点剪切波弹性成像对急性胆囊炎的附加诊断价值

正摘要目的评估点剪切波弹性成像(p SWE)在传统超声诊断急性胆囊炎中的附加价值。方法对216例临床疑似急性胆囊炎的病人分别行B超、彩色多普勒超声以及p SWE检查。对胆囊行形态学和附壁血管评价并对肝右叶行平均剪切波速度(SWV)评价。2位研究者分别独立回顾了常规超声及常规超声联合p SWE的研究结果。结果与85例对照组相比,91例急性胆囊炎组肝右叶距胆囊2 cm范围内的平均SWV值(m/s)显著升高(1.56∶1.03,1.39∶1.04,P0.000 1),临界值为1.29或1.16。在急性胆囊炎诊断中,2位研究者观测到附加的对p SWE影像的回顾性分析结果显示,受试者操作特     

MRI和MRCP诊断急性胆囊炎的临床意义

MR成像在急性胆囊炎中的应用国外近年研究较多,国内文献少见报道,为了提高认识,现搜集经手术证实并有完整临床和MRI、MRCP资料的36例急性胆囊炎病例,回顾性分析其影像表现特点,旨在了解急性胆囊炎的MRI和MRCP表现,并探讨其临床意义.     

急性坏疽性胆囊炎的CT诊断价值

【摘要】目的：通过总结分析急性坏疽性胆囊炎的 CT影像特征，提高急性坏疽性胆囊炎的诊断符合率，为临床选择合理的治疗方式提供依据。方法：回顾性分析经手术病理证实的49例急性胆囊炎（包括急性坏疽性胆囊炎13例和急性非坏疽性胆囊炎36例）患者的临床和CT影像资料，49 例均行MSCT全腹部平扫及双期增强扫描。计算和比较各CT征象对急性坏疽性胆囊炎与非坏疽性胆囊炎的鉴别诊断效能。结果：急性坏疽性胆囊炎组与非坏疽性胆囊炎组的胆囊最大横径、胆囊壁厚度、胆汁CT值、胆囊结石、胆囊周围炎及邻近肝实质强化的差异无统计学意义（P值均＞0.05）；胆囊壁强化不连续或不强化、胆囊壁和/或胆囊腔内积气在急性坏疽性胆囊炎组的发生率高于非坏疽性胆囊炎组，差异有统计学意义（P＜0.05）。结论：急性胆囊炎具有典型的CT影像表现，常可以作出正确诊断。急性坏疽性胆囊炎虽然术前诊断较困难，但仍然有特征性表现。胆囊壁强化不连续或不强化、胆囊壁和/或胆囊腔内积气（有或无胆囊周围积气）可作为鉴别急性坏疽性与非坏疽性胆囊炎的重要征象。     

胆囊炎急性发作期腹腔镜胆囊切除术临床分析

目的 :探讨胆囊炎急性发作时 ,腹腔镜胆囊切除术的方式方法 ,进一步提高腹腔镜操作技术。方法 :对 35 1例胆囊炎急性发作病例 ,腹腔镜胆囊切除术进行回顾性分析。结果 :340例腹腔镜胆囊切除 ,11例中转开腹 ,中转率为3 13%。手术后恢复良好 ,均治愈出院。结论 :胆囊炎急性发作期 ,腹腔镜胆囊切除是完全可行的 ,降低了对患者的创伤 ,使微创技术有了进一步提高。     

77例老年人急性胆囊炎的外科治疗

急性胆囊炎是临床常见的急腹症之一,随着社会老龄化日趋严重,老年急性胆囊炎患者日益增多。老年人患者发病迅速、并发症多、治疗难度大,本文总结分析了我院2005-07～2009-07收治的77例老年急性胆囊炎患者的临床治疗资料,现将结果报道如下。     

手术治疗急性胆囊炎的疗效观察

随着人们生活和饮食习惯的变化,使得急性胆囊炎的发病率逐年增高[1]。急性胆囊炎往往有炎性组织粘连和炎性渗出,手术治疗棘手,采取何种手术方式成为我科研究的热点。本研究通过对我院收治的120例急性胆囊炎患者的临床资料报告如下。     

X线下经皮胆囊穿刺引流治疗急性重症胆囊炎31例分析

目的 评价X线下经皮经肝胆囊穿刺引流术治疗急性重症梗阻性胆囊炎患者的临床疗效和治疗经验.方法 对2006年1月-2008年12月31例急性重症梗阻性胆囊炎患者行X线引导下的经皮经肝胆囊穿刺引流术治疗,通过对比术前、术后实验检查及临床症状的改善评价疗效.结果 31例患者均成功置入引流管,未发生相关并发症.1例合并急性肾功能衰竭患者死亡,其余30例患者症状缓解并带管出院.16例结石性胆囊炎患者于术后1～3个月行择期胆囊切除术,8例结石性胆囊炎患者选择带管生存,6例非结石性胆囊炎患者于胆囊炎治愈后3周至6周拔管.结论 X线下经皮胆囊穿刺引流术操作简便、创伤小、安全性高,是急性重症胆囊炎患者的一种过渡治疗,甚至是终末治疗方法.     

腹腔镜下行急性胆囊炎切除56例临床分析

目的总结腹腔镜下行急性胆囊炎切除术的临床经验。方法对本院2003年7月—2005年6月的56例急性胆囊炎病人施行腹腔镜胆囊切除术(LC)的临床资料进行回顾分析。结果51例成功完成LC,中转开腹手术5例,其中因Calot三角解剖不清,周围致密粘连2例,结石嵌顿于胆囊管1例,胆囊动脉出血2例。术后无严重并发症发生。结论只要能把握住手术时机并注重手术技巧,急性胆囊炎患者行腹腔镜下胆囊切除术是安全可行的。     

急性非结石性胆囊炎的诊断治疗分析

目的总结急性非结石性胆囊炎的诊断和治疗经验。方法对我院1999年3月—2010年11月收治的19例急性非结石性胆囊炎患者的临床资料进行回顾性分析。结果 19例患者均行手术治疗,其中胆囊切除12例,胆囊大部切除2例,胆囊造瘘3例,胆总管探查、T管引流2例。术前误诊7例,误诊率36.8%。除2例死于术后多脏器功能衰竭外,其余病例均治愈出院。结论急性非结石性胆囊炎病情急、进展快、临床表现不典型。早期诊断和及时手术治疗是提高其治愈率和降低死亡率的关键。     

腹腔镜治疗急性结石性胆囊炎145例

目的：总结腹腔镜胆囊切除术（LC）治疗急性结石性胆囊炎的体会。方法：对我院145例急性结石性胆囊炎患者采取LC进行治疗。结果：平均发作时间82.3 h,手术平均时间64 min,出血量平均23 mL,平均引流量36.3 mL。中转开腹4例（占2.7%）,发生胆漏2例,膈下感染1例,无手术死亡。患者均痊愈出院,平均住院时间12.96 d。结论：准确掌握胆囊结石并发急性胆囊炎腹腔镜切除术的适应证,手术是安全可行的。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.