肺内胸膜下区非钙化结节分布及其特征

目的 分析肺内胸膜下区非钙化结节分布及其特征。方法 选择经胸部CT检查发现肺内胸膜下区非钙化结节的体检者1 152例，将胸部CT图像导入人工智能肺结节筛查分析软件，在肺窗上测量结节径线（长/短径）、CT值、距胸膜下最长/最短距离，分析不同肺段、不同肺叶、有/无胸膜接触非钙化结节分布及其特征。结果 在1 152例体检者中共发现胸膜下区非钙化结节1 755个。在不同肺段中，胸膜下区非钙化结节主要分布在右肺S1、S4、S9段以及左肺S1段+S2段、S9段；径线较大结节主要分布在右肺下叶S7、S8段及左肺下叶S9、S10段，较小结节主要分布在右肺上叶S2、S3段；较高CT值结节主要位于右肺下叶S7段和左肺下叶S7段+S8段，较低CT值结节主要位于右肺中叶S5段及左肺上叶S3段、S1段+S2段；位于肺下叶结节比位于肺上叶结节距胸膜下更近，尤其是右肺S8段、左肺S7段+S8段、双肺S10段。在不同肺叶中，胸膜下区非钙化结节主要分布在右肺上下叶；左肺上叶结节径线小于其他肺叶，左肺下叶结节CT值高于其他肺叶，各肺叶结节距胸膜下最长距离相近，右肺中下叶结节距胸膜下最短距离小于其他肺叶。与胸膜接触的非钙化...     

肺梗死的CT影像诊断

目的 分析急性肺血栓栓塞症合并肺梗死患者CT影像特点。方法 回顾性分析64例急性肺血栓栓塞症合并肺梗死患者的CT影像表现,总结肺梗死的数量、位置、形态、有无胸腔积液等。结果 最终纳入急性肺血栓栓塞症386例,其中肺梗死64例,梗死发生率为16.58%。64例肺梗死患者累及双肺上叶血栓数为224(24.62%)个;左舌叶和右肺中叶血栓数为177(19.45%)个;双肺下叶血栓数为483(53.08%)个。共有107个肺梗死灶,41(64.06%)例患者有单个梗死灶,12(18.75%)例患者有两个梗死灶,11(17.19%)例患者有三个或更多梗死灶。4(3.74%)个梗死灶位于左肺上叶固有段,13(12.15%)个位于左肺上叶舌段,左肺下叶有28(26.17%)个;右肺上叶13(12.15%)个,右肺中叶12(11.21%)个,右肺下叶37(34.58%)个。右下叶栓塞发生肺梗死的风险较高(P<0.001)。74(69.16%)个表现为楔形实变影,27(25.23%)个为反晕征,血管征1(0.93%)个,空洞1(0.93%)个,47(43.93%)个出现胸腔积液。不同性别患者的梗死...     

楔形肺切除术治疗肺结核病142例分析

１９８２年６月～１９９６年６月,我们对１４２例周边性肺结核球及结核空洞患者行楔形肺切除术,疗效满意。现报告如下。１　临床资料本组男９３例,女４９例;年龄１８～６３岁。临床表现为咯血或长期痰血４３例,反复脓痰、发热２９例,反复化疗后持续痰菌阳性４２例,肺癌或肺内其他良性病变不能排除２８例。其中肺结核空洞６８例,肺结核球７４例。病变位于右肺上叶３８例,右肺下叶２２例,中叶５例,左肺上叶４１例,左肺下叶１５例。上叶与下叶多处病变２１例（右侧１２例,左侧９例）。病变均位于肺叶周边位置。所有病例均接受规则…     

全胸腔镜肺叶切除术在肺良恶性疾病治疗中的应用

目的探讨全胸腔镜（VATS）肺叶切除术治疗肺良恶性疾病临床疗效。方法总结2010年8月～2012年9月采用胸腔镜治疗17例肺良恶性疾病的临床资料,其中右肺上叶6例,右肺下叶2例,右肺中叶2例,右肺中上叶1例,右肺中下叶2例,左肺上叶2例,左肺下叶2例。术后病理：鳞癌11例,腺癌2例,支气管扩张2例,硬化性血管瘤1例,错构瘤1例。结果1例因胸腔严重粘连,镜下处理困难而中转开胸行VATS辅助小切口手术,余16例全胸腔镜下完成。全组无围手术期死亡。手术时间80一240rain,平均140．2min;手术出血量50～800ml,平均150ml;切除淋巴结4～25枚,平均15．2枚;胸腔引流管留置时间48～92h,平均69．3h;术后总引流量200～900ml,平均300．5ml;术后住院天数7～14d,平均10．5d。回访所有患者均生存良好。结论全胸腔镜肺叶切除治疗肺良恶性疾病能够完成肺门及纵隔淋巴结的清扫,同时具有手术创伤小,出血少,术后疼痛轻,恢复快,并发症少的优点。     

肺叶切除术中肺血管破裂出血的处理

在肺叶切除术中,有些患者易发生肺血管破裂出血。一旦发生,来势凶猛,止血操作困难,甚至有发生失血性休克、心跳骤停的危险。1996年11月～1999年9月,我们曾遇14例,经采取有效措施,均手术成功。现报告如下。资料与方法:本组男9例,女5例;年龄37～74岁,平均62.8岁。鳞状上皮癌8例,腺癌6例。肿瘤侵犯肺叶动脉分支8例,淋巴结粘连肺叶动脉3例,肿瘤侵犯肺静脉干3例。右肺上叶切除术2例,右肺中叶切除术1例,右肺下叶切除术3例,左肺上叶切除术3例,左肺下叶切除术5例。手术取侧位经后外侧切口入胸。若术中见肿瘤或周围淋巴结紧密粘连于肺叶动脉,或肿瘤侵…     

全胸腔镜下肺叶切除的临床应用

目的 探讨全胸腔镜肺叶切除术的临床价值.方法 全胸腔镜下行肺叶切除127例.其中右肺上叶19例,右肺中叶12例,右肺下叶17例,右肺中下叶7例,左肺上叶44例,左肺下叶28例;对94例原发性肺癌患者并同期施行纵隔淋巴结清扫.结果 全组手术均顺利完成.结论 全胸腔镜肺叶切除术疗效可靠、技术可行,安全、微创、恢复迅速,适用于早期周围型肺癌和需要施行肺叶切除的良性肺部疾病,但需要娴熟的内镜下处理血管和清扫淋巴结等关键技术.     

非解剖性肺叶切除在肺部炎性病变手术中的应用

目的探讨非解剖性肺叶切除在肺部炎性病变手术中的应用价值。方法总结2006年6月~2010年3月期间我院16例肺部炎性病变行非解剖性肺叶切除的手术及术后恢复情况。结果 16例患者中,支气管扩张5例,右肺中叶综合症4例,肺脓肿3例,肺囊肿合并感染2例,结核1例,先天性食管支气管瘘合并右下肺感染1例。手术部位：右肺上叶切除1例;右肺中叶切除4例;右肺下叶切除4例;右肺中下叶切除1例。左肺上叶切除1例;左肺下叶切除5例。手术时间1.5~4.2 h,平均2.6±0.8 h。术中出血200~750 m l,平均320±160 m l。术后胸腔闭式引流时间1~6 d,平均2.6±1.5 d。所有患者均顺利恢复。结论当肺部炎性病变手术出现肺门严重粘连而无法常规解剖出肺门血管时,非解剖性肺叶切除是一种安全,简便的肺叶切除方法。     

先天性肺囊肿的诊治（附16例报告）

１９７８～１９９８年，我们收治先天性肺囊肿（下称肺囊肿）患者１６例，现对其诊治进行讨论。１临床资料本组男９例，女７例；年龄５０天至６５岁，平均２８岁。病史５０天至２０年，平均８．６年。其中囊肿位于左肺下叶６例，左肺上叶２例，右肺下叶４例，右肺中叶２例...     

肺撕裂伤的256层螺旋CT诊断研究

目的对256层螺旋CT检查肺撕裂伤的结果进行分析。方法对我院146例肺撕裂伤患者的临床资料以及CT检查结果进行回顾性分析。结果 146例患者中,右肺上叶、中叶、下叶分别为48例、26例、80例,左肺上叶、下叶分别为54例、64例。共累计224个病灶,其中肺周边区及胸膜下的病灶占78.57%(176个病灶),肺中心区域的病灶占21.43%(48个病灶),病灶位置相比差异有统计学意义(P0.05)。并且肺周边区及胸膜下病灶累及一个肺叶、两个肺叶的数量远远多于肺中心区域,差异有统计学意义(P0.05)。CT检查显示,气液囊组的人数与其他两组相比,差异有统计学意义(P0.01)。而且气液囊组的病灶数也远远多于气囊组和血肿组,差异有统计学意义(P0.01)。同时,血肿组患者的病灶大小明显小于其他两组,差异有统计学意义(P0.01)。结论 256层螺旋CT用于肺撕裂伤检查及诊断效果较佳,对此病症的救治极具参考价值,值得广泛应用。     

电视胸腔镜辅助小切口治疗支气管肺癌74例观察

自2002年起，我们对74例支气管肺癌患者采用电视胸腔镜辅助小切口行肺叶或全肺切除＋淋巴结清扫术，取得良好效果。现报告如下。临床资料：本组男46例，女28例；年龄32～75岁，平均63．3岁。其中鳞癌36例，腺癌26例，细支气管肺泡癌9例，小细胞肺癌3例。Ⅰ期14例，Ⅱ期25例，Ⅲa期35例。本组病例中行左肺上叶切除术18例，左肺下叶切除术10例，左全肺切除7例，右肺上叶切除术17例，右肺中叶切除术5例，右肺下叶切除术11例。右肺中下叶切除术6例。     

Swyer-James syndrome with peculiar course and ipsilateral pulmonary vein defect

Swyer-James syndrome (SJS) is a rare disease probably resulting from bronchiolitis obliterans. The radiological findings of this entity are characterized by hyperlucent appearance of one or more lobes of a unilateral lung, decreased lung volume, diminished ipsilateral hilar shadow and hardly visible arterial structure on chest radiography. We report a 50-year-old patient, who had unilateral right lower lung hyperlucency on chest radiography. However, the patient reported a history of pulmonary atelectasis of lobus centralis dexter in the course and the corresponding affliction of ipsilateral pulmonary vein, that rendered the diagnosis more complicated. The radiological and pathological features of this syndrome, as well as differential diagnosis were also discussed.     

广西融水县并殖吸虫虫种的分子鉴别

用分子生物学方法鉴定广西融水县大小两种并殖吸虫囊蚴感染动物后所获成虫的虫种。在广西融水县采集溪蟹分离获得大小两种囊蚴 ,感染大鼠后获成虫 ,曾从形态上鉴定为斯氏狸殖吸虫和巨睾并殖吸虫。但用酚 -氯仿法抽提成虫基因组DNA ,PCR扩增第二内转录间隔区 (ITS2 )基因后测序 ,用Blast程序与GenBank中的斯氏狸殖吸虫、巨睾并殖吸虫等的ITS2基因序列进行同源性检索 ,用PrimerPremier软件比较其基因差异 ,用Phylip软件的Neighbor程序绘制其基因进化树后 ,测得大小囊蚴感染所获成虫的ITS2基因片段分别为 4 37bp、4 33bp ,两者的基因同源性为 10 0 % ,与斯氏狸殖吸虫的基因同源性分别为 10 0 %、99% ,与巨睾并殖吸虫的基因同源性分别为 91%、92 % ;基因序列差异比较 ,大小囊蚴感染所获成虫与斯氏狸殖吸虫的基因序列差异为 0 ,而与巨睾并殖吸虫存在明显差异 ;绘制基因进化树 ,大小囊蚴感染所获成虫与斯氏狸殖吸虫在同一分支同一位置 ,与巨睾并殖吸虫亲缘关系较远。融水县大小囊蚴感染所获成虫与斯氏狸殖吸虫为同一物种 ,小囊蚴感染所获成虫并非巨睾并殖吸虫。     

The hematological status, plasma vitamin B12 and folic acid levels, and intestinal pathology in rats infected with Giardia lamblia

The purpose of our study was to investigate the hematological status, vitamin B12 and folic acid absorption and intestinal pathology after Giardia lamblia infection in a rat model. Adult Wistar rats were assigned randomly to receive human giardia cysts orally in the amount of 5 x 10(5) or 1.0 x 10(6) cysts, or none in the controls. The results showed that all the rats injected with giardia cysts became infected. The cyst output in the infected rats varied considerably. In rats infected with 5.0 x 10(5) giardia cysts, the incubation period until cyst output was 10 days compared with 4 days in rats infected with the higher amount of 1.0 x 106 giardia cysts. The highest peaks for cysts output in these 2 groups were on days 4-33, which decreased gradually to days 40-58. The hematocrit and hemoglobin levels in the infected rats were statistically significantly lower than in the controls on days 16, 22, 33, and 37 post-infection (p < 0.05). A reverse relationship between giardia cyst output and hemoglobin concentration was found in the infected rats (p = 0.05). There were no significant differences in plasma vitamin B12 and folic acid levels between the infected rats and the control rats. No pathological changes were found in the small intestine of infected rats. These findings suggest that giardiasis did not affect the absorption of plasma vitamin B12 and folic acid but caused anemia in a rat model.     

Cloning and analysizing the up-regulated expression of transthyretin-related gene （LR1） in rat liver regeneration following short interval successive partial hepatectomy

AIM: Cloning and analysing the up-regulated expression of transthyretin-related gene following short interval successive partial hepatectomy (SISPH) to elucidate the mechanism of differentiation, division, dedifferentiation and redifferentiation in rat liver regeneration (LR). METHODS: Lobus external sinister and lobus centralis sinister, lobus centralis, lobus dexter, lobus candatus were removed one by one from rat liver at four different time points 4, 36, 36 and 36 hr (total time: 4 hr, 40 hr, 76 hr, 112 hr) respectively. Suppression subtractive hybridization (SSH) was carried out by using normal rat liver tissue as driver and the tissue following short interval successive partial hepatectomy (SISPH) as tester to construct a highly efficient forward-subtractive cDNA library. After screening, an interested EST fragment was selected by SSH and primers were designed according to the sequence of the EST to clone the full-length cDNA fragment using RACE (rapid amplification of cDNA end). Homologous detection was performed between the full-lenth cDNA and Genbank. RESULTS: Forward suppression subtractive hybridization (FSSH) library between 0 h and 112 h following SISPH was constructed and an up-regulated full-length cDNA (named LR1), which was related with the transthyretin gene, was cloned by rapid amplification of cDNA end. It was suggested that the gene is involved in the cellular dedifferentiation in LR following SISPH. CONCLUSION: Some genes were up-regulated in 112 h following SISPH in rat. LR(1) is one of these up-regulated expression genes which may play an important role in rat LR.     

Cloning and analysizing the up-regulated expression of transthyretin-related gene(LR1) in rat liver regeneration following short interval successive partial hepatectomy

AIM: Cloning and analysizing the up-regulated expressionof transthyretin-related gene following short intervalsuccessive partial hepatectomy (SISPH) to elucidate themechanism of differentiation, division, dedifferentiation andredifferentiation in rat liver regeneration (LR).METHODS: Lobus external sinister and lobus centralissinister, lobus centralis, lobus dexter, lobus candatus wereremoved one by one from rat liver at four different time points4, 36, 36 and 36 hr (total time: 4 hr, 40 hr, 76 hr, 112 hr)respectively. Suppression subtractive hybridization (SSH) wascarried out by using normal rat liver tissue as driver and thetissue following short interval successive partial hepatectomy(SISPH) as tester to construct a highly efficient forward-subtractive cDNA library. After screening, an interested ESTfragment was selected by SSH and primers were designedaccording to the sequence of the EST to clone the full-lengthcDNA fragment using RACE (rapid amplification of cDNAend). Homologous detection was performed between thefull-lenth cDNA and Genbank.RESULTS: Forward suppression subtractive hybridization(FSSH) library between 0 h and 112 h following SISPH wasconstructed and an up-regulated full-length cDNA (namedLR1), which was related with the transthyretin gene, wascloned by rapid amplification of cDNA end. It was suggestedthat the gene is involved in the cellular dedifferentiation inLR following SISPH.CONCLUSION: Some genes were up-regulated in 112 hfollowing SISPH in rat. LR1 is one of these up-regulatedexpression genes which may play an important role in rat LR.     

卡氏肺孢子虫肺炎大鼠模型的比较研究

目的　比较用SpragueDawley(SD)大鼠和Wistar大鼠建立卡氏肺孢子虫肺炎 (PCP)模型的差异。 方法　选用SD大鼠和Wistar大鼠 ,随机分为实验组和对照组 ,免疫抑制诱导建立动物模型 ;收集肺组织和支气管肺泡灌洗液 (BALF) ,分别制成肺印片和BALF涂片 ,作Giemsa染色 ,镜检卡氏肺孢子虫滋养体和包囊。结果　共收集实验组SD大鼠和Wistar大鼠的肺组织及BALF标本各 2 8份 ,经Giemsa染色后 ,在肺印片中查见Pneumocystiscarinii(Pc)虫体的阳性率分别为 89.2 9%和10 0 % ,两者之间无显著性差异 (P >0 .0 5 ) ;BALF阳性率分别为 6 0 .71%和 78.5 7% ,两者之间亦无显著性差异 (P >0 .0 5 )。而同种大鼠的肺印片与BALF涂片 ,其阳性率之间有显著性差异 (P <0 .0 5 ) ,且肺印片的检出率均显著高于BALF涂片。同种大鼠不同肺叶的肺印片 ,其阳性率之间无显著性差异 (P >0 .0 5 )。结论　SD大鼠与Wistar大鼠作为PCP模型动物无明显差别     

Multiple branchial cleft-like cysts in a female patient with Hashimoto's thyroiditis

We report a case of branchial cleft-like cysts (intrathyroidal lymphoepithelial cysts) associated with Hashimoto's thyroiditis. Palpation did not detect any nodules. Multiple cystic lesions were detected in the lateral side of the thyroid bilateral lobes by imagings of an I-123 scintigram, Tl-201 scintigram, sonography, and computerized tomography. Sonography displayed multiple cysts with strong echogenic spots in the cystic fluid. Repeated fine needle aspiration biopsies of the cysts consistently revealed only normal lymphocytes. Although these lesions could not be given diagnosis, subtotal thyroidectomy leaving the intact isthmus was performed. Microscopic findings revealed multiple branchial cleft-like cysts lined by flattened epithelial cells. Surrounding the epithelial lining were dense lymphoid follicles with large, reactive germinal centers. The remaining thyroid parenchyma showed Hashimoto's thyroiditis. Multiple branchial cleft-like cysts should be considered when sonographic examination reveals multiple cysts in the lateral side of the bilateral lobes, and fine needle aspiration biopsy displays only normal lymphocytes. To our knowledge, this is the first case of branchial cleft-like cysts associated with Hashimoto's thyroiditis reported in Japan.     

经双氢青蒿素治疗后卡氏肺孢子虫肺炎大鼠的肺部病理学变化

目的　研究经双氢青蒿素治疗后卡氏肺孢子虫肺炎 (PCP)大鼠肺部病理学变化。方法　以地塞米松磷酸钠皮下注射Wistar大鼠建立卡氏肺孢子虫肺炎动物模型 ,用 6 0mg/kg双氢青蒿素治疗实验大鼠 ,杀鼠取肺 ,用光镜和电镜观察肺部病理学变化 ,同时设有感染对照组和正常对照组。结果　肺印片中卡氏肺孢子虫 (Pc)包囊数目显著减少 ,肺组织炎症明显减轻 ,Pc滋养体表膜和核膜破裂 ,胞质中出现大量空泡和高电子密度颗粒 ,Pc包囊中也出现空泡 ,囊内小体变性坏死。结论　双氢青蒿素可杀死Pc滋养体和包囊 ,从而减轻肺组织的炎症反应。     

弓形虫慢性感染小鼠脑内包囊分布的研究

目的观察弓形虫包囊在慢性感染小鼠不同脑组织内的分布情况。方法以AH株弓形虫包囊腹腔感染小鼠20只,饲养3月后取小鼠脑组织,分离出大脑皮层、海马、中脑、小脑和脑干各部分,逐一称重,用PBS液制备成脑组织匀浆(体积均为2 ml)。从每只小鼠的每种脑组织匀浆中各吸取30μl匀浆液,涂片3张,每张10μl,瑞氏染色,显微镜下(10×40)计数弓形虫包囊个数,并用方差分析比较单位浓度(mg/ml)不同脑组织的匀浆液所含包囊的个数有无显著性差异。结果单位浓度(mg/ml)不同脑组织的匀浆液所含包囊的数量有显著性差异(P<0.01),海马和大脑皮层处最多,脑干和小脑处最少。结论弓形虫包囊在慢性感染小鼠不同脑组织内的分布有显著性差异,主要集中于海马和大脑皮层处。     

中药鸦胆子与补骨脂素对卡氏肺孢子虫病大鼠免疫调节的影响

目的 探讨中药鸦胆子和补骨脂素合剂对卡氏肺孢子虫肺炎(PCP)大鼠的免疫调节及杀虫作用。方法 地塞米松皮下注射SD大鼠(2.5mg/只,每周2次,连续6周),建立PCP大鼠模型。药物治疗剂量,每鼠每天口饲中药鸦胆子0.12mg与补骨脂素1mg,连续7d或14d。同时设PCP阳性不治疗对照组及正常大鼠对照组。制作肺组织病理切片观察肺组织病变,制作肺组织印片计数肺孢子虫包囊数观察中药合剂杀虫效果。检测血液中CD4⁺T细胞、CD8+T细胞和α肿瘤坏死因子(TNF-α)的变化,观察中药合剂对PCP大鼠的免疫调节作用。结果 治疗组大鼠,受损的肺组织病变减轻或修复,体重明显回升,肺组织包囊数明显低于阳性对照组(P<0.05)。血液中CD4⁺T细胞、CD8⁺T细胞和TNF-α均较阳性对照组升高(P<0.05)。结论 中药鸦胆子和补骨脂素合剂治疗PCP大鼠,可增强免疫调节作用,并可抑制及杀灭卡氏肺孢子虫。