【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.
目的 探讨胃肠道穿孔的多层螺旋CT（MSCT）表现及诊断价值。 方法 收集2010年3月－2011年3月18例经手术证实为胃肠道穿孔患者的临床及MSCT资料，回顾性分析了胃肠道穿孔及穿孔部位的MSCT表现。 结果 18例患者中，MSCT明确诊断穿孔17例，对穿孔部位准确定位11例。其中术后诊断胃穿孔4例、十二指肠球部穿孔9例、小肠穿孔3例、结肠穿孔1例、阑尾穿孔1例。MSCT表现有腹腔游离气体，肠壁周围局限性积气、腹腔积液及肠袢积液、肠壁增厚、肠腔周围脂肪间隙密度增高（条纹征）。 结论 MS CT有利于显示腹腔游离气体、胃肠道穿孔部位及其肠壁周围的变化情况，对胃肠道穿孔术前的定性及定位诊断有较明显的优势 ，可为临床提供更多有价值的诊断信息。
目的 探讨减少和预防腹腔镜胆囊切除术(LC)并发症的措施。方法 对我院2004年1月至2008年12月期间1 050例LC患者的临床资料进行回顾性分析。结果 手术时间11～86 min，平均32 min; 术中出血2～106 ml，平均21 ml。18例(1.7%)患者中转开腹，其中7例为术中无法完成胆囊三角解剖，4例胆管损伤，2例Mirizzi综合征，1例胆肠内瘘和4例发生无法控制性出血。6例患者术后出现胆漏，其中胆囊床迷走胆管漏2例，肝外胆管漏4例; 8例患者术后继发胆总管结石，2例术后胆囊管残石; 51例术后诊断为胆囊切除术后综合征，其中胆总管下端狭窄24例，残余胆囊管过长（≥1 cm）或残余胆囊结石16例，11例无明显原因。术后1例患者因肺栓塞死亡，2例胆心综合征患者未改善转心内科继续治疗。结论 掌握好LC手术适应证、成熟的LC操作技巧、术中仔细处理胆囊三角和胆囊床、选择性安置腹腔引流管、适时中转开腹是减少术中、术后并发症发生的关键。
目的 应用联合微创介入方法治疗中晚期肝癌并探讨其疗效。方法 我院自1998年4月至2008年11月期间采用联合介入治疗的方法，即行经皮股动脉插管肝动脉化疗栓塞术，同期行B超引导下经皮穿刺瘤内乙醇注射(PEI)治疗中晚期肝癌175例。结果 左肝动脉行肝动脉化疗栓塞7例，右肝动脉行125例，单行化疗而未栓塞43例； 175例均行B超引导下PEI。随访6～28个月，平均19.3个月，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广泛转移。29例存活6～12个月； 146例存活13～28个月，其中27例存活已超过26个月。结论 对于不能切除的中晚期肝癌采用联合介入治疗，因其具有操作简单、疗效可靠、经济、安全等优点，值得临床推广应用。
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.