Résumé
Objective To investigate the clinical characteristics,surgical treatment and outcome for patients with duodenal stromal tumor.Methods Data of 40 patients with stromal tumor of duodenum were reviewed retrospectively.Results All patients received resection including local resection in 14 cases,segmental resection of the duodenum in 17 cases,and pancreaticoduodenectomy in 9 cases.38 cases were followed-up,and two were lost.The median follow-up was 59 months (range 3-240 mos).The 1,3,and 5-year overall survival rates were 92％,76％ and 68％,respectively.No recurrence was found in very-low-risk tumor (n =1) and low-risk turmors (n =4).The 1,3,and 5-year overall survival rates for intermediate-risk tumors were 95％,80％ and 70％,respectively;and those were 69 ％,31％,and 0 for high-risk tumors,respectively.14 of 33 cases (42％) suffered from recurrence after radical resection for intermediate or high-risk tumors.33 postoperative cases received treatment with Imatinib (Glivec) for more than one year,and one case developed recurrence at 2.5 years after operation.4 patients with synchronous liver metastasis received palliative resection and Imatinib,and two survived more than 1 year.Conclusion Surgery is the first choice for duodenal stromal tumor,and Imatinib should be administered for high-risk disease after surgery.
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Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment.Methods The clinical data on the clinicopathological features,surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed.Results Of 17 patients with primary sarcoma of liver,elevation of preoperative serum AFP was detected in one patient (5.9％),HBsAg positivity in 3 patients (17.6％),elevation of CEA in 2 patients (11.8％) and abnormal liver function in 3 patients (17.6％).The main clinical symptoms included epigastric pain in 9 patients,epigastric distention in 7 patients,loss of appetite in 5 patients (including in one patient after resection of gastric carcinoma).Twelve of these 17 patients underwent resection (resection rate 64.7％).Five patients underwent laparotomy and biopsy.Among patients who were treated with surgical resection,10 patients had R0 resection and 2 patients had R1 resection.Postoperatively,5 of these patients underwent adjuvant selective hepatic arterial infusion chemotherapy (mitomycin + fluorouracil + epirubicin),and 4 patients were treated with adjuvant systemic chemotherapy (vincristin,cisplatin,cyclophosphamide and Doxorubicin).The postoperative 1,3 and 5-year overall survival rates for all the patients were 58.8％ (10/17),29.4％ (5/17) and 11.7％ (2/17),respectively.In patients with liver resection,the survival rates were 83.3％ (10/12),41.6％ (5/12) and 16.7％ (2/12),and for R0 resection,100.0％ (10/10),50.0％ (5/10) and 20.0％ (2/10),respectively.Condusions The diagnosis of primary sarcoma of liver was difficult before operation.High survival rate could be achieved by radical resection and adjuvant chemotherapy.
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Objective To explore the clinical significance of CT-angiography (CTA) in predicting hematoma enlargement in patients with acute hypertensive cerebral hemorrhage (HICH). Methods A prospective cohort study was performed on 50 patients with HICH. HICH and spot sign were diagnosed definitely by computerized tomography (CT) and CTA within 3 ~ 6 hours of symptom onset. Patients were dichotomized according to the presence or absence of the spot sign. CT scan was repeated immediately when patients′symptoms worsened or at 24 hours after onset of symptoms in order to find out the enlargement of hematomas. The relationship between hematoma expansion and spot sign of CTA was investigated. Results (1) Thirteen (26.0%) patients demonstrated the presence of spot sign of CTA, and 37 (74.0%) patients were without spot sign. Baseline clinical variables were similar in both groups. (2) Hematoma expansion occurred in 14 (28.0%) patients on follow-up. Eleven (84.6%) patients with and 3 (8.1%) patients without the spot sign of CTA were demonstrated hematoma expansion. The significance difference was found between the two groups (X2=24.27,P<0.05). Conclusions In acute HICH patients, CTA provided more radiological information and the CTA spot sign was associated with the presence of hematoma expansion. The spot sign will be recommended as an entry criterion for future trials of haemostatic therapy in patients with acute HICH.