目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

目的 探讨加味六君子汤联合经口营养补充对COPD稳定期伴营养不良患者营养状况和肺功能的影响。方法 收集呼吸内科COPD稳定期并伴营养不良的患者40例,分为试验组和对照组各20例。试验组在对照组基础上再给予加味六君子汤和经口营养补充,观察治疗前、治疗后3月的营养相关指标和肺功能指标,然后进行统计分析。结果 ①治疗后3月,试验组的体质量、白蛋白、前白蛋白和肺功能指标较治疗前均明显改善(P<0.05)。②与对照组比较,试验组的白蛋白、前白蛋白、血红蛋白均明显升高(P<0.05),肺功能亦有显著改善(P<0.05)。③上臂肌围(MAMC)、三头肌皮褶厚度(TSF)在治疗后的组内及组间比较差异均无统计学意义(P>0.05)。结论 加味六君子汤联合经口营养补充有助于COPD稳定期伴营养不良患者体质量增加、蛋白升高,营养状况好转,从而增加呼吸肌储备,改善患者肺功能。

Objective To observe the influence of modified-liujunzi-decoction combined with Oral nutritional supplements(ONS) on the nutrition status and lung function in patients with chronic obstructive pulmonary disease(COPD). Methods 40 patients of COPD stable phase with malnutrition were divided into two groups and each group with 20 cases. On the basis of the control group, the experimental group was given again modified-liujunzi-decoction and ONS. All cases were tested before and 3 months after treatment, for detecting the nutrition related index and lung function index; T-test was used for data statistical analysis. Results ①3 months after treatment, the body weight, serum albumin, prealbumin and lung function index of the experimental group were significantly improved compared with those before treatment (P<0.05). ②Compared with the control group, the serum albumin, prealbumin and hemoglobin were significantly increased in the experimental group (P<0.05), and lung function was also significantly improved (P<0.05). ③After treatment, the mid-arm muscle circumference (MAMC), triceps skinfold thickness (TSF) comparison of intra group and intra group differences were not statistically significant(P>0.05). Conclusion Modified-liujunzi -decoction combined with oral nutritional supplements help to increase body weight, protein, and improve nutritional status in patients of COPD stable phase with malnutrition, thereby increasing their respiratory muscle reserve and improving lung function.

目的 研究EGFR基因突变与系列肿瘤标志物在160例原发性肺癌患者及51例肺部良性占位病变患者中的表达状况,为肺部占位病变的诊断、鉴别诊断和治疗提供参考依据。方法 160例肺癌患者取新鲜病理组织标本,采用扩增阻滞突变系统荧光PCR(ARMS-PCR)技术检测EGER基因突变;160例肺癌患者和51例良性占位病变患者取外周静脉血用化学发光法检测系列肿瘤标志物,用χ²检验统计分析数据。结果 160例肺癌病例中,EGFR基因野生型比率为47.56%(78/164),EGFR基因突变型比率为52.44%(86/164),突变型中21L858R点突变占23.17%(38/164),19Del缺失突变占22.56%(37/164)。肺癌组中系列肿瘤标志物较良性占位组具显著高表达,P＜0.01。差异有统计学意义。结论 肺癌致病与EGFR基因突变、肿瘤标志物高表达有显著正相关,通过肿瘤标志物和EGFR基因突变检测,结合影像学检查,将有助于肺部占位病变诊断和鉴别诊断,并为治疗手段选择提供参考依据。

Objective To research EGFR gene mutation and series of tumor markers expression in 160 patients with primary lung cancer and 51 patients with lung benign placeholder lesions, provide some references for the diagnosis, differential diagnosis and treatment in lung placeholder lesions. Methods We took fresh pathological tissue specimens from 160 cases of patients with lung cancer, Then used ARMS PCR technique to detect EGER gene mutations. We took the peripheral venous blood in 160 patients with lung cancer and 51 patients with lung benign placeholder lesions, with chemiluminescence method to detect series of tumor markers,and used thechi-square test to statistic and analysis data. Results In 160 cases of lung cancer patients,The EGFR gene wild type rate was 47.56%(78/164).The EGFR gene mutation type rate was 52.44%(86/164).In EGFR gene mutation type,The proportion of 21L858R mutation was 23.17%(38/164),19del mutation was 22.56%(37/164). Series of tumor markers had significantly higher expression in lung cancer group than in benign placeholder lesions group. P＜0.01.The difference was statistically significant. Conclusion Lung cancer pathogenesis and EGFR gene mutations, tumor markers high expression was significantly positive correlation. Through a series of tumor markers and EGFR mutation testing, combined with imaging examination, it will contribute to the diagnosis and differential diagnosis in lung placeholder lesions, and provide the basis for treatment.

目的 探索长链非编码RNA LINC00672在肺癌组织中的表达及其与患者预后的关系。方法 采用实时荧光定量PCR技术检测LINC00672在75对肺癌组织和癌旁正常组织中的表达,分析其在癌组织中的表达水平与肺癌患者临床分期和预后的关联。结果 LINC00672在肺癌组织中的表达显著低于癌旁正常组织(P=0.026),LINC00672高表达与低表达相比能显著降低肺癌患者的死亡率(死亡风险比=0.46;95%置信区间=0.23~0.95;P=0.036),延长患者中位生存期(34个月 vs 18个月,P=0.027)。并且,LINC00672与肺癌预后的关联在低年龄组(<60 a)、吸烟者和非饮酒者中更为显著。进一步相乘交互作用分析显示LINCOO672与饮酒在肺癌死亡风险上具有显著的交互效应(P=0.049)。然而,LINC00672的表达水平在不同分期、T、N、M患者来源的肺癌组织中的表达无显著性差异。结论 LINC00672与肺癌发生发展存在关联,可用于预测肺癌患者的预后。

Objective To explore the expression status of long non-coding RNA LINC00672 in lung cancer tissues and its correlation with survival of lung cancer. Methods We applied the real-time PCR method to measure the expression level of LINC00672 in 53 pairs of lung cancer tissues and adjacent lung normal tissues, and analyzed the correlation between its expression and survival of lung cancer. Results LINC00672 was significantly down-regulated in lung cancer tissues than their adjacent lung normal tissues (P=0.026). Compared to those with low expression level of LINC00672, patients with high expression level of LINC00672 exerted a significant long median survival time than those with low expression level (34 vs 18 months, P=0.027). High LINC00672 expression also contributed to low mortality rate than low LINC00672 expression (hazard ratio=0.46, 95% confidence interval =0.23-0.95, P=0.036). Meanwhile, the correlation was more evident in those low age groups (< 60 years), smokers and non-drinkers. There was also a significant interaction between LINC00672 and drinking on affecting death risk of lung cancer. However, no significant association was observed between LINC00672 expression and clinical stages as well as T, N, M status. Conclusion LINC00672 is correlated with development of lung cancer, which may be a valuable biomarker to predict lung cancer prognosis.

目的 探讨ERCC1、RRM1、TS蛋白表达对晚期非小细胞肺癌(NSCLC)个体化治疗的指导意义。方法 收集经病理确诊的晚期NSCLC患者87例,其中67例愿意接受药敏免疫组化检测的患者作为研究组,采用SP法检测肿瘤组织ERCC1、RRM1、TS蛋白表达,并根据蛋白表达情况选择化疗方案;另外20例患者不进行药敏免疫组化检测,以常规吉西他滨联合顺铂方案化疗,以此作为对照组。比较两组患者化疗的有效率,疾病控制率(DCR),并以无进展生存期(PFS)为指标比较患者预后。结果 研究组67例患者中,PR 33例(49.25%),SD 13例(19.4%),PD 21例(31.35%);对照组20例患者中,PR 4例(20%),SD 4例(20%),PD 12例(60%),两组疗效之间有差异( χ²=6.437,P=0.04),研究组DCR为68.6%,高于对照组DCR 40%,差异有统计学意义(χ²=5.372,P=0.034)。研究组患者的中位PFS高于对照组,研究组的PFS为5月,对照组为3月,差异有统计学意义(P＜0.05)。结论 对晚期NSCLC患者进行ERCC1、RRM1、TS药敏蛋白免疫组化检测,指导个体化治疗方案,能提高患者化疗的疾病控制率及延长患者的疾病进展时间。

目的 对比观察单孔、单操作孔及三孔胸腔镜治疗早期非小细胞肺癌(NSCLC)的临床疗效。方法 选择125 例早期NSCLC患者,分为单孔组(38例)单操作孔组(42例)和三孔胸腔镜组(45例),观察3组手术结果和并发症发生率。结果 3组患者均顺利完成手术,无中转开胸。单孔组手术时间长于单操作孔及三孔组,差异有统计学意义(P＜0. 05)。对比所有3组手术患者的术中出血量及淋巴结清扫数目、术后总引流量及引流管留置时间、术后并发症发生率,差异无统计学意义(P＞0. 05)。单孔组及单操作孔组术后疼痛程度评分优于三孔组,差异有统计学意义(P＜0. 05)。结论 单孔及操作孔胸腔镜治疗早期NSCLC已可取代三孔胸腔镜技术,其术后恢复快,疗效确切,其中单孔手术对设备及胸腔镜医师操作技术熟练程度等要求更高,故在设备仍未有突破性的进展时,单操作孔胸腔镜手术可作为治疗早期NSCLC的优先选择。

Objective To compare the clinical effects of uniportal video-assisted thoracic surgery (VATS), single utility port VATS and 3-portal VATS lobectomy for patients with early stage non-small cell lung cancer. Methods Patients were divided into uniportal VATS lobectomy group(n=38), single utility port VATS lobectomy group(n=42) and 3-portal VATS lobectomy group (n=45). The surgical results and complication rates were observed. Results All patients completed the operation successfully, no one was changed to open operation. Operation time in uniportal VATS lobectomy group were longer than single utility port VATS lobectomy group and 3-portal VATS lobectomy group(P＜0. 05). There were no significant differences in intraoperative blood loss, number of lymph node dissection, the amount and time of postoperative extubation, and the incidence of postoperative complications(P＞0. 05). Post-operative pain score were higher in 3-portal VATS lobectomy group than in uniportal VATS lobectomy group and single utility port VATS lobectomy group (P＜0. 05). Conclusion Uniportal VATS lobectomy and single utility port VATS lobectomy can replace the 3-portal VATS lobectomy in treatment of early NSCLC, because of the faster postoperative recovery and curative effect. Uniportal VATS lobectomy requires special equipment and more operation skills, as there is no breakthrough in the equipment, single utility port VATS lobectomy may still be used as the first choice for treatment of early NSCLC.

目的 探讨腔镜手术治疗老年肺癌的疗效及对肺功能的影响。方法 我们纳入90例老年肺癌患者作为研究对象,随机抽签分为2组,各45例。观察组45例行胸腔镜肺癌切除术,对照组45例行传统开胸肺癌切除术。比较两组患者手术时间、术中出血量、胸腔引流时间、淋巴结清扫数量、术后住院时间、疼痛评分、肺功能及术后并发症情况。结果 两组手术时间、淋巴结清扫数量无差异(P>0.05);观察组术后胸腔引流时间、术中出血量、疼痛评分、住院时间少于对照组(P＜0.05)。观察组术后并发症总发生率低于对照组(P＜0.05)。观察组术后一秒用力呼气容积、用力肺活量、肺活量、一秒用力呼气容积与用力肺活量比值恢复情况优于对照组(P＜0.05)。结论 腔镜微创手术用于老年肺癌患者能够显著降低围术期并发症,缩短患者术后恢复时间,且有助于改善肺功能。

Objective To investigate the efficacy and safety of endoscopic surgery in the treatment of elderly patients with lung cancer. Methods 90 elderly patients with lung cancer in our hospital were divided into two groups,45 cases in each group. The observation group was treated with thoracoscopic lung resection in 45 cases, the control group of 45 cases received conventional open lung cancer resection. The operation time, intraoperative blood loss, thoracic drainage time, lymph node dissection, postoperative hospital stay, pain score, pulmonary function assessment and postoperative complications were compared. Results There were no significant differences in the operation time and lymph node dissection between the two groups (P>0.05). The thoracic drainage time,intraoperative blood loss pain score and hospitalization time in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). The forced expiratory volume, forced vital capacity, vital capacity, one-second forced expiratory volume and forced vital capacity of the observation group were better than those in the control group after operation(P<0.05). Conclusion Endoscopic minimally invasive surgery may significantly reduce perioperative complications in elderly patients with lung cancer, shorten the postoperative recovery time and improve lung function.

目的 对比紫杉醇脂质体(LEP)与紫杉醇(PTX)联合顺铂(DDP)治疗晚期非小细胞肺癌(NSCLC)的临床疗效及安全性。方法 晚期NSCLC患者48例,随机分为对照组和试验组,对照组采用紫杉醇175 mg/m²,试验组采用紫杉醇脂质体175 mg/m²,均联合顺铂75 mg/m²化疗,21天为1个周期,治疗2个周期后评价疗效,记录近期疗效与治疗期间不良反应。结果 近期疗效:对照组有效率37.50%,疾病控制率为79.17%,试验组有效率为41.67%,疾病控制率为83.33%,两组差异均无统计学意义(P>0.05)。不良反应:白细胞减少、贫血及血小板减少的发生率两组差异无统计学意义(P>0.05),脱发和恶心、呕吐的发生率两组差异亦无统计学意义(P>0.05),但试验组皮疹、呼吸困难、肌肉痛及周围神经炎的发生率明显低于对照组,差异有统计学意义(P<0.05)。结论 紫杉醇脂质体治疗晚期NSCLC与紫杉醇疗效相当,但周围神经炎及过敏反应较紫杉醇为轻。

Objective To compare the efficacy and safety of paclitaxel liposome combined with cisplatin and paclitaxel combined with cisplatin in the treatment of advanced non-small cell lung cancer (NSCLC). Methods 48 patients with advanced NSCLC were randomized into two groups, experimental group were given paclitaxel liposome at 175 mg/m²,and control group were given paclitaxel at 175 mg/m². Both groups combined with DDP at 75 mg/m² per cycle every 21 days.The efficacy and safety were evaluated after two cycles. Results The overall response rate was 37.50% in experimental group and 41.67% in control group, and the disease control rate was 79.17% in experimental group and 83.33% in control group. There was no significant difference between two groups(P>0.05). Though there was no significant difference in incidence of neutropenia,anemia, thrombocytopenia and alopecia, nausea and vomiting, but the occurred rates of rash、muscle pain and peripheral neuritis were significantly lower in experimental group than those in control group. Conclusion In the treatment of advanced NSCLC, both paclitaxel liposome combined with cisplatin and paclitaxel combined with cisplatin have similar efficacy, but paclitaxel liposome can significantly reduce the incidence of peripheral neuritis and serious hypersensitive reactions.

目的 探讨同步放化疗治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法 选取我院2014年收治的晚期NSCLC患者102例,随机分为观察组和对照组,对照组以紫杉醇联合顺铂化疗方案(TP)化疗治疗,观察组加用三维适形放疗同步放化疗治疗,观察两组的临床疗效和不良反应。结果 观察组和对照组患者的总有效率分别为43.14%和21.57% (P<0.05),两组患者的总控制率分别为84.31%和66.67% (P<0.05)。两组患者Ⅲ～Ⅳ级胃肠道反应、白细胞减少、骨髓抑制的发生率差异无统计学意义(P>0.05),观察组比对照组增加了放射性肺炎和放射性食管炎的发生 (P<0.05)。两组患者生活质量比较,差异具有统计学意义(P＜0.05)。结论 同步放化疗治疗晚期NSCLC可以显著提高治疗的总有效率、肿瘤的控制率及生活质量,但也使不良反应增加,选择治疗方案时应根据个体情况综合考虑。

Objective To study the clinical efficacy of concurrent chemoradiotherapy in the treatment of advanced non small cell lung cancer (NSCLC). Methods 102 cases of advanced NSCLC treated in our hospital in 2014 were selected and randomly divided into the observation group and the control group. Patients in control group were treated by chemotherapy with Paclitaxel combined Cisplatin (TP), while those in observation group were treated by concurrent chemoradiotherapy with three- dimensional conformal radiotherapy and TP. The clinical efficacy and adverse reactions of the two groups were observed. Results The total effective rate of the observation group and the control group were 43.14% and 21.57% (P<0.05), respectively. The total control rate of the two groups were 84.31% and 66.67%(P<0.05). In two groups III ~ IV gastrointestinal tract reaction, leukopenia, bone marrow suppression occurrence had no statistical significance(P>0.05). Incidence of radiation pneumonitis and radiation esophagitis increased in observation group(P<0.05). The difference of quality of life between the two groups was statistically significant(P<0.05). Conclusion Concurrent radiotherapy and chemotherapy in the treatment ofadvanced non-small cell lung cancer(NSCLC)can not only significantly improve the treatment, tumor control rate and quality of life, but also make adverse reaction increased. Treatment options should be chosen based on individual circumstances into account

目的 探讨罗伊适应模式对肺癌患者术后生活质量的影响。方法 将2012年3月—2015年7月来我院就诊的178例肺癌术后患者,随机分为试验组85例和对照组93例;对照组患者按护理常规进行护理,试验组在常规护理基础上给予罗伊适应模式护理干预;出院时分别比较两组患者住院适应性、治疗依从性、病人满意度及患者生活质量评分。结果 试验组住院适应率为87.1%(74例),对照组住院适应率为66.7%(62例),两组差异有显著性(P<0.01);试验组治疗依从性优良率为88.2%(75例)、对照组治疗依从性优良率72.0%(67例),两组差异有显著性(P<0.01);试验组患者满意度为89.4%(76例),高于对照组患者满意度73.1%(68例),两组差异有显著性(P<0.01);试验组生活质量评分,总体健康得分(74.1±8.3)高于对照组(56.7±5.9),且差异有统计学意义(P<0.01)。结论 罗伊适应模式护理干预,可以提高肺癌患者手术后的住院适应性、治疗依从性及病人满意度,显著改善患者生活质量,在临床推广罗伊适应模式护理干预具有现实意义。

Objective To investigate　the effect of Roy adaptation model on quality of life in patients for lung cancer after surgery. Methods 178 cases of　patients with lung cancer after surgery operation　were randomly divided into observation groups(85 cases) and control groups(93 cases). The control group was treated with routine nursing care and the observation group was treated on the basis of routine nursing care plus Roy adaptation model nursing interventions. When the two groups were compared in patients hospitalized and discharged adaptability, treatment compliance, patient satisfaction and patient quality of life score. Results Hospitalization adaptation in the observation group was 87.1%(74 cases) and control group was 66.7%(67 cases). There was statistically significant difference between two groups(P<0.01); Excellent treatment compliance of observation group was 88.2%(75 cases) and control group was 72.0%(67 cases). There was statistically significant difference between two groups(P<0.01); the observation group patient satisfaction were 89.4%(76 cases), it was higher than 73.1%(68 cases) of control group. There was statistically significant difference between two groups(P<0.01); quality of life in general health score(74.1±8.3) in the observation group was higher than that of control group(56.7±5.9),and there was statistically significant difference between two groups(P<0.01). Conclusion Roy adaptation model nursing intervention may improve the adaptability hospitalized the patients with lung cancer after surgery, treatment compliance and the patient satisfaction, and significantly improve the quality of life of patients. It is worthy of promotion clinically.