肝性脑病(Hepatic Encephalopathy, HE)是由严重肝功能障碍或门体分流引起的脑功能紊乱,主要表现为意识障碍、记忆力下降以及注意力不集中等缺陷的神经或精神方面的改变。常见于肝硬化、急性肝衰竭等患者。基于肝性脑病的发病机制尚未...肝性脑病(Hepatic Encephalopathy, HE)是由严重肝功能障碍或门体分流引起的脑功能紊乱,主要表现为意识障碍、记忆力下降以及注意力不集中等缺陷的神经或精神方面的改变。常见于肝硬化、急性肝衰竭等患者。基于肝性脑病的发病机制尚未明确且药物治疗旨在减少氨的产生和吸收,改善症状并预防复发存在一定的局限性,并对患者的经济条件有较大的损耗。因此,笔者从中医和西医两个方向对治疗肝性脑病的药物进行综述,为寻找有效且符合患者经济条件的药物提供重要临床参考依据。Hepatic encephalopathy (HE) is a disorder of brain function resulting from severe hepatic insufficiency or portosystemic shunt, primarily manifested as neurological or psychiatric alterations including impaired consciousness, decreased memory, and inattention. It is commonly seen in patients with conditions such as liver cirrhosis and acute liver failure. Given that the pathogenesis of HE remains unclear and that pharmacological treatments, aimed at reducing ammonia production and absorption, alleviating symptoms, and preventing recurrence, have certain limitations and impose significant financial burdens on patients, the author conducted a comprehensive review of medications used in the treatment of HE from both traditional Chinese medicine (TCM) and western medicine perspectives. This review provides important clinical reference for identifying effective treatments that are also economically viable for patients.展开更多
目的探讨内镜下逆行胰胆管造影术(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法2020年1月~2023年1月我院收治的AOSC患者103例,其中观察组58例接受ERCP治疗,对照组45例接受开腹手术治疗。采用视觉模拟评分法(VAS)评估疼痛程度...目的探讨内镜下逆行胰胆管造影术(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法2020年1月~2023年1月我院收治的AOSC患者103例,其中观察组58例接受ERCP治疗,对照组45例接受开腹手术治疗。采用视觉模拟评分法(VAS)评估疼痛程度,采用ELISA法检测血清白细胞介素(IL)-6、IL-1、肿瘤坏死因子(TNF)-α和C反应蛋白(CRP)水平。结果观察组术中出血量、手术时间、术后3 d VAS评分和术后住院日分别为(30.7±4.6)mL、(74.3±8.8)min、(3.1±0.8)分和(7.2±1.4)d,均显著短于或少于对照组【分别为(85.4±10.2)mL、(117.6±12.5)min、(4.9±1.1)分和(13.3±3.7)d,P<0.05】;在术后5 d,观察组血清ALT和GGT水平分别为(48.2±4.1)U/L和(163.9±17.2)U/L,均显著低于对照组【分别为(66.9±5.3)U/L和(189.6±21.5)U/L,P<0.05】;观察组血清IL-6、IL-1、TNF-α和CRP水平分别为(82.6±8.3)ng/L、(20.9±4.0)ng/L、(16.2±3.5)ng/L和(18.1±2.2)mg/L,均显著低于对照组【分别为(100.7±11.2)ng/L、(32.7±5.3)ng/L、(23.6±4.3)ng/L和(32.9±4.8)mg/L,P<0.05】;观察组并发症发生率为5.1%,显著低于对照组的17.8%(P<0.05)。结论采用ERCP治疗AOSC患者效果好,术后恢复快,并发症发生率低,值得临床应用。展开更多
目的:探究肝动脉灌注化疗(HAIC)与肝动脉化疗栓塞术(TACE)在原发性巨块型肝癌治疗中的应用疗效。方法:选择2020年1月至2021年12月在广西中医药大学第一附属医院肝胆外科收治的巨块型肝癌患者的资料,根据患者介入治疗手段的不同将患者分...目的:探究肝动脉灌注化疗(HAIC)与肝动脉化疗栓塞术(TACE)在原发性巨块型肝癌治疗中的应用疗效。方法:选择2020年1月至2021年12月在广西中医药大学第一附属医院肝胆外科收治的巨块型肝癌患者的资料,根据患者介入治疗手段的不同将患者分为HAIC治疗组(研究组)和TACE治疗组(对照组),并采用倾向得分匹配法对两组基线资料进行1:1匹配,配对后比较两组在总治疗有效率、并发症发生率等方面的差异。结果:本研究共收集到符合条件的114例原发性巨块型肝癌患者,其中研究组54例,对照组60例,采用倾向得分匹配法完成匹配60例,每组30例,配对后两组基线资料比较无显著差异(P > 0.05);HAIC组与TACE组比较:两组术后AFP指数均较术前明显降低,HAIC组术后AFP指数较TACE组明显低下(P +指数较TACE组明显高出(P 0.05)。结论:肝动脉灌注化疗和TACE对原发性巨块型肝癌均有疗效,并发症少,但肝动脉灌注化疗能够更快有效控制肿瘤进展,可使肿瘤尽快降期,近期疗效较高,可改善患者预后。Objective: To investigate the therapeutic efficacy of hepatic artery infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE) in the treatment of primary massive hepatocellular carcinoma (HCC). Methods: Data from patients with massive HCC admitted to the Hepatobiliary Surgery Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine between January 2020 and December 2021 were selected. Patients were divided into the HAIC treatment group (study group) and the TACE treatment group (control group) based on their interventional treatment methods. Propensity score matching (PSM) was used to perform 1:1 matching of baseline data between the two groups. After matching, differences in total treatment efficacy rate, complication incidence rate, and other aspects were compared between the two groups. Results: A total of 114 eligible patients with primary massive HCC were included in this study, with 54 in the study group and 60 in the control group. After PSM, 60 patients were matched, with 30 in each group. There were no significant differences in baseline data between the two groups after matching (P > 0.05). Comparison between the HAIC group and the TACE group: The AFP index was significantly lower after surgery compared to before surgery in both groups, and the AFP index was significantly lower in the HAIC group than in the TACE group (P + index was significantly higher in the HAIC group than in the TACE group after surgery (P 0.05). Conclusion: Both HAIC and TACE are effective in the treatment of primary massive HCC with few complications. However, HAIC can more rapidly and effectively control tumor progression, enable rapid tumor downstaging, demonstrate higher short-term efficacy, and improve patient prognosis.展开更多
文摘肝性脑病(Hepatic Encephalopathy, HE)是由严重肝功能障碍或门体分流引起的脑功能紊乱,主要表现为意识障碍、记忆力下降以及注意力不集中等缺陷的神经或精神方面的改变。常见于肝硬化、急性肝衰竭等患者。基于肝性脑病的发病机制尚未明确且药物治疗旨在减少氨的产生和吸收,改善症状并预防复发存在一定的局限性,并对患者的经济条件有较大的损耗。因此,笔者从中医和西医两个方向对治疗肝性脑病的药物进行综述,为寻找有效且符合患者经济条件的药物提供重要临床参考依据。Hepatic encephalopathy (HE) is a disorder of brain function resulting from severe hepatic insufficiency or portosystemic shunt, primarily manifested as neurological or psychiatric alterations including impaired consciousness, decreased memory, and inattention. It is commonly seen in patients with conditions such as liver cirrhosis and acute liver failure. Given that the pathogenesis of HE remains unclear and that pharmacological treatments, aimed at reducing ammonia production and absorption, alleviating symptoms, and preventing recurrence, have certain limitations and impose significant financial burdens on patients, the author conducted a comprehensive review of medications used in the treatment of HE from both traditional Chinese medicine (TCM) and western medicine perspectives. This review provides important clinical reference for identifying effective treatments that are also economically viable for patients.
文摘目的探讨内镜下逆行胰胆管造影术(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法2020年1月~2023年1月我院收治的AOSC患者103例,其中观察组58例接受ERCP治疗,对照组45例接受开腹手术治疗。采用视觉模拟评分法(VAS)评估疼痛程度,采用ELISA法检测血清白细胞介素(IL)-6、IL-1、肿瘤坏死因子(TNF)-α和C反应蛋白(CRP)水平。结果观察组术中出血量、手术时间、术后3 d VAS评分和术后住院日分别为(30.7±4.6)mL、(74.3±8.8)min、(3.1±0.8)分和(7.2±1.4)d,均显著短于或少于对照组【分别为(85.4±10.2)mL、(117.6±12.5)min、(4.9±1.1)分和(13.3±3.7)d,P<0.05】;在术后5 d,观察组血清ALT和GGT水平分别为(48.2±4.1)U/L和(163.9±17.2)U/L,均显著低于对照组【分别为(66.9±5.3)U/L和(189.6±21.5)U/L,P<0.05】;观察组血清IL-6、IL-1、TNF-α和CRP水平分别为(82.6±8.3)ng/L、(20.9±4.0)ng/L、(16.2±3.5)ng/L和(18.1±2.2)mg/L,均显著低于对照组【分别为(100.7±11.2)ng/L、(32.7±5.3)ng/L、(23.6±4.3)ng/L和(32.9±4.8)mg/L,P<0.05】;观察组并发症发生率为5.1%,显著低于对照组的17.8%(P<0.05)。结论采用ERCP治疗AOSC患者效果好,术后恢复快,并发症发生率低,值得临床应用。
文摘目的:探究肝动脉灌注化疗(HAIC)与肝动脉化疗栓塞术(TACE)在原发性巨块型肝癌治疗中的应用疗效。方法:选择2020年1月至2021年12月在广西中医药大学第一附属医院肝胆外科收治的巨块型肝癌患者的资料,根据患者介入治疗手段的不同将患者分为HAIC治疗组(研究组)和TACE治疗组(对照组),并采用倾向得分匹配法对两组基线资料进行1:1匹配,配对后比较两组在总治疗有效率、并发症发生率等方面的差异。结果:本研究共收集到符合条件的114例原发性巨块型肝癌患者,其中研究组54例,对照组60例,采用倾向得分匹配法完成匹配60例,每组30例,配对后两组基线资料比较无显著差异(P > 0.05);HAIC组与TACE组比较:两组术后AFP指数均较术前明显降低,HAIC组术后AFP指数较TACE组明显低下(P +指数较TACE组明显高出(P 0.05)。结论:肝动脉灌注化疗和TACE对原发性巨块型肝癌均有疗效,并发症少,但肝动脉灌注化疗能够更快有效控制肿瘤进展,可使肿瘤尽快降期,近期疗效较高,可改善患者预后。Objective: To investigate the therapeutic efficacy of hepatic artery infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE) in the treatment of primary massive hepatocellular carcinoma (HCC). Methods: Data from patients with massive HCC admitted to the Hepatobiliary Surgery Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine between January 2020 and December 2021 were selected. Patients were divided into the HAIC treatment group (study group) and the TACE treatment group (control group) based on their interventional treatment methods. Propensity score matching (PSM) was used to perform 1:1 matching of baseline data between the two groups. After matching, differences in total treatment efficacy rate, complication incidence rate, and other aspects were compared between the two groups. Results: A total of 114 eligible patients with primary massive HCC were included in this study, with 54 in the study group and 60 in the control group. After PSM, 60 patients were matched, with 30 in each group. There were no significant differences in baseline data between the two groups after matching (P > 0.05). Comparison between the HAIC group and the TACE group: The AFP index was significantly lower after surgery compared to before surgery in both groups, and the AFP index was significantly lower in the HAIC group than in the TACE group (P + index was significantly higher in the HAIC group than in the TACE group after surgery (P 0.05). Conclusion: Both HAIC and TACE are effective in the treatment of primary massive HCC with few complications. However, HAIC can more rapidly and effectively control tumor progression, enable rapid tumor downstaging, demonstrate higher short-term efficacy, and improve patient prognosis.
