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.
目的 探討經臍單孔腹腔鏡膽囊切除的可行性、安全性及實用性。 方法 回顧分析2010年11月－2011年2月27例行經臍單孔腹腔鏡膽囊切除術患者的臨床資料。其中男15例，女12例；年齡19～53歲，平均39.5歲。膽囊息肉樣病變12例，病程6個月～8年；膽囊結石17例，結石數量1～9個，大小0.5～1.5 cm，均為非急性期患者，病程1個月～13年。 結果 27例手術均順利完成，無1例中轉開腹或轉為傳統三孔腹腔鏡膽囊切除術，術中生命體征平穩。手術時間35～149 min，平均63 min；術中出血10～20 mL，平均15 mL。所有患者術后2～3 d出院。患者均獲隨訪，隨訪時間6～24個月，平均13個月。術中及術后隨訪期間未發生任何并發癥。臍部瘢痕不明顯，患者滿意度高。 結論 經臍單孔腹腔鏡膽囊切除安全可行，具有創傷小、瘢痕不明顯等優點。
目的:探討老年人自發性氣胸的臨床特點、治療及預后。方法:對本院在2005年11月至2008年4月間收治的79例老年人自發性氣胸患者臨床資料進行回顧性分析。結果:老年人自發性氣胸大多有肺部基礎疾病,臨床表現缺乏特異性,本組誤診為慢性阻塞性肺病急性發作4例、左心衰2例、支氣管哮喘1例。氣胸類型: 張力性氣胸47例(72.1%),閉合性氣胸11例,交通性氣胸21例。采用以肋間閉式引流的為主的治療措施,效果好。結論:老年人自發性氣胸大多有肺部基礎疾病, 易誤診,氣胸的類型以張力性氣胸多見,治療多需排氣減壓術,及早的排氣減壓可望緩解癥狀,縮短肺復張時間,減少患者住院天數, 降低死亡率,提高老年人生活質量。
目的:探討Mirizzi綜合癥的診斷治療特點，以提高其診斷和治療水平。方法：對35例經手術證實為Mirizzi綜合癥的臨床資料進行回顧性分析。結果:35例Mirizzi綜合癥患者中僅4例（11.4%）術前確診。Ⅰ型7例，Ⅱ型17例，Ⅲ型9例，Ⅳ型2例。5例行膽囊切除術，2例行膽囊大部分切除術；膽囊切除、膽囊瓣瘺口修補6例，12例行膽囊切除、膽總管探查、瘺口修補、T管引流術；膽囊切除、膽腸吻合術10例。術后恢復好，隨訪結果，無嚴重并發癥.結論：Mirizzi綜合癥術前確診困難，B超結合MRCP/ERCP檢查可以提高Mirizzi綜合癥的術前確診率，手術容易損傷膽管，手術方式應據病理損傷程度決定。