腹腔镜治疗食管裂孔疝的临床分析

目的:探讨腹腔镜手术治疗食管裂孔疝的临床疗效和安全性。方法:对2009-02~2013-01内蒙古自治区人民医院42例食管裂孔疝修补术的资料进行分析,其中28例行腹腔镜手术(腹腔镜组),14例行开腹手术(开腹组)。结果:腹腔镜组在手术时间,术中出血量,术后住院时间及术后并发症发生率均优于开腹组(P<0.05),两组术前、术后3mon、术后1 a行食管测压、24 h测酸(Demeester评分)结果差别无统计学意义(P>0.05)。结论:腹腔镜手术治疗食管裂孔疝创伤小、恢复快,具有广阔的临床应用前景。     

24 h双通道食管pH监测对胃食管酸反流的监测意义

目的：探讨24 h双通道食管pH监测对胃食管病理性酸反流的监测意义。方法收集2011年8月-2012年9月因胃食管反流相关症状在我院消化科胃肠动力室行动态24 h双通道食管pH监测的51例患者资料,根据24 h双通道食管pH监测结果分为：远端、近端均有病理性酸反流组(20例),仅远端有病理性酸反流组(2例),仅近端有病理性酸反流组(9例),远端、近端均无病理性酸反流组(20例)。比较单、双通道24 h食管pH监测食管病理性酸反流阳性率的差异,分析仅近端食管出现病理性酸反流的可能原因及近端与远端食管酸反流的相关性。结果51例中9例仅近端提示有病理性酸反流,其中8例同时在本院进行了胃镜和(或)高分辨率食管测压检查,1例为Barrett食管(主诉仅为咽部异物感,没有明显的反酸、烧心症状),7例主诉反酸、烧心者中2例食管裂孔疝、2例贲门失迟缓、1例十二指肠球部溃疡和1例胡桃夹食管,另外1例胃镜结果阴性(未做高分辨率食管测压检查)。近端、远端均有病理性酸反流患者近端食管pH＜4所占总监测时间的百分比、卧位pH＜4所占百分比、立位pH＜4所占百分比及Demeester记分均明显高于单纯近端食管病理性酸反流患者(P＜0.05),最长酸反流时间的差异无统计学意义(P＞0.05)。食管近端、远端酸反流均与年龄有关,年龄越大越易反流。结论24 h双通道食管pH监测对有明显胃食管反流症状但pH监测远端食管无病理性酸反流的患者有一定诊断意义。喉咽反流与胃食管反流具有相关性,24 h双通道食管pH监测对其研究有帮助。     

消化道钡剂造影如何发现食管裂孔疝

目的: 在用钡剂行上消化道检查中利用特殊的检查方法诊断食管裂孔疝,提高对传统的X线检查方法的认识.方法:采取多种特殊的检查方法提高对食管裂孔疝的诊断率.结论:食管裂孔疝的诊断正确与否,与检查方法和操作经验有一定的关系.要提高此病的诊断率,必须要熟练掌握科学的操作方法,使钡剂检查消化道疾病由经验技巧性为主,转化为规范化和程序化.     

消化道钡剂造影如何发现食管裂孔疝

目的 :在用钡剂行上消化道检查中利用特殊的检查方法诊断食管裂孔疝 ,提高对传统的 X线检查方法的认识。方法 :采取多种特殊的检查方法提高对食管裂孔疝的诊断率。结论 :食管裂孔疝的诊断正确与否 ,与检查方法和操作经验有一定的关系。要提高此病的诊断率 ,必须要熟练掌握科学的操作方法 ,使钡剂检查消化道疾病由经验技巧性为主 ,转化为规范化和程序化。     

食管裂孔疝的发病机制及诊断方法

食管裂孔疝( hiatal hernia,HH)是消化科的常见疾病之一,自本病描述以来,它的定义逐渐更新,然而对于复杂的膈肌食管裂孔相关组织结构的生理学学说较多,但尚未完全阐明。检查方法虽不少,但仍有误漏诊。本文旨在通过回顾近年来国内外关于HH的基础研究和临床文献,以提高对该病的认识。对目前公认的HH4个亚型解剖学分类的特点做了病因及临床表现的总结。对其发病机制(包括胚胎学、解剖学、生理学和病生理变化)及检查方法的文献进行了较全面的复习和介绍。鉴于HH可能引起严重的并发症,所以准确而快速的诊断至关重要。笔者着重对目前应用X线胸片、上消化道造影、胃镜、CT以及食管测压等诊断本病的检查方法逐一进行了比较与介绍,认为评估HH的主要方法是内镜和上消化道造影。尤其是对于需要手术干预的术前患者而言。上消化道造影被认为在诊断滑动型HH方面比内镜具有更高的敏感性,至少在肥胖人群中如此。临床上,医师需要根据不同患者的表现来选取不同的诊断方法。虽然关于上消化道造影与胃镜这两种方法究竟哪种更为准确尚无定论,但对于偶然发现的HH或患者症状轻微,可以通过内镜和上消化道造影评估。当需要提供额外信息帮助制定进一步临床决策时可以选择CT。在HH患者出现紧急情况(如胃梗阻或缺血时),首先需要下胃管进行胃肠减压,而后进行胸片、胃镜检查。而测压法技术并非是一种灵敏的诊断HH的方法,过多的检查可能延误治疗。     

胃镜下贲门松弛患者WHRM与24h pH-阻抗值的变化特点及意义

目的 应用液态高分辨率食管测压(Water-perfused high resolution esophageal manometry,WHRM)与多通道腔内24小时pH-阻抗监测(24 hours pH-impedance monitoring)技术研究胃镜下贲门松弛患者食管动力特点并进行分析总结.方法 将2015年10月9日~2016年9月9日,本科胃镜下检查发现贲门明显松弛20例患者的胃动力检测:液态高分辨率食管测压与多通道24小时pH-阻抗监测参数结果进行分析.结果 贲门松弛程度与pH小于4时的反流次数、酸反流次数和Demeester评分密切相关.结论 当患者在胃镜检查中被发现贲门松弛时,应当警惕胃食管反流病的发生.     

基层医院胃镜下食管阀瓣分级联合食管胃超声造影对胃食管反流病的诊断价值

目的 探讨胃镜下食管阀瓣分级联合食管胃超声造影在胃食管反流病的诊断价值。方法 收集2018年1月至2020年6月我院341例疑似胃食管反流病患者资料,分析比较胃镜下胃食管阀瓣分级联合食管胃超声造影在诊断胃食管反流病与食管24 h pH阻抗诊断的一致性。比较胃食管反流病患者与非胃食管反流病患者的食管高分辨测压远端潜伏期(DL)、下段食管括约肌综合松弛压(IRP)、食管远端收缩积分(DCI)。结果 胃镜下食管阀瓣分级和食管胃超声造影对胃食管反流病诊断敏感度、特异度、准确度、阳性预测值、阴性预测值比较,差异无统计学意义,胃镜下胃食管阀瓣分级联合食管胃超声造影对胃食管反流病诊断敏感度93.22%、特异度98.10%、准确度94.72%、阳性预测值99.10%、阴性预测值86.65%,分别高于单独使用胃镜下胃食管阀瓣分级或食管胃超声造影,差异有统计学意义(P<0.01)。胃镜下食管阀瓣分级联合食管胃超声造影与食管24 h pH阻抗诊断高度一致(Kappa值0.881)。通过胃食管阀瓣分级联合食管胃超声造影检出的胃食管反流病患者其食管高分辨测压测出DL、IRP大于非胃食管反流病患者,其测出DCI小于非胃食管反流病患者,差异有统计学意义(P<0.01)。结论 胃镜下食管阀瓣分级联合食管胃超声造影诊断胃食管反流病较各自单一检查敏感性、特异性高,可在临床应用。     

X线钡剂造影和胃镜对食管裂孔疝诊断的对比研究

目的:比较X线钡剂造影和胃镜检查对食管裂孔疝的诊断价值.方法:对74例临床上有反酸、烧心、胸背部疼痛等反流症状疑似食管裂孔疝患者同时作X线钡剂造影和胃镜检查,比较这两种检查方法对疑似食管裂孔疝的检出率、年龄与性别构成、体重指数及反流性食管炎检出情况等方面的差异.结果:X线钡剂造影检查出食管裂孔疝64例(阳性率86.49％),未发现食管裂孔疝10例(阴性率13.51％);胃镜检查出食管裂孔疝20例(阳性率27.03％),未发现食管裂孔疝54例(阴性率72.97％);两种方法同时检查出食管裂孔疝16例,符合率21.62％,检出率差异有统计学意义(x2=32,P＜0.01);X线钡剂造影检查出食管裂孔疝的患者在年龄方面较胃镜检出者大,但反流性食管炎的检出率较胃镜低;两种方法检出的食管裂孔疝患者的体重指数均增高.结论:X线钡剂造影较胃镜检查对食管裂孔疝更有诊断价值,且高龄患者检出率高,食管裂孔疝患者体重指数增高,提示肥胖可能是食管裂孔疝的易患因素.     

胃镜诊断52例食管裂孔疝临床分析

食管裂孔疝(hiatus hernia)是指腹腔内脏器(主要是胃)通过膈食管裂孔进入胸腔所致的疾病,为膈疝中常见的类型.以往诊断主要依靠X线钡餐造影,随着胃镜检查技术的普及,胃镜下诊断食管裂孔疝亦逐渐增多.现对我院在2002-09～2004-09间,胃镜诊断的52例滑动性食管裂孔疝结合临床、胃镜下特点及X线诊断分析如下.     

食管高分辨率测压在胃食管反流病中的应用

胃食管反流病(gastroesophageal reflux disease,GERD)是指胃、十二指肠内容物反流入食管引起的反流、胃灼痛等症状以及咳嗽、咽喉炎等食管外症状。目前,临床上主要根据患者的症状来诊断GERD,而胃镜、24h食管阻抗-pH值监测等检查也在GERD的诊疗中发挥不同的作用。近年来,随着食管测压技术的出现和不断发展,食管高分辨率测压(high-resolution manometry,HRM)在胃食管反流病中的应用也越来越受到重视,本文将对食管HRM在GERD中的应用做一综述。     

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.