Search

傳播和應用最佳證據

Relationship between UGT1A1 Polymorphisms and Adverse Effects of Irinotecan in Patients with Esophageal Carcinoma

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.

Clinical Study on Surgical Stabilization for Traumatic Flail Chest

目的　通過對連枷胸兩種不同治療方法的比較，探討該病的優化治療方案。 方法　將2005年1月－2012年11月收治的80例枷胸患者按入選標準分為：保守組40例，通過胸部外固定和（或）呼吸機內固定等方法治療；手術組40例，采用鎳鈦記憶合金環抱式接骨器手術內固定骨折的肋骨，比較兩種治療方法和療效及并發癥情況。 結果　保守組和手術組各死亡3例，原因為呼吸道感染致呼吸衰竭，兩組無差異，但ICU停留和住院天數、機械通氣時間、呼吸道感染等并發癥手術組明顯低于保守組（P＜0.01）。手術組無胸壁畸形，而保守組有18例，兩組比較差異有統計學意義（P＜0.01）。出院3個月后，手術組患者部分肺功能指標顯著優于保守組（P＜0.01）。 結論　手術治療連枷胸可迅速穩定胸壁，消除反常呼吸和激烈疼痛對呼吸的影響，還可減輕連枷胸對患者遠期肺功能的影響，具有較高的臨床應用價值。

The Efficacy of Surgical Treatment for Non-small Cell Lung Cancer with Single Brain Metastasis

目的　探討非小細胞肺癌合并孤立性腦轉移灶的手術治療效果，分析影響患者生存期的因素。 方法　回顧性分析2005年1月－2011年5月46例接受手術治療的非小細胞肺癌合并孤立性腦轉移灶患者的臨床資料，其中男35例，女11例；年齡35～67歲，平均53.2歲；所有患者均行肺部原發腫瘤及腦部轉移腫瘤切除術，其中肺葉切除術42例，全肺切除術4例，術后全部患者行全腦放射治療，部分患者行系統化學療法3～6周期。對隨訪患者的生存時間采用對數秩檢驗，分析影響生存率的因素。 結果　術后病理檢查提示腺癌27例，鱗癌15例，大細胞癌2例，其他類型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個月，平均生存期（27.8 ± 4.5）個月（乘積極限法）。對數秩檢驗結果提示N0與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長（P=0.002）。 結論　外科手術治療非小細胞肺癌合并孤立性腦轉移灶的患者可以取得良好的治療效果，腺癌患者及無縱隔淋巴結轉移的患者生存期長。

Application of Thoracoscopy Combined with Laparoscopy in Esophagectomy for Esophageal Carcinoma

目的探討胸腹腔鏡在食管癌手術中應用的可行性及近期療效。 方法2012年6月至2013年10月四川省人民醫院胸外科90例食管癌患者行胸腹腔鏡聯合食管癌切除術，其中男54例、女36例，年齡47～83歲，平均（63.15±11.10）歲。手術先行胸腔鏡游離胸段食管并清掃淋巴結，再腹腔鏡游離胃行食管胃左頸部吻合術。記錄手術時間、術后胸腔引流管放置時間、平均住院時間、淋巴結清掃枚數、術后并發癥等。 結果全部無圍術期死亡。手術時間260～450 min。術后4～11 d（平均5 d）拔除胸腔閉式引流管，胸腔總引流量為530～4 260 ml。全組共清掃縱隔淋巴結（氣管旁、右下肺韌帶、食管旁、隆凸下及左右喉返神經鏈旁）、腹腔淋巴結（賁門旁、胃左動脈旁）及頸部淋巴結1 395枚，平均每例15.5枚，15例（16.7%）發現淋巴結轉移。術后發生吻合口瘺7例（7.8%），聲音嘶啞5例（5.6%），肺部感染5例（5.6%），乳糜胸2例（2.2%），均經保守治療后痊愈。術后10～14 d出院。門診及電話隨訪82例，隨訪率91.1%，隨訪時間1～16個月，患者全部生存，無復發。 結論胸腹腔鏡聯合行食管癌根治術在技術上是安全可行的，近期療效可靠。

劍突下入路單孔胸腔鏡手術治療自發性氣胸 30 例Subxiphoid approach single-incision video-assisted thoracoscopic surgery for 30 patients with spontaneous pneumothorax

目的 探討劍突下入路單孔胸腔鏡手術治療自發性氣胸的安全性和可行性。 方法 回顧性分析 2014 年 8 月至 2016 年 1 月間劍突下入路單孔胸腔鏡手術治療自發性氣胸 30 例患者的臨床資料，其中男 19 例、女 11 例，年齡 16～28（20.5±5.2）歲。 結果 手術均順利完成，無中轉開胸，無術后出血、漏氣等并發癥。手術時間（30.5±12.4）min，術中出血量（20.0±10.0）ml，術后胸腔引流管留置時間（1.5±0.8）d，術后住院時間（3.5±0.5）d。術后隨訪 1 個月，無復發、感染等其他并發癥。 結論 劍突下入路單孔胸腔鏡手術治療自發性氣胸安全、可行。