经脐切口单孔腹腔镜和标准腹腔镜治疗肾囊肿的对比研究

目的探讨经脐切口单孔腹腔镜和标准腹腔镜治疗肾囊肿临床效果差异,为临床治疗提供参考意见。方法选取在该院进行治疗的肾囊肿患者80例,随机将其分为治疗组和对照组,治疗组采用单孔腔道腹腔镜手术,对照组采用标准腹腔镜手术,治疗结束后,比较两组患者的平均手术时间、平均住院天数、术后住院天数以及切口不适时间等指标,以考察经脐切口单孔腹腔镜以及标准腹腔镜在治疗肾囊肿的临床效果。结果治疗组患者的平均手术时间为（30．6±4．3）min,术中平均出血量为（38．5±6．3）mL,平均住院时间为（4.3±1．7）d,以及切口不适时间为（1．3±0．3）月;对照组患者的平均手术时间为（42．8±7．5）min,术中平均出血量为（58．6±7．9）mL,平均住院时间为（6．6±2．1）d,以及切口不适时间为（2．8±0．6）个月。治疗组患者在平均手术时间、平均住院天数、术后住院天数以及切口不适时间方面明显低于对照组患者。结论经脐切口单孔腹腔镜肾囊肿较标准腹腔镜肾囊肿,具有切口小、出血量少、手术时长短、患者恢复快、住院时间短、不易感染等优点,值得临床优先推广应用。     

急性阑尾炎实施腹腔镜阑尾切除术的效果观察

目的观察急性阑尾炎实施腹腔镜阑尾切除术的效果。方法选取2009年7月-2012年7月60例急性阑尾炎患者,分为腹腔镜手术组和开腹手术组两组,每组30例。对30例患者行腹腔镜阑尾切除术,对30例患者行开腹阑尾切除术。结果与开腹手术治疗相比,腹腔镜手术组手术时间（89.7±41.2）min,术中出血量（81.2±92.0）mL,住院时间（15.8±10.2）;开腹手术组手术时间（114.5±42.6）min,术中出血量（130.2±24.0）mL,住院时间（9.3±4.9）;腹腔镜手术组手术时间,术中出血量较少,住院时间较长,且差异具有统计学意义（P〈0.05）,而两组患者的总住院费用的差异无统计学意义（P〉0.05）。结论腹腔镜阑尾切除术治疗急性阑尾炎具有可靠的疗效,并且安全可行,值得在临床广为推广。     

三孔法腹腔镜胆囊切除术与传统开腹胆囊切除术的临床疗效比较

目的：探讨三孔法腹腔镜胆囊切除术和传统开腹胆囊切除术的临床治疗效果。方法将85例急慢性胆囊炎和结石性胆囊炎患者随机分成2组,观察组46例,采用三孔法腹腔镜胆囊切除术进行治疗,对照组39例,选择传统开腹胆囊切除术进行治疗,记录2组手术所需时间、术中出血量、切口大小以及患者术后恢复情况、起始下床时间、平均住院天数,并对2组治疗方法的疗效进行分析和比较。结果观察组切口长度（2.5±0.7）cm、术中出血量（21.6±0.6）mL、手术时间（36.0±10.4）min、平均住院天数（5.2±2.6）d,对照组切口长度（8.3±2.9）cm、术中出血量（81.5±10.8）mL、手术时间（79.2±9.8）min、平均住院天数（12.8±3.4）d,2组比较差异具有统计学意义（P＜0.05）。结论三孔法腹腔镜胆囊切除术创伤小,有利于患者术后快速恢复,住院天数减少,医疗费用降低,减轻了患者的痛苦和生活负担,而且患者术后并发症少,患者生命质量提高,临床疗效显著。     

急性阑尾炎老年患者腹腔镜治疗的临床疗效分析

目的 探讨腹腔镜阑尾切除术治疗急性阑尾炎老年患者的临床疗效.方法 选取因急性阑尾炎行腹腔镜阑尾切除术的55例老年患者作为研究组,以同期因急性阑尾炎行开腹阑尾切除术的55例老年患者作为对照组,比较两组患者的术中出血量、术后肠功能恢复时间、术后平均下床时间、切口感染率、术后住院时间等指标.结果 腹腔镜手术组术中出血量、术后肠功能恢复时间、术后平均下床时间、切口感染率、术后住院时间均优于开腹手术组,差异均有统计学意义（P＜0.05）.结论 腹腔镜阑尾切除术治疗老年患者急性阑尾炎,创伤小,恢复快,值得临床普遍推广.     

小儿阑尾炎腹腔镜手术的临床研究

目的：探讨阑尾炎患儿行腹腔镜手术治疗的临床效果。方法将阑尾炎60例患儿随机均分为观察组与对照组（n=30）,给予对照组传统开腹手术治疗,给予观察组患儿腹腔镜手术治疗,对比2组患儿的治疗效果。结果观察组手术时间(43.1±2.2)min、术中出血量(45.9±15.7)mL、肠胃功能恢复时间(10.1±2.2)h、住院时间(4.1±2.0)d,显著优于对照组(66.9±6.5)min、(130.2±31.0)mL、(17.9±4.6)h、(7.7±2.2)d（P＜0.05）;对照组切口感染率与镇痛发生率分别为23.3%、20.0%,显著低于观察组的6.7%、3.3%（P＜0.05）。结论阑尾炎患儿行腹腔镜手术治疗效果显著,值得临床推广。     

免气腹单孔法迷你腹腔镜阑尾切除术式临床研究

目的 探讨免气腹单孔法迷你腹腔镜阑尾切除术的临床价值。方法 选择31例急性阑尾炎患者作为试验组，采用免气腹单孔法迷你腹腔镜阑尾切除术；选择同期行传统开放性手术急性阑尾炎患者32作为对照组。总结、分析术后两组患者的切口长度、手术时间、术中出血量、术后住院天数。结果 试验组切口长度、手术时间比对照组短，术中出血量、术后住院天数比对照组少；两组数据比较差异有统计学意义（P〈0．05）。结论 免气腹单孔法迷你腹腔镜阑尾切除术与传统开放性手术比较，切口长度、手术时间短，术中出血量、术后住院天数少，是一项简单易掌握、极具临床推广价植的新型手术方式。     

腹腔镜治疗64例复杂性阑尾炎疗效分析

目的分析对复杂性阑尾炎应用腹腔镜治疗的临床效果.方法 将我院2009年8月一2011年11月收治的64例复杂性阑尾炎患者随机分为两组,对照组32名患者采用开腹阑尾切除术,观察组32名患者采用腹腔镜阑尾切除术.比较两组的手术时间、术中出血量、住院时间和并发症发生率.结果 观察组手术时间为59.2±13.5min,对照组为62.3±11.9min,差异无统计学意义(P>0.05);观察组术中出血量为31.7±15.2ml,住院时间为4.2±1.5d,并发症发生率为9.4%,对照组的术中出血量为43.8±19.9ml,住院时间为6.5±2.8d,并发症发生率为31.3%,比较差异有统计学意义(P<0.05).结论 采用腹腔镜阑尾切除术治疗复杂性阑尾炎,具有创伤小、住院时间短、并发症少等优点,值得临床上推广应用.     

腹腔镜阑尾切除术治疗老年阑尾炎的临床效果分析

目的观察分析腹腔镜阑尾切除术治疗老年阑尾炎的临床效果。方法将我院在2012年2月至2015年2月收治的90例老年阑尾炎患者,采用随机数字法分为对照组45例和观察组45例,对照组采用传统开腹阑尾切除手术治疗,观察组采用腹腔镜阑尾切除术治疗,比较两组患者切口大小、手术时间、手术出血量以及住院时间,比较两组患者并发症发生率。结果观察组切口大小、手术时间、手术出血量以及住院时间明显少于对照组(P0.05),结果差异具有统计学意义;观察组术后并发症发生率明显低于对照组(P0.05),结果差异具有统计学意义。结论腹腔镜阑尾切除术治疗老年阑尾炎的临床效果显著,术后并发症发生率低,安全性高,在临床上值得应用及推广。     

腹腔镜阑尾切除术治疗阑尾炎患者135例疗效观察

目的 探讨腹腔镜阑尾切除术治疗阑尾炎患者的临床疗效。方法 回顾性分析135例阑尾炎患者的临床资料,应用腹腔镜阑尾切除术治疗,观察并记录手术时间,术后活动时间,术后进食时间,术后感染率,住院时间等。结果 本组患者均手术成功,无一例中转开腹,手术时间为30～90min,平均（62.3±25.6）min,术后活动时间为（12.8±3.1）h,术后进食时间为（24.7±5.5）h,平均住院时间为（4.1±1.2）d。本组患者术后均无切口感染、腹腔感染、出血等并发症发生,全部治愈出院。结论 腹腔镜阑尾切除术具有微创、手术时间短、术后疼痛轻微、恢复快,并发症少,住院时间短等优点,是治疗阑尾炎的有效术式。     

经麦氏点横切口与传统麦氏切口阑尾切除的临床对比研究

目的：探讨经麦氏点横切口与传统麦氏点阑尾切除治疗阑尾炎的临床疗效。方法回顾性分析进行治疗的42例阑尾炎患者的临床资料,根据手术方式将42例患者均分为横切口组与麦氏切口组（n=21）,比较2组患者的手术时间、术中出血量、排气时间、住院时间及瘢痕长度。结果横切口组的手术时间为（24.5±2.5）min,麦氏切口组的手术时间为（28.4±2.4）min,横切口组的术中出血量为（100.5±32.5）mL,麦氏切口组的术中出血量为(138.6±42.7)mL,横切口组的排气时间为(16.5±2.7)h,麦氏切口组的排气时间为(20.6±2.8)h,横切口组的住院时间为(6.4±2.1)d,麦氏切口组的住院时间为(8.9±2.3)d,横切口组的瘢痕宽度为（1.2±0.3）mm,麦氏切口组的瘢痕宽度为（4.3±1.6）mm,横切口组的手术时间、术中出血量、排气时间、住院时间、瘢痕宽度都显著低于麦氏切口组,差异有统计学意义（P<0.01）。结论经麦氏点横切口阑尾切术治疗阑尾炎具有手术时间短,术中创伤小,术后恢复快等特点,可在临床中推广应用。     

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.