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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
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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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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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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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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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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纳米碳示踪技术在甲状腺癌侧颈淋巴结清扫术中对血清钙、PTH水平的影响价值 预览
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作者 王宁 刘金彪 《实用癌症杂志》 2019年第6期933-936,共4页
目的 探究纳米碳示踪技术在甲状腺癌侧颈淋巴结清扫术中对血清钙、PTH水平的影响价值。方法 选择84例甲状腺癌患者,根据数字表法随机分为对照组和纳米碳组,每组各42例。对照组行常规手术方法,纳米碳组借助纳米碳示踪剂行手术治疗。结果... 目的 探究纳米碳示踪技术在甲状腺癌侧颈淋巴结清扫术中对血清钙、PTH水平的影响价值。方法 选择84例甲状腺癌患者,根据数字表法随机分为对照组和纳米碳组,每组各42例。对照组行常规手术方法,纳米碳组借助纳米碳示踪剂行手术治疗。结果 对两组患者的手术、住院时间和术中出血量及切口引流量等比较无统计学意义(P>0.05)。淋巴结数量比较显示,对照组人均淋巴结显著低于纳米碳组(P<0.05)。术前,两组患者的血钙和PTH表达水平无显著差异(P>0.05),术后第1天,血钙和PTH均显著下降,并随时间延长血钙和PTH表达水平逐渐提高。组间比较,术后,纳米碳组血钙和PTH表达水平高于对照组(P<0.05)。纳米碳组术后3个月出现低血钙症状(肢体异常、四肢麻木、手足抽搐、肌肉痉挛)情况显著优于对照组(P<0.05)。结论 纳米碳示踪剂在增加淋巴结清扫数量,辨别淋巴结和甲状旁腺组织上具有明显作用,缓解血钙和PTH表达水平降低程度,保护甲状旁腺功能,降低低血钙症状,安全有效。 展开更多
关键词 纳米碳 甲状腺癌 血清钙 甲状腺激素 淋巴结
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超声弹性成像联合常规超声对淋巴瘤性浅表淋巴结肿大的应用价值 预览
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作者 江建伟 陈曼 《中国医学计算机成像杂志》 CSCD 北大核心 2019年第2期176-180,共5页
目的:探讨超声弹性成像联合常规超声在淋巴瘤性浅表淋巴结肿大的应用价值。方法:回顾性分析伴浅表淋巴结肿大的病理证实为淋巴瘤的患者90例与病理证实为转移癌的患者76例,对两组患者常规超声及超声弹性成像特征进行定性和定量分析。结果... 目的:探讨超声弹性成像联合常规超声在淋巴瘤性浅表淋巴结肿大的应用价值。方法:回顾性分析伴浅表淋巴结肿大的病理证实为淋巴瘤的患者90例与病理证实为转移癌的患者76例,对两组患者常规超声及超声弹性成像特征进行定性和定量分析。结果:常规超声检查显示淋巴瘤组比转移组淋巴结的长径、短径更大,淋巴门消失、存在边缘型血流的淋巴结更少,差异有统计学意义(P <0.05)。超声弹性成像显示淋巴瘤组弹性为软的更多,差异有统计学意义(P <0.05)。超声弹性成像与常规超声联合应用诊断淋巴瘤性浅表淋巴结肿大的敏感度和准确度达94.4%和84.3%,均明显高于常规超声。结论:超声弹性成像联合常规超声在淋巴瘤性浅表淋巴结肿大的应用中明显提高其诊断敏感性和准确性,有较大的临床应用价值。 展开更多
关键词 超声弹性成像 常规超声 淋巴瘤 淋巴结
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基于淋巴结分期评分的胰腺癌手术淋巴结清扫数目探讨(附四中心临床研究结果)
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作者 任泰 郭世伟 +13 位作者 王伟珅 王单松 王铮 杨洋 邵子雨 赵安达 束翌俊 王许安 李生慧 张熙 金钢 沈柏用 楼文晖 刘颖斌 《中国实用外科杂志》 CSCD 北大核心 2019年第6期584-589,共6页
目的探讨胰腺癌淋巴结准确分期所需清扫的淋巴结数目。方法回顾性分析美国SEER数据库中3989例切除的胰腺癌淋巴结阳性病人资料并进行建模,得到淋巴结分期评分达到90%时所需的淋巴结清扫数目作为推荐值,并利用SEER数据库2583例与国内93... 目的探讨胰腺癌淋巴结准确分期所需清扫的淋巴结数目。方法回顾性分析美国SEER数据库中3989例切除的胰腺癌淋巴结阳性病人资料并进行建模,得到淋巴结分期评分达到90%时所需的淋巴结清扫数目作为推荐值,并利用SEER数据库2583例与国内93例淋巴结阴性病人进行生存分析验证结果。结果肿瘤最大径<2 cm是胰腺癌淋巴结清扫数量的影响因素。预期对阴性结果达到90%把握时,肿瘤最大径<2 cm的病人需要活检15枚淋巴结,而≥2 cm的病人需要活检20枚。校正假阴性病人后,淋巴结阳性率从60.7%升至71.0%。生存分析提示肿瘤最大径≥2 cm病人中,淋巴结分期评分与生存有相关性(P=0.002)。结论肿瘤最大径是决定胰腺癌淋巴结清扫数量的因素。根据淋巴结分期评分,推荐清扫更多淋巴结。 展开更多
关键词 胰腺癌 肿瘤分期 淋巴结 假阴性率
MRI评估直肠癌淋巴结转移的价值 预览
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作者 刘丹 张菁 +1 位作者 杨岚清 伍兵 《国际医学放射学杂志》 北大核心 2019年第3期326-330,共5页
淋巴结转移是预测直肠癌预后的最重要因素,准确评估淋巴结有无转移有助于临床制定更合理的治疗方案。常规MRI主要依靠淋巴结大小诊断淋巴结性质,准确性不高。扩散加权成像(DWI)能够敏感地发现淋巴结,但转移性淋巴结与非转移性淋巴结的AD... 淋巴结转移是预测直肠癌预后的最重要因素,准确评估淋巴结有无转移有助于临床制定更合理的治疗方案。常规MRI主要依靠淋巴结大小诊断淋巴结性质,准确性不高。扩散加权成像(DWI)能够敏感地发现淋巴结,但转移性淋巴结与非转移性淋巴结的ADC值有部分重叠。动态增强MRI(DCE-MRI)定量分析能反映淋巴结微环境情况,有利于鉴别淋巴结性质。超微超顺磁性氧化铁-MRI(USPIO-MRI)可以诊断淋巴结性质且诊断敏感度较高,但尚未应用于临床。就常规MRI、DWI、DCE-MRI、USPIO-MRI对直肠癌淋巴结转移的诊断价值予以综述。 展开更多
关键词 直肠肿瘤 淋巴结 磁共振成像 扩散加权成像 动态增强磁共振成像 超微超顺磁性氧化铁-磁共振成像
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Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis 预览
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作者 Yi Cheng Nan Huang +3 位作者 Jing Zhao Jianhua Wang Chen Gong Kai Qin 《肿瘤学与转化医学:英文版》 2019年第1期25-29,共5页
Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated... Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppr 展开更多
关键词 simultaneous integrated dose-increasing INTENSITY-MODULATED radiation therapy late-course dose-increasing INTENSITY-MODULATED radiation therapy cervical cancer COMPLICATED with pelvic lymph node metastasis clinical efficacy safety
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Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis 预览
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作者 Xiao-Hao Zheng Wen Zhang +5 位作者 Lin Yang Chun-Xia Du Ning Li Gu-Sheng Xing Yan-Tao Tian Yi-Bin Xie 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第19期2338-2353,共16页
BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis (PALM) and evaluation of therapeutic e... BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis (PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages (stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment (MDT) approach for advanced gastric cancer with clinical PALM remains unknown. AIM To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM. METHODS In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease, especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team. RESULTS In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6%(19/48) of patients in overall and 52.1%(25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0%(24/48) of patients. After chemotherapy, 45.8%(22/48) of patients received D2 gastrectomy, and 12.5%(6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3%(6/22) and 4.5%(1/22), respectively. The median overall survival and progression-free survival of 展开更多
关键词 Gastric cancer Para-aortic LYMPH NODE MULTIDISCIPLINARY GASTRECTOMY Conversion NEOADJUVANT
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Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma 预览
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作者 Yu-Rong Zeng Qi-Hua Yang +4 位作者 Qing-Yu Liu Jun Min Hai-Gang Li Zhi-Feng Liu Ji-Xin Li 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第16期1986-1996,共11页
BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in... BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC. AIM To evaluate the diagnostic value of single source dual energy computed tomography (CT) in regional lymph node assessment for HCC patients. METHODS Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes (n = 156) were divided into either a metastatic (group P, n = 52) or a non-metastasis group (group N, n = 104), and further, according to pathology, divided into an active hepatitis (group P1, n = 34;group N1, n = 73) and a non-active hepatitis group (group P2, n = 18;group N2, n = 31). The maximal short axis diameter (MSAD), iodine concentration (IC), normalized IC (NIC), and the slope of the spectral curve (λHU) of each group in the arterial phase (AP), portal phase (PP), and delayed phase (DP) were analyzed. RESULTS Analysis of the MSAD, IC, NIC, and λHU showed statistical differences between groups P and N (P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λHU in the PP was the best among the three phases (AP, PP, and DP), with a sensitivity up to 81.9%, 83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively. The diagnostic value of combined analyses of MSAD with IC, NIC, or λHU in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to 84.5%, 86.9%, and 86.2%, and a specificity u 展开更多
关键词 COMPUTED TOMOGRAPHY Hepatocellular carcinoma LYMPH NODE METASTASIS Hepatitis Dual energy
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Precision surgical approach with lymph-node dissection in early gastric cancer 预览
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作者 Shinichi Kinami Naohiko Nakamura +4 位作者 Yasuto Tomita Takashi Miyata Hideto Fujita Nobuhiko Ueda Takeo Kosaka 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第14期1640-1652,共13页
The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to trea... The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition. 展开更多
关键词 Stomach neoplasms SURGERY GASTRECTOMY methods Recovery of function SENTINEL LYMPH NODE SURGERY Gastric cancer
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颈部淋巴结结核发生结核性脓肿的危险因素分析
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作者 姚岚 肖和平 《中国防痨杂志》 CAS CSCD 2019年第1期53-56,共4页
目的探讨颈部淋巴结结核患者发生结核性脓肿的相关危险因素。方法分析2013年7月至2016年6月于同济大学附属上海市肺科医院住院确诊的符合纳入标准的280例颈部淋巴结结核患者临床资料,分析颈部结核性淋巴结脓肿发生的危险因素。结果 280... 目的探讨颈部淋巴结结核患者发生结核性脓肿的相关危险因素。方法分析2013年7月至2016年6月于同济大学附属上海市肺科医院住院确诊的符合纳入标准的280例颈部淋巴结结核患者临床资料,分析颈部结核性淋巴结脓肿发生的危险因素。结果 280例颈部淋巴结结核患者中有52例(18.6%)患者在治疗中出现淋巴结脓肿、自行破溃或需要淋巴结切开引流。发生脓肿者中不规范治疗者占38.5%(20/52)、肿大淋巴结直径≥2cm者占76.9%(40/52)、年龄≤45岁者占90.4%(47/52);未发生脓肿者中不规范治疗者占24.6%(56/228)、肿大淋巴结直径≥2cm者占55.3%(126/228)、年龄≤45岁者占77.6%(177/228);差异均有统计学意义(χ^2值分别为4.14、8.23、4.30,P值均<0.05)。多因素logistic回归分析显示,不规范治疗(OR=2.53,95%CI:1.31~4.89)、肿大淋巴结直径≥2cm(OR=2.29,95%CI:1.12~4.66)和年龄≤45岁(OR=3.68,95%CI:1.21~11.17)为发生颈部结核性淋巴结脓肿的危险因素。结论颈部淋巴结结核患者治疗不规范、肿大淋巴结直径≥2cm及年龄≤45岁为发生结核性脓肿的独立危险因素,当颈部淋巴结结核患者出现上述危险因素时要警惕发生结核性脓肿的可能。 展开更多
关键词 结核 淋巴结 脓肿 危险因素 数据说明 统计
腹腔镜手术治疗Ⅰ期子宫内膜癌的疗效分析 预览
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作者 黄倩羽 《中国医学创新》 CAS 2019年第2期112-115,共4页
目的:探讨腹腔镜手术治疗Ⅰ期子宫内膜癌患者的临床效果。方法:选取2012年1月-2013年1月本院收治的Ⅰ期子宫内膜癌患者66例。按照入院先后顺序将其分为观察组和对照组,各33例。观察组接受腹腔镜手术治疗,对照组接受开腹手术治疗。比较... 目的:探讨腹腔镜手术治疗Ⅰ期子宫内膜癌患者的临床效果。方法:选取2012年1月-2013年1月本院收治的Ⅰ期子宫内膜癌患者66例。按照入院先后顺序将其分为观察组和对照组,各33例。观察组接受腹腔镜手术治疗,对照组接受开腹手术治疗。比较两组手术持续时间、术中出血量、淋巴结清扫数量、术后下床时间、盆腔引流量、导尿管留置时间、整体住院时间、并发症发生率、复发率及转移率。结果:两组手术持续时间、淋巴结清扫数量比较,差异均无统计学意义(P>0.05);观察组术中出血量、术后下床时间、盆腹腔引流量、导尿管留置时间、整体住院时间均优于对照组,比较差异均有统计学意义(P<0.05);观察组并发症发生率为9.09%,低于对照组的33.33%(P<0.05);两组复发率、转移率比较,差异均无统计学意义(P>0.05)。结论:通过为Ⅰ期子宫内膜癌患者提供腹腔镜手术治疗,可有效确保其临床治疗效果,减少并发症的发生率,其临床价值值得肯定。 展开更多
关键词 腹腔镜手术 传统开腹手术 Ⅰ期子宫内膜癌 淋巴结 复发率
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PET-CT对临床ⅠA期肺腺癌隐匿性淋巴结转移的预测价值
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作者 吕律 刘瑛 +4 位作者 王小艺 张朝坤 陶秀丽 杨琳 吴宁 《中华肿瘤杂志》 CAS CSCD 北大核心 2019年第6期441-447,共7页
目的探讨^18氟-脱氧葡萄糖(^18 F-FDG) PET-CT对临床ⅠA期肺腺癌患者隐匿性淋巴结转移的预测价值.方法回顾性分析2006年10月至2015年9月272例临床ⅠA期肺腺癌患者的影像和病理资料,所有患者均于术前行PET-CT检查,并行解剖性肺叶切除和... 目的探讨^18氟-脱氧葡萄糖(^18 F-FDG) PET-CT对临床ⅠA期肺腺癌患者隐匿性淋巴结转移的预测价值.方法回顾性分析2006年10月至2015年9月272例临床ⅠA期肺腺癌患者的影像和病理资料,所有患者均于术前行PET-CT检查,并行解剖性肺叶切除和系统性淋巴结清扫.分析肿瘤原发灶PET-CT最大标准化摄取值( SUVmax )及其他临床病理特征与隐匿性淋巴结转移的关系,筛选临床ⅠA期肺腺癌隐匿性淋巴结转移的危险因素.结果共50例(18.4%)患者出现隐匿性淋巴结转移,其中pN1期24例(8.8%),pN2期26例(9.6%).纯磨玻璃结节39例,部分实性结节59例,实性结节174例.所有纯磨玻璃结节患者均未出现隐匿性淋巴结转移.对233例实性和部分实性患者的临床病理特征与隐匿性淋巴结转移的关系进行统计分析,结果显示,T1a期(肿瘤长径≤1 cm)患者均未见淋巴结转移,原发灶SUVmax(Z=-5.663, P<0.001)、结节类型(χ^2=21.586, P<0.001)、原发灶位置(χ^2=12.790,P<0.001)、病理分级(χ^2=22.784,P<0.001)、脏层胸膜受侵(χ^2=5.357, P=0.021)在隐匿性淋巴结转移组(pN+)与无淋巴结转移组(pN0)间的差异有统计学意义.以SUVmax为2.405为界值,预测隐匿性淋巴结转移的灵敏度和特异度分别为90.0%和61.7%,曲线下面积为0.761(95%CI为0.700~0.823),阴性预测值为95.8%.多因素Logistic回归分析显示,原发灶SUVmax>2.405( P<0.001)、原发灶位置为中央(P=0.030)和病理分级高(P=0.024)为隐匿性淋巴结转移的独立危险因素.结论临床ⅠA期肺腺癌原发灶SUVmax>2.405、原发灶位置为中央和病理分级高为隐匿性淋巴结转移的独立危险因素.原发灶影像学表现为纯磨玻璃密度、肿瘤长径≤1 cm、SUVmax≤2.405的患者出现隐匿性淋巴结转移的概率较低,或可避免行系统性淋巴结清扫. 展开更多
关键词 非小细胞肺 腺癌 体层摄影术 发射型计算机 淋巴结
能谱CT术前预测胃腺癌淋巴结转移的价值
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作者 王睿 李靖 +1 位作者 梁盼 高剑波 《临床放射学杂志》 CSCD 北大核心 2019年第3期469-474,共6页
目的探讨能谱CT参数术前预测胃腺癌淋巴结转移的价值。方法回顾性分析2015年1月至2017年1月经病理确诊为胃腺癌并行能谱CT扫描的210例患者的临床及影像学资料,根据有无淋巴结转移分为淋巴结转移组(123例)和非转移组(87例)。记录胃癌患... 目的探讨能谱CT参数术前预测胃腺癌淋巴结转移的价值。方法回顾性分析2015年1月至2017年1月经病理确诊为胃腺癌并行能谱CT扫描的210例患者的临床及影像学资料,根据有无淋巴结转移分为淋巴结转移组(123例)和非转移组(87例)。记录胃癌患者的临床及病理学资料,并在后处理工作站中测量和计算胃癌原发灶的动静脉期CT值、碘浓度(IC)值和标准化碘浓度(nIC)值。采用组内相关系数(ICC)评价两名医师测量各参数值的一致性;采用独立样本t检验比较两组间定量资料;采用卡方检验或Kruskal-Wallis H检验比较两组间定性资料;采用受试者工作特征(ROC)曲线分析能谱IC值鉴别淋巴结转移的诊断效能,并确定其最佳阈值。采用Logistic回归分析筛选有预测意义的指标并计算其优势比(OR)。结果淋巴结转移组和非转移组患者肿瘤原发灶的分化程度、Borrman分型、T分期、最厚径、动静脉期IC值和动静脉期nIC值差异均有统计学意义(P<0.05),而患者的性别、年龄、肿瘤的部位、Lauren分型和动静脉期CT值差异均无统计学意义(P>0.05)。肿瘤原发灶的动静脉期IC和nIC值的ROC曲线下面积(AUC)分别为0.647、0.764、0.695、0.849,并以静脉期nIC=0.47为临界值判断淋巴结的转移性效能最佳。Logistic回归分析显示,肿瘤Borrman分型、最厚径、T分期及静脉期nIC值是影响胃腺癌淋巴结转移状态的独立预测指标(P<0.05)。结论肿瘤原发灶的Borrman分型、最厚径、T分期及能谱CT参数静脉期nIC值可以评价并预测胃腺癌淋巴结转移,提高CT胃癌术前诊断N分期的准确度,为临床胃癌患者个体化治疗提供更多依据。 展开更多
关键词 胃腺癌 淋巴结 体层摄影术 X线计算机 能谱成像
Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma 预览
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作者 Wei Jiang, Hong-Yan Wei +1 位作者 Hai-Yan Zhang Qiu-Luan Zhuo 《世界临床病例杂志》 2019年第1期49-57,共9页
BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients;h... BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients;however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on 展开更多
关键词 CONTRAST-ENHANCED ultrasound ELASTOGRAPHY PAPILLARY THYROID cancer CERVICAL LYMPH node metastasis
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