原发性肝癌并发胆结石

目的：观察研究原发性肝癌（ＰＨＣ）并发胆结石发生率及其发生机理，方法：采用腹部Ｂ超和ＣＴ影像学检查确定ＰＨＣ患者并发胆结石，结果：并发胆结石发生率：ＰＨＣ组２２％（３６／１５２）和继发性肝癌（ＭＨＣ）组４．５％（２／４４）比较有明显差异。Ｐ〈０．０５，ＰＨＣ组和肝硬化（ＬＣ）组２５％（１４／５６）比较无明显差异，结论：并发胆结石，ＰＨＣ组远无高于ＭＨＣ组，其原因可能与两组在门脉高压和肝功能损害存在     

超声检查应用于亚临床HRS的价值

目的 探讨超声检查应用于亚临床肝肾综合征（preclinicalHRS）的价值。方法 应用多普勒超声检测肾功能正常的肝硬化腹水患者和肝硬化无腹水惠者的肾脏血流动力学改变，并与正常组对照。结果 肝硬化无腹水组与对照组肾动脉血流动力学参数无差异。肝硬化腹水组肾动脉舒张期血流速（PDV）显著低于肝硬化无腹水组和对照组（P〈0．01），而收缩期血流速（PSV）三组之间无差异（P〉0．05）。但肝硬化腹水组肾动脉阻力指数（RI）和搏动指数（PI）均显著高于其余两组（P〈0、01）。结论 本研究中肝硬化腹水组可以归入亚临床HRS。多普勒超声能敏感、客观地评价肾功能正常的肝硬化患者肾脏血流动力学紊乱情况，进而了解肾小球滤过率（GFR）和肾血流状态，对亚临床HRS的诊断有重要价值。     

优质护理用于肝硬化腹水的临床效果观察

目的探讨优质护理用于肝硬化腹水患者的临床效果。方法我院收治的肝硬化腹水患者150例，随机分为对照组和观察组，对照组给予常规护理，观察组给予心理护理、饮食指导、健康教育等全方位的优质护理，患者出院前对两组患者临床疗效及护理满意程度进行评价。结果观察组总有效率为89．33％，死亡I例（I．33％），对照组总有效率为77．33％，死亡3例（4．00％），两组比较具有显著性差异，观察组患者的有效率及对护理的满意度明显好于对照组。结论优质护理用于肝硬化腹水患者，能够增加患者的生存时间和提高生存质量。     

肝硬化并发热89例原因分析

发热在肝硬化患者中甚为常见，如不及时、正确诊治，可使肝硬化患者病情加重，甚至影响预后。我们就近5年收治的肝硬化197例进行发热原因分析。1临床资料肝硬化197例，其中伴发热89例，占45．18％。男59例，女30例，平均年龄42．7岁。代偿期6例，失代偿期83例；有腹水83例，肝昏迷32例，上消化道出血20例，黄疽19例，贫血31例，肝肾综合征12例，并发癌16例，末梢血白细胞减少（M4X10’／L）21例，血小板减少（M100X10’／L）10例，低蛋白血症（白蛋白M30g／L）’v例，肝功能异常ss一例，HmAg阳性用例。住院期间死亡21例，同期不发热的肝…     

无明显肝病史的老年肝硬化58例

在老年肝硬化中有部分人既往无显性急、慢性肝病史，临床症状亦不明显，仅在肝硬化失代偿后才被发现而失去了早期诊治的机会。近年来，我们收治58例。1临床资料1．1一般情况本组58例，男45例，女13例；年龄60～84岁，平均64．3岁。肝硬化均经CT和B超证实。有13例经纤维胃镜检查，27例经吞钡透视证实有食管胃痛静脉曲张。肝硬化合并腹水35例（60％），上消化道出血13例（22％），肝硬化伴活动性肝炎4例（7％），肝硬化并肝癌6例（Ic％）。1．2早期不典型症状（1）慢性出血：有13例（22％）曾有慢性或反复牙龈出血、鼻出血或皮下出血等现象…     

胸部穿透伤164例报告

胸部穿透伤１６４例报告曾会昌杨康王明荣我院１９７５年６月～１９９２年６月共收治胸部穿透伤１６４例，报告如下．临床资料男１５２例，女１２例；年龄４～５２岁，平均２４岁，其中１５～３０岁１２１例（７３％）．致伤原因：刀刺伤１４８例，其中左胸伤１０４例，右...     

乙型肝炎肝硬化失代偿期临床指标与预后关系研究

目的：观察乙型肝炎肝硬化失代偿期临床指标与预后的关系。方法：回顾性分析乙型肝炎肝硬化失代偿期80例临床资料及6个月、1年和3年累计病死率。结果：住院好转组与住院死亡组TBIL、ALB、INR和Chitd-Pugh评分两组比较，差异非常显著（P〈0．01），ALT、GLB和HBV-DNA水平两组比较，差异不显著（P〉0．05）。本组病例失代偿期肝硬化患者6个月、1年和3年累计病死率分别为12．5％、26．3％及37．5％；并发腹水54例，6个月、1年和3年累计病死率分别为18．5％、35．29／6及48．2％；并发上消化道出血31例，6个月、1年和3年累计病死率分别为6．5％、32．3％及41．9％；并发肝性脑病10例，6个月、1年和3年累计病死率分别为60．O％、90．O％及90．09／5；并发肝肾综合征11例，6个月、1年累计病死率分别为72．7％、100％。结论：乙型肝炎肝硬化失代偿期患者临床病死率高、并发症多，积极防治各种并发症是提高患者生存率的关键。     

西宁地区肝硬化失代偿期患者酸碱,电解质,血气监测的临床意义

为了解西宁地区肝硬化失代偿期患者酸碱及电解质变化的情况，对３１例该类患者和２５例健康人测定了血气及电解质，并经统计学处理，结果：３１例患者合并低氧血症２０例（Ｐ＜０ .０５），低二氧化碳血症１３例（Ｐ＜０．０１）代谢性碱中毒１４例（Ｐ＜０．００１）。且存在较严重的低血钾，低血钠。与平原地区比较屯有较明显的差异，提示：高原地区失代偿期肝硬化患者酸碱、电解质监测，对肝硬化并发症诊断及治疗有重要的临床意义。     

保留腐皮涂布MEBO早期处理烧伤创面的疗效观察

作者自１９９１年４月至１９９２年１２月收治早期病人２７８例，分去腐皮组（１３０例）和保留腐皮组（１４８例），分别涂布ＭＥＢＯ进行创面早期处理进行比较。于伤后分别进行创面细菌培养，细菌培养阳性率分别为７．５％及１２．５％，统计学处理无显著差别（Ｐ〈０．０５）；创面感染率去皮组为４．６２％，保留组为５．４１％，统计学处理Ｐ〉０．０５，无显著性差别。而创面愈合时间保留组较去皮组提前，经统计学处理有显著性     

胆囊壁声像图改变对鉴别肝硬化性与恶性肿瘤性腹水的价值

目的：探讨胆囊壁声像图改变对鉴别肝硬化性与恶性肿瘤性腹水的价值。方法 对101例肝硬化性腹水与57例恶性肿瘤性腹水的胆囊壁声像图进行回顾性分析，主要观察胆囊壁厚度及回声。结果：肝硬化性腹水胆囊壁均增厚且48．5％(49／101)呈双层增厚回声；恶性肿瘤性腹水胆囊壁多不增厚，单层中度增厚仅1．7％(1／57)。结论 胆囊壁增厚，尤其是双层增厚是肝硬化性腹水与恶性肿瘤性腹水声像图的主要鉴别点。     

Value of acoustic radiation force impulse elastography for the assessment of ascites syndrome

AIM:To assess the feasibility of performing acoustic radiation force impulse(ARFI) elastography in patients with ascites and its predictive value for the cirrhotic or non-cirrhotic etiology of ascites.METHODS:Our study included 153 patients with ascites,mean age 58.8 ± 13.1 years.One hundred and fifteen(75.2%) patients had ascites in the context of cirrhosis,29(18.9%) had non-cirrhotic ascites(diagnosed by clinical,ultrasound,endoscopic and/or laparoscopic criteria) and in 9(5.9%) cases we could not establish the etiology of ascites.We performed 10 ARFI measurements and the median value was calculated and expressed in meters/second(m/s).Among the 29 patients with non-cirrhotic ascites were included:20 laparoscopically demonstrated peritoneal carcinomatosis with histological confirmation,7 acute pancreatitis with ascites which later resolved,and one case each of lymphatic ascites and ascites in the context of a liver abscess.In 11 of the 20 patients with peritoneal carcinomatosis,the liver structure was homogenous in the ultrasound examination and in 9 patients the ultrasound exam revealed liver metastases.RESULTS:We could not obtain valid ARFI measurements in 5 patients(3.2%).The mean liver stiffness measurements by means of ARFI were statistically significantly higher in patients with cirrhotic ascites than in those with non-cirrhotic ascites:3.04 ± 0.70 vs 1.45 ± 0.59 m/s(P < 0.001).For a cut-off value of 1.8 m/s for predicting cirrhosis(and ascites in the context of cirrhosis),as obtained in a previous study,ARFI had 98.1% sensitivity,86.2% specificity,96.4% positive predictive value,92.5% negative predictive value and 95.6% accuracy for predicting cirrhotic ascites.For a cut-off value of 1.9 m/s the accuracy was 94.9% and for a 2 m/s cut-off value it was 92.8%.CONCLUSION:ARFI elastography is feasible in most patients with ascites and has a very good predictive value for the cirrhotic or non-cirrhotic etiology of ascites.     

严重老年胸伤患者临床流行病学特征与救治结局分析

目的 进一步提高严重老年胸部创伤患者的救治水平.方法 对重庆市急救医疗中心1995年6月-2005年5月救治的148例严重老年胸部创伤(年龄≥65岁,AIS≥3)(高龄组)病例资料进行回顾性分析,以同期<65岁严重胸部创伤患者1669例作为对照(AIS≥3)(低龄组).结果 (1)高龄严重胸伤致伤机制以钝性伤为主(124/148,83.8%),较低龄组高(1 157/1 669,69.3%)(P<0.01);致伤原因依次为交通伤、跌倒伤和坠落伤,其中高龄组交通伤及跌倒伤构成比(98/148,66.2%;22/148,14.9%)明显高于低龄组(845/1 669,50.6%;52/1 669,3.1%)(P<0.01).(2)两组ISS、RTS及GCS比较差异无统计学意义(P=0.518;P=0.419;P=0.525).(3)高龄组与低龄组院前时间比较差异无统计学意义(P=0.884).(4)高龄组病死率(23/148,15.5%)显著高于低龄组(109/1 669,6.5%)(P<0.01).(5)高龄组主要并发症发生率(38/148,25.7%)显著高于低龄组(174/1 669,10.4%)(P<0.01).(6)有并发症患者病死率,高龄组(51.7%)较低龄组(26.7%)显著增高(P<0.01),而无并发症患者两组间病死率(6.7%:3.5%)差异无统计学意义(P=0.069).结论 年龄和并发症是预测创伤后救治结局相对独立的因素;加强对高龄老人创伤后危险性的认识,强调并发症的处理与器官功能支持治疗是提高高龄严重胸部创伤患者生存率的关键.     

CT- or sonography-guided biopsy of the liver in the presence of ascites: frequency of complications

The presence of ascites has been considered a contraindication to percutaneous biopsy of the liver. To determine the validity of this assumption, we performed percutaneous biopsies of the liver under CT or sonographic guidance in 28 patients who had ascites and in 28 patients who did not have ascites and compared the complication rates in the two groups. Twenty-two patients (79%) in the group with ascites and 19 patients (68%) in the group without ascites had biopsies to determine the cause or extent of chronic liver disease. The remainder were oncologic patients who had biopsies to determine the cause of a focal hepatic mass. The complication rate in the patients who had ascites (32%) was less than that in the patients who did not have ascites (43%) (the difference did not reach statistical significance, p less than .30). In the ascites group, complications included transient hypotension (five patients), a mild-to-moderate fall in hematocrit (three patients), and a small leak of ascites from the biopsy site (one patient). In the control group, minor complications included transient hypotension (three patients), a mild-to-moderate fall in hematocrit (seven patients), and a small subcapsular hematoma (one patient). One major complication occurred in the control group: a patient required a blood transfusion because of the fall in his hematocrit. We conclude that the complication rate in liver biopsies guided by CT or sonography in the presence of ascites is not higher than similar biopsies done in the absence of ascites. Ascites should not be considered a contraindication for performing such biopsies.     

端粒酶活性在恶性腹水中的诊断价值及疗效监测

目的：探讨端粒酶活性在良恶性腹水中鉴别诊断及恶性腹水化疗疗效监测的临床意义。方法：应用端粒酶PCR ELISA方法检测95例腹水脱落细胞中的端粒酶性及26例恶性腹水腹腔化疗后的端粒酶活性变化,并与细胞学及相关肿瘤标志物进行对比分析。结果：恶性腹水及可疑恶性腹水中的端粒酶活性水平明显高于良性腹水,良性腹水中的端粒酶活性阳性率为8.3%,明显低于其肿瘤标志物阳性率18.3%;恶性腹水中的端粒酶活性阳性率为88.6%,显著高于细胞学诊断（45.7%）及肿瘤标志物（51.4%）的阳性率,其端粒酶活性表达随腹腔化疗疗程而下降,与化疗的有效率大致相符。结论：端粒酶活性可作为良恶性腹水的鉴别诊断标准及恶性化疗疗效的监测指标。     

Prevalence and sonographic detection of Chilaiditi's sign in cirrhotic patients without ascites

OBJECTIVE: Although Chilaiditi's sign is uncommon, its recognition is mandatory to avoid intestinal injury during percutaneous transhepatic procedures. Our purpose was to investigate the prevalence of Chilaiditi's sign in cirrhotic patients without ascites and to review the diagnostic ability of sonography to detect this rare abnormality. CONCLUSION: The prevalence of Chilaiditi's sign was much higher in cirrhotic patients without ascites than in the general population. A precise diagnosis of Chilaiditi's sign was possible using sonography. Percutaneous transhepatic procedures can be performed safely if a route that avoids the intestine is found.     

Non-pulsatile hepatic and portal vein waveforms in patients with liver cirrhosis: concordant and discordant relationships

The relationship between hepatic vein waveform and portal vein waveform (HVW and PVW) was evaluated in 54 healthy subjects and 148 patients with liver cirrhosis and portal hypertension using spectral Doppler ultrasound recordings. In all healthy subjects, the HVW was triphasic and the PVW was slightly pulsatile. 51 of 148 patients (34.5%) had flat non pulsatile HVW with a significantly higher incidence in Child C vs Child A patients (48.9% vs 20.7%, respectively; p<0.01) while 56 of 148 patients (37.8%) had flat PVW, also with significantly higher incidence in Child C vs Child A patients (46.7% vs 25.9%, respectively; p<0.05). Of the 86 patients having flat waves (HVW or PVW), only 21 (24.4%) had concordant flat waves (flat both HVW and PVW) while discordance was detected in the remaining 75.6% patients. Only 22 patients (14.9%) had a triphasic HVW but with broad spectrum and absent window in 20 (90.9%) and significantly lower pre-systolic:systolic (PS) ratio (Vmax of the pre-systolic retrograde wave/Vmax of the systolic antegrade wave) compared with healthy subjects (0.23+/-0.1 vs 0.42+/-0.18, respectively; p<0.001). In conclusion, spectral broadening with window absence and dampening of the retrograde pre-systolic wave mark are the earliest changes in HVW in cirrhotic patients even in the presence of a triphasic pattern. The transmission of hepatic vein pulsatility is not a major factor responsible for portal vein pulsatility.     

Hyperintense nodules on non-enhanced T1-weighted gradient-echo magnetic resonance imaging of cirrhotic liver: fate and clinical implications

PURPOSE: To investigate the fate of hyperintense hepatic nodules on nonenhanced T1-weighted (T1w) gradient-echo (GRE) magnetic resonance (MR) images in cirrhotic patients. MATERIALS AND METHODS: A total of 79 cirrhotic patients with hyperintense nodules (>5 mm) on precontrast opposed-phase (repetition time (TR)/echo time (TE) = 140/2.7 msec) GRE images from initial MRI without T2-weighted (T2w) hyperintensity or arterial hypervascularity were subjected to analysis of subsequent MR images obtained at intervals of 12-56 months (mean = 24.5 months). Multiplicity of hyperintense nodules (group A, up to 8; group B, >8) was correlated with follow-up changes. RESULTS: Group B patients were younger (P = 0.003) than group A patients (mean = 47.5 and 56.2 years, respectively). In 66 group A patients, 39 out of 143 lesions (27%) were enlarged, including 20 malignantly transformed or borderline lesions. Of the 104 lesions (the eight largest lesions in each patient) in 13 group B patients, only three (2.9%) were enlarged. The results of best- and worst-case analyses showed that overall the lesions were benign in 91% and 82% of patients, respectively. CONCLUSION: T1w hyperintense nodules without T2w hyperintensity or arterial hypervascularity in the cirrhotic liver are benign in most cases. In younger patients with numerous macronodules, almost all of these lesions follow a benign course.     

经颈内静脉肝内门体分流术治疗肝硬化门脉高压140例分析

目的探讨经颈内静脉肝内门体分流术（TIPS）治疗肝硬化门脉高压的疗效及安全性。方法回顾性分析140例经TIPS治疗肝硬化门脉高压患者的临床资料,记录术前术后门静脉压力、门静脉和脾静脉直径、食道胃底静脉、腹水的变化,观察术后肝性脑病、复发出血、支架再狭窄等并发症。结果手术成功率及即刻止血率100%,门静脉压力术前（44.7±3.5）cmH2O,术后（23.6±3.8）cmH2O（P<0.01）,门静脉主干直径术前（1.64±0.035）cm,术后（1.27±0.047）cm（P<0.01）,脾静脉直径术前（1.26±0.027）cm,术后（0.95±0.023）cm（P<0.01）。肝性脑病发生率13.6%（19/140）,腹水好转率89%（65/73）,术后12个月复发再出血8.6%（12/140）,支架再狭窄15.7%（22/140）。结论 TIPS是治疗肝硬化门脉高压的有效方法,能有效降低门静脉压力,控制上消化道出血。