中国实用医刊杂志   部级期刊

摘要：目的 探讨瘦素(Lep)和神经肽Y(NPY)在子痫前期患者胎盘组织中的表达变化及意义.方法 应用免疫组织化学染色及图像分析方法检测子痫前期40例(子痫前期组:其中轻度子痫前期18例,重度子痫前期22例)和正常妊娠妇女20例(对照组)胎盘组织中Lep和NPY的表达及定量.结果 ①子痫前期组胎盘组织Lep表达灰度(46±3)较对照组(27±3)高,差异有统计学意义(t＝21.143,P＜0.01);NPY表达灰度(44±4)较对照组(48±4)低,差异亦有统计学意义(t＝3.431,P＜0.01).②轻、重度子痫前期组之间相比较,Lep和NPY的差异均无统计学意义(P＝0.253,P＝0.396).③Lep和NPY表达水平呈负相关(r＝-0.477,P＜0.01).结论 Lep通过自分泌和(或)旁分泌作用抑制胎盘组织NPY的表达,参与了子痫前期的发病. Abstract： Objective To investigate the expression of leptin(Lep) and neuropeptide Y(NPY) in pre-eclamptic placenta and its significance. Methods The expression of Lep and NPY in placenta of 40 mild or sever pre-elampsia cases and 20 normal pregnancy cases were detected by immunohistochemisty staining and image analysis. Results ①Intensity of Lep immnostaining in trophoblast was significantly higher in pre-eclampsia group(46±3) than that in normal controls(27±3) (P＜0.01), but NPY was significantly lower in pre-eclampsia group(44±4) whan that in normal controls(48±4)(P＜0.01). ②There was no significant difference in immunostaining for either Lep or NPY between the mild and severe pre-eclampsia group(P＞0.05). ③NPY level showed negative correlation with Lep(r＝-0.477,P＜0.01). Conclusions Lep may downregulate NPY in placenta by autocrine and(or) paracrine, and consequently influence pathogenesis of pre-eclampsia.

摘要：目的 探讨输卵管妊娠腹腔镜保守手术与传统开腹手术的治疗效果,为选择不同手术方式提供相关依据.方法 回顾性分析2008年9月至2009年4月于郑州大学第三附属医院妇产科住院行手术治疗的210例有生育要求的输卵管妊娠患者,其中140例行腹腔镜手术治疗,70例行传统开腹手术治疗,对两组术中、术后情况进行比较分析.术后随访3～12个月.结果 腹腔镜组术中出血量、手术时间、术后镇痛、住院天数与开腹组比较,差异均有统计学意义(P＜0.05),各指标优于开腹组.术后腹腔镜组宫内妊娠65例(46.43%)、再次异位妊娠55例(39.29%),开腹组宫内妊娠20例(28.57%)、再次异位妊娠35例(50%),两组比较差异均有统计学意义(P＜0.05).结论 腹腔镜保守手术治疗输卵管妊娠对机体损伤小、术后恢复快、临床疗效好,可以作为输卵管妊娠且有生育要求患者保守手术的首选. Abstract： Objective To compare the clinical effect of laparoscopy and laparotomy in treating tubal pregnancy. Methods The clinical datas of the patients with ectopic pregnancy were retrospectively analyzed from September 2008 to Apirl 2009 in our hospital.All of the 210 patients had demand of pregnancy after operation.The cases in laparoscopy and laparotomy group were 140 cases and 70 cases respectively. Results The amounts of bleeding,time of operation,rate of alleviation, duration of hospitalization in laparoscopy group were all significantly lower than those in laparotomy group (P all＜0.05). In laparoscopic operation group,65(46.42%)cases had intrauterine pregnancy and 55(39.29%)cases had recurrence of ectopic pregnancy. In laparotomy group, 20(28.57%)cases had intrauterine pregnancy and 35(39.29%)cases had recurrence of ectopic pregnancy.The above showed significant difference( P all＜0.05).Conclusions Laparoscopy has little damage to human body and has good clinical effect,so it can be the first choice for tubal pregnancy opertions for patients having

摘要：目的 通过对子宫内膜浆液性乳头状癌(UPSC)的临床及病理特征的分析,探讨其合理的治疗方法.方法 自2002年6月至2008年12月我院收治子宫内膜浆液性乳头状癌患者23例,对其临床病理、诊断方法、治疗方法及预后进行回顾性分析.结果 全部患者病例采用手术治疗,术后辅助放疗和(或)化疗者17例.Ⅲ、Ⅳ期患者占56.5%,52.2%的患者肌层浸润深度超过1/2肌层(12/23),52.2%有子宫外扩散(12/23),腹膜后淋巴结转移率为54.5%(6/11),86.6%患者雌孕激素受体阴性.预后差,随访期内12例死亡.结论 UPSC少见,临床诊断困难,依靠病理学检查可以确诊.子宫内膜浆液性乳头状癌有其独特的临床病理特征,与普通的子宫内膜癌明显不同,肿瘤高度恶性,预后差,合理的个体化综合治疗可延长生存期. Abstract： Objective To study the rational therapy for uterine papillary serous carcinoma (UPSC) and analyze its clinical and pathologic features. Methods A retrospective study was conducted on incidence, clinical characteristics,pathological feature,diagnosis and treatment,prognosis of 23 patients with UPSC,who was admitted in our hospital from January 2000 to June 2006.Results All the patients underwent operation, and 17 cases received postoperative radiotherapy and(or) chemotherapy. Among all the patients with UPSC,56.5% was stage Ⅲ and Ⅳ;52.2% with deep myometrial invasion;Estrogen or progestin receptors were negative in 86.6% cases.12 cases died during the follow ing up period, indicating poor prognosis.Conclusions UPSC is an uncommon tumor. It is difficult to make the diagnosis for clinicians.UPSC can be surely diagnosed with clinical pathology.The clinical and pathologic features of UPSC are different from the common endometrial carcinoma. Rational individu alized treatment can prolong survival time.

摘要：目的 探讨引起产后出血的相关因素,提出合理的防治措施.方法 以2004年6月至2009年8月在本院分娩的45例产后出血产妇为总结分析对象,把胎儿娩出后24 h内出血量达到或超过500 ml视为产后出血,对产妇的一般情况、产后出血发生率、产后出血量及时间、产后出血原因、产后出血的危险因素等进行分析.结果 产妇发生产后出血45例,产后出血发生率为1.8%;其中宫缩乏力和胎盘粘连是主要因素.结论 产后出血的相关因素较多,充分认识产后出血的主要原因,正确处理胎盘异常情况,是预防和减少产后出血的重要措施. Abstract： Objective To explore the related factors of postpartum hemorrhage and propose possible preventive measures. Methods Collected the data of parturients 45 cases in our hospital between June 2004 and August 2009, and postpartum hemorrhage was defined as blood loss more than 500 ml during 24 hours after fetal disengagement.We analyzed the general condition of the parturients, incidence rate,the amount of bleeding and time of postpartum hemorrhage,the cause and risk factors of postpartum hemorrhage etc.Results There were 45 cases of postpartum hemorrhage among parturients. The incidence rate of postpartum hemorrhage was 1.8%. The uterine inertia and placental adherence were the main factors.Conclusions There are many related factors of postpartum hemorrhage,that thoroughly realize the main cause of postpartum hemorrhage and correctly handle abnormal condition of placenta is important measures to prevent and reduce postpartum hemorrhage.

摘要：目的 探讨彩色多普勒超声对脑梗死患者颅外段颈动脉及椎动脉超声检查的临床价值.方法 对91例脑梗死住院患者行颅外段颈动脉、椎动脉彩色多普勒检查,观察其动脉壁的形态病变性质和动脉管腔的内径及椎动脉的最大流速(PSV)、阻力指数(RI).结果 91例脑梗死患者中,内径超过正常范围的颈总动脉最多,其中左侧17例,右侧22例.斑块生长部位以颈总动脉多见,类型以扁平斑最多,其次为硬斑.椎动脉PSV减低多见,其中左侧52例,右侧57例;RI超出正常范围的,左侧22例,右侧36例.结论 脑梗死患者颅外段颈动脉及椎动脉的彩色多普勒超声常规检查,提供了形态学及血流动力学改变,为临床诊断及治疗提供了重要的信息. Abstract： Objective To evaluate the clinical value of the color Doppler ultrasound for cerebral infarction in patients with extracranial carotid artery and vertebral artery. Methods Ninty-one cases of cerebral infarction patients in the hospital were examined of extracranial internal carotid artery, vertebral artery by color Doppler ultrasound. The pathological change patterns of arterial wall and the inner diameter of the arterial lumens and the peak flow rate (PSV), resistent index (RI)of the vertebral artery were observed.Results In the 91 cases of cerebral infarction patients, the inner diameter of carotid artery beyond the normal range, there were 17 cases in the left, 22 cases in the right.The most plaqueslie in carotid artery.The type of plaques was flat applanation spot at most, following was hard spot.Vertebral artery's peak flow rate was usually reduce, 52 cases in left, 57 cases in right. 22 patients' resistent index beyond the normal range in the left, and 36 cases in right.Conclusions The color Doppler ultrasound to extracranial carotid artery and vertebral artery provides the morphology and hemodynamics's change, offers important messages for the clinical diagnosis and treatment in the cerebral infarction.

摘要：目的 分析儿童大叶性肺炎的临床特征,指导临床治疗.方法 对85例大叶性肺炎病例进行回顾性分析.结果 ①学龄儿童多见(64.7%),幼儿亦非少见(35.3%);②发热(100%)、咳嗽(98.82%)为主要临床表现,多为高热(T＞39 ℃)(83.53%);早期多为干咳,病程中出现咳痰(78.82%);③痰培养阳性9例(阳性率23.08%);血培养阳性5例(阳性率9.43%);血清肺炎支原体抗体(MP-IgM)阳性51例(阳性率64.56%);白细胞计数64.71%在正常范围.结论 大叶性肺炎病原种类多样,临床表现不典型,应加强实验室检查,及早明确诊断,合理治疗;MP感染引起的大叶性肺炎发病率有上升趋势,应引起重视. Abstract： Objective To investigate the clinical characters of lobar pneumonia in children for reference of clinical strategy. Methods The clinical datas of 85 lobar pneumonia patients that were diagnosed and treated from July 2003 to July 2009 were analyzed.Results ①The majority of them were school-age children, while young children were not rare; the rate was 64.7% and 35.3% respectively. ②Fever and cough were the main clinical manifestations, mostly for high fever; most of them had cough without sputum firstly, and then sputum occurred. ③The positive rate of sputum culture was 23.08%, 9.43% for blood culture, and 64.56% for MP-IgM in the serum; and white blood cell count was in the normal range in 64.71% patients.Conclusions The pathogen of lobar pneumonia was diverse, and clinical manifestations of lobar pneumonia were not typical. For making early diagnosis, clinical laboratory tests should be strengthened, then we could offer proper treatment.Lobar pneumonia caused by MP infection tendedtoincrease, calling for much more attention.

摘要：目的 探讨重症手足口病患儿的临床诊断及治疗体会.方法 采用回顾性分析的方法对本院所收治的68例重症手足口病病例的相关信息进行分析.结果 68例重症手足口病大部分发生在2岁以下儿童;发热61例,白细胞升高50例,皮肤黏膜疹发病率100%;部分病例出现天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和空腹血糖升高;部分病例可并发中枢神经系统损伤,导致神经源性肺水肿和循环衰竭.危重症病例治疗困难,病死率达2.94%(2/68).本组病例中, EV71阳性者23例,CoxA16阳性者2例,其他肠道病毒阳性者18例.结论 重症手足口病发病人群大部分为2岁以下儿童.提高诊断警惕性和及时识别出重症病例的早期临床征象及早期干预性治疗是降低手足口病病死率的关键环节. Abstract： Objective To explore the clinical diagnosis and experiences of treatment of severe patients with HFMD in order to understand HFMD better and accumulate more experience of preventing and treating this disease. Methods Clinical data and treatment of the 68 cases of severe HFMD were analyzed retrospectively. Results In 68 severe cases of HFMD, 58 cases happened children with 2 years lower, fever 61 cases and efflorescence 68 cases (100%). WBC increase in 50 cases rose. AST, CK, CK-MB, LDH and Glu inrease partial cases. Neurogenic pulmonary edema(NPE)and circulation failure could occur on the cases with CNS injure. In 68 cases, 23 cases were EV71-positive, 2 cases were CoxA16-positive, 18 cases were other enterovirus-positive. Treatment of critical cases was difficult, case-fatality rate was high as 2.94%.Conclusions Severe HFMD mostly happened to the children with 2 years lower. Improving diagnosis consciousness and early intervention therapy are critical in reducing the fatality.

摘要：目的 探讨超声引导下酒精硬化治疗肝、肾囊肿所发生的并发症及处理方法.方法 回顾性分析近年所施行的肝、肾囊肿介入性酒精硬化治疗患者202例(均以无水酒精为治疗药物),其中出现并发症23例,包括出血、酒精不耐受、注入无水乙醇后无法顺利抽出、术中出现明显疼痛、操作过程中针尖脱出等.结果 22例均经对症处理,成功治疗,1例因针尖脱出,未行酒精硬化治疗,仅抽出囊液.结论 超声引导下酒精硬化治疗肝、肾囊肿是普遍采用的有效方法,但可发生少数并发症,如经早期发现并正确处理均能予以治愈. Abstract： Objective To explore the causes and treatment of the complications of alcohol sclerotherapy for hepatic and renal cysts with ultrasound-guided. Methods In recent 4 years, 202 cases of hepatic and renal cysts were treated by alcohol sclerotherapy with ultrasound-guided,among which complications were found in 23 cases by retrospective analysis. Results 22 cases were treated successfully. In 1 case, the needle was falling off from the cyst cavity, the liquid of cyst was drained out. Conclusions Alcohol sclerotherapy is a generally applied and efficient method for hepatic and renal cysts. But a few complications might occur due to different factors, which could be treated successfully if you found them early.

摘要：目的 分析宫颈癌MRI表现,评价MRI成像对宫颈癌术前分期的价值.方法 68例经病理证实的宫颈癌患者,在MRI上观察肿瘤的位置、大小、信号特征、浸润范围及累及宫旁的情况,进行MRI影像分期,其中56例MRI术前分期与手术、病理分期对照.结果 68例MRI分期分别Ⅰa 2例,Ⅰb 5例,Ⅱa 34例,Ⅱb 12例,Ⅲa 4例, Ⅲb 5例,Ⅳa 4例,Ⅳb 2例.MRI在判断宫颈癌发生部位的准确率为100%,判断宫旁浸润的准确率为86.7%,判断宫颈癌总的分期准确率为88%.结论 MRI能清楚显示宫颈癌病灶的侵犯范围,对宫颈癌的分期价值极高,对临床制定治疗方案及预后评估有重要意义,建议对宫颈癌患者进行常规检查. Abstract： Objective To analyze the MRI features of cervical carcinoma,and evaluate the value of MRI in staging of cervical carcinoma. Methods Pelvic MRI imaging was performed in 68 patients with cervical carcinoma proved by pathology.MRI images were analyzed for location,size,signal characteristics,extension of the primary tumor and surrounding tissue. MRI findings were compared with clinical staging and surgical pathologic findings.Results Based on MRI staging,stage Ⅰa was seen in 2 cases,Ⅰb in 5 cases,Ⅱa in 34 cases,Ⅱb in12 cases,Ⅲa in 4 cases,Ⅲb in 5 cases,Ⅳa in 4 cases,Ⅳb in 2 cases. The accuracy of MRI imaging in determination of tumor location was 100%, invasion the parauterine tissue was 86.7%. The total accuracy of MRI imaging staging was 88%.Conclusions MRI can well demonstrate the size and extension of the cervical carcinoma, MRI has important value in staging of cervical carcinoma,and very helpful in making the therapeutic plan.It is suggested that MRI should be regarded as a conventional study for the patients with cerivical carcinoma.