目的 总结高龄胆道疾病患者的治疗经验。方法 对近2年来我科收治的60岁以上因胆道疾病入院的急、择期手术患者的临床资料进行了回顾性分析。结果 本组235例中行急诊手术78例(33.2%)，择期手术167例(71.1%)； 合并各种内科疾病者147例，占62.6%，其中以心血管疾病最多，71例(48.3%)，其次为呼吸系统疾病，54例(36.7%)； 术后并发症发生率为23.0%(54/235)，在并发症中以肺部感染发生率最高，占42.6%(23/54)，其次为泌尿道感染，占33.3%(18/54)，再其次为切口感染，占29.6%(16/54)； 全组术后近期死亡7例，占3.0%，其中死于肝、肾功能衰竭4例，呼吸衰竭2例，心衰1例。结论 高龄胆道疾病患者合并疾病多，手术风险性增加，术后并发症发生率较高，因此应加强围手术期的监护与处理，确保患者平安度过手术期。
Objective To study the mechanism of high intensity focused ultrasound (HIFU) and discuss its clinical significance in the treatment of mid-late stage liver cancer. Methods The patients with mid-late stage liver cancer were treated with HIFU. The changes of photography, pathology and immunology after operation were evaluated. Results It was shown that the results of the photographic, pathologic and immunologic examinations changed during the treatment of the patients with HIFU. Conclusion HIFU is effective and safe for the treatment of mid-late stage liver cancer.
Objective To assess the survival of patients receiving high intensity focused ultrasound (HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma (PHCC) victims with HIFU application. Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007. Among them, 101 patients were males and 86 were females (mean age: 47.7 years old, range: 19-79 years old). The average tumor size was 5.7 cm (range: 0.5-18.0 cm). Of these 187 patients, numbers according to Child-Pugh grade of A, B and C were 104, 52 and 31, respectively. According to TNM system, 45, 111 and 31 patients were in stage Ⅱb, Ⅲa and Ⅲb respectively. Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. Results Survival period was (17.3±2.5) months after HIFU treatment of PHCC. The overall survival rate of 3-month, 6-month, 1-year and 2-year were 79.1%, 60.1%, 35.7%, and 29.3%， respectively. It was significant that tumor number (P=0.02), size (P=0.04)， AFP (P=0.04)， Child-Pugh grade (P=0.00)， TNM stage (P=0.01)， tumor metastasis (P=0.03) before HIFU， and tumor recurrence after HIFU (P=0.02) and standard treatment (P=0.02) were prognostic factors by single factor analysis. The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol (P=0.000), and TNM stage (P=0.004) and Child-Pugh grade (P=0.009) before HIFU. Conclusion It is used for improving overall survival rate to found PHCC early, protect liver function, examine comprehensively before HIFU treatment, focus on standard treatment and auxiliary treatment.