CT扫描肝细胞癌边缘肿瘤血管与肿瘤转移和预后的关系

目的　研究肝细胞癌 (HCC)边缘肿瘤血管和肿瘤发生转移的关系 ,探讨从CT预测HCC发生转移潜在可能性。方法　13 4例经手术病理证实的HCC患者 ,术前全部进行CT常规扫描和动态增强扫描。对肿瘤及瘤周组织血管计数。将CT表现与病理结果以及病人随访情况进行比较分析。结果　 (1)肿瘤边缘重度强化组发生转移的机会明显高于轻中度强化组。 (2 )肿瘤边缘出现肿瘤血管者发生转移明显高于无肿瘤血管者。 (3 )肿瘤边缘强化程度与镜下血管计数呈正相关。结论　可以从HCC边缘肿瘤血管、增强程度来判断肿瘤是否发生潜在转移     

小儿脓胸的外科治疗

目的:探讨小儿脓胸的外科治疗.方法:78例小儿脓胸中,65例行脏层胸膜剥脱术,13例行脏层加壁层胸膜剥脱术和肺松解术.结果:本组无手术死亡和并发症,治愈率100%.结论:早期脏层胸膜剥脱术是治疗小儿脓胸理想的手术方法.     

双能量减影胸部摄片诊断肺部结节性病变的价值

目的 探讨数字化X线摄影(digital radiography．DR)中的双能量减影(dual-energy subtraction，DES)胸部摄片技术对肺部结节性病变的诊断应用价值。方法 对60例DR检查时发现肺部结节性病变的患者进行DR双能量减影胸部摄片检查，由两位影像医生把每一患者的普通DR图像与DES图像作对比分析，评价两者对肺部结节的显示情况。结果 DES图像能比普通DR图像检出更多的肺小结节，且DES图像对结节病变的显示更清楚。结论 双能量减影胸部摄片技术可以有效地去除胸廓骨组织影的遮挡影响，获得单纯的软组织图像，对DR诊断肺部结节性病变是有利的补充。     

尿视黄醇结合蛋白和N-乙酰-β葡萄糖苷酶对早产儿肾功能的评价意义

目的 分析尿视黄醇结合蛋白(RBP)、尿N-乙酰-β葡萄糖苷酶(NAG)对评价早产儿肾功能的临床意义.方法 受选新生儿89例,分为早产儿窒息组(18例)、早产儿非窒息组(25例)和足月儿对照组(46例).观察所选对象生后48h内晨尿的RBP和NAG水平,分别与尿肌酐(Cr)相比(以RBP/Cr和NAG/Cr表示);观察血肌酐和血尿素氮,以及非窒息早产儿在生后0~48h,~96h,~168h的RBP/Cr、NAG/Cr变化情况.结果 早产儿窒息组的尿RBP/Cr水平[(0.951±0.629)g/mol]高于非窒息组[(0.389±0.281)g/mol]和足月儿对照组[(0.119±0.081)g/mol],3组间比较差异有统计学意义(P<0.05);非窒息组高于足月儿对照组(P<0.05).早产儿窒息组和非窒息组的尿NAG/Cr比值均高于足月儿对照组,差异有统计学意义(P<0.05),但前两者比较差异无统计学意义(P>0.05).3组间的血肌酐和尿素氮比较差异无统计学意义(P>0.05).早产儿非窒息组尿RBP/Cr与胎龄和日龄均无线性相关(P>0.05),而NAG/Cr与胎龄呈线性负相关(r=-0.625,P<0.05),与日龄呈正相关(P<0.05).结论 尿RBP/Cr和NAG/Cr比值有助于评估早产儿肾功能,前者对窒息损害较后者敏感,后者受胎龄影响更大.

Abstract：

Objective To investigate the clinical value of urinary retinol binding protein(RBP) and N-acetyl-β-glucosaminidase(NAG) for evaluating renal function in preterm neonate.Methods 89 neonates in our NICU were selected,divided into three groups:the asphyxial preterm group (18 cases),the no-asphxial preterm group (25 cases),and the control group (46 term infants without asphyxia).All objects were detected the urinary RBP,NAG and creatinine(Cr).The levels of RBP/Cr and NAG/Cr and blood urea nitrogen(BUN),Cr were observed within 48h after birth after birth.The fluctuations of urinary RBP/Cr and NAG/Cr in no-asphxial preterm group also were observed in 0~48h,~96h,~168h after birth respectively.Results The urinary RBP/Cr levels in asphyxial preterm group [(0.951±0.629)g/mol] were higher than those in no-asphxial preterm group[(0.389±0.281)g/mol] and the control group[(0.119±0.081)g/mol](P<0.05).The urinary RBP/Cr levels in no-asphxial preterm group were also significantly higher than those in the control group(P<0.05).The levels of urinary NAG/Cr in the asphyxial and no-asphxial preterm groups were both higher than those in the control group(P<0.05),but there was no difference betwteen the former two groups(P>0.05).The levels of serum Cr and BUN were no significant difference in the three groups(P>0.05).The urinary RBP/Cr level had non-linear correlation with either postnatal or gestational age in no-asphyxial preterm group.While the urinary NAG/Cr levels negative correlated with the gestational age(r=-0.625,P<0.05).And the correlation between the urinary NAG/Cr and postnatal age was postive(P<0.05).Conclusion The determination of urinary NAG/Cr and RBP/Cr provides a sensitive and reliable method to evaluate the renal function of neonates,especially in preterm infants.The RBP/Cr is affected by asphyxia more than NAG/Cr,which is rather correlated with gestational age.     

江苏省伤寒/副伤寒流行现况、菌株耐药及其分子分型

目的 掌握江苏省伤寒/副伤寒流行现况、病原菌耐药性以及分子分型特征,以确定监测重点.方法 对2007-2011年江苏省伤寒/副伤寒疫情采用描述流行病学回顾性分析;210株伤寒/副伤寒沙门菌耐药性测定采用K-B纸片扩散法;81株伤寒沙门菌分子分型运用脉冲场凝胶电泳(PFGE).结果 近5年江苏省伤寒/副伤寒年均报告发病率为0.47/10万,呈总体下降趋势.人群年龄别发病以0岁组(1.70/10万)高发.病原谱以伤寒沙门菌为主(66.19%),其次为甲型副伤寒沙门菌(23.81%).伤寒/副伤寒沙门菌对萘啶酸耐药率最高(66.19%),对环丙沙星等6种抗生素耐药率低于10.00%,多重耐药率为30.00%.近3年伤寒沙门菌分属4个克隆群37个PFGE型,优势带型为JPPX01.JS0027(11.11%),JPPX0 1.JS0001为地区独特性菌型,JPPX01.JS0014、JPPX01.JS0018和JPPX01.JS0024为扩散性菌型.特征菌型成簇分析发现3起病例具有聚集性特征.结论 江苏省伤寒/副伤寒发病率维持在较低水平,婴儿高发.菌株对多数抗生素较敏感,但部分药物耐药性在增加.由于近年伤寒呈现高度散发状态,未出现占绝对优势的菌型,推测近期发生大规范流行的可能性较小.     

自体心包奇静脉补片肺动脉重建术在中心型肺癌治疗中的应用

目的 探讨自体心包、奇静脉移植补片肺动脉重建技术在中心型非小细胞肺癌治疗中应用的临床价值及其外科技术问题.方法 1992年3月至2009年8月,应用自体心包、奇静脉移植补片肺动脉重建技术治疗62例肺血管受侵犯的中心型非小细胞肺癌.术前行新辅助化疗2个疗程17例,术后pTNM分期:Ⅱb期4例,Ⅲa期46例,Ⅲb期12例.根据肺动脉和支气管受侵的情况,采用自体奇静脉移植补片术18例、心包移植补片术38例、制成心包管间位移植术6例,合并上腔静脉侧壁切除心包奇静脉补片成形术5例,同时行支气管袖式切除51例,肺叶切除11例.术后接受辅助化疗47例,辅助放疗19例.结果 全组术中冰冻和术后病理检查证实肺动脉及支气管切缘均无癌残留.手术死亡2例(3.2%),死因为术后支气管吻合口瘘致呼吸衰竭和术后严重心律失常、心脏骤停各1例.术后主要并发症发生率17.7%(11/62例),经对症处理后治愈.出院前或术后2～6个月经胸部X线、CT、心脏超声及气管镜检查显示2例发生支气管吻合口狭窄,经气管镜微波治疗好转,其余肺通气及血流灌注良好,无肺血管狭窄和栓塞等并发症.60例术后随访6～210个月,平均49.5个月.术后1、3、5、10年生存率分别80.2%(49/60例)、44.7%(21/47例)、31.4%(11/35例)、23.1%(3/13例).结论 自体心包、奇静脉移植补片肺动脉重建技术,可安全、有效地用于治疗肺动脉侧壁切除后缺损较大的中心型肺癌病人;制成心包管间位移植对袖式切除后肺动脉缺损过长吻合困难或失败者,是可行的肺动脉重建技术.

Abstract：

Objective To review the clinical experience of reconstruction of pulmonary artery(PA) by a pateh of autologus pericardium or azygous venae for non-small cell lung cancer. Methods Between March 1992 and August 2009, 62 patients with locally advanced central lung cancer received sleeve resection and reconstruction of PA. According to PTNM classification, 4 patients were in stage Ⅱb, 46 in stage Ⅲa and 12 in stage Ⅲb. 17 patients had induction chemothoerapy. Sleeve lotrate the PA, the surgical procedures included partial PA tangential resections and reconstructions by a pateh of autologous azygous venas in 18 cases , a patch of autologous pericardium in 38 cases and a complete PA sleeve resection reconstructios by a custom-made autologous pericardial conduit interposition in 6 cases. Partial superior vena cava tangential resctions and reconstructions were performed in 5 patients by a patch of autologous pericardium or azygous venae. 47 patients received pstoperative chemotherapy and 19 had radiotherapy. Results There was 2 early postoperative deaths(3.2%). The cause of death was bronchial anastomotic leak led to respiratory failure in 1 case and severe arrhmia led to heart arrest in 1. No cancerous tissue of all resection margins are checked by frzen section histology and examination of resection specimens in the surgical pathology laboratory. The postoperative complications occurred in 11 patients(17.7%) and all of them recovered uneventfully.Roentgenography, flexible bronchoscopy and echocardiography were in normal range in the remaining 60 patients with no bronchial anastomosis stenosis or vascular thombosis before discharge and at 2-6 months after surgery. The mean follow up time was 49.5 months (6-210 months). The overall 1, 3, 5 and 10 yerr survival rates were 80.2%, 44.7% ,31.4% and 23. 1%, respectively. Conclusion Reonstruction of PA by autologous pericardial patch or autologous azygos vein patch is a safe and effective technique for locally advanced lung cancer.For extended circumferential defects of PA,the autologous pericardial conduit interposition could bue used for reconstruction.     

275例右胸小切口在心内直视手术中的应用

目的总结右胸小切口微创技术在先天性心脏病心内直视手术中应用的效果。方法 2000年1月～2011年12月,我科室应用右胸小切口完成各类先天性心脏病的心内直视手术共275例,其中175例在常规体外循环下完成,另外100例在浅低温心脏不停跳体外循环下完成。随机选择同期常规手术(胸正中切口+常规体外循环)患者80例作为对照。结果右胸小切口患者切口长度、手术时间及术后引流量都显著低于对照组;术后呼吸机辅助时间明显低于对照组;不停跳手术组CPB时间明显低于对照组和单纯右胸小切口组;术后监护时间各组间差异无统计学意义。结论右胸微创小切口是一种简洁、高效、经济的微创技术,可和不停跳技术联合应用达到双微创的手术效果。     

联合心脏瓣膜病101例外科治疗分析

目的:总结二尖瓣主动脉瓣双瓣置换术(DVR)治疗联合心脏瓣膜病的外科治疗经验.方法:2008年1月~2011年12月,我科室应用 DVR术治疗联合心脏瓣膜疾病101例,其中男46例、女55例,年龄32~63岁,体重45.2~68kg.风湿性心脏瓣膜病81例,退行性变瓣膜病变14例,感染性心内膜炎6例.NYHA心功能 II级16例,III级74例,IV级11例.结果:全组体外循环时间(107.8±34.4) min,主动脉阻断(78.5±27.2)min,术后呼吸机辅助(10.5±4.8)h,术后监护(61.2±15.5)h,术后住院(10.4±4.3)d.手术死亡6例(5.94%),各类手术并发症22例(21.78%).术后84例随访时间4~48月,11人失访.随访患者心功能都有不同程度好转,活动能力显著改善;术后2年出现左房血栓1例,脑栓塞致左侧肢体瘫痪1例,二尖瓣轻度瓣周漏1例,尚未发现死亡病例.结论:充分的术前准备,术中良好的心肌保护,主动脉瓣间断缝合、二尖瓣连续缝合、保留二尖瓣后瓣及三尖瓣环缩等外科技术的改进和加强术后处理可降低双瓣膜置换术的风险,提高疗效.     

联合心脏瓣膜病101例外科治疗及疗效分析

目的：总结二尖瓣主动脉瓣双瓣置换术（DVR）治疗联合心脏瓣膜病的外科治疗经验。方法：2008年1月-2011年12月,我科室应用DVR术治疗联合心脏瓣膜疾病101例,其中男46例、女55例,年龄32～63岁,体重45．2～68k。风湿性心脏瓣膜病81例,退行性变瓣膜病变14例,感染性心内膜炎6例。NYHA心功能Ⅱ级16例,Ⅲ级74例,Ⅳ级11例。结果：全组体外循环时间（107．8±34．4）min,主动脉阻断（78．5±27．2）rain,术后呼吸机辅助（10．5±4．8）h,术后监护（61．2-．I-15．5）h,术后住院（10．4±4．3）d。手术死亡6例（5．94％）,各类手术并发症22例（21．78％）。术后84例随访时间4—48月,11人失访。随访患者心功能都有不同程度好转,活动能力显著改善;术后2年出现左房血栓1例,脑栓塞致左侧肢体瘫痪1例,二尖瓣轻度瓣周漏1例,尚未发现死亡病例。结论：充分的术前准备,术中良好的心肌保护,主动脉瓣间断缝合、二尖瓣连续缝合、保留二尖瓣后瓣及三尖瓣环缩等外科技术的改进和加强术后处理可降低双瓣膜置换术的风险,提高疗效。