大功率微波消融治疗肝癌临床疗效及其复发危险因素分析

目的比较大功率微波消融治疗小肝癌和大肝癌的疗效,分析大功率微波治疗肝癌的安全性及与术后肿瘤复发相关的危险因素。方法对45例未行其它治疗的乙型肝炎相关性原发性肝癌患者共60个肿瘤病灶行80~100 W大功率和(2450±10)MHz微波频率消融治疗,肿瘤直径范围为3~8 cm,肿瘤直径3~5 cm(小肝癌46个)和肿瘤直径5~8 cm(大肝癌14个)。比较消融治疗后两组肿瘤完全消融率,分析影响大功率微波消融治疗后复发、并发症发生和疗效的相关危险因素。结果在微波消融后1个月行超声造影、增强CT或MRI检查,发现小肝癌组一次性完全灭活率为82.6%(38/46),显著高于大肝癌组的64.3%(9/14,P=0.037);小肝癌组和大肝癌组二次完全灭活率分别为100.0%(46/46)和85.7%(12/14,P0.05);术后4例患者发生右侧少量胸腔积液;大功率微波消融术后局部复发率为22.2%(10/45);1 a和2 a生存率分别为95.6%(43/45)和86.7(39/45);单因素分析显示肿瘤复发与肿瘤病灶临近危险区域(P=0.017)、血清HBV DNA阳性(P=0.027)、病灶数目(P=0.022)和术前AFP水平(P=0.025)有关,多因素分析结果提示HBV DNA阳性(P=0.031)和肿瘤病灶临近危险区域(P=0.039)为原发性肝癌在微波消融治疗后肿瘤复发的独立危险因素。结论大功率微波对于小肝癌完全消融率高于大肝癌,是安全的、高效的;推测乙型肝炎病毒载量与肿瘤病灶临近危险区域是大功率微波消融术后复发的独立危险因素。     

超声引导射频消融治疗老年肝癌的效果及肿瘤残留的危险因素

目的探讨超声引导射频消融(RFA)治疗老年肝癌(HCC)的疗效及肿瘤残留的危险因素。方法接受超声引导RFA治疗的老年HCC患者315例。治疗后1个月评价疗效。采用单因素分析和多元Logistic回归分析法分析与RFA治疗后肿瘤残留有关的危险因素。结果患者的肿瘤完全消融率为90.16%;病灶的完全消融率为91.27%。单因素分析发现靠近肝内大血管和胆囊、肿瘤最大直径>5 cm及联合其他局部治疗影响患者RFA治疗后肿瘤残留(P<0.05)。靠近肝内大血管、肿瘤直径>5 cm及未联合局部治疗是患者RFA治疗后肿瘤残留的危险因素。结论超声引导RFA治疗获得了良好的治疗效果,靠近肝内大血管、肿瘤直径>5 cm及未联合局部治疗是患者RFA治疗后肿瘤残留的危险因素。     

根治性切除治疗原发性肝癌患者预后分析

目的分析影响原发性肝癌(PLC)患者根治性肿瘤切除术后生存的因素。方法 2008年1月~2012年1月我院行肿瘤根治性手术切除治疗的301例PLC患者,其中肿瘤最大径5cm组194例,肿瘤直径≤5cm组107例,采用COX回归分析影响患者术后生存的因素。结果两组术前临床资料比较,除肿瘤直径外,无显著相差(P0.05);术后1 m,肿瘤直径5 cm组患者血清甲胎蛋白(AFP)水平显著高于肿瘤直径≤5cm组(P0.05),而两组肝功能指标比较,无显著性差异(P0.05);随访发现,肿瘤直径5cm组患者总生存期为(19.2±3.8)个月,显著短于直径≤5cm组的(29.4±4.2)个月,而直径5 cm组患者无瘤生存期为(12.3±2.7)个月,也显著短于直径≤5 cm组的(20.9±5.1)个月(P0.05);经单因素分析显示,年龄50岁、手术时间超过240 min、术中出血量500 ml、伴有肝硬化、血清AFP水平高、Child-Pugh分级低、血清白蛋白水平低、存在血管侵犯和肿瘤直径大的患者总生存时间和无瘤生存时间明显缩短(P005),进一步经多因素分析显示,肿瘤直径、血管侵犯、Child-Pugh分级、术中出血量和肝硬化为影响患者总生存期和无瘤生存期的独立危险因素(P均0.05)。结论根治性肿瘤切除术为治疗PLC患者的首选方法,但对存在基础肝硬化或Child-Pugh分级差、肿瘤直径大或有血管侵犯的患者,可能影响术后生存,需要综合考虑治疗方案的制定和选择,以让患者最大获益。     

乙型肝炎相关性孤立性大肝癌手术切除患者长期疗效及影响预后因素分析*

目的 探讨HBV相关孤立性大肝癌患者手术切除后长期疗效,并分析影响其预后的危险因素。方法 2011年1月~2012年1月在我院行手术治疗的600例HBV相关肝癌患者,其中孤立性大肝癌130例,肿瘤直径>5 cm,小肝癌组470例,肿瘤直径≤5 cm。术后门诊随访超过5年,采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验行生存分析,采用Logistic回归分析影响预后的因素。结果 除孤立性大肝癌组肿瘤直径明显大于小肝癌组（P<0.05）外,其余临床特征的比较无统计学差异（P>0.05）;470例小肝癌患者生存时间为（55.0±4.8）个月,无瘤生存时间为（38.6±2.4）个月,1 a、3 a和5 a 生存率为90.1 %、71.5 %和57.1 %,无瘤生存率为71.8 %、47.0 %和36.8 %,而130例大肝癌患者生存时间为（50.0±3.6）个月（x2=12.175,P=0.001）,无瘤生存时间为（30.6±2.7）个月（x2=0.669,P=0.102）,1 a、3 a和5 a生存率为87.5 %、58.4 %和47.1 %,无瘤生存率为66.8 %、45.3 %和32.8 %;肿瘤直径5~10 cm的孤立性大肝癌患者总体生存率和无瘤生存率与小肝癌组比较无统计学差异（x2=0.489,P=0.202;x2=1.257,P=0.098）,肿瘤直径>10 cm的患者总体生存率和无瘤生存率短于小肝癌患者,差异有统计学意义（x2=15.271,P<0.001;x2=8.124,P=0.013）;多因素分析结果显示,HBV DNA载量（≥1×104 U/ml）和肿瘤直径（>10 cm）是影响患者5 a总生存率（OR=1.679,95 % CI:0.987~2.341,P=0.025;OR=2.348,95% CI: 1.024~4.357, P=0.013）和无瘤生存率（OR=2.365,95% CI:2.542~4.368,P=0.013;OR=2.674,95% CI:0.874~1.934,P=0.049）的独立危险因素。结论 肿瘤直径在5~10 cm的孤立性大肝癌患者总体生存率和无瘤生存率与小肝癌患者类似,而肿瘤直径>10 cm的孤立性大肝癌患者总体生存率和无瘤生存率较小肝癌患者短。应针对影响预后的因素给予积极的处理措施,以延长患者术后生存。     

超声引导经皮微波固化治疗肝癌临床研究分析

超声引导经皮微波固化疗法（PMCT）是近年来一种新的肝癌治疗手段,主要适用于不适合手术治疗包括不能手术切除、手术切除困难或不能耐受手术的早期肝癌患者,肝内肿瘤不超过3个,肿瘤直径≤5cm,且无血管内或远处转移灶,肝功能为 Child A 级或 B 级。对于中晚期肝癌患者,微波也可作为一种有效减小肿瘤的手段,以达到减轻痛苦、延缓发展,延长生存时间的目的。近年来,微波固化已成为继手术、放化疗、生物治疗及射频消融后又一种有效治疗肝癌的治疗方法。近年来研究表明,微波固化以其创伤小、简便可靠、疗效显著等优势在肿瘤临床治疗中得到了普遍的推广。现就微波固化在肝癌治疗方面研究进展作一综述。     

超声引导下经皮射频消融治疗小肝癌患者疗效及预后分析

目的比较超声引导下经皮射频消融与肝切除术治疗小肝癌患者的疗效及分析影响生存的危险因素。方法 2011年1月～2015年4月在我院接受治疗的107例肝细胞癌(HCC)患者,接受超声引导下射频消融治疗58例,接受肝叶切除术治疗49例。术后随访3年,采用Cox单因素和多因素回归分析影响HCC患者生存的独立危险因素。结果治疗后,射频消融患者血清ALT水平显著低于肝切除术组(P0.05),而血清ALB水平显著高于肝切除术组(P0.05);两组术后并发症发生率(10.3%对16.3%)比较,差异无统计学意义(P0.05);射频消融治疗患者1 a、2 a和3 a总生存率分别为84.5%(49/58)、65.5%(38/58)和44.8%(26/58),而肝切除术组则分别为85.7%(42/49)、67.3%(33/49)和46.9%(23/49),差异不具有统计学意义(x~2=0.032,P=0.859;x~2=0.040,P=0.842;x~2=0.048,P=0.827);Cox单因素分析结果显示肿瘤数目(HR=0.372,95%CI:0.105～0.876,P=0.033)与HCC患者无瘤生存时间有关,而血清AFP水平(HR=3.043,95%CI:1.007～5.248,P=0.035)、肿瘤数目(HR=0.871,95%CI:0.344～0.902,P=0.401)和肿瘤直径(HR=1.631,95%CI:1.273～3.045,P=0.005)与HCC患者总生存时间有关;Cox多因素回归分析结果显示肿瘤数目多(HR=0.087,95%CI:0.045～0.498,P=0.009)是影响HCC患者无瘤生存的独立危险因素,而肿瘤分化低(HR=2.974,95%CI:1.865～4.097,P=0.046)、肿瘤数目多(HR=0.062,95%CI:0.033～0.378,P=0.002)和肿瘤直径大(HR=2.216,95%CI:1.778～5.026,P=0.007)是影响HCC患者总生存时间的独立危险因素。结论超声引导下经皮射频消融治疗与肝切除术治疗小肝癌患者的临床疗效相当,但射频消融治疗创伤小,术后恢复快,对肝功能的影响小。     

经皮联合开腹微波消融术治疗多发危险部位肝脏转移瘤疗效分析

目的评价经皮联合开腹消融术治疗多发危险部位肝脏转移瘤的有效性及安全性。方法在全麻下采用经皮联合开腹微波消融术治疗1例男性59岁结肠癌并发多个危险部位肝脏转移瘤患者,其危险部位病灶(0.9 cm×0.8 cm)位于肝右静脉与肝中静脉夹角处,毗邻心脏和下腔静脉,采取开腹微波消融治疗;对另2处非危险部位病灶(1.4 cm×0.9 cm和3.0 cm×2.8 cm)采取经皮微波消融治疗,观察术后并发症及肿瘤复发情况。结果该患者手术顺利,术后未出现严重并发症,消融病灶均完全坏死,随访三个月,消融部位未见肿瘤残留,未发现新病灶。结论采取经皮联合开腹消融术治疗多发危险部位肝脏肿瘤是安全有效的。     

超声引导下微波消融对复发性肝癌长期疗效的影响因素研究

目的 探讨超声引导下微波消融对复发性肝癌长期疗效的影响因素。方法 收集2019年9月—2021年9月濮阳市中医医院80例复发性肝癌患者的资料进行回顾性分析,术后随访1年,根据术后1年生存情况将80例复发性肝癌患者分为预后不良组(死亡,22例)及预后良好组(存活,58例)。比较两组临床资料,检测血清甲胎蛋白(AFP)、白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平;通过多因素logistic回归性分析明确影响复发性肝癌患者超声引导下微波消融治疗后长期疗效的因素。结果 预后不良组Child-Pugh分级B级、多发病灶、病灶直径≥3 cm、AFP≥100 ng/mL的患者分别为8例(36.36%)、11例(50.00%)、10例(45.45%)、9例(40.91%),与预后良好组8例(13.79%)、12例(20.69%)、13例(22.41%)、10例(17.24%)相比,差异有统计学意义(P<0.05);经多因素logistic回归性分析,Child-Pugh分级B级、多发病灶、病灶直径≥3 cm、AFP≥100 ng/mL是复发性肝癌患者超声引导下...     

经皮B超引导下微波消融术治疗肝脏巨大血管瘤的可行性、安全性及疗效分析

目的评估微波消融治疗肝脏巨大血管瘤(直径≥10 cm)的可行性、安全性和有效性。方法 2013年12月到2016年6月间,12例肝脏巨大血管瘤(≥10 cm)患者共13个肿瘤接受超声引导下经皮穿刺微波消融治疗。观察治疗相关并发症。所有患者均在术后1个月通过磁共振或增强计算机成像(CT)随访,评估消融治疗效果。结果 12例患者中男性4例,女性8例,平均年龄(41±10)岁。除1例同时存在2枚直径≥10 cm的肝血管瘤,其他患者均只有1枚直径≥10cm。肿瘤最大直径平均(11.7±1.6)cm。13枚巨大血管瘤初始共接受17次微波消融治疗(4例采取有计划2次消融),单枚血管瘤的消融平均时间(39.0±14.4)min。术后2例患者出现急性非少尿型肾功能不全,无腹腔内出血、肝功能衰竭等并发症发生。平均随访时间20.7个月,9例患者10个巨大血管瘤完全坏死,体积显著缩小,一次性完全消融10/13枚。1例术后残留者因生长速度较快,于术后第5个月实施二次微波消融,复查完全坏死,故总体完全消融11/13枚。另外2例因残留体积较小而定期复查,未予任何有创治疗。结论影像引导下微波消融肝脏巨大血管瘤安全、可行,且操作简单、快捷、恢复迅速、损伤轻微,无远期并发症,因而有潜力成为肝脏巨大血管瘤的一线治疗方式。     

肝癌的局部区域治疗

局部区域治疗在影像学引导下靶向杀伤肿瘤,是原发性肝癌最主要的非手术治疗方法,包括放射介入治疗（主要为肝动脉化疗栓塞）和局部消融治疗（瘤内乙醇注射、射频、微波、激光、高强度聚焦超声、冷冻等治疗）。肝动脉化疗栓塞主要应用于不能手术切除的中晚期肝癌,局部消融治疗适用于直径5cm以下的小肝癌。肝癌局部区域治疗强调针对具体病情选择合适的方法进行规范治疗。本文简要评述各种局部区域治疗方法的指征、治疗原则、技术要点和疗效,并讨论手术切除与局部消融治疗小肝癌的选择。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.