善胃得治疗大肠癌50例体会

1996年10月至1999年3月我们应用善胃得对100例大肠癌病人进行治疗对比,取得满意的疗效,现报告如下。 1 临床资料 1.1 一般资料:用药组男31例,女19例。年龄29～76岁,平均51.8岁。结肠癌Dukes分期A期1例,B期5例,C期14例,D期1例。直肠癌B期5例,C期21例,D期3例。合并小肠憩室、肠套叠各1例,肠梗阻5例,     

利妥昔单抗用于致敏患者肾移植的诱导治疗一例

体内群体反应性抗体(PRA)为阳性的患者处于致敏状态.这些抗体产生的原因尚未完全明确,输血、妊娠和再次移植等都是危险因素.为了预防移植后的排斥反应,针对致敏患者在移植前会采取一些措施,例如进行供、受者HLA配型以筛选供者;采用血浆置换和免疫吸附等方法降低患者体内预存抗体的滴度;大剂量静脉注射免疫球蛋白(IVIG)以及使用抗CD20单克隆抗体(如利妥昔单抗)等.我们对1例PRA阳性的肾移植受者使用利妥昔单抗进行诱导,效果良好,现报告如下.     

供肾患者合并多发胆结石一例治疗体会

目的 探讨肾移植供者合并肝胆多发结石的治疗策略.方法 对一例合并有肝管多发结石、胆总管结石的无症状肾移植供者进行肝功能监测及影像学的随访,对供肾前后的结石治疗及今后类似供者的治疗策略结合国内外文献报道进行讨论.结果 供肾手术围手术期行保守治疗,未出现胆石并发症.结论 肾移植供者合并复杂多发肝胆结石,若无症状,建议尽量避免供肾术前行预防性取石根治手术,以免供者失去供肾机会.供肾恢复后再行二期手术治疗效果较好.     

21例冻伤患者治疗体会

辽宁西部地区冬天较长 ,气温相对较低 ,为 - 8.6～ -2 4 .8℃ ,在户外停留时间过长易出现冻伤。笔者单位 1987年1月～ 2 0 0 0年 12月共收治冻伤患者 2 1例 ,现报道如下。临床资料 :本组 2 1例 ,男 17例 ,女 4例。年龄 15岁～ 5 4岁 ,平均 37.5岁。致伤时所属状态和所在月份 :精神障碍 6例、醉酒 12例、乘汽车 1例、站岗 1例、其他 1例 ;11月间 2例 ,12月间 9例 ,1月间 8例 ,2月间 2例。本组病例均为局部冻伤 ,足部 12处 ,其中双足 5例 ;手部 11处 ,其中双手 3例 ;耳廓 6处 ;鼻 1处 ;手指足趾最为多见。冻伤总面积 1%～ 6 % ,均为Ⅲ度以上创…     

183例患者血液透析治疗体会

2000年1月至2005年12月，我院血液透析的患者183例，共行血透4298例次，现报告如下。     

利妥昔单抗治疗儿童硬化性肾炎一例

儿童难治性肾病使用经典的治疗方法如糖皮质激素或免疫抑制剂效果不理想或无效的患者,可考虑B细胞清除治疗(B cell depletion therapy,BCDT)[1].我们应用利妥昔单抗治疗儿童硬化性肾炎1例,报告如下.     

43例肾衰竭患者血液透析治疗体会

1．一般资料：2004年1月至2009年1月我科行血液透析患者43例,男29例,女14例,年龄20-83岁。其中急性肾衰竭8例,慢性肾衰竭35例,所有患者开始透析时均有乏力、恶心、呕吐、少尿或无尿、贫血、高血压、水肿等临床表现,     

37例妊娠期高血压患者治疗体会

目的探讨妊娠期高血压疾病的治疗方法。方法回顾性分析延边妇幼保健院2009年1月～2010年7月31日37例妊娠期高血压患者的临产资料。结果全部病例中妊娠期高血压2例、轻度子痫前期9例、重度子痫前期24例、子痫1例,经解痉、降压、对症治疗及适时终止妊娠,除1例孕妇及胎儿死亡外,其余均治愈出院。结论对妊娠期高血压患者,应根据不同病情、孕周做出不同处理。     

综合治疗一例重型破伤风体会

患者男性,26岁。因燃放鞭炮,将左手1～2指掌间炸伤,曾在当地医院处置,以后局部感染,疼痛,肿胀。伤后第6天自觉乏力,头晕、头痛、咀嚼无力,第7天颈部发硬,继而出现下颌紧张,张口困难,抽搐后来院。查体:体温38.8℃,意识清,苦笑面容,牙关紧闭颈强(+),角弓反张明显,全身肌肉持续强直性收缩,并有阵发性全身肌痉挛抽搐,每次持续最短几秒钟,最长1分30秒,伴有窒息发绀。诊断为重型破伤风。经采取综合措施抢救治疗,住院25天痊愈出院。     

胆管门静脉瘘一例治疗体会

病例介绍 患者,女性,24岁。因右上腹反复疼痛近20余年加重伴黄疸4月收住院。体检:全身皮肤及巩膜中度黄染,浅表淋巴结无肿大;心肺心常,腹平软,右上腹触压痛,莫非氏征阴性,肝区叩击痛。B超示:肝内胆管扩张,右肝管内可探及一约1.4×1.2cm的结石影。血清总胆红素258.9μmol/L,直接胆红素143μmol/L,GPT59U,诊断为先天性胆管结石,阻塞性黄疸。入院后第三天在连续硬膜外麻醉下行胆道探查术,术中见胆囊无异常,切开胆总管,在左右肝管开口上方约1cm处,右肝管内探及一约1.3cm×1.2cm的结石,用取石钳分步取出。突然胆管内大出血,迅速遍布整个手术视野,无法进行操作。立刻将左手食指伸入小网膜孔内,拇指在上压迫肝十二指肠韧带内的门静脉和肝固有动脉,使血暂停后边松     

脂要有你

【内容简介】本视频主要介绍1例利沃素干预正常体重指数(body mass index,BMI)脂肪肝典型病例的诊疗以及随访过程。患者何某,男性、24岁,身高180 cm,体重76 kg,BMI:23.5 kg/m2。患者于1年前开始无明显诱因出现右上腹隐痛疼痛不适,呈持续性胀痛,不伴腹胀、腹泻、无恶心、呕吐,无发热、寒战等,曾于当地医院诊断为脂肪肝,肝功能不全,高脂血症,服用“甘草酸二胺胶囊、水飞蓟宾”等药物疗效欠佳,于2021年11月10日就诊于高青县人民医院脂肪肝中心给予利沃素治疗。     

Treatment of hydatid disease of the liver. Evaluation of a UK experience

BACKGROUND: Hydatid disease of the liver though endemic in many countries, is rare in the UK. We evaluated a 16-year experience of treating hydatidosis using a management protocol combining surgery with anti-scolicidals. PATIENTS AND METHODS: There were 30 patients. 14 (47%) males, median age 41 (range 25-72) years, of whom 21 (70%) were symptomatic. Diagnosis was by serological tests and imaging. All had disease confined to the liver and received peri-operative anti-scolicidal drug therapy. RESULTS: The initial 4 (13%) patients received praziquantel combined with albendazole for 2 weeks and the following 26 (87%) patients received two cycles of albendazole 400 mg twice daily for 28 days, with a 14-day break in between. However, 2 (7%) patients could not tolerate albendazole, one due to GI side effects and the other developed deranged liver functions. These 2 patients subsequently received praziquantel for 2 weeks. All patients underwent surgery. Subtotal cystectomy was carried out on 29 (96%) patients and 1 patient required a segmentectomy. Cystobiliary communications were identified in 15 (50%) of patients which were oversewn using fine absorbable sutures. Of these, 7 had the bile ducts decompressed using a T tube, with only 1 developing a post-operative bile leak. In comparison, 8 were not drained of which 6 leaked (p = 0.03). The median post-operative hospital stay was 8 days (range 5-24). Patients who developed post-operative bile leaks, however, needed prolonged abdominal drainage for a median of 21 days (range 18-24). Two (7%) patients developed histologically proven recurrent disease. The median follow-up was 56 months (range 3-87). CONCLUSION: Surgery combined with anti-scolicidal therapy proved effective. Cystobiliary communications are common and, when identified, should result in the biliary system being drained, to avoid post-operative bile leaks.     

Treatment of highly symptomatic polycystic liver disease. Preliminary experience with a combined hepatic resection-fenestration procedure.

Polycystic liver disease (PLD) associated with autosomal dominant polycystic kidney disease is usually well tolerated. However there is a small subset of patients who become incapacitated by massive liver enlargement and for whom effective nonsurgical therapy is limited. Recent surgical advances in the treatment of PLD have raised uncertainties regarding proper management of these highly symptomatic patients. We have reviewed our recent experience with a combined hepatic resection-fenestration procedure to assess its efficacy in nine patients. All patients underwent resection of two or more liver segments and extensive fenestration of residual cysts in the remnant liver. Symptomatic relief and reduction in abdominal girth were obtained in eight surviving patients, persisting for an average follow-up period of 17 months. No progression of cystic disease has been observed clinically or by computed tomography and hepatic function was preserved. Three patients had no complications. Five patients had complications including transient right pleural effusion (3) and thrombosis of an arteriovenous fistula (2). One patient who had a previous hepatic cyst fenestration and a cadaveric renal transplantation died after operation of an intracerebral hemorrhage after experiencing coagulopathy, hyperbilirubinemia, and sepsis. Our results suggest (1) some highly symptomatic patients with massive PLD may benefit from combined hepatic resection and fenestration with acceptable risk, and (2) previous liver surgery and immunosuppressive therapy may increase the risk of such surgery. Longer follow-up is needed in a larger number of patients to determine the duration of benefit from the combined resection-fenestration procedure for highly symptomatic PLD.     

Safety of donors with fatty liver in liver transplantation

Steatotic liver graft transplantation affect donor safety as well as recipient survival. We investigated safety of donors according to the extent of fatty change. We retrospectively reviewed donors who underwent right hepatectomy from September 1999 to April 2005, dividing them into three groups according to degree of macrovesicular fatty change upon intraoperative liver biopsy. Group 1 included patients with macrovesicular steatosis of 0 approximately 9%: group 2, 10 approximately 19% and group 3, at least 20%. Two hundred forty-five donors were enrolled with a male to female ratio of 2.02:1 and mean age of 31.8 years. There were 163 donors in group 1, 75 in group 2, and seven in group 3. There was no statistically significant difference in body mass index, operative time, blood loss, postoperative peak serum bilirubin, and aspartate transaminase levels among groups 1, 2, and 3. Overall complication rate, including reoperation, biliary stricture, wound infection, ileus, transfusion, bile leak and fluid collection were not different between the groups. Postoperative hospital stay was also not different. Peak alanine transaminase level was different between each group, and prothrombin time between group 1 and 3, but days until return to normal levels in all measured laboratory parameters were not different. Residual liver volume percent was significantly smaller among group 1 compared to others. In conclusion, fatty livers with less than 30% macrovesicular steatosis may be good donor candidates without significant complications as long as sufficient residual liver volume is left for the donor.     

Perioperative care of a patient with acute fatty liver of pregnancy

Acute fatty liver of pregnancy (AFLP) is a late gestational complication with biochemical similarities to the inherited disorders of mitochondrial fatty acid oxidation and clinical similarities to fulminant hepatic failure. The following case illustrates our perioperative management of this rarely encountered disorder.     

Treatment of liver metastases from colorectal carcinoma: our experience

The latest hepatic surgical strategies enable liver resections to be performed on a larger number of patients, improving the survival rate. Moreover, the contribution of radiological techniques and chemotherapy to surgery has led to the multidisciplinary management of patients suffering from liver metastases, involving surgeons, radiologists and oncologists. If surgical treatment is not considered curative, it is appropriate to advise alternative strategies in order to down-stage the disease and make it resectable.