简介:摘要尽管近年来胰腺癌的手术切除率与手术安全性显著提高,但患者远期预后仍无显著改善。在目前多学科诊断与治疗的背景下,胰腺癌作为系统性疾病,传统“surgery first”的治疗策略面临质疑与挑战。对于局部进展期、交界可切除及合并有高复发风险的可切除胰腺癌,提倡先行系统治疗即“surgery last”的治疗策略;对于生物学行为良好的可切除胰腺癌,宜行“surgery first”治疗策略。
简介:Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.
简介:因为不想重头制造轮子,所以会从设计模式中寻求协助一学习了解、甚或组合创造他人的经验与实际的精华。
简介:Treatmentofpancreaticcancerismultimodalandsurgeryisanessentialpart,mandatoryforcurativepotential.Alsochemotherapyisessential,andseriouspostoperativecomplicationsorrapiddiseaseprogressionmayprecludecompletionofmultimodaltreatment.Thesequenceoftreatmentinterventionshasthereforebecomeanimportantconcern,andnumerousongoingrandomizedcontrolledtrialscompareclinicaloutcomeafterupfrontsurgeryandneoadjuvanttreatmentwithsubsequentresection.Inpreviousyears,borderlineresectableandlocallyadvancedpancreaticcancerwasmostoftenconsideredunresectable.Moreeffectivechemotherapytogetherwiththelatestimprovementsinsurgicalexpertisehasresultedinextendedoperations,pushingthebordersofresectability.Multivisceralresectionswithorwithoutresectionofmajormesen-tericvesselsarenowperformedinnumerouspatients,resultinginbetteroutcome,recordedasoverallsurvivaland/orpatientreportedoutcome.Butpostoperativemorbidityincreasesconcurrently,andclinicalbenefitmustbecarefullyevaluatedagainstriskofpotentialharm,associatedwithnewcomprehensivemultimodaltreatmentsequences.Eventhoughcost/utilityanalysesaredeficient,extendedsurgeryhasresultedinsignifi-cantlylongerandbetterlifeformanypatientswithnoothertreatmentalternative.Improvedselectionofpatientstosurgeryand/orchemotherapywillinthenearfuturebepossible,basedonbettertumorbiologyinsight.Clinicallyavailablebiomarkersenablingpersonalizedtreatmentareforthcoming,buttheseoptionsarestilllimited.Theimportanceofsurgicalresectionforeachpatient’sprognosisispresentlyincreasing,justifyingsustainedexpansionofthesurgicaltreatmentmodality.
简介:精索静脉曲张在临床的实践被认出了为在一个世纪。原来,这些过程为疼痛的管理被利用,但是自从1952,修理主要为男不孕的处理。然而,因为pathophysiology不是清楚的,精索静脉曲张的诊断和治疗是争论的,研究的入口标准在中心之中变化了,并且有很少使随机化的临床的试用。不过,临床医生们继续为精索静脉曲张的修正开发技术,基本科学家在精索静脉曲张的pathophysiology上继续调查,并且从未来的使随机化的试用的新结果数据出现在世界的文学。因此,Andrology的亚洲杂志的这个特殊版本被建议报导许多与精索静脉曲张有关的新信息,作为这个工程的特定的部分,现在的文章作为进化的全面评论和校正过程的精炼被开发。
简介:Afirstgradeteachercollectedwell-knownproverbs.Hegaveeachkidintheclassthefirsthalfoftheproverb,andaskedthemtocomeupwiththerest.Hereiswhatthekidscameupwith: