早期胃癌腹腔镜辅助远端胃切除术疗效评价的Meta分析

目的评价腹腔镜辅助远端胃切除术（laparoscopy-assisted distal gastrectomy,LADG）与传统开腹手术（con-ventional open distal gastrectomy,CODG）治疗早期胃癌的临床疗效和安全性。方法检索PubMed、EmBase、临床对照试验资料库（cochrane controlled trials register,CCTR）及中国生物医学数据库（Chinese biomedical literature database,CBM）发表的临床随机对照研究文献,对纳入研究的文献采用Newcastle-Ottawa量表进行质量评价。提取文献原始数据,采用Revman 5.0统计软件对数据进行Meta分析,计算合并OR值和95%可信区间。结果经筛选有8个随机对照试验（ran-domized controlled trials,RCT）共734例患者纳入系统评价。与开腹手术组相比,腹腔镜手术组手术时间长,加权均数差（weighted mean difference,WMD）63.35;95%可信区间（confidence interval,95%CI）[57.96,68.74];P〈0.00001）。出血量少（WMD：-127.95;95%CI[-147.97,-107.93];P〈0.00001）。清扫淋巴结数量少（WMD：-4.21;95%CI[-6.10,-2.31];P〈0.0001）,术后肠道功能恢复快（WMD：-0.43;95%CI[-0.61,-0.24];P〈0.00001）,住院时间短（WMD：-1.29;95%CI[-1.76,-0.83];P〈0.00001）。腹腔镜手术组术后并发症发生率与开腹手术组之间的差异无统计学意义（OR：0.70;95%CI[0.46,1.06];P=0.09）。结论早期胃癌LADG可减少术中出血和术后并发症,但却增加了手术时间,减少了淋巴结的清扫数量;远期效果尚需进一步的RCT研究证实。     

Trivex旋切术治疗下肢静脉曲张258例临床分析

下肢静脉曲张是常见的周围血管疾病。近年来，下肢静脉曲张的微创治疗取得了很大的发展。我院2006年1月-2010年5月采用微创技术Trivex旋切术治疗下肢静脉曲张患者258例（417条肢体），取得了较好疗效，现报道如下。     

肝门部胆管癌预后因素分析

目的 探讨影响肝门部胆管癌的预后因素.方法 回顾性分析1996年1月至2007年5月中国医科大学附属第一医院收治的204例肝门门部胆管癌患者的临床资料.生存时间用中位数表示,生存分析采用Kaplan-Meier法,行Log-rank检验,对17个可能影响预后的因素进行单因素分析,有统计学意义的单因素再采用Cox回归模型进行多因素分析.结果 根治性切除中位生存时间为37个月,姑息性切除为18个月,胆道探查置管引流为11个月,剖腹探查为5个月,肝移植为25个月,五者比较差异有统计学意义(χ2=58.300,P<0.05).肿瘤最长径、门静脉或肝动脉侵犯、局部浸润、残端情况、肿瘤分化程度、淋巴结转移、手术方式对预后有影响(χ2=6.541,8.159,5.837,4.365,13.748,5.346,9.472,P<0.05).Cox回归模型多因素分析表明手术方式、肿瘤细胞分化程度是影响预后的独立因素(b=0.287,0.320,P<0.05).结论 根治性切除是肝门部胆管癌最重要的预后因素,合理的围手术期处理能提高患者的生存率.     

49例肝内胆管细胞癌的临床病理特征与预后分析

肝内胆管细胞癌( Intrahepatic cholangiocarcinoma,ICC)指发生在包括二级胆管在内的末梢侧的原发性胆管细胞癌.在世界范围内,ICC占原发性肝脏恶性肿瘤的10％～20％,其发病率近年来呈上升趋势.随着诊断及治疗技术的不断提高,ICC的根治性切除率也不断提高,但远期疗效仍不理想.本研究回顾分析了49例肝内胆管细胞癌的临床资料,探讨影响其预后的因素. 1 资料与方法 1.1 一般资料     

肝门部胆管癌预后因素分析

Objective To investigate the prognostic factors of hilar cholangiocarcinoma. Methods The clinical data of 204 patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of China Medical University from January 1996 to May 2007 were retrospectively analyzed. The survival rate was calculated using the Kaplan-Meier method and Log-rank test. Seventeen factors that may have influenced prognosis were analyzed by univariate analysis. Factors that were statistically significant were further analyzed by the Cox regression model. Results The median survival times of patients who received radical resection, palliative resec-tion, bile duct exploration and catheter drainage, exploratory laparotomy, and liver transplantation were 37, 18, 11,5 and 25 months, respectively, and there was a significant difference between the 5 groups (χ2 = 58. 300, P < 0. 05). The prognostic factors included tumor size, portal vein or hepatic artery invasion, local invasion, resection margin, tumor grading, lymph node metastasis and surgical procedure (χ2 =6. 541, 8. 159, 5. 837, 4. 365, 13.748, 5.346, 9.472, P <0.05). Multivariate analysis demonstrated that surgical procedure and tumor grading were independent prognostic factors (6=0.287, 0. 320, P <0.05). Conclusions Radical resection is the most important prognostic factor of hilar cholangiocarcinoma. Appropriate perioperative care can improve the survival rate.     

幽门螺杆菌感染与大肠癌关系的Meta分析

[目的]探讨幽门螺杆菌(Hp)感染与大肠癌的关系。[方法]纳入13篇关于Hp感染与大肠癌关系的文献,应用RevMan4.2软件进行Meta分析,计算合并OR值及95%CI,倒漏斗图法定性评价发表性偏倚。[结果]Hp感染与大肠癌发病合并OR值为1.36(95%CI:1.00～1.86,χ2=40.39,P=0.004)。倒漏斗分析图形不对称,失安全系数为115。[结论]Hp感染是大肠癌发生的危险因素。     

肝门部胆管癌预后因素分析

Objective To investigate the prognostic factors of hilar cholangiocarcinoma. Methods The clinical data of 204 patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of China Medical University from January 1996 to May 2007 were retrospectively analyzed. The survival rate was calculated using the Kaplan-Meier method and Log-rank test. Seventeen factors that may have influenced prognosis were analyzed by univariate analysis. Factors that were statistically significant were further analyzed by the Cox regression model. Results The median survival times of patients who received radical resection, palliative resec-tion, bile duct exploration and catheter drainage, exploratory laparotomy, and liver transplantation were 37, 18, 11,5 and 25 months, respectively, and there was a significant difference between the 5 groups (χ2 = 58. 300, P < 0. 05). The prognostic factors included tumor size, portal vein or hepatic artery invasion, local invasion, resection margin, tumor grading, lymph node metastasis and surgical procedure (χ2 =6. 541, 8. 159, 5. 837, 4. 365, 13.748, 5.346, 9.472, P <0.05). Multivariate analysis demonstrated that surgical procedure and tumor grading were independent prognostic factors (6=0.287, 0. 320, P <0.05). Conclusions Radical resection is the most important prognostic factor of hilar cholangiocarcinoma. Appropriate perioperative care can improve the survival rate.     

92例结直肠癌伴肝转移患者的预后分析

目的:探讨影响结直肠癌伴肝转移患者预后的临床病理因素.方法:回顾分析1998年1月至2003年1月中国医科大学附属第一医院和沈阳医学院沈洲医院收治的92例结直肠癌伴肝转移患者的临床资料.并应用Cox回归模型分析影响预后的因素,建立预后指数(prognostic index,PI)方程,并根据PI值将患者分为高危组、中危...     

胆管癌的预后影响因素及预测模型分析

胆管癌的发病率有增高的趋势[1]。由于其特殊的解剖位置及生物学特性,早期易侵犯周围血管、神经、淋巴组织及邻近肝组织,故手术难度大、预后差。     

体重指数对胆管癌患者预后的影响

胆管癌曾被认为是一种较少见的疾病,但近年来胆管癌发病有增多的趋势.由于其特殊的解剖位置及生物学特性,早期易侵犯周围血管、神经、淋巴组织及邻近肝组织,故手术难度大、预后差.随着影像学诊断水平的完善和外科技术的进步,胆管癌切除术的病死率明显下降,但5年生存率仍不理想.因此,对于胆管癌预后的影响因素的研究具有重要意义.