成人先天性胆管囊状扩张症的诊治体会(附22例报告)

目的探讨成人先天性胆管囊状扩张症的诊断及治疗方法。方法回顾性分析我院1984年～2006年收治的成人先天性胆管囊状扩张症22例的临床资料。结果本组22例均行手术治疗。囊肿内引流术再手术率高。囊肿切除肝管空肠Roux-en-Y吻合术无再手术病例,术后并发胆管炎3例、胰腺炎1例、胆瘘1例,均经保守治疗痊愈。全组无手术死亡病例。结论成人先天性胆管囊状扩张症经术前影像学检查能明确分型。单纯内引流术应摒弃,外引流术可为二期手术创造条件。囊肿切除肝管空肠Roux-en-Y吻合术为根治性术式。     

Pelvic Ring Fractures: Utility of Clinical Examination in Patients with Impaired Consciousness or Tracheal Intubation

Abstract Objective: To define the diagnostic accuracy of clinical examination in patients with impaired consciousness or endotracheal intubation to detect pelvic ring fractures and to identify those with severe bleeding. Methods: Included in this prospective data collection with retrolective data analysis were a consecutive series of blunt trauma victims with either a Glasgow Coma Scale ≤ 13 or tracheal intubation. Clinical examination comprised testing for stability of the iliac wings. Results: From 784 subjects (injury severity score 23.3 ± 17.4) 93 patients (11.9%) were found to have a pelvic ring fracture. Clinical instability of the pelvic ring was found in 42 patients. There was only one false positive. Fifty-two fractures could not be identified by clinical examination, including nine fractures (17%) that required surgical fracture stabilization (sensitivity of clinical examination 44.1%). Seventeen fractures (18.3%) were associated with a blood loss larger than 20% of circulating blood volume. Sixteen of those were identified by clinical instability of the pelvic ring (sensitivity 94.1%, specificity 97.0%, positive predictive value 38.1%, negative predictive value 99.9%). Conclusions: Clinical examination for stability of the pelvis in this selected group of patients missed a significant number of pelvic ring fractures including fractures that require surgical stabilization. The finding of a clinically unstable identifies most of the patients with the pelvic ring fracture being a major source of bleeding. A stable pelvis makes pelvic ring fracture as being the source of bleeding quite unlikely.     

Adult height of three renal transplant patients after growth hormone therapy

Three girls with normal growth hormone secretion had received renal transplantation when aged 2 to 6 years. They had had severely retarded growth (SD for height score was −7.4 to −3.7) at the time of transplantation. After renal transplantation, steroid was withdrawn and they were treated with recombinant human growth hormone; they subsequently reached adult heights of 145 to 156 cm. The SD for adult height score was −2.6 to −0.3. The adult height in two patients was over their target height, calculated using the mean of the parents’ height. This report shows the efficacy of steroid withdrawal and recombinant human growth hormone therapy in achieving adult height in these three girls after renal transplantation.     

成人回肠重复畸形的诊治体会

目的探讨成人回肠重复畸形的临床诊断和治疗方法。方法收集1996年2月至2010年12月,我院收治的6例回肠重复畸形患者的临床资料,并结合相关文献对该病的诊治方法进行分析与讨论。结果 本组6例回肠重复畸形患者均为男性,临床表现主要为消化道出血、腹痛、肠梗阻和腹部包块。其中5例行胃镜、结肠镜及腹部CT检查,3例行肠系膜动脉造影检查,均未提示消化道重复畸形;4例行99 Tcm放射性核素显像检查,其中2例提示消化道出血;3例行双气囊小肠镜检查,1例发现双回肠畸形。术前均未明确诊断,仅1例考虑回肠重复畸形可能。6例均行手术治疗,术中发现距回盲部11～100cm范围内有长度为6～25cm的重复肠管。术后病理检查证实均为回肠重复畸形,其中2例见胃黏膜异位,2例见肠腔内憩室,1例并发异位胰腺,1例伴回盲部炎性纤维性假瘤。6例患者术后均恢复良好。结论成人回肠重复畸形极为少见,临床无特异表现,目前暂无敏感性及特异性高的辅助检查,双气囊小肠镜及99 Tcm放射性核素显像有一定提示意义。术前一般很难作出明确诊断。剖腹探查时应考虑到该病的可能,一旦发现,建议手术切除。     

南京地区国人股骨头头颈直径比例的影像学测量

目的 通过X线片确定南京地区国人股骨头头颈直径比例的正常值.方法 选择468例无髋部症状的生活在南京及周边地区的成年中国人,男313名,女155名;年龄17～82岁,其中≤20岁13名,21～30岁88名,31～40岁123名,41～50岁104名,51～60岁102名,61～70岁24名,≥71岁14名,平均年龄42.4岁.摄标准骨盆正位X线片,应用Digimizer软件测量左、右侧股骨头最大直径与股骨颈最小纵径,并分别计算比值.将计算结果与西方人数据进行比较.结果 股骨头头颈直径比例1.33～1.69,平均1.48±0.09.≤20岁者1.46±0.09,21～30岁者1.48±0.09,31～40岁者1.47±0.10,41～50岁者1.46±0.09,51～60岁者1.49±0.10,61～70岁者1.48±0.08,≥71岁者1.49±0.10.不同性别、侧别及年龄组间差异均无统计学意义.南京地区国人股骨头头颈直径比例(左侧、右侧分别为1.48±0.09、1.48±0.10)与欧洲人数据(左侧、右侧分别为1.43±0.09、1.44±0.09)比较差异有统计学意义(P值均＜0.05).结论 南京地区国人股骨头头颈直径比例不存在性别、年龄及侧别差异.国人数据与欧洲人不同与种族的解剖差异有关.正常人群的股骨头头颈直径比例可能对某些髋关节疾病的诊断与治疗具有一定的参考意义.

Abstract：

Objective To measure the femoral head-neck ratio among Chinese adults in Nanjing to explore its clinical significance. Methods 468 Chinese without hip symptoms were chosen randomly. There were 313 males and 155 females. 13 cases were less than 20 years old, 88 cases were from 21 to 30 years old, 123 cases were from 31 to 40 years old, 104 cases were from 41 to 50 years old, 102 cases were from 51 to 60 years old, 24 cases were from 61 to 70 years old, 14 cases were more than 71 years old. The mean age was 42.4 years old (ranged from 17 to 82 years old). The maximum diameter of the femoral head and the minimum vertical diameter of femoral neck length on both sides were measured by Digimizer software in the standard anteroposterior pelvis film. The femoral head-neck ratio (FHNR) was calculated and compared with that of the western. Results The normal FHNR of Chinese in Nanjing was 1.48 ± 0.09 (1.33-1.69). FHNR was 1.46±0.09 in Chinese aged less than 20 years old. It was 1.48±0.09 in Chinese aged from 21 to 30 years, and 1.47±0.10 in those aged 31-40 years, 1.46±0.09 in 41-50 years, 1.49±0.10 in 51-60 years,1.48±0.08 in 61-70 years, 1.49±0.10 in those more than 71 years. There was no difference between male and female, the left and right side or the different age groups. There was no difference between the western and Chinese in Nanjing. Conclusion FHNR measurement has not variation with regard to sex, age and side. It may be useful to understand some kind of the hip diseases.     

17β-雌二醇对子宫内膜异位症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响

目的研究17β-雌二醇(17β-E2)对子宫内膜异位症(内异症)患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响,探讨Wnt/β-catenin信号通路在介导雌激素促进内异症发生发展的作用。方法体外分离培养内异症患者在位子宫内膜间质细胞。用不同浓度17β-E2处理子宫内膜间质细胞48 h;此后选用10-10mol/L 17β-E2处理子宫内膜间质细胞12、24和48 h,逆转录聚合酶链反应(RT-PCR)和免疫印迹法(Western blotting)检测17β-E2处理前后子宫内膜间质细胞β-catenin mRNA和蛋白的表达水平。同法分析雌激素受体拮抗剂ICI182,780(10-6mol/L)对17β-E2促进β-catenin mRNA和蛋白表达的影响。免疫组织化学染色观察17β-E2作用后β-catenin在子宫内膜间质细胞中的定位。结果17β-E2能明显促进内异症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白的表达,并呈剂量和时间依赖性,于10-10mol/L作用48 h最明显。雌激素受体拮抗剂ICI182,780能明显抑制17β-E2对子宫内膜间质细胞β-catenin mRNA和蛋白的表达。免疫组织化学染色发现17β-E2能促进β-catenin在子宫内膜间质细胞核内的表达。结论雌激素可能通过激活Wnt/β-catenin信号通路促进内异症在位子宫内膜的异位种植。     

Liver Transplantation for Cystic Fibrosis in Adults

Purpose To expand our knowledge on liver transplantation for cirrhosis associated with cystic fibrosis in adults. Methods Five patients who underwent a liver transplantation due to cystic fibrosis were reviewed. The outcome of the patients in terms of age, immunosuppression regimen, patient and graft survival, and pre- and post-transplant complications were investigated. Results Five adult liver transplant patients had cystic fibrosis (0.2%). These included 4 men and 1 woman with a mean age of 31 ± 10, ranging from 22 to 52 years old at the time of transplantation. All patients had lung problems. Four patients had exocrine and two had endocrine pancreatic insufficiency. Two are currently alive with a follow-up of 5.8 years and 4 months after transplantation, respectively. There were three deaths from pulmonary embolism at 4.5 years, myocardial infarction with cyclosporine nephrotoxicity at 10.7 years, and lymphoproliferative disorder at 5 months after transplantation. No deaths occurred from lung infection. Only one patient had postoperative pulmonary infectious complications, which were successfully treated with antibiotics and did not result in mortality. Conclusion Adult liver transplantation for end-stage liver disease associated with cystic fibrosis offers encouraging results with a rapid general improvement after surgery and it is now considered to be a safe and acceptable treatment for this disease population.     

成年人小腿外旋畸形的外科治疗

目的探讨成年人小腿外旋畸形的成因、手术方法和治疗效果。方法回顾性分析138例144条腿,平均年龄29.3岁。小儿麻痹后遗症116例,其它原因22例,其中130例合并髋、膝关节和踝足关节的多种畸形209个。术前小腿外旋平均43°,手术先截断腓骨,在胫骨结节下杵臼形截骨,远端内旋至中立位,测量棘、髌、踝力线正常,合并膝内翻、轻度屈膝和膝反屈畸形者同时矫正,截骨端以外固定器或钢针交叉加石膏外固定。结果术后随访平均14个月,128例小腿外旋畸形完全矫正,10例部分矫正。结论小腿外旋是渐进发生的常见畸形,胫骨结节下内旋截骨是简单有效的手术方法,合并髋、膝、踝关节畸形者尽可能同期手术矫正,恢复下肢的持重力线。     

七氟醚用于成人全身吸入麻醉的随机、开放、多中心、阳性对照临床研究

目的评估七氟醚和异氟醚全身麻醉后的苏醒时间及其安全性。方法前瞻性、开放、随机、多中心、异氟醚平行对照临床研究,222例手术时需要全身麻醉、气管插管、预计手术持续时间在2～3h之间的成年择期手术患者,按1:1随机入组接受七氟醚或异氟醚吸入麻醉。评估苏醒时间、拔管时间、改良Aldrete评分达到9分时间、苏醒时间和麻醉药用量之间的关系。根据生命体征、记录的不良事件评价其安全性。结果222例患者中220例完成全部研究过程,其中七氟醚组111例,异氟醚组109例。与异氟醚组相比,七氟醚组苏醒时间缩短5.4min、改良Aldrete评分达到9分时间缩短8.4min、拔管时间缩短4.6min(P<0.01)。两组苏醒时间与麻醉药用量之间均具有相关性,即麻醉药用量越大苏醒时间越长。七氟醚组发生的不良事件均为轻度或中度,且不良事件类型和发生率与异氟醚组相似。结论七氟醚全麻恢复效果优于异氟醚,且安全性和耐受性良好。