不同手术方案在严重肝外伤患者中的疗效和安全性研究

目的：探讨不同手术方案在严重肝外伤患者中的疗效和安全性。方法选取2005年1月至2013年12月严重肝外伤患者96例进行回顾性分析,其中以2005年1月至2007年12月的35例为A组,2008年1月至2010年12月的29例为B组,2011年1月至2013年12月的32例为C组。A组采用肝裂伤创面致密缝合手术治疗,B组采用损伤控制性手术治疗,C组采用选择性肝动脉结扎、肝裂伤面缝合加肝周填塞手术治疗,对不同手术方案在严重肝外伤患者中的疗效和安全性进行研究。结果 C组在手术时间、手术次数和住院时间上相对A、B组明显较少（P＜0．05）;术中出血量、术后3 d 腹腔引流量相对A、B组明显较少（P＜0．05）;C组治愈率相对A、B组明显较高（P＜0．05）,并发症发生率和病死率相对A、B组明显较低（P＜0．05）。三组肝功能表现均良好。结论采取选择性肝动脉结扎加肝周填塞的手术方案治疗严重肝外伤患者时最有效的、也是最安全的,不仅可以减少治疗手术术中、术后出血量,还可以缩短手术与住院的时间,最终提高了对患者的治愈率,避免了并发症的发生,节省了患者的花费,节省了医疗资源,该手术方案值得在临床进一步推广使用。     

胃肝样腺癌18F-FDG PET/CT检查一例

患者男,73岁,因“上腹部疼痛2年”就诊患者2年前无明显诱因出现上腹部疼痛,呈阵发性钝痛,进食后症状可减轻.体格检查无阳性体征.患者无于术、外伤、结核、肝炎病史.血清学肿瘤标志物:AFP连续3次测量均＞1050(正常参考值0～10.9)μg/L,实测值9186.0 μg/L;CEA 、CA125和CA19-9均正常.肝炎标志物阴性 考虑原发性肝癌可能.腹部增强CT示:肝实质未见异常;胃小弯侧、肝门区、肝总动脉旁多发肿大淋巴结佯强化,以肝门区为著,大小约3.0 cm×2.1 cm.CT诊断:腹腔多发肿大淋巴结,考虑腹腔淋巴结转移.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

中西医结合治疗脑出血及血清微量元素相关性的临床观察

脑出血具有高死亡率、高致残率的特点 ,其颅内血肿及继发的脑水肿所形成的占位效应与预后密切相关。脑局部血流量下降、自由基、凝血酶等血肿溶出物参与了脑水肿的形成 ,体内 Zn、Fe等微量元素水平的下降在其中可能起了一定的作用。我们应用补气活血化瘀中药治疗脑出血已取得初步疗效 ,为进一步观察临床疗效与微量元素的关系 ,我们进行了下列研究。1　临床资料 :选择 1997年 7月～ 2 0 0 0年 12月住院的脑出血患者 6 0例 ,符合全国第 4届脑血管病学术会议制定的诊断标准并经颅脑 CT扫描证实为脑出血者 (年龄超过 75岁 ,合并心、肝、肾等严…     

18F-FDG PET/CT监测肝癌治疗后复发转移的价值

目的 评价18F-脱氧葡萄糖(FDG)PET/CT显像在监测手术切除或肝动脉化疗栓塞(TACE)治疗原发性肝癌后复发残留或转移的价值.方法 24例原发性肝癌患者(肝部分切除术6例、肝移植术3例、TACE治疗15例)治疗后4周～2年行18F-FDG PET/CT检查,结果 经病理,DSA或随访证实.结果 24例患者中21例患者经活检、DSA或随访证实为复发或转移.1 9例可见18F-FDG放射性摄取增高灶,其中5例肝部分切除术后患者,2例复发,3例肝内转移;2例肝移植术后患者1例双侧肾上腺转移,1例肝转移、肺转移和骨转移;12例TACE治疗后患者肿瘤残留.2例TACE治疗后患者肿瘤内放射性分布与邻近非肿瘤的肝实质相近,未见异常增高灶,DSA证实肿瘤残留.3例未见异常放射性摄取增高灶,随访未见复发或转移.肝内转移灶的SUVma×3.4～12.5.18F-FDG PET/CT诊断肝癌治疗后复发转移的灵敏度为90.5%、特异性为100%、准确率为91.7%.结论 18F-FDG PET/CT显像可有效监测肝癌治疗后疗效,并指导进一步治疗.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

CYP2E1、GSTT1基因多态性与非霍奇金淋巴瘤易感性的关系

 目的探讨细胞色素P450酶2E1(CYP2E1)和谷胱甘肽硫转移酶(GSTT1)基因多态性与非霍奇金淋巴瘤（NHL）易感性的关系。方法分别采用聚合酶链反应-限制性片段长度多态性技术和聚合酶链反应技术对254例NHL患者和254例健康对照者CYP2E1和GSTT1基因多态性进行分析。结果NHL组和对照组CYP2E1基因多态性分布无明显差异(P>0.05);NHL组GSTT1基因缺失型频率明显高于对照组（48.0% vs 37.8%,P<0.05）。对NHL亚型分析显示,与GSTT1野生型者相比,携带GSTT1缺失型者发生弥漫大B细胞性淋巴瘤和滤泡性淋巴瘤风险分别为1.78倍（95%CI：1.12～2.82,P=0.02）和1.69倍（95%CI：1.03～2.77,P=0.04）。基因多态联合作用分析显示,CYP2E1野生型伴GSTT1缺失型者发生NHL的风险为1.83倍(95%CI：1.14～2.95,P=0.01)。结论GSTT1基因多态性可能是NHL的独立易感因素,GSTT1缺失型与CYP2E1野生型联合作用可进一步增加NHL的发病风险。     

阑尾切除术切口感染的预防

阑尾切除术最常见的并发症是术后切口感染。我院自1992～1998年共施行阑尾切除术327例,由于采取了一系列行之有效的预防措施,切口感染率较前明显下降,取得显著疗效,现分析报告如下。     

18F-FDG PET/CT发现阴囊Paget病伴体内多发转移一例

患者男,64岁,因右侧阴囊处潮湿、溃烂2年入院.无糖尿病、结核病史,无肿瘤家族史.体格检查:右侧阴囊处见大溃疡,表面糜烂、渗液、结痂,面积约5 cm×8 cm,周围皮肤粗糙,有明显异味;双侧腹股沟可触及数枚肿大淋巴结,质硬,活动度差.实验室检查:血清ALP为116.0(正常参考值32～92) U/L,ALT 66.0(正常参考值0～40)U/L,AST 41.6(正常参考值0～40)U/L,细胞角质素片段抗原21-1(cyfra21-1)4.7(正常参考值0～3.3)μg/L,CEA 8.7(正常参考值0～3.4) μg/L.为明确病变的性质及范围,行18F-FDG PET/CT检查.     

经两种导管注射地尔硫卓处理急诊PCI术中无复流现象的疗效比较

目的:观察急诊经皮冠状动脉介入治疗(PCI)术中出现无复流现象后,经微导管向远端血管床注射地尔硫卓的治疗效果。方法:选择PCI治疗中存在“无复流”现象的患者41例为研究对象,其中20例入选导引导管组,经导引导管冠状动脉内注射地尔硫卓2.0 mg;21例入选微导管组,经微导管注射地尔硫卓2.0 mg至靶病变远端:10 min后复查冠状动脉造影,观察两组患者首次和手术结束前末次造影图像,评定冠状动脉血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级及TIMI心肌组织灌注分级(TMPG)、1周内住院期间主要心脏不良事件(MACE)事件。结果:2组均可改善PCI治疗后的“无复流”现象。微导管组手术结束前末次造影TIMIⅢ级比例明显高于导引导管组[95%(20/21)vs.40%(8/20),P<0.05],而且手术结束前末次造影TIMI心肌组织灌注分级(TMPG)Ⅲ级亦较高(90%vs.35%,P<0.05),减少1周内住院期间MACE事件(5%vs.30%,P<0.05)。结论:与经导引导管相比,经微导管注射地尔硫卓明显改善急诊PCI术中无复流现象。