经膀胱途径修补膀胱阴道瘘的临床分析

目的探讨经膀胱途径修补膀胱阴道瘘手术时机的选择以及治疗效果。 方法回顾性分析2012年1月至2018年4月中山大学附属第三医院及外院会诊手术共21例膀胱阴道瘘患者的临床资料。患者年龄24～66岁,病程3个月至30年。所有患者均行膀胱镜检,单个瘘口16例、2个瘘口4例、3个瘘口1例,瘘口大小0.3～1.5 cm,瘘口位于输尿管口旁6例,膀胱底后壁9例,输尿管间嵴后方6例。 结果21例均行膀胱阴道瘘修补术,其中16例经膀胱途径,4例经膀胱联合经腹途径,1例经膀胱联合阴道途径。除子宫内膜癌术后辅助放疗引起者行膀胱联合阴道途径修补术后2个月仍出现少量漏尿外,其余20例经膀胱途径修补术均取得成功,随访1～65个月均无漏尿及输尿管损伤等并发症发生。 结论经膀胱途径修补膀胱阴道瘘是一种安全有效的方法,对于复杂性瘘,术中根据瘘口具体情况联合经腹或阴道进行修补,可以提高治愈率、减少并发症的发生。     

Ultrasonic-assisted preparation of highly active Co3O4/MCM-41 adsorbent and its desulfurization performance for low H2S concentration gas

Co₃O₄/MCM-41 adsorbents were successfully prepared by ultrasonic assisted impregnation (UAI) and traditional mechanical stirring impregnation (TMI) technologies and characterized by X-ray diffraction (XRD), N₂ adsorption desorption, Fourier transform infrared spectra (FT-IR), transmission electron microscopy (TEM), scanning electron microscopy (SEM) and thermogravimetry-differential thermal analysis (TG-DTA). The H₂S removal performances for a simulated low H₂S concentration gas were investigated in a fixed-bed. The effect of preparation and adsorption conditions on the H₂S removal over Co₃O₄/MCM-41 were systematically examined. The results showed that UAI promotes more and well defined highly dispersed active Co₃O₄ phase on MCM-41. As compared to the Co₃O₄/MCM-41-T prepared via TMI, the saturated H₂S capacity of Co₃O₄/MCM-41-U prepared via UAI improved by 33.2%. The desulfurization performance of adsorbents decreased in the order of Co₃O₄/MCM-41-U > Co₃O₄/MCM-41-T > MCM-41. The Co₃O₄/MCM-41-U prepared using Co(NO₃)₂ concentration of 10%, ultrasonic time of 2 h, calcination temperature of 550 °C and calcination time of 3 h exhibited the best H₂S removal efficiency. At adsorption temperature of 25 °C with model gas flowrate of 20 mL min⁻¹, the breakthrough time of Co₃O₄/MCM-41-U was 10 min, and the saturated H₂S capacity and H₂S removal rate was 52.6 mg g⁻¹ and 47.8%, respectively.

Co₃O₄/MCM-41 adsorbent with high surface area and more active sites was successfully prepared by ultrasonic assisted impregnation (UAI) technology and it has been found that the sulfur capacity was improved by 33.2% because of ultrasonication.     

异基因造血干细胞移植后巨细胞病毒感染的发病情况及疗效分析

目的：探讨异基因造血干细胞移植（allo-HSCT）后,巨细胞病毒（CMV）感染的发病情况及抗病毒治疗的疗效。方法：对在我所接受allo-HSCT的患者23例进行回顾性分析,均应用荧光定量PCR法（FQ-PCR法）检测外周血CMV-DNA含量。CMV感染应用更昔洛韦（GCV）10mg.kg-1.d-1进行治疗。结果：23例患者中7例移植后发生CMV感染,占30.43%。GCV治疗的总有效率约为85.71%。6例在GCV治疗过程中出现白细胞和血小板减少。结论：FQ-PCR法可以应用于allo-HSCT后早期准确诊断CMV感染。GCV对allo-HSCT后CMV感染的预防及治疗效果可靠。     

50例造血干细胞移植感染及经验性抗感染治疗分析

目的：探讨造血干细胞移植（HSCT）后感染的发生率、病原菌分布情况及经验性治疗方法。方法：对50例患者HSCT后感染及相应治疗的临床资料进行综合分析。结果：50例患者HSCT后,在ANC≥0．5×10^9／L前出现感染的有44例（88％）,在ANC≥2．0×10^9／L前出现感染的有14例（28％）。采用我院选用的经验性治疗方案,即一线为碳青霉烯类单药或加用氨基糖甙类;二线选三代头孢菌素加用万古霉素;三线选了另一种碳青霉烯类加两性霉素B／伊曲康唑治疗。最终仅有3例患者因同时并发有重度移植物抗宿主病或植入失败导致的特殊感染而死亡。结论：我院采用的抗感染治疗的三线使用方案对于治疗HSCT后粒细胞缺乏／减少状态下发热患者是相当有效的。