介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水疗效观察

目的 评价介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水的疗效。方法 回顾性分析2004年2月—2010年1月我院55例良性门脉高压症行介入性门腔分流术患者的临床资料,观察分流道近期和远期的通畅情况,并分析生存时间和并发症。结果 手术成功率为100%,患者门静脉压力梯度(portal pressure gradient,PPG)均达到要求,即PPG≤1.60kPa或PPG降低2.00kPa。术后1～5年生存率分别为70.4%、60.8%、60.8%、60.8%、60.8%;分流道再狭窄率分别为7.3%、13.1%、24.0%、24.0%、24.0%;消化道曲张静脉出血复发率分别为9.8%、19.3%、26.0%、26.0%、26.0%;肝性脑病发生率分别为14.8%、23.9%、35.8%、57.2%、57.2%。结论 介入性门腔分流术治疗门脉高压症所致曲张静脉出血及腹水疗效可靠。如应用覆膜支架,门腔分流道通畅率较高。肝性脑病及复发性出血等并发症的发生率较低。     

增强CT诊断孤立性肠系膜上动脉夹层

目的分析增强CT诊断孤立性肠系膜上动脉(SMA)夹层的价值。方法分析22例孤立性SMA夹层的CT特征,提出新的分型方法,并结合文献进行分析。结果 22例夹层均累及SMA弯曲部前壁,其中21例(21/22,95.45%)经增强CT确诊;夹层近端距SMA开口平均(10.31±8.67)mm(0~32.03mm),夹层长度平均(73.37±42.69)mm(15.96~205.91mm)。按症状分组,无症状组(4例)夹层近端距SMA开口平均距离为(16.21±10.97)mm(1.00~32.03mm),有症状组(18例)平均为(9.17±6.15)mm(0~25.98mm);无症状组夹层长度平均为(34.81±44.01)mm(15.96~73.84mm),有症状组平均为(83.46±41.90)mm(26.40~205.91mm)。无症状组真腔狭窄率平均为44.16%±12.33%,有症状组为74.35%±22.37%(P=0.042)。随着夹层向SMA远、近端延展,保守治疗效果变差。结论增强CT是诊断SMA夹层的有效方法。孤立性SMA夹层均累及SMA弯曲部前壁,临床症状及疗效与夹层长度和真腔狭窄度有关。本研究提出的新分型方法有助于全面描述SMA夹层的影像学特征,进而确定治疗方案。     

下肢深静脉血栓形成的治疗

下肢深静脉血栓形成(deep vein thrombosis,DVT)发病率有逐年增多的趋势。其主要危害一方面可使患肢肿胀,影响活动,严重时可致残,另一方面可导致肺栓塞,严重时可致命。目前,临床上对于DVT的诊断已无困难,但在治疗方面始终存在分歧。现将DVT的治疗做一综述。1单纯抗凝治疗抗凝治疗是DVT的基础治疗,大量临床随机对照试验证实,抗凝治疗可以抑制血栓蔓延,降低肺栓塞的发生率和病死率。故除非有抗凝禁忌,否则所有DVT患者均应接受抗凝治疗。抗凝治疗的主要方法为应用普通肝素、低分子肝素及香豆素类药物抑止纤维蛋白的形成。DVT急性期以低分子肝素为首选[1~3]。需长期抗凝则首选华法林。Snow等[3]推荐在治疗的第1天开始联合应用香豆素类药物和低分子肝素或肝素,待国际标准化比率(international normalizedratio,INR)达到2.0后停用肝素。因为单独应用抗凝治疗只能抑制血栓的生长、蔓延,不能迅速消除血栓[4,5],难以有效避免下肢深静脉血栓形成后综合征(post thrombosissyndrome,PTS)的发生,故单纯抗凝仅适用于有溶栓和手术禁忌的患者。抗凝治疗的时间长短因人而...     

基于CiteSpace的肺癌免疫治疗研究的可视化分析

Objective To understand the current status of research on lung cancer immunotherapy to provide a reference for further investigation and future topic selection in this field. Methods CiteSpace visualization analysis software was used to analyze 400 Chinese studies in CNKI and 5 001 English studies in the Web of Science database from 2005 to 2021, with “lung cancer” and “immunotherapy” as keywords. Keyword co-occurrence analysis was performed on 17 English studies of “Lung Cancer” “Immunotherapy” and “Single cell sequencing” in the Web of Science database. Results “Non-small cell lung cancer” “immunosuppressants” “PD-L1” “dendritic cells” and “cytokine-induced killer cells” are current research hotspots in lung cancer immunotherapy. Monoclonal antibody drugs including nivolumab, pembrolizumab, atezolizumab, and durvalumab are hotspot drugs. Immunotherapy combined with chemotherapy as well as PD-L1 expression have become the focus of continuous research. The majority of studies on lung cancer immunotherapy are conducted in the United States, followed by China. Conclusion Lung cancer immunotherapy has gradually become a research hot spot in China. In the future, in-depth research is needed to provide cutting-edge directions for lung cancer immunotherapy. © 2023, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

股浅动脉重建对下肢动脉硬化闭塞症治疗的随机病例对照研究

目的： 评价忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症的安全性和有效性。方法： 应用前瞻性的随机病例对照研究方法对忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症的有效性和安全性进行评价,将北京大学第三医院2014年5月至2015年3月36例下肢动脉硬化闭塞症患者随机分为股浅动脉重建组（20 条患肢）和非重建组（16 条患肢）, 重建组均采用腔内治疗重建股浅动脉血运,非重建组均不重建股浅动脉,仅处理同时存在的髂动脉及股深动脉病变,比较两组患者临床疗效、并发症及治疗费用。结果： 两组患者的年龄、性别构成、治疗前踝肱指数、TASC（trans atlantic inter sociery consensus）分级及Rutherford分级均具有可比性（P>0.05）,术后1周内重建组显效率和总有效率均优于非重建组［75.0% vs.12.5%（P<0.001）; 90.0% vs. 37.5%（P=0.001）］,两组均无围手术期并发症及死亡病例。3个月随访时重建组显效率优于非重建组［65.0% vs. 25.0%（P=0.017）］,两组总有效率差异无统计学意义［85.0% vs.68.8%（P=0.422）］;6个月和12个月随访时两组显效率及总有效率差异均无统计学意义［显效率60.0% vs.37.5% （P=0.180）,80.0% vs.87.5%（P=0.672）;总有效率60.0% vs.43.8%（P=0.332）,85.0% vs.87.5%（P=1.000）］,重建组治疗费用高于非重建组［（53 367.4±24 518.3）元 vs.（30 397.5±15 354.4）元（P=0.011）］。重建组随访期间发现股浅动脉再狭窄/闭塞者8例,其中3例再次介入治疗,再次腔内治疗率为15.0%。结论： 忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症安全、有效、经济,可以作为部分外周动脉疾病患者的首选治疗方法。     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

基于Web of Science的肺癌可改变危险因素文献计量和可视化分析

目的 旨在探究肺癌发病的可改变危险因素（即在任何方面都可以通过干预而改变的决定因素）的研究现状、热点和前沿。 方法 检索并分析Web of science (WOS) 数据库相关研究文献，利用Excel 2019分析发文量，Citespace 5.6.R1软件构建国家、机构合作网络，关键词共现和突现网络及参考文献的共被引网络及共被引聚类时间轴图。 结果 共获得文献1 186篇，发文量以1980年为界显著增加，共被引居前10的文献涉及7个学科，期刊平均IF2018 = 6.66。发文量居前3的国家和机构分别是美国、法国、中国和美国国家癌症研究所、国际癌症研究中心、法国国家健康与医学研究院。国家间合作链条以美国为中心，中国、加拿大、英国、瑞典、荷兰等国在国家间合作具有较强的中心性。吸烟一直是热点，方法从以病例-对照研究为主演变为以队列研究为主，热门领域从最开始的饮食扩展到职业和空气中有害物质接触。结论 肺癌可改变危险因素研究涉及领域广，研究热点集中于行为习惯和有害暴露，发文质量高，欧美国家和机构发文量及发文时间处领先地位。     

忽略股浅动脉重建与普通球囊重建治疗股浅动脉狭窄/闭塞远期疗效对照研究

【摘要】 目的 对比普通球囊重建与忽略股浅动脉重建（nSFA）方案治疗股浅动脉（SFA）病变的远期疗效、安全性和治疗费用。 方法 回顾性分析2014年1月至2016年4月收治的106例SFA重度狭窄/闭塞患者（115条患肢）临床资料,分为nSFA组（n=47,55条患肢）和经皮腔内血管成形术（PTA）组（n=59,60条患肢）。比较两组患者Rutherford分级改善率、生存率、保肢率以及主要不良事件发生率、治疗费用和住院时间。 结果 两组患者基线资料和病变特征具有可比性。nSFA组失访1例。nSFA组、PTA组随访时间分别为60（22,77）个月、60（1,76）个月。两组患者近期Rutherford分级改善率、生存率和保肢率差异均无统计学意义（P＞0.05）。nSFA组患者远期Rutherford分级改善率、围手术期主要不良事件发生率、肢体相关主要不良事件发生率、治疗费用、住院时间均优于PTA组,差异有统计学意义（P＜0.05）。结论 SFA重度狭窄/闭塞患者nSFA治疗方案与PTA重建SFA方案相比,远期疗效和安全性较好,治疗费用较低,尤其对于膝下动脉流出道较好的SFA多节段闭塞患者。     

孤立性肠系膜上动脉夹层的腔内治疗

目的 探讨孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)的临床特点及治疗策略. 方法 回顾性分析2008年9月至2012年10月北京大学第三医院介入血管外科收治的19例IDSMA患者的临床表现、诊断方法、治疗策略及效果等临床资料.其中男15例,女4例,年龄41 ～ 84岁,平均(56±12)岁.临床症状腹痛15例、无症状4例.18例经增强CT确诊、1例经超声诊断.结果 19例夹层均累及肠系膜上动脉弯曲部前壁.对于4例无症状患者,保守治疗3例,另1例假腔形成瘤样扩张,行支架植入.对有症状的15例患者采取腔内治疗,包括经留置导管动脉内区域性解痉治疗4例;支架植入11例.全部患者均治愈,无并发症.随访时间7～46个月,平均(21±10)个月,19例均无症状,彩超和增强CT显示支架均通畅.结论 IDSMA均发生于肠系膜上动脉弯曲部的前壁.对无症状患者可行保守治疗.对有症状患者,如无动脉破裂或肠坏死,推荐植入支架、完全覆盖肠系膜上动脉弯曲部.经导管动脉内区域性解痉治疗是有效的辅助治疗措施.