The authors analysed the medical records of 30 patients with congenital cystic disease of the liver treated in this hospital and with a review of the article some problems of diagnosis and treatment are discussed. B-altrasonic scaner (B-US), computerized tomographic scanning and magnetic resonance imaging appeared to be most helpful in diagnosing and treating this disease. After comparing different treatments, such as aspiration .alcohol sclerotherapy, fenetration, cyst resection and partial hepatectomy, the arthors state the best results could be achieved by alcohol sclerotherapy under B-US guidence (6 cases) or fenestration (15 cases) with no postoperative complication. Malignant change was found in one patient of this group.
Objective To evaluate the efficacy and safety of endoscopic variceal ligation (EVL) versus endoscopic variceal sclerotherapy (EVS) for acute esophageal variceal bleeding in patients with liver cirrhosis.Methods We searched CBMdisc (1979 to 2006), CNKI (1994 to 2006) and VIP for randomized controlled trials (RCTs) and quasi-RCTs comparing EVL and EVS for acute esophageal variceal bleeding patients with liver cirrhosis. The methodogical quality of included trials was critically assessed and the data were extracted by two reviewers, working independently. The Cochrane Collaboration’s RevMan 4.2.7 software was used for meta-analysis. Results Nine RCTs involving a total of 1371 patients were included: 688 in EVL group and 683 in EVS. The meta-analyses showed a significant reduction for mortality [RR 0.60, 95%CI (0.36, 0.98)], and non-significant reductions in complications, rebleeding and emergency hemostasis in the EVL group compared to the EVS group. EVS was non-significantly better than EVL for the rate of eradication varices and recurrent varices. Conclusions For acute esophageal variceal bleeding in patients with liver cirrhosis, EVL has better effect and fewer complications than EVS. However, because the quality of included RCTs was poor, the strength of our conclusions was limited. Further high-quality RCTs are required.
目的:观察比较胃镜下硬化剂注射联合药物治疗和单纯硬化剂注射治疗、药物治疗食管静脉曲张出血的疗效。方法:95例肝硬化并食管静脉曲张出血患者,分成三组。32例患者给予硬化剂注射联合药物治疗,31例患者给予硬化剂治疗,32例患者给予药物治疗。观察三组患者急诊止血率,近期出血率、远期再出血率、曲张静脉消失率、曲张静脉复发率。 结果: 联合组、硬化剂组、药物组急诊止血率分别为93.8%.90.3%、68.8%;联合组、硬化剂组、药物组近期出血率分别为6.3%、9.7%、46.9%;联合组、硬化剂组、药物组曲张静脉消失率分别为90.6%、83.9%、1.9%;联合组、硬化组与药物组急诊止血率、近期出血率、曲张静脉消失率有显著差异。联合组、硬化剂组、药物组远期出血率分别为9.4%、59.4%、31.3%; 联合组、硬化剂组、药物组曲张静脉复发率分别为18.8%、45.2%、87.5%;联合组与硬化组、药物组远期出血率、曲张静脉复发率有显著差异。结论:胃镜下硬化剂注射联合药物治疗食管静脉曲张出血可显著提高疗效。
目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。
目的 探讨泡沫硬化剂治疗复发性下肢静脉曲张的临床疗效。方法 选择我院2011年1月至2012年3月期间23例（26条患肢）复发性下肢静脉曲张的患者，其中男9例，平均年龄58.6岁；女14例，平均年龄53.3岁。静脉曲张复发病史1个月～6年，平均3.2年。对其行超声引导下患肢曲张静脉内注射1%聚桂醇泡沫硬化剂后弹力袜压迫，治疗后3d、3个月超声检测曲张静脉闭合情况及有无深静脉血栓形成，3个月后不定期病房随访。结果 23例患者均在超声引导下成功行泡沫硬化剂治疗，20例（22条患肢）注射1次，3例（4条患肢）注射2次，每例患者每次平均应用5ml泡沫硬化剂。末次注射结束后3d观察曲张静脉均成功闭合。平均随访6个月，治疗后1周2例出现轻度血栓性浅静脉炎，2周内自行缓解，均无严重并发症发生。治疗后3个月3例（4条患肢）局部复发，复发率15.4%，再次局部泡沫硬化剂治疗后至今未复发。10例（12条患肢）注射部位皮肤出现轻度色素沉着，3个月后减轻，6个月至1年消退。所有患者临床症状得到不同程度的缓解。结论 泡沫硬化剂治疗复发性下肢静脉曲张近期疗效确切且并发症少。
Foam sclerotherapy is one of the major therapies for varicose veins in lower limbs. It is important to know the influence factor of foam stability which is beneficial to curative effect. The present experiment explored influence of 9 kinds of driving speed on foam stability when using the method of Tessari. Syringes of 5 mL were chosen to do this experiment which was carried out at the liquid gas ratio of 1:4 and the environment temperature of 20℃. A home-made automatic sclerosing foam preparation equipment was used to prepare the foam. A camera recorded the entire process of foam decay. And foam stability indexes which includes drainage time, half-life, foam half-life volume and the drainage rate curve, were analyzed. The results showed that when driving speed ranged from 100 mm/s to 275 mm/s, foam drainage time and the half-life showed a trend of rising. When the driving velocity was greater than 275 mm/s, the foam drainage time and half-life time reduced a little. The largest drainage time and the half-life differences were 340.0% and 118.8% compared to their minimum value. Meanwhile the pressure increased with the increase of driving speed, so that the solubility of carbon dioxide increased and the foam half-life volume decreased with the increase of the driving speed. It can be concluded that when using the method of Tessari to prepare sclerosing foam, driving speed has a significant effect on its stability. With driving speed increasing, foam decay mechanism changes from gas diffusion to liquid drainage as the main function, so the foam stability increased at first and then decreased later. The foam is relatively more stable at the speed of 275 mm/s, which could be considered as the best driving speed.
Based on the principle of manual preparation of sclerosing foam with Tessari method, using the analysis of user requirements and combining it with theory of mechanics, we designed an automatic equipment. The device could be used to replace the manual operation, and could overcome the shortcomings of manual sclerosing foam preparation, such as the difficulty in controlling of pushing speed and stroke and poor reproducibility. This automatic device has the functions of adjustable pushing speed, pushing frequency, pushing stroke and is suitable for a variety of different types of syringes. It can not only provide quantitative parameters for the study of foam properties, but also be used for the standardization of clinical sclerosing foam. The experimental study on "the effect of pushing speed on the stability of foam" was carried out with using the device, and the experimental results were quite satisfactory.
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.