门静脉瘤导致全消化道静脉曲张并反复异位静脉曲张破裂出血1例报告

正门静脉瘤是一种罕见的疾病,主要表现为门静脉主干及分支局限性囊状或梭形扩张,发病率为0.067%～0.43%~([1-2])。消化道异位静脉曲张(ectopic varices,Ec V)占所有静脉曲张出血的1.0%～5.0%~([3]),其较为少见,而由门静脉瘤引起的门静脉高压导致的消化道Ec V破裂出血则更为罕见。1病例资料患者男性,38岁,因"反复出现呕血、黑便8年"于2020年1月5日入本院。既往体健,无肝病病史。2013年第1次发生消化道出血时于外院行胃镜示:胃、十二指肠多发静脉曲张;     

TRB3基因+251A/G多态性与代谢综合征患者左房功能的相关性研究

目的 探讨TRB3基因+251A/G多态性与代谢综合征（MS）患者左房功能改变的相关性。方法 选择MS患者177例,正常对照组156例。采用酚/氯仿法提取全血DNA,PCR-RFLP法检验受试者TRB3基因第二外显子+251A/G的多态性位点。应用应变率成像技术测量左房各壁的应变率。结果 +251A/G位点AA、AG+GG基因型和等位基因的频率分布在正常对照组和MS组,两组间差异有统计学意义（P均<0.05）;与正常对照组相比,MS组左房平均收缩期应变率峰值（mean SSR）、平均舒张早期应变率峰值（mean ESR）显著降低（P均<0.001）,提示MS患者左房储存器和管道功能显著减低,左房平均舒张晚期应变率峰值（mean ASR）差异无统计学意义（P>0.05）,MS患者左房助力泵功能无显著变化;与AA基因型相比,AG+GG基因型者左房mean SSR、mean ESR和mean ASR均明显降低（P均<0.05）;多元线性回归分析显示mean ESR、mean ASR与TRB3基因+251A/G多态性G等位基因之间存在数量依存关系（P<0.05）。结论 TRB3基因+251A/G多态性G等位基因与MS患者左房功能受损相关,在MS患者左房功能损害中可能起重要作用。     

前列腺透明细胞腺癌3例报道并文献复习

目的 探讨前列腺罕见肿瘤原发透明细胞腺癌(CCA)的临床病理学特征及鉴别诊断。 方法 分析3例前列腺CCA临床病理学特点并复习相关文献。采用一组免疫组化抗体进行鉴别诊断。 结果 3例患者年龄29~54岁;2例发生于前列腺小囊,1例发生于前列腺内。2例临床表现为血精,1例为进行性排尿困难。肿瘤由腺管状、乳头状及实体型三种结构混合存在。腺管和乳头表面可见肿瘤细胞呈鞋钉样排列。3例肿瘤细胞均表达CK7、PAX-8、HNF-1β,部分区域表达AMACR、NapsinA、CA125。术后随访12~15个月,其中1例复发,并肺及腹股沟淋巴结转移;1例未见复发和转移;1例失访。 结论 前列腺原发CCA血清前列腺特异性抗原(PSA)水平不高,可伴有CA125升高,出现血精症状的年轻男性需提高警惕,诊断主要依靠组织病理学检查及免疫表型,发生于前列腺内的较发生于前列腺小囊的预后差。     

羰花青荧光染料示踪在大鼠胚胎皮肤成纤维细胞移植中的应用

目的 探讨羰花青荧光染料CM-Dil示踪大鼠胚胎皮肤成纤维细胞的可能性.方法 体外培养孕16 d的Wistar大鼠胚胎皮肤成纤维细胞,用10μg/ml的CM-Dil标记,流式细胞仪观察CM-Dil对细胞生长的影响,计算细胞增殖指数(PI).将标记细胞注射移植到同种异体大鼠背部深Ⅱ度烫伤创面,分别于注射后0、1、3、7、14、28 d取创面全层皮肤标本,荧光显微镜观察CM-Dil示踪效果.结果 标记后15 min,细胞呈现圆形红色荧光,高倍镜下可见双层膜结构.标记与未标记大鼠皮肤胚胎成纤维细胞P1分别为76.9±2.8和75.8±2.0,差异无统计学意义(t=0.80,P>0.05).CMDil标记细胞异体移植后第1天取材的大鼠创面皮肤标本中荧光信号较少;第3天标本荧光信号明显增多,荧光信号区域呈"烧杯形"分布;第7天标本可见"烧杯形"区域底部变宽,显示细胞增殖;第14天标本仍能检测到中等强度的荧光信号;第28天标本能检测到微弱的荧光信号.结论 适宜浓度的CM-Dil对胚胎皮肤成纤维细胞没有毒性.CM-Dil订在皮肤组织内淬灭较慢,4周内保持良好的荧光示踪稳定性,是一种比较理想的胚胎皮肤成纤维细胞荧光标记物.     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Objective To study the microcirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital re-cording of survival arca. Results When compared with the other groups, the perfusion volume of mi-crocirculation enhanced, flaps survival improved (97.54±2.73) %, blood capillary were stronger, to-gether with microscopic changes were significant in the expanded prefabricated groups (P<0.05). Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.     

保留十二指肠升部的改良胰十二指肠切除术临床疗效分析

Objective To investigate the value of modified pancreatoduodenectomy in the treatment of ampullary carcinoma by comparing the efficacy of pancreatoduodenectomy with preservation of ascending portion of duodenum and that of Whipple procedure. Methods The clinical data of 133 patients with ampullary carcinoma who had been admitted to the Qilu Hospital from 1990 to 2006 were retrospectively analyzed. Of the 133 patients, 88 received Whipple procedure (group A) and 45 received pancreatoduedenectomy with preservation of ascending portion of duodenum (group B). The preoperative condition of the patients and short- and long-term efficacy of the 2 procedures were compared by Fisher exact probability, t test, chi-square test, Kaplan-Meier survival curve and Log-rank test, and the differences between the efficacy of the 2 procedures were compared. Results The operation time, time of gastrointestinal function recovery, hospital stay and ratio of patients with blood transfusion were (366±111) minutes, (7.4±1.4) days, (24±9) days and 76% (67/88) in group A, and (325±32)minutes, (4.3±1.4)days, (31±14)days, 42% (19/45) in group B, with significant difference between the 2 groups (t = 2.34, 2.08, 1.98 ; χ2 = 14.99, P < 0.05). The medium survival time of patients in groups A and B were (19.0±1.5)months and (16.9±1.7) months, with no significant difference between the 2 groups (χ2 = 0.46, P > 0.05). There was no significant difference in the occurrence of postoperative complications between the 2 groups (P > 0.05). Conclusions Pancreateduodenectomy with preservation of ascending portion of duodenum can be applied for patients with ampullary carcinoma.     

利妥昔单抗致重度急性低钾血症1例

摘要：<正>1 病例资料患者男,50岁,因滤泡性淋巴瘤拟行R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松龙）方案治疗,于2021年4月23日入院。8 d前,患者因"右侧腹股沟肿物半月余",在我院外科门诊行右腹股沟淋巴结切除活检术,术后病理:（右腹股沟）符合淋巴结滤泡性淋巴瘤,Ⅱ级。患者平素健康状况良好,无食物药物过敏史,父亲因"胃癌"及"肝癌"去世10余年,母亲因"胰腺癌"去世10余年。否认家族性遗传病、传染病病史。     

经阴道超声联合胎儿纤维连接蛋白预测自发性早产的临床价值

  目的  分析经阴道超声测量子宫宫颈前角（ACA）、宫颈长度（CL）联合胎儿纤维连接蛋白（fFN）预测自发性早产（SPB）的临床价值。  方法  选取2019年6月~2022年6月我院收治的98例先兆早产孕妇为研究对象,根据是否发生SPB将其分为SPB组（n=33）和足月组（n=65）。采用单因素及Logistic多因素回归分析先兆早产孕妇发生SPB的风险因素。通过绘制ROC曲线评估ACA、CL及fFN对SPB的预测效能。  结果  经单因素分析,两组孕前BMI、胎膜早破、宫内感染、羊水过多、妊娠期糖尿病情况及ACA、CL、fFN水平的差异有统计学意义（P < 0.05）。经Logistic多因素回归分析,胎膜早破、ACA、fFN是先兆早产孕妇发生SPB的风险因素（OR>1,P < 0.05）,孕前BMI、CL是先兆早产孕妇发生SPB的保护因素（OR < 1,P < 0.05）。ROC曲线显示,当ACA≥ 116.500°时,预测先兆早产孕妇发生SPB的AUC为0.630,敏感度为48.5%,特异性为69.2%。当CL≤25.000 mm时,AUC为0.667,敏感度为54.5%,特异性为73.8%。当fFN≥96.155 μg/L时,AUC为0.652,敏感度为60.6%,特异性为69.2%。三者联合预测的AUC为0.740,敏感度为72.7%,特异性为75.4%。  结论  经阴道超声测量ACA、CL及fFN水平均对预测先兆早产孕妇发生SPB具有一定预测价值,且三者联合预测效能更佳。