食管癌3DCRT中CT与吞钡检测GTV-T长度差异的临床研究

目的探讨食管癌3DCRT中CT与吞钡检测GTV-T长度差异的临床意义。方法 23例食管癌患者,按CT模拟定位体位,在模拟机下进行吞钡透视,确定病灶上下界,并用铅笔标记并固定于皮肤上行CT模拟定位扫描,传输图像至TPS计划系统。勾画GTV-T时,按食管壁厚度>5 mm来计算病变长度,并计算用铅点标记的食管病变长度。结果根据CT检查得出的GTV-T长度与吞钡检查结果相比较,有显著性差异(P<0.05)。结论勾画GTV-T时,不能简单按CT图像上食管壁厚度>5 mm来计算病灶长度,而应结合胃镜、吞钡检查、PET-CT及EUS结果。     

螺旋CT二维重建对肝肾间肿瘤的定位意义

目的:探讨螺旋CT二维重建对肝肾问占位性病变的诊断价值,提高CT对右上腹占位病变的诊断准确性.方法:对25例经外科手术和病理证实的肝肾间占位病灶的CT资料进行2次阅片分析.第一次仅提供横断位CT图像进行诊断,然后同时提供横断位和二维重建的进行诊断.与手术和病理结果对照,比较分析两次诊断的准确性,并探讨对肝肾间占位病灶CT定位和定性诊断有价值的征象.结果:25例经外科手术和病理证实的肝肾间占位病灶,包括原发性肝细胞肝癌9例、肾上腺腺瘤7例、肾上腺腺癌2例、肾上腺来源的嗜铬细胞瘤3例、肾上腺髓样脂肪瘤1例、肾细胞肾癌2例、后腹膜来源的间质瘤1例,肿瘤直径在5～15cm不等.使用横断位图像定位诊断正确17例(68%),包括肝脏源性6例、肾上腺源性9例、肾源性2例,其中定性诊断正确15例(60%).使用横断位结合二维重建图像诊断正确21例(84%),包括肝脏源性8例、肾上腺源性11例、肾脏源性2例,其中定性诊断正确18例(72%),定位和定性诊断准确率均明显提高.在所有有利于CT定位的征象中,"杯口征"是最直接、最可靠,也是价值最大的定位征象.结论:利用多层螺旋CT扫描速度快、图像分辨率高的特点,采用薄层扫描以及多平面重建,能很好地观察肿瘤的全貌及其与周围脏器的关系,有利于辨别肝肾间占位的来源,明显提高病变的定位和定性诊断准确率.     

Dedicated bifurcation stents – Mechanistic,hardware, and technical aspects

Percutaneous coronary intervention (PCI) in bifurcation lesions is associated with lower success rate, higher acute complication rates and higher event rates in follow-up.The reason for this higher than usual complication rate relates to the relationship between anatomy, flow, and atheroma distribution in bifurcation lesions.Further, stenting these lesions can be a prolonged procedure and can be technically more demanding. The most common complication is the loss of significant side branch (SB). Main vessel (MV) stenting may enhance the carina displacement and atheroma shift across the SB ostium leading to SB ostium narrowing.Finally, complications, if they occur, are more difficult to manage. Dedicated bifurcation stent has been developed to overcome the number of limitations associated with conventional bifurcation PCI. The main advantage of most dedicated bifurcation stents is to allow the operator to perform the procedure on a bifurcation lesion without the need to rewire the SB.     

Duodenal adenocarcinoma: Advances in diagnosis and surgical management

Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma(DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multiinstitutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles.     

纤维蛋白原与冠状动脉临界病变血流储备分数的相关性

目的探讨血浆纤维蛋白原水平与冠状动脉临界病变血流储备分数(FFR)的相关性及其临床意义。方法入选经冠状动脉造影检查为冠状动脉临界病变(冠状动脉狭窄程度为50%~70%)并行FFR检查的患者,根据冠状动脉FFR测得值分为FFR≥0.8组(23例)和FFR0.8组(14例)。入选患者均于入院后检测纤维蛋白原、总胆固醇、甘油三酯、尿酸、肌酐、血糖等指标。采用相关分析和ROC曲线分析纤维蛋白原与FFR的相关性。结果应用偏相关分析控制可能影响纤维蛋白原及冠状动脉血管病变的因素包括年龄、性别、血脂、血糖水平等,结果显示FFR0.8组患者血浆纤维蛋白原水平明显高于FFR≥0.8组(3.50±0.72 g/L比2.68±0.63 g/L,P0.05),纤维蛋白原水平与FFR值呈负相关(r=-0.477,P0.01);ROC曲线分析显示,最适宜的截断点为2.692 g/L,应用FFR值=0.8作为判断冠状动脉临界病变有无缺血的敏感度为92.9%,特异度为65.2%。结论血浆纤维蛋白原可用于检测冠状动脉临界病变心肌有无缺血,与冠状动脉临界病变心肌缺血程度相关,可作为预测冠状动脉临界病变心肌有无功能性缺血及支架植入的影响因素。     

Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction

AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent(PS) or nasobiliary catheter(NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedurerelated adverse events, stent/catheter dysfunction(occlusion or migration of PS/NBC, developmentof cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution(bilirubin level 3.0 mg/d L) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study(PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients(46%), bile duct cancer in 172(41%), gallbladder cancer in three(1%), and ampullary cancer in 50(12%). The median serum total bilirubin was 7.8 mg/d L and 324 patients(77%) had ≥ 3.0 mg/d L. During the median time to surgery of 29 d [interquartile range(IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio(SHR) = 4.76; 95%CI: 2.44-10.0, P 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method(PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.     

头颈部IgG4相关性疾病的临床及影像学诊断

头颈部IgG4相关性疾病是新认识的一种多器官系统病变,临床上以血清IgG4升高、广泛的IgG4阳性淋巴浆细胞组织浸润、组织纤维化及皮质类固醇激素治疗有效为特征.在CT和MRI上也可呈现一些相对特征的表现,CT和MRI不仅能为头颈部IgG4相关性疾病的诊断及鉴别诊断提供有价值的信息,而且能为临床治疗方案的选择及其疗效、预后的评估提供帮助.     

性交出血与宫颈癌及癌前病变的关联

目的：讨论性交出血与宫颈癌及癌前病变的关系.方法：2011年1月至2012年11月我院妇科门诊在自愿接受宫颈癌筛查的患者中选取有性交出血史的631例患者均进行液基细胞学检查、电子阴道镜下宫颈四象限多点活检＋宫颈管搔刮术（ECC）,然后病理诊断,对临床资料进行回顾性分析.结果：TCT阳性率55.47％,其中LSIL 194例,占30.75％,ASC-US 76例（12.04％）,ASC-H 31例（4.91％）,HSIL 48例（7.61％）,AGC 1例（0.16％）.阴道镜下活检病理结果,宫颈上皮内瘤变（CIN） 176例（27.89％）,其中CINⅡ＋CINⅢ101例（57.39％）;宫颈癌19例（3.01％）.结论：性交出血是宫颈病变的警示,我们要重视有性交出血的患者,重点随访.为了降低其宫颈癌及癌前病变漏诊率及误诊率,要采用积极的检查手段.     

64排螺旋CT血管成像诊断肠系膜上动脉病变

目的探讨64排螺旋CT血管成像在临床诊断肠系膜上动脉病变及肠系膜上动脉相关病变的价值。方法以31例初步诊断为疑似肠系膜上动脉病变或肠系膜上动脉相关病变的患者作为研究对象。对所有患者行全腹部多层螺旋CT容积扫描。待获取扫描原始数据后,采用图像后处理技术进行图像的后处理,包括：三维最大密度投影（3DMIP）、多平面重组（MPR）、容积再现（VR）。并对扫描结果进行分析。结果所有患者经多螺旋CT血管成像均可使肠系膜上动脉及其分支清晰显示。其中,肠系膜上动脉压迫综合症12例,包括＂胡桃夹＂综合征7例和十二指肠淤滞症5例;肠系膜上动脉夹层3例,包括孤立性肠系膜上动脉夹层1例和胸腹主动脉夹层累及肠系膜主动脉2例;肠系膜上动脉缺血性病变15例。结论 64排多螺旋CT血管成像可清晰观察到肠系膜上动脉及其周围血管的各种病变情况,对肠系膜上动脉病变及肠系膜上动脉相关病变的诊断具有重要价值,值得在临床肠系膜上动脉病变的诊断中推广应用。     

病灶清除椎间植骨内固定治疗腰椎术后椎间隙感染的疗效

目的：观察病灶清除椎间植骨内固定治疗腰椎术后椎间隙感染的疗效。方法：回顾性分析11例腰椎同盘突出症术后椎间隙感染患者的病例资料,采取后路病灶清除、植骨融合、保留内固定的手术治疗方法。结果：11例患者全部治愈,无1例复发。结论：手术治疗是腰椎间盘突出症术后椎间隙感染首选方法,可尽快缓解患者腰痛,缩短治愈时闷。