目的 分析子宫癌肉瘤的临床诊疗过程及其特征,以期提高对该病的认识。方法 回顾性分析我院收治的1例藏族女性子宫癌肉瘤患者的临床资料。并检索中国万方、中华医学期刊、PubMed等数据库,对相关文献进行系统性分析,归纳其临床、病理特点。结果 本例患者术后一般情况良好,切口痊愈出院,电话随访了解到患者术后9月均未按期进行复查,亦未行术后辅助治疗,无法获得辅助治疗和随访复诊的情况。结论 子宫癌肉瘤在临床上较为少见,无特异性临床表现,确诊依靠病理,病理上有特殊性,含有癌和肉瘤两种组织成分,治疗上参考子宫内膜癌的高危特殊组织类型处理,但缺少有效的治疗手段,需要采用各种综合治疗,预后较差。

Objective To analyze the clinical diagnosis and treatment of uterine carcinosarcoma and its characteristics,in order to improve the understanding of the disease．Methods The clinical data of a Tibetan woman with uterine carcinosarcoma treated in our hospital was analyzed retrospectively．The databases of China Wanfang,Chinese Medical Journal and PubMed were searched,and the relevant literatures were systematically analyzed to summarize the clinical and pathological characteristics．Results This patient was generally in good condition after operation．The incision was healed and she was discharged．The telephone follow-up found that the patient did not receive re-examination as scheduled in 9 months after the operation,and did not receive postoperative adjuvant treatment．The follow-up situation was unable to obtain．Conclusions Uterine carcinosarcoma is relatively rare in clinic and has no specific clinical manifestations．The diagnosis depends on pathology．It has particularity in pathology and contains two kinds of tissue components：cancer and sarcoma．Treatment refers to high-risk special tissue types of endometrial cancer,but there is a lack of effective treatment means,a variety of comprehensive treatment is needed,and the prognosis is poor．

目的 探讨非小细胞肺癌（NSCLC）组织中转化生长因子β激活激酶1（TAK-1）与T细胞因子-4（TCF-4）在 mRNA以及蛋白水平的表达情况及其相关性,并分析两者与NSCLC患者临床病理因素的关系。方法 收集NSCLC手术标本51例,每例均包含肺癌组织及配对癌旁组织,所有患者的术后诊断均经病理结果证实,通过RT-PCR以及Western blot法检测TAK1、TCF-4在癌组织及配对癌旁组织中的表达情况,并通过SPSS进一步分析两者的相关性及其与临床病理因素的关系。结果 TAK1与TCF-4 mRNA以及蛋白水平在NSCLC患者癌组织中均高表达,其中TAK1蛋白的表达与NSCLC的TNM分期（P=0.022）、淋巴结转移（P=0.014）相关,TCF-4蛋白的表达与NSCLC的TNM分期相关（P=0.045）。TAK1在NSCLC组织中的表达与TCF-4呈正相关（r=0.427,P=0.002）。结论 TAK1 mRNA及蛋白水平在NSCLC组织中均高表达,并与TCF-4呈正相关,TAK1有可能成为NSCLC诊断及预后的一个潜在靶标,并且TAK1与TCF-4的联合应用有可能成为一种更为理想的NSCLC辅助诊断及临床治疗方法。

Objective To investigate the mRNA and protein expressions of transforming growth factor β-activated kinase 1（TAK1）and T cell factor-4（TCF-4）in non-small cell lung cancer（NSCLC）tissues and their correlation,and to analyze the relationship between TAK1/TCF-4 and clinicopathological factors in NSCLC patients．Methods Cancer tissues and matched adjacent tissues of 51 NSCLC patients in our hospital were collected．The postoperative diagnosis of all patients was confirmed by pathological results．The expression of TAK1 and TCF-4 in cancer tissues and paired adjacent tissues were detected by RT-PCR and Western blot,then SPSS was used to further analyze the correlation between TAK1 and TCF-4 and clinicopathological factors．Results TAK1 and TCF-4 mRNA and protein were highly expressed in NSCLC tissues,and TAK1 protein expression was significantly correlated with TNM stage of NSCLC（P=0.022）and lymph node metastasis（P=0.014）;TCF-4 protein expression was significantly correlated with TNM stage of NSCLC（P=0.045）．TAK1 expression in NSCLC tissues was positively correlated with TCF-4（r=0.427,P=0.002）．Conclusions TAK1 mRNA and protein were highly expressed in NSCLC tissues and positively correlated with TCF-4．TAK1 may become a potential target for the diagnosis and prognosis of NSCLC,and the combined application of TAK1 and TCF-4 may become a more ideal method for the auxiliary diagnosis and clinical treatment of NSCLC．

我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术（ES）,但术后并发症发生率及围手术期死亡率较高,自膨式金属支架（SEMS）被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术（SBTS）与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。

In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year．Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence．Emergency surgery（ES）is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high．Self-expanding metallic stents（SEMS）can convert some emergency procedures into stent as bridge to surgery（SBTS）, which is recommended by some guidelines as the initial treatment option for obstructive colon cancer．SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement．The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes．There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes．At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications．

目的 分析在胃癌诊断中应用人表皮生长因子受体2（HER-2）结合肿瘤标志物检测的意义。方法 回顾性选取2019年6月—2021年6月我院收治的100例胃癌患者作为胃癌组,另选同期收治的60例胃良性肿瘤患者作为胃良性肿瘤组。比较HER-2与多项肿瘤标志物检测的诊断效能等。结果 胃癌组HER-2、糖类抗原（CA）125、CA72-4及CA19-9浓度与阳性表达率高于胃良性肿瘤组（P<0.05）。对于胃癌诊断,免疫组化指标HER-2检测的敏感度为72.00%,正确率为77.00%;多项肿瘤标志物检测的敏感度为77.00%,正确率为80.00%;二者联合检测的敏感度为89.00%,正确率为90.00%;相较于多项肿瘤标志物与HER-2单一检测,二者联合检验的正确率、敏感度更高（P<0.05）。结论 HER-2结合血清肿瘤标志物检验对胃癌的诊断价值较高。

Objective To analyze the significance of human epidermal growth factor receptor 2（HER-2）combined with tumor marker in the diagnosis of gastric cancer．Methods A total of 100 patients with gastric cancer admitted to our hospital from June 2019 to June 2021 were retrospectively selected as the gastric cancer group, and 60 cases of gastric benign tumor admitted to our hospital during the same period were also selected．The diagnostic efficacy of HER-2 was compared with those of multiple tumor markers．Results The concentration and positive expression rate of HER-2, carbohydrate antigen（CA）125, CA72-4 and CA19-9 in gastric cancer group were higher than those in gastric benign tumor group（P<0.05）．For the diagnosis of gastric cancer, the sensitivity of the immunohistochemical indicator HER-2 detection was 72.00%, and the accuracy rate was 77.00%．The sensitivity and accuracy of detecting multiple tumor markers were 77.00% and 80.00%, respectively．The sensitivity of the combined detection of the two was 89.00%, and the accuracy was 90.00%．Compared to multiple tumor markers and HER-2 single detection, the combined test of the two had a higher accuracy and sensitivity（P<0.05）．Conclusions The detection of HER-2 combined with serum tumor markers has high diagnostic value for gastric cancer．

直肠癌是全球常见的消化道恶性肿瘤之一,准确的影像学评估对直肠癌的诊断和治疗决策至关重要。在各种影像学检查中,磁共振成像已逐渐成为直肠癌不可或缺的检查手段,其中酰胺质子转移加权（APTw）成像是当前直肠癌磁共振成像中的一种极具发展前景的成像技术,其是通过检测病灶中内源性可移动蛋白的酰胺质子与水质子之间的交换,可以更好地在分子水平评估直肠癌病灶的蛋白质浓度、pH值、温度和代谢状态等,在直肠癌中有极大的应用潜能,有助于实现精准医疗。本文主要综述APTw成像在直肠癌中的研究进展、发展前景及尚存在的问题。

Rectal cancer is one of the most common gastrointestinal malignancies worldwide, and accurate imaging evaluation is essential for the diagnosis and treatment of rectal cancer．In various imaging examinations, magnetic resonance imaging（MRI）has gradually become an indispensable means of rectal cancer, among which amide proton transfer-weighted（APTw）imaging is a promising imaging technology．APTw imaging is to detect the exchange between amide protons of endogenous mobile proteins in lesions and water quality particles, which can better assess the protein concentration, pH, temperature, and metabolic status of rectal cancer at the molecular level．It has great application potential in rectal cancer and contributes to precision medicine．This article mainly reviews the research progress, development prospect and remaining problems of APTw imaging in rectal cancer．

目的 探讨胃癌误诊为环状胰腺并胰腺炎并十二指肠梗阻的原因和治疗。方法 对本院收治的1例由胃癌误诊为环状胰腺并胰腺炎以及十二指肠梗阻患者的临床情况加以总结,并总结复习和分析相关文献。结果 本例患者虽最终明确诊断为胃癌,但病理提示分化差,合并全身多处骨转移,疾病进展迅速,后续放化疗效果欠佳。早期诊断、早期治疗是影响胃癌患者预后的关键。结论 胃癌骨转移的发病率低,极少进行骨转移评估,易造成误诊。当出现胃十二指肠流出道梗阻时,虽患者合并环状胰腺,仍需警惕胃癌的可能,及早完善全身检查,明确诊断,采取正确的治疗措施。

目的 探讨亚实性肺腺癌结节CT征象在预测侵袭风险中的价值。方法 选取经胸部CT检查发现并经病理证实为肺腺癌的亚实性结节共76个病灶,病灶分为侵袭前组与侵袭组2组,分析结节CT征象,行统计学分析,明确亚实性肺腺癌结节侵袭性的预测因素。结果 侵袭前组（包括原位腺癌、微浸润性腺癌）共31例;侵袭组[浸润性腺癌（IAC）]共45例。2组在最大平均直径、结节平均CT值、结节形状、分叶、毛刺、胸膜牵拉征、有无实性成分、肿瘤微血管CT成像征间比较差异有统计学意义（P<0.05）,而在空泡征、空气支气管征方面比较差异无统计学意义（P>0.05）。结节最大直径预测浸润性腺癌侵袭性界值为13.63 mm,敏感度、特异度分别为68.9%、96.8%,AUC为0.885;平均CT值预测IAC侵袭性界值为-528 HU,敏感度、特异度分别为84.4%、83.9%,AUC为0.867。回归分析显示病灶最大平均直径（OR=2.015、P=0.01）可以作为浸润性肺腺癌结节的独立预测因子。结论 亚实性肺腺癌结节侵袭前组和侵袭组在最大直径、平均CT值、形状、分叶、毛刺、微血管征存在差异;结节的最大平均直径是IAC的独立预测因子。

Objective To investigate the value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules．Methods A total of 76 subsolid pulmonary adenocarcinoma nodules detected by chest CT and pathologically confirmed were selected,and the lesions were divided into pre-invasion group and invasion group．CT signs of nodules were analyzed and statistical analysis was performed to determine the predictive factors of invasion of subsolid pulmonary adenocarcinoma nodules．Results There were 31 cases in the pre-invasion group（including adenocarcinoma in situ and minimally invasive adenocarcinoma）and 45 cases ininvasion group[invasive adenocarcinoma（IAC）]．There were significant differences in maximum mean diameter,mean CT value of nodule,nodule shape,lobule,burr,pleural stretch sign,solid component and microvascular CT imaging signs between the two groups（P<0.05）,but there were no significant differences in vacuole sign and air bronchial sign between the two groups（P>0.05）．The maximum diameter of nodules predicted the invasion boundary of invasive adenocarcinoma was 13.63 mm,the sensitivity and specificity were 68.9% and 96.8%,respectively,and the AUC was 0.885．The mean CT value predicted the invasive boundary of IAC was -528 HU,the sensitivity and specificity were 84.4% and 83.9%,respectively,and the AUC was 0.867．Regression analysis showed that the maximum mean lesion diameter（OR=2.015,P=0.01）was an independent predictor of infiltrating lung adenocarcinoma nodules．Conclusions There were differences in the maximum diameter,mean CT value,shape,lobed,burr and microvascular signs between the pre-invasion group and the invasion group．The maximum mean diameter of nodules was an independent predictor of IAC．

目的 探讨鳞状上皮细胞抗原（SCCA）、人乳头瘤病毒（HPV）-DNA联合阴道镜检查在宫颈鳞状细胞癌（SCC）筛查中的应用价值。方法 选择2019年1月1日—2021年12月31日在中山市博爱医院就诊并确诊为SCC的妇女作为研究对象,共纳入100例SCC患者（SCC组）,同时选择200例经活检确诊为宫颈慢性炎症的患者（宫颈慢性炎症组）作为阴性对照。采用阴道镜观察研究对象的宫颈情况,并采集研究对象的宫颈组织标本进行HPV-DNA检测。采集研究对象的静脉血,采用化学发光免疫法测定研究对象SCCA的水平。以病理检查结果为金标准,分别对HPV-DNA检测、外周血SCCA两者联用以及阴道镜、HPV-DNA检测、外周血SCCA三者联用进行筛查效果的评价。结果 SCC组研究对象的年龄≥40岁者、出血者、性生活开始年龄≤20岁者比例均高于宫颈慢性炎症患者组;而宫颈慢性炎症患者组疼痛的比例高于SCC患者组,差异均有统计学意义（P<0.01）。χ²检验结果显示,SCC组研究对象的SCCA阳性率高于宫颈慢性炎症组（P<0.001）。阴道镜结合SCCA、HPV-DNA检测筛查SCC的灵敏度和特异度均高于单独使用SCCA和HPV-DNA,并取得较好的约登系数（75%）和Kappa值（0.730）。结论 采用阴道镜结合HPV-DNA、SCCA可有效提高SCC疾病的约登系数与Kappa值,其联合诊断的效能高于单独使用阴道镜、HPV-DNA或SCCA诊断SCC。

Objective To study the application value of squamus cell carcinoma antigen（SCCA）and human papillomavirus（HPV）-DNA combined with colposcope in cervical squamous cell carcinoma（SCC）screening．Methods Women diagnosed with SCC who visited Boai Hospital of Zhongshan city from January 1,2019 to December 31,2021 were selected as research subjects,including 100 patients with SCC（SCC group）and 200 patients with chronic cervical inflammation confirmed by biopsy（chronic cervical inflammation group）．The cervix of the subjects was observed by colposcope,and cervical tissue samples were collected for HPV-DNA testing．Venous blood of subjects was collected and SCCA levels were determined by chemiluminescence immunoassay．Using pathological examination results as the gold standard,the screening effect of combination HPV-DNA test and peripheral blood SCCA test,combination colposcope,HPV-DNA test and peripheral blood SCCA were evaluated respectively．Results In SCC group,the proportion of age≥40 years old,bleeding,sexual life age ≤20 years old were higher than those in chronic cervical inflammation group,but chronic cervical inflammation group had higher rate of pain than those in SCC group（P<0.01）by Chi-square test．SCCA positive rate in SCC group was higher than that in chronic cervical inflammation group（P<0.001）by Chi-square test．The sensitivity and specificity of colposcope combined with SCCA and HPV-DNA were higher than those of SCCA and HPV-DNA alone,and better Youden’s coefficient（75%）and Kappa value（0.730）were obtained．Conclusions Colposcope combined with HPV-DNA and SCCA can effectively improve the Youden’s coefficient and Kappa value of SCC disease,and its combined diagnosis efficiency was higher than that of colposcope,HPV-DNA and SCCA alone in the diagnosis of SCC,which has high clinical promotion significance．

目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激（TOF）比值将试验组患者分为试验组A（TOF≤0.1）、试验组B（0.10.8）。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组（P<0.01）,空白对照组患者TOF比值高于其他组（P<0.01）;空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义（P>0.01）;试验组A患者肌松恢复指数低于其他组（P<0.01）,空白对照组患者肌松恢复指数高于其他组（P<0.01）。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积（FEV1）、用力肺活量（FVC）和FEV1/FVC比较差异无统计学意义（P>0.05）。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。

Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer．Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects．The patients were randomly divided into a blank control group and an experimental group using a random number table method．Then,combined with the train-of-four（TOF）ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A（TOF≤0.1）,experimental group B（0.10.8）．The residual muscle relaxation and lung function between groups were compared．Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups（P<0.01）,while the TOF ratio of patients in the blank control group was higher than that of other groups（P<0.01）．There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit（P>0.01）．The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups（P<0.01）,while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups（P<0.01）．There were no significant differences in force expiratory volume in one second（FEV1）,forced Vital capacity（FVC）and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation（P>0.05）．Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels．

目的 应用锥形束CT比较改良颈肩体热塑膜和传统颈肩体热塑膜体位固定装置在颈胸段食管癌患者放射治疗中的摆位差异,分析两种固定方式对锁骨上下区摆位误差的影响。方法 分析2021年6月—2022年10月在南京医科大学第一附属医院行放射治疗的29例食管癌患者的临床资料。将患者分为改良颈肩体热塑膜组（改良组）和光板颈肩体热塑膜组（对照组）,对比分析2组病例不同配准区域的摆位误差。结果 改良组在X（左右）方向的平移误差及Rz（冠状面）方向的旋转误差小于对照组,差异有统计学意义（P<0.05）。改良组锁骨上下区在X（左右）方向的平移误差以及Rx（矢状面）方向的旋转误差小于对照组,差异有统计学意义（P<0.05）。改良组的整体靶区外放范围在X、Y方向上均小于颈肩体组,改良组在锁骨上下区的X方向靶区外放范围也更小。结论 对于颈胸段食管癌需行锁骨上下区放疗的患者,应用改良颈肩体热塑膜可减少平移误差,控制旋转角度,减少靶区外放范围。

Objective To compare the set-up errors between the modified neck-shoulder body thermoplastic film and the traditional neck-shoulder body thermoplastic film fixation device in the radiotherapy of patients with cervical and thoracic esophageal cancer by cone beam CT,and to analyze the influence of the two fixation methods on the positioning error of the upper and lower clavicular region．Methods The clinical data of 29 patients with esophageal cancer who underwent radiotherapy in the First Affiliated Hospital of Nanjing Medical University from June 2021 to October 2022 were analyzed．The patients were divided into two groups：the modified neck-shoulder body thermoplastic film group（the modified group）and the smooth neck-shoulder body thermoplastic film group（the control group）,the positioning errors in different regions of the two groups were compared and analyzed．Results The translation error in the X（left and right）direction and the rotation error in the Rz（coronal plane）direction of the modified group were smaller than those of the control group,and the differences were statistically significant（P<0.05）．The translation error in the X（left and right）direction and the rotation error in the Rx（sagittal plane）direction of the superior and inferior clavicular region in the modified group were smaller than those in the control group,and the differencs were statistically significant（P<0.05）．The overall target area of the modified group was smaller in X and Y directions than that of the neck-shoulder body group,and the target area of the improved group in X direction was also smaller in the upper and lower clavicle area．Conclusions For patients with cervical and thoracic esophageal cancer who need radiotherapy in the upper and lower clavicular region,the application of modified neck shoulder body thermoplastic film can reduce the translation error,control the rotation angle and reduce the external radiation range of the target region．