Approach Fusion of Trinocular Stereo and Inertial Data for Underwater Robotic Navigation Pr

中国现代医药杂志2009年6月第11卷第6期MMJC,Jun 2009,Vol 11,No．6我们2004年3月~2008年10月采用TLIF 手术、椎间融合器植入后外侧植骨融合术治疗腰椎退行性滑脱患者12例，疗效满意，现总结如下。

1资料与方法1.1一般资料本组患者共12例，其中男5例，女7例，年龄42~69岁，平均51.2岁，病程10月~4年，平均2.1年，滑脱程度按Meyerding 分类：Ⅰ度8例，Ⅱ度4例。

滑脱节段:L 4滑脱8例，L 5滑脱4例。

全部病例均有CT 和MRI 检查。

1.2临床表现所有病例都有长期严重的下腰痛、神经源性间歇性跛行，伴一侧或双侧下肢放射痛,经严格保守治疗半年以上无效。

术前JOA 评分5~22分，所有患者均摄正侧位、双斜位、过伸过屈侧位片排除其他类型滑脱。

1.3手术方法所有病例均根据术前的症状来选择施行TLIF 的手术，如果呈现椎间盘突出或椎间孔狭窄并绝大部分偏向一侧,则选择该侧。

本组均采用全麻,后正中常规入路,先植入4枚椎弓根螺钉,切除病变间隙一侧小关节上下关节突,显露椎间孔,保护好神经根及硬膜,在纤维环上作一方形切口,摘除椎间盘,利用椎间隙撑开器初步撑开椎间隙后组装固定棒撑开椎间隙。

利用各型刮匙、软骨凿、咬骨钳彻底切除椎间盘,彻底清除终板软骨面。

直骨凿切除上下椎体的后缘,松开固定装置,再次使用椎间隙撑开器撑开椎体后固定。

至此对中央椎管，侧方椎管和后方椎管全部处理完毕，最终要求无压迫、无粘连和神经根、硬膜囊的无张力移动。

粘连松解以及神经根管的减压是关键步骤。

在髂后上棘开窗取松质骨并修成骨粒约10ml 。

把部分松质骨粒置入椎间隙前1/3并压紧。

试模测量椎间隙高度，取适当高度直径Cage 并装填松质骨粒后置入椎间隙，使滑脱症提拉复位，椎弓根螺钉行加压后锁紧螺母。

2结果术后卧床4周，带腰围扶拐下床活动，经3~12个月随访的结果，术后症状消失9例,明显减轻2TLIF 手术治疗腰椎退行性滑脱邓雄伟张云庆杨惠光金峥骆文兴韦山周枫【摘要】目的总结TLIF 手术在腰椎退行性滑脱治疗中应用价值。

基于有序图像的快速三维重建刘保江;尹颜朋【摘要】如何提高重建速度一直是三维重建中的一个关键问题.传统的三维重建方法由于需要对输入的所有图像做任意两图像之间的匹配,故不适合大场景的重建.提出一种基于有序图像的快速三维重建方法,仅需对有序图像序列中的相邻图像做匹配,减少匹配阶段时间,从而提高重建速度.实验结果表明,提出的方法与传统的全匹配方法相比,能达到相同水平的重建效果,但在重建速度上具有明显的优势.【期刊名称】《现代计算机（专业版）》【年(卷),期】2017(000)035【总页数】4页(P81-84)【关键词】三维重建;SFM;快速重建【作者】刘保江;尹颜朋【作者单位】四川大学计算机学院,成都 610065;四川大学计算机学院,成都610065【正文语种】中文0 引言计算机三维重建技术是当前研究的一个热点。

三维重建目的是从输入的多张二维场景图像恢复出场景三维立体模型。

与传统的利用激光扫描仪等精密设备直接测量出物体三维模型相比具有方便、成本低以及适用范围广等优点，在文物考古、医疗卫生、旅游、数字娱乐和军事测绘导航等各个领域应用广泛。

进几十年来出现了许多基于图像视觉的三维重建方法，例如明暗度法[1-3]、纹理法[4-6]、轮廓法[7-8]、运动法[9]、调焦法[10]、双目视觉法[11]和多目视觉法[12]等。

但是大都存在重建精度较差、鲁棒性较差问题，或是重建效果不错，但存在运算时间太长问题。

故如何在达到不错的重建质量基础上提高重建速度就显得十分重要。

针对上面提出的方法存在的问题，本文提出一种基于有序图像序列的快速三维重建方法，在三维重建过程中，仅对相邻的图像进行特征匹配，对于n张输入图像，能够将匹配阶段的时间复杂度从O（n2）降低到O（n），对于大场景的重建在时间上节省尤为明显。

然后利用多视图几何和对极几何约束关系，计算出场景的几何结构和摄像机的参数信息，重建出场景的三维立体模型，并使重建质量达到传统的三维重建的水平。

中外医疗 China &Foreign Medical Treatment 综述预见性护理在植入式静脉输液港化疗患者中的研究进展徐雅敏，宋夏云复旦大学附属华东医院日间化疗病房，上海200040［摘要］预见性护理是一种具有前瞻性的护理方法，旨在预防和减少患者的并发症。

在植入式静脉输液港（implantable venous access port, IVAP）化疗患者中，预见性护理对于降低感染、血栓形成、导管堵塞等并发症的风险具有重要意义。

本文综述了预见性护理在植入式静脉输液港化疗患者中的相关内容，包括IVAP化疗患者的常见并发症、不良反应和护理需求，预见性护理的概念、实施方法和具体措施，预见性护理在IVAP化疗患者中的研究现状，预见性护理在IVAP化疗患者中的发展趋势。

研究表明，预见性护理能够通过全面评估患者的病情和护理需求，制定个性化的护理计划，采取针对性的护理措施，有效降低IVAP化疗并发症的发生风险，提高患者的生活质量和护理满意度。

同时，本文也指出了目前研究的不足之处，为未来的研究方向提供了参考。

［关键词］预见性护理；植入式静脉输液港；化疗；并发症；生活质量；研究进展［中图分类号］R4 ［文献标识码］A ［文章编号］1674-0742（2023）11(b)-0194-05 Research Progress of Predictive Nursing in Patients with Implantable In⁃travenous Infusion Port ChemotherapyXU Yamin, SONG XiayunDepartment of Day Chemotherapy Unit, East China Hospital Affiliated to Fudan University, Shanghai, 200040 China [Abstract] Predictive nursing is a proactive approach to care aimed at preventing and reducing complications in pa⁃tients. Predictive nursing is important for reducing the risk of complications such as infection, thrombosis, and cath⁃eter blockage in patients with chemotherapy at implantable venous access port (IVAP). This paper reviewed the rel⁃evant contents of predictive nursing in patients with implantable intravenous infusion port chemotherapy, including the common complications, adverse reactions and nursing needs of patients with IVAP chemotherapy, the concept, imple⁃mentation methods and specific measures of predictive nursing, the research status of predictive nursing in patients with IVAP chemotherapy, and the development trend of predictive nursing in patients with IVAP chemotherapy. Stud⁃ies have shown that predictive nursing can effectively reduce the risk of complications of IVAP chemotherapy by com⁃prehensively evaluating patients' conditions and nursing needs, formulating personalized nursing plans and taking tar⁃geted nursing measures, improving patients' quality of life and nursing satisfaction. At the same time, this paper also pointed out the shortcomings of the current research, and provided a reference for the future research direction.[Key words] Predictive nursing; Implantable intravenous infusion port; Chemotherapy; Complications; Quality of life; Research progress化疗是治疗癌症的重要手段之一，植入式静脉输液港（implantable venous access port, IVAP）作为一种新型的化疗方式，能够有效地提高化疗的疗效和患者的生存质量。

•论著•中国现代医生2020年11月第58卷第32期三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术屮的应用刘海涛王黎彬戚维波银杨帆施谷平张小航赵俊杰马兴杰浙江省嘉兴市第一医院嘉兴学院附属医院心胸外科，浙江嘉兴314000［摘要］目的探讨利用Deepinsinghl软件进行三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术中的应用价值。

方法回顾性分析2018年1~12月我院行胸腔镜解剖性肺段切除术治疗的22例术前疑似早期肺癌患者的临床资料。

术前将胸部增强CT检查的断层二维图像信息以DICOM格式导入Deepinsinghl系统中进行三维重建及虚拟手术规划实施精准肺段切除。

观察指标:①术前三维重建及虚拟手术规划情况;②术中及术后情况。

③随访情况。

结果①术前三维重建及虚拟手术规划情况：22例患者术前均完成三维重建和虚拟手术规划;②术中及术后情况：22例患者均顺利行胸腔镜解剖性肺段切除术，无中转开胸。

22例患者手术时间为(115.05±27.54)min,术中出血量为(78.64±16.14)mL，术后拔管时间为(3.55±1.06)d,术后住院时间为(7.27±2.62)凿遥术后发生肺部感染2例，发生肺动脉栓塞1例，均经保守治疗后痊愈。

术后肿瘤TNM分期为：良性肿瘤1例,0期9例,IA期11例、IB期2例遥三维重建和虚拟手术规划评估肿瘤性质的准确率为95.5%(21/22)遥③随访情况:随访期间所有患者均未发生局部复发、远处转移及死亡情况。

结论应用三维重建及虚拟手术规划能实现精准肺段切除，可提高胸腔镜解剖性肺段切除术的准确性和安全性。

［关键词］肺部肿瘤；三维重建技术;虚拟手术规划技术;肺段切除术［中图分类号］R655.3［文献标识码］A［文章编号］1673-9701(2020)32-0004-04Application of three-dimensional reconstruction and virtual surgical plan­ning in thoracoscopic anatomic lung segment resectionLIU Haitao WANG Libia QI Weibo YANG Fan SHI Guping ZHANG Xiaohang ZHAO Junjie MA XingjieDepartment of Cardiolhoracic Surgery,Jiaxing First Hospital in Zhejiang Province,Affilialed Hospital of Jiaxing Univer­sity,Jiaxing314000,China［Abstract］Objective To explore the application value of three-dimensional reconstruction and virtual surgical planning using Deepinsinght software in thoracoscopic anatomic lung segment resection.Methods The clinical data of22pa­tients with preoperative suspected early lung cancer who underwent thoracoscopic anatomic lung segment resection in our hospital from January to December2018were retrospectively analyzed.The two-dimensional tomography informa­tion of chest enhanced CT examination was imported into Deepinsinght system in DICOM format for3D reconstruction and virtual surgical planning for accurate lung segment resection.The observation index included:①preoperative three-dimensional reconstruction and virtual operation planning;于intraoperative and postoperative conditions;③follow-up situation.Results①Preoperative three-dimensional reconstruction and virtual operation planning:All the22 patients completed3D reconstruction and virtual operation planning before the operation.于Intraoperative and postop­erative conditions:All the22patients underwent thoracoscopic anatomic lung segment resection successfully,without conversion to thoracotomy.The operative time of22patients was(115.05±27.54)min,the intraoperative blood loss was(78.64±16.14)mL,the postoperative extubation time was(3.55±1.06)d,and the postoperative hospital stay was(7.27±2.62)d.Postoperative pulmonary infection occurred in2cases and pulmonary embolism in1case,all of which were cured after conservative treatment.Postoperative tumor TNM stage was benign in1case,stage0in9cases,stage IA in11cases, and stage IB in2cases.The accuracy of3D reconstruction and virtual surgical planning in assessing the nature of the tumor was95.5%(21/22).③Follow-up:No local recurrence,distant metastasis,or death occurred during the follow-up period.Conclusion The application of3D reconstruction and virtual surgical planning can achieve accurate lung seg­ment resection and improve the accuracy and safety of thoracoscopic anatomic lung segment resection.［Key words］Lung tumor;Three-dimensional reconstruction technology;Virtual surgical planning technology;Lung seg­ment resection［基金项目］浙江省医药卫生科技计划项目(2018KY796，2018KY800)▲通讯作者4CHINA MODERN DOCTOR Vol.58No.32November2020中国现代医生2020年11月第58卷第32期•论著窑近年来，肺癌的死亡率逐年上升，已居恶性肿瘤死亡之首［1-2］o随着低剂量螺旋CT广泛地应用于普查，早期肺癌越来越多地被发现。

脑立体手术英语Here is the English essay on the topic of "Stereotactic Brain Surgery" with a word count of over 600 words:Stereotactic brain surgery has revolutionized the field of neurosurgery, offering a precise and minimally invasive approach to treating a wide range of neurological disorders. This advanced surgical technique utilizes 3D imaging and computer-guided technology to precisely target specific areas of the brain, allowing surgeons to access and address complex brain structures with unprecedented accuracy.The term "stereotactic" refers to the use of a three-dimensional coordinate system to locate and operate on a specific target within the brain. This technique involves the creation of a frame of reference, which is typically a rigid structure that is attached to the patient's head. Using this frame, surgeons can accurately map the patient's brain and identify the precise location of the targeted area, ensuring that the surgical intervention is carried out with the utmost precision.One of the primary advantages of stereotactic brain surgery is itsability to treat conditions that were previously considered inoperable or too risky for traditional open cranial surgery. These include brain tumors, Parkinson's disease, essential tremor, obsessive-compulsive disorder, and chronic pain syndromes, among others. By accessing the brain through a small incision and using specialized instruments, surgeons can minimize the physical trauma to the patient, resulting in faster recovery times and reduced risk of complications.The stereotactic brain surgery process typically begins with the acquisition of detailed neuroimaging scans, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans. These images are then integrated into a 3D computerized model of the patient's brain, which allows the surgical team to plan the procedure with meticulous precision. During the surgery, the patient's head is securely fixed within the stereotactic frame, ensuring that the brain remains stationary and the surgical instruments can be accurately positioned.One of the most remarkable advancements in stereotactic brain surgery is the use of intraoperative imaging techniques, such as real-time MRI or CT scanning. These technologies allow the surgical team to continuously monitor the progress of the procedure and make adjustments as needed, further enhancing the precision and safety of the operation.In the case of brain tumors, stereotactic surgery can be used to either remove the tumor or to deliver targeted radiation therapy, known as stereotactic radiosurgery. This approach is particularly effective for small, deep-seated tumors that may be difficult to access through traditional open surgery. By focusing the radiation beam on the tumor while sparing the surrounding healthy brain tissue, stereotactic radiosurgery can effectively treat the lesion while minimizing the risk of collateral damage.For movement disorders like Parkinson's disease and essential tremor, stereotactic brain surgery can be used to target specific regions of the brain responsible for the abnormal neurological symptoms. By precisely stimulating or lesioning these areas, surgeons can often achieve significant improvements in the patient's motor function and quality of life.In the field of psychiatric disorders, such as obsessive-compulsive disorder, stereotactic surgery has shown promise in addressing treatment-resistant cases. By targeting specific areas of the brain involved in the pathophysiology of these conditions, surgeons can potentially alleviate the debilitating symptoms and improve the patient's overall well-being.The success of stereotactic brain surgery is largely dependent on the expertise and experience of the surgical team, as well as the carefulplanning and execution of the procedure. Patients undergoing this type of surgery are typically evaluated by a multidisciplinary team of neurosurgeons, neurologists, radiologists, and other specialists to ensure that the treatment plan is tailored to their individual needs.Overall, stereotactic brain surgery has transformed the way neurosurgeons approach complex neurological and psychiatric disorders. By leveraging advanced imaging technologies and computer-guided techniques, this minimally invasive approach has the potential to improve patient outcomes, reduce surgical risks, and expand the range of treatable conditions. As the field of stereotactic neurosurgery continues to evolve, it is likely that we will witness even more remarkable advancements in the years to come.。

Ch inese Jou rnal ofN e w Drugs 2010,19(21)[作者简介] 吴雅楠,女,硕士研究生。

联系电话:(010)82805123,E-m ai:l wuyanan1210@s i na .co 。

[通讯作者] 范田园,女,副教授,主要从事新型缓控释、靶向给药系统与生物材料的应用研究。

联系电话:(010)82801584,E -m ai :l ti anyuan_f an@bj m u 。

#综述#不透X 线栓塞微球的制备及评价研究进展吴雅楠,张 苑,范田园(北京大学药学院药剂学系,北京100191)[摘要] 近年来介入栓塞治疗在临床医学中发挥着越来越重要的作用。

微球是介入栓塞治疗中最常用的栓塞材料之一。

目前用于临床的栓塞微球基本上都能够透过X 线,即在X 线下不显影。

为提高栓塞治疗的效果和便利性,人们做了大量不透X 线栓塞微球的研究,但作者未见综述报道。

本文总结归纳了多种不透X 线微球的制备方法及特点,介绍了对不透X 线微球的主要评价方法)))动物体内栓塞效果和X 线下显影效果以及生物相容性评价,为此类微球的研制和评价提供了参考。

[关键词] 不透X 线微球;栓塞;制备;生物相容性;动物研究[中图分类号]R979.1 [文献标志码]A [文章编号]1003-3734(2010)21-1944-05Advances i n preparation and eval uati on on radiopaquem icrospheres for e mbolizati onWU Ya -nan ,Z HANG Yuan ,FAN T ian -yuan(D epart m ent o f P har m aceutics ,School of P har m aceutical Sciences ,Peking University,B eijing 100191,China)[Abstract] Interventional e mbo lization therapy has been play i n g m ore and m ore i m portant r o le i n cli n ica l m ed icine for recent years .M icrospheres is one o f the m ost co mm on used e m bo li c m aterials in i n terventional e m bo l-i zati o n .H o w ever ,m ostm icrospheres i n present cli n ical use can no t be visua lized on X-ray i m ages .To i m pr ove the effect and convenience o f e mbolization therapy ,radiopaque m icrospheres w ere developed i n large a m ount o f re -search w or ks .Th is revie w summ arized the preparation and study i n radiopaque m icrospheres ,i n c l u d i n g an i m al ex -peri m ent and b ioco mpatibility stud ies ,to prov ide va l u able reference fo r deve l o p m ent and eva l u ation of rad i o paque m icrospheres .[K ey w ords] rad iopaque m icrospheres ;e m bo lization ;preparati o n ;b i o co mpatibility ;ani m a l stud i e s 介入栓塞治疗是一种有效的临床治疗方法,在治疗毛细血管瘤、动静脉畸形、动静脉瘘、富血供肿瘤以及子宫肌瘤等疾病中起到了不可替代的作用。

1引言气体分析对实验条件的要求特别严格，不像水样分析，温度等外部因素对水的影响不大，气体分析与之不同之处在于，实验室的温度，采样时的温度、气压、流量等在不同季节都应有所区别的，否则测量的结果就会有偏差［1］。

2实验部分2.1方法与原理二氧化硫测定原理就是二氧化硫被甲醛缓冲溶液吸收后，生成稳定的羟甲基磺酸加成化合物，在样品溶液中加入氢氧化钠使加成化合物分解，释放出的二氧化硫与副玫瑰苯胺（PRA ）、甲醛作用，生成紫红色化合物，根据颜色深浅用分光光度计在577nm 处测定［2］。

本方法的主要干扰物为氮氧化物、臭氧及某些重金属元素。

加入氨磺酸钠可消除氮氧化物的干扰，采样后放置一段时间可使臭氧自行分解，加入CD-TA 可消除或减少某些重金属元素的干扰。

2.2仪器空气采样器、分光光度计、多孔玻板吸收管、恒温水浴器、具塞比色管。

2.3试剂蒸馏水、环已二胺四乙酸二钠、氢氧化钠、甲醛、邻苯二甲酸轻钾、氨磺酸钠、碘、碘化钾、可溶性淀粉、碘酸钾（优级纯）、盐酸、硫代硫酸钠。

2.4标准曲线的绘制在进行标准曲线的绘制时，最能体现外部因素对其测定结果的影响。

取14支10m L 的具塞比色管，分A ，B 两组，每组7支，分别对应编号。

A 组按表1配制标准系列。

表1二氧化硫标准系列B 组各管分别加入0.05%PRA 使用液1.00m L ，A 组各管分别加入0.6%氨磺酸钠溶液0.5m L 和1.5mol /L 氢氧化钠溶液0.5m L 混匀，再逐管迅速将溶液全部倒入对应编号并装有PRA 使用液的B 管中，立即具塞摇匀后放入恒温水浴中显色。

显色温度与室温之差应不超过3℃，根据不同的季节和环境条件选择显色温度与时间，见表2。

摘要：介绍了甲醛吸收—副玫瑰苯胺分光光度法的原理，探讨了该方法标准曲线的制作，并根据实验经验提出几点注意事项。

关键词：大气；二氧化硫；甲醛吸收—副玫瑰苯胺分光光度法；注意事项Abstract ：The principle of formaldehyde absorption -pararosaniline spectrophotometric method is introduced.Thepreparation of the standard curve of this method is discussed ，and some precautions are put forward based on ex-perimental experience.Key words ：atmosphere ；sulfur dioxide ；formaldehyde absorption -pararosaniline spectrophotometry ；precautions中图分类号：X 831文献标识码：A文章编号：1674-1021（2019）07-0073-02收稿日期：2019-05-07；修订日期：2019-07-10。

WHO Model Formulary for ChildrenBased on the Second Model List of Essential Medicines for Children 2009世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准目录WHO Library Cataloguing-in-Publication Data:WHO model formulary for children 2010.Based on the second model list of essential medicines for children 2009.1.Essential drugs.2.Formularies.3.Pharmaceutical preparations.4.Child.5.Drug utilization. I.World Health Organization.ISBN 978 92 4 159932 0 (NLM classification: QV 55)世界卫生组织实验室出版数据目录：世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准处方集1．基本药物 2.处方一览表 3.药品制备 4儿童 5.药物ISBN 978 92 4 159932 0 (美国国立医学图书馆分类：QV55)World Health Organization 2010All rights reserved. Publications of the World Health Organization can be obtained fromWHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: ******************). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the aboveaddress(fax:+41227914806;e-mail:*******************).世界卫生组织2010版权所有。

•380 •浙江临床医学2021年3月第23卷第3期•诊治分析•自体PRP治?tK O A的疗效及对相关介质的景如向李悦沈斌陈利宁倪向明徐仲翔吴峰淼吕存贤*【摘要】目的探讨关节腔内注射自体富血小板血浆（PR P )治疗膝骨性关节炎（K O A)的疗效及其对相关介质的影响方法选取2016年7月至2019年3月温州市中医院收治的K O A患者100例，按随机数字表法分为观察组和对照组，每组各50例，两组患者基础治疗相同，观察组同时采用关节腔内注射自体P R P治疗，比较两组治疗前后的膝关节功能状态及实验室检查指标水平，并进行疗效评估结果治疗3个 月、6个月后，两组膝关节功能评分比较，观察组W O M A C评分低于对照组，而Lysholm评分高于对照组,，治疗6个月后，观察组血清M M P3、T1M P-1、P G E2、S P、L T B4、L T C4测定值均低于对照组（P<0.05 ) 两组患者疗效比较，观察组显效率（64% )明显高于对照组（44% )，差异有统计学意义（P<0.05) 结论关节腔内注射丨)R1)治疗K O A可以改善患者症状、降低骨关节炎相关介质水平，临床效果满意【关键词】富血小板血浆骨性关节炎基质金属蛋白酶3基质金属蛋白酶抑制物-1【A b s tr a c t 】Objective To explore the effect o f intra-articular injection o f autologous platelet-rich plasma ( PRP ) on knee osteoarthritis ( KOA ) and its influence on related mediators. Methods A total o f 100 KOA patients admitted to Wenzhou Hospital o f Traditional Chinese Medicine from July 2016 to March 2019 were selected and divided into observation group and control group according to the random number table method, with 50 cases in each group. The basic treatment o f the two groups was the s«ime, and the observation group was at the same time Intra-articular injection o f autologous PRP was used to compare the functional status o f the knee joints before and after the treatment and the level o f laboratory test indicators, and the efficacy was evaluated. Results After 3 months and 6 months o f treatment, the knee joint Hinction scores o f the two proups were compared. The W OM AC score o f the observation group w«is lower than that o f the control group, while the Lysholm score was higher than that o f the control group. After 6 months o f treatment, the measured values o f serum M M P3, T IM P-1, PGE2, SP, LT B4, and LT C4 in the observation group were lower than those in the control group (P<0.05 ) . The efficacy o f the two groups o f patients were compared, the observation group's significant rate ( 64% ) was significantly higher than that o f the control group ( 44% ) , and the difference was statistically significant ( P<0.05 ) . Conclusion Intra-articular injection o f PRP in the treatment o f KOA can improve patients' symptoms and reduce the level o f osteoarthritis-related mediators, and the clinical effect is positive.【K e y words】Platelet—rich plasma Osteoarthritis Matrix metalloproteinase 3 Matrix metalloproteinase inhibitor—1膝骨性关节炎（KOA )是一种累及膝关节组织的 关节疾病，病情进一步发展易导致关节软骨的变性和 脆裂，影响患者的正常活动」_21。

·临床研究·作者单位：325000浙江省温州市中西医结合医院妇科（朱淑嫔、姚锐、林一禾），超声科（陈仙秋）三维超声自由解剖成像联合断层超声成像对宫腔粘连的诊断价值朱淑嫔姚锐林一禾陈仙秋摘要目的探讨三维超声自由解剖成像（OmniView ）联合断层超声成像（TUI ）对宫腔粘连（IUA ）的诊断价值。

方法选取我院收治的112例疑似IUA 患者，均行OmniView 和TUI 检查，比较OmniView 、TUI 单独及联合应用诊断IUA情况，并与宫腔镜检查结果进行一致性分析；绘制受试者工作特征（ROC ）曲线分析OmniView 、TUI 单独及联合应用对IUA 的诊断效能。

结果112例患者中，宫腔镜检出IUA 98例，其中中央型62例，周围型11例，混合型25例；非IUA 14例。

OmniView 检出IUA 93例，其中中央型59例，周围型10例，混合型24例；非IUA 患者19例。

TUI 检出IUA 88例，其中中央型58例，周围型7例，混合型23例;非IUA 患者24例。

OmniView 及TUI 检出IUA 与宫腔镜检查结果的一致性均一般（Kappa =0.681、0.625，均P <0.001），联合应用与宫腔镜检查结果的一致性较好（Kappa =0.813，P <0.001）。

ROC 曲线分析显示，OmniView 联合TUI 诊断IUA 的曲线下面积、灵敏度、特异度和准确率分别为0.939、95.92%、92.86%、95.54%，AUC 高于各方法单独应用（均P <0.05）。

结论OmniView 联合TUI 对IUA 具有较好的诊断价值，可用于临床筛查。

关键词超声检查，三维；自由解剖成像；断层超声成像；宫腔粘连［中图法分类号］R445.1；R711.74［文献标识码］ADiagnostic value of three-dimensional ultrasound freehand anatomical imaging combined with tomographic ultrasound imaging forintrauterine adhesionsZHU Shupin ，YAO Rui ，LIN Yihe ，CHEN XianqiuDepartment of Gynaecology ，Wenzhou Integrated Traditional Chinese and Western Medicine Hospital ，Zhejiang 325000，China ABSTRACTObjectiveTo explore the value of three-dimensional ultrasound freehand anatomical imaging （OmniView ）combined with tomographic ultrasound imaging （TUI ）in the diagnosis of intrauterine adhesions （IUA ）.MethodsA total of 112patients with suspected IUA admitted to our hospital were selected ，and all patients underwent OmniView and TUI examination.The results of hysteroscopy were used as the gold standard to analyze the consistency of IUA examined by OmniView ，TUI alone and in combination.Receiver operating characteristic （ROC ）curve was drawn to analyze the diagnostic efficacy of OmniView ，TUI alone and in combination for IUA.ResultsAmong 112patients ，98cases of IUA were detected by hysteroscopy ，including62cases of central type ，11cases of peripheral type and 25cases of mixed type ，and 14cases of non-IUA.93cases of IUA were detected by OmniView ，including 59cases of central type ，10cases of peripheral type ，and 24cases of mixed type ，and 19cases of non-IUA.88cases of IUA were detected by TUI ，including 58cases of central type ，7cases of peripheral type ，and 23cases of mixed type,and 24cases of non-IUA.The consistency of OmniView and TUI in detecting IUA was general （Kappa =0.681，0.625，both P<0.001），and the consistency of combined detection was better （Kappa =0.813，P<0.001）.ROC curve analysis showed that the area under the curve ，sensitivity ，specificity and accuracy of OmniView combined with TUI in the diagnosis of IUA were 0.939，95.92%，92.86%and 95.54%，respectively.AUC of combined detection was higher than that of eachalone （both P <0.05）.Conclusion OmniView combined with TUI have good value in the diagnosis of IUA ，which can be used forclinical screening.KEY WORDS Ultrasonography ，three-dimensional ；Freehand anatomical imaging ；Tomographic ultrasound imaging ；Intrauterine adhesions宫腔粘连（intrauterine adhesions，IUA）是指由于手术或炎症等因素刺激，损伤了子宫内膜和内膜基底层的完整性，导致子宫间质中的纤维蛋白原渗出、沉积，造成宫腔前后壁粘连［1-2］。

立体定向放射治疗英语When it comes to fighting cancer, one of the most advanced treatment options is stereotactic radiotherapy.It's like using a laser-guided missile to precisely target cancer cells. You can think of it as a GPS-guided surgery without the knife.You know, stereotactic radiotherapy is really changing the game in cancer care. It allows doctors to deliver high doses of radiation to tumors while minimizing damage to healthy tissue. It's kind of like painting a bulls-eye on the tumor and only affecting that area.Hey, did you hear about the latest stereotactic radiotherapy techniques? They're getting more and more advanced. Now, they can even track tumor movements in real-time during treatment, making sure the radiation is hitting the target accurately.Talking about stereotactic radiotherapy, it's not justabout the technology. It's also about the team behind it. You need a skilled radiologist, oncologist, and other medical professionals working together to ensure the best possible outcome for the patient.For patients, stereotactic radiotherapy can be a life-saving treatment. It's often less invasive and has fewer side effects than traditional surgery. Plus, the recovery time is often shorter. So if you or someone you know is facing cancer, stereotactic radiotherapy might be a treatment option worth exploring.。

赵刚等肿瘤立体定向消融放疗联合免疫治疗的研究进展第 11 期肿瘤立体定向消融放疗联合免疫治疗的研究进展①赵刚涂甲丁卜嘉蕊王然玉张书涵（吉林大学公共卫生学院，国家卫生健康委员会放射生物学重点实验室，长春 130021）中图分类号R734.2 文献标志码 A 文章编号1000-484X（2023）11-2461-06［摘要］近年来，随着放疗技术的迅速发展，特别是影像技术和计算机技术的发展，肿瘤立体定向消融放疗（SABR）实现了精准地将非常高剂量的射线传递到肿瘤局部，而对周围正常组织的损伤降到最低。

SABR除了对肿瘤的直接杀伤作用外，还具有免疫调节作用，SABR的作用相当于原位疫苗接种的效果，导致受照射局部肿瘤释放大量肿瘤相关抗原和损伤相关模式分子等，促进了机体抗肿瘤T细胞反应，使肿瘤的免疫原性细胞死亡增加，并可能诱发抗肿瘤的远端效应。

然而，肿瘤周围微环境通常处于免疫抑制状态，单独SABR的免疫调节作用很难奏效，因此，在SABR的同时引入免疫调节剂的联合治疗方案非常具有说服力。

免疫调节剂可解除肿瘤周围的免疫抑制状态，从而与SABR发挥协同作用，这种协同关系已在实验室模型中得到广泛证实，目前多项早期临床试验正在进行中。

［关键词］立体定向消融放疗；免疫治疗；免疫调节剂；肿瘤Progess in tumor stereotactic ablative radiotherapy combined with immuno-therapyZHAO Gang，TU Jiading，BU Jiarui，WANG Ranyu，ZHANG Shuhan. NHC Key Laboratory of Radiobiology，School of Public Health， Jilin University， Changchun 130021， China［Abstract］In recent years， with the rapid development of radiotherapy technology， especially imaging technology and computer technology， stereotactic ablative radiotherapy （SABR） has accurately delivered very high doses of radiation to the tumor region， and minimized damage to surrounding normal tissue. SABR in addition to direct effect of tumor killing，also has immunomodulatory effects， SABR effects is equivalent to in situ vaccination effect， which lead to irradiation local tumor release large tumour-associated antigens and damage associated molecular patterns，promote body anti-tumor T cell response，increase tumor immunogenic cell death， and may induce anti-tumor abscopal effect. However， the surrounding tumor microenvironment is generally in an immunosup‐pressive state， and the immunomodulatory effects of SABR alone are difficult to work， so the combination treatment regimen of immu‐nomodulators accompany with SABR is very convincing. Immunomodulators can relieve the immune suppressive state surrounding tumors and thus cooperate with SABR， which has been widely demonstrated in laboratory models， and multiple early-stage clinical trial studies are currently under way.［Key words］Stereotactic ablative radiotherapy；Immunotherapy；Immunomodulator；Tumor1 立体定向消融放疗的概念立体定向消融放疗（stereotactic ablative radio‐therapy，SABR）又称体部立体定向放射治疗（stereo‐tactic body radiation therapy，SBRT）、立体定向放射外科（stereotactic radiosurgery，SRS）等［1］，本文以下统称SABR。

区获得性肺炎临床结局的预测价值[J ].西部医学,2023,38(1):125-129.[3]㊀Kuluozturk M ,in E ,Telo S ,et al.Efficacy of copeptin in dis-tinguishing COVID -19pneumonia from community -acquired pneumonia [J ].Med Virol ,2021,93(5):3113-3121.[4]㊀梁振宇,陈荣昌.慢性阻塞性肺疾病诊疗指南(2021年修订版)修订历程及思考[J ].中华结核和呼吸杂志,2021,44(3):165-166.[5]㊀薛晓艳,高占成,朱继红,等.中国社区获得性肺炎诊断和治疗指南的评价[J ].北京大学学报(医学版),2006,38(3):276-279.[6]㊀焦桂微,刘晓民,任强,等.慢性阻塞性肺疾病合并社区获得性肺炎与慢性阻塞性肺疾病急性加重期患者的临床对比分析[J ].哈尔滨医科大学学报,2021,55(6):593-597..[7]㊀王彦霞,李亚轻,牛占丛,等.老年CAP 患者感染病原菌分布㊁血浆D -D ㊁AT -Ⅲ㊁PC 检测以及相关危险因素分析[J ].中国病原生物学杂志,2020,15(7):838-841.[8]㊀申春梅,冷蓓铮,刘亚隽,等.成人非典型社区获得性肺炎患者病原体感染情况分析[J ].检验医学,2020,35(1):29-32.[9]㊀石齐芳,盛鹰,杨光耀,等.慢性阻塞性肺疾病急性加重合并呼吸衰竭患者短期预后相关合并症的初步筛选[J ].实用医学杂志,2021,37(5):643-647.ʌ文章编号ɔ1006-6233(2023)07-1201-08增强现实导航联合七步两枪法用于3D 腹腔镜缩小右半肝切除术中效果分析吴永融,㊀刘㊀振,㊀郝树青,㊀韦㊀敏(广西壮族自治区柳州市人民医院肝胆胰外科,㊀广西㊀柳州㊀545002)ʌ摘㊀要ɔ目的:探讨增强现实(AR )导航联合七步两枪法在3D 腹腔镜缩小右半肝切除术中的应用价值㊂方法:简单随机化法将2019年1月至2022年1月我院收治的104例肝癌患者分为标准组和改良组,每组各52例㊂标准组实施3D 腹腔镜右半肝切除术,改良组采用AR 导航联合七步两枪法行3D 腹腔镜缩小右半肝切除术㊂比较两组手术一般情况㊁术后康复进程㊁血红蛋白㊁白蛋白㊁肝功能[总胆红素(TBil )㊁谷草转氨酶(AST )㊁谷丙转氨酶(ALT )]㊁凝血功能[凝血酶原时间(PT )㊁凝血酶原活动度(PA )㊁活化部分凝血活酶时间(APTT )㊁纤维蛋白原(FIB )]㊁免疫球蛋白[免疫球蛋白G (IgG )㊁IgA ㊁IgM ]㊁并发症及随访1年复发率㊂结果:改良组手术时间㊁术后肠鸣音恢复时间㊁术后排气时间㊁术后下床活动时间㊁术后置管时间㊁住院时间均短于标准组,术中出血量㊁肝实际切除体积低于标准组,剩余肝体积高于标准组(P <0.05);改良组术后3d ㊁术后5d 血红蛋白㊁白蛋白㊁PA ㊁FIB 高于标准组,TBil ㊁AST ㊁ALT ㊁PT ㊁APTT 低于标准组(P <0.05);改良组术后3d ㊁术后5d 的IgG ㊁IgA ㊁IgM 高于标准组(P <0.05);改良组并发症总发生率㊁随访1年复发率分别为1.92%(1/52)㊁3.92%(2/51),与标准组的5.77%(3/52)㊁8.00%(4/50)比较,无显著差异(P >0.05)㊂结论:AR 导航联合七步两枪法能优化3D 腹腔镜缩小右半肝切除术路径,减少术中出血及肝切除体积,减轻肝功能和免疫功能损伤,改善患者凝血功能,缩短患者恢复进程,具有较好安全性及近中期效果㊂ʌ关键词ɔ㊀增强现实;㊀腹腔镜;㊀肝切除术;㊀凝血功能;㊀肝功能;㊀免疫球蛋白ʌ文献标识码ɔ㊀A㊀㊀㊀㊀㊀ʌdoi ɔ10.3969/j.issn.1006-6233.2023.07.028Analysis of the Effect of AR Navigation Combined with the Seven -Step Two -ShotMethod for 3D Laparoscopic Reduction of the Right HemicolectomyWU Yongrong ,LIU Zhen ,HAO Shuqing ,et al(Liuzhou People 's Hospital ,Guangxi Liuzhou 545002,China )ʌAbstract ɔObjective :To investigate the value of augmented reality (AR )navigation combined with the seven -step ,two -shot method in 3D laparoscopic reduction of the right hemicolectomy.Methods :A simple㊃1021㊃ʌ基金项目ɔ广西壮族自治区卫生健康委员会自筹经费科研课题,(编号:Z -B20221390)ʌ通讯作者ɔ刘㊀振randomization method was used to divide104patients with hepatocellular carcinoma admitted to our hospital from January2019to January2022into a standard group and a modified group,with52patients in each group. The standard group underwent3D laparoscopic right hemicolectomy,and the modified group underwent3D lap-aroscopic reduced right hemicolectomy using AR navigation combined with the seven-step two-shot method. The two groups were compared in terms of the general condition of surgery,postoperative recovery process,he-moglobin,albumin,liver function[total bilirubin(TBil),glutamic aminotransferase(AST),glutamic amin-otransferase(ALT)],coagulation function[prothrombin time(PT),prothrombin activity(PA),activated par-tial thromboplastin time(APTT),fibrinogen(FIB)],immunoglobulin[immune globulin G(IgG),IgA,IgM], complications and recurrence rate at1year follow-up.Results:The operation time,recovery time of postopera-tive bowel sounds,postoperative exhaustion time,postoperative bed activity time,postoperative tube placement time,and hospital stay were shorter in the modified group than in the standard group,and the intraoperative bleeding and actual volume of liver resection were lower than in the standard group,and the remaining liver volume was higher than in the standard group(P<0.05);hemoglobin,albumin,PA,and FIB were higher in the modified group than in the standard group at3d and5d postoperatively,and TBil,AST,ALT,PT,APTT were lower than those in the standard group(P<0.05).The IgG,IgA,and IgM at3d and5d postoperatively were higher in the modified group than in the standard group(P<0.05);the overall complication rate and re-currence rate at1year follow-up in the modified group were1.92%(1/52)and3.92%(2/51),respective-ly,which were not significantly different from5.77%(3/52)and8.00%(4/50)in the standard group(P> 0.05).Conclusion:AR navigation combined with the seven-step,two-shot method can optimize the path of 3D laparoscopic reduction of right hemicolectomy,reduce intraoperative bleeding and hepatic resection volume, mitigate liver function and immune function damage,improve patients'coagulation function,and shorten pa-tients'recovery process,with better safety and near-to mid-term results.ʌKey wordsɔ㊀Augmented reality;㊀Laparoscopy;㊀Hepatectomy;㊀Coagulation;㊀Liver function;㊀Immunoglobulin㊀㊀肝癌是常见恶性肿瘤,具有较高的发病率及死亡率,相关研究[1]显示,中国肝癌发病率与死亡率分别位居所有恶性肿瘤第四位和第二位,严重危害国人的生命与健康㊂手术是肝癌首选治疗方式,已获得国内外专家广泛认可㊂腹腔镜手术是肝癌常用治疗手段,其创伤轻微,可促进术后恢复㊂近年数字智能微创诊疗技术迅速发展,使得腹腔镜手术安全性显著提高[2]㊂增强现实(Augmented reality,AR)导航技术能将术前三维模型投影至腹腔镜手术影像中,可提高肝脏解剖结构可视化程度,避免重要组织意外损伤,提高手术安全性[3]㊂由于肝右叶钝厚,且位于较深部位,腹腔镜肝切除术存在诸多技术难点,被认为是高难度㊁高风险手术㊂而 七步两枪法 的提出使得腹腔镜右肝切除术更加规范化㊁标准化,在腹腔镜右肝切除术中展现显著优势[4]㊂手术为创伤操作,会激活应激反应,促使机体释放炎症因子,产生免疫功能抑制,增加并发症风险㊂研究[5]表明,癌细胞与手术创伤均会消耗机体凝血因子,导致凝血功能紊乱,影响患者预后㊂本研究选取我院104例肺癌患者,旨在从免疫功能㊁凝血功能等方面探究AR导航联合七步两枪法用于3D 腹腔镜缩小右半肝切除术中的临床价值㊂报道如下㊂1㊀资料与方法1.1㊀一般资料:以2019年1月至2022年1月我院收治的104例肝癌患者作为研究对象,均符合2015年版‘原发性肝癌规范化病理诊断指南“[6]中原发性肝癌的诊断标准,且病灶局限于右半肝㊂入选标准:符合中国肝癌分期[7](CNLC)㊁美国麻醉医师协会[8](ASA)分级中相关标准;肿瘤未出现远端转移患者;术前未接受过放化疗患者;患者或家属签署同意书㊂排除标准:合并其他肿瘤患者;心㊁肾㊁肺等脏器严重障碍患者;多发肿瘤患者;肿瘤细胞侵犯邻近脏器组织;妊娠或哺乳期女性;凝血功能障碍者;精神疾病或认知功能障碍者;全身感染性疾病患者;近期存在手术史患者㊂脱落标准:自愿退出研究者;随访期间参与其他研究患者;随访期间失访者㊂简单随机化法将患者分为改良组(n=52)和标准组(n=52)㊂两组一般资料比较,无显著差异(P>0.05),均衡可比㊂见表1㊂本研究经我院伦理委员会审批㊂㊃2021㊃表1㊀两组患者基线资料比较基线资料改良组(n=52)标准组(n=52)χ2/t/u P性别(%)0.6390.424男29(55.77)33(63.46)女23(44.23)19(36.54)年龄(岁)Age(years)52.79ʃ11.2850.13ʃ12.740.5760.566体重指数(kg/m2)19.85ʃ1.5820.24ʃ1.65 1.2310.221肿瘤直径(mm)54.39ʃ10.2856.17ʃ10.450.8760.383 CNLC分期(%) 1.0770.300Ⅰ期35(67.31)32(61.54)Ⅱ期17(32.69)20(38.46)饮酒史(%)31(59.62)35(67.31)0.6640.425 ASA分级(%)0.4020.688 I级34(65.38)31(59.62)Ⅱ级13(25.00)17(32.69)Ⅲ级5(9.62)4(7.69)1.2㊀手术方法1.2.1㊀术前准备:询问病史,进行血常规㊁尿常规㊁血糖㊁血压㊁心肺功能㊁凝血功能等相关检查,针对心肺功能㊁血糖㊁血压㊁凝血功能异常者给予调整治疗㊂术前进行影像CT㊁MRI检查及活检穿刺干预,明确肝切除范围备好全血,由同一高年资手术团队于无菌环境完成手术㊂1.2.2㊀标准组实施3D腹腔镜右半肝切除术:患者取仰卧分腿位,气管插管实施全身麻醉,体表术区常规消毒铺巾,脐部行切口建立12~14mmHg的CO2气腹㊂操作医生佩戴3D眼镜,并经观察孔置入3D腹腔镜,直视下分别于脐带偏右锁骨中线㊁剑突下㊁脐部与剑突连线中点偏左位置㊁右腋前线肋缘下行切口,建立主副操作孔,依次置入操作器械,腹腔镜探查肝脏病变组织及肝脏周围情况㊂Pringele法阻断肝门,打开左㊁右半肝腹膜,离断部分至右肝缔背侧间隙细小分支,悬吊并阻断,显示右半肝缺血线并进行标记,以切割闭合器离断㊂由脚向头侧方向游离肝中静脉分支至第二肝门后离断;离断下腔静脉韧带,充分暴露肝右静脉后切割闭合器离断㊂分离右半肝与右肾上腺㊁下腔静脉及肝裸区间隙,切除右半肝㊂缝合肝静脉分支出血位置,肝创面电凝止血,取出标本,清理术区㊁肝断面留置引流管,退出并清点操作器械,缝合切口㊂1.2.3㊀改良组采用AR导航联合七步两枪法行3D腹腔镜缩小右半肝切除术:①采用图像三维可视化软件读取CT图像数据以评估肝病变情况并进行虚拟肝切除,并计算虚拟切除肝体积和剩余肝体积㊂②以七步两枪法实施AR导航联合3D腹腔镜缩小右半肝切除术㊂患者体位㊁麻醉㊁操作通道建立均参照标准组㊂3D腹腔镜探查肝脏表面形态㊁颜色㊁腹腔镜情况及病灶转移情况,离断镰状韧带和肝圆韧带,采用肝上下腔静脉窝和胆囊底部,并结合肝脏形态作为基点,进行3D腹腔镜与AR手术系统图像融合及配准㊂切除胆囊,融合肝门部脉管结构投影与手术区域,游离肝肾韧带㊁胆总管㊁右三角韧带及右冠状韧带,夹闭并离断肝右动脉门静脉右支㊂观察肝脏表面缺血线,将虚拟右半肝切除手术与肝静脉模型融合,观察肝脏表面静脉走行,夹闭并离断肝内粗大管道近端,游离肝实质,导㊃3021㊃航下离断夹闭肝中静脉分支,直线切割闭合器离断右肝蒂,处理肝中静脉分支,向上继续游离肝实质,解剖并离断肝右静脉,分离第三肝门肝短静脉,离断右侧三角韧带和冠状韧带㊂取出标本,腹腔镜处理均参照标准组㊂1.2.4㊀术后干预:监测血压㊁体温㊁脉搏㊁呼吸等生命体征;预防性给予抗感染,并给予营养支持㊁维持电解质平衡治疗;疼痛明显者予以镇痛;妥善固定引流管,保持引流管畅通,并观察引流液性状㊁颜色及引流量;肠道蠕动和排气功能恢复后,饮食由全流逐渐恢复普饮食㊂1.3㊀检测方法:采集患者术前㊁术后3d㊁术后5d患者肘静脉血5mL置入肝素抗凝管,AmiCORE离心式血液成分分离机(费森尤斯卡比股份有限公司)以转速3000r/min㊁半径10cm离心10min分离血清-70ħ冷藏待测㊂采用干式化学法检测血红蛋白㊁谷丙转氨酶(ALT)㊁谷草转氨酶(AST)水平,试剂盒购自杭州安旭生物科技股份有限公司;溴甲酚绿法检测白蛋白水平,试剂盒购自南京澳林生物科技有限公司;钒酸盐氧化法测定总胆红素(TBil)水平,试剂盒购自北京赛诺浦生物技术有限公司;采用ACL TOP750LAS全自动凝血分析仪(Instrumentation Laboratory Company)检测凝血酶原时间(PT)㊁凝血酶原活动度(PA)㊁活化部分凝血活酶时间(APTT)㊁纤维蛋白原(FIB)水平;以免疫透射比浊法测定免疫球蛋白G(IgG)㊁免疫球蛋白A (IgA)㊁免疫球蛋白M(IgM)水平,试剂盒购自上海玉兰生物技术有限公司㊂均由本院检验科同等高年资检验师按照仪器及试剂盒操作要求完成检测㊂1.4㊀观察指标:①手术一般情况:手术时间㊁术中出血量㊁术中输血㊁肝预切除体积㊁肝实际切除体积㊁剩余肝体积㊂②术后康复进程:术后肠鸣音恢复时间㊁术后排气时间㊁术后下床活动时间㊁术后置管时间㊁住院时间㊂③血红蛋白㊁肝功能㊁白蛋白:肝功能指标:TBil㊁AST㊁ALT㊂④凝血功能:PT㊁PA㊁APTT㊁FIB㊂⑤免疫球蛋白:IgG㊁IgA㊁IgM㊂⑥并发症㊁复发率:并发症:腹腔出血㊁手术部位感染㊁肺部感染㊁胆瘘;随访1年通过门诊复查记录患者复发情况㊂1.5㊀统计学方法:以统计学软件SPSS25.0进行数据分析㊂计数资料以(%)表示,2个格子理论值T<1时,采用Fisher确切概率法检验;2个格子理论值:1ɤT<5时,采用校正χ2检验;2个格子理论值:Tȡ5时,采用未校正χ2检验;等级资料采用Ridit检验㊂计量资料服从K-S正态性分布且具备Bartlett方差齐性,采用( xʃs)表示,以t检验㊂P<0.05表示差异具有统计学意义㊂2㊀结㊀果2.1㊀手术一般情况:改良组手术时间㊁术中出血量㊁肝实际切除体积均少于标准组,剩余肝体积高于标准组(P<0.05);两组术中输血㊁肝预切除体积比较,无显著差异(P>0.05)㊂见表2㊂表2㊀两组患者手术一般情况比较组别n 手术时间(min)术中出血量(mL)术中输血肝预切除体积(mL)肝实际切除体积(mL)剩余肝体积(mL)改良组52305.66ʃ38.79318.27ʃ80.190(0)645.09ʃ38.63639.88ʃ41.25597.28ʃ33.90标准组52341.70ʃ42.54394.68ʃ72.351(1.92)638.22ʃ35.79664.32ʃ37.11565.44ʃ36.82χ2/t 4.514 5.102-0.941 3.176 4.588 P<0.001<0.001 1.0000.3490.002<0.0012.2㊀术后康复进程:改良组术后肠鸣音恢复时间㊁术后排气时间㊁术后下床活动时间㊁术后置管时间㊁住院时间短于标准组(P<0.05)㊂见表3㊂2.3㊀血红蛋白㊁白蛋白㊁肝功能:两组术后3d㊁术后5d 血红蛋白㊁白蛋白均低于术前,TBil㊁AST㊁ALT均高于术前(P<0.05);改良组术后3d㊁术后5d血红蛋白㊁白蛋白高于标准组,TBil㊁AST㊁ALT低于标准组(P<0.05)㊂见表4㊂2.4㊀凝血功能:两组术后3d㊁术后5d的PT㊁APTT均高于术前,PA㊁FIB均低于术前(P<0.05);改良组术后3d㊁术后5d的PT㊁APTT低于标准组,PA㊁FIB高于标准组(P<0.05)㊂见表5㊂㊃4021㊃表3㊀两组术后康复进程比较( xʃs)组别n术后肠鸣音恢复时间(d)术后排气时间(d)术后下床活动时间(h)术后置管时间(d)住院时间(d)改良组52 1.85ʃ0.46 2.18ʃ0.5417.88ʃ3.57 3.98ʃ1.328.59ʃ2.01标准组52 2.34ʃ0.57 2.75ʃ0.6020.64ʃ4.22 4.70ʃ1.1411.07ʃ2.55 t 4.824 5.092 3.601 2.977 5.508 P<0.001<0.001<0.0010.004<0.001表4㊀两组血红蛋白肝功能白蛋白变化( xʃs)指标组别n术前术后3d术后5d 血红蛋白(g/L)改良组52125.60ʃ9.44113.82ʃ8.99115.34ʃ9.06标准组52127.11ʃ10.87104.93ʃ9.24105.50ʃ7.94F F组间=8.816,F时间=22.485,F交互=9.714P P组间<0.001,P时间<0.001,P交互<0.001 TBil(μmoL/L)改良组5226.52ʃ4.7739.81ʃ7.5932.24ʃ6.30标准组5227.30ʃ5.0543.35ʃ9.1839.78ʃ7.11F F组间=14.159,F时间=29.571,F交互=11.873P P组间<0.001,P时间<0.001,P交互<0.001 AST(U/L)改良组5237.59ʃ9.82108.77ʃ16.8171.30ʃ12.15标准组5235.88ʃ10.61126.34ʃ20.5592.63ʃ11.08F F组间=10.395,F时间=59.371,F交互=19.463P P组间<0.001,P时间<0.001,P交互<0.001 ALT(U/L)改良组5233.60ʃ9.13195.48ʃ27.44113.00ʃ18.25标准组5232.79ʃ8.56232.66ʃ31.96164.96ʃ22.73F F组间=14.158,F时间=48.593,F交互=20.272P P组间<0.001,P时间<0.001,P交互<0.001白蛋白(g/L)改良组5232.40ʃ2.6630.01ʃ2.2530.62ʃ2.58标准组5232.87ʃ2.9528.36ʃ2.4728.79ʃ2.10F F组间=6.185,F时间=11.387,F交互=7.121P F组间=0.003,F时间<0.001,F交互<0.0012.5㊀免疫球蛋白:两组术后3d㊁术后5d的IgG㊁IgA㊁IgM均低于术前(P<0.05);改良组术后3d㊁术后5d的IgG㊁IgA㊁IgM高于术前(P<0.05)㊂见表6㊂㊃5021㊃表5㊀两组凝血功能变化( xʃs)指标组别n术前术后3d术后5d PT(s)改良组5212.44ʃ0.9515.18ʃ1.3414.36ʃ0.90标准组5212.38ʃ0.9715.90ʃ1.1215.28ʃ1.05F F组间=10.935,F时间=23.285,F交互=11.492P P组间<0.001,P时间<0.001,P交互<0.001PA(%)改良组5293.92ʃ8.6676.58ʃ7.6982.11ʃ7.04标准组5294.57ʃ9.3570.46ʃ8.3375.34ʃ6.86F F组间=12.496,F时间=24.8354,F交互=10.239P P组间<0.001,P时间<0.001,P交互<0.001 APTT(s)改良组5231.82ʃ3.9034.17ʃ3.8333.79ʃ2.76标准组5232.03ʃ4.1435.96ʃ3.4434.35ʃ2.28F F组间=5.504,F时间=12.375,F交互=7.108P P组间=0.008,P时间<0.001,P交互<0.001 FIB(g/L)改良组52 3.19ʃ0.35 2.84ʃ0.22 2.94ʃ0.26标准组52 3.20ʃ0.29 2.50ʃ0.17 2.67ʃ0.23F F组间=9.854,F时间=26.384,F交互=10.372P P组间<0.001,P时间<0.001,P交互<0.001表6㊀两组免疫球蛋白变化( xʃs,g/L)指标组别n术前术后3d术后5d IgG改良组5211.25ʃ2.368.99ʃ1.619.11ʃ1.43标准组5211.60ʃ2.59 6.24ʃ1.157.00ʃ1.26F F组间=25.016,F时间=32.626,F交互=12.387P P组间<0.001,P时间<0.001,P交互<0.001 IgA改良组52 4.06ʃ0.57 2.78ʃ0.55 3.27ʃ0.52标准组52 4.14ʃ0.63 1.96ʃ0.60 2.40ʃ0.55F F组间=21.549,F时间=30.315,F交互=10.483P P组间<0.001,P时间<0.001,P交互<0.001 IgM改良组52 2.91ʃ0.46 1.83ʃ0.20 2.14ʃ0.25标准组52 2.86ʃ0.52 1.56ʃ0.18 1.73ʃ0.29F F组间=19.372,F时间=43.184,F交互=13.591P P组间<0.001,P时间<0.001,P交互<0.001㊃6021㊃2.6㊀并发症㊁复发率:两组术后无肝功能衰竭及围手术期死亡病例,改良组并发症总发生率为1.92%(1/52),与标准组的5.77%(3/52)比较,无显著差异(P>0.05)㊂随访1年,改良组1例失访,标准组2例失访,获访患者中,改良组复发率3.92%(2/51)与标准组8. 00%(4/50)比较,无显著差异(P>0.05)㊂见表7㊂表7㊀两组并发症复发率比较n(%)组别n并发症腹腔出血㊀㊀㊀手术部位感染㊀㊀㊀肺部感染㊀㊀㊀胆瘘㊀㊀㊀总发生率㊀复发率改良组520(0.00)0(0.00)1(1.92)0(0.00)1(1.92)2(3.92)标准组521(1.92)1(1.92)0(0.00)1(1.92)3(5.77)4(8.00)χ20.2600.177 P0.6100.6743㊀讨㊀论腹腔镜手术是肝癌首选治疗方案,尤其是3D腹腔镜右半肝切除术的疗效及安全性均在临床得到证实,但右半肝解剖位置特殊,手术操作难度较大,临床应用具有局限性㊂本研究尝试将AR导航联合七步两枪法用于3D腹腔镜缩小右半肝切除术中,结果表明改良组能优化手术操作,减少术中出血,促进术后康复,考虑因素是AR导航技术联合七步两枪法能增加解剖组织可视化程度,降低手术操作难度,避免胃肠组织过度牵拉㊂本研究还显示,改良组肝实际切除体积㊁术后3d㊁5d肝功能指标水平低于标准组,剩余肝体积㊁术后3d㊁5d血红蛋白㊁白蛋白均高于标准组,提示AR 导航技术联合七步两枪法能减轻肝功能损伤,究其原因在于AR导航与3D腹腔镜结合能提高肝内脉管走行及解剖情况,使右半肝精准解剖,减少正常肝组织分离㊂肝脏是合成凝血因子及抗凝因子的重要场所,也是纤维蛋白溶解物㊁抗纤溶因子重要 加工厂 ,而肝脏病变会打破凝血和纤溶平衡,造成凝血功能障碍[9]㊂由于凝血㊁抗凝㊁纤溶功能贯穿肝癌各个阶段,因此监测凝血功能指标变化情况,对减少术中出血及输血具有指导意义[10]㊂本研究中,术后3d㊁5d两组PT㊁APTT较术前升高,PA㊁FIB较术前降低,说明外科手术会造成不同程度的凝血功能障碍,而术后3d㊁5d 改良组上述凝血功能指标均优于标准组,提示应用AR导航联合七步两枪法对凝血功能影响更小,这也是术后早期恢复较快的重要因素㊂分析原因在于改良组在完整切除病灶的同时,增大残留肝体积,减轻重要功能性管道损伤,进而保护肝脏代偿功能与血流灌注有效性,避免凝血因子大量消耗[11]㊂免疫球蛋白是体液免疫重要组成部分,其中IgA 通过黏膜发挥抵御作用;IgM㊁IgG可通过激活和固定介质,调理巨噬细胞吞噬功能,增强对靶细胞灭杀作用[12,13]㊂因此,免疫球蛋白水平变化可反映机体免疫状态㊁疾病恢复及预后情况㊂本研究显示,术后3d㊁5d 两组IgG㊁IgA㊁IgM低于术前,说明两种手术均会造成免疫功能损伤,但改良组高于标准组,这与AR导航㊁七步两枪法的应用能减轻组织损伤,减少机体应激对免疫功能的抑制作用以及增加残留肝体积可促进免疫球蛋白合成有关㊂另外,两组并发症总发生率与术后1年复发率间无显著差异,提示AR导航㊁七步两枪法的应用能取得理想的近期效果,且具有较高安全性㊂综上可知,AR导航联合七步两枪法用于3D腹腔镜缩小右半肝切除术近期疗效显著,可优化手术,减少出血,减轻正常肝组织损伤,并可改善肝功能㊁免疫功能及凝血功能,促进患者恢复,且安全性较高㊂ʌ参考文献ɔ[1]㊀Liu Z,Jiang Y,Yuan H,et al.The trends in incidence of pri-mary liver cancer caused by specific etiologies:results fromthe global burden of disease study2016and implications forliver cancer prevention[J].Hepatol,2019,70(4):674-683.[2]㊀Gorgec B,Benedetti Cacciaguerra A,Lanari J,et al.Assess-ment of textbook outcome in laparoscopic and open liver sur-gery[J].JAMA Surg,2021,156(8):212064. [3]㊀Zhu W,Zeng XJ,Xiang N,et al.Application of augmentedreality and mixed reality navigation technology in laparoscop-ic limited right hepatectomy[J].Chin Surg,2022,60(3):249-256.[4]㊀孔都.模式化腹腔镜右半肝切除术的技术要点及临床应用研究[D].山东:山东大学,2019.㊃7021㊃[5]㊀张成雷.可手术乳腺癌患者的循环肿瘤细胞与凝血功能及病理特征的关系研究[J].中国医学创新,2019,16(19):62-65.[6]㊀中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015年版)[J].临床肝胆病杂志,2015,31(6):833-839.[7]㊀中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗指南(2022年版)[J].中华消化外科杂志, 2022,21(2):143-168.[8]㊀Bartha E,Ahlstrand R,Bell M,et al.ASA classification andsurgical severity grading used to identify a high-risk popula-tion,a multicenter prospective cohort study in Swedish tertia-ry hospitals[J].Acta Anaesthesiol Scand,2021,65(9): 1168-1177.[9]㊀Groeneveld D,Cline-Fedewa H,Baker KS,et al.Von wille-brand factor delays liver repair after acetaminophen-induced acute liver injury in mice[J].Hepatol,2020,72(1):146-155.[10]㊀罗圆圆,汪德清,周玲玲,等.体外大剂量失血/输血模型的建立及不同大剂量输血策略对模型凝血功能的影响[J].中国输血杂志,2021,34(6):599-603. [11]㊀Goikoetxea-Usandizaga N,Serrano-Macia M,Delgado TC,et al.Mitochondrial bioenergetics boost macrophage activa-tion,promoting liver regeneration in metabolically compro-mised animals[J].Hepatology,2022,75(3):550-566.[12]㊀Horton MB,Hawkins ED,Heinzel S,et al.Speculations onthe evolution of humoral adaptive immunity[J].ImmunolCell Biol,2020,98(6):439-448.[13]㊀陈加新,胡嵩,陈怡发,等.腹腔镜肝切除术对原发性肝癌患者免疫球蛋白及VEGF aFGF水平的影响[J].河北医学,2022,28(4):604-608.ʌ文章编号ɔ1006-6233(2023)07-1208-05探讨分析改良肛裂切除术联合中药坐浴治疗慢性肛裂的疗效孙利军(河北省平泉市医院,㊀河北㊀平泉㊀067500)ʌ摘㊀要ɔ目的:分析慢性肛裂患者应用改良肛裂切除术和中药坐浴联合治疗的临床价值㊂方法:对我院肛肠科2020年3月至2021年9月门诊或住院收治的接受肛裂切除术的慢性肛裂120例患者进行回顾性研究,根据患者的手术方式将患者分成传统手术组与改良手术组㊂传统手术组(n=57)患者的治疗方式是传统肛裂切除术+中药坐浴,改良手术组(n=63)患者的治疗方式是改良肛裂切除术+中药坐浴治疗㊂对两组患者的手术时间㊁住院天数㊁术后伤口愈合时间㊁疼痛评分情况㊁术后并发症发生情况㊁治愈率及术后复发率等指标观察记录㊂结果:在治疗前,传统手术组和改良手术组患者的一般临床信息(性别㊁年龄㊁病程㊁便血情况㊁疼痛程度㊁分期情况等)差异均无统计学意义(P>0.05)㊂传统手术组手术时长(24.13ʃ3.04)min大于改良手术组(19.17ʃ2.91)min,差异有统计学意义(P<0.001)㊂传统手术组患者的住院时间为(9.21ʃ1.89)d大于改良手术组(6.23ʃ1.27)d,差异有统计学意义(P<0.001)㊂在术后48h后,改良手术组统计的手术前后VAS得分差值均数(4.45ʃ1.22)分明显大于传统手术组手术前后VAS得分差值均数(2.71ʃ1.90)分,差异有统计学意义(P<0.001)㊂传统手术组患者的创口愈合时间(21.60ʃ3.53)d大于改良手术组(19.03ʃ3.23)d(P=0.001)㊂在手术后1个月,改良手术组患者的切口愈合甲级率(92.06%)与传统手术组患者的切口愈合甲级率(87.72%)差异无统计学意义(P=0.626)㊂传统手术组患者的术后并发症发生率(11例,19.30%)远大于改良手术组(2例,3.17%),(χ2=6.471,P=0.011)㊂改良手术组的治愈率为65.08%,传统手术组的治愈率为59.65%,改良手术组治愈率明显高于传统手术组,但组间比较差异无统计学意义(P=0.539)㊂截止手术后3个月随访期结束,传统手术组和改良手术组患者术后均未出现复发㊂结论:改良肛裂切除术和中药坐浴联合治疗慢性肛裂可以有效地缩短手术时长,术后恢复更快,缓解术后疼痛程度和缩短创口愈合时间,有效规避并发症的发生㊂ʌ关键词ɔ㊀改良肛裂切除术;㊀慢性肛裂;㊀中药坐浴;㊀临床研究ʌ文献标识码ɔ㊀A㊀㊀㊀㊀㊀ʌdoiɔ10.3969/j.issn.1006-6233.2023.07.029Exploring and Analyzing the Efficacy of Modified Anal Fissure Resection Combined ㊃8021㊃ʌ基金项目ɔ河北省承德市科技计划项目,(编号:202201A027)。

第52卷第4期表面技术2023年4月SURFACE TECHNOLOGY·363·纯钽表面微弧氧化“类骨小梁”状多孔涂层的细胞相容性王伟强，王舒月，于凤云，王轶农（大连理工大学，辽宁 大连 116024）摘要：目的提高医用纯钽的生物活性，利用微弧氧化（MAO）技术在其表面制备出“类骨小梁”状分级多孔涂层，并对比该涂层与传统“火山坑”状MAO涂层以及机械抛光纯钽表面在表面粗糙度、亲水性以及细胞相容性方面的差异。

方法使用0.1 mol/L Na2B4O7和0.05 mol/L Na3PO4电解液在纯钽表面分别制备出“类骨小梁”状及“火山坑”状多孔涂层（分别命名为B-MAO和P-MAO涂层）。

采用扫描电镜、X射线衍射以及X射线光电子能谱对不同结构涂层进行形貌观察和相组成分析，使用十字划格法评价涂层结合强度，使用激光共聚焦显微镜测定涂层的表面粗糙度，使用接触角仪测量其亲水性，并将小鼠前成骨细胞（MC3T3-E1）接种于材料表面，对比不同形貌状态对细胞铺展、增殖以及成骨分化的影响。

结果 MAO 涂层物相主要为Ta2O5。

B-MAO涂层由于内部孔隙度高，应力释放充分，涂层结合强度高，而P-MAO涂层则因具有分层现象和较大的残余应力，易从基体剥落。

抛光纯钽表面、P-MAO、B-MAO涂层表面的粗糙度分别为0.06、1.50、1.58 μm，与之相应的接触角分别为42.6°、15.5°、7.2°。

细胞初期粘附结果表明，MAO 涂层表面细胞数量多于抛光纯钽表面，且B-MAO涂层细胞铺展能力优于P-MAO涂层和抛光钽表面。

CCK-8测试结果表明，细胞数量随时间逐渐增加，MAO组细胞增殖能力好于抛光组，B-MAO组细胞增殖能力最优。

ALP活性方面，B-MAO组也高于P-MAO和抛光组。

结论 MAO涂层相较于抛光纯钽表面具有更高的粗糙度以及亲水性，从而具有高的细胞粘附和增殖能力。

第二章中枢神经系统颅内非病理性钙化：1、松果体与缰联合钙化2、大脑镰钙化3、床突间韧带钙化（前后床突）4、侧脑室脉络丛钙化（侧脑室三角区对称出现）5、基底节区局限性钙化6、小脑齿状核局限性钙化7、颈内动脉虹吸段钙化8、小脑幕和岩床韧带的局限性钙化基底节钙化在年轻人中出现，考虑甲状旁腺功能低下可能。

颈总动脉在C4椎体水平分为颈内和颈外神经胶质瘤（glioma）[glaɪ'əʊmə]星形细胞肿瘤（astrocytic tumors）[,æstrə'sɪtɪk] 占颅内原发肿瘤60%I级毛细胞型星形细胞瘤（pilocytic astrocytoma，PA）[pɪlə'saɪtɪk] [,æstrəsai'təumə]好发小脑，囊变时囊壁轻度或不强化II级弥漫性星形细胞瘤（diffuse astrocytoma，DA）[,æstrəsai'təumə]III级间变性星形细胞瘤（anaplastic astrocytoma，AA）[,ænə'plæstɪk]Ⅳ级胶质母细胞瘤或多形性胶质母细胞瘤（glioblastoma multiform，GBM）['ɡlaiəu,blæs'təumə] ['mʌltɪfɔːm]表观扩散系数值（apparent diffusion coefficient，ADC）少突胶质细胞瘤（oligodendroglioma）['ɔliɡəu,dendrəɡli'əumə]间变性少突胶质细胞瘤（anaplastic oligodendroglioma）[,ænə'plæstɪk] ['ɔliɡəu,dendrəɡli'əumə]室管膜瘤（ependymoma）[e,pendi'məumə]间变性室管膜瘤（anaplastic ependymoma）[,ænə'plæstɪk] [e,pendi'məumə]髓母细胞瘤（medulloblastoma）[mə'dʌləu,blæs'təumə]常位于小脑蚓部，突入第四脑室，边界清楚75%见于15岁以下，4-8岁为发病高峰儿童颅后窝中线区实体性肿块，增强明显均一强化，多为髓母脑膜瘤（meningioma）[mi,nindʒi'əumə] 来源蛛网膜粒帽细胞无正常神经元故NAA峰缺乏非典型表现：1、全瘤囊性为主；2、肿瘤内密度不均匀；3、环形强化；4、壁结节；5、全瘤低密度并不均匀强化；6、瘤内有高密度出血灶；7、肿瘤完全钙化；8、骨化性脑膜瘤；9、瘤周脑脊液样低密度区；10、酷似脑内的肿瘤；11、多发性脑膜瘤。