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手术联合抗结核和抗病毒治疗颈部淋巴结结核并发艾滋病患者(附12例临床效果分析)
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作者 王力维 吴常青 《中国防痨杂志》 CAS CSCD 2019年第6期704-708,共5页
搜集2012年4月至2018年6月于苏州大学附属传染病医院经保守治疗无效,行外科手术治疗的12例(能耐受手术)颈部淋巴结结核(CTL)并发艾滋病患者的临床资料。男10例,女2例;年龄19~62岁,平均(38.0±11.3)岁。均在规范的抗结核、抗病毒药... 搜集2012年4月至2018年6月于苏州大学附属传染病医院经保守治疗无效,行外科手术治疗的12例(能耐受手术)颈部淋巴结结核(CTL)并发艾滋病患者的临床资料。男10例,女2例;年龄19~62岁,平均(38.0±11.3)岁。均在规范的抗结核、抗病毒药物治疗的同时辅以手术治疗,对比分析术前与术后3个月CD4^+T淋巴细胞水平、CD4^+T淋巴细胞/CD8^+T淋巴细胞比值、血红细胞沉降率(ESR)等。术后3个月CD4^+T淋巴细胞为(267.07±77.89)个/μl,术前为(156.80±84.83)个/μl,CD4^+/CD8^+T淋巴细胞比值为0.68±0.53,术前为0.47±0.32,差异均有统计学意义(t=28.30,P=0.019;t=20.37,P=0.033)。术后ESR为(15.88±11.08)mm/1h,术前为(52.32±17.12)mm/1h,差异有统计学意义(t=12.92,P=0.025)。12例患者均获得随访,11例患者手术切口均一期愈合、CTL症状消失;1例切口延期愈合,经过2个月局部换药愈合;3例CTL复发再行二次手术,术后切口愈合良好;1例在治疗过程中死亡,死亡原因为艾滋病晚期且并发肺孢子虫肺炎。可见,规范的抗结核、抗病毒药物控制,联合适当时机合理精准的手术干预对CTL并发艾滋病患者治疗疗效较好。 展开更多
关键词 结核 淋巴结 获得性免疫缺陷综合征 共病现象 淋巴结切除术 药物疗法 联合 治疗结果
Carbon Nanoparticles for Identifying Lymph Nodes during Surgery in Colorectal Cancer: A Meta-Analysis 预览
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作者 Miao Liu Ai Shen +3 位作者 Wei Li Lihui Chen Xiufeng Chen Hao Sun 《癌症治疗(英文)》 2019年第2期134-145,共12页
Aim: To investigative the efficacy of carbon nanoparticles (CNs) to identify the lymph nodes during radical surgery in colorectal cancer. Method: The MEDLINE, EMBASE and Cochrane Library databases were searched electr... Aim: To investigative the efficacy of carbon nanoparticles (CNs) to identify the lymph nodes during radical surgery in colorectal cancer. Method: The MEDLINE, EMBASE and Cochrane Library databases were searched electronically to identify the studies that compared the use of CNs (CN group) with control group in patients undergoing colorectal cancer radical surgery (from January 2009 to November 2018). The primary outcome was the number of retrieved central lymph nodes. Results: This meta-analysis identified 2 randomized controlled trials and 5 non-randomized controlled trials. Compared with the control group, the CN group resulted in an average of 7.16 more lymph nodes removed per patient (WMD = 7.16, 95% CI = 3.76 to 10.57, p < 0.01), 7.26 minutes less required for retrieving lymph nodes (WMD = -7.26, 95% CI = -13.43 to -1.09, p = 0.02), and 15.1 ml less blood loss during operation (WMD = -15.11, 95% CI = -23.15 to -7.06, p < 0.01). Although there was no significant difference in the metastatic lymph nodes between the two groups (OR = 1.02, 95% CI = 0.79 to 1.31, p = 0.87), there was 1.45 times more metastatic lymph of the stained nodes in CN group than in the control group (OR = 1.45, 95% CI = 1.13 to 1.85, p < 0.01). In addition, lymph nodes less than 5 mm were detected significantly more in the CN group than in the control group (OR = 2.15, 95% CI = 1.77 to 2.63, p < 0.01). Conclusions: The technique of CNs labeled lymph node staining in curative colorectal carcinoma is easy and effective, which can improve the retrieved number of lymph nodes, especially for nodes < 5 mm. The black stained lymph node indicates higher risk of metastasis. Further high quality RCT is needed to verify these conclusions. 展开更多
关键词 Carbon Nanoparticles LYMPH NODE COLORECTAL Cancer
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Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer 预览
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作者 Si-Cheng Zhou Yan-Tao Tian +9 位作者 Xue-Wei Wang Chuan-Duo Zhao Shuai Ma Jun Jiang Er-Ni Li Hai-Tao Zhou Qian Liu Jian-Wei Liang Zhi-Xiang Zhou Xi-Shan Wang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第31期4502-4511,共10页
BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications af... BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety. 展开更多
关键词 RECTAL cancer LATERAL PELVIC LYMPH NODE DISSECTION Indocyanine green LATERAL PELVIC LYMPH NODE
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New metastatic lymph node classification for early gastric cancer should differ from those for advanced gastric adenocarcinoma:Results based on the SEER database 预览
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作者 Jian-Xian Lin Jun-Peng Lin +9 位作者 Ping Li Jian-Wei Xie Jia-Bin Wang Jun Lu Qi-Yue Chen Long-Long Cao Mi Lin Ru-Hong Tu Chao-Hui Zheng Chang-Ming Huang 《世界临床病例杂志》 2019年第2期145-155,共11页
AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and 2011 were retrieved from the National Cancer In... AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and 2011 were retrieved from the National Cancer Institute’s Surveillance,Epidemiology,and End Result database.The overall survival(OS)based on the eighth edition and new tumor lymph node metastasis(TNM)staging systems were compared,and the analysis was repeated in an external validation set from the Fujian Medical University Union Hospital database.RESULTS There were no significant differences in OS between N1 and N2 cancers or between N3a and N3b cancers in cases of EGC.The X-tile program identified that the new staging system for EGC consisted of T1N0,T1N1’[1-6 metastatic lymph nodes(LNs)],and T1N2’(≥7 metastatic LNs).Compared with the eighth edition of the TNM staging system,the OS of patients in T1N1’stage was similar to that of patients with stage IIA disease,whereas the OS of patients in T1N2’stage was similar to that of patients with stage IIB disease.The new TNM staging system exhibited a slightly lower Akaike Information Criterion value and higher χ^2 and c-statistic compared with the eighth edition of the TNM classification system.Similar results were found in the external validation dataset from the external validation set.CONCLUSION We have developed an optional new TNM staging system with a better predictive ability that can be used to accurately predict the 5-year OS of patients with EGC. 展开更多
关键词 Early gastric cancer GASTRECTOMY Tumor LYMPH NODE METASTASIS CLASSIFICATION N CLASSIFICATION LYMPH NODE Prognosis
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Treatment of invasive fungal disease:A case report 预览
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作者 Xue-Fei Xiao Jiong-Xing Wu Yang-Cheng Xu 《世界临床病例杂志》 2019年第16期2374-2383,共10页
BACKGROUND In recent years,the incidence of fungal infection has been increasing,often invading one or more systems of the body.However,it is rare for lymph nodes to be invaded without the involvement of other organs.... BACKGROUND In recent years,the incidence of fungal infection has been increasing,often invading one or more systems of the body.However,it is rare for lymph nodes to be invaded without the involvement of other organs.CASE SUMMARY A 21-year-old man was admitted to hospital for repeated cough for 2 mo and abdominal pain for 1 mo.Physical examination revealed multiple lymph nodes enlargement,especially those in the left neck and groin.CT scan showed multiple lymph nodes enlargement in the chest,especially left lung,abdominal cavity,and retroperitoneum.The first lymph node biopsy revealed granulomatous lesions of lymph nodes,so intravenous infusion of Cefoperazone tazobactam combined with anti-tuberculosis drugs were given.Because fever and respiratory failure occurred 4 d after admission,mechanical ventilation was given,and Caspofungin and Voriconazole were used successively.However,the disease still could not be controlled.On the 11th day of admission,the body temperature reached 40° C.After mycosis of lymph nodes was confirmed by the second lymph node biopsy,Amphotericin B was given,and the patient recovered and was discharged from the hospital.CONCLUSION No fixed target organ was identified in this case,and only lymph node involvement was found.Caspofungin,a new antifungal drug,and the conventional first choice drug,Voriconazole,were ineffective,while Amphotericin B was effective. 展开更多
关键词 Invasive FUNGAL disease Case report Lymphadenectasis LYMPH node BIOPSY MYCOSIS of LYMPH NODES AMPHOTERICIN B
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高频超声下不同类型颈部肿大淋巴结分区规律研究 预览
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作者 尚海涛 董婧 +1 位作者 吴博林 程文 《实用肿瘤学杂志》 CAS 2019年第5期447-450,共4页
目的探讨高频超声下转移性淋巴结及其他常见颈部淋巴结疾病在颈淋巴结解剖分区中的分布规律。方法回顾性分析2016年9月—2017年9月共547例颈部肿大淋巴结资料,根据病理结果分为非特异性淋巴结炎、淋巴结结核、淋巴瘤、转移性淋巴结四类... 目的探讨高频超声下转移性淋巴结及其他常见颈部淋巴结疾病在颈淋巴结解剖分区中的分布规律。方法回顾性分析2016年9月—2017年9月共547例颈部肿大淋巴结资料,根据病理结果分为非特异性淋巴结炎、淋巴结结核、淋巴瘤、转移性淋巴结四类,记录淋巴结常规超声参数及其在颈部淋巴结解剖分区中的分布。结果不同颈部淋巴结疾病在颈部淋巴结解剖分区中的分布状态不同。头颈部肿瘤的颈部淋巴结转移多分布于Ⅱ(62.00%)、Ⅲ(54.00%)及Ⅳ区(53.00%),锁骨下原发肿瘤的颈部淋巴结转移主要分布于Ⅴ(72.56%)、Ⅳ区(34.15%)。对特定肿瘤而言,还存在淋巴结转移的高危区域。结论超声检查可显示淋巴结疾病在颈部解剖分区中的分布情况。术前明确淋巴结疾病在解剖分区中的分布规律,可为临床的诊疗、手术术式及清扫范围提供更精确的依据。 展开更多
关键词 超声 淋巴结 颈部解剖分区
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甲状腺微小乳头状癌超声特征与颈部淋巴结跳跃性转移的相关性研究
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作者 王晓庆 魏玺 +3 位作者 徐勇 王海玲 忻晓洁 张晟 《中华肿瘤杂志》 CAS CSCD 北大核心 2019年第5期373-377,共5页
目的探讨甲状腺微小乳头状癌(PTMC)超声特征与颈部淋巴结跳跃性转移的相关性。方法回顾性分析385例颈部淋巴结转移阳性PTMC的术前原发灶超声特征、颈部淋巴结转移情况。以术后病理诊断为金标准,评价超声诊断PTMC患者颈部淋巴结转移的效... 目的探讨甲状腺微小乳头状癌(PTMC)超声特征与颈部淋巴结跳跃性转移的相关性。方法回顾性分析385例颈部淋巴结转移阳性PTMC的术前原发灶超声特征、颈部淋巴结转移情况。以术后病理诊断为金标准,评价超声诊断PTMC患者颈部淋巴结转移的效能。应用χ2检验和多因素Cox回归模型分析PTMC原发灶的超声特征与颈部淋巴结跳跃性转移的关系。结果 385例PTMC患者中,仅有中央区淋巴结转移231例,仅有侧颈区淋巴结转移31例,中央区+侧颈区淋巴结转移123例。354例颈部淋巴结无跳跃性转移患者中,Ⅱ区转移48例,Ⅲ区转移92例,Ⅳ区转移83例,Ⅴ区转移9例,Ⅵ区转移354例。31例颈部淋巴结跳跃性转移患者中,Ⅱ区转移12例,Ⅲ区转移14例,Ⅳ区转移14例,Ⅴ区转移1例。术前超声诊断PTMC患者颈部中央区淋巴结转移的灵敏度和特异度分别为46.3%和66.7%,诊断侧颈区淋巴结转移的灵敏度和特异度分别为91.0%和87.8%。单因素分析显示,病灶位置、病灶直径、被膜侵及的长度/结节周长与跳跃性转移的发生有关(均P<0.05)。多因素Cox回归分析显示,病灶位置、被膜侵及的长度/结节周长是跳跃性转移发生的独立危险因素(均P<0.05)。结论术前超声诊断PTMC侧颈区淋巴结转移的灵敏度与特异度均高于诊断颈部中央区淋巴结转移。病灶位于甲状腺上极、被膜侵及的长度/结节周长≥1/4的PTMC患者易发生颈部淋巴结跳跃性转移。 展开更多
关键词 甲状腺乳头状癌 超声 淋巴结 跳跃性转移
纳米炭示踪胃癌第四组淋巴结活检对脾门淋巴结清扫的意义研究 预览
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作者 张晨嵩 李靖 +1 位作者 范东伟 姚廷敬 《淮海医药》 CAS 2019年第4期331-332,337共3页
目的:利用纳米炭的淋巴示踪原理,探讨进展期胃癌第二组、第四组、第十一组淋巴结和脾门淋巴结的相关关系。方法:选取我科需要行“腹腔镜全胃切除术联合D2淋巴结清扫术”的进展期胃癌病例,常规行纳米碳示踪淋巴结清扫,将术后病理中的第... 目的:利用纳米炭的淋巴示踪原理,探讨进展期胃癌第二组、第四组、第十一组淋巴结和脾门淋巴结的相关关系。方法:选取我科需要行“腹腔镜全胃切除术联合D2淋巴结清扫术”的进展期胃癌病例,常规行纳米碳示踪淋巴结清扫,将术后病理中的第二组、第四组和第十一组淋巴结和脾门淋巴结的转移情况进行对比分析。结果:胃癌第四组淋巴结和脾门淋巴结具有一定的相关性,第二组、第十一组淋巴结同脾门淋巴结无明显相关关系,第四组淋巴结可视为脾门淋巴结的前哨淋巴结。结论:进展期胃癌中,第四组淋巴结可作为脾门淋巴结的前哨淋巴结,即第四组淋巴结阴性的患者可不行脾门淋巴结清扫,从而降低手术并发症的发生率。 展开更多
关键词 进展期胃癌 纳米炭 淋巴结
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Fat clearance and conventional fixation identified ypN0 rectal cancers following intermediate neoadjuvant radiotherapy have similar long-term outcomes 预览
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作者 Nan Chen Ting-Ting Sun +3 位作者 Zhong-Wu Li Yun-Feng Yao Lin Wang Ai-Wen Wu 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第10期877-886,共10页
BACKGROUND As a prognostic factor for colorectal cancer,lymph node(LN)status,particularly the number of LN harvested,has been demonstrated to be essential in the evaluation of quality control in terms of surgical spec... BACKGROUND As a prognostic factor for colorectal cancer,lymph node(LN)status,particularly the number of LN harvested,has been demonstrated to be essential in the evaluation of quality control in terms of surgical specimen.Neoadjuvant chemoradiation,however,decreases the LN harvest.Therefore,certain approaches(such as fat clearance or methylene blue)has drawn significant attention in order to raise LN yield.AIM To compare the long-term oncologic outcome of ypN0 rectal cancer identified using fat clearance(FC)or conventional fixation(CF)following 30 Gy in 10 fractions(30 Gy/10f)of neoadjuvant radiotherapy(nRT).METHODS Three hundred and eighty-two patients with resectable and locally advanced rectal cancer were treated by 30 Gy/10f intermediate nRT(biologically equivalent dose of 36 Gy)plus total mesorectal excision.Two specimen fixation methods(FC or CF)were non-randomly used.The ypN0 status was identified in 124 and 101 patients in the FL and CF groups,respectively.Primary endpoints were local recurrence-free survival(LRFS)and cancer-specific survival(CSS).RESULTS The median follow-up of patients was 5.1 years.The median numbers of retrieved LNs in the FC and CF groups were 19.5(range,4-47)and 12(range,0-44),respectively,with a significant difference(P=0.000).The percentages of patients with 12 or more retrieved nodes were 82.3%and 50.5%(101/159)in the FC and CF groups,respectively,with a significant difference(P=0.000).The LRFS at 5 years were 95.7%and 94.6%in the FC and CF groups,respectively,without statistical difference(P=0.819).The CSS at 5 years were 92.0%and 87.2%in the FC and CF groups,respectively,without statistical difference(P=0.482).CONCLUSION For patients with ypN0 rectal cancer who underwent 30 Gy/10f preoperative radiotherapy,the increased retrieval of LNs using fat clearance is not associated with survival benefit.This time-consuming fixation method has a low efficacy as a routine practice. 展开更多
关键词 NEOADJUVANT radiotherapy RECTAL cancer Fat clearance Survival LYMPH node CONVENTIONAL FIXATION
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纳米碳在胃癌淋巴结清扫过程中效果的meta分析
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作者 彭志浩 李玉明 《中国普外基础与临床杂志》 CAS 2019年第9期1093-1100,共8页
目的探讨纳米碳对于胃癌患者的临床实用性及安全性,评价其在胃癌根治术中的应用价值。方法检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)以及万方数据库自建库以来至2019年2月期间收录的与胃癌根治术中纳米碳示踪与... 目的探讨纳米碳对于胃癌患者的临床实用性及安全性,评价其在胃癌根治术中的应用价值。方法检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)以及万方数据库自建库以来至2019年2月期间收录的与胃癌根治术中纳米碳示踪与非纳米碳示踪比较的相关文献,提取2组患者的淋巴结检出数、淋巴结检出时间、淋巴结转移数及术后并发症数据,采用RevMan 5.3软件进行meta分析。结果共检索出文献88篇,入选10篇。其中5项随机对照研究,5项病例对照研究;纳米碳组784例,非纳米碳组695例。mate分析结果显示,与非纳米碳组比较,纳米碳组的术中淋巴结检出数较多,淋巴结检出时间较短,淋巴结转移数较多,差异均具有统计学意义(P<0.05);而对术后并发症,2组的并发症发生率比较差异无统计学意义(P>0.05)。结论纳米碳对胃癌淋巴结有明显的示踪作用,可降低术中淋巴结检出难度,提高淋巴结检出率,避免传统淋巴结清扫手术过程中的盲目性。 展开更多
关键词 胃癌 纳米碳 淋巴结 META分析
头侧中间入路与传统中间入路腹腔镜直肠癌根治术治疗直肠癌的效果比较 预览
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作者 常云峰 曹英伟 +2 位作者 李立伟 苗建光 王晓平 《癌症进展》 2019年第17期2045-2047,2058共4页
目的探讨头侧中间入路与传统中间入路腹腔镜直肠癌根治术治疗直肠癌的效果比较。方法将60例接受腹腔镜直肠癌根治术的患者,根据手术入路不同分为对照组和观察组,每组30例。对照组患者接受传统中间入路腹腔镜直肠癌根治术,观察组患者接... 目的探讨头侧中间入路与传统中间入路腹腔镜直肠癌根治术治疗直肠癌的效果比较。方法将60例接受腹腔镜直肠癌根治术的患者,根据手术入路不同分为对照组和观察组,每组30例。对照组患者接受传统中间入路腹腔镜直肠癌根治术,观察组患者接受头侧中间入路腹腔镜直肠癌根治术,比较两组患者的围手术期相关指标、氧化应激指标水平和并发症发生情况。结果观察组患者手术时间、清扫肠系膜下动脉(IMA)附近淋巴结时间均短于对照组患者,第253组淋巴结清扫数目多于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者术中出血量和住院时间比较,差异均无统计学意义(P﹥0.05)。手术前、术后3天和术后5天时,两组患者丙二醇和超氧化物歧化酶(SOD)水平比较,差异均无统计学意义(P﹥0.05)。观察组患者并发症总发生率为13.33%,低于对照组患者的16.67%,但差异无统计学意义(P﹥0.05)。结论与传统中间入路腹腔镜直肠癌根治术相比,头侧中间入路腹腔镜直肠癌根治术更有利于彻底清扫第253组淋巴结,缩短手术时间,且对机体的应激损伤较小。 展开更多
关键词 头侧中间入路 直肠癌 直肠癌根治术 淋巴结 手术时间
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远端胃癌行D2根治术中清除第12p组淋巴结的临床意义 预览
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作者 蒋笃均 蔡彬 +1 位作者 周廷亮 张跃 《实用癌症杂志》 2019年第10期1683-1687,共5页
目的探讨远端胃癌行D2根治术中清除第12p组(No. 12p)淋巴结的临床意义。方法回顾性分析行胃癌D2根治术(对照组,n=126)、胃癌D2根治术中清扫No. 12p组淋巴结的远端胃癌患者(观察组,n=180)临床资料及病理资料,对比2组手术效果,分析No. 12... 目的探讨远端胃癌行D2根治术中清除第12p组(No. 12p)淋巴结的临床意义。方法回顾性分析行胃癌D2根治术(对照组,n=126)、胃癌D2根治术中清扫No. 12p组淋巴结的远端胃癌患者(观察组,n=180)临床资料及病理资料,对比2组手术效果,分析No. 12p组淋巴结转移与临床病理参数的关系。结果观察组手术时间、术中出血量长/高于对照组(P <0. 05);其他指标比较,无统计学差异(P> 0. 05)。观察组中共24例在清扫中发现No. 12p淋巴结转移,转移率为13. 33%(24/180);BorrmanⅢ~Ⅳ型患者No. 12p淋巴结转移率高于BorrmanⅠ~Ⅱ型,多发癌No. 12p淋巴结转移率高于胃角、胃窦区,浆膜受侵者No. 12p淋巴结转移率高于浆膜未受侵者,高、中分化者No. 12p淋巴结转移率低于低分化者,N0~1 No. 12p淋巴结转移率低于N2~3,肿瘤直径<3 cm、3~5 cm者No. 12p淋巴结转移率低于肿瘤直径> 5 cm者,差异均有统计学意义(P <0. 05);Logistic回归分析发现,Borrman分型Ⅲ~Ⅳ型、浆膜受侵、分化程度低、肿瘤直径> 5 cm为远端胃癌患者发生No. 12p淋巴结转移的危险因素(P <0. 05)。结论远端胃癌行D2根治术中清除No. 12p淋巴结,不会明显影响手术效果,尤其对于Borrman分型Ⅲ~Ⅳ型、浆膜受侵、分化程度低、肿瘤直径> 5 cm患者可能有积极意义。 展开更多
关键词 远端胃癌 D2根治术 12p 淋巴结 临床意义
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基于影像组学分类器术前预测直肠非黏液性腺癌淋巴结转移 预览
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作者 谭显政 陈浩 +6 位作者 张亭 吴瀚慧 曾艳峰 黄锋 余毅龙 刘建滨 刘鹏 《中南大学学报:医学版》 CAS CSCD 北大核心 2019年第3期271-276,共6页
目的:探讨影像组学方法在术前预测直肠非黏液性腺癌淋巴结转移中的价值。方法:回顾性分析91例手术病理切片证实为直肠非黏液性腺癌患者的影像学资料,其中61例为训练样本,30例为验证样本。基于全瘤体积,从每个原发病灶术前高分辨T2加权成... 目的:探讨影像组学方法在术前预测直肠非黏液性腺癌淋巴结转移中的价值。方法:回顾性分析91例手术病理切片证实为直肠非黏液性腺癌患者的影像学资料,其中61例为训练样本,30例为验证样本。基于全瘤体积,从每个原发病灶术前高分辨T2加权成像(T2-weighted imaging,T2WI)图像中提取影像组学特征1 301个。基于训练样本,利用最小绝对收缩和选择算子(the least absolute shrinkage and selection operator,LASSO)逻辑回归方法筛选关键特征并构建影像组学分类器。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价影像组学分类器的辨别效能,并将其与形态学标准进行比较。在验证样本中验证影像组学分类器的价值。结果:由5个影像组学特征构建的分类器与淋巴结转移状态有关(P<0.001)。在训练样本和验证样本中,影像组学分类器诊断淋巴结转移的曲线下面积分别为0.874(95%CI:0.787~0.960)和0.878(95%CI:0.727~1.000),形态学标准诊断淋巴结转移的曲线下面积分别为0.619(95%CI:0.487~0.752)和0.556(95%CI:0.355~0.756)。无论是训练样本还是验证样本,影像组学分类器的诊断效能均高于形态学标准(均P<0.05)。结论:影像组学分类器可术前个体化预测直肠非黏液性腺癌淋巴结转移,而且其诊断效能高于形态学标准。 展开更多
关键词 直肠肿瘤 磁共振成像 淋巴结 影像组学
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超声引导下经皮穿刺活检对颈部肿大淋巴结病变的诊断价值 预览
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作者 李伟 徐栋 +1 位作者 韩哲 邵琦 《实用医学影像杂志》 2019年第3期248-250,共3页
目的探讨超声引导下经皮穿刺活检对颈部淋巴结病变的诊断价值。方法用粗针(16G)和细针(22G)在超声引导下经皮穿刺162例颈部肿大的淋巴结,所取出目标组织能做出明确的组织病理诊断者为取材满意,否则为不满意。全部病例以超声引导穿刺活... 目的探讨超声引导下经皮穿刺活检对颈部淋巴结病变的诊断价值。方法用粗针(16G)和细针(22G)在超声引导下经皮穿刺162例颈部肿大的淋巴结,所取出目标组织能做出明确的组织病理诊断者为取材满意,否则为不满意。全部病例以超声引导穿刺活检病理肯定诊断或术后病理为最后诊断。结果162例患者中,158例取材满意,穿刺取材满意率为97.5%。超声引导下粗针和细针穿刺活检对诊断颈部淋巴结病变的灵敏度、特异度和准确度分别为98%、100%、99%和86%、100%、96%,两种类型的针良恶性的诊断差异无统计学意义(P>0.05)。而二维超声诊断的相应指标分别为85%、77%、83%,差异有统计学意义(P<0.05)。结论在超声引导下行经皮穿刺活检颈部肿大淋巴结病变的准确度高,并发症低,是临床诊断颈部肿大淋巴结的有效方式。 展开更多
关键词 超声引导 淋巴结 活组织检查 诊断价值
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手动粗针与全自动活检浅表淋巴结的诊断价值比较 预览
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作者 刘士榕 谭石 +2 位作者 崔立刚 贾建文 刘昊 《中国微创外科杂志》 CSCD 北大核心 2019年第1期22-25,共4页
目的比较超声引导下手动粗针穿刺活检(manual core needle biopsy,MCNB)与全自动切割式活检(automatic cutting needle biopsy,ACNB)在浅表淋巴结活检中的应用价值。方法对我院2014年6月~2016年4月浅表淋巴结肿大150例,全自动切割式活... 目的比较超声引导下手动粗针穿刺活检(manual core needle biopsy,MCNB)与全自动切割式活检(automatic cutting needle biopsy,ACNB)在浅表淋巴结活检中的应用价值。方法对我院2014年6月~2016年4月浅表淋巴结肿大150例,全自动切割式活检枪穿刺2次,然后单纯使用活检针手动取材1次,6例毗邻神经或大血管者仅行MCNB。获取的组织条分别标记后送病理。比较2种方法的取材成功率、特异性病变检出率及并发症发生率。结果6例因毗邻重要结构仅行手动活检,ACNB144例,取材成功139例(96.5%)。MCNB150例,取材成功139例(92.7%),2组取材成功率差异无统计学意义(χ^2=2.218,P=0.145)。2种方法均获得明确病理诊断的淋巴结128例,其中ACNB与MCNB的特异性病变检出分别为96例(75.0%)和112例(87.5%),差异有显著性(χ^2=6.564,P=0.010)。2组均无严重并发症发生。结论ACNB与MCNB用于超声引导下浅表淋巴结活检均具有较高的取材成功率及安全性,MCNB特异性病变检出率更高,且可用于毗邻重要脏器的高风险淋巴结穿刺活检,具有一定的临床价值。 展开更多
关键词 活组织检查 手动 超声引导 淋巴结
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超声引导下经支气管针吸活检术在肺癌诊断中的应用 预览
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作者 刘宇 黄伟鹏 +4 位作者 常琦 殷均阳 王益民 郭海周 李辑伦 《河南外科学杂志》 2019年第4期9-13,共5页
目的评价超声引导下经支气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在肺癌诊断中的应用价值。方法回顾性分析2017-11—2018-10间75例拟诊肺癌并接受EBUS-TBNA的患者的临床资料。EBUS... 目的评价超声引导下经支气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在肺癌诊断中的应用价值。方法回顾性分析2017-11—2018-10间75例拟诊肺癌并接受EBUS-TBNA的患者的临床资料。EBUS-TBNA未能明确诊断者,根据患者情况行外科手术或随诊6个月。结果影像学怀疑肺癌伴纵隔淋巴结和(或)肺门淋巴结肿大(短径≥1cm)59例,经EBUS-TBNA确诊肺癌51例。8例未能明确诊断,经胸腔镜或开胸手术确诊肺癌2例、肺部炎性病变4例、结核及结节病各1例。大气道旁肺实质内占位16例。经EBUS-TBNA确诊肺癌13例,肺部炎症1例及结核1例,经内科保守治疗并随诊6个月,病变部位明显吸收;左肺下叶气管旁肺占位1例,经胸腔镜手术证实为鳞癌。EBUS-TBNA在本组肺癌诊断中敏感度为95.5%(64/67),特异度为100%(8/8),阳性预测值为100%(64/64),阴性预测值为72.7%(8/11),准确度为96%(72/75)。所有患者检查耐受良好,无任何相关并发症发生。结论对于肺癌的诊断,EBUS-TBNA是一种安全有效的检查技术。 展开更多
关键词 肺癌 支气管内超声 经支气管针吸活检术 淋巴结 诊断
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Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer 预览
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作者 Yu-Ning Chu Ya-Nan Yu +6 位作者 Xue Jing Tao Mao Yun-Qing Chen Xiao-Bin Zhou Wen Song Xian-Zhi Zhao Zi-Bin Tian 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第35期5344-5355,共12页
BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection... BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial. AIM To determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC. METHODS We retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses. RESULTS LNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (>30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s types. Multivariate analysis demonstrated SM1 in 展开更多
关键词 Early gastric cancer LYMPH node metastasis PREDICTORS Endoscopic SUBMUCOSAL DISSECTION Expanded INDICATIONS
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不同表观扩散系数评估子宫内膜癌盆腔淋巴结转移的应用价值 预览
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作者 徐培红 龚琼 +1 位作者 彭峰 李涛 《医学影像学杂志》 2019年第4期636-639,共4页
目的 探讨扩散加权成像(diffusion weighted imaging, DWI)对子宫内膜癌盆腔转移性与非转移性淋巴结的鉴别诊断价值。方法 对我院27例子宫内膜癌患者的常规MR及DWI图像进行分析,自动生成表观扩散系数(diffusion weighted imaging, ADC)... 目的 探讨扩散加权成像(diffusion weighted imaging, DWI)对子宫内膜癌盆腔转移性与非转移性淋巴结的鉴别诊断价值。方法 对我院27例子宫内膜癌患者的常规MR及DWI图像进行分析,自动生成表观扩散系数(diffusion weighted imaging, ADC);依据病理结果,分别比较转移性淋巴结与非转移性淋巴结之间ADCmax值、ADCmean值以及ADCmin值的差异,以ROC曲线比较各ADC值诊断效能。结果 共计检出转移性淋巴结28例、非转移性淋巴结68例;两者ADCmax值、ADCmean值以及ADCmin值的两两比较均有统计学差异(均 P <0.05);ADCmax值、ADCmean值以及ADCmin值诊断转移性淋巴结对应的ROC比较(AUC分别为0.832、0.908、0.966),差异亦均具有统计学意义(均 P <0.05)。结论 不同ADC值对子宫内膜癌盆腔转移性淋巴结的定性诊断具有较高的价值,其中ADCmin值的诊断效能最佳。 展开更多
关键词 子宫内膜癌 磁共振成像 淋巴结
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Gastric neuroendocrine neoplasms type 1: A systematic review and meta-analysis 预览
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作者 Apostolos V Tsolakis Athanasia Ragkousi +2 位作者 Miroslav Vujasinovic Gregory Kaltsas Kosmas Daskalakis 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第35期5376-5387,共12页
BACKGROUND To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients wit... BACKGROUND To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients with gastric neuroendocrine neoplasms type 1 (GNENs1) have not been fully elucidated. AIM To determine the rate of LN metastases and its impact in survival in patients with GNEN1 in relation to certain clinico-pathological parameters. METHODS The PubMed, EMBASE, Cochrane Library, Web of Science and Scopus databases were searched through January 2019. The quality of the included studies and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS) in accordance with the Cochrane guidelines. A random effects model and pooled odds ratios (OR) with 95%CI were applied for the quantitative meta-analysis. RESULTS We screened 2933 articles. Thirteen studies with 769 unique patients with GNEN1 were included. Overall, the rate of metastasis to locoregional LNs was 3.3%(25/769). The rate of LN metastases with a cut-off size of 10 mm was 15.3% for lesions > 10 mm (vs 0.8% for lesions < 10 mm) with a random-effects OR of 10.5 (95%CI: 1.4 -80.8;heterogeneity: P = 0.126;I2 = 47.5%). Invasion of the muscularis propria was identified as a predictor for LN metastases (OR: 17.2;95%CI: 1.8-161.1;heterogeneity: P = 0.165;I2 = 44.5%), whereas grade was not clearly associated with LN metastases (OR: 2;95%CI: 0.3-11.6;heterogeneity: P = 0.304;I2 = 17.4%). With regard to GNEN1 local recurrence, scarce data were available. The 5-year disease-specific survival for patients with and without LN metastases was 100% in most available studies irrespective of the type of intervention. Surgical resection was linked to a lower risk of recurrence (OR: 0.3;95%CI: 0.1-1.1;heterogeneity: P = 0.173;I2 = 31.9%). The reported complication rates of endoscopic and surgical intervention were 0.6 and 3.8%, respectively. CONCLUSION This meta-analysis confirms that tumor size ≥ 10 mm and invasion of the muscularis propria are linked to a hi 展开更多
关键词 GASTRIC NEUROENDOCRINE neoplasms TYPE 1 META-ANALYSIS LYMPH node metastasis Tumor size Invasion ENDOSCOPY Surgery
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增强CT联合超声对甲状腺乳头状癌中央区淋巴结转移的诊断价值 预览
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作者 王进 杨欢欢 《海南医学》 CAS 2019年第21期2811-2813,共3页
目的分析增强CT联合超声对甲状腺乳头状癌(PTC)中央区淋巴结转移的诊断效能。方法回顾性分析2014年1月至2019年1月间在榆林市第三医院接受治疗的68例初治PTC患者的临床资料,所有患者均由同一治疗小组完成甲状腺切除手术联合中央区淋巴... 目的分析增强CT联合超声对甲状腺乳头状癌(PTC)中央区淋巴结转移的诊断效能。方法回顾性分析2014年1月至2019年1月间在榆林市第三医院接受治疗的68例初治PTC患者的临床资料,所有患者均由同一治疗小组完成甲状腺切除手术联合中央区淋巴结清扫,经手术病理验证,患者在术前1周均进行增强CT和超声检测。以病理学诊断为金标准,同时确定增强CT、超声检测及联合诊断的假阴性、真阴性、假阳性和真阳性,并计算准确度、特异度与敏感度,分析不同诊断方法间整体诊断情况有无差异。结果以病理学诊断作为转移性淋巴结诊断标准,增强CT、超声、联合检测的特异度分别为92.50%、75.00%、97.50%;准确度分别为72.06%、67.65%、77.94%,敏感度分别为35.71%、57.14%、61.30%,增强CT诊断真阳性37例、假阳性12例、真阴性16例、假阴性3例,超声检测真阳性30例、假阳性12例、真阴性16例、假阴性10例,联合检测真阳性39例、假阳性18例、真阴性10例、假阴性1例,增强CT和超声诊断一致性较差(K=0.236),增强CT、超声和联合诊断一致性一般(K分别是0.646、0.478)。结论增强CT联合超声能够克服各自的不足,能提高检测PTC患者中央区转移性淋巴结诊断效能。 展开更多
关键词 甲状腺乳头状癌 淋巴结 超声检查 增强CT 诊断价值
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