目的:研究Child-Pugh分級對失代償期肝硬化預后的預測價值。方法:對34例死于失代償期肝硬化患者進行回顧性分析,應用Child-Pugh分級對初次入院資料進行評分及分級,并計算初次入院至死亡的時間。結果:Child-Pugh分級A級生存時間56.2±24.7月、B級33.1±10.5月、C級12.6±9.6月;以上消化道出血為主要表現的患者,生存時間相對非出血者低(Plt;0.05)。結論:Child-Pugh分級可做為預測失代償期肝硬化患者的生存時間的重要的客觀指標。而是否伴有上消化道出血對生存時間有較大的影響;上腹部增強CT對失代償期肝硬化患者有無肝腎分流等側支循環的評估有助于出血風險的判斷。
目的 探討和分析反流性食管炎與幽門螺桿菌感染之間的關系。 方法 回顧性分析2009年1月－2011年11月間胃鏡確診為反流性食管炎334例，所有患者均行快速尿素酶試驗；其中反流性食管炎合并消化性漬瘍57例，慢性非萎縮性胃炎102例。 結果 反流性食管炎的幽門螺桿菌感染率為21.6% ，在幽門螺桿菌感染陽性的患者中最多見并發消化性潰瘍，而在幽門螺桿菌感染陰性的患者中最多見并發慢性非萎縮性胃炎，解剖結構和動力障礙性疾病絕大多數并發于幽門螺桿菌陰性患者。A和B級反流性食管炎的幽門螺桿菌感染陰性的患者多于幽門螺桿菌感染陽性的患者。在A級反流性食管炎中幽門螺桿菌感染率28.0%，B級為8.4%，C+D級為0.0%。 結論 反流性食管炎中幽門螺桿菌感染率低，幽門螺桿菌陽性的反流性食管炎多并發于消化性潰瘍，提示幽門螺旋桿菌對反流性食管炎發病有一定保護作用。
Objective To evaluate the efficiency and security of physical exercise with low intensity against malnutrition and sarcopenia in patients with cirrhosis. Methods Between December 2014 and October 2015, 37 patients with cirrhosis were divided into two groups according to their willings, with 19 in the exercise group and 18 in the control group. Endurance of the exercise for 3 months were recorded. Mid-arm circumference, " up and go” time, width of portal vein and Child-Pugh score were compared before and after the research between the two groups. Results Three months later, the mid-arm circumference and the " up and go” time of the exercise group [(33.99±2.15) cm, (9.17±0.35) s] were better than those before the exercise [(32.09±2.58) cm, (9.77±0.46) s] and those in the control group [(31.93±2.04) cm, (9.76±0.30) s], and the differences above were all statistically significant (P<0.05). The change of the width of portal vein was positively correlated with pre-exercise body mass index in overweight patients (r=0.93, P=0.007). Conclusions Physical exercise with low intensity is safe and effective against malnutrition and sarcopenia in patients with cirrhosis. Overweitht patiens or malnutrition at the early stage may benefit more.
【摘要】 目的 探討肝硬化食管靜脈曲張程度與門脾靜脈內徑、肝功能Child-Pugh分級間的關系。 方法 對2007年1月-2010年1月間56例肝硬化患者行增強CT，測量門靜脈主干及脾門部脾靜脈直徑，采用Child-Pugh分級標準進行肝功能分級，并行胃鏡了解食管靜脈曲張的程度。 結果 食管靜脈曲張程度與門、脾靜脈內徑呈正相關，而Child-Pugh分級與門脾靜脈內徑、食管靜脈曲張程度無相關性。 結論 根據門、脾靜脈內徑可預測肝硬化上消化道出血的可能性；在Child-Pugh分級基礎上對患者上消化道出血的風險進行評估顯得尤為重要。【Abstract】 Objective To discuss the relationship among the esophageal varices, the diameter of portal vein and spleen vein, and Child-Pugh score in patients with liver cirrhosis. Methods The study included 56 patients who had liver cirrhosis between January 2007 and January 2010. We measured their portal vein and spleen vein diameter with CT; used Child-Pugh score to grade their hepatic function; and detected the degree of the esophageal varices by endoscopy. Results There was a positive correlation between the degree of esophageal varices and diameter of portal vein and spleen vein, while no correlation showed between portal vein and spleen vein diameter, degree of esophageal varices, and Child-Pugh score. Conclusion The upper gastrointestinal bleeding in patients with liver cirrhosis can be predicted by the diameter of portal vein and spleen vein, assessment of upper gastrointestinal bleeding based on Child-Pugh score should also be taken into account.
目的 比較CT門靜脈血管成像（CTP）與內鏡診斷肝硬化胃食管靜脈曲張的效果，探討CTP對肝硬化門靜脈高壓側支循環血管的顯示及其在隨訪中的價值。 方法 對2010年1月－2011年12月收治的43例肝硬化患者行多排螺旋CT增強掃描門靜脈血管成像，觀察胃食管靜脈曲張程度，及有無其他側支開放，并在4周內行內鏡檢查，了解胃食管靜脈曲張的程度。 結果 43例患者中有33例經胃鏡確診食管靜脈曲張，其中CTP診斷與胃鏡相符29例；胃鏡診斷胃底靜脈曲張14例，其中有12例CTP診斷與之相符；CTP診斷胃食管靜脈曲張與內鏡有較好的相關性和一致性，但在判斷食管靜脈曲張部位上與胃鏡一致性較差。 結論 對肝硬化患者可采用CTP進行隨訪，以評估胃食管靜脈曲張出血風險，可減少不必要的內鏡隨訪。
Objective To summarize the etiology and clinical features of Mounier-Kuhn syndrome (MKS) so as to enhance the acknowledgement of MKS. Methods Three cases of MKS were reported and the keywords with " Tracheobronchomegaly”, " Mounier-Kuhn syndrome” were analyzed through the mode of literature retrieval in CNKI, VIP and Pubmed databases. Results There were 214 cases around the world including 14 cases of MKS in China. With unknown etiology and non-specific clinical feature, MKS is characteristic with congenital absence of tracheal or bronchial elastic tissue. MKS is diagnosed with remarkably dilated trachea and bronchus through chest CT or bronchofibroscope, accompanied with genetic defects. The ratio of men to women is 8.5 to 1. There is no radical cure. Symptomatic treatment and surgical treatment when necessary could be available. Conclusions MKS is a rare progressive hereditary disease, irrelevant to smoking and sharing a similar cause with generalized elastolysis, which need pay much attention to the physical examination of skin or elastic tissue. The diagnosis of MKS should be based on not merely airway diameter but also the overall clinical, pathologic, and radiologic profile.
Objective To enhance the understanding of the primary salivary glandtype lung cancer (PSGLC) and improve the diagnostic rate of the disease. Methods The clinical data of 41 patients with PSGLC pathologically confirmed in West China Hospital between October 2009 and October 2015 were analyzed in terms of clinical features, therapy and prognosis. Results All the 41 patients (21 males and 20 females) accounted for 0.22% (41/18 738) of the primary malignant lung tumor diagnosed in the same period. The patients aged from 16 to 72 with the median age of 43.6. The disease course was 1 month to 6 years, and 12 had smoking history. There were 23 cases of adenoid cystic carcinoma, 15 of mucoepidermoid carcinoma and 3 of acinic cell carcinoma. The symptoms, chest-computed tomography and fiberbronchoscopy examination had no specificity. There were 34 patients who had undergone surgery, in whom 3 had fiberbronchoscopy, 4 had oral traditional Chinese medicine treatment, 5 had chemotherapy and radiotherapy at the same time, 9 received chemotherapy only, and 4 recived radiotherapy only. Follow-up period lasted for 2-65 months, with the median time of 38 months. Two patients had recrudescence, 6 patients had distant metastasis and 1 patient died. Conclusions PSGLC have no specific clinical features; its diagnosis basically rely on pathological examination. After comprehensive treatment mainly on surgery, the prognosis of the disease is better than other malignant lung cancers.