介入化疗治疗子宫颈癌49例分析

[目的]评价经子宫动脉介入灌注化疗对子宫颈癌的疗效及并发症.[方法]49例子宫颈癌采用Seldinger技术,经右侧股动脉穿刺并分别插管至左、右子宫动脉行灌注化疗.[结果]介入治疗后症状缓解率为100.0%,均行根治术.46例患者可观察到肿块体积明显缩小,总有效率为93.8%.[结论]经子宫动脉灌注化疗可作为根治术前常规的辅助方法.     

新生儿细菌性脑膜炎预后不良的危险因素分析

目的 探讨新生儿细菌性脑膜炎预后不良的危险因素。方法 回顾性分析152例细菌性脑膜炎新生儿的临床资料,根据转归分为预后良好组（n=122）与预后不良组（n=30）,比较两组患儿的一般情况、首发症状及实验室检查结果,分析预后不良的危险因素。结果 预后不良组极低出生体重、外周血WBC < 5×10⁹/L或 > 20×10⁹/L、C-反应蛋白 > 50 mg/L、脑脊液WBC > 500×10⁶/L、脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L比例高于预后良好组（P < 0.05）,血培养和/或脑脊液培养阳性率、革兰阳性菌及无乳链球菌培养阳性率高于预后良好组（P < 0.05）。多因素logistic回归分析显示,脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L是新生儿细菌性脑膜炎预后不良的独立危险因素。结论 脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L是新生儿细菌性脑膜炎预后不良的危险因素。     

Onyx embolization of a spinal epidural hemorrhage caused by thoracic spinal epidural arteriovenous fistula: A case report and literature review

Spinal epidural hemorrhages (SEDH) caused by spinal epidural arteriovenous fistulas (SEAVFs) are rare; thus, their specific pathogenesis has not been explained. Furthermore, the standard treatment for SEAVFs has not yet been defined. Here we report the case of a 36-year-old Chinese man who experienced acute onset chest pain and tightness. His symptoms rapidly aggravated until the lower limbs were unable to support him. Spinal magnetic resonance angiography (MRA) revealed a localized SEAVF and a secondary spinal cord lesion at the T4 level. Digital subtraction angiography (DSA) confirmed the presence of the SEDH/SEAVF at the T3–4 level with the left radicular artery feeding the fistula. Based on DSA and MRA findings, SEDH, local spinal cord infarction, and spinal venous reflux disorder were conditionally diagnosed. Using the arterial route, Onyx-34 was injected into the fistula to embolize the feeding arteries and the venous system. Angiography was performed after the microcatheter was withdrawn, and no residual fistula or anterior spinal artery was observed. The six-week follow-up MRI showed acceptable healing of the SEAVF, and the patient improved neurologically. This case suggests that endovascular treatment with Onyx-34 embolization should be considered a promising treatment strategy for this type of complicated SEAVF.     

影响分化型甲状腺癌术后促甲状腺激素抑制治疗疗效因素的研究进展

分化型甲状腺癌（DTC）在全部甲状腺癌类型中最为常见,占94%以上。目前主要采取根治性手术切除、选择性放射（¹³¹I）治疗和促甲状腺激素（TSH）抑制治疗的综合治疗,总体预后较好。TSH能够与DTC细胞表达的TSH受体结合,刺激DTC细胞生长,因此TSH抑制治疗是减少DTC患者术后肿瘤复发风险的重要环节,已得到国内外多项指南的明确推荐。但在临床实践中,仍存在部分患者难以实现TSH抑制治疗目标,需要反复调整治疗剂量以达到预期目标,治疗过程中可能伴随乏力、嗜睡或心悸等不适。本文主要总结DTC术后TSH抑制治疗疗效的影响因素,以期帮助临床医生为DTC患者提供更好的术后TSH抑制治疗和随访管理,以提高患者生活质量,延长远期生存时间,降低DTC术后复发率。     

Simultaneous occurrence of subarachnoid hemorrhage and cerebral venous sinus thrombosis: A systematic review of cases

Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done. Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female‐to‐male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty‐nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board.     

胸主动脉腔内修复术采用裙边型烟囱支架（Longuette™）的PATENCY临床试验研究结果

背景与目的 烟囱技术是胸主动脉腔内修复术（TEVAR）中重建左锁骨下动脉（LSA）的方法,Ⅰa型内漏是其主要并发症。裙边型烟囱支架（Longuette?）专为烟囱技术设计,用于重建LSA时降低Ⅰa型内漏。为评估Longuette?烟囱支架联合TEVAR治疗累及LSA的Stanford B型主动脉夹层（TBAD）的疗效,笔者开展了前瞻性、多中心临床试验（PATENCY临床试验）。本研究总结PATENCY临床试验的1年结果和经验。方法 2018年10月—2022年3月,全国26家血管外科中心参与PATENCY临床试验,共纳入150例符合标准的TBAD患者。所有患者均在TEVAR术中采用Longuette?烟囱支架重建LSA。评估患者围手术期和术后12个月的临床效果和不良事件,并分析患者术后1年累积生存率、LSA通畅率和无内漏率。结果 患者年龄30~77岁,平均（54.48±11.12）岁,138例（92.0%）患者合并高血压病;急性、亚急性和慢性TBAD分别占74.7%,17.3%和8.0%。124例（82.7%）患者采用全身麻醉。手术成功率为99.33%（149/150）,手术时间（91.67±41.47）min,X线暴露时间（31.36±16.71）min,手术出血量为（71.55±60.40）mL。围手术期内漏发生率为5.33%（8/150）,包括Ⅰ型6例、Ⅱ型1例、Ⅳ型1例;1例（0.67%）患者发生Longuette?烟囱支架急性闭塞,再次实施腔内手术后恢复通畅;1例（0.67%）患者术后发生急性脑梗死;2例（1.33%）患者术后发生逆撕的Stanford A型主动脉夹层,其中1例术后3周死亡。术后30 d死亡2例（1.33%）。142例患者进行了密切随访,随访时间为11.67（5~16）个月。无主动脉支架和Longuette?烟囱支架移位。2例Ⅰ型内漏患者分别于术后6个月和1年进行了再次介入栓塞手术治疗,术后1年随访仍有6例患者有轻微的内漏持续存在,患者TBAD假腔保持稳定,无明显症状,均予以保守治疗。Longuette?烟囱支架内狭窄和闭塞分别发生1例和2例,逆撕的Stanford A型主动脉夹层患者1例,假腔增大,患者均无明显症状,予以保守治疗。无发生脑卒中、截瘫、左上肢缺血等并发症。术后12个月累积生存率、LSA通畅率、无内漏率分别为97.96%、97.96%和91.91%。结论 采用Longuette?烟囱支架在TBAD腔内治疗中重建LSA简便、安全、有效,其能够有效降低围手术期Ⅰa型内漏的发生率,为微创治疗主动脉弓部病变提供新的治疗方式。     

脑AVM血管内栓塞治疗术后的护理

脑动静脉畸形(AVM)是脑实质内的血管在胚胎发育成型过程中受到阻碍,动静脉之间直接交通而形成的先天性疾病.以往传统的方法采用手术切除病灶,近年来,随着介入放射学的兴起,血管内栓塞已成为一种治疗脑AVM新的、独特的首选方法[1],栓塞治疗后的护理是保证栓塞治疗成功的关键,我科2003年1月～2006年5月行脑AVM血管内栓塞治疗共36例,取得较好的治疗效果,现将护理体会总结如下.     

急性心肌梗死自溶现象及其影响因素分析

目的分析急性心肌梗死（AMI）梗死相关血管（IRA）的自溶（SR）现象,探讨SR现象的影响因素。方法连续观察205例未予静脉溶栓治疗,直接行急诊冠状动脉造影的AMI患者,根据TIMI血流分为自溶组（前向血流TIMI 2-3级）和非自溶组（前向血流TIMI 0-1级）,分析其临床和造影特点,并寻求发生SR的影响因素。结果自溶组共49例（23.9%）。与非自溶组比较,一般临床情况差异无统计学意义（P〉0.05）,但自溶组发生梗死前心绞痛的比例较高（38.8%比22.4%,P〈0.05）。而非自溶组多支病变和存在侧支循环的比例高于自溶组（P〈0.05）。Logistic回归分析则提示多支病变和侧支循环是发生SR现象的独立影响因素。结论SR是AMI患者较常见的现象,其独立影响因素是多支病变和侧支循环。     

肾动脉瘤14例诊治报告

为探讨肾动脉瘤(RAA)的特点和诊治方法,回顾性分析2015年6月-2019年10月我院收治的14例RAA患者的临床资料.14例患者中,男8例,女6例;年龄40～77岁,平均59.1岁;左肾RAA 6例,右肾RAA 7例,双肾RAA 1例;体检发现8例,表现为腰腹部疼痛5例,表现为血压骤升1例;2例RAA破裂,1例表现...     

全血肌钙蛋白T即时检测诊断急性心肌梗死的意义

目的探讨床边全血即时检测心肌肌钙蛋白T(cTnT)早期诊断急性心肌梗死(AMI)的临床意义和不良后果预测价值。方法对收入急诊抢救室的128例高度可疑的AMI患者24 h内抽取静脉血检测cTnT,同时用同一份标本分别检测肌酸激酶(CK)及其同工酶(CK-MB)活性。结果在发病6 h和24 h内cTnT检测AMI的敏感性分别为74.3%和97.1%,特异性为97.7%。而CK及CK-MB的活性6 h内检测AMI的敏感性分别为40%和35.7%。结论cTnT快速即时检测对诊断AMI具有高度的敏感性和特异性,该方法简单快速,适宜床边检测,有助于早期确诊AMI,特别适用于急诊及院前急救。