目的 总结创伤性纵隔气肿(traumatic mediastinal emphysema,TPM)与自发性纵隔气肿(sponta-neous mediastinal emphysema,SPM)的常见病因、临床表现、治疗及预后,了解两组疾病特征的差异.方法 回顾性分析2013年1月至2019年8月我院收治的41例纵隔气肿(mediastinal emphysema,PM)患者的临床资料,按有无明确外伤病因分为TPM 27例与SPM 14例.结果 41例PM患者平均年龄(39.22±18.80)岁,男36例,女5例,男女比例7.2:1.TPM组27例,年龄(43.19±17.54)岁;SPM组14例,年龄(28.15±15.20)岁.SPM临床表现主要有胸痛(11/14)、胸闷(6/14)、咳嗽(4/14)、咽喉肿痛或异物感(4/14)及皮下气肿(4/14),TPM则为胸痛(22/27)、咳嗽(16/27)、胸闷(14/27)、呼吸困难(9/27)及皮下气肿(21/27);SPM治疗以吸氧、抗感染、禁食等治疗为主,仅1例行胸腔闭式引流治疗,而TPM组的有创治疗包括胸腔闭式引流13例、纵隔切开减压1例、机械通气2例及气管切开1例;SPM出院随访除1例失访未知外,其余恢复良好,TPM出院随访20例恢复良好,4例失访未知,3例死亡,包括2例院内死亡和1例院外死亡.结论 TPM和SPM症状都以胸痛为主,皮下气肿是最常见体征,呼吸困难与皮下气肿是区分TPM与SPM的最主要症状和体征.SPM是病程简单,而TPM病程相对复杂,需经历较长的气肿吸收期,治疗上需要更多的有创治疗方式,尤其以胸腔闭式引流治疗为多见,其预后的主要影响因素仍是创伤合并症,尤其是颅脑损伤.

Objectives:To research the clinical effect of testosterone undecanoate capsules in middle-and -old-aged patients with male hypogonadism.Methods:120 middle-and-old-aged patients with male hypogonadism were chosen and divided into observation group and control group according to the random number table methods.Patients in observation group were treated by the testosterone undecanoate capsules 40 mg bid,and patients in the control group were treated by liuwei dihuang capsule,three months after treatment.The sexual function,frequency of sex,sexual satisfaction,physical condition and mental state between the two groups were compared and analyzed.Results:① The IIEF score,number of sex and sexual satisfaction in the two groups after treatment were improved significantly than those before treatment,the difference was statistically significant (P ＜ 0.05),and the observation group improved more significantly,with statistically significant difference (P ＜ 0.05).② The KPS score in two groups after treatment was improved significantly than that before treatment,with statistically significant difference (P ＜0.05),more significant in the observation group,with statistically significant difference (P ＜ 0.05).Conclusion:For the middle-and-old-aged male hypogonadism patients,testosterone undecanoate capsules can not only improve the patients’ sexual function,but also improve the status of mental nerve,which is worth popularizing in clinical.

目的：探讨单用坦洛新与联合托特罗定用于治疗良性前列腺增生症下尿路症状的疗效。方法选择我院2011年2月~2013年2月具有良性前列腺增生症下尿路症状的患者60例，随机分成两组，其中对照组29例，给予选择性α-受体阻滞剂（坦洛新），试验组31例，给予α-受体阻滞剂联合M-受体阻滞剂（坦洛新+托特罗定）。用药6w后分别进行国际前列腺症状IPSS、生活质量指数QOL、最大尿流率Qmax的测定。结果治疗后对照组IPSS、QOL、Qmax分别为17.3±4.0、3.5±0.6、13.5±2.1，试验组IPSS、QOL、Qmax分别为14.0±4.3、3.3±0.7、14.1±1.6，进行均数t检验后两组差异具有统计学意义（P<0.05）。结论 M-受体阻滞剂联合选择性α-受体阻滞剂用于治疗良性前列腺增生症下尿路症状的疗效优于单用选择性α-受体阻滞剂。

Objectives To explore the efficacy of tolterodine in treating feminine overactive bladder.Methods Twenty patients were treated with tolterodine combined with tamsulosin anddiclofenacsodium.The total therapylasted 4 weeks.The time of urination perday,the average amount of mona-urination and the maximum amount of mona-urination were observed and the changes of all indexes before and after treatment were assessed.Results Before treatment,the daily mean frequency of urination was (18 ± 3)times,the daily mean single urine volume was(105 ± 31) mL and the daily mean maximum urine volume was (154 ± 30) mL.After treatment,the daily mean urination frequency was (10 ± 2) times,the daily mean single urinevolume was (283 ± 72)mL and thedaily mean maximum urinevolume was(356 ± 78)mL.All the indicators showed significantly differenct between before and after treatment(P ＜0.05).Conclusions Tolterodine combined with tamsulosin and diclofenac sodium can be an effective method for female over active bladder of tolterodine invalid.

Objective To investigate the impact of carvedilol on cardiac function and plasma levels of BNP and NT-pro BNP of patients with chronic heart failure. Methods A total of 120 patients with chronic heart failure were selected in the People's Hospital of Wuxi from June 2012 to June 2014,and they were randomly divided into control group and observation group,each of 60 cases. Patients of both groups received conventional treatment,and patients of observation group received extra carvedilol,both groups treated for 6 months. SBP, DBP, LVEF, LVESD, LVEDD, plasma levels of BNP and NT-pro BNP were compared between the two groups before and after treatment. Results No statistically significant differences of SBP,DBP,LVEF,LVEDD or LVESD was found between the two groups before treatment( P 0. 05); after treatment, SBP, DBP,LVEDD and LVESD of observation group were statistically significantly lower than those of control group, while LVEF of observation group was statistically significantly higher than that of control group( P 0. 05). No statistically significant differences of plasma level of BNP or NT-pro BNP was found between the two group before treatment( P 0. 05),while plasma levels of BNP and NT-pro BNP of observation group were statistically significantly lower than those of control group( P 0. 05).Conclusion Carvedilol can effectively improve the cardiac function and reduce the plasma levels of BNP and NT-pro BNP of patients with chronic heart failure,is helpful to improve the prognosis.

Objectives To reduce the incidence of rectal injuries and rectovesical/ectourethral fistula and improve the diagnosis and management of rectovesical/ectourethral fistula.Methods According to the reports in the literatures,the diagnosis and management of rectovesical/ectourethral fistula in 5 cases were analyzed retrospectively.Results Among 88 patients who underwent laparoscopic radical prostatectomy,three cases developed rectovesical fistula after operation which was not found by intraoperative digital rectal examination.At 1217 days postoperatively,rectovesical fistula occurred and was cured by conservative approachs such as catheterization and nutritional support without surgical intervention including colostomy and surgical repair.One case developed rectovesical fistula because of pelvic tumor.After receiving ureterocutaneostomy and descending colon exteriorization the general condition of the patient improved and the temperature dropped.A case of 18-month ectourethral fistula after pelvic stromal tumor operation was cured by perineal repair.Conclusions During the operation,several factors such as radiotherapy,operation history,pelvic hematoma,infection and neoadjuvant therapy may lead to difficult dissection of prostate,especially the apex of the prostate and recto-urethralis and cause rectal injuries.Meanwhile,reducing the electrical heat injury of ultrasound knife and monopolar electrocoagulation to rectal anterior wall and avoiding postoperative pelvic infection may reduce the incidence of rectal injuries.When rectovesical/ectourethral fistula occurred,conservative management should be first considered,such as catheterization and nutritional support.If the fistula still did not close after three months or fecal stream still existed,colostomy should be performed.Furthermore,if the fistula did not close three months after colostomy,surgical repair should be considered.And surgical repair should be performed according to general condition of patients and the location of orificium fistulae.Surgical repair is less effective to treat the fistula caused by tumor than urinary/fecal diversion.

目的:探讨经尿道精囊镜技术对保守治疗无效的顽固性血精患者的诊断及治疗价值。方法:2010年8月至2012年3月,对9例顽固性血精患者行精囊镜检查。年龄32～49岁,平均40.3岁。入院前症状持续12～26个月,经过>1年的保守治疗。术前行经直肠超声和盆腔CT或MRI检查,排除前列腺、精囊肿瘤。采用StorzF6/7.5输尿管硬镜行精囊镜检查,术后静脉使用抗生素治疗。结果:本组手术时间20～62min,平均39min。术后未出现发热、附睾炎及直肠损伤等严重并发症。5例在精囊镜检查后1个月,4例在检查后3个月内,血精完全消失。结论:采用精囊镜技术对一些久治不愈的血精患者进行检查和治疗,既可以明确诊断,又可以对精囊进行冲洗,并解除射精管梗阻,具有创伤小、效果好、并发症少等优点,是治疗顽固性血精的有效方法之一。

Objectives To evaluate the performance of dual source computed tomography coronary angiography(DSCTCA) for detecting in-stent restenosis in small coronary arteries.Methods Totally 76 patients(59 males,17 females) with chest pain were prospectively evaluated by DSCT-CA after coronary stent implantation within 6-12 months.The patients were divided into different groups according to heart rate and the results of coronary angiography : heart rate≤ 70 bite / min group [n=48,heart rate(58±5) bite / min] and heart rate ﹥ 70 bite / min group [n=41,heart rate(78± 9) bite / min];simple group(single stent,n =54) and complex group(overlapping stents and bifurcation stent,n = 35);right coronary group(n =33),left circumflex coronary artery group(n =43) and left anterior descending group(n=13).Sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV) of DSCT-CA in different groups were compared.Results Totally 89 stents were implanted in 76 patients and 31.4%(28 / 89) of them were proven restenosis.Sensitivity,specificity,PPV and NPV of DSCT-CA calculated in all stents were 89%,87%,76% and 95% respectively.DSCT-CA diagnostic performance of herat rate ≤70 bite / min group and heart rate ﹥ 70 bite / min group had no significant difference(P 0.05).DSCT-CA diagnostic performance in three main coronary branches was similar to each other(P0.05).Sensitivity,PPV,specificity,NPV of DSCT-CA in complex group was significantly lower than those in simple group(83% vs.94%,P0.05;63% vs.88%,P0.05;74% vs.95%,P0.05;89% vs.97%,P0.05;respectively).Within simple group,sensitivity was similar to specificity(94% vs.95%,P 0.05) and PPV was significantly lower than NPV(88% vs.97%,P0.05).Quality control chart showed that ratio of DSCT-CA detection for in-stent restenosis in small coronary arteries was increased year by year.Ratios in 2006 and 2007 were lower than average level and ratio in 2009 was twice higher than average level.Conclusions DSCT-CA can be the screening method for detecting in-stent restenosis in small coronary arteries,of which,negative individuals can be screened out of in-stent restenosis and positive individuals should perform coronary angiography for accurate diagnosis.

目的探讨女性膀胱过度活动症(OAB)的有效治疗方法。方法选择诊断为OAB且口服托特罗定后无效的20例女性患者,给予口服托特罗定2mg,每日2次;坦索罗辛0.2mg,每晚1次;肛塞双氯芬酸钠25mg,每日2次。用药时间为4周,观察用药前后日平均排尿次数、日平均单次尿量、日单次最大尿量各指标变化。结果联合治疗前患者日平均排尿次数(18±4)次,日平均单次尿量(105±32)ml,日平均单次最大尿量(154±31)ml;联合治疗后日平均排尿次数(10±3)次,日平均单次尿量(283±73)ml,日平均单次最大尿量(356±80)ml,差异均有统计学意义(P<0.05)。结论托特罗定联合坦索罗辛及双氯芬酸钠能够有效改善口服托特罗定无效的女性OAB患者临床症状,提高生活质量。

目的以血管内超声-虚拟组织学分析（IVUS-VH）为参照,观察血清学指标对不稳定斑块的预测意义。方法纳入69例冠心病患者,检测心脏型脂肪酸结合蛋白（HFAP）、肌钙蛋白Ⅰ（cTnⅠ）及高敏C反应蛋白（hsCRP）水平后,行IVUS-VH分析斑块性质,通过受试者工作特征曲线（ROC）分析各项指标对不稳定斑块的诊断意义及联合检测对不稳定斑块的诊断符合率。结果HFAP、hsCRP、cTnⅠ的ROC曲线下面积分别为:0.833、0.692、0.647（均为P＜0.05）。联合检测HFAP、hsCRP、cTnⅠ对不稳定斑块判断符合率为93.75%。联合检测HFAP和hsCRP,符合率为63.16%,联合检测hsCRP和cTnI,符合率为64.52%,联合检测HFAP和cTnⅠ,符合率为66.67%。任意两项指标联合检测,对不稳定斑块的判断符合率差异均无统计学意义。结论对不稳定斑块的判断,单项指标检测:HFAP最优,其次为cTnⅠ,最后为hsCRP;联合指标检测:HFAP、cTnⅠ、hsCRP三者联合优于任意两者联合。

<正>患者,男,18岁。因"反复左侧腰部疼痛不适6个月"收住入院,无肉眼血尿,疼痛时伴恶心,无呕吐。查体:左侧腰部无压痛,左肾区轻度叩痛。影像学检查:B超:左肾积水,左输尿管上段扩张,IVU:左输尿管上段梗阻,左肾积水,左侧尿路逆行造影示:左输尿管上段梗阻,阻段管腔内见多个条索状迂曲的充盈缺损(图1)。术前诊断:左输尿管上段梗阻,左肾积水,输尿管多发息肉?排除手术禁忌,行腹腔镜下左输尿管探查术。患者麻醉成功后,取右侧卧位,腰部作3个Trocar入路,建立人工

Objective To summarize the experiences of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery.Methods Methods Retrospectively analyzed 105 cases(from May 2009 to May 2011) of aortic aneurysm surgery with deep hypothermic circulatory arrest(DHCA).78 cases were male and 27 cases were female.The operation procedure included Bentall procedure and semi arch replacement in 6 cases,ascending aorta replacement and semi arch replacement in 5 cases,Bentall procedure and elephant trunk technique in 61 cases,ascending aorta replacement and elephant trunk technique in 33 cases.Combined operations included coronery artery bypass grafting(10 cases),mitral valve replacement or mitral valve repair(24 cases) and tricuspid valve repair(11 cases).Results Average cardiopulmonary bypass time was 81-374(178.6±41.5) min,average DHCA time was 8-36(23.2±10.1) min,average selective cerebral perfusion time was 8-46(30.4±12.4) min,nasopharynx temperature during DHCA was 15.5-23.5(19.5±1.7)℃,rectal temperature during DHCA was 18.0-25.6(20.6±1.6)℃.89 patients' hearts automaticly rebeated and 16 rebeated after defibrillation.5 cases died postoperatively.The complications included multiorgan failure for 3 cases,malignant arrhythmia for 1 case and sudden bleeding for 1 case.Conclusion The use of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery can get effective brain protection and reduce the postoperative nervous system complications with acceptable results.

<正>冠心病已成为危害人民生命的重要疾病,血管内皮损害是冠心病发生发展的关键因素[1]。麝香保心丸在我国的医疗实践中被广泛使用。本研究旨在观察麝香保心丸对冠心病患者血管内皮是否具有保护作用。

OBJECTIVE:To evaluate the value of dual source computed tomography coronary angiography (DSCT-CA) on detecting in-stent restenosis (> 50% luminal narrowing) in symptomatic patients referred for quantitative coronary angiography (QAC).METHODS:Fifty five patients (43 males) with chest pain after coronary stent implantation within 6 - 12 months were evaluated by DSCT-CA and QAC. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DSCT-CA were calculated using coronary angiography as gold standard.RESULTS:Eighty nine stents were implanted. In-stent restenosis was evidenced in 28 stents (31.5%) by QAC. The sensitivity, specificity PPV and NPV of DSCT-CA for the diagnosis of in-stent restenosis was 89%, 87%, 76% and 95%, respectively. Diagnostic efficiency was not affected by heart rate and the sensitivity was 0.94 vs. 0.82, the specificity 0.88 vs. 0.90, the PPV 0.76 vs. 0.75 and the NPV 0.97 vs. 0.93 (all P > 0.05) between patients with heart rate < 70 beats/min and patients with heart rate ≥ 70 beats/min. The sensitivity (84% vs. 100%), specificity (81% vs. 96%), PPV (70% vs. 90%) and NPV (91% vs. 100%) were similar between overlapping or bifurcations stents and single stents. The specificity (100% vs. 80% vs. 66%) and PPV (100% vs. 95% vs. 53%) were significantly higher in the groups with stents ≥ 3.50 mm, stents 3.00 mm than in stents ≤ 2.75 mm (both P < 0.05).CONCLUSION:Diagnostic efficiency of in-stent restenosis with DSCT-CA in the large diameter stent is better than in the small diameter stent and the diagnosis efficacy is not affected by heart rate and stent distribution.

目的探讨腹腔镜输尿管膀胱再植治疗医源性输尿下段狭窄的可行性及疗效。方法对20例医源性输尿管下段狭窄的患者施行腹腔镜下输尿管膀胱再植术,并评价治疗效果。结果 20例手术均获成功。手术耗时93～150min,平均130min/侧。术中出血20～150ml,平均75ml。术后5天拔引流管下地活动,无1例漏尿,1周后拔出尿管出院,平均住院时间9d。术后1个月拔除双J管,术后3～6个月膀胧造影显示I度双侧输尿管返流2例,无返流18例。随访3～16个月,B超、IVU和MRU复查患肾分泌功能改善,无吻合口狭窄,患肾积水明显减轻,其中中度肾积水7例,轻度肾积水者8例,无明显肾积水者5例。结论腹腔镜下输尿管膀胱再植治疗医源性输尿管下段狭窄是可行的,且具有创伤小、恢复快、疗效确切的优点,是一种安全、有效的微创治疗,有实用价值。

BACKGROUND:Myocardial perfusion tomographic imaging and magnetic resonance imaging were commonly used to evaluate myocardial reperfusion following stem cell transplantation for treatment of acute myocardial infarction (AMI). However,the repetitiveness of this method is poor,and has radioactivity. OBJECTIVE:To estimate the reperfusion of intravenous myocardial contrast echocardiography (IMCE) in patients with AMI using intravenously infused SonoVue before and after intracoronary autologous bone marrow mononuclear cells transplantation. METHODS:IMCE was performed in 24 AMI patients before and after intracoronary autologous bone marrow mononuclear cell transplantation. The maximal amplitude score (A),the mean ascending slope of the curve (β) and the product of A×β were measured,and compared with results from myocardial perfusion tomographic imaging. Myocardial reperfusion was assessed. RESULTS AND CONCLUSION:IMCE results exhibited that A,β and A×β were significantly increased following transplantation (P < 0.01). The changes in β value were maximal following vessel unobstruction,and change range of A value was increased following 6-month follow-up. These indicated that perfusion speed was accelerated immediately following vessel unobstruction. Myocardial perfusion defect was obviously improved at 6 months following transplantation. Myocardial nuclide intake was enhanced immediately and at lag phase in the infarct region at 6 months following transplantation,and the score of single photon emission computed tomography imaging was significantly diminished (P < 0.05). These indicated that results of IMCE are basically identical to that of myocardial perfusion tomographic imaging,and IMCE can noninvasively assess microcirculation perfusion of transplanted myocardial cells.

Objective To investigate surgical technique feasibility of laparoscopic retroperitoneal lymph node dissection(LRPLND) in the treatment of testicular tumor.Methods From April 2006 to September 2009,11 patients with primary testicular nonseminomatous germ cell tumors(NSGCT) received LRPLND at 1 week after orchiectomy.9 cases were on clinical stageⅠand 2 cases were on clinical stageⅡb.10 patients were right side,only one patient was left side.Results All the operations were successfully performed.The mean operating time was 280 min,the mean intraoperative blood loss war 100 ml(30-600) None of the patients required blood transfusion and no case had major injuries or complications.The mean dissectied lymph node number was 12.Mild chylous occuredin 1 patient,which was cured within 1 week by low-fat diet.The mean hospital stay was 9 days.No evidence of recurrence or distant metastasis was found during the follow-up of 6-48 months after the operation.Conclusions LRPLND is technically feasible,the morbidity and complication were significantly lower.Once the learning curve has been overcome,the operative time could decreased significantly.

<正>患者,男性,38岁。因性交无射精10年余就诊。1998年因左附睾结核钙化行左附睾切除。性交时无射精,伴有性高潮,无尿频、尿急和尿痛。查体:心肺无异常,双侧睾丸大小约15 ml,质地可,右侧附睾、输精管无结节、无串珠感,左侧输精管扪不清,肛检前列腺质韧、无结节感。直肠B超示左射精管钙化,右输精管远端局部钙化。CT示前列腺

<正>膀胱结石为泌尿系结石中常见疾病,直径在3.0cm以内的膀胱结石临床较常见,膀胱巨大结石属于罕见病例[1],青年膀胱巨大结石在临床更不多见,本院于2008～2009年收治青年膀胱巨大结石患者2例,现报道如下。1病例1

<正>本研究应用重组人脑钠肽(recombinant human brain natriuretic peptide,rhBNP)静脉注射治疗失代偿心力衰竭患者,并与硝酸甘油、多巴酚丁胺作比较,观察患者心肾功能及血流动力学的变化,以及对肾素-血管紧张素-醛固酮系统(RAAS)的影响,现报道如下。