目的 探讨不能切除的肝门胆管癌的治疗方法。方法 1992年1月至1997年1月采用胆肠桥式吻合术治疗该病12例。结果 该术式简单、实用、减黄效果满意。结论 胆肠桥式吻合是治疗不能切除的肝门胆管癌的较理想术式之一。
Good collateral circulation can effectively improve the prognosis of patients with severe stenosis or occlusion of cerebral blood supply artery. Studies have shown that CT angiography (CTA) can non-invasively and intuitively evaluate the degree of stenosis and collateral blood flow in diseased vessels. Rapid and accurate CTA collateral circulation score is of great significance for clinical decision-making and judging the prognosis of ischemic stroke. At present, there are many scoring scales based on CTA collateral circulation. This article will review the existing 7 CTA collateral circulation scoring scales, the advantages and disadvantages of clinical application and related research progress in predicting prognosis, aiming to provide a reference for clinicians to choose the collateral circulation score scale and the best treatment plan according to different situations.
门脉高压性胃病是肝硬变门脉高压症患者的主要并发症之一，病变几乎累及全部消化道，现就门脉高压性胃病的临床表现、病理特点、发病机理、诊断与治疗讨论如下……
Objective To investigate appropriate treatment strategy and timing for patients with subacute myocardial infarction and severe ischemic mitral regurgitation （IMR）. Methods A total of 89 patients with subacute myocardial infarction and severe IMR underwent surgical treatment from January 2005 to December 2011 in Beijing Anzhen Hospital. There were 66 male patients and 23 female patients with their mean age of 64 （55-73） years. All the patients received only coronary artery bypass grafting （CABG） after 3 months of medication treatment without specific management for their IMR. Echocardiography was examined before medication treatment，preoperatively and 6 months after CABG to analyze their IMR degree and measure left ventricular end-systolic dimension （LVESD），left ventricular end diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF）. Results There was no surgery-related death，perioperative myocardial ischemia or other severe postoperative complication. Eighty-one patients （91.0%） were followed up for 6-60 months. At 6 months after CABG，mitral regurgitation area （3.1±1.3 cm2 vs. 5.6±2.3 cm2），LVEDD （51.3±4.2 mm vs. 54.3±5.5 mm） and LVESD （31.7±3.9 mm vs. 34.6±4.3 mm） were significantly decreased than preoperative values （P＜0.05），but LVEF was not statistically different from preoperative value （59.1%±3.9% vs. 58.9%±5.6%，P＞0.05）. From the third year during follow-up，all the patients received annual CT examination of their coronary artery，and no significant graft stenosis （graft stenosis＞50%） was found. Conclusion With appropriately delayed CABG and right medication treatment，patients with subacute myocardial infarction and severe IMR may no longer need concomitant surgical management for their IMR， which can decrease surgical risks and reduce treatment cost.
Objective To evaluate postoperative quality of life （QOL） of patients aged over 65 after mitral valvereplacement （MVR）. Methods Ninety patients aged over 65 undergoing MVR by the same surgical group in Departmentof Cardiovascular Surgery of Anzhen Hospital were prospectively enrolled in this study. There were 62 male and 28 femalepatients with their age of 65-76 （68.6±6.8） years. There were 55 patients with hypertension，38 patients with type 2 diabetes，and all the patients had persistent atrial fibrillation. Nottingham Healthy Profile （NHP，Part I） and Duke Activity StatuIndex （DASI） were used to evaluate preoperative and postoperative QOL. According to the choice of prosthetic heart valves they received，all the patients were divided into two groups with 45 patients in each group: biological valve group and mechanical valve group. All the patients received MVR via the interatrial groove approach under general anesthesia and cardiopulmonary bypass. Mechanical valve replacement was performed using continuous suture without preserving the posterior leaflet of the mitral valve. Biological valve replacement was performed using interrupted suture and some of the posteriorleaflet of the mitral valve was routinely preserved. Patients in both groups underwent intraoperative bilateral pulmonary vein isolation and left atrial appendage ablation using a bipolar radiofrequency ablation device. The left atrial appendage was not excised or ligated. Results Postoperative QOL of all the patients was significantly better than preoperative QOL. There was no statistical difference in NHP and DASI at the 6th month after discharge between the 2 groups. But from the 1st year after discharge，QOL of the biological valve group was significantly better than that of the mechanical valve group. At the 3rd year after discharge，NHP and DASI of the mechanical valve group was not statistically different from those at the 1st year after discharge，but NHP and DASI of the biological valve group was significantly better than those at the 1st year after discharge. Conclusions QOL of elderly patients are significantly improved after MVR. Patients who receive biologicalvalve replacement may acquire better long-term QOL than patients who receive mechanical valve replacement.
Objective To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combinedwith postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee. Methods BetweenSeptember 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 femaleswith a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left kneesand 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 ± 2.3)° and (122.9 ± 5.6)°,respectively; the Lysholm score was 43.2 ± 6.7; and the International Knee Documentation Committee (IKDC) score was53.2 ± 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posteriorsynovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticularlesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, andstaging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. Results Poplitealartery was injuryed in 1 case and the branch of popl iteal veins were injuryed in 3 cases during operation. Intra-articularhemorrhage occurred in 1 case at 3 days after operation. The other patients achieved heal ing of incision by first intentionwithout nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months(median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extentionand flexion of the knee joint were (0.2 ± 1.3)° and (135.9 ± 6.6)°, respectively; the Lysholm score was 89.8 ± 5.8; and the IKDCscore was 87.8 ± 5.8. All indexes were significantly improved when compared with the preoperative ones (P lt; 0.05). At 6 monthsto 8 years postoperatively, 8 cases had occurrence, and they had sl ight limitation of the range of motion but had no pain andswelling of the knees after reoperation. Conclusion According to the scope and degree of the knee joint lesions, arthroscopyand/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.
Objective To systematically evaluate the effectiveness of intra-articular hyaluronic acid injection after arthroscopic debridement for knee osteoarthritis (KOA). Methods Databases including The Cochrane Library, SCI, MEDLINE, EMbase, CBM and WanFang Data were searched from inception to 2012, so as to collect randomized controlled trials (RCTs) on intra-articular hyaluronic acid injection after arthroscopic debridement (combined therapy) vs. monotherapy in treating KOA. Two reviewers independently screened literature according to inclusion and exclusion criteria, evaluated quality, and extracted data. Then the meta-analysis was conducted using RevMan5.0 software. Results A total of 7 RCTs involving 526 patients were included. The results of meta-analyses showed that: there was no significant difference in the excellent-good rate between the combined therapy group and the monotherapy groups including either the intra-articular hyaluronic acid injection group (RR=1.40, 95%CI 0.99 to 1.98, P=0.06) or the arthroscopic debridement group (RR=1.09, 95%CI 0.93 to 1.26, P=0.29). But the intra-articular hyaluronic acid injection group was inferior to the combined therapy group in improving Lysholm score, with a significant difference (MD=–14.81, 95%CI –17.55 to –12.08, Plt;0.000 01). Conclusion Arthroscopic debridement combined with intra-articular hyaluronic acid injection for KOA shows no significant difference in the excellent-good rate compared with the monotherapy, but it is superior to the monotherapy of hyaluronic acid injection in improving Lysholm score, so it is believed the combined therapy group is superior to the control groups in therapeutic effects. Due to the limited quantity and quality of the included studies, this conclusion needs to be proved by performing more high quality RCTs
【摘要】 目的 探讨关节镜治疗膝关节滑膜软骨瘤病的疗效。 方法 2005年1月—2009年10月，对23例（28膝）滑膜软骨瘤病患者入院行X线片、关节活动度检查、视觉模拟评分以及Lysholm膝关节功能评分。根据镜下所见分为表浅型6例，游离体型17例。结合病理学检查行Milgram 分期，Ⅱ期16例，Ⅲ期7例。所有患者均行关节镜下病变滑膜切除及游离体取出治疗。 结果 所有患者均随访13~57个月，平均（32.3±6.7）个月，术后伤口均甲级愈合。术后（5.05±2.43） d恢复正常生活或工作。症状明显改善21例（91.30%），部分改善2例（8.70%），对疗效满意23例（100%）。膝关节关节活动度由术前的伸膝（14.29±16.34）°以及屈膝（106.07±35.83）°提高到术后的伸膝（1.79±2.79）°及屈膝（132.64±35.64）°，差异具有统计学意义（Plt;0.05）。负重行走时疼痛视觉模拟评分由术前的（3.81±2.02）分降低到术后的（0.37±0.65）分（Plt;0.05）。Lysholm评分由术前的（43.20±8.24）分升至术后6个月的（86.72±5.40）分（Plt;0.05）；术后1年复诊并检查膝关节正侧位X线片，均未见滑膜软骨瘤体，所有患者无复发。 结论 关节镜下游离体取出术联合病变滑膜切除术疗效满意，关节疼痛明显减轻，功能恢复，是一种治疗膝关节滑膜软骨瘤病确切有效的方法。【Abstract】 Objective To investigate the therapeutic effect of arthroscopic treatment on synovial chondromatosis. Methods A total of 23 patients (28 knees) with synovial chondromatosis were diagnosed and treated in our hospital from January 2005 to October 2009. All of the patients underwent radiographic imaging examination, knee joint range of motion (ROM), visual analogue scale (VAS) and Lysholm score. According to distinct arthroscopic appearance, superficial pattern was found in 6 patients and loose body lesion pattern was in 17. Additionally, combined with pathological examination, according to the Milgram staging，Stage Ⅱ was in 6 patients and Stage Ⅲ was in 7. Arthroscopic limited synovectomy and removal of loose bodies were performed on all the patients. Results The patients were followed up for 13-57 months with the mean of (32.3±6.7) months. The wound of all patients healed up. The time of returning to normal work and life was (5.05±2.43) days for average. The postoperative symptom was markedly alleviated in 21 patietns and partly alleviated in 2. All patients were satisfied with the therapeutic effect. The mean activity of knee joint was significantly different befoe and after the surgery (Plt;0.05) preoperative extension and flexion degrees were (14.29±16.34) and (106.07±35.83) degrees, respectively; postoperative extension and flexion degrees were (1.79±2.79) and (132.64±35.64) degrees (flexion) , respectively. The mean VAS score of weight bearing walking was 0.37±0.65 after theoperation and 3.81±2.02 before the peration; the difference was significantly different (Plt;0.05). The preoperative Lysholm knee score was 34-67 with the mean of 43.20±8.24, and the post-operative score was 71-99 with the mean of 86.72±5.40. There were differences in preoperative and post-operative scores (Plt;0.05) . Radiographic imaging examination of knee joint was performed 1 year after the opertation, no loose bodies was seen and no patients recurred. Conclusion The therapeutic effect of arthroscopic limited synovectomy and removal of loose bodies is good on synovial chondromatosis.