3D腹腔镜技术在腹腔镜辅助根治性全胃切除术中的应用价值

目的探讨3D腹腔镜技术在腹腔镜辅助全胃切除术及D2淋巴结清扫中的应用价值。方法选取2015年2月至2016年3月郑州大学附属肿瘤医院收治的符合入组标准的行腹腔镜辅助根治性全胃切除术的73例患者,根据患者使用腹腔镜的不同将其分为3D腹腔镜组(3D组,35例)和2D腹腔镜组(2D组,38例)。比较两组患者腹腔镜下食管空肠吻合时间、脾门清扫时间、总手术时间、出血量、淋巴结清扫数、排气时间、进食时间、术后短期并发症(吻合口瘘、吻合口出血、乳糜漏及胰漏)和术后住院时间。结果 3D组腹腔镜下食管空肠吻合时间、脾门清扫时间、总手术时间和出血量均明显优于2D组(P<0.05);两组淋巴结清扫数、排气时间、进食时间、术后短期并发症(吻合口瘘、吻合口出血、乳糜漏及胰漏)和术后住院时间比较,差异无统计学意义(P>0.05)。3D组出现吻合口瘘1例,2D组出现吻合口瘘2例,胰瘘2例,乳糜漏1例,均经保守治疗后恢复出院。结论 3D腹腔镜技术在腹腔镜辅助根治性全胃切除术中是安全可行的,且能缩短腹腔镜下食管空肠吻合时间、脾门清扫时间及总手术时间,减少术中出血量。     

手辅助腹腔镜胃癌根治性全胃切除术15例

目的总结手辅助腹腔镜技术在胃癌D2根治性全胃切除术中应用的临床经验。方法回顾性分析15例全胃切除术患者的临床资料。结果成功施行手辅助腹腔镜胃癌D2根治性全胃切除术15例。上腹部手术切口长(6.79±1.3)cm;手术时间(168±19)min,腹腔镜手术时间(31±11)min;术中出血(228.57±32.1)mL;手术清扫淋巴结(17.64±4.1)枚。手术后(9±1.5)d出院。没有吻合口漏、出血、切口感染等手术并发症发生。结论手辅助腹腔镜胃癌D2根治性全胃切除术在淋巴结清扫范围和数目上均能够达到胃癌手术操作规范要求,而且安全性好,值得进一步研究。     

自牵引后离断顺蠕动食管空肠吻合在全腹腔镜全胃切除术中的应用效果

目的 探讨自牵引后离断(SPLT)顺蠕动食管空肠吻合在全腹腔镜下全胃切除术中的应用效果.方法 回顾性分析2018年6月至2020年7月安徽医科大学附属巢湖医院胃肠外科43例行全腹腔镜下根治性全胃切除术患者的临床资料,根据术中食管-空肠的吻合方式,行SPLT顺蠕动吻合的20例患者作为SPLT组,行Overlap吻合的23例患者作为Overlap组.根据术中及术后情况,分析比较两组患者手术时间、食管-空肠吻合时间、术中出血量、淋巴结清扫数量、术后肛门恢复排气时间、术后并发症例数等指标的差异.结果 所有患者均予全腹腔镜下胃癌根治术并常规行D2清扫,无中转开腹.SPLT组患者手术时间为(162.48±18.34)min、食管空肠吻合时间为(26.12±5.38)min,均短于Ovelap组,差异有统计学意义(P<0.05).两组患者术中出血量、淋巴结清扫数量、术后肛门恢复排气时间及术后并发症比较,差异无统计学意义(P>0.05).结论 全腹腔镜下全胃切除术中SPLT顺蠕动吻合方式操作简单可靠,能明显缩短手术时间,预后恢复较好,临床值得推广.     

腹腔镜下胃癌D2根治术58例分析

目的探讨腹腔镜下胃癌D2根治术的临床效果及手术技巧。方法回顾性分析58例在腹腔镜下行胃癌D2根治术患者的临床资料。结果本组行根治性全胃切除+Roux-en-Y吻合术15例,根治性远端胃大部切除+毕氏II式吻合的43例。平均手术时间(260±35)min,平均出血(60±40)ml,清扫淋巴结(20±4)枚,术后排气时间2～4 d,术后进流质时间3～4 d。术后发生十二指肠残端漏1例,经保守对症治疗后痊愈。结论腹腔镜下胃癌D2根治术治疗胃癌具有安全、有效且创伤小的特点,有利于术后快速康复。     

食管空肠双吻合在腹腔镜下全胃切除术中的应用

目的 探讨食管空肠双吻合技术在腹腔镜下全胃切除手术中应用的可行性和效果。方法 回顾性分析2012年4月至2014年10月同济大学附属第十人民医院胃肠外科15例行腹腔镜下全胃切除术患者手术时间、术中出血量、术后病理资料、术后肠道功能恢复时间等资料。结果 15例患者均成功完成腹腔镜下全胃切除手术。手术时间为(223.2±21.67)min,术中出血量为(105.9±19.88)ml,平均清扫淋巴结(25.5±8.3)枚,术后平均排气时间为(2.1±0.98)d,术后下床活动时间为(3.4±1.22)d,平均住院天数为(9.8±2.66)d,2例出现手术相关并发症(肺部感染),其余患者术后恢复良好。结论 双吻合技术在腹腔镜全胃切除术中的应用可靠、安全,并可有效避免吻合口狭窄等并发症的发生。     

3D高清全腹腔镜残胃癌切除术的临床疗效分析

探讨因良性疾病而行胃大部切除术后发生的残胃癌患者,应用3D全腹腔镜残胃癌切除术的临床疗效。　方法　收集2015年5月至2018年6月大连医科大学附属第二医院收治的19例行3D高清全腹腔镜残胃癌手术患者资料,所有患者既往因胃良性疾病而行胃大部切除术,本次入院术前均经胃镜和病理活检确诊为胃癌。采用回顾性横断面研究方法,对患者手术及术后恢复情况、病理情况、住院费用等进行统计学分析,并随访其生存及复发情况。　结果　（1）手术情况：19例残胃癌患者中,行3D高清全腹腔镜根治性残胃切除术18例,行3D高清全腹腔镜姑息性残胃切除术1例。19例行3D高清全腹腔镜残胃切除术患者,手术时间为（223.63±53.47）min,术中出血量为（136.32±82.95）mL,淋巴结清扫数目为（26.05±6.84）枚。（2）术后情况：术后离床活动时间（1.39±0.46）d,术后肛门首次排气时间（2.08±0.92）d,术后进流食时间（4.45±2.39）d,拔除引流管时间（9.95±5.28）d,术后住院时间为（13.74±9.69）d。总费用（80271.69±22536.91）元。患者术后出现食管空肠吻合口漏1例,十二指肠残端漏1例,切口感染1例,肺部感染2例,无围手术期死亡。（3）随访情况：对19例行3D高清全腹腔镜残胃切除术患者随访,随访时间3~40个月,中位随访时间17个月;随访期间死亡7例,存活12例。　结论　对于因良性疾病而行胃大部切除术后发生的残胃癌,应用3D全腹腔镜行残胃切除术是安全、有效的。     

近端胃癌腹腔镜与开腹全胃切除术的临床疗效比较

目的 比较腹腔镜根治性全胃切除术和开腹根治性全胃切除术治疗近端进展期胃癌的近期临床疗效.方法 回顾性分析2010年1月至2016年6月于暨南大学第二临床医学院行腹腔镜根治性全胃切除术的192例近端进展期胃癌患者(腹腔镜组)与行开腹根治性全胃切除术的224例近端进展期胃癌患者(开腹组)的临床资料,比较两组患者的手术切口长度、术中出血量、手术时间、术后肛门首次排气时间、手术后并发症、死亡率、手术后住院时间及住院费用等.结果 与开腹组比较,腹腔镜组患者的手术切口长度更短,术中出血量更少,手术时间更长,术后肛门首次排气时间更短,住院费较高,差异均有统计学意义(P<0.05);腹腔镜组患者术后并发症尤其是肺部感染/肺不张、急性肺栓塞、急性心肌梗塞等发生率及死亡率较开腹组高,差异均有统计学意义(P<0.05).结论 近端进展期胃癌患者行腹腔镜根治性全胃切除术手术创伤小、患者痛苦较小、术中出血少、术后恢复快,但手术时间明显长以及体位、气腹等原因,对患者(尤其是老年患者)心肺功能影响较大,出现严重并发症的机会也较高.     

残胃近端空肠反转Roux-en-Y吻合在全腹腔镜远端胃癌根治术中的应用

目的:探讨全腹腔镜远端胃癌根治术后采用残胃近端空肠反转Roux-en-Y吻合进行消化道重建的手术方式的临床应用。方法:回顾性总结12例远端胃癌患者行全腹腔镜下远端胃癌根治术后采用残胃近端空肠反转Roux-en-Y吻合的消化道重建方式的手术方法和手术后情况。结果:12例患者均完成全腹腔镜下残胃近端空肠反转Roux-en-Y吻合,手术时间(265.0±23.6) min,消化道重建时间(46.0±13.2) min,出血量为(57.0±19.5) mL。术后患者排气时间为(2.7±0.5) d,术后住院时间为(8.2±1.4) d,淋巴结清扫数目(29.4±5.6)枚,没有发生手术相关早期并发症。结论:全腹腔镜下采用残胃近端空肠反转Roux-en-Y吻合的消化道重建的方式安全,操作简便,术后恢复快,更符合肿瘤手术无瘤原则,是一种理想的全腹腔镜胃癌根治术后消化道重建方式。     

手辅助腹腔镜胃癌根治性全胃切除术的价值评估

目的：探讨手辅助腹腔镜胃癌根治性全胃切除术的临床应用价值。方法：采用回顾性研究方法。收集2016年5月—2017年5月12例患者的临床资料,分析手术时间、手术切口长度、术中出血量、淋巴结清扫数目、术后肠道恢复功能时间以及住院时间。结果：12例患者均成功完成手辅助腹腔镜胃癌根治性全胃切除术,无中转开腹,无围手术期死亡。手术时间（167 ± 18）min,手术切口长度（6.57 ± 1.1）cm,术中出血量（225.56 ± 31.5）mL,淋巴结清扫数目（16.5 ± 3.2）枚,术后肠道恢复功能时间（3.5 ± 1.5）d,住院时间（8.6 ± 1.2）d。均未出现吻合口漏、出血、切口感染等术后并发症,恢复良好。结论：手辅助腹腔镜胃癌根治性全胃切除术安全可行,预后较好,淋巴结清扫范围和数目均能够达到根治性胃癌手术的标准,值得推广使用。     

手辅助腹腔镜技术在胃癌D2根治性全胃切除术中应用

目的探析对胃癌患者接受D2根治性全胃切除术治疗中联合手辅助腹腔镜技术对病情的改善作用和推广意义。方法选取本院2013年-2016年期间用全胃切除术治疗的胃癌患者30例相关临床资料为本文分析数据来源,所有患者均在手辅助腹腔镜引导下采取胃癌D2根治性全胃切除术,对患者数据资料回顾性分析并归纳该技术在胃癌D2根治性全胃切除术的应用价值。结果所有患者均顺利完成手术治疗。上腹部手术切口长度在6-7厘米范围间,平均长度为(6.57±0.33)厘米;手术时间在150-180分钟范围间,平均手术时间为(166.7±12.3)分钟;腹腔镜部分所用时间在18-58分钟范围间,平均所用时间为(31.2±11.4)分钟;术中出血量在84-400毫升范围间,平均出血量为(228.6±32.1)毫升;淋巴结清扫数量在13-35枚范围间,平均清扫淋巴结数量为(17.6±4.1)枚。结论对胃癌患者在D2根治性全胃切除术中联合手辅助腹腔镜技术,对患者清扫淋巴结的范围还有数量上都有着令人满意的治疗效果,且术后患者不会发生相关严重不良反应以影响康复和生活质量,值得临床不断完善和推广。     

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.     

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.     

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.