电视胸腔镜肺叶切除手术体会

目的 探讨电视胸腔镜肺叶切除手术方法的可行性。方法 回顾分析1997年8月～2002年12月，对122例患者施行电视胸腔镜肺叶切除术，其中肺癌切除98例，按1997年UICC标准，Ⅰ期53例，Ⅱ期36例，Ⅲa期9例；支气管扩张10例，炎性假瘤4例，结核瘤3例，多发巨大肺大疱3例。行单肺叶切除105例，右肺双叶切除12例，左全肺切除5例，右全肺切除2例。结果 除2例胸膜广泛粘连和1例肺裂发育不全中转手术外，其余均顺利完成手术。手术时间平均为163min，平均术后住院时间10天，平均胸腔引流时间2．2天，全组无手术死亡及严重并发症，手术效果满意。随访1～64个月，肺良性病变术后康复良好。Ⅰ期，Ⅱ期和Ⅲa期肺癌术后其3年生存率分别为91．9％、48．0％和33．3％。结论 胸腔镜肺叶切除术，只要严格掌握手术适应证，合理使用传统器械与内镜器械互相配合，手术是安全可行的，肺癌切除肺门和纵隔淋巴结清扫也是可行的，同样可以达到与传统开胸手术的效果。     

颅内血肿的手术指征与术式分析

目的 分析总结颅内血肿手术经验及手术指征。方法 统计本科1年来开颅清除颅内血肿及穿刺吸除颅内血肿的总数、治疗效果并加以分析。结果 1年来共手术治疗颅内血肿45例。开颅治疗27例，治愈18例，好转6例，死亡3例。穿刺治疗18例，治愈9例，好转7例，死亡2例。结论 颅内血肿开颅清除与穿刺吸除各有其优缺点，应掌握指征根据具体病情采取适宜的手术方法。     

100例粘连性肠梗阻再手术临床分析

2000年1月～2005年1月我院粘连性肠梗阻再手术病例100例，年龄21～78岁（平均49．6岁），男62例，女38例。二次手术距前次手术时间7天～8年，单纯粘连性松解术9例，松解加部分或大部分肠切除术89例，捷经手术2例。     

巨大甲状腺肿瘤83例外科治疗分析

目的评价巨大甲状腺肿瘤外科治疗的临床合理性与安全性。方法回顾性分析1985年1月～1999年6月收治83例巨大甲状腺肿瘤外科治疗的临床资料。结果83例巨大甲状腺肿瘤经术后病理组织学证实良性肿瘤56例．恶性肿瘤27例；83例均获随访，随访时间为6个月～10年，其中良性病变56例均存活无复发，恶性病变27例5年生存率达96％（26／27），10年生存率达88％（24／27）。结论外科手术切除是治疗巨大甲状腺肿瘤可靠有效的治疗手段，手术力求术野清楚，操作细柔，防止意外出血，保证手术安全，减少术后并发症的发生。     

95例高龄大肠癌的手术治疗

目的：探讨高龄大肠癌的外科治疗方法。方法：对95例高龄大肠癌的临床资料进行回顾性分析。本组平均年龄74．5(70—87)岁，伴肠梗阻38例，行急诊手术20例。肿瘤部位：直肠40例，乙状结肠25例，结肠肝曲7例，横结肠10例，回盲部7例，升结肠3例，结肠脾曲2例，降结肠1例。高中分化腺癌80例(84．2％)，低分化肿瘤15例(15．8％)。行Dixon术18例，Miles术10例、乙状结肠切除13例，余行左、右半结肠切除、横结肠切除、乙状结肠造瘘术等。结果：随访3年，生存3年以上65例(68．4％)，生存2年以上15例(15．80%)，2年内死亡15例(15．8％)。结论：高龄大肠癌治疗以手术为主，手术的目的是切除肿瘤，防止梗阻，提高生活质量。     

腹部术后并发症早期再手术43例分析

我科１９９２年７月至１９９８年７月６年间因腹部术后并发症早期再手术４３例，分析如下。１临床资料本组４３例（外院转入６例）中，男３３例，女１０例；年龄２２～８６岁，６０岁以上１６例。其中二次以上手术４例，最多１例行６次手术。二次手术间隔时间最短仅２小时...     

颈椎前路手术的近期并发症及其原因探讨

我院自1998年6月～2002年6月，行颈椎前路减压手术158例，在取得较好手术效果的同时，发生了28例次手术并发症，现对并发症发生的原因进行分析。     

118例食管裂孔疝的手术治疗

1986年10月至2000年12月间，我们共手术治疗食管裂孔疝病人118例，现报道如下。     

老年胆道疾病手术65例诊治体会

本院从１９８０年至２００１年，共手术治疗６５例老年胆道疾病，现将诊治体会报告如下。１临床资料１．１一般资料：本组６５例，男性３６例，女性２９例；６５～７４岁４０例，７５～８４岁１８例，８５岁以上７例。最大年龄８９岁，平均７１岁。１．２临床表现：腹痛６５例（１００％），恶心呕吐４１例（６６％），发热３７例（６１％），黄疸１６例（２６％），休克１３例（２１％），肩背部放射痛１２例（２０％），腹部压痛６１例（９４％），腹肌紧张３１例（４６％）。１．３手术方法：入院后２４小时内手术者３８例，２７例经保守…     

胸腔镜手术麻醉处理的体会

胸腔镜手术麻醉处理的体会尤新民＊金熊元＊鲍泽民我院自１９９４年１～８月胸腔镜手术麻醉２４例，现小结如下。临床资料病例２４例，男１５，女９例，年龄１８～７８岁，平均年龄４９岁。病种：肺大泡反复发作自发性气胸１７例，术前肺压缩８０～９５％，左侧１０例，右...     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92