Surgical management for carcinoma of the gallbladder: a single-institution experience in 25 years

Background Gallbladder carcinoma is rare and associated with dismal outcomes. Radical surgery is the only curative treatment, and options for adjuvant therapy remain limited. This study aimed to determine the factors influencing outcome of treatment in patients with gallbladder carcinoma, and to identify the patients who might benefit from radical surgery and adjuvant therapy. Methods Medical records and follow-up histories of 150 patients with gallbladder carcinoma who had undergone surgery between April 1980 and December 2005 were retrospectively reviewed. The factors predictive for the survival of the patients were identified using multivariate analysis. Results Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 26.2%. After curative resection （40% of the patients）, the 5-year survival rate was 60.3%. The patients who underwent R0 resection had a significantly longer median survival （97.3 months） than those who had R1/R2 resection （8.3 months） or only laparotomy （3.7 months） （P 〈0.0001）. Univariate analysis showed that resectability, American Joint Committee on Cancer staging, tumor grade, adjuvant therapy, jaundice at presentation, depth of tumor invasion, lymph node involvement, distant metastasis, and carcinoembryonic antigen level were statistically significant predictors for survival. Multivariate analysis revealed American Joint Committee on Cancer staging and resectability were independent prognostic factors for survival. The patients who underwent noncurative resection might benefit from adjuvant therapy （median survival, 12.4 months vs 7.2 months, P=-0.006）. Conclusions Favorable survival rate can be achieved after curative resection, even for selected patients with advanced disease. Adjuvant therapy may improve the survival of patients with gallbladder carcinoma.     

Clinical and pathological features and surgical treatment of Budd-Chiari syndrome-associated hepatocellular carcinoma

Background Budd-Chiari syndrome （BCS） is characterized by liver sinusoidal congestion,ischemic liver cell damage,and liver portal hypertension caused by hepatic venous outflow constriction.The aim of this research was to investigate the clinicopathological features of BCS-associated hepatocellular carcinoma （HCC） and explore its surgical treatment and prognosis.Methods Clinical data from 38 patients with BCS-associated HCC who were surgically treated in our hospital from July 1998 to August 2010 were retrospectively analyzed.The clinicopathological features and prognosis of patients with BCS-associated HCC and surgical treatment for BCS-associated HCC were investigated.Results Compared to the patients with hepatitis B virus （HBV）-associated HCC,the patients with BCS-associated HCC showed a female predominance,and had significantly higher cirrhosis rate,higher incidence of solitary tumors,lower incidence of infiltrative growth,higher proportion of marginal or exogenous growth,lower rate of portal vein invasion,and higher degree of differentiation.Median survival was longer in patients with BCS-associated HCC （76 months） than in those with HBV associated HCC （38 months）.Of 38 patients with BCS-associated HCC,22 patients who received combined surgery mainly by liver resection plus cavoatrial shunts exhibited hepatic venous outflow constriction relief,while the other 16 patients only underwent liver resection.The combined surgery group had significantly longer survival and lower incidences of post-operative lethal complications （P 〈0.05）.Multivariate analysis showed that relief of hepatic venous outflow obstruction was a protective factor for survival of patients with BCS-associated HCC,whereas portal vein invasion was a risk factor.Conclusions BCS-associated HCC has a more favorable biological behavior and prognosis than HBV-associated HCC.For patients with BCS-associated HCC,tumor resection accompanied with relief of hepatic venous outflow obstruction can reduce the incidence of complications and extend survival.     

Prognosis of the short-term efficacy of thymectomy for myasthenia gravis with serum protein profiles

Background The extended thymectomy for myasthenia gravis （MG） is currently available, but in 20%-40% of the patients the results were not satisfactory. There are no ideal indicators forecasting surgical results before operation. The surface enhanced laser desorption ionization-time of flight-mass spectroscopy （SELDI-TOF-MS） is a currently new technique for detection of protein profiles, and some progresses have been made in cancer diagnosis and efficacy evaluation, but there is no report on efficacy forecasting of MG surgery. This study aimed to establish an efficacy prognosis model for forecasting the efficacy of surgery for MG by analysis of serum protein profiles of MG patients before surgery. Methods Fifty-six MG patients 6 months after extended thymectomy were enrolled in the study. They were classified into effective or non-effective groups according to symptoms and medication. Their pre-operative blood samples were analyzed for protein profiles by the SELDI-TOF MS technique, and protein peaks were identified for establishment of the efficacy prognosis model of MG surgery. Additional 100 MG patients were subjected to model validation and their pre-operation protein profiles reviewed for post-operative results. The results were compared with those of the post-operative follow-up so as to validate the prognosis model. Results For the model establishment, symptoms were improved in 33 patients and not improved in 18 patients, with an effective rate of 64.7%. Five （8.9%） patients were lost to follow-up. Within the molecular weight range of 1 000 to 20 000, 3 specific protein peaks were found to be significantly different between the effective and non-effective groups, ie M4110-76, M3394-58, and M1258-55. Using the efficacy prognosis model constructed with these data, the accuracy rate of classification was 87.9% for the effective group, and 83.3% for the non-effective group, with a total accuracy rate of 86.3%. For the model evaluation, 2 （8.9%） patients were lost to follow-up, 62 patients were effective and 36 were non- effective. By comparing with the real results of follow-up with 65 effective and 33 non-effective patients with an effective rate of 66.3%, the accuracy rate of prediction by the prognosis model was 86.2% for the effective group, and was 81.8% for the non-effective group with a total accuracy rate of 84.5%. Conclusions By protein profiles analysis of pre-operative blood samples taken from MG patients with the SELDI-TOF MS technique, protein peaks correlated with surgery efficacy in MG patients can be found for primary forecasting short-term efficacy of surgery for MG patients.     

Surgical treatment of 21 patients with spinal metastases of differentiated thyroid cancer

Background Differentiated thyroid cancer （DTC） is a common primary cancer for spinal metastases （SM）.The treatments for DTC spinal metastases （SM） have evolved from simple surgery and radiotherapy to a multidisciplinary comprehensive therapeutic strategy of combined spinal surgery,general surgery,radiotherapy,nuclear medicine and endocrinology.The purpose of this study was to discuss the efficacy and prognosis associated with different surgical treatments of SM patients with DTC.Methods A total of 21 consecutive patients with SM of DTC that were treated between 1999 and 2013 were studied.Biopsy was routinely performed to achieve the pathological diagnosis before treatment.Three patients underwent total spondylectomy intralesionally or piecemeally,and 18 had curettage.Postoperative recurrence and survival times were analyzed by the Kaplan-Meier methods.Results Nineteen patients （90％） had an average of 42.7 months （range,7-170 months） follow-up.The median visual analogue scale for pain reduced from 5 points to 1 point （P ＜0.01）,and the median Karnofsky performance score increased from 70 to 90 points after surgery （P ＜0.01）.Seventeen patients with neurological deficits attained improvements after surgeries,of at least one level according to the Frankel classification （P ＜0.01）.Eight patients with curettage had recurrence.Four patients died of DTC,12 patients lived with disease,and three patients were disease-free.No significant effects on postoperative recurrence or survival were observed between surgery combined with conservative treatment,total spondylectomy,the number of bone metastases and visceral metastasis.Conclusions DTC-SM have a relatively favorable prognosis,and curettage and stabilization can effectively relieve the pain and improve the quality of life and neurological status of the patients.For patients with Tomita scores of ＜3,total spondylectomy may have better clinical outcomes.Comprehensive therapeutic strategies including surgery,radioiodine,external beam     

Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma

Background The management of intrahepatic cholangiocarcinoma （ICC） remains a challenge due to poor prognosis. The aim of this study was to summarize the surgical management experience in recent 10 years and to identify the influencing factors related to outcome of patients with ICC in a single hepatobiliary center. Methods From January 1995 to June 2005, 136 patients with ICC undergoing surgery were reviewed retrospectively. Survival rates of patients were calculated using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were identified by the Cox regression model. Results Seventy-nine of 136 patients underwent resection, and 65 of 79 patients were curative （R0）. The surgical mortality was 2.2%. The 1-, 3- and 5-year survival rates of patients undergoing R0 resection were 72.1%, 35.6% and 20.1% respectively, which were significantly longer than those who underwent palliative resection and exploration, respectively （P 〈0.01）. At stage IV of the disease, 10 patients who underwent aggressive curative resection achieved a better median survival than those （n=12） without resection （14 months vs 3 months, P 〈0.001）. The independent prognostic factors of the whole group were TNM stage （OR, 2.013, P=0.008） and curative resection （OR, 2.957, P=0.003）. Higher TNM stage （OR, 1.894, P=0.004） and lymph node metastasis （OR, 4.248, P=0.005） linked to poor prognosis after R0 resection. For patients without lymph node metastasis, the median survival of those who underwent regional lymphadenectomy was comparable with those who did not （18 months vs 22 months, P=0.817）. Conclusions R0 resection is mandatory for ICC patient to achieve long-term survival. Aggressive resection benefits for selected patients with local advanced disease. Higher TNM stage and lymph node metastasis were poor prognostic factors for ICC patients after R0 resection.     

Fcγ receptor IIIA polymorphisms and efficacy of rituximab therapy on Chinese diffuse large B-cell lymphoma

Background Rituximab is used extensively in combination with chemotherapy to cure non-Hodgkin＇s lymphoma （NHL）, and not only accelerates short-term improvement, but also prolongs patient survival and decreases relapse. The aim of this study was to evaluate the impact of Fcγ receptor IliA （FcyRIIIA） gene polymorphisms on the response to rituximab therapy for newly diagnosed B-cell lymphomas. Methods Patients with newly diagnosed histologically-proven CD20-positive B-cell lymphoma were eligible for the study. All of the patients received rituximab combined with chemotherapy （CHOP）. The FcyRIIIA type was analyzed by PCR. The initial efficacy was assessed after 6 cycles and the long-term survival was determined. Results Thirty-four patients were recruited between October 2005 and April 2006. The FcyRIIIA distribution was as follows： 11 patients were VV, 5 were FF, and 18 were VE After a median of 6 cycles （range 4-8） of rituximab combined chemotherapy, the overall response rate was 79% （82% in the VV group, 83% in the VF group, and 60% in the FF group; P=0.04）. After a median follow-up time of 37 months （range 34-41）, there were 12 relapses among 27 responders （44%）; 5 of 9 patients （5/9） in the VV group, 5 of 15 patients （33%） in the VF group, and 2 of 3 patients （2/3） in the FF group （P=0.21）. The 1-year overall survival in the VV, FF, and VF groups was 80%, 60%, and 80%, respectively, and the 3-year overall survival was 58%, 40%, and 69%, respectively （P=0.08）. After analysis by COX regression, only the international prognosis index and response to initial treatment were significantly related to overall survival. Conclusions The distribution of FcyRIIIA polymorphisms in this B-cell lymphoma population shows that VF is most frequently expressed, followed by VV and FE Patients with the FcyRIIIA VV and VF types are more sensitive to the initial treatment of rituximab combined with chemotherapy and have superior long-term survival compared with those with FF. Nevertheless, FcyRIIIA polymorphisms do not predict prognosis independently.     

Clinical observation of local resection or enucleation for uveal melanoma

Backround Local resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation. Methods Totally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality. Results There were statistically significant differences in the largest basal diameter of the tumor （t=-3.441）, the tumor thickness （t=-4.140）, the ciliary body infiltration （X2=8.391）, and the duration of follow-up （Z=3.995） between the two groups （P 〈0.05）. The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis （RR=1.752, 95% CI 1.066- 2.880, P=0.027）, the largest basal diameter of the tumor （RR=3.508, 95% CI 1.934-6.336, P=0.000）, and the histological type （RR=2.444, 95% CI 1.106-5.877, P=0.046）. The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation （X2=1.214, P 〉0.05）; the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation （X2=1.304, P 〉0.05）. The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 （92.60%） among persons retaining eye. Conclusions The survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local res     

Both the 5th and 6th Editions of TNM Staging System Fail to Independently Predict Long-term Prognosis after Radical Hepatectomy in Hepatocellular Carcinoma Sized 〉 or = 5 cm

Objective To validate the predictive power of the 5th and 6th editions of TNM staging system （TNM-5, TNM-6） in a Chinese patient cohort with hepatocellular carcinoma （HCC） sized 〉 or = 5 cm after radical hepatectomy. Methods Consecutive 121 patients with HCC sized 〉 or = 5 cm undergoing radical hepatectomy between January 1995 and December 2002 were included. The impact of clinicopathological variables on prognosis was determined by univariate and multivariate analyses, after excluding 2 perioperative deaths. Results In univariate analysis, TNM-5 stage did not show prognostic significance for overall or disease-free survival, as opposed to TNM-6 stage, Edmondson-Steiner grade, portal vein tumor thrombosis （PVTT）, vascular invasion, satellite nodule, Child-Pugh grade, and hepatitis B surface antigen （HBsAg） positivity. When these significant variables were entered in multivariate analysis, Edmondson-Steiner grade was the sole independent prognosticator for both overall and disease-free survival, whereas Child-Pugh grade independently influenced disease-free survival. However, TNM-6 stage lost its predictive potential in multivariate analysis. Conclusions Neither TNM-5 nor TNM-6 staging system is revealed to be independently prognostic in patients with HCC sized 〉 or = 5 cm after radical hepatectomy. Therefore, TNM-6 calls for more support in many subsets of HCC patients.     

Efficacy and feasibility of radiofrequency ablation for decompensated cirrhotic patients with hepatocellular carcinoma

Background Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation （RFA） in treating hepatocellular carcinoma （HCC） patients with poor liver function （Child-Pugh class C）, who are not suitable for surgery or hepatic artery chemo-embolization.Methods Thirteen HCC patients （the number of tumors was 17） with liver function of Child-Pugh C （scores： 10.2±0.4）were included in the study. Among the patients, 8 were male and 5 were female with the average age of （61.6±10.9）years old. The average size of HCC was （3.8±1.0） cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors （2-3 tumors）. All the patients were treated with RFA.Results There were 22 RFA sessions （1-4 sessions per patient） in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients （69.2%）, in 7 of them, the liver enzyme returned to pre-RFA level in 1-3 months. One month after RFA, the Child-Pugh grading was 10.3±0.8 （Child-Pugh C）, while that of pre-RFA was 10.2±0.4 （Child-Pugh C）, with no significant difference. Computer tomography （CT） one month after RFA showed that the tumor necrosis rate was 88.2% （15/17）. Five patients had 2-4 repeated RFA due to HCC recurrence.During the follow-up of 2-69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% （3/22 sessions）, including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure.Conclusions Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.     

Neoadjuvant chemotherapy of cisplatin and fluorouracil regimen in head and neck squamous cell carcinoma: a meta-analysis

Background The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas （HNSCC） still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil （PF） regimen in enhancing the overall survival of and decreasing Iocoregional relapse and distant metastasis in HNSCC patients. Methods Medline and manual searches were performed to identify all published randomized controlled trials （RCTs） investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included Iocoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group （chemotherapy plus Iocoregional treatment） versus the control group （Iocoregional treatment alone） and was presented as a point estimate with 95% confidence intervals （CI）. Results Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the Jocoregional relapse was 0.92 （0.70-1.22, 95%CI）, which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 （0.33-0.68, 95% CI） and 1.28 （1.01-1.62, 95% CI） respectively, which were both statistically significant. Conclusions Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on Iocoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.     

Musashi-1在肝细胞肝癌中的表达及其与临床预后的关系

目的 研究Musashi-1在肝细胞肝癌患者癌组织及癌旁组织中的表达,探讨其与临床预后的关系及对肝癌细胞转移侵袭的影响.方法 收集我院2000年6月至2010年6月间138例行根治性肝细胞肝癌切除术患者的术中肝癌以及癌旁样本,利用免疫组织化学方法检验癌组织与癌旁组织中Musashi-1的表达水平;通过Pearson x2检验和Fisher精确检验分析Musashi-1与患者临床特征以及预后之间的关系.利用qPCR检测癌组织和癌旁组织中CD133的表达并对癌组织中Musashi-1与CD133的表达水平进行相关性分析.构建稳定过表达Musashi-1的人肝癌细胞系SMMC-7721细胞,利用Sphere成球实验检测Musashi-1对肿瘤细胞成球能力的影响,利用肿瘤侵袭实验探究Musashi-1对肿瘤细胞侵袭能力的影响.结果 138例肝细胞肝癌患者中有105例(76.1％)癌组织中Musashi-1的表达高于癌旁组织(P＜0.05).Musashi-1的表达与甲胎蛋白(AFP)水平、腹水、远处转移有关(P＜0.05),而与性别、年龄、乙肝病史、肿瘤大小、子灶、门静脉癌栓、镜下癌栓等无关.Musashi-1的表达水平对患者总体生存率和无瘤生存率有显著影响(P＜0.05).肝癌组织中CD133 mRNA的表达高于癌旁组织(P＜0.05),且CD133的表达与Musashi-1的表达呈正相关(R2=0.78,P＜0.001).体外实验证实过表达Musashi-1的SMMC-7721细胞的成球能力和侵袭能力增强.结论 Musashi-1在肝细胞肝癌中表达增加,对肝细胞肝癌的进展可能具有促进作用,其表达水平可以为判断预后提供参考.     

射频消融辅助椎体次全切除术治疗脊柱转移瘤的效果及安全性评价

目的 评价射频消融（radiofrequency ablation,RFA）辅助椎体次全切除术治疗脊柱转移瘤的效果及安全性.方法 选择行RFA辅助椎体次全切除术治疗的32例脊柱转移瘤（研究组）和单纯行椎体次全切除术治疗的51例脊柱转移瘤患者（对照组）.记录2组患者的手术时间、术中出血量;于术前,术后1周、1个月、3个月、6个月行疼痛视觉模拟评分（visual analogue scale,VAS）,评价疼痛缓解情况;并采用Frankel脊髓损伤分级和美国东部肿瘤协作组（Eastern Cooperative Oncology Group,ECOG）分级评价脊髓功能;记录复发及并发症.结果 研究组手术时间较对照组短、术中出血量较对照组少（P＜0.05）.2组术后1周、1个月、3个月、术后6个月VAS均较术前显著降低（P＜0.01）,2组间差异无统计学意义（P＞0.05）.2组疼痛缓解有效率差异无统计学意义（87.50％ vs82.35％,P＞0.05）.2组术后Frankel分级和ECOG分级平均改善1级.随访期间研究组复发率显著低于对照组（28.13％ vs 68.63％,P＜0.05）,但2组病死率差异无统计学意义（15.63％ vs 13.73％,P＞0.05）.结论 RFA辅助椎体次全切除术可缩短手术时间、减少出血、减轻术后疼痛、降低术后复发率,获得较好的治疗效果,较单纯椎体次全切除术有一定优势,值得临床借鉴.     

胰十二指肠切除术后胰漏相关危险因素的Meta分析

目的 分析我国胰十二指肠切除术(PD)后发生胰漏的危险因素,为临床有效降低胰漏的发生提供理论支持。 方法 采用Meta分析的方法,对我国2002年6月—2012年6月期间公开发表的有关PD术后发生胰漏的危险因素的33篇文献进行分析。 结果 年龄、性别、术前白蛋白、血红蛋白、手术时间及有无合并糖尿病、高血压、冠心病对PD术后胰漏的发生无相关性(P＞0.05);术前胆红素水平≥171 μmol/L组胰漏发生率明显高于胆红素水平＜171 μmol/L组(P＜0.05),而术前进行减黄治疗无明显降低胰漏的发生(P＞0.05);胰管直径≥3 mm组胰漏发生率明显低于胰管直径＜3 mm组(P＜0.05);放置胰管支撑物引流组能明显降低胰漏的发生(P＜0.05);术中出血量≥1 L组胰漏发生率明显高于出血量＜1 L组(P＜0.05);术后使用生长抑素类药物组能有效降低胰漏的发生率(P＜0.05);既往有上腹部手术史组PD术后胰漏发生率明显高于既往无上腹部手术史组(P＜0.05)。 结论 术前高胆红素血症、胰管直径细小、未放置胰管支撑物引流、术中出血量较多、术后未预防性使用生长抑素类药物及既往有上腹部手术史是胰漏的危险因素。      

眼轮匝肌复合瓣结合上睑皮肤松弛矫正术修复较大面积睑黄瘤术后缺损效果观察

目的 探讨眼轮匝肌复合瓣结合上睑皮肤松弛矫正术修复较大面积睑黄瘤术后缺损的效果。 方法 选取较大面积睑黄瘤术后缺损患者92例,依照随机数表法分为观察组和对照组,每组46例。对照组采用单纯手术切除缝合,观察组采用眼轮匝肌复合瓣结合上睑皮肤松弛矫正术修复。比较2组手术时间、肉芽生长时间、治愈时间,残留瘤体评分、凹陷瘢痕评分和色素异常评分,美容效果以及复发率和并发症发生率。 结果 2组手术时间比较差异均无统计学意义（P＞0.05）,观察组肉芽生长时间、治愈时间均短于对照组（P＜0.05）;术后1个月2组残留瘤体评分、凹陷瘢痕评分、色素异常评分及综合评分比较,差异均无统计学意义（P＞0.05）,术后6个月,2组残留瘤体评分、凹陷瘢痕评分、色素异常评分及综合评分均降低（P＜0.05）,且观察组更低（P＜0.05）;观察组和对照组优良率分别为92.00%和80.52%,观察组的优良率高于对照组（P＜0.05）;2组复发率和并发症发生率比较差异均无统计学意义（P＞0.05）。 结论 眼轮匝肌复合瓣结合上睑皮肤松弛矫正术修复较大面积睑黄瘤术后缺损患者,能够缩短康复时间,提高美容效果,安全可靠。     

老年颅内破裂动脉瘤患者手术预后影响因素分析

目的探讨影响老年颅内破裂动脉瘤患者行开颅动脉瘤夹闭术预后的因素。 方法回顾分析老年颅内破裂动脉瘤患者74例,依据患者术后6个月时改良Rankin评分（Modified Rankin Scale,mRS）分为预后良好组(mRS 0~2分)45例和较差组（mRS 3~6分）29例,并对可能影响手术预后的因素进行分析。 结果2组在性别、高血压、糖尿病、冠心病、吸烟史、饮酒史、抗血小板或抗凝史、脑出血病史、动脉瘤部位、多发动脉瘤、手术时间、再出血、癫痫、非神经系统严重症状差异无统计学意义（P＞0.05）。预后良好组在年龄≥70岁、Hunt-Hess分级Ⅲ~Ⅴ级、合并虚弱症、手术时机＞3 d、动脉瘤直径≥7 mm、发生脑缺血卒中和脑积水比例比预后较差组更低,差异有统计学意义（P＜0.05或P＜0.01）。多因素Logistic回归分析结果显示,Hunt-Hess分级、虚弱症、手术时机及脑缺血卒中对预后有影响,差异有统计学意义（P＜0.05）,而年龄、动脉瘤直径及脑积水对结果无影响,差异无统计学意义（P＞0.05）。 结论老年颅内破裂动脉瘤患者行开颅手术的预后受多种因素影响,Hunt-Hess分级、虚弱症、手术时机、脑缺血卒中是重要的影响因素。     

巨大左心室心瓣膜置换术后近中期的疗效以及危险因素分析

目的 观察巨大左心室患者行心脏瓣膜置换手术后近中期的手术疗效以及探讨影响其预后的相关危险因素.方法 回顾性分析82例心瓣膜病合并巨大左心室患者行心瓣膜置换术的临床资料,比较术前术后近中期的心脏大小以及心脏功能的改变,并探讨影响其预后的相关危险因素.结果 术后近中期左心房内径、左心室舒张期末内径、左心室收缩期内径(LVESD)均较术前减小,差异有统计学意义(P＜0.05),而术后左心室射血分数值、左心室缩短率值与术前比较差异无统计学意义,术后心功能分级(NYHA)与术前比较差异有统计学意义(P＜0.05);影响患者预后的相关危险因素有术前LVESD值＞6.0 cm、心功能NYHA分级在Ⅳ级、术后未使用血管紧张素转化酶抑制剂(ACEI)类药物或者β-受体阻滞剂(P＜0.05).结论 心瓣膜病合并巨大左心室患者行心瓣膜置换术后围手术期死亡率低,且术后近中期心脏的形态大小发生了明显的逆重构过程,心功能同样明显改善,手术疗效满意.心功能Ⅳ级、LVESD≥6.0 cm、术后未使用小剂量的ACEI类药物或β-受体阻滞剂是影响预后的主要危险因素.     

癌组织VEGF表达与原发性肝细胞癌进展的关系研究

目的 探讨血管生成与原发性肝细胞癌进展的关系。方法 收集1993年～2000年41例病人的手术切除病理证实与原发性肝细胞癌的标本，行免疫组化染色（SABC法）检测血管内皮生长因子（VEGF）的表达以及肿瘤组织和肿瘤旁组织的微血管密度（MVD）。其中男34例，女7例；年龄35～65岁，平均48．8岁；肿瘤直径≤5cm者13例，〉5cm者28例，有包膜者19例，无包膜者22例。细胞学分级：Ⅰ级8例，Ⅱ级18例，Ⅲ级11例。Ⅳ级4例。门静脉或（和）肝静脉有癌栓形成者7例，无癌栓者34例。HbsAg或HBcAb阳性者33例，阴性者8例。结果 VEGF表达阳性率为70．7％（29／41）。VEGF的表达与MVD呈显著正相关（P〈0．01）。VEGF的阳性表达率与肿瘤病灶大小、有无静脉癌栓呈显著相关，肿瘤直径大、病期晚者表达率显著增高（P〈0．05或0．01）。有包膜的肿瘤VEGF表达率显著低于无包膜者。VEGF的表达与细胞学分级和是否有肝炎病毒感染无显著性相关。结论 肝细胞癌中VEGF的分泌增多可导致微血管数目增加，促进了其进展和转移。肿瘤较大、分期较晚的病例血管生成活性高，提示预后较差。     

非小细胞肺癌区域淋巴结中肺组织特异性基因的表达与预后的关系

目的：探讨非小细胞肺癌（non-small-cell lung cancer,NSCLC）区域淋巴结人肺组织特异性基因（lunx mRNA）的表达与预后的关系。方法：应用SYBR GreenⅠ嵌合荧光法进行逆转录聚合酶链反应（real-time RT-PCR）用以检测74例NSCLC手术切除区域淋巴结Lunx mRNA的表达,对入选患者进行为期3年的随访观察,并对6个可能影响NSCLC患者预后的因素进行Cox回归模型分析。结果：手术切除区域淋巴结Lunx表达率与年龄、营养指数、3年内的复发或转移率之间有相关性（P＜0.01, P＜0.01, P＜0.05）,而患者的性别、肺癌病理类型、分期与手术切除区域淋巴结Lunx表达率之间无相关性（P＞0.05）;NSCLC患者的生存时间与术后辅助治疗及与Lunx表达有统计学意义（P＜0.05, P＜0.01）。结论：NSCLC患者Lunx mRNA表达与其生存时间显著相关, 提示Lunx mRNA可作为NSCLC淋巴微转移的分子标志物及监测患者3年预后的指标之一;同时术后辅助治疗是延长患者生存时间的一项重要措施;荧光实时RT-PCR相对定量方法可应用于NSCLC淋巴微转移的检测,该方法可能有助于早期肺癌转移的诊断。     

肝硬化肝癌患者手术切除预后影响因素的回顾性研究

目的 探讨合并肝硬化的不同大小肝癌患者临床资料特点及肝切除术近远期预后的影响因素.方法 回顾性分析第三军医大学西南医院2008-2012年期间因肝癌而接受肝脏切除手术且具有肝硬化的连续患者资料共703例.收集患者临床病理资料并进行随访.对可能影响近、远期预后的因素分别进行Logistic及Cox回归分析.结果 703例患者中,男性638例,女性65例.其中,肿瘤最大直径＜5 cm的患者(小肝癌组,ST组)280例(39.8％),肿瘤最大直径≥5 cm的患者(大肝癌组,LT组)423例(60.2％).与ST组患者比较,LT组患者术前甲胎蛋白、天门冬氨酸氨基转移酶(AST)及脉管癌栓发生率较高,但白蛋白及血小板较低.术中资料表明LT组患者复杂手术比例、术中失血量、肝门阻断时间及手术时间都较高.而LT组患者术后并发症的总发生率也较高(35.0％vs27.1％,P=0.029).多因素分析显示,在ST组中,复杂手术(OR:2.755,95％CI:1.196～6.344,P=0.017)是独立的危险因素,而白蛋白水平低于35g/L(OR:4.049,95％CI:2.105 ～ 7.752,P＜0.01)与手术时间＞240 min(OR:3.044,95％CI:1.912 ～4.847,P＜0.01)是LT组独立的危险因素.远期预后分析显示:LT组患者无瘤生存时间(progression-free survival,PFS)和总生存时间(overall-survival,OS)均比ST组短(P＜0.01).多因素分析显示,在ST组中,癌栓是影响PFS的独立危险因素;而Child-Pugh B级、癌栓和复杂手术是影响OS的独立危险因素.在LT组中,癌栓和手术时间＞240 min均为影响PFS的独立危险因素;而AST ＞40 U/L和癌栓是影响OS的独立危险因素.结论 直径＜5 cm的小肝癌较之直径≥5 cm的大肝癌患者有着更高的近、远期生存率.而选择无癌栓的大肝癌病例,改善术前白蛋白、转氨酶水平,提高手术熟练度及合理使用手术器械[如射频消融辅助(radiofrequency ablation assist,RFA)]以缩短手术时间,可以降低术后并发症并改善大肝癌手术治疗的预后.