宫腔镜诊治围绝经期子宫出血(附138例报告)

目的 :探讨宫腔镜在诊治围绝经期异常子宫出血 (perimenopausaluterinebleeding ,PMUB)的价值。方法 :回顾分析PMUB 138例用宫腔镜诊治的临床资料。结果 :138例中子宫内膜息肉 5 5例 ,子宫颈息肉 2 9例 ,粘膜下子宫肌瘤 4 0例 ,子宫内膜增生过长 6例 ,子宫内膜不典型增生 3例 ,子宫内膜癌 1例 ,正常子宫内膜 4例。总体检查阳性率为 97 10 %。术中 1例发生子宫穿孔并发症。术后随访 2 ～12个月 ,随访率为82 6 1% ,患者症状明显改善 10 6例 ,满意率为 92 98%。结论 :用宫腔镜诊断PMUB有相当高的特异性和准确性。可同时治疗良性病变 ,减少不必要的开腹手术 ,是治疗PMUB的首选方法。     

宫腔镜在绝经后妇女子宫内膜病变中的诊治价值

目的探讨宫腔镜在绝经后子宫内膜病变中的诊治价值。方法回顾性分析2002年1月～2006年11月行官腔镜诊治的107例绝经后子宫内膜病变患者的临床资料，包括绝经后不规则阴道出血68例，B超检查子宫内膜增厚无阴道出血39例。并对手术时间、术中出血、并发症、术后病理和随访结果进行分析。结果106例顺利完成宫腔镜下检查及治疗，1例子宫穿孔，保守治愈。手术时间15～60min，（26．8±9．5）min，出血量10～60ml，（30．2±18．3）ml。术后病理结果：子宫内膜息肉69例（64．5％），黏膜下子宫肌瘤18例（16．8％），子宫内膜不典型增生12例（11．2％），子宫内膜癌2例（1．9％），正常子宫内膜6例（5．6％）。90例（84．1％）术后随访3～12个月，（6．0±3．8）月，其中8例子宫内膜息肉复发，再次宫腔镜手术治疗。结论官腔镜检查是绝经后子宫内膜病变首选的检查方法，可直视下观察子宫内膜的形态变化并取活检送病理；官腔镜治疗可以完整切除子宫内膜息肉、子宫黏膜下肌瘤等子宫内膜良性病变。     

硬膜下水瘤发展为慢性硬膜下血肿2例报道

硬膜下水瘤发展为慢性硬膜下血肿临床报道少见。我们收治 2例 ,报告如下。1　病例资料例 1,男 ,5 9岁 ,头部外伤后头昏头痛 3小时入院。伤后无昏迷 ,呕吐 2次胃内容物。头颅ＣＴ :左侧小脑部硬膜外血肿 ,约 2 0ｍｌ,双侧额颞部硬膜下积液 ,左侧明显 ,ＣＴ值 5Ｈｕ。体检 :神清 ,双瞳孔 2 .5ｍｍ ,颈项强直 ,克氏征 ( )。入院后立即行左小脑部硬膜外血肿清除术。术后 6日头颅ＣＴ :双侧额颞部硬膜下积液较入院时增多 ,未予处理。伤后 40天头颅ＣＴ :左额颞部硬膜下血肿 ,右额颞部硬膜下积液明显吸收。行左侧颅骨钻孔引流 ,引流出暗红色血性…     

外阴血管及淋巴疾病

外阴血管瘤并非真正的肿瘤，实际上是血管的畸形，因此将外阴血管瘤归在外阴血管及淋巴疾病中介绍。与身体其他部位血管瘤一样，它是从先天性焰色痣发展生成。常生长于大阴唇，有时可在阴阜生长，呈小红血管痣，或蓝、红海绵状肿物、柔软、边界不清楚，可发展较大。一般无临床症状，但大的海绵状血管瘤会引起压迫症状和坠胀感。外阴血管瘤大体上可分为：毛细血管瘤，海绵状血管瘤和血管角质瘤。     

CO2腹腔镜手术对机体免疫机能的影响

腹腔镜手术，特别是二氧化碳(C02)气腹腹腔镜手术对机体全身免疫影响小，但可能改变腹腔局部细胞免疫机能，加速肿瘤细胞腹腔内种植。就腹腔镜手术对全身及腹腔局部免疫功能的影响进行综述。     

奇乳海参中两个具有抗真菌活性的三萜皂苷

目的：研究奇乳海参体内的化学成分，寻找结构新颖具有抗真菌活性的三萜皂苷类成分。方法：应用多种色谱分离技术对奇乳海参体内的化学成分进行分离纯化，根据化合物的理化性质，波谱数据及化学方法鉴定其结构。结果：分离得到2个三萜皂苷化合物，分别为axilogoside A（1）和holothurin B（2），并对其抗真菌活性进行了研究（4≤MIC80≤16μg·mL^-1）。结论：化合物1为一新的三萜皂苷化舍物，化合物2为首次从奇乳海参中分离得到，它们均显示一定的抗真菌活性。     

同型半胱氨酸与肢体闭塞性动脉硬化关系研究

肢体闭塞性动脉硬化是临床常见的外周动脉疾病,常造成患者截肢,甚则危及生命。目前越来越多的证据表明同型半胱氨酸(Hcy)水平升高已成为新的动脉粥样硬化的独立危险因素。本研究采用病例对照的方法对肢体闭塞性动脉硬化患者血清同型半胱氨酸水平、临床病情严重程度及相关因素进行初步探讨。现将结果分析报告如下:     

孕妇血浆中sCD40及其配体与子痫前期发病及肾功能损害的关系

目的 探讨孕妇血浆中可溶性白细胞分化抗原(sCD40)和sCD40配体(sCD40L)水平变化与子痫前期发病及肾功能损害的关系.方法 选择2008年8月-2010年6月在青岛大学医学院附属医院产科分娩的轻度子痫前期孕妇28例(轻度子痫前期组),重度子痫前期孕妇35例(重度子痫前期组);另选同期妊娠结局良好的健康孕妇30例为对照组.比较3组孕妇分娩孕周及血压变化、血小板计数并检测其血常规、C反应蛋白(CRP)、尿常规、24h尿蛋白定量,以及血清尿酸(UA)、肌酐(Cr)、尿素氮(BUN)等生化指标.采用ELISA法检测3组孕妇血浆中sCD40和sCD40L的水平,并对血浆sCD40和sCD40L的水平与各临床指标的相关性进行分析.结果 (1)血常规及l临床指标:重度子痫前期组和轻度子痫前期组孕妇血浆CRP水平(分别为10.8及7.1 mg/L)均明显高于对照组(3.3 mg/L),前后两者分别比较,差异均有统计学意义(P＜0.05);重度子痫前期组高于轻度子痫前期组,两组比较,差异也有统计学意义(P＜0.05).重度子痫前期组孕妇分娩孕周(32.5周)明显低于轻度子痫前期组(37.2周)和对照组(38.6周),分别与对照组比较,差异均有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).重度子痫前期组孕妇血小板计数(132×109/L)明显低于轻度子痫前期组(212×109/L)和对照组(216×109/L),分别比较,差异有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).3组孕妇之间血红蛋白水平及白细胞数分别比较,差异均无统计学意义(P＞0.05).(2)血浆sCD40及sCD40L水平:重度子痫前期组、轻度子痫前期组和对照组孕妇血浆sCD40水平分别为133.6、126.5和90.7 ng/L,sCD40L水平分别为12.5、10.4和4.4 ng/L,24h尿蛋白定量分别为4.5、0.8 g和0,UA水平分别为486、289和162 μmol/L,重度子痫前期组以上各指标均明显高于轻度子痫前期组和对照组,差异均有统计学意义(P＜0.01);轻度子痫前期组也明显高于对照组,差异也有统计学意义(P＜0.01).重度子痫前期组孕妇血浆Cr(89 μmol/L)、BUN(5.32 mmol/L)水平高于轻度子痫前期组(分别为66μmol/L及4.49mmol/L)和对照组(分别为57 μmol/L及3.32 mmol/L),分别比较,差异均有统计学意义(P＜0.05);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).(3)相关性分析:轻、重度子痫前期组孕妇血浆sCD40水平与24 h尿蛋白定量呈正相关(r=0.434,P＜0.05),与UA、CRP呈明显正相关(r=0.536、0.528,P＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.135、0.183、-0.133、0.190、0.167、-0.221,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与24 h尿蛋白定量、UA、CRP均呈明显正相关(r分别为0.591、0.445、0.539,P均＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.178、0.212、-0.292、0.144、0.135、-0.273,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与sCD40呈明显正相关(r均为0.707,P＜0.01).对照组孕妇血浆sCD40、sCD40L水平与各项临床指标均无相关性(P＞0.05).结论 子痫前期孕妇血浆中sCD40和sCD40L水平明显升高,可能参与了子痫前期的发病,并导致肾功能损害.sCD40和sCD40L水平变化也与子痫前期的严重程度相关.

Abstract：

Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.