1.Clinical research of percutaneous liver way hard mirror gravel for the treatment of hepatolith surgery path selection
Ping WANG ; Zhaoshan FANG ; Beiwang SUN ; Jiafen XIE ; Yanmin LIU ; Chen YE
The Journal of Practical Medicine 2014;(20):3245-3247,3248
Objective To compare the clinical treatment effects, advantages and disadvantages,and clinical application value of percutaneous liver mirror of gravel (PTCSL) treating hepatolith in two different paths, and provide the reference for the future operations. Methods 81 patients with liver and gallbladder stones form March 2007 to July 2007 were selected, and they were randomly divided into observation group and control group. Observation group take colostomy lithotomy method, which is the one step colostomy lithotomy method, while the control group take two-step methods. Then stone-taking net rate, incidence of complications and hospitalization time were compared between two groups of patients after the treatment cycle of the bleeding. Results After the treatment, statistical results showed that calculi net rate, incidence of complications and length of hospital stay in two groups of patients were not significantly differences (P > 0.05). But the blood loss by the method of one-step colostomy lithotomy in observation group was obviously lower than by the two-step method in control group (P<0.05). Conclusions In clinical, percutaneous liver way mirror lithotripsy (PTCSL) is a more effective method for treatment of hepatolith, two kinds of surgical methods on the path in the clinical treatment effect and complications of the control aspect have the obvious curative effect, but the one-step method of colostomy lithotomy has less blood loss, which under certain conditions can be considered as the choice of operation.
2.Percutaneous transhepatic one-step biliary fistulation lithotomy combined with laparoscopic cholecystectomy for choledocholithiasis with gall stones
Canhua ZHU ; Beiwang SUN ; Ping WANG ; Yanmin LIU ; Yanjun LUO ; Jiafen XIE ; Xinghua ZHOU
Chinese Journal of General Surgery 2021;36(3):178-181
Objective:To evaluate the clinical value of percutaneous transhepatic one-step biliary fistulation(PTOBF)lithotomy plus laparoscopic cholecystectomy(LC) in the treatment of choledocholithiasis combined with cholecystolithiasis.Methods:From Jul 2012 to Jun 2018, 44 patients with cholecystolithiasis and choledocholithiasis were treated by PTOBF + LC ( n=20) vs laparoscopic common bile duct exploration(LCBDE)+ LC( n=24). Results:The success rate of one-step operation in both groups was 100%.The average intra-operative hemorrhage and the average hospital stay after operation were higher in LCBDE+ LC group (all P<0.05). The post-operative complication rate of PTOBF lithotomy + LC group was 10.0% (2/20), recurrence rate of observation period was 10.0% (2/20), while that of LCBDE+ LC group was 8.3% (2/24), and 12.5% (3/24), the difference was not statistically significant (all P>0.05). Conclusion:PTOBF lithotomy combined with LC is a safe, effective and feasible minimally invasive method for the treatment of choledocholithiasis combined with gall stones.
3.Clinical analysis of elderly patients with anti-MDA5 antibody-positive dermatomyositis
Jia WANG ; Jiafen LIAO ; Ni MAO ; Qi TANG ; Shu LI ; Fen LI ; Jinwei CHEN ; Xi XIE
Chinese Journal of Geriatrics 2022;41(9):1066-1070
Objective:To retrospectively analyze the clinical characteristics of elderly patients with anti-MDA5 antibody-positive dermatomyositis.Methods:Data of 62 patients with anti-MDA5 antibody-positive dermatomyositis admitted to Second Xiangya Hospital from May 2016 to December 2019 were collected and patients were divided into an elderly group(≥60 years old, 17 cases)and a non-elderly group(<60 years old, 45 cases). The clinical manifestations, laboratory test resuls, treatment and prognosis of the patients in both groups were statistically analyzed.Results:A total of 62 patients with anti-MDA5 antibody-positive dermatomyositis were included in this study, including 17 elderly patients(27.4%)with an average age of(65.5±5.3)years and 45 non-elderly patients(72.6%)with an average age of(46.5±8.4)years.Compared with non-elderly patients, older patients had a shorter disease duration[(1.6±1.0)months vs.(3.7±3.3)months, t=3.883, P<0.001], a higher proportion of patients with exertional dyspnea(15/17 or 88.2% vs.26/45 or 57.8%, χ2=5.11, P=0.024)and with combined positive anti-Ro-52 antibodies(15/17 or 88.2% vs.26/45 or 57.8%, χ2=5.11, P=0.024), and a higher mortality rate[(12/17 or 70.6%) vs.(8/45 or 17.8%, χ2=15.748, P<0.001)]. In contrast, fewer elderly patients than non-elderly patients had the Heliotrope's sign(9/17 or 41.2% vs.38/45 or 57.8%), χ2=5.07, P=0.024). Conclusions:Elderly patients with anti-MDA5 antibody-positive dermatomyositis have a unique clinical phenotype with an acute onset, atypical rashes, severe pulmonary lesions, making treatment difficult, and have a poor prognosis.