目的 探討胰管結石慢性胰腺炎的診斷和治療。方法 收集我院1993年3月至2003年9月經手術治療的胰管結石慢性胰腺炎患者34例的臨床資料并進行回顧性分析。結果 全組病例均經B超和CT檢查確診，均經手術治療。手術方式： 胰十二指腸切除術5例； 胰管切開取石、胰空腸Roux-Y吻合術27例，其中同時行膽囊切除術6例，Oddi擴約肌切開、T管引流術4例，膽腸Roux-Y吻合術2例； 胃空腸、膽腸吻合加活檢術2例。治愈31例，緩解2例，死亡1例。結論 影像學檢查是診斷本病的重要手段，準確率高。根據合并癥和胰管擴張程度選擇合適的手術方式，可取得良好治療效果。
Objective To evaluate the urine cytology silver staining combined with ultrasonography（USG）in the detection of bladder transitional cell carcinoma （TCC） recurrence after transurethral resection of bladder tumor（TURBT）in terms of sensitivity and specificity. Methods Cystoscopy was used as “gold standard”. Urine cytology combined with USG or cystoscopy was measured separately and blindly. AgNORs protein stained by silver were used in cytology with Kappa of inter-observers 0.81. For the USG, the patients were scanned with trans-rectal probe with Kappa of inter-observers 0.76. The results of urine cytology combined with USG （Positive when urine cytology and/or USG positive. Negative when both urine cytology and USG negative） were compared with “gold standard”. Results The 148 consecutive superficial TCC patients with TURBT one year previously were included in this study. Fifty seven recurrenced cases were detected. Recurrence rate was 38.51%. The sensitivity and specificity of urine cytology silver stain were 89.47% （95% CI 0.82 to 0.98） and 87.91% （95% CI 0.81 to 0.95）. Area under ROC curve was 82.22%. The sensitivity and specificity of USG were 57.90% （95% CI 0.45 to 0.71 ） and 90. 11% （ 95% CI 0.84 to 0.96）. Area under ROC curve was 73.13% . The sensitivity was improved to 94. 74% （95% CI 0.89 to 1.00） when cytology combined with USG. But specificity decreased to 84. 62% （95% CI 0.77 to 0.92 ）. Area under ROC curve was improved to 98.28%. Conclusions Urine cytology silver stain combined with USG improves the high sensitivity for follow-up TCC patients after TURBT. The non-invasive protocol is suggested.
目的 評價B超引導下核心針活檢術（CNB）對不可觸及的乳腺病變（NPBL）的診斷價值。方法 采用18G Tru-cut針結合活檢槍對88例患者的96個NPBL行B超引導下CNB，并與切除活檢病理結果比較。結果 NPBL大小4～23mm（平均13.1mm）。在CNB中，86個為良性，2個為可疑惡性，6個為惡性，2個取材不良。在切除活檢中9個為惡性，87個為良性。CNB可疑惡變的2個NPBL均為惡性，1個惡性NPBL誤診為乳腺腺病，取材不良的2個NPBL均為良性。本組NPBL中惡性病變占9.38%（9/96），B超引導下CNB對NPBL的良惡性診斷正確率為98.94%（93/94），診斷乳腺癌的敏感性為88.89%（8/9），特異性為100%（8/8），良性病變的病理診斷符合率為97.70%（85/87），取材不良為2.08%（2/96）。結論 B超引導下CNB對NPBL的診斷具有較高的敏感性和特異性，結果準確可靠。
目的 探討與評價術中B超定位下經肝膽管取石在肝內膽管結石治療中的手術指征及優劣性。方法 總結2002～2006 年29例肝內膽管結石行肝葉切除+經肝膽管取石患者的臨床資料,對其手術效果及并發癥進行分析。結果 無膽管損傷及手術死亡病例, 并發癥發生率為37.93%，殘石率為10.34%。結論 術中B超定位下經肝膽管取石結合肝葉切除對肝內膽管結石是一種較好的治療方式，主要適用于Ⅱb型肝內膽管結石患者。
目的 探討膽源性肝膿腫的診治方法。方法 對我院2000~2004年期間收治并確診為膽源性肝膿腫的12例患者進行分析，在應用抗生素和全身支持的前提下，再依據其病變發生、發展的不同階段采用不同手段治療。結果 4例急性期患者中2例行急診膽道引流手術后治愈，另2例轉為亞急性期（膿腫融合期）； 6例亞急性期患者均經B超導向下行膿腫穿刺抽膿后注入抗生素治療后治愈； 4例慢性期患者行膿腫切開引流后治愈。結論 本病在應用廣譜抗生素（二聯抗生素）和全身支持治療的前提下，再根據病變不同時期采用不同方法治療，可獲得良好效果。
B-type ultrasound images have important applications in medical diagnosis. However, the widely spread intensity inhomogeneity, low-scale contrast, constructed defect, noise and blurred edges all make it difficult to implement automatic segmentation of lesion in the images. Based on region level set method, a subordinate degree region level set model was proposed, in which subordinate degree probability of each pixel was defined to reflect the pixel subjection grade to target and background respectively. Pixels were classified to either target or background by calculation of their subordinate degree probabilities, and edge contour was obtained by region level set iterations. In this paper, lesion segmentation is regarded as local segmentation of specific area, and the calculation is restrained to the local sphere abide by the contour, which greatly reduce the calculation complexity. Experiments on B-type ultrasound images showed improved results of the proposed method compared to those of some popular level set methods.
Ｄｕｒｉｎｇ ｔｈｅ ｐａｓｔ ５４ ｍｏｎｔｈｓ ａ ｔｏｔａｌ ｏｆ ２４ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｓｅｃｏｎｄａｒｙ ｈｅｐａｔｉｃ ｃａｒｃｉｎｏｍａ ｈａｖｅ ｂｅｅｎ ｔｒｅａｔｅｄ ｂｙ ｒｅｓｅｃｔｉｏｎ ｏｆ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｉｓ ａｎｄ ｐｏｓｔｏｐｅｒａｔｉｏｎ ｐｅｒｃｕｔａｎｅｏｕｓ ｉｎｔｒａｈｅｐａｔｏｐｏｒｔａｌ ｃｈｅｍｏｔｈｅｒａｐｙ（ＰＨＰＣ） ｕｎｄｅｒ ｕｌｔｒａｓｏｕｎｄ ｇｕｉｄａｎｃｅ Ａ ｆｏｌｌｏｗｕｐ ｆｒｏｍ ｆｉｖｅ ｍｏｎｔｈｓ ｔｏ ｆｏｕｒ ｙｅａｒｓ ｓｈｏｗｓ ｔｈａｔ ２１ ｐａｔｉｅｎｔｓ ｈａｖｅ ｓｕｒｖｉｖｄｅ ｆｏｒ ５ ｔｏ ４８ ｍｏｎｔｈｓ ｅｘｃｅｐｔ ３ ｅｘｔｒｅｍｅｌｙ ａｄｖａｎｃｅｄ ｃａｓｅｓ． Ｔｈｅ ａｕｔｈｏｒｓ ｓｕｇｇｅｓｔ ｔｈａｔ ａ ｃｏｍｂｉｎｅｄ ｔｈｅｒａｐｅｕｔｉｃ ｍｅｔｈｏｄ ｆｏｒ ｔｒｅａｔｉｎｇ ｓｅｃｏｎｄａｒｙ ｈｅｐａｔｉｃ ｃａｒｃｉｎｏｍａ ｉｓ ｍｏｒｅ ｅｆｆｅｃｔｉｖｅ ｔｈａｎ ｅｉｔｈｅｒ ｓｉｍｐｌｅ ｈｅｐａｔｅｃｔｏｍｙ ｏｒ ｃｈｅｍｏｔｈｅｒａｐｙ．
Objective To investigate the significance of urinary trypsinogen-2 dipstick test and the ratio of urinary amylase to urinary creatinine for the diagnosis of acute pancreatitis(AP).Methods A total of 57 consecutive patients who were suspected as AP presenting with abdominal pain at the emergency department experienced the test of serum and urinary amylase, urinary creatinine assay, urinary trypsinogen-2 dipstick and ultrasonography. Results There were 18 patients diagnosed as acute pancreatitis, the serum amylase assay had a sensitivity of 88.9 percent (cutoff value, 300 U per liter) and a specificity of 87.2 percent, the sensitivity and specificity of the urinary amylase assay and the ratio of urinary amylase to urinary creatinine were 88.9 (cutoff value, 2000 U per liter), 94.4 (cutoff value, 120 U per mmol Cr), 84.6 and 89.7 percent, respectively. The sensitivity and specificity of the urinary trypsinogen-2 test strip were 94.4 and 92.3 percent. The sensitivity of the ultrasonography were 88.9 percent. Conclusion Urinary trypsinogen-2 dipstick test is a good index for the diagnosis of AP. The ratio of urinary amylase to urinary creatinine is also a useful index and may be better than urinary amylase for the diagnosis of AP.