目的 研究新辅助化疗联合保肢手术治疗骨肉瘤的临床效果。方法 根据既往治疗骨肉瘤方法的不同,将56例患者分为对传统保肢组（A组）和现代保肢组（B组）,各28例。A组用采用传统保肢方案,即保肢手术+术后化疗方案进行;B组采用现代保肢方案,即新辅助化疗+保肢手术+术后化疗方案进行。化疗方案均采用CTX + VCR +MTX+ ADM方案,比较两组转移/复发率、术后1 年、2年及 3 年生存率、肢体功能、临床疗效情况。结果 比较两组的转移/复发率及3年后的死亡率,B组低于A组(P<0.05);肢体功能优良率及临床疗效,B组高于A组(P<0.05)。结论 新辅助化疗联合保肢手术能够降低骨肉瘤患者转移/复发率、死亡率,改善肢体功能,提高临床疗效。

Objective To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma. Methods Based on the previous methods of treating osteosarcoma, 56 patients were divided into the traditional limb salvage group (A group) and the modern limb salvage group (B group), 28 cases for each. The traditional limb salvage surgery + postoperative chemotherapy regimen were used in group A, and modern limb salvage regimen was performed in group B, ie neoadjuvant chemotherapy + limb salvage surgery + postoperative chemotherapy. The CTX + VCR +MTX+ ADM protocol was used in the chemotherapy regimens. The metastasis/recurrence rate, the 1-year, 2-year and 3-year survival rates, limb function, and clinical efficacy were compared between the two groups. Results The metastasis/recurrence rate and the mortality rate after 3 years in the two groups were compared. The B group was lower than that of the group A (P<0.05). The excellent rate of limb function and clinical efficacy were higher in the B group than that of in the group A (P<0.05). Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery may reduce the metastasis/recurrence rate and mortality of osteosarcoma patients, improve limb function and increase clinical efficacy.

目的 分析针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的临床效果。方法 选择我院收治的乳腺肿物患者200例进行观察（2012年1月—2017年12月）,针对200例乳腺肿物患者存在的305个乳腺不可触及肿物进行活检检查,采用随机分组的方式将其分成两组后针对常规组100例乳腺肿物患者实施传统手术治疗,针对治疗组100例乳腺肿物患者实施超声引导下微创旋切活检术治疗,对比两组的治疗效果。结果 两组乳腺肿物患者之间对比的术中出血量、术后愈合时间、术后并发症发生率、治疗显效率存在差异（P<0.05）,统计学有意义;且超声引导下微创旋切活检术对于乳腺癌的诊断检出率较高。结论 针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的疗效显著,促进患者预后。

Objective To analysis of the clinical effect of ultrasound guided minimally invasive rotary biopsy for untouchable breast masses. Methods A total of 200 patients with breast masses were selected for observation （January 2012 to December 2017）, and 305 untouchable breast masses in 200 patients were examined by biopsy. It was divided into two groups randomly and then treated with traditional surgical treatment for 100 patients with breast masses in the routine group and 100 patients with breast masses in the treatment group with minimally invasive biopsy under the guidance of ultrasound. The therapeutic effects of the two groups were compared. Results There were differences between the two groups in the amount of intraoperative bleeding, postoperative healing time, the incidence of postoperative complications and the effective rate of treatment （P < 0.05）, and the differences were statistically significant （P < 0.05）. The diagnostic rate of breast cancer was higher with minimally invasive rotary biopsy guided by ultrasound. Conclusion The effect of ultrasound-guided minimally invasive rotary biopsy on untouchable breast masses is significant and promotes the prognosis of the patients.

目的 比较分析神经内镜和常规开颅手术在治疗高血压脑出血时的优劣。方法 回顾性分析我院神经外科2015年12月1日—2017年12月31日收治的60例高血压脑出血患者,根据治疗术式的不同,分为对照组和观察组,各30例。对照组行常规开颅手术,观察组给予神经内镜治疗,通过对比两组患者的手术时长、术中出血量、血肿清除率、住院时间、术后并发症及术后6个月随访效果,分析两组优劣。结果 观察组手术时长短于对照组,差异有统计学意义（P<0.05）;观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组血肿清除率高于对照组,差异有统计学意义（P<0.05）;观察组术后并发症（颅内感染、肺部感染）发生率低于对照组,差异有统计学意义（P<0.05）,而两组再次出血及死亡率差异均有统计学意义（P>0.05）;观察组患者术后预后效果优于对照组,差异有统计学意义（P<0.05）。结论 神经内镜在治疗高血压脑出血时对比常规开颅手术具有显著缩短手术时长及住院时间,提高血肿清除率,减少术中出血,降低颅内及肺部感染率等优势,值得临床推广应用。

Objective To compare and analyze the advantages and disadvantages of neuroendoscopy and conventional craniotomy in the treatment of hypertensive intracerebral hemorrhage. Methods 60 patients with hypertensive intracerebral hemorrhage admitted to our hospital from December 1,2015 to December 31,2017 were divided into the control group and the observation group,each with 30 cases. The control group underwent conventional craniotomy,and the observation group underwent neuroendoscopic treatment. The length of operation,intraoperative blood loss,hematoma clearance,length of hospital stay,postoperative complications,and follow-up after 6 months were compared between the two groups, to analysis the advantages and disadvantages of both groups. Results The duration of operation in the observation group was shorter than that in the control group （P<0.05）. The intraoperative blood loss in the observation group was less than that in the control group （P<0.05）;The hematoma clearance rate in the observation group was higher than that in the control group （P<0.05）;The incidence of postoperative complications （intracranial infection,lung infection） in the observation group was lower than that of the control group （P<0.05）. There was no statistically significant in rebleeding and mortality between the two groups （P>0.05）. The prognosis of the observation group was better than that of the control group. In the control group,the difference was statistically significant （P<0.05）. Conclusion Neuroendoscope in the treatment of hypertensive intracerebral hemorrhage compared with conventional craniotomy may shorten the length of operation and hospital stay,improve hematoma clearance rate,reduce intraoperative bleeding,reduce intracranial and pulmonary infection and other advantages. It is worthy of clinical promotion and application.

目的 不同通道下的经皮肾镜取石术肾盂压力监测治疗鹿角形肾结石的临床分析。方法 选取我院2016年1月–2017年12月收治的鹿角形肾结石患者120例,通过随机分组,分别采用16F、18F、20F、22F、24F 作为手术通道,在气管插管全麻下置入8/9.8F 输尿管镜行经皮肾镜气压弹道碎石取石术,行经皮肾镜取石术,术中通过监测输尿管导管的压力,即肾盂内压并记录。测压系统每秒钟采集一次数据并录入数据库。观察不同通道下肾盂内压力以及取石速度。结果 在24F通道下肾盂内压力最低,与其他通道组进行比较,差异有统计学意义（P<0.05）;肾盂内压力大于40 cmH₂O时在24F通道下取石速度最短,与其他通道组进行比较,差异有统计学意义（P<0.05）;24F通道与22F通道下取石速度最快,与其他通道组进行比较,差异有统计学意义（P<0.05）。结论 肾盂内压监测使经皮肾镜取石术更加安全和精确,值得临床进一步推广应用。

Objective To investigate the pyelolithic pressure monitoring in percutaneous nephrolithotomy of different channel in treatment of renal staghorn calculi. Methods 120 patients of staghorn renal calculi in our hospital were selected from January 2016 to December 2017. These patients were randomly divided into 5 groups according to the operation channel（16F,18F,20f,22F,24F）. During operation,renal pelvis,ureter catheter pressure and operation time were recorded. Results The lowest renal pelvis pressure could be found in the 24F channel and the difference was statistically significant（P<0.05）. The lowest operation time could be found in the condition of the renal pelvis pressure of more than 40cmH₂O and 24F channel（P<0.05）. Beside of this, the fastest stone-free rate could be found in 22F and 24F channel（P<0.05）. Conclusion Monitoring of renal pelvic pressure makes percutaneous nephroscopic surgery more accurate and safety. It is worthy of clinical application.

目的 观察利妥昔单抗在治疗造血干细胞移植后血小板输注无效的有效性和安全性。方法 回顾分析我院2014年1月—2017年6月收治的11例利妥昔单抗治疗的造血干细胞移植后血小板输注无效的病例资料,其中包括重型地中海贫血8例,急性髓系白血病1例,重型再生障碍性贫血2例。结果 10例造血干细胞移植后血小板输注无效患者经利妥昔单抗治疗,375 mg/m²,每周1次,2~3次后血小板输注无效的状况明显改善;1例造血干细胞移植后血小板输注无效患者接受1次利妥昔单抗治疗,仍存在血小板输注无效,最终因颅内出血死亡。结论 利妥昔单抗是治疗造血干细胞移植后血小板输注无效的一种很有效的治疗方法。

Objective The purpose of our study was to evaluate the efficacy and safety of rituximab in the treatment of platelet transfusion refractoriness after hematopoietic stem cell transplantation. Methods We retrospectively analyzed 11paitents （8 thalassemia major,2 sever aplastic anemia,and 1 acute myeloid leukemia） with platelet transfusion refractoriness after hematopoietic stem cell transplantation. All 11 patients received treatment of rituximab. Results 10 of 11 platelet transfusion refractoriness patients after hematopoietic stem cell transplantation had improvement of platelets transfusion,1 patient of 11 platelet transfusion refractoriness patients had no response and died of intracranial hemorrhage. Conclusion Rituximab is a promising treatment in patients with platelet transfusion refractoriness after hematopoietic stem cell transplantation.

目的 分析并探讨应用通窍活血汤配合舒血宁注射液在治疗糖尿病视网膜病变(单纯型)中的临床效果。方法 80例患者(80只眼)按照随机的方式将其列入对照组(40只眼)和治疗组(40只眼)两组,对照组给以调节血糖、饮食控制、运动疗法等常规治疗控制血糖稳定并口服通窍活血汤,治疗组在对照组的基础上,口服通窍活血汤再配合舒血宁注射液离子导入,所有患者均由同一位眼科专科医生分别在治疗前后对所选患者行眼压、视力、眼底镜检查,同时观察其治疗前后血液流变学、血脂变化情况,观察治疗效果。结果 治疗前后血糖、糖化血红蛋白改变无差异,治疗组视力、眼底均较对照组明显改善(P＜0.01),血液流变学,血及血脂各指标的改善较对照组比较有统计学意义(P＜0.01)。结论 通窍活血汤配合舒血宁注射液在单纯型糖尿病视网膜病变中的治疗效果显著,可有明显改善患者的血脂及血液流变学,安全可靠,适合临床长期推广应用,具有较高的社会效益和经济效益,值得临床推广应用。

目的 探讨两种不同手法复位治疗向地性眼震水平半规管良性阵发性位置性眩晕的临床效果。方法 选取水平半规管良性阵发性位置性眩晕患者50例,分组进行不同手法复位治疗,短期治疗效果不佳者结合强迫长时间健侧卧位法治疗。结果 初次治疗360-Barbecue复位法组治愈率80%,Gufoni复位法组患者治愈率72%;两组患者结合强迫长时间健侧卧位法,第二天复查治愈率分别为92%和88%,两组比较差异无统计学意义(P>0.05)。结论 两种手法复位均能有效治疗向地性眼震水平半规管良性阵发性位置性眩晕,近期疗效相近,对于无效者结合FPP可增加治愈率。

Objective To study the effects of two different manual reduction of geotropic nystagmus horizontal semicircular canal benign paroxysmal positional vertigo. Methods 50 cases of patients with two different groups, treated with different manual reduction. Patients with short term treatment but ineffective were treated in combination with forced prolonged lateral position FPP. Results The cure rate of initial treatment in the 360-Barbecue manual reduction groups was 80%, the Gufoni manual reduction groups was 72%. As the patients combined with FPP, the cure rate was 92% and 88% respectively in the second day treatment. There was no significant difference between the two groups(P>0.05). Conclusion Both of the different manual reduction may effectively treat HC-BPPV. Their recent curative effect is similar. For ineffective cases may increase the cure rate combined with FPP.

目的 探讨双柏散与喜疗妥软膏治疗经外周静脉穿刺置入中心静脉导管(PICC)相关性静脉炎的临床疗效对比。方法 选取PICC相关性静脉炎患者80例,随机分为观察组和对照组各40例,观察组采用双柏散水蜜制剂外敷,对照组采用喜疗妥软膏外涂,观察2组临床疗效。结果 观察组显效率87.5％,总有效率97.5％;对照组显效率65％,总有效率80％。观察组显效率和总有效率均高于对照组(P<0.05)。两组在治疗后各时点疼痛评分均低于治疗前(P<0.01);对照组在治疗24h后各治疗时点疼痛评分均低于治疗前,差异有显著性意义(P<0.01),但在12 h治疗时点疼痛评分虽亦低于治疗前,但差异无显著性意义(P>0.05)。观察组患者在治疗后12 h、24 h、36 h和48 h时点的静脉炎疼痛评分均低于对照组,差异有显著性意义(P<0.01或P<0.05),而在72 h时点两组疼痛评分差异无显著性意义(P>0.05)。结论 本研究结果表明双柏散外敷治疗PICC相关性静脉炎效果优于喜疗妥组,且疼痛症状改善时间更早。

Objective To compare clinical efficacy in the treatment of phlebitis correlation with peripherally inserted central catheter (PICC) between Shuangbai Powder and Hirudoid cream. Methods 80 patients with PICC correlation phlebitis were randomly divided into observation group and control group. There were 40 cases in the observation group treated with Shuangbai Powder and 40 cases in the control group treated with Hirudoid cream. We observed clinical curative effect of two groups. Results The efficiency rate was 87.5% and total effective rate was 97.5% in the observation group. The efficiency rate was 65% and total effective rate was 80% in the control group. The difference of the efficiency rate and total effective rate between observation group and control group was significance (P<0.05). The pain scores were lower in observation group after treatment than it was before(P<0.01);The pain scores were lower in control group after 24 hours treatment than it was before(P<0.01);The pain scores after 12 hours of treatment lower than before, but there was no significant difference(P>0.05). The pain scores after 12 hours,24 hours,36 hours and 48 hours of treatment in observation group were lower than control group(P<0.01 or P<0.05),but there was no significant difference in the pain score of both groups after 72 hours of treatment(P>0.05). Conclusion The clinical efficacy in the treatment of phlebitis correlation with peripherally inserted central catheter (PICC) by Shuangbai Powder is better than Hirudoid cream, and the time of pain relief in the group treated by Shuangbai Power is earlier than it treated by Hirudoid cream.

目的 探讨七氟烷复合静脉诱导在脑动脉瘤栓塞术中的临床效果。方法 分析2013年1月—2015年12月在我院接受脑动脉瘤栓塞术80例患者的临床资料,根据随机数字表法分为研究组(n=40)和对照组(n=40),对照组采用全凭静脉诱导插管方法,研究组采用七氟烷复合静脉诱导插管方法,比较两组患者的应用效果。结果 两组患者血流动力学、血浆E及NE、呛咳反应发生率、阿托品及血管活性药物使用率比较,研究组均明显优于对照组(P＜0.05)。结论 七氟烷复合静脉诱导用于脑动脉瘤栓塞术对患者血流动力学和应激反应的影响较小,具有较高的安全性和可靠性,可应用于临床。

Objective To explore the clinical effect of sevoflurane combined with intravenous induction in the treatment of cerebral aneurysm embolization. Methods The clinical data of 80 patients with cerebral aneurysm embolization in our hospital from January 2013 to December 2015 were analyzed and divided into study group (n=40) and control group (n=40) according to the random number table. The control group was treated by intratracheal intubation with total intravenous induction. In the study group, sevoflurane combined intravenous induction with intratracheal intubation was used to compare the effect of the two groups. Results Compared with the control group, the hemodynamics, the plasma E and NE, the incidence of cough reaction, atropine and vasoactive drug use were significantly better than those in the control group (P<0.05). Conclusion Sevoflurane combined with intravenous induction for cerebral aneurysm embolization in patients with less impact on hemodynamics and stress response, with high safety and reliability, can be used clinically.

目的 研究不同剂量重组人干扰素α1b雾化吸入治疗毛细支气管炎的疗效及安全性。方法 选取2016年1月—2016年9月期间我院儿科收治的年龄≤2 a的毛细支气管炎患儿86例,均符合毛细支气管炎诊断标准,随机分为观察一组(29例)、观察二组(29例)和对照组(28例)。所有患儿均给予综合常规治疗,观察一组患儿雾化吸入生理盐水+质量浓度为0.2 g/L的沙丁胺醇+1 μg/(kg·次)重组人干扰素α1b,观察二组患儿雾化吸入生理盐水+质量浓度为0.2 g/L的沙丁胺醇+2 μg/(kg·次)重组人干扰素α1b。比较三组患儿治疗有效率、临床症状改善和不良反应发生情况。结果 观察一组与观察二组在治愈率和总有效率两个方面均显著高于对照组(P<0.05),但观察一组与观察二组治愈率和总有效率比较差异不显著(P>0.05);观察一组和观察二组患儿临床症状和体征持续时间明显少于对照组(P<0.05),但观察一组和观察二组患儿临床症状和体征持续时间无显著差异(P>0.05);三组患儿不良反应发生率差异不显著(P>0.05)。结论 低剂量与高剂量雾化吸入重组干扰素α1b对于小儿毛细支气管炎临床疗效接近,且均无严重不良反应,综合经济效益和社会效益考虑,在临床上推广低剂量雾化吸入重组干扰素α1b治疗小儿毛细支气管炎更具价值。

Objective To study the effects of different doses of recombinant human interferon α1b inhalation efficacy and safety in the treatment of bronchiolitis. Methods 86 cases of children, who were less than 2 years old were selected in department of pediatrics from January 2016 to September 2016. They were randomly divided into for observation group Ⅰ (29 cases), observation group Ⅱ(29 cases) and control group (28 cases). All the patients were treated with conventional therapy. Group Ⅰ with atomization inhalation of salbutamol and 0.02% with saline+1 μg /kg times of recombinant human interferon α1b were observed and the same as in the two groups Ⅱ with atomization inhalation of salbutamol and 0.02% with saline+2 μg /kg recombinant human interferon α1b. The treatment efficiency, the improvement of clinical symptoms and adverse reactions were compared. Results The cure rate and total effective rate of observation group Ⅰand Ⅱ were significantly higher than those in the control group (P<0.05), there were no significant differences in the cure rate and total effective rate between observation group Ⅰand Ⅱ(P>0.05). The clinical symptoms and signs of the patients of observation group Ⅰand Ⅱ were significantly higher than those in the control group (P<0.05), there were no significant differences in the clinical symptoms and signs of the patients between observation group Ⅰand Ⅱ(P>0.05). There was no significant difference in the incidence of adverse reactions between the three groups (P>0.05). Conclusion There were no serious adverse reactions in low dose and high dose of atomization inhalation of recombinant interferon α1b for close to the clinical curative effect of children with bronchiolitis. Considering comprehensively economic benefits and social benefits, it is worth of promotion low dose of atomization inhalation of recombinant interferon 1b in the treatment of children with bronchiolitis.