腹腔镜在腹股沟疝修补术中的应用

目的：探讨腹腔镜在腹股沟疝修补手术中的优缺点，方法：31例腹股沟疝行腹腔镜疝修补术，其中斜疝25例，直疝6例，复发疝4例，均行腹腔内术式（TAPP）。结果：手术全部完成，平均手术时间61min(40-95min),无中转手术，4例同时行胆囊切除术，平均住院7．5d，术后近期随访无复发，结论：腹腔镜疝修补术是一种安全的手术，术后恢复时间短，复发率低。     

咪喹莫特乳膏治疗尖锐湿疣临床观察

尖锐湿疣（Condyloma acuminatum，CA）是由人类乳头瘤病毒（Human papillomavirus，HPV）感染所致的表皮瘤样增生，属于我国常见的性传播疾病之一，目前治疗方法以局部除疣为主，但以往单一的疗法应用均易复发，局部注射药物或局麻做激光、微波、电离子术等患者较痛苦，尤其是女性患者不易接受。我们于2004年5月-2005年10月采用5％咪喹莫特乳膏治疗疣体小，数目少且暴露差的34例外生殖器和肛周尖锐湿疣（CA）患者，并与20％竹叶草脂治疗进行对照观察。现将观察结果报告如下。     

L-arginine对局灶脑缺血脑细胞凋亡和微血管密度的影响

目的探讨NO合成底物左旋-精氨酸(L-Arg)对兔局灶脑缺血后血管再生和脑细胞凋亡的影响。方法兔局灶脑缺血后应用L-Arg,流式细胞仪定量分析细胞凋亡率的变化,CD34免疫组织化学测脑组织微血管密度(MVD),脑组织含水率评价脑水肿。结果与对照组比较,L-Arg组脑细胞凋亡率明显减少(8.72±2.62 vs 16.62±2.82,P<0.01),同时脑组织MVD却明显增加(1.21±0.43 vs 0.69±0.22,P<0.01)。结论外源性L-Arg可减少缺血后脑细胞凋亡并促进缺血后血管再生,对局灶脑缺血具有重要的神经保护作用。     

粒细胞集落刺激因子治疗下肢缺血性疾病

目的探讨粒细胞集落刺激因子(rhG-CSF)对下肢缺血模型血管新生的影响。方法制作兔左下肢缺血模型,术后随机分为rhG-CSF治疗实验组(n=24)和对照组(n=24);应用流式细胞学技术、动脉造影、免疫组织化学染色检查,比较两组外周血CD34 细胞的含量、缺血下肢侧枝血管计数及肌肉毛细血管密度。结果治疗后3 d实验组CD34 含量(%)为(0.7150±0.0873)明显高于对照组(0.3983±0.0853),差异有统计学意义(P<0.01);实验组在第15、30天时侧枝血管计数(6.33±0.82、9.17±0.75)均高于对照组(3.33±0.52、4.17±0.75)(P<0.01);第40天实验组内收肌毛细血管密度平均为8.5/HP,明显高于对照组4.2/HP(P<0.01)。结论rhG-CSF可以增加兔缺血下肢的毛细血管数量,有促进血管新生的作用。     

^1H-magnetic resonance spectroscopy screening for animals with acute cerebral infraction suitable forthrombolytic therapy

BACKGROUND: As a non-invasive technique which can provide comprehensive biological information, 1H-magnetic resonance spectroscopy (1H-MRS) may provide valuable reference data for irreversible recovery or reversible changes in ischemic tissue after stroke. OBJECTIVE: To monitor and evaluate the effect of the urokinase thrombolytic therapy after experimental acute cerebral ischemia by 1H-MRS technology and investigate its adaptability. DESIGN: Randomly controlled animal study. SETTINGS: Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science. MATERIALS: Eleven healthy adult Sprague-Dawley (SD) rats, weighing 260–300 g and of both genders, were supplied by Experimental Animal Center of Tongji Medical Collage, Huazhong University of Science and Technology [SCXK (e) 2004-007]. 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. METHODS: The experiment was carried out in Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science from August 2003 to December 2005. ① The rats were randomly divided into 30-minute self-thrombo-embolism group (n =6) and 60-minute self-thrombo-embolism group (n =5). Six rats in 30-minute self-thrombo-embolism group were occluded with clot embolus for 30 minutes and 5 rats in 60-minute self-thrombo-embolism group were occluded for 60 minutes. 10 000 U/kg urokinase was dissolved in 2 mL saline and the operation lasted for 5 minutes. ② 1H-MRS was performed before thrombolysis and at 3 hours and 24 hours after successful embolization. The metabolic changes of N-acetyl-L-aspartic acid (NAA)/phosphocreatine (PCr) + creatine (Cr), choline phosphate (Cho)/PCr+Cr and lactic acid (Lac)/PCr+Cr in the region of interests were analyzed. ③ The T2W image was conducted 24 hours after the thrombolytic therapy with TR=500 ms and TE=25 ms. ④ The subjects were sacrificed immediately after 1H-MRS and the brain tissues were cut into pieces and stained with HE method; in addition, pathological changes were observed under optic microscope. MAIN OUTCOME MEASURES: ① Metabolic changes of NAA/PCr+Cr, Cho/PCr+Cr and Lac/PCr+Cr in the region of interests; ② T2W image at 24 hours after the thrombolysis; ③ pathological observation of brain tissue. RESULTS: Eleven rats were all involved in the final analysis. ① Metabolic changes in the region of interests : In 30-minute self-thrombo-embolism group, the Lac peak emerged immediately after the embolism, but the ischemic zone decreased 3 hours after the thrombolytic therapy (0.252±0.01, 0.603±0.01, P < 0.01). Lac/(PCr+Cr) ratio was 0.290±0.01 at 24 hours after thrombolysis, which was higher than that at 3 hours after thrombolysis (P < 0.01). The NAA/ (PCr+Cr) ratio decreased significantly at 3 hours after the thrombolysis as compared with that before thrombolysis (0.922±0.16, 1.196±0.01, P < 0.05). In 60-minute self-thrombo-embolism group, the Lac/(PCr+Cr) ratio was higher at 3 hours after thrombolysis than that before thrombolysis (0.846±0.12, 0.601±0.11, P < 0.05) and the NAA/(PCr+Cr) decreased at 3 hours after the embolism. Fluctuation of NAA/ (PCr+Cr) ranged from 0.68 to 0.75 before thrombolysis and from 0.71 to 0.75 at 3 hours after thrombolysis. ② T2W image: T2W image showed that 2 subjects in 30-minute self-thrombo-embolism group whose Lac/NAA was higher than 0.7 suffered from intracranial hemorrhage. This meant that the subjects with Lac/NAA > 0.7 were more likely to suffer from intracranial hemorrhage. ③ Histological and morphological examinations: Optic microscope demonstrated that interspace surrounding nerve cells was widened at ischemic center; neurons were swelling; nucleus was stained lightly; pyknosis and mesenchymal edema were mainly observed in lateral cortex of brow and vertex and in lateral part of corpus striatum. CONCLUSION: ①Compound parameters in ischemic area before thrombolysis should be regarded as an important predicting marker for thrombolytic therapy, effect evaluation and termination. ② 1H-MRS combining with other imaging technique is a detecting way for screening cases who are suitable for thrombolytic therapy.     

桂林市传染病网络直报工作第一年效果分析

目的观察传染病网络直报系统启动一年来的传染病监测质量,探讨网络直报评价方法.方法描述研究网络直报工作效果.结果实行网络直报后,传染病从临床医生发现到疾病预防控制机构接到报告的平均时间由5.48 d缩短至1.67 d,报卡数量增加20.84%,21.03%的报告卡得到校正,网络直报覆盖率县辖区医院为96.55%,市城区为69.23%,79.21%的直报单位有专用电脑.结论网络直报的启用及其系统的建立,提高了桂林市传染病疫情报告的质量和水平,同时应尽快建立与之相应的疫情报告管理方法和标准.     

108例支气管哮喘患者舌脉象特征分析

目的：探讨对支气管哮喘临床辨证有意义的舌脉象客观指标，以辅助临床诊断。方法：应用TP—I型中医舌脉象数字化分析仪检测108例患者舌脉象参数，分析支气管哮喘发作期与缓解期的舌脉象特征。结果：108例支气管哮喘患者的舌象中，舌色以淡红舌、淡紫舌多见，舌苔以白苔、黄苔、薄苔为多见；脉象以弦脉、滑脉、弦滑脉为多见；舌脉象参数中舌色指数、苔色指数、厚苔指数、胖瘦指数在哮喘发作期各证型中有显著性差异（P〈0．05）；RPSR1、RPSR3、RPSR4、RBF、RLMS2、PLMP2、RLMS3、RLMP3在哮喘发作期与缓解期有显著性差异（P〈0．05）。结论：支气管哮喘患者的脉象参数、舌色指数、苔色指数、厚苔指数、胖瘦指数、RPSR1、RPSR3、RPSR4、RBF、RLMS2、PLMP2、RLMS3、RLMP3对其辨证分型有重要参考价值。     

银杏内酯B柔性纳米脂质体的制备及体外透皮研究

目的：制备银杏内酯B(GB)柔性纳米脂质体，并对其体外透皮规律进行研究。方法：采用薄膜分散法制备银杏内酯B柔性纳米脂质体，并对其形态及粒径大小进行分析；采用改良的 Franz 扩散池进行体外透皮吸收试验，比较银杏内酯B醇溶液、银杏内酯B柔性纳米脂质体及普通银杏内酯B纳米脂质体的经皮累积渗透量及渗透速率。结果：此方法制得的脂质体平均包封率为(89.52±1.76)%，平均粒径为(208.3±25.49) nm，Zata电位为-49.2 mV。柔性纳米脂质体8 h的累积透过量为189.97 μg·cm^-2，8 h的渗透速率为23.75 μg·cm^-2·h^-1。结论：柔性纳米脂质体包封率较高，稳定性良好，可显著促进银杏内酯B的透皮吸收。     

腹腔镜结直肠癌手术的并发症及防治（附116例报告）

目的：探讨腹腔镜结直肠癌手术并发症及防治原则。方法：回顾分析2004年11月至2006年10月116例腹腔镜结直肠癌手术的临床资料。结果：腹腔镜结直肠癌手术无围手术期死亡病例,中转开腹6例,中转率5.2%;术中并发症发生率9.5%（11/116）;术后早期并发症发生率10.3%（12/116）。结论：不断提高腹腔镜手术操作技巧,严格按照腹腔镜结直肠癌手术操作规范施术,重视关键步骤的解剖及操作程序,具备处置意外的能力,是防治腹腔镜结直肠癌并发症的关键。     

胰岛素瘤的诊断和治疗：附137例报告

目的总结胰岛素瘤的诊断方法和外科治疗效果。方法回顾性分析近26年来收治的胰岛素瘤137例患者的临床资料。结果男77例,女60例。137例均具有典型的Whipple三联症。B超,CT,MRI检查的阳性率分别为35.1%,67.9%,58.1%。126例手术治疗患者中,102例(80.9%)行胰岛素瘤摘除术,4例(3.2%)行胰十二指肠切除术,16例(12.7%)行胰体尾切除术,另外4例(3.2%)行开腹探查术。切除的122例肿瘤中,良性占96.7%,恶性3.3%;单发肿瘤98.4%,多发1.6%。86.9%肿瘤直径≤2.0cm。13.1%肿瘤位于胰头;位于胰体和胰尾者分别为46.7%和40.2%。结论Whipple三联症,结合IRI,IGR,C-肽,以及胰岛素原的检测水平,可作为胰岛素瘤的定性诊断依据。胰岛素瘤的定位诊断仍很困难,联合应用多种影像学检查方法有助于提高检出率。治疗首选肿瘤摘除术,如果术中探查未能找到肿瘤,不宜盲目行胰体尾切除术,应排除其他原因所致低血糖症,同时进一步完善影像学检查方法,明确定位后,再考虑二次手术治疗。