无保护左主干病变治疗远期疗效的Meta分析

目的比较冠状动脉旁路移植术(CABG)和药物涂层支架(DES)在治疗无保护左主干病变(ULMCA)上的远期疗效。方法在PubMed、EMBASE和Cochrane数据库检索有关两种方法治疗ULMCA长期随访的研究文献,采用RevMan 5软件进行数据分析,主要结果为死亡、心肌梗死、脑血管事件、靶血管血运重建(TVR)、复合终点事件、主要不良心脑血管事件(MACCE)。结果纳入12篇文献,共7 824例。3年以上随访结果显示,DES组在死亡率(RR=0.86,95%CI0.67¹.10,P=0.23)、复合终点事件发生率(RR=0.86,95%CI 0.611.10,P=0.23)、复合终点事件发生率(RR=0.86,95%CI 0.61¹.21,P=0.38)与CABG组相比差异无统计学意义,但DES组TVR风险(RR=3.67,95%CI 3.081.21,P=0.38)与CABG组相比差异无统计学意义,但DES组TVR风险(RR=3.67,95%CI 3.08⁴.37,P<0.001)显著增高。亚组分析结果显示:5年随访DES组死亡风险(RR=0.74,95%CI 0.614.37,P<0.001)显著增高。亚组分析结果显示:5年随访DES组死亡风险(RR=0.74,95%CI 0.61⁰.89,P=0.001)、复合终点事件风险(RR=0.64,95%CI 0.530.89,P=0.001)、复合终点事件风险(RR=0.64,95%CI 0.53⁰.78,P<0.001)均比CABG组显著降低,但TVR风险(RR=4.20,95%CI 3.150.78,P<0.001)均比CABG组显著降低,但TVR风险(RR=4.20,95%CI 3.15⁵.60,P<0.001)仍显著增高。结论 DES与CABG在治疗ULMCA上3年以上死亡率、复合终点事件发生率相当,但DES的TVR风险较高。     

结肠黏膜尿道成形治疗复杂性超长段尿道狭窄的长期疗效

目的 观察结肠黏膜尿道成形术治疗复杂性超长段尿道狭窄的长期效果和影响因素. 方法 2000年10月至2009年9月采用结肠黏膜尿道成形治疗复杂性超长段尿道狭窄46例.年龄17 ～70岁,平均39岁.尿道狭窄段长10.0～20.0 cm,平均15.2 cm.术前有平均2.7次不成功的尿道修复史.通过定期门诊或电话随访进行术后疗效评估,包括排尿情况和尿流率检查,部分患者行尿道造影和尿道镜检查等.以不需要任何处理包括尿道扩张,能正常排尿,尿流率在正常范围内者视为手术成功. 结果 结肠黏膜重建尿道的长度为11.0～21.0 cm,平均15.4 cm.1例失访,余45例随访20～120个月,平均62个月.发生与手术相关的并发症4例(8.9％),其中3例于术后3、8和24个月发生尿道外口狭窄,1例术后29个月发生结肠黏膜新尿道与尿道近端吻合口狭窄.另2例发生与结肠黏膜尿道成形术无关的尿道狭窄. 结论 结肠黏膜尿道成形术治疗复杂性超长段尿道狭窄术后长期效果理想;影响术后效果的因素是尿道口狭窄和吻合口狭窄.     

嗜铬细胞瘤合并腹部卒中一例报告

患者,男,50岁.因脐周痛1d于2007年12月21日入普外科.有高血压病史多年,无外伤史.查体:神清,四肢末梢发绀,血压200/130 mm Hg(1 mm Hg=0.133 kPa),脉搏140次/min,律齐,心肺(一),腹平软,脐周压之有不适感,无压痛及反跳痛,未扪及肿块,肝区无叩痛,肠鸣音不亢进,移动性浊音(+).血常规检查:白细胞2 1.9×109/L,红细胞4.29×1012/L,血红蛋白133 g/L.     

肿瘤危险因素评分对非肌层浸润性膀胱肿瘤预后判断的价值（附248例报告）

目的：评价膀胱肿瘤复发及进展评分对非肌层浸润性膀胱肿瘤预后判断的价值。方法：收集自2006年7月～2010年3月于我院接受腔内治疗的248例T0和T1期膀胱肿瘤患者临床资料,记录肿瘤数量、肿瘤大小、肿瘤临床分期、病理级别、既往有无肿瘤复发及有无伴随原位癌等相关资料,以EORTC（The European Organization for Research and Treatment of Cancer）肿瘤风险评分表对患者评分,随访术后患者肿瘤复发及进展情况。结果：本组肿瘤复发危险评分为O～15分,平均（4．37±2．93）分;肿瘤进展危险得分为0～23分。平均（5．21±3．95）分。随访3～60个月,平均（25．8±18．5）个月,共有123例（49．6％）肿瘤复发,平均（11．4±6．5）个月。87例（70．7％）于1年内肿瘤复发,36例（29．3％）复发超过1年。24例（19．5％）肿瘤进展[平均（9．8±6．2）个月]。复发评分0～2分者肿瘤复发不足20％,进展评分0～2分者肿瘤无进展。3分者肿瘤进展率为6．1％。肿瘤数量是肿瘤复发与进展的首要危险因素,相对危险度分别为2．229和5．246。结论：肿瘤复发及进展评分可简便准确地判断非肌层浸润性膀胱肿瘤患者预后,但仍有修改与完善的必要。     

吡柔比星灌注预防复发性膀胱癌术后复发的疗效观察

吡柔比星(THP)是阿霉素衍生物的新一代蒽环类抗肿瘤药物.我科自1998年7月～2002年6月对54例复发性膀胱癌术后应用THP进行膀胱灌注,并将该组患者与同期采用其他药物灌注膀胱者进行比较,探讨预防和治疗膀胱癌的最佳方案.     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

血及尿DKK3在造影剂所致急性肾损伤中的预测价值

目的:探讨外周血及尿液中Dickkopf相关蛋白3(DKK3)对冠脉造影术后造影剂诱导的急性肾损伤(CI-AKI)的预测价值。方法:纳入2019年8月至2021年8月在东南大学附属中大医院行冠脉造影和经皮冠脉介入治疗(PCI)的患者466例,根据患者冠脉造影前后的血肌酐水平评估患者是否发生CI-AKI。采用ELISA法检测患者血及尿液中DKK3含量,单因素及多因素Logistic回归分析筛选CI-AKI的危险因素,受试者工作特征(ROC)曲线评估DDK3对CI-AKI的诊断价值。结果:466例患者中共有35例发生CI-AKI,发生率为7.5%。CI-AKI患者血DDK3和尿DKK3/尿肌酐值均高于非CI-AKI患者(均P<0.05)。Logistic回归分析结果显示尿DKK3/尿肌酐值是CI-AKI的独立危险因素(OR=3.24, 95%CI 2.61～4.92)。ROC曲线分析显示尿DKK3/尿肌酐值预测CI-AKI的曲线下面积(AUC)是0.659(95%CI 0.544～0.775,P=0.002)。结论:CI-AKI患者血DKK3和尿DKK3/尿肌酐值较未发生CI-AKI...     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

斑蝥素半乳糖化脂质体冷冻干燥工艺及性质研究

目的制备斑蝥素半乳糖化脂质体(Lac-CTD-Lips)冻干粉,并对其理化性质进行考察。方法利用冷冻干燥法制备Lac-CTD-Lips冻干粉,以粒径、外观、复溶时间及复溶后外观为指标,采用单因素试验筛选冻干处方最佳工艺,考察冻干前后脂质体的形态学变化、粒径、p H值及包封率。结果采用内外加法,冻干保护剂的质量浓度为20%,甘露醇-海藻糖比为3∶2,以速冻的方式,于-50℃冻干机冷阱预冻,冷冻干燥24 h,可获得较满意的冻干粉。与冻干前比较,冻干后脂质体形态未发生明显变化;冻干前后脂质体的粒径分别为(211.6±0.05)nm、(233.2±0.12)nm,Zeta电位分别为(0.08±0.01)m V、(-3.30±0.21)m V,包封率分别为(86.11±0.64)%、(84.20±0.15)%。结论 Lac-CTD-Lips冻干工艺稳定、可行,可为其进一步研究奠定基础。     

急性心肌梗死严重三支病变合并室性电风暴一例

严重的三支冠状动脉疾病在冠心病中较为常见,可引起慢性心力衰竭和室性心律失常.当急性心肌梗死(AMI)伴有室性电风暴(YES)时,治疗变得相当困难.本文作者报道1例AMI严重三支病变合并VES的病例,并结合文献进行讨论,可为VES临床诊疗提供一定的经验借鉴.