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1.
目的 完善相关术前评估并取得患者知情同意后,国内首次开展单孔多通道经腹3D腹腔镜肾切除术,探讨该手术的可行性和安全性,总结操作经验。方法 2013年8月5日,我科完成1例单孔多通道经腹3D腹腔镜下肾切除术(右侧)。患者术前检查示:肌酐81 μmol/L;核素(99mTc DTPA)肾功能检查:右肾9.5 mL/min,左肾65 mL/min。诊断为“右肾重度积水”,所以给予患者行右肾切除术。术中先于右侧腹直肌外侧缘脐水平上1 cm处向头侧取长约3 cm手术切口,在游离肾蒂动静脉后,分别离断肾脏动静脉,后于髂血管水平离断右侧输尿管。将肾脏装入取物袋,延迟切口至约4 cm,从原切口取出。结果 在不增加任何额外切口的情况下顺利完成手术,手术时间154 min,术中出血150 mL。患者术后第1天胃肠道功能恢复后进食。术后第1天患者术后检查示:肌酐为76 μmol/L,术后第1天、第2天、第3天视觉模拟疼痛评分分别为2/10、1/10、0/10,术后未使用任何止痛药物,第3天出院,无任何术中或术后并发症。结论 单孔多通道经腹3D腹腔镜下肾切除术安全、可行、有效。术后患者疼痛轻,恢复快,切口小。单孔3D腹腔镜由于手术图像立体感强,手术操作精确度高,手眼协调难度明显降低,具有良好的临床应用前景,但目前完成的病例数较少,仍需要临床经验积累。  相似文献   

2.
目的:探讨经腹腔路径腹腔镜活体供肾切取技术的方法以及手术的安全性和临床意义.方法:2008年5月及8月分别对1例58岁的父亲和1例50岁母亲供肾亲属肾移植的供者实施经腹腔路径腹腔镜活体供肾切取并随访.结果:手术用时分别为130 min和110 min,出血量各50 ml,热缺血时间30 s和2 min;肾动脉长度分别为4.0 cm和3.5 cm,肾静脉长度各为3.0 cm,开放血流后30 s和10 s供肾泌尿,2例供者术后肾功能正常,均7 d拆线出院,无手术并发症,受者肾功能恢复良好.结论:经腹腔路径腹腔镜活体供肾切除术可以满意解剖肾血管和保留足够长的输尿管,而且安全、有效,创伤小、恢复快、痛苦少,供者易于接受.  相似文献   

3.
目的 探讨后腹腔镜下供肾切取术(RPLDN)与传统开放活体供肾切取术(ODN)在活体供肾切取术中临床应用.方法 对45例供者采用后腹腔镜供肾切取术的22例,传统开放取肾手术的23例,所有供受者随访3~24月,分析资料进行比较总结.结果 RPLDN与ODN相比较:手术时间无明显差异(分别为75±35 min与65±26 min,p>0.05),术中出血亦较少(分别为150±50 ml与110±40 ml,p>0.05),RPLDN供肾热缺血时间相对较长(分别为107±34 s与20±5 s,P>0.05),所取血管长度较短(供肾动脉3.8±1.6 cm/4.2±0.6 cm,P<0.05;供肾静脉2.5±1.3 cm/3.5±0.8cm,P<0.05);供者术后恢复方面,RPLDN的供者术后下床时间较早(分别术后3±1 d与术后5±1 d,P<0.05).肾移植术中血管开放后供肾均在1 min内泌尿,RPLDN术后1周出现排斥反应1例,肾功能恢复延迟(DGF)1例.ODN受者术后1月出现急性排斥1例,其余均在术后3 d血清肌酐恢复至正常.所有供者术后7 d伤口拆线后均出院.结论 后腹腔镜手术与传统开放手术在亲属供肾切取临床应用术中、术后并发症方面比较均未见明显差异,但是腹腔镜活体供肾切取术对供者具有创伤小,恢复快、不影响肾功能等优势,更能促进亲属肾移植的开展,增加供肾来源.  相似文献   

4.
亲属活体供肾切取术式选择探讨   总被引:1,自引:0,他引:1  
目的 探讨亲属活体供肾切取术式选择的策略及不同术式的临床效果.方法 回顾总结我院2004年1月至2007年6月119例亲属供肾切取的4种术式:(1)经腹部开放手术22例;(2)经腹膜后隙腹腔镜下切肾21例;(3)经腹手助式腹腔镜下切肾13例;(4)经腰部腹膜后隙开放手术切肾63例.比较开放手术与腹腔镜手术手取肾的手术时间、供肾热缺血时间、供肾动静脉长度、供肾移植后3 d内血肌酐的下降速度、供者术后平均住院日及住院费、供者术后并发症.结果 开放手术比腔镜手术组:手术时间短(P=0.0033)、供肾热缺血时间短(P=0.0001);供者术后住院时间长(P=0.0000) 住院费用多(P=0.0000);受者术后3 d血肌酐下降速度快(P=0.0001);供肾血管长(左P=0.0000,右P=0.0001).并发症:腔镜组:皮下气肿1例、DGF2例、术中腰静脉大出血改开放手术2例,开放组术后继发肾上腺大出血再手术1例.两组无移植肾丢失及供者生存意外发生.结论 开放手术与腔镜手术切取活体供肾均是安全的术式.亲属活体供肾切取术式的选择应根据供者肾脏血管的形态、供者体形、术侧、术者对术式的熟练程度综合决定.开放手术取肾稳妥、快捷;腔镜手术取肾损伤小,恢复快,供肾血管短、移植早期血肌苷下降速度慢.  相似文献   

5.
[目的]探讨手辅助腹腔镜下活体供肾切除术的临床经验和安全性。[方法]10例供者进行手辅助腹腔镜下活体供肾切除术,术前对供者进行全面评估,常规移植给受者,观察记录术中出血量、手术时间、供肾热缺血时间、并发症发生情况及供受者的恢复情况。[结果]所有的手术均顺利完成,6例患者切取左肾,4例患者切取右肾,供者术中出血量(116.7 75.3)mL,供肾热缺血时间为(159.8 80.2)s,手术时间为(207.5 80.6)min,术后肾周引流管引流量为(138.0 217.1)mL,平均住院时间为(10.5 4.3)d,供者术前肌酐为80.6μmol/L,术后1周的肌酐为110.4μmol/L,两者差别有统计学意义(P<0.05),后逐渐降至正常。供者术后出现上腹疼痛1例和术后发热1例,1例受者肾功能延迟恢复,其余受者顺利恢复。[结论]手辅助腹腔镜下活体供肾切除术对供者影响小,是一种安全、可靠且可能广泛推广应用的手术方法。  相似文献   

6.
目的     探讨腹腔镜辅助小切口亲属活体供肾切取术手术方式的安全性及实用性。方法      回顾性分析济南军区总医院泌尿外科2007年12月至2009年6月,15例采用腹腔镜辅助小切口进行活体供肾切取的健康供肾者临床资料。结果     15例手术均成功,供肾热缺血时间(40±15)s,切取供肾平均手术时间65(50~85)min。术中出血(50±20)mL,移植肾开放血流后来尿时间平均为1min;移植肾功能恢复正常时间2~3d,血肌酐水平(110±30) μmol/L,供者切口引流管留置1~3d,术后住院时间5~6d。结论     腹腔镜辅助小切口活体供肾切取术不使用气腹,具有创伤小、手术时间短、恢复快、安全性和实用性较高特点,兼顾腹腔镜与开放手术的优势,并具有良好的经济性。  相似文献   

7.
【目的】探讨手辅助腹腔镜下活体供肾切除术的临床经验和安全性。【方法】10例供者进行手辅助腹腔镜下活体供肾切除术,术前对供者进行全面评估。常规移植给受者,观察记录术中出血量、手术时间、供肾热缺血时间、并发症发生情况及供受者的恢复情况。【结果】所有的手术均顺利完成,6例患者切取左肾,4例患者切取右肾,供者术中出血量(116.7±75.3)mL,供肾热缺血时间为(159.8±80.2)s,手术时间为(207.5±80.6)min,术后肾周引流管引流量为(138.0±217.1)mL,平均住院时间为(10.5±4.3)d,供者术前肌酐为80.6μmol/L,术后1周的肌酐为110.4umol/L,两者差别有统计学意义(P〈0.05),后逐渐降至正常。供者术后出现上腹疼痛1例和术后发热1例,1例受者肾功能延迟恢复,其余受者顺利恢复。【结论】手辅助腹腔镜下活体供肾切除术对供者影响小,是一种安全、可靠且可能广泛推广应用的手术方法。  相似文献   

8.
腹腔镜活体供肾切取肾移植2例临床观察   总被引:1,自引:0,他引:1  
目的:探讨腹腔镜活体供肾切取术的可行性及优越性,了解受者移植术后临床效果.方法:对2例亲属活体供肾采用腹腔镜活体供肾切取,1例经腹腔途径,穿刺分别位于脐部、左肋缘下腹直肌旁和腋中线平脐处,供肾经脐部切口取出.另一例经后腹腔途径,在腋后线肋缘下1cm处建立腹膜后间隙并置入穿刺套管,然后分别在腋中线髂嵴上和腋前线肋弓下置入穿刺套管及操作器械.充气压力1.87 kPa,在肾周脂肪囊内游离肾脏,于肾下极平面找到输尿管,游离至髂血管水平.经平行腹股沟韧带切口取出供肾.经简单修整灌洗后移植受者的右髂窝内.受者已随访1年以上.结果:供者术后恢复快,均于40d内恢复正常工作,随访过程中无不良主诉.2例受者随访15~18个月,尿量及肾功能均在正常范围,无并发症发生.结论:腹腔镜活体供肾切取创伤小、恢复快.移植肾功能恢复及预后良好.  相似文献   

9.
活体供肾在肾脏移植中所占的比例越来越大,部分地区甚至已经超过尸肾来源[1],临床对活体取肾术的要求也越来越高.目前常用的活体供肾获取方法主要包括开放式(传统开放活体供肾切取术、小切口开放活体供肾切取术)和腹腔镜供肾切除术(经典腹腔镜活体供肾切取术、手辅助腹腔镜活体供肾切取术、后腹腔镜活体供肾切取术)[2-5].  相似文献   

10.
活体肾移植供者术后的回顾分析   总被引:4,自引:0,他引:4  
目的:对亲属活体肾移植供者术后的肾功能和生活质量进行调查.方法:回顾性分析2000年5月-2007年4月亲属活体间捐肾的供者93例,对供者在捐肾手术前、手术后7 d,术后>6个月的血肌酐、内生肌酐清除率(Ccr)、尿蛋白情况进行检测,并利用国际上通用的SF-36健康调查量表对供者术后的生活质量进行调查.结果:供肾切取术后7 d和术前相比,供体血肌酐上升30.16 μmol/L,上升幅度为38.5%(P=0.0000<0.05),差异有统计学意义但无临床意义(数值在正常值范围内);术后7 d和术后>6个月相比(P=0.1095>0.05)差异无统计学意义.供肾切取术后7 d和术前相比,Ccr下降38.44 mL/min,下降幅度为40.1%(P=0.017<0.05),差异有统计学意义但无临床意义(数值在正常值范围内);术后7 d和术后>6个月相比(P=0.1095>0.05),差异无统计学意义.供者术后的生活质量评分比普通人群略低(但P>0.05).结论:亲属活体肾移植的供者在捐肾后肾功能未见减退,且生活质量较好,和普通人群无明显差异.  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.  相似文献   

15.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.  相似文献   

16.
A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(~'4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.  相似文献   

17.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.  相似文献   

18.
Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.  相似文献   

19.
Objective To measure Derpl and Blot5 allergen levels in asthmatics' homes in Hongkong.Methods Seventy houses were enrolled for a mite indoor environment study. Dust samples were obtained from two sites of each patients' house: bed and floor. Derpl and Blot5 levels were quantified by a two-site monoclonal antibody-based ELISA technique.Results The levels of Derpl allergens found in bed (geometric mean (GM) 3.43 μg/g of dust; 95%CI, 1.89-4.96 μg/g)and on the floor (GM 1.12 μg/g of dust; 95%CI, 0.71-1.53 μg/g) indicated significant differences (P=0.005). However, the levels of Blot5 allergens found in bed (GM 19.00 μg/g of dust; 95%CI, 0.89-38.90 μg/g) and on the floor (GM 6.14 μg/g of dust; 95%CI, 0.40-11.90 μg/g) showed no statistically significant difference. In addition, in regards to the exposure index for Derpl and Blot5 allergens found in bed and on the floor, 17.6% in bed and 8.6% on the floor had levels of Blot5 ≥ 10 μg/g of dust, higher than those obtained for Derp1 (7.2% and 0% in bed and on the floor respectively, P< 0.05); higher percentages in bed and on the floor (25.0% and 35.7%) were observed for levels of Blot5 =0 μg/g of dust as compared with Derpl in bed and on the floor (4.3% and 14.5% respectively, P< 0.05).Conclusions Derpl and Blot5 are the major allergens found in this regional study, Blot5 is a more potent allergen in Hongkong, probably reflecting the high level of exposure to Blomia tropicalis (Bt). Bt and Dermatophagoides pteronyssinus (Dp) allergens should be included for precise diagnosis and effective immuno-therapeutic treatment of mite allergy in Hongkong.  相似文献   

20.
ANTI-PROLIFERATION EFFECT OF ORIDONIN ON HL-60 CELLS AND ITS MECHANISM   总被引:4,自引:0,他引:4  
Objcetive To investigate the anti-proliferation effect of oridonin on leukemic HL-60 cells and its mechanism. Methods HL-60 cells in vitro in culture medium were given different concentrations of oridonin. The inhibitory rate of cells were measured by microculture tetrazolium (MTT) assay, cell apoptotic rate was detected by flow cytometry (FCM), morphology of cell apoptosis was observed by hoechst 33258 fluorescence staining, and the activity of telomerase was detected using telomere repeat amplification protocol (TRAP) PCR-ELISA before and after apoptosis occurred. Results Oridonin could decrease telomerase activity, inhibit growth of HL-60 cells, and cause apoptosis significantly. The suppression was both in time- and dose-dependent manner. Marked morphological changes of cell apoptosis including condensation of chromatin and nuclear fragmentation were observed clearly by hoechst 33258 fluorescence staining especially after cells were treated 48-60 hours by oridonin. Conclusions Oridonin has apparent anti-proliferation and apoptotic effects on HL-60 cells in vitro, decreasing telomerase activity of HL-60 cells may be one of its most important mechanisms. These results will provide strong laboratory evidence of oridonin for clinical treatment of acute leukemia.  相似文献   

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