本文报道1例成功采用与供者同型的A型血浆给O型受者实施两次血浆置换，抗A血型抗体如期降至≤1∶8并顺利完成手术；两次A型血浆置换均未产生临床不良事件。为ABO血型不相容肾移植受者血浆置换提供了新的思路。

目的 测定不同级别宫颈鳞状上皮内病变(SIL)中p16、Ki-67、P53蛋白的表达水平,探讨联合检测上述生物学标记物对HSIL的辅助诊断价值.方法 回顾性分析2015年3月-2018年3月首都医科大学附属北京同仁医院阴道镜活检病理标本共180例,根据病理组织学诊断结果分为HSIL组、LSIL组及宫颈炎组,每组各60例,其中宫颈炎组作为对照组.采用免疫组化SP法检测p16、Ki-67、P53表达情况,判断检测方法的灵敏度、特异度,评价联合检测的诊断效能.结果 p16在HSIL组、LSIL组及宫颈炎组的阳性率分别为95.00％、73.33％、15.00％;Ki-67阳性表达率分别为86.67％、65.00％、8.33％;P53阳性表达率分别为96.67％、80.00％、8.33％.p16、Ki-67和P53阳性表达率随宫颈病变级别的升高而呈上升趋势,三组比较差异有统计学意义(P<0.01);p16、Ki-67和P53三种生物学指标联合应用并联灵敏度95.6％,特异度85.5％;三者串联灵敏度81.6％,特异度100％.结论 p16、Ki-67和P53在一定程度上可以客观反映SIL严重程度,联合应用可有效筛选HSIL,提高HSIL诊断准确率,为精准分流SIL病人提供依据,指导个体化治疗.

Objective To study the characteristics of lower extremity deep-vein thrombosis(LDVT)after gynecological operation and its risk of developing into pulmonary embolism (PE),furthermore,to evaluate the diagnostic value of LDVT by lower extremity venous ultrasonography to prevent the occurance of PE.Methods 395 patients underwent gynecological operation from April to December in 2008.Patients deep veins of lower limbs were scanned separately 24 hours before surgery,48～72 hours and 96～120 hours after the surgery.If thrombosis happened,pulmonary artery lines would accept further CTPA examination to make sure whether PE existed,and color Doppler ultrasound would continue to observe dynamicly.No postoperative ultrasonography LDVT appearing,but clinical symptoms,signs or laboratory tests showing the possibility,CTPA also must be carried out to make sure whether PE existed or not.Results After gynecological pelvic surgery without early positive preventive measures,the incidence of LDVT was 11.1% among which,42.8% would develop into PE.Conclusions Early after gynecologic surgery,LDVT appears mostly in the lower limb deep vein.There is a high risk of PE for patients with LDVT.LDVT is the main factors leading to PE.Ultrasonography of dual-limb vein,especially lower deep vein is imperative for the high-risk groups after Gynecologic surgery.

Objective To observe the effectiveness of intermittent pneumatic compression(IPC) and low-molecular-weight heparin(LMWH) medication for the prevention of lower extremity deep vein thrombosis(LEDVT) with color Doppler ultrasonography after gynecological pelvic surgeries.Metheds A total of 219 patients who received pelvic surgery because of gynecopathy were divided into 3 groups randomly according to the risk levels for thrombo-embolism:group A with no prevention strategy as control group;prevention group:group B using IPC to prevent LEDVT and group C using LMWH to prevent LEDVT.Color Doppler ultrasonography was performed to scan the lower extremities 1 day before operation and 2 days after operation.Dynamic observation was continued if there was thrombosis.Rusults The morbidity of LEDVT was 11.64% in group A,4.11% in group B and 0.68% in group C,morbidity in group with prevention reduced obviously than that in group without prevention(P0.0001);there was no difference between group B and C(P=0.06).The DVT ratio of high risk cases in group A was 42.86%,moderate risk cases was 5.88% and low risk cases was 8.00%;the DVT ratio of high risk cases in group B was 14.28%,moderate risk cases was 6.06% and no DVT was found in low risk cases.DVT ratio of moderate risk cases in group C was 2.94%,none in low risk and high risk cases;DVT ratio of high risk cases in prevention group reduced obviously than that in control group(P=0.01).Conclusion The mobidity of postoperative LEDVT in gynecological surgeries was 11.46% with no positive prevention.Both IPC and LMWH can effectively prevent LEDVT after pelvic surgery,and the latter is more effective.IPC and LMWH should be used in prevention treatment routinely on high risk postoperative patients.

患者女,25岁,因"发现枕部肿物并渐进性增大13年"人院.临床检查:左枕部可见10 cm×8 cm大小肿物.彩色多普勒超声:枕后部头皮明显增厚、隆起,范围11.2 cm×9.8 cm×3.1 cm(长×宽×厚),边界清晰,内可见粗细不等,纡曲扩张的管状结构互相交通,压缩肿物可变形.CDFI见管状结构内充满血流信号(图1).Doppler为动静脉血流信号,呈高速低阻型,峰值流速81 cm/s,RI 0.35.肿物周围可见沿枕动脉走行区域之粗大血管与肿物相通.诊断:枕部血管瘤(蔓状血管瘤可能性大).DSA:血管瘤由双侧枕动脉供血,栓塞双侧枕动脉(图2).手术后病理:头皮蔓状血管瘤.