目的 探讨超声检查在附睾占位性病变诊断中的应用价值.方法 回顾性分析2005年1月～2013年12月于我院进行手术治疗的56例附睾占位性病变患者的临床资料及超声检查资料,并与病理结果对照.结果 56例附睾占位性病变中,附睾炎14例,附睾结核12例,附睾囊肿17例,腺瘤样瘤2例,乳头状囊腺瘤7例,附睾恶性肿瘤4例.术前通过分析临床资料和超声检查结果诊断39例,诊断符合率为69.64％.结论 超声检查具有直观、无创、可重复等特点,结合临床症状、触诊、实验室检查及实验性治疗等方法有助于提高附睾占位性病变的诊断及鉴别诊断水平.

Objective To compare the clinical value of plasmakinetic resection of bladder tumor (PKRBt) and transurethral resection of bladder tumor (TURBt) in treating bladder tumors.Methods 282 patients with bladder tumors who had underwent transurethral endoscopic surgery from January 2000 to December 2013 were divided into PKRBt group (132 cases) and TURBt group (150 cases). The clinical data, operation duration, intraoperative blood loss and the occurrence rate of obturator nerve relfex of PKRBt group were compared with those of TURBt group.Results There were no significant differences between the two groups in terms of operation duration and intraoperative blood loss (P>0.5). There were significant differences between the two groups in terms of the occurrence rate of obturator nerve reflex (P<0.05) occurred during the operation process of bladder tumors which were located at the lateral posterior wall of bladders.Conclusion It is safe and effective to use PKRBt and TURBt to treat superifcial bladder tumors. The occurrence rate of obturator nerve relfex of PKRBt is lower than that of TURBt, which indicates that the operation safety of PKRBt is higher than that of TURBt.

目的：探讨经尿道输尿管镜碎石术治疗输尿管结石的应用体会。方法回顾性分析1365例经尿道输尿管镜碎石术治疗的输尿管结石患者资料，统计分析成功率及并发症。结果 1365例输尿管结石患者，输尿管镜一次碎石1274例，碎石成功率93.33%。术中严重并发症为输尿管损伤，包括输尿管穿孔7例，黏膜撕脱3例。结论经尿道输尿管镜治疗输尿管结石相对高效、安全、创伤小，熟练操作、掌握技巧可提高成功率，减少并发症。

[Objective] The evaluation of femoral artery PCI postoperative application Perclose ProGlide(Abbott,USA) suture bleeding vessels for the safety and reliability,analysis and common complications preventive measures.[Methods] In February 2007 to January 2011 in our hospital from 3109 patients via the artery PCI postoperative Perclose ProGlide blood vessels for application suture bleeding effect were retrospectively summarized,analyzed,and the reason for failure in complications,observe the recent complications.[Results] Hemostatic rate was 95.6%(2973/3109),stop bleeding time(2.9±0.8)min,postoperative braking time(4.3±1.5)h,a mean of the length of time(4.5±1.2)d.The overall incidence of complications in 1.6%(51/3109),including hematomas(19 cases),ooze blood in 16,10 cases of local infection,pseudo-aneurysms in 3 patients,the artery sandwich in 2 cases,retroperitoneal hematoma in 1.Among them is complications associated with suture bleeding 1.2%.By March 2012,a mean follow-up(12±2) months,follow-up rate 66.7%(2013/3109),follow-up complication rate 0.1%(3/2013),including 2 cases late-occurred femoral artery interlining,1 case of late femoral artery thrombosis.[Conclusion] The application Perclose ProGlide PCI suture bleeding vessels for is a safe and reliable hemostatic measures,is worth further promotion.

Objective:To Explore the feasibility of the rectus beside single incision in treatmenting the carcinoma of the ureter. Methods:The rectus beside incision begins from rib bow down to anterior superior spine inside,with a curved inward extension at the end,emphasizing tumor-free principle.Results:Among 17 cases,16 cases were conducted resection of kidney,ureter and bladder orificeshape cuff smoothly,only one case could not be resected because iliac blood vessel were infiltrated with ureter,all were discharged from the hospital without tumor growing around incision.Conclusion:The rectus beside incision is a good pattern to treat the carcinoma of the ureter with the tumor-free principle.

高血压是最常见的心血管疾病之一,其致残、致死率高,本文就如何认识高血压对非心脏手术的影响及其潜在的风险性作一评价并提出术前处理参考建议,以期对广大非心血管临床医生有所帮助.

Objective To investigate the effects of valsartan and perindopril on serum cytokine levels and myocardial fibrosis in patients with chronic heart failure of dilated cardiomyopathy(DCM).Methods Serum concentrations of TNF-α,IL-6,TGF-β1 and serum procollagen Ⅲ peptide(PCⅢ),laminin(LN),hyaluronic acid(HA) in normal controls(n=30) and patients with CHF resulting from DCM(n=30),who were randomized into valsartan group(n=15) and perindopril group(n=15),were measured before and 3 months after treatment respectively.Left ventricular ejective fractions(LVEF) were also estimated in those subjects.Results There was a significant increase in serum levels of TNF-α,IL-6 and PCⅢ,LN,HA in patients with CHF compared with normal controls(P0.01) while the serum levels of TGF-β1 decreased(P0.01).The serum levels of TNF-α,IL-6 and PCⅢ,LN,HA were negative related to LVEF but TGF-β1 was positive related to LVEF.There was a significant decrease in serum levels of TNF-α,IL-6 and PCⅢ,LN,HA and increase in TGF-β1 and LVEF in both valsartan group and perindopril group,but the changes in the valsartan group was more visible.The increasing of cardiac function and the decreasing of myocardial fibrosis have some relationship.Conclusion There is a disequilibrium in the levels of serum concentrations including TNF-α,IL-6 and TGF-β1 and a significant increase in serum levels of PCⅢ,LN,HA in patients with CHF of DCM,and the serum levels of cytokine and myocardial fibrosis are related to LVEF.Valsartan or perindopril adjusts the balance of the serum levels of cytokine and ameliorated myocardial fibrosis and LVEF but the effect of valsartan is more visible.

心房颤动是当今心律失常研究的热点与治疗难点,其发病机制复杂,目前认为多数起源于肺静脉的异常冲动,抗心律失常药物转复房颤及维持窦性心律的疗效有限,因而寻求更为有效的非药物治疗方法成为目前研究的重点。现阶段主要的非药物疗法有电复律、心房起搏、植入型心房除颤仪、外科手术及经导管消融治疗,尤其是经导管消融可能成为治疗房颤的一线措施。

Objective To summarize our experience with combined cardiac pacing and beta-blocker therapy in patients with long-QT syndrome. Methods Nine patients with long-QT syndrome were treated with Propranolol. Its effectiveness was analyzed during matched periods before and after starting beta-blocker therapy. If sinus bradycardia, sinus arrest and atrioventricular occurred during the Propranolol treatment, DDD pacemaker were implanted. Results After initiation of beta-blockers, there was a significant reduction in the rate of cardiac events [(0.86±0.92) to (0.34±0.69) events per patient per year, P0.01] . Numbers of cardiac events per patient were decreased significantly [(3.5±3.6) to (0.9±1.1),P0.01] after the treatment. Sinus bradycardia in 5 patient and atrioventricular block in 4 patients occurred during the Propranolol treatment were implanted DDD pacemaker . The mean paced rate was (86.0±7.8) beats/min (range, 70 to 100 beats/min). After that , QTc in all patient were normal and cardiac events recurred in only one patient. Conclusion Beta-blockers are associated with a significant reduction in cardiac events in LQTS patients. However, syncope and aborted cardiac arrest continue to occur while patients are on prescribed beta-blockers. Because 8 of 9 patients remain without symptoms with beta-blocker therapy and continuous pacing, combined therapy appears to provide reasonable, long-term control for this high-risk group.

ObjectiveTo investigate the effects of pravastatin on serum monocyte chemoattractant protein-1(MCP-1),tumor necrosis factor-α(TNFα) and interleukin-6(IL-6) in patients with unstable angina(UA).MethodsSerum MCP-1,TNFαand IL-6 were detected by radioimmunoassay and enzyme linked immunosorbent assay(ELISA)4 weeks before and after oral administration of pravastatin in 25 patients with UA.ResultsThe contents of serum MCP-1,TNFαand IL-6 in patients with UA were significantly increased compared with control group(P=0.01).A significant decreased serum MCP-1,TNFα and IL-6 contents were observed 4 weeks after pravastatin-taken(P=0.01).ConclusionThese findings indicate that MCP-1,TNFα and IL-6 may play an important role in the pathophysiologic changes of UA and pravastatin has a beneficial effect on decreasing serum MCP1,TNFα,IL-6 and alleviating inflammatory reaction in patients with UA.

Objective To evaluate the relationship between the ratio of positive circulating endothelial cell(CEC)expressing endothelial lipase to total CECs(EL+/CECs)and the risk factors of coronary artery disease(CAD).Methods According to angiography examination,107 patients with acute coronary syndrome(ACS),69 patients with stable angina pectoris(SAP)and 82 patients excluded coronary artery disease as control,were studied.Risk factors of CAD including family history of CAD,smoking,diabetes,hypertension,body mass index(BMI)et al,were collected.Blood samples were collected from ulnar vein and biochemical indicators including blood lipid level,serum glucose,hsCRP,et al were detected.Circulating endothelial cells(CECs)were separated.EL was detected by immunohistochemistry and the ratio of EL+/CECs was calculated.Results EL+/CECs was significantly different among groups ACS,SAP,and control group.The EL+/CECs in the ACS group was the highest among three groups.In patients whose EL+/CECs was higher than average level,risk factors such as the family history,smoking,diabetes,lower HDL level et al,were stronger than those whose EL+/CECs was lower than average(P0.05).Regression analysis indicated that the EL+/CECs was affected by the risk factors as family history of CAD,smoking,diabetes,lower HDL level,LDL/HDL,and hsCRP level.Conclusions EL+/CECs is positively correlated to the clinical dangerous degree of CAD and is affected by risk factors of CAD.

心房颤动(Atrial fibrillation,AF)是一种常见类型的房性心律失常,是脑卒中致残或致死的重要危险因素.随着中国人口老龄化加速,使得未来AF的发病率将逐年增加.AF最大的危害是导致脑卒中与体循环栓塞,使患者组织损伤、器官功能障碍,在很大程度上降低了患者的生活质量.由此而引起的医疗费用增加而加重家庭与社会的负担.国内外研究均已证实,合理的抗栓治疗能明显减少AF栓塞的发生.然而,目前对AF抗栓治疗的力度明显不够且欠规范,应当引起重视.

Objective To investigate the relationship between the oxidized low-density lipoprotein(ox-LDL) in the blood from the coronary sinus and impaired endothelium-dependent vasodilation in patients with coronary artery disease(CHD).Methods Four groups of patients were subjected,including acute myocardial infarction group(AMI,n=22),unstable angina group(UA,n=29),and stable angina group(SA, n=25) and control group(n=20) who was first suspected as CHD and then verified with normal coronary angiograms.Blood form the coronary sinus was collected through cardiac cathetering and the ox-LDL level was measured by Sandwich ELISA method.Brachial arterial hyperemia-induced flow mediated dilation(FMD) and sublingual nitroglycerin(NTG) mediated vasodilation were measured by high resolution ultrasound.Results The blood level of ox-LDL in patients with CHD was markedly higher than those in control group(P0.01),with those of AMI and UA significantly higher than those of the SA group(P0.01),and those of AMI group higher than those of UA group(P0.05).Compared with control group,the FMD in CHD group was significantly decreased(P0.05),but no significantly difference was seen in NTG between the CHD and control groups.As for the FMD,there was no difference between in AMI and UA groups,though these 2 groups were lower than SA group(P0.05).Conclusions In the CHD patients,their blood ox-LDL level in coronary sinus is increased and FMD is decreased,indicating that ox-LDL and endothelium-dependent vasodilation may be one of the pathophysiological basis of acute coronary syndrom.

Objective:To retrospectively compare the efficacy and safety of ultrasound-guided thrombin injection （UGTI） with ultrasound-guided compression repair （UGCR） in patients with postcatheter-izational femoral arterial pseudoaneurysms （PSA）. Methods: Thirty patients of this iatrogenic PSA [8 males, 22 females, average age （66. 5±5. 2） years] in our institution from 1997 to 2004 were retrospectively analyzed. Among them, 11 patients were treated with UGCR, 2 under continuous ultrasonographic （US） guidance and 9 under the guidance of femoral arterial bruit auscultation and dorsalis pedis artery palpation. Because UGCR was failed in 5 patients, consecutively 24 patients were treated with UGTI. Swine thrombin solution at a concentration of 200 U/ml was injected percutaneously using 22-25 gauge needles under color Doppler US. Demographics, clinical variables, pseudoaneurysm characteristics, and results of the 2 groups were compared by using Fisher’s exact test and Student’s t test. Results: The initial success rate of UGCR was 36. 4% （4/11） and the overall success rate was 45. 5% （5/11）. Ten of 11 patients suffered from local pain during the compression, but there was no any complication in UGTI group. The average dose of injected thrombin was （180 + 82） U for PSA of a single loculus and （315±150） U for multiloculated PSA. The initial success rate of UGTI was 89.5% （17/19） and the overall success rate was 100% （24/24）. Conclusion;UGTI offers a safe, quick and effective means of definitively treating femoral pseudoaneurysms and seems superior to UGCR. The amount of thrombin applied on our people seems smaller compared with others’ work.

Objective To investigate the effects of losartan on serum monocyte chemoattractant protein-1(MCP-1),tumor necrosis factor-α(TNF-α) and interfon leukocyte-6(IL-6) in patients with congestive heart failure(CHF).Methods Serum monocyte chemoattractant protein-1(MCP-1), tumor necrosis factor-α(TNF-α) and interfon leukocyte-6(IL-6)were detected before and after 4 weeks oral treatment with losartan in 35 patients with CHF.Results The contents of serum MCP-1, TNF-α and IL-6 were significantly increased(P0.01).A significant decreased serum MCP-1, TNF-α and IL-6 contents were observed after 4 weeks of losartan therapy(P0.01).Conclusion These findings indicate that MCP-1, TNF-α and IL-6 may play an important role in the pathophysiologic changes of CHF and losartan has a beneficial effect in decreasing serum MCP-1, TNF-α and IL-6 in patients with CHF.

老年慢性心力衰竭(chronic heart failure,CHF)合并室性心律失常,尤其是室性心动过速更为常见,老年人心力衰竭患者猝死与非持续性室性心动过速明显相关[2],是临床治疗难点,本文应用美托洛尔和血管紧张素转换酶抑制剂培哚普利治疗老年人CHF室性心律失常,观察疗效.

Objective To investigate the level of coronary endothelial injury and dysfunction, the jeopardy score of coronary artery lesion by angiography, and their correlations in patients with stable angina (SA) or unstable angina (UA). Methods The 20 patients with UA, 17 patients with SA and 18 patients excluding coronary heart disease (control) were studied. Blood samples were collected during percutaneous coronary intervention (PCI). To investigate the coronary endothelial injury and dysfunction, we measured the concentrations of nitric oxide (NO)? endothelin (ET) and the number of circulating endothelial cells (CEC) in coronary sinus blood. The jeopardy score for coronary artery lesion was evaluated according to the method by Califf. Results In angina patients, especially in UA patients, NO concentration in coronary sinus blood was lower, while ET concentration and CEC number were markedly higher than those in control group. The jeopardy scores showed no difference between UA and SA. The coronary endothelial injury and dysfunction showed a positive correlation with jeopardy scores. Conclusion The coronary endothelial injury and dysfunction is not only the initiation factor, but may play a key role in the progression of atherosclerosis and coronary heart disease. Coronary angiography combined with detection of coronary endothelial injury and dysfunction may better describe the lesion of coronary artery, and evaluate the prognosis of patients with coronary heart disease.

目的了解经皮冠状动脉介入治疗(PCI)中心包积液/心脏压塞发生率、发生的相关因素、处理以及预后,为PCI的正确操作及合理选用器械提供参考.方法分析了1 246例PCI资料,包括住院病历、PCI操作记录、护理记录和影像学资料,判定心包积液/心脏压塞发生原因、时间、临床表现、处理方式和结果.结果共8例心包积液(0.64%)、3例心脏压塞(0.24%),其中10例(91%)在导管室确诊,1例(9%)延期发现.冠状动脉造影直接发现导引钢丝和/或球囊致冠状动脉穿孔9例(81.8%),其中球囊通过冠状动脉破口未扩张2例,球囊通过冠状动脉破口并扩张1例,冠状动脉穿孔多发生在慢性完全闭塞性病变(CTO);通过临床表现、超声心动图证实起搏电极导线致右心室穿孔2例(18.2%),均出现在心肌梗死后患者.球囊通过冠状动脉破口并扩张1例,发生迟发性心脏压塞,6 h后急诊外科干预引流后治愈;右心室临时起搏电极导管穿破右心室2例,1例行心包穿刺术,另1例心包穿刺后留置猪尾导管引流2 d成功治愈.结论冠状动脉及右心室穿孔是PCI并发心包积液/心脏压塞的主要原因,前者多发生在CTO患者,后者易出现于心肌梗死后患者.正确的操作方法及合理的器械选择可能减少此并发症的发生.冠状动脉穿孔较心室穿孔易于诊断,心包积液/心脏压塞多数能在导管室早期发现,并能得以合理的处理.