晚期肾母细胞瘤的术前治疗

目的　探讨晚期肾母细胞瘤术前治疗的必要性 ,并分析术前全身化疗和肾动脉化疗栓塞合并全身化疗的治疗效果。方法　 30例Ⅲ、Ⅳ期肾母细胞瘤分为 2组 :①未术前治疗组 11例 ;②术前治疗组 19例 (又分为全身化疗亚组 6例和肾动脉化疗栓塞合并全身化疗亚组 13例 )。结果　未术前治疗组手术死亡率 18.2 % (2 /11) ,肿瘤完整切除率 9.1% (1/11) ,2年无瘤生存率 9.1% (1/11)。术前治疗组手术死亡率 0 % (0 /19) ,肿瘤完整切除率 6 3.2 % (12 /19) ,2年无瘤生存率 73.7% (14 /19)。肿瘤完整切除率比较和 2年无瘤生存率比较差异均有高度显著性意义 (<0 .0 1)。术前治疗组中 ,肾动脉化疗栓塞合并全身化疗亚组完整切除率和 2年无瘤生存率均高于全身化疗亚组。结论　术前治疗可明显提高Ⅲ、Ⅳ期肾母细胞瘤的完整切除率和 2年无瘤生存率。术前肾动脉化疗栓塞与全身用药化疗并用疗效更好。     

Risk factors for wound infection after cholecystectomy.

BACKGROUND AND PURPOSE: Surgical site infection (SSI) after cholecystectomy is a common problem. The aim of this study was to identify the possible risk factors for the development of SSI. METHODS: 545 consecutive patients who received open (125) or laparoscopic (420) cholecystectomy due to gallbladder disease during the years 1998 to 2000 were included in the study. Potential risk factors including clinical features, biochemical data, and operative types were analyzed by univariate and multivariate analysis. RESULTS: The overall incidence of SSI was 4.4% (24/545). The wound complication rate was significantly lower in the laparoscopic group than in the open group (1.4% vs 14.4%, respectively). Factors associated with SSI found by univariate analysis (p < 0.05) included age, gender, acute cholecystitis, white blood cell count, serum albumin, blood glucose and bilirubin level, type of surgery, operative time and positive bile culture. Stepwise logistic regression analysis showed that abnormal blood glucose [odds ratio (OR), 4.7; 95% confidence interval (CI), 1.6 to 13.5], positive bile culture (OR, 3.5; 95% CI, 1.2 to 10.4), and open cholecystectomy (OR, 4.3; 95% CI, 1.3 to 13.6) were the most significant predictors of SSI. CONCLUSION: Poor control of diabetes mellitus before surgery, positive bile culture and open cholecystectomy significantly increased the rate of SSI. These findings indicate that better control of diabetes mellitus, and appropriate selection of surgical procedure and antibiotic regimen in the management of high-risk patients may reduce the incidence of postoperative SSI.     

Characteristics and trends in incidence of inflammatory bowel disease in Taiwanese children.

BACKGROUND AND PURPOSE: Although chronic inflammatory bowel disease (IBD) is rare in Asian children, increasing numbers of pediatric patients with chronic IBD worldwide have been noted in recent years. This study was conducted to delineate the trend in incidence and clinical patterns of childhood IBD in Taiwan. METHODS: All children admitted to National Taiwan University Hospital (NTUH) between 1979 and 2000 who met the criteria for IBD, Crohn's disease (CD), ulcerative colitis (UC), probable CD (PCD), or indeterminate colitis were included. The clinical features and outcomes were analyzed retrospectively. Incidence was calculated using cases of chronic diarrhea during the same period of time as the risk population. RESULTS: IBD was diagnosed in 17 children (9 females and 8 males, aged 2 months to 18 years) during the study period. Six (35%) of these children had UC, 9 (53%) had CD, and 2 (12%) had PCD. The cumulative incidence of CD during 1979-1995 was 0.85%, and increased to 2.6% during 1996-2000 (p < 0.001), while the incidence of UC did not change significantly between these periods (from 0.85% to 0.99%, p = 0.16). The median interval from onset to diagnosis was 7.7 months. Eighty percent of patients had moderate to severe disease activity at diagnosis. The follow-up duration ranged from less than 1 year to 20 years, with a mean of 4.3 years. Two patients were lost to follow-up. Eighty six percent of patients responded to treatment, and 80% of patients had inactive to mild disease activity when re-evaluated at the end of 2000. CONCLUSION: There has been a marked recent increase in the incidence of childhood CD in Taiwan but the rate of childhood UC has remained unchanged. Eighty percent of cases of childhood IBD responded well to treatment.     

923份住院病历抗菌药使用情况调查分析

目的：调查住院患者抗菌药使用情况，提高临床合理使用抗菌药水平。方法：抽取深圳市属某综合医院2004年4月1、4、7、10、13、16、19、22、25、28日共10d34个临床科室的所有出院病历923份，对其抗菌药使用情况进行统计分析。结果：75．1％的患者(693／923)使用了一共86种抗菌药(其中头孢菌素类27种)，其中514例患者使用了2种以上的抗菌药，34例患者使用了6种以上的抗菌药，最多者使用了17种抗菌药。手术科室抗菌药使用率和联合用药率均明显高于非手术科室。仅87例进行了微生物学检查和药敏实验。没有一例进行血药浓度监测。结论：抗菌药使用广泛，比例偏高；多凭经验用药，缺少药敏实验依据。用药方案不尽合理，存在滥用现象。     

自体血液回输在腹腔镜下宫外孕失血性休克治疗中的应用研究

目的 研究自体血液回输在腹腔镜下宫外孕失血性休克治疗中的安全性和效果。方法 选择42例宫外孕或黄体破裂，失血性休克患者行腹腔镜探查，血肿清除并止血术，随机分成两组：一组腹腔镜下直接清除血肿（A组）；另外一组在腹腔镜下清除血肿时，应用Autolog^TM Autotransfusion System（USA—made）（AA组），收集手术野和体腔内的出血、积血，处理后回输给患者。结果 AA组和A组比较，患者术中生命体征没有明显差异（P〉0．05）；但AA组较A组输血液成分、胶体，明显减少（P〈0．01）。结论 研究可以认为：自体血液回输在腹腔镜下宫外孕失血性休克治疗中的应用可节约血源且安全有效，临床上值得推广应用：     

骨缝精确标识性颅面骨三维有限元模型的建立

目的建立骨缝精确标识性颅面骨三维有限元模型，为进一步开展各种正畸一矫形力作用下的颅面部生物力学研究提供一处重要的平台。方法选择替牙晚期10岁女孩干燥头颅骨作为材料供给，要求颅面骨完整无缺损，各骨缝结构保存完好。采用丁氧膏精确定位颅面骨各相关骨缝和标志点的具体位置，螺旋CT扫描获得颅面骨各断层的二维影像，并借助ANSYS程序生成实体模型。根据骨缝标志点的三维坐标确定颅面骨各骨缝结构的空间定位，采用光滑平面简化处理骨缝接触面，骨缝宽度设定为0．2mm。网格划分，力学参数设定，最终建立起骨缝标识性颅面骨三维有限元模型。结果所建立的骨缝标识性颅面骨三维有限元模型几何形态逼真，与实体标本以及三维CT影像相比具有较高的相似性，模型共包括21480个节点和83688个单元。结论通过在干燥头颅骨上对相关骨缝结构进行精确标识，并在建模时做适当的简化处理将骨缝结构所特有的生物力学性质融入三维有限元模型中，进一步提高了所建模型的仿真程度。     

短期应用尼尔雌醇对绝经妇女生殖系统的影响

目的观察绝经后短期应用尼尔雌醇对妇女生殖系统包括阴道、宫颈、子宫及卵巢的影响。方法服药组和对照组FSH、E2水平、阴道细胞、宫颈刮片、经阴道彩色多普勒超声检查卵巢大小、子宫大小、子宫内膜厚度以及用涂片免疫组化法测定子宫内膜细胞的PCNA。结果两组血生殖激素水平均为绝经状态，服药组FSH略低于对照组（P〈0．05）：两组E2水平相仿（P〉0．05）。两组阴道上皮成熟值差异有非常显著性（P〈0．001）。两组宫颈刮片检查均正常。两组子宫体积、子宫内膜厚度、卵巢体积以及宫腔收集液中内膜细胞涂片PCNA指数差异无显著性（P〉0．05）。结论绝经妇女短期应用尼尔雌醇能促进阴道上皮生长，具有正性效应；对宫颈、子宫及内膜无明显不良增殖影响；对生殖系统是安全有效的。     

耐多药结核分支杆菌基因突变在耐药性检测中的应用

目的探讨耐多药结核病（MDR-TB）临床分离株rPOB、KatG和rpsL基因突变在耐药性检测中的应用价值。方法采用聚合酶链反应-单链构象多态性（PCR-SSCP）技术分析了54株同时耐异烟肼（INH）、利福平（RFP）、链霉素（SM）的多耐药临床分离株和45株药物敏感株的rPOB、KatG、rpsL基因突变。结果以结核分支杆菌H37RV为对照，45株药物敏感株的rPOB、rpsL基因SSCP图谱正常，其特异性为100％；KatG基因有2株图谱异常，特异性为95．6％。89株结核分支杆菌临床分离株均未发现rPOB、KatG、rpsL基因缺失，其PCR扩增产物SSCP分析结果表明：54株多耐药临床分离株中，49株rPOB基因图谱异常；32株KatG基因图谱异常；40株rpsL基因图谱异常。其敏感性分别为rPOB（90．7％）、KatG（59．3％），rpsL（74．1％）。结论结核分支杆菌耐肿、INH、SM耐药性的产生主要是由于rPOB、KatG和rpsL基因突变所致。PCR-SSCP技术有望成为结核分支杆菌耐药性检测的方法之一。     

慢性阻塞性肺疾病急性发作期血清α-羟丁酸脱氢酶变化的意义

目的 研究慢性阻塞性肺疾病（COPD）急性发作（AECOPD）时血清α-羟丁酸脱氢酶（α—HBDH）的变化及其与病情的关系。方法 测定66例AECOPD患者血清α—HBDH及其动脉血气分析，并且与59例COPD稳定期患者和34例健康对照者进行比较；研究血清α—HBDH变化与动脉血气分析指标之间的关系。结果 AECOPD组患者血清α—HBDH明显高于健康对照组和稳定期CODP患者组；血清α—HBDH与动脉血pH值和动脉血氧分压（PaO2）呈显著的负相关，相关系数分别是r=-0．654（P〈0．01），r=-0．401（P〈0．01）；血清α—HBDH与动脉血二氧化碳分压（PaCO2）呈显著的正相关，相关系数r=0．422（P〈0．01）。结论 AECOPD时血清α—HBDH明显升高；血清α-HBDH升高可能与AECOPD患者病情的严重程度有关。