腹部损伤延迟性脾破裂40例诊治分析

目的探讨腹部损伤延迟性脾破裂的诊治方法。方法对1996年1月～2005年12月收治腹部损伤延迟性破裂40例的临床资料进行回顾性分析，结果保守治疗10例（25％），30例患者均行手术治疗（75％），无1例发生并发症。结论手术治疗是延迟性脾破裂常选用的治疗方法，保守治疗应严格掌握治疗指征。     

B超检查对外伤性脾破裂的诊治意义

中对52例外伤性脾破裂进行B超检查。根据B超检查结果及其临床情况，38例立即手术治疗，14例保守治疗。在保守治疗过程中，通过B超复查等临床观察，有4例及时中轻手术。手术病例中，B超脾破裂诊断符合率92．9％，腹腔内出血诊断符合率97．6％。本就B超检查对脾破裂的鉴别诊断及治疗指导意义和价值，以及B超检查的安全性进行了讨论。     

外伤性脾破裂29例非手术治疗体会

目的 探讨外伤性脾破裂的非手术治疗适应证及临床效果。方法 对非手术治疗29例外伤性脾破裂的临床资料进行分析。结果 非手术治疗成功27例（93．1％），住院时间为8-32d，平均16d，27例出院后经随访（3个月～2年，平均1.4年）及CT检查。证实脾破裂已愈合，无并发症发生。其余2例于入院后72h出现迟发性出血中转手术治疗。结论 非手术治疗外伤性脾破裂是保脾治疗的一项重要措施，只要严格掌握适应证，此方法还是较安全的。     

外伤性脾破裂40例非手术治疗经验

目的 总结外伤性脾破裂非手术治疗的临床经验。方法 总结分析Ⅰ级脾损伤程度的40例非手术保脾的治疗经验。结果 除2例因治疗中于第3、5d出现活动性出血而中转手术治疗外，其余均非手术治疗成功，成功率为95％。住院时间8～20d，平均15d。38例出院3月后B超、CT复查均证实脾破裂已愈合．随访3月至半年，无1例再出血。结论 非手术治疗外伤性脾破裂具有可行性，合理掌握适应症，避免不必要的手术．避免了因切脾而出现的凶险性感染等，降低了患者的住院费用，节省了人力、物力。     

外伤性脾破裂18例非手术治疗体会

目的 总结外伤性脾破裂非手术治疗的适应症及临床效果。方法 回顾性分析18例外伤性脾破裂非手术治疗的临床资料。结果 非手术治疗成功17例（94．4％），中转手术治愈1例，住院时间9～21d，平均15d。结论 非手术治疗外伤性脾破裂是保脾的一项重要措施，只要严格掌握适应症，严密观察病情变化，此方法是比较安全的。     

外伤性脾破裂保脾治疗的探讨

探讨外伤性脾破裂保脾治疗的临床经验。分析了63例外伤性脾破裂保脾治疗的方法和治疗效果。12例保守治疗治愈，51例手术保脾的患者无一例切口感染，无腹腔内感染，切口一期愈合，对外伤性脾破裂患者，有条件的情况下，应尽可能采用保脾治疗。     

非手术治疗创伤性脾破裂112例分析

目的探讨Ⅰ-Ⅳ级外伤性脾破裂治疗方式的选择。方法回顾分析我院近5年来112例Ⅰ-Ⅳ级外伤性脾破裂患者临床资料。结果112例Ⅰ-Ⅳ级外伤性脾破裂患者中一般保守治疗81例，介入栓塞止血11例，急诊开腹手术13例，中断保守治疗行开腹手术7例；入院时查CT腹腔未见游离液体或少量游离液体67例，保脾治疗成功67例；腹腔中量游离液体者45例，保脾治疗成功25例；按美国外伤外科学会AAST分级制订的脾脏损伤程度分级标准，Ⅰ级24例，Ⅱ级30例，Ⅲ级42例，Ⅳ16例。结论有选择的保脾治疗脾破裂是安全、有效的治疗方法，其中入院时血压稳定，腹腔无或少量游离液体者能保持较高的保脾治疗成功率；介入栓塞止血能显著提高保脾治疗的成功率。     

198例脾破裂手术救治体会

脾是腹部外伤中最易受损的脏器，临床所见的脾破裂85％是真性破裂，出血量大，病人可迅速出现休克。脾损伤是常见的急腹症，占腹腔内实质性脏器伤的首位，若未得到及时和正确的处理，甚至可以导致患者的死亡。对脾外伤早期诊断并及时、正确的处理是减少并发症关键。我院于2005年12月-2007年12月共手术治疗脾破裂198例，效果满意，现报告如下。     

保留胃短动脉的保脾手术3例

近年许多文献强调对外伤性脾破裂应尽量采用保留全睥或部分脾组织的保守手术．以保留脾功能。我科自1990年4月～1996年8月共收治外伤性脾破裂102例．采用单纯缝合或部分切除保留脾手术18例。其中采用保留胃短动脉的保留脾手术3例，效果较好现报道如下：     

基层医院诊治外伤性脾破裂32例的体会

目的 总结外伤性脾破裂的诊断与治疗。方法 回顾性分析2000年1月～2006年1月收治的32例外伤性脾破裂的临床资料。结果 非手术治疗8例，脾切除术16例，脾修补术16例，保脾手术2例。全部治愈出院，术后无严重并发症发生。结论 及时诊断和根据外伤情况选择术式是提高临床治愈率的关键。     

1848例妊娠中期羊水细胞染色体核型分析

目的探讨羊水细胞染色体核型分析在妊娠中期产前诊断中胎儿染色体病的必要性和安全性。方法对妊娠19～23周的符合产前指征的孕妇在B超引导下行羊膜腔穿刺术,抽取羊水15～20ml,对羊水中胎儿脱落细胞进行培养、制片、显带,并分析染色体核型。结果在1848例孕妇的羊水染色体检查结果中,异常核型62例,胎儿染色体异常率为3.35%,其中唐氏高风险919例,异常29例,异常检出率3.16%,18-三体高风险128,异常4例,异常检出率3.15%,NTD高风险22例,异常1例,异常检出率4.54%,高龄736例,异常24例,异常检出率3.26%,不良孕产史40例,异常1例,异常检出率2.50%,超声检查淋巴水囊瘤4例,异常3例,异常检出率75.00%。结论在目前技术阶段,羊水细胞染色体培养和核型分析可显著减少染色体病患儿的出生,在产前诊断中有着不可替代的作用。     

超声检查在闭合性腹外伤诊断中的价值

目的 探讨超声检查在诊断闭合性腹外伤中的应用价值。方法 回顾性分析2013年1月~2018年1月在我院经超声检查后手术证实或CT证实的106例闭合性腹外伤患者的声像图表现。结果 106例闭合性腹外伤中95例超声探查到腹腔游离液体,均经手术证实为腹腔脏器挫裂,其中脾挫裂65例,包括延迟性脾挫裂12例,占脾挫裂18.46%。7例误诊,其中肝挫裂伤1例,复合挫裂伤3例,小肠挫裂伤3例。超声诊断与手术符合率为92.63%。11例超声未探及游离液体,均经手术或CT证实为腹腔脏器挫伤或血肿。结论 超声检查对腹腔游离液体检出在闭合性腹外伤的诊断中发挥着重要的作用。     

加长型PFNA治疗老年人股骨近端粉碎性骨折的临床观察

目的观察加长型PFNA(long proximal femoral nail antirotation,PFNA-long)治疗老年患者股骨近端粉碎性骨折的临床疗效。方法自2009年3月~2012年5月在我院28例股骨近端粉碎性骨折老年患者应用加长型PFNA治疗,观察患者手术时间、术中出血量,评估术后髋关节功能恢复情况。结果本组患者手术时间为65~112分钟,平均为74分钟;术中出血400~600ml,平均为500ml;术后随访评估患髋关节功能优良26例,可2例,优良率为92.9%;术后所有患者均未出现退钉、髓内针断裂、切口感染、患肢深静脉血栓形成、骨折不愈合等并发症。结论加长型PFNA是治疗老年患者股骨近端粉碎性骨折的有效方法。     

Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution

PURPOSE: Although many studies have demonstrated improvements in short-and long-term outcomes of gastric cancer surgery, changes in long-term survival over time are not well-established. This study was conducted to evaluate changes in host, tumor, and treatment factors in patients treated at a single institution over a period of 45-yr. PATIENTS AND METHODS: We retrospectively evaluated 9282 patients with gastric cancer from 1955 to 1999, and divided the 45-yr into 4 time frames based on published articles: 1955 to 1962 (n=228), 1963 to 1972 (n=891), 1973 to 1988 (n=2789), and 1989 to 1999 (n=5374). RESULTS: Remarkable changes were noted in host, tumor, treatment factors, and prognosis. Among host factors, patients of more advanced age were identified in the 4th period and mean age shifted from 49 to 55 yrs. Among tumor factors, early gastric cancers and upper body tumors increased up to 32% and from 7% to 13%, respectively. An increase in the annual number of patients (from 29 to 649), gastrectomies (from 14 to 600), rate of resection (from 50% to 90%), rate of curative resection (up to 92%), and proportion of total gastrectomy (from 8% to 29%) was noted. Operative mortality was reduced from 6.1% to 0.7%. The overall 5-yr survival rate significantly increased from 22% to 65%. CONCLUSION: Treatment results of gastric cancer surgery have improved remarkably over the 45-year period. Increase of early stage gastric cancer with early diagnosis considerably influenced the improved survival of patients with gastric cancer.     

垂体泌乳素瘤性不孕症的药物治疗效果探讨

目的探讨单纯药物治疗垂体泌乳素微腺瘤(瘤体直径<1.0cm)和巨腺瘤(瘤体直径>1.0cm)所致不孕症的效果。方法选择32例垂体性不孕患者,其中微腺瘤22例,巨腺瘤10例,用溴隐亭治疗。部分病例加用克罗米酚和hCG或hMG辅助治疗。结果31例妊娠,30例足月分娩。产后随诊治疗30例,其中4例腺瘤消失,22例瘤体明显缩小,4例无明显改变。结论对于瘤体不是太大,无压迫症状的不孕患者,单纯用药物保守治疗也能取得较满意的效果,不一定非要选择手术治疗,以确保患者达到希望生育的目的。     

急诊肺炎患者发生急性肺损伤/急性呼吸窘迫综合征危险因素分析

目的探讨急诊肺炎患者发生急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的早期危险因素。方法回顾性分析中国医科大学附属第一医院急诊科收治的100例肺炎患者,其中男性62例,女性38例;年龄49~79岁,平均年龄62岁。观察72h,发展至ALI/ARDS为ALI/ARDS组,未发展至ALI/ARDS的分为单纯肺炎组。收集两组患者的年龄、性别、生命体征、初始所需吸氧浓度及初诊的实验室检查(白细胞、血小板计数、血清白蛋白、尿素氮、丙氨酸氨基转移酶)指标,对各项因素进行单因素分析,单因素分析有显著意义的变量行二项分类的Logistic回归分析。结果 100例患者35例发展为ALI/ARDS,65例未发展为ALI/ARDS。单因素分析结果显示,患者是否发展为ALI/ARDS与年龄、性别、体温、呼吸频率、休克、白细胞计数、尿素氮等比较,差异无统计学意义(P0.05);初始所需吸氧浓度(维持血氧饱和度≥90%)、改良后的快速急诊内科评分(REMS)、低蛋白血症与发展为ALI/ARDS差异有统计学意义(P0.05)。二项分类的Logistic回归分析显示,仅吸氧浓度、改良后的REMS评分是发展为ALI/ARDS的独立危险因素。其中吸氧浓度2 L/min的灵敏度为77.1%,特异度为86.2%;改良后的REMS≥7发生ALI/ARDS灵敏度为74.3%,特异度为72.3%。结论初始吸氧浓度及改良后的REMS评分与ALI/ARDS的发生存在正相关,初始吸氧浓度2 L/min和/或改良后的REMS≥7的肺炎患者应予以重视,是ALI/ARDS的高危患者,争取做到早期诊治。     

Analysis of K. pneumoniae by monoclonal antibody: immunohistochemical detection of K. pneumoniae surface antigen injected into mice and rats.

The monoclonal antibody Kp62 recognized surface antigenic determinants of some strains of Klebsiella pneumoniae. The antigen recognized by Kp62 was demonstrated on the bacterial surface using immunoelectron microscopy. Kp62 reacted with K. pneumoniae No. 1 or K. pneumoniae B 5055 and lipopolysaccharide (LPS) from the same bacteria. However, Kp62 was not inhibited by the LPS from Escherichia coli (E. coli) O111:B4 and E. coli O55:B5. Thus, Kp62 might be a useful monoclonal antibody to detect K. pneumoniae and LPS from K. pneumoniae. The possibility to visualize the localization of K. pneumoniae LPS injected into animals using immunohistochemical methods with this monoclonal antibody was examined. It was possible to detect the injected LPS in the spleen of mouse and rat with the monoclonal antibody to K. pneumoniae. In order to detect the early events taking place in the spleen after intravenous injection of LPS, time course of LPS distribution in mice and rats was studied. After 30 min, 2, 4, 8 and 24 h LPS localized in the marginal zone (MZ) in mice and rats, although the degree of LPS positive cells varied. The cells responsible for trapping the injected LPS appeared to be marginal zone macrophages. The early trapping of LPS by marginal zone macrophages was thought to be important for the following immune responses to the injected LPS. Interestingly the antigenic determinant on the injected LPS appeared to last long on or within the cells in the spleen from the injected animals. Such a remaining antigen might be important for the continuous stimulation of B cells by the LPS. With respect to the distribution of red pulp (RP) and white pulp (WP), we found the varied distribution of LPS between mouse and rat, and SPF and conventionally fed (Conv) animals. For example, LPS-positive cells in RP of rat were scarce, while significant degree of LPS-positive cells were observed in mice. And in WP, LPS-positive cells were observed in Conv DA rats, but not in mice or SPF-fed Wistar rats. These results may suggest that the mode of antigen processing may be different in the spleen of rat and mouse or even among the different strain of rats and previous sensitization to the LPS (or the similar antigenic determinants) may lead to the different distribution of LPS in the spleen. The monoclonal antibody specifically raised against K. pneumoniae was shown to be very useful to follow the fate of LPS derived from K. pneumoniae using immunohistochemical method.(ABSTRACT TRUNCATED AT 400 WORDS)     

The role of balloon angioplasty in the management of coronary artery disease

PTCA is a new technique for the treatment of certain patients with coronary artery disease. It involves dilatation of stenotic segments of artery using a balloon catheter, and is carried out in cardiac catheterization laboratories. If successful, the need for coronary bypass surgery may be removed, although some patients with initially successful PTCA will come to surgery eventually. Successful PTCA is associated with relief of angina, improved angiographic appearances and coronary perfusion. The primary success rate is between 65% and 80%, and the restenosis rate approximately 25%. 80% of patients will be angina free one year after PTCA. In this paper the indications, contraindications, technology, results and complications are discussed.     

精索静脉曲张患者手术前后精液质量及精子形态变化的研究

目的探讨精索静脉曲张患者手术治疗前后精液质量及精子形态的变化。方法选择我院泌尿外科精索静脉曲张患者70例,分别在手术前和手术后进行精液常规分析和精子形态学分析。结果 70例精索静脉曲张患者手术后精子密度、活率和A级精子活力百分率较术前明显提高,精子畸形率明显降低,两组差别有显著性意义（P〈0.05）。结论精索静脉曲张可对男性生殖功能产生不良影响。     

Expression of p27 and PTEN and clinical characteristics in early laryngeal squamous cell carcinoma and their correlation with recurrence

Laryngeal squamous cell carcinoma is a common malignant tumor of otolaryngeal region. At present, effective treatment of laryngeal squamous cell carcinoma still depends on surgery and radiotherapy. In recent years, application of CO₂ laser resection in the treatment of stage T1 glottic carcinoma can remove the tumor completely and reduce the injury of laryngeal tissues. But recurrence still happened in some postoperative patients. Here, we selected 131 patients to compare the therapeutic effects of CO₂ laser resection and traditional split laryngeal surgery on the early laryngeal cancer, examined the expression of p27 and PTEN by immunohistochemistry in early laryngeal squamous cell carcinoma tissues in correlation to clinical outcome. After two years follow-up 14/85 (16.5%) of CO₂ laser treatment group presented with local recurrence (recurrent group), while that of split laryngeal surgery group was 6/46 (13.0%). There was no statistical significance in recurrence rate between the two groups (P > 0.05). 10 of all the 111 (9.0%) non-recurrent patients did not follow the doctor’s advice to quit smoking after the operation, while 12 in the 20 (60.0%) recurrent patients did not; the difference between the two groups was statistically significant (P < 0.01). The positive rates of p27 were 80.2% (105/131) and 43.5% (57/131), and that of PTEN were 83.2% (109/131) and 48.9% (64/131) in the cancer adjacent tissues (negative surgical margin tissues) and in laryngeal carcinoma tissues, respectively (P < 0.001). The expression rates of p27 and PTEN in laryngeal carcinoma tissues of the recurrent group were 20.0% (4/20), 10.0% (2/20) and that in non recurrent group were 47.7% (53/111) and 55.9% (62/111), respectively, with a significant difference (P < 0.001). In addition, the expression of p27 and PTEN in tumor resected marginal tissues of the recurrence group was 50.0% (10/20), 40.0% (8/20) and that in non recurrence group was 85.6% (95/111) and 91.0% (101/111), respectively; the difference was also statistically significant between both groups (P < 0.001). In conclusion, there is no statistically significant difference in tumor recurrence rate between CO₂ laser surgery and traditional split laryngeal surgery. Postoperative recurrence is closely related to resume smoking. The recurrence rate of p27 and/or PTEN-negative patients was higher than that of the positive ones,that should be followed up closely after treatment.