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.
目的:探讨Mirizzi综合症的诊断治疗特点，以提高其诊断和治疗水平。方法：对35例经手术证实为Mirizzi综合症的临床资料进行回顾性分析。结果:35例Mirizzi综合症患者中仅4例（11.4%）术前确诊。Ⅰ型7例，Ⅱ型17例，Ⅲ型9例，Ⅳ型2例。5例行胆囊切除术，2例行胆囊大部分切除术；胆囊切除、胆囊瓣瘘口修补6例，12例行胆囊切除、胆总管探查、瘘口修补、T管引流术；胆囊切除、胆肠吻合术10例。术后恢复好，随访结果，无严重并发症.结论：Mirizzi综合症术前确诊困难，B超结合MRCP/ERCP检查可以提高Mirizzi综合症的术前确诊率，手术容易损伤胆管，手术方式应据病理损伤程度决定。
Objective To investigate the early diagnosis and treatment methods of primary duodenal papilla carcinoma. Methods The medical records of 54 patients with primary duodenal papilla adenocarcinoma underwent operation between January 2002 and December 2008 were reviewed. Results Thirty seven cases received fiberduodenoscopy and 35 cases received ERCP, and the accuracy of them were both 100%. Forty four patients received duodenopancreatectomy and 10 patients received jaundice-reducing operation. The 1-, 3-, and 5-year cumulation survival rate was 68%, 50%, and 29%, respectively. Conclusions Fiberduodenoscopy and ERCP are the effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early rational radical operation are essential for successful treatment of duodenal papilla carcinoma.
ObjectiveTo study the clinical manifestations, pathologic characteristics, imaging features, diagnosis and treatment of adenomas of extrahepatic bile duct.MethodsTwo cases of adenomas of extrahepatic bile duct in our hospital and 14 cases reported in the literatures were analyzed retrospectively.ResultsThe patients’(male 5, female 11) mean age was 58.4 years (range 21-85). The main manifestations included jaundice (n=11), abdominal pain (n=8),fever (n=6),dyspepsia (n=4),body weight loss (n=3) and claycolored stool (n=1). The locations of tumors were in the left hepatic duct (n=1), right hepatic duct (n=3), hepatic common bile duct(n=3）,the junction of cystic duct and common bile duct (n=1），distal common bile duct (n=8). The pathologic types were tubular adenomas (n=5), papillary (villous) adenomas (n=10),and mucous adenoma (n=1). All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination.ConclusionIt is difficult to correctly diagnose adenomas of extrahepatic bile duct before operation, because the clinical manifestations are usually atypical. The definite diagnosis should depend on histopathologic examination. It is the key to completely resect the tumors. Postoperative followup should be done on regular basis.
ObjectiveTo study the protective effect of hepatocyte growth factor(HGF) on grafted mucous membrane of transplanted small bowel.MethodsTotal small bowel transplantation was made in inbred Wistar (RT1k) rats heterotopically,either total parenteral nutrition (control group,n=10) or hepatocyte growth factor supplemented TPN (HGF group,n=10) was given to the recipients from the 2nd day to the 10th day postoperatively. Morphological parameters of the transplanted intestinal mucosa, such as mucosal villous height, villous width, crypt depth, mucosal thickness and villous surface area were observed. Variation of ultrastructure of transplanted epithelial cells was observed. Composition of mucosal protein and DNA content were tested. ResultsComparison between HGF group and the control group were as follows. Mucosal villous height (298.79±22.31） μm vs （176.45±14.62） μm, P=0.001, villous width (107.46±12.34） μm vs （74.20±16.85） μm, P=0.004, crypt depth (104.56±11.17） μm vs （74.45±8.34） μm, P=0.000 5, mucosal thickness (409.53±35.83） μm vs （259.38±24.65） μm, P=0.003, and villous surface area (0.101±0.011) mm2 vs (0.041±0.005) mm2, P=0.001 were found significantly increased in HGF group compared with control group, there were no obvious difference decrease as compared to pretransplant parameters.Mucosal protein composition was higher in HGF group than that in control group （89.65±9.28) mg/g wet wt vs (53.73±11.45) mg/g wet wt, P=0.012, baseline (92.64±10.52) mg/g wet wt, nearly equal to baseline; DNA composition was also high in HGF group （0.89±0.09) mg/g wet wt vs (0.51±0.06) mg/g wet wt, P=0.008, baseline (0.91±0.09) mg/g wet wt. Nearly normal ultrastructure of the graft was maintained in HGF group, atrophied microvilli and broken mitochondrial crista were observed in control group.ConclusionHepatocyte growth factor can improve mucosal structure, preserve enterocyte ultrastructure of isograft after small bowel transplantation in rat.
Objective To evaluate the efficacy and safety of tetramethylpyrazine (TMP) for diabetic peripheral neuropathy (DPN). Methods Randomized controlled trials were identified from CBM (1978-2003.3), TCMLRS (1980-2003.3), Medline (1970-2003.3), EMbase (1970-2003.3) and Cochrane Library (issue 3, 2003). We handsearched Journal of Traditional Chinese Medicine (1990-2002), New Chinese Medicine (1990-2002), Chinese Journal of Integrated Traditional and Western Medicine (1990-2002) and Research of Traditional Chinese Medicine (1990-2002). Papers of the controlled trials of clinical therapeutic studies on DPN treatment by Chinese medicine herb TMP were included and analyzed according to the criteria of the Cochrane Handbook in 1997. Results Six RCTs involving 669 patients were included, with all trials of low methodological quality. Meta-analysis indicated TMP was more effective than western medicine on pain or numbness of extremities of DPN [The pooled OR = 10.12, 95%CI (6.70 to15.28), P=0.000] and motor nerve conduction velocity change of common peroneal nerves and median nerves . Only one trial reported the side effects of TMP, such as dizziness and headache. Conclusions Based on the review, TMP infusion may have positive effect on DPN. However, the evidence is not b enough due to the general low methodological quality, so we can’t draw a reliable conclusion about the effects of TMP for DPN at the moment. Further large randomized, double blind, placebo-controlled trial are needed.
Objective To evaluate the therapeutic efficacy and safety of trazodone versus alprazolam for generalized anxiety disorder (GAD). Methods After the third day of a three-day screening period, 60 patients with generalized anxiety disorder were randomly assigned to the trazodone group (30 patients, 50-150 mg/d), and alprazolam group (30 patients 1.2-4 mg/d) for 4 weeks. Patients and their doctors were blind. Data were analyzed by SPSS 10.0 and intention-to-treat analysis. Results The total effective rate of trazodone was 77% (23/30), while alprazolam was 70% (21/30) (Pgt;0.05) .No difference was seen for adverse events. None was lost to follow in the two groups. Conclusions Trazodone appears to be as effective as alprazolam in treating generalized anxiety disorder. Adverse events may include confusion and loss of appetite, but patients are able to tolerate these.
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。
【摘要】 目的 探讨胰管结石的诊断和治疗方法。 方法 回顾性分析2000年1月－2009年1月收治的50例胰管结石患者临床资料。其中男37例，女13例；年龄36~70岁，平均49岁。病程7 d~10年，平均6.8年。46例出现腹正中及左上腹间歇疼痛，伴腰背部放射痛。50例均行B型超声和CT检查，诊断阳性率分别为90%（45/50）和96%（48/50）；27例行磁共振胰胆管成像检查，诊断阳性率为92.6%（25/27）。所有患者均行手术治疗，包括胰十二指肠切除术8例；胰管切开取石、胰空肠Roux-Y吻合术42例，同时行胆囊切除术12例，Oddi括约肌切开、T管引流术6例，胆肠Roux-Y吻合术2例。 结果 所有患者均取出胰管结石，结石大小为0.2~2.0 cm，结石数目为1~50枚。1例患者术后发生切口感染，经积极抗感染及伤口换药处理后治愈。46例治愈出院，2例好转出院， 2例术后出现并发症死亡。术后40例获随访，随访时间1~48个月，平均24个月。随访期间2例胰管结石伴胰头癌患者因术后胰头癌复发死亡。余38例中有8例术后胰管结石复发，再次行手术治疗后治愈；其中有2例术后仍有腹痛，但较术前有明显好转。 结论 影像学检查是诊断胰管结石的重要手段，准确率高，一旦诊断应根据合并症和胰管扩张程度选择合适的手术方式，可取得良好治疗效果。【Abstract】 Objective To investigate the diagnosis and treatment methods for pancreatolithiasis. Methods The clinical data of 50 patients with pancreatolithiasis from January 2000 to January 2009 were retrospectively analyzed. Among them, there were 37 males and 13 females aged between 36 and 70 averaging at 49.3. The course of the diseases ranged from 7 days to 10 years with an average time period of 6.8 years. Forty-six patients had intermittent pain in the median abdomen and left upper quadrant combined by ectopic pain in the back. Various image examinations including abdomen ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP) were performed in 50, 50, and 27 patients, respectively. Pancreatic duct stones were found in 45 of 50 cases (90％) with ultrasonograhy, 48 of 50 cases (96%) with CT scan, and 25 of 27 cases (92.5%) with MRCP. All patients received surgeries including 8 cases of pancreatodudenectomy, 42 cases of pancreatolithotomy plus side to side pancreatojejunostomy. At the same time, there were 12 cases of cholecystectomy, 6 cases of sphincterotomy and T-duct drainage, and 2 cases of Roux-Y anastomosis. Results Pancreatic duct stones were successfully removed in all cases, and the size of the stones ranged from 0.2 to 2.0 cm in diameter. The number of stones removed from each patient ranged from 1 to 50. Symptoms of all patients ameliorated obviously. One patient had incision infection after surgery, and recovered through active antibiotic treatment. Forty-six patients were cured and discharged from the hospital; 2 patients had their conditions improved and were discharged from the hospital; and the other 2 patients died of postoperative complications. Forty patients were followed up for 1 to 48 months with an average time of 24 months. During the follow-up, 2 patients with pancreatolithiasis and carcinoma of head of pancreas died of the recurrence of the cancer. Eight patients had recurrence of pancreatic stones and were cured after a second operation. Among the 8 cured patients, 2 still had abdominal pain, but their conditions were greatly improved after surgery. Conclusion Imaging techniques are important methods in diagnosing pancreatolithiasis with a high precision. Once the diagnosis of pancreatolithiasis is made, surgical procedures should be selected according to the combined diseases and the level of pancreatic duct dilation.
【摘要】 目的 探索针灸治疗慢性功能性便秘的特点及规律,以期为制定针灸治疗功能性便秘优选方案提供参考。方法 运用文献计量学方法,通过回顾分析1999年—2008年的针灸治疗慢性功能性便秘文献,以中国期刊全文数据库为资料来源,对这些文献进行定量分析。结果 共纳入86篇文献,分布在41种期刊上；针灸治疗功能性便秘最常用的穴位是天枢、大肠俞、足三里、支沟、上巨虚。结论 针灸治疗本病操作方法繁多,临床研究水平普遍较低,需进一步探讨针灸治疗的优化方案。