223例老年腹股沟疝无张力修补术的临床经验

目的总结无张力修补术治疗老年人腹股沟疝的临床经验。方法回顾性分析223例(260例次)65岁以上老年腹股沟疝无张力修补术的临床资料,其中Ⅰ型疝75例次(28.8%),Ⅱ型58例次(22.3%),Ⅲ型97例次(37.3%),Ⅳ型30例次(11.5%)。98例病人(43.9%)合并不同程度的内科疾病。230例次(88.5%)采用局部麻醉,全麻6例次,连续硬膜外麻或腰麻24例次。主要术式有疝环充填 平片修补术168例次(67.5%)、双层网片修补术57例次(22.9%),普理灵疝装置疝修补术15例次(6.0%)。结果单侧手术平均时间40min,平均住院时间4d。术后切口疼痛30例次,术中或术后需留置导尿20例次,出现血(清)肿7例次,复发1例次,无手术死亡及切口感染病例。结论老年腹股沟疝无张力修补术是安全?可靠和有效的,建议应用局麻。提倡无张力疝修补术的"个体化"治疗原则。     

胃良性和恶性病变组织中β-半乳糖凝集素3和接骨木凝集素的表达及其临床病理意义

Objective To study the expressive levels of galectin-3(gal-3) and sambucus nigra agglutinin (SNA) and their clinicopathological significance in the benign and malignant lesions of stomach. Methods EnVisonTM immunohistochemistry for assaying gal-3 expressive level and ABC cytochemistry for determining SNA expressive level were used in conventional paraffin-embedded sections from specimens of gastric cancer(n=49), peritumoral tissues(n=20), metastastic foci of lymph nodes(n=36), and different types of benign lesions(n=80). Results The positive rates of gal-3 and SNA were significantly higher in gastric cancer tissues than those in peritumoral tissues and different types of benign lesions (P<0.05, P<0.01). The positive cases of gal-3 and/or SNA in peritumoral tissues and benign lesions showed mild- to severe-atypical hyperplasia of mucous epithelial cells. No difference was found between the primary foci and metastatic foci in gal-3 and SNA expressions (P>0.05). The positive rates of gal-3 and SNA were significantly lower in histologic grade Ⅱ, infitrating depth T1,T2 and no-metastasis of regional lymph node than those in histologic grade Ⅲ, Ⅳ, infitrating depth T3,T4 and metastasis of lymph node in gastric cancer(P<0.05). The positive rates of gal-3 and SNA were higher in lymphnede metastatic site N1 and no-metastasis of distant organs than those in lymphnede metastatic site N2, N3 and metastasis of distant organs, but no significant difference was found (P>0.05). The consistence was found between the expression of gal-3 and SNA in gastric cancer tissues (χ2=6.59,P<0.05). Conclusions The expressive levels of gal-3 and SNA may be important molecular markers of lectins for reflecting the carcinogenesis, progression and biological behaviors in gastric cancer.     

G-B-R复配物对模拟微重力效应诱导骨丢失的防护作用

目的 从天然产物中寻找到对微重力效应诱导骨丢失具有防护作用的复配物。方法 通过24种天然产物对骨髓干细胞和成骨细胞的增殖活性,筛选出具有较强效果的天然产物并对其进行复配;随后通过复配物对模拟微重力效应下昆明小鼠骨质丢失的影响来评价其骨丢失防护作用。结果银杏叶和荞麦花粉的复配物显示出最强的骨髓干细胞增殖活性;熟地黄显示出最强的成骨细胞增殖活性;在模拟微重力环境下不同剂量的银杏叶、荞麦花粉与熟地黄的复配物均显示出不同程度的骨丢失防护作用;高剂量组可以显著提高模型组小鼠血清中碱性磷酸酶的活性及股骨中的有机物含量。结论 通过对天然产物促骨髓干细胞和成骨细胞增殖活性进行筛选和复配,发现所获得的G-B-R复配物对微重力效应诱导的骨丢失具有良好的防护作用。     

胃良性和恶性病变组织中β-半乳糖凝集素3和接骨木凝集素的表达及其临床病理意义

Objective To study the expressive levels of galectin-3(gal-3) and sambucus nigra agglutinin (SNA) and their clinicopathological significance in the benign and malignant lesions of stomach. Methods EnVisonTM immunohistochemistry for assaying gal-3 expressive level and ABC cytochemistry for determining SNA expressive level were used in conventional paraffin-embedded sections from specimens of gastric cancer(n=49), peritumoral tissues(n=20), metastastic foci of lymph nodes(n=36), and different types of benign lesions(n=80). Results The positive rates of gal-3 and SNA were significantly higher in gastric cancer tissues than those in peritumoral tissues and different types of benign lesions (P<0.05, P<0.01). The positive cases of gal-3 and/or SNA in peritumoral tissues and benign lesions showed mild- to severe-atypical hyperplasia of mucous epithelial cells. No difference was found between the primary foci and metastatic foci in gal-3 and SNA expressions (P>0.05). The positive rates of gal-3 and SNA were significantly lower in histologic grade Ⅱ, infitrating depth T1,T2 and no-metastasis of regional lymph node than those in histologic grade Ⅲ, Ⅳ, infitrating depth T3,T4 and metastasis of lymph node in gastric cancer(P<0.05). The positive rates of gal-3 and SNA were higher in lymphnede metastatic site N1 and no-metastasis of distant organs than those in lymphnede metastatic site N2, N3 and metastasis of distant organs, but no significant difference was found (P>0.05). The consistence was found between the expression of gal-3 and SNA in gastric cancer tissues (χ2=6.59,P<0.05). Conclusions The expressive levels of gal-3 and SNA may be important molecular markers of lectins for reflecting the carcinogenesis, progression and biological behaviors in gastric cancer.     

腹腔热灌注化疗对患者生命体征的影响

目的探讨腹腔热灌注化疗对患者生命体征的影响,为评估该种治疗方法临床应用的安全性提供依据。方法对收治的20例恶性肿瘤患者进行腹腔热灌注化疗,治疗温度43℃,时间60 min,灌注速度500 mL/min。监测患者治疗前及治疗术中15,30,45,60 min各时点进水口、出水口及患者体表、直肠、鼓膜的温度;监测各相应时点的血压、心率、呼吸、血氧饱和度;分析该疗法对患者体生命体征的影响。结果腹腔热灌注化疗前至治疗60 min结束时患者的腋窝、鼓膜、直肠温度平均分别上升了0.9℃,0.7℃和0.9℃;治疗过程中各时点血压、心率、呼吸、血氧饱和度等数值均在正常范围内,治疗前及治疗过程中无明显变化。结论以43℃的治疗温度,500 mL/min的灌注速度进行腹腔热灌注化疗60 min,可引起体温轻微升高,但对各重要生命体征无明显影响。腹腔热灌注化疗对机体生理影响轻微,临床应用安全可靠。     

PPH加硬化注射治疗Ⅲ～Ⅳ期混合痔15例远期疗效观察

目的观察PPH加硬化剂注射治疗Ⅲ～Ⅳ期混合痔的远期疗效。方法采用PPH加硬化剂注射联合治疗Ⅲ～Ⅳ期混合痔19例。结果 19例患者均顺利完成手术,手术时间15～20min,切除后吻合处向上回缩良好。随访23～57个月,平均33个月。4例失访,12例效果良好,3例症状复发,表现为再次脱出和出血,复发时间分别为术后14个月、24个月和30个月,2例术后肛门瘙痒症状未缓解,排便功能均满意,无肛门狭窄及肛门失禁。结论 PPH加硬化剂联合应用是治疗Ⅲ～Ⅳ期一种简单、安全、可靠、康复快的方法,远期疗效满意。     

手榴弹片伤5例治疗分析

目的 探讨手榴弹片伤后的救治方法和效果。方法 分析5例手榴弹片炸伤患者的临床资料及治疗情况。结果 5例患者均康复出院，住院时间3～5周，无任何后遗症。结论 手榴弹片炸伤应遵循早期处理原则，根据异物大小所处部位决定是否取出，经上述处理，患者预后良好。     

经纤维支气管镜治疗支气管胸膜瘘6例

支气管胸膜瘘（BPF）是指肺泡、各级支气管与胸膜腔交通的窦道。2004年以来我们采用经纤维支气管镜注射医用吻合胶（0B胶）加持续胸腔闭式引流或间断残腔冲洗治疗BPF6例，现总结报道如下。     

微波消融治疗良性甲状腺结节1928例临床分析

目的 探讨微波消融(MWA)治疗良性甲状腺结节的有效性及安全性。方法 对2015年1月至2020年1月在中国人民解放军联勤保障部队第九O八医院接受彩超引导下经皮冷循环MWA治疗的甲状腺结节患者1928例(共4886枚良性甲状腺结节,其中实性结节2812枚、囊性结节248枚、囊实性结节1826枚)的临床资料进行回顾性分析,比较患者术前与术后1、6、12、24个月结节体积及术前与术后1、3个月甲状腺功能的变化情况。结果 术后1、6、12、24个月甲状腺结节体积均较术前显著减少(P<0.05),81.6%的结节体积术后24个月减少量达到50%以上,18.4%的结节术后12个月消失;术后1、3个月患者甲状腺功能各指标与术前比较差异无统计学意义(P>0.05)。术后随访期间未见重大手术并发症发生。结论 MWA治疗良性甲状腺结节微创、安全、有效。     

孤立性肾盂扩张胎儿全基因组染色体拷贝数变异测序结果分析

目的探讨胎儿孤立性肾盂扩张染色体拷贝数变异测序（CNV-seq）结果及预后。方法对76例孤立性肾盂扩张胎儿进行介入性产前诊断,回顾性分析其染色体核型及CNV-seq结果,随访妊娠结局。结果76例孤立性肾盂扩张胎儿的染色体核型分析仅1例唐氏综合征,1例9号染色体倒位。76例胎儿CNV-seq分析同样仅有1例为唐氏综合征,2例为多态性拷贝数变异（CNV）,其余均未发现致病性、可能致病性或致病性未知的CNV。76例肾盂扩张出生胎儿中男孩51例,女孩25例。2例引产,其中1例因唐氏综合征引产,另1例因胎儿双肾重度积水引产。其余74例活产复查B超未见有肾盂扩张加重或肾积水。结论胎儿孤立性肾盂扩张绝大部分预后良好,除非孕妇唐氏筛查或无创产前检测高风险,产前无需常规行CNV-seq分析。