腹腔镜治疗急性结石性胆囊炎270例临床体会

目的探讨腹腔镜治疗急性结石性胆囊炎（LC）的临床体会。方法回顾分析2005年1月～2008年12月施行LC手术270例患者的临床资料。结果 LC完成急性结石性胆囊炎手术265例,手术成功率98.15%,手术时间平均（56.70±23.49）min,术中出血平均（54.34±17.52）mL。无胆管损伤、腹腔内出血、肠漏等并发症发生。中转开腹手术5例（1.85%）。术后住院平均（5.23±1.19）d。结论对于急性结石性胆囊炎应按常规LC程序进腹,正确处理胆囊三角、重视腹腔引流管的应用、及时中转开腹手术,则腹腔镜胆囊切除术是安全可行的。     

急性胆囊炎行急诊腹腔镜胆囊切除术的处理技巧

目的探讨急诊腹腔镜胆囊切除术的可行性并总结手术处理技巧.方法回顾性分析67例急性结石性胆囊炎患者急诊行腹腔镜胆囊切除术（laparoscopic cholecystectom,LC）的临床资料.结果 64例患者顺利完成LC,3例患者行中转开腹胆囊切除,LC手术时间26～90 min,平均56 min,术中出血量5～130 mL,平均80 mL,16例患者术中使用了止血纱布,18例患者放置了腹腔引流管,无胆管损伤等严重并发症发生.结论选择合适的手术时机,熟练地掌握LC的操作技巧,急性胆囊炎时实施腹腔镜胆囊切除术是安全、有效、可行的.     

腹腔镜手术治疗急性胆囊炎67例的临床分析

目的探讨腹腔镜手术治疗急性胆囊炎的疗效及安全性。方法选取2010年1月-2011年10月期间该科进行胆囊切除术的急性胆囊炎患者78例作为研究对象,其中67例成功接受腹腔镜胆囊切除术,11例中转开腹,现回顾分析前述67例急性胆囊炎患者的临床资料。结果①67例成功接受腹腔镜胆囊切除术的患者,手术时间43～110min,平均（73.5±12.2）min;术中出血量14～151mL,平均（45.2±30.9）mL;术后引流量12～218mL,平均（34.3±58.6）mL;住院时间6～15d,平均（8.1±2.3）d。②67例患者术后共有5例患者出现了并发症,并发症发生率为7.5%,其中2例患者并发穿刺孔感染,3例患者术后腹腔引流管内出现胆汁样引流液,体积42～218mL,平均（60.5±48.7）mL。经对症支持治疗后,上述5例患者均治愈。③67例成功接受腹腔镜胆囊切除术的患者均治愈出院。结论腹腔镜胆囊炎切除术进展不顺利时应及时中转开腹,一旦发现术后并发症应及时对症处理,这些是腹腔镜胆囊炎切除术成功治疗急性胆囊炎患者的重要因素。     

腹腔镜治疗急性结石性胆囊炎46例临床分析

目的探讨腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎的临床疗效及安全性。方法回顾性分析行LC治疗的46例急性结石性胆囊炎患者的临床资料。结果 44例(95.7%)成功行LC,其中顺行切除26例,逆行切除10例,顺逆结合切除4例,胆囊大部分切除4例;中转开腹2例(4.3%)。LC手术时间35～145 min,平均(53.5±10.6)min;术中出血35～105 mL,平均(50.3±5.8)mL;术后住院时间4～10 d,平均(5.5±1.5)d。所有患者均无胆管损伤、术后出血及胆漏、腹腔内脏器损伤等并发症发生。术后随访1～12个月,患者均康复,未再出现胆囊炎的症状与体征。结论合理地选择手术时机,且熟练地掌握LC技术和手术要点,LC治疗急性结石性胆囊炎腹是一种实用、安全、有效的手术方法,值得基层医院推广应用。     

腹腔镜手术治疗急性胆囊炎临床体会（附95例报告）

目的探讨腹腔镜胆囊切除术（LC）治疗急性胆囊炎的可行性及手术技巧。方法回顾性分析2004年5月～2008年5月95例急性胆囊炎LC手术的临床资料。结果LC手术全部成功,无中转开腹手术,平均手术时间65min（45～130min）,术后恢复顺利,无胃肠道损伤、胆管损伤等严重手术并发症,术后平均住院5d（3～7d）。结论只要能把握住手术时机并注重手术技巧,急性胆囊炎患者行腹腔镜下胆囊切除术是安全可行的。     

急性化脓性胆囊炎的腹腔镜胆囊切除术108例临床分析

目的探讨急性化脓性胆囊炎腹腔镜手术（LC）的可行性及处理方法。方法对我院1997年8月至今LC治疗急性化脓性胆囊炎108例的临床资料进行回顾性分析。结果本组LC成功率88．9％（96／108）,手术时间为45～175min,平均75min,中转开腹率11．1％（12／108）,无严重并发症及死亡,全部患者均痊愈出院。结论急性化脓性胆囊炎发病早期应积极行腹腔胆囊切除术,术中要重视对Calot三角的处理。急性化脓性胆囊炎已逐渐成为腹腔镜胆囊切除的适应证。     

急性结石性胆囊炎腹腔镜胆囊切除术的临床分析

目的探讨急性结石性胆囊炎行腹腔镜胆囊切除术（LC）的手术体会。方法对60例急性结石性胆囊炎施行急诊腹腔镜胆囊切除术,术中均放置腹腔引流管。结果60例中顺利完成LC手术56例,其中行胆囊大部切除术3例,本组平均手术时间50min,术后平均进食时间20h,术后平均引流量50mL,拔除引流管时间1～3d,术后平均住院4d,本组未发生严重并发症。结论急性结石性胆囊炎施行急诊Lc是安全的手术方式。     

腹腔镜胆囊切除术治疗急性胆囊炎合并胆囊结石体会

目的探讨急性胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术（laparoscopic cholecystect omy,LC）的术式、术中处理,并发症的防治。方法回顾性分析我院2005年2月至2009年2月为54例急性胆囊炎合并胆囊结石患者行LC的临床资料。结果50例成功完成LC,腹腔镜完整胆囊切除术44例,胆囊大部切除术加残余胆囊黏膜电灼破坏术6例。因Calot三角致密粘连,解剖不清,转开腹3例,因胆囊坏疽中转开腹1例。手术时间40～130min,平均60min。术后住院5～10d,平均7.2d。术后无严重并发症发生。结论急性胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术是安全有效的。     

腹腔镜胆囊切除术治疗急性胆囊炎的体会

目的探讨腹腔镜胆囊切除术治疗急性胆囊炎的可行性和安全性。方法回顾性分析我院2008年10月至2013年12月收治的37例行腹腔镜胆囊切除的急性胆囊炎患者的临床资料。结果 37例患者中,手术时间50～130 min,平均为(105±32.5)min,出血量10～250 mL,平均为(189±78)mL,置腹腔引流管6例,术中中转开腹4例,并发胆漏2例,无胆管损伤、无切口感染及粘连性肠梗阻等并发症。37例均痊愈出院。结论急性胆囊炎行腹腔镜胆囊切除术安全可行,但需要有熟练的腹腔镜操作技术,充分认识急性胆囊炎的解剖特点,把握好手术适应证,并能适时的中转手术。     

急性胆囊炎腹腔镜手术时机的选择与手术技巧

目的介绍腹腔镜胆囊切除术（LC）治疗急性胆囊炎手术时机的选择与手术技巧。方法回顾分析2006年至2010年LC治疗急性胆囊炎87例。结果本组急诊行LC,手术时间30～100min,平均65min。术后并发症1例,为术中发现胆囊窝部胆汁,当即剖腹,未发现胆管损伤,放置腹腔引流管;一次手术成功率98.85%（86/87）。结论正确选择手术时机和熟练掌握手术技巧,可在腹腔镜下完成急性胆囊炎的胆囊切除术。     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.