腹腔镜下性腺切除术17例临床分析

性分化和发育异常，临床非常少见，其中一部分患者因含有Y染色体需要切除性腺。传统的手术方式是开腹探在，再行陛腺切除。我们自2003年7月至2005年10月，开展了腹腔镜下性腺切除术，效果满意。现报道如下。     

绝经12年,阴道出血半年(病案讨论见本期第52页)

患者 ,女 ,6 1岁 ,Ｇ0 /Ｐ0 。因绝经 1 2年 ,阴道出血半年 ,于 1 998年 1 0月 1 0日入院。患者于 1 986年自然绝经 ,1 998年 4月、7月无明显诱因阴道少许出血 2次 ,无阴道流液 ,无腹疼发热 ,无消瘦 ,否认服用激素和补品等。既往史 :1 6年前子宫肌瘤史 ,无高血压、糖尿病或肥胖病史 ;1 990年因右侧乳腺浸润性导管癌行乳腺癌根治术 ,术后放疗化疗各一程 ,后用三苯氧胺(ＴＡＭ ) 2 0ｍｇ/ｄ连续治疗 6年 ( 1 990～ 1 996年 ) ,ＴＡＭ治疗期间白带较多 ,但无阴道出血 ,未行妇科检查。入院查体 :Ｔ :36 5°Ｃ ,Ｐ :80次 /分 ,Ｒ :2 0次 /分 ,Ｂ…     

236例尘肺病人死因分析

目的探讨尘肺病死亡情况及预防对策。方法对1979~2003年间,淮北矿业集团职业病防治院236例尘肺及尘肺结核住院死亡病例进行回顾性调查分析。结果尘肺死因中,呼吸系统疾病居首位且死亡多为冬春季节。结论为降低尘肺病死率,应积极预防,加强自身防护,控制呼吸道感染,治疗并发症等。     

性分化与性发育异常13例分析

目的:探讨性分化和发育异常的临床特点,并对腹腔镜在治疗中的应用进行评价。方法:对我院13例行腹腔镜切除性腺的性分化和发育异常病例资料进行分析。结果:13例均为女性外阴,含有Y染色体或Y的成分,性腺位于腹腔内或腹股沟内,4例为条索状原始性腺,9例为睾丸。3例有始基子宫和输卵管。性激素水平符合绝经期表现。11例经腹腔镜完成手术,2例转传统手术,手术后1~2天出院。结论:含有Y染色体或Y成分的性腺位于腹腔或腹股沟内并且丧失正常功能,是手术切除的指征,腹腔镜手术具有微创和术后恢复快的优势。     

定量分析鼻咽癌患者外周血游离EBV

目的:分析外周血游离Epstein-Barr病毒(EBV)是否特异地出现于鼻咽癌患者。方法:收集鼻咽癌患者和非鼻咽癌肿瘤患者血浆各50例,正常人血浆30例,提取DNA,荧光定量PCR检测EBV拷贝数,比较游离EBV在上述人群的差异。结果:在25例(50%)鼻咽癌患者血浆中检测到游离EBV,其拷贝数波动于1×103拷贝/ml血浆～2.6×106拷贝/ml血浆,中位数为5.3×105拷贝/ml血浆。在50例非鼻咽癌肿瘤患者和30例正常人血浆中均未检测到游离EBV。结论:游离EBV出现于鼻咽癌患者外周血,可能是一个较特异的鼻咽癌标志物。     

松生拟层孔菌提取物对肝癌细胞H22和肉瘤细胞S180的抑制作用

目的:观察松生拟层孔菌(Fomitopsis pinicola,FP)乙醇提取物Ⅰ号(简称FP-Ⅰ)的体内外抗肿瘤活性及其可能的机制。方法:以乙醇提取FP,获取乙酸乙酯相即为FP-Ⅰ。MTT法检测FP-I体外对小鼠肝癌细胞株H22及小鼠肉瘤细胞株S180增殖的抑制作用;建立S180细胞小鼠移植瘤模型,检测各组小鼠瘤质量、抑瘤率、胸腺指数、脾脏指数、外周血白细胞数及淋巴细胞比例、肿瘤红细胞花环形成率,H-E染色观察FP-Ⅰ对各组S180移植瘤细胞凋亡的影响及心、肝、肾、胸腺和脾脏的组织学变化。结果:50、100、200、400μg/ml FP-Ⅰ对S180细胞增殖的抑制率分别为22.35%、32.49%、40.01%和74.01%,对H22细胞的抑制率分别为45.19%、51.10%、66.37%和82.40%。25、50、100 mg/kg FP-Ⅰ对小鼠S180移植瘤生长的抑瘤率分别为79.92%、66.18%和78.45%,CTX阳性对照(30 mg/kg)的抑瘤率为84.10%;中、高剂量FP-Ⅰ组S180荷瘤小鼠的淋巴细胞比例、胸腺指数及红细胞花环率均有一定程度的提高(P<0.05或P<0.01);各剂量组的S180移植瘤细胞均出现细胞凋亡的典型形态变化。结论:松生拟层孔菌提取物具有较强的抗肿瘤活性,其机制与其增强小鼠免疫功能和诱导肿瘤细胞凋亡有关。     

初治肺结核患者强化治疗前后血清中IL-2、IL-4、IL-10、IFN-γ水平变化的临床意义研究

目的:探讨血清中细胞因子IL-2、IL-4、IL-10、IFN-γ水平在初治肺结核患者强化治疗前后变化的临床意义。方法:选择涂阳初治肺结核病患者50例(结核组)及正常健康对照组50例,分别空腹抽取静脉血,采用酶联免疫测定法(ELISA)测定血清中IL-2、IL-4、IL-10、IFN-γ的水平。结果:对照组和治疗2个月后的结核组血清中4种细胞因子IL-2、IL-4、IL-10及IFN-γ的水平较治疗前的结核组具有统计学意义(P0.05)。50例结核涂阳患者治疗2个月后有38例转阴,痰菌转阴率为76%。结论:检测血清中细胞因子IL-2、IL-4、IL-10及IFN-γ水平对于结核患者免疫状况,治疗方案有效与否及病情变化的判断有一定作用。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.