射频消融联合经导管肝动脉化疗栓塞治疗不能切除的原发性肝癌

Background Radiofrequency ablation （RFA） followed by transarterial chemoembolization （TACE） for unresectable primary liver cancer （PLC） has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated. Methods From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4＋8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small （〈3.0 cm）, 33 with medium （3.1-5.0 cm）, and 68 with large （〉5.0 cm） tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later. Results Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 （13.5%） cases, by laparoscopic approach in 19 （15.7%）, and through laparotomy in the remaining 92 （72.4%）. RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model. Conclusion RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicatinq the peripheral viable tissue and micro-metastasis.     

65岁及以上老年肝脏肿瘤患者个体化射频消融治疗经验总结

随着社会老龄化,65岁以上老年肝脏肿瘤患者亦逐渐增多,此类疾病的治疗很大程度上取决于患者的总体状况。在某些有合并症的老年患者中,行肝癌根治性切除手术及肝移植并不适合 [1] ,射频治疗为这些不适合立即行肝脏根治性肿瘤切除术的患者提供了一种替代治疗方法,并于2009年被美国国立综合癌症网络肝癌治疗指南列为肿瘤根治性治疗方法之一,具有疗效确切、局部创伤小等优点。     

胆囊结石 胆囊切与保的权衡

胆囊结石是我国的一种常见病、多发病。由于可引起胆绞痛、急性胆囊炎等合并症,因此对于胆囊结石一般需要积极治疗。关于胆囊结石切除胆囊和去除结石保留胆囊的两种治疗方法,人们已经争论了100余年。     

基于临床决策思维模式的PBL与CBL相结合的教学课程设计

根据原发性肝癌诊疗过程中临床决策思维模式（clinical decision thinking mode, CDTM），为住院医师规范化培训设计以问题为基础的学习（problem-based learning, PBL）与以案例为基础的学习（case-based learning, CBL）相结合的教学课程。肝癌治疗方法选择的CDTM是多方案择优，其临床决策规则包含决策条件、行动方案和决策树。针对临床决策规则的理论学习适于设计PBL教学，而对于临床决策实践则适于设计CBL教学。PBL与BCL相结合的教学，有利于住院医生循序渐进地提高临床决策思维能力。     

胆囊息肉手术需谨慎选择

胆囊息肉在健康人群中极其多见,其中有很小一部分患者因发生癌变需要手术。然而仅根据胆囊息肉的大小这一简单的指标作为手术与否的界限,对有些患者似乎有过度治疗的倾向。     

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通常临床上所称胆囊息肉,实际上是指胆囊息肉样病变(polypoid lesion of gallbladder,PLG)。这一概念在50年前由Jones提出而沿用至今[1-2]。PLG应该如何治疗,一直存在一些争论或分歧。随着腹腔镜微创技术的发展,腹腔镜胆囊切除术(LC)的病例数急剧增长。在LC开始应用的最初几年,     

长-鞍团体智力测验北方中学生常模的编制

目的：建立长—鞍团体智力测验(C-AITG)北方中学生常模，检验它的测量学特征。方法：在东北三省和内蒙古、河北、北京、天津部分地区采样，共收集3700例有效样本，按照年级和年龄分组，年级分六组(初一—高三)，年龄分七组(12岁～18岁)。结果：常模包括分测验的原始分、量表分、总智商。信度和效度均达到了测量学要求，因素分析结果表明，量表结构模型比较理想。结论：C-AITG可以在北方中学生人群中使用。     

老年患者腹腔镜胆总管探查一期缝合与T管引流的临床疗效分析

目的:比较老年胆囊结石合并胆总管结石患者行腹腔镜胆总管探查一期缝合与T管引流术的临床疗效,总结临床经验。方法:回顾分析2012年8月至2016年8月为115例胆囊结石合并胆总管结石老年患者(≥65岁)行腹腔镜联合胆道镜胆总管探查的手术资料与随访资料,其中一期缝合63例(缝合组),T管引流52例(T管组)。结果:115例手术均顺利完成,无一例中转开腹。两组术中出血量、引流管拔除时间、残余结石发生率差异均无统计学意义(P>0.05),缝合组手术时间、术后镇痛药物使用率、术后住院时间低于T管组(P<0.05),但术后胆漏发生率高于T管组(P<0.05)。结论:与T管引流相比,腹腔镜一期缝合治疗老年胆总管结石患者具有更好的临床疗效。在严格把握手术适应证、确保结石取净、镜下精细缝合的前提下,可作为老年胆总管结石患者优先选择的术式。