86例高龄胆道疾病患者围手术期处理探讨

目的回顾性分析高龄胆道疾病患者围手术期处理情况,评价其术后疗效。方法对86例65岁以上老年胆道手术患者临床资料进行了分析,围手术期处理包括术前全面检查、合并病处理、手术时机及麻醉的选择,术中、术后重要脏器的监护,营养支持以及并发症防治等。结果86例患者中治愈75例;好转5例,因内科并发症转科治疗3例,死亡3例。术后并发症18例（20．93％）。结论高龄胆道手术患者加强围手术期处理,对减少并发症,提高疗效具有重要意义。     

高龄胸部肿瘤患者的围手术期处理

目的探讨高龄胸部肿瘤患者的围手术期处理及并发症的预防。方法回顾性总结105例65岁以上高龄胸部肿瘤患者的围手术期处理的临床经验。结果术后死亡3例,发生早期并发症31例,主要是心血管并发症(18例)和肺部并发症(13例)。结论高龄并非开胸手术的禁忌证,严把手术适应证、经过积极的术前准备、合理的设计手术切除范围,可使大部分患者安全度过围术期。     

胆道手术病人的围手术期护理

作者将胆道手术病人的资料完整的、无选择的２００例进行了回顾性地分析。针对绝大多数病人对手术惧怕心理，我们术前耐心地做好患者的思想疏导工作，使病人正确对待手术，积极配合医护人员治疗。术后及时准确观察生命体征的变化，详细记录各种出入量，特别对１２指肠瘘瘘口下三腔管经常用生理冲洗，防止堵塞，保护好瘘口周围皮肤。遇到紧急病发时，如过敏性反应、大出血等，一面通知主管医师；一面进行紧急处理。     

围手术期胆道出血的诊断和处理

由于胆管与血管紧邻在同一Glisson鞘内的特殊解剖关系以及发生在胆管内的感染,结石、肿瘤等一些病理性改变高居不下,使围手术期的胆道出血时有发生,特别是随着对肝胆疾病日益增多的侵袭性诊断和治疗手段等非意识性损伤,使这类出血呈上升趋势,我院自1993年1月至1997年4月,收治了31例术中及术后发     

老年患者胆道手术围手术期的观察及护理

目的手术前全面检查,评估健康状况,治疗合并疾病,做好充分术前准备的重要性。方法本文通过对128例老年胆道手术患者围手术期的观察及护理,手术后密切观察病情变化,监测各项生理指标,尤其是伴随疾病的监测及护理。结果全组128例老年胆道手术患者围手术期经过顺利,无住院死亡及严重并发症发生。结论做好各种引流管的护理,加强基础护理及营养支持,防止并发症发生是提高手术安全性的关键。     

高龄患者骨折的围手术期护理

目的提高高龄患者骨折围手术期护理质量。方法对我院的66例高龄患者骨折的围手术期护理,(按照何种方法、分组等开展课题研究)进行探讨、总结。结果在66例高龄患者(病种？？)疾病分组,采取办法(传统与创新)中有58例痊愈出院,8例好转出院,且无一例发生并发症。结论应当加强高龄患者骨折围手术期护理,确保患者顺利康复。     

高龄患者腹腔镜胆囊切除术围手术期处理(附70例临床分析)

目的探讨80岁以上高龄患者行腹腔镜胆囊切除术围手术期的处理。方法回顾分析70例80岁以上高龄患者行腹腔镜胆囊切除术围手术期的处理措施。结果行腹腔镜胆囊切除术68例,中转开腹2例,手术时间35～145min,平均45min,住院时间4～8d,平均5d,术后无死亡病例及严重并发症发生。5例发生肺部感染,经积极对症、抗炎及支持治疗等痊愈。4例出现皮下气肿,1～3d后均自行吸收。术后随访1个月,所有病例情况良好,饮食恢复正常,检查腹部B超和肝功能正常,无残留结石。结论 80岁以上高龄患者行腹腔镜胆囊切除术风险大,难度高,但只要作好充分的术前准备,手术谨慎操作,术后严格管理,有针对性处理围手术期的各种问题,高龄患者行腹腔镜胆囊切除术是安全可行的。     

高龄患者食管癌围手术期的心理护理

食管癌是胸外科常见的恶性肿瘤,老年男性居多,手术是食管癌的主要治疗方法,由于癌肿造成食管梗阻,病人出现吞咽困难、消瘦、贫血、脱水、营养不良等,对日常生活造成极大影响.     

超高龄股骨颈骨折患者人工髋关节置换围手术期处理

目的：总结超高龄股骨颈骨折患者人工髋关节置换的围手术期处理方法及疗效。方法2008年10月~2013年10月对20例股骨颈骨折的超高龄患者(年龄≥86岁),采用有效的围手术期综合处理和人工髋关节置换手术。结果20例患者均安全渡过围手术期,术后早期出现并发症6例。结论个体化的围手术期综合处理是超高龄股骨颈骨折患者人工髋关节置换手术的有效保障。     

超高龄股骨颈骨折患者围手术期的护理体会

目的：探讨超高龄股骨颈骨折患者围手术期的护理体会。方法选取我院2013年8月份收取的40例超高龄股骨颈骨折患者进行手术治疗,对患者围手术期进行的护理以及随访等进行记录,总结患者围手术期护理方法。结果40例超高龄股骨颈骨折患者经过手术治疗,在围手术期对患者进行全面的护理后,90%患者恢复良好,基本能够正常运动,并无并发症出现。结论对超高龄股骨颈骨折患者进行全民的围手术期护理不仅减轻了患者的受病痛苦,还有利于尽快帮助患者恢复,并减少并发症的出现。     

A bile based study of Clonorchis sinensis infections in patients with biliary tract diseases in Ulsan, Korea

Stool examination is believed to be the most reliable method for detecting Clonorchis sinensis (CS) eggs. However, it has limited value for diagnosing clonorchiasis when the biliary tract is obstructed or when there is a light infection. We evaluated the infection states of CS in patients with biliary tract diseases using a bile sample. From January 2001 to August 2003, 238 patients who had undergone endoscopic biliary drainage were prospectively included in the study. The patients' bile samples were obtained directly from the nasobiliary drainage tube and then analyzed to detect CS eggs. The overall CS egg positive rate was 28.2% (35.4% in males, 19.4% in females). The egg positive rate was similar in all age groups examined: 26.7% in 30-39 years, 25.0% in 40-49 years, 24.4% in 50-59 years, 30.2% in 60-69 years, 35.3% in 70-79 years, and 25.0% in 80 years of age and over. There were no significant differences in the egg positive rate between the disease groups: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, and 26.4% in gallstone diseases. Our results show that the CS infection rate was very high, regardless of the age, gender, and type of diseases of the patients. Although the study population was limited to patients with biliary tract diseases, it is assumed that clonorchiasis is still an endemic disease in Ulsan, Korea.     

胆道探查术中的多种微创措施的临床研究

目的探讨胆道探查术中采取多种措施减轻胆道创伤方法。方法回顾性分析本院1991年1月至2007年1月收治的胆道探查手术患者975例,传统组471例,行传统胆道探查;微创组504例,采用小切口、胆道镜探查取石、球囊导管取石、离子体冲击波碎石、经胆道球囊乳头扩张成形、胆总管一期缝合等多种方法联合应用。结果微创组平均手术时间41 min,出血量30ml,胆道损伤0.5%,取石成功率94.6%。结论胆道探查术中采取多种微创措施简单有效,有效地减少了术后并发症的发生。     

Clonal analysis of metachronous double biliary tract cancers

The molecular mechanisms underpinning the development of metachronous tumors in the remnant bile duct following surgical resection of primary biliary tract carcinomas (BTCs) are unknown. This study aimed to elucidate these mechanisms by evaluating the clinicopathologic features of BTCs, the alterations to 31 BTC-related genes on targeted sequencing, and the aberrant expression of p53, p16, SMAD4, ARID1A and β-catenin on immunohistochemistry. Twelve consecutive patients who underwent resection of metachronous BTCs following primary BTC resection with negative bile duct margins were enrolled. Among the 12 metachronous tumors, six exhibited anterograde growth in the lower portion and six exhibited retrograde growth in the upper portion of the biliary tree. Surgical resection of metachronous BTCs resulted in recurrence-free survival in seven, local recurrence in five, and death in two patients. Nine achieved 5-year overall survival after primary surgery. Molecular analyses revealed that recurrently altered genes were: TP53, SMAD4, CDKN2A, ELF3, ARID1A, GNAS, NF1, STK11, RNF43, KMT2D and ERBB3. Each of these was altered in at least three cases. A comparison of the molecular features between 12 paired primary and metachronous BTCs indicated that 10 (83%) metachronous tumors developed in clonal association with corresponding primary tumors either successionally or phylogenically. The remaining two (17%) developed distinctly. The successional tumors consisted of direct or evolved primary tumor clones that spread along the bile duct. The phylogenic tumors consisted of genetically unstable clones and conferred a poor prognosis. Metachronous tumors distinct from their primaries harbored fewer mutations than successional and phylogenic tumors. In conclusion, over 80% of metachronous BTCs that develop following primary BTC resection are probably molecularly associated with their primaries in either a successional or a phylogenetic manner. Comparison between the molecular features of a metachronous tumor and those of a preceding tumor may provide effective therapeutic clues for the treatment of metachronous BTC. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.     

Exome sequencing of 22 genes using tissue from patients with biliary tract cancer

Biliary tract cancers (BTC) are a rare heterogeneous disease group with a dismal prognosis and limited treatment options. The mutational landscape consists of genetic aberrations both shared by and characteristic for anatomical location. Here, we present exome sequencing data on 22 genes from a phase 2 trial using a clinically validated panel used in patients with colorectal cancer. A total of 56 patients were included in a one-armed phase 2 trial investigating the treatment combination of capecitabine, gemcitabine, oxaliplatin, and cetuximab. Tissue DNA yield and quality allowed analysis of 30 patients on our panel including 22 genes. ARID1A (33%) and TP53 (33%) were found to be most frequently mutated followed by KRAS mutations found in 20% of the patients. Mutational aberrations in ARID1A were found more prevalent than expected, whereas TP53 and KRAS were in concordance with earlier reported data. Mutation in CTNNB1 was significantly associated with poor prognosis. Our panel is clinically validated and suitable for a high volume of samples to detect mutations in patients with BTC. However, it is reasonable to assume that the clinical utility could be optimized in this patient group by extending the panel to include BTC specific mutations with potential therapeutic consequences such as IDH1/2, FGFR fusions, ERBB3, and BRCA1/2.     

Bile acid analysis in biliary tract cancer

The etiology of biliary tract cancer is obscure, but there are evidences that bile acid plays a role in carcinogenesis. To find the association between biliary tract cancer and bile acid, this study compared the bile acid concentration and composition among patients with biliary cancer, biliary tract stones, and no biliary disease. Bile was compared among patients with biliary tract cancer (n = 26), biliary tract stones (n = 29), and disease free controls (n = 9). Samples were obtained by percutaneous transhepatic biliary drainage, endoscopic nasobiliary drainage, or gallbladder puncture, and analyzed for cholic, deoxycholic, chenodeoxycholic, lithocholic, and ursodeoxycholic acid composition. Total bile acid concentration was lower in the cancer group than the biliary stone and control groups; the proportions of deoxycholic (2.2% vs. 10.2% and 23.6%, p < 0.001 and p < 0.001, respectively) and lithocholic acid (0.3% vs. 0.6% and 1.0%, p = 0.065 and p < 0.001, respectively) were also lower. This result was similar when disease site was limited to bile duct or gallbladder. Analysis of cases with bilirubin 相似文献   

胆道造影测量胆道容积的实验研究

目的 探索临床可行的胆道容积测量疗法,为胆道消融栓塞提供数据。方法 日本大耳兔行右外侧叶肝胆管外引流术,在X线透视下经引流管行胆道造影,使各级胆管充分显影时所用造影剂体积即胆道容积。结果 体重无明显差别时,雌雄兔子右外侧叶肝胆道容积无显著差异。测得兔右外叶胆管容积。结论 X线透视下行胆道造影地目前测量胆道容积有效可行的方法。     

Arterial vascularisation of the extrahepatic biliary tract

Summary The aim of this study was to establish a plan of the arterial distribution to the main supraduodenal biliary tract in order to draw practical conclusions for biliary surgery, especially in bilio-alimentary and biliobiliary anastomoses and liver transplantation. It was based on a study of 60 fresh subjects and was carried out using four different methods: dissection after injection of colored latex into the superior mesenteric a. (10 subjects), radiography and dissection after injection of Micropaque into the celiac trunk (10), dissection after injection of Indian ink into the common hepatic a. (10) and radiography and dissection after selective injection of the right hepatic a. or the gastroduodenal a. (30). Analysis of the results leads to definition of three types of vascularisation and two territories, superior and inferior, overlapping at the level of the mouth of the cystic duct. The practical implications for biliary surgery and liver transplantation are discussed.This study was made with the aid of a grant from the Fondation Martine Midy.     

Brush cytology of the biliary tract: retrospective study of 278 cases with histopathologic correlation

Bile aspiration during endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography has been used as a diagnostic tool in the evaluations of pancreatic and biliary tree strictures for the last two decades. However, recently biliary tract brush cytology has become the method of choice in evaluating pancreatic/biliary tract abnormalities. The aim of this study was to evaluate the accuracy of pancreatobiliary lesions by an endobiliary cytotechnique. From 1993-1999, 278 pancreatobiliary brushings were performed at our institutions. Cytologic material was air-dried for Diff-Quik stain or fixed in ethanol for Papanicolaou staining. The cytologic diagnoses were classified in three categories: 1) benign, 2) atypical/suspicious, or 3) malignant. Subsequent surgical biopsy was available in 87 (31%) patients. There were 150 males and 128 females with a mean age of 63 yr (range 22-97); 167 (60%) were benign cases. Follow-up surgical material was available in 39 cases, seven of which showed adenocarcinoma; 67 of all cases (24%) were atypical/suspicious cases. Follow-up surgical material was available in 31 cases, 17 (55%) of which showed adenocarcinoma; 32 cases (12%) were malignant cases. Follow-up surgical material was available in 15 cases. All 15 cases were in agreement with the cytologic diagnosis. Twelve (4%) cases were unsatisfactory for cytologic examination. Follow-up surgical material was available in two cases. One case showed mucinous cystadenoma of the pancreas. The other case showed benign duct epithelium. Our study shows a sensitivity of 68% and a specificity of 100%. Of the atypical cases, 55% were malignant on follow-up biopsy. Brush cytology of pancreatobiliary strictures is the most widely used technique in the diagnosis of carcinoma, with a high degree of specificity.     

PTEN loss and KRAS activation cooperate in murine biliary tract malignancies

Carcinomas of the biliary tract are aggressive malignancies in humans. Loss of the tumour suppressor PTEN has previously been associated with cholangiocarcinoma development in a murine model. Activation of KRAS is reported in up to one‐third of human cholangiocarcinomas and 50% of gall bladder carcinomas. In this study we aimed to test the potential interaction between PTEN and KRAS mutation in biliary tract malignancy. We used an inducible Cre–LoxP‐based approach to coordinately delete PTEN and activate KRAS within the adult mouse biliary epithelium. We found that activation of KRAS alone has little effect upon biliary epithelium. Loss of PTEN alone results in the development of low‐grade neoplastic lesions, following long latency and at low incidence. Combination of both mutations causes rapid development of biliary epithelial proliferative lesions, which progress through dysplasia to invasive carcinoma. We conclude that activation of the PI3′K pathway following loss of PTEN is sufficient to drive slow development of low‐grade biliary lesions in mice. In contrast, mutational activation of KRAS does not result in a similar phenotype, despite a prediction that this should activate both the RAF–MEK–ERK and PI3′‐kinase pathways. However, mutation of both genes results in rapid tumourigenesis, arguing that PTEN normally functions as a ‘brake’ on the PI3′‐kinase pathway, limiting the influence of KRAS activation. Mutation of both genes creates a ‘permissive’ environment, allowing the full effects of both mutations to be manifested. These data reveal an in vivo synergy between these mutations and provides a new mouse model of biliary tract malignancy. Copyright © 2013 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.