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Objective To investigate the application value of percutaneous sinus-tract cholangioscopy in the diagnosis and treatment of residual intra-and extra-hepatic bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 1 045 patients with intra-and extra-hepatic bile duct stones who underwent percutaneous sinus-tract cholangioscopy or stone extraction in the Second Affiliated Hospital of Zhejiang University from January 2003 to June 2016 were collected.Patients received percutaneous sinus-tract cholangioscopy or stone extraction at 6-8 weeks after T tube drainage.Observation indicators:(1) diagnosis and stone extraction situstions:cases with residual stones,stone extraction frequency and clearance rate;the critics of clearance rate are no residual stone dnring operation combined with B ultrasound or T-tube cholangiography;(2) postoperative complications:incidence and management of postoperative complications,prognosis and ClavienDindo classification for postoperative complication;(3) follow-up situation.T-tube was removed when there was no residual stone.Patients were followed up by outpatient examination up to April 2017.B ultrasound reexamination was performed to detect the recurrence of stone once every 3-6 months.Results (1) Diagnosis and stone extraction situstions:among 1 045 patients,results of cholangioscopy showed 147 wihout bile duct stones and 898with bile duct stones.Of 898 patients,2 618 times cholangioscopic explorations for stone extraction were performed,with a maximum frequency of 16 times,and 851 had stones clearance,with a overall clearance rate of 94.77％(851/898).The clearance rates of extra-and intra-hepatic bile duct stones were 100.00％(221/221) and 93.06％(630/677).Of 47 patients with residual stones,16 didn't receive cholangioscopy due to branches stricture or occlusion of intrahepatic duct,13 failed to take out stone due to T-tube dislodgement (9 cases) and improper placement (4 cases) induced closed T-tube sinus tract,7 had T-tube sinus tract duodenal fistula,6 gave up stone extraction,3 was due to longer sinus tract induced bending and 2 was due to T-tube sinus tract fracture.(2)Postoperative complications:among 1 045 patients,297 had level Ⅰ-Ⅱ mild complications and 13 had level Ⅲand above severe complications.The common complications included fever,vomiting,diarrhea and so on;the special complications included T-tube sinus tract duodenal fistula of 13 patients,T-tube sinus tract fracture of 4 patients,rupture of broken stones pole of 3 patients,massive hemobilia of 2 patients,acute pancreatitis of 2patients and cardiac arrest of 1 patient.The above complications were improved by symptomatic and supportive treatments.(3) Follow-up situation:among 1 045 patients,558 received long-term follow-up,with follow-up time of 10-171 months and a median time of 79 months.Eight-four patients had stone recurrence.Of 13 patients with recurrence of extrahepatic bile duct stones,7 took out stones by endoscopic retrograde cholangio pancreatography (ERCP) and 6 underwent reoperations.Of 71 patients with recurrence of intrahepatic bile duct stones,43underwent reoperations and 28 received conservative treatment.Conclusions Percutaneous sinus-tract cholangioscopy for residual intra-and extra-hepatic bile duct stones is safe and effective,with good diagnosis and treatment values and a high clerance rate.The integrity of T-tube sinus-tract is a key of complete stones removal.
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<p><b>OBJECTIVE</b>To explore efficacy and safety of modified FOLFIRINOX (mFOLFIRINOX) regimen by dose attenuation in locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer(MPC).</p><p><b>METHODS</b>Between April 2014 and October 2015, 35 patients with LAPC (n=18) or MPC (n=17) were treated with mFOLFIRINOX regimen (irinotecan 135 mg/m(2), oxaliplatin 68 mg/m(2), 5-FU 2 400 mg/m(2), no bolus of 5-FU, leucovorin 400 mg/m(2)) in the Second Affiliated Hospital of Zhejiang University School of Medicine. The primary end point was progression free survival. The second end points were overall survival, objective response rate, adverse effects, surgical resection rate for LAPC.</p><p><b>RESULTS</b>Among 35 patients, 6 patients (17.1%) who dropped out and received less than 2 cycles were excluded for response analysis. Among the other 29 patients, 9 patients had grade 3 or 4 adverse effects. No patients ceased treatment due to adverse effects. The 29 patients received 5 (2-13) cycles were evaluated by efficacy and found partial remission in 16 cases, stable disease in 10 cases, progression disease in 3 cases. Response rate was 55.2%. Nine patients with LAPC accomplished surgery after neoadjuvant treatment without perioperative complication and death, and 6 patients accepted R0 resection.</p><p><b>CONCLUSIONS</b>The mFOLFIRINOX regimen used in the study is well-tolerated in Chinese population with high treatment efficacy on patients with LAPC and MPC. Further investigation of efficacy and adverse effects on more advanced pancreatic cancer patients is necessary.</p>
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols , Camptothecin , Disease Progression , Disease-Free Survival , Fluorouracil , Leucovorin , Neoadjuvant Therapy , Organoplatinum Compounds , Pancreatic Neoplasms , Drug Therapy , Tertiary Care Centers , Treatment OutcomeABSTRACT
Objective To compare the value among three hilar cholangiocarcinoma (HCC) staging systems,Bismuth-Corlette classification,TNM staging system and MSKCC classification,in predicting the resection rate and prognosis of HCC patients.Methods The clinical and histopathological data of 154 HCC cases were analyzed retrospectively.Three different staging methods were performed respectively to analyze the correlations with respectability and survival.Chi-square test and Kaplan-Meier analysis were applied to find clinical and histopathological factors related to prognosis.Results There was no significant difference in resectability between Bismuth-Corlette classification or TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ.The resection rates of MSKCC T1,T2 and T3 were 68.6％,44.8％,19.2％respectively (x2 =20.03,P =0.000).With higher T stage,resection rate obviously declined.The survival predicted by TNM staging and MSKCC classification was better than Bismuth-Corlette classification.Tumor differentiation,LN involvement,distant metastasis,margin status,TNM stage and MSKCC classification were significantly correlated with survival.Conclusions The MSKCC classification predicted resectability better than Bismuth-Corlette classification and TNM staging system,while both MSKCC classification and TNM staging system predicted survival better than Bismuth-Corlette classification.Clinical and histopathological factors such as tumor differentiation,LN involvement,metastasis,margin status,TNM staging,MSKCC classification were correlated with survival.
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Objective To determine the expression of sodium-hydrogen exchanger (NHE) 1 in gastric carcinoma tissue,and investigate the relationship between NHE1 expression and clinicopathological characteristics.Methods The expression levels of NHE1 mRNA and protein were detected in both gastric carcinoma tissue (48 cases) and paraneoplastic tissue (40 cases) by reverse transcription polymerase chain reaction (RT-PCR) and Western blot.The relationship between the expression levels of NHE1 mRNA and protein and the clinicopathological characteristics was analyzed.Results The relative expression levels of NHE1 mRNA and protein in gastric carcinoma tissue were 0.791 ± 0.286 and 1.475 ± 0.142,in paraneoplastic tissue were 0.352 ± 0.069 and 0.329 ± 0.048,and there were statistical differences (P ＜ 0.01).The expression level of NHE1 mRNA was positively correlated with NHE 1 protein in the gastric carcinoma tissue (r =0.375,P ＜ 0.05).The expression levels of NHE1 mRNA and protein were associated with the depth of invasion,lymph node metastasis and TNM staging (P ＜ 0.05).However,the expression levels of NHE1 mRNA and protein were no associated with age,gender and tumor differentiation (P ＞ 0.05).Conclusion The expression levels of NHE1 mRNA and protein are significantly up-regulated in gastric carcinoma tissue,which may be involved in the development of gastric carcinoma.
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Sepsis is a common acute systemic infection,severe sepsis has a high rate of mortality,and its incidence rate is rising year by year.Due to the overproduction of free radicals in sepsis,microcirculation blood is drived disorder,multiple organ function can be impaired.This review describes the role of ascorbic acid in sepsis patients,which can reverse the oxidative stress injury rapidly through an eNOS-dependent mechanism,resisting platelet adhersion,preventing capillary embolism,resevering microcirculation blood flow,so as to improve patients' survival.
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Objective To discuss the clinical features, diagnostic methods and treatment of the primary hepatic sarcomas. Methods The clinical data of 4 patients with primary hepatic sarcoma admitted to our hospital from January 1998 to December 2008 were viewed. Results There were 3 males and 1 female with age from 25 to 65 years. Abdominal pain, fatigue, weight loss and mass were among the complains. All 4 cases were misdiagnosed as liver cyst, liver cancer and liver adenoma respectively, and final diagnosis was established only by laparotomy and pathology. They were malignant mesenchymoma, carcinosarcoma, leiomyosarcoma and malignant fibrous histiocytoma respectively. Till now, 3 cases were still alive (respectively 4, 56 and 84 months after surgery), 1 case died intraoperatively. One case recurred 5 years after the operation. Conclusions Primary liver sarcoma is difficult to diagnose. Postoperative pathology and immunohistochemical examination remain the mainstay for final diagnosis. The prognosis is dependent on pathological type, differentiation, tumor invasion and metastasis.
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Objective To study the operative technique and operative field exposure of laparoscopic splenectomy (LS). Methods The clinical data of 11 cases including 1 case of cirrhosis with splenosis and 10 cases of idiopathic thrombocytopenic purpura (ITP) who underwent laparoscopic splenectomy since June 1999 were analyzed retrospectively. Results 9 cases of LS were successfully performed. 6 cases took dorsal desubitus position, whose mean operative time was 3.5 hours and mean blood loss was 200ml. The operative time of the case who took right lateral desubitus position was 4 hours and the blood loss was 80ml. 2 cases took right inclined lateral desubitus position, and the operative time was 2.5 hours and 3.0 hours and the blood loss all was 100ml. 1 ITP patient of the 9 cases underwent novo-laparotomy in 6 hours after LS because of intraabdominal hemorrhage. 2 ITP cases required conversion into open splenectomy. Conclusions Satisfactory exposure and dissection of peri-splenic ligaments and constitution as well as successful control of splenic pedicel are the