肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

急性心肌梗死患者的护理体会

目的 探讨急性心肌梗死患者的护理方法与要点.方法 通过对33例急性心肌梗死患者的护理,总结护理干预的重要性.结果 本组33例患者中,治愈12例,占36.4%,好转19例,占57.6%,死亡3例,占6%.结论 治疗急性心肌梗死患者,细致和精心的护理对于抢救急性心肌梗死患者的生命有极其重要的作用.     

局麻下无张力疝修补术42例

目的总结局麻下进行疝环充填式无张力疝修补术治疗腹外疝的可行性及其优越性。方法采用意大利"赫美"疝环充填物及网状补片加强后壁对42例腹外疝在局麻下进行无张力疝修补术,观察手术时间、术后疼痛、并发症、复发率。结果本组病例手术时间35~80 min,平均55 min,下床活动时间为6~24 h,术后仅有1例需应用止痛药,术后未出现尿潴留、伤口感染及阴囊积液等并发症。全部病例治愈出院,住院时间3~7 d。随访6~48个月未见复发。结论这是一项更符合人体解剖结构和疝的病理生理的手术方法,具有传统方法无法比拟的优势。尤其适宜在基层医院推广。     

不同药物对高危型HPV持续感染及宫颈癌前病变合并高危型HPV感染的临床疗效对比研究

目的对比不同药物对高危型人乳头瘤病毒(Human papilloma vrius,HPV)持续感染及宫颈癌前病变合并高危型HPV感染的临床疗效。方法收集2018年9月至2020年1月符合入组标准的120例受试患者,按照患者意愿分配为4组。Nr-CWS组(30例)给予外用红色诺卡氏菌细胞壁骨架(Nr-CWS)阴道上药,隔日给药1次,连续给药10次;保妇康栓组(30例)给予阴道用保妇康栓3个月;干扰素组(30例)给予阴道用重组人干扰素α-2b栓3个月;空白对照组(30例)不给予处置,仅按时随访。所有的受试者均于停药后的1、4、8、12个月行HPV和TCT检测,必要时行阴道镜检查及组织病理学检查,比较各组的HPV转阴率、TCT改变、阴道镜及组织病理学改变。结果停药后1个月,Nr-CWS组的转阴率及总有效率高于保妇康栓组及空白对照组,差异具有统计学意义(P<0.05),转阴率高于干扰素组(P<0.05),但总有效率相比差异无统计学意义(P>0.05)。停药后4个月,Nr-CWS组的转阴率高于干扰素组、空白对照组(P<0.05);Nr-CWS组的总有效率高于空白对照组(P<0.05)。停药后8、12个月,Nr-CWS组的转阴率及总有效率高于空白对照组(P<0.05)。保妇康栓组和干扰素组的总有效率均高于空白对照组(P<0.05)。四组停药后的TCT、阴道镜和低级别鳞状上皮内病变(Low-grade squamous intraepithelial lesion,LSIL)转归情况比较,差异均无统计学意义(P>0.05)。结论外用Nr-CWS、保妇康栓和重组人干扰素α-2b栓在治疗高危型HPV感染上均有显著疗效,外用Nr-CWS在一定程度上优于传统的保妇康栓和重组人干扰素α-2b栓。     

GGF、PCNA与垂体瘤侵袭性关系探讨

目的：探讨胶质生长因子（GGF）、增殖细胞核抗原（PCNA）与人垂体腺瘤侵袭性生长的关系。对垂体瘤生长的生化机制作进一步探讨,并对术后生长作预测。方法：免疫组织化学方法分析GGF、PCNA在147例垂体瘤中的表达,分析GGF、PCNA的表达与垂体腺瘤侵袭性关系。用GGF干预垂体瘤细胞,观察细胞生长、细胞周期变化情况。结果：GGF、PCNA在多数侵袭性垂体瘤阳性表达,侵袭性垂体腺瘤中GGF表达显著大于非侵袭性腺瘤（P〈0.05）;复发组GGF、PCNA表达明显高于非复发组（P〈0.05）。结论：GGF可以明显促进垂体瘤细胞生长,与其侵袭性有重要作用。GGF、PCNA能够部分地反映垂体腺瘤细胞的增殖状态及侵袭潜能,可为临床上评价垂体腺瘤侵袭性、复发、治疗及预后提供参考。     

小网膜淋巴管瘤1例

患者,男,27岁.上腹部胀痛半个月.该患者近半月无明显诱因出现上腹部胀痛,进食及右侧卧位时加重.查体:腹部平坦,全腹软,无压痛及反跳痛,无肌紧张.超声所见:胰腺前上方可见多个大小不一聚集的囊性无回声团块,境界清楚.超声提示:胰腺囊肿.CT表现:肝胃之间小网膜囊内见多个囊性病灶,大小不一,紧密聚集,直径约6.5 cm×5.6 cm×4.5 cm,境界清晰,边缘光滑锐利,壁薄,肿块密度均匀,CT值20 HU,增强扫描后病灶无强化(图1).CT诊断:胰腺假囊肿可能.术后病理诊断:海绵状淋巴管瘤(图2).     

颅内未破裂动脉瘤Pipeline栓塞装置置入术后支架内狭窄的危险因素

目的 探讨颅内未破裂动脉瘤（UIA）Pipeline栓塞装置（PED）置入术后内支架狭窄（ISS）的发生率、临床预后和危险因素。方法 回顾性分析2015年9月至2020年10月接受PED治疗的460例UIA的临床资料。术后6个月复查DSA评估ISS，以PED内的管腔直径较术前缩窄超过50%定义为ISS。结果 术后中位随访时间8个月（IQR:5～16个月）。在随访过程中，66例（14.3%）出现ISS，其中17例（3.7%）出现载瘤动脉闭塞。末次随访，8例ISS有所恢复，31例为轻度ISS,10例为重度ISS,17例载瘤动脉闭塞；3例出现偏瘫，1例单侧视野缺损，1例死亡，其余61例无症状；56例（84.8%）颅内动脉瘤完全闭塞。多因素logistic回归分析显示，后循环动脉瘤（OR=2.895;95%CI 1.731～4.839;P=0.001）、球囊扩张（OR=2.380;95%CI 1.154～4.912;P=0.019）是UIA病人PED置入术后发生ISS的独立危险因素。结论 ISS是UIA病人PED置入术后常见的并发症，后循环动脉瘤和球囊扩张术治疗的病人更易发生ISS。     

大剂量DDP化疗不完全水化的肾毒性研究

在实施含大剂量DDP的肿瘤化疗方案过程中,我们采用不完全水化方案,减少病人化疗中的输液量.观察46周期含大剂量DDP的联合化疗不同水化方案的肾毒性反应,总结如下.     

小儿体外循环重症法洛四联症血液稀释对血栓弹性描记图的影响

目的 探讨小儿体外循环重症法洛四联症（TOF）根治术，两种血液稀释度对血栓弹性描记图（TEG）凝血和纤溶指标的影响。方法 20例小儿重症TOF分为两组，每组10例。采用6％羟乙基淀粉液作为血液稀释液，Ⅰ组将血液稀释至红细胞压积（Hct）0．35；Ⅱ组将血液稀释至Hct0．40。观察心肺转流前、肝素化转流后15min、鱼精蛋白拮抗后15min、术后24小时TEG各项凝血指标变化。结果 两组TEG术前R、K、a、MA、CL30、CI正常范围。肝素化转流后各项指标稀释显著（P〈0．01）。鱼精蛋白拮抗后15min，Ⅰ组TEG各项指标基本在正常范围。Ⅱ组R、MA、CI偏离正常范围。术后24h，I组CI综合凝血指数在正常范围。Ⅱ组R、CI仍偏离正常（P〈0．05）。结论 小儿重症TOF将体外循环前血液稀释至Hct0．35对凝血功能的影响TEG显示是安全的。     

老年高血压患者的动态心电图监测与临床意义

我院1999-06～2002-02收治老年高血压102例，对其动态ECG监测总结分析如下。