武连仲教授治疗坐骨神经痛经验

全国名中医天津中医药大学第一附属医院针灸科武连仲教授用多年的临床经验总结概括出针刺的理、法、方、穴、术，其创立的"通经止痛"针刺疗法在临床中疗效佳，武老在治疗坐骨神经痛时，取足太阳膀胱经和足少阳胆经具有走窜针感的经穴为主穴，其配伍精确，组方严密，手法独特，可供临床参考。本文将武老运用"痛经止痛"针刺法治疗坐骨神经痛的经验从"理、法、方、穴、术"方面做浅述。     

腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石的临床对照研究

目的:比较腹腔镜胆总管探查术(LCBDE)与内镜下十二指肠乳头括约肌切开术(EST)治疗胆总管结石的临床效果。方法:回顾性分析2012年11月—2014年3月收治的210例胆总管结石患者资料,按手术方式分为LCBDE组(116例)和EST组(94例),对比两组相关临床指标。结果:两组手术成功率差异无统计学意义(99.1%vs.95.74%,P=0.175),但LCBDE组一期治愈率高于EST组(97.4%vs.90.4%,P=0.038);两组残余结石率、平均住院时间与住院费用均无统计学差异(均P0.05),但EST组一期治疗后9例残余结石患者行第2次EST治疗,6例残余结石患者行第3次EST治疗;首次EST失败的患者,其住院时间与花费明显增加;LCBDE组围手术期总并发症以及远期并发症发生率均明显低于EST组(均P0.05),差异主要来源于EST相关并发症。结论:LCBDE治疗胆总管结石一期治愈率高于EST,且并发症率低于EST组,能保留十二指肠乳头括约肌的生理功能,可同时实施腹腔镜胆囊切除术处理胆囊病变。因此,在多数情况下,应首先考虑LCBDE。     

数字人体经络信息获取的多光谱探测技术研究

本文首先阐述了数字人体的多光谱探测技术的国内外研究现状和意义;然后讨论了数字人体经络信息获取的多光谱探测技术的研究内容、研究目标、拟采取的研究方法、技术路线,人体经络系统物质流、信息流探测获取的实验方案及可行性分析等;为数字人体经络的信息获取提供了技术方法.     

Outcomes of Second Look Exploration in Testicular Torsion of Children

Background:

Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.

Objectives:

The aim of this study is to evaluate the second look exploration and outcomes in TT.

Patients and Methods:

Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.

Results:

Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.

Conclusions:

TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.     

从"醒脑开窍"针刺疗法探讨国医大师石学敏院士对中医脑病的贡献

"醒脑开窍"针刺疗法是我国著名中医药学家和教育家、中国工程院院士、国医大师、石学敏中医发展基金会理事长石学敏教授于1972年为治疗中风病创立的针刺疗法。该疗法临床应用已达40余年，在中风病等多种疾病治疗中确实显示出其卓越的疗效。通过大量的临床观察和基础实验研究，对机体多系统疾病均有良好的调节作用。该疗法不仅限于中风病的应用，一切脑性麻痹或瘫痪(如小儿脑瘫、一氧化碳中毒和脑外伤后等)；严重的疼痛(如神经痛、内脏痛、创伤痛和癌瘤痛等)；精神疾病(如癫狂痫、抑郁症、百合病和癔病等)；还有部分其他系统(如尿崩症、遗尿和二便失控等疾病)均有非常好的疗效。从脑主神明的认识；"醒脑开窍"针刺疗法的提出与确立；创立中风病机新理论等方面，并探讨中国工程院院士、国医大师石学敏教授对中医脑病的新贡献。     

现代教学法与传统教学相结合在心血管临床教学工作中的实践与探索

目的:探讨现代教学法与传统教学相结合在心血管临床教学工作中的实践与探索。方法:选择本院心血管科室2012年6月-2013年3月的实习生180名,分为传统教学组、现代教学组和结合教学组。观察三组的临床教学效果。结果:结合教育组平日成绩及笔试考核均无一人在60分以下,其平均成绩高于高于传统教学组25%,高于现代教学组15%。而笔试成绩高于其他两组10%和5%。结论:现代教学法与传统教学相结合对心血管临床教学有明显的效果,有利于实习医生对相关疾病的掌握,值得在本院各科室进行推广。     

高职《中药鉴定学》教学模式的思考与探索

中药鉴定学是中药学及相关专业的一门专业课,课程知识多且零碎,内容却极其枯燥,怎样提高学生的学习兴趣,提高中药鉴定学的教学质量,使所学药材更加易学易认,调动学生的积极性,是大家不断研究和商讨的课题.审视当前中药鉴定学的教学活动,笔者对其理论教学、实验教学内容和教学模式进行思考与探索.     

我院开展远程会诊的实践与探索

远程会诊在我国的发展经历多个时期,作为实现分级诊疗和发展远程医疗的有力手段已在全国各级医院得到广泛应用。国内开展远程会诊的竞争激烈,并且出现受众需求个性化、缴费流程不合理、学科覆盖不全面的问题。中国人民解放军总医院在扩充远程会诊专家团队、优化远程缴费路径和加强资源融合等方面进行了实践和探索。作者总结了远程会诊的发展和新形势、分析远程会诊实践中出现的问题,在探索远程会诊实践的基础上提出了关注远程早期筛查、常规检测、诊断后转诊等建议,进一步思考和展望,促进了远程会诊服务能力的进一步提升。     

Laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation

AIM:To investigate the possibilities and advantages of laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct compaired with traditional open operation.METHODS:Laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation were performed in two groups of patients who had gallstones in the left lobe of liver and in the common bile duct.The hospitalization time,hospitalization costs,operation time,operative complications and post-operative liver functions of the two groups of patients were studied.RESULTS:The operation time and post-operative liver functions of the two groups of patients had no significant differences,while the hospitalization time,hospitalization costs and operative complications of the laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration in the common bile duct group were significantly lower than those in the traditional open operation group.CONCLUSION:For patients with gallstones in the left lobe of liver and in the common bile duct,laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct can significantly shorten the hospitalization time,reduce the hospitalization costs and the post-operative complications,without prolonging the operation time and bringing about more liver function damages compared with traditional open operation.This kind of operation has more advantages than traditional open operation.     

超声心动图在主动脉夹层早期诊断价值探讨

目的：探讨超声心动图在主动脉夹层早期诊断应用价值。方法回顾性分析经胸超声心动图诊断的主动脉夹层18例患者的资料。结果超声心动图提供DeBaKeyI型10例, DeBaKeyII型1例, DeBaKey III型7例。中度或中度以上主动脉瓣关闭不全6例,有4例假腔内附壁血栓形成。9例可见左心室内径扩大,3例合并左室收缩功能减低。4例可见少量心包积液。结论在主动脉夹层早期诊断中,超声心动图具有方便、快捷、可重复对照等特点,对识别困难的胸痛或腹痛提供早期诊断及鉴别诊断,同时可以评估主动脉夹层对主动脉瓣、左室大小及收缩功能的影响,及对分支血管的累及情况。为手术方式的选择及风险评估提供重要的参考依据。