2012年浙江省血吸虫病疫情监测结果

目的掌握浙江省血吸虫病疫情变化情况,为制定防治策略提供科学依据。方法系统抽样结合环境抽查法进行螺情监测,查到的钉螺用压碎法检查血吸虫感染情况,用土埋结合药物方法灭螺。对血清学筛查结果阳性者（畜）进行粪检确认。结果2012年浙江省实际有螺乡镇95个,有螺村343个,实有钉螺面积102．3×104m2,其中新发钉螺面积0．34×104m2;解剖钉螺91281只,未发现感染性钉螺。血清学查病131288人,阳性率为0．89％（1165／131288）,查出输人性血吸虫患者7例（其中1例为急性血吸虫病例）,未发现本地粪检阳性患者（畜）。2012年浙江省共有历史晚血病例1171例,实际救助晚血患者1014人。结论浙江省血吸虫病疫情稳定,但残存钉螺面积呈上升趋势,输人性病例时有发生,今后血防重点是查灭钉螺和防控外来传染源。     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

目的 评价高场强术中磁共振(iMRI)对脑胶质瘤手术切除程度及手术策略的影响.方法 解放军总医院神经外科自2009年10月至2010年6月将高场强iMRI系统应用于胶质瘤切除术患者106例,术前了解术者的切除意图(全切、次全切、大部切除),术前1 d患者常规行MRI扫描,应用影像数据和软件计算术前肿瘤体积,术中常规使用神经导航手术,依据术者的需求采集影像.必要时行iMRI扫描计算术中残余肿瘤体积和肿瘤体积切除百分比,分析使用iMRI对肿瘤切除程度、手术策略的影响.结果 术前计划全切48例,次全切41例,大部切除17例.术中第一次扫描示42例(39.6%)完全切除,64例(60.4%)仍有残留,其中25例由于肿瘤与重要功能区或重要传导束紧邻而未作进一步切除,其余39例(36.8%)改进手术策略,标记出残留肿瘤后进一步手术,25例(23.6%)胶质瘤最终全切除,肿瘤体积切除百分比由(76.5±20.5)%提高到(94.2±8.7)%,差异有统计学意义(U=2.000,P=0.000);最终实际全切67例,次全切25例,大部切除14例,全切率有所提高.106例患者平均肿瘤体积切除百分比由第一次扫描时的(86.3±20.2)%提高到最终扫描时的(93.6±12.4)%,差异有统计学意义(U=4.000,p=0.000).结论 高场强iMRI的应用可显著提高脑胶质瘤的切除程度,改进手术策略.

Abstract：

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

亚低温对急性肺损伤大鼠高迁移率族蛋白1表达的影响

目的 观察亚低温对急性肺损伤(ALI)大鼠肺组织高迁移率族蛋白1(HMGB1)及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)表达的影响.方法 将24只雄性SD大鼠采用随机数字表法分为生理盐水组、ALI组和亚低温治疗组,每组8只.ALI组、亚低温治疗组分别给予内毒素(LPS)5 mg/kg尾静脉注射;亚低温治疗组同时采用体表降温法使大鼠肛温维持在(33.0±1.0)℃,持续4 h.观察12 h后各组大鼠肺组织病理,测定肺湿干质量比(W/D)、PaO2,并采用逆转录-PCR反应检测肺组织HMGB1 mRNA的表达,ELISA法测定血清TNF-α、IL-10浓度.结果 ①ALI组TNF-α浓度显著高于生理盐水组和亚低温治疗组(P<0.01);ALI组IL-10浓度显著高于生理盐水组(P<0.01),但低于亚低温治疗组(P<0.05).②ALI组HMGB1 mRNA的表达水平显著高于生理盐水组和亚低温治疗组(P<0.01).③ALI组肺组织出现充血、水肿、中性粒细胞浸润,亚低温治疗组肺部炎症较ALI组减轻.结论 亚低温可能通过抑制HMGB1 mRNA、TNF-α的表达,并上调抗炎介质IL-10的表达,从而减轻内毒素性大鼠肺损伤.     

急性有机磷农药中毒对胆碱酯酶和多巴胺水平的影响

目的观察急性有机磷农药中毒对脑组织中多巴胺水平和胆碱酯酶活性的影响及意义。方法 20只小鼠按随机数字表法分为中毒组和对照组各10只。中毒组:敌敌畏用生理盐水配成溶液,按10 mg/kg腹腔注射诱发小鼠中毒;对照组给予等量生理盐水腹腔注射。分别在中毒组中毒后及对照组腹腔注射后的1 h、24 h、48 h、72 h和120 h测定乙酰胆碱酯酶(AchE)活性及多巴胺水平,每个时间点取2只小鼠进行测定。结果对照组在不同时间点血AchE活性、脑组织AchE活性均较中毒组高(P0.05)。对照组1 h、24 h脑组织多巴胺活性较中毒组高(P0.05);对照组72 h、120 h脑组织多巴胺活性较中毒组低(P0.05);两组48 h脑组织多巴胺水平比较,差异无统计学意义(P0.05)。结论有机磷农药中毒不但引起乙酰胆碱在脑组织蓄积,也可引起多巴胺水平异常增高,脑神经递质含量变化可能是导致中毒性精神障碍的原因。     

创伤性膈疝诊治分析

随着现代交通运输工农业的高速发展,意外事故不断出现,特别是胸腹部联合伤患者尤其突出,造成膈肌破裂,创伤性膈疝的发病率有明显上升趋势.因胸腹部挤压伤致膈肌破裂或因其它暴力致膈肌破裂使腹腔脏器疝入胸腔的胸部外科和腹部外科联合性疾病.创伤性膈肌破裂是胸外科严重急症之一,经常同时存在呼吸系统、循环系统、消化道系统症状,患者发病急,需行急诊手术.这就要求术者具备熟练、精湛的操作技术和负责的态度,力求尽快改善呼吸循环功能,方能挽救患者生命.河北省秦皇岛市第二医院于1986至2010年共收治20例创伤性膈疝,报告如下.     

中药介入化疗序贯法分期治疗晚期肺癌2例经验

肺癌（1ungcancer）是最常见的肺原发性恶性肿瘤,绝大多数肺癌起源于支气管黏膜上皮,故亦称支气管肺癌。在临床中,笔者采用中药介入化疗序贯法（肺癌介入术＋中药＋对症支持治疗）分期治疗晚期肺癌,取得了较好效果,现介绍如下。     

直肠癌根治术后复发转移特点及危险因素分析

目的 研究直肠癌根治术后复发转移特点及其相关危险因素,为术后随访监测、防治复发转移提供依据.方法 回顾性研究中国医学科学院肿瘤医院1999年1月至2004年12月内初次根治手术治疗的1039例直肠癌病例资料,分析术后复发转移的特点及危险因素.结果 随访期间发生复发344例,占33.2％;常见的复发形式依次是局部复发（13.6％）、肝转移（6.9％）、肺转移（6.0％）.单因素分析显示：围手术期输血、病理大体类型、肿瘤大小、肿瘤位置、脉管瘤栓、癌结节、分化程度、T分期、N分期、M分期是复发转移的相关因素（P＜0.05）.多因素分析显示：术前CEA、肿瘤位置、脉管瘤栓、瘤结节、T分期、N分期是复发转移的独立危险因素（P＜0.05）.结论 直肠癌术后存在好发复发转移部位和与复发转移相关的独立危险因素;术后辅助放化疗等多学科综合治疗是降低直肠癌术后复发转移、延长生存期的有效手段.     

合溪水库工程对血吸虫病传播的影响及预防控制对策研究

目的 观察合溪水库建设工程对血吸虫病传播的影响,提出预防控制血吸虫病流行的对策。 方法 根据《血吸虫病防治条例》的相关规定,开展合溪水库建设工程血吸虫病卫生学评价工作。收集工程设计报告和血防历史资料,现场勘测工程涉及区域有关情况,开展螺情和病情现况调查,综合分析工程建设项目对血吸虫病流行和传播的影响,提出预防控制血吸虫病流行的措施。结果 合溪水库建设工程对血吸虫病传播具有利弊两重性,如不采取措施则会弊大于利。一方面可在局部区域内消灭钉螺以及阻止钉螺扩散;但另一方面也存在着钉螺孳生、繁殖、扩散以及传染源输入的风险,可能造成区域内血吸虫病重新传播流行。针对影响风险,在工程建设期和运行期需要趋利避害,采取应对措施,防止因工程建设导致钉螺扩散和血吸虫病重新传播流行,提高建设项目的综合效益。结论 合溪水库建设工程存在血吸虫病重新传播流行的潜在危险,应采取有效的控制措施以降低风险。     

食管癌根治术后再次气管插管的原因与对策探讨

目的 探讨食管癌根治术后患者再次气管插管的病因及预防再插管损伤的措施。方法 回顾性分析2012年1月至2013年12月收治的470例施行食管癌根治术的患者中14例术后再次气管插管的临床资料与转归。结果 再次气管插管14例,占全组患者的2.98％（14／470）;术后气管插管拔除至再次气管插管的时间间隔为0.5～360 h,中位间隔时间为50 h;其中因呼吸功能衰竭需再次气管插管10例,占71.4％（10／14）;再次气管插管后救治成功9例,成功率为64.3％（9／14）。结论 重症呼吸功能衰竭是食管癌根治术后患者再次气管插管的主要病因;预防再次气管插管以及避免其次生风险的关键在于预防各种术后并发症。