CT导向下采用监测乙醇浓度硬化治疗单纯性肾囊肿的临床经验

目的:评价CT导向下采用监测乙醇浓度硬化治疗单纯性肾囊肿的安全性、有效性。方法:2006年5月²011年6月,67例患者69个单纯性肾囊肿在我院行CT导向下抽吸及无水乙醇硬化治疗。治疗时监测注入囊内乙醇CT值的变化,当CT值小于或等于-190 HU时,保留10 min后将液体抽尽。治愈:囊肿消失;有效:囊肿直径缩小50%以上;无效:囊肿直径缩小小于50%。结果:67例患者69个单纯性肾囊肿均成功行CT导向下抽吸及无水乙醇硬化治疗。治愈56例(81.2%),有效10例(14.5%),无效3例(4.3%)。囊肿平均直径从术前7.2 cm(范围42011年6月,67例患者69个单纯性肾囊肿在我院行CT导向下抽吸及无水乙醇硬化治疗。治疗时监测注入囊内乙醇CT值的变化,当CT值小于或等于-190 HU时,保留10 min后将液体抽尽。治愈:囊肿消失;有效:囊肿直径缩小50%以上;无效:囊肿直径缩小小于50%。结果:67例患者69个单纯性肾囊肿均成功行CT导向下抽吸及无水乙醇硬化治疗。治愈56例(81.2%),有效10例(14.5%),无效3例(4.3%)。囊肿平均直径从术前7.2 cm(范围4¹3 cm)缩小至术后1.5 cm(范围013 cm)缩小至术后1.5 cm(范围0⁵ cm;P<0.001)。其中2例患者术后出现低热。结论:CT导向下采用监测乙醇浓度硬化治疗单纯性肾囊肿是一种简单、安全、有效的微创治疗方法。     

单纯性肾囊肿分型及其意义的研究

目的 分析单纯性肾囊肿分型及其意义的研究.方法 方便选取该院60例单纯性肾囊肿患者,收取时间为2014年7月—2015年6月期间,根据患者囊肿位置、大小、是否突出肾表面从而分为3种类型,Ⅰ型囊肿为患者囊肿直径<3 cm、Ⅱ型囊肿为患者囊肿直径>3 cm并且位于肾实质内,Ⅲ型囊肿为患者囊肿直径>3 cm并且突出肾表面,观察复发情况以及治疗方式.结果 30例Ⅰ型肾囊肿患者,5例患者采用B超引导性行穿刺抽液治疗,复发率为60.00%、10例Ⅱ型肾囊肿患者,8例患者采用腹腔镜肾囊肿去顶减压术治疗、复发率为12.50%、2例患者采用B超引导下肾囊肿穿刺硬化治疗,复发率为50.00%,20例Ⅲ型肾囊肿患者治疗后,均未复发.结论 通过对单纯性肾囊肿患者进行分型,临床医生能为不同类型的单纯性肾囊肿患者提供准确的术前评估标准,Ⅰ型肾囊肿患者应定期到医院进行观察,Ⅱ型肾囊肿患者应采用腹腔镜肾囊肿去顶减压术为首选手术方式,Ⅲ型肾囊肿患者应采用B超引导下肾囊肿穿刺硬化治疗或者腹腔镜肾囊肿去顶减压术作为治疗方案.     

多层螺旋CT多期扫描对肾占位性病变的诊断及鉴别诊断价值探讨

目的旨在探讨多层螺旋CT多期扫描对肾占位性病变的诊断及鉴别诊断价值。方法选取我院2015年8月~2017年11月收治的肾占位性病变患者80例,所有患者均进行多排螺旋CT平扫及增强扫描,整理80例患者的临床及影像学资料,以手术或病理活检结果做参照,计算CT平扫及多期增强扫描肾占位性病变的鉴别诊断价值。结果 CT平扫对不同类型肾占位性病变的总检出率、诊断符合率分别为85.00%(68/80)、71.25%(57/80),低于多期增强扫描100%(80/80)、97.50%(78/80),差异具有统计学意义(χ~2分别为12.973、20.907,P<0.001);肾囊肿CT平扫表现为典型边界清晰的囊性病灶,平均CT值为15HU,形态多为类圆形,囊壁薄,多期增强扫描中未见明显强化;结核性脓肾CT平扫主要为多发囊状低密度区,直径0.5cm,多期增强扫描中呈现轻度强化;肾血管平滑肌瘤瘤体形态多为类圆形,最小径2.4cm,最大径10.96cm,6例患者平扫为稍低密度影,3例瘤体呈现稍高密度影,2例瘤体呈现混杂密度,多期增强扫描明显强化;肾盂癌病灶外形不规则,肾盂期增强扫描可见肾盂内充盈缺损,6例患者累及肾实质;肾癌平均最大径(6.12±1.03)cm,多位于上级,6例患者表现为明显强化,18例患者呈现轻-中度强化,出血、囊性改变区域未见明显强化。结论多层螺旋CT多期扫描可有效显示对不同肾占位性病变的图像特征,检出率及诊断符合率高,可为临床提供相关影像学资料。     

输尿管镜囊肿内切开引流术治疗肾囊肿的观察与护理

单纯性肾囊肿的自然发生率约为0.5%～5.7%[1].囊肿小于4 cm而无症状者一般无需治疗,有腰痛、尿血、感染,或囊肿压迫集合系统引起肾积水,或压迫肾实质、肾血管引起高血压,或囊肿在小儿患者引起呼吸运动受限时则需进行治疗[2].近年来,我科采用经输尿管镜下肾囊肿内切开引流术治疗肾囊肿,进行评价并随访,结合临床综合护理,疗效显著,现报告如下.     

肾透明细胞癌的螺旋CT表现和病理改变

目的分析肾透明细胞癌的螺旋CT表现和病理改变。方法42例肾透明细胞癌均经手术病理证实,观察肿瘤平扫密度及动态增强螺旋CT表现及病理改变。结果CT平扫6例为等密度,15例为低密度,5例为高密度,16例为混杂密度。平扫、皮质期、实质期、肾盂期肿瘤实体CT值范围分别为：23~53HU、98~159HU、48~102HU、45~82HU。皮质期41例强化峰值≥88HU,肾盂期迅速下降;40例肿瘤细胞排列为实性,含丰富血窦;40例肿瘤强化不均匀,病理上40例可见出血、坏死、囊变。CT上25例可见假包膜,病理上35例可见假包膜。结论肾透明细胞癌的螺旋CT表现与病理类型及肿瘤结构有关。     

CT三期动态增强扫描在肾癌诊断中的临床价值研究

目的旨在探讨CT三期动态增强扫描在肾癌诊断中的临床价值。方法选取我院2015年1月-2017年1月收治的肾癌患者58例,收集58例患者的临床资料、影像学资料等,分析58例肾癌患者CT平扫及CT三期增强扫描的图像表现,并以手术或病理学活检结果为标准,比较CT平扫与CT三期增强扫描对肾癌的检出率及诊断准确率。结果 CT平扫准确诊断患者例数为43例,准确诊断率为74.13%,明显低于三期动态增强扫描98.27%(57/58)差异具有统计学意义(χ2=1 4.2 1 0,P0.0 0 1);C T平扫中5 8例肾癌患者平均CT值(32.17±8.54)HU,平均病灶直径(4.95±4.30)cm;多数病灶呈等密度状态密度较均匀,主要表现为病灶旁肾周间隙内出现"毛刺"、"线状"结构。三期动态增强扫描中,动脉期平均CT值(85.11±30.44)HU,实质期平均CT值(62.10±21.64)HU,多数患者病灶外观呈个类圆形,6例患者呈不规则形;动脉期均出现不同程度的中-高度强化,其中49患者增强后可见清晰边界,多数患者可见假包膜、"短刺"征,中心区出血、坏死、囊变及钙化未出现明显强化;实质期强化程度逐渐减弱,病灶区域呈现"快进快退"特征,静脉期扫描强化程度减弱明显。结论 CT三期动态增强扫描对肾癌准确诊断率高,可清晰显示病灶情况,为临床治疗提供可靠影像学资料。     

后腹腔镜肾囊肿去顶术93例报告

腹腔镜肾囊肿去顶术是上世纪90年代的新技术,近年来在国内得到了广泛的应用。我们于2001年5月~2005年12月采用后腹腔镜肾囊肿去顶术治疗肾囊肿93例,取得了良好疗效。现报告如下。资料与方法1.一般资料本组93例,男52例,女41例;年龄27~85岁,平均51岁。所有患者术前均经B超I、VP、CT或MRI检查确诊为单纯性肾囊肿,左侧44例,右侧49例。囊肿位于肾上极34例,肾中极38例,肾下极21例。腹侧37例,背侧56例。囊肿直径4.5~11 cm,平均7.5 cm。有腰部胀痛不适45例,体检时B超发现48例。2.手术方法气管插管全麻下,患者取健侧卧位,髂棘上2~3 cm(A点)切开…     

超声引导经皮穿刺聚桂醇注射液硬化治疗单纯性肾囊肿的临床价值

目的探讨超声引导经皮穿刺聚桂醇注射液硬化治疗单纯性肾囊肿的临床价值。方法选取2015年6月至2017年6月我院收治的102例单纯性肾囊肿患者,采用随机数字法分为对照组51例与观察组51例,对照组患者接受传统手术治疗,观察组患者接受超声引导经皮穿刺聚桂醇注射液硬化治疗,观察两组患者疗效并比较。结果观察组治疗总有效率显然高于对照组(χ~2=16.237,P0.05)。观察组患者手术操作时间、囊肿体积等均显然低于对照组(P0.05);观察组一次穿刺成功率高于对照组(χ~2=12.418,P0.05)。结论在超声引导下对单纯性肾囊肿患者实施经皮穿刺聚桂醇注射液治疗,其临床疗效显著,可有效减少操作时间、提高穿刺有效率、促使囊肿体积缩小、快速消除病症、改善患者生活质量,值得借鉴。     

超声引导下硬化治疗单纯性肾囊肿50例临床分析

<正>单纯性肾囊肿是临床常见病,一般无明显临床症状,常偶然发现,囊肿直径<4cm不必处理,定期随访。当囊肿较大、继发感染、出血、肾实质明显受压或疑有恶变时,应手术干预,我     

肝血管瘤周围灌注异常的CT分析

目的：探讨肝血管瘤周围灌注异常（HPD）的螺旋CT特点,并综合文献分析其形成机制。方法：回顾分析183例患者共276个肝血管瘤的CT动态增强表现,分析其周围的异常灌注与血管瘤大小及强化速度的关系。结果：276个肝血管瘤出现异常高灌注62个（22.46%）。肝动脉期表现为楔形、节段性或不规则形强化;门静脉期密度略高于肝实质或与肝实质相等,延迟期与肝实质等密度。快速强化型血管瘤出现肝实质灌注异常现象的几率（40.29%）大于慢速强化型（4.40%）;直径（d）≤2 cm小血管瘤HPD的发生率（28.49%）高于d〉2 cm大血管瘤（11.34%）。结论：肝血管瘤周围异常灌注具有特征性的CT表现,易见于快速强化型的小血管瘤,肝脏CT动态增强扫描是诊断肝脏异常高灌注的有效方法。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.