梗阻性大肠癌68例外科治疗体会

目的探讨梗阻性大肠癌的诊治原则.方法回顾性分析我院68例梗阻性大肠癌病例的诊治经过及预后情况.结果68例病例均经手术治疗,I期切除吻合术64例(94.1%),近端结肠造口术4例(5.9%)行肠造瘘II期吻合术.术后切口感染4例、发生吻合口瘘2例,无手术死亡病例发生.结论综合患者的全身情况、肿瘤局部侵犯情况及梗阻程度选择合理的术式,良好的围手术期处理是保证结直肠肿瘤I期切除吻合成功,防止吻合口瘘并发症等的关键.     

结直肠癌伴急性梗阻48例的外科治疗

目的: 探讨结直肠癌伴急性梗阻的术式选择。方法: 回顾分析48例结直肠癌伴急性梗阻患者的临床资料。其中,行一期肿瘤切除吻合术24例,一期肿瘤切除吻合口外置术或Hartmann术16例,捷径手术或双腔造口术8例。结果: 术后22例出现并发症,其中肺部感染10例,切口感染8例,腹腔感染2例,切口裂开2例。4例病死,围手术期病死率为8.3%,余44例均痊愈出院。结论: 病情允许时,应当一期切除肿瘤行肠吻合术,积极的术前准备和术后处理、合理的手术方式对减少并发症、降低病死率有重要意义。     

结直肠癌急性梗阻手术方式选择思考

目的探究结直肠癌急性梗阻手术最佳方式。方法选择2013年7月至2014年7月来我院就诊的163例患者为研究对象,结合患者实际情况,选择合适的手术方法。结果本次实验共计163例患者,其中I期肿瘤切除+吻合术者52例。单纯结肠造瘘者20例,实施捷径手术者23例,I期肿瘤切除+近端结肠造瘘者68例。死亡7例,并发症者10例,其中切口感染4例,吻合口漏6例。一年内生存率为79.74%。结论对于结直肠癌急性梗阻患者,医护人员应全面重视其围手术期处理工作,同时结合其实际情况,选择合适的手术方式。     

老年人结直肠癌穿孔临床诊治分析

目的探讨老年人结直肠癌穿孔的特点、诊断方法、术式选择及疗效和进一步提高诊治水平的措施。方法回顾性分析我院53例老年人结直肠癌穿孔患者的临床资料。结果术前明确诊断20例(37.7%)。行右半结肠癌根治性切除I期肠吻合术20例;行左半结直肠癌I期根治切除,Hartmann造口术26例;姑息性结直肠癌切除术+近端结肠造口+远端关闭术5例,单纯修补穿孔+近端结肠双腔造瘘术2例。围术期死亡9例(13.2%),44例治愈或好转。结论老年人结直肠癌合并穿孔病死率较高,误诊率较高,并发症多,要详细地采集病史、进行严格的体格检查和分析辅助检查结果,制定个体化诊疗方案,及时手术、选择合理的手术方式可减少病死率,提高生活质量。     

远端结肠梗阻Ⅰ期切除吻合51例临床分析

目的:探讨远端结肠梗阻行Ⅰ期切除吻合术的可行性。方法:对51例远端结肠梗阻患者,术前常规行梗阻远端清洁灌肠,术中行梗阻近端肠减压及顺行全结肠灌洗术,再行Ⅰ期切除吻合术,观察术后患者的恢复情况。结果:51例患者术后均无吻合口瘘发生,有3例出现切口感染,无其它严重并发症出现,切口感染的患者中2例为糖尿病患者。结论:对部分远端结肠梗阻患者术中行结肠灌洗后,行Ⅰ期切除吻合是安全、可行的,避免了患者再次接受手术的痛苦,同时减少了患者的医疗费用。     

左半结肠癌并急性肠梗阻105例临床分析

目的:探讨左半结肠癌伴急性肠梗阻患者手术方式的选择。方法:回顾性分析105例左半结肠癌合并急性肠梗阻患者病例资料及手术方式。结果:50例患者施行Ⅰ期肿瘤切除吻合术;52例施行Ⅰ期肿瘤切除吻合、末端回肠造口术;3例采用肿瘤切除,肿瘤近端结肠造口术。结论:左半结肠癌伴急性肠梗阻患者视术中肠道准备及吻合口血运情况,可行Ⅰ期切除吻合或Ⅰ期切除吻合、回肠造瘘术,对于身体情况较差高龄患者可行肿瘤切除,肿瘤近端结肠造口术。     

结直肠癌并发肠梗阻56例诊治分析

目的 探讨结直肠癌并发肠梗阻的诊断和治疗：方法 回顾性分析56例结直肠癌并发肠梗阻患者的临床资料。结果 一期肿瘤切除吻合术16例．一期切除肿瘤双腔造口术13例．Hartmann手术9例．捷径手术或造瘘术18例：术前诊断率为53，5％，术后主要并发症为切口感染、切口裂开、肺部感染和多器官功能衰竭．围手术期病死率为1.8％。结论 良好的术前准备和术后处理，合理的手术方式是减少并发症．降低病死率的关键：病情允许时．一期切除肿瘤行肠吻合术是可行的，     

大肠癌致肠梗阻的外科处理

目的探讨结直肠癌致急性肠梗阻病例的外科处理原则和方法。方法分析1990～2004年我院收治的56例结直肠癌致肠梗阻的外科治疗资料,结合近年文献,评价其外科处理方法。结果56例均行手术治疗,Ⅰ期行右半结肠切除12例;Ⅰ期行横结肠切除5例;Ⅰ期行左半结肠切除26例;Ⅰ期行左半结肠或上段直肠癌切除、近端造口(Hartmann造口术)、远端关闭待Ⅱ期吻合术12例,其中肿瘤无法切除行乙状结肠造口2例;1例行回肠横结肠捷径手术。术后出现并发症11例,其中肺部感染5例,泌尿系感染2例,切口裂开2例,呼吸衰竭及心肌梗死各1例,无吻合口瘘等并发症发生。死亡2例,病死率为3.57%。结论重视对结直肠癌致肠梗阻的外科治疗,选择合适的术式,可减少并发症发生,提高疗效。对于左半结肠癌或上段直肠癌致肠梗阻,做好术中的肠道减压及灌肠、行Ⅰ期左半结肠切除是安全可行的。     

大肠癌并发肠梗阻外科治疗89例临床分析

目的:通过89例临床病例观察分析,探讨大肠癌并发肠梗阻的外科治疗方法.方法:回顾性分析2008年6月至2011年7月我院收治手术的89例大肠癌致肠梗阻病例资料.结果:89例患者中左半结肠一期切除吻合术52例,其中行Ⅰ期肿瘤切除吻合术33例,肿瘤切除、结肠造口28例,先行双筒结肠造口、Ⅱ期再肿瘤切除再吻合术5例.右半结肠一期切除吻合23例,均行Ⅰ期肿瘤切除吻合术.直肠癌Melis手术9例,其中4例不能保肛而行肿瘤切除加结肠造口术,5例行Ⅰ期肿瘤切除吻合术.结论:根据大肠癌并发肠梗阻的病情需要,合理选择合适的外科治疗方法,做好围手术期的处理是提高疗效的关键.     

梗阻性结直肠癌的外科治疗

目的:探讨梗阻性结直肠癌的外科治疗方法.方法:回顾性分析2004年1月-2009年12月手术治疗的28例结直肠癌伴急性肠梗阻病人的临床资料.结果:28例均经手术治疗.右半结肠癌伴梗阻12例,其中11例行右半结肠一期切除,无吻合口漏发生,另1例癌肿不能切除行短路手术;横结肠切除一期吻合1例;一期左半结肠切除肠吻合术6例,术后发生吻合口漏1例,其中2例乙状结肠癌伴梗阻者行金属内支架置入,解除梗阻后2周行一期肿瘤切除肠吻合;Hartmann手术5例,术后恢复顺利,造口排便通畅,3～6个月后4例均进行了顺利关瘘手术,1例永久造瘘;肿瘤无法切除行单纯结肠造口4例.结论:重视围手术的处理,根据急性梗阻性结直肠癌病人全身情况和局部条件合理选择手术方式.     

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.     

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…     

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.     

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.     

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.