超微经皮肾镜取石术治疗肾结石的体会

初探超微经皮肾镜取石术(SMP)治疗肾结石的安全性和临床疗效。选择2015年8月~2016年5月我院收治的肾结石患者26例,均有多次输尿管软镜和(或)体外冲击波碎石术(ESWL)治疗失败史,结石位于下盏、中盏、肾盂、肾盂合并下盏、肾盂合并输尿管上段分别为11例、1例、5例、5例、4例。结石直径平均为(1.2±0.6)cm。术后均不留置肾造瘘管及双"J"管。26例患者手术均成功完成,单通道24例,双通道2例,手术平均时间(47±19)min,术后第1天结石清除率为96.2%(25/26),1例为下盏残留结石直径约0.7cm,1例术后出现发热(体温38℃),术后住院时间(2.0±0.9)d。术后均未出现严重感染、尿外渗、肾周血肿等并发症。SMP治疗小于2cm的肾结石安全有效,尤其可作为ESWL及输尿管软镜术后残石的补救性治疗方法。     

黄疸

本文报告了一例44岁男性黄疸病人的诊治经过与分析。该病人因黄疸、食欲差,先被诊断为“黄疸型肝炎”,用中药治疗无效。后经B超检查诊断为“胆囊、胆管多发结石”建议手术治疗。术前,结合病史、体检及多种影像学检查手段复查,诊断确定为“下段胆管癌、梗阻性黄疸、肝及胆囊淤滞性肿大”。手术探查中,因发现胰腺头部肿物,考虑胰头癌可能,遂行胰十二指肠切除术。术后病理检查报告为胆总管下段低分化腺癌伴胰腺头部癌组织侵犯。结合此病例的特点及诊治过程,对表现为黄疸,容易与胆总管下段癌混淆的各种良、恶性肝、胆、胰疾病作了有针对性的分析与鉴别。     

黄疸

本文报告了一例44岁男性黄疸病人的诊治经过与分析.该病人因黄疸、食欲差,先被诊断为"黄疸型肝炎",用中药治疗无效.后经B超检查诊断为"胆囊、胆管多发结石"建议手术治疗.术前,结合病史、体检及多种影像学检查手段复查,诊断确定为"下段胆管癌、梗阻性黄疸、肝及胆囊淤滞性肿大".手术探查中,因发现胰腺头部肿物,考虑胰头癌可能,遂行胰十二指肠切除术.术后病理检查报告为胆总管下段低分化腺癌伴胰腺头部癌组织侵犯.结合此病例的特点及诊治过程,对表现为黄疸,容易与胆总管下段癌混淆的各种良、恶性肝、胆、胰疾病作了有针对性的分析与鉴别.     

体外冲击波治疗≥2cm肾结石疗效的多因素分析

探讨应用体外冲击波碎石(ESWL)治疗≥2cm肾结石的疗效。收集2007年7月~2016年8月,在山东大学附属省立医院应用ESWL治疗肾结石≥2cm患者518例,对ESWL术后3个月的复查结果进行分析。结果显示,在治疗后3个月总净石率和有效率分别为64.3%和71.0%;多元回归分析显示肾结石的数目、形状、位置、表面积和密度与ESWL的效果均显著相关(P0.05)。对于结石表面积低于400mm2而且KUB平片确诊为低密度的结石,有效的结石治愈率为92.0%,净石率为90.6%。对于表面积400mm2且密度小于第12肋骨密度的肾结石,即使最大径超过2cm,ESWL是首选治疗方式。     

体外冲击波与传统方法治疗腰椎间盘突出症疗效比较

比较放散式体外冲击波与传统保守治疗腰椎间盘突出症的临床疗效及生命质量评价。对2010年6月至fi013年6月收治且获得随访的257例腰椎间盘突出症患者进行分析,其中男139例,女118例。根据治疗方式不同随机分为两组,并在治疗前后应用日本骨科学会（JOA）下腰痛评分法及视觉模拟评分（VAS）进行疗效评价,应用健康调查评分量表SF-36进行生活质量评价。对患者进行随访1周～12周,平均（10．0±3．4）周,治疗组治疗后2周和4周VAS评分低于对照组,治疗后1周、2周及4周JOA评分高于对照组,治疗后4周、8周和12周的生理机能、生理职能、总体健康、情感职能和躯体疼痛得分高于对照组,差异有统计学意义（P〈0．05）。放散式体外冲击波治疗腰椎间盘突出症疗效较好,并能够较好地提高患者的生活质量。     

跟腱龙装置微创治疗急性跟腱断裂的临床疗效

报道应用跟腱龙（Achillon）装置微创技术治疗急性跟腱断裂的短期疗效。2009年10月～2013年4月共收治29例急性跟腱断裂患者,其中全部为运动损伤,年龄23岁～49岁,平均35．5岁。受伤至手术时间2天～5天。术前经临床查体及M RI检查确诊。术中采用跟腱断裂处3cm横行切口,使用跟腱龙装置进行跟腱缝合。术后早期功能锻炼并随访记录并发症和AOFAS评分。结果29例患者随访6个月～22个月,平均15个月,没有患者出现切口感染、跟腱再断裂、腓肠神经损伤等严重的并发症。平均AOFAS 评分94．1分。跟腱龙微创技术治疗急性跟腱断裂具有令人满意的疗效。     

后腹腔镜肾盂输尿管切开取石术34例临床体会

探讨后腹腔镜下肾盂、输尿管切开取石的技术要点和临床应用价值.回顾性分析34例后腹腔镜肾盂、输尿管切开取石术的临床质料.男22例,女12例,肾盂结石10例,输尿管结石24例.结果34例成功完成腹腔镜取石术,手术时间40min～90min,平均58min,术中出血10 ml～30ml,术后1例漏尿3d,术后3d～5d拔除后腹腔引流管,术后住院7d～9d,34例随访12个月～26个月,患者肾输尿管积水均明显好转,无结石复发及输尿管狭窄.后腹腔肾盂输尿管切开取石术可部分取代肾盂结石的开放手术,可作为输尿管上段结石ESWL或(和)URL治疗失败的首选治疗方案.     

中国人群脂肪肝主要影响因素的荟萃分析

为系统评价中国居民脂肪肝发病的主要危险因素,检索文献数据库,收集国内1997年～2008年有关脂肪肝发病危险因素的16篇文献,利用Meta分析方法,进行综合统计分析,累计病例7200例,对照11884例。结果超重（23≤BMI〈25）、肥胖（BMI≥25）、过量饮酒、吸烟、高脂饮食、食用蔬菜、饮绿茶、爱好运动、运动少、高脂血症、高HDL—Ch、低HDL-Ch、高血压、高血糖、高血总胆固醇（≥6．5mmol／L）及糖尿病合并0R值（95％CI）分别为1．68（0．68～3．90）、5．01（3．23～7．76）、3．52（1．52～8．15）、1．18（1．01～1．37）、2．82（1．50～5．31）、0．45（0．37～0．55）、0．52（0．43～0．64）、0．32（0．14～O．74）、3．49（1．26～9．65）、4．91（2．69～8．96）、0．31（0．17～0．57）、2．14（1．50～3．03）、2．19（1．43～3．35）、2．75（1．66～4．58）、2．96（0．26～32．98）、2．29（1．30～4．01）。结论为目前影响中国人群脂肪肝发生的危险因素依次为肥胖、高脂血症、饮酒、运动少、高脂饮食、高血糖、糖尿病、高血压、低HDL—Ch和吸烟;保护因素为饮用绿茶,食用蔬菜,以及高HDL—ch;尚不能确定与中国人脂肪肝发生的相关性因素为超重和高血胆固醇。     

ERCP诊疗进展及热点

内镜逆行胰胆管造影(ERCP)技术经过40余年的发展,日渐成熟,越来越多的胆胰系统疾病需要通过内镜微创技术得到有效的诊断和治疗。本文从疾病分类角度出发,在肝外胆管结石、良恶性胆道梗阻、胆系感染、急慢性胰腺炎、胰腺恶性肿瘤等方面详细介绍了ERCP诊断和治疗技术的进展及热点问题,并提出了国内ERCP发展面临的问题。     

Slit2与MVD及食管癌生物学行为关系的研究

研究食管鳞状细胞癌组织中神经迁移蛋白Slit2的表达及其与微血管密度的关系,并探讨两者与食管鳞癌临床病理特征的关系。采用免疫组化SP法检测64例癌组织和36例癌旁组织中Slit2蛋白的表达水平及CD34标记的微血管密度（microvessel density,MVD）。Slit2蛋白在食管鳞状细胞癌和癌旁组织中的表达阳性率分别为70．3％和16．7％。两者的表达差异有统计学意义（χ^2=26．53,P〈0．01）;食道鳞状细胞癌和癌旁组织中MVD计数分别为（44．07±17．44）／mm^2,（25．26±7．91）／mm^2,两者存在显著性差异（r=7．383,P〈0．01）;Slit2表达阳性的肿瘤组织MVD明显大于Slit2阴性表达的肿瘤组织[（49．30±15．78）／mm^2对（34．44±17．06）／mm^2,P〈0．05）],Slit2蛋白的表达水平与肿瘤大小、TNM分期和淋巴结转移显著相关;MVD计数与浸润深度、TNM分期和淋巴结转移显著相关。肿瘤组织中Slit2蛋白的表达与MVD计数呈正相关（r=0．683,P〈0．01）。结论认为食管鳞状细胞癌组织中Slit2蛋白表达和MVD计数与其生物学行为密切相关,是通过Slit2基因介导肿瘤新生血管的形成实现的,Slit2是调节食管癌血管生成的重要因子。     

微创与开腹手术治疗胆管结石患者生存质量的比较

采用消化病生存质量指数（gastrointestinal quality of life index,GIQLI）前瞻性测定45例微创内引流一期缝合术与42例开腹胆总管探查术治疗肝外胆管结石在术前、术后2,4,8,12周的生存质量值。结果显示微创组较开腹组治疗肝外胆管结石更有利于患者术后恢复和生存质量提高,微创手术患者术后生存质量更好。     

上皮间质转化与胆管癌

上皮间质转化（EMT）是指上皮细胞失去原来的极性,转变为间质细胞的现象。在这个过程中,上皮细胞的标志物E-钙黏蛋白表达下调、间质细胞标志物波形蛋白表达上调,因此也称其为上皮间质转变的重要标志及特征。上皮间质转化参与了多种恶性肿瘤的生长、侵袭和转移。胆管癌是肝胆恶性肿瘤中恶性程度极高的肿瘤,其临床症状表现的较晚,大多数情况下已失去了手术的最佳治疗机会。如何认识胆管癌的发展过程,并寻找早期的预警指标,对于胆管癌患者来说EM T 的发生以上皮细胞标志物的减少、间质细胞的表型增加为特征,严重影响着胆管癌患者的肿瘤进展过程及预后,对EM T 的研究将有助于寻找新的抗癌靶点。     

门静脉血流改变对晚期高位胆管癌的诊断价值

通过探讨正常人与高位胆管癌病人之间的门静脉血流改变,发现两者之间有明显的不同。所以门静脉血流改变在诊断高位胆管癌方面具有重要意义。     

Incidence and diagnosis of lumbosacral pouch diverticula]

The myelograms of ninety-nine patients with an ischias symptomatology were analyzed. In fifteen of the subjects there were found lumbosacral radicular pouch diverticula which, after elimination of other nosogenic factors, were considered chiefly responsible for the clinical and neurological pictures observed in six cases. The pathological and anatomical, clinical and radiographic results described by the authors represent a disease picture which is little known and, hence, not generally included in the differential diagnosis of ischialgia, but which has been found to yield to neurosurgical treatment in selected cases.     

IgG4相关性胆胰疾病的诊断和治疗

近年来发现,IgG4相关性疾病可累及全身多系统多器官,目前研究提示IgG4相关性胆胰疾病主要有IgG4相关性硬化性胆管炎和自身免疫性胰腺炎（AIP）.前者是一种免疫发病机制未明、生化学特点以及胆管影像学表现与原发性硬化性胆管炎（PSC）相似,对糖皮质激素应答良好的疾病.后者临床表现为复发性胰腺炎、梗阻性黄疸,伴胆管、涎腺等其他器官受累.实验室检查血清和组织学IgG4明显升高.影像学表现为胰腺呈“腊肠样”外观,伴主胰管弥漫不规则狭窄,同样对激素治疗敏感.二者常同时受累、关系密切,易误诊为胆管癌、硬化性胆管炎或胰腺癌,本文将当前国内外研究现状做一介绍,供临床诊治参考.     

Microgenetic patterns of adaptation on the Stroop task by patients with bronchial asthma and duodenal peptic ulcer

Microgenetic patterns of adaptation on the Stroop task were assessed by means of the Serial Color-Word Test given 21 patients with bronchial asthma and 20 with duodenal peptic ulcer, who were compared with 41 normal controls matched for sex, age, and education. Two measures were calculated on each of the five trials of the test, one of linear change and one of nonlinear change in reading times. As predicted, patients presented more frequently patterns characterized by high nonlinear change and less frequently stabilized patterns (low linear and nonlinear change of reading speed). Linear and nonlinear change were then calculated on the five linear change scores and the five nonlinear change scores; again patients presented more frequently patterns characterized by high nonlinear change on both the linear change scores and nonlinear change scores and less frequently stabilized patterns. These findings indicate strong similarities between the adaptation patterns of patients with ulcer and asthma and the microgenetic patterns previously known to characterize neurotic and psychotic patients. Furthermore, scores on the Serial Color-Word Test also differentiated between ulcer and asthma groups.     

Psychophysical exponents for single papillae: A comparison with whole-mouth exponents

Taste intensity judgments in response to chemical stimulation of single human fungiform papillae were obtained by the method of magnitude estimation. Intensity scales constructed from these data were compared to those obtained from the same subjects in response to stimulation of the whole mouth. Single papilla functions conformed well to the power law governing the growth of sensation magnitude, although a minority of single papilla functions exhibited peaking of response magnitude at intermediate concentrations, followed by a decline in response magnitude at higher concentrations. Single papilla exponents were found to be lower than whole mouth exponents and were positively correlated with detection and/or recognition thresholds of the papillae for most compounds. Exponents of summated single papilla functions were greater than median single papilla exponents, but their relative magnitude vs. whole mouth exponents varied by test compound. The data were discussed in relationship to previous findings concerning flow rate effects, threshold-exponent relationships across the tongue surface, and level-dependent spatial summation.     

Task-dependent role for dorsal striatum metabotropic glutamate receptors in memory

The effect of post-training intradorsal striatal infusion of metabotropic glutamate receptor (mGluR) drugs on memory consolidation processes in an inhibitory avoidance (IA) task and visible/hidden platform water maze tasks was examined. In the IA task, adult male Long-Evans rats received post-training intracaudate infusions of the broad spectrum mGluR antagonist α-methyl-4-carboxyphenylglycine (MCPG; 1.0, 2.0 mM/0.5 μL), the group I/II mGluR agonist 1-aminocyclopentane-1,3-carboxylic acid (ACPD; 0.5 or 1.0 μM/0.5 μL), or saline immediately following footshock training, and retention was tested 24 h later. In the visible- and hidden-platform water maze tasks, rats received post-training intracaudate infusions of ACPD (1.0 μM), MCPG (2.0 mM), or saline immediately following an eight-trial training session, followed by a retention test 24 h later. In the IA task, post-training infusion of ACPD (0.5 and 1.0 μM) or MCPG (1.0 and 2.0 mM) impaired retention. In the IA and visible-platform water maze tasks, post-training infusion of ACPD (1.0 μM), or MCPG (2.0 mM) impaired retention. In contrast, neither drug affected retention when administered post-training in the hidden-platform task, consistent with the hypothesized role of the dorsal striatum in stimulus-response habit formation. When intradorsal striatal injections were delayed 2 h post-training in the visible-platform water maze task, neither drug affected retention, indicating a time-dependent effect of the immediate post-training injections on memory consolidation. It is hypothesized that MCPG impaired memory via a blockade of postsynaptic dorsal striatal mGluR's, while the impairing effect of ACPD may have been caused by an influence of this agonist on presynaptic “autoreceptor” striatal mGluR populations.     

全胸腔镜肺癌切除术的技术分析与趋势

全胸腔镜肺叶切除术在肺良性疾病和早期肺癌中的治疗作用已得到肯定。目前三孔法是大部分中心采用的手术术式,可以完成所有肺叶切除术。手术顺序：探查如发现第二肺门处肺动脉比较表浅,按照肺静脉-肺动脉、肺裂-支气管的顺序,如第二肺门处肺动脉位置较深,下叶按肺静脉-支气管-肺动脉-肺裂,部分肺动脉分支可以包含在肺裂中以切割缝合器处...     

A brief (one-hour) quantitative neuropsychological assessment with three performance-based tests: strong concordance with proficiency scores for a more extensive test battery

Raw scores for each of several dozens of traditional and more recently developed neuropsychological tests were correlated with an impairment index composed of all of these scores from the records of 162 patients who had been assessed following impacts of substantial mechanical energies. A score of either less than 20 correct binaural responses for a dichotic word listening task, more than 99 sec. for Trails B, and more than 3.8 min. to complete the Tactual Performance Test with both hands correctly classified 85% of patients whose z scores were less than -1.0 (below average) or -1.0 or above (average) for a composite neurocognitive index. The results suggest that these three tests, administrable within about one hour, may be employed as a more objective criterion rather than "clinical impressions" for discerning if patients require more extensive neuropsychological testing.