髋臼周围肿瘤的保肢手术

目的:探讨髋臼周围肿瘤临床治疗方法及疗效.方法:对16例髋臼周围肿瘤进行临床回顾分析.其中骨巨细胞瘤5例,软骨肉瘤5例,骨转移性腺癌2例,骨肉瘤2例,骨恶性淋巴瘤1例,骨恶性纤维组织细胞瘤1例.均行肿瘤切除及骨盆环重建.结果:本组16例患者手术均顺利,肿瘤获彻底切除,平均随访时间3(1～5)年,无术中休克或死亡,无盆腔脏器损伤.伤口均一期愈合,无1例感染.全部病例均可负重行走.结论:髋臼周围肿瘤的保肢手术是可行的,但应严格掌握其适应证.     

髋臼周围恶性骨肿瘤切除后组配式假体重建的疗效分析

目的：探讨肿瘤切除后组配式假体重建治疗髋臼周围恶性骨肿瘤的疗效。方法：回顾性分析2006年8月至2012年12月接受肿瘤切除组配式半骨盆假体重建术治疗的髋臼周围恶性肿瘤患者22例,男性11例,女性11例,患者年龄44(16~65)岁。22例患者中软骨肉瘤13例,骨肉瘤5例,尤文氏肉瘤2例,恶性纤维组织细胞瘤1例,骨巨细胞瘤1例。按照Enneking骨盆肿瘤分区,II+III区为11例,I+II+III区为5例,I+II区为3例,II区为3例。结果：患者均获随访,随访时间为49(11~103)个月。至最后1次随访,无瘤存活13例(59%),死亡9例(41%)。8例(36%)患者发生远处转移,5例(23%)患者发生局部复发。根据美国骨与软组织肿瘤协会评分标准,13例存活患者的评分为(18.5±5.7)分,其中11例患者保肢成功,其评分为(20.7±2.0)分。结论：髋臼周围恶性骨肿瘤扩大切除后组配式假体重建可获得较好的 疗效。     

原发性骶骨肿瘤32例治疗体会

原发性骶骨肿瘤在临床上比较少见 ,文献报道在骨肿瘤中其发病率为 3 %～ 4% [1] ,较常见的原发性骶骨肿瘤为脊索瘤 ,其次为骨巨细胞瘤和神经鞘瘤。本文 3 2例原发性骶骨肿瘤患者 ,均接受了手术切除 ,并进行了随访。1　临床资料1 .1　一般资料从 1 985年～ 1 996年 ,治疗 3 2例原发性骶骨肿瘤患者 ,其中男性 2 1例 ,女性 1 1例 ,最小年龄 1 3岁 ,最大年龄 5 7岁 ,平均 42 .3岁 ,脊索瘤 1 5例 ,骨巨细胞瘤 8例 ,神经鞘瘤 5例 ,动脉瘤样骨囊肿 2例 ,骨母细胞瘤及软骨肉瘤各 1例 ,均行手术切除 ,脊索瘤、骨巨细胞瘤患者术后进行放疗 ,4例脊索瘤…     

经数字减影血管造影术介入后骨盆肿瘤切除与重建

目的：探讨分析经数字减影血管造影术（DSA）介入后骨盆肿瘤切除与功能重建的临床方法及疗效。方法：对28例骨盆肿瘤患进行术后临床回顾分析。其中骨巨细胞瘤10例,软骨肉瘤7例,骨转移性腺癌4例,骨肉瘤3例,骨恶性淋巴瘤1例,骨恶性纤维组织细胞瘤1例,动脉瘤要囊肿2例,均行肿瘤切除及骨盆环重建。结果：本组28例患手术均顺利,肿瘤获彻底切除,平均随访时间3年（1－5年）,无术中休克或死亡,无盆腔脏器损伤,伤口均一期愈合,无1例感染,全部病例均可负重行走。结论：经DSA介入后骨盆肿瘤切除肿瘤切除与重建功能的保肢手术是可行的,但应严格掌握其适应证。     

原发性骶骨肿瘤的治疗

目的：研究原发性骶骨肿瘤的临床特征，诊断，治疗方法及随访结果。方法：复习文献，分析12例原发性骶骨肿瘤的患者，其中脊索瘤8例，骨巨细胞瘤3例，骨肉瘤1例。均行肿瘤切除，术后放疗或化疗。随访5～7年。结果：1例脊索瘤及2例骨巨细胞瘤患者术后局部复发，再次手术切除，其他患者经随访术后局部及全身未见复发。结论：脊索瘤在原发性骶骨肿瘤中的发病率居首，患者条件允许的前提下，原发性骶骨肿瘤的治疗应采取以手术为主的综合治疗。     

脊柱原发性恶性肿瘤的外科治疗策略探讨

目的探讨脊柱原发性恶性肿瘤患者应用外科手术外科治疗的效果及并发症。方法选择2009年1月～2010年10月的共诊断收治的脊柱原发性恶性肿瘤患者100例,其中,脊索瘤43例,骨髓瘤17例、恶性淋巴瘤12例、软骨肉瘤8例、骨肉瘤7例、尤文肉瘤6例、恶性纤维组织细胞瘤5例、纤维肉瘤2例。所有患者都采取手术经前路切除肿瘤的方法来治疗,观察治疗效果。结果 100例脊柱原发性恶性肿瘤患者中,其中有94例（94%）手术结束后疼痛得到不同程度的缓解,6例手术后疼痛没有明显的减轻。所有患者都随访,随访周期为12个月。在12个月的随访期内未见患者有严重的并发症。同时,还有11例患者手术后出现了脑脊液漏的情况,经医护人员应用抗生素及抬高床尾等措施治疗后全部愈合。结论对于脊柱原发性恶性肿瘤破坏单个或相邻的2个脊椎时,正确的治疗方法是：应采用前后路联合手术切除肿瘤的方法进行治疗。患者在确诊手术前手术医生一定要做好分期设计手术方案,以保证最大程度的合理切除肿瘤,这样不但可以降低手术后复发率,还可以减少并发症以及患者经济负担。本文100例脊柱原发性恶性肿瘤患者取得了满意疗效,值得临床推广。     

骶尾部肿瘤切除麻醉手术的配合

骶尾部肿瘤切除手术难度大 ,术中出血多且止血困难 ,如不及时处理可发生休克甚至死亡。我室自 1989年 1月至1998年 6月共行骶尾部肿瘤手术 40例 ,术中大出血 2 7例 ,发生率 6 8.2 % ,其中急性失血性休克 10例 ,术后死亡 1例。现将我们在麻醉手术中的护理配合介绍如下。1　临床资料1.1　一般资料 :本组 40例 ,男 2 5例 ,女 15例 ,40 d至 5岁 11例 ,16～ 18岁 2 9例。肿瘤类型包括巨细胞瘤 15例 ,恶性畸胎瘤 11例 ,骶骨脊索瘤 6例 ,软骨肉瘤及骶骨浆细胞瘤各 2例 ,尤文氏瘤、骨母细胞瘤、恶性淋巴瘤、骶骨神经鞘瘤各 1例。1.2　手术体位及时间…     

肩胛骨恶性肿瘤的保肢治疗

目的探讨肩胛骨恶性肿瘤的保肢治疗方法。方法自2007年,我们对8例肩胛骨恶性骨肿瘤实施了保肢术。男5例,女3例;年龄11～63岁,平均45.6岁。肩胛骨骨肉瘤4例,肩胛骨软骨肉瘤3例,肩胛骨恶性纤维组织细胞瘤1例,行限制型全肩胛骨假体置换手术。术后应用化疗。结果术后随访,8例患者中无失访病例,8例随访平均22个月（3～28个月）,1例死亡。根据Enneking[1]肢体功能评价标准：良6例,可2例。     

膝关节周围恶性骨肿瘤原位微波灭活术初探

在恶性骨肿瘤尤其是骨肉瘤的治疗中 ,对股骨远端或胫骨近端行瘤段骨瘤外解剖 ,并用微波对肿瘤进行原位灭活是保肢的重要手段。我院自 1996～ 1999年采用该术式治疗膝关节周围恶性骨肿瘤 32例 ,经初步随访 ,取得较满意的疗效。1　资料与方法1.1　一般资料　骨肿瘤患者 32例 ,男 17例 ,女 15例 ,12～6 2岁 ,平均 2 4 .6岁。肿瘤位于股骨下端 17例 ,胫骨上端 15例。骨肉瘤 19例 ,骨巨细胞瘤复发 5例 ,软骨肉瘤 4例 ,恶性纤维组织细胞瘤 2例 ,骨旁骨肉瘤 2例。Ｅｎｎｅｋｉｎｇ分级均在Ⅱｂ 以内。1.2　方法1.2 .1　术前准备　患者术前检查 ,包…     

三维可视化技术在胸骨肿瘤切除和胸壁重建中的应用

目的：探讨三维可视化技术在使用钛板及模块化假体进行胸骨重建的临床效果。方法：回顾性分析了2013年6月至2019年12月,在徐州医科大学江阴临床学院胸心外科施行了根治性切除的10例胸骨肿瘤病例,10例患者术前均行常规CT检查及三维可视化重建,其中6例病例使用钛板进行胸骨重建,4例病例使用模块化假体进行胸骨重建。结果：10例患者手术均顺利完成,围手术期间1例患者出现较严重的肺部感染,予以对症治疗后治愈,余患者无明显手术并发症。术后病理结果显示浆细胞瘤2例,软骨肉瘤4例,胸骨及周围软组织转移性甲状腺滤泡性癌1例,恶性纤维组织细胞瘤1例,软骨母细胞瘤1例,骨肉瘤1例。10例患者随访期为60个月;2例软骨肉瘤患者复发死亡,生存期分别为10个月及30个月;1例浆细胞瘤患者因多发转移死亡,生存期为28个月;1例软骨肉瘤患者因其他原因死亡,生存期为40个月;余患者未见复发,状况良好。结论：三维可视化技术在胸骨肿瘤切除及胸骨重建的术前评估和术中操作中有极大的指导作用,具有广泛的应用前景。     

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.