鼻胆管引流灌注治疗急性胰腺炎的临床价值

目的　探讨鼻胆管引流灌注 (ENBD)治疗急性胰腺炎的临床价值。方法　 40例经B超或CT检查无胆总管、肝总管结石的急性胰腺炎患者随机分为ENBD治疗组和对照组 ,ENBD治疗组在常规逆行性胰胆管造影 (ERCP)检查时做胆汁常规检查及细菌培养 ,术后留置鼻胆管引流并交替应用 0 .9%氯化钠 5 0ml +庆大霉素 8万U 8h和 0 .5 %灭滴灵 5 0ml 8h灌注持续 3～ 5d ,对照组应用善宁 0 .1mg皮下注射 8h持续 3d并观察其 1年内的复发情况。结果　ENBD治疗组 2 0例患者胆汁中均发现有白细胞及黄、黑色泥沙样物 ,6例培养出微生物 ( 3 0 % ) ,ENBD治疗组与善宁治疗组的腹痛消失时间分别为 ( 8.45± 8.40 )h和 ( 3 8.10± 3 5 .43 )h(P =0 .0 0 2 ) ,血清淀粉酶恢复至正常所需时间分别为 ( 18.0 0± 8.2 6)h和 ( 5 6.40± 48.80 )h(P =0 .0 0 2 ) ,两组的 1年复发率分别为 5 %和 40 % ,其差异均有非常显著性 (P <0 .0 1)。结论　鼻胆管引流灌注治疗急性胰腺炎疗效确切而安全 ,能减少复发 ,胆汁淤积和感染在急性胰腺炎的发病中起重要作用。     

Risk factors to discriminate neoplastic polypoid lesions of gallbladder: A large-scale case-series study

BackgroundPolypoid lesion of gallbladder (PLG) size larger than 10 mm is considered to be one of the surgical indications, but the final pathological results are mostly non-neoplastic polyps. The aim of the study was to define the risk factors to discriminate neoplastic PLG and create more precise criteria for surgical indications.MethodsA large scale, case-series study based on 2704 patients who underwent cholecystectomy for PLG was designed. Logistic regression analysis and receiver operating characteristic curve (ROC) was adopted to identify risk factors and the optimal size criteria for predicting neoplastic PLG.ResultsPatients in the neoplastic group were significantly older than those in the non-neoplastic group and the average PLG size is much larger in the neoplastic group (18.5 ± 4.7 mm vs 12.6 ± 3.6 mm). Neoplastic PLGs are prone to be single and non-neoplastic polyps are usually multiple. On Multivariate logistic regression analysis, PLG size larger than 15 mm and age older than 43 years were found to be the independent risk factors to discriminate neoplastic PLG （Odds ratio 3.546 and 2.77 respectively）. The ROC curve showed that 12 mm might be the more reasonable PLG size threshold for the surgical suggestion.ConclusionsConsidering its moderate diagnostic accuracy, the size of gallbladder polyp larger than 10 mm is insufficient to indicate surgical therapy for PLG and 12 mm should be the more optimal polyp's size threshold. Patients older than 43 years have a higher risk of having neoplastic polyps.     

间断冷含血停跳液在心脏瓣膜置换术中的心肌保护作用

目的评价间断冷含血停跳液在心脏瓣膜置换术中心肌保护的临床效果。方法54例心瓣膜置换术的患者,均使用按4:1比例灌注冷含血停跳液,观察体外循环时间、主动脉阻断时间、自动复跳率、住院死亡率。结果体外循环时间47～218mins,阻断主动脉时间26～102mins,心脏自动复跳43例,占80%,住院死亡2例,死亡率3.7%。结论间断冷含血停跳液在心瓣膜置换术中有良好的心肌保护作用。     

大肠癌VEGF和CD44V6及E-cadherin表达的差异及意义

目的 :探讨大肠癌术前活检、浸润前缘和转移灶癌组织血管内皮生长因子 (vascularendothelialgrowthfactor ,VEGF)、CD44选择性拼接变异体 6(CD44Variant 6,CD44V6)和E上皮型钙黏附素 (E cadherin)表达的差异以及与大肠癌浸润转移的关系。方法 :检测 94例大肠癌术前活检、浸润前缘癌组织和 48例转移灶癌组织VEGF、CD44V6和E cadherin的表达。结果 :术前活检癌组织VEGF、CD44V6的阳性表达率低于浸润前缘癌组织 ( 4 6 8%、3 8 3 %vs 5 6 4%、48 9% ) ;转移灶癌组织VEGF、CD44V6的阳性表达率与浸润前缘癌组织相近 ( 5 8 3 %、5 0 %vs 5 6 4%、48 9% )。术前活检癌组织VEGF的阳性表达率与大肠癌Duke’s分期、淋巴结转移有关 ;浸润前缘癌组织VEGF的阳性表达率与大肠癌Duke’s分期、浸润深度、淋巴结转移有关。术前活检和浸润前缘癌组织CD44V6的阳性表达率与大肠癌Duke’s分期、浸润深度、淋巴结转移有关。E cadherin在术前活检、浸润前缘和转移灶癌组织中的阳性表达率相近 ( 5 9 6%、5 2 1%和5 8 3 % ) ,E cadherin的表达与大肠癌生物学行为无关。结论 :浸润前缘癌组织和术前活检癌组织VEGF和CD44V6的表达与大肠癌生物学行为有关。VEGF、CD44V6在浸润前缘癌组织的表达比术前活检癌组织的表达更能反映大肠癌浸     

Impact of gender on the clinicopathological features of patients with primary IgA nephropathy

Objective To explore the impact of gender on the clinicopathological features of patients with primary IgA nephropathy (IgAN). Methods All patients with IgAN who were biopsy-proven in The First Affiliated Hospital, Sun Yat-sen University from January 2006 to December 2011 were divided into two groups by gender: male group and female group. The clinical manifestations and pathological features of two groups were retrospectively investigated and compared. Results A total of 1512 primary IgAN patients were enrolled in the study, and the ratio of male to female was 1∶1.16, with a median age of 32(26, 39) years old at biopsy. Compared to female patients, male patients with IgAN exhibited more severe clinical manifestations including worse renal function, greater urinary protein excretion, and more frequent occurrence of hypertension, hypertriglyceridemia and hyperuricemia. Besides, male patients had worse histological lesions, including more severe segmental sclerosis, tubular-atrophy/interstitial fibrosis and interstitial infiltration. For female patients, hematuria, including gross and microscopic hematuria, was more frequent. Conclusion Male patients with IgAN were with worse clinicopathological changes than those of female.     

经尿道前列腺汽化和开放手术对老年前列腺增生患者性功能的影响

目的 评价经尿道前列腺汽化(TUVP)和开放性手术对老年前列腺增生(BPH)患者术后性功能的影响。方法 分别统计TUVP组(52例)、耻骨上经膀胱前列腺切除组(SPP组，46例)和耻骨后保留尿道前列腺切除组(Madigan组，32例)术后6、12个月勃起障碍与逆行射精的发生率。结果 术后6个月勃起障碍的发生率：TUVP组、SPP组、Madigan组分别为13．4％(7例)、15．2％(7例)、12．5％(4例)，术后12个月分别为11．5％(6例)、15．2％(7例)、12．5％(4例)；术后6、12个月逆行射精的发生率3组分别为46．2％(24例)、39．1％(18例)、9．3％(3例)。结论 TUVP与传统开放性手术SPP及Madigan手术对勃起障碍及性活动的影响不明显，但逆行射精的发生率较Madign手术组高，提示TUVP对术后射精功能有较大影响。     

腮腺多形性腺瘤包膜特征与手术边界的确定

目的：研究腮腺多形性腺瘤包膜特征与安全手术边界,为临床治疗提供病理学依据。方法：选择53例腮腺多形性腺瘤术后连续病理切片．镜下观察肿瘤包膜情况,对肿瘤包膜内浸润、伪足及卫星结节的深度进行测量。采用SPSS16．0软件包对数据进行统计学分析。结果：腮腺多形性腺瘤的包膜特征与其术后复发密切相关,肿瘤包膜内浸润、伪足及卫星结节包膜侵袭的最大及平均距离分别为0．846mm、（0．399±0．1501mm,1．692mm、（0．737±0．3651mm．2．369mm、（1.448±0．635）mm;肿瘤包膜不完整、包膜浸润、伪足及卫星结节与肿瘤大小无显著相关性吟0．05）。结论：腮腺多形性腺瘤包膜外5mm以上范围为手术安全切除边界．可达到根治效果．     

36例灯盏花素注射液不良反应分析

目的分析灯盏花素注射液所致不良反应的一般规律及特点,为临床合理用药提供参考。方法对本院2010年6月~2013年6月收集的36例灯盏花素注射液药品不良反应进行统计分析。结果 36例灯盏花素注射液药品不良反应中,有12例（33.33%）既往有过敏史,有18例（50.00%）用药30 min内出现药品不良反应,主要为变态反应（36.36%）,36例患者均痊愈,无出现后遗症或导致死亡。结论临床应重视灯盏花素注射液引起不良反应的特点,加强用药监测,确保用药安全。     

26例子宫颈小细胞癌临床病理特征及预后分析

目的探讨宫颈小细胞癌(SCCC)的临床病理特征及预后。方法收集26例原发性SCCC患者,回顾性分析其临床病理资料、特征及预后。结果 26例患者中,24例患者表现为宫颈接触性出血或不规则阴道流血,2例表现为月经不规则伴经期延长,妇检发现宫颈赘生物,其中15例为健康体检宫颈液基细胞学检查发现非典型细胞。26例患者中,ⅠB1期10例,ⅠB2期8例,ⅡA2期2例,ⅢB期4例,ⅣB期2例。组织学特点为肿瘤细胞不规则巢片状分布,瘤细胞大小及形态较一致,圆形或短梭形,细胞质少,核深染,核仁不明显,核分裂像多见,其中2例合并中分化腺癌,2例合并宫颈高级别上皮内瘤变(CINⅢ级)。26例患者均行免疫组织化学染色,细胞角蛋白(CK)阳性率为100%、细胞膜抗原(EMA)阳性率为84.6%、神经元特异性烯醇化酶(NSE)阳性率为100%、突触素(Syn)阳性率为92.3%、CD56阳性率为92.3%、嗜铬蛋白A(Cg A)阳性率为69.2%、TTF1阳性率为7.7%,Ki67阳性率为70%~90%。结论 SCCC少见,临床表现无特殊性,形态学与肺小细胞癌相似,瘤细胞表达联合神经内分泌标志物对诊断及鉴别诊断具有重要意义,其早期即可复发或转移,恶性程度高,预后差。