目的 总结高龄胆道疾病患者的治疗经验。方法 对近2年来我科收治的60岁以上因胆道疾病入院的急、择期手术患者的临床资料进行了回顾性分析。结果 本组235例中行急诊手术78例(33.2%)，择期手术167例(71.1%)； 合并各种内科疾病者147例，占62.6%，其中以心血管疾病最多，71例(48.3%)，其次为呼吸系统疾病，54例(36.7%)； 术后并发症发生率为23.0%(54/235)，在并发症中以肺部感染发生率最高，占42.6%(23/54)，其次为泌尿道感染，占33.3%(18/54)，再其次为切口感染，占29.6%(16/54)； 全组术后近期死亡7例，占3.0%，其中死于肝、肾功能衰竭4例，呼吸衰竭2例，心衰1例。结论 高龄胆道疾病患者合并疾病多，手术风险性增加，术后并发症发生率较高，因此应加强围手术期的监护与处理，确保患者平安度过手术期。
Objective To assess the survival of patients receiving high intensity focused ultrasound (HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma (PHCC) victims with HIFU application. Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007. Among them, 101 patients were males and 86 were females (mean age: 47.7 years old, range: 19-79 years old). The average tumor size was 5.7 cm (range: 0.5-18.0 cm). Of these 187 patients, numbers according to Child-Pugh grade of A, B and C were 104, 52 and 31, respectively. According to TNM system, 45, 111 and 31 patients were in stage Ⅱb, Ⅲa and Ⅲb respectively. Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. Results Survival period was (17.3±2.5) months after HIFU treatment of PHCC. The overall survival rate of 3-month, 6-month, 1-year and 2-year were 79.1%, 60.1%, 35.7%, and 29.3%， respectively. It was significant that tumor number (P=0.02), size (P=0.04)， AFP (P=0.04)， Child-Pugh grade (P=0.00)， TNM stage (P=0.01)， tumor metastasis (P=0.03) before HIFU， and tumor recurrence after HIFU (P=0.02) and standard treatment (P=0.02) were prognostic factors by single factor analysis. The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol (P=0.000), and TNM stage (P=0.004) and Child-Pugh grade (P=0.009) before HIFU. Conclusion It is used for improving overall survival rate to found PHCC early, protect liver function, examine comprehensively before HIFU treatment, focus on standard treatment and auxiliary treatment.
Objective To study the mechanism of high intensity focused ultrasound (HIFU) and discuss its clinical significance in the treatment of mid-late stage liver cancer. Methods The patients with mid-late stage liver cancer were treated with HIFU. The changes of photography, pathology and immunology after operation were evaluated. Results It was shown that the results of the photographic, pathologic and immunologic examinations changed during the treatment of the patients with HIFU. Conclusion HIFU is effective and safe for the treatment of mid-late stage liver cancer.
ObjectiveTo evaluate the therapeutic effect of liver transplantation (LT) combined with adenovirus-mediated delivery of herpes simplex virus thymidine kinase / ganciclovir (ADV-TK/GCV) in treatment of patients with hepatocellular carcinoma (HCC), so as to benefit more patients with HCC beyond the Milan criteria. MethodsThe clinicopathologic data of patients with HCC underwent LT by the author team since 2007 were collected and analyzed. The patients were assigned into simple LT group and LT+ADV-TK/GCV group. The 5-year cumulative overall survival rate and relapse free survival rate of all LT patients and the patients with LT beyond the Milan criteria by simple LT and LT+ADV-TK/GCV therapy were compared. Meanwhile, Cox regression was used to analyze the risk factors affecting long-term overall survival rate and relapse free survival rate of all patients with HCC after LT. ResultsA total of 216 patients eligible for inclusion were collected in this study, including 134 patients in the simple LT group and 82 patients in the LT+ADV-TK/GCV group, 162 of whom beyond the Milan criteria, including 101 patients underwent the simple LT and 61 patients underwent the LT+ADV-TK/GCV. There were no statistical differences in the baseline data between the simple LT and LT+ADV-TK/GCV in all patients and patients beyond the Milan criteria (P>0.05). There were no statistical differences in 5-year overall survival rate and relapse free survival rate of all patients with HCC (P>0.05). The 5-year cumulative overall survival rate of the LT+ADV-TK/GCV group was better than that of the simple LT group in the patients beyond the Milan criteria (χ2=4.11, P=0.047), but it was not found that the 5-year cumulative relapse free survival rate had statistical difference (27-month survival time as the critical value, P=0.46, P=0.06). Cox regression multivariate analysis results showed that the larger cumulative tumor diameter, the preoperative elevated serum alpha fetoprotein (>400 μg/L), later TNM stage, and without combination of ADV-TK/GCV therapy increased the probability of shorter overall survival of patients after LT; and the patient’s older age, the larger cumulative tumor diameter, and later TNM stage increased the probability of shorter relapse free survival after LT, and it was not found that the combination of ADV-TK/GCV therapy had an impact on the relapse free survival. ConclusionLT combined with ADV-TK/GCV therapy can obviously improve overall survival among patients beyond the Milan criteria, more patients with advanced HCC will be candidates for LT combined with ADV-TK/GCV therapy.
【摘要】 目的 探索针灸治疗慢性功能性便秘的特点及规律,以期为制定针灸治疗功能性便秘优选方案提供参考。方法 运用文献计量学方法,通过回顾分析1999年—2008年的针灸治疗慢性功能性便秘文献,以中国期刊全文数据库为资料来源,对这些文献进行定量分析。结果 共纳入86篇文献,分布在41种期刊上；针灸治疗功能性便秘最常用的穴位是天枢、大肠俞、足三里、支沟、上巨虚。结论 针灸治疗本病操作方法繁多,临床研究水平普遍较低,需进一步探讨针灸治疗的优化方案。