经阴道彩色多普勒诊断未破裂型输卵管妊娠

本文介绍经阴道彩色多普勒诊断未破裂型输卵管妊娠２６例，１３例经手术及病理检查证实，１３例经临床确诊，符合２５例，诊断符合率９６．１５％；误诊１例，误诊率３．８５％。经阴道彩色多普勒检查其二维图像清晰，彩色血流灵敏，能更早发现输卵管妊娠包块内特异的滋养层周围血流及同侧卵巢的黄体血流，使输卵管妊娠在破裂前就能作出诊断，具有较高的临床应用价值。     

妊娠黄体瘤1例报告并文献复习

目的：探讨妊娠黄体瘤（LP）的误诊原因。方法：对1例典型LP病例进行全面病理学检查和组化及免疫组化染色，与正常卵巢黄体进行对比分析，并复习文献。结果：LP均发生于妊娠后期，临床无明显自觉症状，其病理形态学、组织学、免疫组化反应与正常卵巢黄体相似。多在剖腹产时偶然发现而误为卵巢肿瘤。结论；LP为妊娠后期卵巢黄素化细胞的结节状增生，并非真性肿瘤。妊娠期出现卵巢明显增大，应首先考虑到本病的可能性。必要时术中可作活检，以避免误切卵巢。     

Gastric ulceration caused by heater probe coagulation

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.     

肝移植术后血管胆道并发症的介入治疗

目的:评价介入治疗对肝移植后胆道、血管并发症的价值。材料和方法:18例肝移植患者接受了介入治疗。其中肝动脉狭窄8例,行肝动脉造影及溶栓治疗;下腔静脉及肝静脉狭窄2例,行内支架置入术;胆瘘及胆道狭窄8例,行PTCD治疗。结果:胆道并发症8例,PTCD治疗后症状消失;肝动脉狭窄8例,溶栓后肝动脉完全开放6例,1例血流部分开放,1例肝动脉血流未恢复再次肝移植治疗;下腔静脉及肝静脉狭窄2例内支架置入术后下腔静脉梗阻及肝肿大症状消失。结论:介入治疗是治疗肝移植后胆道血管并发症的有效方法。     

妊娠肝内胆汁淤积症患者胎盘组织中血管内皮生长因子的表达

目的观察血管内皮生长因子(VEGF)在妊娠肝内胆汁淤积症(ICP)胎盘中的表达.方法采用免疫组织化学方法,检测25例正常妊娠胎盘(对照组)和25例ICP胎盘(ICP组)中VEGF的水平.结果 VEGF在正常妊娠胎盘和ICP胎盘中分布基本一致,分布在滋养细胞、血管及绒毛间质.在ICP组VEGF为轻度表达占76%,中度表达占24%,无重度表达;而在对照组VEGF轻度表达占24%,中度表达占44%,重度表达占32%.ICP组中VEGF表达明显低于对照组(P＜0.01).结论 VEGF在胎盘中主要由绒毛滋养细胞分泌,ICP胎盘中VEGF的减少可能与胎盘血管生成减少及胎盘滋养叶细胞浸入异常有关,在ICP发病中占有一定的地位.     

Total and free tissue factor pathway inhibitor in pregnancy hypertension.

OBJECTIVE: To clarify the role played by tissue factor pathway inhibitor (TFPI) in pregnancy hypertension. METHODS: Using enzyme-linked immunosorbent assays, hemostatic measurements were obtained for women with pre-eclampsia (n=51), nonproteinuric hypertension of pregnancy (n=62), postpartum pre-eclampsia 24 h after childbirth (n=31), and no hypertension (healthy pregnant controls, n=100). RESULTS: There was a significant increase in circulating free TFPI levels in women with pre-eclampsia (9.7+/-6.2 ng/mL) or nonproteinuric hypertension of pregnancy (8.3+/-5.3 ng/mL) compared with healthy controls (5.3+/-2.1 ng/mL). In women with pre-eclampsia the levels remained elevated after placental delivery (10.6+/-4.0 ng/mL). Free protein S levels were significantly higher in women with pre-eclampsia (40.0%+/-10.7%), nonproteinuric hypertension of pregnancy (37.1%+/-12.5%), or postpartum pre-eclampsia (39.3%+/-9.1%) than in healthy pregnant controls (32.2%+/-8.5%). CONCLUSION: Increased levels of the physiologically active free forms of TFPI and free protein S, 2 coagulation inhibitors, may protect women with pregnancy-induced hypertension from the risks of hemostatic activation.     

颈丛阻滞下行颈动脉内膜剥脱术--附32例分析

目的观察颈丛阻滞下行颈动脉内膜剥脱术的效果.方法 28名ASAⅡ～Ⅲ级患者行32例颈动脉内膜剥脱术,采用深浅丛联合阻滞,观察围术期血液动力学指标变化,分流管放置率和并发症情况.结果 麻醉后血压和心率与麻醉前相比差异有显著性(P＜0.05),其它时点与麻醉前相比差异无显著性(P＞0.05).颈动脉夹闭前后收缩压和心率的波动性的差异无显著性(P＞0.05).围术期高血压的发生率为50.0%,低血压6.25%,心动过速28.1%,心动过缓6.25%,分流管放置率6.25%.患者满意率84.4%.无1例改用全麻,无严重围术期并发症.结论颈丛阻滞是颈动脉内膜剥脱术安全、有效的麻醉方法.     

妊娠中晚期合并输尿管结石的急诊腔内技术处理

目的探讨妊娠中晚期合并输尿管结石急诊腔内技术处理的安全性和有效性。方法1998年6月至2005年3月,对17例妊娠中晚期合并输尿管结石急症的患者行急诊腔内技术治疗。患者年龄21～35岁,平均27岁,孕周20～36周,平均29周。表现为肾绞痛反复发作11例,发热4例,急性梗阻性无尿2例。结石位于左侧5例、右侧10例、双侧2例；结石位于输尿管上段8例、中段5例、下段2例,双侧下段2例。结石大小6mm×7mm～13mm×21mm。患侧轻度肾积水6例,中度11例。行经尿道输尿管镜下气压弹道碎石14例；输尿管上段结石推至肾盂1例；因无法进镜而单纯留置双J管2例。结果17例患者的肾绞痛、发热等症状经治疗后完全消失。结石一次取净者14例(82.4%)。残留结石者3例,留置双J管至分娩后,其中1例每3个月更换双J管。未发生先兆流产或早产等情况,无输尿管穿孔及其他并发症。留置双J管后出现排尿后腰部不适1例,3d后缓解；术后肉眼血尿1例,6d后自行消失。17例均顺利生产,婴儿健康。结论经尿道输尿管镜腔内技术治疗妊娠中晚期合并输尿管结石急性发作安全、有效。     

Removal of laryngeal mask airway: airway complications in children,anaesthetized versus awake*

The laryngeal mask airway (LMA) must be inserted during deep anaesthesia. There are no guidelines concerning the removal of LMA, i.e., in awake or anaesthetized patients. The aim of this randomized prospective study was to compare the incidence of respiratory complications after LMA removal in anaesthetized or awake paediatric patients. Sixty children (ASA PS I or II), ranging from 4 months to 12 years of age, were studied. In patients breathing spontaneously, anaesthesia was induced and maintained with nitrous oxide, oxygen and halothane. Patients were randomly divided into two groups: group 1 removal of LMA in awake patients, or group 2 removal of LMA in anaesthetized patients, i.e., in patients receiving halothane at an alveolar concentration of 2 MAC adjusted for age and oxygen for 5 min. In both groups, patients received 100% oxygen after removal of LMA. After removal the incidence of respiratory complications was highest (P < 0.05) in group 1. Therefore, in healthy children undergoing elective surgery, the authors conclude that it is safer to perform the LMA removal in anaesthetized patients.