利用植物悬浮细胞体系对骆驼蓬碱进行生物转化

目的:利用植物悬浮细胞培养体系对骆驼蓬碱进行生物转化。方法:利用长春花、一叶萩、烟草和金银花植物悬浮细胞培养体系转化骆驼蓬碱,应用薄层色谱法和质谱法对转化结果进行检识。结果:4种植物悬浮细胞培养体系中均检测到新的转化产物,该转化产物采用碘化铋钾溶液在薄层色谱上显色,在正离子模式下,准分子离子为213.0,二级碎片为198.1、170.2,初步推测为去氢骆驼蓬碱。结论:利用植物悬浮细胞培养体系生物转化的方法可以将骆驼蓬碱转化成去氢骆驼蓬碱。     

原发性胃肠道恶性淋巴瘤的诊断与治疗

胃肠道是结外型淋巴瘤的好发部位,早期症状缺乏特异性,术前诊断较困难,临床误诊率高,其疗效和预后与胃肠道其他恶性肿瘤不同.我院1995～2001年共收治38例胃肠道恶性淋巴瘤患者,所有患者均经手术及病理证实,现分析报告如下.     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

自动管电流模式在头颈部动脉CT造影使用低剂量射线的可行性

目的在不影响显像质量的前提下,探讨应用自动管电流模式在256层螺旋CT头颈部动脉造影中降低射线剂量的可行性。方法对60例怀疑头颈部动脉疾病的患者进行头颈部动脉CT造影显像。患者被分为两组,即常规管电流扫描组(A组)和自动管电流扫描组(B组),每组30例。A组采用250 mAs管电流扫描,B组采用自动管电流扫描。对两组图像信号噪声比、对比度噪声比和有效剂量进行评估。结果 A,B两组图像信号噪声比分别为(37.47±9.39)和(36.85±7.96),无统计学差异(P=0.79)。两组图像对比度噪声比分别为(32.13±9.06)和(31.86±7.66),无统计学差异(P=0.90)。A组的CT容积剂量指数固定无变化,均为16.5mGy,B组为(10.55±0.94)mGy,差异有统计学意义(P0.001)。射线剂量降低约36.1%。结论与常规管电流比较,自动管电流模式头颈部动脉CT造影在不降低图像质量的情况下,射线剂量明显降低。提示该方法使用低剂量是可行的。     

右美托咪啶辅助星状神经节阻滞治疗老年患者三叉神经疱疹后神经痛的可行性

目的 评价右美托咪啶辅助星状神经节阻滞治疗老年患者三叉神经疱疹后神经痛的可行性.方法 拟行星状神经节阻滞的三叉神经疱疹后神经痛的老年患者45例,性别不限,年龄65～85岁,体重45～85 kg,ASA分级Ⅱ级.采用随机数字表法,将患者随机分为3组(n=15):单纯星状神经节阻滞组(SGB组)、0.4μg/ml右美托咪啶辅助星状神经节阻滞组(DS1组)和0.6 μg/ml右美托咪啶辅助星状神经节阻滞组(DS2组).DS1组和DS2组于星状神经节阻滞前分别静脉输注浓度为0.4和0.6μg/ml的右美托咪啶0.1 ml/kg,SGB组输注等容量生理盐水,输注时间15 min.给予0.5％罗哌卡因8～10ml行星状神经节阻滞.记录阻滞起效时间和阻滞维持时间.记录术中心动过缓、低血压和呼吸抑制的发生情况.于治疗后1、2、4和8周时,行VAS评分,0～3分为镇痛满意,计算镇痛满意率.结果 三组心动过缓、低血压及呼吸抑制的发生率比较差异无统计学意义(P＞0.05).与SGB组比较,DS1组和DS2组阻滞维持时间延长,治疗后2、4和8周时镇痛满意率升高(P＜0.05);DS1组和DS2组阻滞起效时间、阻滞维持时间和镇痛满意率比较差异无统计学意义(P＞0.05).结论 与单纯星状神经节阻滞相比,右美托咪啶辅助星状神经节阻滞治疗老年患者三叉神经疱疹后神经痛的效果更佳.     

超声造影检查在肾肿瘤射频消融术后疗效评估中的应用价值

目的 探讨实时超声造影(CEUS)检查在肾肿瘤射频消融(RFA)术后疗效评估中的作用.方法 对47例肾肿瘤患者(肾癌40例,肾血管平滑肌脂肪瘤7例)49个病灶行RFA治疗,其中经腹腔镜下RFA 30例,开放手术RFA 17例.术后1周行常规超声及CEUS检查,观察造影剂在动脉相与实质相的灌注情况,评价病灶消融范围,并与增强CT结果比较.影像学上病灶无增强被认为是消融完全. 结果 49个病灶完全消融47个(95.9%).CEUS显示肾消融灶最大径为2.4～10.0 cm,平均(4.6±1.5)cm,其中消融灶大于原病灶者45个、与原病灶相同者3个、小于原病灶者1个.CEUS提示RFA术后原病灶有局部强化6例,其中2例经增强CT证实.以增强CT结果作为诊断标准,CEUS对RFA术后残留灶诊断的敏感性为100.0%,特异性为91.8%.术后平均随访11(4～21)个月,患者均存活. 结论 CEUS检查与CT结合对评价肾肿瘤RFA术后疗效具有实用价值.

Abstract：

Objective To discuss the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of treatment efficacy of radiofrequency ablation (RFA) in patients with renal tumors.Methods Forty-seven patients (40 renal cell carcinomas and 7 angiomyolipomas of kidney) with 49 renal tumors were treated with RFA. Tumors were ablated by laparoscopy-assisted (n= 30) and open surgical (n= 17) RFA. The CEUS and contrast-enhanced CT were performed 1 week after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Results Forty-seven (95. 9%) of 49 tumors were successfully ablated. The mean length of the major axis at the maximal necrotic area was 4. 6 cm. Compared with the lesions before RFA, the necrotic areas were bigger in 45 patients, identical in 3 patients, and smaller in 1 patient. Six lesions showed a residual enhancement at the portion adjacent to the normal renal parenchyma on follow-up CEUS, while 2 were confirmed by CT scans. The sensitivity and specificity of CEUS for detection of residual tumors were 100. 0% and 91.8%, respectively. All patients survived in the follow-up period ranging from 4 to 21 months. Conclusion CEUS combined with CT could be useful for evaluating treatment efficacy of RFA for renal tumors.     

肾包膜下积液19例临床分析

目的探讨肾包膜下积液的成因和治疗方法。方法回顾分析19例肾包膜下积液,其中12例因尿路梗阻,4例因肾实质感染而形成;3例原因不明。均经CT明确诊断。结果19例肾包膜下积液中,15例针对病因治疗,即解除梗阻,控制肾实质感染后,积液均有吸收减少;原因不明予以对症治疗。积液亦被吸收。结论尿路梗阻是肾包膜下积液的常见原因,增高的肾盂压力使得尿液经静脉、淋巴管或直接返流到肾周;急性肾绞痛因肾盂压力的急剧升高,更易形成包膜下积液。肾实质的感染也是形成积液的重要原因。在对因治疗,解除梗阻,控制感染后,肾包膜下积液均可逐渐被吸收。     

逼尿肌活动低下在下尿路症状中的临床特征及诊疗策略分析

目的:探讨逼尿肌活动低下(DU)在下尿路症状(LUTS)患者中的流行病学现状、临床特征及诊疗策略。方法:回顾性分析了我院1 019例排除神经源性膀胱及解剖结构异常的LUTS患者的尿流动力学检查结果及随访资料,探讨DU在LUTS中的流行病学及临床诊治特点,并对106例DU患者治疗前后行尿流动力学检查,结合文献进行临床分析。结果:在就诊患者中,储尿期症状最为多见,在男性患者中,排尿期症状稍多于储尿期症状,而女性患者储尿期症状明显多于排尿期症状。男性患者中膀胱出口梗阻(BOO)的患者为57.9%,而女性患者中压力性尿失禁(SUI)患者达到了43.3%。27.4%男性及23.2%女性诊断为DU,男性及女性患病率差异无统计学意义。DU患者与非DU患者的临床表现无明显差异,均以LUTS为主要表现。DU可能合并有逼尿肌过度活动或BOO。DU随着年龄的增加,患病率逐渐增加。106例DU患者经治疗后行尿动力学检查发现逼尿肌收缩力有一定提高,治疗前后逼尿肌肌力差异有统计学意义。结论:DU是LUTS患者的常见病因,并有可能同时合并有逼尿肌过度活动或BOO。目前针对DU患者的治疗有一定效果。     

腰大池置管引流治疗颈椎前路手术后并发脑脊液漏

目的探讨腰大池置管引流治疗颈椎前路手术后并发脑脊液漏的临床疗效及安全性。方法回顾性分析2011年6月—2016年12月颈椎前路手术后并发脑脊液漏并接受腰大池置管引流治疗的17例患者(观察组)的临床资料,以同时期因外伤致硬膜破损脑脊液漏并接受腰椎穿刺引流术治疗的21例患者作为对照组,以治愈率、引流时间、24 h引流量、头痛持续时间以及治疗期间头晕、恶心、呕吐发生例数评价治疗脑脊液漏的疗效;以并发症发生和随访期恢复情况评价其安全性。结果所有患者均随访12个月,2组患者脑脊液漏均治愈。观察组脑脊液24 h引流量明显高于对照组,头痛持续时间、引流时间均短于对照组,差异均有统计学意义(P 0.05);观察组治疗期间头晕、恶心、呕吐发生例数显著低于对照组,差异具有统计学意义(P 0.05)。所有病例均未发生颅内感染等严重并发症。观察组伤口愈合良好,随访期内无再发脑脊液漏、脑脊液囊肿形成;对照组治疗期内并发高热1例,经抗感染治疗后痊愈,随访期内1例患者脑脊液漏复发。结论腰大池置管引流治疗颈椎前路手术后并发脑脊液漏疗效确切,具有治疗时间短、并发症少、患者痛苦小的优点,值得临床推广应用。     

前路或前-后联合入路治疗下颈椎骨折脱位合并关节突交锁

目的探讨前路或前-后联合入路治疗下颈椎骨折脱位合并关节突交锁的疗效。方法手术治疗17例下颈椎骨折脱位合并关节突交锁患者,9例行前路切开(复位)内固定融合术,8例行前-后联合入路切开(复位)内固定融合术。记录手术时间和术中出血量,观察并发症情况。采用VAS评分评估疼痛改善情况,采用ASIA脊髓损伤分级评估神经功能恢复情况。X线检查评价椎体复位、关节突解锁及颈椎曲度改善情况。结果患者均获得随访,时间12～47(21. 6±8. 6)个月。前路术式的手术时间为90～110(98. 1±6. 9) min,术中出血量为90～120(109. 7±14. 7) ml;前-后联合入路术式的手术时间为180～240 (212. 4±16. 7) min,术中出血量为380～580(443. 3±70. 4) ml。VAS评分:术后3个月较术前明显下降(P 0. 01),末次随访较术后3个月进一步下降(P 0. 01)。颈椎曲度:术后3个月及末次随访均较术前明显改善(P 0. 05),且末次随访无明显丢失(P 0. 05)。末次随访时,患者脊髓神经功能ASIA评分均较术前显著改善;椎体滑脱及关节突交锁均得到满意复位。除1例脑脊液漏、5例吞咽不适及1例C5神经根麻痹外,无其他并发症发生。结论前路或前-后联合入路治疗下颈椎骨折脱位合并关节交锁的临床效果满意。