Objective To investigate the measurement of fractional exhaled nitric oxide ( FeNO) in elderly patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods FeNO test was applied for 42 elderly patients with ACOS before treatment. Another 42 patients with chronic obstructive pulmonary disease ( COPD) , 35 patients with asthma and 42 patients without respiratory diseases were taken as control groups. Results (1) Before treatment, the level of FeNO in the ACOS group was (48. 6 ± 13. 9) ppb, which was higher than in the non-respiratory disease group [(21. 5 ± 11. 8)ppb] and the COPD group [(34. 7 ± 13. 4)ppb] (P<0. 01, respectively), but lower than in the asthma group [(61. 5 ± 15. 1)ppb] (P<0. 01). (2) Taking 27 ppb as cut-off value of FeNO, the increased rate of FeNO (≥27 ppb) in the ACOS group (83. 3%) was significantly higher than that in the COPD group (52. 4%) and the non-respiratory disease group (21. 4%) (P<0. 01, respectively), while it had no significant difference with the asthma group ( 88. 6%) ( P>0. 05 ) . Conclusion FeNO is signifi-cantly higher in elderly ACOS patients, and its determination has a good effect to assess airway inflammation in elder-ly patients.

目的提高对非流行地区肝泡状棘球蚴病的认识。方法 对5例来自于非流行地区的贵州某县肝泡状棘球蚴病患者的临床资料进行回顾性分析。结果 5例患者均来自贵州省某县,当地此前未出现过类似病例。所有患者均无食用生肉史,但有犬类接触史。病程20 d至4个月。主要表现为右上腹胀痛5例,乏力4例,发热2例。包虫IgG抗体阳性3例。B超、CT等影像学检查大多有其特征性表现。病灶均位于肝右叶,大小8 cm×4 cm~12 cm×7 cm。5例患者均采取手术治疗,切除病灶,术后病理确诊。术后常规服用阿苯达唑半年以上。随访5~20个月,未见复发。结论 泡状棘球蚴病较为少见,但非流行地区也要重视该病的散发出现。B超、CT检查及包虫IgG抗体检测有一定参考价值。

OBJECTIVE:To explore the curative effect of malignant peritoneal mesothelioma (MPM) with intraperitoneal combination chemotherapy. METHODS: Nineteen patients with MPM were treated with a combination chemotherapy protocol consisting of adriamycin, cisplatin and mitomycin through injection of peritoneal cavity once a week. Every patient was treated 3-4 times.RESULTS: The short-term therapeutic efficacy was CR 52.6% (10/19),PR 31.6% (6/19),NC 15.8% (3/19), respectively. The response rate in the chemotherapy group (84.2%) was significant higher than that in the control group (41.7%), χ2=6.091 87,P0.025.CONCLUSIONS: The short-term therapeutic efficacy is significant in the treatment of MPM with intraperitoneal combination chemotherapy. It may be one of the effective therapeutic methods for MPM.

目的:探讨应用异丙酚作镇静麻醉辅助经皮肝穿刺射频消融(PRFA)治疗肝脏肿瘤的可行性,评价其效果和安全性.方法:将27例行PRFA治疗的肝癌病人辅以异丙酚静脉麻醉,记录患者体温、脉搏、呼吸、血压、氧饱和度、治疗时间及不良反应等.以25例未用异丙酚的PRFA患者作为对照组.结果:本组治疗中与治疗前比较,体温升高,脉搏及呼吸频率在治疗5 min时最快(P＜0.01),其余时段虽有增快但无统计学意义;收缩压与舒张压在治疗5 min时升高,其余时段降低,无统计学意义;血氧饱和度在静注异丙酚5、25 min时呈下降趋势(P＜0.01).异丙酚组患者的疼痛、大汗及恶心/呕吐显著低于对照组(P＜0.01～＜0.05),未发生明显不良反应.结论:应用异丙酚麻醉辅助PRFA,可明显减轻病人的痛苦,提高PRFA治疗的依从性和彻底性.

Objective To study the clinical value of minilaproscopy(5 mm in diameter) in diagnosing complicated ascites diseases.Methods 50 patients with ascites of unknown causes were randomly divided into minilaparoscopy group and conventional laparoscopy group,25 patients in each;minilaparoscopy and conventional laparoscopy(10 mm in diameter) were made respectively,and the examination results,confirmed diagnosis rate and adverse reaction were compared between the two groups.Results Accurate diagnosis was gained in 49 cases out of the 50:32 cases with tuberculous peritonitis,11 cases with malignant peritoneal mesothelioma,5 with peritoneum metastatic adenocarcinoma and 1 with signet-ring cell carcinoma;the time for minilaparoscopy was significantly shorter than that for conventional laparoscopy(28±6 min and 36±9 min respectively,P>0.01),the confirmed diagnosis rate in both groups showed no significant difference(96% and 100% respectively,P>0.05);No severe complications occurred in both groups.Conclusions The performance of minilaparoscopy is easier than that of conventional laparoscopy but with the same effect,causes smaller injury and less suffering in patients.

目的分析亚热带西南战区战伤救治护理特点,以提高战时护理配合能力.方法对我院"自卫还击战"和"两山作战"2 894份战伤病历进行回顾性分析.结果危重伤员多,自救伤员少;分类后送的多,滞留伤员少;护理操作多,文书书写少;专科处置多,辅助检查少;一、二线医院伤员多,当天到达总医院的伤员少.结论 (1)西南战区地理环境条件恶劣,应提高空运救护能力;(2)规范野战护理管理,统一野战护理预案及检查标准;(3)加强和平时期医院的野战演练,以迎接未来战争的挑战.

Objective: To evaluate the efficacy of cluster electrode radiofrequency ablation (RFA) to treat primary liver carcinoma. Methods: 47 patients with 53 primary liver tumors confirmed histologically were treated with RF-2000 TMRFA under ultrasound or CT guidance. The blood supply and coagulation necrosis in the treated tumors were evaluated with ultrasound and CT. Results: Blood supply of tumors was disappeared in 65.3% (32/49) and compete coagulation necrosis of tumors was seen in 66.0% (35/53) after RFA. The rate of complete blood supply extinction was 100% in the 20 tumors 3?cm in diameter (another 4?tumors without blood supply before RFA), and the rate of completely concreted necrosis of the 24 tumors (3?cm) was 100%. Blood supply was completely disappeared in 81.8% (9/11) tumors and complete coagulation necrosis was observed in 72.7% (8/11) tumors of 3～5?cm. However, the rate of complete blood supply extinction and coagulation necrosis was significantly lower in the tumors 5?cm. The patients with tumor 5?cm had longer survival time. Conclusion: RFA is minimally invasive, safe and effective for primary liver carcinoma. The smaller the tumor is, the more effective the therapeutic efficacy is.

经皮集束电极射频消融(radiofrequency abla-tion,RFA)治疗直径小于5 cm的中小肝癌已取得了满意的近期疗效[1,2],但对大肝癌则无明确治疗作用.

目的:评价诊断性腹腔镜的检查方法、效果及安全性,提高腹部疑难疾病的早期诊断率.方法:回顾分析58例腹部疑难疾病患者的腹腔镜检查情况,其中腹水原因待查35例,腹水+腹部包块23例.结果:58例患者中诊断为结核性腹膜炎31例,恶性腹膜间皮瘤23例,腹膜转移癌2例,盆腔结核及慢性盆腔炎各1例.不同疾病在腹腔镜下有不同表现.操作时间25～70 min,平均38 min.并发症为活检处出血4例,其中3例为自限性出血,1例经局部喷洒凝血酶后停止,术后伤口漏水5例.对腹腔镜下有肯定判断的12例患者同时进行治疗.结论:腹腔镜检查具有安全、简便、微创、痛苦小、确诊率高等优点.诊断性腹腔镜值得进一步推广应用.

我科自 1995 年开展诊断性腹腔镜技术,取得了较好效果,现从多方面对该技术进行评价,以便总结经验、提高确诊率、减少并发症.

目的探讨经皮集束电极射频消融(radiofrequency ablation,RFA)对小肝癌(直径≤3cm)的治疗效果.方法利用RF-2000TM肿瘤射频治疗系统,在B超引导下对21例小肝癌患者24个肿块进行经皮肝穿刺射频热凝治疗,并用B超及CT检查以了解RFA治疗效果,随访观察其复发和生存情况.结果RFA治疗后100%(20/20)的肿块血供消失(另4个治疗前即无血供),且24个肿块呈完全凝固性坏死(100%).随访6月～3年,21例中存活19例,半年生存率100%.存活的19例中,已有5例生存半年,4例生存1年,6例生存2年,4例生存3年.结论集束电极RFA治疗小肝癌创伤小,安全,疗效可靠.

我院于1999年6月～2003年1月采用经皮射频毁损治疗法(PRFA)治疗肝癌67例,取得较好疗效.

目的:探讨超声引导经皮集束电极射频消融(RFA)治疗中小肝癌(直径≤5cm)的疗效.方法:利用RF-2000品肿癌射频治疗系统,在B超引导下对29例中小肝癌患者34个肿块进行经皮肝穿刺射频热凝冶疗,并用B超及CT检查以了解RFA治疗效果,随访观察其复发和生存情况.结果:RFA治疗后93.3%(28/30)的肿块血供消失(另4个直径≤3 cm的肿块治疗前即无血供),且94.1%(32/34)的肿块呈完全凝固性坏死.对有血供的2个肿块再次进行了 RFA治疗.随防6月～3年,29例中现存活25例,半年生存率100%.存活的25例中,已有6例生存半年,7例生存1年,7例生存2年,5例生存3年.结论:集束电极RFA治疗中小肝癌创伤小,安全,疗效可靠.

根据内科专科护理特点,为探索适应内科疾病的整体护理方法,我们采取有针对性地护理管理举措,取得一定成效.

Objective To evaluate the effects of diagnostic laparoscopy on hepatic and renal function in patients with complicated abdominal diseases. Methods The hepatic and renal functions of 58 patients were analyzed before and after laparoscopy.Of all the patients,35 were with unknown origin ascites and 23 with ascites and celiac masses. Results Out of the 58patients,31 were diagnosed to be tuberculous peritonitis,23 were malignant peritoneal mesothelioma,2 were peritoneum metastatic carcinoma,1 was tuberculous pelviperltonitis and 1 was chronic pelviperitonitis.All the patients showed normal hepatic and renal function before laparoscopy.24 hours after laparoscopy, ALT was slightly increased in only 4 patients(40-60U/L) ,Tbil, AST,GGT,BUN,Cr in all the 58 patients while ALT in 54 patients were normal; 48 hours after laparoscopy, all the parameters turned to be normal. The average values of all the parameters were not significantly changed at 24 and 48 hours after laparoscopy compared with that before laparoscopy(P 0.05}. Conclusion Diagnostic laparoscopy has no obvious effect on hepatic and renal function of patients with complicated abdominal diseases.

目的:探讨经皮射频消融(PRFA)对肝脏恶性肿瘤的治疗效果.方法:利用RF-2000TM肿瘤射频治疗系统,在B超或CT引导下对55例肝恶性肿瘤患者73个肿块进行经皮肝穿刺射频热凝治疗,并用B超及CT检查以了解PRFA治疗效果.结果:PRFA治疗后60.9%(42/69)的肿块血供消失,61.6%(45/73)的肿块呈完全凝固性坏死.其中直径小于3cm中的20个肿块(另4个治疗前即无血供)全部血供消失(100%),24个肿块呈完全凝固性坏死(100%);直径为3～5cm的18个肿块中16个血供消失(88.9%),14个完全凝固性坏死(77.8%);而直径大于5 cm的肿瘤则治疗后肿块血供完全消失及完全凝固性坏死率均显著降低.肿瘤直径小于5 cm的患者生存期较长.结论:集束电极PRFA治疗肝脏恶性肿瘤创伤小,安全,疗效可靠.肿瘤越小治疗效果越好.

Objective To evaluate the therapeutic efficacy and safety of pe rcutaneous clust er electrode radiofrequency ablation(RFA)to treat hepatic cavernous hemangioma o f diameter5cm.Methods 7 patients with 9 lesions of hepatic ca vernous hemangio ma confirmed histologically were treated with RF-2000 TM RFA under ultraso u nd or CT guidance.The blood supply in the treated lesions was evaluated with col or ultrasound. Results Every patient was treated one time .All had no complica tion of bleeding .Blood supply was disappeared in 6 lesions and vanished approxi mately in 2 lesions within 1 months.Another one that had much blood supply was t reated again with RFA,and then the blood supply disappeared.All lesions were red uced to 50% in volume and no one relapsed during the subsequent following up of 6-12 months.Conclusion RFA is minimally invasive,safe and effe ctive for small hepatic cavernous hemangioma but the clinical value should be st udied further.

随着人口流动性增大等原因,结核性腹膜炎的发病率有上升趋势.为此,我们将结核性腹膜炎15例的特点进行分析. 1 临床资料 1.1 一般情况 15例均为男性;年龄19～28岁,平均20岁.病程15 d～2个月,平均24d.均为初次发病.有结核中毒症状6例,以腹水为主15例,腹胀11例,腹痛9例,发热8例,腹部包块2例.

病例 男,70岁.因剑突下及肝区剧痛半天入院.疼痛呈持续绞窄性痛,向后背放射,不能忍受,不能平卧.