目的探讨肝癌手术切除后的序贯综合治疗,以达到有效防治肿瘤复发的目的。方法从我科收治的肝癌患者中挑选3例手术治疗后进行序贯综合治疗并取得良好效果病例，对其临床资料进行分析，从中获取有关肝癌术后治疗的经验。结果3例肝癌患者在我科手术后接受了积极的预防复发措施，虽最终均出现复发，但对待复发的肿瘤均采取积极的应对措施，获得了长期生存。结论对于肝癌手术切除后的患者进行积极的序贯性综合治疗有较好的临床意义，鼓励对术后复发病例进行积极序贯综合治疗。
The simple ablation of the duplicated thumb might have some residual deformities after operation that often leads to functional disorders of the hand. Since 1988, the postoperative disorders in 9 patients were treated. The plastic surgery was performed for the adduction of the thumb, lateral deviation and insufficient after plastic repair of the hand. The configuration and the function of the thumb were satisfactory.
Objective To evaluate the clinical efficacy of integrated treatment ( sequential noninvasive following invasive mechanical ventilation, bronchoscope suction, combined inhalation) in patients with acute respiratory failure induced by chronic obstructive pulmonary disease ( COPD) . Methods 59 elderly patients with COPD and acute respiratory failure in ICU fromJuly 2006 to July 2009 were enrolled in the study. The patients were randomized into three groups, ie. a non-invasive mechanical ventilation group ( NIV group) , a sequential non-invasive following invasive mechanical ventilation group ( SV group) , a integrated treatment group ( IT group) . APACHEⅡ score, clinical pulmonary infection score ( CPIS) ,arterial blood gas analysis, respiratory rate ( RR) , heart rate ( HR) , and mean artery blood pressure ( MAP)at 0 h, 3 h, 3 d, 12 d after treatment were recorded. Results With the extension of treatment time,APACHEⅡ score, CPIS score, RR, HR, PaCO2 , and white blood cells gradually reduced, while pH and PaO2 gradually increased in the three groups ( P lt;0. 05) . The differences in RR, HR, PaCO2 , and PaO2 at the time of 3 d and 12 d were significant between the three groups( P lt;0. 05) . The occurrence of pulmonary infection control ( PIC) window and ventilation associated pneumonia ( VAP) had no difference among the three groups( P gt;0. 05) . The duration of total mechanical ventilation, durations of ICU stay and hospital stay were shorter in SV group than those in NIV group( P lt;0. 05) . The duration of total mechanical ventilation,duration of invasive mechanical ventilation, durations of ICU stay and hospital stay were shorter in IT group than those in SV group( P lt;0. 05) . The incidence of VAP was higher in SV group than NIV group, but lower in IT group than SV group( P lt;0. 05) . Hospital mortality was lower in SV group than NIV group, and higher in IT group than SV group( P lt; 0. 05) . Conclusion In elderly COPD patients with acute respiratory failure, integrated treatment given early can reduce the duration of mechanical ventilation, the length of ICU and hospital stay, and decrease the morbidity of VAP and mortality.
This article report 5 cases of malunion or nonunion ofthe fractures of the jaws which were treated by functional re-duction. From the anatomical and physiological point ofview, this operation was highly versatile and reliable. The re-construction was accomplished precisely in one stage. All pa-tients had a good prognosis.
目的 探讨影响乳腺癌骨转移发生、发展的因素及治疗方法。 方法 对106例乳腺癌骨转移患者的临床特点及近期疗效进行回顾性总结。 结果 乳腺癌骨转移的发生及发生早晚与腋窝淋巴结的转移数目相关。治疗以全身治疗为主，包括化疗、内分泌治疗、放疗、放射性同位素内照射及二磷酸盐的综合治疗。 结论 乳腺癌患者，特别是伴有较多数目腋窝淋巴结转移者，应进行同位素骨扫描检查，一旦出现骨转移，应积极进行全身治疗，转移局限者，可进行局部外放射治疗。
Objective To investigate a synthetical technique combining static and dynamic states for treating facial paralysis. Methods From October 1993 to November 2005, 93 patients (26 males, 67 females; aged 9-69 years; illness course, 6 months to 24 years) with facial paralysis were admitted for treatment, of whom 48 were unknown in their pathological origins, 32 had a history of intracranial or ear operation, 13 had their facial paralysis related to trauma. We applied synthetical techniques for treating facial paralysis, including denerved muscle (extensor hallucis brevis and extensor digitorum brevis) free graft using an operating or chemical technique, temporal muscular flap suspending, treatment of eye closure by uplifting zygomomalar tissues and temporal muscular flap suspending, brow lifting by the Buried Guiding Suture Appliance, Botox injection, and the nerve amputation of normal side for mandibular marginal ramus paralysis. Results After the treatment for 82 patients with the method of the denerved muscle free graft combining femporal muscular flap suspending, 3 patients with the method of uplifting zygomo-malar tissues combining temporalmuscular flap suspending for eye closure, 15 patients with the method of the Buried Giding Suture for eyebrow lifting, 4 patients with the Botox injection and nerve amputation of normal side for the mandibular marginal ramus paralysis,93 patientshad a good therapeutic result. The follow-up for 3 months to 10 years in all the patients revealed that 75 patients were satisfied with their treatment results and 13 patients were almost satisfied according to the criteria for the facialsymmetrical checking and the House-Brackmann grading system. The technique hadadvantages of a complete survival of the related small muscles, a hidden incision, less trauma for the Botox injection, and the denerved muscles for surrounding nerve inserting. Conclusion The synthetical technique combining static and dynamic states for treating facial paralysis is a good therapeutic method and the therapies for facial paralysis should vary with the different conditions of the paralysis. We advocate an individuation treatment for facial paralysis.
ObjectiveTo explore the value of multidisciplinary team (MDT) discussion in the comprehensive treatment of HER-2 positive breast cancer.MethodThe clinical data of 2 patients with HER-2 positive breast cancer admitted to the Affiliated Hospital of Southwest Medical University after MDT discussions were analyzed retrospectively.ResultsCase 1 was a 32-year-old woman diagnosed with left breast non-special type invasive carcinoma at admission, cT2N1M0, stage ⅡB, WHO grade 2, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 20%). After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 6 cycles, and the efficacy evaluation was partial response, received left breast conserving surgery and axillary lymph node dissection (ALND), postoperative staging ypT1aN1ycM0, stage ⅡA, Miller-Payne grade 4, the patient was satisfied with the shape of breast, received radiotherapy and anti-HER-2 therapy after surgery. At present, there was no recurrence and metastasis during anti-HER-2 therapy. Case 2 was diagnosed with right breast non-special type invasive carcinoma at admission, cT3N0M0, stage ⅡB, WHO grade 3, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 40%), local advanced breast cancer. After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 2 cycles, and the efficacy evaluation was progressive disease. After the replacement of two neoadjuvant chemotherapy regimen, the efficacy evaluation was still progressive disease. Finally after MDT discussion, the patient received right breast mastectomy and ALND, postoperative staging ypT4bN1ycM0, stage ⅢB, Miller-Payne grade 1, received radiotherapy, adjuvant treatment with pyrotinib and capecitabine after surgery. The patient was followed up for 3 months by telephone, the patient did not follow the doctor’ instructions, no recurrence and metastasis was found in the review.ConclusionUnder the precision medical system, comprehensive treatment of breast cancer based on the MDT model could target patients’ disease characteristics, physical conditions, previous diagnosis and treatment, family situation, and other individual factors, formulate the best personal treatment plan for patients, and bring greater benefits to patients.
【摘要】目的 分析原发性乳腺恶性淋巴瘤（primary breast lymphoma,PBL)的临床特点、诊断和治疗。方法 回顾我院2001～2004年收治的3例PBL并复习有关文献，分析其临床特征、诊断情况和治疗方法。结果 3例均为非何杰金淋巴瘤（NHL），属B细胞源性。PBL分期均为Ⅱ期。结论 PBL早期正确诊断，行手术、放疗和化疗联合治疗，效果满意。
近年来,胃癌研究发展迅速,许多先进技术和治疗理念逐渐引入外科领域并为大家接受,以手术为主,辅以化疗、生物靶向治疗的综合治疗观念已经建立,成为主导趋势,现就这方面的问题予以讨论,并与同道商榷.……