【摘要】 目的 用高频超声对正常女性乳腺健康体检，探讨其在临床及乳腺普查方面的应用价值。 方法 对2006年1月－2009年12月间7 532例健康女性乳腺体检声像图进行分析，并对各年龄段的乳腺病变超声结果分布情况进行统计。 结果 共检出乳腺病变2 861例（37.98%），正常者4 671例（62.02%）。所有受检者中，囊性病变1 904例（25.28%），实性病变944 例（12.53%），混合性病变13例（0.17%），伴有副乳者692例。囊性病变及实性病变单侧多于双侧，混合性病变均为单侧。常见病中，囊性病变多于实性病变，发病年龄分布在20～30岁及31～40岁年龄段。 结论 高频超声作为女性乳腺疾病的一种常规检查，能对乳腺占位性疾病提供较为准确的诊断，对乳腺癌早期发现、早期诊断、早期治疗提供一种科学依据。【Abstract】 Objective To explore the clinical value of high-frequency sonography for normal clinical breast examination in breast screening. Methods From January 2006 to December 2009, 7 532 healthy women underwent breast sonography. The results of sonography in the individuals with different ages were statistically analyzed. Results Breast lesions were found in 2 861 cases (37.98%) and the other 4 671 were healthy. Among all of the individuals, 1 904 cases (25.28%) had cystic lesions, 944 (12.53%) had solid lesions and 13 (0.17%) had mixed lesions. There were 692 cases of accessory mammary tissue. Unilateral cystic nodules and solid nodules were more common than bilateral ones, whereas mixed nodules were usually sunilaterally. Cystic nodules were more common than solid nodules. Most common onset of breast lesions is in the individuals with the age of 20-30 and 31-40 years. Conclusion High-frequency sonography, as an examination for normal clinical breast screening provides more accurate diagnosis and early detection of breast lesions, which can provide scientific evidence for early detection, diagnosis and treatment for breast cancer.
Objective To evaluate the clinical effects of harmonic scalpel application in thoracoscopic surgery for lung cancer, which may guide its reasonable application. Methods We retrospectively analyzed the clinical data of 145 lung cancer patients receiving thoracoscopic surgery from January to March 2017 in our hospital. There were 57 patients with thoracoscopic pulmonary wedge resection, and harmonic scalpel was used in 34 patients (8 males, 26 females at age of 59.68±10.91 years), and was not used in 23 patients (13 males and 10 females at age of 59.13±11.21 years). There were 88 patients receiving thoracoscopic pulmonary lobectomy, among whom harmonic scalpel was used in 80 patients (36 males and 44 females at age of 59.68±10.91 years), and was not used in 8 patients (5 males, 3 females at age of 61.63±5.60 years). We recorded the perioperative outcomes of all patients. Results In the 34 patients undergoing thoracoscopic pulmonary wedge resection by harmonic scalpe, the operation time was 90.09±43.52 min, the blood loss was 21.32±12.75 ml, the number of lymph nodes resected was 5.12±4.26, duration of drainage was 3.15±1.16 d, volume of drainage was 535.00±291.69 ml, the length of postoperative hospital stay was 4.56±1.40 d, and no postoperative complication was observed. In the 80 patients receiving thoracoscopic pulmonary lobectomy by harmonic scalpel, operation time was 131.88±41.82 min, blood loss was 42.79±31.62 ml, the number of lymph nodes resected was 13.54±8.75, duration of thoracic drainage was 4.47±2.30 d, drainage volume was 872.09±585.24 ml, the length of postoperative hospital stay was 5.81±2.26 d, and 20 patients had postoperative complications. No complication occurred in the 8 patients without harmonic scalpel. Conclusion Harmonic scalpel showed satisfactory effectiveness and safety in lung cancer thoracoscopic surgery.
ObjectiveTo investigate the changes of peritoneal macrophages function of mice with gastric cancer in the CO2 pneumoperitoneum environment, as well as its effect on the peritoneal metastasis of gastric cancer. MethodsAn orthotopic implantation model of mouse forestomach cancer was established using the 615 mouse. The mice bearing tumors were randomly divided into five groups (n=30): anesthesia alone, laparotomy, and 2, 4, and 6 mm Hg CO2 insufflation groups. Peritoneal macrophages were collected from six mice in each group and cultured. The macrophage phagocytic function on neutral red and the levels of NO and TNF-α produced by macrophages were measured after 12, 24, 48, and 72 h of culture. The remaining mice were observed after two weeks for the rate of peritoneal metastasis of forestomach cancer cells and the total weight of implanted nodules. ResultsNo death and ascites were found and the difference of weight body was not significant in all mice (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages in the laparotomy group after 12 h of culture were all significantly higher than those in other four groups (Plt;0.05). The corresponding values in the 2, 4， and 6 mm Hg CO2 insufflation groups after 12 h were all significantly lower than those in the anesthesia alone group (Plt;0.05). Among three insufflation groups, the corresponding values in the 2 mm Hg after 12 h were significantly higher than those in the 4 and 6 mm Hg CO2 insufflation group, though the difference in the two latter was not significant (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages in the 6 mm Hg CO2 insufflation group after 24 h of culture were all significantly lower than those in other four groups (Plt;0.05), while the difference in the four groups was not significant (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages after 48 h and 72 h were not significantly different in the five groups (Pgt;0.05). The rate of peritoneal metastasis of mice was significantly lower in the 6 mm Hg insufflation CO2 group (75.0%, 15/20) than that in the anesthesia alone group (100%, 24/24), Plt;0.05, but higher than other three groups(Plt;0.05), which was not different in 2 mm Hg (47.8%, 11/23), 4 mm Hg insufflation group (45.45%, 10/22) and laparotomy group (50.0%, 10/20), Pgt;0.05. The total weight of implanted nodules of mouse forestomach cancer was (1.24±0.48) g, (1.02±0.38) g, (0.96±0.33) g, (0.93±0.45) g, and (1.18±0.37) g in the anesthesia alone group, the laparotomy group, and 2, 4, and 6 mm Hg CO2 insufflation group, and the difference was not significant (Pgt;0.05). ConclusionHigh pressure (6 mm Hg) CO2 pneumoperitoneum can constantly inhibit the phagocytosis and cytokine secretion functions of peritoneal macrophages in gastric cancer-bearing mice and promote peritoneal implantation of gastric cancer.
Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=−11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. ConclusionThe perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.
Objective To investigate the value of laparoscopy in resetting and repairing of inguinal incarcerated hernia. Methods Clinical data of 11 patients with acute inguinal incarcerated hernia treated with laparoscopy from March 2007 to February 2008 were reviewed, including 3 cases of direct inguinal hernia and 8 cases of oblique inguinal hernia. Results There were 7 patients with incarcerated hernia who were reset automatically after general anaesthesia, and 4 patients who were reset with laparoscopy. All the hernias were repaired with the transabdominal preperitoneal (TAPP) method after observed or improved the blood cycle of the incarcerated intestinal tract under laparoscopy. Average follow-up time was 6.6 months (2-12 months) after operation. Good recover and no recurrence were showed in all patients. Conclusion Laparoscopy is a safe technology in resetting and repairing of inguinal incarcerated hernia
Objective To explore the treatment methods for group Amanita exitialis poisoning, and summarize the treatment strategies for group Amanita exitialis poisoning. Methods A group of Amanita exitialis poisoning patients admitted to the Department of Emergency Medicine of the Affiliated Hospital of Yunnan University on July 31, 2023 were retrospectively included. We graded the patients’ condition and analyzed their clinical data, treatment methods, and blood purification selection modes. Results A total of 6 patients with Amanita exitialis poisoning were included, with an average age of 52 years. There were 2 patients with grade Ⅰ, 2 patients with grade Ⅱ, 1 patient with grade Ⅲ and 1 patient with grade Ⅳ. Grade Ⅰ patients choosed single one mode hemoperfusion (HP), grade Ⅱ patients choosed single multiple mode HP, grade Ⅲ patient choosed multiple mode HP combined with plasma exchange, and grade Ⅳ patient choosed multiple mode HP combined with plasma exchange, double plasma molecular adsorption system and continuous renal replacement therapy. After individualized comprehensive treatment, 5 patients were cured and discharged, and 1 patient died. Conclusions In the treatment of group Amanita exitialis poisoning, in addition to basic drug treatment, it is necessary to first consider factors such as the side effects of blood purification and the economic conditions of the patient. Then, according to the different disease grades of the patient, single or combined blood purification, single or multiple treatment modes can be choosed. Early selection of appropriate individualized blood purification modes can effectively buy time for poisoning patients.