腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

脐静脉内皮细胞在妊娠期肝内胆汁淤积症胎儿缺氧中的作用

目的 探讨脐静脉内皮细胞(HUVEC)在妊娠期肝内胆汁淤积症(ICP)胎儿缺氧机制中的作用.方法 分别对ICP患者(20例,ICP组)及正常孕妇(20例,对照组)新生儿脐静脉内皮进行原代细胞培养,采用免疫细胞化学(ICC)染色及图像分析等技术,检测HUVEC中的SS、SP及NPY的表达.结果 培养第5天的HUVEC,ICC染色结果显示,与正常对照组相比,ICP组舒血管活性物质(SS、SP)表达减弱,而缩血管活性物质(NPY)表达增强;用细胞图像分析仪对ICC染色进行定量分析,以平均光密度(AOD)值表示着色强度,ICP组HUVEC的SS为(0.091 4±0.026 4),SP为(0.164 2±0.056 6),明显低于对照组(0.330 3±0.154 2,0.321 7±0.126 3)(P＜0.01),而ICP组HUVEC的NPY为(0.450 0±0.086 3)明显高于对照组(0.197 2±0.122 2),差异有统计学意义(P＜0.01).结论 ICP患者离体的HUVEC表达舒缩血管活性物质异常,提示HUVEC本身功能失调可能参与了脐血管痉挛引起的急性胎儿缺氧过程.     

腘动脉损伤手术修复与介入治疗的对比分析

目的 探讨腘动脉损伤手术修复术和介入治疗对急性腘动脉损伤的临床疗效.方法 收集2020年10月至2021年4月云南大学附属医院收治的6例急性腘动脉损伤(PAI)患者的临床资料,对救治时间、多学科团队(MDT)协作模式、传统手术和介入开通血管的方法等影响截肢率的因素进行分析.结果 6例急性PAI患者中,5例患者保肢成功,...     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

胎儿单脐动脉临床评估及预后

目的:了解单脐动脉胎儿的转归,围生结局及处理方式。方法:回顾我院近4年170例单脐动脉胎儿的临床资料(经超声、MRI、羊水或脐血染色体检查、引产胎儿尸体解剖结果等),随访出生后婴儿情况并进行临床评估及分析。结果:单脐动脉合并其他结构畸形的发生率为49.3%,合并一种畸形的发生率为15.9%,合并多种畸形发生率为33.3%;单脐动脉胎儿合并染色体异常发生率为18.4%;行MRI检查37例,与超声结果相符29例,8例与超声结果有差异,与超声符合率为78.4%。结论:超声检查易早期诊断单脐动脉,单脐动脉具有胎儿畸形的高风险性。单脐动脉合并其他结构畸形者建议行胎儿染色体检查。超声、染色体检查诊断未发现合并畸形的胎儿出生后仍有异常可能。单脐动脉不是剖宫产指征。     

罕见M+Le(a+)HDFN病例1例并文献复习

目的 通过1例母儿罕见血型不合病例对胎儿和新生儿溶血病(HDFN)进行国内外文献复习及总结.方法 总结该罕见病例的病史,分析并对比该家系的各个血型系统,回顾性分析国内外相关研究进展.结果 该病例以"胎儿不明原因胸腔积液"为主要表现,既往有"晚孕期胎动减少、新生儿不明原因死亡"病史.经家系血型分析认为M+L e(a+)是导致该病例母儿血型不合的主要原因.结合文献分析MN血型或许与Lewis血型具有协同作用.结论 在孕期管理中应重视对不典型胎儿水肿、胎动减少等孕妇进行不规则抗体和大脑中动脉收缩期峰值流速筛查,重视不同血型系统协同致病的潜在风险,并加强对HDFN的认识和规范管理.     

间充质干细胞在组织工程中的应用进展***☆

背景：间充质干细胞主要存在于结缔组织和器官间质中,具有强大的增殖能力和多向分化潜能及免疫调节等多种功能;同时具有来源方便,易于分离、培养、扩增和纯化等优点,因而在组织工程,基因治疗等领域日益受到重视。 目的：综述不同来源间充质干细胞的生物学特性、对其他细胞的支持作用、免疫原性、免疫调节作用及其应用。 方法：应用计算机检索2001-03/2010-03 PubMed数据库相关文章,检索词为“mesenchymal stem cells,tissue engineering”,同时检索万方数据库相关文章,检索词为“间充质干细胞,组织工程”。共检索到文献182篇。 结果与结论：间充质干细胞来源于中胚层间充质,不仅具有多向分化的潜能,单独应用于组织工程,而且具有为其他细胞的生长繁殖提供支持的作用,可以调节机体的免疫状态等特性而被广泛应用于医学领域。目前,间充质干细胞功能的研究虽然取得了一些成就,但有关研究才刚刚起步,仍存在许多理论和技术问题,对于如何有效控制其在体内定向分化、增殖、迁移并整合参与宿主细胞组织功能还需要大量深入和系统研究。     

冠心病患者血浆TNF-α与CK-MB、LDH、cTnI水平及冠脉病变的相关性分析

目的研究分析冠心病患者血浆肿瘤坏死因子（TNF-α）与冠脉病变及心肌酶学指标的相关性,探讨其临床意义。方法从山西医科大学第二临床医院选取经冠状动脉造影证实为冠心病的患者60例,其中稳定型心绞痛（SA）12例,不稳定型心绞痛（UA）31例,急性心肌梗死（AMI）17例,另设对照组28例。用酶联免疫吸附（ELISA）法测定各组血浆TNF-α浓度,用免疫标记法测定肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）及肌钙蛋白I（cTnI）浓度;Gensini积分法对冠脉狭窄程度进行定量评价,并分析TNF-α与冠脉病变程度的相关性。结果冠心病组血浆TNF-α、CK-MB、LDH浓度显著高于对照组（P〈0.05）;AMI组TNF-α、CK-MB、LDH、cTnI水平明显高于对照组、SA组和UA组（P〈0.01）;UA组TNF-α、CK-MB水平明显高于对照组和SA组（P〈0.05）,LDH水平明显高于SA组（P〈0.01）,TNF-α水平明显高于对照组（P〈0.05）,LDH水平明显低于对照组;SA组CK-MB水平与对照组比较差异无统计学意义。Gensini积分与TNF-α呈正相关（P〈0.01）;AMI组TNF-α与CK-MB、LDH、cTnI呈正相关（P〈0.01）。结论冠心病患者血浆TNF-α炎症因子的水平明显升高,随冠脉病变的严重程度增高而增高,提示冠心病患者体内已存在炎症反应,TNF-α在其发病机制中起一定作用,可作为冠心病炎症活性的独立指标。CK-MB、LDH、cTnI反映心肌损伤及坏死的程度,联合评估两种指标的水平对于临床估计冠心病的危险程度具有重要的意义。     

山西汉族高血压人群与蛋白酶体α_6亚单位基因多态性的相关性研究

<正>泛素-蛋白酶体途径(ubiquitin-proteasome pathway,UPP)是Hershko等[1]发现的一种高效蛋白降解途径,主要负责真核细胞内蛋白的选择性降解,由泛素、泛素活化酶、泛素偶联酶、泛素—蛋白连接酶、26S蛋白酶体以及泛素再循环酶等组     

胎儿下尿路梗阻的宫内诊断与治疗进展

胎儿下尿路梗阻(lower urinary tract obstruction,LUTO)的发病率为2.2/100013,有多种病理表现,以后尿道瓣膜症(posterior urethral valves.PUV)(占64%)和尿道闭锁(占39%)最为常见.大多数受累者为男性胎儿;若为女性胎儿发病,则可能合并有更为复杂的疾病和结构异常,特别是泄殖腔发育异常,如梅干腹综合征(占4%).