Objective To study the relationship of hepatitis B virus （HBV） to spontaneous rupture of hepatocellular carcinoma （HCC-SR） and its mechanism. Method The related literatures about theory of HCC-SR were consulted and reviewed. Results The injury of small arteries was usually followed in patients with HCC-SR， which was related to vascular autoimmune injury caused by the HBV infection. The small arteries in which immune complex deposited were readily injured， as a result HCC-SR happened while vascular load increased. Conclusion The HBV infection resulted in vascular autoimmune injury maybe a important factor in the pathogenesis of HCC-SR.
①在自发性气胸的治疗方面:目前尚无足够高质量的临床证据确定任何干预或非干预措施对自发性气胸的治疗更有效.现有2个小样本的随机对照试验(RCT)显示,胸腔闭式引流比穿刺抽气治疗气体消散更快,但穿刺抽气治疗更能减少患者痛苦和住院时间;1个小样本的随机对照试验显示,采用标准的胸腔闭式引流管或细管,两者的置管时间无差异,但对大量积气的患者,标准管的气体吸收率高于细管;另1个小样本的随机对照试验显示,在使用瓣膜单向阀或水封引流瓶方面,两者对患者的气胸吸收率无影响,但使用瓣膜单向阀更能减少患者痛苦和住院时间;在胸腔闭式引流管连接负压吸引方面,1个小样本的随机对照试验显示,是否连接负压吸引对疗效无影响.②在自发性气胸复发的预防方面:2个随机对照试验和1个非随机对照试验显示,化学性胸腔粘连术比非化学性胸腔粘连术更能减少自发性气胸的复发率,但胸腔粘连术同时也引起患者疼痛和住院时间的延长;无足够临床证据证明需在首次或自发性气胸复发时采用胸腔粘连术;无足够临床证据进行外科和化学性胸腔粘连术疗效的比较,仅有1个小样本的随机对照试验提示进行电视胸腔镜手术比直接开胸术的住院时间短,但在降低复发率方面,两者无显著性统计学差异,但由于样本量的问题,尚不排除两者问有临床意义差异.
Objective?To summarize our experience of surgical treatment of Boerhaave’s Syndrome. Methods We retrospectively analyzed clinical records of 14 patients with Boerhaave’s syndrome in West China Hospital between January 1998 and December 2011. There were 11 male patients and 3 female patients with a mean age of 55.2±14.4 years and mean time interval between onset and admission of 49.6±21.2 h. Primary repair was performed in 11 patients.Esophagectomy and reconstruction of digestive track was performed in 1 patient and intra-luminal stent implantation was applied in 1 patient. Intercostal catheter insertion was performed in 1 patient.?Results?Thirteen patients underwent surgical therapy, and their survival rate was 84.6% (11/13). Among the eleven patients who underwent primary repair, 8 patients (72.7%)were cured and 3 patients experienced postoperative leakage resulting 2 deaths. The other one patient was cured with in-hospital time of 22.3±7.0 d. Two patients underwent digestive track reconstruction and intra-luminal stent implantation respectively and all survived with in-hospital time 39.0±5.7 d. Another patient underwent bedside chest drainage and died 10 d after admission.?Conclusion?Aggressive surgical management is an effective way to treat Boerhaave’s syndrome, and primary repair can lead to ideal prognosis in delayed patients whose time interval between onset and admission is beyond 24 h. Digestive track reconstruction and intra-luminal stent implantation are alternative methods on condition that primary repair can not be accomplished.
Objective To explore the diagnosis and treatment for spontaneous rhexis hemorrhage of liver cancer. Methods Clinical data of thirty patients who suffered from spontaneous rhexis hemorrhage of liver cancer from January 1995 to March 2009 were collected and analyzed retrospectively. Results Twenty-six cases were stanched by surgical therapy, in which 14 cases underwent liver cancer resection, 10 cases underwent bleeding transfixion and hepatic artery ligation (or intubation), and 2 cases underwent omentum stuff transfixion. Four cases died one week after surgery, one died after 15 d, 9 cases died 1 to 3 months after operation, 5 cases survived after 4 to 6 months, 3 cases survived after 7 to 12 months, and in 4 cases survival time was longer than 12 months (in which one patient’s survival time was 16 months, one was 5 years and two patients were still alive with survival time of 3 and 13 years respectively). Four patiens went through the non-surgical therapy and survival time was 3 to 14 d. Conclusion The spontaneous rhexis hemorrhage of the liver cancer is not the telephase of the liver cancer. Early diagnosis and operation can stanch bleeding effectively. The surgical therapy is better than the non-surgical therapy. Resection of liver neoplasms in time can raise long-term survival time.
Abstract: Objective To compare the sensitivity and accuracy of autofluorescence bronchoscope (AFB) and white light bronchoscope (WLB) in airway examination for patients with central type lung cancer. Methods From September 2009 to May 2010, 46 patients including 36 males and 10 females with an average age of 62.1 years underwent both AFB and WLB procedures in People’s Hospital of Peking University. Among them, 35 were preliminary diagnostic cases and 11 were postoperative surveillance cases. Local anaesthesia of glottis and airway, and general anaesthesia with continuous intravenous drugs were given before electric bronchoscope was adopted. All patients underwent WLB examination followed by AFB procedure. All suspicious abnormal visual findings were recorded for biopsy and pathological examination. Results All procedures were carried out safely without death or severe complications. We performed bronchoscopy 48 times for all 46 patients and 159 tissues of various sites were taken out for biopsy and pathologic examination which showed 64 malignancies and 95 none malignancies. In 64 malignancies, AFB found all but WLB missed 15 with a missed diagnosis rate of 23.4%. Thirtysix times of examination were performed for the 35 preliminary diagnostic cases and 56 sites of malignancy were found. AFB found all, while WLB missed 12, and 6 sites of malignancy found by AFB were larger in size than those found by WLB. AFB detected 3 cases of multisite malignancy, but WLB missed these diagnoses. The results of AFB and WLB were the same for 26 patients. Twelve times of bronchoscopy were performed for the 11 postoperative surveillance cases and 8 sites of malignancy were found. AFB found them all while WLB missed 3 which were two recurrent cases during the early period after lung cancer surgery. The sensitivity of AFB and WLB was 100.0 % and 76.6%(Plt;0.05) respectively, and the negative predictive value of AFB and WLB was 100.0% and 84.5%(P=0.002) respectively. Conclusion AFB has a better sensitivity and negative predictive value than WLB in detecting mucous canceration lesions in central type lung cancer, and is more accurate in assessment of tumor margins, more sensitive in finding multiple lesions in airway and detecting early cancer recurrence in postoperative surveillance patients.
目的:探讨COPD(慢性阻塞性肺病)并自发性气胸的临床特点、治疗及预后。方法:对2001年1月至2008年12月间本院收治的48例COPD并自发性气胸患者进行临床分析。结果:48例COPD并自发性气胸患者临床表现多样,首次确诊率不到80%,死亡率8.25%,单纯抽气治愈10例,胸腔闭式引流治愈22例。胸腔闭式引流+负压吸引治愈15例,手术治疗1例。肺复张平均天数单纯抽气10天, 胸腔闭式引流9天, 胸腔闭式引流+负压吸引7天, 手术治疗15天.结论:COPD并自发性气胸治疗多需排气减压术,复张时间较长,治疗以胸腔闭式引流+负压吸引为宜。