创伤性急性肺损伤后高迁移率族蛋白B1的临床相关性研究

目的 研究创伤性急性肺损伤(acute lung injury,ALI)后血清高迁移率蛋白-1(high mobility group box 1 protein,HMGB -1)的水平变化,探讨其与MODS、急性生理学与慢性健康状况Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)评分的相关性,以及其对MODS发生率和死亡率的预警作用. 方法 测定10例正常人与40例ALI患者伤后第1,4,7天的血清HMGB -1水平.根据MODS的诊断标准,将损伤组分为两组:MODS组13例,非MODS组27例.同时评定其MODS、APACHEⅡ分值. 结果 组间比较:非MODS组第1,4,7天HMGB -1水平的表达均高于MODS组(P＜0.05);非MODS组HMGB -1水平的表达高于正常对照组,但低于MODS组.组内比较:非MODS组第4天HMGB -1水平的表达明显高于第1天(P＜0.01),第7天较第4天明显降低(P＜0.01),甚至低于第1天.MODS组血清HMGB -1水平的表达显著升高,并延续数天,第7天较第4天有所降低,但仍高于第1天.伤后第1,4,7天MODS评分随HMGB -1水平的动态变化差异明显.伤后第1,4,7天APACHEⅡ评分比较,差异明显.相关性分析显示,HMGB -1水平的表达与MODS评分、APACHEⅡ评分显著相关. 结论 (1)HMGB -1在ALI患者中呈高表达,其作为晚期炎症介质参与炎性反应往往升高较晚,且持续时间较长.(2)HMGB -1水平变化与并发MODS密切相关.(3)常规检测血清HMGB -1水平并联合评定MODS、APACHEⅡ评分有助于对创伤后脏器功能不全的预测.     

Treatment of complicated hepatic cystic hydatidosis with intrabiliary rupture by pericystectomy in combination with Roux-en-Y hepaticojejunostomy

This study retrospectively reviewed 9 cases of complicated hepatic cystic hydatidosis with intrabiliary rupture who were surgically treated with pericystectomy in combination with Roux-en-Y hepaticojejunostomy in our hospital from 2004 to 2010. The clinical features, results of laboratory tests, B-mode ultrasonography and CT, post-operative recovery, days of hospital stay after the operation and post-operative complications were statistically analyzed and the patients were fol-lowed up. The subjects in our series included 7 males and 2 females, whose average age was 50.78±7.58 years. Before operation, 9 patients suffered from pain of the right upper quadrant and jaundice, which, in 4 cases (44.45%), were accompanied with fever and chills. Preoperative B-mode ul-trosonography and CT showed that all the 9 patients had single hydatid cyst, with their diameter be-ing 9.33±1.58 cm on average. The lesions involved segments Ⅴ, Ⅵ in 6 cases, and segment Ⅳ in 3 cases. By WHO classification, 7 cases were classified as CE3 and 2 cases as CE4. They all had choledochectasia. The subjects underwent the surgery uneventfully. Intraoperatively, 2-4 biliary fis-tula orifices were found, with the average of the orifice being (0.79±0.20) cm. After the operation, one patient developed incision infection, one had pulmonary infection and one suffered from reflux cholangitis. No anastomotic leaks or peri-operative deaths took place and follow-up revealed no re-currence and implantative metastasis. We are led to conclude that pericystectomy in combination with Roux-en-Y hepaticojejunostomy can achieve satisfactory results for the treatment of compli-cated hepatic cystic hydatidosis with intrabiliary rupture.     

小儿腹腔镜阑尾切除术与开腹阑尾切除术术后心理创伤程度的比较

目的:对比分析腹腔镜和开腹阑尾切除术在治疗小儿急性阑尾炎术后小儿的心理创伤程度.方法:需手术治疗的2～14岁患有阑尾炎的小儿40例,按其意愿分为两组,20例行腹腔镜阑尾切除术(LA),20例行传统开腹阑尾切除术(OA),并观测两种术式后的患儿心理创伤程度指标:易激怒发生率、抑郁发生率、夜惊失眠发生率、换药恐惧、参加体育活动时间.结果:LA组发生易激怒、换药恐惧及开始参加运动的时间与OA组相比,两组间差异有统计学意义(P＜0.05),而LA组与OA组术后患儿发生抑郁、夜惊失眠相比较,两组间差异无统计学意义.结论:LA组与OA组患儿相比其心理创伤程度低.     

肝包虫病外科治疗进展

肝包虫病又称肝棘球蚴病 ,是畜牧地区常见的寄生虫病 ,约大多数是犬绦虫 (细粒棘球绦虫 )的蚴侵入并寄生在人体肝脏所引起的单房性包囊肿 (肝棘球蚴病 ) ,少数由泡状棘球绦虫的蚴所引起的泡状棘球蚴病 (肝泡球蚴病 )。百余年来一直将手术作为治疗棘球蚴病较为理想的方法 ,但由于术后复发率高及并发症多 ,后果令人担忧。多年来不少学者不断改进操作以减少复发及其它并发症 ,先后出现多种术式 ,总体可分为传统术式、微创术式和根治术式。一、传统术式内囊摘除术是最常用的手术方法 ,早在十九世纪中叶已开展。手术时将病变部位显露后 ,抽除囊液…     

肝包虫外囊切除在防治残腔并发症中的应用价值

目的　探讨肝包虫囊肿外囊切除在预防和治疗残腔并发症中的应用价值。方法　对83例首次发病肝包虫病患者实施肝包虫囊肿外囊切除术 ,并与 5 1 8例保留外囊术式的术后残腔并发症发生情况进行比较研究 ,评价外囊切除术对残腔并发症的预防价值 ;对 1 2例已患术后残腔并发症患者实施外囊切除术 ,评价外囊切除木对残腔并发症的治疗价值。结果　外囊切除术的术后残腔并发症低于保留外囊术式组 (P <0 .0 1 )。 1 2例已患术后残腔并发症患者实施外囊切除术后 ,无残腔并发症复发。结论　肝包虫囊肿外囊切除可有效的预防、治疗残腔并发症。     

胆囊息肉样病变发病因素研究进展

随着人口老龄化加重、生活节奏加快及生活习惯改变,胆囊息肉样病变发病率日益增加,了解胆囊息肉样病变自然病程及病因对胆囊息肉的预防和治疗有重要意义。近年来胆囊息肉样病变研究有较大进展,本文就国内外对胆囊息肉样病变的病因和发病机制及自然病程的研究进展作一综述。     

两种肝包虫病外科治疗术后超声随访结果分析

目的　探讨肝包虫囊肿外囊切除与保留外囊两种术式疗效差异。方法　采用超声诊断技术对2 90例肝包虫病患者进行随访。病例分组为:外囊切除术式组(4 9例)与保留外囊术式组(2 41例)。对两组的术后残腔形成、原位复发两项指标进行对比分析。结果　外囊切除术的术后残腔并发症及原位复发均低于保留外囊术式组(P <0 .0 1,P <0 .0 5 )。结论　肝包虫囊肿外囊切除可降低残腔并发症与原位复发。     

肝囊型棘球蚴囊周肝细胞超微结构观察

用透射电镜观察8例肝脏细粒棘球蚴囊肿周围肝组织及6例正常肝组织的肝细胞超微结构。观察到细粒棘球蚴囊周围肝细胞坏死、萎缩和死亡。肝细胞坏死、萎缩等是肝脏细粒棘球蚴病肝脏损伤的重要基础。     

新型接触式人工蓝宝石Nd:YAG激光刀于用临床肝、脾部分切除

新型接触式人工蓝宝石Nd:YAG激光刀是在原有的石英光纤激光刀的基础上发展而来的。作者用这种新型激光刀进行了13例肝、脾部分切除术。结果表明,它克服了许多非接触式激光刀的不足之处,具有切割力强、止血效果好、组织损伤小、操作方便和不易损坏等优点,更适宜于血供丰富的实质脏器手术中应用。