目的 通过对连枷胸两种不同治疗方法的比较，探讨该病的优化治疗方案。 方法 将2005年1月－2012年11月收治的80例枷胸患者按入选标准分为：保守组40例，通过胸部外固定和（或）呼吸机内固定等方法治疗；手术组40例，采用镍钛记忆合金环抱式接骨器手术内固定骨折的肋骨，比较两种治疗方法和疗效及并发症情况。 结果 保守组和手术组各死亡3例，原因为呼吸道感染致呼吸衰竭，两组无差异，但ICU停留和住院天数、机械通气时间、呼吸道感染等并发症手术组明显低于保守组（P＜0.01）。手术组无胸壁畸形，而保守组有18例，两组比较差异有统计学意义（P＜0.01）。出院3个月后，手术组患者部分肺功能指标显著优于保守组（P＜0.01）。 结论 手术治疗连枷胸可迅速稳定胸壁，消除反常呼吸和激烈疼痛对呼吸的影响，还可减轻连枷胸对患者远期肺功能的影响，具有较高的临床应用价值。
ObjectiveTo investigate the distribution of uridine diphosphate-glucuronosyltransferase 1A1 (UGT1A1) gene polymorphisms in esophageal carcinoma (EC) patients, and their relationship with adverse effects (delayed diarrhea and neutropenia) of Irinotecan. MethodsForty-eight patients with esophageal squamous carcinoma who were admitted to Sichuan Provincial People's Hospital between January and October 2012 were recruited in the study. There were 37 male and 11 female patients with their age of 56 (25-38) years. Formalin-fixed, paraffin-embedded samples were collected from those EC patients and genomic DNA was extracted. UGT1A1 polymorphisms were detected by PCR and DNA sequencing. Three genetic loci were investigated including UGT1A1* 28 (TA6 > TA7), UGT1A1* 6 (211G > A) and UGT1A1* 93 (-3156G > A). Adverse effects (delayed diarrhea and neutropenia) of patients with different UGT1A1 polymorphisms after Irinotecan treatment were recorded. The relationship between UGT1A1 polymorphisms and Irinotecan-induced adverse effects was analyzed. ResultsUGT1A1 polymorphisms were detected in 10 out of 48 (20.8%) EC patients. UGT1A1* 93 (-3156G > A)polymorphisms were most common with the polymorphism rate of 16.7% (8/48), followed by GT1A1* 6 (211G > A) polymorphisms with the polymorphism rate of 4.2% (2/48). The incidences of grade 3~4 diarrhea and grade 3~4 neutropenia after Irinotecan treatment in the patients with UGT1A1 polymorphisms were 60.0% and 40.0% respectively, which were significantly higher than those of the patients with wild type UGT1A1 (21.1% and 15.8% respectively, P < 0.05). UGT1A1 polymorphism rates were 45.5% (5/11) in female patients and 13.5% (5/37) in male patients, which were significantly different (P < 0.05). ConclusionsIn EC patients, 2 polymorphism loci including UGT1A1* 93 (-3156G > A) and GT1A1* 6 (211G > A) can effectively predict adverse effects caused by Irinotecan treatment. UGT1A1 polymorphism rate of male patients is significantly lower than that of female patients.
目的 探讨非小细胞肺癌合并孤立性脑转移灶的手术治疗效果，分析影响患者生存期的因素。 方法 回顾性分析2005年1月－2011年5月46例接受手术治疗的非小细胞肺癌合并孤立性脑转移灶患者的临床资料，其中男35例，女11例；年龄35～67岁，平均53.2岁；所有患者均行肺部原发肿瘤及脑部转移肿瘤切除术，其中肺叶切除术42例，全肺切除术4例，术后全部患者行全脑放射治疗，部分患者行系统化学疗法3～6周期。对随访患者的生存时间采用对数秩检验，分析影响生存率的因素。 结果 术后病理检查提示腺癌27例，鳞癌15例，大细胞癌2例，其他类型2例。患者1年生存率80%，2年生存率41%，3年生存率14%，中位生存期23个月，平均生存期（27.8 ± 4.5）个月（乘积极限法）。对数秩检验结果提示N0与N1患者比N2患者生存率高（P=0.024），腺癌患者生存期比非腺癌患者生存期长（P=0.002）。 结论 外科手术治疗非小细胞肺癌合并孤立性脑转移灶的患者可以取得良好的治疗效果，腺癌患者及无纵隔淋巴结转移的患者生存期长。
目的探讨胸腹腔镜在食管癌手术中应用的可行性及近期疗效。 方法2012年6月至2013年10月四川省人民医院胸外科90例食管癌患者行胸腹腔镜联合食管癌切除术，其中男54例、女36例，年龄47～83岁，平均（63.15±11.10）岁。手术先行胸腔镜游离胸段食管并清扫淋巴结，再腹腔镜游离胃行食管胃左颈部吻合术。记录手术时间、术后胸腔引流管放置时间、平均住院时间、淋巴结清扫枚数、术后并发症等。 结果全部无围术期死亡。手术时间260～450 min。术后4～11 d（平均5 d）拔除胸腔闭式引流管，胸腔总引流量为530～4 260 ml。全组共清扫纵隔淋巴结（气管旁、右下肺韧带、食管旁、隆凸下及左右喉返神经链旁）、腹腔淋巴结（贲门旁、胃左动脉旁）及颈部淋巴结1 395枚，平均每例15.5枚，15例（16.7%）发现淋巴结转移。术后发生吻合口瘘7例（7.8%），声音嘶哑5例（5.6%），肺部感染5例（5.6%），乳糜胸2例（2.2%），均经保守治疗后痊愈。术后10～14 d出院。门诊及电话随访82例，随访率91.1%，随访时间1～16个月，患者全部生存，无复发。 结论胸腹腔镜联合行食管癌根治术在技术上是安全可行的，近期疗效可靠。