目的总结糖尿病并细菌性肝脓肿(DPHA)的临床特点和诊治经验。方法回顾性分析我院2002年3月至2010年12月期间出院的DPHA与无DPHA(NDPHA)患者的临床资料。结果细菌性肝脓肿患者共22例，其中DPHA患者11例。DPHA组人口学特征、临床表现、白细胞计数与NDPHA组比较差异均无统计学意义(Pgt;0.05); DPHA组血白蛋白低于NDPHA(P=0.006)，而ALT高于NDPHA(P=0.006)。DPHA组病灶个数多于NDPHA组(P=0.032)，且病灶直径也大于NDPHA组(P=0.006)。脓培养: 2组大肠杆菌均为3例; DPHA组克雷伯杆菌4例，而NDPHA组无克雷伯杆菌。DPHA组发生切口感染7例、腹腔感染2例，NDPHA组发生切口感染3例。 DPHA组抗生素使用时间、住院时间及住院费用均高于NDPHA组(Plt;0.05)。2组均分别治愈6例、好转5例，2组均无死亡患者。结论DPHA有其特殊的临床特征，并发症多，住院费用高，但预后与NDPHA差别不大。
目的探讨广泛门静脉血栓形成（portal vein thrombosis，PVT）的诊治经验。 方法回顾性分析笔者所在医院2004年1月至2012年12月期间收治的7例广泛PVT患者的临床资料。 结果按Yerdel’s分级7例患者属Ⅲ～Ⅳ级；男4例，女3例；年龄28～54岁，中位年龄45岁；起病至就诊时间4～10 d，平均6.9 d。表现为上腹痛3例，全腹痛、腹胀4例，血便2例，休克1例，腰背痛1例，恶心、呕吐3例。查体：有腹膜炎体征3例，左下腹压痛1例，腹水征阳性3例，肠鸣音消失2例，减弱1例。2例行D-二聚体检查均升高。所有患者超声检查均提示门静脉血栓形成、累及肠系膜上静脉。给予抗凝、祛聚、溶栓等基础治疗；1例经肠系膜上动脉导管溶栓，2例手术切除坏死肠管，其中1例同时行脾切除术。1例术后发生肠瘘，经保守治疗治愈；3例患者发生门静脉高压性胃肠病，口服普萘洛尔治疗。 结论早期行血浆D-二聚体及影像学检查，尽早行抗凝治疗，无禁忌时行溶栓或介入治疗以及实时手术治疗，PVT患者可有较好的预后。
Precision medicine is a novel medical modality based on genome sequencing, bioinformatics and big data science. The studies regarding tuberculosis always concentrated on the bacteria and host in the setting of precision medicine. This review mainly introduces the application of precision medicine in the diagnosis and treatment of tuberculosis. The limits of the Chinese studies with respect to precision medicine in tuberculosis are also discussed. Moreover, the article predicates its future development.
目的 提高对幼年性息肉致小肠套叠的诊治水平。方法 按检索策略，检索PubMed、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（CSJD）、中国期刊全文数据库（CJFD）及CNKI数字图书馆的相关文献，并结合笔者所在医院于2011年收治的1例幼年性息肉致小肠套叠病例资料，对该病进行一系统的描述。结果 共检出相关文献65篇，按纳入及排除标准，最后纳入6篇文献。共7例患者，临床表现为腹痛、呕吐5例，便血2例，贫血3例；经超声检查诊断4例；全组均行小肠切除肠吻合术，其中1例为腹腔镜辅助手术；有1例患者共实施了3次手术，最后死于恶液质，其余患者恢复较好。结论 幼年性息肉致小肠套叠为临床罕见疾病，超声检查仍为首选诊断方法；提高医师对该病的认识，术中彻底探查肠道，必要时术中行快速冰冻切片病理学检查，有望减少息肉遗留，改善患者的预后。
Objective To explore the technique and effectiveness of percutaneous retrograde cannulated screw fixation for acute stable scaphoid waist fracture by a transtrapezial approach. Methods Between May 2010 and April 2012, 23 patients with acute stable scaphoid waist fracture were treated with percutaneous retrograde cannulated screw fixation by a transtrapezial approach. There were 18 males and 5 females, aged 21-54 years with an average of 32 years. All fractures were caused by supporting with hands after falling. The locations were the left side in 10 cases and the right side in 13 cases. The major symptoms included the wrist swelling, tenderness at the anatomic snuff box, and grip weakness. Two cases were accompanied by distal radius fractures. The time between injury and operation ranged from 1 to 5 days with an average of 3 days. Results All incisions healed by first intention. All the cases were followed up 4-26 months with an average of 10 months. All fractures healed 6-12 weeks postoperatively with an average of 8.2 weeks. The patients resumed normal life and work at 4-6 weeks and at 2-4 months after operation, respectively. At last follow-up, all the wrists were free from the pain and the tenderness. The postoperative grip power ranged from 30 to 51 kg (mean, 37 kg). The active flexion-extension range of motion was 140-165° with an average of 153.7°. All patients were satisfied with the results of treatment. Conclusion Percutaneous retrograde cannulated screw fixation by a transtrapezial approach is a simple, safe, and reliable method to treat acute stable scaphoid waist fracture. By this approach, it is easier to place the screws into the center of the long axis of scaphoid.
Objective To explore the effect, operational essential, and clinical meaning of transilluminated powered phlebectomy for patients with varicose vein of the lower extremity. Methods In the study, 255 patients with 363 lower extremities of varicose vein in our hospital between May 2006 and November 2009 were treated by transilluminated powered phlebectomy. According to revised clinical etiology anatomic and pathophysiological classification system (CEAP), there were 104 limbs in C2, 53 limbs in C3, 155 limbs in C4, 34 limbs in C5, and 17 limbs in C6. The patients were followed up to observe postoperative complications. Results All varicose vein labeled before operation were resected. Surgical time was (100±20) min in unilateral lower extremity and (147±19) min in bilateral lower extremities. Total 221 patients (302 lower extremities) were followed up in 4 to 46 months, median follow up time was 24.5 months. Total 167 cases (247 lower extremities) had accepted the operation more than 1 year, 154 cases (229 lower extremities) in which were followed up. In the 229 lower extremities above, recurrences occurred in 11 extremities, small amounts of residual small varices were observed in 2 extremities, the recurrence rate was 5.68% （13/229）. Twenty-one limbs with ulcer were healing in 3 to 6 weeks after operation. Postoperative complications: there was paresthesias or pain of ankle area in 16 limbs, which was improved in 3 to 6 months after physical therapy; there was ecchymosis of skin of leg in 112 limbs, which disappeared in 3 to 5 weeks after operation; there was light edema in 37 limbs, which disappeared in 1 to 2 weeks after operation; there was local hematoma in 2 limbs, incision light infection in 5 limbs, skin and subcutaneous tissue necrosis above medial malleolus in one limb, and back of knee popliteal skin lesion in 2 limbs, which were all cured by the symptomatic treatment. Conclusions Surgical treatment of varicose veins is actually the combination of various surgical procedures. Varicose vein extraction using transilluminated powered phlebectomy is safe, efficacious, and cosmetically satisfactory.
Objective To research the methods and techniques of SD rat bone marrow stromal cells （MSCs）culture in vitro and to provide a large number of MSCs for cell therapy. Methods Bone marrow from the femur and tibia of the early age SD rats was taken to culture to the passage 1-4 （P1-P4）, its growth was observed and P3 cells were evaluated by HE staining and immunohistochemisty. Results The growing speed of P1-P3 was faster than that of P0, cells fusion was 85%-90% after 3-4 d and the cells were arranged in groups liked whirlpool shape or parallel; （3.4-3.6）×104/cm2 cells were gained and the total cell number of P1-P3 was 4.08×106, 2.44×107 and 2.85×108 respectively, the rate of trypan blue rejecting stained was 95%-97%. P4’s growing speed was slower than before, 1.42×109 in 3.0×104/cm2 cells were gained, and the rate of rejecting stained was 95%. P4-cell output was amplified nearly 2 000-fold higher than P0-cell. P3 immunohistochemical analysis indicated CD105+ cells 61.9%， CD44+ 45.4%， CD29+ 16.8%， CD45+ 8.2%， CD31+ 13.7%， CD34+ 8.3% and CD11b+ 1.5%, respectively. Conclusion The culture of whole bone marrow is suitable for a large number of MSCs provision in vitro, and can meet the needs of the cell therapy research.
目的 探讨腹腔镜胆囊切除术（LC） 中采用提胆囊壶腹、看Rouviere沟、胆囊后三角入路法切除胆囊，对成功完成LC和预防胆管、血管损伤的临床意义。方法 2009年7月至2011年12月期间应用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法（研究组） 切除胆囊112例，同期常规方法（对照组） 行LC 55例，比较2组的临床疗效。结果 2组一般临床资料比较差异无统计学意义（P＞0.05），具有可比性。研究组112例成功完成了LC，无中转开腹及并发症发生。对照组55例LC发生并发症3例，其中2例胆管损伤及1例左肝动脉损伤。研究组的并发症发生率明显低于对照组〔0 （0/112）比5.45% （3/55），P＜0.05〕，研究组和对照组间术中出血量、手术时间、住院时间及中转开腹率差异均无统计学意义 〔术中出血量： （8.95±3.95） mL比（8.09±3.91） mL，P=0.189；手术时间：（84.72±37.15） min比（77.05±37.22） min，P=0.212；住院时间：（6.40±2.39） d比（7.02±3.41） d，P=0.178〕。结论 在LC中，采用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法，相对容易精准解剖壶腹部与胆囊管移行区，完整显露胆囊壶腹部、胆囊管、胆总管及胆囊动脉，既是成功完成LC的保证，又可有效避免术中胆管和血管的损伤。