Résumé
Purpose@#Spontaneous rupture is a potentially serious complication of liver cancer. A risk score was developed and validated for predicting spontaneous rupture based on a retrospective study. @*Methods@#Multiple logistic regression analysis was used to study the relationship between clinical variables and spontaneous rupture. The independent rupture predictors were converted into a score based on the odds ratio. Predicted attributes of the developed scores were then verified using a dataset in 2019. @*Results@#The incidence of spontaneous rupture was 5.5% from 2002 to 2019. A 10-point score (α-FP of ≥400 μg/L, 1; protrusion from liver surface, 2; ascites, 3; tumor size of >5 cm, 4) was derived for prediction of rupture and area under the receiver-operating characteristic curve was 0.9 (95% confidence interval, 0.87–0.92). When applying a cutoff value of 5 points or more, the specificity was 0.87 and the sensitivity was 0.84. A validation cohort consisting of 202 hepatocellular carcinoma patients reproduces the predictive, identification, and calibration characteristics. The observed rate of spontaneous rupture according to risk stratification of the score was 0.6% for those with a score of 0–4, 21.6% for a score of 5–7, and 36.4% for a score of 8–10 in the validation cohort. @*Conclusion@#Here, based on routine clinical data, we determine the factors that affect prognosis and propose an effective tool for predicting spontaneous rupture, which may be useful in guiding priority treatment of high-risk patients or clinical routine preventive treatment.
Résumé
Three patients with nutcracker syndrome (NCS) were enrolled in the study. Their clinical symptoms mainly included proteinuria and serious varicocele. Color Doppler ultrasound and computed tomography showed that the patients had constricted abdominal aortas, reduced superior mesenteric artery angles, and thinned left renal veins. Patients then underwent left spermatic vein ligation and iliac vein anastomosis. They were checked three months after their operation, and results showed that their sperms were improved and their proteinuria disappeared. The color Doppler ultrasound showed new cycle pathways. NCS clinical manifestations are complicated, and need combination diagnosis of symptoms and auxiliary examination to determine surgical indications. Ligation of spermatic vein and vein anastomosis can be used to treat NCS.