解析：这则病例系列在3b和3c方面报告得不错，详细讲述了每个患者的诊治经过，包括随访结局等。3d结论也有指示意义，即PD-1抑制剂有关的免疫相关不良事件可能会在停药后发生，提醒同行留意。但这则病例的创新点没有点出来，一上来就说了这个内容很重要，然后就没有下文了。如果要改，可以写成免疫抑制剂相关不良事件绝大多数出现于用药期间，目前在停药后仍然出现的文献如何，而这篇文章在已有文献基础上，补充了什么，然后再介绍三则病例，这样自明性和吸引力都会提高。

欠佳报告示范[7] ：

Indwelling urethral catheter placement is a common and comparatively safe procedure. Misplacement of a urethral catheter into the upper urinary tract is unusual, and only a few cases have been reported. We describe the case of a 43-year-old man who presented with oliguria and had a history of chemotherapy for known metastatic lung cancer. As he had no history of urological disease, urethral catheterization was expected to be uneventful. The catheter was unable to be pulled back to the bladder neck once the balloon was inflated, and the patient expressed discomfort. Subsequent computed tomography revealed that the tip of the catheter was placed in the middle of the right ureter. Unbeknownst to the physicians before urethral catheterization, the patient had severe lower urinary tract symptoms and urinary bladder dysfunction with hydronephrosis, likely due to chemotherapy. Based on the patient’s symptoms and imaging results, we judged the possibility of severe ureteral injury to be low. The malpositioned catheter was removed uneventfully after complete balloon deflation and then reinserted properly. He was admitted to the medical department but died as a result of an exacerbation of the underlying disease unrelated to the incident. If urethral catheter placement seems abnormal, physicians should aspirate and irrigate to confirm correct positioning before balloon inflation; then, they should carefully pull the inflated balloon near the neck of the bladder while monitoring the patient’s symptoms. Although urethral catheter placement is comparatively safe, physicians must keep in mind that patients who have undergone chemotherapy might be at a risk for this rare complication.

解析：这则病例的故事讲得非常完整，既给出了患者年龄（43岁）等信息，也给了重要的病史信息（已知转移性肺癌，化疗史，无泌尿系统疾病史），还阐述了整个诊断（输尿管损伤）、干预（尿道导尿）和结局（死亡）全经过。文章结论也很明确：接受过化疗的患者有可能容易出现尿道导管误置入上尿路的情况。但文章的独特点、创新点还可以写得更好。作者认为该文的独特点是报道尿道导管误置入上尿路的病例很罕见，即这是一则罕见病例。这确实是该文的一个点，但不是独特点。那么，这一则的出现，和其他罕见的出现，有何不同呢？其实，再追究深一步即可：既往这一情况本身就很罕见，而该病例进一步补充了这样的一个信息，即既往接受过化疗的患者容易出现尿道导管误置入上尿路这一罕见的情况。独特点在于“接受过化疗”。

良好报告示范[8] ：

Chyle leakage after modified radical neck dissection is a rare condition that could be occasionally life-threatening if untreated. We report the first case of successful management of a thoracic duct injury using Viscum album extract (Helixor-M). A 54-year-old woman diagnosed with papillary thyroid cancer of the right lobe of the thyroid with metastasis to cervical lymph node levels II-VI, bilaterally, underwent total thyroidectomy and modified radical neck dissection. Three days postoperatively, the surgical team identified a thoracic duct injury due to drainage of chyle from the Jackson-Pratt drain inserted in the right side of the patient’s neck. Various medical treatments (octreotide, withdrawal of enteral feeding, and total parenteral nutrition) and surgical treatments [lymphatic ligation of cervical lymph node level IV and negative pressure wound therapy (vacuum-assisted closure)] were performed, but the drainage persisted. Viscum album extract (Helixor-M) was then injected through the drain. The dose of Viscum album extract was increased while being cautious of its adverse effects, such as nausea, vomiting, erythema, induration at the injection site, and flu-like symptoms. The injection was effective in stopping the drainage and the patient’s condition improved, without recurrence. The patient was discharged on the 64th postoperative day without any further complications. Our results suggest that treatment of thoracic duct injury after neck surgery with Viscum album extract (Helixor-M) may be a novel, less invasive alternative approach to treat cases resistant to standard treatments.

解析：条目3a背景清晰——改良根治性颈部切除术后的乳糜漏是一种罕见的情况，如果不加以治疗，有时可能危及患者生命。独特点清晰——第一例使用Helixor-M成功处理胸导管损伤的病例。条目3b和3c故事完整——患者情况为54岁，女性，甲状腺右叶乳头状癌并转移到双侧颈部淋巴结Ⅱ～Ⅳ级；干预经过为甲状腺全切除术和改良根治性颈部切除术术后3天出现糜烂物引流导致胸腔管道损伤，进一步行药物治疗（给出了药物名称）和手术治疗（给出了具体手术方式）；对于患者结局，详细报告了不良反应，病情改善情况包括是否复发，也具体给了随访时间和随访情况。条目3d结论清楚表态——用粘液囊提取物Helixor-M可以治疗对标准治疗有抵抗的病例，是创伤较小的替代方案。

参考文献（向上滑动阅读）

[6]Kimura HST，Araya T，Murata A，et al. Late-onset programmed cell death protein-1 inhibitor-induced pneumonitis after cessation of nivolumab or pembrolizumab in patients with advanced non-small cell lung cancer：a case series[J]. Transl Lung Cancer Res，2021，10(3)：1576-1581.

[7]Cho SK，Kim MS，Chung HS，et al. Transurethral Foley catheter misplacement into the upper urinary tract in a patient with a history of lung cancer and chemotherapy：a case report and considerations to keep in mind[J]. Transl Androl Urol，2021，10(3)：1347-1351.

[8]Kim CW，Kim JS，Lee AH，et al. Viscum album extract (Helixor-M) treatment for thoracic duct injury after modified radical neck dissection：a case report[J]. Gland Surg，2021，10(2)：832-836.

未完待续......

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AME旗下13本期刊最新影响因子｜2021年6月

本文作者：张开平 AME Publishing Company

校对人员：林 瑶 AME Publishing Company

杨芳慧 AME Publishing Company

尚炳含 AME Publishing Company

责任编辑：黄冰滢 AME Publishing Company

排版编辑：袁 舒 AME Publishing Company

b.01. 20 22. 02.22.01

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