实验性腹主动脉瘤瘤体外径与iNOS相关性分析及分期研究

Objective To construct new model of experimental abdominal aortic aneurysm (AAA) and detect the AAA outer diameter and the change of induce nitric oxide synthase(iNOS) in the abdominal aor-tic aneurysm in different period,and analysis the correlation between experimental AAA and iNOS.Methods During the operation of the experiment group,the vascular prosthesis of PTFE was implanted to the rabbit abdominal aorta to form an aneurysm,while sham operation was done in the control group.The tissue of ab-dominal aortic aneurysm was harvested in 1 d,7d,14d,and 28d after operation,respectively.The tissue bo-mogenate concentration of iNOS in the abdominal aortic aneurysm were detected by enzyme linked immu-nosorbent assay (ELISA).Results In experimental group,mean concentration of the tissue bomogenate concentration of iNOS in the abdominal aortic aneurysm in 1 d,7 d,14 d,28 d were (22.129 ±2.518)μ/mL,(27.337±5.321) μ/mL,(36.047±4.584)μ/mL,(44.756±1.799)μ/mL,respectively;In control group,that was (12.499±1.807)μ/mL.The concentration of iNOS in experimental group was significantly higher than that of control group (P < 0.01).The difference during the experimental group all had statisti-cal significance (P < 0.05).Conclusion It is possible that iNOS has some biological function during the formation and progression of the abdominal aortic aneurysm.     

SUCCESSFUL ENDOSCOPIC CLOSURES OF COLONIC PERFORATIONS REQUIRING ABDOMINAL DECOMPRESSION AFTER ENDOSCOPIC MUCOSAL RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY COLON CANCER

Endoscopic submucosal dissection (ESD) for colorectal cancer is not widely accepted because of its technical difficulty and the risk of perforation. In addition, the risk of peritonitis cannot be completely eliminated even if a perforation is closed successfully. Reported here are two cases of early colon cancer in which the patients sustained iatrogenic perforations of the ascending colon during conventional endoscopic mucosal resection and of the sigmoid colon during ESD, respectively, requiring abdominal decompression with an 18 G Medicut needle. Both of these perforations were successfully treated by endoscopic clipping. In conclusion, conservative medical management may be possible in patients who have undergone successful closure of colonic perforations using endoscopic clipping. In order to perform immediate endoscopic closure, abdominal decompression has been useful to decrease patient discomfort and colonic lumen collapse. Now, CO₂ insufflation is being used effectively for the prevention of pneumoperitoneum.     

腹茧症的影像诊断

目的探讨腹茧症的影像特点，提高术前诊断水平。方法回顾性分析经手术病理证实的腹茧症6例，术前均进行立位腹部X线平片和腹部CT检查，4例同时行胃肠道钡剂造影，复习其影像表现。结果6例立位腹部X线平片中3例诊断为肠梗阻。4例胃肠道钡剂造影，均可见小肠交错盘绕成团，呈“菜花”状或“手风琴”状表现。6例CT检查，均可见小肠聚集成团，其周围可见膜样的囊状物将其包裹。结论对患者进行胃肠道造影时观察到“菜花”状征象，或CT检查时观察到小肠聚集成团被一层膜样物包裹，应考虑到腹茧症的可能。     

海水浸泡对腹部开放伤实验犬肝脏功能及形态学的影响

目的 探讨腹部开放伤后海水浸泡对实验犬肝功能及肝脏病理形态学的影响.方法 20只实验犬致伤后随机分为对照组(n=10)和浸泡组(n=10).对照组为单纯腹部外伤,浸泡组于致伤后置入人工配制的海水中.分别于致伤前(0h)及出水后4、8、12、16、20h取血测定总胆红素(TB)、ALT、AST、LDH、血氨(NH3)、凝血酶原时间(PT)、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、内毒素(ETX)水平,于24h处死动物对肝组织进行病理检查.结果 与对照组比较,浸泡组TB、ALT、AST和PT增高,16h后升高明显.浸泡组伤后4h和12h LDH明显高于对照组,伤后4h血NH3明显高于对照组(P＜0.05).TNF-α、IL-6和ETX的变化与肝功能的损害程度呈正比.与对照组比较,浸泡组肝脏的病理形态学改变明显.结论 海水浸泡可导致实验犬的肝功能损伤和肝细胞病理形态学变化.     

子宫切除术对生存质量的影响

目的：研究子宫切除术对生存质量的影响。方法：对108例因良性疾病而行腹式子宫切除术者进行前瞻性队列研究，术前及术后3，6，12个月进行调查问卷，观察症状、泌尿及胃肠功能、性功能、心理状况、社会生活状态的变化。结果：子宫切除术后3个月症状、压抑、焦虑程度减轻，社会生活状态显著提高，泌尿及胃肠功能、性功能无改变，这些改善持续至术后12个月。结论：子宫切除术可有效缓解妇科良性疾病所产生的症状，症状的缓解有利于改善生存质量。大多数因妇科良性疾病而行腹式子宫切除术的妇女，在术后1年，生存质量提高。     

不同麻醉方式对上腹部手术患者血浆前列腺素和血栓素的影响

目的　观察不同的麻醉方法对上腹部手术患者血浆 6 酮 前列腺素F1α( 6 keto PGF1α ,PGF1α)和血栓素B2 (TXB2 )的影响。方法　择期上腹部手术患者 2 0例 ,随机分两组 :Ⅰ组为硬膜外麻醉组 ;Ⅱ组为全身麻醉组。于麻醉前、诱导后、手术 10min、手术 5 0min及术毕采静脉血 ,用放射免疫法测定血浆中PGF1α和TXB2 的含量。结果　 ( 1)PGF1α在Ⅰ组麻醉后升高 ,术毕明显高于术前 (P <0 .0 5 ) ;Ⅱ组诱导后下降 ,然后渐升 ,术毕达高峰 (P <0 .0 5 )。 ( 2 )TXB2 在Ⅰ组麻醉后均明显降低 (均为P <0 .0 1) ;Ⅱ组诱导后显著降低 (P <0 .0 1) ,但术毕却明显升高 (P <0 .0 5 )。 ( 3)PGF1α与TXB2 的比值 (K/T值 )在Ⅰ组麻醉后均显著升高 (均为P <0 .0 1) ,而Ⅱ组仅见诱导后显著增高。结论　硬膜外麻醉对减轻术后早期应激反应优于全麻     

带腹直肌蒂胸骨翻转术治疗漏斗胸10例疗效分析

目的:探讨漏斗胸的外科治疗。方法:应用带腹直肌蒂胸骨翻转术对10例漏斗胸病人进行外科治疗。结果:本组病例手 术效果满意,术中翻转胸骨片血运丰富,术后长期随诊,无复发。结论:带腹直肌蒂胸骨翻转术治疗漏斗胸具有手术操作简便、出血少、 术后恢复快、矫正效果满意、术后无复发等特点。     

腹主动脉瘤的腔镜治疗

20世纪90年代之后随着腔镜技术的发展，腔镜在腹主动脉瘤治疗中的应用逐渐兴起并且技术日趋成熟。其微创、术后快速恢复及确切的短中期效果等优点使其成为继传统开腹手术和经皮腔内支架置入术后的第三种治疗方法。目前腹主动脉瘤的腔镜治疗可分为全腹腔镜腹主动脉瘤手术、腹腔镜辅助腹主动脉瘤手术、助腹主动脉瘤手术、机器人辅助腹主动脉瘤手术、腔镜联合经皮腔内治疗等。