腹腔镜阑尾切除术219例临床应用体会

目的:总结腹腔镜阑尾切除术的临床应用体会。方法:回顾性分析219例接受腹腔镜阑尾切除术的患者资料。结果:219例中,215例行腹腔镜阑尾切除术,4例行腹腔镜阑尾周围脓肿引流术。手术均顺利完成,无1例中转开腹,术后无1例发生切口感染、肠粘连、肠梗阻、腹腔残余脓肿形成等并发症,全部治愈出院。结论:腹腔镜阑尾切除术具有创伤小、恢复快、住院时间短、术野清晰、探查范围广、并发症少等优点,尤其在术前诊断不明确时可弥补开腹阑尾切除术的不足,值得进一步推广。     

腹腔镜阑尾切除术的临床疗效分析

目的：总结腹腔镜阑尾切除术的临床应用体会。方法：回顾性分析112例接受腹腔镜阑尾切除术的患者资料。结果：112例中,110例行腹腔镜阑尾切除术,2例行腹腔镜阑尾周围脓肿引流术。手术均顺利完成,无1例中转开腹,术后无1例发生切口感染、肠粘连、肠梗阻、腹腔残余脓肿形成等并发症,全部治愈出院。结论：腹腔镜阑尾切除术具有创伤小、恢复快、住院时间短、术野清晰、探查范围广、并发症少等优点,尤其在术前诊断不明确时可弥补开腹阑尾切除术的不足,值得进一步推广。     

腹腔镜阑尾切除术86例临床分析

目的：总结探讨腹腔镜阑尾切除术的临床应用价值。方法：回顾性分析2004年1月～2009年1月86例腹腔镜阑尾切除术。结果：84例手术顺利,2例中转开腹,无切口感染、腹腔脓肿、粘连性肠梗阻等并发症发生。结论：腹腔镜阑尾切除术以安全、创伤小、痛苦轻、恢复快、并发症少等优点,逐渐成为阑尾切除的首选手术方法。     

阑尾常规开腹手术与腹腔镜切除术的护理对比分析

目的：探讨阑尾常规开腹手术与腹腔镜切除术的不同护理方法。方法：选择42例行常规开腹手术的阑尾炎患者，以及同期45例行腹腔镜切除术的阑尾炎患者，针对不同术式对护理方案进行调整，观察患者术后排气时间、术后并发症发生率、止痛药使用情况、住院时间等指标。结果：本次研究中，开腹组及腔镜组止痛药使用率、术后并发症发生率、平均住院时间组间差异无统计学意义（P＞0.05），平均肛门排气时间组间差异有统计学意义（P＜0.05），全部患者均痊愈出院。结论：阑尾常规开腹手术与腹腔镜切除术经科学合理的护理，均可获得较好的术后康复。     

腹腔镜阑尾切除术86例临床分析

目的:总结探讨腹腔镜阑尾切除术的临床应用价值.方法:回顾性分析86例腹腔镜阑尾切除术病例.结果:84例手术顺利,2例中转开腹,无切口感染、腹腔脓肿、粘连性肠梗阻等并发症发生.结论:腹腔镜阑尾切除术以安全、创伤小、痛苦轻、恢复快、并发症少等优点逐渐成为阑尾切除的首选手术方法.     

小儿腹腔镜阑尾切除术与开腹阑尾切除术疗效比较

目的比较小儿腹腔镜阑尾切除术与开腹阑尾切除术的临床效果。方法选择2011年1月至2014年6月洛阳市妇女儿童医疗保健中心收治的急性阑尾炎患儿217例,其中112例行腹腔镜阑尾切除术(腹腔镜手术组),105例行开腹阑尾切除术(开腹手术组),对比2组患儿的临床疗效及术后并发症情况。结果 2组患儿手术时间比较差异无统计学意义(P>0.05),腹腔镜手术组患儿术中出血量显著少于开腹手术组(P<0.05),胃肠功能恢复时间和住院时间显著短于开腹手术组(P<0.05)。腹腔镜手术组和开腹手术组患儿并发症发生率分别为10.7%和31.4%,腹腔镜手术组患儿并发症发生率低于开腹手术组(P<0.05)。结论腹腔镜阑尾切除术治疗小儿急性阑尾炎术中出血量少,术后患儿恢复快,住院时间短,且并发症少。     

腹腔镜阑尾切除术26例分析

目的 探讨腹腔镜阑尾切除术的疗效。方法 对26例行腹腔镜阑尾切除术的病人进行回顾性分析。结果 26例中手术成功24例，手术成功率96％，平均手术时间34．5min，平均住院时间3．5d，无手术死亡率及并发症。结论 腹腔镜阑尾切除术优于传统开腹阑尾切除术，值得临床推广应用。     

腹腔镜阑尾切除在基层医院的应用

目的探讨腹腔镜阑尾切除术的优势以及是否适宜在基层医院推广。方法比较55例开腹阑尾切除术(开腹组)和54例腹腔镜阑尾切除术(腹腔镜组)的手术时间、术后镇痛、排气时间、住院天数、切口感染率和残余脓肿率。结果两组手术时间无显著差异,而在其余方面腹腔镜组均优于开腹组。结论腹腔镜阑尾切除术创伤小,术后疼痛轻,胃肠功能恢复快,术后并发症少,住院时间短,手术难度不大,无须昂贵附加设备,便于在基层医院推广。     

无金属残留腹腔镜阑尾切除术236例体会

目的 总结无金属残留腹腔镜阑尾切除术在治疗阑尾炎中的效果.方法 回顾性分析无金属残留腹腔镜阑尾切除术236例的临床资料.结果 236例全部完成无金属残留腹腔镜阑尾切除术,无一例中转开腹.8例术后肩部疼痛,1例残端瘘,1例术后脐部戳孔感染,随访1～20个月,未发现肠粘连、肠梗阻、阑尾残株炎、术后出血等并发症.结论 无金属残留腹腔镜阑尾切除术治疗阑尾炎可降低阑尾切除术后并发症,应作为阑尾切除术的首选方式.     

小儿腹腔镜与开腹阑尾切除术的比较

目的 比较腹腔镜与开腹阑尾切除术两种术式的优越性.方法 2004年1月～2006年6月,分别应用腹腔镜阑尾切除术92例和开腹阑尾切除术48例,记录两种术式的手术时间、术后各项指标恢复情况及并发症.结果 腹腔镜阑尾切除术组手术时间、镇痛剂应用、肛门排气时间、住院时间、切口感染率、粘连性肠梗阻发生率和腹腔脓肿发生率等指标明显低于开腹阑尾切除术组(P＜0.01).结论 腹腔镜阑尾切除术创伤小、恢复快且并发症少,明显优于常规开腹阑尾切除术.     

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.