B超引导下经皮穿刺置管腹腔引流术的临床应用体会

目的探讨B超引导下经皮穿刺置管引流（PCD）腹腔积液（或积脓）的治疗效果。方法采用B超定点对23例腹腔积液（或积脓）患者施行PCD治疗。结果 23例均置管成功,病人在置管后48～72h症状缓解,腹部体征消失,B超检查证实脓腔缩小。本组23例平均引流时间8.4d,其中引流最短时间4d,最长时间21d,全部痊愈。结论 B超引导下经皮穿刺置管引流治疗腹腔积液（或积脓）创伤小,操作简便,易于掌握,引流效果好,医疗费用低,可避免因急诊手术或再次手术所致并发症的优点,适合基层医院推广应用。     

术中肺解剖定位法用于肺结节全胸腔镜下切除术的临床价值

目的探讨术中肺解剖定位法用于肺结节全胸腔镜下切除术的临床价值。方法选取胸部CT检查发现肺部磨玻璃样病变（GGO）结节的患者60例（肺结节共78枚）,均行肺结节全胸腔镜下切除术治疗。其中30例患者采用CT引导Hook-wire肺结节定位法（术前CT引导下穿刺针定位,术中找到穿刺针位置,行肺局部切除）,设为A组;另30例患者采用术中肺解剖定位法（通过术前肺CT薄层扫描确定肺结节与最近标志线关系,在术中萎陷肺表面找到肺结节的垂直投影点,予缝线标记,行肺局部切除）,设为B组。观察并比较两组患者肺结节定位正确率、手术切除时间、住院时间及住院费用。结果A、B两组患者肺结节定位正确率（86.7%比90.0%）、手术切除时间[（9.8±3.3）min比（10.5±2.8）min]、住院时间[（5.5±1.0）d比（5.6±1.1）d]及住院费用[（4.9±0.4）万元比（4.9±0.3）万元]比较均无统计学差异（均P＞0.05）。结论术中肺解剖定位法用于肺结节全胸腔镜下切除术具有可行性好、安全性高、无有创定位带来的并发症等优点,且手术时间不延长,术前定位工作量明显减少,可供同行借鉴。     

肺部小结节胸腔镜术前CT引导下钩线穿刺定位的临床应用

目的探讨胸腔镜术前CT引导下钩线穿刺定位在肺部小结节诊治中的临床应用价值。方法对98例胸部CT检查发现肺部小结节的患者行胸腔镜术前CT引导下钩线穿刺定位,共定位114颗肺部小结节（术前均无明确诊断）,定位结束后送手术室行胸腔镜肺局限性切除术。观测肺部结节大小及胸膜下距离、穿刺定位时间、定位成功率、穿刺后并发症和中转开胸比率等。结果本组患者的肺部结节直径（6.9±2.1）mm;胸膜下距离（9.5±6.9）mm。行CT引导下钩线穿刺定位操作顺利,定位成功率98.2%,定位时间：19～30min。穿刺后并发症包括气胸、出血和钩线脱落,发生率分别为22.4%、11.2%、3.1%。除2例患者中转开胸,余96例患者均成功完成胸腔镜手术,中转开胸率2.0%。术后所有患者均能明确肺部结节性质。结论胸腔镜术前CT引导下肺部小结节钩线穿刺定位是一种安全有效的方法,适用于一些定位困难的肺部小结节患者。     

改良式双胸管引流在肺癌微创手术中的应用

目的：探究改良式双胸管引流在肺癌微创手术患者中的应用效果分析。方法：选取行右上肺叶切除术+系统性淋巴结清扫术符合条件的236例患者临床资料,根据引流方式的不同分为：放置改良式双胸管引流组（A组）108例,男55例,女53例,年龄（49.00±4.23）岁,肿瘤直径（2.01±0.74）cm,吸烟者34例,体重（75.00±3.75）kg;放置单胸管引流组（B组）128例,男60例,女68例,年龄（50.00±2.37）岁,肿瘤直径（1.97±0.56）cm,吸烟者35例,体重（72.00±4.67）kg。两组患者的性别组成、年龄、体重、肿瘤直径比较差异均无统计学意义（P > 0.05）。观察比较两组患者术后的胸腔引流量、住院时间、住院费用,应用止痛药次数、术后疼痛评分、并发症情况。结果：A组患者胸腔引流量略少于B组患者,但无统计学差异（P > 0.05）;A组患者拔管（24 F粗胸管）时间［（1.13±0.65）d vs.（3.56±1.05）d,P < 0.05］,住院天数［（3.02±0.82）d vs.（4.86±1.11）d,P < 0.05］,住院费用［（6.72±0.63）万元vs.（8.27±0.74）万元,P < 0.05］均小于B组。A组根据术后疼痛评分应用止痛药次数［（2.02±0.72）次vs. （3.87±0.93）次,P < 0.05］,术后1个月VAS评分［（1.52±0.62）分vs. （3.41±0.52）分,P < 0.05］均小于B组患者;A组并发症发生率（1.69% vs. 4.24%,P＞0.05）低于B组患者,但差异并无统计学意义。结论：改良式双胸管引流与单胸管引流相比,缩短患者住院时间,减少患者住院费用,并且在术后恢复中减轻患者疼痛,有利于患者加速康复     

单腔中心静脉导管在创伤性胸腔积液伴肺不张中的应用研究

目的探讨床边B超定位下单腔中心静脉导管在创伤性胸腔积液伴肺不张中胸腔引流的应用价值。方法选择2012年12月至2016年5月因创伤导致闭合性胸腔积液并伴有同侧肺不张患者70例，伤后24～48h胸腔CT检查积液为中等量以上，其中男46例，女24例，年龄19～69（51.3±11.7）岁。采用随机数字表法分为硅胶管组35例，中心静脉导管组35例，两组患者分别于床边B超定位后切开或者穿刺置管引流。比较两组患者术中疼痛评分、积液估计量与实际引流量、置管时间、肺不张持续时间、引流管残端细菌培养阳性率。结果中心静脉导管组疼痛级别低于硅胶管组，差异有统计学意义（字2=11.704，P＜0.05），中心静脉导管组术后置管时间与肺不张持续时间[（3.5±1.1）、（7.2±2.8d]均较硅胶管组[（5.5±1.8）、（9.9±4.3）d）]短，差异均有统计学意义（t=9.511、4.863，均P＜0.05）。两组积液估计量[（680±210）、（757±210）ml）]比较,差异无统计学意义（t=0.020，P＞0.05），中心静脉导管组实际引流量（862±264）ml，少于硅胶管组（1066±275）ml，两组比较，差异有统计学意义（t=0.297，P＜0.05）。中心静脉导管组残端细菌培养阳性率（51.4%）低于硅胶管组（82.3%），差异有统计学意义（字2=7.835，P＜0.05）。结论对创伤后胸腔积液伴肺不张患者使用单腔中心静脉管作胸腔引流有其优越性，值得临床推广。床边B超评估及定位能获得更大受益。     

超声引导在CT增强检查静脉留置针穿刺困难患者中的应用研究

目的：探讨超声引导在CT增强检查静脉穿刺困难患者中留置针穿刺的可行性及操作要点。方法：将46例血管情况差的患者作为对照组,应用常规留置针穿刺法进行穿刺;将43例常规穿刺失败患者纳入实验组,应用超声引导留置针穿刺法进行穿刺。采用卡方检验法,比较2组穿刺成功率、穿刺并发症;采用配对样本t检验法,比较2组患者选血管用时、穿刺次数、进针次数。结果：46例常规穿刺患者3例穿刺成功,43例超声引导穿刺均成功,其中一次穿刺成功38例,二次穿刺成功5例,穿刺成功率高达100%,实验组与对照组相比,一次穿刺成功率（χ2=70.940,P=0.000）、总成功率（χ2=77.770,P=0.000）均有明显差异,其并发症发生率也明显降低（χ2=15.151,P=0.000）;选血管用时明显缩短（3.65±1.57 vs. 36.86±7.11,t=32.412,P<0.01）;穿刺次数明显减少（1.12±0.32 vs. 3.56±0.50,t=31.866,P<0.01）;进针次数明显减少（1.21±0.47 vs. 7.56±1.65,t=23.685,P<0.01）。结论：将超声引导留置针穿刺术应用于CT增检查静脉穿刺困难患者中,提高了穿刺成功率,减轻了患者痛苦,为患者顺利完成CT增强检查提供了保障,其操作简单、安全,值得临床推广。     

经额立体定向丘脑血肿穿刺治疗中等量丘脑出血破入脑室的疗效研究

目的 探讨经额立体定向丘脑血肿穿刺治疗中等量丘脑出血破入脑室的疗效。方法 回顾性分析2018年1月至2021年12月在金华市中心医院神经外科行钻孔引流的中等量丘脑出血（15～30ml）破入脑室的73例患者的临床资料，其中51例行经额框架立体定向丘脑血肿穿刺置管引流（丘脑穿刺组），22例仅行侧脑室穿刺置管引流（脑室穿刺组），比较两组患者的临床特征及疗效。结果 两组的性别、年龄、高血压和糖尿病比例、抗血小板和抗凝药物服用、入院格拉斯哥昏迷评分（Glasgow coma scale，GCS）、丘脑血肿量、左/右侧出血、发病至手术时间、再出血率、颅内感染率差异无统计学意义（P≥0.05）；脑室穿刺组引流管留置时间和住院时间均长于丘脑穿刺组（P<0.05），丘脑穿刺组出院前、术后1个月、术后2个月、术后3个月的Barthel指数[（65.4±9.7）分、（68.7±9.5）分、（71.2±9.0）分、（73.8±8.1）分]均高于脑室穿刺组[（55.3±10.3）分、（57.5±9.9）分、（60.1±8.2）分、（61.4±9.5）分]（P<0.05）。结论 经额立体定向丘脑血肿穿刺治疗中等量丘脑出血破入脑室可短期内清除丘脑血肿，缩短引流管留置时间和住院时间，改善患者预后。     

超声引导下经皮穿刺置管引流对腹部手术后局限性积液的疗效

目的:探讨超声引导下经皮穿刺置管引流对腹部手术后局限性积液的疗效及安全性。方法:回顾性分析29例腹部手术后因局限性积液行超声引导下穿刺置管引流患者的临床资料。患者手术后7 d至3个月不等,男20例,女9例,年龄37～81岁。超声或CT确诊为肝占位手术后肝内或肝周积液17例,肝硬化脾切除术后左膈下局限性积液12例。在超声定位引导下使用邦特一次性直穿式引流套管针(7F)穿刺置管引流。结果:29例均一次性置管引流成功,无其他脏器损伤及并发症。所有患者症状消失,白细胞及中性粒细胞计数恢复正常,囊腔消失,拔管后复查囊腔未见复发,术后带管时间为4 d～2个月。结论:超声引导下经皮穿刺置管引流治疗术后局限性积液的操作简单、费用低廉、安全可靠,是临床一种安全、有效的治疗方法。     

CT引导经皮穿刺纵膈置管的临床应用

目的探讨螺旋CT引导经皮穿刺纵膈置管的临床应用。方法研究分析在该院治疗的纵膈淋巴瘘、纵膈大血管间隙脓肿、食道胃吻合口纵膈瘘、食道破裂纵膈脓肿、食道术后经皮纵膈胃造瘘与心包积液（积血）患者58例,随机分为观察组和对照组,观察组29例运用CT引导经皮穿刺纵膈置管,对照组29例运用B超引导经皮穿刺纵膈置管引流,对比分析两组患者的置管成功率及并发症。结果观察组29例患者均1次性置管成功（成功率为100%）,随访2周至6个月均未发生严重并发症,对照组29例患者成功率为89.66%,术中2人有出血现象,1人发生气胸。结论 CT引导经皮穿刺纵膈置管治疗纵膈淋巴瘘、纵膈大血管间隙脓肿、食道胃吻合口纵膈瘘、食道破裂纵膈脓肿、食道术后经皮纵膈胃造瘘与心包积液（积血）定位准确、安全有效,效果显著,值得在临床中推广应用。     

介入性超声治疗腹部外科术后并发症42例

目的:评价超声引导下徒手穿刺置管引流术在腹部外科手术后并发症处理中的应用价值。方法::回顾性分析超声引导下徒手穿刺置管引流术应用于42例积液类并发症治疗中的临床资料(治疗组),并与同期20例行单纯临床支持保守治疗的资料(对照组)相比较。结果:介入性超声治疗组和单纯保守治疗组的治愈率及平均外科术后住院天数分别为90.5%、55%及(10.7±4.5)d、(22.5±7.5)d;两组比较均有显著性差异(P<0.01)。结论:超声引导下徒手穿刺置管引流术是治疗腹部外科手术后积液类并发症的有效、安全、简便方法。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.