全去带可控盲结肠贮尿囊尿动力学的研究

目的　比较不去带、间断去带及全去带三种情况下贮尿囊尿动力学特征 ,探讨全去带可控盲结肠贮尿囊的尿动力学特征及其机制。方法　将 18头猪随机分成 3组 ,分别施以完整肠管可控盲结肠膀胱术 (A组 ) ,间断去结肠带可控盲结肠膀胱术 (B组 )和完全去结肠带可控盲结肠膀胱术 (C组 ) ,分别测定 3种贮尿囊压力和容量的关系 ,测定 3种贮尿囊的半径和长径。结果　全去带贮尿囊半径和长径均增加 ,容量增加。全去带可控盲结肠贮尿囊容量较大压力较低。结论　全去带可控盲结肠贮尿囊较不去带和间断去带贮尿囊有较好的尿动力学特征。     

去带盲结肠可控膀胱术

目的　改进膀胱癌患者膀胱全切后贮尿和排尿问题。　方法　对 2 3例全膀胱切除患者行去带盲结肠可控膀胱术。　结果　 2 2例术后随访 3～ 30个月 ,3个月后贮尿囊容量 45 0～ 6 0 0ml,平均 5 5 0ml,平均内压 (14± 8)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　去带盲结肠可控膀胱术是一种较为理想的尿流改道方法 ,具有较好的应用价值。     

去带可控盲升结肠膀胱术的尿动力学实验与临床研究

目的　评价去带可控盲升结肠膀胱术的应用价值。　方法　对１５ 头猪去带盲升结肠膀胱术动物实验模型及２３ 例膀胱癌患者去带可控盲升结肠膀胱术进行尿动力学测定,观察贮尿囊容量、内压及输出道压参数。　结果　动物实验结果显示切断结肠带后贮尿囊内压降低,容量、长度及周径均增加。２３ 例患者术后均获得了良好的可控,３ 个月贮尿囊容量可达４００ｍｌ。１３ 例术后（１９．２±８．９）个月尿动力学显示贮尿囊最大容量为（６９７ ±２０４）ｍｌ,最大充盈压为（５８ ．７ ±２４．５）ｃｍＨ２Ｏ,输出道最大闭合压为（１０４ ．３±３３ ．８）ｃｍＨ２Ｏ。　结论　该术式可以获得大容量、低内压的贮尿囊,具有操作简单、可控效果好、节省肠袢等优点。     

去带可控盲结肠膀胱术的疗效观察（附30例报告）

目的 评价去带可控盲结肠膀胱术的疗效。方法 采用膀胱全切去带可控盲结肠膀胱术治疗膀胱癌30例。结果 30例随访8－40个月。1年后贮尿囊容量360－580ml,贮尿囊内最大压力19．5－78．5cmH2O。白天完全可控28例,可控率93％;夜间完全可控27例,可控率90％。贮尿囊造影及IVU显示单侧输尿管狭窄并肾脏轻度积水1例,无输尿管返流。血清电解质及肾功能正常。结论 去带可控盲结肠膀胱术操作简单,并发症少,疗效可靠,是一种较理想的尿流改道方法。     

去带盲升结肠可控膀胱术临床研究

目的建立一种操作简单、并发症少、较理想的可控性尿流改道术. 方法对26例膀胱癌等肿瘤患者行根治性膀胱切除术后,游离截取15～20 cm盲升结肠,间隔0.5～1.0 cm切断结肠带,建成去带盲升结肠可控膀胱并开口于脐部. 结果随访2～51个月,可控效果好,并发症少,术后6个月3～6 h放尿1次,每次尿量为350～600 ml.尿动力学显示最大充盈压为(59±24) cmH2O,输出道最大闭合压为(104±34) cmH2O. 结论去带盲升结肠可控膀胱术是一种比较理想的可控膀胱术.     

可控盲结肠膀胱术19例

目的 :探讨膀胱全切术后可控盲结肠膀胱术的选择及应用。方法 :回顾性分析我科 1 9例可控盲结肠膀胱术患者的临床资料。结果 :1 9例患者术后恢复较好 ,储尿囊平均容量 4 80ml,平均压力 (1 .96± 0 .4 9)kPa ,排尿控制较好 ,插管容易 ,无尿失禁及输尿管反流。结论 :可控盲结肠膀胱术具高容量、低内压、控制排尿等特点 ,可极大提高患者的生活质量 ,其中以可控去带盲结肠膀胱术最为简单、有效 ,值得临床应用     

盲结肠膀胱术加强输出道可控机制的临床研究

目的　改进盲结肠膀胱术输出道手术方法 ,建立一种控尿可靠、插管方便、并发症少的可控输出道。　方法　对 4 7例膀胱癌患者行膀胱癌根治切除 ,37例采用去结肠带建立盲结肠贮尿囊 ,10例非管状化建立盲结肠贮尿囊 (改良Indianapouch) ,截取末端回肠 12～ 14cm ,剖开肠管重叠绕圈缝合成双层肠壁结构 ,回盲肠交界处浆肌层缝合 ,构筑回盲部小乳头状回肠套叠结构 ,建成长 12cm的输出道。盲肠端与盆腔腹壁缝合 ,远端与脐孔吻合 ,全长固定潜行于腹壁下贮尿囊和腹直肌之间。　结果　全部患者插管顺利 ,白天完全可控 4 5例 ,夜间完全可控 4 4例 ,术后 6个月输出道闭合压 4 0 .5～ 12 5 .6cmH2 O ,充盈状态输出道最大闭合压明显高于空虚状态 (P <0 .0 5 )。　结论　改进的缩窄末端回肠输出道是一种较理想的可控输出道。     

可控性膀胱术与回肠新膀胱术(附68例报告)

目的　评价不同术式可控性膀胱术及回肠新膀胱术的疗效。　方法　对 6 8例膀胱全切除术后患者采用 4种可控性尿流改道及回肠新膀胱术式 ,术后对患者控尿、导 (排 )尿 ,贮尿囊容积、内压 ,影像学及血生化资料进行比较。　结果　回肠套叠式输出道 3例中有 2例部分脱套致术后尿失禁 ,需再次手术 ;缩窄末端回肠式输出道 44例控尿均良好 ,除 1例插管困难外余均能用 16～ 2 0F尿管自行导尿。去管折叠式贮尿囊 39例 ,其中回肠贮尿囊 3例、结肠 2 2例、回结肠 14例 ,能达到低压贮尿囊要求 ,但早期有 8例发生贮尿囊过度扩张 ,容量 1470～ 16 5 0ml;去带结肠贮尿囊 8例 ,容量 430～6 0 0ml,充盈压 30～ 45cmH2 O(1cmH2 O =0 .0 98kPa) ,有蠕动波 ,术后早期有 2例尿漏。回肠新膀胱2 1例 ,容量 35 0～ 46 0ml,充盈压 12～ 2 0cmH2 O ,日间尿失禁 1例 ,夜间尿失禁 2例 ,其余无尿失禁。　结论　盲升结肠 30cm剖开对折成形可控性膀胱可满足低压贮尿囊要求 ,去带结肠贮尿囊由于易发生术后尿漏或粘连 ,内压较高 ,不够理想。缩窄末段回肠式输出道控尿效果好、内腔大、插管顺利、并发症少 ,明显优于回肠套叠输出道。回肠新膀胱术贮尿排尿功能良好 ,术后生活质量高 ,但应严格选择手术适应证。     

女性去带盲结肠新膀胱术(附四例报告)

目的 提高女性患者膀胱全切术后生活质量。方法 采用改良根治性膀胱切除加去带盲结肠新膀胱术治疗女性膀胱癌4例。在根治性膀胱切除术中3例采用保护阴道前壁方法，1例采用切除阴道前壁方法。结果 随访6～30个月，4例患者白天均可控制排尿，3例夜间能控制排尿，1例夜间有尿失禁。尿动力学检查显示贮尿囊容量305～438ml，最大囊内压18～45cmH2O(1cmH2O=0．098kPa)，剩余尿量0～30ml，最大尿流率15．1～22．6ml／s。贮尿囊造影及IVu检查未见输尿管返流和输尿管狭窄。血电解质和。肾功能正常。结论 女性膀胱癌患者行改良的根治性膀胱切除去带盲结肠新膀胱术可获得满意的排尿控尿效果。     

三种可控性结肠贮尿囊的效果比较

目的　寻求理想的可控性尿流改道术式。　方法　 3 7例患者 ,采用去带盲升结肠贮尿囊者 13例 ,采用penn贮尿囊者 11例 ,采用改良Indiana贮尿囊者 13例。其中 3 5例行尿动力学检查 ,对不同贮尿囊的容量和压力结果进行比较。　结果　去带盲升结肠尿囊组 3个月时的容量和压力与另 2组贮尿囊的结果比较差异有非常显著性意义 (P <0 .0 1) ,3种贮尿囊的容量、囊内压均可随时间的推移得到改善 ,术后 12个月时其容量之间的差异无显著性意义 (P >0 .0 5 )。Penn贮尿囊能有效降低收缩压。阑尾作输出道者均可获得良好的尿控。　结论　Penn贮尿囊和改良Indiana贮尿囊是较理想的可控性尿流改道术式 ,去带盲升结肠贮尿囊有手术操作相对简单的优点     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.