目的 比较开腹、腹腔镜和经皮肝穿刺引流3种方法治疗细菌性肝脓肿的优劣性，为细菌性肝脓肿治疗方法的选择提供参考依据。方法 回顾性分析笔者所在医院2010年9月至2011年7月期间收治的39例细菌性肝脓肿患者的临床资料，根据其治疗方式将患者分为开腹组、腹腔镜组和经皮经肝穿刺引流组（穿刺组）3组，对3组的首次治愈者比例、1个月治愈者比例、发生并发症者比例、住院时间及住院费用进行比较。结果 开腹组、腹腔镜组和穿刺组首次治愈者比例分别为10/12、8/9及12/18，3组间差异有统计学意义（P＜0.05）； 1个月治愈者比例分别为11/12、9/9及17/18，3组间差异无统计学意义（P＞0.05）；发生并发症者比例分别为2/12、1/9及2/18，腹腔镜组和穿刺组之间的差异无统计学意义（P＞0.05），2组与开腹组相比差异均有统计学意义（P＜0.05）；住院时间分别为（15.4±4.5） d、（9.7±2.3） d及 （16.7±5.8） d （P＜0.05）；住院费用分别为（1.9±0.5）万元、（1.3±0.3）万元及（0.8±0.2）万元（P＜0.05）。结论 开腹组、腹腔镜组和穿刺组3种治疗方法各有利弊，个体化选择治疗方式是肝脓肿的治疗策略。
ObjectiveTo discuss clinical manifestation, laboratory examination, imaging and pathological features of intrahepatic cholangiocellular carcinoma(ICC) patients with fever as initial symptom accompanied with liver area pain, in order to improve the clinicians' acquaintance for ICC under similar circumstances. MethodThe case informations including medical history, clinical manifestation, laboratory examination, imaging finding, pathological examination, and treatment of 4 patients diagnosed with ICC by pathological biopsy from july 2013 to October 2014 in the First hospital of Lanzhou University were analyzed retrospectively. ResultsAll of four cases showed the fever as the initial symptom accompanied with the liver area pain. All of them had got chronic HBV infection. The WBC, neutrophil percentage, and procalcitonin were increased on admission in 3 cases. the levels of serum ALP and GGT were elevated in 3 patients. The AFP was obviously increased in 1 patient. The serum CA19-9 had moderately elevated in 2 patients. the ferroprotein was obviously increased in 2 patients. All the patients were confirmed under the abdominal CT scans and the liver pathological biopsy. ConclusionPatients with fever and liver area pain as intial symptoms, and with chronic hepatitis B and space-occupying lesions, who should be alert for ICC.
ObjectiveTo investigate clinical application value of totally laparoscopic splenectomy via anterior approach. MethodsThe clinical data of 26 consecutive patients underwent totally laparoscopic splenectomy via anterior approach from March 2012 to June 2015 in this hospital were analyzed retrospectively. There were 11 males and 15 females. These patients included 2 cases of traumatic spleen ruptures, 4 cases of idiopathic thrombocytopenic purpuras, 1 case of hereditary spherocytosis, 3 cases of splenic cysts, 5 cases of autoimmunity hemolytic anemias, 2 cases of splenic hemangioma, 1 case of hematolymphangioma, 8 cases of cirrhosis portal hypertensions. The operative time, intraoperative bleeding, postoperative time to out-of-bed activity, the first flatus/bowel motion time, complications, and hospital stay were analyzed retrospectively. ResultsTwenty-six patients were successfully carried out totally laparoscopic splenectomy via anterior approach. The average operation time was 93 min (72-120 min). The average blood loss was 60 mL (10-80 mL). The postoperative time to out-of-bed activity was 24 h. The first flatus/bowel motion time was 2-3 d. The average hospital stay was 7 d (6-9 d). The postoperative pancreatic fistula (Grade A) occurred in 1 patient, who recovered well on day 6 by postoperative drainage management. After 5-32 months of following-up, all patients recovered smoothly without any long-term complications. ConclusionThe preliminary results of limited cases in this study show that totally laparoscopic splenectomy via anterior approach is feasible, safe, and minimally invasive.
ObjectiveTo investigate the expression of tripartite motif 21 (TRIM21) in gastric cancer tissues and its relationship with clinical pathological characteristics and clinical prognosis.MethodsPublic database was used to analyze the expression level of TRIM21 in gastric cancer tissues and the relationship between its expression and clinical prognosis. Gene set enrichment analysis (GSEA) was used to analyze the signaling pathways that TRIM21 might participate in. The expressions of TRIM21 in 80 gastric cancer tissues and 30 para-cancer tissues were detected by immunohistochemical staining, and the relationship between TRIM21 expression and clinicopathologic characteristics was analyzed.ResultsTRIM21was significantly low-expression in gastric cancer tissues, and the clinical prognosis of patients with low TRIM21 expression was significantly worse (P<0.05); GSEA showed that TRIM21 was involved in the regulation of helper T cell differentiation in gastric cancer patients (P<0.000 1, FDR<0.000 1).ConclusionsTRIM21 is poorly expressed in gastric cancer tissues and indicates the poor clinical prognosis. Moreover, TRIM21 is involved in the regulation of helper T cell differentiation and has a negative regulatory effect on the occurrence and development of gastric cancer.
ObjectiveTo explore value of preoperative neutrophil-to-lymphocyte ratio (NLR) combined with carbohydrate antigen 19-9 (CA19-9) in evaluating prognosis for patients with pancreatic head carcinoma.MethodsThe clinical data of patients with pancreatic head carcinoma underwent radical pancreaticoduodenectomy in the Lanzhou University Second Hospital from February 2011 to August 2017 were retrospectively analyzed. The preoperative serum albumin (ALB), CA19-9, NLR, carcino-embryonic antigen (CEA), alpha-fetoprotein (AFP), N stage, tumor differentiated degree, and other indicators were recorded and the patient’s overall survival was recorded. Linear correlation analysis was used to examine the association of NLR with serum CA19-9. The receiver operating characteristic (ROC) curve was used to calculate the cutoff values of NLR and CA19-9 corresponding to the overall survival rate of 2-year. Kaplan-Meier method was used for survival analysis. Cox proportional hazards regression model was used to evaluate the prognostic value of preoperative CA19-9 and NLR.Results① A total of 121 patients were enrolled in this study. There was no significant correlation between the preoperative serum CA19-9 and NLR (r=0.100 05, P=0.272 9). ② Multivariate analysis showed that higher NLR, higher CA19-9 level, higher N stage, and lower tumor differentiation were the risk factors for overall survival of pancreatic head carcinoma (P<0.05). ③ The cutoff values of CA19-9 and NLR in evaluating the 2-year overall survival rate were 123.3 U/mL and 2.34 respectively by the ROC curve analysis, the area under ROC curve of CA19-9, NLR, and CA19-9 combined with NLR were 0.763, 0.686, and 0.823, respectively. ④ The proportions of patients with CEA≥5 μg/L and ≥N1 stage were higher in the patients with CA19-9≥123.3 U/mL as compared with patients with CA19-9<123.3 U/mL (P<0.05); The proportions of patients with preoperative serum ALB level <35 g/L and CEA≥5 μg/L, ≥N1 stage, and poor differentiation were higher in the patients with NLR≥2.34 as compared with the patients with NLR<2.34 (P<0.05). ⑤ Kaplan-Meier survival analysis showed that patients with CA19-9≥123.3 U/mL and NLR≥2.34 had worse overall survival than those patients with CA19-9<123.3 U/mL and NLR<2.34 (HR=3.599, P<0.01; HR=2.506, P<0.01). The patients with CA19-9≥123.3 U/mL and NLR≥2.34 (n=42), CA19-9≥123.3 U/mL or NLR≥2.34 (n=48), CA19-9<123.3 U/mL and NLR<2.34 (n=31) had better overall survival in turn (overall and between groups, all P<0.01).ConclusionPreoperative serum CA19-9 combined with NLR has an important value in evaluating prognosis for patients with pancreatic head carcinoma.
ObjectiveTo evaluate prognostic value of change of immune status in locally advanced gastric cancer (LAGC) patients. Methods We retrospective collected 210 LAGC patients who underwent treatment in our department from January 2013 to December 2018, then we collected lymphocyte-to-monocyte ratio (LMR) and cLMR (change of lymphocyte-to-monocyte ratio, cLMR) before operation and after three cycles of adjuvant chemotherapy. We had developed a new immune state change score (ICS) based on preoperative LMR (pLMR) and cLMR, and explored its prognostic value. The definition of ICS in this study was: ICS=1, pLMR≤4.53 and cLMR≤1; ICS=2, pLMR≤4.53 and cLMR>1, or pLMR>4.53 and cLMR≤1; ICS=3, pLMR>4.53 and cLMR>1. Results The results of multivariate Cox proportional hazard regression model showed that ICS was an influencing factor for overall survival [ICS=2, RR=0.397, 95%CI (0.260, 0.608), P<0.001; ICS=3, RR=0.080, 95%CI (0.040, 0.162), P<0.001), patients with ICS scores of 2 and 3 had better overall survival. In addition, the prognostic accuracy of ICS was superior to pLMR and Clmr, and the C-index of ICS [0.806, 95%CI (0.746, 0.865)] was higher than that of pLMR [0.717, 95%CI (0.635, 0.799), P=0.003)] and cLMR [0.723, 95%CI (0.641, 0.806), P=0.005)]. Based on this, a Nomogram model included ICS, CEA, and pTNM staging was constructed to predict the 3-year and 5-year survival rates of patients. The calibration curve and C-index [0.821, 95%CI (0.783, 0.859)] showed high discrimination and accuracy of Nomogram, and decision curve analysis confirmed that the model had good clinical application value. Conclusions The dynamic changes in the patient’s immune status before and after adjuvant therapy are related to the overall survival of LAGC patients. As an evaluating system which combined the cLMR and pLMR, ICS can better predict the prognosis of LAGC patients.