单层纵切纵缝在十二指肠乳头肿瘤局部切除术中的应用

目的总结10例行十二指肠乳头肿瘤局部切除术的经验,探讨十二指肠肠壁单层纵切纵缝的缝合方式对十二指肠乳头肿瘤局部切除术相关并发症及术后十二指肠切口愈合的影响。方法针对性选取2012年12月‐2017年4月10例山东省千佛山医院肝胆外科收治患有十二指肠乳头肿瘤并进行十二指肠乳头局部切除术的患者为研究对象,其中,良性肿瘤8例,恶性肿瘤2例。所有研究对象均采用3-0的可吸收线单层纵切纵缝十二指肠前壁,观察其手术效果及术后恢复情况。结果所有研究对象手术均顺利完成,无围术期死亡,无出血、肠瘘和胆漏,未见十二指肠梗阻、胃排空无力及术后消化道溃疡等并发症,术后十二指肠切口愈合良好。结论单层纵切纵缝方法用于十二指肠乳头肿瘤局部切除术简单易行,且并发症较少,适宜临床推广应用。     

局部切除术在十二指肠乳头肿瘤治疗中的应用

目的:探讨局部切除术治疗十二指肠乳头肿瘤的安全性。方法:收集2002年4月至2012年10月在郑州大学第一附属医院采用局部切除术治疗十二指肠乳头肿瘤的41例患者的临床资料,对其进行回顾性分析。结果:术后病理结果是良性肿瘤24例,十二指肠乳头癌17例,24例良性病变术后患者恢复良好,17例乳头癌患者中15例随访1～11 a,其5年生存率为73.3%(11/15)。结论:对于十二指肠乳头肿瘤,局部切除术是一种安全、可行、有效的手术方式。     

局部切除术治疗十二指肠乳头癌16例体会

十二指肠乳头癌是一种常见的肝胆外科疾病，通常采用胰十二指肠切除术治疗，但手术时间长，手术难度大，并发症及手术死亡率高，不适合高龄、有严重并发症的有高危因素的患者。局部切除术创伤小，能切除原发肿瘤，解除胆道和胰管的梗阻，延长生存期。我们回顾性分析1984～1999年16例局部切除的十二指肠乳头癌病人的临床病理资料，报道如下。     

十二指肠乳头腺瘤内镜切除术

随着内镜检查和逆行胰胆管造影(ERCP)的应用,十二指肠乳头肿瘤检出率越来越高,其中以腺瘤最为常见,约占70%,其恶变率约为30%,具有重要临床意义。在过去,手术切除是十二指肠乳头腺瘤的标准治疗方法,胰十二指肠根治术虽然能完全切除病变但其死亡率高达2%~10%,术后复发率为25%~33%;经十二指肠局部切除术的复发率更是高达50%[1]。自从1989年Shemesh等第一次报道了成功为4例手术后腺瘤复发的病人施行内镜腺瘤烧灼治疗后[2],内镜乳头切除术逐渐成为十二指肠乳头腺瘤的首选治疗方法。十二指肠壶腹是胰管和胆总管开口的重要部位,所以内镜乳头切除…     

十二指肠肿瘤58例外科诊断与治疗

目的:提高十二指肠肿瘤的诊治水平。方法:对58例十二指肠肿瘤外科诊治的临床资料进行回顾性分析。结果:(1)十二指肠肿瘤位于乳头上方4例,乳头周围50例,乳头下方4例;(2)临床表现随部位不同而不同,乳头上方肿瘤临床表现上腹部疼痛和呕吐,呕吐物胃内容,不含胆汁;乳头周围肿瘤临床表现为梗阻性黄疸,肤目黄染伴不同程度上腹不适和不规则发热,可扪及肿大胆囊;乳头下方肿瘤临床表现上腹疼痛伴呕吐,呕吐物为胃内容含胆汁,或呕血,黑便,可扪及肿块;(3)消化道气钡造影诊断正确率57.14%,B超35.9%,CT70.59%;纤维十二指肠镜为90.48%;(4)病理组织学诊断恶性肿瘤54例,其中十二指肠腺癌51例,包括十二指肠溃疡伴溃疡边缘癌变1例,乳头状腺瘤伴癌和局限性癌变各1例和十二指肠平滑肌肉瘤3例;乳头腺瘤2例;乳头壶腹部溃疡1例和乳头黏膜下腺癌样增生1例;(5)外科手术,胰十二指肠切除术50例,根治性胃十二指肠切除术4例,根治性十二指肠节段性切除术3例,经十二指肠乳头开口处肿瘤局部切除,胰胆管引流术1例;(6)治疗结果:全组均治愈或好转出院,无手术死亡率;随访结果,获随访21例,1年生存率66.67%,3年生存率42....     

内镜下手术治疗十二指肠乳头部腺瘤20例体会

目的 探讨内镜下手术治疗十二指肠乳头部腺瘤的经验.方法 回顾性分析十二指肠乳头部腺瘤的术前评价,对内镜下十二指肠乳头切除术(EP)治疗腺瘤的切除成功率、并发症发生率、残留率、局部复发率等进行总结.结果 2006-07~2011-07间确诊十二指肠乳头部腺瘤27例.其中7例为单纯腺瘤,10例为腺瘤伴LIEN,6例为腺瘤伴HIEN,4例为腺瘤伴灶性癌变.术前进行评估,共筛选20例进行内镜下EP治疗.EP切除总有效率为95%(19/20),一次EP治疗成功率为75%(15/20);术后随访19例,时间8~72个月不等,平均24个月.术后发现残留2例(10%),复发2例(10%).出现并发症4例6次(20%);术中和恢复期并发症(＜术后24 h):术中出现穿孔1例(5%),术后24 h内出血1例(5%),急性胰腺炎(轻症)2例 (10%);急性胆管炎1例(5%).迟发性和晚期并发症(﹥术后24 h):胆管塑形结石1例(5%).所有出现并发症患者均保守治疗痊愈,无死亡病例.结论 十二指肠乳头部的解剖部位特殊,该部位腺瘤外科手术复杂、创伤大、死亡率高.因此,内镜下手术治疗十二指肠乳头部腺瘤有着重要的临床价值.随着内镜技术的发展,EP已逐渐成为十二指肠乳头部腺瘤的一种安全、有效的治疗方法.     

十二指肠乳头旁憩室切除术的临床研究

目的 探讨十二指肠乳头旁憩室切除术的手术方式和手术技巧,以提高十二指肠乳头旁憩室切除率和降低手术并发症的发生率.方法 回顾性分析1996年6月～2006年10月成功施行的17例十二指肠乳头旁憩室切除术的临床资料.结果 17例十二指肠乳头旁憩室均顺利施行十二指肠乳头旁憩室切除术且手术效果良好,十二指肠乳头损伤、胰瘘或肠瘘等严重并发症的发生率为0.结论 恰当的手术方式和手术技巧是提高十二指肠乳头旁憩室切除率、降低并发症发生率的关键.     

十二指肠良性肿瘤的手术治疗

目的 探讨十二指肠良性肿瘤的诊断和治疗方法.方法 回顾性分析18例经病理证实的十二指肠良性肿瘤的临床资料,包括临床症状、诊断方法、病灶部位、手术方式、病理结果和预后等.结果 18例患者均行手术切除治疗,其中8例行局部切除术,1例行肠段切除术,1例行胃大部切除术,3例行乳头部肿瘤切除加括约肌成形术,5例行胰十二指肠切除术;病理检查证实腺瘤5例、管状腺瘤2例、绒毛状腺瘤2例、管状绒毛状腺瘤2例、错构瘤2例、错构瘤性息肉1例、Brunner腺瘤1例、腺肌瘤1例、纤维瘤病1例、异位胰腺1例;经2～60个月随访,1例死于非相关疾病,1例失访,其余生活质量良好.结论 上腹部不适和上消化道出血是十二指肠良性肿瘤最为常见的症状,手术切除是首选的治疗方法,且预后良好.     

十二指肠乳头旁憩室切除术的临床研究

目的探讨十二指肠乳头旁憩室切除术的手术方式和手术技巧，以提高十二指肠乳头旁憩室切除率和降低手术并发症的发生率。方法回顾性分析1996年6月～2006年10月成功施行的17例十二指肠乳头旁憩室切除术的临床资料。结果17例十二指肠乳头旁憩室均顺利施行十二指肠乳头旁憩室切除术且手术效果良好，十二指肠乳头损伤、胰瘘或肠瘘等严重并发症的发生率为0。结论恰当的手术方式和手术技巧是提高十二指肠乳头旁憩室切除率、降低并发症发生率的关键。     

十二指肠间质瘤的诊断与治疗探讨

目的 探讨十二指肠间质瘤的临床诊断和治疗.方法 回顾性分析1995年1月～2005年10月我院收治的13例十二指肠间质瘤的临床资料. 结果本组病人以黑便和腹痛为主要临床症状,临床诊断需综合利用B超、CT、胃镜、内镜超声检查确定.肿瘤位于十二指肠降部9例,球部2例,水平部及升部各1例.肿瘤直径2.2～13.0 cm,平均5.7 cm.7例十二指肠降部肿瘤行胰十二指肠切除术,4例行肿瘤局部切除术,1例行远端胃大部切除术,1例行十二指肠节段切除术.1例术后3年半死于肝转移,1例术后5年复发死亡,其余病例已健康存活11个月～10年.结论 十二指肠间质瘤恶性多见,应积极手术治疗,肿瘤完全切除可获良好预后.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.