目的 总结高龄胆道疾病患者的治疗经验。方法 对近2年来我科收治的60岁以上因胆道疾病入院的急、择期手术患者的临床资料进行了回顾性分析。结果 本组235例中行急诊手术78例(33.2%)，择期手术167例(71.1%)； 合并各种内科疾病者147例，占62.6%，其中以心血管疾病最多，71例(48.3%)，其次为呼吸系统疾病，54例(36.7%)； 术后并发症发生率为23.0%(54/235)，在并发症中以肺部感染发生率最高，占42.6%(23/54)，其次为泌尿道感染，占33.3%(18/54)，再其次为切口感染，占29.6%(16/54)； 全组术后近期死亡7例，占3.0%，其中死于肝、肾功能衰竭4例，呼吸衰竭2例，心衰1例。结论 高龄胆道疾病患者合并疾病多，手术风险性增加，术后并发症发生率较高，因此应加强围手术期的监护与处理，确保患者平安度过手术期。
Objective To study the mechanism of high intensity focused ultrasound (HIFU) and discuss its clinical significance in the treatment of mid-late stage liver cancer. Methods The patients with mid-late stage liver cancer were treated with HIFU. The changes of photography, pathology and immunology after operation were evaluated. Results It was shown that the results of the photographic, pathologic and immunologic examinations changed during the treatment of the patients with HIFU. Conclusion HIFU is effective and safe for the treatment of mid-late stage liver cancer.
Objective To assess the survival of patients receiving high intensity focused ultrasound (HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma (PHCC) victims with HIFU application. Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007. Among them, 101 patients were males and 86 were females (mean age: 47.7 years old, range: 19-79 years old). The average tumor size was 5.7 cm (range: 0.5-18.0 cm). Of these 187 patients, numbers according to Child-Pugh grade of A, B and C were 104, 52 and 31, respectively. According to TNM system, 45, 111 and 31 patients were in stage Ⅱb, Ⅲa and Ⅲb respectively. Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. Results Survival period was (17.3±2.5) months after HIFU treatment of PHCC. The overall survival rate of 3-month, 6-month, 1-year and 2-year were 79.1%, 60.1%, 35.7%, and 29.3%， respectively. It was significant that tumor number (P=0.02), size (P=0.04)， AFP (P=0.04)， Child-Pugh grade (P=0.00)， TNM stage (P=0.01)， tumor metastasis (P=0.03) before HIFU， and tumor recurrence after HIFU (P=0.02) and standard treatment (P=0.02) were prognostic factors by single factor analysis. The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol (P=0.000), and TNM stage (P=0.004) and Child-Pugh grade (P=0.009) before HIFU. Conclusion It is used for improving overall survival rate to found PHCC early, protect liver function, examine comprehensively before HIFU treatment, focus on standard treatment and auxiliary treatment.
【Abstract】ObjectiveTo investigate the effect of high intensity focused ultrasound (HIFU) on the immunity of patients with advanced primary liver cancer (PLC). MethodsForty cases of PLC admitted to our institution from Mar. 2003 to Dec. 2003 were included in this study. Patients were divided into 2 groups and received either HIFU or radiofrequency ablation (RFA) treatment randomly. CD3, CD4, CD8, CD4/CD8, NK, IL-2, TNF were chosen to assess the immune status before and after treatment. The results were compared statistically. ResultsThe survival rate after HIFU was 80.0%, 61.1%, 42.9%, 33.3% at 3 months, 6 months, 9 months and 1 year respectively, which was similar to that after RFA treatment. The changes of immunity parameters of CD3, CD4, CD8, CD4/CD8, NK, IL-2 and TNF were not significant after HIFU treatment. In addition, the differences of those parameters between HIFU group and RFA group were insignificant. ConclusionThere are no detrimental effects on immunity in the early period after HIFU treatment.
目的 探讨经脐单孔腹腔镜胆囊切除的可行性、安全性及实用性。 方法 回顾分析2010年11月－2011年2月27例行经脐单孔腹腔镜胆囊切除术患者的临床资料。其中男15例，女12例；年龄19～53岁，平均39.5岁。胆囊息肉样病变12例，病程6个月～8年；胆囊结石17例，结石数量1～9个，大小0.5～1.5 cm，均为非急性期患者，病程1个月～13年。 结果 27例手术均顺利完成，无1例中转开腹或转为传统三孔腹腔镜胆囊切除术，术中生命体征平稳。手术时间35～149 min，平均63 min；术中出血10～20 mL，平均15 mL。所有患者术后2～3 d出院。患者均获随访，随访时间6～24个月，平均13个月。术中及术后随访期间未发生任何并发症。脐部瘢痕不明显，患者满意度高。 结论 经脐单孔腹腔镜胆囊切除安全可行，具有创伤小、瘢痕不明显等优点。