体外冲击波碎石治疗肾下极结石的疗效观察

回顾性总结了３２６例直径为０．６￣２．３ｃｍ肾下极结石患者行体外冲击波碎石（ＥＳＷＬ）的资料。每位患者ＥＳＷＬ后均常规给予中药排石冲剂，ＥＳＷＬ后１个月及每隔６￣１２个月进行Ｘ线检查和临床随访。结果３２６例中，１６２例（４９．７％）在ＥＳＷＬ后１个月复查无结石，７５例（２３．０％）在１￣９６个月（平均２１个月）的随访中排净结石，总无石率为７２．７％。其余患者中，残余结石减少，保持稳定或增多者分别为     

ESWL对肾,输尿管影响的动物实验及临床观察

动物实验分为幼兔ＥＳＷＬ组、对照组及成年兔ＥＳＷＬ组，于ＥＳＷＬ后２４ｈ及３个月，分别观察分肾功能，肾生长发育，分肾静脉血及外周血肾素水平（ＰＲＡ）的变化。结果２４ｈ后冲击侧肾功能下降。３个月后肾功能已恢复，肾生长发育不受影响，冲击侧肾静脉血及外周血ＰＲＡ与对照组及未冲击侧相比未发现升高，肾内有灶性纤维化等改变，其中１只幼兔冲击肾发生萎缩，广泛纤维化。临床观察１６９２例ＥＳＷＬ患者中有３例输尿管结石ＥＳＷＬ后肾积水加重，血肌酐升高，３例冲击肾发生萎缩，其中１例功能丧失，１例伴肾周巨大血肿。认为一般情况下ＥＳＷＬ的危害不大，但个别情况可发生肾萎缩、功能丧失，故行ＥＳＷＬ时仍应谨慎为妥。     

体外冲击波碎石治疗肾盏结石244例

目的：探讨体外冲击波碎石（ＥＳＷＬ）治疗肾盏结石的效果。方法：对ＥＳＷＬ治疗的肾盏结石２４４例（肾上盏结石５７例,肾中盏结石１８例及肾下盏结石１６９例）进行回顾性调查,ＥＳＷＬ后１个月及每６～１２个月行Ｘ线腹部平片或Ｂ超检查及临床随访。结果：肾上盏结石排净率为７３．７％,肾中盏结石为６１．１％,肾下盏结石为７８．７％。结论：ＣＳＷＬ仍是肾下盏结石的首选治疗方法。     

上尿路结石ESWL治疗后再行开放手术原因分析（附37例报告）

报告上尿路结石经ＥＳＷＬ治疗后仍需行开放手术者３７例，占同期上尿路结石开放手术的１２．５％，其中肾切除１０例。提示经ＥＳＷＬ治疗后再行开放手术时需行肾切除的可能性明显高于未经ＥＳＷＬ治疗者。肾周粘连、输尿管增粗、僵硬是术中所见的主要病理改变，占４８．６％。并着重讨论了ＥＳＷＬ治疗后开放手术的原因，认为结石残留、ＥＳＷＬ对组织的损伤是造成ＥＳＷＬ后仍需开放手术的重要因素。     

自制倒置床治疗ESWL后肾下盏残留小结石(附184例报告)

自制倒置床治疗ＥＳＷＬ后肾下盏残留小结石（附１８４例报告）蒋展兴刘成倍吴桂强我院１９８９年１２月～１９９４年６月，应用自制倒置床治疗ＥＳＷＬ后肾下盏残留小结石１８４例，效果满意。报告如下。临床资料本组肾结石患者２６８４例，施行ＥＳＷＬ后，肾内残留小结...     

应用ESWL治疗套石篮套石后滞留输尿管内3例报告

应用ＥＳＷＬ治疗套石篮套石后滞留输尿管内３例报告陈湘龙，魏守顺，曹祥福我院自１９８７年６月～１９９４年６月采用Ｄｏｒｎｉａ套石篮行膀胱镜与输尿管肾镜套石术１０３例，术中发生套石篮滞留８例，其中３例采用ＥＳＷＬ处理，效果满意。现予介绍。１临床资料本组３...     

体外冲击波碎石前后机体内皮素的变化和钙离子拮抗剂对肾…

将３６只家兔随机三组，Ａ组；１５只，未用异搏定；Ｂ组；１５只，异搏定处理；Ｃ组；６只，正常对照。Ａ和Ｂ组予体外冲皮碎石（ＥＳＷＬ），观察ＥＳＷＬ前后血、尿和肾组织中皮素的变化，结果Ａ组ＥＳＷＷＬ后１，３天尿和肾中内皮素显著升高，Ｂ组ＥＳＷＬ后１天尿内皮素轻度升高，而网组血中内皮素无明显变化。ＥＳＷＬ后早期机体内皮素升高可能肾损害有关，异搏定可抑制内皮素的升高，减轻肾损害。     

上尿路结石ESWL治疗后复发原因探讨

自１９８７年３月～１９９２年１２，我所行ＥＳＷＬ治疗上尿路结石３１５０５例，经复查结石复发１２０例，复发率为３．４％。１２０例复发结石中原位复发８３例，其中第一次ＥＳＷＬ治疗后无残留结石者６２例，有残留结石者２１例。非原位复发３７例。复发时间分别为３个月～６年。复发石仍以草酸钙结石为主。对结石复发的原因分析认为：在ＥＳＷＬ治疗后，力求结石排净、去除病因是预防结石复发的根本措施。     

ESWL对肾功能的早期影响

为观察ＥＳＷＬ对肾脏的损害作用，测定了２６６例患者ＥＳＷＬ前后尿液微量白蛋白（ＡＬＢ）、转铁蛋白（ＴＲＦ）、尿视黄醇结合蛋白（ＲＢＰ）、Ｎ－乙酰－β氨基葡萄糖苷酶（ＮＡＧ）等项指标的变化。结果表明：ＥＳＷＬ对肾小球和肾小管功能有一定的可逆性损害，建议ＥＳＷＬ治疗肾或输尿管上段结石，尤其是合并有肾积水时，重复治疗的间隔时间需要１～２周。认为上述４项指标对监测ＥＳＷＬ引起的肾脏损伤有一定的临床意义。     

双J导管的临床应用

双Ｊ导管的临床应用郑宝钟徐忠华周尊琳孟彦１９９１年１２月～１９９６年１月，我院应用双Ｊ导管作内引流术５２例。报告如下。临床资料本组男３５例，女１７例，年龄１４～７３岁。其中肾盂成形术１９例（双侧３例），ＥＳＷＬ前置管４例，ＥＳＷＬ后石街形成经输尿管肾...     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7–, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20–, MUC2–). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

Oddi括约肌肌电活动实验模型的建立

目的建立研究Oddi括约肌肌电活动的动物模型和实验方法。方法将双极金属钩状电极通过浆膜层置入Oddi括约肌，记录不同条件干预下家兔的Oddi括约肌肌电活动信号，调整电生理实验参数并经放大、滤波及计算机处理后，对其大小、波形、幅度进行分析。结果不同条件干预下的家兔Oddi括约肌的肌电活动在波形、频率、幅度等方面均有明显的不同，具有明显的规律性。重复实验可得到相似的结果。结论使用双极金属钩状电极配以合理的电生理实验参数调整可以稳定地采集到在体的家兔Oddi括约肌肌电活动信号。这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。