经子宫动脉氨甲蝶呤灌注及栓塞 在宫颈妊娠保守治疗中的应用

目的探讨经子宫动脉氨甲蝶呤灌注化疗及栓塞术在宫颈妊娠保守治疗中的应用价值.方法 6例宫颈妊娠患者,孕龄36～68天,经阴道超声检查明确诊断后,行双侧子宫动脉氨甲蝶呤灌注及栓塞治疗.结果所有患者均一次治疗成功,术后患者的阴道出血明显减少或中止,血β-HCG水平迅速下降.患者的宫颈形态及月经周期于治疗后4个月内恢复正常.结论子宫动脉氨甲蝶呤灌注化疗及栓塞术是保守治疗宫颈妊娠的有效方法.     

颈椎颈髓损伤后外科治疗时间对预后的影响

目的:前瞻性比较颈椎颈髓损伤患者在3d内与10~14d内进行外科干预后神经功能恢复的情况。方法:32名急性颈椎颈髓损伤的患者根据入选标准随机分为早期手术组(3d内手术)和择期手术组(10~14d内手术)。分别记录患者术前和术后2年的Frankel分级和感觉、运动评分(依据美国脊髓损伤学会的标准)。结果:与术前相比,两组患者术后的感觉、运动评分均有明显改善(P<0.01),Frankel分级的改善程度早期手术组明显优于择期手术组(P<0.01)。结论:急性颈椎颈髓损伤在3d内进行手术治疗者神经功能恢复的结果优于10~14d内行手术者。因此,颈椎颈髓损伤后应尽可能地早期进行外科干预。     

尿道发育不良性阴茎弯曲的手术矫治

目的临床研究尿道发育不良性阴茎弯曲27例的手术方式和疗效。方法皮肤切口绕过菲薄尿道,脱蜕尿道表面阴茎皮肤,切断阴茎腹侧之深浅筋膜,伸直阴茎,手术不伤及尿道。结果27例阴茎下弯得以伸直,其中1例因留置橡胶导尿管导致阴茎部尿道狭窄,经尿扩治疗2年余,排尿尚通畅。结论采取保护菲薄尿道的切口脱蜕阴茎皮肤,切断增厚的阴茎筋膜能伸直Ⅰ型弯曲的阴茎。     

大剂量甲基强的松龙在伴有严重脊髓受压的脊髓型颈椎病围手术期的应用

目的:探讨大剂量甲基强的松龙(methylprednisolone,MP)在伴有严重脊髓受压的脊髓型颈椎病患者围手术期应用的价值。方法:选取有严重脊髓受压的颈椎病患者62例,采用颈前路椎体次全切除减压植骨内固定或后路单开门减压椎管扩大成形术治疗。按照围手术期是否使用MP分为MP治疗组和对照组。MP治疗组38例,术中操作达椎前或后路达椎板时静脉给予MP30mg/kg,15min滴完;45min后给予5.4mg/kg/h维持23h,术后第1～3天均按80mg/次静脉滴注,每天2次;术后第4天停用。对照组24例,施行同样减压术,于手术当时开始常规使用地塞米松(DXM)治疗,10mg/次,每天1次,应用3d。比较两组患者术后1周内脊髓功能JOA评分和相关并发症发生率。结果:术前MP治疗组及对照组患者JOA评分分别为6.9±2.3分和7.5±2.7分,差异无统计学意义(P>0.05)。术后MP治疗组JOA评分为11.9±3.2分,改善率为49.5%;对照组为9.1±2.1分,改善率为16.8%,两组间比较有显著性差异(P<0.01)。消化道溃疡、感染等并发症发生率两组间均无统计学意义(P>0.05)。术后对照组中4例出现症状加重,经对症处理后1例完全恢复,2例肢体仍有麻痛感,1例肌力未完全恢复正常。结论:围手术期大剂量使用MP在伴有严重脊髓压迫的颈椎病患者的减压治疗中具有明显改善神经功能的作用,可有效地预防由于手术所造成的神经刺激症状,相关并发症比较少见。     

颈椎前路手术后邻近节段运动变化的生物力学研究

目的利用压敏片(PSF)技术,测量颈椎前路手术后关节突关节内压力的变化,探讨颈前路手术后远期邻近节段退变的生物力学发病机制。方法10具新鲜成人颈椎尸体标本(C2～T1),行前路C4,5椎间盘切除、C4,5椎间植骨钢板内固定术。将压敏片置于关节突关节内,在脊柱三维运动试验机上测量0载荷和2N·m载荷下,后伸、左右侧弯、左右旋转过程中关节突关节内压力的变化。结果颈椎前路手术后,邻近节段关节突关节内的压力增加,以后伸和左右旋转时最为明显,差异有显著性意义(P<0.05)。结论颈椎前路短节段植骨融合术后,邻近节段关节突关节内压力明显增加,可诱发邻近节段关节突关节的退变,从而引起相应的病症。     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

无骨折脱位型颈脊髓损伤再手术原因分析

目的:探讨无骨折脱位型颈脊髓损伤患者再次手术治疗的原因,总结经验教训。方法:对1993年1月～2003年2月间13例经再次手术治疗的无骨折脱位型颈脊髓损伤患者的临床资料进行回顾性分析,根据其影像学表现,分析致伤的病理基础与形成因素的特点。结果:患者再手术的原因主要有:(1)前次手术入路选择不当(8例);(2)前次手术中脊髓减压不彻底(5例)。再手术后均获随访(平均43个月),神经功能得到了一定的改善(JOA评分改善率平均为40.6%)。结论:手术入路选择不当和减压不彻底是无骨折脱位型颈脊髓损伤再手术的主要原因,再次手术治疗应针对此类损伤致伤特点,选择合理的手术入路,并矫正前次手术不当之处,可获得一定的疗效。     

P53基因突变与宫颈癌关系的研究

目的：通过对宫颈癌Ｐ５３基因７－８外显子突变的研究，探讨该基因的突变与宫颈癌的发生、发展之间的关系。方法：本文运用聚合酶链式反应（ＰＣＲ）方法，对宫颈癌组织Ｐ５３的７－８外显子是突变进行了试验，并与非肿瘤的慢性宫颈炎（宫颈糜烂、宫颈息肉）组织作了对照。结果：１０例宫颈癌标本中有７例出现了Ｐ５３７－８外显子的突变，阳性率高；而８例作为对照的宫颈炎标本仅有１例出现可疑的阳性结果。结果：试验结果说明，宫     

颈椎病前方入路术后恢复不良的原因分析

１９８０年１２月至１９９３年１２月，我科经前方入路治疗颈椎病并获随访１８３例，其中３７例（２０．２％）术后恢复不满意，ＪＯＡ恢复率小于６０％。根据主诉与症状，我们把这些病人分成４组。（１）术后症状立即加重，１年内仍无改善者４例。（２）术后症状无明显改善，１年后仍无进步者１１例。（３）术后症状减轻，但经过一段时间后，原症状又复出现者８例。（４）双下肢症状好转，但又出现新的上肢症状或上肢原症状加重者１４例。结合术后Ｘ线、ＣＴ、ＭＲＩ和椎管造影等检查所见，我们将发现的主要问题归纳为手术操作、病情发展演变、原有胸腰椎病和脊髓受压变性等情况。本文对以上发生的问题进行了分析，提出在以后的手术中应特别注意的事项。     

Polymorphism p53 codon-72 and invasive cervical cancer: a meta-analysis.

OBJECTIVES: Although some studies have reported that the arginine isoform on codon 72 of p53 increases the susceptibility to invasive cervical cancer, such data remain controversial. The objective of this study was to quantitatively summarize the evidence for such a relationship. METHODS: Our data sources consisted of a MEDLINE search of the literature published before December 2002, bibliography review, and expert consultation. Thirty-seven studies met the inclusion criteria. Information on sample size, study design, Hardy-Weinberg equilibrium, and method of genotype determination was abstracted by two reviewers using a standardized protocol. The overall odds ratio (OR) of the p53 gene on invasive cervical cancer was estimated using the Mantel-Haenzel method. RESULTS: The overall OR (95% confidence interval) for cervical cancer among those with the homozygous mutant (Arg/Arg) was 1.2 (1.1-1.3, P=0.001) compared with those with the heterozygous mutant (Arg/Pro). By a cellular type of cervical cancer, the overall OR among those with Arg/Arg was statistically significant in adenocarcinomas (1.7, 1.1-2.6, P=0.024), but not in squamous cell carcinomas (1.1, 0.9-1.2, P=0.960), compared with Pro/Pro. Compared with Arg/Pro, the OR among those with Arg/Arg was statistically significant in HPV types 16 (1,5, 1.2-2.0, P=0.002). CONCLUSIONS: Overall, the p53 gene was associated with increased risk for invasive cervical cancer. However, the risk varied by country, cellular, and HPV type.