目的 總結胸部創傷流行病學及臨床特征，為創傷的預防和救治提供科學依據。 方法 回顧性分析 2005～2015 年我院胸心外科連續收治 1 250 例胸部創傷患者的臨床資料。根據患者傷情，分別采用無創性保守治療、胸腔閉式引流術、開胸探查止血術、肋骨內固定術及其他胸部及心臟創傷的修補術。觀察創傷患者致傷類型、創傷部位、治療方式與臨床預后以及 2012 年前后時間分布及其相關性。 結果 全組男 999 例（79.9%）、女 251 例（20.1%），平均年齡（44.0±17.7）歲。非穿透性損傷 885 例（70.8%），穿透性損傷 365 例（29.2%），死亡 8 例（0.64%）。肋骨骨折 766 例，骨折內固定手術干預占 16.1%（123/766），手術復位內固定患者平均住院時間明顯短于保守治療患者（9.55 dvs. 16.38 d，t=6.574，P=0.000）。2012 年后非穿透性損傷較 2012 年前有所升高（81.8%vs. 66.3%），而穿透性損傷較前明顯下降（18.2%vs. 33.7%）（χ2=28.9，P=0.000）。2012 年前后創傷部位中肋骨骨折（P=0.000）、肺挫傷（P=0.000）、氣胸（P=0.000）和胸腹聯合傷（P=0.001）均發生了明顯變化。 結論 2012 年是我院 10 年期間胸部創傷類型及創傷部位發生明顯變化趨勢的重要時間截點，對我院下一步胸部創傷救治側重點轉變帶來了新的思考和考驗。
ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
ObjectivesTo systematically review the association between pretreatment serum ferritin (SF) concentration and prognosis in lung cancer patients.MethodsDatabases including PubMed, EMbase, Web of Science, CNKI, VIP and WanFang Data were electronically searched to identify cohort studies on the relationship between the pretreatment SF concentration and prognosis of lung cancer patients from inception to January, 2020. Literature screening, data extraction and quality evaluation of included studies were independently performed by two reviewers. Then, meta-analysis was conducted by Stata 12.0 software.ResultsA total of 8 cohort studies involving 1 002 lung cancer patients were included. The results of meta-analysis indicated that patients with higher pretreatment SF concentration had poorer overall survival (HR=1.70, 95%CI 1.06 to 2.73, P=0.029) compared with patients with lower pretreatment SF concentration. Subgroup analysis based on the pathological type manifested showed that pretreatment SF concentration only had high prognostic value in small cell lung cancer patients (HR=4.78, 95%CI 2.83 to 8.05, P<0.001).ConclusionsLung cancer patients with high pretreatment SF level have worse overall survival. Pretreatment SF concentration may serve as an independent prognostic factor in lung cancer, especially in small cell lung cancer. Due to the limited quality and quantity of included studies, more prospective well-designed studies are required to verify above conclusions.