①在自发性气胸的治疗方面:目前尚无足够高质量的临床证据确定任何干预或非干预措施对自发性气胸的治疗更有效.现有2个小样本的随机对照试验(RCT)显示,胸腔闭式引流比穿刺抽气治疗气体消散更快,但穿刺抽气治疗更能减少患者痛苦和住院时间;1个小样本的随机对照试验显示,采用标准的胸腔闭式引流管或细管,两者的置管时间无差异,但对大量积气的患者,标准管的气体吸收率高于细管;另1个小样本的随机对照试验显示,在使用瓣膜单向阀或水封引流瓶方面,两者对患者的气胸吸收率无影响,但使用瓣膜单向阀更能减少患者痛苦和住院时间;在胸腔闭式引流管连接负压吸引方面,1个小样本的随机对照试验显示,是否连接负压吸引对疗效无影响.②在自发性气胸复发的预防方面:2个随机对照试验和1个非随机对照试验显示,化学性胸腔粘连术比非化学性胸腔粘连术更能减少自发性气胸的复发率,但胸腔粘连术同时也引起患者疼痛和住院时间的延长;无足够临床证据证明需在首次或自发性气胸复发时采用胸腔粘连术;无足够临床证据进行外科和化学性胸腔粘连术疗效的比较,仅有1个小样本的随机对照试验提示进行电视胸腔镜手术比直接开胸术的住院时间短,但在降低复发率方面,两者无显著性统计学差异,但由于样本量的问题,尚不排除两者问有临床意义差异.
目的 探讨腹股沟疝的病因及如何降低无张力疝修补术后的复发率。方法 对716例行无张力疝修补术的腹股沟疝患者的临床资料进行回顾性分析。 结果 所有患者手术均顺利，无手术死亡和切口感染。术后出现阴囊积液11例，经穿刺抽液后痊愈； 并发尿潴留23例，经导尿处理后24～48 h恢复正常。术后随访3～51个月，复发1例，复发率为0.1%。结论 腹内高压是导致成人腹股沟疝的重要因素，为有效降低无张力疝修补术后复发率，除了建立腹股沟区现代解剖生理的新概念外，必须注意防治腹内高压及遵循手术治疗中的“个体化” 原则。
Objective To evaluate the efficacy and safety of intraoperative mesenchymal chemotherapy with 5-FU implants in radical gastrectomy of advanced gastric cancer. Methods From January 2008 to September 2009， 102 patients with historically proven advanced gastric cancer were enrolled in our department and were allocated to undergo either radical gastrectomy and intraoperative mesenchymal chemotherapy with 5-FU implants 800 mg（treatment group， n=51）， or radical gastrectomy alone （control group， n=51）. The postoperative complications and recurrence rate between two groups were compared. Results There were no significant differences on the volume of abdominal cavity drainage， count of white blood cells， albumin level， and gastrointestinal adverse events between the two groups （P＞0.05）. After a median follow-up of 28 months， the local recurrence rate was lower among patients in treatment group than that in control group （16.3% vs. 39.1%， P＜0.05）， the survival rate of 3-year was higher in treatment group than that in control group （85.8% vs. 67.3%， P＜0.05）. Conclusions Compared with the control group， there are no significant adverse reactions on patients with advanced gastric cancer who were implanted fluorouraci1 implants during operation， which can reduce local recurrence rates and improve the survival rates.
Objective To analyze the effects and recurrence rate of single miconazole and the miconazole plus living preparation of lactobacillus for the treatment of the uncomplicated vulvovaginal candidiasis. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2008) MEDLINE (1966 to January 2009); PubMed (1966 to January 2009); EMbase (1966 to January 2009); CNKI (1966 to January 2009), and the Chinese Biomedicine Database (CBM) (1966 to January 2009) to identify randomized controlled trials of single miconazole versus the miconazole plus living preparation of lactobacillus.The quality of the included trials was assessed. RevMan 5 software was used to conduct meta–analysis. Results Eight trials involving 5 156 patients were included in the effect analysis. Meta-analysis showed miconazole plus with living preparation of lactobacillus was better compared with just miconazole (RR=0.96, 95%CI 0.92 to 1.00, Z=2.12, P=0.03; RR=0.92, 95%CI 0.85 to 0.99, Z=2.17, P=0.03).Seven trials involving 4 852 patients were included in recurrence rate analysis. Meta-analysis showed miconazole plus living preparation of lactobacillus had lower recurrence rate compared with single miconazole (RR=3.72, 95%CI 1.94 to 7.13, Z=3.97, Plt;0.000 1; RR=12.85, 95%CI 8.27 to 19.96, Z=11.37, Plt;0.000 01). Conclusion Currently available evidence shows that the effect in the combined group is better, and the recurrence rate is lower.
Objective To evaluate the impact of transcatheter arterial chemoembolization（TACE） on survival and tumor recurrence in patients with primary liver cancer， provide reference of clinical diagnosis and treatment for the primary liver cancer patients. Methods Two hundred and twenty-two cases of primary liver cancer were divided into TACE group （n=110） and control group （n=110）， TACE was performed after operation in the TACE group， convention treatment was performed after operation in the control group. The survival and tumor recurrence rates were compared between the TACE group and control group. Results The 1-， 2-， and 3-year survival rates were 83.64%， 56.36%，and 42.73% in the TACE group， respectively， which were 65.45%， 40.91%， and 21.82% in the control group，respectively. The differences were statistically significant （P＜0.05）. The 1-， 2-， and 3-year tumor recurrence rates were 20.91%， 54.55%， and 67.27% in the TACE group， respectively， which were 38.18%， 57.27%， and 70.91% in the control group， respectively. The 1-year tumor recurrence rate in the TACE group was significantly lower than that in the control group （P＜0.05）， but the differences of the 2- and 3-year recurrence rates were not statistically significant（P＞0.05）. Conclusions TACE treatment for primary liver cancer patients can increase long-term survival， but can’tdecrease long-term recurrence.
ObjectiveTo summarize the latest research progress of intersphincteric fistula ligation in the treatment of anal fistula. MethodsThrough the retrieval of CNKI and PubMed literature database, the principle, clinical application and related improvement of LIFT were reviewed. ResultsLigation of intersphincteric fistula tract is a sphincter preserving surgery in recent years. Because it has the advantage of ensuring the integrity of the sphincter, less damage to the anal function after operation, the wound healing quickly and so on, it has been accepted by domestic and foreign scholars. ConclusionLIFT to cure anal fistula while ensuring the anal function integrity, is the development trend of anal fistula surgery, is worthy to be popularized.
Objective To investigate the value of thyroid stimulating hormone (TSH) inhibition therapy in postoperative patients with differentiated thyroid carcinoma. Methods One hundred and six patients with differentiated thyroid carcinoma after total or near-total thyroidectomy were divided into two groups: TSH inhibition therapy group and thyroid hormone replacement therapy group. The non-recurrence and (or) non-metastasis rate in two groups was analyzed retrospectively by Wilcoxon statistical analysis. Results The non-recurrence and (or) non-metastasis rate of 3-， 5- and 10-year in TSH inhibition therapy group were 98.31%， 92.41% and 75.45% respectively， and were higher than those (93.57%， 84.18% and 52.06% respectively) in thyroid hormone replacement therapy group （P=0.046 5）. Conclusion TSH inhibition therapy after total or near-total thyroidectomy may be an essential treatment for differentiated thyroid carcinoma patients.
Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.