补肾益气养血方联合激素替代疗法治疗卵巢早衰临床研究

目的:探讨补肾益气养血方联合激素替代疗法治疗卵巢早衰(POF)脾肾阳虚证的疗效。方法:将POF患者124例按随机数字表法分为对照组和观察组,每组62例。对照组口服戊酸雌二醇片,最后10天加黄体酮胶丸。观察组在对照组基础上内服补肾益气养血方。2组连续治疗6周。比较2组脾肾阳虚证症状评分、Kupperman评分及临床疗效。检测2组血清雌二醇(E_2)、卵泡刺激素(FSH)、黄体生成素(LH)水平。结果:观察组患者的脾肾阳虚证症状(腰膝酸软、畏寒肢冷、夜尿多、食欲不振、面色萎黄、性欲淡漠、精神倦怠)评分显著低于对照组(P 0.01)。治疗后3周和6周,观察组患者的Kupperman评分显著低于对照组同期(P 0.01)。观察组的临床总有效率为88.71%,显著高于对照组(72.58%)(P 0.05)。与对照组比较,观察组治疗后患者血清E_2水平显著升高,FSH和LH水平明显减少(P 0.01)。结论:补肾益气养血方联合激素替代疗法治疗POF,可明显改善患者的脾肾阳虚证症状积分和临床症状,提高临床疗效,调节患者体内激素水平。     

正常人各方位视网膜神经纤维层厚度值的测量

【目的】应用光学相干断层成像术(OCT)测量我国正常人视网膜神经纤维层(RNFL)各钟点范围厚度值和平均值;分析RNFL各钟点范围厚度值之间的差异及其与年龄、性别、眼别之间的关系。【方法】用OCT对104例(183眼)正常人进行以视乳头为中心的环行扫描,扫描直径3.46mm,记录平均和各个钟点范围的RNFL厚度值并分析其与年龄、性别和眼别的关系。【结果】正常人以1030～、1130～、1230～、130～、230～、330～、430～、530～、630～、730～、830～、930～12个钟点范围测量的RNFL厚度(μm)分别为144±14、141±16、135±12、104±17、78±15、90±18、130±16、147±17、145±13、92±16、80±11、103±10,而全周平均RNFL厚度值则为（116±5）μm。颞上(1030～1230)、颞下(530～730)和平均RNFL厚度均与年龄呈负相关(P值为0.005～0.000)。不同性别各钟点范围及平均RNFL厚度均数的比较,差异无显著性(P值为0.356～0.781)。正常人左、右眼各钟点范围及平均RNFL厚度之间差异亦无显著性(P值为0.155～0.612)。【结论】正常人各钟点范围RNFL厚度以颞上(1030～1230)和颞下(530～730)最厚,鼻侧(230～)和颞侧(830～)最薄;RNFL厚度随年龄的增加而变薄;各钟点范围RNFL厚度值与性别和眼别无关。     

腹腔镜联合胆道镜治疗胆管结石的临床疗效

目的 探讨腹腔镜联合胆道镜治疗胆管结石的临床疗效。方法 选取2018年3月至2020年3月于本院普外科接受治疗的70例胆管结石患者作为研究对象,采用随机数字表法分为两组,各35例。对照组采用传统开腹手术治疗,研究组采用腹腔镜联合胆道镜治疗,比较两组临床疗效、手术相关指标及术后并发症发生情况。结果 研究组手术时间、住院时间及肠道功能恢复时间均明显短于对照组,且术中出血量明显少于对照组,差异有统计学意义（P<0.05）。研究组术后并发症发生率为8.57%,显著低于对照组的42.86%,差异有统计学意义（P<0.05）。研究组治疗总有效率为97.14%,显著高于对照组的77.14%,差异有统计学意义（P<0.05）。结论 腹腔镜联合胆道镜治疗胆管结石效果显著,可缩短手术时间、住院时间、胃肠道恢复时间,减少术中出血量,且并发症较少,安全性较高,值得临床推广应用。     

外伤性后颅窝硬膜外血肿22例分析

本院自1996年1月至2006年12月共收治外伤性后颅窝硬膜外血肿22例，分析如下。     

城镇母乳喂养状况及影响因素分析

随机抽取３２７名６～８月儿童及其父母，采用人户问卷回顾性调查，调查其家庭、孕妇孕产、哺喂及健康教育情况及儿童体格发育情况五个方面５０余项指标，结果表明：完全母乳喂养组儿童营养指数（ｐｅｌｄｉｓｉ指数）优于非完全母乳喂养组（Ｐ〈０．０１），其患感冒次数与患腹泻病次数均少于完全母乳喂养儿童（Ｐ〈０．０５及Ｐ〈０．０１）。提出有利于母乳喂养的六个因素。     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

肝脏局灶性嗜酸性粒细胞浸润与转移瘤的CT影像表现

目的比较肝脏局灶性嗜酸性粒细胞浸润（FEI）与转移瘤（HMs）的CT影像特征。方法回顾性分析25例临床诊断为肝脏FEI及30例肝脏HMs患者的临床及CT影像资料,比较两组病灶数目、大小、分布、形态、密度、三期强化特点及特征表现,采用秩和检验或t检验分析两者差异。结果共发现136个病灶,其中FEI 84个、HMs 52个,所有病灶边界均不清晰。肝脏FEI平扫表现为稍低或等密度,低密度占77.4%,直径5~59 mm,85.7%病灶分布于肝包膜下或门静脉周围肝实质,89.3%病灶形态为楔形和不规则形;三期增强扫描,呈均质渐进性强化,绝大部分病灶门静脉期显示最清晰,可见“门脉穿行征”、平衡期“病灶缩小征”。肝脏HMs病灶绝大部分平扫表现为低密度,约占90.4%,直径8~65 mm,67.3%病灶分布于肝脏包膜下,部分分布于深部肝实质,96.2%病灶形态为圆形或类圆形;增强扫描,82.7%病灶表现为不均质强化,边缘环形强化是其特征,其中61.5%病灶可以呈“牛眼征”,其余病灶呈均质强化。结论肝脏FEI可出现“渐进性强化”、“门静脉穿行征”、平衡期“病灶缩小征”等特征;肝脏HMs多有明确原发病灶病史,边缘环形强化,特别是“牛眼征”。这些特征对鉴别肝脏FEI与HMs有重要意义。     

复方乳酸杆菌治疗幽门螺杆菌临床疗效观察

目的 探讨用微生物制剂治疗幽门螺旋杆菌(HP)的效果。方法 选取我院检测幽门螺旋杆菌阳性病人160例,随机分成两组。治疗组用复方乳酸杆菌联合替普瑞酮治疗一个月。对照组用常规质子泵抑制剂(PPI)方案治疗7 d。疗程结束后分别行胃镜病理活检及14C呼气试验检测HP,比较两组治疗方案的HP根除率。结果 治疗组根除率87.75%,对照组根除率76.92%,两组比较差异无显著性,P＞0.05。结论 微生物制剂治疗幽门螺旋杆菌感染方面的作用与抗菌药相似,可进一步扩大总结与应用。