目的 探讨卵巢上皮性癌患者治疗前后外周血血小板计数(PLT)变化的临床意义。方法 采用全血细胞自动分析仪检测115例卵巢上皮性癌患者治疗前和经过有效治疗后的97例患者血小板计数增多检出率的比较,并分析卵巢上皮性癌患者治疗前血小板计数增多与临床病理因素的相关性。结果 33.04％卵巢上皮性癌患者治疗前伴有血小板计数增多,经过有效治疗后,血小板计数增多者降为9.28%,较治疗前明显下降,差异有统计学意义(P<0.05)。卵巢上皮性癌患者治疗前血小板增多与FIGO分期、残余肿瘤灶直径、腹水细胞学和临床疗效相关(P＜0.01)。结论 血小板作为一种简单、经济、灵敏的临床常用指标,监测其表达对于预测卵巢癌临床疗效和预后评估具有临床价值。

目的 探讨腹腔镜治疗肝右叶癌的疗效。方法 2011年6月—2014年9月我院对78例肝右叶癌行手术治疗,其中18例行全腹腔镜肝癌切除术,60例行开腹肝癌切除术。比较两组患者的手术时间、术中出血量、术后住院时间、术后并发症发生率、术后一年生存率。结果 腹腔镜组手术时间为(348.8±98.8)min,长于开放手术组,差异具有统计学意义(P<0.05);腹腔镜组术中出血量、术后住院时间、术后并发症发生率均少于开放手术组,相比差异具有统计学意义(P<0.05);两组患者术后1年复发率及生存率比较未见统计学意义(P>0.05)。结论 腹腔镜治疗肝右叶癌手术难度大,但相比开腹手术,腹腔镜肝右叶癌切除术具有术中出血量少、术后住院时间短、术后并发症发生率低的优点。

Objective To evaluate the clinical efficacy of laparoscopic treatment of carcinoma of the right lobe of the liver. Methods from June 2011 to September 2014 in our hospital 78 cases of liver cancer of right lobe underwent surgical treatment, including 18 cases of pure laparoscopic liver resection, 60 cases underwent open resection of hepatocellular carcinoma. Comparing the two groups of patients with operation time,intraoperative bleeding volume,postoperative hospitalization time, postoperative complication rat and one year survival rate. Results The operative time of laparoscopic group was 348.8±98.8 min, longer than the open surgery group, the difference has statistical significance (P<0.05); The intraoperative bleeding volume,postoperative hospitalization time,postoperative complication rate in the laparoscopic group was less than that of the open surgery group, the difference has statistical significance (P<0.05); Two groups of patients with postoperative 1 year survival rate and recurrence rate were not statistically significant (P>0.05). Conclusion Laparoscopic treatment of the liver cancer of the right lobe is difficult, but compared to open surgery, laparoscopic resection of the liver cancer of the right lobe has advantages of less bleeding, shorter postoperative hospitalization, lower postoperative complication rate.

目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.

目的 探讨结肠粪性穿孔的发病原因、临床特点、诊断和治疗方法。方法 回顾性分析广州市第一人民医院2012年1月—2015年1月收治的12例结肠粪性穿孔病人的临床资料。结果 本组病人共12例,均因腹膜炎体征行剖腹或腹腔镜探查术,术中根据Maurer标准诊断为结肠粪性溃疡穿孔。本组病人术后治愈出院10例,治愈率为83.3%,2例80岁以上病人因感染中毒性休克、多器官功能衰竭分别于术后第2天及第3天在重症监护病房死亡,死亡率为16.7%,术后主要合并症为肺炎(10例,83.3%)及胸腔积液(12例,100%)。结论 在临床工作中,了解结肠粪性穿孔发生的危险因素,及时进行有针对性的辅助检查,快速手术干预是降低病死率的关键。

Objective To explore the causes, clinical characteristics, diagnosis and treatment of stercoral perforation of colon. Methods The clinical data of 12 cases of stercoral perforation of colon from Jan 2012 to Jan 2015 were retrospectively analyzed. Results There were twelve patients who were diagnosed stercoral perforation of colon according to accurate diagnostic criteria during the open or laparoscopic operation. Of the 12 cases, 10 cases (83.3%) were cured, 2 cases (16.7%) died because of septic shock and multiple organ failure in the intensive care unit. After operation 10 cases (83.3%) had pulmonary infection and 12 cases (100%) had pleural effusion. Conclusion The key of improve the prognosis of stercoral perforation of colon depends on the full understanding of risk factors, proper preoperative examination and prompt surgical procedures.

目的 探讨胰腺神经鞘瘤的临床特点和诊治方法。方法 总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果 共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁(范围17～89岁),其中女性40例(56%)。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6.1 cm(1～20 cm)。肿瘤位于胰头部29例(40%)、胰体/尾部32例(44%),沟突部6例(8%)。肿瘤表现为实性肿物27例(38%)、囊性28例(39%)、囊实性10例(14%)。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例 (7%) 患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[(13.8±6.2)cm vs (5.6±4.1)cm,P=0.0004)]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论 胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。

Objective To analyze clinical presentation, diagnosis, treatment options, and outcome of pancreatic schwannoma. Methods A retrospective study of clinical data of a case in our hospital and 71 cases reported in literature with pancreatic schwannoma. Results 72 cases were analysed. The mean age was 54 years (range 17-89 years), with 56 % of patients being female. Mean tumor size was 6.1 cm (range 1-20 cm). Tumor location was the head (29 cases), body and tail (32 cases), and uncinate process (6 cases). 27 cases exhibited solid tumors and 28 cases exhibited cystic tumors. Treatment included pancreaticoduodenectomy (23 cases), distal pancreatectomy (15 cases), enucleation (16 cases). 5 cases (7%) were malignant schwannoma. Tumor size of malignant group was significant larger than benign group (13.8±6.2 cm vs 5.6±4.1 cm,P=0.0004). There was no local recurrence metastasis,or death at the follow-up after operation (range 3-65 months). Conclusion The clinical manifestations of pancreatic schwannoma are lack of specificity and preoperative diagnosis remains difficulty. The tumor size was significantly related to classification of malignant or benign. Pancreatic schwannoma has satisfactory prognosis with surgical treatment.

目的 探讨胸部良性疾病非计划二次手术的原因,降低非计划二次手术率,研究防止措施。方法 回顾性分析2006年5月—2016年5月间胸部良性疾病患者行外科手术治疗的临床资料574例,其中16例术后因各种原因行非计划二次手术,总结胸部良性疾病外科治疗后非计划二次手术的临床特点、治疗经过及原因,对可能的影响因素进行单因素分析和多因素分析。结果 本组患者行非计划二次手术,无死亡病例,二次手术手术时间为30～215(135.6±47.4) min。术中出血量50～650 (313.6±93.1)mL。术后住院时间7～30(15.7±6.8)d。二次手术原因包括术后出血 (10例)、术后肺持续漏气(4例)、切口感染(2例)。单因素分析首次手术疾病分类,首次手术时间,首次手术方式与胸部良性疾病非计划二次手术相关性有统计学意义(P<0.05),多因素分析结果显示首次手术疾病分类,首次手术时间,首次手术方式是胸部良性疾病非计划二次手术的独立危险因素(P<0.05)。结论 根据胸部良性疾病的不同疾病类别来估计和预防可能出现的并发症,特别是胸部炎症性病变,术前充分准备、术中仔细操作、术后并发症的早期积极处理,能降低胸部良性疾病非计划二次手术的发生率。

Objective To investigate the causes of benign thoracic disease unplanned reoperation,improve the level of diagnosis and treatment and reduce the rate of unplanned reoperation. Methods From May 2006 to May 2016,594 cases of benign thoracic disease were performed thoracic surgery,including 16 patients underwent the unplanned reoperation due to various reasons. The clinical characteristics, therapy course and results of benign thoracic disease unplanned reoperation were analyzed retrospectively. Results The patients underwent the unplanned reoperation were no deaths. The operative time 30～215(135.6±47.4)min, intraoperative blood loss 50～650 (313.6±93.1)mL,postoperation hospitalization duration 7～30(15.7±6.8)d. The causes of benign thoracic disease unplanned reoperation were as follows: postoperative bleeding (10 cases), prolonged air leaks (4 cases),incision infection (2 cases). Univariate analysis showed first-time classification of diseases, operative time and operation method were statistically significant (P<0.05), Multivariate Logistic regression analysis revealed first-time classification of diseases, operative time and operation method were independent factors associated with benign thoracic disease unplanned reoperation. Conclusion According to the different classification of benign thoracic disease to estimate and prevent possible complications, we need to have sufficient preoperative preparation, intraoperative careful operation. Early active processing can be taken in postoperative complications.It can reduce the incidence of unplanned reoperation in benign thoracic disease,especially the chest inflammatory diseases.

目的 总结分析青光眼术后前房形成延缓的原因与处理措施。方法 选取2010年12月—2013年12月在我院行青光眼滤过术的84例患者(112眼),回顾性分析术后发生浅前房的原因及相应处理措施。结果 术后出现浅前房为26眼,占23.2%;其中高滤过泡引流过畅18眼(69.2%),结膜伤口渗漏5眼(19.2%),脉络膜脱离2眼(7.6%),恶性青光眼1眼(3.8%),大多数浅前房均经保守治疗恢复,1例需行再次手术。结论 青光眼术后前房延缓形成发生率较高,主要原因是脉络膜脱离、滤过作用强、结膜伤口渗漏、恶性青光眼等,及时发现并采取相应处理是浅前房恢复正常的关键。

目的 探讨脊髓小脑性共济失调一家系的临床表现、影像学特点和基因型及三者之间的联系。方法 描述一家系5例患者的临床表现,总结其特点,对部分患者行头颅磁共振及基因检测。结果 一家系4代7名成员中共有5例发病,以行走不稳和言语含糊为突出表现,头颅MRI示小脑萎缩,基因检测SCA3相关基因的CAG重复数为65次,确诊为SCA3。结论 SCAs为一组神经系统遗传性疾病,临床以共济失调和构音障碍为突出表现,基因检测可为临床提供准确的分型。

Objective To explore the relation of clinical manifestation, MRI and gene data with the spinocerebellar ataxia. Methods To give a description of the clinical manifestation of the spinocerebellar ataxia patients, summarize the characteristics, and part of them to make the MRI and genetic detection. Results There are 5 patients among 7 numbers of 4 generations in the family.The main clinic features included gait ataxia and ambiguity in speech. Brain MRI showed atrophy on cerebellum. The repeated times of CAG of SCA3 were 65, diagnosed as SCA3 patient. Conclusion SCAs is one group of genetic diseases. The clinical manifestations are ataxia and dysarthria. Molecular genetic detection can be used for SCA subtype diagnosis.

目的 探讨产褥期静脉血栓栓塞症的发病机制、诊断、高危因素及预防措施。方法 回顾性分析2008年1月—2014年12月间在东莞市长安医院住院诊治的7例产褥期静脉血栓栓塞症患者的临床资料。结果 7例患者产后均未主动进行静脉栓塞症的预防性治疗,3例为静脉栓塞症高危患者,4例为静脉栓塞症中危患者。结论 应对产褥期患者进行静脉栓塞症的风险评估,并根据风险评估积极主动地预防静脉血栓栓塞症。

Objective To study the pathogenesis, clinical manifestation of venous thromboembolism, and its risk factors and preventive measures. Methods 7 cases of venous thromboembolism admitted in our hospital from 2008 to 2014 were reviewed retrospectively. Results All of the 7 cases were not given preventive treatment actively.3 cases were in high-risk, the other 4 cases were in intermediate risk. Conclusion It is important to assess the risk of venous thromboembolism during puerperium. And it is necessary to prevent venous thromboembolism actively based on the risk assessment.

目的 探索复发性卵巢癌放射治疗临床的效果和副作用。方法 采用回顾性分析中山大学肿瘤防治中心放射治疗中心2002年1月—2014年9月收治的复发性卵巢癌采用放射治疗的临床资料和治疗结果。结果 23例患者5年生存率为48.6%,中位生存期为54,局部无瘤生存期中位数为11.9。结论 对于局限性复发性卵巢癌放射治疗有较好的疗效和较少的副作用。

Objective To explore the clinical efficacy and side effects of radiation therapy for recurrent ovarian cancer. Methods We performed a retrospective analysis of clinical data and treatment outcomes from recurrent ovarian cancer patients who received radiation therapy from January 1999 to December 2012 at radiation treatment center of Sun Yat-sen university Cancer Center. Results Among 23 patients, the five-year survival rate was 48.6%, the median survival time was 54, and the local median disease-free survival was 11.9. Conclusion Radiation therapy has better efficacy and less side effects for non-metastatic recurrent ovarian cancer.