颈胸联合部肿瘤手术及并发症的处理

目的探讨颈胸联合部肿瘤手术及并发症处理的有关技术问题。方法16例颈胸联合部肿瘤施行手术。颈正中加胸骨正中切口4例,颈正中、胸骨次全劈开（第3前肋间平面以上）和胸部前外侧联合切口（hemi—shell ineision．半蛤壳状切口）12例。肿瘤完全切除13例,姑息性减状切除3例。结果全组无手术死亡,1例原始神经外胚层瘤术后18、26个月分别转移至右肺尖、心包,已行2次、3次手术。随访4～96个月．晚期死亡3例,死于肿瘤复发。结论颈胸联合部肿瘤组织来源呈多样化,以神经源性肿瘤多见;一经确诊应争取手术治疗;半蛤壳切口创伤稍大,但术野清晰,利于防止副损伤;肿瘤切除时要防止大血管的损伤。注意气管的悬吊复位,利于保持气管通畅。     

小儿纵隔、颈纵隔型淋巴管瘤19例临床分析

目的 探讨小儿纵隔、颈纵隔型淋巴管瘤的诊断和治疗。方法 分析19例纵隔及颈纵隔型淋巴管瘤的临床资料，其中颈纵隔型14例，瘤体均深入锁骨或胸骨到达纵隔内，纵隔型5例，瘤体位于前上或后纵隔内。所有病例均由病理证实。结果 14例颈纵隔型中，2例系先行颈部病灶切除，术后发现纵隔病灶而再次经胸手术；1例先经胸行囊肿切除，术后再次行颈部囊肿切除；10例经颈胸联合切口手术；1例放弃手术。5例纵隔型均侧胸人路手术。完整切除3例，其他病例行囊肿揭顶引流，部分切除，残留囊壁石炭酸烧灼。术中发现左肺发育不良1例，术中损伤无名静脉1例，术后复发3例，无死亡病例。结论 颈纵隔部位的肿瘤一经诊断应立即手术，切口的选择应遵循充分暴露、避免损伤的原则；术中不宜强求完整切除，残留囊腔敞向胸膜腔可减少术后复发。     

原发性纵隔肿瘤及囊肿的诊断和外科治疗(附272例报告)

目的：探讨原发性纵隔肿瘤及囊肿的诊断和外科治疗。特别是术中防治意外损伤及保证手术安全的技术问题。方法：对我院手术治疗的原发性纵隔肿瘤及囊肿272例患者的临床资料进行分析。结果：272例中神经源性肿瘤占28.3%。其次为胸腺肿瘤或囊肿（27.6%)和畸胎样瘤（20.l2%);X线检查与术后病理诊断的基本符合眩为73.9%(201例）：均在全麻下施行手术,其中开胸手术266例,经颈部手术4例,颈胸分别切口同期手术2例;手术方式包括肿瘤或囊肿完全切除、大部切除和开胸探查等,术中上腔静脉损伤4例。其中1例经右心耳上腔静脉插管后修补 ,二期（术后2周）拔除上腔静脉插管治愈。手术死亡6例,手术死亡率为2.2%。结论：在原发性纵隔肿瘤及囊肿中,神经源性肿瘤的发病率居首位,其次为胸腺瘤和畸胎样瘤;胸部X线检查是诊断本病的主要手段;充分的围手术期处理,认真选择切口,在手术操作中防治重要组织器官操作是保证手术安全的关键。     

经胸骨L形切口切除前纵隔肿瘤囊肿

目的 探讨经胸骨L形切口切除前纵隔肿瘤囊肿的可行性.方法 18例前纵隔肿瘤囊肿患者,采用全麻单腔气管插管,胸部正中8～10 cm切口,根据肿瘤囊肿的大小及部位,选取第3或第4肋间横断胸骨(向左或向右),直视下切除肿瘤囊肿.结果 17例患者经此切口完整切除肿瘤或囊肿,其中3例侵犯邻近肺组织,予以肺部分切除,2例侵犯心包,予以心包部分切除.1例侵犯重要血管,姑息性切除.平均手术时间120min(80～140 min),术后均恢复顺利,术后平均住院时间10天,2例肺部感染.术后平均随访时间为24个月(8～36个月).结论 经胸骨L形切口手术创伤较小,术后恢复较快,能在直视下完整切除前纵隔肿瘤或囊肿,是一种可供选择的手术方法.     

纵隔肿瘤15例诊治体会

2007年5月～2009年3月经手术和病理诊断的纵隔肿瘤共15例,包括胸腺类瘤5例,神经源性3例,畸胎样瘤1例,间叶组织瘤2例,胸内甲状腺2例,其他2例.对这15例诊治分析,认为:(1)纵隔肿瘤的诊断:病史、症状、体征结合X线检查术前多能确诊.(2)切口的选择:除胸腺癌,胸腺瘤并重症肌无力.胸骨后甲状腺及突向双侧胸腔的肿瘤采用正中切口外其余均采用后外侧切口.(3)胸腺瘤,良性者提倡术后放疗以防复发,并重症肌无力者术中术后应合理应用抗胆碱酯酶药.(4)神经源性,胸顶部者应注意勿伤臂丛神经;椎管内呈哑铃状者应分期手术.(5)畸胎瘤:对于巨大瘤体者可采用破囊减压;合并肺部并发症者主张肺叶一并切除.(6)囊性畸胎瘤术前及术中切开前应注意与主动脉瘤相鉴别.     

纵膈肿瘤156例的诊治体会

1972年 2月～ 1994年 10月经手术和病理诊断的纵膈肿瘤共 15 6例 ,包括胸腺类瘤 5 7例 ,神经源性 36例 ,畸胎样瘤 18例 ,间叶组织瘤 2 1例 ,胸内甲状腺 5例 ,其它 19例。对这 15 6例诊治分析 ,认为 :1.纵膈肿瘤的诊断 :病史症状、体征结合X线检查术前多能确诊。 2 .切口的选择 :除胸腺癌 ,胸腺瘤并重症肌无力 ,胸骨后甲状腺及突向双侧胸腔的肿瘤采用正中切口外其余均采用后外侧切口。 3.胸腺瘤 ,良性者提倡术后放疗以防复发 ,并重症肌无力者术中术后应合理应用抗胆碱酯酶药。 4.神经源性 ,胸顶部者应注意勿伤臂丛神经 ;椎管内呈哑铃状者应分期手术。 5 .畸胎瘤 :对于巨大瘤体者可采用破囊减压 ;合并肺部并发症者主张肺叶一并切除。 6 .囊性畸胎瘤术前及术中切开前应注意与主动脉瘤相鉴别。     

经颈胸双切口治疗胸廓入口纵隔肿瘤1例

2012年7月我们收治了1例胸廓人口纵隔肿瘤患者,人院诊断为“左胸廓入口神经源性肿瘤”。在为该病例施行肿瘤切除手术巾,首先采用左颈部锁骨入路切口,继而又采用左第3肋间胸部前外侧切口,最终经颈胸双切口径路完整切除纵隔肿瘤。术后病理确诊为“左后上纵隔神经鞘瘤”。经手术等综合性治疗,患者痊愈出院。     

原发性纵隔肿瘤及囊肿的诊断和治疗分析

目的探讨原发性纵隔肿瘤及囊肿的诊断、鉴别诊断以及外科治疗。方法对我院近2年来手术治疗的95例原发性纵隔肿瘤及囊肿患者的临床资料进行分析。结果 95例中神经源性肿瘤27例,占28.4%;其次为胸腺肿瘤或囊肿24例,占25.3%和畸胎样瘤20例,占21.1%。均在全麻下施行手术,其中开胸手术43例,胸腔镜下手术46例,经颈部手术6例;手术方式包括完整切除、大部切除和开胸探查等。结论在原发性纵隔肿瘤及囊肿中,神经源性肿瘤的发病率居首位,其次为胸腺瘤和畸胎样瘤;胸部X线和CT检查是诊断本病的主要手段;充分的围手术期处理,认真选择手术切口,在手术操作中防治重要组织器官损伤是保证手术安全的关键。     

胸腔镜技术在纵膈肿瘤诊断与治疗中的应用

目的 探讨胸腔镜技术在纵膈肿瘤诊断和治疗方面的应用价值.方法 回顾性分析27例施行胸腔镜纵膈肿瘤手术切除患者的临床资料.结果 27例患者中23例经完全胸腔镜肿瘤切除,4例胸腔镜辅助小切口完成手术.术后恢复良好,均治愈出院,无围手术期严重并发症发生.术后病理检查结果显示胸腺瘤7例,胸腺增生3例,胸腺囊肿2例,心包囊肿1例,神经源肿瘤8例,支气管源性囊肿4例,畸胎瘤1例,转移癌1例.结论 胸腔镜技术具有微创、并发症少、住院时间短等优点,适合于大多数纵膈肿瘤治疗.     

纵膈肿瘤225例诊断及外科治疗

目的 总结纵隔肿瘤的诊断和外科特殊处理方法。方法 该组２２５例纵膈肿瘤中以畸胎瘤,胸腺瘤及神经源性肿瘤居多。手术选择胸骨正中或胸后外侧两种切口入路,肿瘤切除１９７例,单纯探查活检２８例。结果 术后死亡１例。随访２个月－２３ａ,良性肿瘤术后预后良好,无肿瘤复发;恶性纵隔肿瘤术后辅以放疗和化疗,疗效尚满意。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.