经皮冠状动脉介入治疗对冠心病患者术后焦虑和抑郁影响的研究

目的 评价经皮冠状动脉介入治疗对冠心病患者术后焦虑和抑郁影响。方法 600例冠心病患者根据是否在冠状动脉造影时接受支架植入术治疗分为支架组（n = 400）和非支架组（n = 200）,400例支架组患者根据术后是否接受心理干预治疗进一步随机分成干预组（n = 200）和非干预组（n = 200）。患者入院后1 d、PCI治疗后1 d、出院时分别采用焦虑自我量表和抑郁自我量表进行焦虑和抑郁评分,比较不同时间患者焦虑和抑郁评分。结果 3组患者平均年龄、性别构成、血红蛋白含量、总胆固醇含量、甘油三酯含量、低密度脂蛋白胆固醇含量和高密度脂蛋白胆固醇含量差异均无统计学意义（均P > 0.05）,具有可比性。入院后1 d,3组冠心病患者焦虑和抑郁评分差异均无统计学意义（均P > 0.05）;PCI治疗后 1 d,干预组和非干预组冠心病患者焦虑和抑郁评分均显著高于非支架组（均P < 0.05）,干预组和非干预组冠心病患者焦虑（t = 11.21,P < 0.01;t = 9.96,P < 0.01）和抑郁评分（t = 8.56,P < 0.01;t = 6.73,P < 0.01）均显著高于入院后1 d。出院时,3组冠心病患者焦虑和抑郁评分差异均有统计学意义（均P < 0.05）,干预组和非干预组冠心病患者出院时焦虑（t = 21.57,P < 0.01;t = 15.77,P < 0.01）和抑郁评分（t = 24.33,P < 0.01;t = 15.01,P < 0.01）均显著低于PCI治疗后 1 d,干预组焦虑和抑郁评分均显著低于非干预组（均P < 0.05）。结论 PCI治疗会加重冠心病患者术后焦虑和抑郁状态,而心理干预治疗可减轻焦虑和抑郁状态。     

侧后路椎间孔镜下髓核摘除术治疗青少年腰椎间盘突出症的早期疗效观察

目的探讨经皮侧后路椎间孔镜下髓核摘除术治疗青少年腰椎间盘突出症的临床疗效。方法 2010年2月~2011年7月,我院收治的12例青少年腰椎间盘突出症患者接受了经皮侧后路椎间孔镜下髓核摘除术治疗并获得随访。其中男8例,女4例;年龄12~20岁,平均14.6岁。比较手术前后Oswestry功能障碍指数(Oswestry Disability Index,ODI)、下肢疼痛视觉模拟评分(visual analogue scale,VAS)及术后12个月时Macnab评分对临床疗效进行分析。结果 12例患者均获得随访,随访时间17~30个月,平均21.3个月。术后1周、3个月,6个月,12个月及末次随访时ODI指数、下肢疼痛VAS评分与术前相比均明显降低,差异有统计学意义(P0.05)。按照Macnab评分标准,术后12个月时,优7例,良4例,可1例,优良率为91.7%(11/12)。结论经皮侧后路椎间孔镜下髓核摘除术治疗青少年腰椎间盘突出症短期内能取得满意的临床疗效,其长期疗效及安全性有待进一步研究。     

鼻内镜手术后筛窦黏膜转归的病理组织形态学观察及临床意义

目的：了解鼻内镜手术后修复各阶段筛窦黏膜的组织学转归情况，探讨术后筛窦黏膜转归过程的组织形态学规律，为完善治疗、提高手术治愈率提供科学的依据。方法：采用Messerklinger术式治疗22例成年慢性鼻窦炎（CS）及慢性鼻窦炎鼻息肉（CSNP）患者，分别在术后恢复的3个阶段进行形态学观察和光镜、电镜检查。结果：（1）术腔清洁阶段术腔分泌物潴留，光镜下上皮缺失、黏膜缺损，水肿，炎性细胞浸润，黏膜下出血；（2）黏膜转归竞争阶段可有囊泡、小息肉和肉芽生长，光镜下上皮细胞增生，部分杯状细胞增生，黏膜下腺体增生或减少；（3）上皮化完成阶段见术腔清洁，镜下大部分黏膜基本恢复正常，部分固有层为致密结缔组织取代，可见不典型腺体。结论：鼻内镜术后筛窦黏膜可以再生，鼻内镜术中、术后筛窦黏膜的正确保护和处理对黏膜再生修复有重要作用。     

Percutaneous transluminal coronary angioplasty - Histopathological analysis of nine necropsy cases

Summary From 1982 to 1984 nine of 300 patients undergoing transluminal coronary angioplasty died. The nine coronary arteries and one saphenous aorto-coronary by-pass graft affected by angioplasty were studied by light microscopy. The following types of lesions were found, frequently in association: rupture of the plaque, circumscribed or reaching to the intimal layer or extending beyond it, dissections (fissures) between arterial layers, intra-plaque haemorrhage, plaque emboli and thrombosis. In two cases the therapeutic approach was considered to be clinically and pathologically successful; the patients survived 24 h (case 6) and forty days (case 4). Case 6 which presented recent lesions indicative of success showed, in contrast with the other non-successful cases, rupture affecting not only the initimal layer but also deeper structures of the arterial wall. There were also more extensive fissures. Case 4 which presented late alterations indicative of success showed a plaque fracture whose borders were kept apart by fibrous tissue. In conclusion, we believe that angioplasty allows the re-establishment of arterial blood flow by provoking deep intimal and medial rupture producing a small fissure between the arterial layers and a widening of the lumen; in cases with good late results these alterations cicatrize leaving a wider arterial lumen.     

Percutaneous endoscopic lumbar discectomy (PELD)

Percutaneous endoscopic lumbar discectomy (PELD) is a new technique for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. The technique was introduced in Germany by the authors in April 1987. The method is indicated in patients with non-equestrated lumbar disc herniation with an intact lorsal longitudinal ligament. In local anesthesia, a working cannula (OD 5 mm) is placed at the dorsal lateral border of the disc. The disc space is opened with anulus trephines and the nucleus pulposus is removed with rigid and flexible forceps as well as with automated shaver systems under intermittent endoscopic control (discoscopy). The procedure is performed in local anesthesia. The results of the first thirty patients with a follow-up time between 6 months and 17 months could be graded as excellent in 13 cases, as good in 9 cases, as fair in 6 cases, and as bad in 2 cases. The relief of symptoms as judged by the patients was between 70–100 percent in the majority of the cases. Three patients had to be reoperated at the same level and site, because of either persistent or recurrent sciatica. The performance in local anesthesia, the atraumatic extraspinal approach, the reduced time of hospitalization and post-operative morbidity as well as the reduced time of work incapability are the main advantages of this new method.     

标准通道经皮肾镜取石术治疗孤立肾肾结石的长期安全性和有效性

目的: 探讨超声引导下标准通道经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗孤立肾肾结石患者的长期有效性和安全性。方法: 回顾性分析2008年9月至2014年6月于北京大学人民医院行PCNL治疗的22例孤立肾肾结石患者临床资料以及5年以上随访资料,记录围手术期相关指标、术后无石率(stone free rate,SFR)及并发症发生率,采用超声检查评估远期结石复发率,通过血肌酐及估计肾小球滤过率(estimated glomerular filtration rate, eGFR)评估肾功能情况。结果: 本组22例患者中,平均年龄为(50.3±11.8)岁,10例解剖性孤立肾,12例功能性孤立肾,中位结石直径为1.65(1.1~3.9) cm,全部为多发结石,包括7例鹿角形结石。术前的中位血肌酐为104.5(60.0~460.0) μmol/L,平均eGFR为(60.3±29.4) mL/min。平均手术时间为(88.2±42.0) min,各有11例单通道和双通道PCNL。术后第一天的中位血肌酐为102.0(63.0~364.0) μmol/L,平均eGFR为(58.0±25.1) mL/min,与术前相比差异均无统计学意义。术后平均住院时间为(8.7±5.2) d。本组有5例(22.7%)患者出现短期并发症,其中4例患者同时出现术后感染和大量出血,保守治疗后好转,1例患者出现胸膜损伤,行胸腔闭式引流后好转; 2例(9.1%)患者出现长期并发症,术后3个月发生输尿管狭窄,行球囊扩张术后好转;其余15例(68.2%)患者均未见并发症。中位随访时间为6.2(4.7~11.1)年,最近一次随访的中位血肌酐为104.0 (72.4~377.0) μmol/L,平均eGFR为(60.1±23.7) mL/min,与术前相比差异均无统计学意义,6例(27.3%)患者出现肾功能减退。术后初始和最终SFR分别为72.7%和100%; 6.2年的随访时间内9例(40.9%)患者结石复发,复发后共进行13次取石手术,最近一次随访的SFR为63.6%。结论: 本研究目前是国内外已有报道中关于孤立肾肾结石患者PCNL术后随访时间最长的研究,超声引导下标准通道PCNL治疗孤立肾肾结石是安全有效的,可以达到理想的SFR。长期随访结果表明仍有较高的结石复发率,但术后患者远期肾功能稳定,部分患者出现轻度肾功能减退。     

经皮肺内注射无水乙醇的动物实验研究

为了观察经皮穿刺注射无水乙醇对肺组织的局部作用和全身影响 ,为经皮穿刺注射无水乙醇 (PEI)治疗肺癌的安全性和可行性提供依据 ,我们进行了家兔肺内PEI的初步实验研究。结果显示 :PEI后的第 1天至第 3天 ,注射局部的肺组织发生凝固性坏死 ,周围肺水肿、充血 ,伴大量嗜中性白细胞浸润。 1～ 2周后 ,肺局灶性上皮细胞肉芽组织增生 ,最后纤维化。PEI早期既无大面积肺组织坏死 ,亦无明显的全身副作用。本研究结果提示 ,肺内PEI是安全可行的     

内镜逆行胰胆管造影介导光动力疗法治疗胆管癌研究进展

胆管癌恶性程度高,早期诊断困难,绝大多数患者被确诊时已不可行手术切除,患者生存质量低,生存 周期短,传统放射治疗和化学药物治疗效果欠佳且不良反应大,因而缺乏有效的控制手段。内镜逆行胰胆管造影 (endoscopic retrograde cholangiopancreatography,ERCP)是诊断和治疗胆道疾病的重要手段,而光动力疗法(photodynamic therapy,PDT)作为胆管癌的一种新的局部治疗方法优势明显。近年来,ERCP介导的PDT治疗胆管癌的研究在国外逐 渐兴起。其可有效缓解胆管癌患者的症状,提高生存质量,延长生存期,有望成为治疗胆管癌的新手段。     

小儿鼻颅底针形内窥镜的检查与手术

目的：探讨应用针形内窥镜对小儿鼻颅底疾病进行探查与手术的方法及疗效。方法：在外径１．９ｍｍ的进口针形内窥镜及电视同图像系统监视下,对８例小儿（７ｄ￣１２岁）鼻颅底有关疾病进行探杳与手术。结果：先天性后鼻孔闭锁３例中,１例好转,３例痊愈。外伤性脑脊液鼻漏１例,经修补痊愈先天性脑膜脑膨出２例,确诊后１例暂缓治疗。另１例行内窥镜手术痊愈。颅底神经母细胞瘤２例取材作病理检查确诊。结论：在电视图像监视下应用     

经皮腰椎间盘切除术治疗复发性腰椎间盘突出症

目的：总结经皮腰椎间盘切除术治疗传统后路术后复发性腰椎间盘突出症的经验。方法：分析１９９５年１月至１９９８年１２月采用经皮腰间盘切除术治疗１９例复发性腰椎间盘突出症的临床资料。结果：穿刺成功率１００％,术后随访１０～３２月,平,平均２１月,优１１例、良５例,可２例,差１例,优良率８４．２％。结论：在具有再次开放手术适应症的复发性腰椎间盘突出症中,初次手术行单节段半椎板、全椎板切除和开窗术者中一侧单