腹膜后纤维化的超声诊断

目的探讨腹膜后纤维化的声像图特点。方法回顾性分析7例原发性腹膜后纤维化、4例继发性腹膜后纤维化患者的超声表现。结果11例患者均表现为腹主动脉前壁及两侧壁被条带状低弱回声包绕,10例伴双侧肾盂输尿管积水,1例伴右侧肾盂输尿管积水同时伴有右下肢肿胀。6例经手术病理证实,3例行双侧输尿管内支架术,2例经激素治疗后好转。结论超声可直接显示腹膜后腹主动脉周围纤维斑块及肾脏、血管的受累情况,并动态随访治疗效果,具有较高的临床应用价值。     

腹膜后间隙分区用于判断腹膜后肿瘤来源

目的 观察腹膜后间隙分区用于判断腹膜后肿瘤来源的价值。方法 回顾性分析经手术病理证实的109例单发腹膜后肿瘤CT资料,包括38例神经源性、62例间叶源性、7例胚胎源性肿瘤及2例其他来源。采用器官分区法将腹膜后间隙分为脊柱前区、脊柱旁区和肾周区,基于中心线分区法分为中央前区、中央后区和外侧区;以肿瘤最大长径与最大短径的交叉点为肿瘤中心点,于相应轴位CT图像中分别根据器官分区法及中心线分区法确定肿瘤中心点所在区域,观察不同性质肿瘤的分布。结果 基于器官分区法,38例神经源性肿瘤中,3例位于脊柱前区、31例位于脊柱旁区、4例位于肾周区,62例间叶源性肿瘤,位于脊柱前区8例、脊柱旁区10例、肾周区44例,7例胚胎源性肿瘤,位于脊柱前区4例、脊柱旁区1例、肾周区2例,2例其他来源肿瘤分布于脊柱旁区及肾周区;基于中心线分区法,38例神经源性肿瘤分布于中央前区6例、中央后区29例、外侧区3例,62例间叶源性肿瘤位于中央前区19例、中央后区5例、外侧区38例,胚胎源性肿瘤位于中央前区5例、外侧区2例,2例其他来源肿瘤分布于中央前区及外侧区。根据2种分区法,不同来源腹膜后肿瘤在腹膜后间隙各区分布的差异均有统计学意义(χ²=53.94、68.07,P均＜0.01)。结论 腹膜后间隙分区对判断腹膜后肿瘤来源具有一定价值。     

Defense mechanisms of the peritoneal cavity

The peritoneal cavity contains resident and migratory cell populations, which play crucial roles in the local defensive response against bacterial invasion. Although mononuclear phagocytes predominate in the peritoneal cavity of healthy subjects, recent attention has been focused on mesothelial and dendritic cells. Kinetic analysis of inflammatory mediators has derived from experimental models of peritonitis, but advances in the understanding of the roles of molecules such as lipocortins, PAF, leukotriene B4, PPAR gamma agonists, and chemokines has also been made. Little is known about the peritoneal response to physical trauma in the context of the abdominal compartment syndrome. Studies on the cellular and molecular pathology of intra-abdominal abscesses, peritoneal sclerosis, and other less frequent clinical entities (e.g., tertiary peritonitis) are needed. Biological therapy may contribute to improved clinical management of such diseases.     

Lymphatic vessels and tertiary lymphoid organs

Tertiary lymphoid organs (TLOs) are accumulations of lymphoid cells in chronic inflammation that resemble LNs in their cellular content and organization, high endothelial venules, and lymphatic vessels (LVs). Although acute inflammation can result in defective LVs, TLO LVs appear to function normally in that they drain fluid and transport cells that respond to chemokines and sphingosine-1-phosphate (S1P) gradients. Molecular regulation of TLO LVs differs from lymphangiogenesis in ontogeny with a dependence on cytokines and hematopoietic cells. Ongoing work to elucidate the function and molecular regulation of LVs in TLOs is providing insight into therapies for conditions as diverse as lymphedema, autoimmunity, and cancer.     

特发性腹膜后纤维化的超声诊断

目的腹膜后纤维化(RPF)是一种十分少见的疾病,其中特发性占2/3。起病隐匿,无典型症状、体征和特异性的实验室及影像学表现,诊断困难。本文的目的是通过回顾我院的特发性RPF病例,总结其超声声像图特征,提高超声诊断水平。方法回顾性分析18例患者,记录其就诊原因、主要阳性体征、实验室检查结果以及超声声像图特征。结果①18例患者,男女比例为2.6∶1,平均年龄47.6岁。经腹腔镜或手术活检病理证实者13例,其余5例为临床诊断。从出现症状到做出诊断平均14.9个月。②均无明确的用药史、感染、手术、外伤及肿瘤的病史。最常见的就诊原因和实验室异常结果分别为:疼痛和血沉加快。③所有患者均进行超声检查,55.6%的患者发现腹膜后病变,主要表现为腹膜后弥漫性低回声,无血流信号,并伴有肾积水;另有22.2%的患者只有肾积水;少数患者出现血管受压的表现。本病的超声声像图特征需要与腹主动脉瘤伴发血栓、腹膜后恶性肿瘤或淋巴结转移、多发性大动脉炎鉴别。结论特发性RPF无典型的症状、体征和特异性的实验室检查。超声检查的敏感性较低,原因可以从两方面分析:一是检查者对这一疾病缺乏认识,从而忽视了腹膜后的检查;二是患者的客观条件,影响了腹膜后病变的显示。     

Tobramycin absorption from the peritoneal cavity

Previous studies have found serum tobramycin concentrations greater than 8 mg/L among patients undergoing treatment for peritonitis using hourly dialysate exchanges containing 10 mg/L of tobramycin. In this study, tobramycin absorption from the peritoneal cavity was evaluated among patients treated with exchanges of 180 min. intraperitoneal duration. Six patients in each group were studied. Mass transfer coefficients [MTC (mL/min.)] were calculated for noninfected (C) and peritonitis (P) periods. The mean MTC for C was 6.5 +/- 2.1 (SD) mL/min., and for P, 18.5 +/- 8.2 (SD) mL/min. (p less than 0.01). Peritonitis increased the rate of uptake from the peritoneal cavity. In these acute studies, the total dose of tobramycin delivered was small, so that serum concentrations remained less than 0.2 mg/L among controls and 0.5 mg/L among patients with peritonitis. Prolonged exposure to tobramycin, in association with more rapid absorption from the peritoneal cavity, may lead to serum concentrations greater than 8 mg/L.     

原发性腹膜后脂肪肉瘤的超声和CT诊断

目的探讨原发性腹膜后脂肪肉瘤的超声和CT影像特征。方法分析经手术病理、穿刺活检证实的26例原发性腹膜后脂肪肉瘤的影像表现。结果 26例腹膜后脂肪肉瘤CT扫描依据瘤内病理组织学成分不同呈现不同的密度,超声依据纤维成分多少表现为强或低回声。结论腹膜后脂肪肉瘤超声多表现为不均质高回声或低回声实性肿块,CT一般为有脂肪密度和软组织密度的肿块。     

Hydatid hepatic cysts rupture into the biliary tract, the peritoneal cavity, the thoracic cavity and the hepatic subcapsular space: specific computed tomography findings

Background: This study attempts to demonstrate the role of computed tomography in the diagnosis of hepatic hydatid cyst rupture based on specific imaging findings and to propose combinations of the imaging findings diagnostic for specific types of rupture. Methods: Eleven patients were studied with computed tomography of the abdomen, with 4–8 mm slice thickness, after the oral administration of contrast material and intravenous contrast material in 6 cases. Results: Based on a combination of imaging findings the types of hepatic hydatid cyst rupture were: intrabiliary rupture in 7 patients, intraperitoneal rupture in 1 patient, intrathoracic rupture in 1 patient, hepatic subcapsular rupture in 2 patients. Structural deformity of the cyst was present in all cases, combined with: dilatation of the intrahepatic bile ducts (intrabiliary rupture); intraperitoneal fluid collections with diffuse haziness and stranding of the mesenteric fat (intraperitoneal rupture); an inhomogeneous lesion in the thorax with ipsilateral pleural effusion (intrathoracic rupture); a hydatid cyst located peripherally, with discontinuity of its adjacent to the hepatic capsule wall and subcapsular fluid collection (subcapsular rupture). The imaging findings were surgically and pathologically confirmed. Conclusions: Using combinations of specific imaging findings we correctly diagnosed the type of hepatic hydatid cyst rupture in all cases.     

The peritoneal cavity as a bioreactor for tissue engineering visceral organs: bladder, uterus and vas deferens

Our objective was to produce avascular, myofibroblast-rich tissue capsules for use as autologous grafts for hollow, smooth muscle-walled visceral organs-bladder, uterus and vas deferens. To produce tissue for grafting, templates of the appropriate shape were implanted in the peritoneal cavities of rats or rabbits. After 2-3 weeks, the templates were removed, the encapsulating myofibroblast-rich tissue harvested and grafted to replace resected segments of bladder, vas deferens or uterus of the same animals in which the tissue was grown. Bladder grafts showed 100% patency after 14 months and had developed a morphology similar to normal bladder. Tubes of myofibroblast tissue grafted unilaterally into resected rabbit vasa deferentia developed a morphology resembling native tissue, with sperm in the ejaculate indicative of normal function. At 12 weeks after grafting, uterine graft tissue had increased in thickness and developed the morphology of normal uterus, with endometrium overlying several layers of smooth muscle cells (myometrium-like) which were interspersed with collagen fibrils; grafted uterine horns supported embryos to the late stages of gestation. This study shows that myofibroblast tissue produced in the peritoneal cavity is sufficiently plastic to permit differentiation of cells into bladder, vas deferens or uterine smooth muscle. As a method for producing autologous graft material for repair/replacement of these organs, this approach has many benefits over conventional and current tissue-engineering strategies.     

女性盆腔腹膜后囊肿超声表现

<正>盆腔腹膜后间隙内存在直肠中下段、输尿管、髂血管及骶前间隙等重要结构,其内囊肿发病率为1/250 000～1/5 750^[1],明确诊断对于临床选择手术入路具有重要意义,但鉴别其与盆腔内卵巢及附件囊肿常遇困难^[2]。超声具有无辐射、无创、动态、实时、简便及经济等特点,已成为常规检查女性盆腔的主要手段^[3],可通过经阴道/直肠超声、经腹及经会阴联合超声动态扫查诊断盆腔腹膜后囊肿。本研究观察女性盆腔腹膜后囊肿超声表现。