卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

中国优秀马拉松运动员ACE基因I/D多态性频率分布特征

通过分析中国马拉松运动员ACE基因I/D多态频率分布特征,探讨其作为杰出耐力基因标记的可行性。选择我国马拉松健将、国际健将级运动员26名作为马拉松运动员组,汉族学生216名作为对照组。对两组受试者进行ACE基因I/D多态性测定。结果显示:我国马拉松运动员组的等位基因频率和基因型频率与对照组比较无显著差异,其中15名国际健将中无一DD型纯合子,提示我国优秀马拉松运动员的纯合子DD型频率低下是其ACE基因多态频率分布的主要特征。     

中央型肺癌术后螺旋CT检查价值探讨

目的探讨螺旋CT对于监测中央型肺癌术后局部复发及胸内淋巴结转移的价值。方法回顾性地对55例110人次中央型肺癌术后胸部增强螺旋CT资料进行分析。结果支气管残端或吻合口复发9例,12人次。胸内淋巴结26例33人次淋巴结短径≥1 cm,其中14例结合临床及CT诊断为淋巴结转移。结论对中央型肺癌术后复发的监测,螺旋CT是最好手段之一,但对肿大淋巴结性质的评价有一定局限性。     

磁共振质子波谱成像(1H-MRSI) 在胶质瘤诊断中的应用

目的探讨利用磁共振波谱成像(MRSI)反映胶质瘤恶性度的价值.方法41例病理证实胶质瘤,原发39例、复发2例,行MR及MRS扫描,MRS数据经残差Z分数统计模型及LLI、Lip/Cho等指标划分肿瘤边界及不同代谢区,并结合MRI结构成像,划分出肿瘤的高代谢活性区、肿瘤浸润边界、坏死区及乏氧区.结果肿瘤浸润边界均超过MR常规图像上的肿瘤边界.Ⅱ级肿瘤高代谢活性区大部分位于肿瘤区内,但Ⅲ、Ⅳ级则大部分位于肿瘤边界;随肿瘤恶性度升高,肿瘤出现了坏死区及乏氧区.结论MRSI对确定肿瘤恶性度及划分肿瘤边界具有一定价值.     

眼眶内下壁爆裂性骨折整体修复29例

目的探讨眼眶内下壁骨折整体修复手术方法。设计回顾性病例系列。研究对象29例(29眼)眼眶内下壁骨折患者。方法对29例眼眶内下壁爆裂性骨折者采用整体羟基磷灰石复合人工骨(HA)修复。对比观察手术前后眼球突出度、复视程度,眼眶CT观察术后骨折修复情况。主要指标眼球突出度,复视程度。眼眶CT影像。结果29例眼眶内下壁骨折整体修复术中,加例眼球内陷全部矫正,9例欠矫1～2mm,4例术后复视未完全缓解。结论眼眶内下壁骨折整体修复是一种眼眶骨折修复的新方法,效果好,并发症少。(眼科,2006,15：348-350)     

骨质疏松相关基因的研究进展

骨质疏松(osteoporosis,OP)在很大程度上受基因的影响。在OP的相关基因中,维生素D受体(VDR)基因、雌激素受体(ER)基因、Ⅰ型胶原基因及转化生长因子基因都是重要的候选基因。VDR基因中BB基因型者比Bb及bb基因型者的腰椎骨密度(bone mineral density,BMD)低,骨丢失率高。FokⅠ基因型与腰椎BMD降低有明显相关性,ff基因型者腰椎BMDXx基因型者>xx基因型者。Ⅰ型胶原基因与骨量呈显著相关性,COLIA1基因突变可致低骨量、骨脆性增加。转化生长因子β(TGF-β)基因对调节骨形成和骨吸收有重要作用,TGF-β基因中可发生碱基丢失,这种变异多见于OP患者。     

经腹膜后隙途径腹腔镜活体供肾切取32例

目的 探讨经腹膜后隙途径腹腔镜活体供肾切取的技术和效果。方法 32名供者中，男性15名，女性17名。29例取左肾，3例取右肾。供者全身麻醉，取侧卧位，共选3个穿刺点，第1个穿刺点选在12肋缘下2cm与骶棘肌外侧缘1cm交叉点，第2个穿刺点选在第1个穿刺点向前8～10cm，或肋缘下2cm与腋前线交叉点，第3个穿刺点位于髂棘上2cm与腋中线交叉点，分别插入12mm、10mm和5mm的Trocar。以自制水囊扩张器扩张腹膜后隙，游离供肾和输尿管，前6例用直线切割缝合器切断肾动脉和静脉，后26例用带锁的塑料夹夹闭切断肾动脉和静脉，在第1个穿刺点向下的延长切口将肾取出。结果 32只供肾切取顺利，手术耗时60～180min，出血量20～200ml，供肾热缺血时间3～8min，冷缺血时间25～50min。3只肾静脉较短，分别为1cm、1．5cm和2cm，另有1只供肾动脉内膜损伤。移植术后第1d，受者的尿量为2800-10 100ml，无移植肾功能恢复延迟发生。结论 经腹膜后隙途径腹腔镜活体供肾切取是安全、可行的，对供者创伤小，所获供肾的质量较好，但要求有熟练的腹腔镜技术。     

对血吸虫病患者心理护理问题的思考

长期以来,对血吸虫病患者心理护理方面重视不够。鉴于此,根据湖北省孝感市血吸虫病防治所2003~2004年收治的251例血吸虫病患者的心理状况观察资料,浅谈对不同病型血吸虫病患者心理护理的对策。1不同类型血吸虫病患者的心理特点1.1急性血吸虫病这类患者以新感染者为主。患者对血吸虫病比较陌生,医护人员及家属一举一动直接影响其心理活动。具体表现为:情绪紧张,对该病不了解,经常找医生打听病情,担心病情过重难以医治,因而造成失眠纳差,情绪不安,植物神经功能紊乱等。1.2慢性血吸虫病这类患者多数是疫区20~50岁的青壮年,均为家庭的主要劳动力…     

移植人羊膜细胞对大鼠创伤性脑损伤的实验研究

目的 探究大鼠TBI后脑内移植人羊膜细胞（HACs）对大鼠运动功能的影响。方法 HACs经分离、Hoechst33342标记后重悬调整细胞浓度为10^5/μl；采用改进的Feeney自由落体法打击大鼠脑皮层后肢运动区域，损伤后24h经微量注射器和立体定向仪将Hoechst33342标记的HACs 10μl分别移植于挫伤灶中心和挫伤灶边缘；在TBI后的28d内采用钉板平衡木行走测试大鼠运动功能变化，运动功能检测结束后取出脑组织行组织学检测。结果 治疗组滑落脚步数明显少于对照组（P〈0．05）；移植的HACs呈蓝色荧光；部分移植HACs可见MAP-2阳性表达。结论 移植HACs使大鼠TBI后运动功能明显改善。     

口内入路下颌角弧线形截骨术

目的:探索更好的下颌角肥大截骨缩小术式。方法:为获得更好的术后效果,我们采用口内入路下颌角弧形截骨术,将弧形截骨线延长到颏神经处,并对颏结节进行打磨,使截骨线延续流畅,伴小颏者同时行隆颏或颏截骨前移。结果:自2002年以来,我科采用口内入路下颌角长弧线形截骨术矫正320例下颌角肥大患者,均取得了良好的效果。结论:口内入路延长弧形截骨术缩小下颌角可以获得更好术后效果。