目的 探讨以肺间质改变为主的不典型肺结核的CT特征。方法 收集2018 年1月—2018 年12月期间44例经我院临床及实验室确诊的以肺间质改变为主的不典型肺结核的CT影像学资料,进行归纳总结,分析其影像特点。结果 44例以肺间质改变为主的不典型肺结核其中14例患者在肺叶的分布呈局限性分布,其中主要分布于右肺上叶占13例;30例呈弥漫性分布;以间质改变为主的局限性分布及弥漫性分布的不典型肺结核均以细网织影、微结节、细支气管壁增厚、小叶间隔增厚为主要表现,树芽征、磨玻璃影在弥漫性分布中相对常见,其合并空洞、支气管扩张、纵膈淋巴结肿大钙化、胸膜炎、肺大疱的比例高于局限性分布患者;以肺间质改变为主的不典型肺结核呈局限性分布(14例)的患者预后良好,13例呈显著吸收,1例吸收良好;弥漫性分布(30例)的患者中,18例显著吸收,其中6例未吸收或吸收欠佳。结论 以肺间质为改变为主的非典型肺结核具有其特征性,了解其CT特点有助于提高临床诊断及更好的评价治疗预后。
Objective To discuss value of the CT features of atypical pulmonary tuberculosis with pulmonary interstitial changes and improve the early diagnosis of pulmonary tubeculosis. Methods The CT imaging data of 44 patients with atypical pulmonary tuberculosis with interstitial changes was collected from January 2018 to December 2018,and the imaging characteristics were analyzed. Results In 44 cases of atypical pulmonary tuberculosis,14 cases of atypical pulmonary tubeculosis were the localized distribution,13 cases were mainly in the right upper lobe,and 30 cases were diffuse distribution. The atypical pulmonary tuberculosis of the localized and diffuse distribution mainly with interstitial changes was characterized by tine reticular shadow,micnodule,thickening of bronchiole wall and thickening of interlobular Septa. Tree-bud sign and ground-glass shadow were common in diffuse distribution,and the proportions of cavity,bronchiectasis,mediastinal lymphadenopathy calcification,pleurisy and bullae were higher than that in localized distribution. The atypical pulmonary tuberculosis patients with localized pulmonary interstitial changes (14 cases) have a favourable prognosis,13 cases with significant absorption,1 case with favourable absorption,and 18 cases with the atypical pulmonary tuberculosis patients with diffuse pulmonary interstitial changes (30 cases) with significant absorption,6 cases with no absorption or poor absorption. Conclusion The atypical pulmonary tuberculosis with interstitial changes has its characteristics,and the CT features is helpful to improve the clinical diagnosis and better evaluation of treatment prognosis.
目的 了解广州市海珠区肺结核患者登记情况及流行特征,为进一步做好海珠区肺结核防治提供依据。方法 收集2008—2017年海珠区结核病信息管理系统中按现住址登记的肺结核患者资料,采用描述性流行病学方法和相关统计方法对肺结核患者登记资料进行分析。结果 2008—2017年海珠区共报告登记肺结核患者 14 384 例,年报告发病率由2008年的105.3/10万下降到2017年的73.1/10万,呈下降趋势(χ2=164.973,P<0.001);男女发病相对比为2:1;各个年龄组均有发病,其中25～34岁年龄组发病人数最多,占总发病数的21.61%;职业分布方面,家务及待业人群最多,占总发病率34.48%,其次分别是其他(不固定职业),占17.29%,退休人群,占15.12%,学校学生占比5.52%。地区分布方面,各街道年平均发病率相差较大,最高为131.23/10万,最低的为66.40/10万,差异有统计学意义(χ2 =164.973,P<0.001)。结论 广州市海珠区肺结核疫情呈逐年下降趋势,但部分街道肺结核发病率仍达100/10万以上。男性人群、25~34岁年龄组和低收入人群(家务及待业、不固定职业、退休人群)是防控的主要人群,学生肺结核发病人数多,要加强学校结核病防控和筛查工作。
Objective To understand the registration situation and epidemic characteristics of tuberculosis patients in Haizhu district of guangzhou, and to provide a basis for further prevention and treatment of tuberculosis in Haizhu district. Methods The data of tuberculosis patients registered at present address in the TB information management system of Haizhu district from 2008 to 2017 were collected, and the registration data of tuberculosis patients were analyzed using descriptive epidemiological methods and relevant statistical methods. Results From 2008 to 2017, 14 384 cases of tuberculosis patients were reported in Haizhu district. The annual reported incidence rate decreased from 105.3/100,000 in 2008 to 73.1/100,000 in 2017, showing a down ward trend (χ2 = 164.973, P<0.001). The relative incidence of male and female was 2:1; all age groups had morbidity, of which 25~34 years old group had the largest number of cases, accounting for 21.61% of the total number of cases; in occupational distribution, household chores and unemployed were the most, accounting for 34.48 %, followed by other (non-fixed occupations), accounting for 17.29%, retired people, accounting for 15.12%, and school students accounting for 5.52%. In terms of regional distribution, the average annual incidence rate of each street varied greatly, with the highest being 131.23/100,000 and the lowest being 66.40/100,000. The difference is statistically significant(χ2=164.973,P<0.001). Conclusion The incidence of tuberculosis in Haizhu district of Guangzhou has been decreasing year by year, but the incidence of tuberculosis in some streets is still more than 100/100,000. Male population, 25~34 years old group and low-income population (domestic and underemployed, irregular occupation, retired population) are the main population for prevention and control. Students have a large number of cases of tuberculosis, so we need to strengthen prevention, control and screening of tuberculosis in schools.
目的 探讨市区院前急救流行病学特征,为制定院前急救策略和合理调配急救资源提供参考依据。方法 采用回顾性资料收集方法选取我院2013—2014年院前急救患者14000例(对照组),2017年院前急救患者9 630例(观察组)作为研究对象,对两组的性别、年龄、死亡原因等建立数据库,采用描述性研究和圆形分布方法进行统计分析,并对比两组数据,分析院前急救患者变化趋势。结果 对照组急救患者性别男性所占比例高于女性,年龄45~55岁所占比例最高,死亡原因创伤所占比例最高,心脑血管疾病其次;观察组急救患者性别男性所占比例高于女性,但低于对照组男性所占比例,年龄45~55岁所占比例最高,但比例低于对照组,死亡原因创伤所占比例最高,心脑血管疾病其次。结论 根据院前急救时间分布规律合理调配急救资源,充分发挥院前急救功能,提高院前急救水平。
目的 分析15例腹腔妊娠患者的临床病例特点,为临床工作提供参考依据,进一步减少漏诊及误诊的情况。方法 收集我院2002年1月—2018年6月期间住院治疗的腹腔妊娠患者的临床病例资料。回顾性分析并总结患者的临床诊治特点。通过t检验,进一步比较腹腔镜与腹式手术患者围手术期情况是否存在统计学差异。结果 1例B超检查提示大网膜妊娠可能;另1例入院前外院B超提示腹腔妊娠,孕8+周单活胎;其余13例患者术前B超提示宫内未见孕囊,子宫旁有包块,提示异位妊娠可能,术前未能明确腹腔妊娠。14例患者行手术治疗,另1例行介入穿刺保守治疗。术中探查发现腹腔妊娠病灶种植部位：位于大网膜5例,位于盆腔9例（膀胱区右下方盆壁1例,子宫直肠窝右侧直肠表面1例,右侧宫骶韧带2例,子宫下段前壁瘢痕处右缘1例,偏左侧肠管与子宫粘连之间1例、右侧盆壁1例、子宫直肠窝1例、子宫左侧圆韧带起始端1例）,位于腹腔1例（腰3椎体前方、腹主动脉与下腔静脉之间）。结论 腹腔妊娠的异位妊娠病灶种植部位非常广泛,超声检查需进一步扩大检查范围。必要时可选择MRI或CT检查准确定位,减少漏诊及误诊的情况。
Objective To analysis and summary clinical characteristics of 15 patients who were diagnosed with abdominal pregnancy,which supply reference for clinical work. Methods 15 cases who were diagnosed with abdominal pregnancy and admitted to Guangdong Women and Children hospital between January 2002 and June 2018 were identified. Retrospective analysis was used to summarize the clinical characteristics of diagnosis and treatment in 15 patients. Test statistics used Student's t test to find if there was statistical difference between laparoscopic and abdominal surgery patients in perioperative period. Results One case was likely diagnosed with greater omentum pregnancy by type B ultrasound. Another one patient was diagnosed with abdominal pregnancy which has 8+ weeks pregnant single live fetus by type B ultrasound in other hospital prior to hospitalization.The B ultrasound tests of the other 13 patients showed there were no sac in uterus and enclosed mass beside uterus which were diagnosed with ectopic pregnancy, but not positive diagnosis with abdominal pregnancy.Surgery was performed for 14 patients.We found more different sites where gestational sacs plant in abdominal pregnancy patients in operation, 5 cases sacs planted in greater omentum, 9 cases sacs planted in pelvic cavity including 1 case sac planted in pelvic wall bottom-right bladder,1 case sac planted in rectum outside right-hand of Douglas pouch,2 cases sacs planted in right utero-sacral ligament,1 case sac planted in right-side of scar in lower uterus segment,1 case sac planted in adhesive tissue between the lift intestinal canal and uterus,1 case sac planted in right pelvic cavity,1 case sac planted in Douglas pouch,1 case sac planted in initiating terminal of the lift round ligament of uterus. The inteventional puncture with medical treatment was supply for only 1 patient,CT test showed the sac planted in abdominal: ahead of third lumbar vertebra between abdominal aorta and inferior vena cava. Conclusion There are more sites where gestational sacs can plant in abdominal pregnancy patients. Ultrasound is first choice for patient who was considered ectopic pregnancy and better to expansion the inspection range. MRI or CT may find sacs plant site who was considered abdominal pregnancy which may reduce missed diagnosis and misdiagnosis. Surgery is first performed who was diagnosed with abdominal pregnancy. Medical treatment for patients who vital signs are stable.
目的 探讨直肠神经内分泌肿瘤的临床病理特征。方法 回顾性分析46例直肠神经内分泌肿瘤患者的临床病理资料,对不同病理分级的患者在性别、年龄、肿瘤直径、浸润深度、肝及淋巴结转移等方面进行比较。结果 直肠神经内分泌肿瘤男性多见,肿瘤多位于直肠中下段。免疫组化检测显示CgA、Syn、CD56阳性率分别为40.0%、97.8%、100%。36例Ki-67阳性指数≤2％,6例Ki-67阳性指数在3％～20％,4例Ki-67阳性指数＞20％。不同病理分级的肿瘤与患者年龄、肿瘤直径、浸润深度、淋巴结及肝转移相关,与性别不相关。结论 直肠神经内分泌肿瘤缺乏临床特异性症状,联合CgA、Syn和CD56染色可提高直肠神经内分泌肿瘤的诊断率。病理分级对预测肿瘤浸润深度、肝或淋巴结转移有重要参考价值。
Objective To investigate the pathological and clinical significance of 46 cases of rectal neuroendocrine tumors(NET). Methods Retrospectively analyzed the clinical and pathological feature of 46 patients with rectal NET, and assessed possible interactions between different pathological grades and gender, age, tumor diameter, depth of invasion, lymph node and liver metastasis. Results Rectal NET appeared more frequently in males than in females. Most tumors located in middle and distal third of rectum. The positivity rates of immunohistochemical marker CgA, Syn, CD56 were 40.0%, 97.8%, 100.0%, respectively. The cases of Ki-67 positivity rate under 2%, ranged between 3%-20%, above 20% were 36, 6, 4, respectively. Different pathological grades were significantly correlated with age, tumor diameter, depth of invasion, lymph node and liver metastasis, but not with gender. Conclusion Rectal NET had nonspecific symptoms. Combined immunohistochemical staining, such as CgA, Syn and CD56, was important in the evaluation of rectal NET. Pathological grading might be very useful for prediction of invasion depth, lymph node and liver metastasis.
目的 总结女性生殖系统中恶性中胚叶混合瘤（MMMT）的临床病理特征及预后，分析P53及错配修复蛋白与MMMT发病之间的关系。方法 收集大理大学第一附属医院2015年9月—2022年9月15例经手术切除病理诊断为MMMT的病例，总结临床病理特点、免疫表型（P53、错配修复蛋白等）、治疗方案并随访。结果 15例MMMT原发于子宫10例，卵巢5例。发病年龄范围49~76岁，平均年龄60岁，中位年龄58岁。临床表现为阴道流血或流液，伴或不伴腹痛或盆腔包块。镜下肿瘤均由不同比例的恶性上皮和间叶源性肿瘤构成，P53野生型12例，突变型3例；错配修复蛋白（MSH6、MSH2、MLH1、PMS2）检测存在缺失的有4例。15例患者中均行手术治疗，12例行盆腔淋巴结清扫术，术后辅以放化疗。随访失访2例，死亡4例，复发6例，3例术后无复发和转移。结论 恶性中胚叶混合瘤临床少见，恶性程度高，病理诊断上存在困难，需要辅以免疫组织化学染色，P53及错配修复蛋白缺失与MMMT的发生存在一定关系。治疗上需要手术切除，辅以放化疗。
Objective To summarize the clinical and pathological characteristics and prognosis of malignant mesodermal mixed tumor（MMMT）in the female reproductive system，and analyze the relationship between P53 and mismatch repair proteins and the onset of MMMT．Methods A total of 15 cases diagnosed with MMMT after surgical resection at the First Affiliated Hospital of Dali University from September 2015 to September 2022 were collected．The clinical and pathological characteristics，immune phenotype（P53，mismatch repair protein，etc. ），treatment plan were summarized．And the patients were followed-up．Results Ten of 15 cases of MMMT were primary in the uterus and 5 of 10 in the ovaries．The age range of onset was 49 to 76 years old，with an average age of 60 and a median age of 58．Clinical manifestations included vaginal bleeding or fluid discharge，with or without abdominal pain or pelvic masses．Under the microscope，all tumors were composed of malignant epithelial and mesenchymal tumors in different proportions，with 12 cases of P53 wild-type and 3 cases of mutant type．There were 4 cases of missing mismatch repair proteins（MSH6，MSH2，MLH1，PMS2）detected．Among the 15 patients，all underwent surgical treatment，and 12 underwent pelvic lymph node dissection with postoperative adjuvant chemotherapy and radiotherapy．Two cases were lost to follow-up，four cases died，six cases recurred，and three cases had no recurrence or metastasis after surgery．Conclusions MMMT are rare in clinical practice，with high malignancy and poor prognosis．Pathological diagnosis is difficult，and immunohistochemical staining is needed．The absence of P53 and mismatch repair protein is related to the occurrence of MMMT. Surgical resection is required for treatment，supplemented by radiotherapy and chemotherapy．
