梅毒性主动脉瘤的外科诊治策略

目的：分析梅毒性主动脉瘤患者的外科诊治经验，探讨梅毒性主动脉瘤的疾病特点及治疗方法。方法：选取2010年10月至2018年8月在海军军医大学长海医院诊断为梅毒性主动脉瘤的20例患者，包括12例非急诊手术患者和8例急诊手术患者。所有患者梅毒血清学检验结果均呈阳性，同时全主动脉CT增强造影提示主动脉明显扩张。对于非急诊患者，术前给予驱梅治疗及激素治疗以降低患者梅毒血清学指标水平，同时预防吉海反应的发生；对于急诊入院的患者，及时进行手术干预，预防主动脉瘤破裂导致死亡。结果：在接受治疗的20例患者中（无论是在急诊手术还是非急诊手术），呼吸机辅助时间、ICU停留时间、住院时间，术后24h和48h白细胞计数、中性粒细胞比例，术后感染等结果均优于常规动脉瘤手术患者。病理染色提示，血管壁炎性细胞浸润，且炎性细胞主要位于滋养血管周围。术后随访结果提示，两组患者术后均取得了良好的远期效果。结论：对于主动脉瘤患者，应充分考虑梅毒性主动脉瘤的可能。对于非急诊患者，常规药物治疗配合手术是治疗的首选手段；对于主动脉内径大于6cm，或发生急性主动脉夹层的急诊患者，直接手术更为安全、可行、有效。     

梅毒性心脏病的X线与超声心动图检查

梅毒性心脏病为晚期梅毒的重要并发症。梅毒性心脏病是指由梅毒螺旋体进入主动脉外层与中层，导致主动脉炎，产生主动脉瘤、冠状动脉瘤、冠状动脉口狭窄和主动脉瓣关闭不全等病变，螺旋体亦可侵入心肌，引起心脏树胶样病变，并引起相应临床症状。我国自解放后梅毒已基本控制，但由于某些原因，近几年梅毒发病人数明显增加，梅毒性心脏病的发病趋势也在不断增加，应引起高度重视。     

Bentall手术配合及体会

主动脉管壁因各种原因的损伤和破坏引起瘤样扩大，称为主动脉瘤，根据病因可分为硬化性、梅毒性、中层囊性坏死性、创伤性、细菌或真菌性主动脉瘤；按部位可分为升主动脉瘤部、弓部主动脉瘤和降主动脉瘤。临床上常表现为突发的剧烈疼痛、休克和压迫症状，病情发展非常迅速，随时都有血管破裂大出血的可能，病情凶险，预后不良。发病24h内死亡率40％，无论保守治疗还是手术治疗，死亡率都很高幅。因此，凡确诊为主动脉瘤，特别是瘤体大于5cm以上者，须争取及早手术治疗。本院自2007年1月-2008年6月对7例患者进行升主动脉瘤和弓部主动脉瘤切除及升主动脉和主动脉弓人造血管置换手术，均取得成功。现将护理体会报道如下。     

腹主动脉瘤破裂临床分析并文献复习——附2例报告

目的:探讨腹主动脉瘤破裂的临床特点及诊治方法.方法:总结分析2例腹主动脉瘤破裂患者的临床资料并进行文献复习.结果与结论:2例均为高龄患者,均有外伤史、高血压病史,伤后腹部疼痛,体格检查腹部有搏动性肿块.B超检查发现腹主动脉行程区有局灶性无回声区,与腹主动脉相连,搏动与心律同步,提示动脉瘤破裂.1例转外院行腹主动脉瘤切除及人工血管置换术,治愈.另1例拒绝手术,病情稳定后出院.对于有外伤史、高血压痛史,伤后腹部疼痛、腹部有搏动性肿块的高龄患者,应及时行腹部B超及CT检查,明确有否腹主动脉瘤,对于确诊为腹主动脉瘤破裂的患者应尽早行手术治疗.     

1例梅毒性升主动脉瘤合并主动脉瓣关闭不全病人的护理

梅毒性升主动脉瘤是因梅毒螺旋体侵入主动脉壁引起的炎症性病理改变，可扩展到主动脉瓣区形成主动脉瓣关闭不全。临床上极少见。我院2004年3月收治1例病人给予精心治疗和护理。术后2周痊愈出院。现将护理体会报告如下。     

上腔静脉压迫综合征

上腔静脉压迫综合征(以下简称SVCS)是由于静脉回流至上腔静脉水平受阻所引起的一种临床综合征,1757年Willam Hunter首次报导了由梅毒性主动脉瘤所引起的SVCS,此后陆续有不少报道,且随着时代的不同SVCS的病因也有所改变。本世纪初,常见的病因为梅毒性主动脉瘤、结核及慢性纵隔炎等,现在成人中约2/3的SVCS是恶性肿瘤所引起。 解剖及病因 上腔静脉的管壁薄、其内静动脉压力低,且位于胸骨与脊柱之间,周围与胸主动脉,右主支气管     

主动脉瘤切除手术的护理配合

主动脉瘤的常见病因是梅毒和粥样硬化,也有由于损伤或感染而产生的,少数主动脉窦主动脉瘤为先天性的。主动脉瘤按形状可分囊状主动脉瘤、棱形主动脉瘤和夹层主动脉瘤等。按发生的部位又可分为胸主动脉瘤、腹主动脉瘤、主动脉弓主动脉瘤及主动脉窦主动脉瘤等几种。由于主动脉瘤发生的部位、形状、大小、方向各有不同,手术方法也因之而异。护理人员必须对各种方法有所了解才能做好术前准备及术中配合工作。今将     

1例梅毒性升主动脉瘤合并主动脉瓣关闭不全病人的护理

梅毒性升主动脉瘤是因梅毒螺旋体侵入主动脉壁引起的炎症性病理改变 ,可扩展到主动脉瓣区形成主动脉瓣关闭不全[1] 。临床上极少见。我院 2 0 0 4年 3月收治 1例病人给予精心治疗和护理 ,术后 2周痊愈出院。现将护理体会报告如下。1　病例介绍　　病人 ,男 ,63岁 ,主因胸骨后疼     

梅毒血清学阳性的冠心病133例回顾性分析

目的 分析以冠心病诊断入院的梅毒螺旋体明胶凝集试验（TPPA）阳性患者的临床资料特点,为梅毒性心血管病的诊断提供有益参考.方法 从病案室调取2009～2011年心脏科诊断为冠心病并且梅毒血清学试验阳性的患者病例133份,同时随机抽取同期梅毒血清学检查阴性的冠心病患者病例100份作为对照,分析两组患者的性别、年龄、超声心动图及冠状动脉造影的特点.结果 两组均以男性多见.133例TPPA阳性患者中复检RPR阳性者为32例（24.06％）,超声心动图检查示升主动脉增宽、主动脉瓣关闭不全较TPPA阴性组有显著统计学意义（P＜0.01）,主动脉窦部增宽亦有统计学意义（P＜0.05）,而TPPA阳性组中RPR阳性组与RPR阴性组超声心动图检查差异无统计学意义,两组中主动脉瓣退行性变及主动脉瓣狭窄伴关闭不全差异均无统计学意义;冠状动脉造影检查示TPPA阳性组冠状动脉口狭窄较TPPA阴性组差异有统计学意义（P＜0.05）,TPPA阳性者中RPR阳性者与RPR阴性者差异亦有统计学意义（P＜0.05）.结论 对于病史不详的TPPA阳性的冠心病患者,即使RPR检查阴性,如果检查发现有升主动脉增宽、主动脉瓣关闭不全、主动脉窦部增宽及冠状动脉口狭窄的表现,提示可能潜在梅毒性损害,若同时存在其中几项,则可能性进一步增大,提醒临床医师加以重视,完善相关病史,综合分析,及时诊断和治疗.     

医学名词介绍(4) 心血管病学(上)

汉文名英文名梅毒性冠状动脉口　狭窄syphiliticcoronaryostialstenosis　梅毒性心肌树胶　样肿syphiliticgummaofmyocardium　动脉硬化arteriosclerosis动脉粥样硬化atherosclerosis主动脉瘤aorticaneurysm主动脉夹层dissectionofaorta马方综合征Marfansyndrome血栓闭塞性脉管炎　thromboangiitisobliterans ,Buergerdisease雷诺病Raynauddisease心房粘液瘤atrialmyxoma静脉炎phlebitis血栓性静脉炎thrombophlebitis列夫病Levdisease勒内格尔病Lenegredisease长Q T间期综合征longQ Tsyndrome罗马诺沃德综合征Romano Wardsyndrome耶韦…     

Syphilitic mesaortitis

A rise in the incidence of latent and late forms of neuro- and visceral syphilis significantly complicates diagnostics of the disease in patients admitted to emergency medicine clinics. Syphilis is believed to be a cause of roughly 0.5% of all cardiopathies. Late syphilitic lesions of the cardiovascular system (cardiovascular syphilis) occur in 0.25-0.96% patients in need of therapeutic treatment, 93.4% of them present with mesaortitis but its life-time diagnosis is possible only in 10% of the cases. Syphilitic lesions in the aorta are especially well apparent at the points of its branching into coronary arteries of the heart and aortic arch. One of the main consequences of syphilitic aortitis is the narrowing of coronary arteries frequently complicated by atherosclerosis, coronary thrombosis, and the resulting myocardial infarction. Another severe complication of syphilitic aortitis is progressive aortic valve insufficiency (in 25-50% of the patients) related to dilatation of the valve ring affected by inflammation. Some patients develop bacterial endocarditis of the aortic valve. Close localization of the coronary artery junction and the aortic valve account for a combination of aortic valve insufficiency and coronary insufficiency in patients with syphilitic process in the initial part of aorta. A case report is presented.     

A rare case of rupture of a syphilitic aortic aneurysm into the esophagus

A case of the rupture of a syphilitic aortic aneurysm into the esophagus in a woman aged 64 with cured breast cancer was observed. A clinical picture, autopsy and microscopy findings were described. The authors underlined the rarity of the case, difficulty of intravital and morphological diagnosis which could be attributed to syphilis pathomorphosis. Of great importance for diagnosis are a detailed life history, clinical symptoms, instrumental methods of investigation, especially in oncological practice where differential diagnosis with exophytic esophageal cancer seems difficult.     

2884例孕早期孕妇梅毒感染情况分析及处理

目的了解孕早期孕妇梅毒感染情况,采取防治策略,避免先天梅毒发生。方法对孕早期例行优生检查孕妇进行梅毒血清学检查,利用梅毒甲苯胺红试验(TRUST)检测梅毒非特异性抗体,阳性者再进行梅毒明胶颗粒试验(TPPA)检测梅毒特异性抗体,结合流行病史、临床症状及体征诊断梅毒。告知孕妇知情同意采取驱梅治疗或终止妊娠。结果 2884例孕早期孕妇实验室检查结果为:TRUST阳性18例,其中滴度1∶32有2例、1∶16有2例、1∶4有4例、1∶2有10例。18例TRUST阳性者TPPA皆阳性。诊断为一期梅毒1例,二期梅毒2例,早期隐性梅毒15例。梅毒感染率0.62%(18/2884)。18例梅毒孕妇皆接受驱梅治疗,其中3例选择终止妊娠,15例选择继续妊娠并遵医嘱定期检查。结论孕早期孕妇存在一定数量梅毒感染,应将梅毒血清学检查纳入优生检查项目,可以及早采取防治措施,避免胎传梅毒发生,保证优生优育。     

Liver dysfunction in patients with early syphilis: a retrospective study

Syphilis is one of the unrecognized etiologies of liver dysfunction. The incidence of syphilitic hepatitis is currently unknown. We conducted a retrospective study of causative agents of liver dysfunction at the time of diagnosis of early syphilis. Our study shows that 39 % (44/112) of early syphilis patients have liver enzyme abnormalities at the time of diagnosis and that 2.7 % (3/112) of patients are diagnosed with syphilitic hepatitis. Clinicians should include syphilitic hepatitis in the differential diagnosis for those patients with sexually transmitted diseases presenting with liver enzyme abnormalities.     

室间隔缺损合并主动脉窦瘤破裂的外科治疗

目的:总结室间隔缺损合并主动脉窦瘤破裂的外科治疗经验。方法:29例室间隔缺损合并主动脉窦瘤破裂的患者均在全麻低温体外循环下行室间隔缺损及窦瘤修复术,同时纠治心内合并畸形。结果:本组无手术死亡病例,随访3个月～6年,未发现室间隔缺损及窦瘤残余分流或窦瘤破裂复发。3例出现主动脉瓣轻度或中度反流。1例行主动脉瓣置换术患者术后1年因瓣周漏再次手术。结论:室间隔缺损合并主动脉窦瘤破裂一经诊断明确,应尽早手术治疗,术中精确修复,加强心肌保护,同期彻底矫治合并心内畸形可获满意疗效。     

Syphilitic aortitis complicated by multiple aortic aneurysms: findings of multidetector CT

We report a case of syphilitic aortitis complicated by multiple aortic aneurysms in a 50-year-old man with elevated rapid plasma reagin titer of 1:128 and positive Treponema pallidum particle agglutination test. 256-slice MDCT depicted two saccular aneurysms in the descending thoracic aorta with a markedly thick mural thrombus causing the trachea and esophagus to shift to the right. Thickening of the aortic wall was also noted. Stenting of the proximal descending thoracic aortic aneurysm and aorto-right common carotid artery bypass were performed. Operative findings revealed thickening of the descending thoracic aortic wall with a coarse luminal surface.     

先天性梅毒感染性死胎1例尸检的病理观察

目的 探讨先天性梅毒感染性胎儿的病理特点。方法 ①尸体解剖观察大体形态；②显微镜观察主要脏器组织学改变。结果 本例病理特点主要为：①胎盘苍白肿大；②多脏器纤维化伴不同程度梅毒螺旋体浸润；③梅毒感染性肝硬化、胰腺炎和关节骨软骨炎等。结论 患梅毒孕妇的梅毒螺旋体通过胎盘进入胎儿血液，并播散至肝、脾、肾上腺、心、肺等脏器中大量增殖，导致胎儿感染并胎死宫内。     

胸主动脉瘤的外科治疗

目的:总结7例胸主动脉瘤病人的外科治疗经验.方法:7例病人中胸降主动脉瘤2例,主动脉根部瘤(马凡综合征)2例,夹层动脉瘤3例,均为Ⅱ型夹层动脉瘤,其中1例合并冠心痛,前降支单支病变.胸降主动脉瘤在低温体外循环下行人工血管置换术.升主动脉瘤和Ⅱ型夹层动脉瘤在低温体外循环下行Bentall手术,其中1例采用带管道无支架生物瓣,同时行冠脉搭桥手术.结果:6例存活,1例死于低心排综合征.结论:在胸主动脉瘤的外科治疗中,Bentall手术是治疗升主动脉瘤较好的手术方法.外科手术技术是手术成功的重要因素.体外循环管理,良好的心肌保护和血液保护是保证手术成功的重要手段.带管道无支架生物瓣对老年人及抗凝有禁忌或主动脉根部较小者更适宜,对合并冠心病的患者宜同期行冠脉搭桥术.     

Ruptured abdominal aortic aneurysm presenting as buttock pain

This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another unusual presentation of ruptured abdominal aortic aneurysm and highlights the importance of careful history taking and clinical examination. A high index of clinical suspicion of aneurysm rupture should be maintained in elderly patients presenting with a history of collapse.     

The pathophysiology of acute syphilitic funisitis.

There is an increase in the number of cases of syphilis in pregnancy in the United States. Fetal death may occur in syphilis from acute or chronic infections. A case is presented in which an acute fetal infection occurred. The patient presented at 31 weeks' gestation, with a decrease in fetal movements and non-reactive cardiotocography. Ultrasound and Doppler analysis of the fetal heart, cerebral and umbilical arteries, aorta and umbilical vein led to the suspicion of acute cardiac failure. An amniocentesis yielded a white cell count of 1122 white blood cells, with 91% polymorphs, but the Gram stain was negative. The fetus developed a persistent bradycardia and was delivered. The diagnosis of acute severe syphilitic funisitis was suspected from histological sections of the cord. Diagnosis was established from maternal and fetal blood. Modern ultrasound techniques, including imaging, Doppler and cardiotocography, can lead to the analysis of the pathophysiology of disease states. An acute syphilitic infection should be suspected when this constellation of findings is found.