后腹腔镜手术与传统开放手术在活体供肾切取术的临床应用

目的 探讨后腹腔镜下供肾切取术(RPLDN)与传统开放活体供肾切取术(ODN)在活体供肾切取术中临床应用.方法 对45例供者采用后腹腔镜供肾切取术的22例,传统开放取肾手术的23例,所有供受者随访3～24月,分析资料进行比较总结.结果 RPLDN与ODN相比较:手术时间无明显差异(分别为75±35 min与65±26 min,p>0.05),术中出血亦较少(分别为150±50 ml与110±40 ml,p>0.05),RPLDN供肾热缺血时间相对较长(分别为107±34 s与20±5 s,P>0.05),所取血管长度较短(供肾动脉3.8±1.6 cm/4.2±0.6 cm,P<0.05;供肾静脉2.5±1.3 cm/3.5±0.8cm,P<0.05);供者术后恢复方面,RPLDN的供者术后下床时间较早(分别术后3±1 d与术后5±1 d,P<0.05).肾移植术中血管开放后供肾均在1 min内泌尿,RPLDN术后1周出现排斥反应1例,肾功能恢复延迟(DGF)1例.ODN受者术后1月出现急性排斥1例,其余均在术后3 d血清肌酐恢复至正常.所有供者术后7 d伤口拆线后均出院.结论 后腹腔镜手术与传统开放手术在亲属供肾切取临床应用术中、术后并发症方面比较均未见明显差异,但是腹腔镜活体供肾切取术对供者具有创伤小,恢复快、不影响肾功能等优势,更能促进亲属肾移植的开展,增加供肾来源.     

腹腔镜活体供肾切取(附1例报告)

目的：探讨更完善的活体供肾的切取方式。方法：对1例母亲供肾亲属肾移植的供者实施腹腔镜活体供肾切取并随访供受体1个月，结果：供肾者无明显并发症，术后住院及恢复工作时间明显缩短，术后疼痛明显减轻；受者肾功能恢复良好，结论：腹腔镜活体供肾切取术是一种有效而安全的活体供肾切取方法。     

手辅助腹腔镜下活体供肾切除术10例报告

[目的]探讨手辅助腹腔镜下活体供肾切除术的临床经验和安全性。[方法]10例供者进行手辅助腹腔镜下活体供肾切除术,术前对供者进行全面评估,常规移植给受者,观察记录术中出血量、手术时间、供肾热缺血时间、并发症发生情况及供受者的恢复情况。[结果]所有的手术均顺利完成,6例患者切取左肾,4例患者切取右肾,供者术中出血量(116.7 75.3)mL,供肾热缺血时间为(159.8 80.2)s,手术时间为(207.5 80.6)min,术后肾周引流管引流量为(138.0 217.1)mL,平均住院时间为(10.5 4.3)d,供者术前肌酐为80.6μmol/L,术后1周的肌酐为110.4μmol/L,两者差别有统计学意义(P<0.05),后逐渐降至正常。供者术后出现上腹疼痛1例和术后发热1例,1例受者肾功能延迟恢复,其余受者顺利恢复。[结论]手辅助腹腔镜下活体供肾切除术对供者影响小,是一种安全、可靠且可能广泛推广应用的手术方法。     

手助腹腔镜活体取肾的临床观察

目的：探讨手助腹腔镜活体供肾切取肾移植的可行性和优越性。方法：对6例亲属供体采取手助腹腔镜活体左肾切取,均经腹膜后途径。观察并记录肾切取手术时间、供肾热缺血时间、患者移植肾功能恢复情况及供者的康复情况。结果：供肾切取手术时间平均150min;热缺血时间平均3．5min,移植肾恢复灌注后排尿时间平均82s。供者术后1月内恢复正常生活。6例受者随访3个月,尿量和肾功能均在正常范围。结论：手助腹腔镜活体供肾切取术易于掌握、手术时间短;供肾热缺血时间短;供者痛苦小、术后恢复快,是临床值得推广应用的一种供肾切取方法。     

后腹腔镜活体供肾切取193例

目的:总结后腹腔镜下活体供肾切取术193例的经验,优化改进操作技术,使其更加标准化.方法:选择北京大学第三医院2003年12月至2016年2月行后腹腔镜下活体供肾切取术共193例,全身麻醉下,取腰部3个通道操作,彻底游离肾后,在肾下极7～8 cm处切断输尿管,用endo-cut或hem-o-lok分别夹闭切断肾动静脉,迅速取出肾用4℃肾保存液进行灌注,然后将离体肾保存在冰盐水中准备移植,记录手术时间、出血量、并发症发生情况、供者和受者肾功能情况.结朵:193例手术均获得成功,手术时间85 min(55 ～135 min),1例因出血手术中转开放.术中出血量60 mL(20 ～200 mL),所有供者均不需输血.供肾热缺血时间2.2 min(2～5 min).发生供者并发症3例,均为术后肾区血肿,保守治疗均自行吸收,未见不良影响,其余供者均未见异常.供者术后住院5.7 d(4～9d).193例供者中162例得到随访,平均随访42个月(1～58个月),均未见异常.2例受者发生移植肾输尿管吻合口漏尿,经手术修补后痊愈;3例受者发生移植肾被膜下血肿.1例受者发生移植肾功能延迟恢复,其余受者肾功能恢复良好.供、受者随访期间肾功能均未见异常.结论:后腹腔镜下活体供肾切取术安全可靠,经不断技术改良后已经成熟和标准化,其应用前景广泛,但应由有经验的医生操作以预防并发症的发生.     

55岁以上活体供肾移植中供受者肾功能的恢复特点

目的 探讨使用年龄≥55岁的活体供肾肾移植的临床特点、疗效及安全性.方法 对北京朝阳医院近年完成的19例供者年龄在55岁以上的活体供肾肾移植手术进行回顾性研究.19例供者平均年龄58岁,肌酐清除率(Ccr)平均(81.7±2.2)ml/min;19例受者平均年龄34岁,血液透析时间平均4个月.移植肾术中常规0点穿刺行组织学检查.结果 全部供者均平稳度过围手术期,未发生任何手术并发症,血肌酐术后1周均在正常范围内.术后1年血肌酐和Ccr分别与术后1周和6个月时比较差异无统计学意义.血压和血糖无明显变化,尿蛋白(-).所有受者肾功能早期恢复,无移植物功能延迟恢复(OGF)发生.7例接受Ccr低于80 ml/min供者肾源的受者术后血肌酐下降相对缓慢.在19例供肾中,3例肾小球硬化超过10%.结论 肾源紧缺是目前制约肾移植发展的重要因素,放宽对活体供者年龄的限制无疑会扩大肾源,挽救更多尿毒症患者;高龄供者的活体肾移植是安全可行的.     

经腹腔路径腹腔镜活体供肾切取术

目的:探讨经腹腔路径腹腔镜活体供肾切取技术的方法以及手术的安全性和临床意义.方法:2008年5月及8月分别对1例58岁的父亲和1例50岁母亲供肾亲属肾移植的供者实施经腹腔路径腹腔镜活体供肾切取并随访.结果:手术用时分别为130 min和110 min,出血量各50 ml,热缺血时间30 s和2 min;肾动脉长度分别为4.0 cm和3.5 cm,肾静脉长度各为3.0 cm,开放血流后30 s和10 s供肾泌尿,2例供者术后肾功能正常,均7 d拆线出院,无手术并发症,受者肾功能恢复良好.结论:经腹腔路径腹腔镜活体供肾切除术可以满意解剖肾血管和保留足够长的输尿管,而且安全、有效,创伤小、恢复快、痛苦少,供者易于接受.     

腹腔镜活体供肾切取肾移植2例临床观察

目的:探讨腹腔镜活体供肾切取术的可行性及优越性,了解受者移植术后临床效果.方法:对2例亲属活体供肾采用腹腔镜活体供肾切取,1例经腹腔途径,穿刺分别位于脐部、左肋缘下腹直肌旁和腋中线平脐处,供肾经脐部切口取出.另一例经后腹腔途径,在腋后线肋缘下1cm处建立腹膜后间隙并置入穿刺套管,然后分别在腋中线髂嵴上和腋前线肋弓下置入穿刺套管及操作器械.充气压力1.87 kPa,在肾周脂肪囊内游离肾脏,于肾下极平面找到输尿管,游离至髂血管水平.经平行腹股沟韧带切口取出供肾.经简单修整灌洗后移植受者的右髂窝内.受者已随访1年以上.结果:供者术后恢复快,均于40d内恢复正常工作,随访过程中无不良主诉.2例受者随访15～18个月,尿量及肾功能均在正常范围,无并发症发生.结论:腹腔镜活体供肾切取创伤小、恢复快.移植肾功能恢复及预后良好.     

单中心儿童抢先肾移植回顾性分析

目的探讨对终末期肾脏病(ESRD)患儿行抢先肾移植的临床效果。方法 2007年1月至2019年5月郑州大学第一附属医院共进行了202例儿童肾移植手术,其中12例为抢先移植。通过收集12例肾脏移植供受者临床资料,对ESRD儿童抢先移植的临床效果进行回顾性分析。结果供肾中亲属活体(LD)与公民死亡捐献(DD)比例为11∶1,供受者男女比例均为8∶4,供者平均年龄为(13.89±4.52)岁,供者平均体质量为(39.33±8.75)kg,受者平均年龄为(13.61±1.70)岁,受者平均体质量为(39.00±4.67)kg。12例供肾动静脉均为单支,手术顺利,术前及术后1 d、1周、3个月、6个月、12个月、12～83个月血肌酐水平分别为(660.11±104.03)、(219.78±22.45)、(90.67±18.01)、(80.56±12.77)、(74.00±11.82)、(88.33±9.54)、(84.54±13.68)mol·L~(-1)。1例亲属活体供肾者最近1次随访肾功能为109 mol·L~(-1),肾功能良好。所有受者均未发生肾功能延迟恢复(DGF)。1例LD受体术后4周发生移植肾感染,充分引流,接受敏感抗生素等治疗后恢复;1例DD受者术后8个月发生急性T细胞介导排斥反应(穿刺活检证实),接受甲强龙激素冲击治疗后好转。术后随访时间中位数为16.5(5～83)个月,随访至今人肾存活率100%,所有受者术后12个月肾功能及1例亲属供者术后肾功能均稳定。结论抢先肾移植可使ESRD患儿获益,避免透析相关并发症是其主要优势,在较大的移植中心可开展。     

机器人辅助腹腔镜与后腹腔镜活体供肾切取术临床对比研究

目的:探讨机器人辅助腹腔镜与单纯后腹腔镜活体供肾切取术临床疗效。方法:选取行亲属活体供肾切取术60例,其中31例行机器人辅助腹腔镜手术,29例行后腹腔镜手术。术后采取相应的护理措施,对比分析两组患者的手术时间、术中出血量、下地时间、拔管时间、住院时间及术后并发症。结果:两组患者手术均成功,机器人辅助腹腔镜组患者术中出血量、下地时间、拔管时间及住院时间均较后腹腔镜组明显缩短(P<0.05),而手术时间和术后并发症的发生率比较无统计学差异(P>0.05)。两组供、受者术后均规律随访1年以上,供者无高血压、肾功能异常等并发症;机器人辅助组和后腹腔镜组受者移植肾的存活分别为29例(93.6%)和28例(96.6%),两组比较无统计学差异(P>0.05)。结论:机器人辅助腹腔镜供肾切取术与腹腔镜手术相比较,手术效果相同,而术中出血量少,患者下地时间早,术后引流管留置时间短,住院时间短,恢复快,可明显提高护理工作质量及患者的满意度。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.