O形宫颈环扎术矫治孕期宫颈功能不全（附19例报告）

目的：探讨宫颈环扎矫治孕期宫颈机能不全的临床效果及环扎术的优点。方法：对确诊宫颈机能不全的孕妇,在非麻醉状态下宫颈环扎术,手术除缝针穿行处,无其它任何副损伤,术前术后常规保胎至无流产征兆,一般不需用抗生素。结果：本组19例,手术后3～5d内全部出院,门诊随访直至分娩。手术成功率100%。结论：非麻醉状态下宫颈环扎术是矫治孕期宫颈机能不全的理想方法。     

宫颈环扎术治疗宫颈机能不全60例疗效观察

目的探讨宫颈环扎术治疗妊娠期宫颈机能不全的疗效。方法对60例孕妇合并宫颈机能不全者,36例施行宫颈环扎术治疗,观察妊娠结局。结果孕妇手术36例中,延长妊娠至足月28例,早产4例,流产4例,胎儿成活32例,与非手术组比较有显著性差异（P〈0.01）。结论宫颈机能不全行宫颈环扎术可以延长孕妇的孕周,改善妊娠结局。     

宫颈环扎术治疗宫颈机能不全60例疗效观察

目的探讨宫颈环扎术治疗妊娠期宫颈机能不全的疗效。方法对60例孕妇合并宫颈机能不全者,36例施行宫颈环扎术治疗,观察妊娠结局。结果孕妇手术36例中,延长妊娠至足月28例,早产4例,流产4例,胎儿成活32例,与非手术组比较有显著性差异（P〈0．01）。结论宫颈机能不全行宫颈环扎术可以延长孕妇的孕周,改善妊娠结局。     

改良式宫颈环扎术联合间苯三酚应用于宫颈机能不全患者的临床研究

目的探讨宫颈机能不全患者行改良式宫颈环扎术及术后应用间苯三酚保胎治疗的疗效。方法对21例确诊为宫颈机能不全患者,于孕16～24周施行宫颈内口环扎术,术后应用间苯三酚行保胎治疗,观察妊娠结局。结果延长妊娠至足月分娩18例(85.7%),早产2例(9.5%),流产1例(4.8%),胎儿成活20例(95.2%)。结论改良式宫颈环扎术联合间苯三酚应用于宫颈机能不全,可以延长妊娠时间,提高足月新生儿分娩率。     

彩超诊断宫颈机能不全7例报告

本文回顾分析2 0 0 0～2 0 0 2年经彩超诊断并经宫颈环扎术及保守治疗证实的7例宫颈机能不全孕妇,报道如下。1　资料与方法7例均系我院住院患者。其中初孕妇2例,5例具有2次以上流产、早产史,年龄2 9～3 6岁,孕龄18～2 4周。仪器:Diason ics公司的Spectra及惠普公司生产的HP -5 5 0 0 ,探头频率3 .5MHz。孕妇适度充盈膀胱,于耻骨联合上常规做纵横向扫查,测量宫颈管长度、宫颈内口宽度以及宫颈管扩张情况。可疑宫颈机能不全者,住院观察或行宫颈环扎术及保守治疗。2　结果　　7例宫颈机能不全孕妇中,宫颈长度<2cm者3例,2～3cm者4例,宫颈内口…     

经会阴部和经腹部超声对宫颈机能不全的诊断价值分析

目的探讨经会阴部超声和经腹超声检查对宫颈机能不全的诊断效果。方法选择我院收治的疑似宫颈机能不全患者100例,随机分为观察组和对照组,每组50例,观察组通过会阴部进行超声检测,对照组通过腹部进行超声检测,分析和对比两组患者的临床效果。结果经会阴部超声检查宫颈机能不全的阳性率为96%,而经腹部超声检查宫颈机能不全的阳性率仅为80%,腹部超声检查的阳性率低于经会阴部超声,两组比较差异具有统计学意义(P0.05)。结论经会阴部超声检查对宫颈机能进行全面筛选,可早发现早治疗。     

U形缝合治疗宫颈内口机能不全35例体会

宫颈内口机能不全系先天发育不良或后天损伤所致，是导致妊娠中晚期流产或复发流产的常见原因。其特点是妊娠中晚期无宫缩而宫口逐渐开大，羊膜囊膨出或破裂，导致流产或早产。妊娠期进行宫颈环扎术或宫颈U形缝合术有利于妊娠的继续，减少晚期流产或早产的发生，现报道如下。     

宫颈环扎术后便秘原因分析及护理对策

宫颈环扎术是治疗宫颈功能不全的有效方法,对防治孕中期反复自然流产、延长妊娠时间、提高胎儿成活率起着关键的作用。宫颈机能不全的发生率约0．1％～2％,在妊娠16—28W习惯性流产中占15％左右。宫颈环扎手术患者心理压力大,恐惧排便时增加腹压引起流产,长期平卧活动量减少及药物的刺激作用,使得环扎术后患者普遍存在便秘现象。便秘本身不是一种疾病,但大量干硬的粪便积存在直肠内长期不排出可引起肠道收缩,进而促进子宫收缩,引起流产或早产,使保胎失败,所以,宫颈环扎术后患者发生便秘这一现象逐渐引起人们的重视。     

超声对妊娠期宫颈机能的监测

妊娠期宫颈的主要机能是内口紧闭,防止细菌侵入,使胎儿保留在子宫内直至分娩。妊娠33周宫颈逐渐成熟,开始变短、变软,分娩时宫颈展平,内口扩张。如上述过程发生过早,则为宫颈机能不全;宫颈机能不全发病率约占0．1％～0．8％,是导致习惯性晚期流产及早产的常见原因,约有15％的早产由宫颈机能不全引起。孕期行宫颈机能监测,早期发现宫颈机能异常可减少流产及早产发生率。2004年1月起我院对2600例孕期检查的孕妇行动态宫颈机能监测,对其中有习惯性流产及早产史等孕妇重点监测,结果报道如下。     

周围缝扎术结合常规手术治疗返流性静脉功能不全性溃疡30例

目的：探究周围缝扎术在慢性返流性静脉功能不全并发溃疡治疗中的作用。方法：下肢静脉曲张并发溃疡30例随机分为2组（每组15例）,对照组行常规静脉曲张剥脱手术及股浅静脉瓣膜环缩术;缝扎组在常规手术同时行溃疡周围缝扎术。测量并记录治疗前后患肢超声多普勒血管检查结果、静脉血氧饱和度、立位静脉压、溃疡部位经皮氧分压、局部病理检查、电镜检查及溃疡愈合时间,随访6～24个月。结果：两组治疗后浅静脉、深静脉交通支静脉返流明显减少,静脉血氧分压上升,溃疡部位经皮氧分压上升,线粒体数量增多、形态正常,粗面内质网形态正常,立位静脉压及压力降低比改善明显,两组内无明显差异。缝扎组局部白细胞浸润减少,毛细血管淤血减少,溃疡愈合时间明显缩短,复发率降低。结论：周围缝扎术可减轻溃疡局部血液淤滞及炎性细胞浸润,可明显缩短溃疡愈合时间;缝扎术可降低复发率,简便易行,患者经济负担较轻。     

自制隧道式穿刺针在骨肿瘤及瘤样病变介入穿刺中的应用研究

目的:探讨隧道式穿刺针在骨肿瘤性(样)病变介入性穿刺中对于提高病变检出率和诊断符合率的应用价值。方法:回顾性分析了88例骨肿瘤性(样)病变患者的介入穿刺。两组各取44例患者分别采用隧道式穿刺针(应用组)和传统细穿刺针(对照组)进行穿刺、比较。结果:将两组病例的穿刺成功率、组织取出量、细胞学检查满意率及诊断符合率等指标进行比较,发现应用组均优于对照组。结论:隧道式穿刺针在骨骼病变的介入穿刺中明显优于传统细针穿刺,但由于病例统计数目不够多,影响因素尚未完全发现,有待于进一步研究。     

Cervical venous reflux in dynamic brain scintigraphy.

Cervical venous reflux, shown by dynamic brain scintigraphy, was investigated through three avenues of approach: (A) by reviewing 371 randomly chosen routine dynamic intracerebral bloodflow studies to estimate its incidence; (B) by correlative positive-contrast superior venacavography in patients with characteristic cervical venous reflux; and (C) by performing dynamic brain scintigraphy while utilizing various positional and physiologic maneuvers to attempt to produce cervical venous reflux in patients who did not exhibit this phenomenon on earlier examination. Although any obstruction of the superior vena cava or a properly timed Valsalva maneuver in selected patients can produce the scintigraphic picture of cervical venous reflux, in most cases it is a normal phenomenon due to incompetent or absent cervical venous valves.     

Experimental ovine model of primary venous valve incompetence: a pilot study

PURPOSE: To compare two techniques used to create a larger animal model of venous valve incompetence. MATERIALS AND METHODS: To achieve vein dilatation as the primary cause of valve incompetence, common carotid jugular vein (JV) fistulas were created and optional filters were placed into the JV of sheep. Altogether, nine inferior vena cava filters were placed in three sheep in two stages. Six filters were placed caudal to the most caudal JV valve in three sheep and removed 6 weeks later. Then, three filters were placed across the most caudal valve in two sheep with competent valves and removed 3 weeks later. A common carotid artery-JV fistula was created in three sheep and followed-up for 1-3 weeks. Ascending and descending venograms were obtained to determine the JV sizes and function of their valves. The JVs removed at necropsy were studied with venoscopy. RESULTS: Only one of the six JVs with filters caudal to the most caudal valve had incompetent valves after filter removal at 6 weeks. In addition, only one of three JVs with the filter across the valve had incompetent valves after filter removal at 3 weeks. At 1-3-week follow-up of the group with common carotid artery-JV fistula, all three JVs had incompetent valves in the cephalad vein portion, but only one JV had an incompetent valve in its caudal portion. At venoscopy, the incompetent valves showed various degrees of damage ranging from shortening to the destruction of valve leaflets. CONCLUSION: Dilation of the valve annulus with a removable vena cava filter failed to produce valve incompetence. The promising results with the common carotid artery-JV fistula justify further detailed research.     

Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women

OBJECTIVE. Incompetent and dilated ovarian veins have been reported in association with pelvic congestion syndrome. We postulate that incompetent and dilated ovarian veins are often an incidental CT finding, with a low diagnostic value. To verify our hypothesis, we studied the frequency of incompetent and dilated ovarian veins seen on CT in asymptomatic women. MATERIALS AND METHODS. We retrospectively analyzed helical CT scans and medical records of 34 consecutive female renal donors between 18 and 46 years old (mean age, 33 years). An incompetent and dilated ovarian vein was defined as a contrast-filled vein measuring 7 mm or greater, seen during the arterial phase of helical CT. RESULTS. Incompetent and dilated ovarian veins were found in 16 (47%) of 34 asymptomatic women. All 16 women had left ovarian vein involvement; six (37.5%) had bilateral involvement. The mean diameters for the left and right (incompetent and dilated) ovarian veins were 9.1 mm and 8.8 mm, respectively (range, 7-12 mm). Of 16 women with incompetent and dilated ovarian veins, 15 (94%) were parous. Of 18 women with normal ovarian veins, nine (50%) were parous. Overall, incompetent and dilated ovarian veins were found in 15 (63%) of 24 parous women, and in one (10%) of 10 nonparous women (p < 0.05). CONCLUSION. Incompetent and dilated ovarian veins are frequently seen on CT in asymptomatic parous women. As an isolated finding, it is unlikely to be associated with pelvic congestion syndrome.     

64层螺旋CT对80例肠梗阻的诊断

目的:探讨64层螺旋CT在肠梗阻诊断中的应用。方法:收集经临床诊断为肠梗阻的80例CT资料,采用多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、表面遮盖显示(SSD)、容积再现技术(VRT)、模拟内窥镜(VE)等多种处理方法,进行图像重组,并分析其表现。结果:在80例病例中,64层螺旋CT对肠梗阻诊断的敏感性100%,病因诊断正确率96%,包括粘连性肠梗阻25例,肠道肿瘤24例,肠外肿瘤压迫2例,肠扭转6例,绞窄性肠梗阻1例,肠系膜上动脉栓塞1例,肠套叠8例,腹股沟疝3例,动力性肠梗阻10例。结论:64层螺旋CT检查对了解肠梗阻的部位、原因、严重程度以及病变肠管血供情况发挥重要作用,可以作为临床诊断的首选检查。     

Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in “clearing”¹ the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had “clay-shoveler” fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury.     

Evaluation of vertebral artery injury from ballistic trauma to the neck

This study was conducted to assess the likelihood of vertebral artery injury after gunshot wounds to the neck in patients without and with fracture of the cervical spine. All patients presenting to the emergency department with cervical gunshot wounds were evaluated with cervical spine radiographs; if a fracture was suspected, a computed tomographic scan was obtained. All patients with cervical gunshot wounds underwent selective angiography of the cervical vessels. The images were retrospectively reviewed by three American Board of Radiology boardcertified radiologists, assessing for the presence of fracture and vascular injury.Of the 50 patients presenting with ballistic trauma to the neck, 21 patients had sustained a cervical spine fracture; of these, 9 patients had a vertebral artery injury. Only 1 of the 29 patients without a cervical spine fracture had vascular damage. In that patient, however, the bullet was lodged between the transverse processes of the cervical vertebrae at the level of vascular injury.In the absence of a cervical spine fracture or evidence that the missilés trajectory has crossed the vertebral artery, injury to the vertebral artery is unlikely after a gunshot wound to the neck. A computed tomographic scan of the neck may help in tailoring the angiogram performed after ballistic injury.     

腹腔镜下电钩切除直肠癌（附14例报告）

目的：探讨腹腔镜下应用电钩行直肠癌手术的方法和可行性。方法：回顾性分析2009-08～12腹腔镜下用电钩切除直肠癌14例临床资料。结果：14例患者手术顺利,无肠道并发症,手术时间缩短,费用降低。结论：腹腔镜下应用电钩行直肠癌手术是安全可行的。     

艾滋病合并颈髓弓形虫感染的MRI表现(附3例报道)

目的：探讨艾滋病合并脊髓弓形体感染的影像表现。方法：回顾性分析3例艾滋病合并脊髓弓形体感染的影像表现,3例均经MRI颈髓平扫及增强检查,其中1例行头部及胸部MRI平扫及增强检查。结果：1例多部位,多发,2例仅颈髓单发,2例弓形虫抗体（IgA、IgG）检测阳性,1例弓形虫抗体（IgA）检测阴性,弓形虫抗体（IgG）阳性;2例治疗后复查病灶明显缩小,1例病灶消失;MRI平扫脊髓增粗肿胀,病灶呈短T1、短T2信号,周围水肿呈长带状长T1、长T2信号;增强扫描,病灶呈环状、螺旋状或靶形增强。结论：艾滋病患者脑、脊髓内多部位,多病灶,MRI增强呈环状、螺旋状或结节状增强,高度提示脑脊髓感染,影像表现具有特征性,但无特异性。MRI对脑脊髓弓形虫感染是有效的诊断方法。     

Chiari-Ⅰ型畸型的影像学检查

Objective:To discuss the relationship between the Chiari- Ⅰ deformity and the perioccipital foramen magnum region defor mity in imaging, clinical and pathological manifestation. Methods: Forty one cases of Chiair- Ⅰ deformity in which 28 cases had undergone MRI, 29 cases for CT, and 9 cases for both these two examinations were studied. Results: There was the tonsilla cerebelli herniation in all CT cases which had extent downward from foramen magnum, 25 to C1 bottom level, 4 down to C2 level and below. The tonsilla cerebelli as a soft mass is posterior to cervical spinal cord in magnum foramen level in all axial imaging. In 8 of 9 cases of CTM show the cervical spinal cord deformation due to tonsilla cerebelli compression. Sagittal reconstruction images show that the tonsilla cerebelli extended downward to the spinal canal from the posterior fossa. All 28 cases of MRIgroup showed wedge-shaped tonsilla herniation extending 5 ～ 8 mm down ward magnum foremen; non indicate pathologic characteristics of Chian- Ⅰ deformity. Conclusion: The cervical and medullary curvature was due to the posterior fossa invagination but not to the Chiari- Ⅰ deformity itself.