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Objective To evaluate the efficacy of microwave ablation in the treatment of small hepatic carcinoma with liver cirrhosis.Methods Altogether 50 patients with small hepatic carcinoma with liver cirrhosis from April 2009 to June 2013 were divided into microwave ablation group (n =26) or resection group (n =24).The microwave ablation group was treated by laparoscopic microwave ablation while the resection group was treated by laparoscopic resection.The time of operation,intraoperative blood loss,length of hospital stay,postoperative complications,postoperative liver functions,and 1-year,2-year,3-year survival rate of each group were observed.Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased and the albumin (ALB) was decreased postoperatively in both groups,and all recovered in 7 days after operation.The ALT and AST in microwave ablation group were lower than resection group,and the ALB was higher than resection group,with statistical significances (P ＜ 0.05).The operation time in microwave ablation group was (53.5 ± 8.5) min,significantly less than the resection group [(92.9 ± 19.8) min,t =-9.019,P =0.000].The intraoperative blood loss in microwave ablation group was (41.9 ± 17.2) ml,significantly less than the resection group [(131.3 ± 66.0) ml,t =-6.663,P =0.000].The length of hospital stay in microwave ablation group was (7.8 ± 1.0) d,significantly less than the resection group [(10.4 ± 1.3) d,t =-7.742,P =0.000].The rate of postoperative complication in microwave ablation group was 19.2％ (5/26),significantly less than the resection group [45.8％ (11/24),x2 =4.059,P =0.044].The 1-year,2-year,and 3-year survival rates in microwave ablation group were 100％,88.5％,80.8％,respectively,and those in resection group were 100％,91.7％,83.3％,respectively.There were no statistical differences between the two groups (log-rank x2 =0.077,P =0.792).Conclusions Microwave ablation therapy is feasible in the treatment of small hepatocellular carcinoma with cirrhosis that located in the special area and endoscopic surgery is not easy to remove.Microwave ablation has advantages of less trauma,simple performance and less complications.
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Objective To observe the feasibility and efficacy of small-incision high-ligation of great saphenous vein combined with endovascular microwave coagulation plus local injection of lauromacrogol for varicose veins of lower limbs . Methods From October 2012 to October 2013, there were 60 patients (70 legs) treated by high-ligation of the great saphenous vein , during which endovascular microwave coagulation was performed by using radiator and an additional injection of sclerotherapy at local tortuous vessels was carried out ( observation group ) .The control group ( between August 2011 and September 2012 ) underwent the traditional saphenous vein ligation plus superficial vein stripping surgery .The operation time , blood loss during operation , number of incisions , length of groin incision , and postoperative complications were compared between the two groups . Results As compared with the control group , the observation group had singnificantly shorter operative time , fewer blood loss , fewer surgical incisions , and shorter groin incision, respectively [(50.8 ±2.6) min vs.(103.5 ±16.0) min, t=-25.183, P=0.000;(43.2 ±4.6) ml vs.(107.5 ± 35.2) ml, t=-14.030, P=0.000;2.2 ±0.7 vs.6.3 ±2.5, t=-12.233, P=0.000;(2.3 ±0.3) cm vs.(4.8 ±0.3) cm, t=-17.697, P=0.000].There was no significant difference in complications rates between the two groups : local skin numbness occurred in 40 cases in the observation group and in 38 cases in the control group (χ2 =0.147, P =0.702 ) and subcutaneous congestion was noted in 4 cases in the observation group and in 9 cases in the control group (χ2 =2.157, P=0.142). Conclusion Small-incision high-ligation of the great saphenous vein combined with endovascular microwave coagulation plus local injection of lauromacrogol for varicose veins of lower limbs has advantages of minimal invasion , good cosmetic outcomes , quick recovery , high efficacy, fewer complications , and easy performance .
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Objective To investigate the effects and their potential mechanisms of splenectomy plus esophagogastric devascularization on non-invasive indexes of liver fibrosis and the cirrhosis progress in portal hypertensive patients with HBV-related cirrhosis. Methods Twenty consecutive portal hypertensive patients with positive HBsAg,negative HBV-DNA and Child-Pugh A(n=14)or B(n=6)were collected in this study. ELISA method was used to test the level of serum MMP-1 and TIMP-1;electrochemilumines-cence was used to measure hyaluronic acid( HA),N-terminal type Ⅲ procollagen peptide( PC-Ⅲ),lami-nin(LN)and collagen typeⅣ(C-IV). Results The serum TIMP-1,HA,PCⅢ,LN,and C-Ⅳwere signifi-cantly lower than the preoperative levels(p<0. 05),and MMP-1 slowly increased compared with the pre-operative levels(p<0. 05). The changes between TIMP-1 and HA,PC-Ⅲ,LN,or C-Ⅳ were positively correlated(r=0. 458~0. 783,p<0. 01/0. 05). The changes between MMP-1 and HA,PC-Ⅲ,LN,or C-Ⅳ were negatively correlated(r= -0. 545~ -0. 873,p<0. 01/0. 05). Conclusion Splenectomy plus esophagogastric devascularization can decrease non-invasive hepatic fibrosis serum markers and cytokines (TIMP-1),conducive to slowing down the disease progression in patients with cirrhosis.
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Objective To investigate the diagnostic value of CT and MRI in basal ganglia germinoma.Methods The clinical and imaging data in 1 7 patients with basal ganglia germinoma proved pathologically or clinically were analyzed retrospectively.Results All patients were male with an age rang from 8 to 18 years old and a mean age of 10.8 years.The most common symptom was hemi-paresis.Imaging features of the lesion were as follows:① usually irregular shape(11/17,64.7%)and cystic degeneration (10/17, 58.8%)without space-occupying effect and surrounding edema (12/17,70.6%);② isointensity on conventional MRI,hyperintensi-ty on DWI and hyperdensity on CT;15 patients (15/17,88.2%)with one or more than one appearances including multiple lesions, the lesion extending into surrounding structures and Waller degeneration.Conclusion Some clinical and imaging features of the basal ganglia germinoma are characteristic,and CT and MRI shows higher diagnostic value for the disease.
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Objective To identify the blood perfusion characteristics of different kinds of liver cancer and individualize interventional treatment models by color Doppler ultrasound(CDUS) and contrast-enhanced ultrasonography (CEUS). Methods The blood perfusion characteristics of 315 patients with liver cancer comfirmed by pathology were analyzed and classified using CDUS and CEUS. Individual interventional therapy models were selected based on the classification. Therapeutic effects were evaluated by EUS,contrast-enhanced CT(CECT) and DSA simultaneously. Results Liver cancer can be classified by the blood perfusion characteristics from CEUS examination. The individualized interventional treatment models were selected and evaluated according to the characteristics:①Solitary small HCC of diameter ≤3 cm group were treated via percutaneous ethanol injection(PEI),radiofrequency(RF) or percutaneous microwave coagulation therapy(PMCT). Necrosis rates of the lesions were 95.0% - 97.9%, 1 and 3 years survival rates were 98.0% and 87.8% ,respectively. ②Diameter ≤5 cm and lesions ≤3 group were treated with RF or PMCT combined PEI. Necrosis rates of the lesions were 93.7% - 94.8% ,1 and 3 years survival rates were 89.8% and 81.4% ,respectively. ③Diameter ＞5 cm and hypervascular tumor main fed by the hepatic artery group were treated with TACE,PEI combined RF or PMCT. Necrosis rates of the lesions were 71.4% - 73.8%, 1 and 3 years survival rates were 66.2% and 47.6%, respectively. ④ Diameter ＞5 cm and hypervascular tumor fed by double blood supply or accompanied by portal vein tumor thrombus group were treated with selective portal vein embolization(SPVE) based on the above treatments. Necrosis rates of the lesions were 53.3% - 55.6%, 1 and 3 years survival rates were 64.7% and 40.0%, respectively. Conclusions Classifying the blood perfusion characteristics and choosing individualized interventional treatment models by CEUS are of important clinical significance in non-surgical treatment of liver cancer.
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Objective To compare the expression of mIFN-γ, replicative activities and anti-tumor activities of CNHK300-mIFN-γand Ad-mIFN-γin normal and gastric cancer cells. Methods The replicative activities of viruses in cells were measured by viral replication assay. CPE assay was used to detect the antitumor effect of viruses. The expression level of mIFN-γ in cancer cells was detected by ELISA. Results The infection of CNHK300-mIFN-γled to an obvious expression of mIFN-γin gastric cancer cells. The vector system CNHK300-mIFN-γpossessed more replicated potential than Ad-mIFN-γ, and could specifically kill most of BGC-823 cells at MOI value of 0.1, which was much better than that by the traditional adenoviral vector. Conclusion CNHK300-mIFN-γcan selectively replicate and effectively express mIFN-γ in tumor cells, and specifically kill gastric cancer cells, suggesting a splendid future as a new anticancer agent.
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Objective To compare the effects of laparoscopic cholecystectomy and laparoscopic common bile duct exploration combined choledochoscopic exploration( method A)and duodenoscopic sphincterotomy combined with laparoscopic cholecystectomy( method B) in treating choledocholithiasis with cholecystohthia-sis. Methods A retrospective study was adopted to analyze by statistical methods comparatively the clinical data of 114 patients, concerning operation time, blood lost, odynolysis rate, conversion rate,calculi residual rate ,complication rate ,hospitalization time and cost, et al. 68 cases were treated by method A,and 72 ca-ses were treated by method B. Results There were statistical differences in calculi residual rate, a conver-sion rate, apart complication rates and hospitalization cost between two groups, but there was no statistical difference in other index. Conclusion The two methods for choledocholithiasis and cholecystohthiasis has advantage and shortcoming respectively. The treatment for patients must be individualized by MRCP/USG, actual state of illness, and so on.
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In order to have better understanding of the etiology and treatment of the endoleak after endovascular graft exclusion for abdominal aortic aneurysms, experiences with the treatment of endoleak in 38 cases received EVGE for AAAs were reviewed.Among them, 4 cases were complicated with endoleak. Type Ⅰ endoleak occurred in two cases, type Ⅱ in one case, and type Ⅲ in one case. One case was converted to open surgery, the other three cases were kept under observation. The results showed that DSA is a useful in the diagnosis of endoleak.The endoleak can be sealed by stretching the graft and inserting an extension or another stent graft and embolizing collateral vessel.
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This study is to evaluate the effect of sequence arterial reconstruction on lower extremity arteriosclerotic occlusion. 36 patients underwent bypass operation. Among them,1 case died of acute renal failure, and 1 case died of acute myocardial infarction. The arterial reconstructive patency rate was 100% after operation, and was 89 2% and 70 2% 2 and 5 years after operation respectively. It is suggsted sequence arterial reconstruction is safe and effective for lower extremity arteriosclerotic occlusion. The key to the successful operation lies in the patent inflow and outflow of the arterial reconstruction. Biocomposite graft in combination with common ostium technique would be helpful.
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Objective To explore the operative procedure and perioperative management of gastric cancer with liver cirrhosis.Methods Clinical data of 28 cases of gastric cancer with liver cirrhosis who were surgically treated in our hospital during the last seven years were retrospectively analyzed.Preoperatively,a detailed examination,and improvement of their nutritional status,liver function,and prothrombin time were aggressively made,and the possibility of tumor removal was estimated.Seven patients underwent radical proximal subtotal gastrectomy,and 4 of these cases underwent splenectomy and pericardial devascularizaion simultaneously.Five cases underwent total gastrectomy,and 3 of them had splenectomy and pericardial devascularizaion simultaneously.Twelve patients underwent radical distal subtotal gastrectomy,and 5 of these cases had splenectomy and suture of pericardial varices simultaneously.Four patients had palliative distal subtotal gastrectomy.The support of liver function and intense monitoring and management of complications were carried out postoperatively.Results Varying degrees of ascites occurred in all the 28 patients postoperatively,and other complications such as early liver coma occurred in five patients,extensive wound bleeding in three patients,left subdiaphragmatic abscess in one patient and wound infection in two patients.The morbidity rate was 100%(28/28).However,all the complications were recovered by non-surgical treatment.There were no perioperative deaths in this series.Conclusions Gastric cancer patients with liver cirrhosis are at a significant risk of developing postoperative complications.The surgical procedure should the "individual" principle based on liver function,history of upper gastrointestinal bleeding and the location of gastric carcinoma.Good hepatic reserve and perioperative care,meticulous hemostasis during operation,and prevention and treatment of postoperative complications are the likely determinants of operative prognosis.
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Objective To study the clinical characteristics, surgical treatment and prognosis of thyroid carcinoma in children. Method The clinical data of 25 children with thyroid carcinoma undergoing operative treatment from 1980 to 2001 were analyzed retrospectively. Results 25 children all underwent surgical treatment .Of them,17 were papillary carcinomas,3 papillary carcinomas with follicular elements,3 follicular carcinomas,1 medullary carcinoma and 1 fibrosarcoma. 21 children were followed up periodically from 4 months to 18 years (average time 6years). There were two deaths in the followed-up period,1 died of pulmonary insufficiency in extensive pulmonary and cervical lymph nodes metastases two years after the operation; 1 died of fibrosarcoma recurrence. The other children were all alive in good condition. Conclusions Most of the thyroid carcinoma in children are papillary carcinomas, and the prognosis is usually excellent. Operation is the main therapeutic method. A proper surgical procedure is major approach in treatment. Re-operation is also necessary, and might get a long-term survival even if the patient has recurrent thyroid carcinoma with cervical lymph node metastases.