Objective To assess the survival of patients receiving high intensity focused ultrasound (HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma (PHCC) victims with HIFU application. Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007. Among them, 101 patients were males and 86 were females (mean age: 47.7 years old, range: 19-79 years old). The average tumor size was 5.7 cm (range: 0.5-18.0 cm). Of these 187 patients, numbers according to Child-Pugh grade of A, B and C were 104, 52 and 31, respectively. According to TNM system, 45, 111 and 31 patients were in stage Ⅱb, Ⅲa and Ⅲb respectively. Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. Results Survival period was (17.3±2.5) months after HIFU treatment of PHCC. The overall survival rate of 3-month, 6-month, 1-year and 2-year were 79.1%, 60.1%, 35.7%, and 29.3%， respectively. It was significant that tumor number (P=0.02), size (P=0.04)， AFP (P=0.04)， Child-Pugh grade (P=0.00)， TNM stage (P=0.01)， tumor metastasis (P=0.03) before HIFU， and tumor recurrence after HIFU (P=0.02) and standard treatment (P=0.02) were prognostic factors by single factor analysis. The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol (P=0.000), and TNM stage (P=0.004) and Child-Pugh grade (P=0.009) before HIFU. Conclusion It is used for improving overall survival rate to found PHCC early, protect liver function, examine comprehensively before HIFU treatment, focus on standard treatment and auxiliary treatment.
目的:探讨Mirizzi综合症的诊断治疗特点，以提高其诊断和治疗水平。方法：对35例经手术证实为Mirizzi综合症的临床资料进行回顾性分析。结果:35例Mirizzi综合症患者中仅4例（11.4%）术前确诊。Ⅰ型7例，Ⅱ型17例，Ⅲ型9例，Ⅳ型2例。5例行胆囊切除术，2例行胆囊大部分切除术；胆囊切除、胆囊瓣瘘口修补6例，12例行胆囊切除、胆总管探查、瘘口修补、T管引流术；胆囊切除、胆肠吻合术10例。术后恢复好，随访结果，无严重并发症.结论：Mirizzi综合症术前确诊困难，B超结合MRCP/ERCP检查可以提高Mirizzi综合症的术前确诊率，手术容易损伤胆管，手术方式应据病理损伤程度决定。
目的 探讨经脐单孔腹腔镜胆囊切除的可行性、安全性及实用性。 方法 回顾分析2010年11月－2011年2月27例行经脐单孔腹腔镜胆囊切除术患者的临床资料。其中男15例，女12例；年龄19～53岁，平均39.5岁。胆囊息肉样病变12例，病程6个月～8年；胆囊结石17例，结石数量1～9个，大小0.5～1.5 cm，均为非急性期患者，病程1个月～13年。 结果 27例手术均顺利完成，无1例中转开腹或转为传统三孔腹腔镜胆囊切除术，术中生命体征平稳。手术时间35～149 min，平均63 min；术中出血10～20 mL，平均15 mL。所有患者术后2～3 d出院。患者均获随访，随访时间6～24个月，平均13个月。术中及术后随访期间未发生任何并发症。脐部瘢痕不明显，患者满意度高。 结论 经脐单孔腹腔镜胆囊切除安全可行，具有创伤小、瘢痕不明显等优点。
目的:探讨老年人自发性气胸的临床特点、治疗及预后。方法:对本院在2005年11月至2008年4月间收治的79例老年人自发性气胸患者临床资料进行回顾性分析。结果:老年人自发性气胸大多有肺部基础疾病,临床表现缺乏特异性,本组误诊为慢性阻塞性肺病急性发作4例、左心衰2例、支气管哮喘1例。气胸类型: 张力性气胸47例(72.1%),闭合性气胸11例,交通性气胸21例。采用以肋间闭式引流的为主的治疗措施,效果好。结论:老年人自发性气胸大多有肺部基础疾病, 易误诊,气胸的类型以张力性气胸多见,治疗多需排气减压术,及早的排气减压可望缓解症状,缩短肺复张时间,减少患者住院天数, 降低死亡率,提高老年人生活质量。