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.     

氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者糖、脂代谢及体质量的影响

目的 探讨氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者的糖、脂代谢和体质量的影响。方法 对服用氯氮平（89例，氯氮平组），服用氟哌啶醇（87例，氟哌啶醇组）及服用氯丙嗪（83例，氯丙嗪组）治疗的慢性精神分裂症患者于治疗前后的不同时间进行血糖、胰岛素、血脂及体质量测定，并做相关因素分析。结果 氯氮平组治疗第90天和第180天空腹血糖异常（空腹血浆血糖〉7.0mmo/L）的发生率分别为8％及24％，氟哌啶醇组分别为1％和2％，氯丙嗪组分别为1％及4％。治疗第90天氯氮平组和氯丙嗪组的空腹及餐后2h血糖浓度均较治疗前升高，治疗第180天的血糖浓度高于第90天，氟哌啶醇组各时点的变化则不明显；差异均有统计学意义（P均〈0．01）。治疗第90天，氯氮平组的体质量平均高于治疗前5．5％，氯丙嗪组高于治疗前4．8％；治疗第180天两组分别高于治疗前9．1％和7．4％；氟哌啶醇组则无明显变化；三组间的差异有统计学意义（P〈0．01）。三组患者治疗第180天的胰岛素浓度均高于治疗前，差异均有统计学意义（P均〈0．01），但三组间的差异无统计学意义（P〉0．05）。氯氮平组和氯丙嗪组的胆固醇和甘油三酯浓度均高于治疗前，差异均有统计学意义（P均〈0．01），氟哌啶醇组则无明显变化。治疗第180天氯氮平组和氯丙嗪组患者血糖、胰岛素、血脂浓度与体质量均有一定相关性（r=0．23-0．39）；氯氮平组的血糖、体质量、血脂代谢还与血药浓度呈显著性相关（r=0．28-0．62），差异均有统计学意义（P〈0．05或〈0．01）。结论 氯氮平和氯丙嗪治疗影响慢性精神分裂症患者的糖、脂代谢及体质量。     

载瘤动脉闭塞术治疗颅内巨大动脉瘤的探讨

目的总结和探讨脑血管造影和载瘤动脉闭塞在治疗颅内巨大动脉瘤上的作用及特点。方法60例颅内巨大动脉瘤患者,根据其脑血管造影的特点采取血管内介入方法[可脱式球囊和(或)弹簧圈]闭塞载瘤动脉近端53例、闭塞载瘤动脉两端后孤立动脉瘤7例;其中23例闭塞前先行颅内-外血管搭桥术。结果出院时Rankin评分分级:单纯血管内介入治疗组37例中轻残3例,合并颅内-外血管搭桥术组23例中死亡1例、重残2例。1-6年的影像学随访动脉瘤无复发。结论血管内介入结合颅内-外血管搭桥术闭塞载瘤动脉是治疗颅内巨大动脉瘤的方法之一。     

钝性肝脾肾损伤的CT平扫与增强扫描比较

目的:比较CT平扫与增强扫描对肝脾肾钝性损伤的诊断能力。方法:回顾性分析临床疑似钝性肝脾肾损伤,并经手术和临床观察证实的CT平扫和增强扫描的患者84例。结果:平扫确定的损伤:肝12例,脾25例,肾5例;平扫可疑损伤:肝22例,脾15例,肾5例。增强确定的损伤:肝32例,脾40例,肾12例(全肾梗塞1例,局限性梗塞3例);对比剂外溢(活动性出血)3例;无可疑损伤。平扫无异常而增强确定有损伤:肝10例,脾5例,肾2例。增强显示的损伤灶比平扫范围明显大、病灶多、界限清楚。结论:CT增强扫描显示肝脾肾损伤明显优于平扫,延时扫描有助于发现活动性出血,应常规增强扫描。     

微创清除术治疗高血压脑出血35例的临床观察

目的观察应用微创清除术救治高血压脑出血的临床疗效。方法对68例高血压脑出血患者采用随机分成内科组(33例,采用控制血压治疗脑水肿等方法)和微创组(35例,采用微创清除术治疗)。采用格拉斯神经功能缺损评分量表及日常生活能力量表评分比较两组的近期(1个月)和远期(6个月)疗效。结果微创组近期优良率(60%)和远期良好率以上(70.3%)高于内科组(30.3%、46.2%%),差异有显著性(P<0.05,P<0.01);微创组近期死亡率(14.3%)明显低于内科组(54.5%),差异有显著性(P<0.01)。结论高血压脑出血采用微创清除术疗效优于内科治疗。     

多层螺旋CT在胰腺癌诊断中的应用

多层螺旋CT（MSCT）使扫描速度，薄层，覆盖范围达到了很好的统一，是胰腺癌最佳的单项检查手段。本文介绍了MSCT运用于胰腺的技术优势以及具体检查方法，重点叙述其在胰腺癌的诊断，术前可切除性的评估等方面的应用。     

股骨近端纤维结构不良的手术治疗

目的探讨股骨近端纤维结构不良的手术治疗方式。方法对19例股骨近端纤维结构不良的不同手术治疗方式及术后疗效进行回顾性分析。结果1例术后3d引流管口渗出血清样物质，加强抗感染、营养支持及换药处理后愈合。19例均获随访，时间13—58个月。复查X线片见缺损修复区内有新骨生成改变，骨折处骨愈合；1例术后20个月因外伤致股骨转子下内固定物旁骨折再次手术发现肿瘤复发，行再次刮除植骨内固定术后14个月愈合；除1例未行内固定的病例外，余患者术后患肢功能均得到良好恢复，8—12个月可弃拐行走。结论股骨近端纤维结构不良应积极手术治疗，在彻底刮除病变和充分植骨的基础上，强调内固定的应用。     

内吗啡肽在脊髓背角浅层的镇痛机制

内吗啡肽(EM)是μ阿片受体(MOR)的内源性配体。脊髓背角浅层(Ⅰ，Ⅱ层)是阿片类物质调制外周伤害性信息的关键部位，其内含EM和MOR的结构很密集。在脊髓背角浅层，EM可以抑制初级传入末梢释放谷氨酸和P物质，增加中枢内源性镇痛系统的下行投射末梢在脊髓背角释放去甲肾上腺素和5-羟色胺，抑制脊髓背角Ⅱ层(胶状质)兴奋性中间神经元释放神经活性物质。在脊髓背角浅层EM可能通过以上途径实现对外周伤害性信息传递的调制并发挥镇痛作用。     

米非司酮对妊娠中期胎儿心脏超微结构的影响

目的:探讨米非司酮对妊娠中期胎儿心脏超微结构的影响。方法:将计划引产孕妇随机分为两组:对照组(水囊组)10例,实验组(米非司酮+水囊)15例。实验组按孕龄分为实验Ⅰ组(10例,16~22周),实验Ⅱ组(5例,23~28周)。实验组口服米非司酮100mg,连服3天,行水囊引产,对照组只行水囊引产。胎儿娩出后取心肌组织进行样本制备,然后在电镜下观察组织的超微结构。结果:细胞肿胀、空化,细胞膜不完整,闰盘分离,部分细胞连接消失。细胞核多呈不规则形,核内染色质凝聚呈块状,部分细胞核空化,核周围可见脂褐素。大部分肌丝断裂,肌节结构消失,少数可辩残留肌节结构,其间可见少量核糖体,但各带结构不清。线粒体肿胀,高度空化,嵴断裂,细胞基质局部空化。毛细血管内皮细胞肿胀。心肌组织细胞的超微结构有改变,且孕龄越小,超微结构改变越明显。结论:米非司酮可以引发胎儿心脏的缺血缺氧性改变。