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反切与反切系联法 预览
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作者 麻哲齐 《桂林师范高等专科学校学报》 2019年第2期53-56,共4页
反切作为我国传统的一种注音方法,汉末到唐代一直广为流行,是识字正音的注音工具。东汉时期,佛教在中国的传播触发了中国学者对汉字注音方式的研究,反切注音法就在梵文拼音文字的注音原理影响下应运而生。反切对汉字字音结构进行分析,... 反切作为我国传统的一种注音方法,汉末到唐代一直广为流行,是识字正音的注音工具。东汉时期,佛教在中国的传播触发了中国学者对汉字注音方式的研究,反切注音法就在梵文拼音文字的注音原理影响下应运而生。反切对汉字字音结构进行分析,采用反切上、下两个字为一个被拼切汉字注音的原则,避免了“读若”“譬况”和“直音法”注音不准确的问题,且也对我国拼音字母发展具有重要影响。清代音韵学家陈澧在其著作《切韵序》中首创“反切系联法”分析《广韵》中的反切,以推求声类和韵类,为古音的探究开拓了一条科学的研究道路。 展开更多
关键词 反切法 反切原则 系联法 系联条例
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Endoscopic resection techniques for colorectal neoplasia:Current developments 预览
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作者 Franz Ludwig Dumoulin Ralf Hildenbrand 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第3期300-307,共8页
Endoscopic polypectomy and endoscopic mucosal resection(EMR)are the established treatment standards for colorectal polyps.Current research aims at the reduction of both complication and recurrence rates as well as on ... Endoscopic polypectomy and endoscopic mucosal resection(EMR)are the established treatment standards for colorectal polyps.Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times.Cold snare resection is the emerging standard for the treatment of smaller(<5mm)polyps and is possibly also suitable for the removal of noncancerous polyps up to 9 mm.The method avoids thermal damage,has reduced procedure times and probably also a lower risk for delayed bleeding.On the other end of the treatment spectrum,endoscopic submucosal dissection(ESD)offers en bloc resection of larger flat or sessile lesions.The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer.Due to its minimal recurrence rate,it may also be an alternative to fractionated EMR of larger flat or sessile lesions.However,ESD is technically demanding and burdened by longer procedure times and higher costs.It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer.The latest addition to endoscopic resection techniques is endoscopic fullthickness resection with specifically developed devices for flexible endoscopy.This method is very useful for the treatment of smaller difficult-to-resect lesions,e.g.,recurrence with scar formation after previous endoscopic resections. 展开更多
关键词 COLORECTAL NEOPLASIA COLORECTAL cancer screening Cold SNARE RESECTION ENDOSCOPIC POLYPECTOMY ENDOSCOPIC mucosal RESECTION ENDOSCOPIC submucosal dissection ENDOSCOPIC full-thickness RESECTION Adenoma recurrence rate
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Predicting systemic spread in early colorectal cancer: Can we do better? 预览
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作者 Scarlet Fiona Brockmoeller Nicholas Paul West 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第23期2887-2897,共11页
Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision... Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision can be an attractive option, especially for fragile patients with multiple comorbidities, but it is only safe from an oncological point of view in the absence of lymph node metastasis. Patient risk stratification through careful analysis of histopathological features in local excision or polypectomy specimens should be performed according to national guidelines to avoid under-or over-treatment. Currently national guidelines vary in their recommendations as to which factors should be routinely reported and there is no established multivariate risk stratification model to determine which patients should be offered major resectional surgery.Conventional histopathological parameters such as tumour grading or lymphovascular invasion have been shown to be predictive of lymph node metastasis in a number of studies but the inter-and intra-observer variation in reporting is high. Newer parameters including tumour budding and poorly differentiated clusters have been shown to have great potential, but again some improvement in the inter-observer variation is required. With the implementation of digital pathology into clinical practice, quantitative parameters like depth/area of submucosal invasion and proportion of stroma can be routinely assessed. In this review we present the various histopathological risk factors for predicting systemic spread in pT1 colorectal cancer and introduce potential novel quantitative variables and multivariable risk models that could be used to better define the optimal treatment of this increasingly common disease. 展开更多
关键词 Early colorectal CANCER Bowel CANCER screening Local RESECTION Major RESECTION Morphological RISK factors Conventional HISTOPATHOLOGY PARAMETERS Novel HISTOPATHOLOGY PARAMETERS RISK STRATIFICATION models Digital pathology
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Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis 预览
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作者 Fares Ayoub Donevan R Westerveld +3 位作者 Justin J Forde Christopher E Forsmark Peter V Draganov Dennis Yang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第18期2251-2263,共13页
BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection t... BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes. AIM To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm. METHODS We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I2 were used to test for heterogeneity. Pooling was conducted using a random-effects model. RESULTS Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%)(pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I^2 = 0%, P = 0.67). CONLUSION Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy. 展开更多
关键词 META-ANALYSIS CLIPPING ENDOSCOPIC RESECTION ENDOSCOPIC mucosal RESECTION
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Khubchandani’s procedure combined with stapled posterior rectal wall resection for rectocele 预览
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作者 Yi Shao Yong-Xing Fu +3 位作者 Qing-Fa Wang Zhi-Qiang Cheng Guang-Yong Zhang San-Yuan Hu 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第11期1421-1431,共11页
BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has... BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani’s procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rec 展开更多
关键词 RECTOCELE RECTAL prolapse Obstructed defecation syndrome Khubchandani’s PROCEDURE Stapled POSTERIOR RECTAL WALL RESECTION Stapled transanal RECTAL RESECTION
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What is the advance of extent of resection in glioblastoma surgical treatment—a systematic review
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作者 Lei Wang Buqing Liang +3 位作者 Yan Icy Li Xiang Liu Jason Huang Yan Michael Li 《中华神经外科杂志(英文)》 CSCD 2019年第2期102-107,共6页
Glioblastoma multiform (GBM) is the most common malignant brain tumor characterized by poor prognosis,increased invasiveness,and high relapse rates.The relative survival estimates are quite low in spite of the standar... Glioblastoma multiform (GBM) is the most common malignant brain tumor characterized by poor prognosis,increased invasiveness,and high relapse rates.The relative survival estimates are quite low in spite of the standard treatment for GBM in recent years.Now,it has been gradually accepted that the amount of tumor mass removed correlates with longer survival rates.Although new technique advances allowing intraoperative analysis of tumor and normal brain tissue and functional paradigms based on stimulation techniques to map eloquent areas have been used for GBM resection,visual identification of tumor margins still remains a challenge for neurosurgeons.This article attempts to review and summarize the evolution of surgical resection for glioblastomas. 展开更多
关键词 GLIOBLASTOMA multiform (GBM) Biopsy Extent of RESECTION (EOR) GROSS total RESECTION (GTR)
The impact of extent of pancreatic and venous resection on survival for patients with pancreatic cancer 预览
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作者 Matteo Serenari Giorgio Ercolani +7 位作者 Alessandro Cucchetti Matteo Zanello Enrico Prosperi Guido Fallani Michele Masetti Raffaele Lombardi Matteo Cescon Elio Jovine 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第4期389-394,共6页
Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgica... Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgical therapy in this disease.This study aimed to investigate the impact of extent of pancreatic and venous resection on short-and long-term outcomes in patients with pancreatic adenocarcinoma(PDAC).Methods:This was a retrospective study from a prospectively maintained database of pancreatic resections for PDAC.Short-and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy(TP)or pancreaticoduodenectomy(PD)with simultaneous portal vein(PV)and/or superior mesenteric vein(SMV)resection.Venous resections were carried out as tangential venous resection(TVR)or segmental venous resection(SVR).Patients were divided into 4 groups:(1)PD+TVR,(2)PD+SVR,(3)TP+TVR,(4)TP+SVR.Uni-and multivariate Cox regression analysis were performed to identify factors associated with survival.Results:Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for PDAC.Among them,25 were submitted to PD+TVR(25.3%),12 to PD+SVR(12.1%),23 to TP+TVR(23.2%),and 39 to TP+SVR(39.4%).Overall,major morbidity(Clavien-Dindo grade≥IIIA)was 26.3%.Thirty-and 90-day mortality were 3%and 11.1%,respectively.There were no significant differences among groups in terms of short-term outcomes.Median overall survival of patients submitted to PD+TVR was significantly higher than those to TP+SVR(29.5 vs 7.9 months,P=0.001).Multivariate analysis identified TP(HR=2.11;95%CI:1.31–3.44;P=0.002)and SVR(HR=2.01;95%CI:1.27–3.15;P=0.003)as the only independent prognostic factors for overall survival.Conclusions:Up-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC.Perioperative treatments in high-risk surgical groups may improve such poor outcomes. 展开更多
关键词 PANCREATIC RESECTION VASCULAR RESECTION PANCREATIC cancer surgery
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Abdominoperineal Resection in Rectal Cancer in General Surgery Department at Gabriel Toure University Hospital 预览
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作者 Amadou Traore Abdoulaye Diarra +19 位作者 Madiassa Konate Souleymane Thiam Soumaila Keita Tani Kone Boubacar Karembe Assitan Kone Boubacar Sidibe Amadou Bah Amadou Ma?ga Ibrahim Diakite Bakary Tientigui Dembele Alhassane Traore Adegne Togo Lassana Kante Moussa Samake Moustapha Issa Mangane Thierno Madane Diop Mamadou Salia Diarra Adama Diakite Gangaly Diallo 《外科学(英文)》 2019年第1期16-23,共8页
The objectives: Were to determine the hospital frequency of abdominoperineal resection (APR);to determine mortality and morbidity rates and to assess oncologic outcomes. Method and patients: We performed a retrospecti... The objectives: Were to determine the hospital frequency of abdominoperineal resection (APR);to determine mortality and morbidity rates and to assess oncologic outcomes. Method and patients: We performed a retrospective study between 2008 and 2013 in general surgery department at Gabriel Toure University Hospital (UH) which included all patients admitted for rectal cancer confirmed by pathological examination, and having undergone an APR. Results: We have collected 17 cases which accounted for 65.38% of curative resections of rectal cancer. The sex-ratio was 0.89 and the averageage was 49.53 years. The average tumor distance from the anal verge was 4.59 ± 1.7 cm. All patients had adenocarcinoma of the rectum. The histopathologic grade was well in 7 cases, moderate and poor in 5 cases each. According to the pathologic TNM classification, 13 patients were classified T4, 14 patients N+. APR was associated with hysterectomy and partial colpectomy in 4 cases. The average duration of interventions was 202.06 ± 25.68 minutes. The average duration of hospitalization was 18.24 ± 04.89 days. The postoperative mortality and morbidity rates were 5.88% and 29.42%, respectively. Local recurrence was observed in 6 patients and liver metastasis in 2 patients. The overall survival rate was 37.5% at 2 years and 18.75% at 5 years. Conclusion: APR still occupies an important place in our practice. Our results could be improved by the recent introduction of neoadjuvant radio chemotherapy in Mali. 展开更多
关键词 Abdominoperineal Cancer MALI RECTUM RESECTION SURGERY
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神经母细胞瘤患儿原发肿瘤手术切除程度与生存预后的关系
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作者 闫焕 杨正兵 《中国肿瘤临床与康复》 2019年第3期280-283,共4页
目的探讨神经母细胞瘤(NB)患儿原发肿瘤手术切除程度与生存预后的关系。方法选取2011年5月至2015年7月间四川省成都市妇女儿童中心医院收治的行手术切除治疗的91例NB患儿,按照原发肿瘤手术切除程度不同分为两组,其中31例手术切除<90... 目的探讨神经母细胞瘤(NB)患儿原发肿瘤手术切除程度与生存预后的关系。方法选取2011年5月至2015年7月间四川省成都市妇女儿童中心医院收治的行手术切除治疗的91例NB患儿,按照原发肿瘤手术切除程度不同分为两组,其中31例手术切除<90%原发病灶的患儿纳入A组,60例手术切除≥90%原发病灶的患儿纳入B组,比较两组患儿的临床疗效及不良反应。随访截止至2018年7月31日,记录患儿的生存情况,分析手术切除程度与生存预后的关系。结果 A组患儿治疗后总有效率为45. 2%,明显低于B组的91. 7%,差异有统计学意义(P <0. 05)。随访截止时,91例患者中存活34例,总生存率为37. 6%。单因素分析结果显示,NB患儿生存情况与临床分期、配合化疗、神经元特异性烯醇化酶(NSE)、远处转移及手术切除程度有关,差异均有统计学意义(均P <0. 05)。A组患者平均生存时间为(19. 42±6. 25)个月,明显低于B组的(50. 74±13. 16)个月,两组比较,差异有统计学意义(P <0. 05)。Cox回归分析结果表明,配合化疗和手术切除程度是NB患儿总体生存时间的独立影响因素,差异均有统计学意义(均P <0. 05)。结论配合化疗和手术切除原发病灶程度可影响NB患儿的生存预后,临床治疗时,应综合考虑患儿身体状况,选择手术切除范围。 展开更多
关键词 神经母细胞瘤 手术切除 原发肿瘤 生存 切除程度
Prostate resection speed:A key factor for training and broad outcomes? 预览
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作者 Jack Donati-Bourne Shahd Nour +1 位作者 Emiliya Angova George Delves 《世界临床泌尿杂志》 2019年第1期1-8,共8页
BACKGROUND Trans-urethral resection of prostate(TURP)is one of the most commonly performed operations in urology to treat bladder outflow obstruction(BOO)in men.TURP surgery is also a key for endo-urological training ... BACKGROUND Trans-urethral resection of prostate(TURP)is one of the most commonly performed operations in urology to treat bladder outflow obstruction(BOO)in men.TURP surgery is also a key for endo-urological training in the British National Health Service(NHS)for training junior urologists.The working hypothesis is that prostate resection speed(PRS)in the context of bipolar TURP surgery,is not a key factor in major complication rates or broad patient outcomes at 3 mo after surgery,and therefore supervising consultants should not focus primarily on resection speed when teaching TURP.AIM To investigate objective differences in consultants vs trainees PRS and whether PRS affected complication rates/outcomes after TURP.METHODS Retrospective descriptive study analyzing patient case-notes,operative and electronic records,study undertaken at Burton Queen’s Hospital NHS Foundation Trust,United Kingdom,a secondary care centre in the public sector of the NHS.Participants included:all Bipolar TURPs undertaken between 13/04/2016 and 27/06/2017.Exclusions:patients undergoing concomitant operations or where intra-operative equipment problems occurred.Resected prostate(g),operative time,post-operative complications and outcomes at 3-mo were obtained from electronic records.Clavien-Dindo Grade II complications or above considered significant.Binary successful yes/no outcome at 3-mo after surgery included both patients who reported moderate to significant symptom improvement,or being catheter-free for those catheterized before TURP.RESULTS 157 patients were identified.After exclusion a total of 125 patients were included from analysis.The mean PRS for trainees(0.34 g/min)was found to be lower than the mean PRS for consultants(0.41 g/min).The operating urologist’s PRS was not observed to be related to the number of TURPs that they performed during the period of the study.The trainee vs consultant means post-operative success rates(86.5%vs 90.5%)were comparable.The Trainees’patients did not suffer any significant complication 展开更多
关键词 PROSTATE RESECTION Trans-urethral RESECTION of PROSTATE TRAINING SPEED
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U形病灶挖除术对子宫腺肌病合并深部浸润型子宫内膜异位症行保留子宫可行性
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作者 焦艳 龚利 《社区医学杂志》 2019年第5期283-286,共4页
目的深部浸润型子宫内膜异位症(deeply infihmting endometriosis,DIE)是指病灶浸润侵袭至腹膜下深度>5mm的子宫内膜异位症,子宫腺肌病病灶分布广泛且边界不清,术后复发率高。本研究探讨U形病灶挖除手术治疗子宫腺肌病合并深部浸润... 目的深部浸润型子宫内膜异位症(deeply infihmting endometriosis,DIE)是指病灶浸润侵袭至腹膜下深度>5mm的子宫内膜异位症,子宫腺肌病病灶分布广泛且边界不清,术后复发率高。本研究探讨U形病灶挖除手术治疗子宫腺肌病合并深部浸润型子宫内膜异位症时,能否在保留子宫的基础上切除子宫腺肌病病灶及周围DIE病灶。方法选取2011-05-31-2016-10-31在武汉商职医院妇产科接受手术治疗的55例伴有子宫腺肌病的DIE患者作为主要研究对象,根据患者要求在保留子宫的基础上,使用开腹手术+U形病灶挖除手术治疗。观察比较患者术前、术后3个月、术后6个月及12个月的视觉模拟评分(visual analogue scale,VAS),观察记录患者术前和术后12个月月经量减少情况、子宫体积大小和血清糖链抗原125(carbohydrate antigen 125,CA125)水平、妊娠分娩情况及并发症情况。结果 U形病灶挖除手术切除病灶并保留子宫的成功率100.00%;术后12个月的痛经VAS评分为(2.04±1.53)分,显著低于术前的(9.13±1.12)分;肛门坠胀VAS为(1.27±0.94)分,显著低于术前的(5.14±2.02)分;性交痛VAS评分为(1.38±0.65)分,显著低于术前的(3.87±1.84)分;术后12个月的月经量为(42.79±8.02)mL,明显少于术前(113.38±11.65)mL,t=8.882,P<0.001;CA125水平为(17.21±6.59)U/L,明显低于术前(95.43±17.94)U/L,t=15.219,P<0.001;术后12个月患者的子宫体积为(83.2±10.2)cm2,明显小于术前的(117.3±33.4)cm2,t=6.252,P<0.001;术后发生并发症3例(5.45%),对症治疗后均已痊愈。结论 U形病灶挖除术能够顺利挖除伴有子宫腺肌病的DIE患者的病灶部位,改善临床症状,减少并发症,同时还能有效保留患者子宫。 展开更多
关键词 子宫腺肌病 U形挖除术 深部浸润型子宫内膜异位症 切除病灶 保留子宫
Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus:An improvement in technique over 15 years 预览
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作者 Nan Ge Jin-Long Hu +2 位作者 Fei Yang Fan Yang Si-Yu Sun 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第11期1054-1064,共11页
BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria(MP tumors).Three endoscopic resection techniques have been develope... BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria(MP tumors).Three endoscopic resection techniques have been developed to treat these tumors,including ligation-assisted endoscopic full-thickness resection(L-EFTR),snareassisted EFTR(S-EFTR),and endoscopic submucosal dissection-assisted EFTR(EEFTR).To date,no studies have compared these techniques.AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital,China.Standard demographic and clinicopathologic data,including sex,age,tumor size,surgeon details,and pathological results,were collected.Data regarding operation duration,cost,enbloc resection,and severe complications were also extracted and compared.RESULTS A total of 36 patients(27 women)with a mean age of 55.8±10.20 years were included in this study.The mean tumor size was 9.0±3.98 mm.All the methods showed a 100%en-bloc resection rate and 0%severe complication rate.There was no statistically significant difference among the three groups in the operation duration(P=0.148).The cost comparison for the whole procedure was as follows:E-EFTR>L-EFTR>S-EFTR(5837.5±7212.96 CNY,5970.7±3465.27 CNY,5852.0±6438.25 CNY,respectively,P<0.001).CONCLUSION S-EFTR,L-EFT,and E-EFTR are all effective for resection of small MP tumors in the gastric fundus.S-EFTR is superior in terms of cost-effectiveness. 展开更多
关键词 Endoscopic full-thickness resection LIGATION Muscularis propria SNARE Endoscopic submucosal dissection COST
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关节镜下跟距骨联合切除术
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作者 冯龙 王红玉 姜厚森 《中国矫形外科杂志》 CAS CSCD 北大核心 2019年第7期651-654,共4页
[目的]介绍关节镜下内后方入路行跟距骨联合切除治疗疼痛性跟距骨联合的手术技术与疗效。[方法]2014年7月~2017年3月,采用关节镜下经内后方入路跟距骨联合切除治疗疼痛性跟距骨联合患者12例。自后内侧建立通道,用刨刀刨除踝关节后方的... [目的]介绍关节镜下内后方入路行跟距骨联合切除治疗疼痛性跟距骨联合的手术技术与疗效。[方法]2014年7月~2017年3月,采用关节镜下经内后方入路跟距骨联合切除治疗疼痛性跟距骨联合患者12例。自后内侧建立通道,用刨刀刨除踝关节后方的脂肪组织,充分暴露出母长屈肌腱,然后刨除母长屈肌腱外侧的脂肪组织,充分显露出跟骨、距骨、胫骨的后缘。关节镜下可见骨性联合完全替代了关节间隙,用磨钻由后向前顺序磨除骨联合。采用VAS疼痛评分、美国足踝外科(AOFOS)后足评分,以及术后患者主观满意度评估临床疗效。[结果] 12例患者获得24个月随访。疼痛VAS评分由术前(6.82±0.80)分减少至末次随访时(1.52±1.20)分,差异有统计学意义(P<0.05)。AOFOS后足评分由术前(48.80±6.85)分提升至末次随访时(86.90±7.44)分,差异有统计学意义(P<0.05)。患者主观疗效满意度调查:满意8例,较满意2例,一般2例;满意率83.33%。12例患者术后24个月复查踝关节X线片未见跟距骨桥复发征象。[结论]对跟距关节无骨性关节炎、跟距骨联合面积未达到整个跟距关节面1/2的疼痛症状的骨联合,关节镜下行跟距骨联合切除术短期疗效优良。 展开更多
关键词 跟距骨联合 切除 关节镜术
Resection of retrohepatic inferior vena cava without reconstruction for hepatic alveolar echinococcosis
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作者 Bo Ran Ying-Mei Shao +6 位作者 Tie-Ming Jiang Rui-Qing Zhang Qiang Guo Abuduaini Abulizi Yusfu Yimiti Hao Wen Tuerganaili Aji 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第13期1623-1624,共2页
To the Editor:Echinococcus multilocularis(E.multilocular is)which can cause alveolar echinococcosis(AE),mainly involve the liver.[1]AE diagnosis mainly depends on epidemiological evidence,clinical presentation,serolog... To the Editor:Echinococcus multilocularis(E.multilocular is)which can cause alveolar echinococcosis(AE),mainly involve the liver.[1]AE diagnosis mainly depends on epidemiological evidence,clinical presentation,serology test results,and radiological examinations.,2]Surgery is a main treatment method.[3]We describe a case with complicated AE who underwent resection of retrohepatic inferior vena cava(RHIVC)without reconstruction.The study was approved by the ethics review board of the First Affiliated Hospital of Xinjiang Medical University. 展开更多
关键词 RESECTION of retrohepatic INFERIOR RECONSTRUCTION ECHINOCOCCOSIS
Treatment of early stage (T1) esophageal adenocarcinoma: Personalizing the best therapy choice 预览
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作者 Lindsay Danielle Kumble Elisabeth Silver +3 位作者 Aaron Oh Julian A Abrams Joshua R Sonett Chin Hur 《世界荟萃分析杂志》 2019年第9期406-417,共12页
Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic r... Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic resection(ER)presents a potential curative treatment option that is less invasive and carries fewer risks procedure related risks,but it is associated with higher rates of cancer recurrence following the procedure.For some patients,age and comorbidities may prevent them from having esophagectomy as a treatment option,while other patients may be operative candidates but do not wish to undergo esophagectomy for a variety of reasons related to their values and preferences.Furthermore,while anxiety of cancer recurrence following ER may significantly diminish a patient’s quality of life(QOL),so might the morbidity surrounding esophagectomy.In addition to considering health status,patient preferences,and impacts on QOL,physicians and patients must also consider what treatments would be both beneficial and available to the patient,considering esophagectomy methods-minimally invasive vs open-or the use of chemoradiotherapy in addition to ER.Our article reviews and summarizes available treatment options for patients with early EAC and their potential effects on the health and wellbeing of patients based on the current data.We conclude with a request for more research of available options for early EAC patients,the conditions that determine when each option should be employed,and their effects not only on patient health but also QOL. 展开更多
关键词 Esophageal cancer ADENOCARCINOMA T1b ESOPHAGECTOMY Endoscopic resection CHEMORADIOTHERAPY Quality of life
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WHO Ⅱ、Ⅲ级脑膜瘤显微外科术后复发的影响因素 预览
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作者 崔萌 暴洪博 李丹妮 《现代仪器与医疗》 CAS 2019年第1期25-28,共4页
目的:分析世界卫生组织(WHO)Ⅱ、Ⅲ级脑膜瘤术后复发的影响因素。方法:回顾性分析我院2009年2月至2015年2月收治的125例病理诊断明确为WHOⅡ、Ⅲ级的脑膜瘤患者临床资料,采用统计学方法处理数据,总结WHOⅡ、Ⅲ级脑膜瘤术后复发的影响因... 目的:分析世界卫生组织(WHO)Ⅱ、Ⅲ级脑膜瘤术后复发的影响因素。方法:回顾性分析我院2009年2月至2015年2月收治的125例病理诊断明确为WHOⅡ、Ⅲ级的脑膜瘤患者临床资料,采用统计学方法处理数据,总结WHOⅡ、Ⅲ级脑膜瘤术后复发的影响因素,为临床治疗提供理论依据。结果:WHOⅡ、Ⅲ级脑膜瘤术后复发率为32.80%。Kaplan-Meier单因素生存分析发现,合并年龄>60岁、颅底及其他部位肿瘤、肿瘤最大径>5cm、部分切除、Ki-67表达水平≥8%、术前癫痫、瘤周水肿的患者复发率较未合并者高,且差异有统计学意义(P<0.05)。多因素Cox回归分析发现,年龄>60岁、颅底及其他部位肿瘤、肿瘤最大径>5cm、部分切除、Ki-67表达水平≥8%、术前癫痫、瘤周水肿是WHOⅡ、Ⅲ级脑膜瘤术后复发的独立危险因素(P<0.05)。结论:WHOⅡ、Ⅲ级脑膜瘤术后复发率较高,对合并术后复发危险因素的患者应加强随访观察,及早干预。 展开更多
关键词 脑膜瘤 世界卫生组织Ⅱ级 世界卫生组织Ⅲ级 切除术 复发 危险因素
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Significance of multivisceral resections in oncologic surgery: A systematic review of the literature 预览
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作者 Giorgi Nadiradze Can Yurttas +1 位作者 Alfred Konigsrainer Philipp Horvath 《世界荟萃分析杂志》 2019年第6期269-289,共21页
BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevat... BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevated morbidity rates are not clearly defined. AIM To systematically review the literature on oncologic long-term outcomes and morbidity and mortality in cancer surgery a systematic review of the literature was performed. METHODS PubMed was searched for relevant articles (published from 2000 to 2018). Retrieved abstracts were independently screened for relevance and data were extracted from selected studies by two researchers. RESULTS Included were 37 studies with 3112 patients receiving MVR for colorectal cancer (1095 for colon cancer, 1357 for rectal cancer, and in 660 patients origin was not specified). The most common resected organs were the small intestine, bladder and reproductive organs. Median postoperative morbidity rate was 37.9%(range: 7% to 76.6%) and median postoperative mortality rate was 1.3%(range: 0% to 10%). The median conversion rate for laparoscopic MVR was 7.9%(range: 4.5% to 33%). The median blood loss was lower after laparoscopic MVR compared to the open approach (60 mL vs 638 mL). Lymph-node harvest after laparoscopic MVR was comparable. Report on survival rates was heterogeneous, but the 5-year overall-survival rate ranged from 36.7% to 90%, being worst in recurrent rectalcancer patients with a median 5-year overall survival of 23%. R0 -resection, primary disease setting and no lymph-node or lymphovascular involvement were the strongest predictors for long-term survival. The presence of true malignant adhesions was not exclusively associated with poorer prognosis. Included were 16 studies with 1.600 patients receiving MVR for gastric cancer. The rate of morbidity ranged from 11.8% to 59.8%, and the main postoperative complications were pancreatic fistulas and pancreatitis, anastomotic leakage, cardiopulmonary events and post-operative bleedings. Total mortality was between 0% a 展开更多
关键词 COLORECTAL CANCER Gastric CANCER Primary RECURRENT Multivisceral RESECTION Hyperthermic INTRAPERITONEAL chemotherapy MORBIDITY
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Endoscopic management of esophageal cancer 预览
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作者 Osman Ahmed Jaffer A Ajani Jeffrey H Lee 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第10期830-841,共12页
Esophageal cancer(EC)generally consists of squamous cell carcinoma(which arise from squamous epithelium)and adenocarcinoma(which arise from columnar epithelium).Due to the increased recognition of risk factors associa... Esophageal cancer(EC)generally consists of squamous cell carcinoma(which arise from squamous epithelium)and adenocarcinoma(which arise from columnar epithelium).Due to the increased recognition of risk factors associated with EC and the development of screening programs,there has been an increase in the diagnosis of early EC.Early EC is amenable to curative therapy by endoscopy,which can be performed by either endoscopic resection or endoscopic ablation.Endoscopic resection consists of either endoscopic mucosal resection(preferred in cases of adenocarcinoma)or endoscopic submucosal dissection(preferred in cases of squamous cell carcinoma).Endoscopic ablation can be performed by either radiofrequency ablation,cryotherapy,argon plasma coagulation or photodynamic therapy,amongst others.Endoscopy can also assist in the management of complications post-esophageal surgery,such as anastomotic leaks and perforations.Finally,there is a growing role for endoscopy to manage end-of-life palliative symptoms,especially dysphagia.The growing use of esophageal stents,debulking therapy and dilation can assist in improving a patient’s quality of life.In this review,we examine the multiple roles of endoscopy in the management of patients with EC. 展开更多
关键词 ESOPHAGEAL cancer ENDOSCOPY RESECTION Ablation STENT Barrett’s ESOPHAGUS
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Endoscopic submucosal dissection as excisional biopsy for anorectal malignant melanoma: A case report 预览
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作者 Shigeo Manabe Yoshio Boku +3 位作者 Michiyo Takeda Fumitaka Usui Ikuhiro Hirata Shuji Takahashi 《世界临床病例杂志》 2019年第13期1652-1659,共8页
BACKGROUND Anorectal malignant melanoma (AMM) is a rare disorder with an extremely poor prognosis. Although there is currently no consensus on the treatment methods for AMM, surgical procedures have been the most comm... BACKGROUND Anorectal malignant melanoma (AMM) is a rare disorder with an extremely poor prognosis. Although there is currently no consensus on the treatment methods for AMM, surgical procedures have been the most common treatment methods used until now. We recently encountered a case of AMM that we diagnosed using endoscopic submucosal dissection (ESD). To our knowledge, this is the first case of ESD for AMM, suggesting that ESD can potentially be a diagnostic and treatment method for AMM. CASE SUMMARY A 77-year-old woman visited our hospital with a chief complaint of anal bleeding and a palpable rectal mass. Colonoscopy revealed a 20-mm protruded lesion in the lower rectum. After obtaining biopsy specimens from the lesion, although a malignant rectal tumor was suspected, a definitive diagnosis was not made. Endoscopic ultrasonography revealed tumor invasion into the submucosal layer but not the muscular layer. Therefore, we performed an excisional biopsy using ESD. Immunohistochemical examination of the ESD-resected specimen revealed tumor cells positive for Human Melanin Black-45, Melan-A, and S-100. Moreover, the tumor cells lacked melanin pigment;thus, a diagnosis of amelanotic AMM was made. Although the AMM had massively invaded the submucosal layer and both lymphatic and venous invasion were present, we closely monitored the patient without any additional therapy on the basis of her request. Six months after ESD, local recurrence was detected, and the patient consented to wide local excision. CONCLUSION It is suggested that ESD is a potential diagnostic and treatment method for AMM. 展开更多
关键词 ENDOSCOPIC SUBMUCOSAL DISSECTION ANORECTAL malignant MELANOMA ENDOSCOPIC MUCOSAL resection Case report
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食管癌新辅助放化疗后手术时机选择的系统评价与Meta分析
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作者 何枫 帖红涛 +4 位作者 郎伟思 罗骏 陈丹 吴庆琛 杨龙 《中国胸心血管外科临床杂志》 CAS CSCD 2019年第11期1125-1135,共11页
目的研究新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)和食管癌切除术之间时间间隔(简称为时间间隔)对食管癌临床结局的影响。方法计算机检索PubMed和EMbase数据库,检索时间为建库至2018年3月。随机效应模型用于所有Meta分析,而... 目的研究新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)和食管癌切除术之间时间间隔(简称为时间间隔)对食管癌临床结局的影响。方法计算机检索PubMed和EMbase数据库,检索时间为建库至2018年3月。随机效应模型用于所有Meta分析,而不考虑异质性。Meta分析采用RevMan5.3软件进行。文献的主要结局为手术死亡率、吻合口瘘发生率及生存情况,次要结局为病理完全缓解率、R0切除率、切缘阳性率。结果共17个研究含18 173例患者纳入本研究。其中,原始研究13个包含2 950例患者,基于数据库研究4个含15 223例患者。相关性分析发现时间间隔与手术死亡率呈显著正相关(Spearman系数0.360,P=0.027)。剂量-效应Meta分析发现nCRT后存在一个相对较佳的手术时间窗。进一步对主要结局不同时间截点(较短与较长时间间隔分界点)分析发现:(1)时间截点在30~70 d内时,较短时间间隔均可降低手术死亡风险[7~8周:RR=0.67,95%CI(0.55,0.81),P<0.05;30~46 d:RR=0.63,95%CI(0.47,0.85),P<0.05;60~70 d:RR=0.64,95%CI(0.48,0.85),P<0.05];(2)时间截点在30~46 d内时,较短时间间隔可以降低吻合口瘘发生风险[RR=0.39,95%CI(0.21,0.72),P<0.05];时间截点在7~8周时,较短时间间隔对吻合口瘘发生风险的影响处于临界状态[RR=0.73,95%CI(0.52,1.03),P>0.05];(3)当时间截点在7~8周内时,较长时间间隔会显著增加远期死亡风险[HR=1.17,95%CI(1.00,1.36),P<0.05]。对次要结局分析发现,时间截点在56~60 d时,较短时间间隔可以显著降低切缘阳性率[RR=0.53,95%CI(0.38,0.75),P<0.05]。结论在一定时间截点内,尽可能缩短时间间隔可以降低手术死亡率、吻合口瘘发生率、远期死亡风险及切缘阳性率。建议食管癌切除术应该在患者体能恢复后尽早进行,不超过7~8周最佳,支持目前研究推荐的nCRT后3~8周内。 展开更多
关键词 食管癌 新辅助放化疗 手术切除 时间间隔 系统评价/META分析
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