胡桃夹征致左侧精索静脉曲张的介入治疗（附12例报道）

目的 探讨胡桃夹征（NCS）致左侧精索静脉曲张的诊断与治疗。方法 回顾性分析12例胡桃夹征致左侧精索静脉曲张患者的临床资料。12例患者均采用左肾静脉造影＋支架置入术治疗,术前、术后分别经彩色多普勒超声显像、选择性左肾静脉造影和(或)CT及MRI等检查。结果 术后左肾静脉狭窄管腔扩张,血流恢复通畅。术前彩超显示左肾静脉狭窄段内径为1.1～2.9 mm,平均(2.1±0.2)mm,术后为4.8.～8.0 mm,平均(6.5±0.6)mm（t＝10.74, p＝0.00）;术前狭窄段血流速度为44～200 cm/s,平均为(108.0±31.6)cm/s,术后22～49 cm/s,平均为(33.3±4.15)cm/s（t＝4.58, p＝0.00）,均有明显的统计学意义。除1例患者术后复查仍表现为左精索静脉曲张外,其余患者精索静脉反流消失,5例血尿及2例蛋白尿患者术后1周复查尿常规正常。结论 经皮左肾静脉支架置入术创伤小,住院时间短,近期效果明显,我们认为是目前治疗左肾静脉压迫综合征的首选方法,但远期效果有待观察。 【关键词】胡桃夹征 左侧精索静脉曲张 可膨式金属支架管     

多普勒超声检查对胡桃夹综合征的临床诊断价值

目的 探究多普勒超声检查对胡桃夹综合征的临床诊断价值。方法 选择2018年7月至2020年5月遂溪县人民医院收治的50例胡桃夹综合征患者作为研究组,另选择48名同期于我院行健康体检的志愿者作为对照组,所有参检者均行多普勒超声检查。比较2组超声检查结果,以及研究组患者在平卧位、站立背伸位狭窄扩张部位近端左肾静脉内径及血流速度、狭窄处左肾静脉内径及血流速度。结果 研究组腹主动脉（AO）与肠系膜上动脉（SMA）间夹角、左肾静脉狭窄段内径、最狭窄处左肾静脉血管内径（d2）/近肾端受压前最宽处左肾静脉血管内径（d1）值均小于对照组,差异有统计学意义（P<0.05）;站立背伸位近端左肾静脉内径、狭窄处左肾静脉血流速度,近端左肾静脉内径/狭窄处左肾静脉内径值、狭窄处左肾静脉血流速度/狭窄扩张部位近端左肾静脉血流速度均大于平卧位,狭窄处左肾静脉内径、狭窄扩张部位近端左肾静脉血流速度均小于平卧位,差异有统计学意义（P<0.05）。结论 在胡桃夹综合征临床诊断中应用多普勒超声能够清晰观察血流情况及流速,具有操作简单、无创性等优势,能够为临床鉴别诊断提供可靠依据,可将其作为诊断胡桃夹综合征的首选...     

肠系膜上动脉夹角测量对“胡桃夹”综合征的诊断探讨

目的应用64排螺旋CT血管成像研究“胡桃夹”患者与正常对照组肠系膜上动脉与腹主动脉夹角以及左肾静脉受压情况，探讨螺旋CT血管成像在诊断“胡桃夹”综合征方面的临床应用意义。方法使用64排多层螺旋CT，回顾性观察134例正常检查者及4例“胡桃夹”综合征患者肠系膜上动脉与腹主动脉夹角的大小，左肾静脉水平肠系膜上动脉与腹主动脉之间的距离，左肾静脉最窄内径及左肾门左肾静脉最宽内径，以明确正常人肠系膜上动脉与腹主动脉夹角的大小对左肾静脉形态的影响，并计算出正常人肠系膜上动脉与腹主动脉夹角的参考范围。结果134例正常人中，肠系膜上动脉与腹主动脉的夹角为49．8°±26．2°，“胡桃夹”综合征患者为25．3°±8．0°;正常人左肾静脉水平肠系膜上动脉与腹主动脉距离为（1．26±0．72）cm，“胡桃夹”综合征患者为（0．58±0．21）cm，差别均有统计学意义。正常人肠系膜上动脉与腹主动脉夹角的大小影响左肾静脉的形态，漏斗型左肾静脉（左肾门区左肾静脉最宽内径与左肾静脉最窄内径的比值〉3）的出现率在肠系膜上动脉与腹主动脉夹角〈35°时为30．6%（（15／49），〉35°时为4．7％（4／85），两组有显著差异（P〈0．05）。结论64排多层螺旋CT清楚显示肠系膜上动脉与腹主动脉的夹角以及左肾静脉受压情况。     

精索静脉结扎术治疗胡桃夹综合征合并左侧精索静脉曲张8例报告

胡桃夹综合征(nutcracker syndrome,NCS)又称左肾静脉压迫综合征,是由于先天或后天形体变化等原因致使腹主动脉和肠系膜上动脉之间夹角变小,左肾静脉受到两者的挤压导致肾静脉血回流受阻,从而引起的以血尿、蛋白尿为主的泌尿系综合征[1].精索静脉曲张是导致男性不育的一个主要原因,文献报道在左侧精索静脉曲张的患者中有72%伴有左肾静脉受压[2].我们采用开放式精索静脉高位结扎术治疗了8例NCS合并左侧精索静脉曲张的患者,现报告如下.     

精索静脉曲张与左肾静脉血流动力学关系的研究

目的探讨精索静脉曲张(VC)的发病机制。方法利用彩色多普勒超声对70例VC患者及30例健康志愿者进行精索静脉、左肾静脉内径及血流动力学参数观察,比较两组左肾静脉近段、远段的血流速度与内径(V/D)比值;比较VC组Ⅰ、Ⅱ、Ⅲ级间的左肾静脉近段、远段的V/D的差异;对VC患者精索静脉内径与左肾静脉近段的血流V/D进行相关分析。结果VC组中有68.6%(48/70)患者有左肾静脉受压者,而对照组中仅为10.0%(3/30)。VC组LRV近段V/D比值高于对照组、远段V/D小于对照组。Ⅰ级、Ⅱ级、Ⅲ级VC组的LRV近段V/D比值分别为(141.00±29.17)、(193.11±53.78)、(270.85±83.93),提示VC的程度越重,左肾静脉近段的血流V/D比值就越大。VC患者精索静脉内径和LRV近段的血流V/D呈正相关(r=0.601,P<0.01)。结论左侧VC与左肾静脉受压有着密切的联系,左肾静脉近段的血流V/D比值可反映精索蔓状静脉丛整体的血流动力学改变。     

彩色超声多普勒诊断18例胡桃夹综合征

胡桃夹综合征即左肾静脉压迫综合征又称胡桃夹现象,是由于先天性或后天因形体变化等原因造成的左肾静脉在经过肠系膜上动脉(SMA)和腹主动脉(AO)之间的夹角处受到挤压后,导致左肾静脉近端(靠近肾门处)扩张而引起的一系列综合征.彩色超声多普勒可以通过测量SMA和AO之间的夹角,通过脊柱后伸位试验前和试验后对左肾静脉受压处和扩张处的内径以及血流速度的数值变化情况来判断是否存在胡桃夹现象,为临床提供可靠依据[1-2].     

多层螺旋CT血管造影诊断胡桃夹综合征的影像评价

目的评价多层螺旋CT血管造影(MSCTA)诊断胡桃夹综合征(NCS)的影像特点及临床价值。方法选取经临床表现和相关检查确诊的NCS患者(观察组)和泌尿系统无异常症状及体征的非NCS者(对照组)各50例,行MSCTA检查。结果观察组腹主动脉后方的左肾静脉前后径(D1)、左肾静脉在夹角位置受压的截面积(S1)、肠系膜上动脉与腹主动脉夹角、肠系膜上动脉与腹主动脉间距离均小于对照组,近肾端最宽处截面积(S2)、S2/S1、左右肾体积差均大于对照组(P<0.01)。结论 MSCTA对左肾静脉及其周围结构能清晰显影,可直观评估左肾静脉受压情况,用于诊断NCS具有较高的临床价值。     

彩色多普勒血流动力学指标对儿童胡桃夹现象的诊断价值

目的探讨彩色多普勒检查中血流动力学指标对儿童胡桃夹现象的诊断价值。方法对70例血尿查因疑似患儿进行二维彩色多普勒检查,测量患儿仰卧位、侧卧位、脊柱后伸15～20min左肾静脉经过肠系膜上动脉与腹主动脉之间受压变窄的内径、血流峰值及窄后内径、血流峰值,并将8例胡桃夹现象阳性患儿数据与从59例正常儿童中随机选取的8例相应数据进行比较。结果胡桃夹现象阳性患儿其左肾静脉狭窄处内径范围在1.25～2.17mm之间,狭窄处峰值流速在129.80～201.46cm/s;正常儿童左肾静脉狭窄处内径范围在1.33～2.41mm之间,狭窄处峰值流速在27.26～69.36cm/s。结论左肾静脉狭窄处峰值流速可作为诊断胡桃夹现象阳性的一项参考指标。     

左肾静脉压迫综合征(胡桃夹现象)1例报告

患者女,55岁。因血尿及蛋白尿伴腹痛而就诊。患者常规腹部检查准备,空腹,充分暴露上腹部,取仰卧位、坐位,脊柱后伸位15~20 s,于上腹部做纵横断面扫查,显示下腔静脉、左肾静脉、肠系膜上动脉及腹主动脉等血管图像,观察到左肾静脉起始部内径约4.9 mm,向左追踪至肠系膜上动脉与腹主动脉夹角处时内径变细窄,约2.5 mm,彩色血流信号稀薄。行至腹主动脉左前方时内径明显增宽约8.5 mm,彩色充盈良好,流速14.7 cm/s,阻力指数(R I)0.36,脊柱后伸位20 s观察该段左肾静脉内径达10.6 mm。B超诊断:左肾静脉压迫综合征(胡桃夹现象)。后经数字减影血管造影…     

胡桃夹综合征7例诊治体会

胡桃夹综合征(NCP,nutcyacker syndrome),也称胡桃夹现象、左肾静脉压迫综合征.指左肾静脉(Left yenal,IRV)在腹主动脉和肠系膜上动脉形成的夹角之内受到机械性挤压、血流回流受阻所致的左肾静脉高压综合征.主要表现为血尿和(或)蛋白尿,可有腰腹痛、男性精索静脉曲张、女性盆腔静脉淤血综合征等表现.     

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.