胆囊颈部及胆囊管结石嵌顿112例急诊手术治疗体会

目的总结胆囊颈部、胆囊管结石嵌顿所致结石性急性胆囊炎手术治疗的体会。方法回顾性分析2005年12月至2010年12月手术治疗胆囊颈部、胆囊管结石嵌顿所致112例结石性急性胆囊炎的临床资料。结果术前经影像学检查诊断为结石梗阻性急性胆囊炎112例,全部行腹腔镜探查。78例（69.64%）完成腹腔镜胆囊切除术（LC）;34例（30.36%）中转开腹手术。112例均置腹腔引流管。全部治愈。术后住院时间3～21d,平均6.4d。结论术前影像学检查难以区分胆囊颈结石、胆囊管结石嵌顿,急性期患者胆囊三角解剖不清、粘连,胆囊肿大、壁厚,给LC造成相当大困难。但选择好适应证、掌握好手术技巧,仍可用LC治疗大部分急性发作期的结石性急性胆囊炎     

结石嵌顿并急性胆囊炎的腹腔镜治疗

[目的]探讨急诊行腹腔镜胆囊切除术（LC）治疗结石嵌顿并急性胆囊炎的可行性。[方法]回顾性分析我院2006年1月至2010年12月105例LC治疗胆囊结石嵌顿并急性胆囊炎患者病历资料。[结果]本组105例患者中100例顺利完成腹腔镜下胆囊切除术,5例术中转为开腹手术,中转率4.76%;术后无胆漏及腹腔出血等并发症。全部患者均治愈出院,无死亡病例。[结论]胆囊结石嵌顿并发急性胆囊炎行LC疗效可靠、安全、可行。但需注意适应症选择,完善术前准备,选择手术时机,正确手术操作,术中常规腹腔引流。     

腹腔镜治疗急性嵌顿性胆囊结石247例分析

目的探讨腹腔镜胆囊切除术治疗急性嵌顿性胆囊结石的临床应用可行性及价值。方法回顾分析2002年-2007年247例急性结石嵌顿性胆囊炎患者行腹腔镜手术的临床资料。结果腹腔镜手术成功235例,成功率95.14%,中转开腹12例,无胆道损伤,无死亡病例。术后平均住院3.9d。结论LC治疗急性结石嵌顿性胆囊炎是安全、可行的。须严格掌握适应证、手术时机、手术技巧,适时中转手术是提高手术成功率、降低并发症的关键。     

腹腔镜胆囊切除术中胆囊结石嵌顿性胆囊炎的处理

目的总结腹腔镜胆囊切除术中胆囊结石嵌顿性胆囊炎的治疗经验。方法应用腹腔镜技术治疗结石嵌顿性胆囊炎126例。结果本组腹腔镜胆囊切除术（Laparoscopic cholecystectomy,LC）术中,无中转开腹;术中无胆道损伤、血管损伤、胃肠道损伤等;无死亡病例。结论经过充分术前准备,选择手术时机、手术操作方法,结石嵌顿性胆囊炎腹腔镜胆囊切除术是安全可行的。     

急性胆囊炎合并胆囊结石嵌顿的腹腔镜处理

目的 探讨急性胆囊炎合并胆囊结石嵌预行腹腔镜胆囊切除术(LC)的方法和处理特点.方法 回顾性分析2000年1月至2007年1月本院收治的85例行LC术的急性胆囊炎合并胆囊结石嵌顿患者.结果 中转开腹12例.10例Calot三角探作困难,2例胆道造影发现胆总管结石.术后放置腹腔引流管83例.85例患者术后均顺利康复,无胆管损伤等并发症发生.结论 在急性胆囊炎合并胆囊结石嵌顿的患者采用LC手术时,正确地选择手术时机,熟悉Calot三角的解剖结构,充分估计处理胆囊管嵌须结石的手术难度及适时中转开腹可有效地减少胆管损伤等并发症的发生,顺利地完成手术操作.     

腹腔镜治疗结石嵌顿性急性胆囊炎

目的 探讨结石嵌顿性急性胆囊炎腹腔镜手术价值。方法 应用腹腔镜手术治疗结石嵌顿性急性胆囊炎30例。结果 27例顺利完成腹腔镜胆囊切除术(LC)，3例中转开腹，术中无胆管损伤、血管损伤，无死亡病例。结论 只要正确掌握手术操作方法，及时中转开腹，能有效地降低并发症，结石嵌顿性急性胆囊炎行LC是安全可行的。     

腹腔镜手术治疗结石嵌顿性胆囊炎54例临床分析

目的:探讨腹腔镜胆囊切除术(LC)中胆囊颈部结石嵌顿的处理方法。方法:回顾性分析腹腔镜手术治疗54例胆囊颈部结石嵌顿性胆囊炎患者的临床资料。结果:54例均顺利完成LC,无中转开腹,均痊愈出院。其中7例胆囊大部分切除加腹腔引流。结论:LC治疗胆囊颈部结石嵌顿性胆囊炎是安全可行的。     

急性结石嵌顿性胆囊炎的腹腔镜手术体会

目的探讨急性结石嵌顿性胆囊炎行I期腹腔镜胆囊切除术的手术方法。方法回顾性分析79例急性结石嵌顿性胆囊炎行I期腹腔镜胆囊切除术（LC）的临床资料。结果75例LC手术成功,4例中转开腹。结论急性结石嵌顿性胆囊炎行I期腹腔镜胆囊切除术是安全可行的,术者熟练的操作技术是成功的关键。     

腹腔镜手术治疗胆囊颈部结石嵌顿患者45例体会

目的:探讨腹腔镜手术(LC)在治疗胆囊颈部结石嵌顿患者中的手术时机、手术方式和治疗效果。方法:回顾性分析我院2010年7月-2011年7月45例LC治疗急性胆囊炎发作伴胆囊颈部结石嵌顿患者的临床资料。27例予抗炎解痉治疗后早期(72h内)行LC治疗;4例经过抗炎解痉治疗症状好转出院后2周内再发,再度入院行急诊手术治疗;14例抗炎解痉治疗后出院1个月后来我院再行LC手术治疗。结果:45例手术均顺利进行,34例术后放置腹腔引流管,无中转开腹手术病例,未出现胆管损伤、胆瘘、出血等严重并发症,无手术死亡病例,术后患者恢复良好。结论:LC治疗急性胆囊炎伴胆囊颈部结石嵌顿手术治疗较无症状患者困难。我院治疗的14例1个月后来院行手术患者手术时间、术后放置引流管时间、住院时间均较其余31例手术患者时间短,术后恢复快。证明急性期胆囊炎伴胆囊颈部结石嵌顿患者予抗炎解痉治疗出院,等炎症消退后再行手术治疗是安全、可靠、可行的。     

急性结石性胆囊炎腹腔镜胆囊切除术中转开腹影响因素分析

目的研究急性结石性胆囊炎腹腔镜胆囊切除术的手术时机及影响中转开腹的相关因素。方法选择219例我院收治的急性结石性胆囊炎并行腹腔镜胆囊切除术患者,按手术时机分为A、B、C、D四组。A组为48 h内手术63例,B组为48~72 h内手术53例,C组为72 h~2周内手术58例,D组为入院后先行抗感染及对症治疗,在发作两周后择期手术45例,收集相关临床资料进行统计学分析。结果 A、D组手术时间、术后腹腔引流量、并发症、中转开腹率较B、C组少(P<0.05),而A、D组手术时间、术后腹腔引流量、并发症比较,差异无统计学意义(P>0.05),A组中转开腹率与D组比较,差异有统计学意义(P<0.05)。体温、右上腹肌紧张、触及胆囊、白细胞计数、B超见胆囊肿大、胆囊壁厚度、胆囊颈部结石嵌顿与中转开腹有关(P<0.05)。手术时机、白细胞计数、胆囊颈部结石嵌顿是急性结石性胆囊炎腹腔镜胆囊切除术中转开腹独立危险因素(OR=2.892、3.168、2.124,P<0.05)。结论急性结石性胆囊炎可尽早进行手术,发作48 h内是腹腔镜手术治疗最佳时机,其次可先行保守治疗后再择期手术治疗,可减少手术风险及并发症,中转开腹受到手术时机选择、血象及结石位置影响,应综合考虑提高腹腔镜手术成功率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.