摘要:目的:探討老年人梗阻性大腸癌的圍手術期處理。方法:回顧性分析2003年至2008年間71例60歲以上老年人梗阻性大腸癌的圍手術期處理情況。 結果:術前發現并存病者43例,術中出現并發癥19例,術后發生并發癥37例得,除5例死亡外,均得到有效控制,死亡原因與并存疾病有關。結論:加強圍手術期處理,積極治療并存疾病,老年人梗阻性大腸癌的治療同樣能取得滿意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
Objective
To summarize the clinical features, diagnosis, and treatment of acute deep venous thrombosis (DVT) at lower extremity of aged patients.
Method
Clinical data of 98 aged patients with acute DVT at lower extremity who got treatment in our hospital from Junuary 2012 to December 2014 were analyzed retrospectively.
Results
Of 98 aged patients with acute DVT at lower extremity, the time from disease developed to treatment was 1 day to 10 days with an average of 4 days. The main symptom was low limb swelling progressively. All the patients were treated by the comprehensive treatment based on individual anticoagulation. A total of 96 patients (98.0%) were followed up, and the follow-up period ranged from 12 months to 24 months (average of 18 months). Of 96 patients followed-up, we found a statistically significant difference between lower extremities before treatment and those at 3 months after treatment in venous clinical severity score (VCSS) and the change of lower extremity circumference (P<0.001). Of 96 patients, 9 patients were cured, 81 patients had markedly effective results, and 6 patients had effective results. None of the patients suffered from fatal pulmonary embolismin in duration of hospital day and follow-up period, and no one suffered form DVT recurrence.
Conclusions
The aged patients with acute DVT at lower extremity usually see a doctor lately. The comprehensive treatment based on individual anticoagulation is safe and effective in treatment of acute DVT at lower extremity of aged patients.
Objective To explore the effect of age and gene therapyon the differentiation of marrow mesenchymal stem cells （MSCs） of the rats. Methods MSCs from the young (1-month-old), adult (9-month-old), and the aged(24monthold) rats were expanded in culture and infected with adenovirus mediated human bone morphogenetic protein 2 gene (Ad-BMP-2). The expression of BMP-2 and osteoblastic markers such as alkaline phosphatase(ALP), collagen Ⅰ(Col Ⅰ), bone sialoprotein(BSP) and osteopontin(OPN) were assayed during the process of differentiation. Their abilities to induce ectopic bone formation in nude mice were also tested. Results There was no significant difference in the expression of BMP-2 among the 3 groups. ALP activity assay and semi-quantitative reverse transcription polymerase chain reaction(RT-PCR) demonstrated that there were no significant differences in the expression of osteoblastic markers ALP, Col-Ⅰ, OPN and BSP amongthe 3 groups. Histomorphometric analysis indicated that there were no significant differences in the volume of the newly formed ectopic bones in nude mice amongthe 3 groups. Conclusion MSCs obtained from the aged ratscan restore their osteogenic activity following human BMP-2 gene transduction, therefore provides an alternative to treating the aged bone disease.
摘要:目的:探索區域文化、亞文化、經濟水平、教育環境、家庭環境等因素對學齡兒童行為的影響。方法: 比較分析岳陽市與濟寧市學齡兒童行為問題調查結果。結果:岳陽市與濟寧市學齡兒童行為問題總體現患率分別為9.19%和10.7%(χ2=8.804, Plt;0.05),但與全國22個城市協作調查組報告結果(12.97±2.19)%基本相符;行為問題現患率和構成比存在性別與地區差異(Plt;0.05),男性兒童行為問題現患率高于女性兒童、男性兒童以“A行為”為主、女性兒童以“N行為”為主;行為問題現患率在8、9、12歲三個年齡段有地區差異(Plt;0.05)。結論:學齡兒童行為問題與區域文化、亞文化、經濟水平、教育環境、家庭環境等因素有關聯,與男女生物學特征的差異和不同環境的反應傾向及年齡等生物社會心理因素有關。Abstract: Objective: To explore the factors affect schoolaged children behavior by regional culture, subculture, economic level, educational environment, family environment and so on. Methods: Compared and analyzed the investigation results of schooleaged children behavior from Yueyang City and Jining City. Results: The prevalence rate of schoolaged children with behavior problems reflects respectively 9.19% and 10.7% (χ2 = 8.804, Plt;0.05), which is in collaboration with the National Investigation Unit report on the results (12.97 ± 2.19)%; the prevalence rate and composition exist gender and regional differences (Plt;0.05). The behavior problems prevalence rate of male child is higher than female children, male children in “A behavior” mainly, female children in “N behavior” mainly; The behavior problems prevalence rate at the age of 8,9,12 exist regional differences (Plt;0.05). Conclusion: Schoolaged children behavior problems are associated with regional culture, subculture, economic level, educational environment, family environment and other factors, and have something with biopsychosocial factor as the differences in male and female biological characteristics, different environments and age.
Objective
To compare therapeutic effects of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transcatheter arterial chemoembolization (TACE) on patients with advanced hepatocellular carcinoma.
Methods
Thirty-five patients with advanced hepatocellular carcinoma admitted in the Department of Hepatobiliary and Pancreatic Surgery of Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from August 1, 2014 to August 1, 2015 were randomly divided into ALPPS group and TACE group, in which 17 cases treated by the ALPPS and 18 cases treated by the TACE. The survival, changes of liver function and life quality, postoperative complications and mortality were compared in these two groups. The follow-up was performed by the telephone and the outpatient.
Results
① The baselines such as the age, gender, diameter of tumor, complications had no significant differences in these two groups (P>0.05). ② The changes of liver function and life quality after operation in the ALPPS group were significantly better than those in the TACE group (P<0.05). ③ The complications after operation were observed in 5 cases (there were 2 cases of bile leakage, 1 case of intraabdominal bleeding, 1 case of peritoneal effusion, and 1 case of pulmonary infection) in the ALPPS group, which in 13 cases (there were 6 cases of nausea and vomiting, 4 cases of liver function damage, 2 cases of granulocytopenia, 1 case of fever) in the TACE group. The rate of the overall complications in the ALPPS group was significantly lower than that in the TACE group (5/17versus 13/18, P=0.018). ④ The overall survival in the the ALPPS group was significantly better than that in the TACE group (P=0.024). During follow-up period, the deaths happened in 3 cases duo to hepatocellular carcinoma and 1 case duo to traffic accident, 1 case was lost on month 8, 12 cases were still alive in the ALPPS group; the deaths happened in 10 cases duo to hepatocellular carcinoma, 1 case duo to coronary disease, and 1 case duo to cerebral infarction, 6 cases were still alive in the TACE group.
Conclusion
Preliminary results of limited cases in this study show that ALPPS has a better effect than TACE on patients with advanced hepatocellular carcinoma.
摘要:目的: 觀察瑞格列奈、阿卡波糖聯合治療老年性2型糖尿病患者的臨床療效及安全性。 方法 :觀察58例2型糖尿病患者服用瑞格列奈及阿卡波糖,療程12周,監測治療前后空腹及餐后2 h血糖(FBG、PBG)、糖化血紅蛋白(HbAlc)、肝功、腎功。 結果 :FBG、PBG及HbAlc較治療前顯著下降(Plt;005),尤其是餐后血糖更為明顯(Plt;001)。無一例肝腎功能損害,也無嚴重低血糖及其它嚴重不良反應發生。 結論 :瑞格列奈聯合阿卡波糖治療2型糖尿病降糖作用確切,而且安全性、耐受性良好。Abstract: Objective: To observe the clinical efficacy and safety of combined treatment of repaglinide and acarbose in aged patients with diabetes type 2 Methods : After oral administration of repaglinide and acarbose for 12 weeks, 58 patients with type 2 diabetes were observed. The concentrations of fasting blood glucose (FBG), 2 h postprandial blood glucose (PBG), glycosylated hemoglobin (HbAlc), liver and kidney functions were monitored before and after treatment. Results : The levels of FBG, PBG and HbAlc were significantly decreased compared with pretreatment (Plt;005), especially PBG (Plt;001). No case of liver and kidney dysfunction was found, without serious hypoglycemia and other serious adverse events as well. Conclusion : Repaglinide and acarbose have the precise function in the treatment of type 2 diabetes, with good security and good tolerance.
From December 1995 to December 1997, 1 500 patients with gallstones or together with biliary duct stones accepted laparoscopic cholesystectomy (LC) or LC+laparoscopic common bile duct exploration (LCDE). There were 9 had serious complications (0.6%) occured . While the mean age was 54.9 years old. The sex ratio (female∶male) was 1∶1.25. Three cases had major biliary duct disruption, 1 case had stomach perforation, 2 cases had duodenal injuries, 1 bleeding case because cystic artery fail to clip, 1 case had postoperative cystic duct leak, and 1 case with T-tube dislodgement. All complications had been discovered during or shortly after operations. The injuries on the extrahepatic biliary duct with lengths of 0.2-0.4cm, and the gastrodenal injuries sized 0.5-1.0cm. All of the injuries had been sutured laparoscopically without sequela. The one who had postoperative cystic duct leak and jaundice accepted LCDE, proved to have a common bile duct stone. The bleeding cystic artery had been clipped well, and the dislodged T-tube replaced well. The results show if the complications which may be very serious or complex had been discovered shortly after or during the operations, its can be managed with laparoscopic technique safely by experienced operators.
ObjectiveTo evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. MethodsThe clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. ResultsA total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). ConclusionStaged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.
Objective
To explore application value of multi-disciplinary team (MDT) model in patient underwent associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS).
Methods
A huge mass of liver right lobe about 90.9 mm×75.5 mm×77.5 mm was found by the preoperative abdominal CT examination, which was considered as the primary liver cancer. The ALPPS was decided to perform through the discussion by the Departments of Radiology, Anesthesiology, Infectious disease, Oncology, and Hepatobiliary surgery. The first step operation included the exploratory laparotomy, associating ligation of the right branch of portal vein and disconnection of left and right hemi liver, radiofrequency ablation, and cholecystectomy. The second step operation was performed at 45 d after the first step operation, which included the release of the abdominal adhesion and the resection of the right lobe of liver.
Results
During the period of the two steps surgeries, though the patient had the liver failure, hepatic encephalopathy, and poor proliferation of the left lobe of liver, and so on, the ALPPS was finished smoothly and the R0 resection was achieved through the collboration of MDT. After the surgery, the related complications were treated by the MDT, the patient got great recovery and no recurrence or metastasis occurred during the following-up.
Conclusion
It is feasible to use ALPPS in treatment of primary giant liver cancer under MDT model, it will be more conducive to clinical brainstorming for the best treatment and better income of patient.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
