继发性高血压误诊原因分析

目的分析继发性高血压(secondary hypertension, SH)的误诊原因,提高SH诊断及鉴别诊断能力。方法回顾分析我院2015年2月-2016年3月收治的20例SH误诊病例资料。结果本组误诊率18.87%,均以血压升高为主要表现就诊,血压160~210/90~120 mmHg,并伴有心悸、胸闷、头痛、多汗、恶心头晕、多饮多尿、发作性四肢无力、记忆力减退、腰痛、轻度下肢水肿等症状。病初均误诊为原发性高血压,后经详细问诊,进一步的医技检查,确诊为原发性醛固酮增多症5例,肾上腺嗜铬细胞瘤及皮质醇增多症各4例,多囊肾3例,肾动脉狭窄及多发性大动脉炎各2例。误诊时间0.5~3.0年。20例确诊后给予手术治疗16例和药物保守治疗4例,随访1年血压控制平稳。结论 SH表现形式多种多样,缺乏特异性,由于部分临床医生对SH缺乏认识,诊断经验欠缺,极易导致误诊。     

微创经皮肾镜取石术与输尿管镜下碎石术治疗输尿管上段嵌顿性结石的疗效比较

目的 比较微创经皮肾镜取石术(mPCNL)与输尿管镜下碎石术(URL)治疗输尿管上段嵌顿性结石中的疗效及安全性。方法 回顾性分析2017年1月至2019年2月在本院收治的85例输尿管上段嵌顿性结石患者的临床资料。38例患者采用mPCNL术（mPCNL组），47例患者采用URL术（URL组），比较两组患者的手术时间、术后住院时间、并发症发生率、术后3～5 d的结石清除率、术后30 d的结石清除率情况。结果 mPCNL组手术时间、术后住院时间明显大于URL组，差异有统计学意义（P<0.05）。 手术效果方面，mPCNL组术后3～5 d结石清除率[100%（38/38）]明显高于URL组[85.1%（40/47）]，术后1个月mPCNL组结石清除率[100%（38/38）]明显高于URL组[93.6%（44/47）]，差异有统计学意义（P<0.05）。 术后并发症方面，mPCNL组总并发症发生率为13.2%（5/38）、URL组为128%（6/47），差异无统计学意义（P>0.05）。结论 mPCNL与URL对输尿管上段嵌顿性结石均具有良好疗效，而mPCNL在不明显增加手术并发症的基础上具有更好的结石清除率，可作为一种常规方法。     

急性胆源性胰腺炎肝损伤研究进展

急性胆源性胰腺(acute biliary pancreatitis,ABP)不仅存在胰腺的急性炎症,还往往合并胆道系统的梗阻或感染,肝功能损伤是ABP最常见的并发症之一,病理机制主要包括感染和内毒素、胆汁淤积、胰酶损伤、微循环障碍和氧化应激等,其研究结论多来源于动物实验.在内科常规治疗ABP基础上,积极抗感染治疗和尽快解除胆道梗阻能促进ABP相关肝损伤的恢复.     

Antenatal screening and fetal intervention

Congenital malformations are a common cause of reduced life expectancy and disability and can affect all body systems, thus are relevant to all surgeons. One in 50 children will have a major or significant congenital anomaly at birth. Since the advent of antenatal ultrasound (US) there has been the potential to diagnose many congenital anomalies before birth. This can forewarn parents and clinicians, so that treatment can be started promptly following birth rather than waiting for the baby to become symptomatic. It has also raised the possibility of treatment in utero with the goal of stopping or reversing the pathological effects of the anomaly on the developing tissues, which hopefully will reduce morbidity and mortality once the baby is born and thus improve outcomes. This article focuses on congenital anomalies relevant to surgeons, initially looking at screening and diagnosis and how this may affect treatment and surgery following delivery. The second part will look at some of the interventions that have been tried to treat “surgical” congenital anomalies in utero.     

Modified diagnostic criteria,grading classification and newly elucidated pathophysiology of hepatic SOS/VOD after haematopoietic cell transplantation

Sinusoidal obstruction syndrome (SOS), previously known as hepatic veno-occlusive disease (VOD), remains a multi-organ system complication following haematopoietic cell transplantation (HCT). When SOS/VOD is accompanied by multi-organ dysfunction, overall mortality rates remain >80%. However, the definitions related to the diagnosis and grading of SOS/VOD after HCT are almost 25 years old and require new and contemporary modifications. Importantly, the pathophysiology of SOS/VOD, including the contribution of dysregulated inflammatory and coagulation cascades as well as the critical importance of liver and vascular derived endothelial dysfunction, have been elucidated. Here we summarise new information on pathogenesis of SOS/VOD; identify modifiable and unmodifiable risk factors for disease development; propose novel, contemporary and panel opinion-based diagnostic criteria and an innovative organ-based method of SOS/VOD grading classification; and review current approaches for prophylaxis and treatment of SOS/VOD. This review will hopefully illuminate pathways responsible for drug-induced liver injury and manifestations of disease, sharpen awareness of risk for disease development and enhance the timely and correct diagnosis of SOS/VOD post-HCT.