人工气胸辅助单孔或多孔胸腔镜下胸腺切除术的可行性分析

目的探讨人工气胸辅助单孔或多孔胸腔镜下胸腺切除术的应用效果,分析其可行性。方法选取本院2015年2月～2018年9月收治的100例接受胸腔镜术治疗的患者为研究对象,随机分为对照组(n=50)与研究组(n=50)。其中研究组实施人工气胸辅助VATS胸腺切除术治疗,对照组则实施常规胸腔镜术治疗,比较两组的手术时间、住院时间、胸管引流时间及胸管引流量等指标,并统计术后并发症发生情况。结果研究组临床指标(手术时间、胸管引流时间、胸管引流量及住院时间)与对照组对比无显著差异(P0.05);研究组与对照组并发症发生率比较(2.00%vs 14.00%),差异显著(P0.05)。结论人工气胸辅助单孔或多孔胸腔镜下胸腺切除术的可行性较高,应用效果显著,值得进一步推广。     

复发性自然流产夫妇中女性染色体变异的分布情况研究

目的: 分析复发性自然流产( ＲSA) 夫妇中女性染色体情况,为指导生殖诊断及干预提供依据。方 法: 选择 2014－02～ 2018－06 期间在内蒙古医科大学附属医院妇科门诊就诊,确诊为 ＲSA 的 1060 对( 2120 例) 夫 妇进行外周血染色体核型分析,重点观察女性染色体变异的发生率、类型及其分布情况。结果: 2120 例受试者 中染色体异常共检出 154 例( 7．26%) ,染色体异常核型中女性共 99 例占64．29%,男性 55 例占35．71%,女性染色 体异常率高于男性,差异具有统计学意义( P＜0．05) ; 女性染色体异常检出者中以多态变异核型最常见,共检出 57 例,占56．57%,分别为 9 号染色体臂间倒位 27 例,D/G 组随体增加 16 例和次缢痕增加 14 例; 本组染色体结构 异常共检出 39 例,占39．39%,分别为罗伯逊易位 21 例、相互易位 14 例和倒位 4 例; 本组染色体数目异常共检出 3 例,占3．03%,表现为性染色体嵌合。结论: 复发性自然流产夫妇中女性染色体变异比例较高,其分布主要集中 于染色体多态性和染色体结构异常方面; 加强对有自然流产史女性的细胞遗传学观察,对明确 ＲSA 的病因学特 征具有重要意义。     

植入前遗传学筛查用于几种适应症的效率初探

目的探讨植入前遗传学筛查(PGS)用于染色体异常、反复种植失败和反复自然流产患者的效率。方法回顾性研究2015年1月到2016年3月在我中心行PGS治疗,共328个取卵周期和随后进行的263个冻胚移植周期,根据其适应症分为男方染色体异常(A组)、女方染色体异常(B组)、反复种植失败(C组)和反复自然流产(D组),分析4组患者的体外受精-胚胎发育情况、胚胎单核苷酸多态性(SNP)检测分析结果和临床结局。结果 4组患者成熟卵母细胞(MII)率、受精率、卵裂率、D3有效胚胎率均无统计学差异(P0.05);获卵数在A组(12.93±5.73)、B组(13.17±6.65)显著高于C组(10.48±6.07)、D组(10.76±5.47),D组可进行PGS活检的胚胎数与D3有效胚胎数的比率(57.2%)显著高于A组(51.3%)、B组(48.4%)和C组(50.0%)(P均0.05);正常核型胚胎比率C组(71.6%)、D组(58.7%)显著高于A组(39.0%)、B组(33.5%),而无可移植正常核型胚胎的周期率D组(13.5%)显著低于A组(31.3%)、B组(33.3%)、C组(29.1%)(P均0.05);4组患者的妊娠率和流产率均无统计学差异(P0.05)。结论三种适应症的患者实施PGS均能达到满意的临床妊娠率;夫妇染色体异常的患者最终获得正常核型胚胎的几率较低,但是有效避免了高流产率的风险;反复自然流产的患者经PGS筛选后胚胎移植可将流产率控制在较低水平(3.4%)。     

Artificial pneumothorax: a safe and simple method to relieve pain during microwave ablation of subpleural lung malignancy

Background: Microwave ablation has been extensively used for eliminating pulmonary tumors; however, it is usually associated with severe pain under local anesthesia. Decreasing the power and shortening the ablation time can help to relieve the pain; however, this leads to incomplete ablation and an increasing recurrence rate. This research aims to employ an artificial pneumothorax to increase both the curative effect and pain relief during the ablation procedure.

Material and methods: From July 2013 to January 2015, nine patients presenting with 10 subpleural lung tumors (age: 44–78 years) with a high possibility of severe pain underwent the artificial pneumothorax during microwave ablation. The pain assessment scores and complications induced by the artificial pneumothorax were recorded and analyzed by a CT scan follow-up.

Results: The tumors of the nine patients were eliminated successfully using microwave ablation with artificial pneumothorax under local anesthesia. The pain caused by the ablation was relieved to a great extent with an average rate of 94.66% (range: 63.3%–100%) and all tumors were ablated completely. No severe complications occurred after the operation.

Conclusions: The artificial pneumothorax is a reliable therapy to improve the curative effect of microwave ablation under local anesthesia by relieving the pain of the patients.     

血降钙素原联合中性粒细胞比例对肝病自发性细菌性腹膜炎的诊断意义

目的 探讨血降钙素原(procalcitonin, PCT)和中性粒细胞比例(percentage of neutrophils, Neu%)对肝病自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)的诊断价值.方法 回顾性分析2014年1月至2016年12月在西南医院感染科住院且入院后同时检测PCT、血常规、腹水常规和腹水培养的130例肝病腹水患者临床资料,SBP确诊组89例,其中培养阳性且多形核细胞(polyremorphonuclear,PMN)≥250×106/L 患者10例(SBP1组),培养阳性但PMN<250×106/L 患者11例(SBP2组),培养阴性但PMN≥250×106/L 患者68例(SBP3组);非感染性腹水组41例.比较4组患者入院时的血PCT、Neu%、腹水PMN等指标.通过受试者工作曲线(ROC)评价PCT、Neu%对SBP的诊断价值及效能.结果 PMN≥250×106/L 的SBP患者培养阳性率为12.8%.PCT在培养阳性的腹水患者中显著高于培养阴性的患者[中位数(四分位距)]:[4.51(1.54,8.46)vs 0.77(0.21,1.69),P<0.05].通过ROC曲线分析,PCT诊断SBP1、SBP2、SBP3的最佳界值分别为:0.795、0.265、0.405 ng/mL;AUC值依次为:0.963、0.767、0.714;敏感度依次为:100.00%、90.00%、62.30%;特异度依次为:92.70%、63.40%、80.50%;血常规Neu%诊断的最佳界值分别为:68.45%、62.65%、65.00%;AUC值依次为:0.878、0.756、0.669.依据上述界值,降钙素原和中性粒细胞比例两者串联诊断SBP1、SBP2、SBP3的AUC值依次为:0.976、0.865、0.706.结论 血降钙素原和血常规中性粒细胞比例在SBP中均具有一定的预警效果和诊断价值,不同类型SBP其CUT-OFF值不同,临床可根据实际情况综合分析.     

肺结核并发自发性气胸的治疗体会

目的 总结肺结核并发自发性气胸的治疗经验.方法 总结我科治疗的116例肺结核并发自发性气胸患者的临床资料.结果 本组116例患者中,发生2次以上的复发率达8.5％,单纯胸腔闭式引流术治疗复发率21.6％;手术治疗复发率2.2％.气胸总体治愈率94.7％.结论 肺结核并发自发性气胸的治疗应强调个体化;因结核病灶的存在,气胸一般通过保守治疗难以愈合,积极的外科手术疗效更确切、可靠;胸腔镜手术创伤小、术后恢复快,应作为首选;术式应以肺修补和大疱切除为主,应用自体胸膜片修补以及肺切缘加固缝合可有效预防术后肺漏气.     

猪尾导管与普通胸管气胸引流效果与安全性的Meta分析

目的 评价猪尾导管与普通胸管用于气胸引流治疗的有效性及安全性.方法 通过计算机检索PubMed、Cochrane图书馆、Embase、谷歌学术等英文数据库截至2015年11月26日有关猪尾导管与普通胸管治疗气胸的临床对照试验,使用MINORS条目对纳入文献的方法学质量进行评价,采用Revman Manager 5.1软件进行Meta分析.结果 共纳入4篇文献,包括1篇随机对照研究、3篇非随机对照试验,共522例患者,其中使用猪尾导管267例、使用普通胸管255例.经过Meta分析:猪尾导管组相对于普通胸管组,减少了术后置管时间(WMD=-0.33,95％ CI-0.58 ～-0.07,P＜0.05),而气胸治疗成功率(RR=0.94,95％ CI0.87 ～ 1.02,P＞0.05)、术后住院时间(WMD=-2.33,95％ CI-6.87 ～2.22,P＞0.05)、相应并发症的发生率(RR=0.73,95％CI0.29～1.86,P＞0.05),差异均无统计学意义.结论 相比于普通胸管,应用猪尾导管治疗气胸,可有效减少患者术后置管时间,而并发症、术后住院时间、成功率差异均无统计学意义.猪尾导管可有效用于气胸患者的胸腔闭式引流.     

Comparison of myocardial metabolism by using PET after resuscitation between ventricular fibrillation cardiac arrest and asphyxia cardiac arrest北大核心CSCD

Objective To characterize myocardial metabolism using positron emission tomography (PET) in porcine models of ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA) after resuscitation. Methods Thirty-Two healthy miniature pigs were randomized into two groups. The pigs of VFCA group (a = 16) were subject to programmed electric stimulation to create a ventricular fibrillation cardiac arrest, and the pigs of ACA group (n = 16) were subjected to endotracheal tube clamping to establish a cardiac arrest (CA). Once modeling was established, pigs with CA were left untreated for a period of 8 mm. Two minutes following initiation of cardiopulmonary resuscitation (CPR), defibrillation was attempted until the restoration of spontaneous circulation (ROSC) was achieved or animals died. To assess myocardial metabolism, PET was performed before modeling, 4 hrs and 24hrs after ROSC. To analyze 18F-FDG myocardial uptake in PET, the maximum standardized uptake value (SUV1) was measured. Results ROSC was obtained in 100% of pigs in VFCA group and only 50% in ACA group. The average survival time in VFCA pigs was significantly longer than that in ACA pigs (22. 63 ± 0. 95) hvs. (8. 75 ± 2. 54) h, P <0.01. VFCA pigs had better mean arterial pressure and cardiac output after ROSC than ACA pigs. Myocardial metabolism imaging using PET demonstrated that myocardial metabolism injuries after ACA were more severe and widespread than those after VFCA at 4 hrs and 24hrs after ROSC and SUV> was much higher in VFCA group than that in ACA group [4 h after ROSC: (1.9 ± 0. 3) vs. (1.0 ±0.4), P <0. 01; 24 h after ROSC: (2.4 ±0.6) vs. (1.2±0.5), P <0.01]. Conclusions Compared with VFCA, ACA causes more severe cardiac metabolism dysfunction associated with less successful resuscitation and shorter survival time; therefore they should he treated as different pathological entities.     

Ultrasound Findings in Tension Pneumothorax: A Case Report

Background

Delayed recognition of tension pneumothorax can lead to a mortality of 31% to 91%. However, the classic physical examination findings of tracheal deviation and distended neck veins are poorly sensitive in the diagnosis of tension pneumothorax. Point-of-care ultrasound is accurate in identifying the presence of pneumothorax, but sonographic findings of tension pneumothorax are less well described.

Pneumomediastinum,Pneumothorax, and Subcutaneous Emphysema Caused by Colonoscopic Perforation: A Report of Two Cases

Background

Although colonoscopy is generally a safe procedure, lethal complications can occur. Colonoscopic perforation is one of the most serious complications, and it can present with various clinical symptoms and signs. Aggravating abdominal pain and free air on simple radiography are representative clinical manifestations of colonoscopic perforation. However, unusual symptoms and signs, such as dyspnea and subcutaneous emphysema, which are less likely to be related with complicating colonoscopy, may obscure correct clinical diagnosis. We present two cases of pneumomediastinum, pneumothorax, and subcutaneous emphysema caused by colonoscopic perforation.