目的:分析经后腹腔镜肾上腺囊肿去顶减压术的疗效,安全性和临床价值。方法:我院2004年12月至2007年12月6例经后腹腔镜肾上腺囊肿去顶减压临床资料进行回顾分析。结果:经后腹腔镜5例肾上腺囊肿患者顺利切除去顶,其中左侧肾上腺囊肿3例,右侧肾上腺囊肿3例。1例转开放,为双侧肾上腺囊肿。平均手术时间(45.73±1.32)min,平均术中出血量(7.35±0.45)mL。平均住院天数(7.67±0.24)天,平均术后住院天数(5.0±0.11)天。结论:经后腹腔镜肾上腺囊肿去顶减压是一种安全,有效且可行的治疗方式,必要时应及时转开放。
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.
目的 探讨腹部手术后患者发生肾上腺皮质功能减退的临床特点及诊治方法。方法 回顾性总结分析我院自2003年1月至2006年12月期间行腹部手术8 974例患者中17例术后确诊为并发肾上腺皮质功能减退者的临床资料。结果 本组腹部手术后肾上腺皮质功能减退的发生率为0.19%（17/8 974），女性患者多于男性患者，男女之比约为1∶2； 其中55~64岁者2例，65~75岁者12例，75岁以上者3例。临床表现以嗜睡及消化道症状为主。实验室检查尿皮质醇水平降低，促肾上腺皮质激素兴奋试验阳性。1例出现肾上腺危象死亡，其余病例经激素治疗后康复。结论 腹部手术后肾上腺皮质功能减退多数病因不明确。临床以嗜睡及消化道症状为主要表现。实验室检查是确诊和激素治疗的依据。多预后良好，但发生肾上腺危象时仍可危及生命。
ObjectiveTo explore effect of α-adrenoceptor on modulating water of lung in severe acute pancrea-titis (SAP) rat. MethodsThe SD rats were randomly divided into sham operation group (n=5) and SAP group,the SAP group was divided into subgroups of SAP-4 h (n=5) and SAP-24 h (n=5).SAP model was made by injecting taurocholate into bilopancreatic duct.The wet-to-dry ratio,alveolar fluid clearance (AFC),and AFC affected by α1-adrenoceptor inhibitor-prazosin and α2-adrenoceptor inhibitor-yohimbine separately or together were measured in the lungs.The α1-adrenoceptor and α2-adrenoceptor mRNA expressions in the lungs tissues were measured by real-time PCR. Results① The wet-to-dry ratios in the SAP-4 h group and SAP-24 h group were obviously decreased as compared with the sham operation group (P<0.05),which in the SAP-24 h group was significantly lower than that in the SAP-4 h group (P<0.05).② The AFCs in the SAP-4 h group and SAP-24 h group were obviously increased as compared with the sham operation group (P<0.05).The AFCs in the SAP with α1-adrenoceptor inhibitor-prazosin or α2-adrenocpetor inhibitor-yohimbine or prazosin combined with yohimbine were all obviously decreased as compared with the SAP group (P<0.05).③ The α1 adrenoceptor and α2 adrenoceptor mRNAs in the SAP-4 h group and SAP-24 h group were obviously increased as compared with the sham operation group (P<0.05). ConclusionAFC might be modulated by α-adrenoceptor in SAP rat.
目的:探讨经后腹腔镜手术治疗直径≥6.0cm的肾上腺肿瘤的安全性和效果。方法:对我院近5年收治经后腹腔镜手术治疗的直径≥6.0cm肾上腺肿瘤患者的临床资料进行回顾分析,27例患者年龄24～76岁,男性10例,女性17例,肿瘤直径6.0～8.5 cm。病理结果为:髓质脂肪瘤9例,肾上腺皮质腺瘤7例,肾上腺嗜铬细胞瘤6例,节细胞神经瘤3例,肾上腺皮质腺癌1例,肾上腺转移瘤1例。结果:24例患者顺利切除肿瘤,另外3例患者术中转开放手术,平均手术时间(119.46±36.65) min,术中估计出血量(80.14±36.48) mL,术后进食时间(1.88±0.82) d,术后引流管留置时间(2.05±0.65) d,术后住院时间(6.21±1.84) d。 结论:在技术熟练的前提下,直径≥6.0 cm的肾上腺肿瘤经后腹腔镜手术治疗仍然安全、微创。
【摘要】 目的 探讨超声显像对肾上腺肿瘤的定位、定性诊断与鉴别诊断价值。 方法 对 2003年1月-2009年1月125例疑为肾上腺肿瘤患者进行超声及CT检查，并经手术与病理证实。超声显像诊断后经手术与病理证实为嗜铬细胞瘤48例，肾上腺皮质腺瘤41例，皮质腺癌11例，肾上腺转移癌 9例，髓样脂肪瘤8例，结节样增生2例，肾上腺结核4例，胰尾部肿瘤1例，肝脏肿瘤1例，肾上极肿瘤1例。 结果 肾上腺肿瘤的病理类型不同，声像图表现亦各不相同。超声显像定位诊断符合率为96.0%（120/125），定性诊断符合率为91.2% （114/125）。 结论 超声显像对肾上腺肿瘤的定位与定性诊断价值较大，可作为临床诊断的首选检查方法。【Abstract】 Objective To assess the value of ultrasonography in the diagnosis and differential diagnosis of tumors of adrenal gland. Methods From January 2003 to January 2009, 125 patients who were suspected to suffering from adrenal tumors underwent ultrasonography and CT examination. The results were then confirmed by surgery and pathology. There were 48 cases of pheochromocytoma, 41 adenoma, 11 adenocarcinoma, 9 metastatic tumor, 8 adrenal medullary lipoma, 2 nubblar hyperplasia, 4 tuberculosis of adrenal gland, 1 tumor of cauda pancreatic, 1 tumor of liver and 1 tumor of upper pole of kidney. Results The ultrasonographic features varied with different pathological types. The accuracy diagnosis of localizition and qualitation were 96.0% (120/125) and 91.2% (114/125) respectively. Conclusion Ultrasonography is useful in diagnosing tumors of adrenal gland, which may be used as the first choice for the disease.
Objective To investigate the relationship among rats′ stress ulcer and gastric acid, prostaglandin (PGs) and adrenocorticotropin (ACTH) and to probe the pathogenesis, prophylaxis and therapy. Methods Rats′ stress ulcer model was made by cold water soaking and was properly treated with drugs such as hyoscine, dexamethasone, ranitidine and losec. The amount and pH of gastric juice, change of gastric mucosa and PGs and ACTH of blood were determined. Results After rats were fasted for 24 hours a little gastric juice was aspirated. After cold water soaking of rats gastric juice was increased with the pH decreased, there was gastric mucosal bleeding, blood PGs was decreased and ACTH was increased. These suggest that on stress gastric mucosa bleeding is related with decreased gastric juice pH, decreased PGs and increase ACTH.Conclusion To control stress ulcer, pH of gastric juice and amount of PGs should be increased. Losec can increase gastric juice pH, so losec is the first choice to control stress ulcer.
:目的:探讨肾上腺髓样脂肪瘤的临床、影像学及病理特点。方法:回顾性分析28例肾上腺髓样脂肪瘤患者的临床资料,结合文献分析其特点。结果:28例患者肿瘤均经手术切除,并经病理检查证实为肾上腺髓样脂肪瘤,随访至今未见复发。结论:肾上腺髓样脂肪瘤的诊断主要依靠B超、CT和MRI,术前诊断困难,确诊需经病理学检查,手术切除是有效的治疗方法。