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Reported One Case of the Renal Transplant between Identical Twins and Reviewed Literatures

摘要:目的: 报道同卵双生子间肾移植效果,探讨免疫抑制剂及激素的使用、鉴定同卵双生子的方法以及术后随访。 方法 :个案报道结合文献综述。 结果 :手术获得成功。术后随访8月,患者恢复良好。 结论 :同卵双生间的肾移植安全有效,术后不需要使用免疫抑制剂也能维持移植肾功能正常。Abstract: Objective: Reported the effects of renal transplantation between identical twins,explored the use of immunosuppressive drugs and glucocorticoid, identification method of the identical twins and postoperative followup . Methods :Combining case report and literature review. Results :The operation is success.Followup in 8 months,the patient recover well. Conclusion : The renal transplantation between identical twins is safe and effective,the immunosuppressant is not need for the postoperative patients to maintain the graft`s function.

Shone’s综合征一例报告及文献复习

目的 探讨Shone’s综合征的一般规律、治疗策略及其对预后的影响因素，为临床诊治提供借鉴。 方法  2009年7月中山大学附属第一医院收治1例主动脉缩窄合并先天性二尖瓣狭窄患者，女，年龄12岁。属于广义的Shone’s综合征，包括主动脉缩窄、动脉导管未闭、二尖瓣瓣上环、二尖瓣狭窄等畸形。采用体外循环、胸骨正中切口，切除主动脉狭窄段，剪开二尖瓣下与乳头肌粘连的腱索，充分松解两组乳头肌，剪除瓣上纤维环。计算机检索PubMed（1963~2009年）、Elsevier Science（1963~2009年）、Wiley Online Library（1963~2009年）、Ovid（1963~2009年）数据库，收集有关Shone’s综合征的临床研究（前瞻性或回顾性）、病例报告和综述，分析其诊治特点。 结果 本例患者手术时间350 min，体外循环时间156 min，主动脉阻断时间48 min。手术矫治了所有畸形。患者术后2 d拔除气管内插管，3 d转出监护室，心肺功能恢复好；术后第7 d复查超声心动图提示：降主动脉与肺动脉间未见血流相通，降主动脉处未见狭窄和血流障碍，二尖瓣瓣口面积1.9 cm2，肺动脉压降至28 mm Hg；术后2周顺利出院。经检索共纳入19篇文献：其中典型Shone’s综合征回顾性研究5篇，包括112例患者；有关先天性二尖瓣狭窄或左心室流出道狭窄的临床研究14篇。各文献报道的病例类型各异，对手术策略基本达成共识：尽量矫正所有畸形。 结论 Shone’s综合征一经诊断，则应手术治疗，左心室流入道梗阻矫正是影响患者预后的重要因素。

One Case Report of MTX-Induced Aplastic Anemia and Literature Review

We reported one case of MTX-induced aplastic anemia and reviewed related literature to investigate the mechanism of action of MTX, and summarize the clinical feature, diagnostic criteria, risk factor, and interventions. These were hoped to arouse the attention of clinicians and clinical pharmacists, in order to effectively prevent, diagnose, and treat MTX-induced aplastic anemia.

Common Variable Immune Deficiency Combined with Celiac Disease: A Case Report and Literatures Review

ObjectiveTo enhance the understanding of common variable immune deficiency (CVID) combined with celiac disease in order to diagnose and treat the disease as early as possible and delay its complications through the treatment of the disease and study on related literatures. MethodThe experience of diagnosing and treating one case of CVID combined with celiac disease in November 2013 was reported in the present study, and the related literatures were reviewed. ResultsAfter strict gluten-free diet and infusion of intravenous immune globulin, the patient's diarrhea relieved and serum immunoglobulin elevated. ConclusionsCVID is the most frequent symptomatic primary immune deficiency which is related to celiac disease closely, a gluten-sensitive condition characterized by a variable degree of villous atrophy. Once diagnosed, gluten-free diet can alleviate the symptoms.

MDT discussion of 2 cases of hepatocellular carcinoma with bile duct tumor thrombus

Objective To discuss the clinical characteristics, radiological characteristics, diagnosis, and treatment of hepatocellular carcinoma with bile duct tumor thrombus (HCCBDTT), and to improve the level of diagnosis and treatment for it. Methods Clinical data of 2 cases of HCCBDTT admitted in March 2016 and July 2016 in our hospital were analyzed retrospectively, and the related literatures were reviewed. Results Two cases of HCCBDTT were misdiag- nosed as hilar cholangiocarcinoma before operation, and then proved to be HCCBDTT after operation. The 2 cases were both alive during the follow-up period (20 months and 13 months respectively). Conclusions HCCBDTT patients should be comprehensively analyzed basing on the clinical data for diagnosis, and avoiding misdiagnosis. Active surgical treatment can effectively improve the quality of life in HCCBDTT patients, and prolong the survival time.

腹膜前间隙法修补复合疝 3 例报道并文献复习

目的 探讨腹膜前间隙法修补复合疝的临床诊疗经验。 方法 回顾性分析笔者所在医院于 2011 年 7 月至 2015 年 10 月期间收治的 3 例复合疝病例的临床资料和诊疗过程，并进行相关文献复习。 结果 3 例患者均行择期局麻下疝修补术，1 例患者术前诊断为腹股沟疝合并股疝，余 2 例患者术前均诊断为腹股沟疝。3 例患者均经术中探查确诊为复合疝。结合文献复习，复合疝的发生率极低，临床症状隐匿，故容易被混淆及漏诊。对于术前有腹股沟区多个包块病史者及体质消瘦者，应高度警惕复合疝可能，术中应仔细探查腹股沟管及股管，以防遗漏疝。应用大网片行腹膜前间隙修补可同时修补 3 个疝，且操作简便、效果良好，同时降低了医疗费用。 结论 复合疝是一种少见的疝类型，术前诊断较困难，术中易漏诊。通过不断积累病例，完善修补技术，对术前明确诊断、及时治疗及提高患者满意度均大有裨益。

The Mounier-Kuhn syndrome: three cases report and literature review

Objective To summarize the etiology and clinical features of Mounier-Kuhn syndrome (MKS) so as to enhance the acknowledgement of MKS. Methods Three cases of MKS were reported and the keywords with " Tracheobronchomegaly”, " Mounier-Kuhn syndrome” were analyzed through the mode of literature retrieval in CNKI, VIP and Pubmed databases. Results There were 214 cases around the world including 14 cases of MKS in China. With unknown etiology and non-specific clinical feature, MKS is characteristic with congenital absence of tracheal or bronchial elastic tissue. MKS is diagnosed with remarkably dilated trachea and bronchus through chest CT or bronchofibroscope, accompanied with genetic defects. The ratio of men to women is 8.5 to 1. There is no radical cure. Symptomatic treatment and surgical treatment when necessary could be available. Conclusions MKS is a rare progressive hereditary disease, irrelevant to smoking and sharing a similar cause with generalized elastolysis, which need pay much attention to the physical examination of skin or elastic tissue. The diagnosis of MKS should be based on not merely airway diameter but also the overall clinical, pathologic, and radiologic profile.

原发性纵隔骨肉瘤一例

胰腺 Castleman 病 1 例报道并文献复习

目的 总结 1 例胰腺 Castleman 病患者的临床资料，并复习以往文献，总结该病的流行病学特点及诊治体会。 方法 回顾性分析 2016 年 1 月笔者所在医院收治的 1 例胰腺 Castleman 病患者的临床资料，进行文献复习及总结。 结果 该例患者无特殊临床表现，术前行 CT 检查发现胰腺占位，行手术切除，术后病理学诊断为胰腺 Castleman 病。术后 1 个月复查CT未见肿瘤复发及转移，已获访 6 个月，患者恢复良好。经查阅文献，共检索出胰腺 Castleman 病 32 例，男 11 例，女 21 例；年龄 23～74 岁，平均年龄为 46 岁；临床表现仅为腹部疼痛 7 例，腹痛伴发热 1 例，腹痛伴面部、双下肢水肿 1 例，腹痛伴乏力 1 例，腹胀 1 例，背部疼痛 1 例，颈部淋巴结肿大 1 例，吞咽困难 1 例，发热、乏力、体质量下降 1 例，无明显临床表现 17 例；肿瘤位于胰腺头部 9 例，胰腺颈部 3 例，胰腺体、尾部 16 例，胰周 4 例；肿瘤直径最小 1.5 cm，最大 7.2 cm；病理学分型为透明血管型（hyaline vascular，HV）19 例，浆细胞型（plasma cell，PC）4 例，混合型（mixed/HV-PC，MV）4 例，未给出明确病理分型 5 例。 结论 胰腺 Castleman 病是少见的淋巴组织增生性疾病，通常无特异临床表现，影像学检查也无特异性，目前仅能通过病理组织学检查确诊。胰腺 Castleman 病的治疗以手术为主，疗效较好。

Small Intestine Intussusception Induced by Juvenile Polyps：A Systematic Literature Review

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。