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关键词： 原发性醛固酮增多症   肾上腺增生   外侧支   右侧肾上腺   肾上腺占位   右肾上腺静脉   超声造影   经导管  

摘要： 患者女,发现右肾上腺占位3个月入院。患者8年前常规测量发现血压升高(150+/80+mmHg)(1 mmHg=0.133 kPa),诊断为"高血压病",2年前开始出现口干多饮多尿、夜尿增多症状。3个月前因肌肉无力急诊就诊,血钾1.78 mmol/L,醛固酮肾素比值(aldosterone-renin ratio,ARR)36.12。肾上腺CT:右侧肾上腺外侧支旁偏囊性结节灶,肾上腺来源可能性大,腺瘤考虑,左侧肾上腺增生(图1~3),诊断为"原发性醛固酮增多症"。

摘要： Background & Aims limited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)-positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long-term prospective study on 427 HCV-positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs). Methods Patients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow-up of 65.2 months according to Baveno VI recommendations. Results About 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients (p < .0001). No patients belonging to Group 1 without baseline EV developed EV at follow-up endoscopy compared with 6.5% in Group 2 patients (p = .02);69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow-up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p = .001). Improvement in Baveno VI status was observed in 118/335 (35.2%, p < .0001) of Group 2 patients and among those without pre-therapy EV, none developed EV throughout the follow-up. Conclusions HCV-positive cirrhotic patients cured by DAAs showing baseline favourable Baveno VI status and no worsening during follow-up can safely avoid endoscopic screening and surveillance. Patients having unfavourable Baveno VI status without baseline EV who improve their status may suspend further endoscopic surveillance.

关键词： Cortisol   Aldosterone   Hypercortisolism   Cushing's syndrome   Adrenal cortex  

摘要： Objective Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing's syndrome. Current guidelines recommend bilateral adrenalectomy for PBMAH, but several studies showed clinical effectiveness of unilateral adrenalectomy despite bilateral disease in selected patients. Our aim was to evaluate the gain of information which can be obtained through adrenal venous sampling (AVS) based cortisol lateralization ratios for guidance of unilateral adrenalectomy. Design We performed a retrospective analysis of 16 patients with PBMAH and clinical overt cortisol secretion in three centers Methods Selectivity of adrenal vein sampling during AVS was defined as a gradient of cortisol or a reference adrenal hormone >= 2.0 between adrenal and peripheral vein. Lateralization was assumed if the dominant to non-dominant ratio of cortisol to reference hormone was >= 4.0. Results AVS was technically successful in all patients based on absolute cortisol levels and in 13 of 16 patients (81%) based on reference hormone levels. Lateralization was documented in 8 of 16 patients. In patients with lateralization, in 5 of 8 cases this occurred toward morphologically larger adrenals, while in 3 patients lateralization was present in bilaterally identical adrenals. The combined volume of adrenals correlated positively with urinary free cortisol, suggesting that adrenal size is the dominant determinant of cortisol secretion. Conclusions In this study the gain of information through AVS for unilateral adrenalectomy was limited in patients with PBMAH and marked adrenal asymmetry.

关键词： 经尿道等离子切除术   良性前列腺增生   前列腺结石   治疗价值  

摘要： 探讨经尿道等离子切除术治疗良性前列腺增生合并前列腺结石的临床价值。方法:选取医院2019年1月至2021年12月收治的90例良性前列腺增生合并前列腺结石患者,随机将其分为甲乙组,分别给予传统开放手术与经尿道等离子切除术治疗,比较两组患者的治疗结局。结果:乙组患者的手术时间、术后冲洗时间、留置导尿管时间、住院时间和术中出血量各项指标明显优于甲组(P<0.05);乙组患者的治疗总有效率为97.77%,其显著高于甲组的77.77%(P<0.05);甲组和乙组患者的并发症发生率分别为24.44%和4.44%,乙组显著低于甲组(P<0.05);乙组患者的生活质量评分明显高于甲组(P<0.05)。结论:经尿道等离子切除术可有效治疗良性前列腺增生合并前列腺结石患者,能够改善各项手术指标,又能减少术后并发症,加快其预后的恢复,在临床上有值得广泛应用的价值。

关键词： 罗哌卡因   腰-硬联合麻醉   良性前列腺增生   麻醉阻滞  

摘要： 目的探讨60岁以上良性前列腺增生患者罗哌卡因蛛网膜下腔阻滞麻醉联合硬膜外阻滞麻醉(腰-硬联合麻醉)的效果。方法选取60岁以上男性良性前列腺增生患者160例,按随机数字表法分为2组:对照组80例采用罗哌卡因硬膜外麻醉,观察组80例采用罗哌卡因腰-硬联合麻醉。比较2组手术时间、手术历时、麻醉效果(感觉阻滞、运动阻滞起效时间,感觉阻滞、运动阻滞恢复时间)、不同时间点(给药前、给药后5 min、10 min、20 min、2 h)平均血压(MAP)与心率(HR)、给药后不良反应发生情况。结果2组手术时间比较,差异无统计学意义(P>0.05)。与对照组比较,观察组手术历时显著缩短,感觉阻滞起效时间、运动阻滞起效时间显著延长,感觉阻滞恢复时间、运动阻滞恢复时间显著缩短,观察组给药后5 min、10 min、20 min MAP、HR及总不良反应发生率均显著降低,差异有统计学意义(均P<0.05)。结论罗哌卡因腰-硬联合麻醉应用于60岁以上良性前列腺增生患者麻醉阻滞效果显著,可有效缩短手术历时、患者恢复时间,且安全性高。

关键词： 多原发癌   舌癌   食管癌   乳腺癌  

摘要： 通过报道舌癌、食管癌、乳腺癌多原发癌一例来了解多原发癌的概念、发病因素、基本治疗思路及预后等。方法:对1例舌癌、食管癌、乳腺癌多原发癌的病例资料及文献进行回顾性分析。结果:该患者既往有乳腺癌、食管癌病史,并行综合治疗。右舌部肿物考虑原发肿瘤,予手术切除,术后病理报告为高分化鳞状细胞癌。结论:舌癌、食管癌、乳腺癌多原发恶性肿瘤的病例罕有报道,其相关诊断和治疗与各原发癌基本一样。多原发恶性肿瘤的预后取决于各原发癌本身的恶性程度及患者的机体情况。

关键词： 老年良性前列腺增生   健康行为   自我护理能力   生活质量  

摘要： 目的探讨老年良性前列腺增生患者健康行为、自我护理能力与生活质量的相关性。方法采用便利抽样法选取2019年1月至2020年2月山东国欣颐养集团新汶中心医院收治的老年良性前列腺增生患者156例为研究对象。采取调查问卷的形式对入选患者的健康行为、自我护理能力及生活质量进行调查,并分析三者之间的相关性。结果老年良性前列腺增生患者健康行为总均分为(58.46±12.04)分,自我护理能力总均分为(48.81±7.45)分,生活质量总均分为(98.41±15.43)分;老年良性前列腺增生患者的健康行为与自我护理能力呈正相关(P<0.01);健康行为与生活质量呈正相关(P<0.01);自我护理能力与生活质量呈正相关(P<0.01)。结论老年良性前列腺增生患者的自我护理能力不仅对其生活质量产生影响,同时还可以通过健康行为对其生活质量产生间接影响。

关键词： 乳腺   良恶性肿瘤   彩色多普勒高频超声   鉴别诊断  

摘要： 乳腺良恶性肿瘤鉴别诊断中应用彩超的诊断价值。方法:抽取我院乳腺肿瘤患者50例,行彩色多普勒高频超声检查,参考病理诊断结果,分析彩色多普勒高频超声诊断情况。结果:良、恶性诊出率彩超和病理诊断相近(P>0.05);良性肿瘤Vmax、RI比恶性肿瘤低(P<0.05); 37例良性患者彩超血流分级0~III级分别为21例,11例,4例,0例;13例恶性肿瘤彩超血流分级0~III级分别为0例,2例,4例,7例。结论:乳腺肿瘤患者可以通过彩超判断患者肿瘤良恶性,通过彩超查看患者肿瘤血流情况,尽早对患者病情进行诊断,促进乳腺肿瘤患者早治疗,从而缓解患者病情。

关键词： 良性前列腺增生症   中西医结合   多学科   治疗   指南  

摘要： 良性前列腺增生症(Benign prostatic hyperplasia,BPH)是引起中老年男性排尿障碍的常见泌尿男科疾病[1].研究表明,60岁男性BPH发病率大于50%,80岁时达80%以上[2].BPH主要表现为组织学上的前列腺间质和腺体成分的增生、解剖学上的前列腺增大、尿动力学上的膀胱出口梗阻和下尿路症状(Lower urinary tract symptoms,LUTS).中医认为本病属于"精癃"、"癃闭"、"淋证"等范畴[3].