Risk factors for occult nodal metastasis in patients with stage ⅠA peripheral non-small cell lung cancer

Objective To study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non-small cell lung cancer.Methods From January 2000 to December 2010,a total of 281 patients with NSCLC[152 men and 129 women,aged ( 60.31±12.13) years;≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital .Clinical data included age,gender,symptoms,history and quantity of smoking history,history of tumor,family history of tumor,site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,cavity were collected compaired and analyzed.Single and multi-variate analysis was performed to determine the independent risk of occult N2 nodal involvement.Results Logistic regression analysis show seven clinical characteristics (fleshless( OR:22.262),history of tumor(OR:5.485),diameter( 0R:3.788),density( OR;5.850),traction of pleural (OR:1.371),border ( OR:8.259) and cavity (OR:7.124) were risk factors.Conclusion Fleshless,history of tumor,diameter,density,traction of pleural and the border and cavity were independent predictors of malignancy in patients with ≤3 cm peripheral non-small cell lung cancer.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

空洞型非小细胞肺癌的预后分析

Objective To explore the survival and prognostic status of the cavitating non-small cell lung cancer. Methods A total 42 surgically treated patients with cavitating non-small cell lung cancer were studied retrospectively. Kaplan-Meiei was used to analyze the relationship between the prognostic factors and survival time. The cavitaing non-small cell lung cancer were matched 1:2 to the patients with non-small cell lung cancer that there is no cavity in X-ray, for gender, age, histology, lymph nodes dissection, stage, and whether receiving chemotherapy. The two groups were compared using the Log-rank test. Results The overall 1, 3, 5- year- survival rates for cavitating non-small cell lung cancer were 76.2%, 28.6%, and 14.7%, respectively. The diameter of the cavity and lymph nodes status significantly influenced syrvivals. 1he overall syrvival between the two groups of patients showed no sig- nificant differences (P=0.075). But the factors of women(P=O.040), younger than 60 years(P =0.032), NO of the lymph nodes dissection group(P=0.046), and staging Ⅰ were significantly influenced 5-year survivals(P=0.048). Conclusion The diameter of the cavity and lymph nodes status were correlated with the survival. The carcinomatous cavity are important prognosis factors for the nan-retail cell lung cancer patients of younger than 60 years, negative of lymph nodes dissection and staging Ⅰ , but whether the carci- nomtous cavity are important prognosis factors for the non-small cell lung cancer patients of woman was not determined.     

影响T1～2期结直肠癌淋巴结转移和预后的因素分析

Objective To investigate factors associated with lymph node metastasis and prognosis in patients with T1-2 colorectal cancer. Methods Patients with pT1-2 colorectal cancer between January 1999 to January 2005 were included. Chi-square test and multivariable logistic analysis were performed to evaluate risk factors associated with lymph node metastasis. Survival outcomes were analyzed using Kaplan-Meier and Cox regression model. Results Tumor location and depth of invasion were independent risk factors for lymph node metastasis (P＜0.01 and P＜0.05). Gender, age, tumorgross pattern, tumor differentiation, carcinoembryonic antigen level, and tumor diameter were notassociated with lymph node metastasis. Lymph node metastasis and distant metastasis on postoperative follow-up were independent risk factors for survival (P＜0.05 and P＜0.01). Conclusion Factors associated with lymph node metastasis in pT1-2 colorectal cancer do not affect the survival. However,lymph node metastasis and distant metastasis are predictive for survival.     

Diabetes patients and non-diabetic patients intensive care unit and hospital mortality risks associated with sepsis

AIM:To compare mortality risks associated with known diabetic patients to hyperglycemic non-diabetic patients.METHODS:PubMed data base was searched for patients with sepsis,bacteremia,mortality and diabetes.Articles that also identified new onset hyperglycemia (NOH) (fasting blood glucose125 mg/dL or random blood glucose199 mg/dL) were identified and reviewed.Nine studies were evaluated with regards to hyperglycemia and hospital mortality and five of the nine were summarized with regards to intensive care unit (ICU) mortality.RESULTS:Historically hyperglycemia has been believed to be equally harmful in known diabetic patients and non-diabetics patients admitted to the hospital.Unexpectedly,having a history of diabetes when admitted to the hospital was associated with a reduced risk of hospital mortality.Approximately 17% of patients admitted to hospital have NOH and 24% have diabetes mellitus.Hospital mortality was significantly increased in all nine studies of patients with NOH as compared to known diabetic patients (26.7%±3.4% vs 12.5% ±3.4%,P0.05;analysis of variance).Unadjusted ICU mortality was evaluated in five studies and was more than doubled for those patients with NOH as compared to known diabetic patients (25.3%±3.3% vs 12.8%±2.6%,P0.05) despite having similar blood glucose concentrations.Most importantly,having NOH was associated with an increased ICU and a 2.7-fold increase in hospital mortality when compared to hyperglycemic diabetic patients.The mortality benefit of being diabetic is unclear but may have to do with adaptation to hyperglycemia over time.Having a history of diabetes mellitus and prior episodes of hyperglycemia may provide time for the immune system to adapt to hyperglycemia and result in a reduced mortality risk.Understanding why diabetic patients have a lower than expected hospital mortality rate even with bacteremia or acute respiratory distress syndrome needs further study.CONCLUSION:Having hyperglycemia without a history of previous diabetes mellitus is a major independent risk factor for ICU and hospital mortality.     

Limited resection for duodenal gastrointestinal stromal tumors:Surgical management and clinical outcome

AIM:To analyze our experience in patients with duodenal gastrointestinal stromal tumors(GIST) and review the appropriate surgical approach.METHODS:We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and 2011.Patient files,operative reports,radiological charts and pathology were analyzed.For surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection(LR).For extended resection pancreatoduodenectomy was performed.Age,gender,clinical symptoms of the tumor,anatomical localization,tumor size,mitotic count,type of resection resectional status,neoadjuvant therapy,adjuvant therapy,risk classification and follow-up details were investigated in this retrospective study.RESULTS:Nine patients(5 males/4 females) with a median age of 58 years were surgically treated.The median follow-up period was 45 mo(range 6-111 mo).The initial symptom in 6 of 9 patients was gastrointestinal bleeding(67%).Tumors were found in all four parts of the duodenum,but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients(33%).Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before resection.In one patient,the GIST resection was done by pancreatoduodenectomy.The 8 LRs included a segmental resection of pars 4 of the duodenum,5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y duodeno-jejunostomy.One of these LRs was done minimally invasive;seven were done in open fashion.The median diameter of the tumors was 54 mm(14-110 mm).Using the Fletcher classification scheme,3/9(33%) tumors had high risk,1/9(11%) had intermediate risk,4/9(44%) had low risk,and 1/9(11%) had very low risk for aggressive behaviour.Seven resections showed microscopically negative transsection margins(R0),two showed positive margins(R1).No patient developed local recurrence during follow-up.The one patient who underwent pancreatoduodenectomy died due to progressive disease with hepatic metastasis but without evidence of local recurrence.Another patient died in complete remission due to cardiac disease.Seven of the nine patients are alive disease-free.CONCLUSION:In patients with duodenal GIST,limited surgical resection with microscopically negative margins,but also with microscopically positive margins,lead to very good local and systemic disease-free survival.     

Peyronie's disease:a silent consequence of diabetes mellitus

Aim:To investigate the clinical characteristics of patients with Peyronie's disease(PD)and diabetes mellitus(DM).Methods:During an 8-year period,a total of 307 men seen at our outpatient clinic were diagnosed with PD.Clinicalcharacteristics,penile deformities and the erectile status of patients with PD and DM together(n=102)were retro-spectively analyzed and compared to patients with PD alone with no risk factors for systemic vascular diseases(n=97).Results:The prevalence of PD among men with DM and sexual dysfunction was 10.7%.The mean ageof diabetic patients with PD was(55.9±8.9)years;in the no risk factor group it was(48.5±9.0)years(P<0.05).The median duration of DM was 5 years.The majority of diabetic patients with PD(56.0%)presented in the chronicphase(P<0.05),and they were more likely to have a severe penile deformity(>60°)than the no risk factor group(P<0.05).In the diabetic group,the most common presenting symptom was penile curvature(81.4 %),followedby a palpable nodule on the shaft of the penis(22.5%)and penile pain with erection(14.7 %).A total of 19.6 % ofpatients were not aware of their penile deformities in the diabetic group.Erectile function,provided by history and inresponse to intracavernosal injection and a stimulation test,was significantly diminished in patients with PD and DM(P<0.05).Conclusion:DM probably exaggerates the fibrotic process in PD.Diabetic patients with PD have ahigher risk of severe deformity and erectile dysfunction(ED).PD seems to be a silent consequence of DM andshould be actively sought in diabetic men.(Asian J Androl 2006 Jan;8:75-79)     

Tumor differentiation as related to sentinel lymph node status in gastric cancer

AIM:To investigate the influence of tumor grade on sentinel lymph node(SLN)status in patients with gastric cancer(GC).METHODS:We retrospectively studied 71 patients with GC who underwent SLN mapping during gastric surgery to evaluate the relationship between SLN status and tumor grade.RESULTS:Poorly differentiated tumors were detected in 50/71 patients,while the other 21 patients had moderately differentiated tumors.SLNs were identified in 58/71 patients(82%).In 41 of the 58 patients that were found to have stained nodes(70.7%),the tumor was of the poorly differentiated type(groupⅠ),while in the remaining patients with stained nodes 17/58(29.3%),the tumor was of the moderately differentiated type(groupⅡ).Positive SLNs were found in22/41 patients in group I(53.7%)and in 7/17 patients in groupⅡ(41.2%)(P=0.325).The rate of positivity for the SLNs in the two groups(53.7%vs 41.2%)was not statistically significant(P=0.514).CONCLUSION:Most of our patients were found to have poorly differentiated adenocarcinoma of the stomach and there was no correlation between tumor grade and SLN involvement.     

非体外循环冠状动脉旁路移植术后再发脑卒中的临床分析

目的 探讨非体外循环冠状动脉旁路移植(OPCABG)术后再发脑卒中的危险因素及临床特点.方法 收集2006年1月至2009年7月437例OPCABG手术并且术前具有脑卒中史病人资料,采集病人手术前、后资料,根据术后有无再发脑卒中分成两组,进行单因素分析和多因素logistic回归分析.结果 437例中术后再发脑卒中32例(7.3%),均为脑梗塞,无脑出血病例.单因素分析发现左室射血分数≤0.50、术后房颤与低血压在两组间差异有统计学意义(P＜0.01).呼吸机辅助时间＞24 h、ICU时间＞24 h及住院时间在两组间差异有统计学意义(P＜0.05).多因素logistic回归分析结果表明,左室射血分数≤0.50(OR=2.837,95%CI:1.238～6.498)、术后房颤(OR=3.065,95%CI:1.157～8.118)与术后低血压(OR=4.209,95%CI:1.805～9.813)是术后再发脑卒中的独立危险因素.结论 左室射血分数≤0.50、术后房颤与低血压是OPCABG术后再发脑卒中的独立危险因素.OPCABG术后再发脑卒中者术后恢复较术后无脑卒中者差.

Abstract：

Objective To analyze the risk factors and clinical features of stroke following off-pump coronary artery bypass grafting in patients with prior stroke. Methods From January 2006 to July 2009, the clinical information of 437 patients undergoing OPCABC in Anzhen Hospital was collected. The patients were divided into stroke group and non-stroke group according to whether stroke occurred after operation. Preoperative and operative variants were evaluated by univariate and multivariate logistic stepwise regression analysis. Results 32 of 437 patients (7.3% ) suffered from stroke after OPCABG, 32 cases were cerebral infarction and no case was cerebral hemorrhage. There were more patients whose left ventricular ejection fraction ≤0. 50 in stroke group than that in non-stroke group (12 of 32, 37.5% versus 69 of 405, 17.0% , P = 0. 004), more patients had atrial fibrillation after operation in stroke group than that in non-stroke group (9 of 32, 28. 1% versus 27 of 405,6.7% , P ＜ 0.001), more patients had hypotension after operation in stroke group than that in non-stroke group (13 of 32,40.6% versus 42 of 405, 10. 4% ; P ＜ 0. 001), more patients had ventilatory time and ICU time after operation in stroke group than that in non-stroke group(9 of 32, 28.1% versus 49 of 405, 12.1% , P =0.021; 14of 32,43.8% versus 97 of 405, 24.0% , P = 0.013), and patients in stroke group took longer to stay in hospital than that in non-stroke group (29.0 ±15. 8 versus 22. 9 ± 10. 4, P = 0. 002 ). Logistic stepwise regression analysis showed that left ventricular ejection fraction SS0.50(OR=2.837, 95%CI: 1.238-6.498), atrial fibrillation after operation( OR =3. 065, 95% CI: 1.157-8.118) and hypotension after operation (OR =4.209, 95%CI: 1.805 -9. 813) were independent risk factors of stroke following offpump coronary artery bypass grafting in patients with prior stroke. Conclusion This data suggest that left ventricular ejection fraction ≤0. 50, atrial fibrillation and hypotension after operation are risk factors for stroke following off-pump coronary artery bypass grafting in patients with prior stroke. These patients with stroke after operation took longer to extubate and stay in ICU and hospital.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.