不同部位自体角膜缘干细胞移植治疗翼状胬肉的临床对比研究

目的观察翼状胬肉切除联合自体不同部位角膜缘干细胞移植治疗原发性翼状胬肉的疗效。方法将原发性翼状胬肉患者51例(62眼)随机分成A、B两组。A组行胬肉切除联合自体上方角膜缘干细胞移植辅助丝裂霉素C治疗。B组行胬肉切除联合自体下方角膜缘干细胞移植辅助丝裂霉素C治疗。观察比较两组患者术眼不适症状持续时间、角膜上皮愈合时间以及翼状胬肉复发情况。结果两组术后不适症状持续时间差异有统计学意义(P<0.05),角膜上皮愈合时间差异无统计学意义(P>0.05),翼状胬肉复发率差异无统计学意义(P>0.05)。结论下方角膜缘干细胞移植治疗原发性翼状胬肉可取得与上方角膜缘干细胞移植相同的效果,且术后异物感持续时间较短。     

翼状胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉疗效观察

选取初发性翼状胬肉患者317例(320眼),随机分为实验组与对照组,实验组209例(210眼),行翼状胬肉切除加自体角膜缘干细胞移植术;对照组108例(110眼),行单纯翼状胬肉切除加巩膜暴露治疗法.结果 显示,随访10～16个月,实验组所有病例移植片均成活,复发17眼(8.1%),对照组复发28眼(25.9%),两组有明显差异(P<0.01).认为翼状胬肉切除加自体角膜缘干细胞移植是一种治疗翼状胬肉有效的手术方法.     

手术切除联合自体角膜缘干细胞移植治疗翼状胬肉疗效观察

目的观察手术切除联合自体角膜缘干细胞移植术治疗翼状胬肉的效果翼。方法选取翼状胬肉患者21例,采用翼状胬肉切除联合自体角膜缘干细胞移植术治疗。结果术后视力提高2行以上者4例,余视力无变化。术后随访7～20个月,翼状胬肉无复发。结论翼状胬肉切除自体角膜缘干细胞移植是治疗翼状胬肉的一种有效方法。     

翼状胬肉逆行切除加自体角膜缘上皮干细胞移植术疗效观察

翼状胬肉是眼科常见病及多发病，目前治疗仍以手术切除为主，但单纯手术切除复发率高。随着角膜干细胞理论的提出，目前已有用自体角膜缘上皮移植术治疗胬肉的临床报道[1]。2000年3月至2002年11月，我们采用逆行切除加自体角膜缘上皮干细胞移植术治疗60例翼状胬肉(75只眼)，取得满意效果，现报告如下。     

翼状胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的效果观察

目的观察基层医院开展翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉的临床疗效。方法对该院收治的66例（80眼）翼状胬肉患者随机分为观察组34例（40眼）和对照组32例（40眼）。观察组行翼状胬肉切除联合自体角膜缘干细胞移植术,对照组行单纯翼状胬肉切除,比较两种手术方式的治愈率。结果通过对观察组和对照组患者术后疗效比较和随访,观察组治愈率（92．5％）明显高于对照组（67．5％）（P〈0．05）。结论翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉效果明显,复发率低,适合基层医院开展。     

不同术式羊膜移植治疗翼状胬肉的临床效果探讨

目的探讨不同术式羊膜移植治疗翼状胬肉的临床效果。方法收集2016-02～2017-03该院收治的150例150眼翼状胬肉患者资料,随机分为观察组和对照组,各75例(眼)。观察组的手术方式为翼状胬肉切除+新羊膜移植术,对照组的手术方式为翼状胬肉切除+常规羊膜移植术。观察两组患者术后临床治疗效果及术后复发情况。结果两组患者术后未复发患者在术后10 d角膜上皮完全愈合,结膜切口愈合良好。经1年随访,观察组和对照组的治愈率分别为94. 7%、70. 7%,复发率分别为6. 7%、13. 3%。两组间比较差异有统计学意义(P 0. 05)。结论采用羊膜移植法治疗翼状胬肉,可保护患者自身结膜完整性、减少损伤、有效提高手术成功率,其中新羊膜移植术操作简便,可推广应用。     

带自体角膜缘干细胞结膜瓣移植治疗翼状胬肉257例临床分析

目的 探讨自体角膜缘干细胞移植治疗翼状胬肉的方法及其疗效.方法 257例翼状胬肉患者,均在手术显微镜下行胬肉切除及自体角膜缘干细胞移植术,术后随访3～27个月,分析临床疗效.结果 本组病例均一次性成功,平均随访1.2 a,均未见复发,亦无并发症发生.结论 自体角膜缘干细胞移植是治疗翼状胬肉的有效方法.     

老年翼状胬肉切除自体角膜缘干细胞移植术后应用软性角膜接触镜的效果

目的探讨软性角膜接触镜治疗老年翼状胬肉切除自体角膜缘干细胞移植术后的临床疗效及安全性。方法按照随机数字表法将93例原发性老年单侧翼状胬肉患者分为观察组(n=47)和对照组(n=46),两组均行翼状胬肉切除联合自体角膜缘干细胞移植手术,观察组术后佩戴治疗性软性角膜接触镜,对照组术后通过绷带对患眼进行加压包扎。记录两组术后第1、3、5、7天的视觉模拟评分(VAS)、角膜上皮修复时间、术后并发症情况以及随访6个月时的复发率。结果术后第3、5、7天,两组VAS评分均低于术后第1天,且观察组低于对照组(P<0.05);观察组角膜上皮修复时间少于对照组,角膜刺激症状发生率低于对照组(均P<0.05);随访6个月时,两组翼状胬肉复发率比较无统计学差异(P>0.05)。结论软性角膜接触镜能有效减轻老年患者翼状胬肉切除自体角膜缘干细胞移植术后的疼痛,且有利于角膜上皮的恢复,安全性高,预后较好。     

翼状胬肉切除及角膜缘干细胞移植术后复发原因分析

目的探讨新型的手术方法翼状胬肉切除及角膜缘干细胞移植术术后复发原因。方法对2003-05～2008-05在我院住院的翼状胬肉患者,265例(356只眼)局麻下施行翼状胬肉切除+角膜缘干细胞移植术术后复发情况进行观察。结果术后观察6～12个月,术后复发有26例(26只眼),复发率为7.3%。结论复发原因主要是与手术医师的手术熟练程度、患眼的病变程度、术前患眼的炎症控制情况及感染等因素有关。     

自体角膜缘上皮移植治疗翼状胬肉疗效分析

近年来, 我们采取翼状胬肉钝性分离切除+角膜缘上皮干细胞移植治疗翼状胬肉患者10例,效果良好.     

Analysis of Recurrence Patterns Following Pterygium Surgery With Conjunctival Autografts

The aim of this article is to evaluate and classify pathogenetic origins based on morphologic reproliferative patterns in patients who underwent pterygium excision with a conjunctival autograft.In this retrospective, observational case series, a total of 116 eyes of 116 patients with pterygium who underwent pterygium excision with a conjunctival autograft between February 2009 and May 2011 were reviewed. Using consecutively recorded photographs, we evaluated preoperative morphologic severity, postoperative complications, recurrences, and growth patterns.The regrowth of fibrovascular tissue was observed in 14 of our study cases (12.1%). Of these, 5 cases (4.3%) showed clinically significant recurrences. We observed 3 different morphologic patterns of recurrence: regrowth over the epithelial defect; transformation of the conjunctival graft into the pterygial tissue; and regrowth from unexcised pterygial tissue. Each recurrence pattern showed characteristic fibrovascular growth, the origin of this regrowth, and grade of severity. In 25 cases (21.6%), postoperative complications were observed. Of the analyzed variables, age <40 years (P = 0.019; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.34–25.28) and the presence of postoperative complications (P = 0.008; OR, 6.32; 95% CI, 1.62–24.58) were statistically significant in multivariate analyses using logistic regression.The use of conjunctival autografts for pterygium surgery is effective, but recurrences are observed in some cases exhibiting unique pathogenic patterns according to their origin. A complete understanding of the pathogenesis of these lesions based on their morphologic regrowth pattern will help to prevent recurrences in patients who undergo pterygium surgery.     

原发性颈淋巴结结核的治疗体会及Elispot技术的诊断价值

目的 探讨原发性颈淋巴结结核的各种治疗方法的优缺点及评价酶联免疫斑点(Elispot)检测外周血中结核分枝杆菌性抗原特异性γ一干扰素水平在颈淋巴结结核中的诊断价值.方法 回顾分析89例原发性颈淋巴结结核患者的临床资料,30例(A组)采用内科治疗(化疗l～1.5年),28例(B组)行肿块全部切除加区域性颈淋巴结清扫术,16例(C组)行淋巴结结核病灶切除术,15例(D组)行病灶切开刮除、开放引流术,所有手术患者术后均化疗1年.用Elispot技术对患者外周血中产生结核菌抗原特异性γ一干扰素的水平进行定量检测,同时检测患者的结核抗体.结果 A组中22例肿块继续增大并增多(73.3%),其中9例形成脓肿破溃;B组无一例复发;C组5例复发(31.3%);D组3例形成结核性窦道,4例再发淋巴结肿块(46.7%);保守治疗和手术治疗复发率比较有明显统计学差异(χ2=9.69,P<0.01),保守治疗复发率明显升高;三种手术方式复发率比较也有明显统计学差异(χ2=14.47,P<0.01),此4组患者手术愈合时间有统计学差异(F=104.44,P<0.01),B组患者手术愈合时间最短.复发率最低;Elispot、结核抗体检测患者的阳性率分别是87.6%、62.9%(χ2=14.61,P<0.01).结论 原发性颈淋巴结结核的治疗应以手术为主, 手术治疗能缩短治疗时间,减少药物用量及不良反应,能明显提高治愈率.降低复发率,而手术方式首选肿块伞部切除加区域性颈淋巴结清扫术;Elispot技术优于结核抗体,可用于颈淋巴结结核的辅助诊断.     

Prevention of hepatitis B virus recurrence after liver transplantation in cirrhotic patients treated with lamivudine and passive immunoprophylaxis

BACKGROUND/AIMS: Treatment with hepatitis B virus immune globulins (HBIG) or lamivudine has reduced the rate of hepatitis B recurrence after liver transplantation to approximately 50%. METHODS: To further decrease hepatitis B recurrence, 33 hepatitis B virus (HBV)-related cirrhotic patients were treated with lamivudine before liver transplantation and with lamivudine together with low-dose HBIG (46 500 IU the first month followed by 5,000 lU/monthly) after surgery. RESULTS: While on lamivudine, serum HBV DNA level decreased significantly in all patients and in 11 (33%) the Child-Pugh score improved. Twenty-six patients were transplanted. Among the 25 who survived for longer than 12 months, only one (4%) experienced a hepatitis B recurrence over an average follow-up of 31 months, a rate significantly lower (P = 0.0002) than the 50% recurrence rate among a historical control group of 12 patients. However, low-level HBV replication was detected sporadically throughout the follow-up in 64% of patients. CONCLUSIONS: Over the medium-term, combined prophylaxis with lamivudine and HBIG significantly decreases the risk of hepatitis B recurrence after liver transplantation. Though low-level HBV infection recurred in two thirds of patients, the pathogenic expression of HBV was prevented.     

The dismal outcome in patients with acute leukaemia who relapse after an autograft is improved if a second autograft or a matched allograft is performed. Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

All patients receiving autografts for acute leukaemia in remission between 1 January 1981 and 31 December 1996 and reported to the European Group for Blood and Marrow Transplantation and had a relapse, were included. The patients underwent an allograft (n = 90, group A), were treated with chemotherapy (n = 2584, group B) or received a second autograft (n = 74, group C). The 2-year survival after relapse was 32 +/- 5%, 11 +/- 1% and 42 +/- 6% in groups A, B and C, respectively. In group A, those with an HLA-A, -B and -DR compatible related or unrelated donor had a 2-year survival of 37 +/- 7% compared to 13 +/- 8% for those receiving a graft from an HLA mismatched donor (n = 20). The following factors were associated with better survival in multivariate analyses: an interval from first autograft to relapse >5 months (P < 0.00001), a first autograft performed later than 1991 (P < 0.00001), patient age below 26 years (median, P < 0.002), group B vs HLA mismatches from group A (P = 0.002), group C vs group B (P < 0.005), patients who were not treated with total body irradiation at first autograft (P < 0.02) and patients in first remission at first autograft (P = 0.02). To conclude, the poor outcome in these patients was improved if a second autograft was feasible (P < 0.005), or if an HLA-matched allograft was performed (NS). Bone Marrow Transplantation (2000).     

Conventional versus on-demand therapy for duodenal ulcer: results of a controlled therapeutic trial

To compare the efficacy of conventional versus on-demand (symptomatic) treatment of duodenal ulcer, 81 patients were randomized into two groups. Group A (n = 40) patients were treated with ranitidine 150 mg twice daily until complete ulcer healing was achieved. Group B (n = 41) received a similar dose of ranitidine until complete relief of pain was achieved, irrespective of ulcer healing. Recurrence of ulcer in group A was treated with a full course of treatment until complete healing of the ulcer was achieved again, whereas, in group B, treatment was given only until pain recurrence was symptomatically controlled. Endoscopic examination was performed each month. Analysis of the results at 8 wk and 28 wk showed that 1) ulcer healing in group A was significantly superior to that in group B up to 24 wk, but at 28 wk the difference was no longer statistically significant (95% vs 70%), 2) the number of painful days were similar in the two groups, 3) group A patients took treatment for a significantly longer period than those in group B, 4) the cost of treatment per patient in group A was significantly greater than that in group B, 5) the recurrence rate assessed in patients followed for 28 wk after complete ulcer healing was similar in the two groups, and 6) the ulcer-related complications were not significantly different in the two groups. These findings indicate that, although on-demand treatment results in slower ulcer healing, it is not associated with an increase in the duration of pain and incidence of complications. A major advantage of this approach was a significant reduction in the cost of treatment. It is concluded that on-demand treatment is an attractive alternative therapeutic approach in the management of duodenal ulcer disease.     

乙型肝炎相关性肝移植后乙型肝炎复发的临床特点分析

目的 总结和探讨乙型肝炎相关性终末期肝病患者在肝移植术后乙型肝炎复发的临床特点.方法 回顾性分析2005年4月至2010年4月期间的253例乙型肝炎相关性肝移植患者的术后随访资料.结果 253例肝移植患者中乙型肝炎复发16例,复发率6.32%(16/253),中位复发时间为术后13个月,术后1、3、5年的累积复发率分别...     

Is postoperative radiotherapy useful for the rectal carcinoma in the era of total mesorectal excision?

BACKGROUND/AIMS: The exact role of postoperative radiotherapy following curative surgery of rectal carcinoma has been debated. In this retrospective study, we examined the effect of radiotherapy on the survival and recurrence rate of rectal cancer patients who underwent total mesorectal excision. METHODOLOGY: Since June 1994, stage II and III rectal cancer patients have been recommended to receive postoperative chemoradiation. Among 175 consecutive patients who had undergone total mesorectal excision, 120 completed postoperative chemoradiation (group A) and 55 patients declined to receive radiation therapy (group B). For the two groups, survival and recurrence rates were compared. Mean follow-up time was 24.7 months. There was no difference between two groups with regard to sex, mean age, stage of the disease, mean tumor height, type of operation and mean follow-up duration. RESULTS: Overall recurrence rate showed no difference between the two groups (24.0% vs. 25.0%, P = 0.28). Local recurrence rate was also similar (10.0% vs. 6.0%, P = 0.11). There was no significant difference in duration to initial recurrence (14.0 months vs. 11.0 months, P = 0.18). The 5-year disease-free survival was 57% in group A and 63% in group B (P = 0.33). Disease-free survival in stage II was significantly better than in stage III. (78% vs. 42% overall, 70% vs. 37% in group A, 92% vs. 44% for group B, P < 0.01). CONCLUSIONS: In this study, we found no beneficial effect of postoperative radiation therapy following total mesorectal excision for the rectal cancer. So far, the prognosis was critically dependent on the stage rather than presence or absence of radiotherapy after total mesorectal excision.     

典必殊对翼状胬肉老年患者手术后疗效的观察

目的观察典必殊对翼状胬肉老年患者术后治疗的效果。方法对90例翼状胬肉老年患者采用改良单纯翼状胬肉切除术＋带蒂结膜瓣转位术，手术后患者随机采用典必殊眼膏点眼或金霉素眼膏点眼。裂隙灯下观察角膜上皮完全愈合后，均改为局部点用典必殊眼液，前3d为6次／d，拆线后改为4次／d，渐减。观察2组患者的临床症状和体征。结果术后应用典必殊眼膏的舒适度及局部反应均明显好于金霉素眼膏组。结论及时足量应用皮质类固醇激素可以有效降低翼状胬肉复发率。因此典必殊可作为翼状胬肉术后的常规用药。     

Effects of killing Helicobacter pyloriquadruple therapy on peptic ulcer： A randomized double-blind clinical trial

AIM: To study the therapeutic efficacy of a Chinese and Western integrated regimen, killing Helicobacter pylori quadruple therapy on H pylori-associated peptic ulcers (PU). METHODS: With prospective and double-blind controlled method, seventy-five active PU patients with H pylori infection were randomized to receive one of the following three regimens: (1) new triple therapy (group A: lansoprazole 30 mg qd, plus clarithromycin 250 mg bid, plus amoxycillin 500 mg tid, each for 10 d); (2) killing Hp quadruple therapy(group B: the three above drugs plus killing H pylori capsule 6 capsules bid for 4 wk) and (3) placebo(group C: gastropine 3 tablets bid for 4 wk). H pylori eradication and ulcer healing quality were evaluated under an endoscope 4 wk after treatment. The patients were followed up for 5 years. RESULTS: Both the healing rate of PU and H pylori eradication rate in group B were significantly higher than those in group C (100% and 96.4% vs20% and 0%, respectively,P<0.005), but there was no significant difference compared to those in group A (88% and 92%, P>0.05). The healing quality of ulcer in group B was superior to that in groups C and A (P<0.05). The recurrence rate of PU in group B (4%) was lower than that in group A (10%) and group C (100%,P<0.01). CONCLUSION: Killing Helicobacter pylori quadruple therapy can not only promote the eradication of H pylori and healing quality of ulcer but also reduce recurrence rate of ulcer.