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OBJECTIVE:To investigate the effects of multidrug resistance gene 1(MDR1)C3435T polymorphism on the dose of analgesia agents(dezocine combined with sufentanil)after joint replacement. METHODS:300 patients receiving joint replace-ment were selected from Tianjin People's Hospital and Tianjin Port Hospital during Jan. 2014-Feb. 2016. They were given dezocine and sufentanil for postoperative analgesia. PCR-RFLP was used to determine MDR1 C3435T polymorphism;VAS scores,Ramesy scores,the dose of dezocine+sufentanil and the occurrence of ADR were compared among different genotypes. RESULTS:Among 300 patients,there were 100(33.3%),102(34.0%)and 98(32.7%)cases of MDR1 C3435T CC,CT and TT genotype,respec-tively,the frequencies of which were all in line with Hardy-Weinberg balance (P>0.05). There was no statistical significance in VAS scores and Ramesy scores among different genotypes 0,24,48 h after surgery(P>0.05). No excessive sedation was found. The dose of dezocine+sufentanil in CT and TT genotype were all significantly lower than CC genotype 0-24 h,>24-48 h after sur-gery,with statistical significance(P0.05). The incidence of postoperative nausea and vomiting (PONV),ADR in TT genotype were significantly lower than CC and CT genotypes,with statistical significance (P0.05). CON-CLUSIONS:With similar sedation and analgesic effect,MDR1 mutant type have lower resistance to dezocine+sufentanil,and smaller drug dose is need,the incidence of ADR is lower. MDR1 genotype can be regarded as an important indicator of clinical in-dividualized treatment.
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Objective To evaluate the therapeutic effect of transanal local excision in the treatment of low rectal cancer.Methods The data of 49 cases of low rectal cancer patients treated by transanal local excision (group A,37 cases of T1 patients and 12 cases of T2 patients) were reviewed retrospectively,and compared with the group of 45 cases treated by radical resection( group B,11 cases of T1 patients and 34 cases of T2 patients).The 5-year survival rates,recurrence rates and postoperative complications between the two groups were compared.Results The incidence of postoperative complications in group A was significantly lower than that in group B(4.1％ vs 15.6％,x2 =4.69,P ＜0.05 ).The 5-year survival rate of group A was 97.9％ and the 5-year survival rate of group B was 95.6％.There was no significantly statistical difference on the 5-year survival rate between the two groups( x2 =0.439,P ＞ 0.05 ).But for the T2 patients,the recurrence rates in group A was 33.3％,which was significantly higher than the T2 patients in group B(5.9％ ) ( x2 =5.89,P ＜0.05 ).All patients with low histopathological grade tumor in group A showed postoperative recurrence and metastasis.Conclusion Transanal local excision with a rigid criteria can get good curative effect in the T1 patients,but not suitable for the T2 patients or patients with low histopathological grade tumor.