造血干细胞移植后并发带状疱疹临床分析

目的 探讨造血干细胞移植后带状疱疹发病情况、临床特点、治疗及转归.方法 回顾分析浙江省中医院血液科可评估的104例接受造血干细胞移植患者预处理方案、移植物抗宿主病预防方案及病毒感染的防治方案等临床资料.结果 104例接受造血干细胞移植患者中有24例(23.08% )并发带状疱疹,其中单倍体相合造血干细胞移植患者带状疱疹发生率为47.6%,非亲缘造血干细胞移植患者带状疱疹发生率为42.1%.应用抗病毒药物,适当减少免疫抑制剂用量及输注人免疫球蛋白,外用干扰素,同时中医中药辅助治疗,平均治疗(20.5±3.8)d后,患者疱疹全部消退,有4 例出现严重疱疹后神经痛,其中2例伴有局部肌肉萎缩.无泛发性疱疹及内脏受累病例,无疱疹相关死亡.结论 造血干细胞移植后发生的带状疱疹起病不典型,综合治疗能够有效地控制,但神经痛持续时间较长.     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.     

终板法伤椎植钉单节段内固定治疗不完全胸腰椎骨折的生物力学研究及临床应用

目的 对终板法伤椎植钉单节段内固定治疗胸腰椎单椎体骨折的生物力学及临床效果进行评价.方法 取猪的24个新鲜胸腰椎椎体标本,48个椎弓根,随机分成4组,分别应用"平行法"及3种不同"终板法"植钉,比较4种植钉法的抗拔出强度.同时回顾分析2003年3月至2006年6月应用该技术治疗的49例胸腰椎骨折患者手术前后伤椎的前后缘高度、后凸Cobb角、椎管内径及矫正丢失、顽固性腰痛、腰椎活动受限等并发症发生情况.结果 "终板法"椎弓根螺钉抗拔出强度明显高于"平行法","伤椎植钉"与正常椎体的"终板法"植钉具有相同的抗拔出强度.49例患者术后均得到良好复位及骨性融合,无内固定失败,无明显矫正角度丢失以及顽固性腰痛、腰椎活动受限等并发症.结论 终板法伤椎植钉单节段内固定能提供足够的抗拔出强度,临床疗效满意.     

应用无内膜接触缝合技术治疗心上型全肺静脉异位引流

Objective Retrospectively analyze surgical correction supracardiac total anomalous pulmonary venous con-nection (TAPVC) using sutureless technique to prevent post-repair pulmonary vein stenosis. Methods Between December 2007 and December 2008, 25 children cases of total anomalous pulmonary venous connection underwent primary surgical cor-rection. The anatomic types of TAPVC were supra cardiac in nine patients, inha cardiac in one, mixed in 3 and intra cardiac in 12. Five of nine supra cardiac TAPVC underwent correction using sutureless technique. There were 2 male and 3 female. Their age at surgeries ranged from 2 months to 13 years, and the body weight were from 4.5 kg to 2.1 kg with an average of (7.9±6.4) kg. After median sternotomy and opening the pericardium, the heart was arrested by delivering cold crystal ear-dioplegia. The heart was then positioned toward the patient' s right and under the right henri sternum. A generous incision across the posterior wall of the left atrium and one on the common pulmonary vein was made. The latter was extended upwards to the midpoint of the vertical vein. The left atrium was subsequently connected to the pulmonary venous confluence by suturing the edge of the atrium to the posterior mediastinal pericardium that surrounding the common pulmonary vein and the vertical vein with 7-0 PDS. The vertical vein was partially ligated after conclusion of CPB, leaving a diameter of 5mm shunt. Routine follow-up with echocardiogram were at diacharging, 3 months, 6 months and 1 year after surgery. Results All 5 cases survived uneventfully excopt 1 baby on ventilation over 7 days after surgery, who had bilateral lung consolidation before the operation. Echocardiogram showed satisfactory results with maxium velocity acrossing the anastomosis of 0.65 -0.85 m/s. Conclusion Sutureleas technique can avoid trauma to the pulmonary venous endothelium and minimize the tension of anastomasis. It may play an important role to prevent post-repair pulmonary vein stenosis. More patients with long-term follow-up are necessary to draw a definite conclusion of this technique.     

CT引导经皮肺穿刺活检检测晚期非小细胞肺癌表皮生长因子受体基因突变

目的研究CT引导经皮肺穿刺活检获得组织检测非小细胞肺癌(NSCLC)表皮生长因子受体(EGFR)基因突变的可行性。方法入组40例晚期或局部晚期无法手术的NSCLC患者,采用18 G自动活检枪,经CT引导行肺穿刺活检获取肿瘤组织,行EGFR基因检测,观察术后并发症,分析检测结果。结果 40例病例均经穿刺活检获得足够的病变组织进行组织学诊断和基因突变检测,EGFR基因突变率为37.5%(15/40),其中腺癌患者突变率为50.0%(12/24),非腺癌患者突变率为18.8%(3/16),两者间差异有统计学意义;3例患者穿刺后出现气胸,3例患者出现咯血;无血胸、纵隔气肿、感染及针道种植等并发症;EGFR基因突变患者使用吉非替尼治疗获得良好疗效。结论 CT引导的经皮肺穿刺活检技术简便、安全,是晚期NSCLC获得肿瘤组织检测EGFR基因突变的可靠方法,能够用于预测晚期NSCLC的靶向治疗效果。     

卫星生物搭载舱的辐射剂量测量及蚕卵生物叠试验

本文利用LiF热释光剂量计对我国生物搭载舱内外宇宙辐射剂量作了监测研究。经过八天的近地轨道飞行,舱内累积辐射剂量约为0.53±0.04mGy,平均日剂量约为0.07mGy/d。舱内辐射剂量主要是能量为50MeV 以上的高能质子形成的。这一剂量水平比地面高27倍,但未超过最大允许剂量,在评价空间生物效应时可作参考。本文还讨论了屏蔽厚度的影响,中子对剂量的贡献及舱内平均日剂量与轨道高度的关系。在生物舱内放置了CR-39塑料核径迹探测器与蚕卵组成的生物叠进行宇宙线重粒子及其生物效应的研究。为判定蚕卵样品是否被重粒子所击中,解决了重粒子射入蚕卵的径迹定位技术。试验表明,生物叠中被重粒子击中的蚕卵孵化率略高于未被击中的蚕卵孵化率,虽因样本量少不能满足统计学要求,但其趋势与国外报导的某些试验结果相一致。     

中西医结合治疗老年人肾病综合征98例疗效观察

目的 :比较中西医结合和单纯西医治疗老年人原发性肾病综合征 (PNS)的临床疗效。方法 :98例老年人PNS随机分为治疗组和对照组。治疗组 (4 9例 )用强的松、环磷酰胺 (CTX)并分阶段辨证配合中药治疗。对照组(4 9例 )单用西药治疗。观察临床缓解率、不良反应率、复发率及缓解时间。结果 :治疗组完全缓解率 (5 9.2 % )和总缓解率 (85 .7% )均显著高于对照组 (38.7%、6 3.2 % ,P <0 .0 5 )。治疗组不良反应率 (36 .7% )明显低于对照组 (80 .1% ,P <0 .0 1)。随防 (4 2± 11.6 4 )月后 ,治疗组复发率 (10 .3% )与对照组 (2 1% )比较无统计学差异 (P >0 .0 5 )。但治疗组平均缓解期为 (36 .7± 4 .6 )月 ,较对照组 (15 .2± 4 .4 )月显著延长 (P <0 .0 1)。结论 :中西医结合治疗老年人肾病综合征优于单纯西医治疗。     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

鹿角形肾结石取石术后尿漏原因分析

目的：探讨鹿角形肾结石取石术后尿漏原因。方法：分析150例鹿角形肾结石取石术后发生尿漏的6例患者的尿液引流方式、肾盂肾盏损伤程度、肾盂类型以及输尿管通畅情况等与发生尿漏的关系。结果：6例尿漏患者中，双J管引流不畅致尿漏3例，其中2例为肾内型肾盂伴术中肾盂肾盏损伤严重，血凝块堵塞双J管，1例为血小板减少出血致双J管堵塞。输尿管部分梗阻致尿漏2例，吻合不满意致尿漏1例。结论：双J管引流不畅和输尿管部分梗阻是导致尿漏的主要原因。建议肾内型肾盂鹿角形结石取石时，如果肾盂肾盏损伤较重，在双J管内引流同时应行肾造瘘；术前应充分了解输尿管通畅情况和凝血功能状态，必要时并作处理。     

聚丙烯酰胺水凝胶注射后不良反应的剖析

目的 研究分析聚丙烯酰胺水凝胶填充物被迫取出者的症状体征和局部病理变化。方法 从2000年1月～2001年12月，我们对15例在外院行聚丙烯酰胺水凝胶注射充填者行充填物取除术。对不良反应的主要症状、体征和切除物的病理变化行统计学分析。结果 主要症状体征中：无美容效果占33.33％，继发畸形占20.00％，局部疼痛占60.00％，局部不适占13.33％，局部硬结占80.00％，局部红肿占6．67％。切除组织的主要病理改变：包膜形成占53.33％，异物巨细胞反应占60．00％，肉芽肿占20.00％。结论 聚丙烯酰胺水凝胶注入体内后会出现一定程度的不良反应，对其临床应用应持谨慎态度。