Objective:Compare the efficiency and safety of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) versus PVE alone before major hepatectomy for patients with hepatocellular carcinoma (HCC).Methods:PubMed, the Cochrane Library were screened. The primary endpoints were overall survival rate (OSR), recurrence-free survival rate (RFSR), the increase in the percentage of FLR volume; secondary endpoints were hepatectomy rate, postoperative complications, hepatic failure rate after surgery, and mortality after surgery.Results:A total of five retrospective studies were included. The results showed the TACE + PVE group had a higher 1-year OSR, 3-year OSR, 5-year OSR, and 10-year OSR than PVE group. The results also indicated the TACE + PVE group had a higher 1-year RFSR, 3-year RFSR, 5-year RFSR, and 10-year RFSR than PVE group. The results demonstrated the TACE + PVE group had a higher FLR volume, as well as higher hepatectomy rate, and lower postoperative complications than PVE group.Conclusions:Sequential TACE and PVE seem to be a more effective therapy than PVE alone before major hepatectomy for HCC patients, with better survival and safety.

Objective:To compare the advantages and disadvantages of thoracic paravertebral nerve block combined with new nasopharyngeal airway preserved spontaneous breathing anesthesia and traditional double-lumen bronchial intubation combined with general anesthesia for thoracoscopic surgery.Methods:A total of 48 patients with thoracoscopic surgery admitted to the department of thoracic surgery, Hunan Provincial People′s Hospital from January 2020 to May 2022 were selected and divided into two groups by random number table method, with 24 cases in each group. The observation group was treated with thoracic paravertebral nerve block combined with a new type of nasopharyngeal airway to retain spontaneous breathing; The control group was treated with traditional double-lumen bronchial intubation combined with general anesthesia. The sedation and analgesia scores, perioperative plasma cortisol, norepinephrine and epinephrine levels, hemodynamic indexes, intraoperative opioid dosage at different time points (T0 after intubation or nerve block, skin incision T1, artificial pneumothorax T2, focus resection T3, and chest closure T4), as well as early out of bed activity and length of stay in hospital after operation were compared between the two groups.Results:The sedation scores of the observation group at T0, T1, T2, T3, T4 were significantly higher than those of the control group (all P<0.05); The analgesic scores at T2, T3 and T4 in the observation group were significantly lower than those in the control group (all P<0.05). The plasma cortisol and epinephrine levels at T0, T1, T2, T3, T4 in the observation group were lower than those in the control group, and the difference was statistically significant (all P<0.05); The levels of norepinephrine at T1, T2, T3 and T4 in the observation group were lower than those in the control group (all P<0.05). There was no significant difference in heart rate at T1 between the observation group and the control group ( P>0.05), but the heart rate at T0, T2, T3, T4 was lower than that in the control group (all P<0.05). The mean arterial pressure at each time point in the observation group was lower than that in the control group, with statistically significant difference (all P<0.05). The total amount of opioid in the observation group was significantly less than that in the control group ( P<0.05). The Visual Analogue Scale (VAS) scores of rest and exercise in the observation group were significantly lower than those in the control group (all P<0.05). The time of getting out of bed , standing, walking, anus exhaust and blowing out the lighter in the observation group were significantly shorter than those in the control group (all P<0.05). The times of nausea and vomiting, patient controlled intravenous analgesia (PCIA) pressing and hospitalization in the observation group were significantly less than those in the control group (all P<0.05). Conclusions:Thoracic paravertebral nerve block combined with new nasopharyngeal airway to preserve spontaneous breathing " tubeless" anesthesia can provide better sedation and analgesia effect and lower perioperative stress level than traditional double-lumen bronchial intubation combined with intravenous inhalation general anesthesia. It also has obvious advantages in rapid recovery after surgery.

目的 比较胃冠状静脉栓塞联合TIPS治疗肝硬化门静脉高压伴上消化道出血的临床疗效.方法 选取2016年8月至2018年8月本院收治的肝硬化门静脉高压伴上消化道出血患者100例,随机分为联合治疗组(胃冠状静脉栓塞联合TIPS治疗)和单独治疗组(TIPS单独治疗),每组50例.比较两组PPG、PVP指标水平,肝功能指标及术后情况.结果 治疗后,两组PPG、PVP水平均显著低于治疗前(P<0.05);治疗前后两组AST、ALT、ALB、TBIL水平比较差异无统计学意义;联合治疗组分流道通畅率、生存率均显著高于单独治疗组,食管胃曲张静脉再出血、整体再出血率、肝性脑病发生率均显著低于单独治疗组,差异均有统计学意义(P<0.05).结论 与TIPS单独治疗比较,胃冠状静脉栓塞联合TIPS治疗肝硬化门静脉高压伴上消化道出血效果显著,能有效改善患者肝功能,提升患者生存率,改善患者预后,值得推广.

目的 探讨Wells评分、Geneva评分和YEARS法对疑似肺栓塞(PE)住院患者的诊断价值.方法 回顾性分析2017年1月至2020年6月因胸痛、呼吸困难和咯血于湖南省人民医院住院治疗的946例疑似PE患者.记录所有入组患者病史、临床表现和辅助检查结果等指标.入组患者均接受Wells评分、Geneva评分和YEARS法评估.以CT肺血管造影(CTPA)为标准,分析3种评分诊断PE的灵敏度、特异度、准确度和Youden指数,同时将3组评分结果与CTPA结果进行一致性分析,并绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估3种评分系统诊断PE价值.结果 946例患者中CTPA确诊为PE患者257例(27.2％).Wells评分、Geneva评分、YEARS法诊断PE灵敏度分别为88.72％、75.88％、93.00％,特异度分别为35.37％、59.36％、25.11％,准确度分别为50.11％、63.85％、43.55％,Youden 指数分别为0.24、0.35、0.18.Wells 评分、Geneva 评分、YEARS 法与 CTPA 的 Kappa 值分别为0.16、0.28、0.11.3种评分准确度两两比较差异均有显著统计学意义(P＜0.01).Wells评分、Geneva评分、YEARS法诊断 PE 的 AUC 分别为0.622±0.019、0.676±0.019、0.591±0.020,其中 Geneva 评分 AUC 最大,与 Wells评分、YEARS法差异均有统计学意义(P＜0.0167),Wells评分与YEARS法差异无统计学意义(P＞0.0167).结论 3种评分对疑似PE住院患者均有一定的诊断价值,Geneva评分整体诊断价值最高,Wells评分和YEARS法诊断均不理想.