目的 观察阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原（HBeAg）阳性慢性乙型肝炎2年的疗效。 方法 2007年1月－2009年1月间178例慢性乙型肝炎患者随机分为试验组91例和对照组87例。试验组给予胸腺五肽1 mg，隔日皮下注射，疗程52周；同时阿德福韦酯10 mg/d口服104周。对照组给予阿德福韦酯10 mg/d，口服104周。治疗26、52、104周及停药52周时，分别检测血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乙型肝炎病毒（HBV）DNA含量及HBV血清标志物。 结果 治疗52周后，试验组在ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率与HBeAg/HBeAb血清转换率方面都比对照组高。停药52周时，试验组与对照组的ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率、HBeAg/HBeAb血清转换率分别为74.73%与51.72%、75.82%与54.02%、25.27%与8.05%、26.37%与10.34%、18.68%与8.05%（χ2=10.652、9.313、9.421、7.574、4.313，P＜0.05）。 结论 阿德福韦酯联合胸腺五肽治疗HBeAg阳性慢性乙型肝炎比单独使用阿德福韦酯抗病毒治疗效果更好，有助于提高HBeAg/HBeAb血清转换率，减少停药后病毒学突破，并且使用安全。Objective To evaluate the efficacy of adefovir dipivoxil (ADV) combined with thymopentin on chronic hepatitis B patients with positive hepatitis B e antigen (HBeAg). Methods Between January 2007 and January 2009, 178 chronic hepatitis B patients with positive HBeAg were randomly divided into two groups: the treatment group (91 cases) and the control group (87 cases). All patients in two groups received 10 mg of ADV once a day for 104 weeks, while the patients in the treatment group received 1 mg of thymopentin for subcutaneous injection every other day for 52 weeks. The rates of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) normalization, serum hepatitis B virus (HBV) DNA clearance and HBeAg loss and anti- HBeAg seroconversion were evaluated at pretreatment, and 52, 104 and 156 weeks after treatment, respectively. Results After 52-week treatment, The rates of ALT and AST normalization, serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion in the treatment group were higher than those in the control group. In 52-week follow-up after 104 weeks treatment, the rates of ALT and AST normalization , serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion of two groups were 74.73% versus 51.72%, 75.82% versus 54.02%, 25.27% versus 8.05%, 26.37% versus 10.34%, 18.68% versus 8.05%, respectively (χ2 = 10.652, 9.313, 9.421, 7.574, 4.313; P＜0.05). Conclusions It is more effective for adefovir dipivoxil combined with thymopentin on HBeAg-positive patients with chronic hepatitis B than using adefovir alone. Combination treatment could improve the rates of HBeAg seroconversion and reduce the breakthrough of HBV after drug withdrawal. And it is safe.
ObjectiveTo explore the evaluation value of preoperative multislice spiral computed tomography angiography (MSCTA) for normative radical gastrectomy. MethodsThe anatomic distributions of celiac trunk and its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which compared with postoperative pathological results. ResultsThe accuracy rate of preoperative MSCTA evaluating the distribution of celiac trunk and its three branches and their tributaries was 100%. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25.58%. Abnormal right hepatic arteries were found in 11 cases (12.79%), abnormal left hepatic arteries in 7 cases (8.14%), both abnormal right and left hepatic arteries in 1 case (1.16%), and abnormal common hepatic arteries in 3 cases (3.49%). Straight splenic arteries were found in 24 cases (27.91%), slightly curved splenic arteries in 44 cases (51.16%), and significantly curved splenic arteries in 18 cases (20.93%). Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58%（65/86）, 74.42%(64/86), and 91.86%(79/86), respectively. ConclusionsPreoperative MSCTA is an objective way to assess the distributions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.
【摘要】 目的 探讨高压氧联合药物治疗突发性耳聋（sudden deafness， SD）的疗效。 方法 2008年2月-2010年7月，对174例SD患者采用高压氧（治疗压力0.2 MPa）及配合扩血管、营养神经等药物进行治疗，并观察其疗效。 结果 高压氧联合药物治疗SD总有效率为85.7％，SD的发病就诊时间是影响预后的主要因素，发病就诊时间≤7 d时，治疗有效率可达95.6%；≥15 d时，疗效明显降低。 结论 高压氧联合药物治疗SD疗效确切，且高压氧治疗越早疗效越好。 【Abstract】 Objective To observe the therapeutic effect of hyperbaric oxygen combined with medical treatment on sudden deafness. Methods Between February 2008 and July 2010, 174 patients with sudden deafness were treated by a combined therapy, including hyperbaric oxygen and medicals. The therapeutic effect was analyzed. Results The total effective rate was 85.7％. The simultaneous phenomenon such as vertigo and vomiting and onset-diagnosis duration were the two major factors affecting the prognosis. When the onset-diagnosis duration was ≤7 days, the effective rate reached 95.6%; when the onset-diagnosis duration was≥15 days, the therapeutic effect decreased significantly. Conclusion Hyperbaric oxygen combined with medical treatment is effective for sudden deafness, and the hyperbaric oxygen treatment should be performed as earlier as possible.
ObjectiveTo prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy and RouxenY gastrojejunostomy after proximal subtotal gastrectomy.MethodsTwentysix cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or even number of the admission number.After proximal subtotal gastrectomy and esophagogastrostomy, the control group underwent pyloroplasty while the experimental group with pyloruspreserving RouxenY gastrojejunostomy.The inflammatory reaction of the tissue obtained at the esophagogastric junction using a fiber gastroscope was observed after half year of postoperative followup in the two groups.An examination of gastric emptying of a radionuclidelabeled test meal were performed.According to the Visick score of followup data,the effects of operation were evaluated.The 5year survival rate was also evaluated.ResultsThe postoperative gastrointestinal symptoms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclidelabeled test meal showed that the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagogastric junction showed that the inflammatory reaction in the experimental group was slighter than that in the control group.There was no significant difference between the two groups in the survival rate.ConclusionFor patients with carcinoma of the gastric fundus and cardia, after proximal subtotal gastrectomy and esophagogastrostomy,compared with pyloroplasty,pyloruspreserving RouxenY gastrojejunostomy can decrease the reflux esophagitis,and relieve the postoperative gastrointestinal symptoms.