先天性肝囊肿(附30例报告)

回顾收治的３０例先天性肝囊肿病例，结合文献着重讨论了诊断中的注意事项和治疗方法。认为Ｂ超、ＣＴ及ＭＲＩ对其诊断及协助处理有价值。治疗上比较了单纯穿刺抽液、穿刺抽液加硬化剂注入、囊肿开窗术、囊肿切除或部分肝切除等方法，认为对于单纯性先天性肝囊肿病例采用超声导引下穿刺注射硬化剂（６例）或囊肿开窗术治疗（１５例），均可取得优良效果。本组中有１例发生恶变。     

The Usefulness of Endoscopic Color Doppler Ultrasonography (ECDUS) for Endoscopic Injection Sclerotherapy (EIS)

Abstract: We studied 12 patients using endoscopic injection sclerotherapy (EIS) guided by endoscopic color Doppler ultrasonography (ECDUS). The ECDUS was performed with a PENTAX FG-32UA (7.5MH2, convex type) and a HlTACHl EUB 565 as a display machine. The EIS needle, as well as changes in intramural blood flow before and after EIS were clearly observed with the ECDUS. When the sclerosant was injected properly into the esophageal varices, the blood flow in the esophageal varices could not be detected with color Doppler flow imaging nor with fast-Fourier transform (FFT) analysis. Therefore EIS was safely performed with an adequate volume of sclerosant having been accurately injected into the varices. Of the disadvantages of this technique, the forceps channel was found to be a bit narrow, and the anterior view was somewhat oblique. Even so, EIS guided by ECDUS is surely a promising method for the treatment of esophageal varices, especially once the technical difficulties are overcome. (Dig Endosc 1994; 6 : 39–44)     

REVIEW: Pharmacotherapeutic agents in the treatment of portal hypertension

Certain vasoactive substances reduce portal pressure in patients or animals with portal hypertension by either inducing splanchnic vasoconstriction or reducing hepatic vascular resistance. Studies have shown that propranolol or nadolol significantly reduce the risk of a first episode of gastrointestinal (GI) bleeding and increase the survival rate in patients with cirrhosis and oesophageal varices. Isosorbide-5-mononitrate is also effective in the prevention of bleeding. The combination of betablockers and nitrates may be more effective than one drug alone. These results show that β-adrenoceptor antagonists must be used to prevent the first episode of GI bleeding. Beta-blocker administration also significantly reduces the risk of recurrent GI bleeding and increases the survival rate in patients with cirrhosis. Studies have shown that propranolol is as effective as endoscopic sclerotherapy. The combination of a beta-blocker with endoscopic sclerotherapy may be more effective than pharmacological or endoscopic treatment alone for the prevention of rebleeding. Finally, new experimental and clinical studies are needed to improve the pharmacological treatment of portal hypertension.     

聚桂醇硬化剂治疗口腔颌面部血管瘤和脉管畸形专家共识

[提要] 血管瘤和脉管畸形是一组复杂的来源于脉管系统的疾病。婴幼儿血管瘤以内皮细胞增殖为特征,是最常见的婴幼儿良性肿瘤。脉管畸形是胚胎发育时期脉管系统发育异常所致,超过60%的脉管畸形发生于头颈部。血管瘤和脉管畸形可能引起严重的面部畸形和功能障碍,硬化治疗是其常用的治疗方法。过去常用的硬化剂有平阳霉素、博来霉素、无水乙醇、十四烷基硫酸钠、OK-432、强力霉素、鱼肝油酸钠等。近年来,国产硬化剂聚桂醇被广泛用于血管瘤和脉管畸形的治疗,泡沫化硬化治疗技术的发展推动了其临床应用,其治疗有效性和安全性已被大量研究所证实。为了进一步规范该技术的应用,我们组织专家制定了该专家共识。今后将依据最新出版的文献和临床治疗经验及时更新,为该领域的临床医师提供指导。     

Application of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity

PurposeThe aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy (FS).MethodsA total of 64 patients (35 females, 29 males; mean age, 57 ± 11 years [range, 29–79 years]) with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019. The maximum diameter of the vein branches was >20 mm, which appeared to be cystic dilatation and forms large-scale in the crus or the thigh. All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia. The surgical time, pain/phlebitis, number of incisions, amount of bleeding, recurrence of varicose vein, incidence of surgical site infections (SSIs), satisfaction score, and improvement in clinical symptoms were evaluated respectively with the patients in two groups: Group A, with patients who underwent treatment with the Trivex system, and Group B, patients who underwent treatment by point-form-stripping combined with FS.ResultsAll procedures were performed successfully. The average operative time in Group A was 56 ± 11 min, whereas that of Group B was 90 ± 33 min, which was a significant difference (p < 0.05). Group A patients felt little pain after surgery, whereas in Group B the level of pain peaked on postoperative day 30, mostly due to thrombophlebitis after FS. There was no recurrence of varicose vein was observed in any patient, however, there were some residual effects in Group B, including the amount of bleeding volume, in-hospital stays, pain/phlebitis, and number of incisions (P < 0.05). There were no significant differences with respect to SSIs, improvement in clinical symptoms, and satisfaction scores observed (p>0.05).ConclusionsThis study shows that patients benefited from both treatment options. However, primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy (FS). In summary, the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy (FS) for those who demand a high level of appearance, and especially for young patients, the Trivex system is recommended.     

经阴道超声引导下换洗法介入硬化治疗卵巢囊肿的临床价值

目的探讨经阴超声引导下换洗法介入硬化治疗卵巢囊肿的效果。方法采用常规法和换洗法2种方法介入硬化治疗卵巢囊肿共研究硬化治疗卵巢囊肿患者66例,子宫内膜异位囊肿17个,单纯囊肿49个,均为单侧,术后随访3~18个月。结果 2种方法的治疗效果有明显差别。其中换洗法治疗组36例,治愈率94.44%（34/36）,显效率2.78%（1/36）,无效率2.78%（1/36）。常规法治疗组共30例,治愈率70.00%（21/30）,显效率16.67%（5/30）,无效率13.33%（4/30）。结论经阴超声引导下换洗法介入硬化治疗卵巢囊肿明显提高治愈率。该方法操作简便、安全有效、费用低廉,值得临床推广应用。     

Prophylactic versus emergency sclerotherapy of large esophageal varices prior to liver transplantation

From January 1985 through July 1987, adult patients accepted for liver transplantation with large esophageal varices were enrolled in a study evaluating the use of prophylactic vs emergency sclerotherapy. Six hundred forty-eight subjects received prophylactic sclerotherapy, and 172 received emergent sclerotherapy. Esophageal stricture formation was increased 12.9-fold (P<0.001), esophageal perforation 6.4-fold (P<0.005), and postsclerotherapy bleeding esophageal ulcers 3.7-fold (P<0.001) in those receiving emergency sclerotherapy as opposed to prophylactic sclerotherapy. These differences were even greater if the number of sclerotherapy sessions rather than the number of patients was used as the denominator for the comparisons. In total, 19.6% of emergency sclerotherapy cases were associated with an untoward outcome of sclerotherapy; only 1.9% of cases receiving prophylactic sclerotherapy experienced an untoward outcome (P <0.001). These data demonstrate that emergency sclerotherapy is associated with a greater prevalence of complications and support earlier studies that show that sclerotherapy prevents variceal bleeding over the short term. The data also suggest that when applied to patients with large varices awaiting orthotopic liver transplantation, it enhances the chance of a patient surviving to be transplanted by preventing a variceal bleed and the spiral of liver failure and death that frequently follows an episode of acute variceal bleeding.     

Congenital hepatic fibrosis in Indian children

BACKGROUND: Congenital hepatic fibrosis (CHF) is an uncommon cause of portal hypertension in children. So far, there is no report of this from the subcontinent. We have studied the clinical spectrum of CHF in North Indian children. METHODS: Fifteen children were diagnosed with CHF on the basis of their liver histology over a period of 6.5 years. Their clinical details were recorded. Oesophagogastroduodenoscopy and abdominal ultrasonography were performed in all cases. All siblings were examined clinically; and ultrasonography, endoscopy and liver biopsy were performed if there was firm hepatomegaly. Children with variceal bleeding were managed by endoscopic sclerotherapy. The median age of these children was 8 years with a male to female ratio of 1.5:1. RESULTS: Only one sibling (of 33) was diagnosed as having CHF. The predominant presentations were variceal bleeding in six, abdominal distension in seven and incidental detection of organomegaly in two. Hepatomegaly was present in all patients and splenomegaly in all but one. Liver function and renal function tests were normal in all children, except for a raised serum alkaline phosphatase in six. Two children had associated renal cysts, two had choledochal cysts, one each had Caroli's disease and biliary atresia and two children had portal vein thrombosis. Variceal obliteration was achieved in five children after an average 4.8 sclerotherapy sessions and one required a mesocaval shunt. On follow up (median 41 months, range 1-80 months) all are doing well. CONCLUSIONS: Congenital hepatic fibrosis is mainly sporadic in India and associated renal lesions are uncommon. Endoscopic sclerotherapy is effective in controlling variceal bleed and the prognosis is universally good in the absence of renal diseases.     

Sclerotherapy for esophageal variceal bleeding in advanced hepatocellular carcinoma: An 8-year experience in Taiwan

Between August 1983 and December 1991 at the Taichung Veterans General Hospital, Taiwan, 65 advanced hepatocellular carcinoma (HCC) patients with esophageal variceal bleeding received endoscopic injection sclerotherapy (EIS) and 60 such patients received conservative medical treatment without EIS. The rate of successful control of acute bleeding was 72.5% (27/40 patients) in the EIS group and 56.7% (34/60 patients) in the non-EIS group. The rebleeding rate was lower in the EIS group than in the non-EIS group (26.9% vs 73.5%). Thirty-one of the EIS and 44 of the non-EIS treatment patients, mainly Child's B and C patients, died within 2 months after the first bleeding. In the short term, EIS decreased the mortality due to esophageal variceal bleeding, but the survivors still had to face hepatic failure and tumor growth. Thus, benefits of EIS were noted on short-but not on long-term survival. The mean survival times were 2.38 months for the EIS group and 1.79 months for the non-EIS group. Since EIS had no beneficial effects on long-term survival it is doubtful whether sclerotherapy applied to esophageal variceal bleeding in patients with advanced HCC would be worthwhile, as the endoscopic procedure would only add to their suffering.