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1.
郭勇  沈迎建 《中国现代医生》2008,46(17):155-155
目的总结1993年3月~2005年12月手术治疗重症肌无力并发胸腺瘤,胸腺增生的手术疗效。方法对40例MG并发胸腺瘤,胸腺增生患者行胸腺及胸腺瘤切除术,随访结果进行分析。结果术后患者肌无力症状缓解13例(占32.5%),改善19例(占47.5%),无效5例(占12.5%),恶化2例(占5.0%),死亡1例(占2.5%),患者手术后的疗效与Osserman分型、胸腺的病理类型及术前病程的长短有关,与性别、年龄无关。结论胸腺切除治疗MG的效果满意,对MG患者应及早手术治疗。  相似文献   

2.
Long-term prognostic analysis of thymectomized patients with myasthenia gravis   总被引:11,自引:1,他引:10  
目的 探讨重症肌无力胸腺切除术后影响远期生存的因素。 方法 采用胸腺切除术治疗170例重症肌无力患者,其中124例术后获得超过40个月的远期随访,运用COX回归模型分析可能影响远期预后生存的有关因素,包括胸腺的各病理类型、性别、年龄、病程、术前临床Osserman分型和治疗。 结果 本项研究表明,胸腺的不同病理类型是影响胸腺切除术后远期生存的唯一重要因素,术后远期生存率有明显差异,表现为胸腺增生>良性胸腺瘤>胸腺萎缩>恶性胸腺瘤(P<0.05)。 结论 胸腺的不同病理类型是影响重症肌无力胸腺切除术远期生存的重要因素。  相似文献   

3.
目的评价外科治疗重症肌无力(MG)的效果,探讨影响术后肌无力危象发生及治疗效果的因素。方法回顾我院2000-2007年外科治疗21例重症肌无力患者的临床资料,对其疗效及影响术后肌无力危象发生及影响治疗效果的因素进行分析。结果重症肌无力的症状完全缓解有5例(23.8%)部分缓解14例(66.7%)无效1例(4.8%),死亡1例(4.8%)。病程长短、Osserman分型和胸腺的病理类型是术后肌无力危象发生的相关危险因素,治疗效果与病程、Osserman临床分型有关。结论外科治疗重症肌无力有良好的效果及可行性。  相似文献   

4.
重症肌无力84例胸腺和胸腺瘤切除疗效评价   总被引:1,自引:0,他引:1  
目的:研究胸腺和胸腺瘤切除对重症肌无力的疗效。方法:采用手术切除胸腺治疗各型重症肌无力的患者共84例,其中存在胸腺瘤的有47例。结果:手术完全切除81例,手术中无死亡。术后随访73例,按Mondon标准来判定疗效,缓解29例,改善33例,无变化或加重8例,死亡3例。结论:认为胸腺和胸腺瘤切除是治疗重症肌无力的一种较为有效的方法,应及早手术,同时重症肌无力的远期疗效与性别、胸腺病理无关,与手术切除的彻底性、年龄差别、Osserman临床分型及病程有关。  相似文献   

5.
重症肌无力173例胸腺切除远期疗效及预后分析   总被引:2,自引:0,他引:2  
目的 探讨重症肌无力胸腺切除术后的预后因素。方法 对173例经胸骨正中切口行胸腺切除术的重症肌无力患进行定期随访,并扫性别、年龄、病程、临床分型、病理分型、伴发甲亢、伴发危象等因素进行统计分析。结果 缓解49例,改善82例,无变化20例,恶化12例,晚期死亡10例,总缓解率28.3%,有效率75.7%。结论 胸腺切除治疗重症肌无力临床切实可行,以病程较短、临床Ⅱ型、胸腺增生可获得较好疗效;伴胸腺瘤及50岁以上患疗效较差;伴发危象或甲亢不影响疗效。  相似文献   

6.
胸腺瘤外科治疗体会   总被引:1,自引:0,他引:1  
目的:了解胸腺瘤及合并有重症肌无力患者的手术治疗与预后的关系。方法:回顾总结128例胸腺瘤患者的一般资料及治疗方法。结果:完整手术切除109例(85.2%),姑息性切除14例(10.9%),探查活检5例(3.9%),其中有1例死亡(0.8%)。结论:胸腺瘤治疗应尽可能完整地切除肿瘤及部分周围组织,以达到手术彻底切除。胸腺瘤合并重症肌无力的围手术期处理至关重要。  相似文献   

7.
目的探讨胸腺切除术后护理干预工作对重症肌无力患者生活质量的影响。方法选取我院2011年3月-2013年6月42例拟行胸腺切除术治疗成人重症肌无力患者作为试验组,行护理干预;另外取同一时期50例胸腺切除满3年的成人重症肌无力患者为对照组,行常规护理。采用调整后的欧洲癌症研究与治疗组织QLQ—C30量表,随访3年后比较二组患者的生活质量。结果二组的SAS、SDS评分均较治疗前下降,差异有统计学意义(P均=0.000),观察组的SAS、SDs评分下降幅度大于对照组,差异有统计学意义(t=5.766,P=0.000;t=6.788,P=0.00),试验组患者的生活质量较对照组的生活质量有明显改善。结论护理干预可有效改善成人重症肌无力胸腺切除术后患者心理健康程度,降低患者心理压力,进而改善患者术后恢复,改善患者远期的生活质量。  相似文献   

8.
13例重症肌无力胸腺扩大切除术疗效分析   总被引:1,自引:0,他引:1  
李杰  项咏梅  王树军  张道忠  王义 《安徽医学》2010,31(12):1454-1456
目的探讨胸腺扩大切除术治疗重症肌无力的远期疗效以及影响预后的相关因素。方法回顾性分析1999年3月至2009年7月13例重症肌无力胸腺扩大切除术的病例资料以及术后的远期疗效。结果在平均为5年(0.5~10年)的随访期内,13例患者中完全缓解8例,部分缓解3例,无效2例,完全缓解率为61.5%,有效率为84.6%。不同性别、年龄的患者有效率差异无统计学意义。术前病程短和Ossermann分型为I型I、Ia型的患者有效率更高。术后病理中胸腺囊肿或增生者的有效率显著高于胸腺瘤者。结论胸腺扩大切除术治疗重症肌无力可以获得较好的疗效;术前病程、Osserman分型以及胸腺病理为胸腺瘤者可能是影响疗效的相关因素。  相似文献   

9.
目的:探讨外科治疗单纯胸腺瘤与合并重症肌无力的胸腺瘤的临床、病理差异及预后分析。方法:回顾性分析 2008年1月—2018年12月于南京医科大学第一附属医院胸外科接受手术治疗的胸腺瘤患者临床和术后病理资料,对比分析单纯胸腺瘤患者与合并重症肌无力胸腺瘤患者围术期疗效及远期预后之间的差异。结果:共354例患者纳入本研究。单纯胸腺瘤组301例,男139例,女162例,平均年龄(54.11±12.57)岁,平均肿瘤直径(6.42±2.94)cm,Masaoka-Koga分期:Ⅰ期147例 (48.8%)、Ⅱ期68例(22.6%)、Ⅲ期15例(5.0%)、Ⅳ期71例(23.6%),腔镜手术比例55.5%,R0切除比例96.3%,后续治疗患者比例21.9%。胸腺瘤合并重症肌无力组共53例,男31例,女22例,平均年龄(53.74±10.21)岁,平均肿瘤直径(5.12±2.11)cm, Masaoka-Koga 分期:Ⅰ期24例(45.3%)、Ⅱ期16例(30.1%)、Ⅲ期4例(7.6%)、Ⅳ期9例(17.0%),腔镜手术比例56.6%,R0切除比例98.1%,后续治疗患者比例13.2%。两组术后总生存率差异无统计学意义。多因素分析提示,年龄≥55岁、肿瘤直径 ≥6 cm、术后病理分型为 B 型、Masaoka-Koga 分期Ⅲ~Ⅳ期及需要后续治疗是影响胸腺瘤患者预后的独立因素。结论:相比单纯胸腺瘤,胸腺瘤合并重症肌无力患者更年轻,肿瘤直径更小。完整切除是改善胸腺瘤患者预后的重要因素,术后准确的病理分型及分期可以更好地预测患者预后。  相似文献   

10.
目的研究重症肌无力患者胸腺的病理改变、临床分型和分期的临床意义。方法回顾性分析173例行胸腺切除重症肌无力患者的术后病理所见与临床特点。结果173例胸腺组织表现为胸腺增生88例(50.87%),胸腺瘤79例(45.66%),正常胸腺4例(2.31%),胸腺萎缩2例(1.16%);胸腺增生组14例(15.91%)、胸腺瘤16例(20.25%)出现术后肌无力危象;重症肌无力患者Osserman临床分型、Masaoka临床病理分期、病理类型间有一定的相关性;多数重症肌无力患者有一种或多种免疫学指标异常。结论综合分析重症肌无力患者的临床资料,结合免疫学的检测结果,有助于该病的有效防治。  相似文献   

11.
Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P< 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P< 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.  相似文献   

12.
Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.  相似文献   

13.
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.  相似文献   

14.
Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.  相似文献   

15.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.  相似文献   

16.
A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(~'4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.  相似文献   

17.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.  相似文献   

18.
Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.  相似文献   

19.
Objective To measure Derpl and Blot5 allergen levels in asthmatics' homes in Hongkong.Methods Seventy houses were enrolled for a mite indoor environment study. Dust samples were obtained from two sites of each patients' house: bed and floor. Derpl and Blot5 levels were quantified by a two-site monoclonal antibody-based ELISA technique.Results The levels of Derpl allergens found in bed (geometric mean (GM) 3.43 μg/g of dust; 95%CI, 1.89-4.96 μg/g)and on the floor (GM 1.12 μg/g of dust; 95%CI, 0.71-1.53 μg/g) indicated significant differences (P=0.005). However, the levels of Blot5 allergens found in bed (GM 19.00 μg/g of dust; 95%CI, 0.89-38.90 μg/g) and on the floor (GM 6.14 μg/g of dust; 95%CI, 0.40-11.90 μg/g) showed no statistically significant difference. In addition, in regards to the exposure index for Derpl and Blot5 allergens found in bed and on the floor, 17.6% in bed and 8.6% on the floor had levels of Blot5 ≥ 10 μg/g of dust, higher than those obtained for Derp1 (7.2% and 0% in bed and on the floor respectively, P< 0.05); higher percentages in bed and on the floor (25.0% and 35.7%) were observed for levels of Blot5 =0 μg/g of dust as compared with Derpl in bed and on the floor (4.3% and 14.5% respectively, P< 0.05).Conclusions Derpl and Blot5 are the major allergens found in this regional study, Blot5 is a more potent allergen in Hongkong, probably reflecting the high level of exposure to Blomia tropicalis (Bt). Bt and Dermatophagoides pteronyssinus (Dp) allergens should be included for precise diagnosis and effective immuno-therapeutic treatment of mite allergy in Hongkong.  相似文献   

20.
ANTI-PROLIFERATION EFFECT OF ORIDONIN ON HL-60 CELLS AND ITS MECHANISM   总被引:4,自引:0,他引:4  
Objcetive To investigate the anti-proliferation effect of oridonin on leukemic HL-60 cells and its mechanism. Methods HL-60 cells in vitro in culture medium were given different concentrations of oridonin. The inhibitory rate of cells were measured by microculture tetrazolium (MTT) assay, cell apoptotic rate was detected by flow cytometry (FCM), morphology of cell apoptosis was observed by hoechst 33258 fluorescence staining, and the activity of telomerase was detected using telomere repeat amplification protocol (TRAP) PCR-ELISA before and after apoptosis occurred. Results Oridonin could decrease telomerase activity, inhibit growth of HL-60 cells, and cause apoptosis significantly. The suppression was both in time- and dose-dependent manner. Marked morphological changes of cell apoptosis including condensation of chromatin and nuclear fragmentation were observed clearly by hoechst 33258 fluorescence staining especially after cells were treated 48-60 hours by oridonin. Conclusions Oridonin has apparent anti-proliferation and apoptotic effects on HL-60 cells in vitro, decreasing telomerase activity of HL-60 cells may be one of its most important mechanisms. These results will provide strong laboratory evidence of oridonin for clinical treatment of acute leukemia.  相似文献   

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