我和周生和风月之间

1她轻描淡写地燃支烟,表情沧桑,恨不得天色总是灰黑、头发再蓬乱一点,这样的风情,周生总要受点吸引吧?说真的,苏苏长得不好看,个子太高,人又太瘦。幸好年轻,虽然貌不惊人,但盛夏的天气里,随便罩件小吊带也挺青春的。像每个女孩子一样,苏苏喜欢照镜子,每次都会顾影自怜,如果能再矮一点,如果能再胖一点,也许爱情就会不期而至了吧?     

肥胖和代谢外科的现状和未来肥胖和代谢外科的现状和未来

肥胖病正成为全球流行的疾病,严重威胁着人类的生命健康及生活质量。在病态肥胖的治疗中,运动、饮食控制、药物治疗及其他一些物理治疗效率低,极易反弹,只有通过外科手术,才能获得持续有效的减重效果。正因病态肥胖治疗的迫切性与重要性及内科治疗效果的限制性,加之腹腔镜技术在减肥外科手术中的应用,     

指甲和甲床的再生和修复

指甲是指端的一种重要结构,它的正常生长与甲床有密切关系。如甲床形态不良,则指甲将发生畸形;如甲床有大面积缺损,则指甲生长将停止在缺损的近侧。因此,指甲的再生和修复取决于甲床的再生和修复。近年来对这方面研究较多,且有一些新概念和方法。现简介如下。 1、指甲的功能 人类指甲的主要功能是:①由于指甲较远节指     

肥胖和代谢外科的现状和未来

肥胖病正成为全球流行的疾病,严重威胁着人类的生命健康及生活质量.在病态肥胖的治疗中,运动、饮食控制、药物治疗及其他一些物理治疗效率低,极易反弹,只有通过外科手术,才能获得持续有效的减重效果.正因病态肥胖治疗的迫切性与重要性及内科治疗效果的限制性,加之腹腔镜技术在减肥外科手术中的应用,手术治疗病态肥胖变得越来越流行,近几年手术数量迅速翻倍[1].国内也于2000年开始开展腹腔镜手术治疗病态肥胖[2],手术创伤减轻,几乎不影响外观,增加了此手术的接受度.本文主要总结国内外近来对肥胖病和减肥手术方面的研究成果及最新进展.     

麻醉风险评估和分级管理的软件开发和应用

目的开发麻醉风险评估和分级管理平台的软件,促进麻醉风险的评估和分级管理。方法系统软件采用VFP9．0关系型数据库语言和Visual Studio 2015编程,其中麻醉患者风险评估方法参照Hussman、Aust和“Lemon”等方法。结果开发了Windows环境下运行的麻醉风险评估和分级管理系统,包括患者信息库、风险评估、风险分级管理、过程考核、查询统计以及知识库6个模块。实现对手术患者风险识别和评估、分级管理、智能信息档案以及过程考核等过程进行管理。结论此系统有利于麻醉患者风险评估和分级管理,操作简单容易。     

肩关节疾病和运动损伤的诊断和治疗

人体不同部位的损伤有着不同的诊断和治疗方式,而诊疗手段的专一性和特异性都在以不同的速度得到发展。其中手外科发展最早,髋膝关节外科次之,脊柱外科随后。近年来,人类对肩关节疾病的认识、诊断和外科治疗技术等方面的进展步伐很快。虽然仍有很多领域有待认识和发展,但是我们在面对肩关节疾病时,绝不再是诊断上的懵然无知和治疗上的束手无策。我们已经初步认识了肩关节的活动机制、损伤结构、有助于诊断的体检方法和影像学手段、损伤后重建肩关节解剖功能的外科手术适应证,以及肩关节特殊的康复训练方案及进程。     

肾血管性高血压论断和治疗和进展

在肾血管性高血压的诊断中，肾血管造影仍被认为是准确性最高的检查方法，但侵入性、操作复杂、造影剂毒性等因素限制了其广泛应用。经皮血管成形术对肾血管性高血压的治疗引起了人们很大兴趣，但因远期效果欠佳阻碍其进一步发展。近年来新材料、新技术的应用，一些特异性、敏感性较高，侵袭性小或无创性新方法的出现，使肾血管性高血压的诊断和治疗发生了很大变化，不仅提高了诊断的准确性和治疗效果，还减轻了病人的痉和并发症，充     

腹腔镜和内镜联合治疗胆囊结石和胆管结石

目的:探讨腹腔镜与十二指肠镜、胆道镜联合治疗胆囊结石和（或）胆管结石的方法及临床应用价值。方法:回顾性分析36例胆囊结石和（或）胆总管结石患者采用经十二指肠镜鼻胆管引流术（ENBD）配合腹腔镜，胆道镜实行胆总管切开探查，胆总管一期缝合术（术前内镜置ENBD管）治疗胆囊结石和（或）胆总管结石的患者的临床资料。结果:34例获得成功，无严重并发症及残石。术后住院时间约8~10 d，手术时间90~180 min；2例中转开腹。28例随访3个月至1年，未见结石复发、胆瘘及胆管狭窄。结论:腹腔镜与十二指肠镜、胆道镜联合治疗胆囊结石和（或）胆管结石具有创伤小、并发症少、恢复快等优势，在一定程度上可取代开腹胆总管探查术，但初期应用应当放宽中转开腹手术指征。     

出血性休克和中毒性休克的诊断和治疗

休克是一个范围广泛的问题。人们对它的理解相对地还不确切,还有不少分歧。正如Hardaway所指出,早先对休克的一些理论被否定了,但新提出来的概念仍然缺乏充分的事实根据。在二次大战期间,随着化验诊断技术的进展使休克概念有了显著的发展,输血和血浆代用品对休克的治疗起一定作用。近二十年来人们发现战伤后肺功能不全和肾功能不全已成为初期复苏成功后伤员的新的威胁。     

疝和腹壁外科材料学进展和新认识

疝和腹壁外科材料学发展迅猛,目前全球有160余种补片材料~([1])。针对病人个体选择最合适的材料是一个难题。理想的腹壁缺损修补材料要有相当的机械张力,耐受感染,尽量减少切口疼痛、局部不适、切口感染、血清肿、肠粘连和腹壁肠漏等较难处理的后遗症发生,以免影响生活质量~([2])。疝和腹壁外科使用修补材料的研究进展与学科发展密切相关。     

Pleuropulmonary and skeletal lymphangiomatosis with chylothorax and chylopericardium

Congenital lymphangiomatosis of lung and bone, with or without chylothorax, is a rare but often fatal systemic lymphatic malformation. In those who survive infancy and early childhood, parietal pleurectomy with excision of lymphatic lakes and ligation of the thoracic duct can be successful. Two patients with lymphangiomatosis are described, 1 with chylothorax and chylopericardium with generalized skeletal lesions and the other with pleuropulmonary lesions and chylothorax. Both were successfully treated with parietal pleurectomy, excision of lymphatic lakes, and ligation of lymphatics, including the thoracic duct. To our knowledge, the triad of generalized skeletal lymphangiomatosis, chylopericardium, and chylothorax has not been previously reported.     

Urodynamic evaluation and electrical and pharmacologic neurostimulation

Summary We introduce a rat model that allows simultaneous or independent recording of bladder and sphincteric activity. Via a polyethylene tube inserted into the bladder dome, bladder pressure is measured in response to constant intravesical saline perfusion. The electrical activity of the intra-abdominal urethra (a well-defined striated muscular tube which, in the rat, constitutes the external urethral sphincter) is recorded simultaneously with an electromyography needle electrode. Thus, precise statements can be made about detrusor/sphincter interrelationships. Changes in urodynamic parameters with the anesthetics urethane, methoxyflurane (Metofane), and thiobutabarbital sodium (Inactin) were investigated. High-frequency oscillations in intraluminal bladder pressure could be demonstrated during micturition cycles only in rats anesthetized with urethane or Metofane. As this high-frequency activity is generated by the striated muscle of the intra-abdominal urethra, the external sphincter of the rat is the force behind urine expulsion. The anesthetic Inactin combined with a low intravesical perfusion rate attenuated spontaneous bladder and sphincteric activity and abolished micturition cycles. This rat model can provide accurate and reproducible measurements of urodynamic changes in response to electrical stimulation of the pelvic and pudendal nerves and pharmacologic stimulation with neuropeptides at the lumbosacral spinal cord level. We recommend using this model with urethane or Metofane for physiologic studies of micturition and with Inactin for meticulous neuropharmacologic and electrostimulatory evaluation of urodynamic parameters.     

储袋炎及回肠肛管储袋功能障碍的诊断与治疗

对于经内科治疗无效或出现不典型增生的溃疡性结肠炎以及家族性腺瘤性息肉病患者．回肠储袋肛管吻合（IPAA）的重建性结直肠切除术已成为外科治疗的首选。但溃疡性结肠炎患者IPAA术后除了一般手术并发症外,还容易出现一系列炎性或非炎性并发症,如储袋炎、储袋克罗恩病、直肠残端封套炎或储袋易激综合征,从而影响患者的手术效果及生活质量。储袋炎是溃疡性结肠炎患者IPAA术后最常见的远期并发症．累计患病率可达50％。储袋镜是储袋功能障碍诊断及鉴别诊断的重要手段。储袋炎可根据病因分为“特发性”与“继发性”．其治疗也不尽相同。抗生素治疗是急性储袋炎的主要治疗方法．一些抗生素依赖的患者则需要长期的维持治疗。对抗生素耐药及依赖的储袋炎的处理是比较棘手的．另外．引起继发性储袋炎的病因亦需尽量发现并进行纠正。     

Endoscopic pancreatic duct drainage and stenting for acute pancreatitis and pancreatic cyst and abscess

Background/Purpose Endoscopic drainage of pancreatic pseudocysts using transpapillary and transmural approaches has been reported. In this study, endoscopic nasopancreatic drainage (ENPD) and pancreatic stenting were performed in patients with pseudocyst and abscess associated with acute pancreatitis, and the usefulness and problems of the procedures were investigated. Methods After endoscopic retrograde pancreatography was done, ENPD and/or pancreatic stenting were performed in 13 patients with pancreatitis and pseudocyst or abscess that communicated with the main pancreatic duct. Results ENPD was performed in seven patients, and was effective in all five patients with cysts: the cysts disappeared or shrank. However, the condition in the two patients with abscess was unchanged, and percutaneous drainage was performed. Stenting was carried out in six patients, and the cyst disappeared or pancreatitis was improved in all six. The stent was removed from two patients, but no recurrence has been noted so far. Conclusions ENPD and stenting are effective therapeutic choices for acute and chronic pancreatitis and pseudocysts, and they are superior to percutaneous drainage to avoid pancreatic fistula, but they may not be effective for pancreatic abscess. Selection of therapeutic methods corresponding to individual cases is important.     

The electrocardiographic and hemodynamic effect of metohexital and propofol with and without esmolol

BACKGROUND: Metohexital and propofol are short-acting induction agents, which have a tendency to prolong the QTc interval of the ECG. We studied whether this increase could be prevented by combining a beta-blocking agent, esmolol, with these drugs. Simultaneously, we studied the hemodynamic effects of these combinations. METHODS: In a randomized, double-blind study, 80 ASA I-II young adults were premedicated with oxycodone and atropin and allocated to one of four groups: propofol (P), propofol + esmolol (P + E), metohexital (E) or metohexital + esmolol (M + E). The doses were 2 mg/kg propofol/metohexital and 1 mg/kg esmolol. Alfentanil 15 microg/kg was used in all groups. The hemodynamic parameters were measured non-invasively and the electrocardiographic parameters using the signal processing method. RESULT: The highest QTc values, which often exceeded the normal upper limit of 440 ms, were recorded at the baseline or immediately after the administration of the induction drugs. The intervals were significantly shorter if esmolol was co-administered with either propofol or metohexital. The heart rate increased in the group M and decreased in the group P + E but remained unchanged in the groups P and M + E. Systolic and diastolic arterial pressures decreased during the study in all groups, most prominently in group P + E. CONCLUSIONS: During the anesthesia induction, the QTc interval was significantly shorter when esmolol was co-administered with either propofol or metohexital. The hemodynamic responses were properly controlled with the combination of metohexital and esmolol as well as with propofol alone, but the combination of propofol and esmolol tended to cause hemodynamic depression.     

心脏瓣膜钙化与骨质疏松

本文对４０例５０及５０岁以上中老年人伴有心脏瓣膜钙化的病人做骨密度检查，结果显示瓣膜钙化（心脏退行性变）的病人骨密度低于正常对照组又高于ＢＭＤ减低组，提示心脏退行性变病人的ＢＭＤ与正常ＢＭＤ呈负相关而与骨密度减低组病人呈显著正相关。简要讨论骨质疏松、软组织钙化、骨质增生之间可能的内在联系。     

腹腔镜手术联合药物在中重度子宫内膜异位症诊治中的应用

目的:探讨腹腔镜联合药物治疗中重度子宫内膜异位症的效果。方法:选择2003年12月至2006年12月确诊为子宫内膜异位症的患者98例,术前半年内未用过激素治疗,肝、肾功能正常,无心肺疾患。随机分为对照组50例,腹腔镜手术+米非司酮;研究组48例,腹腔镜手术+孕三烯酮。腹腔镜下进行病变分期,术后随访12~36个月,观察各组有效率、术后复发率、术后妊娠率及血CA125水平变化、肝、肾功能变化。结果:对照组有效率60.0%,研究组有效率84.3%,研究组疼痛症状和体征完全缓解率高于对照组,复发率低于对照组,两组比较差异有统计学意义(P<0.05)。对照组术后10个月内复发5例,均为中重度患者,且病情复发程度与血CA125水平升高呈相关性,经服用孕三烯酮后病情得到控制。研究组复发2例,均发生在术后12个月以后,为重度患者,经再次服用孕三烯酮后病情得到控制。研究组于术后服药后出现闭经32例,停药后2~3个月月经恢复,无痛经及性交痛。对照组闭经48例、子宫内膜过度增生1例,停药后半年内恢复月经。结论:孕三烯酮及米非司酮均可作为中重度子宫内膜异位症腹腔镜术后的控制用药,因其服药方便、有效、副作用少可用于广大患者,而孕三烯酮的服药效果明显优于米非司酮且不影响子宫内膜,对复发的子宫内膜异位症治疗仍然有效而备受偏爱。     

慢性前列腺炎与性功能障碍的调查分析

目的 :调查慢性前列腺炎患者性功能障碍的患病率及其与年龄、病程的关系。　方法 :对 2 0 0 0例患者进行了问卷调查 ,内容包括 :①年龄、身高、体重、职业、病程、治疗情况等 ;②国际前列腺炎症状评分指数表 (NIH CPSI) ;③勃起功能国际指数问卷 5 (IIEF 5 )。　结果 :176 8份调查表有效 (88.4 % )。慢性前列腺炎患者性功能障碍的患病率为 4 9.0 % ,其中 ,早泄占 2 6 .4 % ,勃起功能障碍占 14 .9% ,早泄合并勃起功能障碍占 7.7%。　结论 :慢性前列腺炎患者性功能障碍的患病率较高 ,患病率与患者年龄及病程呈负相关。     

食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患的临床资料。结果 本组患经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂，6例为医源性穿孔，5例为创伤性穿孔，10例为食管癌并食管支气管瘘，9例为食管憩室并食管支气管瘘。治疗予以食管修补9例；胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术)；食管切除胃食管吻合术12例(其中3例为食管修补失败)；胃造瘘术4例；置入食管支架4例；食管支气管瘘切除修补3例；食管瘘口修补并肺叶切除2例；食管胃弓上短路1例，颈部引流2例；放弃治疗3例。治愈25例，好转11例，死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。     

Trends and perspectives in pancreas and simultaneous pancreas and kidney transplantation

Pancreas transplantation is still the best option to achieve normoglycaemia and insulin independence in patients with type I diabetes. As a result of improvements in surgical techniques, immunosuppression and patient selection, one year survival rates of 95, 83, and 88% for patient, pancreas, and kidney survival, respectively, are reported for patients with simultaneous pancreas and kidney transplantation. The main goals for the future are to reduce postoperative morbidity, to identify the relevant indications for single pancreas transplantation, to adopt the best surgical technique for individual patients' needs (bladder versus enteric drainage with or without portal venous delivery of insulin), and to develop immunosuppressive strategies with low nephrotoxic and diabetogenic potential.