后腹腔镜肾切除术的初步体会(附28例报告)

目的:总结后腹腔镜肾切除术的手术治疗方法和临床体会。方法:回顾研究后腹腔镜肾脏切除手术治疗各类肾脏疾病28例,其中肾癌14例,肾盂癌7例,上段输尿管癌2例,肾萎缩4例,肾结核1例。结果:手术均获成功,无手术并发症发生。手术时间75～160min,平均95min;术后8～24h进食,术后住院7～11d。结论:后腹腔镜肾脏切除手术具有损伤小、恢复快、住院时间短,对腹腔脏器干扰少等优点,具有良好的临床应用前景。     

后腹腔镜肾切除术86例临床体会

目的:探讨后腹腔镜技术在肾切除治疗中的临床应用效果。方法:对86例患者行后腹腔镜肾脏切除手术。单纯性肾切除54例,肾癌根治性切除术21例,联合尿道电切镜肾输尿管全切除11例。观察手术时间、术中出血量、住院时间、术中术后并发症及手术效果。结果:1例因术中出血中转开放手术,85例手术成功。手术时间为50~200min,平均79min。术中出血量为30~650ml。恢复肠功能时间为16~48h,术后均在第1天下床活动。术后住院时间为6~13d,平均7d。结论:后腹腔镜肾切除术具有恢复快、创伤小、疗效可靠的特点,具有良好的临床应用价值。     

后腹腔镜肾切除术的临床体会

目的总结腹膜后腹腔镜肾切除手术的临床经验。方法回顾分析后腹腔镜肾脏切除术治疗18例各类肾脏疾病患者的临床资料,其中无功能肾积水12例,肾萎缩3例,肾结核2例,肾癌1例。结果手术均获成功,无手术并发症发生。手术时间80-180min,平均100分钟;术后8-24h进食,术后住院7-14d。结论腹膜后腹腔镜肾脏切除手术具有患者损伤小、康复快、住院时间短、对腹腔脏器干扰少等优点,具有良好的临床应用前景。     

后腹腔镜保留肾单位肾肿瘤手术

目的：探讨后腹腔镜下保留肾单位治疗肾肿瘤的方法。方法：后腹腔镜下保留肾单位手术治疗肾脏肿瘤患者12例,其中肾细胞癌6例,肾错构瘤6例。肿瘤直径2.0～3.7 cm,平均2.7 cm。结果：12例手术均成功,手术时间60～210 min,平均115 min。术中出血25～150 mL,平均106 mL。肾蒂血流阻断时间18～43 min,平均28 min。术后住院4～7 d,平均5.7 d。6例肾细胞癌术后切缘均为阴性。术后随访6～18个月,平均11.3个月,复查B超及CT未见肿瘤残留及复发,静脉尿路造影（IVU）提示患侧残肾显影良好。结论：后腹腔镜保留肾单位肾肿瘤手术,具有创伤小、出血少、住院时间短以及术后恢复快等优点,是替代开放手术治疗小的肾肿瘤的安全方法。     

后腹腔镜肾脏切除术

目的 探讨后腹腔镜肾脏切除术的治疗经验.方法 回顾性分析行后腹腔镜肾脏切除术33例病人的临床资料,其中无功能肾切除24例,肾盂癌根治性切除6例,输尿管癌根治性切除2例,肾结核切除1例.结果 33例中手术成功30例,1例因出血、2例因肾周粘连改行开放手术.手术时间2～3.5h,平均2.5h,术中出血30～120ml,平均80ml,术后24～48h下床活动.本组无大出血、气胸等并发症发生.结论 经后腹腔镜行肾脏切除术,具有创伤小、恢复快的优点,对肾脏疾病的适应证广,适用于肾的良、恶性病变.     

35例后腹腔镜下保留肾单位肾部分切除术的方法及临床价值

目的 探讨后腹腔镜下行保留肾单位肾部分切除手术的方法及其临床价值.方法 2005年9月至2009年5月采用腹腔镜经后腹腔对35例肾脏肿瘤患者行保留肾单位的肾脏部分切除术.结果 35例手术均取得成功.平均手术时间85min,平均热缺血时间25min;平均出血量240mL;平均术后住院时间9d;术后无需要再次手术的并发症.随访1～30个月无局部肿瘤复发及远处转移.结论 后腹腔镜下保留肾单位的肾脏部分切除术安全、有效,对小于4cm的肿瘤具有较好的临床应用价值.     

后腹腔镜下根治性肾切除术

目的:总结后腹腔镜下根治性肾切除术的治疗经验。方法:回顾研究后腹腔镜肾脏切除手术治疗各类肾脏疾病23例,其中肾癌14例,肾盂癌5例,上段输尿管癌2例,肾萎缩2例。结果:23例手术均顺利,手术时间平均105min,平均出血110ml,术后8h~24h进食,术后住院7d~11d,未出现并发症。23例随访2个月~21个月,平均12.8个月,均健在,未见肿瘤复发。结论:该手术具有手术时间短、安全可靠、患者恢复快、操作简单等优点,是一种实用的手术方法。     

腹膜后腹腔镜下肾切除术34例临床分析

目的探讨腹膜后腹腔镜下肾切除术的临床效果及应用价值。方法对2008年8月～2010年6月行腹膜后腹腔镜肾脏切除手术34例的临床资料进行回顾性分析。结果 34例手术均获得成功,平均手术时间125min,平均出血量80ml,术后第2天即可下床活动及饮食,术后平均住院时间7天,术中和术后未发生严重的并发症。随访1～20个月,单纯肾切除无其他并发症;2例肾癌患者未见肿瘤复发或转移。结论腹腔镜肾切除术具有创伤小、恢复快、安全可靠,可在基层医院逐步推广应用     

后腹腔镜肾部分切除术治疗T1a期肾细胞癌32例报告

目的：评价后腹腔镜肾部分切除术（RLPN）治疗T1a期肾细胞癌的安全性和临床效果.方法：回顾性分析32例行后腹腔镜肾部分切除术的T1a期肾细胞癌患者的临床资料.观察手术时间、术中出血量、热缺血时间、术后住院天数.结果：31例手术均顺利完成,1例术中出血较多转开放性手术.手术时间90～155 min（平均115 min）;热缺血时间15～34 min（平均23 min）;术中出血40～280 mL（平均105 mL）;术后住院8～l0d（平均9d）.术后1例发生漏尿.患者均康复出院.术后病理：肾透明细胞癌24例,嫌色细胞癌6例,乳头状癌2例.随访3～79个月,患者均未见肿瘤局部复发、远处转移及切口种植等.结论：后腹腔镜肾部分切除术治疗T1a期肾细胞癌安全可行,是≤4.0cm的Tta期肾细胞癌的首选治疗术式,值得在具备条件的医院临床推广.     

后腹腔镜肾切除术的临床应用（附39例报告）

目的探讨后腹腔镜肾切除术的临床应用价值。方法 2007年2月-2011年3月采用后腹腔镜技术行肾癌根治性切除术18例,肾盂癌和输尿管癌根治性切除术6例,单纯肾切除15例（积水无功能肾6例,肾结核7例,萎缩无功能肾2例）。观察手术时间、术中出血量、术中术后并发症及手术效果。结果 39例后腹腔镜手术时间90～235min,平均（142±48）min;术中出血量70～290 mL,平均（123±28）mL,术中、术后均未输血;引流管拔除时间24～72h,术后住院时间4～8d,平均（6.3±1.5）d,术后均未发生严重的并发症。术后随访1～48个月,7例结核患者经抗结核治疗后无复发,18例肾癌和6例肾盂癌和输尿管癌患者未见肿瘤复发、切口种植转移或远处转移。结论后腹腔镜肾切除术创伤小、恢复快、临床疗效安全可靠。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.