原发性腹膜后脂肪肉瘤18例临床分析

目的探讨原发性腹膜后脂肪肉瘤（PRPLS）的诊治特点。方法回顾性分析18例PRPLS患者的临床资料。结果18例共施行手术19次,均获随访,随访时间4个月至7年。术后标本病理：分化型脂肪肉瘤共8例,包括脂肪瘤样脂肪肉瘤4例,黏液性脂肪肉瘤2例,多形性脂肪肉瘤2例;去分化性脂肪肉瘤3例;混合型8例,有2种甚至3种以上病理分类,其中1例含骨肉瘤分化。18例患者分为首次手术组及复发手术组,两组总生存率采用Kaplan-Meier生存分析法显示差异无统计学意义（P=0．650）。结论绝大部分PRPLS可凭影像学检查明确诊断,无论是原发还是复发患者,手术切除仍是标准治疗手段,完整切除肿瘤（必要时联合多脏器切除）可显著降低肿瘤的复发率。     

再次或多次手术治疗复发性腹膜后 脂肪肉瘤的临床意义

目的 探讨再次手术或多次手术治疗复发性腹膜后脂肪肉瘤的治疗策略和临床意义。方法 回 顾性分析2013 年1 月—2017 年8 月北京大学第一医院普通外科收治的16 例腹膜后脂肪肉瘤术后复发患者（复 发组）行再次或多次手术的临床资料,随访时间12 ～ 62 个月,平均30 个月;观察其术后效果。结果 16 例 腹膜后肿瘤术后复发患者共行手术30 例次,手术时间60 ～ 840 min,平均360 min ;中位手术时间270 min, 术中出血50 ～ 33 100 ml,平均3 755 ml ;中位出血量800 ml。其中,28 例次手术为联合脏器切除。原发性腹 膜后脂肪肉瘤行手术治疗患者（原发组）与复发组在肿瘤最大径、是否多灶等指标比较,差异无统计学意义 （P >0.05）,而手术时间、出血量及是否联合脏器切除比较,差异有统计学意义（P <0.05）。随访期间无瘤存 活率为25%（4/16）,带瘤生存8 例,死亡4 例。结论 对于复发性腹膜后脂肪肉瘤患者,经多学科评估和完 善的术前准备,可行再次或多次手术治疗。     

腹膜后巨大脂肪肉瘤三例报道

目的探讨腹膜后巨大脂肪肉瘤的临床特点.方法对3例腹膜后巨大脂肪肉瘤进行回顾性分析.结果3例切除肿瘤重量分别为10、6、6kg,术前影象学检查可提示肿瘤的位置、质地、周围脏器受压与推移情况,动脉数字减影造影可显示肿瘤的主要供应血管.3例肿瘤均手术切除,1例因术后复发已行3次手术.结论腹膜后脂肪肉瘤巨大者不少见,手术切除率高,有术后复发倾向,应定期随访,发现复发可再次手术切除.     

腹膜后肿瘤26例临床分析

目的探讨腹膜后肿瘤的临床诊断与治疗。方法回顾性分析26例腹膜后肿瘤患者的临床诊断与治疗情况。结果影像学检查CT的诊断率为90.5%,核磁共振成像技术的诊断率为100.0%。肿瘤第1次手术完全切除14例(53.8%),部分切除6例(23.1%),探查加活组织检查6例(23.1%)。其中完全切除14例中联合脏器切除6例(42.9%);部分切除6例中联合脏器切除1例(16.7%)。14例完全切除者复发7例,二次手术5例,3例完全切除肿瘤,2例联合脏器切除。病理类型分别为平滑肌肉瘤8例,淋巴肉瘤6例,脂肪肉瘤4例,神经母细胞瘤3例,间皮肉瘤2例,血管肉瘤2例,囊性淋巴瘤1例。7例手术后复发患者中平滑肌肉瘤4例,淋巴肉瘤2例,间皮肉瘤1例。26例患者平均住院(12.9±3.8)d,平均随访(25.6±13.7)个月。出院后3例患者2 a内死亡,2 a生存率为88.5%。结论腹部无症状肿块应考虑腹膜后肿瘤可能,CT、核磁共振成像技术是重要的诊断性检查。提高手术切除率是改善预后、减少术后复发、提高生存率的重要方法。     

复发性腹膜后脂肪肉瘤再手术探讨

目的探讨复发性腹膜后脂肪肉瘤的特点及再手术切除技巧。方法分析16例复发性腹膜后脂肪肉瘤患者的临床资料,其中14例再手术。结果再手术平均2.64次,术后病理显示,脂肪瘤样脂肪肉瘤2例,硬化性脂肪肉瘤9例,炎性脂肪肉瘤2例,纤维肉瘤1例。所有手术患者均顺利出院,最长已存活8年。结论复发性腹膜后脂肪肉瘤仍是一种低度恶性肿瘤,极少具有浸润性生长的特点,囊内切除再清扫周围残留能取得较好的手术效果,不主张强行完整切除或联合脏器切除。     

原发性腹膜后脂肪肉瘤1例报道及文献复习

<正>原发性腹膜后脂肪肉瘤(Primary retroperitoneal liposarcoma)是最常见的腹膜后肿瘤,常常发病隐蔽,发现时往往累及到周围脏器,给手术切除带来困难,手术后易复发,且对放化疗敏感性较差,给临床带来较大的困难[1]。本院收治的1例原发性腹膜后巨大脂肪肉瘤,顺利切除,并结合文献复习,现报告如下。     

原发性腹膜后脂肪肉瘤119例临床分析

目的 探讨原发性腹膜后脂肪肉瘤(PRPLS)的治疗方法.方法 回顾性分析1999～2008年解放军总医院收治的119例PRPLS患者临床资料.结果 114例行手术探查,于该院共行手术153例次,肿瘤完全切除115例次,肿瘤完全切除率75.2%,其中联合切除79例次,联合手术完全切除率51.6%.肿瘤部分切除者的1、3、5年生存率分别为70.6%、58.3%、30.7%,肿瘤完全切除组1、3、5年生存率分别为89.5%、82.7%、78.3%.结论 争取联合脏器切除达到完全切除是改善预后的关键.对复发的肿瘤应争取适时再次手术.     

原发性腹膜后恶性肿瘤的外科治疗与预后分析

目的 探讨原发性腹膜后恶性肿瘤的外科治疗和预后.方法 回顾性分析中国医学科学院北京协和医学院肿瘤医院1996年1月至2007年12月外科治疗的191例原发性恶性腹膜后肿瘤的临床资料并进行分析,应用SPSS 13.0对随诊资料进行统计学比较.结果 191例原发性腹膜后恶性肿瘤中,临床症状主要表现为腹部肿块(122例、63.9%),腹痛(77例、40.3%),腹胀(48例、25.1%)等.术后病理脂肪肉瘤75例(39.3%).肿瘤完整切除142例,姑息性切除35例,剖腹探查肿瘤活检术14例.完整切除组、姑息性切除组和剖腹探查组的中位生存期分别为56、33、11个月,差异有统计学意义(P=0.00).结论 手术切除是腹膜后恶件肿瘤的有效治疗方法,积极的外科治疗、争取完整切除可以延长患者的生存期.对于复发患者,应争取再次手术切除.     

腹膜后巨大脂肪肉瘤三例报道

目的 探讨腹膜后巨大细胞肉瘤的临床特点。方法 对１３例腹膜后巨大脂肪肉瘤进行回顾性分析。结果 ３例切除肿瘤重量分别 为１０．６、６ｋｇ,术前影象学检查可提示肿瘤的位置,质地、周围脏器受压与推移情况,动脉数字减影造影可显示肿瘤的主要供应血管,３例肿瘤均手术切除,１例因术后复发已行３次手术。结论 腹膜后脂肪肉瘤巨大者不少见,手术切除率高,有术后复发倾向,应定期随访,发现复发可再次手术切除。     

手术切除应对肠系膜肉瘤术后复发的临床观察

目的 寻找肠系膜肉瘤术后复发的治疗对策.方法 回顾分析6例肠系膜肉瘤病人的临床资料.结果 6例病人中,肠系膜平滑肌肉瘤4例,肠系膜脂肪肉瘤2例,均经3～5次手术治疗,生存时间3～10年.结论 手术切除肠系膜肉瘤是目前有明确疗效的治疗方法,必要时可行多脏器联合切除,多次复发者争取多次手术,争取完整、彻底的切除肿瘤.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.