儿童单纯乳房早发育是常见的内分泌疾病之一,中医称之为"男女童稚乳疬",本文以中医基础理论为基础,从阴阳失衡,肾气不足、冲任失调,阴虚火旺、郁而化火,脾失健运、痰湿内生几个方面,分析本病的病因病机,以及王志华教授用中药内服合并散结乳癖膏外敷治疗本病的经验,目的 是消除发育异常的乳腺腺体、改善乳房疼痛的症状,并附验案一则.

目的 分析儿童急性阑尾炎非手术治疗失败的危险因素,提高临床医师对该病的认识.方法 回顾性分析2013年1月—2018年12月我院儿科急性阑尾炎接受非手术治疗的158例患者资料,其中成功组110例,失败组48例.比较2组临床特征、实验室检查及腹部超声检查结果 ,采用Logistic回归分析儿童急性阑尾炎非手术治疗失败的危险因素.结果 成功组和失败组年龄、性别、腹痛时间、发热、呕吐、腹泻、腹胀、转移性右下腹痛及发病季节差异均无统计学意义(均P>0.05).实验室检查方面,2组患儿白细胞计数、中性粒细胞计数、淋巴细胞计数、C-反应蛋白比较差异无统计学意义(均P>0.05).腹部超声检查结果 显示,失败组阑尾粪石(31.3％vs.4.5％,χ2=21.555)和阑尾周围渗液(39.6％vs.12.7％,χ2=14.587)发生率高于成功组(P<0.01);2组患者阑尾最大直径、阑尾壁厚度、腹腔淋巴结肿大比例比较差异均无统计学意义(P>0.05).Logistic回归分析结果 发现阑尾粪石(OR=11.081,95％CI:3.567～34.421)、阑尾周围渗液(OR=5.196,95％CI:2.189～12.332)是儿童急性阑尾炎非手术治疗失败的危险因素.结论 阑尾粪石、阑尾周围渗液是儿童急性阑尾炎非手术治疗失败的危险因素,此类患者应引起临床医师重视,尽早采取手术治疗.

肉芽肿性小叶性乳腺炎是一种以乳腺小叶为中心的肉芽肿性病变.结合仝小林“脏腑风湿”理论,认为部分肉芽肿性乳腺炎是一类“乳房风湿病”,属脏腑风湿范畴;并从脏腑风湿的角度阐述部分肉芽肿性乳腺炎的病因病机、治疗原则等,提出风寒湿内侵是病因,产后体虚、寒湿内伏是病机,痰湿瘀互结是关键,化热溃破是进展.应以扶正祛邪为大法、分肿块期、脓肿期及溃后期三个不同阶段论治.为肉芽肿性乳腺炎提供新的辨证治疗思路.

肉芽肿性乳腺炎是一种育龄期妇女常见病,王志华教授采用中医辨证分期治疗,内治以风药为特色,外治运用洞式引流联合祛腐搔刮术,具有疮口小、痛苦少、愈后疤痕小的特点,能最大限度地保留乳房的功能和外形,疗效显著,优势明显,在临床上受到患者的一致认可,为临床辨治肉芽肿性乳腺炎提供了有益参考.

产后缺乳首见于《诸病源候论》,目前临床常见分型为气血亏虚证、肝郁气滞证、痰浊阻滞证.通过分析肾与元气、冲任、经血、津液、脾脏的关系,以及影响乳汁化生的因素,认为肾与乳汁的化生及分泌有密切关系,结合产后缺乳的临床表现,从肾精、肾气、肾阴、肾阳四个方面入手,探讨产后缺乳的辨证论治.产后缺乳患者的黄腻苔多因肾阴虚损、水湿郁结所致,应以益肾滋阴、健脾行气、利水通乳为治疗原则.

外吹乳痈相当于西医的哺乳期乳腺炎,是哺乳期发生于乳房部位的急性化脓性疾患,具有发病急、传变快、易成脓的特点,严重影响了哺乳期女性的生活质量.王志华教授认为外吹乳痈尤贵分期论治,辨证施治,综合运用中医外治法,局限病变范围,掌握合适手术时机,能够最大程度上保留乳汁,减轻疼痛程度,提高乳母生活质量.

目的 针对不同年龄阶段的儿童对其急性肠系膜淋巴结炎的疾病特点展开分析.方法 选取2015年10月～2016年9月诊断为"肠系膜淋巴结炎"的患儿112例为研究对象,以年龄分为3个阶段:婴幼儿10例、学龄前儿童27例、学龄儿童56例,对其疾病临床特点进行分析.结果 不同年龄段疾病儿童均会出现腹痛的表现,其中52例患儿(57％)的白细胞在正常范围,白细胞升高34例,以学龄儿童最为集中;其次白细胞低于正常的主要集中在婴幼儿.结论 对于儿童急性肠系膜淋巴结炎的患儿需要对不同的年龄段进行特点分析,而后根据年龄特点展开针对性的中西医结合治疗和相应的对症处理,可提升治疗效果.

目的:观察益气活血联合利水通络法治疗乳腺癌术后上肢淋巴水肿气虚血瘀型的疗效.方法:36例随机分为试验组和对照组各18例,试验组予中药汤剂内服联合膏贴外敷,对照组予综合消肿疗法治疗.结果:试验组疗效优于对照组(P＜0.05).结论:益气活血利水通络法治疗乳腺癌术后上肢淋巴水肿气虚血瘀型具有较好疗效.

傅山著有《青囊秘诀》,但鲜有人知,该书阐述了痈肿疮疡等疾病的理论,同时对20余种痈疽疮疡进行分析,形成理、法、方、药完备的外科诊疗体系.本文将从乳痈论入手,辨阴阳、别虚实,通过探讨子母生克辨治要法,重视固护胃气,以窥探傅氏在外科辨证论治之精妙.

肉芽肿性乳腺炎可归属于中医“乳痈”“乳漏”的范畴.其病程较长,未溃时表现为局部肿块、漫肿、皮色不变、皮温不高、疼痛等一派寒痰凝聚的症状;溃后则脓水淋漓,创口难敛,缠绵难愈,或愈后易复发.风药是指具有升发、疏散特性的一类药物,具有升、托、发、散、化、达、窜、通等作用.从风药的作用特点出发,结合风药用于中医外科疾病的理论依据、肉芽肿性乳腺炎的病因病机以及各期的临床表现,探讨风药在肉芽肿性乳腺炎内治方药中的应用,认为其具有温通经脉、透邪解毒、扶正祛邪的作用.

Objective To investigate the clinical features of acute pancreatitis (AP) in children of differem age.Methods From January 2010 to December 2015,pediatric inpatients with AP were searched by pediatric inpatient medical records retrieval system.According to age,patients were divided into three groups:infant and toddler group (age 0 years to three years),preschool group (age ＞three years to six years) and school-aged group (age ＞ six years to 16 years).The clinical features,etiology and laboratory findings of differem age groups were retrospectively analyzed.One-way analysis of variation or rank sum test was performed for measurement data analysis.Chi-square test or Fisher exact probability test was used for the count data analysis.Results A total of 88 pediatric patients (male 38,female 50) were enrolled,and the mean age was (8.8±4.4) years.Infant and toddler group,preschool group and schoobaged group were 16,14,58 cases,respectively.The average days of hospitalization of infant and toddler group,preschool group and school-aged group were (8.4±1.9),(9.4±2.6) and (7.5± 2.5) days,respectively,and the difference was statistically significant (F=3.649,P=0.030).About 93.2％ (82/88) pediatric patients had abdominal pain.The incidence rate of epigastric distention of school-aged group (34.5％,20/58) was higher than those of infant and toddler group (2/16) and preschool-aged group (1/14).The rate of nausea/vomiting of infant and toddler group was significantly higher than those of preschool group and school-aged group (12/16,4/14 and 46.6 ％ (27/58),respectively),and the differences were both statistically significant (x2 =6.250 and 6.805,both P＜0.05).Biliary pancreatitis was the main etiology of infant and toddler group and preschool group,and the incidence was 6/16 and 6/14,respectively.Whereas,there was a variety of etiologies in school-aged group.There were 20 cases (22.7％) of severe AP.The severe cases were more in the infant and toddler group and preschool group (7/16 and 6/14,respectively),and less in school-aged group (12.1％,7/58).There was no statistically significant difference among the three age groups in blood amylase level,lipase level,white blood cells count,blood glucose level,blood calcium level and blood urea nitrogen (all P＞0.05).The percentage of obese children of school-aged group was significantly higher than those of infant and toddler group and preschool group (31.0％,18/58;1/16 and 1/14,respectively),and the difference was statistically significant (x2 =6.689,P=0.035).In addition,the level of serum total cholesterol of school aged group was higher than that of infant and toddler group and preschool group ((5.1±0.9),(3.9±0.6) and (4.8±0.8) mmol/L,respectively),and the difference was statistically significant (F =13.855,P＜ 0.01).The positive rates of abdominal ultrasound of infant and toddler group,preschool group and school-aged group were 5/16,4/14 and 21.1％ (12/57),respectively,and there was no statistically significant difference (x2 =0.889,P 0.706).The positive rates of magnetic resonance cholangiopancreatography (MRCP) of infant and toddler group and school-aged group were 4/4 and 5/6,respectively,and which were both higher than those of pancreases computed tomography (CT) examination (4/14 and 51.2％,22/43) and those of abdominal ultrasound (5/16 and 21.1％,12/57),and the differences were significant (x2 =6.655 and 15.207,both P＜0.05).Conclusions Obese children is more in school-aged children with AP.Children of this age should pay more attention to life style.Nausea or vomiting symptom is more obvious in the infant and toddler children with AP and the condition is more severe.If children of this age with unexplainable vomiting,AP should be considered.Biliary factors are more common in the infant and toddler children with AP.When children are suspected with abnormal structure of pancreatic and biliary ductal system,MRCP should be conducted.

乳房部及乳晕部皆可病发乳瘘,目前临床对于乳晕部乳瘘的认识及治疗处于瓶颈期,临床方法多样,但无标准治疗手段.随着微创理念的不断深入,越来越多的治疗方法精益求精,洞式引流联合祛腐搔刮术,结合祖国传统医学与现代医学理念治疗乳瘘效果可观.

目的:观察复方黄柏液治疗下肢静脉性溃疡的临床疗效.方法:将84例下肢静脉性溃疡患者随机分为治疗组和对照组,治疗组43例患者在常规换药基础上采用复方黄柏液湿敷治疗,对照组41例患者在常规换药的基础上采用碘伏纱条湿敷治疗,同时两组联合中药汤剂内服,观察比较两组患者的临床疗效和治疗前后疮面分泌物细菌培养及白细胞变化情况.结果:治疗后两组患者临床疗效、疮面分泌物细菌培养情况比较差异具有统计学意义(P＜0.05),而治疗后白细胞变化情况比较差异无统计学意义(P＞0.05).结论:复方黄柏液具有燥湿收敛、清热解毒功效,对于溃疡面肉芽组织的生长及局部微环境的改善均具有明显作用,彰显了中医“偎脓长肉”的思想,可有效促进下肢静脉性溃疡愈合.

Abstact:Objective To explore the clinical characteristics of biliary pancreatitis in children.Methods The clinical data from 10 children with biliary pancreatitis from January 2011 to July 2015 were retrospectively analyzed.Result In 10 children (2 males and 8 females), the average age was 6.1?±?4.9 years old, and the average hospital stay was 8.4?±?3.8 d. There were 4 cases of gallstone, 4 cases of cholestasis, 2 cases of calculus of bile duct, 2 cases of choledochocyst and 1 case of pancreatic divisum. Abdominal pain was the main clinical manifestation in these 10 children. All of them had elevated serum amylase, with the maximum value of 106-922 U/L. Six cases had elevated lipase of 22-2000 U/L. Six cases had abnormal serum alanine aminotransferase. Two cases had hypokalemia. One case had hypoglycemia. Four cases had acid-base imbalance. Abdominal ultrasonography showed pancreatitis in 4 cases. CT showed pancreatitis in all children. All of the children were treated by fasting, lfuid infusion, maintaining water and electrolyte balance, inhibiting gastric acid by omeprazole and inhibiting pancreatic secretion by octreotide. Nine cases were improved by conservative treatment and discharged, and one case was transferred to surgery. Conclusion The incidence of biliary pancreatitis in children is low. The clinical manifestation is atypical. Pancreatic duct abnormalities are more common in young children, in whom the effect of conservative treatment is relatively good.

目的 观察蒲地蓝消炎口服液联合头孢地尼胶囊治疗哺乳期急性乳腺炎初期的疗效.方法 收集天津中医药大学第一附属医院2015年7月-9月确诊为哺乳期急性乳腺炎初期产妇80例,将其分为治疗组40例和对照组40例;治疗组采用蒲地蓝消炎口服液、头孢地尼胶囊联合手法按摩排乳;对照组采用头孢地尼胶囊联合手法按摩排乳,比较两组治疗疗效.结果 治疗组治愈率为100.0％,对照组治愈率为77.5％,治疗组明显优于对照组,差异有统计学意义(P＜0.05);治疗组与对照组的脓肿形成率、回乳率以及肿痛消除时间的比较均有差异,且差异有统计学意义(P＜0.05).结论 蒲地蓝消炎口服液联合头孢地尼胶囊治疗哺乳期急性乳腺炎初期疗效显著,是临床推广和应用的有效方案.

目的:观察中药配合手术治疗乳腺纤维瘤的复发率.方法:将84例乳腺纤维瘤患者随机分成两组各42例.治疗组采用手术切除病灶合围术期辨证施治服用中药治疗,对照组采用手术切除治疗,两组患者均在术后半年、1年、2年、3年进行电话随访复发情况.结果:总复发率治疗组为7.14％,对照组为52.38％,两组比较,差异有统计学意义(P＜0.05).结论:中药配合手术治疗乳腺纤维瘤,疗效确切,不易复发,值得推广.

目的:观察止痛消痈汤治疗乳痈的临床疗效.方法:采用止痛消痈汤加减治疗82例.结果:82例患者,3～5剂治愈61例,1周左右治愈15例,10 ～20剂治愈6例.结论:用止痛消痈汤治疗乳痈,效果较显著.

目的 观察小切口配合中药内服外敷治疗哺乳期急性化脓性乳腺炎的疗效.方法 对40例哺乳期急性化脓性乳腺炎患者,采用王志华主任小切口切开引流术配合中药内服外敷,乳房按摩等治疗方法,观察其疗效.结果 治疗7～14 d40例患者全身症状消失,伤口甲级愈合,局部无红肿疼痛、脓肿及积液,总有效率100％.结论 小切口配合中药内服外敷治疗急性化脓性哺乳期乳腺炎具有切口小、疗效好、费用低,损伤乳络少等作用,能保留乳汁,无需回乳,不影响哺乳等.

Objective Analyse and report the diagnosis and treatment process of vulvar epithelioid sarcoma, it provides a basis for rare case in clinic. [Methods] Through the analysis of the patient's il ness, treatment, and pathology examination, and the effect of the treatment of prognosis of vulvar epithelioid sarcoma of the summary, truly record the occurrence of vulvar epithelioid sarcoma development, treatment and prognosis. [Results] The intraoperative pathologic examination in patients diagnosed the vulvar epithelioid sarcoma, and it used the removal of expanding. Now the patient is not recurred. [Conclusion] Vulvar epithelioid sarcoma is clinical y rare, needs combined with immunohistochemical examination at the time of diagnosis, removal of local expansion is the effective method to treat, it is not exactly curative effect of chemotherapy and radiotherapy.