卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

失代偿期肝硬化与HBV感染状况的调查

通过对79例失代偿期肝硬化患者血清HBV感染指标调查分析后发现:肝硬化者中有HBV感染者占77.2％(61/79),并且以男性居多占63.3％(50/79)。提示:HBV感染是我国肝硬化的主要发病因素;男女性间乙肝后肝硬化的发病率有显著性差异,P<0.05。对59例进行了HBV二对半血清学检测的失代偿期肝硬化者分析后发现:HB_sAg、HB_eAg、抗HB_e都阳性及HB_sAg、抗HB_e、抗H_C都阳性者出现机率最高,与其余组合阳性者间有显著性差异,P<0.025。其意义有待探讨。     

清肺理气活血利气法治疗肺心病67例

从1980年至1990年以清肺、理气、活血、利水法治疗肺心病67例,在临床上收到满意的效果,现报道如下。一般资料 67例均系住院患者,心功能全部失代偿,其中男56例,女11例,年龄40岁以下1人,40～49岁14人,50～59岁30人,60～69岁11人,70岁以上6人;病程10年以上20人,15年以上15人,20年以上27人,25年以上5人;合并支气管扩张6例,结核5例,轻度肺脑8例,冠心病4例,主要表现:咳嗽、胸闷、咳痰、气短、喘息胸痛、心悸、呼吸困难、紫绀、浮肿等。诊断与治疗标准:本组67例肺心病,病     

贲门粘膜撕裂综合征21例临床分析

贲门粘膜撕裂综合征２１例临床分析李晓燕，段丽萍，张磊，蒋海燕，贾友兰贲门粘膜撕裂综合征又称Ｍａｌｌｏｒｙ－Ｗｅｉｓｓ综合征，是引起上消化道出血的原因之一。近年来由于急诊内镜的开展，有更多的病例被发现。本文就１９８４年－１９９４年我院经内镜检查证实的２...     

甲状腺机能亢进性腹泻26例

甲状腺机能亢进性腹泻２６例王道直，李晓燕，张清贵甲状腺功能亢进症（简称甲亢）是常见的内分泌疾病。多数甲亢患者有甲状腺肿大，高代谢症群，服征，心血管系统及神经系统兴奋性增高等表现，但临床上有１５％的甲亢病人没有明显的甲状腺肿大，症状轻，常以某一系统症状...     

大肠癌肝转移射频消融后局部复发影响因素的分析

目的 探讨射频消融（radiofrequency ablation,RFA）治疗大肠癌肝转移后局部肿瘤复发的风险因素。方法 回顾性研究213例347个肿瘤实施RFA治疗后局部复发的临床资料,对可能影响RFA局部治疗效果的临床因素进行统计学处理。结果 175例（82.2%）298个肿瘤（85.9%）得到CT或MRI随访资料。大肠癌肝转移灶RFA后肿瘤局部复发率为36.9%（110/298）,局部复发的平均时间为16.4月（2～57个月）。单因素分析显示肝脏转移灶的部位、大小和射频针类型与肿瘤射频后的局部复发相关（P值分别为P=0.000,P=0.021和P=0.026）,但Cox多因素分析则显示只有瘤大小和转移灶部位是大肠癌肝转移射频消融后局部复发的独立预后因素（χ^2=8.522,P=0.000;χ^2=1.321,P=0.022）。结论 肝脏肿瘤的大小和部位是RFA治疗效果的独立影响因素,正确的电极选择和布针是获得肿瘤完全坏死的关键。     

FIZZ1在ApoE基因敲除小鼠动脉粥样硬化斑块内的表达

目的:探讨FIZZ1在ApoE基因敲除小鼠粥样斑块内的表达。方法:C57BL/6JApoE基因敲除鼠及C57BL/6J野生型小鼠各9只,分别喂食高脂饲料及普通饲料,24周后处死,自主动脉根部至腹主动脉离断整支血管,石蜡包埋后作连续切片,行HE染色及FIZZ1免疫组化,检测血管斑块内FIZZ1表达情况,RT-PCR检测斑块内FIZZ1mRNA表达。结果:ApoE基因敲除鼠高脂饲养24周后,主动脉根部动脉粥样硬化明显,斑块体积较大,免疫组化及其RT-PCR可见FIZZ1及其mRNA在粥样硬化斑块内明显表达,同龄野生型C57BL/6J鼠血管壁内未见FIZZ1及其mRNA表达。结论:FIZZ1能在动脉粥样硬化斑块内表达。     

必可酮和舒喘灵气雾剂治疗儿童支气管哮喘56例

儿童支气管哮喘是我国常见病之一,近年来其发病率及死亡率均有上升趋势。其急性发作时,常在夜间及清晨加剧,主要症状有:呼吸困难、胸闷或咳嗽等,其中以呼气性呼吸困难为主要特征,可在短时间内危及生命。我们于1999年2月-2002年4月应用必可酮、舒喘灵气雾剂治疗儿童支气管哮喘56例,临床疗效满意,报告如下。     

氧化低密度脂蛋白功能性调节人内皮细胞的生长调节致癌基因α

目的　探讨oxLDL对人内皮细胞的CXC亚家族趋化因子GROα的调节作用及生理意义。方法　超高速离心得LDL ,氧化后得oxLDL。逆转录PCR分析人内皮细胞系ECV30 4细胞GROαmRNA。GAPDH被用作PCR中正常改变的对照物。酶联免疫检测仪测定ECV30 4细胞表面连接及分泌到溶液中的GROα蛋白。静态细胞粘附试验测定ECV30 4细胞表面连接的GROα蛋白的生理意义。结果　正常ECV30 4细胞不表达GROαmRNA ;OxLDL显著调节其表达 ,诱导效应首先出现在处理后 1h ,最大在 2h ,在 4h时下降。相比较 ,LDL对其mRNA表达没有影响。正常ECV30 4细胞低水平表达细胞表面的GROα蛋白。OxLDL呈浓度依赖性、时间依赖性地上调其表面的GROα蛋白。相比较 ,LDL对其表面表达的GROα蛋白无调节作用。OxLDL对ECV30 4细胞分泌到细胞溶液中GROα蛋白很少有影响。 4 0 μg/mloxLDL处理ECV30 4细胞 2 4h ,造成显著的人单核细胞系U937细胞粘附到ECV30 4细胞数目的增加。用GROα抗体预处理oxLDL刺激的ECV30 4细胞 ,可显著减低U937细胞粘附到ECV30 4细胞的U937细胞数目 (大约 2 / 3)。结论　oxLDL可能功能性上调内皮细胞GROα的表达。