肠系膜上静脉血栓形成临床特点及预后相关因素分析

目的 探讨肠系膜上静脉血栓形成（SWVT）临床特征、诊治方法,研究预后相关因素。方法 回顾性分析华北理工大学附属医院2005~2015年40例肠系膜上静脉血栓形成患者临床资料。结果 主要症状有腹痛、腹胀、发热及呕吐等。40例患者中,29例行单纯抗凝治疗,11例行手术治疗,6例患者30天内死亡。与30天生存率相关的因素为肠切除和确诊前持续时间。结论 该疾病症状不典型,增强CT对诊断具有重要意义,抗凝为基础,保守治疗无效时手术治疗为主要治疗手段,肠切除和确诊前持续时间是影响SMVT 30天生存率相关因素。     

原发小肠间质瘤的预后影响因素分析

目的 探讨影响原发小肠间质瘤的预后影响因素.方法 回顾性分析中国医学科学院肿瘤医院1989 ～ 2009年经病理证实的100例原发小肠间质瘤的临床资料,统计学分析其预后的影响因素.结果 病例总计100例,包括男53例,女47例.其中行根治性手术85例,姑息性手术15例,总的5年生存率为77.6％;5年无病生存率为52.4％.单因素分析影响小肠间质瘤预后的因素包括:肿瘤的大小、核分裂象、Ki -67指数、R0切除、与周围组织粘连、凝固坏死;多因素分析影响小肠间质瘤预后的因素是:R0切除.结论 外科根治性切除是原发小肠间质瘤的主要治疗方法,对于Fletcher中危及以上患者,应考虑辅助靶向治疗.     

消化道内异物手术取出30例分析

目的提高对消化道内异物手术治疗指证的认识。方法回顾分析30例消化道内异物患者的治疗过程和转归。结果术中发现异物在胃内3例,十二指肠内2例,小肠内21例,右半结肠2例,左半结肠2例,并发小肠穿孔1例。十二指肠内异物均送入胃内取出,右半结肠异物推送至小肠内取出,左半结肠异物均推送入直肠由肛门取出。胃内异物切开胃壁取出,小肠内异物切开肠壁取出,30例患者住院7～15d痊愈出院。结论横径大于2.0 cm或长度超过9.0 cm的消化道异物和异物停留消化道内7d以上、出现并发症及自我症状严重的患者需手术取出。     

先天性巨结肠合并小肠结肠炎的临床分析

目的探讨先天性巨结肠(hirschsprung's disease,HD)合并小肠结肠炎(enterocolitis EC)的临床特点、治疗方法及预防措施.方法回顾性分析1993年4月-2012年4月我院收治的82例先天性巨结肠中21例合并小肠结肠炎的临床资料.结果合并小肠结肠炎21例中术前并发小肠结肠炎18例,术后并发小肠结肠炎3例;8例行结肠造口术,7例痊愈,1例死亡;13例未造口患儿,均保守治疗,11例痊愈,2例死亡.造口与未造口者生存率差异无统计学意义(P=0.225).结论结肠灌洗及结肠造口术是治疗小肠结肠炎的有效方法.术前发生小肠结肠炎与手术时间间隔是术后发生小肠结肠炎的重要因素.     

消化道内异物手术取出30例分析

目的提高对消化道内异物手术治疗指证的认识。方法回顾分析30例消化道内异物患者的治疗过程和转归。结果术中发现异物在胃内3例,十二指肠内2例,小肠内21例,右半结肠2例,左半结肠2例,并发小肠穿孔1例。十二指肠内异物均送入胃内取出,右半结肠异物推送至小肠内取出,左半结肠异物均推送入直肠由肛门取出。胃内异物切开胃壁取出,小肠内异物切开肠壁取出,30例患者住院7～15d痊愈出院。结论横径大于2.0 cm或长度超过9.0 cm的消化道异物和异物停留消化道内7d以上、出现并发症及自我症状严重的患者需手术取出。     

犬小肠缺血再灌注后NO、SOD的改变和肾脏c-Fos、bax、bcl-2的表达

目的　研究小肠缺血再灌注后NO、SOD的变化和肾组织的c Fos,bax ,bcl 2表达 ,探讨小肠缺血再灌注后对肾脏的损伤。方法　结扎犬肠系膜上动脉 30min再灌注 ,建立犬小肠缺血再灌注模型 ,测定结扎前和再灌注 0、30、6 0min ,1、4、7d血中NO和SOD的变化 ,用免疫组织化学方法探讨小肠缺血再灌注 0、30、6 0min ,1、4、7d及对照组的肾脏组织c Fos,bax ,bcl 2蛋白的表达特点。结果　小肠缺血再灌注后 ,NO逐渐升高 ,但第 4天低 ,结扎前与除 0min外的其他组比差异有显著性 (P <0 0 1) ;SOD各时间点都明显升高 (P <0 0 1) ;肾脏组织中的c Fos表达十分明显 (P <0 0 1) ;bax的表达逐渐升高 ,30min以后开始差异有显著性 (P <0 0 1) ;bcl 2在 0min不表达 ,30min后差异才有显著性 (P <0 0 1)。结论　小肠缺血再灌注后自由基等的变化可引起肾脏组织的c Fos ,bax ,bcl 2表达的变化 ,从而引起远隔器官肾的损伤趋势。     

新生儿小肠、结肠的长度测量及相关

本文解剖了33例未经固定新生儿尸体,测量了肠管长度。小肠长X272.62±61.06(165.0383.6)cm;十二指肠长X5.68±1.35(2.7～9.0)Cm;结肠长X44.0±6.59(28.5～59.0)cm。按测得长度分类:小肠长度,200cm以下5例,出现率15.15％,201～300cm18例,出现率为54.54％,301～400cm10例,出现率为30.30,400cm以上者为零;结肠长度,30cm以下者1例,出现率为3.03％,30.1～40cm10例,出现率为30.30％,40.1～50cm15例,出现率为45.46％,50.1cm以上者7例,出现率21.21％。本文利用新生儿小肠与结肠长度自身比例叠加,探讨了小肠与结肠长度间的比值。进行小肠长度与结肠间的相关分析,γ=0.7759,p<0.0005;回归分析tb=6.848,p<0.0005。利用结肠长度推算小肠长度的回归方程y=7.183x-44.14±39.14。初步探讨新生儿肠管与成人营管间的关系及生长发育状况。     

维持性血液透析患者静脉导管相关血流感染的影响因素分析

目的:探讨维持性血液透析患者静脉导管相关血流感染的影响因素。方法:选择2019年12月至2020年12月在浙江省中西医结合医院行维持性血液透析患者532例的临床资料进行回顾性分析。记录患者的一般资料及临床资料,单因素及多因素分析维持性血液透析患者静脉导管相关血流感染的影响因素。结果:(1)单因素分析结果显示,穿刺次数>2次、颈内静脉置管、留置时间≥30d、有合并症、血清白蛋白<35 g/L、尿素氮≥21.4mmol/L、血肌酐≥451μmol/L、白细胞计数≥10×109/L的患者感染发生率更高(P<0.001,P<0.05);感染组患者的平均年龄显著高于未感染组(P<0.001)。(2)多因素分析结果显示,患者年龄>60岁、穿刺次数>2次、留置时间≥30d、有合并症是维持性血液透析患者静脉导管相关血流感染的独立危险因素(P<0.001),而血清白蛋白≥30 g/L是保护因素(P<0.001)。结论:维持性血液透析患者静脉导管相关血流感染高危因素包括年龄>60岁、穿刺次数>2次、留置时间≥30d、有合并症等,而患者血清白蛋白≥30 g/L是保护因素。临床上对于存在高危因素的患者应提高警惕,预防静脉导管相关血流感染的发生;同时,应提高穿刺技术,减少穿刺次数。     

糖尿病肾病维持性血液透析长期生存率及其相关因素分析

目的本文对患有糖尿病肾病应用维持性血液透析进行治疗的患者的长期生存率与相关的因素进行分析讨论。方法选取本院2005年—2016年应用维持性血液透析方法治疗糖尿病肾病的患者共计100例,对患者的一般情况、治疗情况与效果等情况进行统计学分析。结果患有糖尿病肾病的患者中老年所占比例较高,他们有较高的心脑血管发病风险,死亡率较高。影响患者长期生存率的因素有并发症的发生、感染等。结论由于糖尿病肾病患者年龄较大人数所占比例高,因此心脑血管并发症发生的风险就很大,患者的1年、3年、5年、10年生存率为:83%、66%、43%和30%。患者近期与远期死亡率发生的原因是:患者并发症的发生所导致的感染等。影响患者长期生存率的因素还有:患者治疗疾病的岁数、并发症发生情况、体重指数、透析情况等。     

探讨胃肠道间质瘤的病理诊断、外科治疗预后相关因素

目的探讨胃肠道间质瘤的病理诊断、外科治疗预后相关因素。方法选取本院52例胃肠道间质瘤患者临床资料进行回顾性分析。结果 52例患者经复查后均得到确诊,其中胃30例,小肠10例,肠系膜3例,结肠3例,食管2例,直肠4例;主要临床表现为腹部隐痛、贫血、呕血、黑便等;所有患者行手术切除治疗,部分行放疗及化疗。结论胃肠道间质瘤的诊断需要结合患者的临床特征表现及各项检查进行,而治疗胃肠道间质瘤的首选方法就是外科手术,其预后主要受到肿瘤性质、年龄、肿瘤最大径及完全切除等因素的影响。     

Aspects of survival from colorectal cancer in Denmark

This thesis has reported survival among Danish colorectal cancer patients over the past decades and it has explored different aspects of the inferior short-term and long-term survival of Danish patients in relation to (i) patient factors: old age and comorbidity; (ii) disease factors: prognostic factors for early death after emergency surgery; (iii) diagnostic factors: impact of diagnostic delay; (iv) treatment factors: seasonal variation in postoperative mortality and the benefit of a new approach for management of obstructive cancer; and (v) structural factors: hospital volume and surgeon characteristics. Short-term survival. For colonic cancer, the 30-day relative survival rose from 86% in 1977-1982 to 90% in 1995-1999, and for rectal cancer it rose from 90% to 94% (I). Data from regional hospital discharge registries show that the overall 30-day mortality rates of colonic and rectal cancer remained stable at about 11% and 4-5%, respectively, during 1985-2004 (II). Stratifying for urgency of surgery, but not for tumour site, the 30-day mortality rate was 6.2% after elective surgery and 22.1% after emergency surgery in the period 2001-2008 according to DCCG data (17). Nevertheless, the 30-day mortality was about twice as high in Denmark as in Norway, Sweden and Scotland, even if the data for these countries are older than the Danish data. Mortality rates after palliative surgery are three times higher than the rates following curative surgery (115). The stage distribution at the time of diagnosis is more unfavourable in Denmark than in the other Nordic countries (114). Comparison of survival among countries is, however, encumbered by several methodological issues related to completeness, and data quality of cancer registries, among others, biases the survival estimates. Like most western populations, the Danish population is ageing and the proportion of elderly colorectal cancer patients aged >75 years has therefore risen from 37% in 1977-1982 to 42% in 1995-1999 (III). Disparity in cancer treatment between elderly and younger patients exists on a number of counts, e.g., the former's curative resection rate is lower, their emergency presentation rate is higher and they are moreover more likely to present with later-stage disease than are younger patients. However, in Denmark the curative resection rate among elderly patients aged >75 years rose from 36% in 1977-1982 to 49% in 1995-1999 (III). This trend was paralleled by an increase in 30-day and 6-month relative survival. Patients aged >70 years have a 30-day mortality rate of 13.1%, but their younger counterparts' mortality rate is only 3.5% (17). A mortality rate at least two to three times higher among the elderly than among younger patients has been reported repeatedly in various populations (95,96,116,127,128,130,131,135,136,144,145). In Denmark there is an inverse relationship between the comorbidity level and the resection rate in colorectal cancer. In the period 1995-2006, surgical treatment of patients with colonic cancer and severe comorbidity became progressively more aggressive, whereas surgical treatment of patients with rectal cancer apparently became more cautious or differentiated (VI). Nevertheless, the overall 30-day mortality rate after resectional surgery remained stable at about 8% in colonic cancer and at about 6% in rectal cancer. Almost every fourth patient had severe comorbidity as determined by an ASA of III or more and their 30-day mortality rate was at least 18% in 2001-2008. Any reduction in their short-term mortality will therefore have a substantial impact on the overall mortality rate. Despite the impact of comorbidity on postoperative mortality, the distinct seasonal variation seen in mortality from cardiovascular and respiratory diseases, with excess mortality in the winter months, has not been observed in postoperative mortality from colorectal cancer (VII). Postoperative mortality from colonic cancer was non-significantly higher in July than in other months of the year (VII). Evidence reveals a volume-outcome relationship regarding postoperative mortality in colonic cancer (IV) and the most recent literature suggests that it probably also is so in rectal cancer. However, volume may be a surrogate marker or proxy for other important structural factors such as quality and capacity of intensive care units, the availability of other clinical services like cardiac care units, multiple medical specialties, multidisciplinary infrastructure and nurse staffing, etc. Postoperative mortality after emergency surgery for colonic cancer was as high as 22% in 2001-2005 and mortality was significantly associated with the postoperative course. Patients developing medical complications had a mortality rate of 57.8%. Independent risk factors for death within 30 days after surgery were age ≥ 71 years, male gender, ASA grade ≥ III, palliative outcome, free or iatrogenic tumour perforation, splenectomy, intraoperative surgical adverse events and postoperative medical complications (VIII). SEMS placement performed on the indication acute bowel obstruction in patients with potentially curable disease can be accomplished with high technical and clinical success rates. The perforation rate, however, may reach 12%. Even so, the mortality rate within 30 days after a SEMS attempt and later surgery may, irrespective of its timing, by very low (3%) relative to the mortality seen after emergency surgery (IX). Long-term survival. The 5-year relative survival improved by 9% for both colonic and rectal cancer from 1977-1982 to 1995-1999 (I). Further improvement has been observed and in 2004-2006, the 5-year relative survival from colonic cancer was 52% (95% CI 51-54) for men and 57% (95% CI 55-58) for women. For rectal cancer the corresponding percentages were 55% (95% CI 53-57) and 57% (95% CI 55-59) (202). Overall, from 1977 until 2006, 1-year and 5-year survival increased almost 0.5-1% annually. Long-term survival has improved more in rectal cancer than in colonic cancer and survival from rectal cancer surpassed that of colonic cancer in the 2000s (202,204). Elderly patients aged >75 years experienced a marked 13-16% increase in relative survival from 1977-1982 to 1995-1999, i.e., a period during which the rate of curative surgery increased pronouncedly among the elderly (III). The survival improvement among their younger counterparts in that period only reached 7%. Mortality from colorectal cancer was only excessive in the elderly during the first two years after surgery. In 1995-2006, about 30-43% of colorectal cancer patients had moderate and severe comorbidity as determined by a Charlson Comorbidity score of 1-2 and 3+, respectively. These comorbid patients had a long-term survival inferior to that of patients with no comorbidity. In colonic cancer, the 5-year survival in 1998-2000 was 43% in patients with no comorbidity and only 20% in patients with severe comorbidity. Comorbidity had an even stronger impact in rectal cancer (VI). Evidence repeatedly demonstrates a volume-outcome effect on long-term survival from colonic and rectal cancer with improved survival being significantly associated with increasing hospital caseload and surgeon's education/specialty (V). In addition, the most recent evidence reveals that surgeon caseload may have a stronger impact on long-term survival than hospital volume which reflects the complexity in the interaction between hospital caseload and surgeon caseload. A total therapeutic delay ≥ 60 day has been shown to have a negative impact on the long-term survival from rectal cancer, but not from colon cancer, given that stage is an intermediate step in the causal pathway between delay and survival (X). Neither provider delay ≥ 60 days, nor hospital delays ≥ 30 days or ≥ 60 days had any prognostic impact on long-term survival from colorectal cancer. Emergency surgery for colonic cancer is associated with an inferior long-term survival. The 5-year survival after acute curative surgery in Denmark is 39% (16). However, the use of SEMS as bridge to elective curative surgery makes it possible to achieve 3-year survival rates similar to those of 75% seen after elective curative surgery for colonic cancer (IX) - despite an unexpectedly high perforation rate.     

TACE联合经皮热消融治疗大肝癌的疗效及预后分析

目的 探讨经皮热消融[射频消融(RFA)及微波消融(MWA)]联合经动脉化疗栓塞术(TACE)治疗大肝癌的疗效及预后.方法 2003年5月至2009年5月中山大学附属第一医院TACE联合热消融治疗45例5～10 cm大肝癌患者,肝功能为Child-Pugh A、B级,其中25例行TACE+RFA治疗,20例行TACE+...     

71例胸腺癌的临床预后因素分析

目的 通过分析胸腺癌患者的临床病理特征及治疗情况,了解胸腺癌的预后相关因素. 方法 对进行手术切除的71例胸腺癌患者进行回顾性分析,按Masaoka分期标准进行分期,其中Ⅱ期7例,Ⅲ期33例,Ⅳ期31例. 并总结本组病例的病理分型、Masaoka分期、治疗及预后. 用Kaplan-Meier法计算生存率,用Logrank行差异显著性检验及生存因素分析. 结果 71 例患者的中位生存期为57. 2 个月,5年生存率为47. 9%,其中完整切除的25 例5 年生存率为68%,部分手术的46例5年生存率为36. 9%. 肿块直径大于或等于8的41例5年生存率为53. 6%,肿块最大径小于8的30例5年生存率为40%. Ⅱ、Ⅲ、Ⅳ期5年生存率分别为57. 1%、69. 7%、29. 0%. 不同病理学类型、鳞癌、腺癌、小细胞癌、腺鳞癌及类癌5 年生存率分别为55. 1%,14. 3%, 28. 6%,33. 3%,100%,手术方式、肿块最大径、Masaoka分期及不同病理学类型对生存差异有统计学意义(P<0. 05),术前治疗、术后放疗及分化程度对生存差异无统计学意义. 结论 手术方式、肿块大小、Masaoka分期及不同病理学类型是预后重要因素,手术方式和肿块大小是患者的独立预后影响因素. 术后辅助放疗可能不是预后不良的指标.     

Effect of retroperitoneal lymphadenectomy on prognosis of patients with epithelial ovarian cancer

Objective To evaluate prognostic factors which have an influence on overall survival and to assess the rational application of retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer. Methods The data of 131 patients treated between January 1990 and December 1998 in Union Hospital and Tongji Hospital were analyzed retrospectively. Survival was calculated using the Kaplan-Meier method and comparisons were performed using Log-rank test. Independent prognostic factors were identified by the Cox proportional hazards regression model. Results Univariate analysis showed that age, general conditions, menopausal status, stage, pathological types, location of the tumor, residual tumor and retroperitoneal lymphadenectomy were prognostic factors. Multivariate analysis showed that age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors. The survival rate could not be improved through retroperitoneal lymphadenectomy in the patients in early stage, advanced stage with residual tumor &gt;2 cm or those with mucinous adenocarcinoma （P&gt;0.05). Among patients in advanced stage cancer with a residual tumor ≤2 cm, 5-year survival was 65% and 30% for patients who did and did not undergo lymphadenectomy, respectively （P&lt;0.01). Among patients with serous adenocarcinoma, 5-year survival was 61% and 31% for patients who did and did not undergo lymphadenectomy, respectively （P&lt;0.01). Conclusions The prognosis of the patients with epithelial ovarian cancer may be influenced by age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy. Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively.     

Prognostic factors for late mortality after liver transplantation for benign end-stage liver disease

Background  There are increasing numbers of patients who survive more than one year after liver transplantation. Many studies have focused on the early mortality of these patients. However, the factors affecting long-term survival are not fully understood. This study aims to evaluate prognostic factors predicting long-term survival and to explore measures for improving the survival outcomes of patients who underwent liver transplantation for benign end-stage liver diseases.

Methods  The causes of late death after liver transplantation and potential prognostic factors were retrospectively analyzed for 221 consecutive patients who underwent liver transplantation from October 2003 to June 2008. Twenty-seven variables were assessed using the Kaplan-Meier method, and those variables found to be univariately significant at P <0.10 were entered into a backward step-down Cox proportional hazard regression analysis to identify the independent prognostic factors influencing the recipients’ long-term survival.

Results  Twenty-eight recipients died one year after liver transplantation. The major causes of late mortality were infectious complications, biliary complications, and Hepatitis B virus recurrence/reinfection. After Cox analysis, the five remaining co-variables were: age, ABO blood group, cold ischemia time, post-infection region, and biliary complications.

Conclusions The major causes of late mortality were infection, biliary complications and Hepatitis B virus recurrence/reinfection. Five variables (Age, ABO blood group, cold ischemia time, infection, and biliary complications) had significant impacts on patient survival.

     

T2N0M0期上尿路尿路上皮癌患者预后相关因素分析:单中心235例患者回顾性研究

目的：分析T2N0M0上尿路尿路上皮癌（upper tract urothelial carcinoma, UTUC）患者长期生存情况以及预后相关因素。方法：回顾性分析2000年1月至2013年12月于北京大学第一医院行手术治疗的T2N0M0 UTUC患者的临床和随访资料,应用Kaplan-Meier法计算生存率,Log-rank方法进行单因素分析,对单因素分析中有统计学差异的变量采用Cox模型进行多因素生存分析。结果：共235例T2N0M0 UTUC患者纳入研究,中位随访时间53（3~142）个月。入组患者中男性95例（40.4%）,女性140例（59.6%）;患者平均年龄（66.73 ±10.49）岁,末次随访时共有74例（31.5%）患者因肿瘤死亡,96 例（40.9%）患者出现膀胱复发,中位死亡时间及复发时间分别为35个月和19.5个月。患者的3年和5年肿瘤特异性生存率分别为89.1%和85.9%;3年和5年无复发生存率分别为85.5%和80.2%。多因素分析发现,年龄大于55岁 (HR=3.138, 95%CI: 1.348~7.306, P=0.008)和肿瘤直径大于5 cm (HR=3.320, 95%CI: 1.882~5.857, P<0.001)是T2N0M0 UTUC患者术后肿瘤特异性死亡的独立危险因素;肿瘤发生在输尿管（HR=1.757, 95%CI: 1.159~2.664, P=0.008）和肿瘤低分级（HR=1.760, 95% CI: 1.151~2.692, P=0.009） 是T2N0M0膀胱复发的危险因素。结论：T2N0M0 UTUC患者肿瘤特异性生存预后较好,肿瘤复发率同非浸润性UTUC相当,但复发较早。肿瘤直径大于5 cm和年龄大于55岁是T2N0M0 UTUC肿瘤特异性死亡的独立危险因素;肿瘤发生在输尿管和肿瘤低分级是T2N0M0 UTUC膀胱复发的危险因素。     

儿童EB病毒相关性噬血细胞综合征18例临床特点及预后分析

目的：分析EB病毒相关性噬血细胞综合征（ EBV-AHS）患儿的临床特点以及预后的危险因素。方法回顾性分析近2年本院收治的18例EBV-AHS患儿的临床表现、实验室检查、治疗转归。根据转归情况分为存活组（10例）及死亡组（7例）,1例放弃治疗,并对两组进行比较,采用Logistic回归方法分析患儿的预后危险因素。结果①患儿以发热（100％）、肝脾肿大（100％）为突出表现,其余表现为多浆膜腔积液（83％）、浅表淋巴结肿大（72％）、呼吸系统症状（72％）、黄疸（39％）、皮疹（16.7％）、中枢神经系统症状（5％）。好转组与死亡组比较差异无显著性。②实验室检查以肝功能损害为最突出（100％）,以酶学改变及低白蛋白血症为主,骨髓细胞学检查均可见噬血细胞（100％）,均存在不同程度的凝血功能障碍（100％）,其次为全血细胞减少（77.8％）,高甘油三酯血症（72.2％）等。血清铁蛋白≥500μg/L者13例（72.2％）。存活组与死亡组比较,死亡组乳酸脱氢酶（ LDH）明显高于存活组,两者比较差异有显著性。死亡组血清白蛋白（ ALB）低于存活组,两者比较差异有显著性。死亡组纤维蛋白原（ FIB）明显低于存活组,两者比较差异有显著性。死亡组NK细胞比例低于存活组,两者比较差异有显著性。③Logistic回归分析显示LDH〉2000U/L是与死亡相关的危险因素（P=0.02）,具有预后意义。结论 EBV-AHS临床表现多样,病情凶险,病死率高,LDH水平是影响EBV-AHS预后的不良危险因素。     

再次接受左房室瓣人工瓣膜置换危险因素分析

【摘要】目的 探讨再次二尖瓣置换术患者早期及中期生存率的高危因素,为临床工作提供指导。方法 回顾性研究2005年1月至2010年12月间于长海医院胸心外科接受再次二尖瓣置换手术的患者55例,对研究对象的生存率及其风险因素进行分析。对照组从在我院进行首次二尖瓣置换术的患者中选取,配对性别、年龄、手术日期。通过单变量和多变量分析评估患者30天和3年的生存率的危险因素。结果 再次二尖瓣置换术患者的30天、1年、3年、5年生存率分别为92.7%,89.1%,83.6%,81.8%,与配对组之间无明显差异。左室射血分数是影响再次二尖瓣置换术患者30天内生存率的独立风险因素（p=0.018,OR=15.333）;糖尿病（p=0.039,OR=6.242）和左室射血分数（p=0.001,OR=66.136）是影响3年生存率的独立风险因素。结论 （1）再次二尖瓣置换术与第一次接受二尖瓣置换术相比,不增加患者早期及中期死亡率;（2）左室射血分数是影响再次二尖瓣置换术患者术后早期生存率的独立高危因素;（3）糖尿病、左室射血分数是影响再次二尖瓣置换术患者术后中期生存率的独立高危因素。     

原发性肝癌化疗栓塞及预后因素分析

目的探讨原发性肝癌的治疗方法和预后因素。方法通过随访回顾性分析121例经股动脉穿刺行经肝动脉化疗栓塞术（Transcatheter arterial chemoembolization,TACE）治疗原发性肝癌患者的病例资料,依据影像学及生存时间判断疗效,并对影响预后的因素进行分析。结果 1年、2年、3年生存率分别为47.1%、11.6%、4.1%,中位生存期15.2个月。完全缓解（CR）2例,部分缓解（PR）33例,总有效率（CR＋PR）28.9%。对患者生存期影响显著的因素包括临床分期、术前肝功能、肿瘤大体形态和TACE次数。结论影响原发性肝癌预后的影响因素有多种,TACE是治疗原发性肝癌的有效治疗手段,可提高生活质量,延长患者生存期。