归肾丸加减联合T管治疗宫腔粘连术后疗效研究

目的:观察归肾丸加减联合T管用于宫腔粘连术后的临床疗效及其对患者子宫内膜雌激素受体(ER)的影响。方法:回顾性分析92例确诊为中重度宫腔粘连并行宫腔镜下粘连松解术的患者,根据术后预防粘连措施的不同分为三组。观察组31例,T管治疗术后予以归肾丸;西药组30例,T管治疗术后予以雌孕激素序贯治疗;球囊组31例,术后予以雌孕激素序贯治疗联合Cook球囊。三组患者均治疗2个月经周期,观察治疗前后宫腔粘连评分、月经量、子宫内膜厚度、子宫内膜ER变化情况、妊娠情况等。结果:观察组总有效率为87.10%、西药组83.33%,球囊组80.65%,三组间总有效率比较,差异无统计学意义(P>0.05)。治疗后三组宫腔粘连评分均较治疗前下降,月经量积分、子宫内膜厚度、子宫内膜ER水平均较治疗前上升,差异有统计学意义(均P<0.05)。观察组与西药组在增加子宫内膜厚度方面均优于球囊组,差异有统计学意义(均P<0.05)。三组在提升月经量积分、子宫内膜ER水平、降低宫腔粘连评分方面比较,差异无统计学意义(均P>0.05)。治疗过程中三组均未出现药物过敏、子宫穿孔、感染等不良反应。结论:归肾丸加减联合T管治疗宫腔粘连术后患者,可有效预防粘连复发,增加月经量,促进子宫内膜增厚,提高子宫内膜ER水平,其总体疗效与雌孕激素序贯治疗联合球囊方案相当,且在增加子宫内膜厚度方面效果更优。

经T管高压冲洗治疗肝胆管结石术后胆道残留小结石的临床研究

目的探讨经T管高压冲洗治疗肝胆管结石术后胆道残留小结石的临床疗效。方法实验组36例治疗前30min肌肉注射山莨菪碱0.2mg/kg,T管外接口常规消毒,用注射器手控将30～50ml无菌生理盐水经T管外接口高压快速冲入胆道内,迅速回抽,并反复操作多次至回抽液清亮无细小结石混杂在其中,冲洗后仍保留T管通畅每3天冲洗1次,共30d;对照组继续保留T管通畅30d。治疗前后采用B超及胆道造影检查胆道残留结石的情况。结果实验组治愈率33.3%,好转率55.6%,有效率88.9%,无效率11.1%;对照组治愈率2.9%,好转率8.6%,有效率11.4%,无效率88.6%。两组疗效比较差异有显著性(P<0.01)。结论经T管高压冲洗治疗肝胆管结石术后胆道残留小结石具有良好的临床效果。

经T管高压冲洗治疗肝胆管结石术后胆管残留小结石的疗效观察

目的：探讨经T管高压冲洗治疗肝胆管结石术后胆道残留小结石的临床疗效.方法：本组病例36例,治疗前30min肌肉注射山莨菪碱（654-2）0.2mg/kg,T管外接口常规消毒,用注射器手控将30～50ml无菌生理盐水经T管外接口高压快速冲入胆道内,后迅速回抽,并反复操作多次至回抽液清亮无细小结石混杂在其中,冲洗后仍保留T管通畅,上述治疗操作1次/3d, 30d为1个疗程.治疗前用B超及胆道造影检查胆道残留结石的情况,治疗后再用同样的方法复查.结果：治愈率33.3%（12/36）,好转率55.6%（20/36）,有效率88.9%（32/36）,无效率11.1%（4/36）.结论：经T管高压冲洗治疗肝胆管结石术后胆道残留小结石具有良好的临床疗效.

Diagnosis and Treatment of Liver Cystadenocarcinoma:Report of 18 Cases

Objective： To discuss the diagnosis and treatment of liver cystadenocarcinoma. Methods： The clinical, imaging, and pathological data of 18 patients with liver cystadenocarcinoma between January 2000 and December 2004 in our hospital were retrospectively analyzed. Results： The liver cystadeno- carcinoma was seen in males and females （m/f： 9/9）; mean age was 51 years. Ultrasonography revealed cystic parenchymatous mass echoes of fluid predominance with uneven margins. Nonenhanced CT revealed intrahepatic low-density space occupying shadows with nodular protrusions on the margins in all cases. Enhancement CT revealed that part of the nodular protrusions and tissues around the lesions were enhanced and the delayed phase disappeared. 66.67% （12/18） of the lesions were more than 10 cm in diameter. The diagnosis of liver cystadenocarcinoma was confirmed by postoperative pathology in all cases. Of these patients, 12 lesions were in the left lobe, 3 in the right lobe, 1 in the mid lobe, 1 in the right and left lobe, and 1 in the caudate lobe. Of tile 18 patients, 6 had completely resect the cystadenocarcinoma, 2 were surgically explored, one received TAE＋fine needle aspiration cytology＋injection of chemotherapy drugs, and 9 underwent radical hepatectomy＋choledochostomy or T-tube drainage, in which, one patient underwent choledochostomy＋left hepatectomy＋radical gastrectomy for cancer＋lymphadenectomy; one patient underwent resection of the cystadenocarcinoma, who had relapse 20 months after the initial procedure. The patient received repeat reseet for the recurrent cystadenoeareinoma＋eholangio-jejunostomy. Six months later she had another relapse and received repeat reseet （only PMCT） for the recurrent cystadenoearcinoma. The patient died from eholangiopleural fistula after third time operation （PMCT） was attempted perioperatively. Seven patients died of metastatic disease after operation. The remaining 10 patients were alive without cancer recurrence or metastasis （mean follow-up 20 months）. Conclusion： Liver eystadenocarcinoma is rarely seen and grows slowly. It shows some typical clinical and imaging features. The crux for diagnosing and treating liver cystadenoeareinoma is how familiar the surgeon is with the pathology and clinical features of the condition. Prolonged survival can be achieved by radical resection of the tumor.

Preoperative sorting of circulating T lymphocytes in patients with esophageal squamous cell carcinoma: Its prognostic significance

AIM: To elucidate the immunologic parameters for the outcome of patients with malignant tumors, especially esophageal squamous cell carcinoma (ESCC) associated with high malignant potential. METHODS: Clinicopathologic features were compared between patients with lower and higher CD4 and CD8 values as well as CD4/CD8 ratio in peripheral blood. RESULTS: The survival rate of patients with higher CD4 value was significantly better than that in patients with lower CD4 value (P = 0.039). The survival rate of patients with higher CD8 value was significantly worse than that of patients with lower CD8 value (P = 0.026). Similarly, the survival rate of patients with higher CD4/ CD8 ratio was significantly better than that of patients with lower CD4/CD8 ratio (P = 0.042). Additionally, multivariate analysis demonstrated that lower CD8 and lower CD4/CD8 ratio were factors independently associated with worse prognosis of patients. CONCLUSION: All the immunologic parameters can predict the outcome of patients with ESCC.