胃癌根治术病人围术期异体输血后外周血单核细胞CD40L表达的变化

目的 研究胃癌根治术病人围手术期异体输血外周血单核细胞(PBMCs)白细胞分化抗原40配体(CD40L)表达的变化。方法 胃癌根治术病人30例,随机分为3组,每组10例。A组围术期不输血,B组围术期输入去白细胞的全血,C组围术期输入异体全血。另选10例健康人作为对照。分别在手术前、术后2、5、10 d采外周静脉血5 ml,用Ficoll分离液梯度离心法分离出PBMCs和血浆,将PBMCs置于自身血浆环境中,并在植物血凝素(PHA,20 mg/L)的刺激下进行培养,48 h后收获细胞,用流式细胞术检测CD40L表达。结果 健康人外周血未受PHA刺激时检测不到CD40L的表达,经PHA刺激后CD40L 细胞占CD4 T细胞的百分数为1.7％±0.4％,与三组胃癌病人术前比较差异无显著性(P>0.05)。与术前比较,B组术后2 d PBMCs CD40L表达升高(P<0.05),C组术后各时点升高(P<0.05);与A组比较,B组术后2 d升高(P<0.05),C组术后各时点升高(P<0.05);与B组比较,C组术后各时点升高(P<0.05)。结论 围手术期异体输血可造成免疫抑制,输异体血后CD40L表达增加,且输全血比输去白细胞的全血更明显。围手术期成分输血优于输注全血。     

髋臼转位截骨(TAO)治疗DDH继发早期OA

目的　介绍一种治疗髋臼发育不良并早期骨性关节炎的髋臼转位截骨术并评价其结果。方法　 4 3例髋关节发育不良 (DDH)并发骨关节病 (OA) ,全部病人实施了髋臼转位截骨术。结果　术后平均 12个月 (10～ 17个月 )随访 ,术后 Harris评分 93分 (85～ 10 0分 ) ,平均增加 2 5分 ,两者比较有显著性差异 ;术后 CE角 2 0°～ 2 8°,平均 2 4°,两者比较有显著性差异 ;术后髋臼指数 37°～ 4 8°,平均 4 5°,两者比较有显著性差异 ;术后 AHI81% (75 %～ 98% ) ,两者比较有显著性差异。结论　髋臼转位截骨术是治疗髋关节发育不良 ( 型 )并发骨关节病 ( 期 )有效的方法     

脾切除贲门周围血管离断术后肝脏血流动力学和储备功能的变化

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.     

甲状腺乳头状微小癌的诊治分析

目的探讨甲状腺乳头状微小癌的临床特征、诊断及治疗方式。方法回顾性分析1985～ 2 0 0 2年间我院收治并经病理证实的甲状腺乳头状微小癌 89例患者的临床资料。结果随访 89例 ,时间 5～ 196个月 ,平均 6 8 9个月。复发 5例 ,无死亡 ,未发现远处转移。因甲状腺良性病变手术而发现微小癌 38例 ,另 5 1例术前怀疑为癌 ,经活检发现微小癌。颈部淋巴结转移 4 0例 ,最多发生在颈深上、中组和气管食管沟组淋巴结。腺叶多发结节转移的发生率显著高于单发结节。不同大小的原发肿瘤 (≤ 5mm ;>5mm)在颈部淋巴结转移的发生率其差异有显著性。是否可触及肿大淋巴结对局部复发率的影响差异有显著性。结论术前触诊、B超检查、术中探查及冰冻组织切片对提高甲状腺乳头状微小癌的诊断非常重要。根据病情选择不同的切除范围 ,疗效是同样的。建议区分两类甲状腺乳头状微小癌 :一类良性进展 ,应以保守性手术为主 ;另一类侵袭性进展 ,有不良预后 ,应行积极的手术方式。     

肾上腺组合性嗜铬细胞瘤四例报告及文献复习

Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.     

肠易激综合征Manning诊断标准的评价

目的 评价Manning标准诊断肠易激综合征(IBS)的真实性。方法 采用自行设计的调查表对499例对象进行调查。结果 1．随着Manning标准中结合指标数的增多，IBS组与非溃疡性消化不良及溃疡性结肠炎组鉴别的灵敏度及其95％CI明显下降，特异度及其95％CI明显上升，同时阳性预测值、阳性似然比及阴性似然比也明显上升。2．符合Manning标准中二项以上结合指标，IBS组就具有较好与健康对照组鉴别的灵敏度及其95％CI、特异度及其95％CI。结论 Manning标准中需要3项以上结合指标可较好地使IBS与非溃疡性消化不良或溃疡性结肠炎鉴别；2项以上结合指标可较好地使IBS与健康人鉴别。     

76例轮状病毒性肠炎临床症状观察

目的 :分析 76例轮状病毒 (RV)性肠炎患者的临床症状。方法 :对 76例不同年龄组 RV肠炎患儿的临床症状进行回顾性分析。结果 :1同时出现呼吸系统症状并伴流涕、鼻塞、咳嗽、气促 59例 ;支气管炎 19例 ;肺炎 5例。 2出现抽搐7例。 3生化检查结果门冬氨酸氨基转移酶 (AST)明显增高 76例 ;肌酸激酶 (CK)增高 52例 ;丙氨酸氨基转移酶 (AL T)轻度增高 48例 ;乳酸脱氢酶 (L DH)增高 13例。 4X线胸片肺纹理增粗 8例 ;双肺斑片影 4例。 5心电图表现窦性心动过速 4例 ,T波改变 1例。结论 :RV感染可造成病毒血症 ,且可呈多系统播散 ,使机体各脏器组织损伤 ,致婴幼儿发病。故要对这一弱小群体实行早期预防保健 ,有关部门应引起重视     

脑干、三叉神经及大脑动脉环的可视化研究

目的 建立人体脑干、三叉神经及大脑动脉环的可视化数字模型。方法 采用首例中国数字化可视人体数据集，在SGI工作站上对脑干及其周围毗邻结构进行计算机三维重建并立体显示。结果 获得人体脑干、三叉神经及大脑动脉环等器官组织的三维重建结构，可对其进行任意径线和角度的适时三维测量。结论 首例中国数字化可视人体数据集能够提供完整而精确的解剖断面数据，脑干及其毗邻的三叉神经、大脑动脉环的可视化模型准确反映出该区域复杂的解剖学结构特点及其相邻器官间的空间毗邻关系，可为该区域的疾病的影像诊断和外科治疗提供形态学依据。     

南昌市中心气传花粉调查

目的：探明南昌市中心气传致敏花粉的种类、数量及季节消长规律，提高过敏性疾病的防治水平。方法：2000年4月--2001年4月期间采用Durham重量法进行为期一年的气传花粉调查，分析其飘散规律。结果：全年都有气传花粉的飘散，存在两次高峰，其一为三、四月，占17．24％及9．15％，以松科、柏科、杉科、桑科及柳属为主；其二为九、十月份，占18．13％及38．52％，以豚属、蒿属、禾本科、藜苋科及Lu草属为主。结论：为本地区过敏性疾病的特异性诊断和治疗及流行病学研究提供了科学依据。     

血管变异型前臂背侧皮瓣修复手部皮肤软组织缺损

目的 探讨骨间后动脉血管变异时前臂背侧皮瓣的切取方法.方法 以骨间后动脉为蒂逆行岛状皮瓣转移修复手部皮肤软组织缺损时,遇到血管变异共9例,采取以骨间后动脉桡侧支为蒂切取逆行岛状前臂背侧皮瓣、以骨间后动脉近端为蒂切取游离骨间后动脉皮瓣、以骨间后动脉穿支为蒂切取游离前臂背侧穿支皮瓣等方法,进行皮瓣转移或移植修复手部创面.结果 9例皮瓣中有8例顺利存活;1例术后2 d皮瓣远端出现肿胀、青紫、小水泡,及时对症处理,5 d后部分皮缘形成干痂,皮瓣颜色恢复正常,脱痂后存活.9例随访3个月至2年,皮瓣质地柔软,弹性好,外形满意.结论 以桡骨间后动脉侧支为蒂的前臂背侧皮瓣逆行转移,以骨间后动脉近端或骨间后动脉穿支为蒂的前臂背侧皮瓣游离移植修复手部创面,是解决骨间后动脉血管变异较理想的方法.