雷公藤多甙联合中草药治疗IgA肾病的病例对照研究

IgA肾病(immunoglobulin A nephropathy,I-gAN)是肾小球系膜病变的一个特殊类型,其发病机制尚未完全明确,临床表现复杂多样。目前,临床上常用的药物主要有激素、雷公藤、环磷酰胺等,都具有一定的疗效,但在药物副作用、血尿的消退、肾功能的稳定及停药后复发等方面均有各自的缺陷。笔者所在科室在慢性肾炎型IgAN的治疗上进行探索,现将结果报告如下。1资料与方法1.1病例选择及分组73例均为铜陵市第一人民医院肾内科住院并经肾活检证实的IgAN患者,除外各种继发性IgAN,并符合以下条件:①按Lee氏分级均在Ⅲ~Ⅳ级间;②无严重的肝损害;③血…     

混合痔术后口服迈之灵对并发症和疗程影响的临床观察

目的:混合痔术后口服迈之灵对术后水肿、出血、疼痛以及疗程等情况的观察.方法:采用随机对照的方法,治疗组48例患者在术前术后常规治疗的基础上,自手术当天开始连服迈之灵300 mg,每天2次,共10 d.对照组50例患者给予术前术后常规的治疗.术后4 d观察两组患者肛门水肿、出血、疼痛的情况及疗程时间.结果:两组患者术后水肿、出血、疼痛比较,治疗组优于对照组(P＜0.05).结论:混合痔术后口服迈之灵可有效缓解水肿、出血、疼痛等症状及缩短了疗程.     

腹膜透析相关性感染状况及预后分析

目的:了解腹膜透析(PD)相关性腹膜炎、隧道感染的菌种及预后.方法:统计腹透患者腹膜炎及隧道感染的发生率、细菌种类、治疗效果和预后.结果:自2000年始至今收住的46例腹透患者共发生腹透相关性腹膜炎27人次,病原菌以金黄色葡萄葡球菌(37.0%)和表皮葡萄球菌(25.9%)为主,隧道感染7人次(3例金葡菌、2例绿脓杆菌、1例表葡菌、1例大肠杆菌).经治疗,25人次腹膜炎治愈,2例因严重的霉菌性腹膜炎而拔管,6人次隧道感染治愈,1例绿脓杆菌感染合并腹膜炎未愈而拔管.结论:感染的病原菌种类影响预后.     

显微外科技术在肛瘘切除缝合术中的应用

肛瘘的常规治疗是肛瘘切开术和肛瘘挂线术，创口需肉芽增生来填充，愈合缓慢，挂线疗法的过程尤其冗长。为了缩短疗程，笔者将显微外科技术应用于肛瘘的治疗，有效解决了上述不足之处，现报道如下。     

结直肠癌组织中survivin和p53的表达及其关系

选择结直肠癌组织和癌旁正常黏膜组织各40例份,采用免疫组化SP法检测其生存素（survivin）和p53。结果显示,survivin在结直肠癌组织中的阳性表达率为75.00%,癌旁组织均为阴性表达,两者相比,P〈0.01 p53表达阳性的结直肠癌组织中survivin的阳性表达率明显高于p53表达阴性者,P〈0.05。认为p53和survivin过度表达在结直肠癌的发生发展过程中起重要作用,且survivin的表达与p53的表达密切相关。     

两种不同材料修复患牙的疗效观察

目的 观察两种不同材料充填修复前牙后牙的临床疗效.方法 前牙264颗,后牙250颗,随机分组后,分别用Dyract复合体和Tetric N-ceram纳米瓷化树脂充填,2年后复查.结果 2年后观察疗效,Dyract复合体充填修复前牙成功率97.66%,Tetric N-ceram纳米瓷化树脂充填修复前牙成功率98.4%,两种材料充填修复前牙疗效差异无统计学意义(P＞0.05).Dyract复合体充填修复后牙成功率87.20%,Tetric N-ceram纳米瓷化树脂充填修复后牙成功率97.56%,Tetric N-ceram纳米瓷化树脂充填修复后牙疗效优于Dyract复合体充填,差异有统计学意义(P＜0.05).结论 Tetric N-ceram纳米瓷化树脂充填后牙临床疗效明显优于Dyract复合体.纳米瓷化树脂适合前牙后牙充填修复.     

吻合器痔上粘膜环切术对肛肠动力学影响的临床研究

目的：比较吻合器痔上粘膜环切术（PPH手术）与传统痔外剥内扎术对肛门直肠动力学影响的差异。方法：采用瑞典生产的肛肠测压仪测量PPH术和传统常规手术术前及术后3月患者的肛管静息压（RASP）、肛管收缩压（MASP）、直肠感知阈值（RSTV）、直肠最大容量阈值（RMTV）的变化，切除标本送病理检查，观察有无肌肉组织和痔组织。结果：PPH术后肛管RASP较术前明显降低（P〈0．01），肛管MASP、直肠RSTV、直肠RMTV较术前有轻微降低但无显著性差异（P〉0．05），肛管RASP在PPH手术组恢复至正常水平，而在传统手术组肛管MASP、直肠RSTV、直肠RMTV较术前和正常值均有显著性降低。病理检查切除标本中无肌肉组织，仅含少量痔组织。结论：PPH手术使重度痔患者的肛管高压明显改变，使肛垫得到保护，而对直肠功能影响较小，使直肠功能得到最大保护。     

一起未经卫生行政部门备案核准的非法组织义诊案例评析

为维护广大人民群众的健康权益，近几年，卫生行政部门加大对医疗服务的监督执法力度，整顿和规范医疗服务市场秩序，优化了医疗执业环境，取得了较好的效果，但仍有一些不法行为，利用一些新的手段，达到推销某种产品，且越来越隐蔽，形式也更加多样，对监督执法工作提出了更高的要求。笔者针对一起未经卫生行政部门备案核准的非法组织义诊案例进行评析，以期有所借鉴。     

经肛内括约肌切除术联合经腹全系膜切除术对超低位直肠肿瘤保肛的应用探讨

Objective To study the combination of trans-anal intersphincteric resection and trans- abdominal total mesorectal excision for anus-retained ultra-low rectal tumors. Methods Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed Results The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2. 1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with canceration and 3 giant villous adenoma. For pathological stages, there were 18 eases at stage pTNM Ⅰ , 5 at Ⅱ A, 1 at Ⅱ B, 4 at ⅢA, 1 at ⅢB and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months. Conclusion The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.     

经肛内括约肌切除术联合经腹全系膜切除术对超低位直肠肿瘤保肛的应用探讨

Objective To study the combination of trans-anal intersphincteric resection and trans- abdominal total mesorectal excision for anus-retained ultra-low rectal tumors. Methods Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed Results The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2. 1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with canceration and 3 giant villous adenoma. For pathological stages, there were 18 eases at stage pTNM Ⅰ , 5 at Ⅱ A, 1 at Ⅱ B, 4 at ⅢA, 1 at ⅢB and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months. Conclusion The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.