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Objective To explore the use of CA199,CEA,CA50 and ALP combined with magnetic resonance imaging (MRI) in diagnosis of intrahepatic bile duct stones with early bile duct carcinoma.Methods The clinical diagnosis of 36 cases of patients with hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and 118 cases with intrahepatic duct stone (IHDS) were analyzed retrospectively.Serum CA199,CEA,CA50,ALP and magnetic resonance (MRI,MRCP) were performed and the results were analyzed.Results Abdominal pain discomfort in Hepatolithasis-associated intrahepatic cholangiocarcinoma showed multiple symptoms.Three typical Charcot syndromes were rare.On the gender distribution,intrahepatic bile duct stones was frequently found in women,on the contrary,Hepatolithasis-associated intrahepatic cholangiocarcinoma was frequently more found in men (P ＜0.05) Abdominal pain and fever in patients of Hepatolithasis-associated intrahepatic cholangiocarcinoma was more than that of patients with Intrahepatic bile duct stone (P＜0.05) When alkaline phosphatase (ALP) was more than 169 U/L,significant difference was seen between two groups (P＜ 0.05) According to the diagnosis of HICC,the accuracy of CA199,CEA,CA50 combined with ALP was 88.6％,the accuracy of magnetic resonance examination alone was 90.2％,and the accuracy of multiple serological markers and magnetic resonance was 95.5％.Conclusion MRI combined with serum CA199,CEA,CA50 and ALP can effectively improve the HICC preoperative diagnosis rate.
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Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy (PD).Methods The clinical data of 186 patients who received PD at the Second Affiliated Hospital of Kunming Medical College from May 2000 to May 2010 were retrospectively analyzed.All patients were divided into pancreatic fistula group (39 patients) and non-pancreatic fistula group ( 147 patients).Risk factors of pancreatic fistula after PD were screened out from 20 factors by univariate and multivariate analysis.The univariate analysis was carried out by chi-square test or Fisher exact test,and the muhivariate analysis was done by Logistic regression.Results Thirty-nine patients were complicated with pancreatic fistula,including 26 in grade A,10 in grade B and 3 in grade C.The results of univariate analysis showed that duration of preoperative jaundicc,loss of body weight at 6 months before operation,preoperative total bilirubin level,preoperative albumin level,postoperative albumin level,length of pancreas dissected,pancreatic tube diameter,pancreatic texture and time of abdominal drainage tube pull out were high risk factors of pancreatic fistula ( x2 =34.990,20.480,8.212,10.890,13.561,11.505,13.820,4.539,36.590,P ＜ 0.05).The results of multivariate analysis showed that duration of preoperative jaundice ＞ 8 weeks,loss of body weight at 6 months before operation ≥ 10％,pancreatic tube diameter ＜ 3 mm,soft pancreatic texture and time of abdominal drainage tube pull out ＞ 5 days were the independent risk factors of pancreatic fistula ( OR =2.229,3.383,1.437,1.273,11.939,P ＜ 0.05).Conclusion Duration of preoperative jaundice ＞ 8 weeks,unconscious loss of body weight ≥ 10％ within 6 months before operation,pancreatic tube diameter ＜ 3 mm,soft pancreatic texture,time of abdominal drainage tube pull out ＞ 5 days would increase the risk of pancreatic fistula after PD.
ABSTRACT
Different degrees of HCV re-infection exist in patients with hepatitis C after liver transplantation. Its pathogenesis is different according to different phases of the disease. Factors affecting its recurrence include HCV gene type, viral load, HLA matching between donor and recipient, time of recurrence, donor's age and so on, in which the application of immunosuppressants is the most important influencing factor. The virological response can be used to evaluate the effects of treatment. Now, it is widely accepted that the best choice and therapeutic plan is Pegy interferon alfa-2a/2b combined with Ribavirin.