结直肠黏液腺癌的临床特点

目的 探讨结直肠黏液腺癌与非黏液腺癌的临床病理特点及其预后。方法总结1994年至2007年间收治的2089例结直肠癌中169例黏液腺癌的病例资料．比较分析结直肠黏液腺癌与非黏液腺癌的临床病理特点和预后及其关系。结果与非黏液腺癌相比,结直肠黏液腺癌肿瘤直径大[（5．52±3．56）cm比（4．62±2．68）cm,P〈0．01]、发病年龄轻[（52．3±16．5）岁比（58．7±13．6）岁,P〈0．01]。结直肠黏液腺癌中结肠占97例（57．4％）,有浆膜浸润116例（68．7％）,发生腹膜转移26例（15．4％）,脏器侵犯44例（26．0％）,淋巴结转移103例（60．9％）;与非黏液腺癌的814例（44.3％）、914例（49．8％）、125例（6．8％）、300例（16．3％）和929例（50．1％）相比,差异具有统计学意义（P〈0．01）;但黏液腺癌的根治性切除率（86．4％）和肝转移发生率（5．3％）与非黏液腺癌（91．5％和8．5％）的差异无统计学意义（P〉0．05）。黏液腺癌和非黏液腺癌患者的中位生存时间分别为52．6和148．2个月,差异有统计学意义（P〈0．01）：可根治切除患者黏液腺癌和非黏液腺癌中位生存时间分别为125．1和151．0个月．差异也有统计学意义（P=0．020）;两组Ⅰ、Ⅳ期患者总生存率差异无统计学意义（P〉0．05）;而Ⅱ、Ⅲ期患者非黏液腺癌中位生存时间149．0个月,明显长于黏液腺癌的67．7个月（P=0．033）。结论黏液腺癌可能是具有独特生物学行为的肿瘤,其预后差与其独特的病理类型有关。     

临床危险评分系统对结直肠癌肝转移患者生存预测及指导新辅助化疗的意义研究

目的评估临床危险评分系统(CRS)对我国结直肠癌肝转移患者的生存预测及指导新辅助化疗决策的作用。方法回顾性分析2000年1月至2012年12月在中山大学肿瘤医院行手术治疗的145例结直肠癌肝转移患者的临床资料,并随访其复发和生存情况,比较CRS低危组和高危组患者的预后差异并分析CRS评分对患者新辅助化疗的影响。结果低危组和高危组患者的中位总生存时间分别为47.5(32,75)个月和21(12,38)个月,差异有统计学意义(P 0.05);低危组和高危组患者的无复发中位生存时间分别为32(9,67)个月和11(7,18)个月,差异有统计学意义(P 0.05)。低危组中接受新辅助化疗和直接手术患者的中位总生存时间分别为42(26,64)个月和55(32,78)个月,差异无统计学意义(P 0.05);无复发中位生存时间分别为11(7,56)个月和45(13,73)个月,差异有统计学意义(P 0.05)。高危组中接受新辅助化疗和直接手术患者的中位总生存时间分别为33.5(12,48)个月和17(13,26)个月,差异无统计学意义(P 0.05);无复发中位生存时间分别为10(6,22)个月和12(7,16)个月,差异无统计学意义(P 0.05)。结论 CRS对结直肠癌肝转移患者的生存情况有较好的预测作用,但是否能作为此类患者实施新辅助化疗的参考依据还需要进一步的研究。     

不同病理类型进展期胃癌的预后因素分析

目的探讨不同病理类型进展期胃癌患者的临床病理特征及预后因素。方法回顾性分析2011年间在南京大学医学院附属鼓楼医院集团宿迁市人民医院行胃癌根治术的98例进展期胃癌患者的临床病理资料,其中胃腺癌53例,胃黏液腺癌30例,胃印戒细胞癌15例,比较不同病理类型进展期胃癌患者的临床病理特征及预后的差异。结果 (1)3种不同病理类型进展期胃癌患者的性别、年龄、神经侵犯及分化程度比较差异无统计学意义(P0.05),而其肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、淋巴管癌栓、侵犯深度及p TNM分期比较差异有统计学意义(P0.05)。(2)单因素分析结果显示,胃腺癌患者的预后与肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、侵犯深度及p TNM分期有关(P0.05),胃黏液腺癌患者的预后与手术根治类型、区域淋巴结转移及p TNM分期有关(P0.05),胃印戒细胞癌患者的预后与区域淋巴结转移、侵犯深度及p TNM分期有关(P0.05)。(3)将与3种不同病理类型进展期胃癌患者预后有关的因素进一步行Cox多因素分析,结果显示,肿瘤位置(P=0.016)、区域淋巴结转移(P=0.042)、侵犯深度(P=0.021)及p TNM分期(P=0.009)是影响胃腺癌患者预后的独立危险因素,区域淋巴结转移是影响胃黏液腺癌患者预后的独立危险因素(P=0.000),肿瘤侵犯深度(P=0.032)及区域淋巴结转移(P=0.002)是影响胃印戒细胞癌患者预后的独立危险因素。(4)随访时间60个月,胃腺癌患者的中位随访时间为32个月,胃黏液腺癌患者为43个月,胃印戒细胞癌患者为23个月,5年累积生存率胃腺癌患者为30.2%,胃黏液腺癌患者为23.3%,胃印戒细胞癌患者为26.7%。三者生存曲线比较差异无统计学(P=0.131)。结论不同病理类型进展期胃癌患者的临床病理特征有一定的差异,从而影响其预后的因素也不同,但是区域淋巴结转移是影响3种不同病理类型进展期胃癌患者的共同预后因素。     

胃黏液腺癌的临床病理和CT特征

目的:探讨胃黏液腺癌的临床病理和CT特征。方法:回顾性分析507例行根治或姑息性切除术的胃癌病例的临床病理资料(20例黏液腺癌和487例非黏液腺癌)及术前的多层螺旋CT检查结果;对比分析20例黏液腺癌和38例非黏液腺癌的CT征象(CT轴位图像上肿瘤最大径、厚度、大体分型及强化方式)。结果:通过术前电镜活检,仅25.0%(5/20)的胃黏液腺癌得到确诊。20例黏液腺癌均为进展期胃癌,487例非黏液腺癌中早期胃癌占16.8%(82/487),但差异无统计学意义(P=0.056)。与非黏液腺癌相比,黏液腺癌肿瘤较大[(6.9±4.0)cm比(4.4±2.3)cm,P=0.011],淋巴结转移率较高(85.0%比60.6%,P=0.028),且Ⅱ～Ⅳ期病例较多(95.0%比72.3%,P=0.025);二者在CT轴位图像上肿瘤最大径(P=0.008)、厚度(P=0.001)、大体分型(P=0.037)和强化方式(P=0.000)间均存在显著差异。但黏液与非黏液腺癌在年龄、性别、肿瘤位置、远处转移和根治性切除率间均无差异。结论:胃黏液腺癌病例数少且多属进展期,通过内镜活检判断黏液腺癌的敏感度较低,而多层螺旋CT则有助于鉴别黏液和非黏液腺癌。     

结直肠印戒细胞癌与黏液腺癌的临床病理特征及外科治疗比较研究

目的:探讨结直肠印戒细胞癌与黏液腺癌在临床病理特点、外科治疗及预后方面的差异。方法:对1992年1月—2008年12月山东大学齐鲁医院普外科收治的67例结直肠印戒细胞癌、179例黏液腺癌患者的临床病理特点和外科治疗进行回顾性分析并进行随访。采用χ2检验分析其相关因素,Kaplan-M eier法进行生存分析,Log-rank检验和C ox检验分别进行预后相关因素的单因素、多因素分析。结果:印戒细胞癌与黏液腺癌在发病年龄、肿瘤部位、有无肠梗阻、手术方式、有无脉管瘤栓、浸润深度、淋巴结转移方面差异具有统计学意义(P0.05)。在性别、术前C EA和肝转移方面差异无统计学意义(P0.05)。印戒细胞癌中位生存期26个月,黏液腺癌中位生存期47个月,差异具有统计学意义(P0.05)。多因素回归分析结果显示病理类型、手术方式为影响预后的独立因素。结论:结直肠印戒细胞癌恶性度高于黏液腺癌,病理类型和手术方式是独立的预后影响因素。根治性手术切除和姑息性减瘤手术可以有效改善预后。     

结直肠高度恶性腺癌的临床病理特点和预后分析

目的 比较三种结直肠高度恶性腺癌(印戒细胞癌、黏液腺癌与低分化腺癌)的临床病理特点及预后.方法 对医科院肿瘤医院1988-2006年收治的有完整随访资料的148例结直肠黏液腺癌、55例印戒细胞癌和281例低分化腺癌的临床病理特点进行回顾性分析.应用SPSS13.0软件进行统计学分析,采用x2检验分析其相关因素,Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较.结果 结直肠印戒细胞癌、黏液腺癌和低分化腺癌在性别、发病年龄、肿瘤部位、有无肠梗阻、手术方式、脉管瘤栓、浸润深度、淋巴结转移和分期方面差异具有统计学意义(x2=7.67,38.4,86.0,14.5,93.7,17.3,62.1,24.4,56.17,P<0.05),印戒细胞癌中位生存期为24个月,黏液腺癌中位生存期为47个月,低分化腺癌中位生存期为49个月,差异有统计学意义(x2=21.3,P<0.05).结论 三种结直肠高度恶性腺癌(印戒细胞癌、黏液腺癌与低分化腺癌)是临床病理特点和预后不同的结直肠恶性肿瘤,印戒细胞癌的恶性度最高,预后差.     

选择性三野淋巴结清扫术治疗胸段食管鳞癌的临床研究

目的分析行选择性三野淋巴结清扫术对胸段食管鳞癌患者的预后影响。 方法2009年6月至2012年9月,四川省肿瘤医院对127例胸段食管癌患者根据肿瘤的位置、外侵程度、术前颈部超声检查结果,进行选择性三野淋巴结清扫。全组共127例患者,其中上段49例;中段67例;下段11例;Ⅰ期2例,Ⅱ期26例,Ⅲ期99例。 结果127例患者共清扫淋巴结4963枚,平均每例清扫淋巴结39.3枚;手术时间(325.6±9.3)min,出血量(316.0±18.7)ml。术后76例患者发生并发症,发生率为59.8%(76/127)病死率为1.6%(2/127)。选择性三野淋巴结清扫术后喉返神经旁淋巴结转移率40.2%(51/127);颈部淋巴结转移率55.9%(71/127),其中,胸中下段食管鳞癌颈部淋巴结转移与喉返神经转移显著相关(χ²＝0.005,P＝0.006)。全组中位生存时间(35.0±1.9)个月,3年生存率51.8%。其中Ⅱ期中位生存时间(42.1±3.4)个月,3年生存率74.5%;Ⅲ期生存时间(32.3±2.0)个月,3年生存率44.8%,两组间比较差异有统计学意义(χ²＝3.940,P＝0.047)。颈部淋巴结阳性患者的中位生存时间(26.2±2.1)个月,3年生存率34.9%;阴性患者中位生存时间(41.5±2.3)个月,3年生存率67.6%,差异有统计学意义(χ²＝15.283,P<0.001)。 结论选择性三野淋巴结清扫术是一种安全可行、可提高颈部淋巴结清扫率,同时又能筛选出潜在获益患者、延长生存的手术方式。     

结直肠癌细胞外黏液成分的临床病理特征及预后分析

目的 研究细胞外黏液成分在结直肠癌中的临床病理差异及对预后的影响.方法 回顾性分析2007年3月至2010年3月收治的207例结直肠癌患者的临床病理数据.按照病理诊断分为黏液腺癌组(A组:局灶性黏液性腺癌62例;B组:黏液腺癌53例)和无黏液腺癌组(C组:低分化腺癌22例;D组:高中分化腺癌70例).应用IBM SPSS Statistics软件,分析各组临床病理特点及生存情况.结果 黏液腺癌组与无黏液腺癌组在肿瘤部位、肿瘤最大径、T分期及TNM分期差异存在统计学意义(P＜0.05),其中A组与B组相比,在性别、肿瘤最大径、T分期及N分期差异存在统计学意义(P＜0.05);四个亚组的年龄、癌胚抗原(CEA)阳性率、肿瘤部位、肿瘤最大径、T分期、N分期、TNM分期、脉管癌栓及神经浸润差异均有统计学意义(P＜0.05).在匹配相同TNM分期条件下,黏液腺癌组和无黏液腺癌组相比,以及四个亚组相比,3年无瘤生存率及3年总生存率差异均无统计学意义.结论 结直肠腺癌细胞外黏液成分的有无以及多寡在临床病理特征上表现出一定的差异,但不是预后的独立影响因素.     

机体缺氧状态与肾透明细胞癌预后的关系

目的 初步探讨机体的慢性缺氧状态对肾透明细胞癌预后的影响. 方法 应用免疫组化方法半定量检测89例肾透明细胞癌标本缺氧诱导因子-lα(HIF-lα)的表达情况.回顾性分析89例患者的临床病理资料,其中男66例,女23例;平均年龄57岁;慢性肺疾病(CPD)组19例,无慢性肺疾病(NCPD)组70例;临床分期1期46例,11期15例,Ⅲ期26例,Ⅳ期2例.并对其预后情况进行随访.用Kaplan-Meier法对是否合并慢性肺部疾病、HIF-lα表达、Hb含量、吸烟史等变量与患者生存时间进行组间分析,同时建立Cox比例风险回归模型分析各变最l与生存时间的相关性.结果 89例随访6 ～84个月,中位随访时间19个月.死亡20例,存活69例.HIF-1α阴性表达15例(16.9％),阳性表达74例(83.1％).CPD组和NCPD组疾病临床分期、血红蛋白水平及HIF-1α表达程度等方面的差异有统计学意义(P＜0.05);两组患者中位总生存期分别为44、71个月,差异有统计学意义(P＜0.05);Hb≤1 10 g/L组和＞1l0g/L组患者中位总生存期分别为43、70个月,差异有统计学意义(P ＜0.05);HIF-1α的表达程度越强,总生存期越短,其差异有统计学意义(P＜0.05).合并CPD、Hb水平、HIF-1α表达是影响肿瘤患者总生存期的独立因素(P＜0.05).其中合并肺部疾病、HIF-1α表达与疾病生存时间呈正相关,Hb水平与疾病生存时间呈负相关. 结论 CPD导致的患者系统性缺氧可加重肾透明细胞癌患者的组织内缺氧状态.机体的缺氧状态与肾透明细胞癌预后存在负相关.     

进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素分析

目的 探讨影响进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素.方法 回顾性分析2000年1月至2007年1月天津医科大学附属肿瘤医院行根治性切除术的385例食管胃结合部腺癌患者的临床资料.其中228例患者术后无复发转移(无复发转移组),157例患者出现复发转移(复发转移组).通过门诊或电话方式进行随访,了解患者生存情况,随访时间截至2012年9月.单因素及多因素分析探讨可能影响患者术后发生复发转移的危险因素.术后复发转移的单因素分析采用x2检验,再将单因素分析中有统计学意义的变量纳入Logistic回归模型进行多因素分析;采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 术后随访时间为3～ 108个月,中位随访时间为36个月.全组患者术后157例发生肿瘤复发转移,肿瘤平均复发时间为根治性切除术后17.9个月.单因素分析结果显示:大体分型、分化类型、浸润深度、阳性淋巴结数目、阴性淋巴结数目及TNM分期有统计学意义(x2=5.248,13.493,12.319,18.315,9.704,10.281,P＜0.05).多因素分析结果显示:分化类型、浸润深度、阳性淋巴结数目及阴性淋巴结数目是食管胃结合部腺癌根治性切除术后复发转移的独立危险因素(OR=1.805,1.809,1.520,0.763,P＜0.05).无复发转移组和复发转移组患者的阳性淋巴结数目分别为(3.86±0.28)枚和(6.89±0.58)枚,两组比较,差异有统计学意义(t=5.118,P＜0.05);无复发转移组和复发转移组患者的阴性淋巴结数目分别为(14.04±0.54)枚和(10.53±0.56)枚,两组比较,差异有统计学意义(t=4.386,P＜0.05).阳性淋巴结数目为0、1～2、3～6、≥7枚的患者5年生存率分别为46.4％、43.8％、27.1％、7.2％,中位生存时间分别为53、47、35、26个月,不同阳性淋巴结数目患者5年生存率比较,差异有统计学意义(x2=54.783,P＜0.05);阴性淋巴结数目为＜9、10 ～15、≥16枚的患者5年生存率分别为22.1％、21.5％、45.5％,中位生存时间分别为28、34、47个月,不同阴性淋巴结数目患者5年生存率比较,差异有统计学意义(x2=22.814,P＜0.05).结论 肿瘤的分化类型、浸润深度、阳性和阴性淋巴结数目是食管胃结合部腺癌根治性切除术后复发转移的独立危险因素,其中阳性和阴性淋巴结数目对患者预后的影响具有重要意义.     

影像尿动力检查在下尿路排尿障碍疾病诊断中的作用

目的 探讨影像尿动力检查在下尿路排尿障碍疾病中的应用价值.方法 2008年12月至2010年3月对115例下尿路排尿障碍患者行影像尿动力检查,确定排尿障碍类型,分析各类疾病的影像尿动力特点.结果 神经原性膀胱患者37例,男性25例,女性12例.其中逼尿肌无反射(DA)18例,膀胱过度活动(OAB)2例,低顺应性膀胱伴肾积水10例,逼尿肌-外括约肌协同失调7例.非神经原性排尿障碍患者59例,男性34例,女性25例;其中膀胱出口梗阻40例,DA 15例,单纯OAB 4例.膀胱扩大术后复查患者7例,男性4例,女性3例.可控回肠膀胱术后男性患者1例.输尿管再植术后男性患者1例.影像尿动力检查显示膀胱尿道功能基本正常者10例,男性6例,女性4例.结论 影像尿动力检查通过压力-流率曲线与实时影像结合分析,可为各类下尿路排尿障碍疾病提供准确的诊断及治疗依据.     

Clinical effects of clenbuterol-HCL in urge incontinence and stress incontinence

A total of 49 patients complaining of pollakisuria and incontinence; 20 patients with overactive neurogenic bladder and 29 patients with stress incontinence, were treated with clenbuterol, and the effects of the drug were studied. Subjective symptoms were improved markedly in 8 patients (17%), moderately in 14 patients (29%), and slightly in 10 patients (21%). The symptoms were unchanged in 15 patients (31%) and aggravated in 1 patient (2%). In objective observation, the volume at first desire to void (P less than 0.01) and the maximum urethral closure pressure (P less than 0.05) significantly increased. The objective symptoms were improved markedly in 2 patients (5%), moderately in 12 patients (27%), and slightly in 11 patients (25%). The symptoms were unchanged in 15 patients (34%) and aggravated in 4 patients (9%). Overall improvement was graded as marked in 7 patients (15%), moderate in 17 patients (35%), slight in 11 patients (23%), unchanged in 13 patients (27%) and aggravated in none. In neurogenic bladder, the overall improvement was graded as marked in 2 patients (11%), moderate in 4 patients (21%), slight in 4 patients (21%), unchanged in 9 patients (47%) and aggravated in none. In stress incontinence, the overall improvement was graded as marked in 5 patients (17%), moderate in 13 patients (45%), slight in 7 patients (24%), unchanged in 4 patients (14%) and aggravated in none. Side effects were noted in 12 patients (25%) and they were all not serious. Finger tremor was the most common side effect (5 patients).(ABSTRACT TRUNCATED AT 250 WORDS)     

An analysis of 103 patients with renal injuries

Between 1971 and 1983, 103 patients with renal injury were admitted to the Department of Urology, Tatebayashi Kosei Hospital. There were 87 males and 16 females. The most frequent age group seen (27.2% of patients) was the 10 to 19 year group. The various causes included traffic accidents (55 patients), falls (16 patients), athletic injuries (8 patients), labor accidents (7 patients), blows (6 patients) and others (11 patients). Associated injuries were present in 52.4% of the patients, including thoracic injuries such as rib fracture (20 patients), lumbar vertebra and transverse process fractures (18 patients), and head injuries (12 patients). Evaluation of the renal injuries was made by excretory urogram (IVP) and conservative management was for most, contusion and rupture, and operation for laceration as a principle: 95 patients (97 renal injuries) were treated by conservative management and 7 patients were treated surgically, 5 patients by nephrectomy and 2 patients by perirenal drainage. Nine patients who had associated injuries were treated surgically. In the follow-up study of 41 patients who had received conservative management and operation (perirenal drainage), followed for more than 6 months and had IVP, urinalysis and blood pressure measurement, representative changes were calyceal deformity (3 patients), renal calculus formation (2 patients) and non-functioning kidney (2 patients) in urograms.     

Surgical treatment of hydatid disease of the liver. A 20-year experience

The medical records of 135 consecutive patients (74 women and 61 men) who underwent surgery for hydatid liver disease were reviewed. The patients ranged in age from 4 to 81 years. Twenty-seven patients had undergone previous surgery for hydatid liver disease. Cysts were solitary in 100 patients and multiple in 35 patients. Seventeen patients had concomitant extrahepatic disease. Conservative procedures were used in 71 patients (capitonnage in 50 patients and partial pericystectomy in 21 patients). Radical procedures were used in 64 patients (total pericystectomy in 35 patients, subtotal pericystectomy in 16 patients, and wedge or major liver resection in 13 patients). Operative mortality was 2.2% and morbidity rate was 23.7%. Recurrent disease was found in 13 patients at a mean interval of 3 years from the first operation. Better short- and long-term results were obtained with the use of radical procedures.     

老年心脏瓣膜置换术患者的围手术期处理

目的分析老年患者心脏瓣膜置换术的治疗效果,总结围手术期处理经验。方法回顾性分析徐州医学院附属医院2011年1月至2014年5月施行心脏瓣膜置换术的47例老年患者的临床资料,其中男19例、女28例,年龄60～79岁;风湿性心脏病35例,退行性心脏瓣膜病10例,先天性主动脉瓣二叶畸形2例;术前心功能分级（NYHA）Ⅱ级23例,Ⅲ级19例,Ⅳ级5例。体外循环下行心瓣膜置换术,或同期行三尖瓣成形术（TVP）、左心房血栓清除术、冠状动脉旁路移植术（CABG）。观察手术早期病死率、并发症及心功能改善情况。结果全组行二尖瓣置换术（MVR）27例,主动脉瓣置换术（AVR）15例,MVR＋AVR5例,同期行TVP4例,左心房血栓清除术3例,CABG6例。全组手术时间138～412（196±52）min,体外循环时间48～301（108±33）min,主动脉阻断时间34～196（87±21）min,住院时间12～31（19±5）d。无术中死亡病例,术后早期死亡2例（4．3％）,死亡原因为左心功能衰竭和多器官功能衰竭。术后发生并发症23例（51．1％）,包括呼吸功能不全6例,肺部感染5例,心律失常5例,切口感染2例,胸腔积液2例,低心排血量综合征2例,肾功能不全1例。通过电话、网上视频、来院复查等方式随访生存患者45例,随访时间1～32个月,随访率100％,心功能改善至I级11例、Ⅱ级32例、Ⅲ级2例。结论针对老年瓣膜疾病的特点,提高手术技巧,改善围手术期处理,可有效降低病死率,减少并发症。     

The surgical treatment of arterial injuries in the civilian population.

During an 8-year period, 191 consecutive patients were treated for arterial injuries. Blunt trauma occurred in 46 patients (24%), low velocity gunshot wounds in 82 patients (43%), shotgun wounds in 22 patients (12%), stab wounds in 20 patients (10%), iatrogenic injury in nine patients (5%), high velocity gunshot wounds in two patients (1%) and other penetrating wounds in ten patients (5%). Preoperative arteriography was performed in 48 patients (25%) who were hemodynamically stable with injuries to major vessels in the thorax, base of neck or extremities and in whom the exact location or extent of injury was unknown. Surgical repair was performed in 184 of 191 patients (96%); seven patients expired intraoperatively before reconstruction could take place. Repair was accomplished in the 184 patients by end-to-end primary anastomosis in 80 patients (44%), lateral sutures in 21 patients (11%), SVG in 71 patients (85%) and Dacron prosthesis in 13 patients (15%). One hundred seventy patients survived (89%) and 21 patients died (11%), seven of the 21 deaths were intraoperative and ten others were due to the effects of trauma to the aorta or its branches.     

伴有糖尿病的老年冠状动脉粥样硬化性心脏病患者桡动脉超微结构研究

目的 研究年龄及糖尿病因素对冠状动脉粥样硬化性心脏病患者桡动脉超微结构的影响.方法 2009年6月至2010年12月我院应用自体桡动脉行冠状动脉旁路移植术(CABG)64例,分为4组:老年非糖尿病组14例,其中男性9例,女性5例,平均年龄(70±4)岁;老年糖尿病组18例,其中男性11例,女性7例,平均年龄(68±5)岁;年轻非糖尿病组20例,其中男性13例,女性7例,平均年龄(53±5)岁;年轻糖尿病组12例,其中男性7例,女性5例,平均年龄(51±6)岁.用电镜观察、比较4组患者桡动脉内膜及中膜的超微结构.结果 扫描电镜下4组患者内皮细胞脱落率差异有统计学意义(X2=18.082,P=0.000);两两比较发现,老年糖尿病组与老年非糖尿病组、年轻糖尿病组与年轻非糖尿病组内皮细胞脱落率差异有统计学意义;老年糖尿病组与年轻糖尿病组、老年非糖尿病组与年轻非糖尿病组之间差异无统计学意义.透射电镜下观察糖尿病组患者桡动脉可见平滑肌细胞性泡沫细胞的出现以及平滑肌细胞向内膜下迁移倾向.对样本内皮细胞的结构、组织水肿的程度、内皮细胞中线粒体的形态学改变3个方面进行半定量评分,年轻非糖尿病组总评分低于年轻糖尿病组(1.32±0.20比4.38±0.30),老年非糖尿病组总评分低于老年糖尿病组(1.43 ±0.20比4.67±0.30);四组总评分采用析因设计方差分析,年龄因素主效应无统计学意义(F=1.24,P=0.270),糖尿病因素有统计学意义(F=41.22,P=0.000),年龄和糖尿病交互作用无统计学意义(F=1.05,P=0.309).结论 经过改良Allen实验及多普勒超声筛选后,不伴糖尿病的老年人与年轻人桡动脉质量相近,而糖尿病患者桡动脉质量明显差于非糖尿病患者.     

Management of leg ulcers in patients with rheumatoid arthritis or systemic sclerosis: the importance of concomitant arterial and venous disease

PURPOSE: We assessed the etiology and the prevalence of peripheral arterial and venous disease in leg ulcers in patients with rheumatoid arthritis and systemic sclerosis and analyzed the outcome after treatment of macrovascular disease. METHODS: A clinical study on 15 consecutive patients with chronic leg ulcers in collagen vascular disease (nine patients with rheumatoid arthritis, six patients with systemic sclerosis) was carried out in a referral center. Angiography was used when the ankle-arm index was less than 0.8; venography was used when venous reflux was detectable by means of a hand-held Doppler examination. Therapies included percutaneous transluminal angioplasty (seven patients), femoropopliteal bypass grafting surgery (one patient), saphenectomy of the greater saphenous vein (six patients), and split skin graft (11 patients). RESULTS: All patients with rheumatoid arthritis exhibited a multifactorial etiology of their ulcers: four of nine patients had peripheral arterial disease, and five of nine patients had venous insufficiency. In one of these patients, arterial and venous disease was combined. Five of six patients with systemic sclerosis exhibited a multifactorial etiology of their ulcers: three of six patients had peripheral arterial disease, and three of six patients had venous insufficiency. One of these patients had both arterial and venous disease. In patients with rheumatoid arthritis, healing was achieved in six of nine patients, and marked improvement occurred in two of nine patients. A below-knee amputation was necessary in one patient with rheumatoid vasculitis. In patients with systemic sclerosis, healing was achieved in three of six patients, and marked improvement occurred in the other three patients. CONCLUSION: Most leg ulcers in patients with rheumatoid arthritis and systemic sclerosis disclose a multifactorial etiology. Relevant arterial and venous disease can be found in approximately half the patients. Our study suggests that revascularization and vein surgery improve the healing of leg ulcers in patients with collagen vascular disease. A prospective trial is now required to confirm these results.     

Surgical treatment of injuries of the large vessels

The authors present an experience with treatment of 99 patients with primary wounds of main vessels. The age of the patients was from 42 through 83 yeas. In 85 patients there were stab wounds, 9 patients had gunshot wounds, in 5 patients injuries of the main vessels were results of blunt trauma. Eleven patients were admitted in the condition of shock of I degree, 27--II degree and 46--III degree, 15 patients were in the terminal state. Wounds of the aorta were diagnosed in 10 patients, 4 patients died. Injury of the superior vena cava was found in 4 wounded patients, nobody died. Postcava was injured in 11 patients, 6 patients died. Wounds of the portal vein were diagnosed in 8 patients, 7 of them died. Operations were fulfilled on 19 patients with wounds of the neck and injuries of the large vessels. One patient died. Injuries of the large vessels of the upper and lower extremities took place in 15 patients. Nobody died.     

胰腺囊性肿瘤的诊治分析

目的 探讨胰腺囊性肿瘤的合理手术方式及术后并发症的处理.方法 对1997年1月至2009年12月收治的32例胰腺囊性肿瘤患者的临床资料进行回顾性分析,男性6例,女性26例,年龄24～76岁.胰腺浆液性囊腺瘤16例;胰腺黏液性囊腺瘤9例,其中1例为黏液性囊腺癌;胰腺导管内乳头状黏液性肿瘤4例;胰腺实性假乳头状瘤3例.肿瘤位于胰头颈部12例,位于胰体尾部20例.结果 所有患者均经手术治疗,无围手术期死亡;10例行胰十二指肠切除术、1例行保留十二指肠胰头切除术、13例行胰体尾切除术(其中2例行腹腔镜下胰体尾切除术)、3例行胰腺肿瘤摘除术、4例行胰腺中段切除术;1例囊腺癌患者仅行姑息手术.术后发生胃瘫3例、胰瘘5例,均经保守治疗痊愈.全组29例患者获得随访,随访时间4个月～10年,3例患者于术后4～34个月分别死于癌转移或其他疾病,其余26例患者均存活,且未发现肿瘤复发或转移.结论 胰腺囊性肿瘤术前应首选无创的CT检查,及时手术探查是防止肿瘤癌变的重要手段;具体的手术方式选择应按个体化原则,并应遵循损伤控制性手术原则;保留器官的手术方式更要重视术后胃瘫、胰瘘等并发症的处理.