应用B超诊断胃术后输入襻梗阻

应用Ｂ超诊断胃术后输入襻梗阻杨守和输入襻梗阻是胃ＢｉｌｒｏｕｔｈⅡ式或Ｒｏｕｒ－ｅｎ－Ｙ式术后非常严重的并发症，一旦发生必须手术矫治，由于缺乏特异的辅助检查方法，常致误诊而造成严重后果。本文就我院从１９８６年７月～１９９５年１０月，首先由Ｂ超诊断并经...     

超声诊断胃切除术后输入襻梗阻及其临床意义

胃切除术后输入襻梗阻较为少见,是特殊类型的肠梗阻,临床上缺乏早期的检查方法,常致误诊而造成严重的后果.本组总结我院1997年1月至2006年7月期间,经超声诊断并经手术证实的胃切除术后输入襻梗阻7例患者资料,现将其声像图特征及其临床意义报告如下.     

胃大部切除术后输入襻慢性梗阻1例

患者男,45岁,曾于1982及1998年先后接受毕Ⅱ式胃大部切除术及胆囊切除术,本次因“4个月前无明显诱因出现腹胀,进食后加重,大便不成形,伴油性分泌物”入院。查体:体温、心率、血压均正常;腹平坦,无胃肠型及蠕动波,未扪及腹部包块,肠鸣音6次/分。     

超声诊断输入袢梗阻1例

患者男,70岁。因胃溃疡出血行毕 Ⅱ式胃大部分切除术后3 0年,突然上腹部阵发性疼痛、呕血、排黑便3周入院。体检:体温正常,心率80次/min ,血压13 6/ 70mmHg( 1mmHg =0 .13 3kPa)。慢性病容,贫血貌。腹平坦,无胃肠型及蠕动波,未扪及包块。肠鸣音正常。血常规:白细胞5 .1×10 9/L ,中性74.5 % ,血红蛋白72 g/L。肝功能正常,大便潜血试验( )。X线钡餐检查:吻合口稍窄,残胃黏膜增粗,输出段排空好,输入段肠管显示不清。胃镜检查:残胃小弯侧可见一约0 .8cm×0 .8cm大小的溃疡,周围黏膜水肿糜烂。超声检查:上腹部可见横置走向的长管状无回声区…     

胰腺Whillp式术后输入襻梗阻超声表现一例

患者男,59岁,因胰头癌行Whillp式术后2年余,近2个月来发热,恶心,呕吐伴全身皮肤黄染而来院就诊.体检:体温38℃,心率80次/min,血压130/70 mm Hg,(1 mm Hg=0.133 kPa)全身皮肤巩膜明显黄染,上腹部见长约20 cm手术疤痕,右上腹饱满感,轻压痛,无反跳痛,肝脾肋下未及,移动性浊音阴性,肠鸣音亢进.实验室检查:ALT 75 μmol/L,AST 164 μmol/L,GGT 854 μmol/L,ALP 638 μmol/L,总胆汁酸46.2 μmol/L,CA 199>1000 KIU/l,白蛋白(A) 24.8 g/L,白蛋白/球蛋白(A/G) 0.8.     

超声显像在输入袢梗阻诊断中的意义

目的 探讨超声显像在输入袢梗阻诊断中的价值。方法 回顾性分析了13年来经手术证实的16例输入袢梗阻患者声像图表现及超声诊断与手术结果的符合情况。结果 输入袢梗阻的超声诊断符合率为94%(15/16）,其声像图表现为中上腹横置长管状无回声暗区。结论 输入袢梗阻的声像图表现有较高的特异性,超声诊断与手术结果的符合率高。     

超声诊断胃疾病的临床价值

目的探讨胃疾病超声诊断的准确性.方法采用空腹饮水法对84例患者进行超声检查.结果超声诊断胃炎诊断符合率76.47%(26/34),胃息肉诊断符合率62.50%(10/16),胃癌诊断符合率86.11%(31/36),胃溃疡诊断符合率25.00%(3/12).结论超声诊断也是检查胃疾病的手段之一.     

心包积液定量诊断的动物实验研究——心包积液量与超声心动图的关系

目的：利用超声心动图与开胸的犬所制作实验性心包积液动物模型相结合,比较超声心动图心包积液液性暗区宽度与心包腔内所注入液体量之间的关系,探讨一简便而又准确的定量诊断心包积液的方法。方法：选用狗(15条)作为研究对象,构建心包积液动物模型,研究心包积液量与超声心动图液性暗区宽度的关系。结果：动物实验表明：1．超声心动图R、L、A心包积液液性暗区宽度及舒张朱期(R L A)／3与心包积液量问均呈正相关,但A值与心包积液量不符合线性关系;2．液性暗区宽度,以A区最宽。结论：动物实验发现：1．(R L A)／3与心包积液量呈线性正相关,可以通过检测R、L、A的值,计算(R L A)／3的值,参考线性方程来初步估算患的心包积液量,定量诊断心包积液。为临床定量诊断心包积液提供一种新的无创性方法;2．心尖区液性暗区最宽,从剑突下进针穿刺心包腔引流积液比较安全、有效。     

壶腹部和胰腺肿瘤超声诊断的临床研究

目的　通过超声与病理对照分析，进一步提高超声检查对壶腹部和胰头癌的认识。方法　应用超声显像观察胆管和胰管扩张情况，了解胆总管全程直至末端，追踪扫查壶腹部和胰腺。当胆总管末端及壶腹部被气体遮盖时，饮水500～1500ml，必要时吃高脂流汁，第二天复查。结果 超声检查16例壶腹部癌均显示胆管和胰管不同程度扩张，肿块呈低回声9例，等回声7例，2例后方有声影。22例胰腺癌引起胆管和胰管扩张20例，2例位于钩突部向后生长，无胰管扩张。肿瘤形态不规则，呈蟹足状向周围浸润性生长，后方轻度衰减。结论 要提高超声显像在壶腹部和胰腺癌中的诊断准确率，除识别两者图像持点外，须结合病程进行分析。     

Cryoablation at Growing Myocardium: No Evidence of Coronary Artery Obstruction or Intimal Plaque Formation Early and Late after Energy Application

Background: Animal studies and clinical observations have demonstrated that radiofrequency current application at growing myocardium may result in coronary artery obstruction. Recently, cryoenergy has emerged as an effective alternative to radiofrequency ablation of arrhythmogenic substrates in pediatric patients. Up to now, there has been a lack of experimental data concerning the effects of cryoenergy application at growing myocardium.
Methods: During general anesthesia, selective coronary angiography of the right and left coronary artery was performed in 10 piglets (age: 6 weeks, body weight: 14–18 kg). Subsequently, cryoenergy was delivered at −75°C for 4 minutes using a 7-F catheter with a 6-mm-tip electrode at the atrial aspect of the tricuspid valve annulus in a posterior and lateral position. Additional cryoenergy lesions were induced via a retrograde approach at the lateral and posterior atrial and ventricular aspect of the mitral valve annulus, respectively. Five animals were restudied after 48 hours by coronary angiography and intracoronary ultrasound and in the remaining five piglets after 3 and 6 months, respectively.
Results: Selective coronary angiography and intracoronary ultrasound studies did not demonstrate any evidence for coronary artery obstruction after 48 hours, 3 months, or 6 months after cryoenergy application. In addition, histological examinations of the cryolesions after 48 hours and after 6 months did not demonstrate any intimal proliferations of the coronary arteries, respectively.
Conclusions: By means of the present study, we did not observe any affection of the coronary arteries after cryoenergy application at growing myocardium in young piglets.     

二维及多普勒超声在锁骨下动脉盗血综合征诊断中的应用

目的分析锁骨下动脉盗血综合征（SSS）的病因、血流动力学、频谱特点、狭窄程度与盗血的关系等问题,评价超声诊断价值。方法患者32例,均经临床检查、超声诊断及相关实验室检查确诊,其中16例经DSA检查证实。仪器应用AcusonSequoia512及128XP/10型超声诊断仪,探头频率2.0～8.0MHz。二维超声常规显示颈动脉、椎动脉、锁骨下动脉及无名动脉的内径及内膜情况,彩色及频谱多普勒检测血流方向及速度。结果32例SSS患者中,动脉硬化及大动脉炎所致各为15例和13例,其他原因者4例。锁骨下动脉狭窄23例,内径0.8～3.8mm,血流速度150～470cm/s;9例锁骨下或无名动脉闭锁,均引起完全性盗血。椎动脉峰值血流速度健侧明显高于患侧（89.0±20.5)cm/svs.(50.6±14.2)cm/s,P＜0.001,患侧出现反向血流。结论SSS最常见病因为动脉硬化和大动脉炎。完全性与部分性盗血与血管狭窄程度有关。彩色多普勒可对完全性SSS做出诊断,部分性者可辅助脉冲多普勒明确诊断。二维及多普勒超声可对绝大多数SSS做出病因学诊断。     

彩色多普勒超声在活体供肝肝移植术中及术后并发症诊断中的应用价值

目的 探讨彩色多普勒超声在活体供肝肝移植(living donor liver transplant,LDLT)术后并发症中的应用价值.方法 分析18例LDLT(其中2例为亲体辅助性肝移植)术中及术后彩色多普勒超声诊断结果.结果 (1)术中发现1例肝动脉血栓;(2)术后第1日与术后3、5、7 d之间门静脉峰值流速差异有统计学意义;(3)2例亲体辅助性肝移植门脉内血流全部或部分反向并流速降低,肝动脉增宽,流速增加,其中1例合并肝静脉流速降低,频谱异常及肝实质坏死;(4)胆道并发症7例,其中4例胆漏,3例胆道吻合口狭窄.结论 彩色多普勒超声在LDLT术中及术后并发症的诊断中具有重要价值.     

多普勒超声评价正常妊娠及妊娠并输尿管结石孕妇肾内动脉血流指数变化

多普勒超声观测Ａ组３０名健康非孕妇女、Ｂ组１４０名正常孕妇及Ｃ组１２例妊娠并输尿管结石孕妇肾内动脉血流指数（ＲＩ、ＰＩ、Ｓ／Ｄ）。结果：Ｂ组１０９名（１１８只肾）有肾积水；无论有无肾积水Ｂ组肾ＲＩ、ＰＩ、Ｓ／Ｄ值与Ａ组无显著差异（Ｐ＞０．０５），除Ｂ组４只积水肾ＲＩ＞０．７（３％）外，Ａ、Ｂ组肾ＲＩ均＜０．７，且Ａ、Ｂ组左、右侧肾ＲＩ差值均＜０．１；Ｂ组积水肾ＲＩ、ＰＩ、Ｓ／Ｄ值高低与肾积水程度及孕周无关（Ｐ＞０．０５）。Ｃ组输尿管梗阻侧肾ＲＩ、ＰＩ、Ｓ／Ｄ均显著高于Ａ、Ｂ组与对侧健肾（Ｐ＜０．００１），梗阻侧肾ＲＩ均＞０．７且与对侧健肾ＲＩ差值＞０．１。结果表明：多普勒超声观测肾动脉血流指数变化对诊断妊娠合并机械性输尿管梗阻有重要意义     

Locating the Level and Extent of Congenital High Airway Obstruction: Fluid in the Airway Tract as Reference Points

Described here are a series of four cases of congenital high airway obstruction in the fetus. All of the patients presented in the second trimester and all had hydrops fetalis. Three cases had bilateral hyperinflated lungs, midline shift of heart, flattening or inversion of the diaphragm, and fetal ascites. Autopsy was performed in one of these three and showed laryngeal atresia. In one fetus, there was only a unilateral huge enlargement of the lung with mediastinal shift. On autopsy, this fetus had atresia of right main bronchus. All parents had terminated the pregnancy following the prenatal diagnosis. Laryngeal atresia is an extremely rare fetal anomaly with dismal prognosis. It is important to differentiate the condition from other lesions with a more favorable prognosis, such as congenital adenomatoid malformation of the lung. Much research is needed in the future to explore the therapeutic options, including fetoscopic intervention or transplantation of stem cell–derived airways.     

超声检查对大肠肿瘤早期诊断病理基础与临床应用系列研究──基础实验

①用二甲肼诱发大鼠结直肠肿瘤３３个，水槽内７．５ＭＨｚ超声检出最小病灶２～３ｍｍ，浸润粘膜层的息肉样良性病变２１．２％，粘膜下层早癌３６．４％，肌层浆膜层中晚期癌４５．５％，肿瘤生物学行为超声图像特征与病理诊断符合率９６．９％。位于粘膜层的原位癌，粘膜肌层的早癌超声无法辩认。病理所见腺癌为主与人类肠癌相似，故鼠肠癌大体所见超声图像及病理为肠癌早期诊断提供超声病理基础。超声对胃肠肿瘤标本的超声分期正率达８６．４％。②用自行研制大肠超声显像液灌注（ＵＢＣＥ）为腹部Ｂ超检查提供良好声窗，图像清晰，增强病人对大剂量保留灌肠的适应力，经Ｘ线气钡双重造影，纤维肠镜手术病理验证ＵＢＣＥ超声检查诊断大肠肿瘤是安全、实用的好方法。     

Ultrasound Analysis of Diaphragm Kinetics and the Diagnosis of Airway Obstruction: The Role of the M-Mode Index of Obstruction

Diaphragm motion in forced expiration can be analyzed using M-mode ultrasound in an anterior subcostal approach. Maximum expiratory diaphragmatic excursion (EDE_Max) and forced expiratory diaphragmatic excursion in the first second (FEDE₁) are considered the physiopathological analogues of vital capacity (VC) and forced expiratory volume in the first second (FEV₁). As the FEV₁/VC % ratio is used as a marker of obstruction, our aim was to determine if the ratio FEDE₁/EDE_Max (M-mode index of obstruction [MIO]) differs between healthy subjects and patients with airway obstruction. One hundred twenty-four outpatients were examined by diaphragm ultrasound after spirometry. The MIO, expressed as the mean ± standard deviation (range), was 87.08 ± 6.64 (72.84–100) in the healthy group (N = 61) and 67.09 ± 12.49 (33.33–91.30) in the group with obstructed airways (N = 63). The difference between the two groups was significant (p < 0.0001), and MIO was significantly correlated with FEV₁/VC (p < 0.0001). A MIO <77 was identified as a possibile cutoff for suspecting an obstructive spirometric pattern with a 95.5% positive predictive value. The MIO can be interpreted as a speed index of diaphragmatic relaxation that seems to be slower in obstructed patients and could be used to screen for obstructed airway diseases.     

以多西他赛为基础的三药对比两药辅助化学疗法对胃癌根治术后临床疗效分析

目的观察多西他赛三药及两药联合对胃癌根治术后辅助化学疗法（化疗）的疗效比较及不良反应。方法回顾性分析解放军总医院2006年1月-2011年12月42例胃癌根治术后患者的临床资料,其中有22例、20例患者分别接受以多西他赛为基础的三药、两药联合辅助化疗。三药联合：多西他赛注射液＋铂类＋氟尿嘧啶／卡培他滨片／替吉奥;两药联合：多西他赛注射液＋氟尿嘧啶／卡培他滨片／替加氟或多西他赛注射液＋铂类;主要观察终点：无疾病生存期（DFS）,次要观察终点：预后因素分析、复发转移情况、不良反应及亚组分析。结果两组中位DFS分别为9．530、7．170个月（P=0．646）;性别、年龄、肿瘤浸润深度、脉管癌栓、淋巴结清扫范围是患者早期复发转移的不良预后因素,三药联合组肝转移率高于两药联合组（P=0.008）;主要不良反应为恶心、呕吐、白细胞减少、腹泻、脱发、血小板减少等,多为1～2级,可耐受,三药联合组较两药联合组易出现不良反应（P=0．011）,以恶心、呕吐为主。结论胃癌根治术后以多西他赛为基础的辅助化疗三药、两药联合对患者疗效及预后无明显差异,且两种辅助疗法不良反应基本可耐受。