Is serum protein electrophoresis useful in separating the "high risk group" in patients with colonic polyps?

BACKGROUND: Adenomas have the highest potential or clinical value from among colonic polyps of developing into adenocarcinoma. The aims of this paper are: to establish criteria to identify the high risk group of patients in a group of patients with colonic polyps, to work out a simple scheme for follow-up care after endoscopic polypectomy, and to establish indications for surgery. The usefulness of determination of electrophoresis of serum proteins has been specially analysed to detect early development of malignant growths in patients with colonic polyps regarding alfa-1/alfa-2 and alfa/beta. 67 cases - 21 women, 46 men were tested. Follow-up endoscopy with the electrophoresis was performed after 6 weeks, 6 and 12 months after polypectomy. 97 polyps were resected with endoscopy in 67 patients. 38 patients (39.17%), those constituting the high risk group, were selected. Included were all polyps with grade II and III of cellular differentiation. CONCLUSIONS: 1) alfa-1/alfa-2 and alfa/beta is a helpful test in identifying the high risk group among patients with colonic polyps and it can be used as a screening test, 2) the determination of beta-2-macroglobuline is not useful in the diagnosis of this group of patients, 3) the electrophoresis of proteins should be the first test to perform on patients with colonic polyps. The relation of electrophoresis to endoscopic polypectomy aids evaluations of patients specially predisposed to malignant.     

Zollinger-Ellison Syndrome due to Primary Gastrinoma of The Extrahepatic Biliary Tree: Three Case Reports and Review of Literature

ObjectiveTo report 3 cases of primary neuroendocrine tumors (PNT) of the extrahepatic biliary tree (EHBT) in patients with Zollinger-Ellison syndrome (ZES), 2 of whom had multiple endocrine neoplasia type 1 (MEN 1).MethodsThree new cases of gastrin-producing tumors of the EHBT are presented, and the pertinent literature relating to PNT of the EHBT is reviewed.ResultsEighty-one previous cases of PNT of the EHBT have been reported in the world literature, 7 of which were hormonally active and associated with peptic ulcer disease, diarrhea, or ZES. Three additional patients presented to us with ZES due to PNT of the EHBT. One patient with MEN 1 was treated with a Whipple procedure for a common bile duct gastrinoma. A second patient underwent left hepatectomy with resection of the confluence of the right and left hepatic ducts for a primary left hepatic duct gastrinoma. The second patient with MEN 1 underwent resection of a gastrinoma at the junction of the cystic duct and the common bile duct.ConclusionAlthough PNT of the EHBT are uncommon, the association with ZES is even more so. Often, nonfunctioning tumors are diagnosed late in the course of the disease from symptoms related to biliary obstruction. Patients with ZES may be diagnosed earlier because of symptoms resulting from gastrin excess. Surgical resection is the only chance for cure and is often helpful in the palliation of symptoms. (Endocr Pract. 2009;15:737-749)     

腹腔镜监控肠镜下（LMCP）息肉摘除术对比常规肠镜下息肉切除的随机对照临床研究

目的:探讨腹腔镜监控下的肠息肉摘除术(LMCP)治疗效果,比较LMCP肠息肉摘除术对比常规肠镜下息肉切除的临床治疗效果及预后情况。方法:将符合条件的所有手术患者随机分为两组,每组各41例,其中试验组使用腹腔镜监控下结肠镜息肉摘除术,对照组单纯使用肠镜行息肉切除术。所有病人均观察并记录其预后情况。结果:研究共纳入82例病人,男53例,女29例,平均年龄70岁。息肉平均大小为2.0 cm。所有患者术后无并发症。试验组和对照组的第一次通便时间分别为13.2 h和24.5h,统计学具有显著性差异P<0.001,风险比为1.81,95%置信区间为[1.13-3.00]。试验组和对照组的总住院天数分别为4.5天和8.0天,统计学具有显著性差异P<0.001,风险比为4.15,置信区间95%CI为[2.40-7.18]。结论:LMCP术对病人具有显著的获益,可以避免不必要的并发症,手术操作更安全。因此,LMCP是一种安全有效的方法,并且创伤更小,住院周期更短,是息肉切除术首选的方法。     

Clinical impact of HLA class I expression in rectal cancer

Purpose To determine the clinical impact of human leukocyte antigen (HLA) class I expression in irradiated and non-irradiated rectal carcinomas. Experimental design Tumor samples in tissue micro array format were collected from 1,135 patients. HLA class I expression was assessed after immunohistochemical staining with two antibodies (HCA2 and HC10). Results Tumors were split into two groups: (1) tumors with >50% of tumor cells expressing HLA class I (high) and (2) tumors with ≤50% of tumor cells expressing HLA class I (low). No difference in distribution or prognosis of HLA class I expression was found between irradiated and non-irradiated patients. Patients with low expression of HLA class I (15% of all patients) showed an independent significantly worse prognosis with regard to overall survival and disease-free survival. HLA class I expression had no effect on cancer-specific survival or recurrence-free survival. Conclusions Down-regulation of HLA class I in rectal cancer is associated with poor prognosis. In contrast to our results, previous reports on HLA class I expression in colorectal cancer described a large population of patients with HLA class I negative tumors, having a good prognosis. This difference might be explained by the fact that a large proportion of HLA negative colon tumors are microsatellite instable (MSI). MSI tumors are associated with a better prognosis than microsatellite stable (MSS). As rectal tumors are mainly MSS, our results suggest that it is both, oncogenic pathway and HLA class I expression, that dictates patient’s prognosis in colorectal cancer. Therefore, to prevent confounding in future prognostic analysis on the impact of HLA expression in colorectal tumors, separate analysis of MSI and MSS tumors should be performed. Frank M. Speetjens and Elza C. de Bruin contributed equally to this work. Cornelis J.H. van de Velde is the Chairperson of the Total Mesorectal Excision Trial.     

Clinical aspects of ECL-cell abnormalities.

ECL cell hyperplasia results from hypergastrinemia, and in man this occurs due to achlorhydria in atrophic gastritis (pernicious anemia [PA]) and gastrinoma (Zollinger-Ellison syndrome [ZES]). Progression to neoplasia, i.e., ECL cell carcinoids (usually small, multicentric and non-functional), occurs in some five to 10 percent of patients with PA where they remain gastrin-dependent and reversible by normalization of serum gastrin by antrectomy. Even if untreated, the carcinoids are almost invariably benign and do not cause death. In ZES, ECL cell hyperplasia is progressive due to hypergastrinemia. However, carcinoids develop only in the MEN-I subtype but pose no additional threat of malignancy. A conservative approach is recommended for small multicentric carcinoids, and the tumors do not need removal. By contrast, single, large, non-gastrin-dependent carcinoids represent a different biological and clinical problem and are frequently malignant.     

Application of endoscopy in pediatric and adolescent gynecology

Early proper diagnostics and treatment of developmental age pathologies in most cases facilitate correct sex organ development, as well as reproductive functions formation. To make the foregoing possible, it is necessary to apply minimally invasive and safest methods like vaginoscopy, hysteroscopy and laparoscopy. The main application field of vaginoscopy and hysteroscopy in pediatric and adolescent gynecology is the diagnosis and treatment of vulvar and vaginal pathologies and developmental anomalies of sex organ. The laparoscopy is becoming a more and more popular method in the treatment of adnexal tumors in children, due to its little invasiveness, quick recovery and less severe pain complaints after the surgery. The application of these endoscopic procedures should always be preceded by the complex noninvasive diagnostics, such as ultrasonography and magnetic resonance imaging. The endoscopic procedures facilitate wide-ranging diagnostics and simultaneously therapeutic management, ensuring minimal invasion and high safety of the surgery. They should be considered diagnostics and treatment of choice in the pathology of vulva, vagina, developmental anomalies of sex organ and adnexal tumors in patients of the developmental age.     

AIMS65评分联合血清GAS、PGE2、BAR对急性非静脉曲张性上消化道出血患者预后的评估价值

摘要 目的：探讨AIMS65评分联合血清胃泌素（GAS）、前列腺素E₂（PGE₂）、血尿素氮/白蛋白比值（BAR）对急性非静脉曲张性上消化道出血（ANVUGIB）患者内镜下止血治疗后预后的评估价值。方法：选取2020年5月～2022年5月北京市和平里医院消化内科收治的108例的ANVUGIB患者,根据患者住院28 d内的预后分为预后不良组和预后良好组。收集患者临床资料,检测血清GAS、PGE₂水平和计算AIMS65评分、BAR。采用单因素和多因素Logistic回归分析ANVUGIB患者内镜下止血治疗后预后不良的影响因素,受试者工作特征（ROC）曲线分析AIMS65评分、GAS、PGE₂和BAR对ANVUGIB患者内镜下止血治疗后预后不良的评估价值。结果：108例ANVUGIB患者预后不良发生率为37.96％（41/108）。单因素分析显示,预后不良组年龄大于预后良好组,心率、休克指数、AIMS65评分、GAS、BAR高于预后良好组,PGE₂水平低于预后良好组（P均＜0.05）。多因素Logistic回归分析显示,年龄增加和休克指数、AIMS65评分、GAS、BAR升高为ANVUGIB患者内镜下止血治疗后预后不良的独立危险因素,PGE₂升高为其独立保护因素（P均＜0.05）。ROC曲线分析显示,AIMS65评分联合GAS、PGE₂和BAR评估ANVUGIB患者内镜下止血治疗后预后不良的曲线下面积大于AIMS65评分、GAS、PGE₂和BAR单独评估。结论：预后不良的ANVUGIB患者AIMS65评分、GAS、BAR均高于预后良好的患者,AIMS65评分联合GAS、PGE₂和BAR评估ANVUGIB患者内镜下止血治疗后预后的价值较高。     

Submandibular gland tumors.

Tumors involving the submandibular gland are rare. However, the incidence of malignancy is much higher than in the parotid (approaching 50 percent). In addition, the 5-year survival rate in patients with malignant tumors of the submandibular gland is much poorer in our series--28 percent versus 71.8 percent for the parotid gland. Because of the poor prognosis in patients with malignant tumors involving the submandibular gland we feel that composite resections should be carried out for all tumors except low-grade mucoepidermoid tumors. In addition, postoperative radiation should be given for specific indications (detailed in the article).     

Prognostic role and therapeutic susceptibility of cathepsin in various types of solid tumor and leukemia: A systematic review

Cathepsins (CTSs) are multifunctional proteins that can play prominent roles in cancer progression and metastasis. In this systematic review, we compared the prognosis of CTS subtypes overexpression in leukemia and solid tumors, and investigated the effect of different factors on CTS prognosis. We systematically searched published articles indexed in PubMed, Scopus, Cochrane library, ISI Web of Science, and EmBase databases from February 2000 until January 2020. Among the selected leukemia and solid tumors studies, overexpression of CTS subtypes in newly diagnosed and treated patients were with poor prognosis in 43 studies (79.6%) and with good prognosis in 9 studies (16.6%). However, there were 2 studies (3.8%) with either good or poor prognosis, depending on conditions and caner stage and host cell. The relation between CTS and human leukocyte antigen (HLA) in leukemia and solid tumors was mentioned in 7 studies (13%). Overexpression of CTS subtypes in all new case patients had contributed to the induction of poor prognosis. It seems that CTS subtypes, based on the type of cancer and its stage, the type of host cells, and the probable relation with HLA, breed good or poor prognosis in patients with cancer. Therefore, monitoring the overexpression of CTS subtypes and determining the effect of each of these factors on CTS prognosis could be helpful in predicting cancer prognosis both in newly diagnosed or under treatment patients. They could also be useful in finding ways for improving the efficiency of contemporary therapeutic strategies in various types of leukemia and solid tumors.     

Long-term postoperative follow-up in patients with apparently benign pheochromocytoma and paraganglioma

Patients with pheochromocytoma or paraganglioma are at risk of developing tumor recurrences or new tumors after successful resection of the primary tumor. This review summarizes current knowledge concerning the incidence and risk factors for such events. The overall incidence exceeds 15%. Patients with inherited tumors have a higher probability of recurrence or new tumors. Most recurrences are metastatic, particularly in patients with SDHB mutations or nonhereditary tumors. We recommend the determination of plasma or urinary metanephrines (normetanephrine and metanephrine) 1 month after surgery. In patients with sporadic, single tumors ≤5 cm in diameter, clinical and biochemical follow-up should be performed every 2 years. However, this follow-up period can be reduced to yearly, if it is more simple and more convenient for patients and physicians. Patients with larger or multiple but apparently benign tumors and/or inherited disease should be tested 6 months after surgery and then every year for the rest of their lives. Imaging follow-up is also required in patients with inherited or malignant tumors.     

Diagnosis and management of tumors of the adrenal medulla.

The adrenal medulla consists of chromaffin cells, the site of catecholamine biosynthesis. Pheochromocytomas are chromaffin-cell tumors; 80-85 % arise from the adrenal medulla and 15-20 % arise from extra-adrenal chromaffin tissues (paragangliomas). Neuroblastomas are primitive tumors that derive from the same blastic precursor as in pheochromocytomas, and are distributed along the sympathetic nervous system. Pheochromocytomas account for 6.5 % of incidentally discovered adrenal tumors; they are found in 50 % of patients with multiple endocrine neoplasia 2A (MEN 2A) and 5-25 % of patients with von Hippel-Lindau (VHL) syndrome. Neuroblastomas are the most common solid extra-cranial tumors in children, and account for 7-10 % of all tumors. The diagnosis of pheochromocytoma should first be established biochemically by measuring plasma free metanephrines (the measurement of urinary fractionated metanephrines is the second choice). Measurements of homovanillic acid (HVA), norepinephrine and vanilmandelic acid (VMA) in urine are a necessity in patients with suspected neuroblastoma. Anatomical (radiological) imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is necessary for both pheochromocytomas and neuroblastomas. Functional (nuclear medicine) methods are useful for both tumors. Scintigraphy with [123I]-metaiodobenzylguanidine is the specific functional imaging test of first choice; if this is not available, scintigraphy with [131I]-MIBG is the second choice. Other newer specific modalities that have been used for evaluating pheochromocytomas include positron emission tomography (PET) with [18F]-F-fluorodopamine (F-DA) and [18F]-F-dihydroxyphenylalanine (DOPA). These should be used when MIBG scintigraphy is negative. Primary treatment for both types of tumor is surgical; chemotherapy is used for inoperable disease. After successful surgery, survival of patients with benign, sporadic pheochromocytomas is believed to be equal to that of the general population. Depending on the extent of disease and age, patients with neuroblastomas have cure rates of 15-90 %.     

经内镜逆行胰胆管造影术后急性胰腺炎患者的血浆白蛋白水平的变化与预后的相关性

摘要 目的：探讨经内镜逆行胰胆管造影术前后急性胰腺炎患者的血浆白蛋白水平的变化与预后的相关性。方法：2015年8月到2019年1月选择在本院诊治的急性胰腺炎患者68例,根据治疗方法的不同分为经内镜逆行胰胆管造影(encoscopic retrograde cholangio pancreatography,ERCP)组和保守治疗组,同期选择在本院进行体检的非胰腺炎患者34例作为对照组。ERCP组患者都给予经内镜逆行胰胆管造影手术治疗,保守治疗组给予内科保守治疗。记录血浆白蛋白水平变化情况,及预后并进行相关性分析。结果：ERCP组和保守治疗组入院时的白细胞计数、中性粒细胞计数、C-反应蛋白、降钙素原均显著高于对照组,淋巴细胞计数、白蛋白均显著低于对照组(P<0.05),且上述指标ERCP组和保守治疗组变化无统计学意义 (P>0.05)。在ERCP组和保守治疗组中,术后1 d血浆白蛋白水平低于术前1 d(P<0.05),但是术后3 d、术后7 d显著高于术前1 d,且ERCP组术后术后3 d、术后7 d血浆白蛋白水平显著高于保守治疗组 (P<0.05)。在ERCP组治疗的总有效率显著高于保守治疗组（P<0.05）;两组并发症发生率对比无统计学意义（P>0.05）。在ERCP组中,选取白蛋白、降钙素原水平等因素,通过logistic回归分析证实白蛋白、降钙素原为影响患者预后的主要危险因素(P<0.05)。结论：急性胰腺炎患者经内镜逆行胰胆管造影手术前后血浆白蛋白水平有显著波动,白蛋白、降钙素原与患者预后显著相关,可预测患者的预后。     

Thymoma: a clinico pathological study of 21 cases and assessment of prognostic features

This is a retrospective and comprehensive study of 21 cases of thymoma treated during a period of 30 years (1954-1984). The tumors were staged into 3 categories: stage 1 for encapsulated completely resectable tumor, stage 2 for nonresectable intrathoracic tumor and stage 3 for tumor with extrathoracic spread. According to their lymphocytic content tumors were separated into 3 groups: 1) predominantly epithelioid (PE); 2) mixed cellular (MC) and predominantly lymphocytic (PL). Incidence of recurrence and survival were correlated with various treatment modalities. The tumor occurred in all age groups with highest incidence in the fourth decade. Six cases were asymptomatic. Myasthenia gravis was present only in one case. The most important prognostic factor was the stage of the tumor. Five-year survival was 69% for stage 2 and 0% for stage 3. All 12 patients who died with evidence of residual disease had PE tumors. Lymphocytic participation might be indicative of a residual functional competence and appears to confer a more favourable prognosis. This is a tumor of uncertain malignant potential which should be excised or debulked, and staged. Post-operative radiotherapy appears to prevent recurrence and improve the prognosis in stage 2. No therapeutic benefits were seen in the stage 3 cases. The value of chemotherapy is uncertain.     

Long-Term Prognostic Analysis after Endoscopic Endonasal Surgery for Olfactory Neuroblastoma: A Retrospective Study of 13 Cases

ObjectivesTo summarize the characteristics and long–term outcomes of olfactory neuroblastoma through the analysis of 13 cases in single institution, with the assessment of treatment modality, prognostic factors.MethodA retrospective study of thirteen cases diagnosed as olfactory neuroblastoma and underwent combined treatments during the period 2000–2010. Statistical analysis was performed to search for prognostic factors and compared different treatment modalities.Results13 patients were enrolled in this study, including 8 male and 5 female, ranging from 15 to 69 (median 43) years old. One patient at stage A was only treated with endoscopic endonasal surgery (EES). Seven patients were treated with preoperative radiotherapy and EES, two with EES and postoperative radiotherapy, and the other three with combined radiotherapy and chemotherapy. The range of follow-up time varied from 23 to 116 months (median 65 months). The 5-year overall survival rate was 46.2% (6/13). To date, these thirteen patients have not suffered local recurrences while two patients had lymph node recurrences and one had distant metastasis in the bone marrow. In 13 patients, 61.5% were diagnosed as late T stage (T3/4), 69.2% late Kadish stage (C/D) and 53.8% were high Hyams grade (I/ II), which indicated poor prognosis. Related prognostic factors were the TNM stage (T stage P = 0.028, N stage P = 0.000, M stage P = 0.007), Kadish stage (P = 0.025) and treatment modality (P = 0.015).ConclusionLate stage of TNM and Kadish staging system indicated a poor prognosis. Combined treatment modality, including endoscopic endonasal surgery, achieved a better outcome than non-surgical approach.     

Neuroendocrine tumors of the small intestine and the appendix - management guidelines (recommended by The Polish Network of Neuroendocrine Tumors)

Polish recommendations regarding management of patients suffering from neuroendocrine tumors of small intestine and appendix are presented. Small intestine, especially ileum represent most common origin of these tumors. Majority of them are well differentiated and grow slowly. Rarely, they are less differentiated with fast growth and poor prognosis. Symptoms are atypical, diagnosis could be often accidental. In 4-10% of patients typical symptoms of carcinoid syndrome are present. Chromogranin A is useful in the laboratory diagnostics, and urinary excretion of 5-hydroxyindoloacetic acid is helpful for the diagnostics and monitoring of the disease. Histopathological diagnostics was extensively described. Ultrasound, colonoscopy, capsule endoscopy, baloon enteroscopy, computed tomography, magnetic resonance and somatostatin analogs scintigraphy could be used for the visualization. The treatment of choice in the neuroendocrine tumors of small intestine and appendix is radical or palliative surgery, if possible using endoscopy. Pharmacotherapy consists of biotherapy and chemotherapy. The crucial in biotherapy is somatostatin analogs application, possible in symptomatic treatment of hormonally functioning tumors. This is treatment of choice in carcinoid crisis. Interferon alfa could be applied because of the same indications as somatostatin analogs, except for carcinoid crisis. Chemotherapy is less successful in disseminated or locally advanced intestinal neuroendocrine tumors, so radioisotope therapy should be considered in each case of unresectable tumor.     

New trends in CLL treatment

We review here results obtained from the various treatment modalities that have been used in CLL patients: chemotherapy; radiotherapy; splenectomy; leukapheresis; monoclonal antibodies and other immunomodulating agents. We conclude that it is still unclear whether patients in stage A (good prognosis) should be treated; intermediate forms of the disease (stage B) should, in most cases, be treated, but a better treatment than chlorambucil has not emerged; results from the Cooperative Group on CLL of Société Fran?aise d'Hématologie indicate that significant progress in the therapy of the advanced stage (stage C) has been achieved with the introduction of the CHOP regimen, using low doses of adriamycin; radiotherapy, splenectomy and immunomodulators such as levamizol, interleukins or interferons, and possibly monoclonal antibodies, are now being actively tested; the results are not yet conclusive.     

Diagnostic and therapeutic difficulties in MEN 1 syndrome

MEN 1 syndrome (Multiple Endocrine Neoplasia type 1) is a rare endocrine disorder characterized by the association of tumors in several endocrine glands, mainly in parathyroids, gut and pituitary. At our institution in the years 1982-2004 we have followed 26 patients with MEN 1 syndrome belonging to 19 families. The diagnosis of MEN 1 was based on Gubbio Consensus (JCEM 86: 5658-5671, 2001). Mean age at the diagnosis of MEN 1 was 35 years. Primary hyperparathyroidism was the most frequent pathology, which was diagnosed in 25 of 26 patients (96%). Gut endocrine tumors were found in 20 patients (77%), while pituitary tumors in 18 (70%). Non-functioning gut tumors were most frequent (n=9), followed by insulinoma (n=7) and gastrinoma (n=4). Prolactinoma was the most frequent pituitary tumor found in 12 patients (67%). Three patients died during the observation period - all of them of generalized gut endocrine tumor (gastrinoma in 2 cases and foregut carcinoid in one case). The management of MEN 1 is not easy and careful analysis of clinical picture is necessary in each individual case. Several important observations can be made on the basis of own experience and the literature: 1. In each sporadic pathology, which may be a part of MEN 1, one should consider. the possibility of MEN 1. The individual MEN 1 abnormalities are often diagnosed after 40 and later 2. MEN 1 tumor are usually multiple thus necessitating a different therapeutic approach (more radical surgery) 3. The most valuable screening tests are: Ca++, PP, CgA and prolactin 4. Endoscopic ultrasound is the most specific method for the localization of pancreatic endocrine tumors. 5. The results of surgical treatment of MEN 1 tumors are worse than that of sporadic tumors. 6. Prognosis in MEN 1 is determined by the behaviour of gut neuroendocrine tumor 7. No genotype/phenotype correlation in MEN 1 syndrome was found so far. In summary, it should be underlined that MEN 1 syndrome is an endocrine disorder, in which early diagnosis and optimal treatment may significantly improve the prognosis.     

巨大垂体腺瘤经蝶手术后发生脑脊液鼻漏的危险因素分析

目的：探讨巨大垂体腺瘤经蝶手术脑脊液鼻漏的发病原因,并提出相关的修补措施。方法：选择2009 年2 月-2012年8 月在我院进行诊治的巨大垂体腺瘤患者180 例,所有患者均采用经蝶手术摘除巨大垂体腺瘤。观察预后情况。结果：在接受经蝶手术的180 例患者中,25例发生脑脊液鼻漏,发生率为13.8%。其中男性15例,女性10例。单因素多因素分析都显示肿瘤大小、慢性蝶窦炎与再次手术与脑脊液鼻漏的发生有直接关系,为独立的影响因素（P〈0.05）。对25 例出现脑脊液鼻漏的患者采用鼻内镜手术进行治疗,全部病例经手术修复后获得一次性治愈。随访6个月,无1例复发,无术后并发症。结论：巨大垂体腺瘤经蝶手术脑脊液鼻漏的发病率比较高,肿瘤大小、慢性蝶窦炎与再次手术为主要的独立危险因素,要积极采用鼻内镜下治疗。     

Current treatment of melanoma metastases of the brain

The appearance of brain metastases in patients with malignant melanoma predicts poor prognosis. During the last ten years important progress has been made in the treatment of brain metastases providing longer survival and better quality of life for these patients. In this review article the different treatment modalities, surgery, radiosurgery, radiation therapy and chemotherapy are described and the results published in the literature are briefly presented. Emphasis is made to show the effectiveness of a multimodality approach of this group of patients resulting in a better clinical outcome.     

三镜联合手术方案治疗胆道结石患者的临床疗效及预后情况分析

目的:研究三镜联合手术方案治疗肝外胆道结石患者的临床疗效及预后情况分析。方法:选择从1999年5月至2014年5月在我院接受治疗的肝外胆道结石患者300例进行回顾性分析。所有患者均接受三镜联合手术方案治疗,290例患者成功接受手术,其中先行经内镜十二指肠乳头造影/切开术(ERCP/EST),然后行腹腔镜胆囊切除术(LC)(先ERCP/EST后LC组)103例,先行LC,然后行ERCP/EST(先LC后ERCP/EST组)73例,同时行LC和ERCP/EST(LC与ERCP/EST同时组)114例。分析患者整体手术情况,对比各组手术相关指标、结石取出情况及并发症。结果:300例患者中,10例因结石过大、缩窄乳头炎、出血及怀疑胆囊癌因素中转开腹。三组手术时间、术中出血量、住院时间与住院费用指标相比,差异均无统计学意义(均P0.05),成功取出结石率及并发症发生率三组相比,差异均无统计学意义(均P0.05)。结论:通过不同手术顺序的三镜联合手术方案治疗肝外胆道结石,临床疗效及患者的预后情况均较好,值得在临床推广应用。