中国实用医刊杂志   部级期刊

摘要：目的 探讨雌激素受体(ER)、孕激素受体(PR)、原癌基因(C-erbB-2)、Ki-67与癌胚抗原(CEA)、糖抗原153(CA-153)联合检测对乳腺癌预后的评估,区分患者的复发危险性,以采取个性化治疗方案,提高患者的长期生存率.方法 120例乳腺癌患者术前检测CEA、CA-153,术中组织标本石蜡切片标本SP法免疫组化检测.结果 120例乳腺癌中ER、PR、C-erbB-2 、Ki-67的阳性表达率分别为62%、51%、38%、73%,CEA、CA-153阳性表达率分别为8%、10%,C-erbB-2、Ki-67与CEA、CA-153的表达与乳腺癌转移与预后呈正相关,ER、PR的表达与乳腺癌转移与预后呈负相关.结论 C-erbB-2、Ki-67与CEA、CA-153的表达是乳腺癌患者预后差的指标,ER、PR的表达提示乳腺癌患者预后好,ER、PR、C-erbB-2、Ki-67与CEA、CA-153联合检测有助于乳腺癌患者的治疗和预后判断. Abstract： Objective To assess the prognosis of patients with breast cancer through the joint inspection of ER, PR, C-erbB-2, Ki-67 and CEA, CA-153. To differentiate patients relapse risk and adopt personalized management plan,which were to improve the patients with long-term survival. Methods The level of CEA,and CA-153 were measured in 120 breast cancer before the surgery, ER,PR,C-erbB-2 and Ki-67 were measured by SP immunohistochemical staining technique on paraffin-embedded specimens of 120 cases of breast cancer. Results The positive rate in patients with lung cancer of ER, PR, C-erbB-2, Ki-67, CEA and CA-153 were 62%, 51%, 38%, 73%, 8%and 10%, respectively. The expression of C-erbB-2, Ki-67, CEA and CA-153 was positively related to the metastasis and prognosis of breast cancer, with the expression of ER and PR being negatively. Conclusions The joint inspection of ER, PR, C-erbB-2, Ki-67, CEA and CA-153 is valuable to prognosis and treatment of breast cancer.

摘要：目的 了解河南两中心城市内的男男性接触人群(MSM)HIV/HCV和梅毒相关知识、态度、行为及其感染状况,为制定有效的防治措施提供信息和依据.方法 采用同伴推动抽样法(RDS)在两城市内对MSM人群经常活动在网络、酒吧、浴池、会所、公园等场所的目标人群进行匿名问卷调查,并采集静脉血进行HIV/HCV和梅毒检测.结果 该人群艾滋病知识总知晓率为89.3%.最近6个月该人群与男性发生性行为时安全套每次都用率为39.88%.HIV阳性率为5.18%,HCV阳性率为5.93%,梅毒阳性率为7.33%.各因素与HIV感染率之间的关系无统计学差异;该人群中离异或丧偶的梅毒感染率为最高(14.3%),婚姻状况与梅毒的感染率有统计学差异;HCV的感染率与年龄、近6个月性伴数、文化程度、安全套使用情况等因素之间有统计学差异.结论 MSM人群中中高危性行为普遍存在,HIV/HCV和梅毒感染率高,应尽快采取针对性的行为干预措施. Abstract： Objective To examine the prevalence of HIV/HCV and syphilis infections and the KAP among men who have sex with men(MSM) in two cities,Henan province,so as to provide information and basis for the development of effective prevention strategy and measures. Methods Respondent Driven Sampling were conduced in the place of Network,Wine bar,Bath house,Club house and Park where the MSM always gathered to collect related information through.anonymous questionnaire.Blood samples were tested for HIV and syphilis infections. Results Awareness rate of HIV knowledge among the people is 89.3%. In the past six months,condom was consistently used in only 39.88% of male to male anal sexual behavior.5.18%were HIV-positive,5.93% were HCV-positive and 7.33% were sero-positive for syphilis infection,in the participants.Between the factors and the HIV infections rate has no significant statistically difference. The syphilis infection rate of the divorced or widowed MSM was the highest amomg the participants.independently

摘要：目的 分析和评价应用人工关节置换术治疗老年股骨粗隆部不稳定骨折的方法及疗效.方法 回顾性分析应用人工髋关节置换手术治疗老年股骨粗隆部不稳定骨折并有完整资料者32例,男18例,女14例,年龄68～86岁,平均73.6岁.骨折类型按Tronzo和Evans分类:Ⅲa型7例,Ⅲb型12例,Ⅳ型13例.结果 32例平均随访时间14个月(9～68个月),无一例感染,无关节严重疼痛、功能障碍或深静脉血栓(DVT)发生,无术后关节早期脱位,无假体断裂、下沉等并发症发生,无一例因手术并发症死亡.Harris评分平均由术前28.4分恢复到术后83.6分.结论 人工髋关节置换术是一种治疗老年股骨粗隆部不稳定骨折的安全有效方法之一,但应严格掌握其手术适应证. Abstract： Objective To study and evaluate the curative result of artificial joint replacement in treatment of unstable intertrochanteric fractures in the eldely. Methods A retrospective analysis of 32 consecutive elderly cases of hip replacement for unstable intertrochanteric fractures was conducted, 32 cases had an average age of 73.6 years (ranged from 68 years to 86 years).Eighteen of 32 cases were male, 14 of 32 cases were female. Type Ⅲa of the fracture by Tronzo-Evans classification were in 7 cases, Ⅲb in 12 cases, Ⅳ in 13 cases.Results Follow-up period from 9 to 68 months (mean 14 months) in 32 cases. The operations succeeded in 32 cases, with no complication such as wound infection, relaxed, joint severe pain, hip dislocation or prcsthesis breakage, and none happened to DVT, none shock or died in operation. The Harris score of patients increased from 28.4 preoperatively to 83.6 postoperatively.Conclusions Hip replacement in treatment of unstable intertrochanteric fractures in the elderly is a satisfactory and safe way. So satisfactory and desirable results can be obtained from the indication controlled.

摘要：目的 探讨甲状腺癌再次手术的意义、手术方式和注意事项.方法 对32例再手术的甲状腺癌患者的临床病理资料进行回顾性分析.结果 总的癌残留率为46.9%(15/32).原发部位残癌率为28.1%(9/32),淋巴结转移率为46.4%(13/28).再次手术所致喉返神经麻痹的发生率为6.3%(2/32),甲状旁腺损伤的发生率为3.1%(1/32).结论 甲状腺癌不规范手术的术后残癌率较高,再手术应根据病情采取恰当的手术方式,疑有淋巴结转移时应行规范化的颈淋巴结清扫术.术中避免喉返神经和甲状旁腺的损伤. Abstract： Objective To discuss the significance, mode, and attentive proceedings of the reoperation for thyroid carcinoma. Methods The clinical pathological datas of 32 thyroid carcinoma reoperation cases were analyzed retrospectively. Results The rate of residual cancer was 46.9%(15/32), in which the residual cancer rate the primary site of was 28.1%(9/32). The rate of lymphnode metastasis was 46.4%(13/28). The rate of laryngeal recurrent nerve injury was 6.3%(2/32)and parathyroid injury was 3.1%(1/32), respectively. Conclusions The rate of residual cancer is high in patients with thyroid cancer underwent nonstandard operation. Reoperation should choose correct operative manipulation according to the patient's condition. Laryngeal recurrent nerve and parathyroid injury should be avoided during surgery for thyroid cancer.

摘要：目的 总结食管癌行食管次全切除胃代食管颈部吻合术的临床经验.方法 回顾性分析132例胸段食管癌手术患者,所有患者均采用食管次全切除胃代食管经食管床颈部吻合术式.结果 全组无围术期死亡患者,无切缘癌阳性.吻合口瘘4例(3.0%),吻合口狭窄5例(3.8%),喉返神经损伤3例(2.3%).103例获随访,所有患者术后生活质量满意,无明显胃食管返流的症状;3、5年生存率分别是78.5%、34.6%.结论 食管次全切除食管纵膈胃颈部吻合术能显著降低食管癌患者围术期病死率和并发症发生率,是治疗食管癌的一种安全有效的手术方式. Abstract： Objective To conclude the clinical experience of subtotal esophagectomy and cervical gastroesophagostomy for the treatment of esophageal carcinoma. Methods One hundred and thirty-two patients with esophageal carcinoma of thoracic part who underwent surgical treatment were analyzed retrospectively.All patients were given subtotal esophageal resection and cervical gastroesophagostomy. Results There were no perioperative mortality,no edge-residual cancer,no postoperative gastroesophageal reflux in all patients.Complications included:cervical anastomotic leakage of 4 cases(3.0%);anastomotic stenosis of 5 (3.8%); larygeal nerve injury of 3 (2.3%).One hurdred and three patients who were followed up showed normal and satisfied life quality.The 3-year,5-year survival rate were 78 5%,34.6%, respectively. Conclusions Cervical gastroesophagostomy after subtotal esophagectomy can decrease peioperative mortality and incidence of complications and can be used as a safe and effective surgical procedure for the treatment of esophageal carcinoma.

摘要：目的 探讨全大肠切除回肠储袋改良为"б"形并直肠肌鞘肛管手工吻合术的临床应用价值.方法 对2000年6月至2009年6月实施的18例全大肠切除改良"б"形回肠储袋-直肠肌鞘肛管手工吻合术的手术方式、术后并发症以及治疗效果进行回顾性分析.结果 近期无吻合口瘘、狭窄、出血、梗阻.除1例患者失访外,其余随诊6个月～2年无复发、癌变、储袋炎、排便困难、大小便失禁及性功能障碍.术后排便节制力优良,疗效满意.结论 全大肠切除"б"形回肠储袋-直肠肌鞘肛管手工吻合术是治疗多原发性大肠癌、慢性运输性便秘、家族性腺瘤性息肉病以及严重溃疡性结肠炎等较为理想的术式. Abstract： Objective To discuss the clinical value of the entire large uscle sheath. Methods Analyzing retrospectively the surgical method, postoperative complications and treatment outcome that learned from the implementation of the 18 patients with complete resection of colorectal by by hand from June 2000 to June 2009. Results There was no anastomotic fistula, stricture, bleeding or obstruction. There was no relapse, cancer, pouch inflammation, bowel problems, incontinence or sexual dysfunction in the operates except for one that hadn't been followed up. All patients satisfied with the excellent treatment and restraint force after the fine. Conclusions The muscular sheath by hand is an ideal method in the treatment of multiple primary colorectal carcinoma, slow transit constipation, familial adenomatous polyposis and ulcerative colitis.

摘要：目的 通过总结特发性肺纤维化(IPF)的临床特点,提高对特发性肺纤维化的诊断及治疗的认识.方法 回顾性分析65例特发性肺纤维化患者的临床资料.结果 IPF主要见于老年患者,临床主要表现为进行性呼吸困难、肺部可闻及爆裂音、杵状指和紫绀,胸部CT表现为磨玻璃样、网状、结节、条索状及蜂窝状阴影,肺功能主要为限制性通气功能障碍伴弥散功能下降.结论 对有慢性咳嗽和进行性呼吸困难的患者及时进行胸部CT检查、肺功能和动脉血气分析,可对本病做出正确诊断,及早应用糖皮质激素治疗有利于改善症状. Abstract： Objective To summarize the clinical characteristics of idiopathic pulmonary fibrosis(IPF) to build up knowledge for early diagnosis and treatment. Methods Sixty-five IPF patients were reviewed retrospectively. Results Most IPF patients are elderly. The main dinical manifestations were an insidious onset of progressive dyspnea, cracks, finger clubbing and cyanosis. The main manifestations of chest CT were reticular, fine nodul and honeycomb formations. Patients who took pulmonary function test mainly showed restrictive impairment and diffusion function reducing. Conclusions Chest CT, pulmonary function test and blood gas analysis should be taken early in IPF patients with progressive dyspnea and non-productive cough in order to obtain timely diagnosis and treatment. Therapy with glucocorticoid may be effective in the improvement of symptoms.

摘要：目的 探讨经母亲对胎儿行被动免疫在预防乙型肝炎病毒(HBV)宫内感染中的作用.方法 对自孕20周起多次肌肉注射乙肝免疫球蛋白(HBIG)的乙肝表面抗原(HBsAg)(+)孕妇68例(A组)及未注射的28例HBsAg(+)孕妇(B组)采用固相放免法和套式PCR检测母血HBsAg、HBV DNA及其新生儿血HBsAg、抗HBS、HBV DNA.结果 A组70例新生儿中64例血清抗HBS(+),与B组相比差异有统计学意义(P＜0.05).A组新生儿血HBsAg、HBV DNA检出率均明显低于B组.A组孕妇用药后血HBsAg滴度及HBVDNA水平较用药前明显下降.结论 经母亲对胎儿行被动免疫可有效预防HBV宫内感染. Abstract： Objective To investigate the effect of passive immunization of fetus by infection of mother with HBIG on drevention of HBV intrauterine infection. Methods Forty-eight pregnant women with HBsAg positive were divided into two groups:group A(68 cases)were injected with HBIG during pregnancy;group B(28 cases)were followed up without injecfion of HBIG as controls. The blood samples of mothers and their infants were tested with radioimmunoassay and PCR. Results of 70 infants in group A,64(91.46%)were positive for anti-HBs(P＜0.05).The infants with HbsAg positive and HBV DNA positive in group A were fewer than those in group B(P=0.02 and ＜0.05). Conclusions Passive immunization of fetus by iniection to mother with HBsAg may prevent HBV intrauterine infection effectively.

摘要：目的 观察注射用红花黄色素与川芎嗪注射液治疗冠心病心绞痛的临床疗效比较.方法 180例患者随机分为治疗组和对照组各90例,治疗组静脉滴注红花黄色素,对照组静脉滴注川芎嗪,2周后观察其临床疗效,心电图以及一般体检项目.结果 治疗组心绞痛,心电图的总有效率分别为91%,54%.对照组心绞痛,心电图的总有效率分别为90%,44%.结论 注射用红花黄色素在改善冠心病心绞痛病情上与川芎嗪疗效类似. Abstract： Objective To compare the effectiveness of carthamin yellow and Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection in treating coronary heart disease and angina pectoris. Methods A total of 180 patients were enrolled in the study, 90 subjects were given carthamin yellow and the other half were given Miltiorrhizae and Ligustrazine Hydrochloride.Observing the effectiveness, cardiograph and test item. Results Effective rate of cardiograph were 91% and 54% in treatment group, 90% and 44% in control group. Conclusions The effectiveness of carthamin yellow for injection treating coronary heart disease and angina pectoris were similar to Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection.