厄贝沙坦治疗高血压患者的临床效果观察

目的：观察厄贝沙坦治疗高血压患者的临床效果。方法：选择2007年1月～2009年1月来本院就诊的高血压患者200例，随机分为两组，厄贝沙坦组100例，采用厄贝沙坦治疗4周；对照组100例采用依那普利治疗，观察患者用药前后动态血压、心脏功能变化，并评价临床疗效。结果：厄贝沙坦组患者治疗总有效率为97％，均未出现明显不良反应：与对照组比较．差异有统计学意义，P〈0．05。厄贝沙坦组治疗后24h、白昼和夜间平均收缩压和舒张压与治疗前比较，差异有统计学意义，P〈0．05；用药后血压晨峰也显著降低，与治疗前比较，差异有统计学意义，P〈0．05：但与对照组间比较，差异无统计学意义，P〉0．05。结论：厄贝沙坦治疗高血压疗效满意，安全性较高，还可降低患者的心脑血管意外的风险。     

应用前列腺素E1注射治疗勃起功能障碍8年经验

目的观察前列腺素E1(PGE1)注射治疗勃起功能障碍(ED)的长期疗效、副作用及预后。方法使用PGE1行阴茎海绵体注射,阴茎硬度检查仪(Rigiscan)连续记录1h,并根据观察结果,调查PGE1注射剂量,确定每例患者合适的注射量,掌握注射方法后回家自行注射。共筛选出ED患者410例,随访患者阴茎勃起情况、药量调整和副作用。结果410例ED患者中,心理性139例,静脉性83例,动脉性36例,神经性78例,混合性74例。对治疗满意的患者有256例(62.44%),其中21例(5.1%)在使用PGE15次后停用,并能达到满意的性生活而治愈。293例(71.46%)患者自述注射时有胀痛感。171例(43.17%)因疼痛(105例)、操作不便(25例)、副作用顾虑(37例)和其他原因(4例)而于6个月后放弃治疗。204例(49.76%)患者使用时间已超过1年,24例(5.85%)患者使用时间已超过5年,7例(1.7%)使用已有8年。未发现阴茎异常勃起和阴茎海绵体纤维化。注射损伤阴茎表面血管致瘀斑者有20例。有27例患者失访。结论PGE1是治疗ED的一种安全有效的药物,可以长期使用。其最常见的副作用是阴茎疼痛。Rigiscan能帮助确定PGE1的注射剂量。     

磁共振尿路成像诊断肾移植输尿管坏死

目的:探讨磁共振尿路成像(MRU)诊断肾移植输尿管坏死的价值。材料和方法:12例肾移植术后怀疑输尿管坏死患者,临床表现为移植肾区肿痛、少尿或无尿,B超提示移植肾盂积水,输尿管扩张,移植肾周积液,用重T2WI快速自旋回波序列和脂肪抑制技术行MRU检查。结果:MRU均显示移植肾盂及肾盏扩张,输尿管上段扩张,重T2WI表现为高信号。输尿管连续性消失,其下方为局限性包裹液性区。在渗出的包裹性尿液邻近或下方可见高信号的膀胱影。12例患者均接受手术探查,术中均发现输尿管有坏死,坏死部位与MRU显示输尿管连续性消失部位一致,输尿管坏死下方可见渗出的尿液,与MRU所见局限性包裹液性区相吻合。结论:MRU诊断肾移植后输尿管坏死具有极高诊断价值。     

后腹腔镜治疗肾上腺肿瘤35例临床分析

目的总结后腹腔镜技术治疗肾上腺肿瘤的临床经验.方法采用后腹腔镜切除肾上腺肿瘤35例,男12例,女23例.年龄25岁～72岁,平均49.8岁.左侧15例,右侧20例.其中嗜铬细胞瘤5例,原发性醛固酮增多症10,柯兴氏病2例,神经节细胞瘤2例,无功能性腺瘤16例.腰部取3个套管针穿刺入路,用自制的水囊扩张器扩张后腹腔,用超声刀将肿瘤切除.结果 35例手术均成功,无中转开放手术病例.术中出血量10～500 ml,平均74 ml.病人均未输血.手术时间45～200 min,平均90 min.结论后腹腔镜手术切除肾上腺肿瘤手术效果确切,手术时间短,术中出血少,损伤小,术后恢复快,可以替代绝大多数肾上腺肿瘤开放手术.     

Pituitary adenomas: Trans‐sphenoidal experience of 300 cases

Objective: The main aim of the present study was to examine the effectiveness and complication rate of the 1 cm right‐sided unilateral sublabial trans‐sphenoidal surgery for patients with pituitary adenoma equal to or greater than 5 mm in diameter. Method: A total of 350 patients were surgically treated for pituitary adenomas between December 1999 and December 2003 in an academic neurosurgical unit in China. Three hundred patients (86%) were treated with the 1‐cm right‐sided unilateral sublabial trans‐sphenoidal approach. The mean age of patients was 43 years (range 10–78 years) and female patients accounted for 59% of the total. One hundred and ninety‐six (64%) patients had functioning endocrine tumours and 104 (36%) patients had non‐functioning tumours or macroadenomas. Tumours which were outside this simple and basic classification were excluded from the study. Results: There were no operative mortalities. One patient developed hypopituitarism and 16 (5%) developed transient diabetes insipidus that required pituitrin treatment. The remission rate for macroadenoma was 85% and that for microadenoma was 98.5% during a medium term follow‐up of 1–5 years. One hundred and fifteen patients had prolactin secreting tumours and 90.4% achieved endocrine remission. Fifty‐six patients had growth hormone secreting tumours and 75.4% achieved endocrine remission. Preoperatively, one hundred and fifty‐one patients presented with visual impairment and 148 (98%) achieved a documented improvement in visual acuity. The mean duration of hospital stay was 4 days (range 3–7 days). Conclusion: This minimally invasive trans‐sphenoidal surgery for pituitary adenomas could be used as the primary treatment for small pituitary tumours. The effectiveness of the tumour removal and low morbidity rate compare favourably with the conventional sublabial approach as well as the more recently developed endoscopic endonasal approaches.     

A female case with Down syndrome and non-neurogenic neurogenic bladder

Although the prevalence of a learned voiding dysfunction and non-neurogenic neurogenic bladder (NNB), which is one type of dysfunctional elimination syndrome, is considered to be relatively rare, the association of NNB with Down syndrome (DS) has been elucidated in male patients. We herein describe the occurrence of NNB in an adult female with DS. The diagnosis was confirmed after completely ruling out any neurological or anatomical anomalies that could be related to a lower urinary tract dysfunction. She had renal dysfunction and multiple obstructive uropathies for which clean intermittent catheterization was successfully introduced.     

Liver and lung resection for colorectal metastasis

Aim: To examine the survival benefit of liver and lung resection for colorectal metastasis and the potential prognostic factors that affect patient survival. Methods: All patients who had resection of lung or liver metastasis for colorectal metastasis in Queen Elizabeth Hospital, Hong Kong from 1995 to 2004 were retrospectively reviewed. The overall and disease‐free survival was analysed, in particularly between liver and lung metastasis. All factors that may have affected the survival were entered into Cox's proportional hazards regression model to identify significant variables associated with survival. Results: At 5 years, the overall survival of patients who had resection of lung and liver metastasis was 44% and 38%, respectively; the disease‐free survival was 26% and 24%, respectively. Overall and disease‐free survival of patients with resection of lung metastasis was comparable to those with resection of liver metastasis. The differentiations of primary tumour and time to metastasis were shown to be significant prognostic factors influencing overall survival. Those patients with systemic chemotherapy after resection of colorectal metastasis demonstrated a significantly higher probability of overall survival. Conclusion: Resection of lung and liver metastases from colorectal origin was safe and both procedures improved survival. The use of chemotherapy after resection of metastasis significantly improved the overall survival.     

股骨转子间骨折微创内固定术的临床分析

目的回顾分析股骨转子间骨折微创内固定术以提高其临床疗效.方法回顾分析C形臂X线光机透视下闭合复位,经皮动力髋螺钉(DHS)内固定术治疗股骨转子间骨折109例,男68例,女41例;年龄42～92岁,平均67.5岁.结果切口长度平均5.1cm;出血量平均49.5ml;手术时间平均38分钟;骨折全部愈合,临床愈合时间58～82天,平均66.5天;2例改切开复位内固定术;2例切口形成血肿;2例术中股骨颈后壁磨穿;1例因过度内旋固定致髋关节外旋受限;其余108例髋关节功能均正常.3例套筒钢板与股骨纵轴不一致;2例股外侧肌医源性损伤.X线评价:5例粗隆上移0.8～1.5cm;109例中未见髋内翻、髋螺钉切割、拔出或穿透股骨头.结论经皮DHS内固定术,是目前治疗股骨转子间骨折新的理想的微创治疗技术.严格掌握手术适应症,正确的手术操作,适时进行康复锻炼是治疗成功的关键,但微创手术内固定器械尚有待改进.