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  • JOURNAL OF CLINICAL SURGERY

    主管单位:湖北省卫生和计划生育委员会
    主办单位:中华医学会湖北分会
    地  址:武汉市武昌区东湖路165号
    邮  编: 430071
    电  话:027-87893476
    电子邮件:whlcwk@126.com
    国际标准刊号:ISSN 1005-6483
    国内统一刊号:CN 42-1334/R
    邮发代号:38-184

Current Issue
20 March 2024, Volume 32 Issue 3
Selection and difference of common approaches for immediate breast reconstruction with endoscopic prosthesis implantation
WANG Zihan,TAO Wei
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  225-227.  DOI: 10.3969/j.issn.1005-6483.2024.03.001
Abstract ( 16 )   PDF (1054KB) ( 6 )   PDF(mobile) (1054KB) ( 2 )  
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The dilemma and challenges of robots in breast surgery
LI Tingting,CHEN Li
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  228-230.  DOI: 10.3969/j.issn.1005-6483.2024.03.002
Abstract ( 8 )   PDF (980KB) ( 5 )   PDF(mobile) (980KB) ( 0 )  
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The design and postoperative management of autologous tissue flap for breast cnacer patients reconstruction
RAO Nanyan
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  231-233.  DOI: 10.3969/j.issn.1005-6483.2024.03.003
Abstract ( 9 )   PDF (363KB) ( 3 )   PDF(mobile) (363KB) ( 0 )  
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Exploration and new thinking of breast plastic endoscopic surgery for breast cancer
ZHANG Qing,DU Zhenggui
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  234-236.  DOI: 10.3969/j.issn.1005-6483.2024.03.004
Abstract ( 8 )   PDF (985KB) ( 6 )   PDF(mobile) (985KB) ( 0 )  
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Recommendations of patients' selection when start for endoscopic breast surgery
DENG Aishi,LIU Xiaoling,WEI Wei
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  236-239.  DOI: 10.3969/j.issn.1005-6483.2024.03.005
Abstract ( 9 )   PDF (989KB) ( 4 )   PDF(mobile) (989KB) ( 0 )  
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Analysis of the effect and recurrence rate of breast-conserving plastic surgery in the treatment of early breast cancer
JIANG Bingjian
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  240-243.  DOI: 10.3969/j.issn.1005-6483.2024.03.006
Abstract ( 11 )   PDF (529KB) ( 6 )   PDF(mobile) (529KB) ( 1 )  
Objective To explore the effectiveness and recurrence rate of oncoplastic breast surgery in the treatment of early-stage breast cancer.Methods A retrospective study was conducted on 50 patients who underwent oncoplastic breast surgery (observation group) and 50 patients who underwent conventional breast-conserving surgery (control group) for early-stage breast cancer between January 2017 and June 2019,selected according to admission order and inclusion/exclusion criteria.The surgical time,intraoperative blood loss,length of hospital stay,immune function indicators,postoperative complication rate,excellent appearance rate of the breast,quality of life score,survival rate,and recurrence rate were compared between the two groups.Results The average intraoperative blood loss in the observation group was (40.27±11.35) ml,which was lower than that in the control group (74.65±21.84) ml.The observation group had shorter surgical time (51.28±6.79) min and hospital stay (7.41±1.87) days compared to the control group (P<0.05).CD3+ and CD4+/CD8+ levels were higher in the observation group than in the control group after surgery (P<0.05).The observation group had a lower incidence of postoperative complications compared to the control group (2.00% vs 14.00%,P<0.05).The excellent appearance rate of the breast was higher in the observation group than in the control group (100% vs 90%,P<0.05).After surgery,the quality of life scores in all factors were higher in the observation group than in the control group (P<0.05).There was no significant difference in postoperative survival rate and recurrence rate between the observation and control groups (P>0.05).Conclusion Oncoplastic breast surgery,compared to conventional breast-conserving surgery,can effectively improve the appearance of the breast,reduce surgical trauma and immune function damage,decrease postoperative complications,and enhance the quality of life of patients with early-stage breast cancer without affecting their long-term prognosis or increasing the recurrence rate.
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Clinical Application of Transverse Neck Incision Surgery in the Removal of the Bilateral Penetrated Cervical Esophageal Foreign Bodies
QIAN Dingfeng,GU Shengqiang,WU Dingding,LU Kun,GUO Jiang
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  244-247.  DOI: 10.3969/j.issn.1005-6483.2024.03.007
Abstract ( 12 )   PDF (378KB) ( 6 )   PDF(mobile) (378KB) ( 0 )  
Objective To explore the key points of surgical treatment of bilateral penetrated cervical esophageal foreign bodies,so as to improve the diagnosis and treatment of esophageal foreign bodies.Methods The clinical datas of 11 patients with bilateral penetrated cervical esophageal foreign bodies from January 2016 to April 2022 were analyzed retrospectively.Results All the patients were treated by transverse neck incision surgery,and gastroscope was placed for synchronous monitoring during operation,10 cases were removed through esophageal crevasse,and 1 case was pulled out from the mouth by the gastroscope.All the foreign bodies were removed smoothly,and all patients resumed eating through mouth,without obvious complications,and the wound healed in one-stage.Gastroscopy was reviewed 6 months after surgery,and esophageal stenosis was grade 0 (Stooler grading standard).Within the follow-up from 6 months to 2 years,all patients could eat normally.Conclusion Bilateral penetrating esophageal foreign body is a special type of difficult and high-risk esophageal foreign body.Based on the multi-disciplinary team(MDT),transverse neck incision suegery can fully expose the bilateral esophageal space at the same time,without blind area,the extraction of foreign body is safe,serious injury can be avoided.Thus,the technique is relatively minimally invasive and worthy of further promotion in the clinical practice in grassroots hospitals.
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A research of the current status and influencing factors of postoperative lateral lymph node recurrence in patients with papillary thyroid carcinoma
XIANG Yue,CHEN Dejie
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  248-251.  DOI: 10.3969/j.issn.1005-6483.2024.03.008
Abstract ( 11 )   PDF (929KB) ( 9 )   PDF(mobile) (929KB) ( 0 )  
Objective To investigate the postoperative lateral lymph node recurrence of papillary thyroid carcinoma (PTC) and its related factors.Methods The clinical and pathological data of 1 229 patients with papillary thyroid carcinoma who underwent surgery in Xiangyang Central Hospital from January 1,2018 to December 31,2022 were retrospectively collected.Results A total of 1229 patients’ data were obtained,including 70 patients in the recurrence group and 1159 patients in the non-recurrence group.Multivariate COX proportional hazards regression analysis showed that tumor size (HR:0.497,95% CI:0.287-0.858),the number of primary tumors (HR:2.037,95% CI:1.209-3.433),capsular invasion (HR:0.476,95%CI:0.251-0.903),extracapsular invasion (HR:0.332,95%CI:0.169-0.657) were the influencing factors of postoperative recurrence in patients with papillary thyroid carcinoma.The proportion of central lymph node metastasis had a good predictive value in multivariate COX regression analysis (P<0.05),and the cut-off value of the proportion of central lymph node metastasis determined by ROC curve was 23.6%.Conclusions Multiple primary lesions,tumor size > 1 cm,capsular or extracapsular extension are risk factors for recurrence of papillary thyroid carcinoma after surgery.In clinical practice,the proportion of central lymph node metastasis ≥23.6% has a good predictive effect on the risk of postoperative lateral lymph node recurrence.
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Diagnostic value of Lymphoedema Functioning,Disability and Health Questionnaire for Lower Limb Lymphoedema and Lymphoedema Quality of Life Questionnaire in secondary lower limb lymphoedema
ZHOU Xuchuan,LIU Bin,HAN Yue,GUO Xiaowei,MA Gejia
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  253-257.  DOI: 10.3969/j.issn.1005-6483.2024.03.010
Abstract ( 9 )   PDF (766KB) ( 5 )   PDF(mobile) (766KB) ( 0 )  
Objective To study the sensitivity and specificity of Lymphoedema Functioning,Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph ICF-LL) and Lymphoedema Quality of Life Questionnaire (LYMQOL),and to explore the optimal cutoff score of the scales,in order to better identify secondary lower limb lymphoedema.Methods 62 patients with secondary lower limb lymphoedema and 37 patients without lymphedema after gynecological cancer operation was collected.Spearman test was used to evaluate the correlation between the scores of the two scales and the Lower Extremity Lymphedema Index (LEL index).Receiver operating characteristic (ROC) was used to evaluate the predictive diagnostic efficacy of the two scales.Results Correlation analysis showed that Lymph ICF-LL score was positively correlated with LEL index (r=0.478,P<0.05),and LYMQOL score was positively correlated with LEL index (r=0.346,P<0.05).Both scales had high accuracy,sensitivity and specificity in detecting secondary lymphedema of lower limbs.The area under the ROC curve of Lymph ICF-LL score in predicting was 0.926 (P<0.05),the optimal cut-off value was 20.1 points,the sensitivity was 83.9% and the specificity was 91.9%.The area under the ROC curve of LYMQOL score in predicting was 0.883 (P<0.05),the optimal cut-off value was 1.9 points,the sensitivity was 80.6%,and the specificity was 83.8%.Conclusion Lymph ICF-LL and LYMQOL have high specificity and sensitivity in the diagnosis of secondary lower limb lymphoedema.The two scales can be used as one of the diagnostic Methods for secondary lower limb lymphoedema.
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Expression of insulin like growth factor 2 gene in Type A aortic dissection
WANG Haitao,JIANG Dingsheng,FANG Zemin
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  258-261.  DOI: 10.3969/j.issn.1005-6483.2024.03.011
Abstract ( 5 )   PDF (1218KB) ( 5 )   PDF(mobile) (1218KB) ( 0 )  
Objective To analyze the expression,change and clinical significance of insulin like growth factor 2 (IGF2) in Type A Aortic Dissection (TAAD).Methods Tissue samples of 9 TAAD patients from January 2015 to December 2019, and aortic tissue samples of 5 patients pruned from heart transplant donors were obtained. Hematoxylin - eosin (HE) staining and elastic fiber (EVG) staining were used to evaluate the structural changes of the aorta in the two groups. The protein expression of IGF2 in aortic wall tissues of the two groups was detected by Western Blot. Immunohistochemical staining (IHC) was used to detect the subcellular distribution and expression of IGF2 in the two groups of samples.Results Hematoxylin-eosin staining (HE) and elastic fiber Verhoeff’s Van Gieson staining (EVG) showed that the cells in the aortic wall tissue of aortic dissection became smaller and disordered,and the elastic fibers became thinner,fractured and disordered.The expression level of IGF2 in aortic wall tissue of TAAD was decreased,and the difference between the two groups was statistically significant (P<0.05).IHC showed that IGF2 was expressed in nucleus,and the expression level in aortic dissection tissues was significantly lower than that in normal tissues,with statistical significance (P<0.05).Conclusion The decreased expression level of IGF2 in aortic wall tissues of TAAD patients may be related to the occurrence of aortic dissection,and IGF2 is expected to be a new target for the prevention and treatment of aortic dissection.
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Summary of key points and clinical application of modified modular subxiphoid thoracoscopic thymectomy
YANG Ziheng,LI Fan,ZHAO Bo
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  262-265.  DOI: 10.3969/j.issn.1005-6483.2024.03.012
Abstract ( 7 )   PDF (894KB) ( 8 )   PDF(mobile) (894KB) ( 0 )  
Objective To summarize the key surgical points of subxiphoid thoracoscopic thymectomy and compare its clinical efficacy with lateral thoracic approach thymectomy.Methods Clinical data of 93 patients who underwent thoracoscopic thymectomy for thymic tumors at Wuhan Tongji Hospital from February 2021 to March 2023 were collected.The patients were divided into the subxiphoid group (n=40) and the lateral thoracic group (n=53) according to the surgical approach.Surgical outcomes,perioperative indicators,and postoperative pain were compared between the two groups.Results Both groups of patients underwent complete or extended thymectomy via thoracoscopy without conversion to open surgery.The subxiphoid group had significantly shorter operation time for complete thymectomy [(60.32±1.53)minutes],operation time for extended thymectomy [(114.52±11.63)minutes],duration of chest tube placement [(3.20±0.91)days],and length of hospital stay [(4.00±0.16)days] compared to the lateral thoracic group [(66.62±1.45)minutes,(138.76±6.35) minutes,(4.00±1.22)days and (4.70±0.18)days,respectively],with statistical significance (P<0.05).The subxiphoid group also had lower VAS scores at 24 hours (3.8±0.8),48 hours (3.0±0.7),and 72 hours (2.6±0.9) postoperatively,compared to the lateral thoracic group [(5.7±0.9),(4.7±0.8),(3.2±0.8),respectively],with statistical significance (P<0.05).There were no significant differences between the two groups in terms of intraoperative blood loss,hospital costs,complication rates,and abnormal sensations after 30 days postoperatively (P>0.05).Conclusion Modified modular subxiphoid thoracoscopic thymectomy is safe and reliable,and offers significant perioperative advantages,especially for patients with Masaoka stage I and II thymomas accompanied by myasthenia gravis (MG).
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Efficacy of video-assisted thoracoscopic lobectomy,anatomic segmentectomy and wedge resection in the treatment of non-small cell lung cancer
WAN Wei,ZHANG Bin,LIU YongZhi,JING Miao,WANG Xiaodong
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  266-270.  DOI: 10.3969/j.issn.1005-6483.2024.03.013
Abstract ( 7 )   PDF (778KB) ( 5 )   PDF(mobile) (778KB) ( 0 )  
Objective To compare the efficacy of thoracoscopic lobectomy,wedge resection and anatomical segmental resection in the treatment of non-small cell lung cancer (NSCLC).Methods 81 patients with NSCLC admitted to our hospital from August 2017 to August 2019 were randomly divided into lobectomy group,segmental resection group and wedge resection group,with 27 patients in each group.The operation conditions (including perioperative conditions,lung function,inflammatory factors,immune function,complications) and prognosis (3-year recurrence rate and distant metastasis rate) of the three groups were compared.Results Compared with the lobectomy group,the specific operation time,drainage volume,and hospitalization days of the segmentectomy group were significantly reduced(P<0.05).Compared with the segmentectomy group,the specific operation time,drainage volume,and hospitalization days of the wedge resection group were significantly reduced(P<0.05).Before surgery,there was no difference in immune function indicators among the three groups(P>0.05).Four weeks after operation,CD4+,CD4+/CD8+,forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),maximum ventilation volume per minute(MVV),and carbon monoxide diffusing capacity(DLCO)in the segmentectomy group were significantly higher than those in the lobectomy group(P<0.05),CD8+,interleukin-6(IL-6),and C-reactive protein(CRP)in the segmentectomy group were significantly lower than those in the lobectomy group(P<0.05).CD4+,CD4+/CD8+,FVC,FEV1,MVV,and DLCO in the wedge resection group were significantly higher than those in the segmentectomy group(P<0.05),and CD8+,IL-6,and CRP in the wedge resection group were significantly lower than those in the segmentectomy group(P<0.05).There was no difference in the 3-year distant metastasis rate and recurrence rate among the three groups(P>0.05).Compared with the lobectomy group,the incidence of various postoperative complications in the wedge resection group and segmental resection group was slightly lower,but there was no difference in comparison (P>0.05).Conclusion Among the three surgical methods,pulmonary wedge resection has relatively small adverse effects on lung function,inflammation and immunity of NSCLC patients,and the postoperative recovery is relatively fast,followed by anatomical segmental resection,and finally lobectomy.There is no significant difference in complications and long-term prognosis among the three.
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The combined detection value of serum miR-134-5p and miR-181a-5p in the differential diagnosis of benign and malignant pulmonary nodules
ZHOU Xinzhi,ZHANG Song,WEI Xiaodong
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  272-275.  DOI: 10.3969/j.issn.1005-6483.2024.03.015
Abstract ( 7 )   PDF (872KB) ( 15 )   PDF(mobile) (872KB) ( 0 )  
Objective To explore the differential value of combined detection of serum microRNA-134-5p(miR-134-5p) and microRNA-181a-5p(miR-181a-5p) in benign and malignant pulmonary nodules.Methods A total of 124 patients with pulmonary nodules who were treated in our hospital from January 2021 to December 2021 were collected as the study subjects.According to pathological results,they were grouped into a benign group of 62 cases and a malignant group of 62 cases;real-time fluorescence quantitative PCR(qRT-PCR) was applied to measure serum levels of miR-134-5p and miR-181a-5p;Pearson was applied to analyze the correlation between serum miR-134-5p and miR-181a-5p;multivariate Logistic regression was applied to analyze the influencing factors of malignant pulmonary nodules in patients;receiver operating characteristic curve(ROC) was applied to evaluate the value of serum miR-134-5p and miR-181a-5p in distinguishing between benign and malignant pulmonary nodules in patients.Results The serum levels of miR-134-5p and miR-181a-5p in patients with malignant pulmonary nodules were obviously lower than those in the benign group(P<0.05);there was a positive correlation between serum miR-134-5p level and miR-181a-5p level in patients with pulmonary nodules(r=0.547,P<0.05);the serum levels of miR-134-5p and miR-181a-5p in patients with malignant pulmonary nodules were correlated with lymph node metastasis and nodule diameter(P<0.05);miR-134-5p and miR-181a-5p were independent protective factors for malignant pulmonary nodules in patients,while nodule diameter was an independent risk factor(P<0.05);ROC analysis showed that the area under the curve(AUC) for combined diagnosis of serum miR-134-5p and miR-181a-5p levels was 0.931,both of which were superior to their individual differentiation(P<0.05).Conclusion The serum levels of miR-134-5p and miR-181a-5p in patients with malignant pulmonary nodules are obviously lower than those in benign patients.The combined detection of the two has important value in distinguishing between benign and malignant pulmonary nodules.
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Study on the relationship between serum levels of vascular endothelial growth factor and insulin-like growth factor-1 and esophagogastric anastomotic fistula in patients after thoracoscopic radical resection of esophageal cancer
HUANG Xiaomei,GUO Ming,LUO Junlong,BAO Chuan’en,HU Meng
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  276-280.  DOI: 10.3969/j.issn.1005-6483.2024.03.016
Abstract ( 6 )   PDF (438KB) ( 5 )   PDF(mobile) (438KB) ( 0 )  
Objective To investigate the relationship between serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1) and esophagogastric anastomotic fistula after thoracoscopic radical resection of esophageal cancer.Methods 425 patients with esophageal cancer treated in our hospital from September 2015 to September 2022 were selected and divided into anastomotic fistula group (31 cases) and non-anastomotic fistula group (394 cases) according to the postoperative esophagogastric anastomotic fistula.Serum VEGF and IGF-1 levels were detected to analyze the risk factors affecting the occurrence of esophagogastric anastomotic fistula after thoracoscopic esophageal cancer surgery and the value of VEGF and IGF-1 in predicting the occurrence of esophagogastric anastomotic fistula after thoracoscopic esophageal cancer surgery.Results The serum levels of VEGF and IGF-1 in anastomotic fistula group decreased gradually after operation,while the serum levels of VEGF and IGF-1 in non-anastomotic fistula group increased gradually.The levels of serum VEGF and IGF-1 before,1 day after,2 day after and 3 day after anastomotic fistula group were lower than those of the group without anastomotic fistula (P<0.05).Postoperative pulmonary infection,hypoalbumin,postoperative 3 d VEGF and postoperative 3 d IGF-1 were associated with esophagogastric anastomotic fistula after thoracoscopic esophageal cancer (P<0.05).Postoperative 3 d VEGF and postoperative 3 d IGF-1 predicted the area under the curve of esophagogastric anastomosis fistula after thoracoscopic surgery for esophageal cancer was 0.675 and 0.655,and the area under the curve of the combined two indexes was 0.841,which was higher than the single index (Delong z=3.752,3.218,P<0.05).Conclusion The serum levels of VEGF and IGF-1 decreased in patients with anastomotic fistula after thoracoscopic radical resection of esophageal cancer,which was closely related to the occurrence of anastomotic fistula.
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Study on the correlation of serum lncRNA TUG1 expression level with liver function and degree of liver fibrosis in patients with liver cirrhosis
LI Yi,SHANG Li
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  281-284.  DOI: 10.3969/j.issn.1005-6483.2024.03.017
Abstract ( 8 )   PDF (343KB) ( 6 )   PDF(mobile) (343KB) ( 0 )  
Objective To investigate the expression of serum long non-coding ribonucleic acid taurine up-regulated gene 1 (lncRNA TUG1) in patients with liver cirrhosis and its correlation with liver function and liver fibrosis.Methods From February 2020 to June 22,92 patients with Hepatitis B cirrhosis of Child-Pugh grade C in our hospital were selected as the liver cirrhosis group,their general data were recorded,and they were grouped into mild-to-moderate group and severe group according to the degree of liver fibrosis;88 healthy subjects in our hospital were the control group.The level of serum lncRNA TUG1 was determined by fluorescence quantitative PCR (qRT-PCR),an automatic biochemical analyzer was applied to measure the levels of serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),and total bilirubin (TBIL),the levels of laminin (LN),type Ⅲ procollagen peptide (PⅢP),and type Ⅳ collagen (CⅣ) were determined by ELISA;Pearson correlation was applied to analyze the correlation of serum lncRNA TUG1 with liver function indexes and liver fibrosis indexes in patients with liver cirrhosis;receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of serum lncRNA TUG1 level in evaluating the degree of liver fibrosis in patients with liver cirrhosis;Multivariate stepwise regression analysis of factors affecting the degree of liver fibrosis in patients with cirrhosis.Results The levels of serum lncRNA TUG1,ALT,AST,TBIL,LN,PⅢP and CⅣ in the liver cirrhosis group were obviously higher than those in the control group (P<0.001).The course of liver cirrhosis,lncRNA TUG1,HBV DNA,ALT,AST,TBIL,LN,PⅢP,and CⅣ in the severe group were obviously higher than those in the mild-moderate group (P<0.05).Serum lncRNA TUG1 in patients with liver cirrhosis was positively correlated with HBV DNA,ALT,AST,TBIL,LN,PⅢP,and CⅣ (r:0.54、0.50、0.49、0.50、0.51、0.52、0.52,P<0.05).The area under the curve (AUC) of lncRNA TUG1 to evaluate the development of severe liver fibrosis in patients with liver cirrhosis was 0.91,the cutoff is 2.61.The lncRNA TUG1 and LN are related to the degree of liver fibrosis in patients with cirrhosis (P<0.05).Conclusion Serum lncRNA TUG1 level is correlated with liver function and degree of liver fibrosis in patients with liver cirrhosis.Detection of serum lncRNA TUG1 level is helpful for evaluating the development trend of liver fibrosis in patients.
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Application of Glisson pedicle approach based on anterrior pedicle-posterior pedicle-right hepatic triangle in laparoscopic anatomic right anterior lobectomy
ZENG Yingying,ZHU Yuhao,WANG Yongfei,LEI Shizhou,JIANG Bin
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  285-288.  DOI: 10.3969/j.issn.1005-6483.2024.03.018
Abstract ( 5 )   PDF (351KB) ( 2 )   PDF(mobile) (351KB) ( 0 )  
Objective To explore the application of laparoscopic anatomic right anterior lobectomy based on anterrior pedicle-posterior pedicle-right hepatic(APR) triangle approach and laparoscopic ultrasound assisted localization.Methods The clinical data of 28 patients who received laparoscopic anatomic right anterior lobectomy at the Hepatobiliary and Pancreatic Surgery Center of Shiyan Taihe Hospital from January 2018 to August 2022 were retrospectively analyzed.Among them,14 patients were set as the experimental group based on the APR triangle approach and 14 patients were set as the control group who underwent the traditional anterior approach.The basic information,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications,postoperative liver function and postoperative hospital stay were compared between the experimental group and the control group,and statistical analysis was carried out.Results The two laparoscopic anatomical hepatectomy Methods of right anterior lobectomy were successfully completed.In terms of intraoperative indexes,the operation time of the experimental group [(340.71±45.82) min] and hilar occlusion time [(56.07±11.47) min] were both shorter than those of the control group [(428.92±90.00) min and (68.36±15.96) min],and the differences were statistically significant (P<0.05).In the experimental group,Serum levels of ALT was (236.51±78.65) U/L at 1 day after surgery, AST was (216.82±95.66)U/L at 1 day after surgery,ALT was (177.23±84.76)U/L at 3 days after surgery,AST was (125.63±55.48) U/L at 3 days after surgery,TBil was (23.57±7.58) μmol/L at 3 days after surgery,which were significantly lower than that in the control group[(658.73±361.55)U/L,(688.88±241.52)U/L,(383.42±199.01)U/L,(232.59±168.5)U/L and (31.46±11.95)μmol/L,respectively](P<0.05).Compared with the control group[(9.86±2.44)d],the experimental group had shorter postoperative hospital stay[(7.79±1.19)d],the difference were statistically significant(P<0.05).There was no recurrence or death in the two groups at 90 days after the operation.Conclusion The Glisson pedicle approach based on APR triangle and abdominal ultrasound assisted localization of laparoscopic anatomical right anterior lobectomy have the advantages of shorter operation time,shorter hilar occlusion time,faster postoperative enzymatic recovery of liver function and shorter postoperative hospital stay.There was no significant difference in postoperative complications between the two groups.
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Analysis of the therapeutic effect of digital subtraction angiography guided rapid exchange through lateral foramen and traditional nasogastric tube decompression in the treatment of adhesive intestinal obstruction
LIAO Tian,WANG Yongheng,LI Lan,HUANG Xiangjun
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  289-292.  DOI: 10.3969/j.issn.1005-6483.2024.03.019
Abstract ( 2 )   PDF (350KB) ( 2 )   PDF(mobile) (350KB) ( 0 )  
Objective Exploring the efficacy analysis of digital subtraction angiography (DSA) guided rapid exchange through lateral foramen and traditional nasogastric tube decompression in the treatment of adhesive intestinal obstruction.Methods A total of 84 patients with adhesive ileus admitted to our hospital from January 2019 to January 2021 were prospectatively selected as the study objects,and the patients were divided into the study group (42 cases) and the control group (42 cases) according to the random number table method.The control group was treated with traditional nasogastric tube decompression,and the study group was treated with DSA-guided tube decompression via lateral foraminal rapid exchange.Compare the differences in efficacy,recovery indicators (exhaust time,extubation time,eating time,first defecation time,abdominal pain relief time,X gas liquid level disappearance time,average hospitalization time),pain degree (VAS score),and quality of life (SF-36 score) between the two groups.Results Rank-sum test of hierarchical data showed that the difference in clinical efficacy between the two groups was statistically significant(P<0.05), and the total effective rate of the study group (92.86%) was higher than that of the control group (71.43%), which was statistically significant (P<0.05). In the study group, the time of exhaustion, extubation time, feeding time, first defecation time, abdominal pain relief time, X-ray gas-liquid plane disappearance time, and mean hospitalization time were (78.61±20.38) hours, (80.35±20.26) hours, (82.49±21.59) hours, (88.66±23.55) hours, (3.49±0.75) days, (4.31±1.16) days, and (6.53±1.10) days in the study group, respectively. The control group was (101.36±31.56) hours, (104.33±28.85) hours, (108.41±25.55) hours, (141.32±35.49) hours, (6.05±1.29) days, (7.29±1.32) days and (10.01±2.06) days, respectively. The difference between the two groups was statistically significant(P<0.05).Repeated-measures ANOVA Results showed that the VAS scores of the two groups were significantly lower at 1 day after treatment and 3 days after treatment compared with the pre-treatment period, and the VAS scores at 3 days after treatment were lower than those at 1 day after treatment, but the VAS scores of the study group were lower than those of the control group at 1 day after treatment and 3 days after treatment, and the difference was statistically significant(P<0.05). The scores of each factor of SF-36 scale at the time of discharge were higher in both groups compared with the pre-treatment period, and the scores of each factor of SF-36 scale at the time of discharge were higher in the study group than in the control group, and the difference was statistically significant (P<0.05).Conclusion DSA guided rapid exchange catheter decompression through lateral foramen has a good therapeutic effect on adhesive intestinal obstruction,which can effectively alleviate patient pain,promote early recovery,and improve quality of life.
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The expression of forkhead box C1 and SRY-related HMG-box 11 in cardiac cancer tissue and their relationship with clinical pathological characteristics and prognosis of patients
LIAO Hanqi,TANG Yi,HU Kai,JIANG Geng
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  293-297.  DOI: 10.3969/j.issn.1005-6483.2024.03.020
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Objective To observe the expression changes of forkhead box C1(FOXC1) and SRY-related HMG-box 11(SOX11) in the normal and cancerous tissues of patients with cardiac cancer,and to explore the relationship between their expression and clinical pathological characteristics and prognosis.Methods A total of 94 patients with cardiac cancer diagnosed in our hospital from March 2018 to March 2020 were collected and grouped into survival group(n=54) and death group(n=40) based on their mortality within 3 years. All patients underwent laparoscopic proximal gastrectomy and gastroesophageal anastomosis. Immunohistochemical Methods were applied to detect the expression levels of FOXC1 and SOX11 in tissues,analysis of the relationship between FOXC1,SOX11 expression levels and 3-year overall survival rate in gastric cardia cancer patients using Kaplan Meier method,and Cox risk regression model was applied to analyze the influencing factors of 3-year prognosis in patients with cardiac cancer.Results The positive expression rate of FOXC1 in cancer tissue of patients with cardiac cancer was higher than that in normal tissues,the positive expression rate of SOX11 was lower than that in normal tissues(P<0.05).The positive expression rate of FOXC1 and negative expression rate of SOX11 in cardiac cancer tissues of patients with pathologic stage III+IV,poorly differentiated tissues,and lymph node metastasis were obviously higher than those of patients with pathologic stage Ⅰ+Ⅱ,moderately/well differentiated tissues,and no lymph node metastasis(P<0.05).The proportions of patients with pathologic stage Ⅲ+Ⅳ,lymph node metastasis,positive expression of FOXC1,and negative expression of SOX11 in the death group were higher than those in the survival group(P<0.05).The 3-year overall survival rate of patients with FOXC1 positive expression in cardiac cancer tissue was lower than that of patients with FOXC1 negative expression(P<0.05);The 3-year overall survival rate of patients with negative SOX11 expression in cardiac cancer tissue is lower than that of patients with positive SOX11 expression(P<0.05).FOXC1 was an independent risk factor for death in cardiac cancer patients during a 3-year follow-up period,while SOX11 was a protective factor for death in cardiac cancer patients during a 3-year follow-up period(P<0.05).Conclusion High expression of FOXC1 and low expression of SOX11 may be involved in the occurrence and development of cardiac cancer,which is closely related to poor prognosis of patients.
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Improved clinical view of the treatment of anal stricture with Modified posterior median longitudinal incision and collagen line transverse suture
ZHANG Yi,TU Linyi,ZHAO Yue,YU Fan,LU Yong,HUANG Mengqi,YU Limin
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  298-300.  DOI: 10.3969/j.issn.1005-6483.2024.03.021
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The Effect of model-based iterative reconstruction,metal artifact reduction,noise-optimized virtual monochromatic imaging in removing lumbar internal fixation metal artifacts:an orthogonal design study
CHENG Qing,XIA Kezhou,PENG Zhoufeng,CHENG Liang,GUO Weichun
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  301-305.  DOI: 10.3969/j.issn.1005-6483.2024.03.022
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Objective To compare the efficacy differences among model-based iterative reconstruction (MBIR),metal artifact reduction(MAR),and noise-optimized virtual monochromatic imaging(VMI+) in the removal of metal artifacts from lumbar spine internal fixation and to propose the best combined scheme.Methods Retrospective collection of lumbar CT raw data of patients after lumbar internal fixation surgery in our hospital,a total of 10 cases.Through orthogonal experimental design,a 3-factor 2-level orthogonal table L8 (27) was designed.The raw data was reconstructed and post-processed according to the scheme of the orthogonal design table,and the CT values and SD values of the high-density metal artifact area near the screw,the low-density metal artifact area on the ventral side of the screw long axis,and the subcutaneous fat control area on the back were measured separately.The Artifact Index (AI) was calculated,followed by intuitive analysis and analysis of variance (ANOVA).Results In the impact on high-density metal artifacts,the order of influence of factors was:C (VMI+) > B (MAR) > A (MBIR);for low-density metal artifacts,the order was:B (MAR) > C (VMI+) > A (MBIR).The effects of different levels of each factor on both high-density and low-density metal artifacts were A2 > A1,B2 > B1,C2 > C1.A (MBIR),B (MAR),and C (VMI+) were significant influencing factors in the removal of high-density and low-density metal artifacts from lumbar spine internal fixation (P<0.001).The interactions between A and B,A and C,and B and C were significant in the impact on high-density metal artifacts (P<0.001);for low-density metal artifacts,the interactions between A and B,and B and C were significant (P<0.05).The optimal combined protocol was identified as A2B2C2.Conclusion Conclusion MBIR,MAR,and VMI+ are significant factors in the removal of metal artifacts from lumbar spine internal fixation.There are differences in the effects of MBIR,MAR,and VMI+ on the removal of metal artifacts:for high-density artifacts,VMI+ > MAR > MBIR;for low-density artifacts,MAR > VMI+ > MBIR.There is an interaction when MBIR,MAR,and VMI+ are used in combination to remove metal artifacts from lumbar spine internal fixation,with the interaction between MAR and VMI+ being the most significant.The best combined scheme of this study is MBIR level 4,130KeV VMI+,MAR.
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Clinical study of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression technique for the treatment of single-segment lumbar spinal stenosis
WANG Wei,LI Xiaochuan,HUANG Chunming,LUO Shaojian,LU Mingnan,LAN Gen,JIANG Cheng,CHEN Jionghui,CHEN Yonglong,ZHANG Zhenwu
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  306-309.  DOI: 10.3969/j.issn.1005-6483.2024.03.023
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Objective To investigate the safety and effectiveness of the unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression (ULBD) technique to treat patients with single-segment lumbar spinal stenosis.Methods 35 Patients with single-segment spinal stenosis treated by the ULBD method in the Department of Spine Surgery,Gaozhou People’s Hospital from July 2020 to May 2021 were selected in this study.The visual analogue scale (VAS) score and Oswestry disability index (ODI) score of low back pain and leg pain were compared between pre-operation and postoperative follow-up at 1 week,3,12 and 20 months.Besides,intraoperative and postoperative complications were statistically analyzed.Results A complete follow-up of 35 cases was obtained with over 20 months.A mild cerebrospinal fluid leak occurred 3 days after surgery in one case whose wound healed after taking enough rest and receiving nutrition.The VAS score for low back pain decreased from 4.51±1.09 before surgery to 1.91±0.47 after the surgery,the VAS score for leg pain reduced from 5.71±1.15 before the surgery to 2.54±0.56 after the surgery,and the ODI index dropped from 0.50±0.09 to 0.22±0.04,with a statistically significant difference (P<0.05).Conclusion Patients with single-segment lumbar spinal stenosis can be treated with the unilateral biportal endoscopy-guided ULBD technique which is characterized by less invasiveness,clear visual fields,and the protection of the soft tissues around the spine.
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Comparison of short-term efficacy between percutaneous intervertebral foramen technique and traditional posterior approach decompression and bone grafting and internal fixation in the treatment of senile degenerative lumbar spinal stenosis
DU Zhuangwen,OUYANG Fan,WANG Enliang,ZENG Fankuan
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  310-313.  DOI: 10.3969/j.issn.1005-6483.2024.03.024
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Objective To compare the short-term efficacy of percutaneous foraminal endoscopy and traditional posterior decompression,bone grafting,fusion and internal fixation in the treatment of senile degenerative lumbar spinal stenosis.Methods 100 elderly patients with degenerative lumbar spinal stenosis admitted to Hainan Qionghai People’s Hospital from January 2018 to January 2021 were selected as the study subjects.They were divided into the observation group(50 case) and the control group(50 case) according to different surgical methods.The observation group used percutaneous foraminal endoscopy technology,and the control group used traditional posterior approach decompression and bone graft fusion internal fixation.Compare the clinical efficacy,perioperative related indicators,lumbar function,pain level,bone metabolism indicators,and complications between two groups.Results The observation group had shorter surgery,postoperative bed rest,and hospital stay compared to the control group,with less intraoperative blood loss compared to the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group,and the total clinical effective rate was higher than that in the control group(P<0.05);One week and three months after surgery,the levels of bone specific alkaline phosphatase(BALP),osteocalcin(BGP),and bone morphogenetic protein-2(BMP-2) in the observation group were higher than those in the control group(P<0.05);At 1 week and 3 months after surgery,the Oswestry Dysfunction Index(ODI) and Japanese Orthopedic Society Low Back Pain Assessment Scale(JOA) scores in the observation group were higher than those in the control group,while the visual analog scale(VAS) score was lower than that in the control group(P<0.05).Conclusion The treatment of degenerative lumbar spinal stenosis with percutaneous transforaminal endoscopy is less traumatic,beneficial for recovery,safer,and has a good therapeutic effect.
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Predictive value of serum Netrin-1 and connective tissue growth factor levels for renal injury after ureteral flexible lithotripsy
LIU Yunfeng,SUN Yaping,LI Bingcheng,FENG Yuanfa,CAO Manchao,WANG Fengyao
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  314-317.  DOI: 10.3969/j.issn.1005-6483.2024.03.025
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Objective To explore the predictive value of serum Netrin-1 and connective tissue growth factor (CTGF) for renal injury after flexible ureteroscopic lithotripsy for renal calculi.Methods A total of 104 patients with renal calculi treated in our hospital from March 2020 to March 2022 after flexible ureteroscopic lithotripsy were selected as the research objects,and 98 people who came to our hospital for physical examination during the same period were selected as the control group.According to the inclusion and exclusion criteria of kidney injury,the patients with kidney stones after flexible ureteroscopic lithotripsy were divided into kidney injury group (n=58) and non-kidney injury group (n=46).The levels of serum Netrin-1 and CTGF were detected by enzyme-linked immunosorbent assay (ELISA). Univariate analysis and multiple Logistic regression were used to analyze the influencing factors of kidney injury after ureteral flexible lithotripsy. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum Netrin-1 and CTGF in kidney injury after ureteral flexible lithotripsy.Results The expression levels of Netrin-1 and CTGF in the study group were higher than those in the control group. Serum Netrin-1 and CTGF levels in renal injury group were higher than those in non-renal injury group. Multivariate Logistic regression analysis showed that Netrin-1≥300 ng/L and CTGF≥0.80 ng/L were risk factors for renal injury after ureteral flexible lithotripsy (P<0.05).The AUC of serum Netrin-1 and CTGF in predicting renal injury after ureteral soft lithotripsy were 0.731(95%CI:0.668~0.813) and 0.845(95%CI:0.798~0.892), respectively. The combined forecast AUC was 0.903(95%CI:0.852~0.955).Conclusion The increased expression levels of serum Netrin-1 and CTGF are closely related to kidney injury after ureteral flexible lithotripsy, and can be used as a biological indicator to evaluate early kidney injury after ureteral flexible lithotripsy, and the combination of the two has higher predictive efficacy.
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Clinical effect of platelet-rich plasma gel combined with vacuum sealing drainage in the treatment of patients with sinus of thoracic wall
GUO Zhongliang,LIU Yuanyuan,LIU Yingping,WANG Jing,XU Min,WANG Guochang
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  318-322.  DOI: 10.3969/j.issn.1005-6483.2024.03.026
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Objective To investigate the clinical effect of platelet-rich plasma gel (APG) combined with vacuum sealing drainage (VSD) in the treatment of patients with sinus of thoracic wall. Methods A total of 89 patients with sinus of thoracic wall who were admitted to the department of plastic surgery of the hospital between October 2019 and March 2021 were selected as the research subjects. They were divided into observation group (n=45) and control group (n=44) by random number table method. The control group was treated with VSD, and the observation group was treated with APG combined with VSD. The healing of sinus of thoracic wall was compared between the two groups. Results The curative effect was significantly different in the two groups (97.78% vs. 86.36, P<0.05). The sinus closure time, wound healing time and hospital stay of observation group [(15.26±2.33) d, (25.19±3.54) d and (41.26±5.33) d] were significantly shorter than those of control group [(27.26±3.05) d, (43.26±5.17) d and (58.64±6.11) d] (P<0.05). The rate of secondary repair surgery and recurrence rate of sinus tract in observation group (0 and 0) were lower than those in control group (11.36% and 13.64%) (P<0.05). After treatment, C-reactive protein (CRP), white blood cell count (WBC), tumor necrosis factor (TNF-α) and Visual Analogue Scale (VAS) in the observation group [(20.36±3.41) mg/L, (5.23±0.64) ×109, (15.26±3.24) pg/mL and (1.23±0.25)] were significantly lower than those in the control group [(26.54±3.57) mg/L, (8.17±0.93)×109, (24.16±3.94) pg/mL and (3.04±0.41)] (P<0.05). 1w and 2w after treatment, the positive rates of bacterial culture in observation group (37.78% and 11.11%) were lower than those in control group (59.09% and 29.55%) (P<0.05). The Vancouver Scar Scale (VSS) of observation group at 1 month and 2 months after wound healing [(7.33±0.85) and (3.26±0.41)] were significantly lower than those of control group [(8.64±0.91) and (5.14±0.62)] (P<0.05). The incidence of adverse reactions in observation group (8.89%) was significantly lower than that in the control group (25.00%) (P<0.05).Conclusion APG combined with VSD can promote the recovery of sinus tract in patients with sinus of thoracic wall, with good antibacterial effect. In addition, it can relieve pain and scar hypertrophy, and reduce adverse reactions.
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The application value of 3D printing in the reconstruction of maxillary sinus wall
LI Qiaoyu,WANG Yingdong
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  324-326.  DOI: 10.3969/j.issn.1005-6483.2024.03.028
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Objective Exploring the clinical diagnostic effect and patients’ satisfaction of 3D printing reconstruction examination intervention in maxillary sinus wall repair.Methods 52 patients with maxillary sinus wall repair admitted to our hospital from April 2022 to November 2022 were collected as research subjects.52 patients were divided into a control group and an observation group using two different methods: CT 3D reconstruction and 3D printed image reconstruction. Each group has 26 cases.The conventional group was diagnosed using 128 slice CT 3D reconstruction examination,while the observation group was diagnosed using 3D printing images (3DPI) reconstruction examination.Medical staff counted the diagnostic efficacy of each group of patients using different methods,and conducted a survey on the overall satisfaction of patients with diagnosis.Results The scores of masticatory function, language function and retention function in observation group were higher than those in conventional group, and the differences were statistically significant (P<0.05). The satisfaction of the conventional group was 26.92%, and that of the observation group was 80.76%, and there was statistical significance between the two groups (P<0.05).Conclusion The scores of masticatory function, language function and retention function in observation group were higher than those in conventional group, and the differences were statistically significant (P<0.05). The satisfaction of the conventional group was 26.92%, and that of the observation group was 80.76%, and there was statistical significance between the two groups (P<0.05).
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Current progress of immune checkpoint inhibitors in the treatment of advanced hepatocellular carcinoma
ZHOU Yi,LIANG Binyong,XIAO Zhenyu
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  328-331.  DOI: 10.3969/j.issn.1005-6483.2024.03.030
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Hepatocellular carcinoma (HCC),frequently diagnosed at advanced stages in China due to insidious onset,faces a dismal prognosis with limited surgical feasibility.The advent of immunotherapy,particularly immune checkpoint inhibitors (ICIs),introduces novel therapeutic prospects,albeit with variable efficacies.The combination of ICIs with various therapeutic strategies is increasingly recognized as a critical approach in the management of advanced HCC.This article reviews recent advances in ICIs for advanced hepatocellular carcinoma and discusses the future prospects of immunotherapy.
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Research progress of single-cell RNA sequencing in tumor-infiltrating immune cells
DU Qilian,SONG Enfeng,HU Qinyong
JOURNAL OF CLINICAL SURGERY. 2024, 32 (3):  332-334.  DOI: 10.3969/j.issn.1005-6483.2024.03.031
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Immune cells are closely related to the progression and treatment of tumors.Single-cell RNA sequencing (scRNA-seq) is widely used in analyzing the biological behavior,mechanisms,and relationship between tumor-infiltrating immune cells and the body at the single-cell level.The Results show that scRNA-seq can comprehensively dissect tumor-infiltrating immune cells and promote personalized and precise clinical treatment.
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