小切口胆囊切除术1280例分析

胆石病包括胆囊和胆管的结石,是常见病、多发病.随着人民生活水平的提高,我国胆石病的特点发生了明显变化.过去胆管结实的发病率胆囊结石高,胆色素结石比胆固醇结石多,现在胆囊结石发生率已高于胆管结石,胆固醇结石已多于胆色素结石.胆囊结石主要为胆固醇性结石或以胆固醇为主的混合性结石.     

胆囊结石的超声诊断

胆囊结石是最常见拘胆系疾病,是急腹症的常见原因.根据结石的化学成分,通常可分为胆固醇结石、胆色素结石和混合性结石三类,其中以胆固醇结石和混合性结石较多见.目的 讨论胆囊结石的超声诊断.方法 根据超声表现进行诊断.结论 同时具备胆囊结石3条典型超声表现,是超声诊断胆囊结石的可靠依据.     

超声对胆囊结石与胆囊动力学关系的研究

目的 探讨胆囊动力学异常在胆囊结石形成中的作用.方法 采用超声实时检测技术观察胆囊结石患者胆囊容积,计算收缩率;同时应用放射免疫法测定血浆胆囊收缩素水平,并与正常对照组进行对比分析.结果 胆囊结石组胆囊收缩率正常者和胆囊收缩率降低者,其空腹胆囊容积均大于正常对照组;胆囊收缩率降低者血浆胆囊收缩素也低. 结论 胆囊空腹容积增大造成胆汁瘀积、成分改变与结石形成有关;胆囊收缩率降低其排空功能下降,陈旧胆汁不能及时排出易导致结石形成;胆囊收缩素减少使胆囊收缩功能减弱,促进胆囊结石形成.     

华支睾吸虫感染与胆囊结石研究报告

目的 探讨华支睾吸虫感染与胆囊结石的关系.方法 随机抽取2006年12月～2009年1月在该院普外科实施内镜保胆取石手术的204例患者的胆囊结石,将结石磨碎过滤后涂片镜检.同时随机抽取同期108例实施内镜保胆取石手术患者的胆汁,离心后将沉渣涂片镜检.结果 204例胆囊结石中163例检出华支睾吸虫卵,检出率79.9%,108例胆汁中,46例检出华支睾吸虫卵,检出率42.6%,两组相比较有统计学意义(P＜0.0001).华支睾吸虫卵在胆色素性结石、胆固醇性结石和混合性结石中的检出率分别为89.6%、57.9%和70.0%,三组相比较有统计学意叉(P＜0.0001);204例胆囊结石中,159例来自华支睾吸虫病流行区.如广东、广西(胆色素性结石占69.2%,胆固醇性结石占5.7%,混合性结石占25.2%),45例来自华支睾吸虫病非流行区,如甘肃(胆色素性结石占11.1%,胆固醇性结石占22.2%,混合性结石占66.7%),两组构成比差异有统计学意义(P＜0.0001).结论 结果第一次表明:华支睾吸虫感染与胆囊结石有密切关系;在华支睾吸虫病流行区,胆囊结石以胆色素性结石为主,在非流行区以胆固醇性结石和混合性结石为主;华支睾吸虫卵在胆囊结石中的检出率明显高于胆汁;胆囊结石磨碎过滤镜检是诊断华支睾吸虫感染简单而有效的方法.     

胆固醇及胆色素结石患者与正常人胆囊胆汁免疫球蛋白浓度的比较

目的：探索作为促成核因子的免疫球蛋白在胆固醇及胆色素结石患者与正常人胆囊胆汁中浓度的差异。方法：采用酶联免疫吸附法（ Ｅ Ｌ Ｉ Ｓ Ａ）测定１６例胆囊结石患者及９例正常对照者的胆囊胆汁中免疫球蛋白 Ｉｇ Ａ、 Ｉｇ Ｍ 和 Ｉｇ Ｇ 的浓度。结果：胆固醇性胆囊结石组胆囊胆汁中 Ｉｇ Ｍ 、 Ｉｇ Ｇ 显著高于胆囊结石组及对照组（ Ｐ＜ ０００１）。而胆色素性胆囊结石组胆囊胆汁中 Ｉｇ Ｍ 、 Ｉｇ Ｇ 浓度与对照组无显著差异（ Ｐ＞ ０４）。３组胆囊胆汁中 Ｉｇ Ａ 浓度无显著差异（ Ｐ＞ ０４）。结论：胆囊胆汁中免疫蛋白与胆固醇结石有一定的关系,其浓度可作为区别正常和成石胆汁的指标。     

胆囊结石病因与致石疾病研究进展

胆囊结石是一种世界性的常见多发病.根据其化学成分组成不同,通常分为以下3类,胆色素结石、胆固醇结石和混合性结石.流行病学研究提示[1],西方国家,大约80%～90%的胆囊结石为胆固醇或混合性结石,只有10%～20%为胆色素结石.但也有一些研究发现超过30%的胆囊结石为胆色素结石.在亚洲,超过70%为胆色素结石,对胆色素结石的发病机制研究甚少.笔者查阅近些年文献,将胆囊结石成因及致石疾病的研究进展综述如下.     

无症状胆囊结石病患者胆囊排空功能的研究

目的对比研究无症状胆石病患者与正常人胆囊排空功能.方法B超测量多个时相胆囊长径、横径、前后径,用椭圆形体积公式计算胆囊容积.结果胆囊结石患者胆囊排空功能明显降低,FV和RV均明显大于对照组;胆囊排空率则较正常人降低.以对照组平均RF 2SD值(32.3%)为界限,将病例组分为胆囊收缩正常组(n=8)和收缩减弱组(n=12),与收缩正常组比较,收缩减弱组RV增大,胆囊排空率降低,但EV却明显下降.结论无症状胆囊结石病患者的胆囊排空功能较正常人明显降低.     

胆囊结石中胆固醇含量与胆囊动力、缩胆囊素及其受体间关系的研究

目的分析胆囊结石中胆固醇的含量与胆囊动力、CCK及其受体间的关系。方法收集来我院进行治疗的93例胆囊结石患者分为三组(n=31):胆色素结石组(A组)、混合性结石组(B组)和胆固醇结石组(C组)。选取健康研究对象30例作为正常对照组(D组)。结果 A、B、C组间的胆固醇含量差异有统计学意义(P<0.05);C组、B组患者的FV、RVmin及EVmax与其他的组别间差异有统计学意义(P<0.05);脂餐后CCK的浓度、CCK-AR含量及活性在各组别中的差异有统计学意义(P<0.05);胆囊结石中胆固醇的含量明显正相关于脂餐后CCK浓度,负相关于EVmax%、胆囊壁中CCK-AR活性、含量(P<0.05);胆囊壁CCK-AR含量、活性明显负相关于脂餐后血浆CCK浓度、明显正相关于EVmax%(P<0.05)。结论胆固醇通过对CCK造成影响而使机体的胆囊动力减弱,从而对于形成胆固醇结石起到了促进作用。     

食用淡馒头测定胆囊收缩功能在微创保胆取石中的应用价值

目的：探讨食用淡馒头后用超声测定胆囊收缩功能的方法在微创保胆取石中的应用价值。方法：回顾性分析180例行微创保胆取石术患者的临床资料,食用150 g淡馒头后,通过超声测定进食60 min后和术后6个月胆囊排空率,评价胆囊收缩功能改变的情况,观察微创保胆取石术后结石复发与术前患者胆囊收缩功能的关系。结果：术后空腹胆囊容积明显较术前增大,差异有统计学意义(P<0.05);术后进食后胆囊容积明显较术前减小,差异有统计学意义(P<0.05);术后胆囊排空率明显较术前好,差异有统计学意义(P<0.05)。微创保胆取石术后6个月复查超声,胆囊结石复发16例。结论：食用150 g淡馒头后用超声测定胆囊收缩功能的方法效果良好,既方便、经济,又无胆绞痛、胰腺炎发生,可以作为胆囊结石患者行微创保胆取石术前检查,值得推广。     

兔胆石性胆囊炎取石前后胆囊形态结构及排空功能的研究

本实验以人胆固醇结石植入兔胆囊，制作胆石性胆囊炎模型，对取石前后胆囊的形态结构和实时超声显像下胆囊应激ＣＣＫ单次剂量（２．５Ｕ／ｋｇ）的排空功能进行对比研究。结果显示：植石３个月后，实验组胆囊壁呈慢性炎症改变，以炎性渗出为主，胆囊排空功能下降。取石３个月后，胆囊炎症持续存在，但以胶原纤维增生为主，胆囊排空功能不因结石的消除而改善，这可能是非胆囊切除的各种方法治疗胆囊结石后胆石复发的基本病因。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.