多极射频消融联合TACE治疗巨块型肝癌的疗效

目的与单纯TACE治疗对比,评价多极射频消融(RFA)联合TACE治疗巨块型肝细胞癌(HCC)的疗效。方法将55例经病理、影像学诊断、血清甲胎蛋白(AFP)检查确诊的巨块型HCC患者随机分为两组:联合组27例,接受TACE联合CT导引下RFA治疗;对照组28例,接受单纯TACE治疗。比较两种方法治疗后的总有效率、血清AFP、肝功能等指标。结果治疗术后1、3个月行增强CT扫描,联合组及对照组术后总有效率分别为85.19%、57.14%(P<0.05)。术后2个月联合组血清AFP值由(413.18±354.70)ng/ml降至(80.16±76.64)ng/ml,对照组由(426.81±385.63)ng/ml降至(161.64±132.89)ng/ml(P<0.05)。联合组及对照组治疗后,总胆红素、丙氨酸转氨酶、谷草转氨酶均有一过性增高,术后2周基本恢复至术前水平,两组间比较差异均无统计学意义(P均>0.05)。结论 RFA联合TA-CE治疗巨块型HCC是安全、有效的综合介入治疗方法。     

Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change

Objective: To evaluate the role of intravesical lidocaine in preventing autonomic dysreflexia (AD) during routine catheter changes in individuals with spinal cord injury (SCI) at T6 or above.

Design: Prospective observational cohort study.

Setting: Outpatient urology clinic.

Participants: Fifty consecutive individuals with SCI at or above T6 and a history of AD having a routine indwelling catheter change.

Interventions: A treatment group of individuals received 10?ml of 2% lidocaine administered into the existing catheter 4–6 minutes prior to catheter change. The control group had the same amount of lidocaine administered into the urethra or suprapubic tract after removing the old catheter and immediately prior to inserting the new catheter (due to the delayed onset of action of the anesthetic, this was assumed to have no initial effect). Systolic blood pressures (SBP) were measured immediately after catheter insertion and then every 30–45 seconds for 5 minutes.

Outcome measures: Incidence and magnitude of AD as determined by SBP following catheter change.

Results: The incidence of AD in the lidocaine treatment group was 14.8% vs 47.8% in the control group (P?=?.011). Pretreatment with lidocaine also demonstrated a significantly attenuated rise in SBP immediately after the catheter change (9.5?mmHg vs 26.9?mmHg for post-treatment, P?=?.014) relative to baseline SBP.

Conclusion: In individuals with SCI at risk of AD, pretreatment with intravesical lidocaine prior to catheter change significantly decreased both the incidence and magnitude of AD. This suggests that pretreatment with intravesical lidocaine is helpful in individuals with SCI who are prone to AD.     

Laparoscopic versus traditional peritoneal dialysis catheter insertion: a meta analysis

Objective: The objective of this study is to compare the catheter-related complications as well as catheter survival between laparoscopic and traditional surgery in peritoneal dialysis catheter insertion. Results: Five randomized controlled trials and 11 cohort studies were identified. Meta-analysis showed laparoscopic catheter is superior to traditional surgery in terms of controlling catheter migration (OR 0.17, 95% CI 0.08–0.33; p?p?=?0.0001; 2-year survival rate: OR 2. 07, 95% CI 1.29–3.33, p?=?0.0001), but slightly increases the risk of bleeding (OR 2.13, 95% CI 1.07–4.23, p?=?0.03). The two groups were not significantly different in other catheter-related complications. As regards the quality of the analysis, only the migration analysis ranked A-level, while the rest fell into Class B or C. The overall research quality was moderate. Conclusion: Laparoscopic surgery is superior to traditional surgery on reducing catheter migration and prolonging catheter survival rate according to our analysis.     

持续缓慢低效血液透析治疗老年Ⅱ型心肾综合征的临床观察

目的比较间断血液透析(intermittent hemodialysis,IHD)和持续缓慢低效血液透析(sustained low-efficiency hemodialysis,SLED)两种血液透析方法治疗老年Ⅱ型心肾综合征(cardiorenal syndrome,CRS)的效果。方法回顾性分析2012年1月至2014年7月在我院治疗的62例老年Ⅱ型CRS患者,均采取右侧锁骨下静脉置入中心静脉导管进行血液透析治疗,按照治疗方法分为IHD组和SLED组,2组观察治疗时间为1周,治疗期均避免大量超滤脱水,避免造成肾灌注不足,加重肾损伤。治疗前及治疗后分别测量中心静脉压(central venous pressure,CVP)、心率(heart rate,HR),采用全自动生化分析仪贝克曼奥林帕斯AU2700检测尿素氮(BUN)、血肌酐(SCr),采用ReLIA多功能免疫检测仪检测N-末端脑钠肽前体(N-terminal Pro Brain Natriuretic Peptide,NT-proBNP),采用飞利浦IE33超声诊断仪检测左室射血分数(left ventricular ejection eraction,LVEF)、肺动脉压(pulmonary arterial pressure,PAP)。结果 2组病例均为老年患者,年龄之间无统计学差异(P0.05)。2组患者治疗后BUN、SCr、NT-proBNP均较治疗前明显降低,LVEF较治疗前明显升高,差异均有统计学意义(P0.01)。IHD组治疗后HR、CVP、PAP下降,差异有统计学意义(P0.05);SLED组治疗后HR、CVP、PAP下降,差异有统计学意义(P0.01);SLED组治疗后HR、CVP、PAP较IHD组均降低,差异有统计学意义(P0.01)。结论IHD和SLED这两种血液透析方法对于老年Ⅱ型CRS患者均有良好的治疗效果。SLED缓慢清除体内多余液体和维持内环境的平稳,并可以持续地清除肾脏髓质在血供不足情况下产生的肾素等多余的心毒性物质,且能维持水、电解质及酸碱平衡,相对于IHD治疗在血液动力学方面更稳定。对于老年Ⅱ型CRS患者采取SLED治疗,既能达到IHD治疗紧急清除毒素、迅速纠正酸碱失衡和电解质紊乱,又能获得较好的血液动力学稳定,而且节约医疗资源,治疗效果更优于IHD。     

多层螺旋 CT 对涎腺结石的诊断价值

目的:探讨多层螺旋CT(MDCT)对涎腺结石的诊断价值及MDCT表现,了解其影像特点。方法:对具有完整头颈部MDCT资料并经手术病理证实的31例涎腺结石的MDCT进行回顾性分析。结果:31例患者共计有阳性结石39个,下颌下腺结石30例(96.77%),7例患者(22.58%)具有多发结石,18例(58.06%)病例伴有明显的炎性症状,结石体积、结石的位置与下颌下腺炎性症状相关,结石越靠后、结石体积越大,下颌下腺炎性症状就越重。结论:MDCT对涎腺结石的诊断有重要的应用价值,能确定结石的形态、数目、大小并定位,为临床手术治疗提供依据。     

经皮椎体成形术联合肿瘤介入摘除术治疗转移瘤导致的椎体压缩性骨折

目的探究经皮椎体成形术(PVP)联合肿瘤介入摘除术(ITR)治疗转移瘤导致的椎体压缩性骨折的疗效,并评价其安全性。方法 2014年1月—2017年6月收治中国人民解放军陆军第八十三集团军医院转移瘤导致的椎体压缩性骨折患者共94例,其中49例采用PVP治疗(PVP组),45例采用PVP联合ITR治疗(PVP+ITR组)。记录2组患者的骨水泥注射量及骨水泥渗漏情况,观察神经功能障碍及感染等并发症发生情况,采用疼痛视觉模拟量表(VAS)评分评价疼痛改善情况。结果所有手术顺利完成,所有患者随访超过12个月。PVP组骨水泥注射量为(3.12±0.67)mL,PVP+ITR组为(5.33±1.67)mL,差异有统计学意义(P 0.05)。PVP组骨水泥渗漏率为48.98%,PVP+ITR组为20.75%,差异有统计学意义(P 0.05)。2组患者术后VAS评分均较术前改善,且术后1、3、6、12个月PVP+ITR组VAS评分优于PVP组,差异均有统计学意义(P 0.05)。2组患者术后均未见神经功能障碍及感染等并发症发生。结论 PVP联合ITR治疗转移瘤导致的椎体压缩性骨折能够有效维持椎体稳定,减少骨水泥渗漏的发生,有效缓解疼痛,具有临床应用价值。     

不同麻醉方式手术患者留置尿管时机选择比较分析

目的观察不同麻醉方式的手术患者留置尿管的最佳时间。方法将2011年1月至2014年1月该院收治的28例因外科手术需要留置尿管的患者,根据麻醉方式及导尿时机选择将其分为腰-硬联合麻醉前留置尿管（Ⅰ前组）、腰-硬联合麻醉10 min后留置尿管（Ⅰ后组）、全身麻醉前留置尿管（Ⅱ前组）、全身麻醉10 min后留置尿管（Ⅱ后组）共四组,各7例。收集、分析相关数据,比较四组患者插管时心率、血压、并发症等各项指标。结果不同麻醉方式麻醉10 min后留置尿管,患者插管前后心率和血压比同种床醉方式麻醉前留置尿管稳定,且患者舒适度好、并发症少,差异均有统计学意义（P〈0.05）。结论无论是腰-硬联合麻醉还是全身麻醉的手术患者,留置尿管的最佳时间均为麻醉10 min后。