目的:探讨腹壁子宫内膜异位症(AWE)的临床特征、分型、治疗及预后.方法:回顾分析2010年1月1日至2019年12月31日就诊于山东大学附属省立医院的241例AWE患者的临床资料.并按病灶浸润深浅分为皮下型、鞘膜型及腹膜型,按是否合并盆腔子宫内膜异位症分为单纯型及复杂型,按病灶个数分为单发型及多发型,比较各组的临床特点.结果:241例AWE患者的平均发病年龄(30.6±4.6)岁.98.8％(238例)既往有剖宫产手术史.93.4％患者就诊时可触及明显腹壁包块,94.6％患者因刀口处或周围疼痛就诊,其中82.9％疼痛与月经周期有明显相关性.208例(86.7％)AWE患者术前做了超声检查,均提示明显包块.病灶大小与病程、手术时间、术中出血量、是否放置补片、单纯型和复杂型、皮下型鞘膜型和腹膜型及住院天数存在正相关,差异有统计学意义(P<0.05).皮下型、鞘膜型和腹膜型的血清CA125水平相比,差异有统计学意义(P<0.05);单纯型和复杂型血清CA125水平相比,差异有统计学意义(P<0.05).皮下型、鞘膜型和腹膜型三型的病灶大小及术中出血量相比,差异有统计学意义(P<0.05);病灶直径越大,侵及深度越深,差异有统计学意义(P<0.05).AWE患者的复发率8.8％,病灶个数为AWE复发的独立危险因素(P=0.033),与单发型相比,多发型AWE患者的复发风险远高于单发型(HR=3.152,95％CI为1.095～9.078).术后药物治疗的26例患者均未复发.结论:AWE应做到早发现、早诊断、早治疗,一旦确诊应立即手术治疗.超声检查和血清CA125对其诊断和分型有意义.多发型AWE术后易复发.术后药物治疗对预防复发有价值.

Objective To analyze and summarize the clinical effects and experiences of orthotopic cardiac transplantation for end-stage heart disease.Methods Twenty-five patients underwent orthotopic cardiac transplantation from March 2003 to October 2012 in Qianfoshan Hospital affiliated to Shandong University.The primary diseases included dialated cardiomyopathy in 18 patients,hypertrophic cardiomyopathy in 4,and ischemic heart disease in 3(one also accompanied by abdominal aorta aneurysm).Conventional Standford orthotopic cardiac transplantation was performed in 1 patient and double cavity vein anastomosis method was performed in 24 patients.Seven patients with moderate or severe pulmonary hypertension received nitric oxide inhalation and iloprost intravenous pumping to treat pulmonary arterial hypertension.Immunosuppressive therapy included cyclosporine A,corticosteroid,and mycophenolate mofetile.Six patients received the Tac monoclonal antibody induction therapy during operation,while 14 received the basiliximab monoclonal antibody during anesthesia induction and on postoperative day 4.According to the plasma peak and vale concentration,the dose of cyclosporine A was regulated in time.Results The succesful rate of the operation was 96%(24/25),with 1 patient died of intestinal bleeding in 25 h after operation.The rest 24 patients were followed up(58±37) months(1-116 months).The 1-,3-,5-year survival rate was 87%,82.3%,72.7%,respectively.Acute rejection occurred in 2 cases at early stage and in 4 at late stage after operation,all recovered after cortieasteriod impulse therapy.Renal failure occurred in 2 cases at early stage(renal function recovery after hemodialysis) and in 4 at late stage after operation.Three patients had lung aspergillus infection(2 of them were cured).Two patients died from transplant dysfunction in 14 months and 41 months after operation.One patient was diagnosed as having endometrial neoplasm after 17 months and was cured by hysterectomy.Conclusion Orthotopic cardiac transplantation is a reliable choice for end-stage heart disease.Strict indication,careful management,and regulatory immunosuppressive therapy of perioperative period are required.Moreover,we should pay attention to observation and treatment of acute injection and infection.

目的 探讨人类白细胞抗原(HLA)配型对移植肾失功患者群体反应性抗体(PRA)产生的影响. 方法对24例术前PRA阴性的初次肾移植病例行供受者HLA分型,移植.肾失功后检测受者PRA并确定抗体特异性.PRA定性、定量及确定抗体特异性用莱姆德混合抗原板(LATM)及莱姆德抗原板1240(LAT1240)检测.HLAI类及Ⅱ类抗原分型用顺序特异引物聚合酶链反应(PCR-SSP)技术.观察PRA产生情况,比较致敏与非致敏病例的HLA配型情况,并分析HLA错配与PRA产生的关系.结果 24例中PRA阳性17例,阴性7例.17例致敏患者中Ⅰ类抗体阳性8例,Ⅱ类抗体阳性15例,Ⅰ类及Ⅱ类抗体同时阳性6例.A1(3例)、A24(2例)、DR7(6例)、DR9(4例)、DRl2(3例)及DRl3(4例)抗体多见,供者特异性抗体(DSA)中A1(2例)、DR7(4例)及DR9(3例)多见.按6抗原配型标准比较Ⅰ类抗原错配数,Ⅰ类抗体阳性组(8例)与阴性组(16例)问比较差异无统计学意义(P＞0.05),按交叉反应组(CREG)配型标准阳性组错配数多于阴性组(P＜0.01);比较Ⅱ类抗原错配数,Ⅱ类抗体阳性组(15例)错配数多于阴性组(9例)(按6抗原配型标准P＜0.05,按CREG配型标准P＜0.01).供者HLA频率及错配频率最高的A2及A30未发现相应抗体产生,供者A1-受者A2、DR7及DR9错配易导致DSA产生.结论 HLA错配是移植肾失功患者致敏的重要原因.供者抗原出现频率及错配频率与PRA及DSA出现频率不完全一致,某些抗原错配更易导致PRA及DSA产生.初次肾移植良好的HLA配型可减少等待再次肾移植患者的致敏发生率.

Objective:To investigate and compare the efficacies between submucosal tetrahydropyranyl injection method during surgery and early instillation of tetrahydropyranyl method in preventing recurrence of superficial bladder tumor after partial cystectomy.Methods:73 patients were randomly divided into 2 groups,A and B.The patients in group A received early instillation of 20 mg tetrahydropyranyl within 6 hours and on the 7th day postoperatively.20 mg tetrahydropyranyl was injected submucously during operation in group B.Conventional regular instillation was performed in both groups from the 2nd week after surgery,20 mg tetrahydropyranyl was instilled once a week for 8 times,and then once a month to one year after the operation.The characters of postoperative hematuria were observed,and any complications of regular instillation were also recorded.The cistoscope was used in regular follow-up.Results:All the patients were followed up for 3 years,and the tumor non recurrence in 1st,2nd and 3rd year after surgery in group A were 85.7%,80% and 77.1% respectively,in group B 92.1%,81.6% and 76.3% respectively,and there is no significant difference between the two groups in this regard(P0.05)Postoperative hematuria lasted a mean of(1.7±0.9)days in group A and(6.2±1.5)days in group B,the difference was statistically significant(P0.001)No obvious systematic complications were observed during the study,although 21 patients showed lower urinary tract symptoms,these regional complications were controllable and reversible,and none of the patients withdrew the study.Conclusions:Both submucosal injection method during surgery and early instillation method with pirarubicin demonstrated effective in decreasing superficial bladder tumor recurrence,but no difference was found between these two methods.Early instillation method seemed to be of more toleration for shorter recovery period of postoperative hematuria.

在对1例低位骶前畸胎瘤患者实施肿瘤切除术中并发骶前大出血,经结扎双侧髂内动脉、阻断腹主动脉、缝扎、图钉按压、双极电凝等处理,均未能止血,改用骶前留置纱布垫填塞压迫后止血。认为妇科手术中并发骶前大出血系由骶前静脉丛或骶椎椎体静脉损伤所致,止血困难,纱布垫填塞压迫效果较好。

>2003年3月至2007年10月我院共收治原发性局限性膀胱淀粉样变患者3例,现报告如下。例1.男,53岁。无痛性全程肉眼血尿5个月,B超检查发现膀胱占位于2003年3月31日入院。患者无尿频、尿急、尿痛。查体未见异常发现。B超示膀胱左侧壁增厚,不规则.范围3.1 cm×0.8 cm,

目的提高临床对阴囊Paget病的认识。方法报告2例阴囊Paget病的患者的临床资料。患者临床初期可表现为红色皮疹,以后表现为乳头状增生与溃烂交替出现,表面附有恶臭分泌物。均经病理检查确诊;手术切除病灶。结果2例患者术后痊愈出院。结论阴囊Paget病极易误诊为阴囊皮肤慢性湿疹或炎症,须依靠病理检查确诊;手术切除病灶有一定疗效。

女性生殖器结核是由结核分枝杆菌侵入机体后引起的女性生殖器炎症,是全身结核的一个表现,常继发于自身其他部位结核.近年来,女性生殖器结核的发病呈上升趋势,尤其在发展中国家.患者往往缺乏明显的症状、体征,为避免临床误诊、漏诊,一般可根据以下几个方面作出诊断.

OBJECTIVE:To determine the best approach to resecting the tumors in paranasopharyngeal space and skull base.METHOD:Through a Weber-Ferguson-Longmire incision,the whole maxilla was freed from bony connections and swung laterally while remaining attached to the masseter muscle and the cheek flap. Then the skull base and paranasopharyngeal space was exposed. So the tumor could be resected completely. Two cases of tumor in paranasopharyngeal space, 1 case of tumor in skull base, by the maxillary swing approach, the tumor was resected under sight. The fat of check was used to pack the space.RESULT:One case was vascular smooth muscle tumor and 1 case was adenoid cystic carcinoma in paranasopharyngeal space, 1 case was chordoma in skull base. The last case received post-operation radiotherapy. All the cases healed with no severe dentofacial malformation and dysfunction. In the follow up period, no one recurred postoperatively.CONCLUSION:The maxillary swing approach to resect the tumor in the skull base and the paranasopharyngeal can expose better. The operation is safe with little damage.