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11.
目的探讨彩色多普勒超声诊断会阴疝的临床价值。方法利用彩色多普勒超声对15例会阴疝患者行术前检查,观察其超声表现。结果前会阴疝14例,疝囊位于尿道与阴道之间;后会阴疝1例,疝囊位于阴道与直肠远端及肛管之间。会阴疝表现为疝囊近端与腹腔相通,远端为盲端。疝内容物为肠管时呈肠壁回声、肠腔内容物或气体回声,CDFI示肠壁少量血流信号;内容物为网膜时呈不均匀中高回声,CDFI示点状血流信号;内容物为膀胱时呈囊状无回声,CDFI示囊壁少量血流信号。其中1例合并会阴部血管瘤,1例合并会阴部纤维脂肪瘤。结论彩色多普勒超声检查可判断有无会阴疝,明确疝的类型,对诊断、鉴别诊断会阴疝具有重要价值。 相似文献
12.
目的:评价平扫CT值在肾上腺常见肿瘤诊断中的应用价值,并结合肿瘤大小优化选择肾上腺腺瘤与非腺瘤的鉴别阈值。方法:回顾性分析经手术及病理证实的肾上腺肿瘤209例(221个病灶),其中腺瘤137个,非腺瘤84个,分别测量肿瘤的大小及平扫CT值并计算不同CT值阚值鉴别腺瘤与非腺瘤的敏感度、特异度、准确度、阳性预测值及阴性预测值。结果:137个腺瘤平扫CT值-12~59(13.19±12.84)HU,直径0.3~7.3cm,其中包括88个无功能性腺瘤,平扫CT值-12~59(15.04±13.01)HU;醛固酮腺瘤43个,平扫CT值-8~42(10.19±12.26)HU;皮质醇腺瘤6个,平扫CT值-4.6~18(7.58±10.16)HU。84个非腺瘤平扫CT值15~69(38.33±10.08)HU,直径1.5~11.6cm,包括:嗜铬细胞瘤43个,平扫CT值15~69(38.67±11.05)HU;节细胞神经瘤5个,平扫CT值18~39(29.60±8.65)HU;皮质癌28个,平扫CT值26~58(38.96±8.84)HU;转移癌8个,平扫CT值28~54(39.75±8.24)HU;腺瘤和非腺瘤的平均平扫CT值差异有显著性意义(t=-15.281,P=0.000)。使用CT值25HU且肿瘤大小≤4cm作为鉴别腺瘤与非腺瘤的阈值时诊断腺瘤的敏感度73.7%,特异度100%,准确度83.7%,阳性预测值100%,阴性预测值70%。结论:平扫CT值在肾上腺腺瘤与非腺瘤的鉴别诊断上有重要价值,以平扫CT值≤25且肿瘤大小≤4cm作为腺瘤的诊断标准是比较合适的,特异度高,敏感度及准确度均较高。但在进一步鉴别腺瘤及非腺瘤的组织类型及具体临床诊断中的作用有限,需结合临床其他检测手段及病理结果做出全面准确的判断。 相似文献
13.
目的探讨Stanford B型主动脉夹层原发破口位置对腹腔主要分支动脉血流灌注的影响。方法回顾性分析130例Stanford B型主动脉夹层患者术前主动脉CTA资料,对受累的腹腔主要分支血管(腹腔干、肠系膜上动脉、双侧肾动脉)缺血类型和灌注损伤程度进行分型,并分析二者与不同夹层原发破口位置的关系。结果 130例患者共计542支分支动脉中,465支(465/542,85.79%)存在缺血,包括337支(337/542,62.18%)动力型缺血及128支(128/542,23.62%)静力型缺血,其中灌注受损69支(69/542,12.73%)、灌注未受损396支(396/542,73.06%);77支(77/542,14.21%)血管无缺血。灌注受损的分支血管中,动力型缺血37支(37/69,53.62%),静力型缺血32支(32/69,46.38%),差异无统计学意义(χ~2=3.077,P=0.215)。夹层原发破口位置对腹腔主要分支动脉缺血类型(动力型、静力型)及灌注改变情况(受损、未受损)无明显影响(χ~2=1.352、0.776,P=0.509、0.678)。结论 B型主动脉夹层原发破口的位置对腹腔主要分支动脉缺血类型及灌注损伤程度无明显影响,评估腹腔主要分支血管缺血及灌注改变情况对指导手术方案制定有重要临床意义。 相似文献
14.
《The Journal of thoracic and cardiovascular surgery》2023,165(2):634-644.e5
BackgroundProsthetic choice for mitral valve replacement is generally driven by patient age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve disease. Our objective was to assess and compare short- and long-term outcomes after mitral valve replacement among patients with biological or mechanical prostheses in the setting of severe ischemic mitral regurgitation.MethodsBetween 2000 and 2016, 424 patients underwent mitral valve replacement for severe ischemic mitral regurgitation at our institution, using biological prosthesis in 188 (44%) and mechanical prosthesis in 236 (56%). A 1:1 propensity score match (n = 126 per group) and inverse probability of treatment weighting were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke, and major bleeding.ResultsIn-hospital mortality and early postoperative adverse events were similar between groups in the propensity score match and inverse probability of treatment weighting cohorts. Overall long-term survival was similar at 5 and 9 years, but mechanical prosthesis recipients were more frequently readmitted to hospital for cardiovascular causes, including stroke and non-neurological bleeding in propensity score matching and inverse probability of treatment weighting analyses (all P values < .004). Type of prosthesis did not independently influence all-cause mortality (hazard ratio, 1.01; 95% confidence interval, 0.71-1.43; P = .959), but placement of a mechanical prosthesis was associated with increased risk of readmission for cardiovascular events (hazard ratio, 1.65; 95% confidence interval, 1.17-2.32; P = .004) among matched patients.ConclusionsThe type of prosthesis has no influence on long-term survival among patients with severe ischemic mitral regurgitation undergoing mitral valve replacement. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses. 相似文献
15.
Hybrid surgical-endovascular procedure was conducted in a 46-year-old male with extensive thoracic aortic aneurysm. Ascending aorta and arch replacement combined with stent elephant trunk implantation was performed first. An open stent-graft was implanted into the descending aorta. One month later, endovascular repair was conducted. Postoperative CTA showed total coverage of the descending aorta by stent-grafts and the descending aortic aneurysm was totally thrombo-excluded. Stent elephant trunk may be a better alternative to conventional elephant trunk in hybrid surgical-endovascular approaches in treatment of extensive thoracic aortic aneurysm. 相似文献
16.
Xian-Peng Yu Chang-Yan Wu Xue-Jun Ren Fei Yuan Xian-Tao Song Ya-Wei Luo Ji-Qiang He Yue-Chun Gao Fang-Jiong Huang Cheng-Xiong Gu Li-Zhong Sun Shu-Zheng Lyu Fang Chen 《中华医学杂志(英文版)》2016,129(7):763-770
Background:
There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.Methods:
All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.Results:
Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.Conclusions:
During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group. 相似文献17.
北京市非瓣膜心房颤动病人日常抗血栓治疗现况分析 总被引:2,自引:0,他引:2
目的 了解北京市非瓣膜心房颤动(房颤)病人日常抗血拴治疗现状,发现房颤病人脑卒中预防存在的问题。方法从北京市城8区(东城区、西城区、海淀区、朝阳区、崇文区、宣武区、石景山区、丰台区)选择8所三级医院和7所二级医院(社区卫生服务中心)。由内科医生对门诊或病房非瓣膜房颤病人采取统一问卷调查。结果 583例病人中75%来源于门诊。其中64.3%来源于三级医院,35.7%来源于社区卫生服务中心。18.9%房颤病人服用华法林,其中39.1%国际标准化测量值(INR)控制在2.0~3.0。68.2%病人华法林服用时间在1年以内。5.7%病人曾经服用华法林。59.3%房颤病人服用阿司匹林,其中85.7%剂量在76~150mg/d,无一例剂量达到325mg/d。18.9%房颤病人未接受任何抗凝治疗。房颤病人不服用华法林的主要原因来自两方面:78.6%病人没有获得抗凝建议,75%以上病人缺乏抗凝知识。房颤病人卒中患病率22.8%,服用华法林者脑卒中患病率22.0%,服用阿司匹林者脑卒中患病率为24.3%,不采取任何措施者脑卒中患病率为21.3%,脑卒中患病率差异无统计学意义(χ^2=1.09,P=0.58)。结论 北京非瓣膜房颤病人抗凝治疗率低于抗血小板治疗率,华法林服用率在我国处于较高水平,但服用时间短,效果欠佳。脑卒中高危房颤病人阿司匹林服用率过高,剂量偏低。提高房颤病人抗凝治疗一方面要改变医生的行为,一方面提高病人抗凝治疗相关知识及治疗依从性。 相似文献
18.
LI Wen-bin XU Xiu-fang ZHANG Jian-qun SONG Shi-qiu PENG Jin-feng WANG Sheng-xun LIU Wei ZHOU Hai-po WANG Zhu-heng LIU Hai-yan ZHOU Qi-wen 《中华医学杂志(英文版)》2008,121(17):1643-1645
Background Aortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease. Methods From October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28+15 years (range, 5-56 years). Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (AI) in 40 cases including one associated with ventricular septal defect (VSD), degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with AI in 1 were studied. The diagnosis was made by ultracardiography (UCG) in all patients. The mean aortic valve annulus diameter (AVD) was (2.45±0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34±0.21) cm. All patients had normal pulmonary valves. The New York Heart Association (NYHA) function class was Ⅱ in 36 cases and Ⅲin 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft. Results There was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was (6.11±0.12) mmHg. The left ventricular diastole diameter (LVDD) decreased significantly from (62±5) mm to (56±3) mm (P 〈0.001). The mean postoperative left ventricular ejective fraction (LVEF) was 0.49±0.23. All patients were in NYHA class Ⅰ-Ⅱ. Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years). All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year af 相似文献
19.
Aortic dissection and aortic aneurysm are two of the most common catastrophic events involving the aorta. Thoracic endovascular aortic repair is now considered as a promising alternative to open surgical graft replacement. The aim of endovascular repair of a thoracic aneurysm is to exclude, and thus depressurize, the aneurismal wall and the aim of the endovascular repair of type B aortic dissection is to obliterate all of the false lumen through thrombosis after sealing the primary entry tears, thus to ensure the true lumen perfusion. But in some special pathologies, such as when the aneurysm and chronic type B dissection are aligned in tandem, or when a visceral branch originates from the false lumen, how should the endovascular repair strategy proceed in this situation? For the endovascular stent repair of some special chronic type B aortic dissection, the false lumen cannot be obliterated, and the true and false lumens in the dissected but with a normal diameter distal aorta need to be perfused at the same time, as practiced in the surgery treatment. In this report, we present a case of endovascular stent repair for a special thoracic aneurysm and chronic type B aortic dissection aligned in tandem. 相似文献
20.
目的:分析总结冠心病合并甲状腺功能减退症外科治疗围术期处理方法。方法:回顾性分析20例冠心病合并甲状腺功能减退患者外科治疗围术期临床资料。结果:全组患者手术效果良好,19例患者经治疗后痊愈出院,围术期死亡1例。术前甲减确诊者均服用左旋甲状腺素片,剂量为12.5~200μg/d,平均(85±11.9)μg/d,(1.15±0.14)μg/kg,术后3d内服用剂量为25~200μg/d,平均(113±11.3)μg/d,(1.56±0.13)μg/kg;术前漏诊6例,术后确诊后立即行激素替代治疗,左旋甲状腺素片最大剂量为250μg/d,最小剂量为75μg/d,平均179.17μg/d,(2.38±0.66)μg/kg;术后机械通气时间14~146 h,平均(38±21)h,ICU停留时间16~67 h,平均(35±14.5)h;术后使用2~5μg.kg-1.min-1多巴胺改善心功能,其中使用肾上腺素维持心功能者4例,剂量在0.02~0.08μg.kg-1.min-1,行IABP辅助治疗者1例,5 d后顺利撤除。结论:冠心病合并甲状腺功能减退症外科治疗增加患者术后机械通气时间、ICU停留时间,术后恢复较甲状腺功能正常者慢,积极有效的围术期处理,术后并发症的发生率、围术期病死率并无明显增高,可安全耐受手术。 相似文献