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Objective:To explore the clinical application value of sentinel lymph node biopsy (SLNB) in patients with early breast cancer after local excision surgery.Methods:A total of 93 breast cancer patients with clinical stage T is/T 1-2N 0M 0 who underwent SLNB and were confirmed by using tumor mass excision biopsy from March 2012 to November 2018 in Shanxi Bethune Hospital were retrospectively analyzed. According to the postoperative paraffin pathology, the patients who were successfully detected sentinel lymph node (SLN) were divided into SLN-positive group with metastasis or SLN-negative group without metastasis. The clinicopathological data were used to analyze influencing factors of SLN metastasis and SLN detection number after excision biopsy of breast masses in the two groups. Results:A total of 87 out of 93 patients were successfully detected SLN and the detection rate was 93.5% (87/93). A total of 255 SLN were detected, and the average number was 2.93 in per patient. All were subjected to rapid intraoperative freezing pathological, and 11 cases with positive SLN were detected. There were 17 patients who underwent axillary lymph node dissection (ALND), including 11 cases with positive SLN and 6 cases with SLN undetected. The paraffin pathology showed that 14 patients were confirmed as positive SLN, including 13 macrometastasis and 1 micrometastasis. The SLN false negative rate was 2.1% (3/14) of intraoperative frozen diagnosis. Univariate analysis showed that histological grade and intravascular thrombus of carcinoma were associated with SLN metastasis after breast cancer local excision; the number of SLN detection was effected by body mass index and staining method; the methylene staining method combined with radionuclide method could improve the detection rate of SLN (all P < 0.05). Multivariate analysis showed that the SLN non-detection of obesity patients was 2.651 times as much as that of normal patients (95% CI 1.592-8.194, P=0.010). Conclusion:The SLNB and appropriate tracer method will have a high SLN detection rate and better clinical application value for early breast cancer patients after breast mass resection.
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Objective To investigate the application value of early and delayed laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in 65 years of age or older patients with severe acute cholecystitis.Methods The prospective study was conducted.The clinical data of 80 patients with severe acute cholecystitis who were admitted to Shanxi Dayi Hospital of Shanxi Academy of Medical Sciences from May 2016 to January 2018 were collected.All patients were divided into two groups by random number table,including patients undergoing LC 72 h later after extubation of PTGD in the PTGD + early LC group,and patients undergoing LC 5-14 days later after extubation of PTGD in the PTGD + delayed LC group.Observation indicators:(1) surgical situations;(2) analysis of liver function before and after LC in the two groups;(3) analysis of serum-related inflammatory factors before and after LC in the two groups;(4) follow-up situations.Patients were followed up by outpatient examination or telephone interview to detect the postoperative complications in the postoperative three months up to April 2018.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was done using the paired t test.Count data were represented as absolute number,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Results Eighty patients were screened for eligibility,including 41 males and 39 females,aged from 65 to 70 years,with an average age of 67 years.There were 40 patients in the PTGD + early LC group and 40 in the PTGD + delayed LC group,respectively.(1) Surgical situations:the operation time,volume of intraoperative blood loss,and duration of postoperative hospital stay were (52± 15) minutes,(29± 11) mL,(18.9± 1.6) days in the PTGD + early LC group,and (88± 13)minutes,(69± 11)mL,(27.7±4.8)days in the PTGD + delayed LC group,respectively,showing significant differences in the above indicators between the two groups (t =11.668,16.219,11.000,P＜0.05).(2) Analysis of liver function before and after LC in the two groups:the levels of aspartate transaminase (AST),alanine aminotransferase (ALT),gamma glutamyl transferase (GGT),and total bilirubin (TBil) of PTGD + early LC group were (53 ± 11) U/L,(203 ±40) U/L,(128± 22) U/L,(19± 6)U/L,(86±21)μmol/L before LC,and (26±5)U/L,(83±23)U/L,(29±3)U/L,(11±5)U/L,(27± 7) μmol/L at 24 hours after LC,showing significant differences in the above indicators before and after LC (t =12.562,16.448,28.199,6.478,16.857,P＜0.05).The levels of AST,ALT,GGT,and TBil of PTGD + delayed LC group were (54± 12) U/L,(203±48) U/L,(130±24) U/L,(19±6) U/L,(85±20) μmol/L before LC,and (29±5) U/L,(151±36) U/L,(53±7)U/L,(17±3)U/L,(31±8)μmol/L at 24 hours after LC,showing significant differences in the above indicators before and after LC (t =13.622,5.481,2.169,1.988,15.855,P＜0.05).There was no significant difference in the levels of AST,ALT,ALP,GGT,TBil before LC between the two groups (t=0.389,0.000,0.389,0.000,0.218,P＞0.05),meanwhile,there were significant differences in the levels of AST,ALT,ALP,GGT,TBil after LC between the two groups (t =2.683,10.067,19.931,6.508,2.380,P＜0.05).(3) Analysis of serum-related inflammatory factors before and after LC in the two groups:the levels of interleukin-1 (IL-1),interleukin-6 (IL-6),high-sensitivity C-reactive protein (CRP),interleukin-10 (IL-10),and tumor necrosis factor-α (TNF-α) of PTGD + early LC group were (71 ±9) ng/L,(82±9)ng/L,(137±16)ng/L,(75±6)ng/L,(67±9)μg,/L before LC,and (87±13)ng/L,(97±9)ng/L,(81± 19)ng/L,(145±6)ng/L,(85±6)μg/L at 24 hours after LC,showing significant differences in the above indicators before and after LC (t ==6.400,7.454,14.259,52.175,10.525,P＜0.05).The levels of IL-1,IL-6,high-sensitivity CRP,IL-10,and TNF-α of PTGD + delayed LC group were (71±9) ng/L,(82± 10) ng/L,(145±28)ng/L,(75±6)ng/L,(67±10) μg/L before LC,and (145±7)ng/L,(135±16) ng/L,(101±1S)ng/L,(146±9) ng/L,(113±10)μg/L at 24 hours after LC,showing significant differences in the above indicators before and after LC (t =41.079,17.766,8.360,41.525,27.578,P ＜ 0.05).There was no significant difference in the levels of IL-1,IL-6,high-sensitivity CRP,IL-10,and TNF-α before LC between the two groups (t =0.000,0.000,1.569,0.000,0.000,P＞0.05),meanwhile,there were significant differences in the levels of IL-1,IL-6,high-sensitivity CRP,and TNF-α after LC between the two groups (t=24.844,13.092,4.833,15.185,P＜0.05).(4) Follow-up situations:80 patients were followed up for 3 months.Two patients in the PTGD + early LC group had postoperative complications,including 1 of bile duct injury and 1 of incisional infection;9 patients of PTGD + delayed LC group had postoperative complications,including 3 of bile duct injury,3 of multiple organ failure,2 of incisional infection,1 of death.There was a significant difference in the postoperative complication between the two groups (x2 =5.165,P＜0.05).Conclusion Early LC after PTGD can effectively shorten operation time,reduce volume of intraoperative blood loss,shorten duration of postoperative hospital stay,protect liver function,reduce the expression of serum inflammatory factors at 24 hours after surgery,and reduce postoperative complications.
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Objective To study the expression of CD147 and collagen Ⅳ protein in gastric carcinoma.Methods Immunohistochemical assay was used to detect the expression of CD147 and collagen Ⅳ protein in 119 cases of gastric carcinoma, 20 cases of normal gastric tissues, and the clinical data was analyzed.Results In 119 cases of gastric carcinoma, the positive expression of CD147 protein was 83.2 %(99/119), the positive expression of collagen Ⅳ protein was 31.9 %(38/119). The expression of CD147 and collagen Ⅳprotein had relationship with metastasis of lymph nodes,depth of invasion and clinical phases (P ＜0.05). There was negative significant correlation between the expression of CD147 and collagen Ⅳ protein in gastric carcinoma (P＜0.01). Conclusion The expressions of CD147 and collagen Ⅳ protein may be used as one of the marks to study gastric carcinoma.