【Abstract】ObjectiveTo analyze the factors influencing the prognosis of patients with bile duct carcinoma after resection. MethodsThe clinical data of 120 patients with bile duct carcinoma receiving resection in our hospital from 1980 to 2004 were collected retrospectively and clinicopathologic factors that might influence survival were analysed. A multiple factor analysis was performed through Cox proportional hazard model. ResultsThe overall 1year, 3year and 5year survival rates were 71.7%, 32.5% and 19.2% respectively. The single factor analysis showed that the major significant factors influencing survival of these patients were histological type of the lesions, lymph node metastasis, pancreatic infiltration, duodenal infiltration, resected surgical margin, perineural infiltration, peripheral vascular infiltration and depth of tumor infiltration (P＜0.05). Lymph node metastasis, pancreatic infiltration and perineural infiltration were found to be the the statistically significant factors influencing survival by multiple factor analysis through the Cox model. ConclusionThe most important prognostic factors for bile duct carcinoma after resection were lymph node metastasis, pancreatic infiltration and perineural infiltration.
ObjectiveTo systematically review the expression of E-cadherin protein and the risk of pancreatic cancer. MethodsWe searched PubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data from inception to October 2016 to collect case-control studies about the correlation between E-cadherin protein expression and the risk of pancreatic cancer. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.2 software and Stata 12.0 software. ResultsSeventeen studies (986 cases in pancreatic cancer group and 433 cases in normal pancreatic tissue group) were finally included. The results of meta-analysis showed that: the expression of E-cadherin protein in the pancreatic cancer group was lower than normal tissue group (OR=0.04, 95%CI 0.01 to 0.23, P=0.000 2), poor differentiation group was lower than high or middle differentiation group (OR=0.44, 95%CI 0.26 to 0.76, P=0.003), lymph node metastasis group was lower than without lymph node metastasis group (OR=0.50, 95% CI 0.31 to 0.81, P=0.005), and the difference was statistically significant. However, there was no significant difference between the clinical stageⅠ-Ⅱ group and Ⅲ-Ⅳ group (OR=0.63, 95%CI 0.25 to 1.59, P=0.33), pancreatic head cancer group and pancreatic body and tail cancer group (OR=1.22, 95%CI 0.72 to 2.07, P=0.46), pancreatic cancer with nerve invasion group and without nerve invasion group (OR=1.45, 95%CI 0.81 to 2.62, P=0.21), pancreatic cancer with vascular invasion group and without vascular invasion group (OR=0.55, 95%CI 0.13 to 2.22, P=0.40). ConclusionLower expression of E-cadherin protein is significantly associated with the risk of pancreatic cancer. Due to the limited quality and quanity of includied studies, the above conclusion should be approved by more studies.
目的 應用聯合微創介入方法治療中晚期肝癌并探討其療效。方法 我院自1998年4月至2008年11月期間采用聯合介入治療的方法，即行經皮股動脈插管肝動脈化療栓塞術，同期行B超引導下經皮穿刺瘤內乙醇注射(PEI)治療中晚期肝癌175例。結果 左肝動脈行肝動脈化療栓塞7例，右肝動脈行125例，單行化療而未栓塞43例； 175例均行B超引導下PEI。隨訪6～28個月，平均19.3個月，死亡15例，其中8例死于肝功能衰竭，7例死于上消化道大出血伴肝癌廣泛轉移。29例存活6～12個月； 146例存活13～28個月，其中27例存活已超過26個月。結論 對于不能切除的中晚期肝癌采用聯合介入治療，因其具有操作簡單、療效可靠、經濟、安全等優點，值得臨床推廣應用。
目的 探討減少和預防腹腔鏡膽囊切除術(LC)并發癥的措施。方法 對我院2004年1月至2008年12月期間1 050例LC患者的臨床資料進行回顧性分析。結果 手術時間11～86 min，平均32 min; 術中出血2～106 ml，平均21 ml。18例(1.7%)患者中轉開腹，其中7例為術中無法完成膽囊三角解剖，4例膽管損傷，2例Mirizzi綜合征，1例膽腸內瘺和4例發生無法控制性出血。6例患者術后出現膽漏，其中膽囊床迷走膽管漏2例，肝外膽管漏4例; 8例患者術后繼發膽總管結石，2例術后膽囊管殘石; 51例術后診斷為膽囊切除術后綜合征，其中膽總管下端狹窄24例，殘余膽囊管過長（≥1 cm）或殘余膽囊結石16例，11例無明顯原因。術后1例患者因肺栓塞死亡，2例膽心綜合征患者未改善轉心內科繼續治療。結論 掌握好LC手術適應證、成熟的LC操作技巧、術中仔細處理膽囊三角和膽囊床、選擇性安置腹腔引流管、適時中轉開腹是減少術中、術后并發癥發生的關鍵。
目的 探討胃腸道穿孔的多層螺旋CT（MSCT）表現及診斷價值。 方法 收集2010年3月－2011年3月18例經手術證實為胃腸道穿孔患者的臨床及MSCT資料，回顧性分析了胃腸道穿孔及穿孔部位的MSCT表現。 結果 18例患者中，MSCT明確診斷穿孔17例，對穿孔部位準確定位11例。其中術后診斷胃穿孔4例、十二指腸球部穿孔9例、小腸穿孔3例、結腸穿孔1例、闌尾穿孔1例。MSCT表現有腹腔游離氣體，腸壁周圍局限性積氣、腹腔積液及腸袢積液、腸壁增厚、腸腔周圍脂肪間隙密度增高（條紋征）。 結論 MS CT有利于顯示腹腔游離氣體、胃腸道穿孔部位及其腸壁周圍的變化情況，對胃腸道穿孔術前的定性及定位診斷有較明顯的優勢 ，可為臨床提供更多有價值的診斷信息。