate exons, including GAPDHS, HSF2BP, HSPA1L, ADAM21, SPEM1, WBP2NL, DDX20, TSGA10 and PGK2. The results of real time q-PCR verification showed that the exons of these 9 sperm were significantly different in the semen samples with high and low fertility ability. Conclusion Nine exons with constant differential expression can be used as biomarkers to evaluate sperm quality.

目的 探讨35周岁以下患者行D5单囊胚移植的可行性。方法 回顾性分析2016年1月—2019年7月期间,女方年龄≤35岁,在本中心行新鲜周期全胚冻后第一冻融移植的663个周期,根据胚胎发育天数及囊胚移植数目分为三组:D3双优胚移植组(D3双优组:n=508)、D5单囊胚移植组(D5单囊组:n=47)、D5双囊胚移植组(D5双囊组:n=108),对三组的临床结局进行比较分析。结果 D5双囊组临床妊娠率高于D3双优组及D5单囊组,且差异有统计学意义(P＜0.05),但D5单囊组与D3双优组相比,无统计学差异(P＞0.05);D5单囊胚的多胎率低于D5双囊组及D3双优组,差异均有统计学意义(P＜0.001),D3双优组的多胎率也低于D5双囊组,差异亦有统计学意义(P＜0.05);D5单囊组和D5双囊组的种植率都高于D3双优组,差异都有统计学意义(分别是P＜0.05,P＜0.001),而D5单囊组合D5双囊组之间无统计学差异(P＞0.05);但三组之间的早期流产率及宫外孕率均无统计学差异(P＞0.05)。结论 年龄≤35周岁的患者全胚冷冻后第一冻融移植周期选择D5单囊胚进行移植,既能获得良好的临床妊娠率和种植率,又极大降低多胎妊娠率。

Objective To investigate the clinical outcomes of the single blastocyst transfer of day 5 in the women under 35 years old. Methods A retrospective study was conducted to analyze clinical outcomes of women less than 35 years old and experienced embryo transfer in the first frozen-thawed cycles from January 2016 to July 2019 in the Center of Reproductive Medicine of Guangzhou Women and Children's Medical Center. According to the embryo developmental days and transfer blastocyst numbers, all patients were divided into three groups: double high-quality cleavage embryo transfer of day 3 (n=508), single blastocyst transfer of day 5(n=47), double blastocyst transfer of day 5(n=108). The clinical outcomes were compared. Results The clinical pregnancy rate of the double blastocyst transfer of day 5 was higher than the other two groups,and the differences were statistically significant(P＜0.05). However, there was no statistical difference between the single blastocyst transfer of day 5 and the double high-quality cleavage embryo transfer of day 3(P＞0.05). The multiple pregnancy rate of the single blastocyst transfer of day 5 was lower than the other two groups, and the differences were statistically significant (P＜0.001),and that of the double high-quality cleavage embryo transfer of day 3 was even lower than that of the double blastocyst transfer of day 5,and the difference was statistically significant(P＜0.05). The implanting rate of the double high-quality cleavage embryo transfer of day 3 was lower than the other two groups, and the differences were statistically significant (P＜0.05;P＜0.001),but there was no statistical difference between the single blastocyst transfer of day 5 and the double blastocyst transfer of day 5 (P＞0.05). However, the early miscarriage rate and the ectopic pregnancy rate did not exhibit statistical differences (P＞0.05). Conclusion Single blastocyst transfer of day 5 can ensure clinical pregnancy rate and implantation rate while effectively reducing multiple pregnancy in the women undergoing the first frozen-thawed cycles of under 35 years old.

目的 探讨高通量透析模式对改善维持性血液透析(MHD)患者β2微球蛋白清除率及高血压的影响。方法 选择2018年9月1日—2018年10月31日期间在广州市增城区新塘医院血液净化中心接受MHD患者40例为实验对象(除外因自身耐受因素长期使用低通量透析患者)。采用随机数表法分两组,每组20例。对照组接受低通量血液透析,观察组接受高通量血液透析。比较两组治疗效果,并记录0个月、3个月、6个月、12个月、18个月治疗前后β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、心率、血压变化,并对两组心血管疾病情况进行统计。结果 观察组总有效率为95.00%,高于对照组的20.00%(P<0.05);治疗后,观察组β2-MG、iPTH均降低,而3个月后对照组略有升高,观察组[(12.48±2.10)mg/L、(210.13±18.12)ng/L]低于对照组[(30.21±2.37)mg/L、(289.41±17.02)ng/L],观察组治疗3个月、6个月、12个月、18个月的β2-MG清除率高于对照组(P<0.05);与治疗前比较,两组的平均动脉压、收缩压均降低,且观察组低于对照组(P<0.05);对照组各时间点24小时舒张压及收缩压差异无统计学意义(P>0.05);与治疗前比较,观察组24小时舒张压、收缩压治疗后1个月、3个月、6个月、12个月、18个月均降低,且低于对照组(P<0.05);两组患者心血管疾病发生率比较:观察组有1例因急性心肌梗死住院行PCI术;对照组有2例因心力衰竭住院治疗,1例因急性冠脉综合症住院治疗。两组并发症发生率比较P>0.05。结论 高通流量透析模式可有效提高MHD患者的治疗效果,有效清除血液毒素,降低患者的高血压,减少并发症,可在临床推广使用。

Objective To investigate the effect of high flux dialysis mode on the improvement of β2-microglobulin clearance and hypertension in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD at the Blood Purification Center of Xintang Hospital, Zengcheng District, Guangzhou from September 1, 2018 to October 31, 2018 (except for long-term low-flux dialysis patients due to self-tolerance factors)were selected. Random number table method was used to divide the patients into two groups,20 patients in each group. The control group received low flux hemodialysis, and the observation group received high flux hemodialysis. The treatment effects of the two groups were compared, levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), changes in heart rate and blood pressure, and statistics on cardiovascular disease in the two groups before and after treatment at 3, 6, 12, and 18 months were recorded. Results The total effective rate in the observation group was 95.00%, which was higher than the 20.00% in the control group (P<0.05). After treatment, the levels of β2-MG and iPTH of the two groups decreased, and the observation group [(13.02±2.10) mg/L, (210.13±18.12) ng/L] was lower than the control group [(19.78±2.37) mg/L, (289.41±17.02)ng/L]; the β2-MG clearance rate of the observation group was higher than that of the control group at 3 months, 6 months, 12 months, and 18 months (P<0.05).Compared with that before treatment, the average arterial pressure and systolic blood pressure of the two groups were reduced, and the observation group was lower than that of the control group (P<0.05); the differences between diastolic blood pressure and systolic blood pressure at each time point in the control group were not significant (P>0.05); the 24-hour diastolic blood pressure and systolic blood pressure of the observation group decreased after 1, 3, 6, 12 and 18 months, compared with those before treatment (P<0.05), and were lower than those in the control group (P＜0.05).Comparison of the incidence of cardiovascular disease between the two groups: 1 case in the observation group was hospitalized for acute myocardial infarction; 2 cases in the control group were hospitalized for heart failure and 1 case was hospitalized for acute coronary syndrome; complications incidence in the two groups were compared (P>0.05). Conclusion The high flux dialysis mode can effectively improve the treatment outcomes of MHD patients, effectively remove blood toxins, lower blood pressure, and reduce the incidence of complications. It can be used in clinical practise.

目的 儿童流感相关坏死性脑病(influenza-associated necrotizing encephalopathy,IANE)是一种严重的流感并发症,目前缺乏早期诊断预警指标,本文探讨血生化和脑脊液检测在儿童IANE早期预警中的作用,为IANE早期诊断提供预测参考。 方法 回顾分析2016年1月—2020年12月在我院接受诊治的确诊流感并发神经系统并发症的患儿。40例流感相关性脑病(influenza-associated encephalopathy,IAE)和32例IANE患儿纳入研究。采用受试者工作特征曲线(ROC)分析来确定所选变量的预警价值。 结果 与IAE组相比,IANE组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐激酶(CK)、乳酸脱氢酶(LDH)、脑脊液乳酸脱氢酶(CSF LDH)、脑脊液蛋白(CSF PRO)均升高,两组差别有统计学意义(P<0.05)。用于区分IAE和IANE的LDH、CSF LDH和CSF PRO的曲线下面积(AUC)分别为0.876、0.853和0.831。LDH>535 U/L预测IANE的敏感度为89.7%,特异度为86.5%。CSF LDH>67 U/L预测IANE的敏感度为82.8%,特异度为73.3%。CSF PRO>0.49 g/L预测IANE的敏感度为73.7%,特异度为76.6%。IANE患儿死亡10例(43.3%),IAE患儿死亡0例(P<0.05)。 结论 IANE组LDH、CSF LDH和CSF PRO明显升高,可作为IANE的早期预警指标。对此类患儿要密切评估,早期预测及干预,减少后遗症及病死率,改善预后。

Objective Influenza-associated necrotizing encephalopathy (IANE) in children is a serious complication of influenza. At present, there is a lack of indicators for early diagnosis and early warning. In this paper, the role of blood biochemical and cerebrospinal fluid detection in early warning of IANE in children is discussed, so as to provide a predictive reference for early diagnosis of IANE. Methods A retrospective analysis was conducted on children diagnosed with influenza and with neurological complications who were treated in our hospital from January 2016 to December 2020. Forty children with influenza-associated encephalopathy (IAE) and 32 children with IANE were included. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive value of the selected variables. Results Compared with IAE group, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine kinase (CK), lactate dehydrogenase (LDH), cerebrospinal fluid lactate dehydrogenase (CSF LDH) and cerebrospinal fluid protein (CSF PRO) were all increased in IANE group, and the differences between the two groups were statistically significant (P<0.05). The area under curve (AUC) of LDH, CSF LDH and CSF PRO used to distinguish IAE from IANE were 0.876, 0.853 and 0.831, respectively. The sensitivity and specificity of LDH>535 U/L for predicting IANE were 89.7% and 86.5% respectively. The sensitivity and specificity of CSF LDH>67 U/L for predicting IANE were 82.8% and 73.3% respectively. The sensitivity and specificity of CSF PRO＞0.49 g/L in predicting IANE were 73.7% and 76.6%. There were 10 deaths of IANE (43.3%) and 0 death of IAE (P<0.05). Conclusion The levels of LDH, CSF LDH and CSF PRO were significantly increased in IANE group, which could be used as early warning indicators for IANE. For such children, close evaluation, early prediction and intervention should be made to reduce sequelae and fatality rate and to improve prognosis.

目的 探讨Sysmex-2100全自动血液分析仪检测β-地中海贫血(β-地贫)患儿血小板参数显示不全的原因。方法 收集2017年4月—2020年4月期间本院确诊β-地贫患儿301人,其中重型病例204例,非重型97例。对301例患儿均采用希森美康Sysmex-2100血细胞分析仪进行血细胞分析,标本制作血涂片充分干燥后经瑞氏-吉姆萨染色,由主管技师及以上检验人员进行人工镜检。结果 301例β-地贫患儿血细胞分析结果出现血小板参数不显示者102例,占33.89％;其中有小红细胞、红细胞碎片、血小板聚集97例(95.10％);血小板直方图异常93例(91.18％)。重型β-地贫患儿血小板参数显示不全者75例,非重型β-地贫患儿血小板参数显示不全者27例,两组间血小板参数显示不全比例差异无统计学意义(P= 0.126)。血小板参数全显示病例的平均红细胞体积高于血小板参数显示不全病例,差异有统计学意义(P< 0.0001)。结论 小细胞低色素性红细胞及红细胞碎片化是β-地贫患儿血小板参数显示不全的主要原因,通过血小板直方图正常与否可大致判断血小板参数的可信度,采用PLT-O通道检测及涂片镜检查找原因,可提高结果的准确性。

目的 描述下肢深静脉血栓(deep vein thrombosis,DVT)患者抗凝药服药知识、信念与依从性的现状并探讨三者间的相关性,为提高下肢DVT患者服药依从性提供依据。方法 采取方便抽样的方法,抽取2019年7月—2020年5月广州市某三甲医院随诊的下肢DVT患者100例。采用一般资料调查表、抗凝药服药知识问卷、中文版服药信念特异性问卷、中文修订版8条目Morisky服药依从性量表进行问卷调查。结果 下肢DVT患者的抗凝药服药知识平均得分为(0.72±0.11)分,处于良好水平;服药信念得分为(2.06±4.34)分,处于中等水平;服药依从性得分为(6.52±1.08)分,处于中等水平;服药知识与服药信念呈正相关(r=0.301,P<0.01),与服药依从性呈正相关(r=0.232,P<0.05);患者的服药信念与服药依从性呈正相关(r=0.373,P<0.01)。结论 提高下肢DVT患者抗凝知识水平可以提高患者的服药信念和服药依从性,提高患者的服药信念可以提高患者的服药依从性。

目的 本研究探讨补肾养骨口服液对强直性脊柱炎的疗效及其安全性。方法 本研究为随机对照试验,研究了补肾养骨口服液+塞来昔布胶囊对比单纯用塞来昔布胶囊治疗强直性脊柱炎的效果,观察指标有腰臀痛程度、僵硬持续时间、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、ASAS 20改善标准,观察时间点为第1和第12周。在整个研究过程中,通过血液、肝脏和肾功能测试来监测安全性,并记录不良反应。结果 有60名患者参加了此次试验。①两组治疗均有效:补肾养骨口服液+塞来昔布胶囊组30例(80.3%),塞来昔布组30例(60.8%),两组的ASAS 20都达到改善标准;但补肾养骨口服液+塞来昔布胶囊组效果好于塞来昔布组(P＜0.05)。②两组监测指标(腰臀痛程度、僵硬持续时间、ESR、CRP)对比,治疗后改善显著,而且补肾养骨口服液+塞来昔布胶囊组比塞来昔布组改善更明显。③两组治疗前后血常规、肝肾功能未见异常,但补肾养骨口服液+塞来昔布胶囊组不良反应发生率12.5%,而塞来昔布组为52.5%,两组差异具有统计学意义(P＜0.05)。结论 本研究说明了补肾养骨口服液在治疗强直性脊柱炎中具有疗效,且较安全。