卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

基质金属蛋白酶及其抑制剂与血管再狭窄

基质金属蛋白酶（matrix metalloproteinase,MMP）是由锌和钙依赖性肽链内切酶多基因家族组成,能消化降解细胞外基质（extra cellular matrix,ECM）的几乎所有成分,是参与ECM降解的最主要的酶。血管重建术后,血管损伤、血流动力学改变、炎症、血栓形成及纤溶激活、氧化应激等因素都可促进MMP的表达和激活,活化的MMP降解ECM,促进血管平滑肌细胞（vascular smooth muscle cell,VSMC）迁移增殖,导致新内膜增生和血管重塑,最终导致血管再狭窄。     

黄牛木中的异戊烯基酮类化合物

目的 研究黄牛木茎60%乙醇提取物的化学成分.方法 运用多种色谱学方法对黄牛木茎60%乙醇提取物的化学成分进行分离,并根据光谱数据鉴定化合物的结构.结果 从该植物中分离得到5个(口山)酮类化合物,分别鉴定为1,7-二羟基-2-(3-甲基丁-2-烯基)-5"-羟基-6"-甲基-6"-(4-甲基戊-3-烯基)-4",5"-二氢吡喃(2",3":3,4)双苯吡酮(Ⅰ)、5,9-二羟基-8-甲氧基-2,2-二甲基-7-(3-甲基丁-2-烯基)-2H,6H-吡喃一[3,2.b]一双苯吡-6-酮(Ⅱ)、黄牛木(口山)酮A(Ⅲ)、4-(3',7'-二甲基辛-2',6'-二烯基)-1,3,5-三羟基-9H-双苯吡-9-酮(Ⅳ)和黄牛木酮A(Ⅴ).结论 化合物Ⅰ为新化合物,命名为越南黄牛木(口山)酮E(cracochinchinone E).化合物Ⅱ和Ⅳ为首次从黄牛木属植物中分离得到.     

国产Fogarty气囊导管对犬腹主动脉壁损伤的超微结构观察

为探讨国产Fogany导管的气囊直径大小及导管通过血管腔次数多少与动脉管壁急性损伤的关系,本文以14条犬为对象,研究了当Fogany导管气囊直径分别等于血管直径的1、1.5及2倍、导管通过血管腔1、2及3次时,该导管对犬腹主动脉壁所致的超微结构损伤改变。结果显示:气囊直径愈大,导管通过血管腔次数愈多,气囊对动脉内膜及肌层的损伤愈重;从轻微的内皮细胞损伤至内皮及内皮下组织的全部剥脱,以及中膜层平滑肌细胞受损,但大多数损伤局限于内膜层。本研究为此种国产Fogany气囊导管应用于临床提供了实验依据。     

西米替丁预防急性脑血管病并发应激性溃疡出血疗效观察

急性脑血管病 (ＡＣＶＤ)并发应激性溃疡出血临床上相当常见 ,病死率甚高 ,我院 1990年 2月～1999年 9月 ,应用西米替丁预防 10 6例病情较重的ＡＣＶＤ并发应激性溃疡患者 ,取得良好疗效 ,现报告如下 :1　临床资料1 1　病例选择　选择经头部ＣＴ检查确诊 ,病变面积大和 /或靠近中线 ,全脑症状重 ,有较大可能发生应激性溃疡者 (就诊时已有消化道出血者未列入 ) ,按入院先后随机分为观察组和对照组 ,每组 10 6例。两组病人年龄、性别、发病时间及病情相似。1 2　方法　观察组除按原发病作相应处理外 ,入院后即给予西米替丁 0 4ｇ加生理盐水稀…     

腹腔镜与开腹胆囊切除术治疗合并肝硬化的胆囊结石疗效比较

目的探讨腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)在合并肝硬化的胆囊结石症治疗中的优点和安全性。方法60例合并肝硬化的胆囊结石症手术患者。所有患者分成LC组和OC组,比较两组间的手术时间、手术出血量、手术并发症发生率和住院时间。结果LC组和OC组手术时间分别为(51.7±12.7)min和(75.7±23.8)min(P<0.05),术中出血量分别为(98.6±25.5)ml和(134.6±36.6)ml(P<0.05),住院时间分别为(6.2±2.9)d和(9.2±3.7)d(P<0.05),手术并发症发生率LC组较OC组低(P<0.05)。结论Child分级为A级和B级合并肝硬化的胆囊结石患者采用LC治疗是相对安全的,具有手术时间短、出血量少、手术并发症低的优点。     

2型糖尿病患者行腹腔镜胆总管切开取石术临床研究

目的:探讨胆总管结石合并2型糖尿病患者行腹腔镜胆总管切开取石术(LCBDE)的可行性、安全性及有效性.方法:回顾性分析2009年12月-2012年12月采用LCBDE治疗的58例合并2型糖尿病(糖尿病组)及同期58例无糖尿病(非糖尿病组)胆总管结石患者的临床资料,比较两组术前、术中及术后的情况.结果:两组患者手术时间、术中出血量、开始进食时间、术后住院时间及中转开腹方面,差异均无统计学意义(t/x 2=3.921,6.940,1.332,1.270,0.342,均P＞0.05).两组术后电解质紊乱、胆管炎、胆瘘、切口感染、肺部感染发生率比较,差异亦均无统计学意义(×2=0.438,0.537,0.342,1.036,0.342,均P＞0.05).两组均无术后结石残余、胆管狭窄及死亡病例.结论:合并2型糖尿病的胆总管结石患者在围手术期严格控制血糖,术中仔细操作的前提下,行LCBDE是可行的、安全的、有效的.     

3D打印技术在肝脏外科应用现状及展望

随着3D打印技术在医学领域的蓬勃发展,传统医学正向着数字化精准医学转换。精准肝脏外科的特点是通过术前精准评估和手术规划、术中精细解剖止血而使患者获得最佳康复。3D技术通过影像学数据构建出肝脏仿真模型,可以让外科医师从三维角度上充分认识肝脏,从而更好完成术前评估与规划。生物3D打印作为近年新兴的学科,未来有望解决肝移植手术供体短缺、肝脏切除术后残肝体积不足等问题。     

乳腺神经内分泌癌3例诊治分析

目的:探讨乳腺神经内分泌癌的临床特点及诊治要点。方法:回顾性分析湖南省人民医院从2013年—2017年收治的3例乳腺神经内分泌癌的临床病理资料。结果:患者均为女性;年龄31~39岁;肿块大小0.5~4.0 cm;2例以乳房肿块就诊,1例以乳头溢液就诊;3例超声表现均为低回声结节;1例行改良根治术,1例行保留乳头乳晕改良根治+一期假体乳房再造术,1例行单纯乳房切除术。组织病理学形态包括实质性癌2例,小细胞性癌1例。免疫组化示3例嗜铬粒蛋白A(CgA)及突触素(Syn)阳性,2例神经元特异性烯醇化酶(NSE)阳性。随访时间6~32个月,1例术后6个月因肝转移而死亡,另2例均无瘤生存。结论:乳腺神经内分泌癌是一种罕见的特殊类型乳腺癌,临床表现及影像学特征通常无特异性,诊断金标准是病理学及免疫组化检测,其治疗是以手术治疗为主的综合治疗,小细胞乳腺神经内分泌癌的预后差。     

微清蛋白尿的检测在肝癌患者术后液体治疗中的应用价值

目的：探讨微清蛋白尿的检测在肝癌患者术后液体治疗中的应用价值。 方法：选择接受手术治疗的肝癌患者作为对象，出现微清蛋白尿者观察组（26例），未出现微清蛋白尿者对照组（34例），检测肾功能指标、免疫功能指标，观察脏器积液情况。 结果：观察组患者血肌酐、血尿素氮、24小时尿蛋白、CD8+含量、脏器积液的例数和引流量均明显高于对照组，内生肌酐清除率和CD3+，CD4+，CD4+/CD8+，NK含量明显低于对照组。 结论：微量清蛋白尿对于判断肝癌术后液体治疗的机体状态具有积极意义。