Objective To evaluate the efficacy and safety of memantine in the treatment of Alzheimer’s disease (AD). Methods The randomized controlled trials (RCTs) about memantine vs. donepezil for patients with AD from January 1989 to July 2011 were searched in CBM, CNKI, WanFang Data, MEDLINE, OVID, EMbase and The Cochrane Library. Two reviewers independently screened the literatures, extracted the data, and evaluated the methodological quality. Then meta-analyses were conducted by using RevMan 5.0 software. Results The total 12 RCTs were included. Among the 2 716 patients involved, 1 459 were in the memantine group, while the other 1 302 were in the donepezil group. The results of meta-analyses showed that the efficacy of the memantine group was superior to that of the donepezil group in MMSE (MD=0.53, 95%CI 0.21 to 0.85, P=0.001), CIBIC-Plus (MD= –0.19, 95%CI –0.31 to –0.07, P=0.002), NPI (MD= –2.9, 95%CI –4.57 to –1.22, P=0.000 7) and SIB (MD=3.12, 95%CI 0.57 to 5.67, P=0.02), with significant differences; but the efficacy of the two groups was similar in ADCS-ADL19 (MD=0.29, 95%CI –0.03 to 0.60, P=0.07). There was no significant difference between the two groups in incidence of side effects (RR=1.14, 95%CI 0.94 to 1.38, P=0.17), but the tolerability of the memantine group was much better (RR=0.78, 95%CI 0.63 to 0.97, P=0.03). Conclusion Based on the current studies, memantine is superior to donepezil in treating Alzheimer’s disease (AD) at present. Although the side effects are similar to donepezil, memantine has much better intolerability and is considered to be safe and effective. For the quality restrictions and possible publication bias of the included studies, more double blind RCTs with high quality are required to further assess the effects.
目的:探讨门静脉高压症(Portal hypertension,PHT)合并胆石症的合理处理方式。方法:回顾分析2003年9月于2008年9月64例PHT合并胆石症患者不同方式手术治疗的结果。根据手术方式不同将64例患者分为三组。A组:仅行胆道手术(n=20);B组:在行PHT手术的同时行胆道手术(n=20);C组:在行PHT手术时对胆囊或胆道结石未作处理(n=24)。结果:死亡率A组10%,B组28.5%,C组4.3%。并发症:A组40%,B组70%,C组25%。结论:PHT合并胆石症无论仅行胆道手术或同期行PHT手术和胆道手术,手术死亡率和术后并发症均显著增加,尤以同期手术为明显。根据患者情况选择正确的手术方式,可有效降低手术风险。
ObjectiveTo investigate and compare the advantages and disadvantages of laparoscopic cholecystolithotomy and laparoscopic cholecystectomy for patients with gallbladder stone. MethodsThe eligible patients with gallbladder stones hospitalized in our department between January 2007 and December 2011 were included, and all of them received either laparoscopic cholecystolithotomy (observation group) or laparoscopic cholecystectomy (control group) minimally-invasive surgery. The operation time, bleeding volume, enterokinesia recovery time, hospital stay, post-operative complication and follow-up results were compared between the two groups. ResultsA total of 148 patients were included, with 68 patients in the observation group and 80 patients in the control group. In this cohort, the success rate of surgery for the observation group and the control group was 100.0% (68/68) and 98.8% (79/80), respectively; and the success rate of complete stone removal was 100% for both two groups. B-ultrasound examination after 2 weeks of treatment showed that gallbladder wall was normal and gallbladder contraction rate was more than 30% for all patients with laparoscopic cholecystolithotomy. The operation time was (49.6±5.2) minutes for the observation group and (50.5±6.2) minutes for the control group, and bleeding volume was (9.5±1.4) mL for the observation group and (50.2±8.1) mL for the control group; the difference in bleeding volume was significant between the two groups (P<0.05). The difference in enterokinesia recovery time[(33.9±2.2) and (34.4±2.6) minutes] or hospital stay[(3.4±1.0) and (3.6±1.2) days] between the observation group and the control group was not significant (both P >0.05). The post-operative complications of bleeding, bile leakage and wound infection were not observed in both two groups, and all patients were followed up for 6 to 12 months with no stone recurrence; and only 2.7% of patients (1/37) had stone recurrence after 3-year follow-up. ConclusionBoth laparoscopic cholecystolithotomy and laparoscopic cholecystectomy procedures are safe and efficient. However, laparoscopic cholecystolithotomy not only reserves gallbladder but also has superiority of less bleeding volume.
Objective To explore the measures for early diagnosis and treatment of iatrogenic injury in the distal part of common bile duct. Methods The clinical data of 20 patients with iatrogenic injury in the distal part of common bile duct treated in our hospital from 1990 to 2008 were analyzed retrospectively. Results The injuries of 15 cases were found during the operation: 11 cases were treated with 3-stoma (bile duct, pancreas, duodenum)+Oddi sphinctreoplasty (OSP), 1 case with OSP+choledochojejunostomy, 2 cases with the perforated common bile duct suture repair+T tube drainage, 1 case with T tube drainage; All of them were cured after surgery. The other 5 cases were not found during the primary operation, 2 cases in which were cured with several operations, the other 3 were dead from infectious shock. Conclusions Early diagnosis and treatment of iatrogenic injury in the distal part of common bite duct can obtain perfect effects. Different procedures should be performed according to different degrees of the injury. The perfect preoperative imaging examination and intraoperative choledochoscopy before bile duct exploration may reduce the occurrence of the injury.
ObjectiveTo assess mid− and long−term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). MethodsWe retrospecctively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. ResultsA total of 33 patients were enrolled, including 23 males and 10 females aged 22−73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow−up AAD of the patients were 46.06±3.54 mm, 34.55±5.17 mm, and 37.12±5.64 mm, respectively. The median follow−up time was 38.20 (18.80−140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was>5 mm per year in 1 patient, and>3 mm in another one. ConclusionMid−term outcomes of AAW in adult patients undergoing AVR are satisfied and encouraging.
目的 探讨Mirizzi综合征的病理特点及合理的诊断治疗方法。 方法 回顾性分析26例经手术确诊的Mirizzi综合征的临床资料。 结果 26例均采用手术治疗，其中行胆囊大部分切除术7例，胆囊切除或胆囊大部分切除加胆总管探查、T管引流术6例，胆囊切除加瘘口修补术11例，胆肠吻合术2例。 结论 Mirizzi综合征术前诊断困难，术中易致胆管损伤，应根据不同的病理分类采取不同的手术方式。
ObjectiveTo assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR).MethodsWe retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively.ResultsThere was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. ConclusionMid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.
ObjectiveTo assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR).MethodsWe retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively.ResultsThere was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year.ConclusionMid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.