高龄患者普外科手术的围手术期处理

随着老年人口的不断增加 ,70岁以上行普外科手术的高龄患者也日趋增多。70岁以上老年人有其特殊的生理和临床特点 ,各器官储备机能降低 ,同时往往并有1～3种以上的并存病 ,因此手术风险大 ,术后并发症也多。如何提高70岁以上高龄患者手术治愈率 ,已成为普外科医师重视的课题。本科自1995年1月～2001年12月手术治疗70岁以上高龄患者50例 ;报告如下。1资料与方法1.1一般资料本组男31例 ,女19例 ;年龄70～90岁。其中胆囊炎伴胆石症15例 ,急性化脓性胆管炎2例 ,胃癌9例 ,结肠癌5例 ,胃肠穿孔2例 ,急性阑尾炎3例 ,腹股沟疝9例 ,甲状腺腺瘤或腺癌5…     

神经内镜下透明鞘内操作治疗高血压脑出血的临床应用

目的比较神经内镜下透明鞘内操作清除脑内血肿,与开颅手术清除脑内血肿的优缺点。方法从2015年11月至2018年11月手术治疗脑内血肿的患者84例,采用神经内镜辅助,透明鞘内操作治疗的患者41例,开颅手术的患者43例,比较两组的手术时间,术中出血量、血肿清除率、术后第4天的颅内压、术后并发症及预后。结果两组患者在手术时间,术中出血量,血肿的清除率,术后第4天颅内压,术后并发症(例)及预后(格拉斯哥评分)良好者比较,P0.05,差异均有统计学意义。结论神经内镜下透明鞘内操作治疗脑内血肿具有手术时间短、清除血肿较彻底、术后脑水肿反应轻、并发症少及预后较好的特点,是一种较好的清除脑内血肿的术式。     

Caroli氏病1例报告

１病例报告患者 ,女 ,６２岁。反复右上腹痛１０年 ,再发２周。体检 :腹平 ,右上腹压痛明显 ,无反跳痛 ,皮肤巩膜黄染。Ｂ超检查 :见肝内多个大小不等 ,圆形或棱形液性暗区 ,大者直径约９ｃｍ ,左肝且可见数枚黄豆大小强光斑。Ｂ超诊断 :先天性胆管囊状扩张症 ;胆囊炎 ,胆囊多发性结石 ;胆总管结石伴扩张。手术探查见左肝肿大 ,胆囊肿大 ,胆总管扩张 (直径约３．５ｃｍ) ,内有多枚结石 ,诊断Ｃａｒｏｌｉ氏病。行胆囊切除 ,胆总管切开取石５０多颗 ,“Ｔ”字管引流术。留置“Ｔ”字管３个月作“Ｔ”字管造影 ,见左侧肝内肝胆管明显扩张 (直…     

大黄对重型颅脑损伤后应激性溃疡的预防作用

目的 探讨重型颅脑损伤后应激性溃疡的发生机制及大黄对重型颅脑损伤后应激性溃疡的预防作用.方法 成年雄性SD大鼠40只按随机数字表法分为假手术组、模型组、大黄治疗组和奥美拉唑治疗组,每组10只.后3组大鼠采用改良的Feeney自由落体法制备重型颅脑损伤模型,大黄治疗组和奥美拉唑治疗组大鼠在模型后分别给予大黄粉悬浊液灌胃和奥美拉唑口服.模型后2、6、24 h对各组大鼠行神经损害严重程度评分(NSS);于模型后24 h采用激光血流仪探头检测各组大鼠胃黏膜血流(pu),取胃前壁组织观察并测量黏液层厚度(μm);HE染色观察胃黏膜的病理变化并计算溃疡指数(UI).结果 与假手术组比较,模型组、大黄治疗组和奥美拉唑治疗组大鼠NSS评分较低,差异有统计学意义(P＜0.05);与模型组比较,大黄治疗组和奥美拉唑治疗组大鼠模型后24 h胃黏膜血流和黏液层厚度增加,溃疡指数降低,且大黄治疗组大鼠胃黏膜血流和黏液层厚度均高于奥美拉唑治疗组,差异有统计学意义(P＜0.05);大鼠NSS评分、胃黏膜血流、黏液层厚度与溃疡指数之间均呈现明显的负相关关系(r=-0.429,P=0.002;r=-0.542,P=0.013;r=-0.465,P=0.024).而胃黏膜血流和胃黏膜黏液层厚度之间呈正相关关系(r=0.680,P=0.001).结论 大黄对颅脑损伤后应激性溃疡有预防性作用,且不减少黏液的分泌,但对颅脑损伤大鼠短期内的行为学评分无明显改善.

Abstract：

Objective To explore the mechanism of stress ulcer induced by severe brain injury and prophylactic effect of rhubarb on this stress ulcer in rats. Methods Forty adult male SD rats were equally randomized into sham-operated group, model group, rhubarb treatment group and omeprazole treatment group (n=10). Rat models of craniocerebral injury in the later 3 groups were established according to modifiod Feeney's method; and then, rhubarb in a suspension manner was given by way of ig into the rhubarb treatment group and omeprazole was given orally to rats in the omeprazole treatment group. The neurological severity scale (NSS) was performed 2, 6 and 24 h after the brain injury. The gastric mucosal blood flow (GMBF) was measured by probe test with laser Joppler flowmetry; thickness of the slime layer was measured; pathological changes of mucous mermbrane were observed by HE staining and the ulcer index was calculated 24 h after the brain injury. Results As compared with the sham-operated group, the other 3 groups enjoyed significantly lower scores of NSS (P＜0.05). Thickness of the slime layer and GMBF in the rhubarb and omeprazole treatment groups were obviously increased,and ulcer index in them was obviously decreased as compared with those in the model group (P＜0.05);the levels of thickness of the slime layer and GMBF in the rhubarb treatment group were significantly higher than those in the omeprazole treatment group (P＜0.05). The scores of NSS, thickness of the slime layer and GMBF were negatively correlated to the ulcer index(r=-0.429, P=0.002; r=-0.542, P=0.013;r=-0.465, P=0.024). Positive correlation was noted between thickness of the slime layer and GMBF(r=0.680, P=0.001). Conclusion Prophylactic effect ofrhubarb on severe brain injury induced stress ulcer is noted in rats. But the rhubarb may neither reduce the mucus secretion nor improve the scores of behavioral evaluation in a short term.     

Oct-4基因在胃癌顺铂耐药中的作用

目的:建立胃癌BGC-823顺铂耐药细胞株,研究Oct-4基因在胃癌顺铂耐药中的作用。方法:使用顺铂逐步增加剂量法诱导胃癌BGC-823细胞,以建立其多药耐药细胞株BGC-823/DDP;MTT细胞毒实验检测顺铂对肿瘤细胞的细胞毒作用;半定量RT-PCR检测Oct-4基因的表达;基因转染干扰Oct-4表达;Western blot实验检测Oct-4蛋白的表达改变。结果:经过30～34周的诱导我们建立了胃癌BGC-823顺铂耐药细胞株;MTT细胞毒实验结果显示顺铂对BGC-823和BGC-823/DDP细胞的IC50值分别为(2.33±0.12)和(21.46±0.97)μmol/L(P<0.01),与BGC-823细胞比较,BGC-823/DDP细胞对顺铂耐药是其9.21倍;半定量RT-PCR检测显示胃癌耐药株BGC-823/DDP高表达Oct-4基因;Western blot结果显示化学合成的siRNA可以靶向下调Oct-4蛋白的表达;siRNA干扰BGC-823/DDP细胞Oct-4基因的表达后,BGC-823/DDP细胞对顺铂的的IC50值从(22.04±1.84)μmol/L减小到(6.15±0.53)μmol/L,二者差异具有统计学意义(P<0.01)。结论:研究结果表明,Oct-4基因的高表达在胃癌顺铂的耐药中起着重要的作用。