中药治疗宫颈癌放射性直肠炎临床观察

目的:观察中药灌肠治疗宫颈癌放射性直肠炎的临床效果.方法:将62例宫颈癌放射性直肠炎患者随机分成治疗组和对照组,治疗组予中药保留灌肠,对照组予温血液透析用水、利多卡因、黄连素片研末灌肠,云南白药、安络血、维生素B6口服,对照两组的治疗效果.结果:经过1个疗程治疗后,治疗组总有效率为93.55%,对照组总有效率为74.19%,两组总有效率比较差异有显著性意义(P＜0.05).结论:中药治疗宫颈癌放射性直肠炎可以提高临床效果.     

复方米汤保留灌肠治疗放射性直肠炎

子宫颈癌居女性生殖器官肿瘤之首 ,采用近距离腔内放疗 ,放射源与直肠极为接近 ,加之直肠组织对放射敏感性高 ,因此易产生放射性直肠炎 ,发生率在 80 %左右[1] 。 1 997年 2月至 1 999年 6月 ,我院采用复方米汤保留灌肠法治疗放射性直肠炎病人 1 1例 ,疗效显著 ,介绍如下。1　临床资料本组 1 1例 ,年龄 45～ 76岁 ,平均 58岁。病人在接受放射治疗期间 ,出现不同程度的下腹疼痛 ,大便次数增多 ,并有里急后重感 ,乙状结肠镜检见肠粘膜水肿、充血 ,甚至广泛性浅表糜烂。其中 4例症状较轻 ,大便 4～ 6次 /d;7例症状较重 ,大便 9～ 1 0次 /d,1例…     

保留灌肠对轻中度放射性直肠炎疗效的影响

目的探讨保留灌肠对轻、中度放射性直肠炎近期疗效的影响。方法将130例宫颈癌根治性放疗后出现放射性直肠炎患者按就诊序号单号分为观察组、双号分为对照组各65例。对照组行常规静脉用药治疗，观察组在此基础上选用西黄芪胶、氢化可的松、呋喃唑酮或庆大霉素、止血粉、象皮粉等行保留灌肠。治疗1个疗程后比较两组近期疗效。结果观察组疗效显著优于对照组（P〈0．05）。结论放射性直肠炎加用保留灌肠可提高疗效。     

手术切除直肠癌患者预后危险因素分析

目的探讨手术切除直肠癌患者预后的相关危险因素。方法回顾性分析286例直肠癌术后患者的临床资料,对比不同因素患者的5年生存率。结果单因素分析显示,不同性别、年龄患者5年生存率比较无统计学差异(P0.05),而不同病程、术前CEA水平、手术方式、肿瘤分化程度、肿瘤大小、肿瘤浸润深度、淋巴结转移个数、肿瘤临床分期患者的5年生存率比较差异具有统计学意义(P0.05);Logistic回归分析显示,术前CEA水平、肿瘤分化程度、淋巴结转移、肿瘤浸润深度以及肿瘤临床分期均为直肠癌术后患者预后不良的独立危险因素(P0.05)。结论术前CEA水平、肿瘤分化程度、淋巴结转移、肿瘤浸润深度以及肿瘤临床分期均为直肠癌术后患者预后不良的独立危险因素。因此,直肠癌的早期诊断及早期手术治疗对于改善患者预后、提高患者生活质量将具有重要意义。     

膀胱癌发病及影响预后的危险因素

膀胱癌是我国泌尿系统最常见的恶性肿瘤.我国膀胱癌的发病率虽然远低于西方国家,但近年来有逐渐增高趋势.与大多数恶性肿瘤一样,膀胱癌的发生是一个多因素、多步骤的病理变化过程.除膀胱癌的分级分期之外,目前环境暴露对于膀胱癌进展复发及预后的影响还知之甚少.明确并控制膀胱癌发病及影响预后的危险因素,对降低膀胱癌的发病率和提高膀胱癌的生存率具有重要意义.     

结直肠癌肝转移危险及预后因素分析

肝脏是结直肠癌最常见的远处转移器官,结直肠癌病人出现肝转移一般预后较差。结直肠癌肝转移分为同时性肝转移和异时性肝转移,对众多的临床以及病理学特征进行的单因素和多因素回归分析提示,影响结直肠癌发生肝转移的危险因素有：浸润深度、淋巴结转移、癌结节、分化程度、癌胚抗原和糖类抗原等。影响结直肠癌肝转移病人预后的因素有：肝转移灶大小及数目、肝外器官转移、原发灶手术切除、肝转移灶手术切除、全身药物治疗等。因此,手术切除肝转移灶、药物治疗获得手术切除机会等治疗模式能够最大程度地提高结直肠癌肝转移病人的存活率。由众多因素组合起来的评分系统,能够较好地预测结直肠癌肝转移病人的预后。     

福尔马林治疗放射性直肠炎出血(附5例报告)

目的:探讨电子结肠镜下局部采用4%福尔马林对放射性直肠炎出血的治疗作用。方法:分析2003~2005年收治的5例慢性放射性直肠炎出血的临床资料。结果:5例放射性直肠炎出血经过经结肠镜和肛镜直视下局部使用4%福尔马林后,出血明显减少,随访1个月、2个月效果满意。结论:局部采用4%福尔马林治疗放射性直肠炎出血简便有效、价廉、可反复进行,未发现有明显并发症。     

福尔马林治疗慢性放射性出血性直肠炎——一种有效但危险的治疗方法

目的:对福尔马林局部应用治疗慢性放射性出血性直肠炎做一回顾性研究评估。方法:1994年1月至2001年12月,对>18岁的慢性放射性出血性直肠炎病人进行回顾性研究,病人均表现为直肠多次出血(每周>3次)未经药物治疗或经内镜治疗。对全部病人均行结肠镜检查排除其他原因的出血,确定放     

银锌霜治疗放射性直肠炎的疗效观察

目的：观察银锌霜治疗放射性直肠炎的疗效。方法：38例放射性直肠炎的患者接受了银锌霜直接涂抹治疗，每天1次，6d为1疗程。结果：治疗后临床症状迅速缓减。结论：外用银锌霜治疗放射性直肠炎患者是简单、安全有效的方法。     

重症急性胰腺炎预后不良的相关危险因素分析

目的：探讨重症急性胰腺炎（SAP）预后不良的危险因素,为临床救治提供参考。方法：对118例SAP患者的临床资料进行回顾性分析,对SAP死亡的相关危险因素进行Logistic回归分析,筛选SAP死亡的相关危险因素。结果：单因素分析结果显示,肌酐（Cr）、血尿素氮（BUN）、空腹血糖（FBG）、血清白蛋白（ALB）与SAP早期死亡有关,而年龄、心率、呼吸、白细胞计数、平均动脉压（MAP）、总胆红素（TBIL）、直接胆红素（DBIL）、血淀粉酶（AMS）、尿淀粉酶（UAMY）等因素与SAP早期死亡无关（P〉0.05）。多因素Logistic回归法分析显示,FBG、Cr、ALB、BUN是SAP早期死亡的危险因素。结论：FBG、Cr、BUN水平升高,ALB水平下降是SAP预后不良的危险因素,需加以重点评估和合理控制。     

Endoluminal formalin application for haemorrhagic radiation proctitis

BACKGROUND: Radiation proctitis is a common complication following radiation therapy for pelvic malignancies. This is associated with significant morbidity which adversely affects the quality of life. Local application of formalin has been used effectively in the treatment of radiation proctitis. METHODOLOGY: Thirty patients with haemorrhagic radiation proctitis who underwent endoluminal application of 4% formalin between January 1998 to October 2002 were followed up prospectively to assess the efficacy of the treatment. RESULTS: The follow up ranged from 5 to 36 months (mean 18.1 months). Nineteen (63.3%) patients had complete response to formalin application while 7 (23.3%) patients had partial response. There were 4 (13.3%) failures. No procedure related complication was observed. CONCLUSION: Local application of formalin is a simple, safe, inexpensive and fairly effective outpatient treatment modality for chronic radiation proctitis.     

铝镁加混悬液联合表皮生长因子保留灌肠治疗放射性直肠炎的疗效观察

目的观察铝镁加混悬液联合表皮生长因子保留灌肠在放射性直肠炎的治疗效果。方法对125例放射性直肠炎患者,按就诊顺序随机分成对照组62例,试验组63例,对照组采用多药物(重组人表皮生长因子,地塞米松注射液,利多卡因针,凝血酶冻干粉,甲硝唑液等)配制成的混悬液,在患者便后或睡前保留灌肠,2次/d,2周为1个疗程,共3个疗程,试验组在对照组的基础上加用铝镁加混悬液,观察两组的临床疗效。结果试验组有效率95.2%,对照组有效率90.3%。结论铝镁加混悬液联合表皮生长因子保留灌肠治疗放射性直肠炎疗效确切,安全,值得临床推广。     

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA＜26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status＜12 years, history of diabetes and anuria (all P＜0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P＜0.05). Multivariate logistic regression analysis showed that education status＜12 years (OR=3.428, 95%CI 1.919-6.125, P＜0.001), post-dialysis diastolic pressure＜73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V＜1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status ＜12 years, post-dialysis diastolic pressure＜73 mmHg and spKt/V＜1.72 are the independent risk factors for cognitive impairment in MHD patients.     

Risk factors associated with intraabdominal infections: a prospective multicenter study

Introduction and methods: A prospective observational multicenter study with 18 hospitals was performed to assess preoperative risk, therapeutic management and outcome of patients with peritonitis. Data collection was carried out according to standardized and recommended definitions. Included in the study were 355 patients with macroscopically confirmed peritonitis. Results: In the univariate analysis, the following factors influenced both the mortality and the incidence of postoperative complications: age, presence of certain concomitant disease, site of origin of peritonitis, type of admission and the ability of the surgeon to eliminate the source of infection. In addition, postoperative infective complications were related to the etiology of peritonitis and the exudate. In the multivariate analysis, APACHE II (P<0.001), successful operation (P<0.001), age (P<0.001), liver disease (P<0.03), malignant disease (P<0.04) and renal disease (P<0.05) turned out to be significant with respect to death. Escherichia coli was the predominant organism (51%), following by enterococci (30%) and bacteroides (25%). There was a significantly higher postoperative infection rate in patients with no adequate treatment of enterococci than patients with adequate treatment or no enterococci (P<0.05). Conclusion: The study demonstrated the important role of the physiological reserve of the patient and of the surgeon, which is not adequately reflected in existing scoring systems. Further investigations are needed to study the impact of enterococci on the outcome. Received: 26 January 1998; in revised form 26 October 1998 Accepted: 27 October 1998     

Chronic radiation proctitis

Background : Increasing use of radiation therapy in pelvic malignancy has led to an increase in the incidence of chronic radiation proctitis. The commonest presenting complaint is rectal bleeding. Methods : A comprehensive MEDLINE search was undertaken for all articles relating to radiation proctitis. Results : The natural history of the disease is poorly documented but improvement is likely in milder forms, with persistence of symptoms in more severe forms. The pathological manifestations of the disease are summarized with particular comparison to acute radiation proctitis. The common clinical presentations and the principles of assessing patients with radiation‐induced proctitis will be reviewed. The present article also reviews current treatment options, with particular reference to newer endoscopic therapies and surgical principles of management. Conclusions : The initial therapy for problematic rectal bleeding related to radiation‐induced proctitis shoud be endoscopic therapy with argon plasma coagulation or topical formalin therapy. Surgery is reserved as a last resort for resistant rectal bleeding and for complicated radiation‐induced strictures and fistulas.     

再次肝移植预后影响因素分析

目的 统计分析天津市第一中心医院再次肝脏移植手术预后的影响因素,探讨提高再次移植术后生存率的对策.方法 1999年1月至2006年12月施行再次肝脏移植手术132例,回顾性研究其中74例病例资料,对可能影响再次肝移植术后生存率的17个因素分析,采用Cox比例风险模型进行多因素分析,筛选出影响再次肝移植预后的显著相关因素.结果 对17个可能影响再次肝移植预后的因素采用Kaplan-Meier方法 单因素分析得出10个与再次肝脏移植术后生存率相关的变量:再次手术时期、肝性脑病、凝血酶原时间(PT)、总胆红素(TB)水平、热缺血时间、术式、术中出血量、术后ICU停留时间、术后感染及术后并发症.多因素分析进入Cox回归模型的有术式、术后ICU停留时问和术后并发症3个变量.结论 影响再次肝移植预后的3个主要因素分别为手术方式、术后ICU停留时间和术后有无并发症的发生.     

894例食管癌术前营养风险危险因素分析与预后

目的 探讨食管癌患者术前营养风险状况与预后的关系,分析营养风险的危险因素.方法 回顾性分析894例食管癌切除患者的临床资料.根据营养风险评分进行分组,总评分＜3分为无营养风险组,总评分≥3分为营养风险组.采用单因素分析术前营养风险状况对术后并发症、住院时间的影响,多因素logistic回归分析术前营养风险的独立危险因素.结果 营养风险组491例,无营养风险组403例.营养风险组术后并发症发生比例明显高于无营养风险组(33.60％对19.60％),差异有统计学意义(P=0.001);营养风险组与无营养风险组术后严重并发症比较(23.01％对8.68％)、平均住院日比较[(37.20±13.89)天对(31.69±13.49)天],差异均有统计学意义(P＜0.05).Logistic回归分析结果显示,患者年龄(OR=1.58,95％ CI:1.101 ～2.268)、入院症状条目数(OR=7.97,95％ CI:6.071 ～10.463)、入院症状严重程度(OR=0.26,95％ CI:0.186～0.385)、入院饮食状况(OR=0.62,95％ CI:0.482～0.813)是发生术前营养风险的独立危险因素(P＜0.05).结论 年龄≥60岁、入院症状多、入院症状严重、入院饮食情况差的食管癌患者容易发生营养风险.存在营养风险的患者住院时间延长,易发生术后并发症.     

直肠神经内分泌肿瘤69例淋巴结转移和预后的影响因素分析

目的研究影响直肠神经内分泌肿瘤（NET）的淋巴结转移及预后因素。方法回顾性分析2003年4月至2011年10月辽宁省肿瘤医院大肠外科收治的69例直肠NET患者的临床资料,分析淋巴结转移及预后与直肠NET临床病理因素的关系。结果69例患者中有9例（13．0％）发生淋巴结转移,单因素分析结果显示：淋巴结转移与直肠NET大小、T分期及G分级有关（均P〈0．01）;多因素分析结果显示：T分期是独立影响淋巴结转移的因素（P=0．002,OR=46．000,95％CI：4．030～525．126）。全组患者的5年总生存率为90．3％,单因素分析结果显示：肿瘤大小、T分期、N分期、M分期、TNM分期及G分级与患者的总体生存率有关（分别为P〈0．01和P〈0．05）;多因素分析结果显示,M分期是长期生存的独立预后因素（P=0．000,HR=2．285,95％CI：1．484～3．518）。TNM分期Ⅰ期行局部和根治切除手术的患者,3年总生存率差异无统计学意义（P〉0．05）;Ⅱ期及以上分期患者,行非根治切除与根治切除手术者3年总生存率差异则有统计学意义（P=0．046）。结论直肠NET的T分期与淋巴结转移有关,TNM与M分期两者交互作用影响患者的预后,故可以作为淋巴结转移及预后的预测因素。TNM分期Ⅰ期的患者推荐行局部切除,Ⅱ期及以上的患者推荐行根治性手术治疗。     

住院患者急性肾损伤的发病及预后相关危险因素分析

目的 探讨住院患者急性肾损伤（AKI）的发病及预后情况,寻找与预后相关的危险因素,为临床更好地认识和预防AKI,改善预后提供依据。 方法 应用医院实验室网络系统筛选2009年1月至12月上海市一家三级甲等综合性医院所有住院患者,应用急性肾损伤网（AKIN）推荐的AKI定义选择病史完整的AKI患者组成研究队列,回顾性分析AKI住院患者的发病率、病因及分布特点、患者及肾脏预后情况。Logistic回归分析影响住院AKI患者预后和肾脏预后的危险因素。 结果 符合入选标准的住院AKI患者共934例,住院患者的AKI发病率为2.41%（934/38 734）。患者男女比例为1.88∶1,平均年龄（60.82±16.94）岁,AKI发病率随着年龄的增加逐渐增高,其中63.4%为外科患者,35.4%为内科患者,1.2%为妇产科患者。病因中肾前性AKI占51.7%,急性肾小管坏死（ATN）占37.7%,急性肾小球和肾小血管病变（AGV）占3.8%,急性小管间质性肾炎（AIN）占3.5%,肾后性AKI占3.3%。患者AKI后28 d存活率为71.8%。AKI后28 d时有65.7%的患者肾功能完全恢复,16.9%的患者部分恢复,17.4%的患者未恢复。AKIⅠ、Ⅱ和Ⅲ期患者的病死率分别为24.8%、31.2%和43.7%。多因素Logistic逐步回归模型结果提示,肾损伤药物史（OR = 2.313）、前1周低血压史（OR = 4.482）、少尿史（OR = 5.267）、肾外脏器衰竭数（OR = 1.376）和行肾脏替代治疗（RRT）（OR = 4.221）是住院AKI患者死亡的独立危险因素;肾外脏器衰竭数（OR = 1.529）和行RRT（OR = 2.117）是住院AKI患者肾脏丢失的独立危险因素。 结论 AKI在住院患者中常见,病死率较高,AKI后可以造成患者的肾脏丢失。预后与肾损害的严重程度密切相关。肾损伤药物史、1周内低血压史、少尿史、肾外脏器衰竭数和需要行RRT是AKI患者死亡的独立危险因素。肾外脏器衰竭数和需要行RRT是肾脏丢失的独立危险因素。     

胃癌腹膜种植转移的危险因素及预后分析

目的:探讨胃癌腹膜转移的危险因素及其预后.方法:回顾性分析352例胃癌患者的临床病理资料进行.结果:全组腹膜转移的发生率为15.1％ (53/352).单因素分析显示,胃癌腹膜转移与性别、组织学类型、浸润深度、淋巴结转移、TNM分期、手术方式及局部复发等有关(均P＜0.01);多因素分析显示,胃癌腹膜转移独立危险因素是胃壁浸润深度( P=0.016,95％CI=0.570～0.945),TNM分期(P＜0.001,95％CI=2.414～4.027),淋巴结转移(P=0.027,95％CI=1.041～1.964),手术方式(P＜0.001,95％CI=1.203～1.870),局部复发(P＜0.001,95％CI=1.376～2.871);腹膜转移患者1,2年生存率分别为44％和10％,而无转移患者分别为97.0％和74.0％,两组间生存率差异有统计学意义(x2=249.411,P＜0.001).结论:胃癌伴腹膜转移预示肿瘤的恶性程度高,预后较差;而胃壁浸润深度,TNM分期,淋巴结转移,手术方式及局部复发等因素是影响胃癌腹膜种植转移的独立危险因素.