目的:总结和探讨甲状旁腺癌的诊断和治疗方法。方法:回顾性总结本院5例甲状旁腺癌的临床资料。结果:5例患者术前颈部均扪及质硬包块,平均血钙浓度为3.82 mmol/L,平均PTH浓度为153.6 pmol/L,4例术中发现周围浸润表现。5例中4例同时行甲状旁腺肿瘤和同侧甲状腺腺叶切除,1例仅行甲状旁腺肿瘤切除。5例术后均诊断为甲状旁腺癌。术后4例得到随访,时间4月～5年。其中2例术后无复发;1例于术后半年局部复发行患侧甲状腺切除,后无复发;1例因全身转移于术后8个月死亡。结论:甲状旁腺癌的诊断非常困难,异常高浓度血钙、血PTH及术中浸润表现和组织病理学特征是甲状旁腺癌诊断的重要依据,99m-Tc-MIBI扫描及超声是病变定位的首选手段,肿瘤及其周围受侵组织的“整块切除”(en bloc resection)是首选的治疗方式。
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
ObjectiveTo investigate the protective effect and mechanism of curcumin on lipopolysaccharide (LPS)-induced acute lung injury.MethodsTotally 24 SD rats were randomly divided into a control group, a LPS group and a LPS+curcumin group (n=8 in each group). The degree of lung injury (oxygen partial pressure, wet/dry ratio, pathological scores) and inflammatory levels [tumor necrosis factor (TNF)-α, interleukin (IL)-6, monocyte chemotactic protein (MCP)-1, Toll-like receptor 4 (TLR4), mobility group box 1 protein (HMGB1) expression] of the lung were detected in different groups.ResultsOxygen partial pressure was significantly lower in the LPS group than that in the control group (P<0.05), while wet/dry ratio, pathological scores and expression levels of TNF-α, IL-6, MCP-1, TLR4 and HMGB1 were significantly higher in the LPS group than those in the control group (P<0.05). Compared with the LPS group, curcumin significantly reduced wet/dry ratio, pathological scores and expression levels of TNF-α, IL-6, MCP-1, TLR4 and HMGB1 in the LPS+curcumin group (P<0.05), while it significantly improved oxygen partial pressure (P<0.05).ConclusionCurcumin might protect LPS-induced acute lung injury through inhibition of TLR4-HMGB1-inflammation pathway.
Gastrointestinal complications after cardiac surgery are rare, but they are associated with significant morbidity and mortality. The mechanisms of gastrointestinal complications after cardiac surgery may be unique, as the abdominal cavity is not involved. This review summarizes the current evidence of the pathophysiology, clinical manifestations, risk factors, and management of gastrointestinal complications after cardiac surgery, aiming to improve the recognition of gastrointestinal complications after cardiac surgery.
Objective To analyze the occurrence of acute gastrointestinal injury (AGI) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) and its impact on prognosis, and to explore the risk factors and early warning indicators for AGI, in order to identify and diagnose AGI at an early stage. Methods This is a prospective observational study. The patients under 14 years with congenital heart disease receiving surgeries with CPB who were admitted to the pediatric ICU of West China Hospital, Sichuan University from December 2020 to December 2021 were included. The general information, perioperative gastrointestinal symptoms and intra-abdominal pressure, surgery-related information, postoperative organ function and prognosis of the children were collected. The patients were divided into an AGI group and a non-AGI group according to the 2012 European Society of Critical Care Medicine AGI diagnostic criteria. ResultsA total of 137 patients were enrolled, including 68 males and 69 females with a median age of 20.0 (6.0, 43.0) months. There were 60 patients in the AGI group and 77 patients in the non-AGI group, with an AGI incidence of 43.80%. The incidences of overall adverse outcomes, low cardiac output syndrome, and infectious complications were higher in the AGI group, and the vasoactive-inotropic score (VIS), mechanical ventilation time, ICU stay, and hospital stay were higher or longer in the AGI group, the differences were statistically significant (P<0.001). AGI was an independent risk factor for the overall adverse outcomes (OR=3.191, 95%CI 1.187 to 8.579, P=0.021). Univariate and multivariate logistic regression analyses indicated that weight, male, CPB time and intraoperative VIS were independent predictors for AGI after pediatric cardiac surgery. The receiver operating characteristic curve indicated that the patients with an intraoperative VIS>10.5 points and CPB time>96.5 min might have a higher possibility of postoperative AGI. ConclusionThe incidence of AGI in pediatric cardiac surgery with CPB is high, and it is an independent risk factor for overall adverse outcomes. Weight, male, CPB time , and intraoperative VIS are independent risk factors for AGI.
The surgical difficulty of congenital heart disease varies greatly. To ensure the safety of surgery and maximize the benefits of patients, various congenital heart surgery scoring systems have been used to evaluate the risk of different complex congenital cardiac operations. However, the complete correction of cardiac anatomical malformations is a common surgical challenge. Recent studies have shown that the correction is closely related to perioperative mortality and postoperative complications, and a new scoring system for the degree of cardiac anatomical malformations has been proposed. Therefore, this review summarizes the literature and discusses different evaluative methods of congenital heart surgery, aiming to optimize the surgical evaluation system for congenital heart surgery, enhance the quality of surgery and improve the prognosis of patients.