ObjectiveTo investigate the effectiveness and safety of ultrasound-guided percutaneous local ablation in the treatment of liver cancer in dangerous areas. MethodsA total of 179 patients with primary liver cancer who were admitted to Tianjin Second People’s Hospital from January 2014 to September 2017 and underwent ultrasound-guided ablation for the first time were enrolled, and according to tumor location, the patients were divided into dangerous area group with 134 patients and non-dangerous area group with 45 patients. All patients received ablation therapy. The patients were followed up to observe tumor recurrence and death, and the patients without recurrence or death were followed up to September 2019. The two groups were compared in terms of complications after ablation, complete tumor response rate, tumor recurrence or progression, and postoperative survival. The two-independent-samples t-test was used for comparison of normally distributed continuous data between two groups; The Mann-Whitney U test was used for comparison of non- normally distributed continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; the Kaplan-Meier method was used to analyze local tumor progression rate and cumulative survival rate, and the log-rank test was used for comparison between two groups. ResultsThere were no significant differences in baseline levels between the two groups. There were no significant differences between the dangerous area group and the non-dangerous area group in the incidence rates of mild complications (42.5% vs 511%, χ2=1.002, P=0.317) and severe complications (6.0% vs 2.22%, χ2=0.453, P=0.290) and the reduction rate and normalization rate of alpha-fetoprotein within 1 month after ablation (reduction rate: 75.0% vs 80.0%, χ2=0.464, P=0.496; normalization rate: 33.9% vs 26.3%, χ2=0.381, P=0.537), and there was also no significant difference in complete tumor response rate between the two groups (91.8% vs 93.3%, P=0.990). The dangerous area group had 1- and 2-year progression-free survival rates of 60.7% and 37.1%, respectively, and the non-dangerous area group had 1- and 2-year progression-free survival rates of 63.5% and 55.0%, respectively, with a median progression-free survival time of 18 months and 27 months, respectively, and there was no significant difference between the two groups (χ2=0.573, P=0.449). The dangerous area group had 1- and 2-year cumulative survival rates of 96.8% and 90.3%, respectively, and the non-dangerous area group had 1- and 2-year cumulative survival rates of 93.3% and 87.8%, respectively, with no significant difference between the two groups (χ2=0.110, P=0.731). ConclusionUltrasound-guided percutaneous local ablation is a feasible, safe, and effective method for the treatment of liver cancer in dangerous areas.

目的 探讨原发性肝癌组织转录相关酸性卷曲蛋白3(TACC3)、p53蛋白表达变化及其与患者临床病理特征和预后的关系.方法 选择原发性肝癌组织和癌旁组织各112例份,采用Western blotting法检测TACC3、p53蛋白表达.分析原发性肝癌组织TACC3、p53蛋白表达与患者临床病理特征和预后的关系.结果 原发性肝癌组织TACC3、p53蛋白相对表达量均明显高于癌旁组织(P均<0.05).原发性肝癌组织TACC3、p53蛋白表达与肿瘤最大直径、临床分期、组织分化程度、淋巴结转移有关(P均<0.05),与性别、年龄、肿瘤数目无关(P均>0.05).原发性肝癌组织TACC3表达与p53蛋白表达呈正相关关系(r=0.613,P<0.05).以TACC3、p53蛋白表达的平均值为临界值,将患者分为TACC3或p53蛋白高表达者与低表达者.TACC3、p53蛋白高表达者3年生存率均明显低于其低表达者(χ2分别为4.843、4.020,P均<0.05).结论 原发性肝癌组织TACC3、p53蛋白表达明显升高,其表达变化与肿瘤进展和患者预后不良有关.

目的 比较肝动脉化疗栓塞(TACE)联合经皮肝穿刺微波消融(PMCT)和单纯PMCT及单纯TACE治疗原发性中晚期肝癌患者的临床疗效.方法 选择60例不能或不愿手术治疗的原发性中晚期肝癌患者(男40例,女20例),分为PMCT+TACE组(联合组),PMCT组,TACE组,比较三组的疗效、安全性及实用性.结果 联合组瘤体缩小(≥50%),AFP转阴(<400 μg/L),综合疗效显著高于TACE组及PMCT组.联合组2年内复查超声、CT、磁共振,3例复发,再次行PMCT联合TACE治疗,肿瘤消失,AFP<400 μg/L;TACE组10例复发,5例AFP≥400 μg/L;PMCT组3例复发且AFP≥400 μg/L.结论 TACE联合PMCT在治疗中晚期肝癌中实用性好,临床治疗效果明显,安全性高,疗效优于单纯TACE或PMCT.

Objective To investigate early renal damage of chronic hepatitis B (CHB) patients and the risk factors related to their renal function. Methods CHB patients who visited the second people’s hospital but did not receive systemic treatment were enrolled in our study. Those who visited for general check-up with no hepatic findings during the same period were selected as control group. Glomerular filtration rate (GFR) of all the participants were estimated by simplified MDRD equation and CKD-EPI equation (designated as M-eGFR and C-eGFR respectively). Influence factors of eGFR were statistically analyzed. Results In the total 528 cases in CHB group, 88 (16.67%) and 62 (11.74%) suffered declined M-eGFR and C-eGFR respectively. By contrast, 10 (8.77%) and 6 (5.26%) cases in the total 114 cases in control group present declined M-eGFR and C-eGFR ac?cordingly. Percentages of renal function impairment, estimated by both M-eGFR and C-eGFR, were higher in the CHB group than those in control group. The difference was statistically significant (χ2=4.518, P<0.05;χ2=4.156, P<0.05). Multiple linear regression analysis indicated that age, HBsAg and body mass index (BMI) were risk factors of M-eGFR while age, HBsAg, gender and serum albumin were risk factors of C-eGFR. On the other hand, HBV-DNA and HBeAg were not risk factors for M-eGFR or C-eGFR. Conclusion HBV infection can lead to early renal damage. Age and HBsAg are main risk factors of renal function impairment. Therefore, renal function should be scrutinized in CHB patients.

Objective To investigate the treatment of percutaneous radiofrequency melting ( RFA ) irregular liver cancer ef icacy and safety, searching for the right treatment condition, thus realizing the complete coagulation necrosis of liver tumor, at the same time to reduce the tumor liver tissue injury. Methods For the selection of ir egular in patients with hepatocel ular carcinoma and 32 cases with RFA therapy. Preoperative and postoperative underwent color Doppler ultrasound, contrast enhanced ultrasound, contrast-enhanced CT scan, detect alpha-fetoprotein, judging curative ef ect and non tumor liver tissue damage range; at the same time routine liver function, blood routine, blood coagulation, observe the adverse reaction and complication rate. Results After 8 weeks, 1.RFA enhanced CT contrast-enhanced ultrasound tip complete necrosis of the tumor in 27 cases, necrotic rate of 86.6%; 4 week review of AFP, 25 cases of AFP patients with positive in 16 cases preoperatively to negative (65.70% ) and the reported ef icacy and no dif erences in ablation treatment of liver carcinoma. 2.2 cases of CT and ultrasound angiography revealed ablation damage nontumorous liver tissues beyond the tumor boundary is more than 1cm;including 1 cases of abnormal liver function, the liver after 2 weeks of treatment to restore normal. The remaining patients had no complications associated with the operation. Conclusion Accurate puncture, catheter ablation range of superposition for ir egular liver RFA treatment, its ef icacy and the sphere and sphere RFA ef ect approaches, and can avoid large nontumorous liver tissues.

胶囊内镜(CE)作为一项重要的、新颖有效的胃肠道诊断技术，已被临床广泛接受而成为一项常规检查手段，并有望进一步扩大其应用指征。该检查安全、无创、依从性好，是诊断胃肠道疾病、尤其是不明原因消化道出血、克罗恩病和小肠肿瘤的极具价值的工具。本文对胶囊内镜临床应用及发展前景作一综述。

Objective To explore the correlation between the enhancement pattern of hepatocellular carcinoma(HCC)on contrast-enhanced ultrasound(CEUS) and its tumor differentiation on histopathology. Methods HCC lesions(n=259)from 224 patients were retrospectively evaluated with CEUS and histopathological examination. CEUS was performed withSono Vue. The characteristics of blood perfusion and parameters of the time-intensity curve(TIC) were analyzed by ACQ soft-ware. Histopathological diagnoses were decided base on Edmonson grading system. Results Pathologic grading of HCC wasnot related to the arrival time(P0.05);The washing-out time point and the enhancement time point and peak time pointall appeared earlier in poorly differentiated HCC group, than those in moderately differentiated HCC group than those in welldifferentiated HCC group(P0.01);The enhancement time point and the expurgation time point are shorter in poorly differ-entiated HCC group than those in moderately differentiated HCC group than those in well differentiated HCC group. All dif-ferences were with statistical significance. The mode of arterial perfusion in early stage was divided into 3 types: spider webtype, radiative type and mixed type. The well differentiated HCC group mainly presented as radiative type(28/49, 47.14%).But the most of poorly differentiated HCC group mainly present as spider web type(88/127, 69.29%). The mix type was morecommon in moderately differentiated HCC group(49/83, 59.03%). Conclusion CEUS show different features of TIC pa-rameters and blood perfusion in different pathological stages of HCC lesions so it can serve as a method to assess the biologi-cal behavior of hepatocellular carcinoma.

目的 探讨大功率微波消融(microwave ablation,MWA)与射频消融(radiofrequency ablation,RFA)治疗较大肝癌的近期临床疗效及术后复发转移相关危险因素.方法 对101例未行其他治疗的原发性肝癌患者中45例(病灶数n=60)行大功率MWA治疗(80 ～ 100 W),56例(病灶数n=68)行RFA治疗.肿瘤直径范围为3～8cm,依据肿瘤直径分为两组:肿瘤直径3～ ＜5cm组及肿瘤直径≥5 cm组.消融后1月行超声造影、增强CT或MRI检查.观察治疗后两组患者肿瘤完全坏死率、局部复发率、并发症、生存情况,随访评价两种手术方式疗效并分析肝癌复发转移的相关危险因素.结果 大功率MWA与RFA对于3～ ＜5cm病灶1次完全坏死率分别为82.6％ (38/46)、80.0％ (40/50);2次完全坏死率分别为100.0％ (46/46)、98.0％ (49/50).MWA与RFA对于≥5cm病灶1次完全坏死率分别为64.3％ (9/14)、33.3％ (6/18);2次完全坏死率分别为85.7％ (12/14)、50.0％ (9/18).MWA与RFA组术后2年总复发率分别为40.0％ (18/45)、42.9％(24/56).MWA与RFA组术后1、2年生存率分别为95.6％ (43/45)、86.7％(39/45)及94.6％(53/56)、89.3％(50/56).两组患者并发症差异无统计学意义(P=0.802).单因素分析示术后复发转移与肿瘤个数(P=0.025)、术前AFP值(P=0.031)、乙肝HBV-DNA载量(P =0.035)及肿瘤病灶邻近危险区域(P=0.001)有关.多因素分析提示,乙肝HBV-DNA载量(P=0.023)与肿瘤病灶邻近危险区域(P=0.001)是肝癌消融治疗术后复发转移的独立危险因素.结论 MWA治疗较大肝癌的完全坏死率比RFA高,局部复发率比RFA低.肿瘤个数、术前AFP值、患者HBV-DNA病毒载量以及肿瘤病灶邻近危险区域都是肝癌术后复发转移的危险因素,其中后两者是独立危险因素.

Objective Comparison on therapeutic effect between transcatheter arterial chemoembolization combined with percutaneous microwave coagulation therapy and percutaneous microwave coagulation therapy for hepatocellular carcinoma.Methods Patients were randomly divided into group TP and group P.Before and after therapy,patients' serum α-fetoprotein level(AFP),responses of tumor,complications related to embolization and survive rates were analyzed between two groups.Results The AFP level and size of tumor in group TP were lower than those in group P(P0.05).There were significant statistical differences in the survival rate between the two groups(P0.05).Conclusion The combination of PMCT and TACE is more effective for hepatocelluar carcinoma than PMCT alone.

OBJECTIVE To study nosocomial infection(NI) and antibiotic usage in a three level of first-class infectious disease hospital. METHODS The point-prevalence survey of NI in all hospitalized patients at one day in the fourth quarter was made from 2007 to 2009. RESULTS The prevalence rates of NI were individually 4.35%,3.50% and 2.17%.The common NI sites were upper respiratory tract,intraabdominal cavity and lower respiratory tract.No statistically difference was found between strength changes of immunodeficiency,urinary catheter,peripheral and central venous catheter.9 strains of pathogenic bacteria were found through delivering samples including 5 strains of gram-positive bacteria and 4 strains of gram-negative bacteria.Antibiotics utilization rate was decreased in 3 years(P=0.058),mostly for one couplet medicine.16 in 21 cases of NI were on antibiotics,and all for one. CONCLUSION The prevalence of NI and antibiotics utilization rate are both decreasing.The most common NI sites are respiratory system and intraabdominal cavity.

OBJECTIVE To continuously evaluate nosocomial infections in gastroenterological units of an infectious disease hospital.METHODS The incidence of nosocomial infections(NIs) in gastroenterological units from Jan 2007.to Dec 2008.was prospectively surveyed.RESULTS All 4343 cases were involved during the surveillance,of which 394 patiend acquired NIs.And the average incidence of NIs was 3.030 cases per 1000 admitted patient-day.457 case-times attacked,the case-times incidence of NIs was 3.515 case-times per 1000 admitted patient-days.The more frequent NI sites were spontaneous bacterial peritonitis(SBP,23%),blood stream infection(BSI,20%),upper respiratory tract infection(URTIs,20%) and lower respiratory tract infection(LRTIs,17%),which accounted to 80% of NIs.Nosocomial LRTIs or BSI were the two leading causes of death assoliated with Nis.The NI incidence in a unit mainly admitting liver failure was the highest 5.02‰,in which BSI 1.65 and 1.08‰ were the highest also.CONCLUSION Respiratory tract infection,SBP and BSI are the major NI of infectious disease hospital on the Chinese traditional infectious disease isolation and prevention strategy.The mortality is higher among patients with nosocomial LRTIs and BSI than other NIs.

Objective To evaluate the efficacy and safety of Percutaneous microwave coagulation therapy(PMCT) for liver tumor abutting the gastrointestinal tract,the gallbladder,the diaphragm,the heart,the kidney and the other danger areas(the shortest distance of tumor from the organ ≤ 0.5cm),to explore the optimal ablation condition in order to achieve complete tumor necrosis while these organs were not burn obviously.Methods This study was undertaken in 45 patients who were with liver cancer abutting the gastrointestinal(4 patients),the gallbladder(10 patients),the diaphragm(24 patients),the heart(9 patients),the kidney(3 patients) and accepted PMCT.All the patients underwent ultrasound and enhanced CT scan before and after the treatment,detection of AFP,liver and kidney function to determine efficacy.Adverse reaction and complication rates,changes of serum AFP,and tumor response rate were observed.Results ⑴According to the results of the CT scan,there were 38 cases of complete tumor necrosis after 8 weeks,necrosis rate is 84.44%;23 cases of AFP turning to negative after 4 weeks(65.71%) in 35 cases of AFP positive patients before operation.There was no difference in efficacy compared that of reported in the literature of non-hazardous area liver cancer.⑵1 patient who was with liver cancer close to the top of the diaphragm developed hemothorax after PMCT treatment,the hemorrhage was absorbed after 7 days of hemostasis treatment;The ablation tip was tearing off and remained in the central area of ablation in 1 patient who was asymptomatic.After 1-year following-up,there was no change in the tip position.There were no other complications arose with the operation.Conclusion The efficacy of a proper PMCT treatment for the liver cancer near danger area is closed to that of PMCT for non-hazardous area,and the complications associated with the operation could be avoid.

肝硬化引起肝源性溃疡(HU)的发生率为非肝硬化的2.5倍,在肝硬化患者中其发病率为18.6%.HU并发消化道出血的发生率明显高于单纯性溃疡,常误诊为食管胃底静脉曲张破裂(EVB)出血.

Objective To observe the impact of esophageal variceal ligation(EAL) on portal hypertensive gastropathy(PHG) in patients with liver cirrhosis.Methods Ninty eight patients with esophageal varices were treated by variceal ligation under endoscope guide before varices disappeared or shrinked.The occurrence and aggravation of PHG were checked on time.Results PHG existed in 80(80.1%) and 86(86.1%) patients before and after ligation,respectively(P 0.05).But 29 cases(29.59%) developed to severe PHG with only 10 cases(10.20%) before the ligation and the difference was significant(P 0.01).Conclusions PHG might become severe shortly after EVL,which should call clinicians' concerns.

患者,女性,26岁,无业.因乏力、食欲不振4个月于2007年6月7日入院.患者于4个月前出现乏力、食欲不振,于外-地医院就诊时发现肝功能异常(具体数值不详),病毒分型均阴性,未予正规诊疗,症状未缓解.

肝硬化门静脉高压食管、胃底静脉曲张破裂出血是慢性肝病患者最凶险的并发症,在肝硬化患者中其发生率及病死率均较高.寻求一种安全有效的临床治疗方法以预防及延缓其发生,提高治愈率和降低病死率非常必要.我院应用内镜下静脉曲张套扎术(endospic varices ligacion,EVL)对食管静脉曲张患者进行破裂出血的一级预防治疗并取得较好疗效.

目的:研究单磷酸阿糖腺苷(Ara-AMP)联合干扰素治疗慢性乙型肝炎的疗效。方法:60例慢性乙型肝炎患者,HBeAg及HBV-DNA均阳性,且HBV-DNA>1×106cop/ml。60例随机分成两组:Ara-AMP联合干扰素(IFN)组30例,干扰素组30例,治疗1个月、3个月、6个月后对肝功能和乙肝血清标志物进行检测分析。结果:Ara-AMP联合干扰素治疗1个月、3个月、6个月时,谷丙转氨酶(ALT)复常率分别为70%、83%、90%,HBV-DNA转阴率分别为16.6%、36.7%、43.3%;HBeAg转阴率均为7.1%、17.8%、17.8%;HBV-DNA转阴率治疗3个月、6个月与治疗前比较有显著性差异(P<0.01)。肝功能在治疗前后比较有显著差异(P<0.05)。单用干扰素治疗1个月、3个月、6个月时,ALT复常率分别为66%、73%、80%;HBV-DNA转阴率3.3%、10.7%、12.3%,HBeAg转阴率均为5.2%;肝功能在治疗前后比较有显著差异(P<0.05),HBeAg转阴率及HBV-DNA转阴率治疗前后比较均无显著差异。两组之间比较HBV-DNA转阴率有显著性差异(P<0.01)。结论:Ara-AMP联合干扰素治疗慢性乙型肝炎抗病毒疗效更明显。

Objective To research the gastric mucosa pathological changes and helicobacter pylori (HP) infection in patients with liver diseases. Methods 577 cases with liver disease including acute hepatitis ( 74),chronic hepatitis (232) and cirrhosis (271) were checked by gastro scope and HP test.Result According to gastro scope examination,all the patients had pathological changes in upper alimentary cabal,37 (6.41%)cases were esophagitis; 271 (46.97%)cases were the bottom of varicosity in stomach and esophagus; 560 (97.05%)cases were gastritis; 46 (7.97%) cases were gastric ulcer; 52 (9.01%)cases were gastric disease with high pressure of portal vein; 2 (0.35%)cases were stomach cancer; 51(8.84%) cases were duodenal ulcer; 34 (5.89%)cases were duodenitis.HP showed positive in 40.03% of patients: acute hepatitis was 32.43%(24/74),chronic hepatitis 43.97%(102/232), and cirrhosis 38.75%(105/271).Conclusion The research shows that it is common in patients with liver disease for gastric mucosa pathological change and the pathological mucosa changes in upper alimentary tract in patients with liver diseases was not far higher than in documented patients with non- liver disease.[

干扰素是目前国际公认的治疗慢性乙型及丙型肝炎的药物,但在抗病毒治疗过程中常造成白细胞和血小板减少,部分患者常因此而延续或中断治疗,从而不能完成疗程,使疗效大大降低.重组人粒细胞巨噬细胞集落刺激因子(GM CSF)刺激骨髓造血虽然效果较好,但因其价格昂贵,应用受到限制[1].我们应用地榆升白片预防和治疗慢性乙型及丙型病毒性肝炎干扰素抗病毒治疗过程中,所致的白细胞减少症,现报告如下.

肝硬化门静脉高压症食管、胃底静脉曲张破裂出血是慢性肝病患者最凶险的合并症之一,笔者在内镜下行套扎术治疗食管静脉曲张取得较好疗效,现报告如下.