剖宫产瘢痕处早期妊娠临床特点及处理

目的　探讨剖宫产子宫瘢痕处妊娠的病例特点和处理方法。　方法　回顾性分析2 0 0 0年 4月至 2 0 0 3年 3月收治的 5例子宫下段剖宫产瘢痕处妊娠患者临床资料。　结果　 5例患者停经 6～ 8周后均有无痛性不规则阴道出血 ,5例患者均在超声监测下行清宫术 ,取得良好结局 ,无一例发生大流血或子宫切除。　结论　有剖宫产史的患者再次妊娠时 ,有发生子宫瘢痕处妊娠的可能 ,诊断时尤其要注意该病的临床特点 ,为防止子宫穿孔可采取超声监测下清宫术及辅助局部氨甲喋呤注射、纱布填塞创面止血等方法。术后应继续进行血hCG、超声等监测。降低剖宫产率和产后严格避孕是主要的预防办法。     

胎儿肠管扩张的产前诊断和临床预后

目的探讨胎儿肠管扩张的原因和临床意义。方法本文对107例产前超声发现胎儿肠管扩张孕妇进行临床管理和结果追踪，如产前出现明显胎儿肠管扩张（扩张的肠襻直径〉30mm）或明确诊断为消化系统畸形者，可选择引产放弃胎儿，并对患儿尸体进行解剖验证；如选择继续妊娠，则严密监测，分娩后行新生儿腹部X线平片拍摄和钡灌肠造影检查是否存在梗阻，并判断梗阻类型。分娩时取脐带血进行胎儿染色体核型分析。结果（1）产前超声表现为肠管扩张的107例孕妇中，78例（72．9％）合并消化系统畸形，其中，54例（69．2％）同时伴羊水增多，5例为染色体异常（7．8％），7例并多发畸形（9．0％）。（2）当胎儿腹部超声影像表现为典型的双泡征时，提示胎儿十二指肠梗阻，临床诊断正确率为100％，绝大部分由十二指肠闭锁和狭窄引起。（3）引起胎儿期肠管扩张的消化系统畸形中，以小肠畸形最为常见，结肠和肛门直肠病变少见。（4）29例胎儿产前超声表现为肠管扩张，分娩后1个月内新生儿未发现异常表现。结论产前诊断胎儿肠管扩张与消化系统畸形密切相关，需给予正确的临床管理和指导。     

Treatment of Urethral Stricture Disease by Internal Urethrotomy,Dilation, or Stenting

Management of urethral strictures depends on the characteristics of each individual case and remains a great challenge in reconstructive urology. Treatment of anterior urethral strictures usually starts with minimally invasive procedures, such as urethral dilatation or internal urethrotomy. The popularity of these methods is based on the simple application, the low complication rate, and the fact that most general urologists do not perform open urethroplasty. These methods offer faster recovery, minimal scarring, and fewer infections, although recurrence is always possible. Success depends on adequate vascularity within the underlying spongiosal tissue, which may substantially increase the failure rate. Because the recurrence rate has remained higher than it was in past decades, various modifications of urethral stricture treatment have been suggested, including laser urethrotomy and urethral stents. Since the late 1980s, two different approaches have been studied to prevent scaring contraction: permanent stent versus temporary stents left indwelling for a limited time and then removed. Although the first reports seemed to promise excellent outcomes, longer follow-up began to cast doubt on the usefulness of urethral stenting as a primary treatment modality for urethral stricture disease. The purpose of our study was to evaluate the published literature with respect to any new information on minimally invasive procedures in the treatment of urethral strictures.Patient summaryThe optimal indications for dilatation or internal urethrotomy are simple bulbar strictures <2 cm without spongiofibrosis or history of previous treatment. Recurrent urethral strictures after repeated interventions are usually more complex and can render the definite open urethral surgery more difficult.     

Percutaneous Papillary Large Balloon Dilation during Percutaneous Cholangioscopic Lithotripsy for the Treatment of Large Bile-Duct Stones: A Feasibility Study

When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.

Graphical Abstract

相似文献   

替加色罗对大鼠结直肠扩张所致自主神经张力变化的影响

背景:结直肠扩张可影响自主神经系统的活动,而心率变异性(HRV)可反映自主神经系统的功能状态。目的:探讨结直肠扩张对自主神经功能的影响,以及替加色罗对自主神经功能的调节作用。方法:18只成年雄性大鼠随机分为药物组(腹腔注射替加色罗)和溶媒对照组,清醒状态下记录心电信号,通过HRV频域分析比较两组大鼠结直肠扩张前后交感神经张力[P1/(P1 P2)]和迷走神经张力[P2/(P1 P2)]的变化。结果:在溶媒对照组,与基础状态相比,结直肠扩张能显著提高P1/(P1 P2)(0.326±0.141对0.403±0.142,P<0.05),降低P2/(P1 P2)(0.674±0.141对0.597±0.142,P<0.05);腹腔注射替加色罗后,扩张期的P1/(P1 P2)和P2/(P1 P2)与基础状态相比无显著变化(0.293±0.130对0.275±0.103, P>0.05;0.706±0.130对0.724±0.103,P>0.05)。结论:结直肠扩张可显著提高交感神经张力,降低迷走神经张力。替加色罗对结直肠扩张所致的自主神经张力变化有抑制作用。     

肱动脉内皮功能与颅内动脉粥样硬化性狭窄的相关性

目的 探讨缺血性脑血管病患者肱动脉血流介导的血管扩张和非内皮依赖性血管舒张与颅内动脉狭窄的相关性。方法 将67例缺血性脑血管病患者根据有无颅内血管狭窄分为两组,颅内血管狭窄组和对照组。对两组患者一般资料及肱动脉血流介导的血管扩张功能、非内皮依赖性血管舒张功能进行对比分析,并进一步分析肱动脉血流介导的血管扩张功能、非内皮依赖性血管舒张功能与颅内血管狭窄数量的相关性。结果 颅内动脉狭窄组有50例,对照组有17例,年龄、肱动脉血流介导的血管扩张功能、非内皮依赖性血管舒张功能、高血压病、糖尿病、既往卒中或短暂性脑缺血发作史与颅内动脉硬化性狭窄相关,且肱动脉血流介导的血管扩张功能（rs-0.869,P0.000）与非内皮依赖性血管舒张功能 （rs－0.490,P0.000）分别与颅内血管狭窄的数量存在负相关关系。非条件Logistic回归分析得出肱动脉血流介导的血管扩张可作为评估颅内动脉硬化性狭窄的独立因素,以肱动脉血流介导的血管扩张功能值为2.95%时诊断颅内动脉硬化性狭窄的可能性最大。结论 颅内动脉硬化性狭窄患者存在肱动脉血流介导的血管扩张功能的降低,且肱动脉血流介导的血管扩张功能可能对颅内血管狭窄有一定的预测价值。     

剖宫产瘢痕妊娠经不同手术方式处理的临床效果分析

目的 分析剖宫产瘢痕妊娠(CSP）经不同手术方式处理的临床效果,探讨CSP 适宜的治疗方法。方法 回顾性分析2014 年1 月～2019 年12 月在九江市妇幼保健院手术治疗的362 例CSP 患者的临床资料,按不同手术方式分为三组：B 超引导下刮宫术121 例（A 组）、腹腔镜下或经阴道CSP 清除术+子宫下段缺陷修补术78 例（B 组）和宫腔镜下CSP 清除术163 例（C 组）。比较分析各组CSP 的术中出血量、术中并发症、手术成功率和术后胚物残留情况。结果 三组手术成功率和术后胚物残留组间两两比较,差异无统计学意义（P＞0.05）,术中出血量B 组[（142.8±9.6）mL]＞A 组[（73.4±3.6）mL]＞C 组[（63.6±7.5）mL],组间两两比较,差异有统计学意义（P＜0.01）,B 组术中并发症的发生（0/78）与A 组（10/121）比较,差异有统计学意义（P＜0.05）。Ⅱ型CSP 术中出血量A 组[（98.6±5.6）mL]＞B 组[（89.5±6.2）mL]＞C 组[（73.6±5.7）mL],组间两两比较,差异有统计学意义（P＜0.05）。Ⅲ型术中出血量、术中并发症和手术成功率三项指标B 组分别与A 组和C 组比较,差异有统计学意义（P＜0.05）。结论 三种手术方式治疗CSP 具有安全、有效和微创的特点,但对不同类型CSP 安全和疗效存在较大差异,因此治疗前应准确评估患者病情和CSP 分型,采用适宜手术方式,达到减少出血和提高治愈率的目的。     

Surgery for bronchiectasis

The incidence of bronchiectasis has declined significantly in industrialized countries and its management has also changed because of the progress of antibiotic therapy. However, for some patients, medical treatment is not sufficient to control the disease and the quality of life is affected. Surgical treatment is then a very good alternative, when a gesture of complete resection of the affected areas is feasible in terms of lung function and it allows, with a low morbidity and mortality, for very satisfactory long-term results and slows down the progression of the disease. In cases of diffuse and inhomogeneous bronchiectasis, a gesture of incomplete resection of cystic, non-perfused and suppurative areas improves symptoms and reduces recurrent infections. When the bronchiectasis is diffuse, but homogeneous, associated with severe respiratory failure, lung transplantation should be considered. Therefore, surgery remains important in the management of bronchiectasis. Its indications and the lung resection gesture to achieve should be discussed based on the symptoms, imaging examinations and the lung function of the patient.     

Dilatations géantes des espaces de Virchow-Robin symptomatiques

Introduction

Perivascular spaces, known as Virchow-Robin spaces (VRS), may become massively enlarged but are usually an incidental finding. However, a few reports on patients with unusually large VRS have mentioned association with neurological symptoms. We report a series of three symptomatic patients with extremely wide Virchow-Robin spaces documented on brain magnetic resonance imaging (MRI).

Methods

We retrospectively analyzed the medical records and brain MRI of three symptomatic patients, who had been diagnosed with VRS widening.

Case reports

In all three patients, the unusual widening of the VRS was located within the subcortical white matter with asymmetric distribution. Their neurological symptoms were epilepsy and neurological deficits which correlated well with the lesions seen on the MRI. Two patients had associated white matter hyperintensities: in the first case associated gliosis and in the second case, with vascular leukoencephalopathy.

Conclusions

Enlarged symptomatic VRS are rare. The underlying pathophysiological mechanisms remain uncertain. We report three cases with symptomatic giant dilatation of the Virchow-Robin spaces.