内镜切除早期胃癌时导致的胃穿孔：使用内镜夹治疗可完全闭合而避免外科手术

背景：当内镜下切除早期胃癌发生胃穿孔时，人们通常采取手术治疗。鉴于内镜下黏膜切除术（EMR）数量的增加和胃穿孔可能性的增加，作进行该研究目的是探索内镜治疗胃穿孔的可行性。方法：从1987-2004年间，在日本国家癌症中心医院行胃EMR的2460例患中，121例患（4．9％）在行EMR时发生胃穿孔。最初的4例患行急诊手术治疗。后来行内镜夹治疗的117例患作为研究对象。结果：用内镜夹闭合成功地治疗了115例胃穿孔患（98．3％）。2例患治疗失败行急诊手术治疗。在过去的6年里，用内镜夹治疗胃EMR时发生穿孔患的治愈率与未穿孔患相似。结论：早期胃癌内镜下切除时发生的胃穿孔可用内镜夹进行保守治疗完全闭合。     

经自然管壁内镜手术胆囊切除术动物实验

目的探讨单孔腹腔镜辅助下自然管壁内镜手术（NOTES）胆囊切除术的操作方法、可行性及安全性。方法采用成年杂种犬模型10只。先后完成内镜下胃造口术、腹腔探查、经脐单孔腹腔镜辅助下胆囊暴露及内镜下胆囊切除术。术后钛夹闭合胃壁切口,常规应用抗生素3d,半流食饲养。2周后处死模型解剖,观察胆囊切除术后改变。结果8只模型胆囊切除术后存活2周,1只实验中死亡,1只存活1周后死于腹腔脓肿,成功率80%（8/10）。平均用时80min/例次（40-150min）,术中肝脏出血应用电凝止血4次,钛夹闭合1次;胆囊及胆囊管残端漏各1次,用钛夹闭合成功。存活两周模型解剖胃壁造口完整闭合,腹腔无脓肿。结论杂种犬能较好模拟人体进行内镜胆囊切除术研究,经脐戳孔辅助经胃途径胆囊切除术是可行的,具有一定的安全性,目前的器械和设备尚不能满足NOTES技术需要,还有待研发。     

自体血痂填充联合皮肤闭合器治疗小切口脂肪液化的临床效果分析*

目的：研究自体血痂填充联合皮肤闭合器治疗手术后小切口脂肪液化的临床疗效。方法：选择2015年1月—2017年1月于石河子大学医学院第一附属医院住院进行腹部手术后出现小切口脂肪液化的患者40例(液化切口长度≤5 cm),按随机分组法分为两组,各20例。 A组采用自体血痂填充联合皮肤闭合器治疗, B组采用传统换药治疗,再将A、 B两组按切口长度分为A1、 B1组(≤3 cm)和A2、B2组(>3~5 cm),各10例。比较A、B两组平均换药次数;比较A1和B1组、A2和B2组患者总有效率、手术切口愈合时间;比较不同手术切口长度的愈合时间。结果：治疗后1周,A组患者总有效率(100%)明显高于B组(80%)(P<0.05);A1、A2组的愈合时间均较B1、B2组短(P<0.05);A1组手术切口的愈合时间较A2组短;A组平均换药次数明显少于B组。结论：使用自体血痂填充联合皮肤闭合器治疗小切口脂肪液化,换药次数少,愈合时间短,值得临床推广。     

闭合复位空心钉内固定术应用于股骨颈骨折的临床研究

目的评价闭合复位空心钉内固定术治疗中青年股骨颈骨折的临床疗效。方法对我院26例中青年股骨颈骨折患者采用闭合复位2枚空心钉内固定术治疗（A组）,与开放复位内固定（B组）进行对比。结果实验A组愈合25例,出现坏死1例;对照B组愈合27例,出现坏死1例;两组在切口长度、术中时间、出血量方面有统计学意义（P〈0．01）,在愈合率上无统计学差异（P〉0．05）。结论闭合复位空心钉内固定治疗中青年股骨颈骨折具有创伤小特点．是一种比较好的治疗方法。     

颈部内镜颌下腺切除术和传统手术的对照研究

目的通过与传统手术临床对照研究,评估颈部小切口电视内镜颌下腺切除术的可行性及其优点。方法术前评估为良性肿瘤的病例26例,手术于颈部皮纹内长2．O～2．5cm的小切13下,内镜辅助完成颌下腺切除术。与同期进行的传统手术病例65例,进行对照研究。对两组病例切口长度、手术时间、术中出血量进行统计分析,比较有无统计学差异。结果两组91倒手术完成顺利,内镜组切1：2（2．3±0．2）cm;术中出血（9．4±4．2）mL;手术时间（74±12）min;术后总引流量平均（21．2±5．7）mL。1例术后出现同侧舌部麻木,2周后恢复。无面神经及舌下神经损伤病例。与传统手术比较,手术切口缩短（P〈0．01）,出血减少（P〈0．01）,术后引流量减少（P〈0．05）,差异有统计学意义。而手术时间差别无统计学意义（P〉0．05）。全部病例随访1～5年,平均29个月,均未见复发。结论内镜下颈部小切口颌下腺切除术手术切口明显缩小,术后美观效果好,并发症少,是一种较为理想的颌下腺切除方法。     

超声乳化术毕眼压对无缝线透明角膜切口闭合的影响

目的：探讨超声乳化术毕眼压与早期无缝线透明角膜切口闭合的相关性。方法将90例（94眼）住院行手术治疗的老年性白内障患者随机分为A组46例（49眼）和B组44例（45眼）。 A组设置术毕眼压15～20 mmHg，B组设置术毕眼压21～25 mmHg。术后3 d内，观察透明角膜切口、眼压、视力、中央角膜内皮细胞、角膜厚度的情况。结果术后3d内，两组视力、眼压、角膜内皮细胞无明显差异，透明角膜切口闭合有差异，角膜切口闭合程度B组明显优于A组。结论术毕适度高眼压能促进超声乳化术后透明角膜切口闭合，眼前段光学相干扫描仪能无创、可重复、高度灵敏的检测早期术后切口情况，指导手术操作，减少术后并发症的发生。     

鼻内镜下真菌性上颌窦炎的治疗体会

目的：探讨鼻内镜下中、下鼻道双径路与鼻内镜下中鼻道两种手术方式治疗真菌性上颌窦炎的疗效。方法40例真菌性上颌窦炎患者行鼻内镜下中、下鼻道上颌窦联合开窗术治疗（A 组）,53例采用鼻内镜下中鼻道开窗术治疗（B 组）。术后随访1～2年,定期行鼻窦冲洗及鼻内镜复查。根据1997年海口标准评定手术疗效。结果A 组治愈36例（90％）,好转4例（10％）,无效0例,有效率为100％;B 组治愈45例（84．9％）,好转1例（1．9％）,无效及复发7例（13．2％）,有效率为86．8％。两组有效率差异有统计学意义（χ2＝5．713,P ＝0．018）。结论鼻内镜下鼻窦术治疗真菌性上颌窦炎有效,可先行中鼻道开窗术,对真菌球不能彻底清除者,加用下鼻道开窗术治疗,可以达到理想的效果。     

不同方法内镜下治疗非静脉曲张性上消化道出血的临床效果研究

目的：研究不同方法内镜下治疗非静脉曲张性上消化道出血的临床效果。方法：选择我院2012—03～2013—06128例确诊的非静脉曲张性上消化道出血患者，采用数字表随机法分为A、B、C、D四组，分别采用不同的内镜下止血方法，治疗后即时和治疗后7d对治疗效果进行评价。结果：B组治疗即刻与7d后治疗有效率分别为100％、96．88％；高于A、C、D组，A组治疗即刻与7d后治疗有效率分别为90．63％、91．25％、高于C、D组，组间比较差异具有显著性（P〈0．05）。C组、D组止血效果比较差异无显著性（P〉0．05）。结论：内镜下注射止血和内镜下钛夹止血两种方法优势明显，是较好的止血方法。     

经自然腔道内镜手术的研究进展

经自然腔道内镜手术（natural orifice transluminal endoscopic surgery,NOTES）是以软式内镜为治疗工具,不经皮肤切口。而是经阴道口、阴道、结直肠等自然腔道对腹腔疾病进行治疗的微创外科治疗方法。自Wilk[1]提出NOTES概念及Kalloo等心[2]发表经胃内镜动物腹腔探查的实验报告后,NOTES成为国内外研究热点,目前已从动物实验进入初步临床应用阶段。现对NOTES的发展历史、研究现状、手术器械发展及其技术展望作综述。     

观察慢性萎缩性胃炎内镜诊断与病理结果对照分析

目的：分析并探讨慢性萎缩性胃炎（ CAG）内镜诊断与病理诊断的关系。方法：选取我院2012年9月～2014年9月收治的120例慢性萎缩性胃炎患者为研究对象,回顾性分析上述患者的临床资料,对其内镜下表现和病理结果进行比较。结果：本组120例患者均经内镜诊断为慢性萎缩性胃炎,经病理诊断证实为CAG82例,诊断符合率为68．33％。内镜下表现为黏膜变薄（A）和白相为主、血管暴露并透明可见（B）37例,病理证实为CAG17例,占45．95％;内镜下表现为黏膜粗糙（C）33例,病理证实为CAG19例,占57．58％;内镜下表现为可见灰色肠上皮化生结节（ D）15例,病理证实为CAG9例,占60％;内镜下表现为A＋B＋C19例,病理证实为CAG17例,占89．47％;内镜下表现为A＋B＋D16例,病理证实为CAG15例,占93．75％。结论：内镜下多种表现对诊断慢性萎缩性胃炎具有较高价值,与病理诊断相结合可提高慢性萎缩性胃炎的临床诊断符合率。     

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…     

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.     

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.     

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.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…