精准肝切除在肝胆管结石病中的临床应用

目的 探讨精准肝切除在肝胆管结石病临床治疗中的应用效果,最终提高患者术后生活质量与生命安全.方法 研究组肝胆管结石病患者采用精准肝切除手术治疗;对照组肝胆管结石病患者进行非规则性肝切除手术治疗.观察并记录两组患者手术治疗效果并进行统计学分析,得出结论.结果 研究组肝胆管结石病患者较对照组患者使用手术时间较长,但其术中出血量、术后引流量、结石完全清除情况、术后并发症发生情况以及住院时间等情况均显著优于对照组(P＜0.05).结论 应用精准肝切除技术对肝胆管结石病患者进行临床治疗,能够有效降低患者术巾出血量,减少患者术后引流量以及并发症发生率,缩短患者住院治疗时间,且患者体内结石完全清除效果较为满意,因此,精准肝切除是应用于临床肝胆管结石病治疗较为安全有效的手术方法,值得临床推广应用.     

精准肝切除在肝胆管结石病中的临床应用

目的:探讨精准肝切除术在肝胆管结石病中的临床应用价值。方法:选取2008年6月-2013年6月本院收治的128例肝内胆管结石病患者,采用前瞻性、非随机对照临床试验方法分为精准肝切除组(68例)和非规则性肝切除组(60例),比较两组患者的手术时间、术中出血量、术后并发症、住院时间、结石清除率和结石复发情况。结果:精准肝切除组术中出血量、ALT峰值、AST峰值、TBIL峰值及住院时间均优于非规则性肝切除组,精准肝切除组术后结石残留率、并发症发生率及复发率(8.8%、11.8%、5.9%)均明显低于非规则性肝切除组(21.7%、23.3%、16.7%),比较差异有统计学意义(P0.05)。结论:精准肝切除治疗肝胆管结石病疗效确切,可缩短患者康复周期,降低术后结石残留率及并发症发生率,减少复发。     

精准肝切除在肝胆管结石病的临床应用

目的 观察精准肝切除术治疗肝胆管结石病患者上的应用.方法 将62例肝胆管结石病患者按照治疗方式分为实验组和对照组,其中对照组23例,实验组39例,分别行非规则性肝切除和精准肝切除,比较2组患者手术时间、术中出血量、术后引流量等指标.结果 术后实验组术中出血量、术后引流量、住院时间分别平均为(384.1±83.5)mL、(132.8±83.2)mL、(12.4±5.5)d,均显著优于对照组(533.9±119.4)mL、(223.7±98.3)mL、(18.1±8.3)d,差异均有统计学意义(P<0.05);实验组38例结石完全清除,有3例发生并发症,且后续治疗后情况好转;对照组15例结石完全清除,10例产生并发症的情况,实验组疗效显著优于对照组,差异有统计学意义(P<0.05).结论 采用精准肝切除方法 治疗肝胆管结石病已经成为主要治疗方式之一,可以显著提高临床效果,减轻手术对患者的痛苦,值得临床推广.     

多处肝切除治疗复杂肝胆管结石病手术71例分析

目的:分析并评价采用多处肝切除手术治疗复杂肝胆管结石的手术方法,探讨如何在提高手术疗效的同时降低并发症的发生率。方法:对我院自2002年10月至2010年12月期间收治的71例复杂肝胆管结石病患者,采用多处肝切除手术进行治疗,分析并评价多处肝切除手术方法的临床治疗效果。结果:顺利完成肝内胆管结石清除手术者52例,清除率为73.2%,残留结石19例,术后3～6个月通过T管窦道胆道镜取石患者17例,结石取净15例,最终结石清除率为94.4%。随访5～8年,平均84个月,有5例肝内胆管结石复发,未见肝内胆管癌与死亡病例。结论:采用多处肝切除手术在治疗复杂肝胆管结石方面的临床疗效令人满意,但仍不能降低手术并发症的发生率。     

精准肝切除治疗肝胆管结石病的临床研究及meta分析

目的：探讨精准肝切除治疗肝胆管结石病的临床研究及 Meta 分析。方法：选取2010年1月至2016年1月收治的肝胆管结石病患者30例，采用精准肝切除术治疗，设为精准组；2000年1月至2009年12月收治肝胆管结石病患者30例，采用传统肝切除术，设为传统组，对比结果，并分析 Meta 情况。结果：精准组手术时间长于传统组，但术中出血、术后并发症率、输血率、住院时间均少于对照组，结石清除率高于对照组（P ＜0.05）。Meta 共纳入10篇文献，传统组和精准组各300例，检索结果与本次结果一致。结论：精准肝切除是现阶段有效的对肝胆管结石病治疗的手段。经Meta 分析也证实，精准肝切除术具结石完全清除率高、手术出血少、创伤小、并发症率低、住院时间短等优点，有较高推广应用价值。     

精准肝切除术在右肝内胆管结石治疗中的应用与分析

目的对于精准肝切除在右肝内胆管结石方面的临床应用与分析。方法随机选取我院2008年6月-2013年7月间50例精准肝切除与50例非精准肝切除治疗右肝胆管结石的病例,分别为观察组与对照组,比较两组患者的术中出血量、术后并发症、手术时间、结石清除率以及住院时间等。结果与非精准肝切除组相比,观察组患者手术时间长于对照组（P〈0.01）,但术中出血量、术后并发症、术后住院时间均明显少于对照组（P〈0.01）,结石清除率明显增高（P〈0.01）。结论右肝精准切除在右肝胆管结石手术治疗中应用良好,是减少并发症的有效途径。     

多处肝切除治疗复杂肝胆管结石病69例手术分析

目的:探讨多处肝切除治疗复杂肝胆管结石病的手术方法,以提高手术疗效和减少并发症发生.方法:回顾性分析近8 a收治的69例应用多处肝切除治疗累及二叶或二叶以上的复杂肝胆管结石病的临床资料.肝内胆管结石同时累及二、三、四、五肝叶的病例分别为47,19,2,1例,伴有肝内胆管狭窄15例,肝局部纤维化和萎缩55例,慢性肝脓肿2例,早期肝内胆管癌1例,胆囊结石9例,胆总管结石35例.2处肝切除67例,3处肝切除2例,合计140处肝切除,包括局部楔形切除41处、规则性肝段切除23处、规则性肝叶切除65处和半肝切除11处.同时行胆囊切除45例,胆总管切开探查或取石68例,胆道T管引流67例.结果:肝内胆管结石手术清除率为73.9%(51/69),残留结石18例,术后经T管窦道取石16例,取净14例,最终结石清除率为94.2%(65/69).手术并发症发生率43.5%,手术死亡率2.9%,肝功能不全是最常见并发症,2例因肝功能衰竭死亡.随访3～94(平均48) mo,肝内胆管结石复发6例.结论:多处肝切除治疗复杂肝胆管结石病的疗效较为肯定,尽管手术并发症的发生率相对较高.准确评估病变累及范围、选择合适的肝切除类型、多保留正常肝组织、防止误伤肝内正常结构、常规胆总管切开和T管引流,是多处肝切除的手术要点.     

精准肝切除治疗肝内胆管结石临床研究

目的 评估精准肝脏切除技术在肝内胆管结石治疗中的应用及临床效果.方法 回顾性分析采用精准肝脏切除技术治疗的肝内胆管结石患者37例的临床资料,总结患者石分布、手术方式、术后并发症发生情况及手术效果.结果 37 例肝内胆管结石患者,再次手术患者6例,初次手术患者31例,其中左肝内胆管结石6例,右肝内胆管结石13例,左右半肝均有结石分布者18例.均按结石分布肝叶或肝段行精准肝脏切除手术,其中16例附加胆总管切开取石T管引流术,手术均成功,无手术死亡病例,术后无肝内胆管结石残留,无严重并发症发生,术后随访1~3年,复发4例.结论 采用精准肝切除治疗肝内胆管结石手术安全,能够减少结石残留,降低复发率,具有较好的临床效果.     

选择性入肝血流阻断在肝胆管结石行规则性肝切除术中的应用

目的探讨选择性入肝血流阻断在肝胆管结石病行规则性肝叶段切除术中的应用技巧。方法回顾性分析该科2004年12月～2007年6月诊治的117例肝胆管结石病例采用选择性入肝血流阻断的方法行规则性肝叶段切除的临床资料。结果117例肝胆管结石病例采用选择性入肝血流阻断的方法行规则性肝叶段切除的治疗效果良好,术中出血及术后并发症均明显减少。结论在治疗肝胆管结石病施行规则性肝叶段切除术中,选择恰当的选择性入肝血流阻断方法是提高肝胆管结石病的治疗效果、降低并发症发生率的有效措施。     

原发性肝胆管结石病肝切除术风险评估

目的:通过术前检测肝胆管结石病患者肝脏功能储备,评估肝切除术的手术风险。方法:回顾性分析134例因原发性肝胆管结石病行肝切除术患者的临床资料,根据术前肝脏储备功能评估方式分为吲哚氰绿组(ICG组)和Child-Pugh评分组(CP组)。比较两组患者术前、术中参数以及术后并发症发生率。结果:ICG组术后肝功能衰竭发生率(0.16%,1/64)明显低于CP组(12.85%,9/70;P<0.05)。ICG组术后总并发症发生率明显低于CP组(18.75%vs37.14%,P<0.05)。结论:吲哚氰绿排泄试验比Child-Pugh评分系统能更有效地评估患者肝储备功能,利于筛选手术患者,减少肝切除术后肝功能衰竭及其他手术并发症,提高手术安全性。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.