小肝癌手术治疗的体会(附41例报告)

目的 :总结小肝癌手术治疗的经验。方法 :回顾性分析本院近 8年 41例小肝癌患者的临床资料 ,其中 3 9例合并肝硬化 ,3 2例HBsAg阳性 ;甲胎蛋白 <2 0 μg·L- 1 13例 ,2 0～ 40 0 μg·L- 1 17例 ,>40 0 μg·L- 1 11例 ;肝功能Child PughA级 2 7例 ,B级 14例。 2 9例予不规则肝切除 (4例病人同时行脾切除加贲门周围血管离断术 ) ,5例予不规则肝切除加无水酒精注射 ,7例予肝左外叶切除 (其中 3例取出门静脉癌栓 )。结果 :术后 1、3、5年生存率依次为 87.8%、73 .2 %、43 .9%。结论 :早发现、早诊断 ,施行合适的外科手术是提高生存率的关键。小肝癌合并门静脉高压症者 ,不能盲目追求根治性肿瘤切除及附加针对门静脉高压症的手术     

肝癌合并门静脉癌栓的处理方法和手术方式选择

目的　探讨肝癌合并门静脉癌栓 (TTPV)的有效处理方法和手术方式选择。方法　对 10 9例肝癌合并门静脉癌栓患者的临床资料进行分析和总结。结果　 31例行保守姑息治疗患者 2～ 8个月内死亡 ,平均生存时间 4 7个月。 78例患者行手术治疗 ,其中 11例行单纯肝癌切除术 ,平均生存时间 11 8个月 ;6 7例行肝癌切除加门静脉癌栓取栓术 ,平均生存时间 2 3 9个月 ;其中 4 9例术后采用了肝动脉和门静脉双插管微量泵灌注化疗 ,其 1,3,5年生存率为 10 0 % ,5 1 5 % ,12 7% ,18例未行插管化疗 ,其 1,3,5年生存率为 79 2 % ,2 3 1% ,0。结论　手术治疗能相对延长肝癌合并门静脉癌栓患者的生存时间 ,手术方式应尽量行肝癌切除加门静脉癌栓取栓术 ,术后使用肝动脉和门静脉双插管微量泵灌注化疗可提高疗效     

三位一体治疗原发性肝癌98例临床分析

目的 :评价不规则肝切除联合肝动脉置泵栓塞化疗对肝癌术后复发率及生存率的影响。方法 :对比分析近18年来 98例肝癌患者单纯肝切除 ( 5 8例 )与肝切除联合肝动脉置泵栓塞化疗 ( 4 0例 )的临床资料。结果 :单纯手术组与手术联合置泵栓塞化疗组 1、3、5年术后复发率分别为 67 2 %对 3 7 5 %、84 4%对 5 5 0 %、94 8%对 72 5 % ,差异有显著性 (P <0 .0 5 )。两组病人 1、3、5年生存率分别为 5 8 7%对 90 %、41 4%对 72 5 %、13 8%对 40 % ,差异有显著性 (P <0 .0 5 )。结论 :肝癌不规则肝切除联合肝动脉置泵栓塞化疗可明显降低术后复发率、提高生存率。     

58例肝门部胆管癌外科治疗体会

目的 :报告 5 8例肝门部胆管癌手术治疗的体会。方法 :回顾分析 1989年至 1998年针对不同临床病理特征分别采用肝门部切除 (A)、联合左肝叶切除 (B)、联合右肝叶切除 (C)、联合胰十二指肠切除 (D)和胆肠内引流 (E)等不同手术方法治疗的 5 8例肝门部胆管癌的治疗结果。结果 :本组病例总体手术切除率为 79.3% ,其中根治切除率StageⅠ、Ⅱ为 10 0 % ,StageⅢ为 6 5 .6 3% ,StageⅣa则为 0 (P<0 .0 5 ) ;不同病理类型的切除率 :乳头型和结节型 10 0 % ,硬化型 81.6 3% ,弥漫型为 0 ;BismuthⅢa、Ⅲb型 95 .2 4 % ,显著高于Ⅰ、Ⅱ、Ⅳ型 (P <0 .0 5 )。手术后总体 5年生存率为 18.97% ,其中StageⅠ 10 0 % ,StageⅡ 80 % ,StageⅢ 15 .6 3% ,StageⅣ则为 0。不同病例分型 :乳头型 5 0 % ,结节型 75 % ,硬化型 14 .2 9% ,弥漫型为 0 ;Bismuth分型Ⅰ型 0 ,Ⅱ型 0 ,Ⅲa型 4 6 .15 % ,Ⅲb型 6 2 .5 % ,Ⅳ型为 0。A、D、E与B、C术式间手术切除率、术后生存率差异有显著性意义 (P <0 .0 5 )。结论 :肝门部胆管癌手术治疗的结果主要与肿瘤的部位、病理类型、临床分期有关 ,联合切除能增加Ⅱ、Ⅲ期病人的手术切除率和根治切除率 ,如何提高术后的远期生存率尚待进一步研究。     

肝动脉化疗栓塞术治疗中晚期肝癌400例

目的　探讨肝动脉化疗栓塞术治疗中、晚期原发性肝癌的方法及疗效。方法　对4 0 0例不能手术切除的中、晚期原发性肝癌,经肝固有动脉或肝左、右动脉,注入超液化碘油抗癌药混悬剂,使用药物为超液化碘油10～30ml,表阿霉素4 0～80mg ,丝裂霉素10～2 0mg ,部分病例加用卡铂2 0 0～30 0mg或5 -FU 1g。35例加用0 5～1块明胶海绵剪成碎颗粒作为栓塞剂。结果　34例肿瘤明显缩小,于治疗后1～6个月行二期手术切除,全组1,2 ,3年生存率分别为4 9 8%、4 2 3%、2 3 5 %。15例生存超过5年,6例超过7年,2例超过8年。结论　介入方法治疗不能手术切除的中、晚期原发性肝癌疗效显著,部分患者可获得二期手术切除。     

原发性肝癌破裂出血48例治疗策略

目的:探讨原发性肝癌(HCC)破裂出血的治疗策略。方法:分析48例HCC破裂出血患者的诊治资料,其中1994年1月至1998年6月收治14例(A组),采用肝癌切除、姑息性手术(包括缝合止血、纱布填塞压迫止血、肝动脉结扎)及保守治疗;1998年7月至2007年12月收治36例(B组),采用肝癌切除、术后肝动脉介入栓塞化疗(TACE)、急诊肝动脉栓塞术(TAE)及保守治疗。结果:A组和B组1、3年生存率分别为21.5%(3/14)、0.0%(0/14)和61.8%(21/34)、17.6%(6/34),2组1年生存率差异有统计学意义(P0.05),3年生存率差异无统计学意义(P0.05)。A组中肝癌切除的4例1、3年生存率为3/4、0/4,B组中肝癌切除+TACE治疗的20例1、3年生存率为75.0%(15/20)、30%(6/20);A组中姑息性手术7例1、3年生存率为0/7、0/7,B组中急诊TAE/TACE治疗的10例1、3年生存率为50.0%(5/10)、0.0%(0/10);B组TACE+肝癌切除的2例中,有1例存活2年半。2组中保守治疗的7例,生存期均未超过6个月,1个月内病死2例。结论:HCC破裂出血根据病情选择性采取肝癌切除、介入治疗等个体化综合治疗,能提高HCC破裂出血的抢救成功机会,延长患者生存期,改善预后。     

中年人原发性肝癌的综合治疗体会

目的　分析总结中年人 (4 0～ 6 0岁 )原发性肝癌患者规范化综合治疗的意义。方法　随机选择中年肝癌患者 88例 ,其中行一期肝叶切除 2 3例 ,介入治疗 2 6例 (其中接受二期切除 8例 ) ,高强度聚集超声 (HIFU)治疗 19例 ,B超引导下无水酒精注射 17例 ,HIFU联合介入治疗 3例 ,全部患者配合免疫治疗和中药治疗。结果　肝切除患者 1,3,5年生存率分别为 79 5 % ,4 7 5 %和 36 1% ,介入治疗者 1,3,5年生存率分别为 4 9 8% ,2 2 4 %和4 5 % ,HIFU治疗的 1,3年生存率为 5 6 2 %和 33 8% ,无水酒精注射治疗组存活 5年以上者 3例 ,存活 3年以上者 5例。 2例 1年内死亡。 3例患者采用HIFU联合介入治疗的方法 ,至今存活。结论　以手术切除为主的规范化综合治疗对中年原发性肝癌患者有较好的疗效 ,是目前肝癌序贯治疗的合理手段     

原发性肝细胞癌86例行不规则切除疗效分析

目的 :评价不规则切除术治疗原发性肝细胞癌 ( PHCC)的疗效。方法 :行不规则切除术治疗 PHCC86例。结果 :全组手术死亡 1例 ,1、3年生存率为 6 5例 ( 75 .6 % ) ,5 3例 ( 6 1.6 % )。 <3cm、3～ 5 cm、>5 cm的 1、3年生存率分别为 18例 ( 90 .0 % ) ,16例 ( 80 .0 % ) ,2 1例 ( 75 .0 % ) ,19例 ( 6 7.9% ) ;2 5例 ( 6 5 .8% ) ,18例 ( 4 7.4 % )。单纯手术组和手术加行肝动脉灌注 ( HAI)和门静脉灌注组 ( PVI)的 1、3年生存率分别为 72 .1%、6 0 .7% ,84 .0 %、6 8.0 %。结论 :采用不规则切除术对机体创伤小 ,减少了术后并发症的发生 ,其临床疗效与规则性肝切除相仿。对大肝癌不要轻易放弃手术 ,术后辅助治疗有待改善     

130例肝癌手术中应用皮下埋入式输药装置的体会

目的 :提高肝癌的诊治水平。方法 :对 130例肝癌手术中放置皮下埋入式输药装置 (DDS)进行回顾性分析。结果 :一期肝切除后 1、3、5a生存率为 86 5 %、5 2 6 %、31 2 % ;无法一期切除而行化疗或放免治疗后 1、3、5a生存率为 5 2 3%、18 7%、0 ,其中 4例获二期切除。结论 :肝癌手术中应常规放置DDS ,术后经DDS进行化疗或放免治疗 ,可提高肝癌的疗效和生存率     

原发性支气管肺癌的外科治疗

目的　了解原发性肺癌的临床特点及外科治疗效果。方法　对 1987年 4月至 2 0 0 2年 6月 180 2例肺癌住院病例进行回顾性分析 ,并对其中 132 5例手术患者进行随访 ,统计 1987年 4月至 1997年 12月间接受肿瘤切除的6 39例患者的 5年生存率。结果　肺癌患者中 ,男性 14 6 8例 ( 81 5 % ) ,女性 334例 ( 18 5 % ) ,平均年龄 ( 5 5 0 0±10 6 6 )岁。鳞癌占 5 0 7% ,腺癌占 38 5 % ,其它占 10 8%。术后总的 5年生存率为 2 9 4 % ,其中Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅳ期患者的 5年生存率分别为 75 0 %、 5 1 1%、 33 3%、 2 8 0 %、 16 7% ,7 3% ,0 %。Ⅰa与Ⅰb期、Ⅱb与Ⅲa期、Ⅲa与Ⅲb期患者的 5年生存率有显著性差异。全肺切除的 5年生存率 ( 19 4 % )远远低于肺叶切除 ( 33 3% ) ,P <0 0 5。 5 0例支气管切缘癌残留患者的 5年生存率 ( 12 0 % )远远低于切缘无癌残留者 ( 30 9% ) ,P <0 0 5。结论　TNM分期、手术方式、支气管切缘是否有癌组织残留是影响术后生存率的重要因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.