经皮肾镜治疗肾结石合并单纯性肾囊肿的效果分析

目的：探讨采用皮肾镜技术治疗肾结石合并单纯性肾囊肿患者的临床疗效及安全性。方法选择40例肾结石合并单纯性肾囊肿患者,采用经皮肾镜取石术对患者进行治疗,观察手术效果。结果所有患者均成功建立经皮肾镜通道,其中单通道34例,双通道6例;手术时间为45～110 min,平均（85±5）min;术后并无任何患者出现大出血、高热以及伤口感染等并发症;术后CT复查结果显示,一期结石取净37例（92.5%）,其余3例患者采用二期经皮肾镜取石术取净结石;所有患者术后随访3～12个月,无任何结石复发患者。结论采用经皮肾镜取石术治疗肾结石合并单纯性肾囊肿患者的效果较好,安全性高,值得推广应用。     

后腹腔镜肾实质切开取石术治疗复杂性肾结石的经验总结

目的 总结后腹腔镜肾实质切开取石术治疗复杂性肾结石的效果及手术技巧.方法 2010年1月～2016年3月本院对复杂肾结石患者实施后腹腔镜肾实质切开取石术23例.男15例,女8例,年龄32～75岁,平均52.6岁.结石长径0.8～5.5 cm,平均2.5 cm.结果 23例手术均成功完成,无中转开放手术者.手术时间40～180 min,平均87 min;9例患者未阻断肾动脉,14例患者肾动脉阻断14～39 min,平均27 min;术中失血量50～450 mL,平均160 mL,无输血病例.术中15例患者放置双J管,放置双J管时间3～8 min,平均4.2 min.术后血红蛋白较术前下降7～22 g/L,平均为10.9 g/L.术后1 d测血清肌酐19例较术前升高,4例较术前下降,平均升高12％.术后住院7～18 d,平均11.2 d.结论 后腹腔镜肾实质切开取石术治疗复杂性肾结石安全有效.可吸收线单层缝合肾实质切实可靠.对于合并同侧肾上腺肿瘤、肾囊肿、肾盂旁囊肿等疾病的患者可作为首选.     

微创经皮肾穿刺取石治疗多囊肾合并上尿路结石

目的 探讨微创经皮肾镜取石术治疗多囊肾合并上尿路结石的临床疗效.方法 17例多囊肾合并肾结石患者均采用B超定位经皮肾镜气压弹道碎石系统治疗,并观察结石清除情况.结果 均一期成功建立皮肾通道,6例同时行双侧碎石.手术时间70～140 min,平均(95.1±19.5)min,术中出血(60±13.4)mL.术中无气胸、腹...     

局麻下二期微通道经皮肾镜取石术治疗高危上尿路结石的疗效观察

目的探讨局麻下二期微通道经皮肾镜取石术（m-PCNL）治疗高危上尿路结石的临床疗效。方法对14例心肺功能障碍伴上尿路感染的老年上尿路结石患者行一期肾穿刺引流+抗生素治疗和局麻下二期m-PCNL，并观察其治疗效果。结果14例患者手术均顺利完成。手术建立F16皮肾通道10例，14F通道4例；二期m-PCNL时间23~58（39.6±10.7）min；手术前后血C反应蛋白、降钙素原、电解质等指标比较，差异均无统计学意义（均P＞0.05）；术中视觉模拟评分法（VAS）评分1.5~6.2（3.0±1.3）分。术后无严重并发症。术后复查X线腹部平片，发现目标结石取净，4例患者下盏残留直径4~8mm结石（其中2例再行m-PCNL取出结石，2例随访观察）。随访3~24个月，发现肾积水均有明显缓解；9例患者尿路感染完全消失，2例患者尿白细胞持续阳性。结论对于合并严重心肺功能障碍、上尿路感染等高危因素的上尿路结石患者，经肾穿刺引流控制感染后，二期采用局麻下头高侧卧位m-PCNL治疗目标结石是一种可选择的简单、安全、有效的方法。     

18例马蹄肾合并肾结石的微创治疗

目的 总结马蹄肾合并肾结石的微创治疗经验,并探讨其安全性与有效性.方法 回顾性分析18例马蹄肾合并肾结石患者的临床资料.结果 4例患者行ESWL治疗,3例排净结石,1例部分碎石移至肾下盏,结石清除率75%(3/4).14例行微创经皮肾取石术(MPNL),单通道取石12例,双通道取石2例;一期结石清除率71%(10/14),4例二期取石,2例患者术后残留结石＜4 mm未处理,总的结石清除率85%(12/14);手术时间55～140 min,平均95 min;住院时间7～23 d,平均15 d;无一例出现严重并发症,无患者需要输血.8例结石标本作成分分析,草酸钙 磷酸钙成分5例,草酸钙成分2例,尿酸成分1例.随访4～58个月,2例失访.1例并发输尿管肾盂连接部梗阻的5岁女童术后反复尿路感染,随访至58个月时结石复发,再次MPNL治愈.结论 ESWL与MPNL治疗马蹄肾合并肾结石安全、有效,掌握不同治疗方法的适应证有利于提高结石清除率.     

微创经皮肾镜碎石取石术治疗输尿管上段嵌顿性结石的疗效分析

目的 探讨微创经皮肾镜碎石取石术治疗输尿管上段嵌顿性结石的疗效.方法 对应用微创经皮肾镜碎石取石术治疗的42例输尿管上段嵌顿性结石患者的临床资料进行回顾性分析.结果 本组患者42例,行一期取石38例,因合并肾积脓行二期取石4例,合并肾结石5例,合并肾积脓4例,取净率100%,手术时间为40～120 min,平均90 min,肾造瘘管放置3～7 d,平均5 d.住院时间7～12 d,平均8 d,无大出血及其他严重并发症发生.结论 微创经皮肾镜碎石取石术治疗输尿管上段嵌顿性结石具有创伤少、住院时间短、出血少、结石清除率高及术后恢复快等优点.     

微创经皮肾镜取石术治疗肾结石患者的疗效观察

目的:探讨微创经皮肾镜取石术治疗肾结石患者的疗效。方法:随机选择94例肾结石患者,均给予微创经皮肾镜取石术治疗。结果:94例患者均行一期取石术,平均单侧手术时间75 min,结石取净率为89.3%(84/94)。术中发生大出血2例,术后继发出血1例,发热4例,均给予患者对症治疗后痊愈。所有患者术后均未发生严重并发症。结论:对肾结石患者行微创经皮肾镜取石术,可取得满意的临床效果。     

微创经皮肾镜取石术治疗马蹄肾结石

目的观察微创经皮肾镜取石术治疗马蹄肾结石临床效果。方法回顾性分析在2005年6月～2009年6月期间12例由KUB加IVU及CT确诊,接受微创经皮肾穿刺取石术治疗马蹄肾结石患者的临床资料。结果12例均一次成功建立通道。穿刺时间12～23min,平均14min。手术时间50～120min,平均65min。术中出血24～105mL,平均40mL,均未输血。本组结石一期清除率为83.3%(10/12),2例需要二次取石,术中无需要输血患者,未出现严重并发症,平均住院天数7d,随访2～24个月,12例肾积水均有不同程度好转,结石取净者未见结石复发。结论微创经皮肾镜取石术治疗马蹄肾结石效果确切、创伤较小,术后并发症少,具有广泛应用价值。     

双侧同期经皮肾镜取石术96例临床分析

目的 探讨双侧同期经皮肾镜取石术安全性及疗效.方法 回顾性分析双侧同期经皮肾镜取石术治疗双侧肾结石或输尿管上段结石患者92例临床资料,主要包括手术、住院时间、输血率、结石清除率及并发症等.结果 经皮肾穿刺均顺利完成,一期双侧碎石86例,第二侧二期碎石6例.手术时间70～250min,平均125min,输血率10.4%,术后平均住院时间6.0d,一期结石清除率80.4%(74/92),总结石清除率为89.1%(82/92).无气胸、腹腔脏器损伤等严重并发症.结论 对双侧肾结石或输尿管上段结石可有选择进行双侧同期经皮肾镜取石术.     

局部浸润麻醉下侧卧位微创经皮肾镜取石术38例观察

目的 探讨局部麻醉(局麻)超声引导下侧卧位行微创经皮肾镜取石术的可行性与安全性.方法 分析2007年8月至2008年8月采用局麻超声引导穿刺行微创经皮肾镜取石术治疗肾结石患者38例的临床资料,分别在术中及术后4、24、48 h行疼痛视觉模拟评分(VAS).结果 36例患者在局麻下完成手术,2例因不能忍受疼痛改为气管插管...     

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…     

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.     

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.