青年与老年直肠癌临床对比分析

目的探讨青年与老年直肠癌的临床、病理及预后差异。方法中国医学科学院肿瘤医院自1990年1月至2000年1月收治40岁以下直肠癌患者138例（青年组），65岁以上者163例（老年组），对这组患者的病例资料进行生存分析和预后的多因素分析。结果青年组Ⅲ期直肠癌患者比例（53．6％，74／138）明显高于老年组（34.3％，55／163）；P=0．001；青年组中黏液腺癌和低分化腺癌患者比例（28．2％，39／138）也高于老年组（10．4％，17／163）P〈0．001。青年组和老年组5年生存率分别为50．4％和64．1％．两组比较差异有统计学意义（P〈0．05）；而按照TNM分期进一步分析显示．同期别两组的生存率差异均无统计学意义（P〉0．05）。多因素分析结果显示，肿瘤T分期（P=-0．001）和淋巴结转移（P〈0．05）是影响两组患者预后的独立因素。结论与老年直肠癌相比，青年直肠癌患者的病期较晚、肿瘤分化程度较低，影响其预后；但相同病期者生存率相似。早期诊疗是提高直肠癌总体生存率的关键。     

维持性血液透析116例患者颈动脉粥样硬化中钙磷代谢的研究

目的：研究维持血液透析（MHD）患者颈动脉粥样硬化中钙磷代谢变化。方法：回顾性分析我院2008年6月～2011年6月超过3个月的MHD患者,进行超声检查患者颈动脉粥样硬化的情况,根据结果分为：无颈动脉粥样硬化对照组及颈动脉粥样硬化组,采用全自动生化分析仪常规检测血清白蛋白（Alb）、c反应蛋白（CRP）、血钙、血磷及PrH等。结果：研究结果表明：颈动脉粥样硬化组患者较无颈动脉粥样硬化对照组患者钙磷代谢紊乱尤为突出,提示血液透析清除血磷不充分。进而导致颈动脉粥样硬化的发生与发展。采用相关分析检测MHD患者血CRP、Alb与颈动脉平均IMT存在相关性（r=－0．21。P〈0．05;r=0．28,P〈0．05）。结论：钙磷代谢紊乱、PTH异常及炎症反应等参与了MHD患者颈动脉粥样硬化的发生与发展。     

双气囊小肠镜对不同年龄人群不明原因消化道出血的诊断

目的探讨不同年龄人群双气囊小肠镜（DBE）检查对不明原因消化道出血（OGIB）的诊断价值。方法回顾性分析2007年1月至2012年1月间武汉大学人民医院消化内科和胃肠外科因OGIB行DBE检查的216例患者的临床资料。按年龄分为青年组（小于或等于40岁）86例,中年组（41～59岁）81例,老年组（大于或等于60岁）49例,比较不同年龄组患者DBE的病变检出情况。结果青年组憩室．小肠重复畸形和克罗恩病的检出率分别为37．2％（32／86）和15．1％（13／86）,明显高于中年组[16．0％（13／81）和9．9％（8／81）,均P〈0．01]和老年组[10．2％（5／49）和0／49,均P〈0．01];但其肿瘤检出率（12．8％,11／86）则明显低于中年组（30．9％,25／81）和老年组（22．4％,11／49）（均P〈0．01）。3组患者DBE检查的诊断率分别为83．7％（72／86）、87．7％（71／81）和81．6％（40／49）,差异无统计学意义（P〉0．05）;并发症发生率分别为1．2％（1／86）、2．5％（2／81）和2．0％（1／49）,差异无统计学意义（P〉0．05）。结论DBE是一种安全、有效的诊断OGIB的检查方法,适用于各年龄人群。不同年龄人群OGIB病因具有各自特点,应根据这些特点制订有效的诊治策略。     

老年人脊髓型颈椎病的特点

目的：探讨老年人脊髓型颈椎病的临床特点,以及年龄对脊髓型颈椎病的预后影响。方法：回顾性对比分析564例脊髓型颈椎病,其中老年患者191例,占33．9％,非老年患者373例。术后随访2～10年,平均5年3个月。结果：老年组中发育性椎管狭窄（x^24．78,P〈0．05、合并退变性椎管狭窄高于非老年组（x^2=49．07,P〈0．01）,有效率（x^2=5．03,P〈0．05）、优良率（x^2=6．5,P〈0．05）低于非老年组。结论：老年人脊髓型颈椎病预后差。     

不同钙浓度腹透液对尿毒症患者颈动脉粥样硬化影响的超声评价及相关因素分析

目的：观察使用不同钙浓度腹透液行持续性不卧床腹膜透析（CAPD）的尿毒症患者颈动脉粥样硬化的超声学改变。并行相关因素分析。方法：将40例初行CAPD的尿毒症患者随机分为2组：标准钙腹透液治疗组（A组，20例）和低钙腹透液治疗组（B组，20例），行正规CAPD治疗并配合碳酸钙口服。观察治疗12个月前后患者颈动脉内-中膜厚度（IMT）、颈动脉粥样斑块数量和超声分型的变化，以及血清钙、磷、钙磷乘积、甲状旁腺素（iPTH）的改变。结果：两组患者初行CAPD治疗前颈动脉IMT、粥样斑块的数量、检出率和超声分型无差异。经过12个月的治疗随访后，B组患者颈动脉IMT、斑块发生率及溃疡斑的检出率显著低于A组（P〈0．05）。与此同时，B组患者的血清钙、磷及钙磷乘积也有着显著意义地降低（P〈0．05或P〈0．01），且均低于治疗后的同期A组患者（P〈0．05或P〈0．01），iPTH则有显著意义地上升（P〈0．01）。整个治疗过程中，两组患者均未有明显低钙抽搐、低血压等情况发生。结论：钙磷代谢紊乱可加重尿毒症CAPD患者的血管损伤，低钙透析液有助于减轻患者的钙磷代谢紊乱，减轻其对血管损伤，延缓颈动脉粥样硬化的进展。     

2型糖尿病患者骨密度与颈动脉粥样硬化斑块相关性分析

目的探讨2型糖尿病患者骨量减低相关因素及其与颈动脉粥样硬化斑块之间的相关性。方法341例2型糖尿病患者，行双能X线骨密度测定，同时行双侧颈动脉彩色多普勒检查并进行各项生化指标检测。结果2型糖尿病患者骨量减低组颈动脉粥样硬化斑块发生率高于骨量正常组（P〈0．01），女性患者更显著。Logistic回归分析显示骨量减低的影响因素有：性别（P=0．021，OR=1．748）、年龄（P=0．000，OR=1．046）、收缩压（P=0．010，OR=1．018），而有否颈动脉粥样硬化斑块未能进入模型。结论在2型糖尿病患者，颈动脉粥样硬化斑块发生率与骨量减低有关尚不能被证实，两者均受增龄影响，尤其在女性。     

不同年龄段直肠癌患者临床病理学特征的研究

目的探讨直肠癌患者年龄与临床病理学特征的关系。方法对161例直肠癌患者的临床资料进行了回顾性分析。其中小于40岁者21例（青年组）,40-60岁者62例（中年组）,大于60岁者78例（老年组）。结果不同年龄组患者入院时的主要临床表现和肿瘤发生部位的差异无统计学意义（P〉0．05）。误诊率以青年组最高．为38．1％（8／21）,显著高于中年组（9．7％,6／62）和老年组（2．6％,2／78）,差异有统计学意义（P〈0．01）。年龄与直肠癌分化程度及TNM分期均呈负相关．随着年龄的增加．低分化和Ⅳ期直肠癌所占比例呈明显下降趋势。结论老年和青年直肠癌患者某些临床病理学特征存在明显差异．青年直肠癌患者肿瘤分化程度较老年患者为低．肿瘤分期较晚。     

颈动脉彩超在缺血性脑血管病中的应用价值

目的 探讨颈动脉彩超在缺血性脑血管病中的应用价值。方法 对100例缺血性脑血管病患者进行颈动脉彩超检查，并检查100例同期住院的非心脑血管病患者作对照。结果 缺血性脑血管病组颈总动脉内膜-中层厚度(M)及颈动脉内径与对照组有明显差异(P＜0.001)，老年组(≥60岁)IMT显著高于＜60岁组(P＜0．001)。缺血性脑血管病颈动脉粥样斑块的发生率为66.0％，斑块好发于颈总动脉分叉处及颈内动脉入口和起始处(87．8％)，以低回声斑块为主(61．0％)，其次为强回声斑块26．7％。100例缺血性脑血管病患者中颈动脉狭窄的发生率为26．0％，以中重度狭窄为主(80．7％)。狭窄部位以颈总动脉(CCA)为主(46．1％)，其次为颈内动脉(ICA)(38．5％)。缺血性脑血管病组颈动脉搏动指数、阻力指数及ICA/CCA比值较对照组高(P＜0．05)。结论 颈动脉彩超检查能确立缺血性脑血管病患者颈动脉粥样斑块的性质、稳定性，能确立颈动脉粥样硬化及颈动脉狭窄程度，提供颈动脉血流动力学参数，为动脉粥样硬化的预防及治疗提供依据，有一定的临床价值，进而减少脑血管病危险因素、控制脑血管病的发生。     

青年人和老年人大肠癌的临床病理对比研究

目的 探讨青年人和老年人大肠癌的临床及病理特征。方法 对78例青年人和老年人大肠癌的临床特征进行分析．测定患者血清CEA、CA242,采用免疫组化方法测定p53、c-erbB-2和CD44v6蛋白的表达情况。结果 青年组和老年组大肠癌在性别分布上无差异,发病部位无差异,青年组肿瘤细胞多数分化程度差（低-未分化）,老年组肿瘤细胞分化程度较好（高-中分化,P〈0．05）,P〈0．05;青年组病程较晚（Duke’s C＋D）,病例的比例较老年组高（P〈0．05）;青年组和老年组CEA、CA242、p53、c-erbB-2、CD44v6的阳性率分别为34．1％、56．1％、53．7％、56．1％、36．6％、和19．6％、23．2％、33．9％、37．5％、17．9％,除CEA外,其余4项指标,2组比较均有显著性差异（P〈0．05）。结论 青年人和老年人大肠癌有不同的临床特点及生物学特征。     

症状性颈动脉狭窄介入治疗的术前评估

目的通过对颈动脉狭窄患者进行综合术前评估，选择介入治疗适应证。方法30例颈动脉狭窄患者，进行MRI、DSA和CTP检查，讨论脑血管狭窄程度、部位、侧支循环和脑血流动力学状态之间的关系。结果患侧与健侧相比，MTT和TTP具有统计学意义（P=0．005和0．002）；狭窄程度与CTP分级之间无明显相关性（r=0．63，P=0．13）；侧支循环越差梗死发生率越高（r=1．0，P=0．017）；灌注越低梗死发生率越高（r=0．999，P=0．033）。结论对于颈动脉狭窄患者应该进行MRI、DSA和CTP的综合分析，以指导临床诊断，治疗及预后等。     

对侧颈动脉闭塞患者颈动脉成形支架置入术的临床分析

目的 探讨对侧颈动脉闭塞患者颈动脉成形支架置入术(CAS)的有效性及安全性.方法 回顾性分析2001年1月至2010年1月治疗的56例对侧颈动脉闭塞、同侧颈动脉狭窄患者的病例特点及CAS的疗效.患者均经数字减影血管造影(DSA)证实为一侧颈动脉闭塞、另一侧颈动脉狭窄,狭窄程度在50%～90%,平均72%±15%.经常规准备后在远端脑保护装置保护下行CAS.结果 56例对侧颈动脉闭塞、同侧颈动脉狭窄患者行CAS的技术成功率100%,术后颈动脉直径狭窄率即术后残余狭窄率为0～30%,平均为13%±8%.患者术后脑缺血症状均获改善,仅1例于术后3 d发生原脑梗死部位的慢性出血(CAS侧),开颅手术后遗留轻微神经功能障碍,无缺血性并发症发生,无死亡病例.患者随访6个月～3年,平均27个月,均无脑缺血症状发作,经颈部血管彩色超声复查47例、DSA复查2例均未发现支架内再狭窄.结论 对侧颈动脉闭塞的高危患者的CAS治疗是安全、有效的,严格的病例筛选、经验丰富的医生操作及术后严谨的综合处理均可以降低手术并发症的发生.

Abstract：

Objective To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion. Methods From January 2001 to January 2010,56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases. Results The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and postprocedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent. Conclusions CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous postprocedure general management can decrease the rate of complication.     

多次缺血预处理诱导脑侧枝循环重建对脑缺血保护的实验研究

目的采用多次压迫阻断右侧颈总动脉的缺血预处理,并逐次递增缺血时间,诱导右侧大脑侧枝循环建立,观察其对脑缺血的保护作用。方法家兔48只,采用随机数字法分为对照组和实验组,每组24只。实验组实验期间实施球囊充气阻断颈动脉血流,每次压迫时间为：次缺血时间=次数×5+40(min)进行,每日2次,直到压迫时间达4 h（总时间为...     

Selective shunting with eversion carotid endarterectomy

PURPOSE: The consensus is that eversion carotid endarterectomy (CEA) is a safe, effective, and durable surgical technique. Concern remains, however, regarding insertion of a shunt during the procedure. We studied the advisability of shunting with eversion CEA by comparing patients who underwent eversion CEA with and without shunting. METHODS: Over 9 years, 624 primary eversion CEAs were performed in 580 selected patients to treat symptomatic (n = 398, 63.8%) and asymptomatic (n = 226, 36.2%) carotid lesions. All eversion CEAs were performed by the same surgeon (E.B.), with the patient under deep general anesthesia, with continuous electroencephalographic (EEG) monitoring for selective shunting, based exclusively on EEG changes consistent with cerebral ischemia. A Pruitt-Inahara shunt was used in 43 eversion CEAs (6.9%). All patients underwent postoperative duplex ultrasound scanning and clinical follow-up at 1, 6, and 12 months and once a year thereafter. Mean follow-up was 52 months (range, 3-91 months). The main end points were perioperative (30-day) stroke and death, and recurrent stenosis. RESULTS: No perioperative death occurred in this series. Overall, ischemic perioperative stroke occurred in 4 of 624 patients (0.6%). Two strokes were minor and two were major. Only one (major) stroke occurred in the group with shunt insertion (1 of 43, 2.3%; P = not significant); the everted internal carotid artery was patent. Long-term follow-up was performed in all living patients. There was no late recurrent stenosis (>50%), and one late asymptomatic occlusive event occurred in the group without shunt insertion. CONCLUSIONS: Shunt insertion can be safely performed during eversion CEA. Perioperative mortality and morbidity after eversion CEA are not statistically modified with shunting.     

老年颈动脉硬化患者血清C反应蛋白测定及意义

目的:探讨 C 反应蛋白(C-reactive protein,CRP)作为系统性炎症因子在老年人颈动脉硬化中的改变及其意义。方法:选取经超声多普勒确诊的颈动脉硬化病人共130例,根据狭窄程度分为重组54例,轻组76例,对照组为经超声多普勒证实无颈动脉硬化病变的健康人,共45例。采用放射比浊法测定血清 CRP、放射免疫法测定血清白细胞介素-6(IL-6)浓度。结果:颈动脉硬化组血清 CRP 水平显著高于对照组(P<0.01);在颈动脉硬化患者中,重组血清 CRP 水平显著高于轻组(P<0.01),但两组间 IL-6浓度无显著差异(P>0.05)。结论:血清 CRP、IL-6水平在颈动脉硬化患者中明显升高,CRP 浓度与颈动脉狭窄程度密切相关。     

Early carotid endarterectomy after stroke

The authors sought to determine if patients with stroke and a high-grade carotid stenosis benefited from a delay before carotid endarterectomy. A retrospective study of 45 patients undergoing carotid endarterectomy after stroke is presented. The patients were divided into two groups: group I (early group, n = 20), composed of patients who had carotid endarterectomy less than 6 weeks after stroke, and group II (late group, n = 25), comprised of patients who had carotid endarterectomy more than 6 weeks after stroke. As assessed by cerebral angiography, 100% of patients in group I and 64% of patients in group II had carotid artery stenoses > 76% (P < 0.001). The median interval from stroke to carotid endarterectomy was 14 days in group I and 129 days in group II. There was no mortality in either group. No patients in either group demonstrated any neurological deterioration. The authors conclude that, in select patients, carotid endarterectomy may be done safely less than 6 weeks after stroke in order to avoid new events or carotid occlusion while awaiting surgery.     

颈动脉外翻内膜剥脱术治疗颈动脉硬化狭窄

目的观察颈动脉外翻内膜剥脱术治疗颈动脉狭窄的疗效。方法24例颈动脉硬化狭窄患者,其中18例有慢性或一过性脑缺血症状,6例无症状;术前均行彩色超声、数字减影动脉造影(DSA)或CT和MRA扫描检查,颈动脉狭窄程度65％～95％;在颈丛麻醉下行颈动脉外翻内膜剥脱术,手术要点是于颈动脉分叉处斜形切断颈内动脉,外翻颈内动脉剥除有粥样斑块的内膜,同时从颈总动脉切口剥除颈总动脉和颈外动脉增厚的内膜。结果全组无手术死亡,术后随访3～20个月,临床症状均有不同程度改善,一过性脑缺血症状消失,4例仍有轻度慢性脑缺血症状。术后行脑部多普勒超声检查,22例脑部供血有明显改善。结论颈动脉外翻内膜剥脱术是一种安全、有效和合理的手术方式。     

A comparison of carotid angioplasty with stenting versus endarterectomy with regional anesthesia

Introduction: Percutaneous transluminal angioplasty with stenting (PTAS) has been considered a potential alternative to carotid endarterectomy (CEA) for stroke prevention. Interventionalists have suggested that PTAS carries less anesthetic risk than CEA. The treatment of carotid stenosis with local or regional anesthesia (LRA) allows direct intraprocedural neurologic evaluation and avoids the potential risks of general anesthesia. Methods: We retrospectively analyzed the clinical charts of 377 patients who underwent 414 procedures for the elective treatment of carotid stenosis in 433 cerebral hemispheres with LRA between August 1994 and May 1997. Group I (312 hemispheres) underwent PTAS, and group II (121 hemispheres) underwent CEA. Results: The indications for treatment included the following: asymptomatic severe stenosis (n = 272; 62.8%), transient ischemic attack (TIA; n = 100; 23.1%), and prior stroke (n = 61; 14.1%). The early neurologic results for the patients in group I (n = 268) included 11 TIAs (4.1%), 23 strokes (8.6%), and 3 deaths (1.1%). The early neurologic results for the patients in group II (n = 109) included 2 TIAs (1.8%), one stroke (0.9%), and no deaths. The total stroke and death rates were 9.7% for the patients in group I and 0.9% for the patients in group II (P = .0015). The cardiopulmonary events that led to additional monitoring were evident after 96 procedures in group I (32.8%) and 21 procedures in group II (17.4%; P = .002). Conclusion: PTAS carries a higher neurologic risk and requires more monitoring than CEA in the treatment of patients with carotid artery stenosis with LRA. The proposed benefit for the use of PTAS to avoid general anesthesia cannot be justified when compared with CEA performed with LRA. (J Vasc Surg 1998;28:397-403.)     

颈动脉狭窄患者CEA应用颈动脉转流效果观察

目的:探讨颈动脉狭窄患者行颈动脉内膜剥脱术(CEA)术中使用颈动脉转流有效性及安全性。方法:回顾性分析79例颈动脉狭窄患者,术中通过经颅多普勒监测双侧大脑中动脉血流速度(VMCA)。阻断颈动脉前后记录系统收缩压、术侧VMCA、对侧VMCA。将79例患者分为两组:A组V2-a<40%V1-a 41例,使用颈动脉转流;B组V2-a≥40%V1-a 38例,未使用颈动脉转流。提高血压使术侧VMCA达到50%V1-a,即刻和恢复血供后记录系统收缩压、术侧VMCA、对侧VMCA。结果:A组、B组不良事件发生率分别为22.0%、5.3%(P=0.032);A组、B组主要不良事件发生率分别为9.8%、5.3%(P=0.743)。结论:颈动脉狭窄患者行CEA术,术中使用颈动脉转流增加不良事件发生率,但对主要不良事件发生率无明显影响,不常规推荐使用颈动脉转流管。     

Surgical versus nonoperative treatment of symptomatic carotid stenosis. 211 patients documented by intravenous angiography.

From 1980 through 1982, intravenous extracranial digital subtraction angiography (DSA) was performed in 6684 patients at the Cleveland Clinic. Of these, 211 previously unoperated patients had prior transient ischemic attacks (TIA) or strokes in conjunction with greater than 50% carotid stenosis on unequivocal DSA studies. Nonoperative management was employed in 126 patients, including 120 (84%) who received antiplatelet therapy or formal anticoagulation. The remaining 85 patients underwent carotid endarterectomy. During a mean follow-up interval of 36 months, there was no overall difference in survival, late TIA, or stroke between the nonoperated and surgical cohorts. However, parity was maintained in these groups only because of the prevalence of intermediate (50-69%) stenotic lesions and stable internal carotid occlusions in the nonoperated group. Carotid endarterectomy provided superior stroke prevention for patients with greater than 70% unilateral stenosis (p = 0.04), for those with greater than 50% bilateral stenosis (p = 0.004), and for those with internal carotid occlusions associated with greater than 50% contralateral stenosis (p = 0.03). The special risk of such discrete subsets should be recognized in order to plan appropriate treatment at the present time, as well as to conduct safe clinical trials in the future.     

高频超声评价2型糖尿病肾病患者肾小球滤过率对颈动脉粥样硬化及血管重构的影响

目的探讨应用高频超声评价肾小球滤过率（GFR）对2型糖尿病肾病患者颈动脉内-中膜厚度（IMT）及颈动脉粥样硬化血管重构的影响。方法将2型糖尿病肾病患者按照GFR分为3组：GFR≥90ml/（min.1.73m2）为A组（34例）,60ml/（min.1.73m2）≤GFR〈90ml/（min.1.73m2）为B组（39例）,GFR〈60ml/（min.1.73m2）为C组（25例）。D组为正常人（50名）。应用高频超声测量颈动脉IMT、斑块部位的血管总面积（TVA）及管腔面积（LA）,计算重构指数（RI）。结果颈总动脉干、颈总动脉分叉处、颈内动脉、颈动脉平均IMT和血管重构率均为A组、B组和C组均高于D组（P均〈0.01）,B组和C组均高于A组（P均〈0.05）,C组高于B组（P均〈0.05）。颈动脉平均IMT与GFR呈负相关（r=-0.33,P〈0.05）。血管重构类型比较：仅C、D组间负性重构差异有统计学意义（P〈0.05）。D组中血管重构类型以无重构为主,其余各组中血管重构类型均以正性重构为主,且各组中正性重构发生率均高于负性重构发生率。结论糖尿病肾病患者随着GFR减低,颈动脉IMT逐渐增厚,GFR可影响颈动脉血管重构。高频超声可准确、快捷地监测糖尿病肾病患者GFR对颈动脉IMT及血管重构的影响。