脾功能亢进患者肝移植术后脾功能恢复不良的原因分析

目的 探讨肝移植术后脾功能亢进恢复情况,分析脾功能亢进恢复不良的原因.方法 分析肝移植前存在脾功能亢进的93例患者,对术后脾功能亢进完全恢复正常的患者(正常组)和脾功能亢进不能完全恢复或不恢复的患者(异常组)进行比较,并对二组患者术后3个月的血小板计数进行相关性分析.结果 术后脾功能亢进完全恢复的正常组患者为60例(64.5%),脾功能亢进不完全恢复或未恢复的患者为33例(35.5%);正常组新肝期门静脉压力比异常组低(t=5.145;P＜0.01);正常组术后脾静脉血流较术前明显增加(t=2.295,P＜0.05),而异常组术前术后脾静脉血流没有差异;术后3个月血小板计数与术前血小板计数、术前脾大小、新肝期门静脉压力和术后脾脏大小有相关性.结论 肝硬化脾功能亢进患者在肝移植术后仍然存在脾功能亢进表现.术后早期各种原因引起的门脉压力下降不明显、脾血流量改善不良、脾脏缩小不明显等可能是导致脾功能恢复不良的因素.     

脾动脉血流量对脾功能亢进程度的影响及相关因素分析

临床上发现肝硬化患者内脏存在高血流动力学改变,尤其以脾动脉血流量增加更为显著.本研究测定36例肝硬化伴脾功能亢进患者的脾动脉血流量,并分析其与血清一氧化氮(NO)水平、脾脏指数(脾脏面积)和血小板计数之间的相互关系,以探讨脾肿大和脾功能亢进发生发展的血流动力学因素.     

肝硬化患者脾切除术后血小板变化及临床意义

全脾脏切除术后机体凝血机制会发生变化,而血小板数量的多少将直接影响机体的凝血状况,甚至导致某些并发症的发生。现就肝硬化伴脾功能亢进者脾切除术后血小板数值变化规律及其临床意义进行初步探讨,期望为术后相应并发症的预防和治疗提供参考。     

脾动脉栓塞治疗肝癌伴肝硬化脾功能亢进20例体会

目的探讨脾动脉栓塞对原发性肝癌伴肝硬化脾功能亢进的治疗效果。方法采用常规的Seldinger法做脾动脉栓塞共20例,术前血小板计数1.9×10     

门静脉高压症脾功能亢进脾巨噬细胞吞噬功能的变化及其与脾亢程度的相关性

目的　观察门静脉高压症患者脾功能亢进(脾亢)时,脾脏巨噬细胞(MΦ)吞噬功能及其与外周血细胞计数变化的相关性。方法　肝硬化门静脉高压症脾亢患者20例(脾亢组),外伤性脾破裂患者6例(对照组)。术前检测患者外周血细胞计数,并收集其手术切除的脾脏,用玻片贴壁法分离培养脾脏MΦ,鸡红细胞吞噬法检测MΦ的吞噬功能。结果　脾脏MΦ吞噬率:脾亢组为(12 6±3 0)%,显著高于对照组(6 9±0 5)%,P<0 01;吞噬指数:脾亢组为0 146±0 035,显著高于对照组0 076±0 008,P<0 01。外周血白细胞计数与脾MΦ的吞噬率负相关(r=-0 472,P<0 05),与吞噬指数也呈负相关(r=-0 625,P<0 01);外周血血小板计数与脾MΦ吞噬率负相关(r=-0 485,P<0 05),与吞噬指数负相关(r=-0 523,P<0 05)。结论　门静脉高压症脾亢脾MΦ吞噬功能增强可能是引起脾亢发生及决定脾亢程度的重要因素。     

肝硬化基础的腹部脏器疾病外科手术治疗时脾功能亢进的处理

目的探讨脾动脉阻断下脾脏微波消融联合腹腔病变脏器切除治疗脾肿大伴脾功能亢进合并其它疾病的临床安全性及近期疗效。方法回顾分析我院16例肝炎肝硬化后脾功能亢进合并其他疾病行脾动脉阻断下脾脏微波消融联合其它腹腔病变脏器切除患者的临床资料。结果 16例患者手术均成功,术后高热4例,左侧胸腔积液8例,脾脏包膜下血肿1例,腹腔渗血1例,皮肤组织淤血2例;未发生脾脓肿、脾脏破裂、顽固性胸腹水、门静脉血栓等,所有患者顺利出院;术后两周及术后一月白细胞、血小板较术前明显升高,且有统计学意义。结论脾动脉阻断下脾脏微波消融联合腹腔病变脏器切除治疗脾肿大伴脾功能亢进合并其它疾病安全,近期疗效显著;     

合并脾功能亢进肝癌患者的外科治疗

目的 探讨肝癌切除合并脾脏切除对肝癌合并脾功能亢进患者的临床意义.方法 回顾性分析2004年3月至2006年1月我科收治的35例合并脾功能亢进肝癌患者的临床资料,其中切脾组12例,未切脾组23例.分析手术前后肝功能以及血小板、白细胞变化情况.结果 35例均成功切除肿瘤.切脾组12例患者术后脾功能亢进消失.术后1周,切脾组患者白细胞由术前的(3.2±1.7)×109/L上升到(8.5±5.3)×109/L,血小板计数由(52.6±23.7)×109/L上升到(245.3士94.6)×109/L(P＜0.01).未切脾组白细胞及血小板计数变化不大.切脾组肝脏功能恢复较快,术后1周基本恢复至术前水平.切脾组患者均接受了较为系统的术后化疗.术后随访2年,切脾组7例生存(58.3％);未切脾组10例生存(43.5％).切脾组与未切脾组患者总的无瘤生存期分别为(16.4±4.3)个月和(14.3士5.2)个月(P＜0.005).结论 肝癌切除合并脾脏切除是治疗合并脾功能亢进肝癌患者的有效方法.     

肝硬化性脾功能亢进术后生活质量分析

肝硬化（hepatic cirrhosis）是各种原因引起的慢性、进行性、弥漫性肝病.随着病变进展可发生门静脉高压（PHT）而引起脾功能亢进（hypersplenism,简称脾亢）,表现为脾脏肿大、外周血细胞（主要是血小板、白细胞）减少,其发生率高达50％ ～ 64％[1].由于其病程长、症状多、并发症多等特点,如果不能得到有效治疗,不但影响患者寿命,也会很大程度上影响患者的社会、心理、生理等功能,导致生活质量（qualify of life,QOL）的严重下降.长期以来,脾切除术联合断流术治疗肝硬化性脾功能亢进一直是外科治疗的首选.本研究调查我院2008年5月至2011年5月期间采用手术治疗肝硬化性脾功能亢进患者148例,术后生活质量分析结果如下.     

脾动脉缩窄对大鼠肝硬化进程影响的实验研究

目的 探讨脾动脉缩窄对大鼠肝硬化进程的影响.方法 将96只SD大鼠随机分3组,对照组仅行开腹术;切脾组开腹行脾脏切除术;脾动脉缩窄组开腹行脾动脉缩窄术,然后腹腔注射硫代乙酰胺诱导肝硬化模型.定期处死一定数量的大鼠,动态观察大鼠血常规、肝功能、肝组织病理改变及血清Tuftsin水平变化.结果 术后对照组大鼠白细胞、红细胞和血小板逐渐下降(P＜0.05),而切脾组和脾动脉缩窄组未见明显变化(P＞0.05);切脾组与脾动脉缩窄组的肝功能损伤和肝硬化程度较同期对照组相比轻(P＜0.05);脾动脉缩窄组血清Tuftsin水平与对照组比较差异无统计学意义(P＞0.05),而切脾组Tuftsin水平显著下降(P＜0.05).结论 脾动脉缩窄术和切脾术均能有效地防止脾功能亢进的发生,从而延缓肝硬化的进展,而脾动脉缩窄术则保留了脾脏的功能.     

脾功能亢进的研究进展(文献综述)

肝功能亢进是肝硬化门静脉高压症的严重并发症之一 ,本文对脾功能亢进的临床表现———脾大、盆血、白细胞和血小板减少症逐一进行原因分析 ,并就脾功能亢进治疗进展进行综述     

Secular Trend in Reported Sperm Counts

Anhand einer Literaturübersicht wird darauf verwiesen, daß während der letzten 50 Jahre allgemein ein Rückgang der Spermatozoendichte von den verschiedenen Autoren bei sog. fertilen Männern publiziert wird. Die Protagonisten auf beiden Seiten der Diskussion begründen ihre Argumente mit den Daten einer größeren Anzahl von Ejakulatuntersuchungen zu verschiedenen Zeiten und meistens an verschiedenen Orten. Es ist nicht diskutiert, daß die Unterschiede zwischen den Mittelwerten der verschiedenen Stichproben statistisch signifikant sind: Was zur Debatte steht, ist ob ein kontinuierlicher Rückgang über einen längeren Zeitraum hierfür verantwortlich zu machen ist.
In der vorüegenden Mitteilung wird ein unterschiedlicher Zugang zu dem Problem angenommen: Es wird der Versuch unternommen, die repräsentativen Daten von Mittelwerten für die Spermatozoendichte von nicht ausgewählten Männern der letzten 45 Jahre zusammenzustellen. 29 dieser Angaben werden zitiert.
Es besteht kein ernsthafter Zweifel darüber, daß die zitierten Spermatozoenmittelwerte einen Abfall in der Zeit seit dem Jahre 1960 aufwiesen. Es ist nicht leicht festzustellen, welcher Artefakt — anders als ein realer, kontinuierlicher, über längere Zeit anhaltender Trend — verantwortlich gemacht werden kann. Dementsprechend wird die Schlußfolgerung gezogen, daß es — wenigstens an einigen Orten — wahrscheinlich einen nachweisbaren kontinuierlichen Rückgang der Spermatozoendichte im Ejakulat des Mannes gibt.     

Haematological indices as surrogate markers of factors affecting mortality after hip fracture

This study investigated the relationship between different components of the full blood count, such as haemoglobin (Hb), total white cell count, total lymphocyte count on admission and total neutrophil count as possible surrogate markers of conditions that lead to increased mortality in hip-fracture patients. A total of 791 patients were studied with 81.2% being females. The 1-year mortality was 26.4% (32.9% in males compared with 24.9% in females). A significant increase in mortality was seen in anaemic patients, especially with Hb 80-100 g l⁻¹ (1-year mortality was 49.2%, p-value < 0.001) and patients with lymphocyte count ≤1.1 × 10⁹ l⁻¹ (33.2% mortality, p-value < 0.0001). There was no relationship between total white cell count or neutrophil count and mortality. This information clearly suggests that Hb and total lymphocyte counts may be surrogate markers for increased mortality after a hip fracture and can be used for audit purposes to adjust for different case mixes between groups.     

向附睾注射不同剂量鱼肝油酸钠与精子计数关系的研究

本文对家兔及人进行了向附睾注射不同剂量的鱼肝油酸钠(SM)与精子计数变化关系的研究。结果表明:向家兔附睾每侧注射SM0.1ml时,6周后4例家兔精子计数全部恢复正常;0.3ml时,10周后10例家兔中4例精子计数恢复正常;当每侧注射0.6ml时,在4个月及9个月各4例家兔观察中,精子计数均未恢复正常,为无精或少精。此外10例志愿者向附睾每侧注射0.5ml后,在术后12个月精子计数观察中,2例计数为6～7×10~6/ml外,其余仍为无精和少精。因此我们认为注射不同剂量的SM能引起不同的精子计数改变。     

大鼠同种异体动脉移植中CD4和CD8淋巴细胞数比值的变化及意义

目的 研究大鼠同种异体动脉移植术前后T淋巴细胞亚群CD4淋巴细胞计数和CD8淋巴细胞计数比值的变化及与急性免疫排斥反应的关系。方法 将45只SD雄性成年大白鼠建立同种异体动脉移植模型,按手术先后随机分为对照组(20只):取未经任何处理新鲜同种异体股动脉作移植。实验组(25只):用经深低温冷冻保存的同种异体股动脉作移植。应用免疫荧光染色技术及流式细胞仪检测2组大鼠术前和术后3、7、14、20d共5个时间组的CD4、CD8阳性细胞百分率,并计算其比值。结果 实验组术后CD4/CD8较术前无明显变化,血管通畅率为100％,未见免疫排斥反应。对照组术后CD4/CD8比值比术前显著增高(P<0.01),20 d时间组的血管通畅率为45％。术后第3天CD4/CD8比值与急性免疫排斥反应程度呈正相关。结论 深低温冷冻保存的大鼠同种异体动脉移植后CD4/CD8比值的变化和术前无明显变化,可作为术后急性免疫排斥反应的免疫学监测指标。     

输精管结扎术残端处理方式与再通关系的研究

用７种残端处理技术完成的２３７３例输精管结扎术的一项前瞻性研究表明，术后２年随访时共有７８例查见精子，其中２７例配偶受孕，精子阳性率为３．２９％，再孕率１．１４％。各种术式的精子阳性率：附睾端开放加包埋０．５５％，两端单纯结扎１．４１％，结扎加筋膜包埋２．６３％，石碳酸烧灼３．１７％，精囊端折叠３．７１％，结扎加电灼４．７５％和不作包埋的附睾端开放７．５３％。经统计学处理各种术式的精子阳性率之间差异有非常显著意义（Ｐ＜０．０００１）。由不同手术者完成的相同术式结果分析表明，除石碳酸烧灼组以外，其余各组皆无组内差异。７个残端处理组的并发症发生率有显著差异（Ｇ＝２０．９６，Ｐ＜０．０１）、其中不作包埋的附睾端开放组并发症发生率达２．１７％，折叠组的出血和感染等发生虽少，但术后近期局部结节反应发生率达４．７７％。本研究表明，输精管残端处理方式的不同可能影响术后节育效果和安全性，但手术者经验和技术水平也起很大作用。     

Variations in Sperm Count in Oligozoospermic or Asthenozoospermic Patients

Using a Coulter Counter, sperm density and total sperm population per ejaculate has been measured repeatedly in a series of oligozoospermic and asthenozoospermic patients. Marked variations in these parameters were found with repeated sampling from the same patient. The implications of such findings are discussed.     

The polymorphonuclear leucocyte count in childhood haemolytic uraemic syndrome

Review of data from 79 children with the haemolytic uraemic syndrome (HUS) showed that the polymorphonuclear leucocyte (PMN) count at presentation in childhood HUS predicts outcome. Logistic regression analysis of several features at presentation identified only the PMN count and the presence of a diarrhoeal prodrome as having a significant effect on the outcome (P<0.01 andP<0.001 respectively). The geometric mean PMN count was significantly raised in 70 children who had typical HUS following a diarrhoeal prodrome (D+cases) compared with that of 9 children who had atypical disease without diarrhoea (D-cases) (t-test on log-transformed data,P<0.005). Fifty-seven children with D+HUS who recovered completely had a significantly lower geometric mean PMN count than D+cases with a bad outcome (P<0.001). Four of these patients, who died in the acute stage of the disease, had a significantly higher mean count than the rest of the D+patients (P<0.001). Multiple regression analysis demonstrated that the PMN count in D+cases was not significantly influenced by haemoglobin concentration, platelet count, length of the prodrome, or the administration of antibiotics in the prodromal period. A high PMN count at presentation in D+HUS indicates a poor prognosis. The data emphasise the heterogeneity of HUS and suggest that PMN participate in the pathogenesis of the disorder in typical D + cases but not in atypical D- cases.     

前列腺液白细胞计数与细菌培养的关系

目的 探讨前列腺液白细胞计数与细菌培养的关系。方法 对2002年9月至2005年1月间，我院泌尿外科门诊962例前列腺炎患者行前列腺液常规检查，计数白细胞。白细胞数目〉10个／高倍镜者为观察组共385例，白细胞数目〈10个／高倍镜者为对照组共577例，同时行前列腺液需氧细菌培养以及支原体、衣原体培养。结果 962例前列腺液标本中，有244例（25．4％）病原体培养阳性，共计培养出病原体285株。研究组白细胞数目为＋、＋＋、＋＋＋、＋＋＋＋时．细菌培养阳性率分别为19．6％、22．5％、31．0％、47．0％、89．3％，对照组前列腺液细菌培养阳性率为19．6％，两组间差别有显著性意义（P〈0．05）。结论 随着前列腺液中自细胞数目的增加，细菌培养阳性率逐渐增高，有助于早期预测细菌培养结果。     

Utility of white cell count and ultrasound in the diagnosis of acute appendicitis

Background: Despite considerable advances in imaging, the diagnosis of acute appendicitis remains a clinical one. Nonetheless, knowledge of the characteristics of commonly used investigations for appendicitis may aid surgical decision‐making. Methods: The pathology, full blood counts and ultrasounds of 1013 patients who underwent appendicectomy were reviewed and subjected to statistical analysis in order to determine diagnostic characteristics of various white cell count and ultrasound results. Results: Total white cell count was found to be higher among patients with complicated appendicitis than those with simple appendicitis or normal appendices. Ultrasound was found to be less accurate than white cell count and neutrophil count in the diag­nosis of acute appendicitis by estimation of area under the receiver operator characteristic curve. Conclusion: Knowledge of the meaning of various white cell count values may be invaluable in clinical decision‐making with regard to the diagnosis of acute appendicitis. Ultrasound is of limited utility in the diagnosis of appendicitis and should only be used in selected clinical situations.     

Fall of platelet count in children with traumatic brain injury： is it of value？

Objective:Trauma is the leading cause of mortality and morbidity among young age groups in Saudi Arabia and developed countries.This study aimed to evaluate the fall of platelet count in children with traumatic brain injury (TBI) as a potential predictor for clinical severity and outcome.Methods:Totally 74 patients with TBI were admitted to the Pediatric Intensive Care Unit (PICU) of our hospital from the beginning of January 2008 to the end of March 2010 (27months).Baseline enrolling criteria were age ≤ 12 years,admission within 4 hours after trauma event,and abbreviated injury scale (AIS)＜3 for extracranial injuries.Injury severity was classified as mild,moderate and severe according to their Glasgow Coma Scale (GCS) scores.Clinical outcomes at discharge were defined as poor (death,severe neurological morbidity) and favorable (moderate disability and good recovery).Platelet count was taken 2-3 times on the first day after admission and thereafter once daily.The percentage fall of platelet count (PFP) was calculated and taken as an index of change.PFP was considered zero if the platelet count was higher than the initial value.Results:PFP was significantly higher in patients with poor outcomes (mean 56.0％±3.8％,median 55.5％) compared to those with favorable outcomes (mean 25.3％±3.2％,median 20.5％,P＜0.01).PFP was also closely related to the severity of TBI,GCS score,clinical outcome and length of stay for survivors (P＜0.01 for each).The frequency of thrombocytopenia was significantly higher in poor outcome parents than in favorable outcome patients (P＜0.05).The validity of thrombocytopenia as a risk factor to predict poor outcome after TBI was:specificity,77.4％; odd ratio (OR),3.1;relative risk (RR),2.15.Receiver operating characteristic (ROC) curve and Youden index showed that the optimum cutoff point of PFP was at 51.5％.Conclusion:PFP is increased with the severity of TBIand it can be taken as a significant independent predicting factor for its outcome as well.