Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
目的总结完全腹腔镜下胆管空肠Roux-en-Y吻合的适应证、禁忌证、技术要点、安全性、并发症的预防及治疗效果。 方法回顾性分析2008年6月至2013年12月期间于笔者所在医院科室接受腹腔镜下胆管空肠Roux-en-Y吻合术的67例患者的临床资料。 结果67例患者中，66例完全在腹腔镜下完成手术，1例于放置蓝蝶后在手助下完成。手术时间144～253 min，平均152 min；术中出血30～220 mL，平均70 mL；术后住院时间6～11 d，平均8.1 d；住院费用2.0～2.5万元，平均2.1万元。术后发生漏胆3例，均经引流后痊愈；术后无肠瘘、出血、腹腔感染、肠梗阻等发生。术后20例患者获访，随访时间5～20个月，中位数为13个月。随访期间发生胆管炎2例，无吻合口狭窄发生。 结论对胆总管囊肿、胆总管下端良性狭窄、胆总管结石伴胆管扩张、壶腹部周围癌等需行胆肠吻合患者施行腹腔镜胆总管空肠Roux-en-Y吻合术是可行的，其手术费用稍高，但患者术后恢复快，且具有微创优势。
ObjectiveTo discussion the indications and contradictions of associating liver partition and potal vein ligation for staged hepatectomy (ALPPS) for primary hepatocellular carcinoma patients. MethodsThe date of 15 patients underwent the ALPPS in West China Hospital between Augst, 2014 and March, 2015 were retrospectively analyzed. The efficacy of the treatment was evaluated by blood test, the volume of residual liver growth, and postoperative follow-up. ResultsFourteen cases underwent the complete ALPPS, 1 case lost because it couldn't match the standard for the second step. The median increase in the future liver remnant(FLR) volume was 205.5 cm3[(-7.92)-270.6 cm3] and the median rate of FLR increase was 56.5%[(-1.89%)-134.74%]. One case died in the perioperative period for the liver failure, 2 cases was found recurrence or metastasis and died in 3 and 4 months after operation, respectively. One case's AFP was found rising but no iconography evidence for recurrence. One case with tumor survival about 4 moths. The remaining 10 patients were alive without recurrence and metastasis. ConclusionsALPPS is a feasible strategy in patients with cirrhosis and can improve the resectability of hepatocellular carcinoma to provide a chance of a cure to those who would not otherwise be able to receive surgery. And we put out an indications and contradictions for ALPPS tentatively.
ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
ObjectiveTo investigate the development and clinical application of the reverse total shoulder arthroplasty. MethodsThe relative publications on reverse total shoulder arthroplasties were extensively reviewed and analyzed. ResultsReverse total shoulder arthroplasty has extensive indications, especially for pseudoparalysis caused by irrepairable rotator cuff tears with forward or upper shift of the humeral head and intact function of deltoid. The clinical research results indicate that the short-term results are satisfactory, but there are some special complications, such as scapular nothching, instability and limities of internal and external rotation. While performing this kind of operation, the selection of the approach, the determination of the prosthetic rotation center should be considered well, and the bone graft should be paid attention to when the bony defect of the glenoid and proximal humerus exists. ConclusionThe using time of the reverse total shoulder arthroplasty is short, so the long-term results should be observed. The development of computer assisted technique is hopeful to be improve the results of the reverse total shoulder arthroplasty.