Objective To explore the relationship between the HBsAg positive patients suffering from hepatocellular carcinoma (HCC) and HBV DNA genotype. Methods By using PCR type-specific primers combined with sequencing of genotype, we analyzed the genotype of HBV DNA in the serum of 500 patients with positive HBsAg in our hospital. Among them, 150 cases suffered from HCC. Results Genotype B and C were both predominant genotypes in HBsAg positive patients. But in HCC group, the rate of genotype C was 65.33% （98/150）, which was significantly higher than that in non-HCC group (88/350, 25.14%), while genotype B, in contrast, was 28.67% （43/150） and 68.86% （241/350）， χ2=75.45， Plt;0.05. The distribution of HBV DNA genotype B or genotype C in different gender or different age groups were not statistically significantly different in cases of HCC (Pgt;0.05). Conclusion Genotype C of HBV DNA is more common in patients with HCC, and maybe there is relationship between genotype C and the occurrence of HCC.
目的探讨原发性胆囊癌治疗的措施。方法对我院1998年4月至2003年2月外科治疗的122例原发性胆囊癌患者的临床资料，结合部分患者随访结果进行分析总结。结果19例Ⅰ、Ⅱ及Ⅲ期胆囊癌患者手术治疗效果满意； 103例Ⅳ、Ⅴ期胆囊癌患者中34例行根治或扩大根治术，根治切除率为33.0%，余69例行姑息性手术治疗，行胆囊癌根治术后患者的平均生存时间明显长于姑息性手术者（17.6个月 vs 7.3个月）。结论对胆囊癌应采取积极的、个体化的治疗措施。扩大根治术可使部分Ⅳ、Ⅴ期胆囊癌患者受益。应注意淋巴结清扫的范围和做到无残留癌的根治性切除。对综合治疗的研究还需进一步深入。
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
ObjectiveTo explore the comprehensive hospital administrative management system for urban and rural cooperation in the process of medical reform. MethodsBy reviewing literature and interviewing directors of the administrative departments and hospital medical staff, we gradually established and improved the administrative management system for urban and rural hospital counterpart support. ResultsBetween 2010 and 2013, 123 medical workers were dispatched to support eight county-level hospitals, after which the comprehensive capacity, and technology and quality control in those hospitals were largely improved. Till the end of 2013, two of those hospitals were promoted to be grade-three class-B comprehensive hospitals; two were promoted as grade-two class-A comprehensive hospitals; three passed the reassessment to be grade-two class-A comprehensive hospitals; and another three county-level medical centers were promoted to be city-level key disciplines. ConclusionThe comprehensive administrative management system improves the management level of grass-roots hospitals at the county level; promotes the social public welfare of tertiary public hospital counterpart support; facilitates the process of medical system reform at the county level; establishes a series of administrative management modes such as unified support, personnel management, assessment standards and evaluation system; and promotes the sustainability of long-term counterpart support system.
ObjectiveTo explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.MethodsThe clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed, and the effect was followed up.ResultsTwo cases were converted to open surgery, and the remaining 29 cases successfully completed laparoscopic surgery. The operative time of 31 patients was 185–490 min (260±106) min; the intraoperative bleeding volume was 200–1 300 mL (491±225) mL; the time of hepatic blood flow occlusion was 20–45 min (29±18) min; the time of choledochoscopy was 10–50 min (28±15) min. The scope of hepatectomy includes: Ⅱ, Ⅲ, Ⅵ, and Ⅶ in 14 cases, Ⅰ, Ⅱ, Ⅲ,Ⅵ, and Ⅶ in 8 cases, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 3 cases, Ⅳ, Ⅴ, and Ⅷ in 3 cases, Ⅱ, Ⅲ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ in 2 cases, Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 1 case. The postoperative anal exhaust time was 24–73 h (41.8±15.2) h; postoperative feeding time was 14–23 h, median feeding time was 19 h; postoperative ambulation time was 15–46 h, median ambulation time was 27 h; postoperative drainage tube extraction time was 3–14 d, median drainage tube extraction time was 5 d; postoperative hospitalization time was 6–15 d, median postoperative hospitalization time was 9 d. Twenty-seven patients were followed up for 7 to 63 months, with a median follow-up time of 25 months. The incidence of complications was 19.4% (6/31), according to Claviein classification, there were 2 cases in grade Ⅰ (6.5%), 1 case in grade Ⅱ (3.2%), 3 cases in grade Ⅲa (9.7%).ConclusionLaparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis, which is performed by a skilled hepatobiliary surgeon.