心腔内组织多普勒对心肌兴奋的发生及传导显像的实验研究

目的初步评价心腔内组织多普勒成像（TDI）对心肌激动及传导的显像功能。方法10只开胸犬心室起搏前后，采用心腔内TDI加速度图模式，分别观察窦性心律和室性心律时房、室间隔与室壁的加速度分布变化。结果心腔内TDI加速度图模式可检测到窦性心律时房、室间隔的加速度增高区域的分布与下移过程；心室起搏时检测到的最早的高加速度区与起搏电极放置部位相一致。结论心腔内TDI技术能够实时显示与心肌电活动密切相关的机械运动，从而使观察心肌兴奋的发生和传导成为可能。     

微探头超声研究食管壁外侧支静脉在食管静脉曲张形成中的作用

目的：探讨微探头超声检测食管壁外侧支静脉在食管静脉曲张形成中的作用。方法：对35例门脉高压症患者在食管静脉套扎(EVL)前进行常规胃镜检查，记录食管静脉曲张分级；然后用UM—3R超声成像系统中的20MHz微探头进行食管下段超声检查，记录食管周围静脉、旁静脉的曲张程度以及穿静脉的有无及类型。结果：35例患者中有30例检测到周围静脉(85．7％)，27例检测到旁静脉(77.1％)。内镜下食管静脉曲张分级越高，周围静脉曲张越严重(P＜0.05)；静脉曲张分级和旁静脉的严重程度之间无统计意义。26例患者检测到穿静脉(74．3％)，曲张静脉分级越高，穿静脉显示率越率。结论：食管壁外侧支静脉在食管静脉曲张形成中均起作用，其中食管周围静脉发挥着更大的作用。     

经直肠彩色多普勒超声检测直肠癌局部血流特征与肿瘤血管生长因子表达的相关性研究

目的 探讨经直肠彩色多普勒超声检测直肠癌局部血流及其与肿瘤血管生成间的关系。方法 回顾分析了经病理证实的直肠癌患者121例，观察直肠癌病灶局部的彩色多普勒血流显像（CDFI）、能量多普勒（PDI）血流信号的变化、分布及特征，采用免疫组织化学技术检测病灶局部血管内皮生长因子（VEGF）的表达，并对血流信号和VEGF表达的阳性细胞半定量分级。结果 CDFI和PDI检查病灶局部血流信号增多，血流信号的增多似与病灶分期无关。uT1和uT2期病灶VEGF表达与CDFI和PDI呈弱相关，uT1和uT2期病灶VEGF的表达与CDFI和PDI显著相关。结论 彩色多普勒超声对病灶血流信号的分析在一定程度上可反映肿瘤病灶的血管生成特征。     

子宫内膜厚度及绝经时间预测阴道出血及子宫内膜癌的价值

目的探讨绝经后子宫内膜厚度及绝经时间对内膜癌的预测价值。方法127例绝经后阴道出血患者内膜活检术前采用经阴道超声测量子宫内膜厚度,比较良、恶性组患者的发病年龄、平均内膜厚度,并对子宫内膜癌与内膜厚度及绝经时间的关系进行分析。结果127例患者(良性病变115例、内膜癌12例)经阴道超声测量,内膜癌组的平均内膜厚度(14.3±7.3)mm大于内膜良性病变组(7.0±4.4)mm(P<0.01)。其中内膜厚度≥10mm者内膜癌9例(9/45);内膜厚度≤5mm者无一例内膜癌。绝经后1～5年阴道出血者内膜厚度≤8mm、绝经5～15年阴道出血者内膜厚度≤6mm、绝经15年以上阴道出血内膜厚度≤5mm者发生内膜癌的可能性较小。结论内膜厚度及绝经时间与内膜癌的发生有相关性,随着绝经时间及内膜厚度的增加其发病率也增加。超声测量内膜厚度可减少绝经后阴道出血患者的内膜活检率。     

前列腺特异抗原＜4μg/L前列腺癌经直肠超声引导穿刺活检的临床研究

目的 评价经直肠超声(TRUS)引导下前列腺穿刺活检对前列腺特异抗原(PSA)＜4μg/L前列腺癌(PCA)诊断的临床价值,借以探讨提高PSA＜4μg/L的PCA诊断率的方法.方法 选取59例PSA＜4μg/L怀疑PCA的患者进行TRUS引导下前列腺多点穿刺活检.分析其TRUS声像图特点尤其对前列腺内结节声像特点进行总结,并比较PCA与非PCA组患者间的PSA、前列腺特异抗原密度(PSAD)、前列腺游离抗原与总前列腺抗原比值(F/T)、前列腺体积(PV),进一步分析PSAD、F/T的各阈值范围内对PCA诊断的敏感性及特异性.结果 59例受检者中经病理证实PCA 16例,检出率为27%,12例PCA患者声像图检查显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高.PCA组与非PCA组间的PSA、PSAD、F/T、PV差异均有统计学意义.将PSAD阈值设为0.09μg/L2时有较高的敏感性及特异性,F/T值设为0.20时有较高的敏感性及特异性,但不及PSAD有优势.结论 TRUS前列腺穿刺活检是确诊PSA＜4 μg/L PCA的最有效方法之一,结合TRUS声像图特点及PSA修正方法可进一步提高PCA的检出率.     

Surgery for Gastrointestinal Stromal Tumors of the Stomach

Background  Gastrointestinal stromal tumors (GISTs) are the main mesenchymal neoplasms in the gastrointestinal tract. Tumor size, mitotic rate, and location correlate with potential malignancy and recurrence rate. Results of surgical treatment of gastric GIST are analyzed with emphasis on recurrence of disease after intermediate follow-up. Methods  From 1998 to 2006, a total of 63 patients (median age 62.1 ± 14.1) underwent gastric resection for GIST. Fifty-five patients (93.6%) returned for follow-up investigations, which included computed tomography in 45, gastroscopy in 32, and endosonography in 29. Positron emission tomography was done in five patients. Results  Mean tumor size was 5.3 ± 3.8 cm. Open atypical gastric resection was done in 32, distal gastric resection in five, and remnant gastrectomy in four patients. Laparoscopic gastric resection was initiated in 22 patients; the conversion rate was four of 22 (18.2%). Overall, R0 resection was reached in 61/63 patients (96.8%). According to the Fletcher criteria, 33 tumors (52.4%) were classified as intermediate or high risk GIST. Six patients (9.5%) died of unrelated causes before follow-up. After a median follow-up of 2.5 years, overall recurrence rate was 7.0% after R0 resection. Conclusion  Histologically proven complete resection is an effective treatment for gastric GIST. Laparoscopic procedures were carried out successfully in selected patients. Preliminary data were presented at the annual meeting of the European Association of Endoscopic Surgeons, Berlin 2006. No research grants funded this study.     

气管内超声实时引导经支气管针吸术对肺癌纵隔肺门淋巴结的诊断价值

目的 研究气管内超声实时引导经支气管针吸术(EBUS-TBNA)对肺癌纵隔和肺门淋巴结的诊断价值及安全性.方法 2008年7-12月,对25例[男18例,女7例,年龄(68±9)岁]诊断为肺癌或疑为肺癌且CT检查显示纵隔或肺门淋巴结肿大患者的28组淋巴结行EBUS-TBNA(EBUS-TBNA组).以2008年1-月由同一操作者因相同适应证而进行常规经支气管针吸术(C-TBNA)的26例患者[男18例,女8例,年龄(66±8)岁)]的28组淋巴结为对照(C-TBNA组).以穿刺针抽吸物检查找到特异性细胞物质或淋巴细胞为阳性结果.比较2组的诊断阳性率及并发症发生情况.结果 EBUS-TBNA组诊断阳性率为92.9%(26/28),明显高于C-TBNA组(60.7%,17/28,χ2=8.114,P=0.004).2组均未发现气胸、气道撕裂、出血(>5 ml)等并发症.结论 气管内超声实时引导可显著提高经支气管针吸术对肺癌患者纵隔和肺门淋巴结的诊断阳性率,且安全性高,应进一步开展应用研究.     

Utility of endoscopic ultrasound in pancreatitis： A review

The close proximity of the endoscopic ultrasound probe to the pancreas results in superior spatial resolution compared to CT scan and MRI. In addition, endoscopic ultrasound （EUS） is a minimally invasive procedure that does not share the relatively high complication rate of ERCP. Due to these advantages, EUS has evolved into an important technique to assess pancreatobiliary disease. This review will discuss the role of EUS in patients with pancreatitis. The indications can be divided into acute pancreatitis and chronic pancreatitis. In acute pancreatitis, EUS is used to determine the etiology; in suspected chronic pancreatitis it is helpful to establish the diagnosis. Lastly, this review will discuss biliary pancreatitis with suspicion for persistent choledocholithiasis.     

Endoscopic ultrasonography (EUS) in the localization of insulinoma

Objective Endoscopic ultrasonography has been accepted as a sensitive modality for preoperative tumor localization in pancreas. We have aimed to determine the performance characteristics of endoscopic ultrasonography in pancreatic insulinoma localization and evaluation of relationship between the tumor size and serum-c peptide level, lowest glucose level and insulin level. Methods Patients suspicious to insulinoma according to clinical and laboratory findings were included. Endoscopic ultrasonography was performed and if a tumor was identified, the patient was referred for surgery. Results A total of 52 patients (24 male and 28 female) with mean age of 42.4 years underwent EUS and 43 patients underwent surgery. In one patient, a tumor was identified both by transabdominal ultrasonography and abdominal CT scan. The overall sensitivity and accuracy of endoscopic ultrasonography for detection of insulinoma was 89.5% and 83.7% respectively. The sensitivity of endoscopic ultrasonography for detection of lesions in pancreatic head, body and tail was 92.6%, 78.9%, and 40.0%, respectively. There was no relationship between c-peptide, lowest blood glucose, insulin blood levels and tumor size in surgery. Conclusion EUS is an accurate method for detection of insulinoma. The accuracy depends on the location of the tumor and is greatest for tumors in the pancreatic head.     

经阴道超声联合检测血β-绒毛膜促性腺激素和孕酮对诊断异位妊娠的价值

目的探讨经阴道超声（TVCDS）联合检测血β-绒毛膜促性腺激素（β-HCG）和孕酮（P）水平对异位妊娠的诊断价值。方法TVCDS检查96例异位妊娠患者,并在当天或次日行β-HCG和P检查,住院治疗者隔天或数天行β-HCG和P复查。结果96例异位妊娠患者包块型76例（79．1％）,直径（47．6±18．4）mm;胚囊型20例（20．9％）在异位妊娠部位可显示胚囊结构,其内见卵黄囊或胎心搏动,直径（12．86±6．85）mm。94例（97．9％）异位妊娠区均显示有彩色多普勒血流信号,并且89例（92．7％）患者PW可探及低阻滋养动脉血流频谱,搏动指数（P1）为（0．46±0．03）。96例异位妊娠者血β-HCG和P水平明显呈低值（P〈0．01）。结论TVCDS结合β-HCG和P测定可提高异位妊娠早期诊断水平。