家犬脑梗死ADC值、T2信号强度的演变规律及病理对照研究

目的了解中风后MR表观弥漫系数(appearance diffuse coefficient,ADC)值、T2信号强度的变化过程,并与形态学检查和免疫组织化学染色结果相对照。方法18只健康成年家犬,制成脑梗死动物模型。依处死时间不同(次日、3d、1周和2周)随机分成4组。手术结束后多时点MR扫描,序列为T1WI、T2WI、3D-TOFMRA、DWI。以MR图像为依据选择病变部位分别进行HE染色,免疫组织化学染色,并进行光镜、电镜观察。测量ADC值、T2信号强度,根据CD34免疫组织化学染色结果计数毛细血管数,方差分析法分析不同时间点结果的差异,并进行相关性分析。结果术后1h DWI可见梗死区明显高信号,且随时间的延长强度逐渐增高。ADC值术后3~4h下降到(5.61±1.39)mm2/s,相对于对侧半球的(9.85±2.04)mm2/s下降了大约43%,2周时达(9.83±1.11)mm2/s,仍然略低于正常。T2信号由24h的(4040.00±468.66)升高到2周时的(4806.80±739.52)。ADCr、T2r的变化与微血管计数变化存在显著正相关关系(r=0.679、0.721,P<0.01)。形态学及电镜观察可见相应不同程度的缺血改变。结论脑梗死后ADC值变化呈先降后升规律,T2信号强度短期内持续升高,与MVC的变化存在正相关关系。     

腹腔镜与开腹手术治疗良性卵巢囊肿的疗效分析

目的:探讨腹腔镜手术治疗卵巢囊肿的临床应用价值。方法:回顾分析2007年1月至2008年1月在我院分别接受腹腔镜与开腹手术治疗卵巢囊肿的患者各32例。结果:腹腔镜组切口明显小于开腹组,术中出血量、手术时间明显少于开腹组,两组比较差异均具有统计学意义(P<0.001);腹腔镜组患者术后镇痛药物使用人数明显少于开腹组(P<0.001),术后肠蠕动恢复时间、住院天数明显短于开腹组(P<0.001),术后工作恢复时间、术后病率明显优于开腹组(P<0.05)。结论:腹腔镜下卵巢囊肿手术安全有效,具有创伤小、术后恢复快、住院时间短及术后病率低等特点。     

卡托普利安体舒通生脉在慢性肺心病合并右心衰治疗中的疗效观察

目的:观察卡托普利、安体舒通、生脉治疗慢性肺心病合并右心衰疗效。方法:将76例患者随机分为两组。对照组给予一般治疗和强心、利尿等常规治疗;治疗组在常规治疗基础上加用卡托普利、安体舒通、生脉,3周后观察两组的疗效。结果:治疗组显效22例,有效13例,总有效率92.1%;对照组显效13例,有效9例,总有效率57.9%;两组的疗效有显著性差异(P<0.005)。结论:卡托普利、安体舒通、生脉联合治疗慢性肺心病合并右心衰疗效明显,可改善心功能,缩短心衰时间。     

耐多药肺结核经支气管镜介入治疗的研究

目的探讨经支气管镜介入配合全身化疗治疗耐多药肺结核的效果。方法经痰结核菌培养确定的复治耐多药肺结核患者随机分为2组,均采用3DZVThAk/15DVTh化疗方案治疗,治疗组同时使用支气管镜介入治疗。结果疗程结束时,治疗组和对照组痰菌阴转率(涂片与培养)、病灶显著吸收率、空洞闭合率分别为88%和52%、82%和54%、60%和28%、66%和34%,2组差异有统计学意义(P均<0.01)。结论经支气管镜介入治疗联合全身化疗对耐多药肺结核能促进痰菌阴转、病灶吸收、空洞闭合,疗效显著优于单纯全身化疗,值得推广。     

吗啡对糖尿病神经病理痛大鼠机械及冷刺激痛敏症状的影响

目的探讨吗啡对糖尿病神经病理痛大鼠机械及冷刺激痛敏症状的影响。方法35只SD雄性大鼠(180～220 g)腹腔注射链脲佐菌素(STZ)制备成糖尿病神经病理痛模型,出现痛敏症状后,随机分为5组,采用von Frey测试针和冷板(5度)法,测量鞘内给予吗啡后不同时间机械缩腿阈值和冷刺激后的抬足次数(次/5min)变化。结果吗啡以剂量依赖方式提高糖尿病神经痛大鼠机械缩腿阈值、降低冷刺激后的抬足次数,给予吗啡后30 min,0.5、1.0、5.0μg剂量吗啡组的机械缩腿阈值明显增高,而冷刺激抬足次数分别为显著下降,分别与用药前和对照组相比,差异有统计学意义(P<0.05)。结论吗啡能显著提高糖尿病神经痛大鼠的机械缩腿阈值,有效减少冷刺激的抬足次数,对神经源性痛具有明显的镇痛作用。     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

儿童骨嗜酸性肉芽肿

目的 提高对骨嗜酸性肉芽肿的诊断及治疗水平，减少误诊。方法回顾性分析了1997年～2001年间收治的29例骨嗜酸性肉芽肿的影像学资料、临床资料及随访结果。行手术刮除病灶及植骨术治疗17例，仅作病灶活检术的5例，非手术治疗7例。结果29例中初诊仅9例为骨嗜酸性肉芽肿，8例为骨病变待诊人院，有12例均诊断为其它疾病。手术治疗的17例中11例痊愈，随访2～5年无复发，3例有残余低密度灶，2例有骨骼的畸形愈合，1例疗效差并已失随访；作病灶活检术的5例中3例痊愈，2例病灶仍有待观察后必要时手术治疗。非手术治疗的7例中2例治愈，4例病灶明显缩小，症状消失，1例放弃治疗。结论 儿童骨嗜酸性肉芽肿的X线表现多样，容易与其它病变混淆而引致误诊或漏诊，X线平片是发现骨破坏病灶和随访嗜酸性肉芽肿的首选和主要的检查方法，强调与临床、病理结合才能提高本病的诊断准确率。治疗上以手术刮除病灶及植骨为佳，在作活检术时尽可能刮除所有病变组织，避免二次手术。     

59例儿童脑动静脉畸形诊治体会

目的报道59例儿童脑动静脉畸形诊治体会。方法回顾分析长征医院1990～2000年收治59例18岁以下脑AVM患儿诊治结果，其中单纯手术治疗10例；栓塞后再手术7例；栓塞后伽玛刀治疗18例；手术后伽马刀治疗3例；单纯栓塞治疗5例；直接伽玛刀治疗13例；未治3例。结果48例（48／59）患儿临床表现为出血，47例（47／56）治疗后没有产生任何新的神经功能缺损，6例（6／56）治疗后出现轻度神经功能缺损或神经功能缺损加重，2例（2／56）患儿遗留严重的神经后遗症，死亡1例。未治3例，死亡1例。结论儿童脑AVM具有出血率高及出血凶猛的特点，应争取积极治疗，合理正确使用显微手术、放疗、血管内栓塞等治疗手段．临床效果满意。     

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??Abstracts?? Objective To study the T2* magnetic resonance imaging for evaluation of iron deposition of liver?? pancreas and heart in β- thalassemia major ??β-TM?? patients and the relationship of the serum ferritin with iron overload. Methods Measurement of hepatic?? pancreatic and cardiac MRI T2* was performed in 153 patients with β-TM from May 1?? 2010 to December 31?? 2010??The demographics and serum ferritin ??SF?? were collected. The rate of the iron overload in liver?? pancreas and heart was analyzed. The rates of combined pancreatic and cardiac iron overload in different hepatic iron overload groups were compared. Results According to MRI T2*?? there was serious hepatic iron overload in 85 cases?? moderate in 39?? mild in 21?? no iron overload in 8. Similarly?? there was pancreatic iron overload in 134?? no iron overload in 19. In terms of cardiac iron overload?? there was serious cardiac iron overload in 37 cases?? mild in 21?? no iron overload in 95. No correlation was found between hepatic?? pancreatic and cardiac MRI T2* and age or SF?? but hepatic MRI T2* correlated with pancreatic and cardiac MRI T2*??P = 0.000?? r = 0.529?? r = 0.369???? and pancreatic MRI T2* correlated with cardiac MRI T2* well ??P = 0.000?? r = 0.715??. As grade of hepatic iron overload increases?? the patients demonstrated higher rate of combination of pancreatic and cardiac iron overload simultaneously ??χ2 = 20.78??P = 0.000??.