凝血酶盐水用于手术中创面止血效果观察

自1995年以来，我们为36例手术中创面大量渗血结扎困难的患者采用凝血酶盐水外敷或冲洗止血，效果满意，报告如下。     

多聚糖术中止血装置用于上消化道动脉性出血的动物实验研究

目的　验证EndoClot多聚糖术中止血装置（EndoClot polysaccharide hemostatic system,EndoClot PHS）用于肝素化上消化道动脉性出血（Forrest Ⅰa）内镜下治疗的有效性和安全性。方法　将12只巴拿马猪以计算机简单随机分组的方法随机分为实验组（n=6）和对照组（n=6）,建立胃动脉性出血动物模型。实验组和对照组分别使用Endoclot PHS和Hemospray喷洒创面止血,胃镜下持续观察30 min,比较2组达到有效止血的时间、止血颗粒使用量、送粉管堵塞及更换次数等。术后观察实验猪存活情况,并发症发生情况等。10 d后,所有实验猪行安乐死并行病理解剖。结果　12只实验猪均达到喷射性或搏动性出血。实验组和对照组达到有效止血的时间［（8.75±0.84） min比（9.83±0.62） min,t=-2.53,P=0.030］及达到有效止血的止血颗粒使用量［（6.71±0.39） g 比（14.10±1.62） g,t=-10.86,P<0.001］比较差异均有统计学意义。2组送粉管堵塞及更换次数差异无统计学意义［（0.64±0.02）次比（0.67±0.04）次,t=-1.64,P=0.131］。实验组气源更稳定,内镜下视野更清晰。实验组和对照组均未出现胃损伤、穿孔及气栓形成,血糖、血常规和肝肾功能均正常,均未出现主要器官的血栓形成及栓塞。结论　EndoClot PHS用于肝素化上消化道动脉性出血（Forrest Ⅰa）动物模型的内镜下治疗是安全有效的。     

经支气管镜氩气刀治疗气道内肿物的分析

目的探讨经支气管镜氩气刀治疗气管内肿物的临床效果。方法对18例气道内肿物的患者进行APC治疗,以病变狭窄再通情况、症状缓解情况进行疗效评价。结果 18例患者共进行了36次APC治疗,其中完全有效5例(27.8%),部分有效8例(44.4%),轻度有效4例(22.2%),无效1例(5.6%)。结论 APC治疗气道内肿物取得较好疗效。     

玉米须对老年小鼠脾脏免疫细胞功能影响的实验研究

目的研究玉米须水煎剂及玉米须粗多糖对老年小鼠脾脏免疫细胞功能的影响。方法用称重法测定小鼠脾脏指数，中性红比色法测量脾脏中巨噬细胞的吞噬功能，MTT法测量脾脏B淋巴细胞增殖能力，以玉米须水煎剂及其粗多糖灌胃老年小鼠30d，观测其对老年小鼠上述指标的影响。结果老年组小鼠脾脏指数下降，脾脏中巨噬细胞的吞噬功能下降，脾脏B淋巴细胞增殖能力下降；与老年组比较，药物治疗组脾脏指数升高，脾脏中巨噬细胞的吞噬功能升高，脾脏B淋巴细胞增殖能力提高，且玉米须水煎剂与粗多糖对上述指标的影响无差别。结论玉米须水煎剂有提高老年小鼠脾脏免疫细胞免疫功能的作用，其功效成份为粗多糖。     

乌司他丁对胰腺创面愈合作用的实验研究

目的 :研究乌司他丁 (UTI)抑制大鼠胰腺分泌及促进其创面愈合的作用。方法 :将 36只大鼠随机分成C、T两组 ,每组 1 8只 ,将其剖腹以显露胰胆管周围胰腺组织 ,在切除 2块等大的胰腺组织后 ,以 0 .2 5 %盐酸注入胰胆管腔即观察到胰腺创面的渗液。对胰腺的 2个创面分别给予缝合及不缝合处理。T组大鼠另需每日经腹内注射UTI,7～ 1 0d后 ,再次剖腹 ,重复将盐酸注入胰胆管腔 ,观察胰腺创面的渗液及愈合情况。结果 :T组胰腺创面愈合率明显高于C组 (P <0 .0 5) ;未经缝合处理的创面愈合率明显高于缝合组 (P <0 .0 5)。结论 :UTI能明显抑制大鼠胰腺的分泌 ,且有良好的抗炎及促进创面愈合的作用     

复方胶原,葡聚糖,二甲基亚砜制剂对烧伤创面愈合影响的实验研究

我们在既往研究的基础上设计了复方胶原、葡聚糖、二甲基亚砜制剂,并观察了其对小鼠Ⅱ°烧伤创面愈合的影响。     

碘过量对大鼠脾脏的形态学影响

目的对不同水平碘过量大鼠的脾脏进行形态学研究,探讨碘过量对机体免疫功能的影响。方法断乳1个月W istar大鼠24只,雌雄各半,随机分为4组:适碘组(NI)、10倍碘组(10H I)、50倍碘组(50H I)和100倍碘组(100H I)。给以不同浓度碘化钾水喂养3个月后,处死取脾脏,对脾脏进行光镜和超微结构研究。结果低水平碘过量(10H I)大鼠脾脏未见明显形态学改变,高水平碘过量(50H I和100H I)大鼠脾脏出现明显形态学改变,即呈现功能活跃的表现。结论高水平碘过量可引起大鼠免疫功能亢进。     

氩气刀联合高频电刀或冷冻治疗恶性气道狭窄的疗效

目的评价氩气刀联合高频电刀或冷冻治疗恶性气道狭窄的临床疗效。方法 65例恶性中心气道狭窄患者根据介入治疗方法不同分为两组,高频电刀组32例接受氩气刀联合高频电刀治疗,冷冻组33例接受氩气刀联合冷冻治疗。观察两组气道直径、气道横截面积、血气分析、气促指数、1 s用力呼气容积、用力肺活量和整体生活质量卡氏功能状态(KPS)评分。结果冷冻组治疗后5 d气道直径增加值和气道横截面积增加率显著高于高频电刀组(P0.01);治疗后两组动脉血氧分压、血氧饱和度、1 s用力呼气容积和用力肺活量均显著高于治疗前,动脉血二氧化碳分压显著低于治疗前(P0.01),两组间差异无统计学意义(P0.05);两组治疗后气促指数均显著低于治疗前(P0.01),两组间差异无统计学意义(P0.05);治疗后两组组内及组间整体生活质量KPS评分和实体瘤疗效差异无统计学意义(P0.05),两组并发症发生率差异无统计学意义(P0.05)。结论氩气刀联合高频电刀与氩气刀联合冷冻治疗均能快速有效缓解恶性中央气道狭窄,两种联合治疗方法的疗效相近。     

甲状腺切除小鼠脾脏形态学动态研究

小鼠甲状腺切除后7天,脾脏指数无明显变化,14天,21天,28天显著下降;实验组脾小体体积密度比7天略有下降,14天明显高于对照组;21天到28天逐渐恢复到正常并有降低的趋势;淋巴鞘体密度比7天明显缩小,14天显著升高,28天又出现明显减少。红髓体积密度比于21天显著增大,28天出现减少的趋势。从而说明持续性的甲低,脾脏重量可显著下降。脾脏内部结构不同时间发生不同的影响,最终表现为脾脏主要结构受抑制的趋势,影响脾脏的功能。     

氩气束综合凝血电刀辅助老年人耻骨上前列腺切除术

我科自１９９６年５月至１９９７年１月采用氩气束综合凝血电刀辅助老年人耻骨上前列腺切除术２０例，与对照组（１０例）相比，此方法具有简化术式、缩短手术时间、减少术中失血等优点     

The effect of splenectomy on resistance of mice to Entamoeba histolytica infection

The role of the spleen in amoebic infection was examined in mice, using strains selected as being either genetically-susceptible (C57BL/6) or genetically-resistant (A/J) to amoebiasis. Splenectomized and sham-operated animals were inoculated intracaecally with 2.5 X 10(5) polyxenic trophozoites of E. histolytica at 6, 12 and 15 days post-splenectomy. The animals were killed 6 or 12 days after infection and the parasite burden was evaluated. Removal of the spleen in both susceptible and resistant mouse strains rendered these hosts extremely resistant to amoebic infection by this criterion. Gross examination of the caeca of non-splenectomized, genetically-susceptible mice showed numerous ulcers over the mucosal surface when compared to the splenectomized group which had superficial lesions or none. These observations suggest that the spleen plays a suppressive role in early anti-amoebic resistance.     

Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats

BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H_2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H_2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH_2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.     

The effect of splenectomy on carbohydrate metabolism

Summary The authors have studied the role of the spleen in carbohydrate metabolism in animal experiments as well as in humans in connection with splenectomy. —Splenectomy was found to exert on carbohydrate metabolism an acute influence which is not identical with glycogenolysis induced by surgical stress.

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Auswirkungen der Milzexstirpation auf den Kohlenhydratstoffwechsel

Zusammenfassung Die Verfasser untersuchten die Rolle der Milz im Kohlenhydratstoffwechsel durch Tierexperimente und am Menschen nach Splenektomie. Der Eingriff beeinflußte den Kohlenhydratstoffwechsel unabhängig von der durch den Operations-Stress induzierten Glykogenolyse.

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Effet de la splénectomie sur le métabolisme des hydrates de carbone

Résumé Les auteurs ont étudié le rôle de la rate dans le métabolisme des hydrates de carbone, dans des expériences effectuées sur l'animal aussi bien que chez l'homme, en relation avec la splénectomie. — Ils ont trouvé que la splénectomie exerce sur le métabolisme des hydrates de carbone une influence aiguë qui n'est pas identique à la glycogénolyse produite par le stress opératoire.

     

Effects of prior splenectomy on remnant liver after partial hepatectomy with Pringle maneuver in rats.

BACKGROUND/AIMS: In the case of the liver resection, the temporary occlusion of the hepatoduodenal ligament (Pringle maneuver) is often used. However, the maneuver causes hepatic ischemia/reperfusion (I/R) injury that strongly affects the recovery of patients. The present study investigated the effects of prior splenectomy on the remnant liver in partial hepatectomized rat with Pringle maneuver. METHODS: Pringle maneuver was conducted just before a two-thirds partial hepatectomy. Efficacy of splenectomy was assessed by survival rate, serum alanine aminotransferase (ALT), neutrophil infiltration into liver, recovery of remnant liver weight, and liver proliferating cell nuclear antigen (PCNA) levels. Ischemic preconditioning was performed as follows; 10 min of total hepatic ischemia followed by 10 min of reperfusion. RESULTS: In partial hepatectomized rats with 30 min of Pringle maneuver, seven out of 12 rats died within 3 days. On the other hand, when splenectomy was performed on 3 days before the maneuver, only one out of 12 rats died. When prior splenectomy was performed on eight and 18 days before the Pringle maneuver, respectively, similar efficacy was observed. In addition, prior splenectomy on 3 days before the maneuver showed that serum ALT activity, neutrophil infiltration, recovery of remnant liver weight, and PCNA levels in partial hepatectomized rats with Pringle maneuver were also ameliorated as compared with those of control rats without splenectomy. When effects of prior splenectomy were compared with those of ischemic preconditioning in these situations, efficacy of prior splenectomy was comparable with that of the ischemic preconditioning. CONCLUSIONS: Prior splenectomy ameliorated the I/R injury in the remnant liver after partial hepatectomy with Pringle maneuver. Effects of prior splenectomy may influence the liver for long duration, because splenectomy on 18 days before the maneuver still exerts effective action.     

氩激光治疗糖尿病视网膜病变黄斑水肿

目的观察氩激光治疗糖尿病视网膜病变黄斑水肿的临床疗效。方法对274例（364只眼）糖尿病视网膜病变黄斑水肿患者,首选激光治疗,根椐病变性质对其黄斑区周围行氩激光光凝术。术后3m检查视力、OCT、FFA。结果术后3m显效165只眼（45．18％）,有效164只眼（45．05％）无效35只眼（9．61％）。黄斑水肿完全消退170只眼（46．70％）,部分消退159只眼（43．68％）,总有效率为90．38％。结论氩激光治疗早期糖尿病视网膜病变黄斑水肿效果较好。     

氩离子凝固术联合质子泵抑制剂治疗Barrett食管的长期疗效分析

目的评估氩离子凝固术（APC）联合质子泵抑制剂（PPI）逆转Barrett食管（BE）的长期疗效。方法对2004年至2007年经胃镜检查并经病理证实的36例BE患者采用APC联合PPI（每天20mg）治疗,分别于治疗后第1、6、12个月复查,以后每年1次内镜随访。结果36例患者共行48次APC治疗,平均1．33次／例,经治疗后均获得BE完全逆转。随访14～51个月,中位时间36个月,BE总复发率为16．7％（6／36）,1年复发率为2．8％（1／36）,2年复发率为11．1％（4／36）。Logistic回归分析显示,2年复发率和总复发率与APC治疗次数呈明显正相关（P值分别为0．004和0．007）。结论APC联合PPI治疗BE是一种安全、有效的方法,且长期疗效较好。     

Therapeutic effect of argon plasma coagulation on small malignant gastrointestinal tumors

In endoscopy, argon plasma coagulation (APC) is a new principle of non-contact electrocoagulation and has proved to be a sufficient tool for palliative endoscopic treatment of gastrointestinal neoplasms, predominantly of the oesophagus and colorectum. In a study of 67 patients suffering from histologically confirmed and endosonographic T1-staged tumours of the gastrointestinum, 10 patients were selected for endoscopic APC treatment because of the impossibility of surgical therapy. Although the application was primarily of a palliative nature, in 9 of 10 cases of minor neoplasms, no further tumour could be detected in biopsies during the observation period (9.45±2.8 months). One patient was not cured locally. In none of the patients was any serious complication noticed during the outpatient follow-up. The effective results and lack of severe complications suggest this technique as an alternative therapy in selected patients with smaller gastrointestinal tumours.Abbreviation APC argon plasma coagulation