改制微导管同轴法再通治疗输卵管阻塞性不孕的临床应用研究

目的 改制微导管同轴法再通提高输卵管阻塞病人的治愈率。方法 将改制微导管插入至输卵管近端入口,应用推注的压力分离粘连。对于阻塞较严重的病人,直接进和导丝再通,在推注及导丝的反复作用下,大部分阻塞的输卵管均可复通。结果 复通率为９２．６％（３６５／３９４）,２００例受治者中有８２例怀孕,占４１％。结论 改制微导管配合同轴导管行选择性输卵管复通术,输卵管复通率明显高于文献报道,特别为无法治疗的伞端受阻     

The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy patients with or without left ventricular outflow tract obstruction: Assessment with first-pass perfusion imaging using 3.0-T cardiac magnetic resonance

Purpose

To assess regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction using 3.0-T cardiac magnetic resonance (CMR) first-pass perfusion imaging.

Materials and methods

Forty-two HCM patients, including 25 HCM patients with left ventricular outflow tract obstruction (HOCM), 17 HCM patients without left ventricular outflow tract obstruction (NOHCM), and 14 healthy subjects underwent CMR. The left ventricular (LV) function, left ventricular end-diastolic wall thickness (EDTH), and diameter of left ventricular outflow tract (LVOT) were measured and calculated. Based on the signal–time curve of the first-pass myocardium perfusion imaging, perfusion parameters including upslope, time to peak, and peak intensity, were assessed and compared by using one-way analysis of variance and independent t tests.

Results

On the first-pass perfusion imaging, lower upslope and peak intensity and longer time to peak were found in HCM patients compared with normal subjects (all p < 0.05). In contrast to the NOHCM group, the average time to peak of the HOCM group was increased (13.30 ± 4.82 s vs 16.28 ± 4.90 s, p < 0.05), but first-pass perfusion upslope was reduced (4.96 ± 2.55 vs 2.58 ± 0.77, p < 0.05). According to the bull's-eye model, the HOCM group's average thickness of basal segments was thicker than the NOHCM group, especially the anteroseptal, inferolateral, and anterior wall values, with a corresponding lower first-pass perfusion upslope than the NOHCM group (all p < 0.05). A significant correlation was observed between first-pass perfusion upslope and LV EDTH (r = −0.551, p < 0.001) and LVOT diameter (r = 0.472, p < 0.001).

Conclusions

The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction can be detected with first-pass perfusion CMR imaging.     

肾盂输尿管连接部梗阻30例临床分析

为探讨肾盂输尿管连接部(PUJ)梗阻的诊治方法,总结分析我院1992年～1997年收治的PUJ梗阻30例。B超30例,IVU26例,逆行肾盂造影10例,CT6例。30例均行Anderson-Hynes成形术。随访3月～2年,29例治愈,1例留置肾造瘘管。PUJ梗阻14岁以前发病多见,早期易误诊为消化道疾病,大多数病人经B超和IVU联合检查明确诊断。治疗首选Anderson-Hynes成形术,强调术中探查输尿管全段,双J管内引流有其适应证。     

移植肾输尿管梗阻的诊断与治疗：（附13例报告）

为了提高对移植肾输尿管梗阻患者的诊断与治疗水平，对在５３６例次肾移患者中发现的１３你输尿管梗阻患者进行临床总结分析，其中输尿管狭窄性梗阻１０例，输尿管结石性梗阻３例。分析认为，肾移植术后早期排斥反应、伤口深部感染及漏尿可能与发生移植肾输尿管狭窄性梗阻有关，而肾移植术后高尿酸血站与输尿管结石形成有关。提出Ｂ超、肾图、经皮顺行造影和肾盂内压测定为诊断移植肾输尿管梗阻的手段；对于输尿管狭窄性梗阻患者，早     

烧伤合并体腔积液、麻痹性肠梗阻、消化道出血1例报告

1临床资料患者,男,43岁,因"火焰烧伤后27 d伴腹痛、腹胀、腹泻4d"于2009年11月1日入院.患者于入院前27 d双下肢被火焰烧伤,立即就诊于当地医院,予清创、包扎、抗休克等治疗.伤后第2天转入当地某医院,外用中药(成分不详)治疗约20 d,其间使用多种抗生素(用药不详).     

脑室-腹腔分流术后分流不畅的原因分析及处理

目的 总结脑室-腹腔分流术后发生分流不畅的治疗经验。方法 2010年1月至2014年1月采用脑室-腹腔分流术治疗脑积水患者87例。结果 术后出现分流不畅共6例,占6.90%（6/87）。梗阻性脑积水患者3例,远端和近端梗阻各1例,行神经内镜下第三脑室底造瘘术;远端堵塞1例,行脑室-心房分流术后好转。交通性脑积水患者3例,1例远端堵塞,行左侧脑室-腹腔分流术后好转;2例分流系统通畅但症状进行性加重,更换更低压力分流泵后好转。结论 严格把握脑室-腹腔分流术指征,选择合适分流系统和手术方式,规范精细的手术操作有助于预防术后分流不畅的发生;脑室-心房分流术、第三脑室底造瘘术对分流不畅的治疗有较好作用。     

多层螺旋CT对肺栓塞影像表现及与其严重性关系的评价

目的 评价多层螺旋CT肺栓塞影像表现及与其严重性的关系.资料与方法 回顾性分析104例临床诊断肺栓塞患者的临床及影像学资料,测量心血管参数:主肺动脉直径、右心室短轴最大径(RVMSA)、左心室短轴最大径(LVMSA)及RVMSA/LVMSA比值,计算CT肺动脉成像(CTPA)阻塞指数,评价CTPA上栓子的形态和与双能量CT(DECT)上灌注缺损的关系及CTPA阻塞指数与心血管测量参数的关系.结果 104例中,32例因图像丢失(n=10)、CTPA图像欠佳,不满足测量要求(n=9)或未行CTPA检查(n=13),故只对72例患者的影像学资料进行分析评价.完全闭塞型肺栓塞DECT表现为整个肺叶灌注降低或某个肺段灌注缺损,部分闭塞型DECT表现为灌注降低或正常.CT阻塞指数与心血管测量参数具有一定的相关性(P<0.05),以CT阻塞指数与RVMSA/LVMSA比值相关性最高(r=0.519,P<0.001).结论 肺灌注异常与否取决于肺动脉栓塞的程度;CT肺动脉阻塞指数可用于评价肺栓塞的严重性.     

先天性肾盂输尿管连接处梗阻性肾积水的神经性因素研究

目的探讨神经性因素在先天性肾盂输尿管连接处梗阻性肾积水发病中的作用。方法将31例患儿手术切除的肾盂输尿管连接处（实验组）、同一患儿输尿管切缘（切缘对照组）、产前排除泌尿系异常、孕32周以上引产并进行尸体解剖的胎儿30例（阴性对照组）进行病理分析。显微镜下观察神经节细胞及神经纤维的分布。分析神经节细胞和神经纤维在各组中的分布及差异。结果切缘对照组以及阴性对照组的神经纤维分布密度均多于实验组,而切缘对照组与实验对照组比较,差异无统计学意义。结论神经性因素是先天I生。肾盂输尿管连接处梗阻性肾积水的重要原因。临床应充分切除输尿管连接处狭窄段,以减少术后复发。