食管癌切除管状胃替代重建的临床应用

目的 探讨食管癌患者用管状胃重建上消化道的应用价值.方法 对笔者所在医院2008年1月～2009年8月共84例食管癌患者手术实施直线切割缝合器胃小弯侧切除,用管状胃重建上消化道的资料进行回顾性分析,并重点探讨该术式在防止并发症方面的优势.结果 本组84例患者中,颈部吻合口瘘2例,胸胃瘘1例,吻合口狭窄2例,无胸胃综合征、返流性食管炎及胃漏发生,提高了患者的生活质量.结论 以直线切割缝合器制作管状胃,重建上消化道治疗食管癌可有效预防或减少胸胃综合征、返流性食管炎、胸胃漏、吻合口瘘和吻合口狭窄等并发症的发生,术后对患者肺功能影响小,远期生活质量高.     

管状胃加幽门成形术在食管癌切除术中的应用

目的探讨管状胃加幽门成形术在食管癌切除术中的临床意义。方法对95例用管状胃加幽门成形重建上消化道的食管癌患者资料进行回顾性分析,并重点探讨该术式在防止并发症方面的优势。结果术后发生颈部吻合口瘘2例,胸胃瘘1例,吻合口狭窄4例,胃出血1例,胸胃无力征2例,其余病例均恢复良好。结论管状胃加幽门成形术可以使食管癌术后吻合口瘘的发生率明显降低,有效地解决食管癌术后胸胃综合征、反流性食管炎等并发症问题,提高患者的生活质量。     

管状胃在食管癌切除术中的临床应用

目的探讨食管癌病人用管状胃重建上消化道的价值。方法对78例食管癌病人用管状胃重建上消化道的资料进行回顾性分析，并重点探讨该术式在防止并发症方面的优势。结果本组78例病人中，无胸胃综合症、返流性食管炎及胃漏发生，无吻合口瘘和吻合口狭窄，提高了病员的生活质量。结论用管状胃重建上消化道治疗食管癌可有效预防或减少胸胃综合症、返流性食管炎、胸胃漏、吻合口瘘和吻合口狭窄等并发症的发生。     

管状胃在胸腔镜下食管癌切除术中的应用

目的探讨管状胃在胸腔镜食管癌切除术中的应用价值。方法回顾性分析安阳市肿瘤医院胸二科2010年7月至2012年2月76例行胸腔镜食管癌切除术患者的临床资料,总结管状胃的应用价值。结果术后肺部感染11例,声音嘶哑7例,吻合口狭窄2例,无吻合口瘘、胸胃综合征及明显反流性食管炎等并发症,均顺利康复出院。结论管状胃可以降低胸腔镜下食管癌切除术术后肺部感染、吻合口瘘、胸胃综合征、反流性食管炎、胃排空障碍等并发症的发生率。     

管状胃成形在食管癌切除术中的应用

目的探讨食管癌病人用管状胃重建上消化道的应用价值。方法对64例食管癌病人手术实施直线切割缝合器胃小弯侧切除,用管状胃重建上消化道的资料进行回顾性分析,术后随访,重点探讨该术式在防止并发症方面的优势。结果本组64例病人中,无胸胃综合症、返流性食管炎及胸胃漏发生,吻合口瘘发生率低,提高了病人的生活质量。结论以直线切割缝合器制作管状胃,重建上消化道治疗食管癌可有效预防或减少胸胃综合征、返流性食管炎、胸胃漏、吻合口瘘等并发症的发生,术后对病人肺功能影响小,远期生活质量高。     

管状胃加幽门成形术治疗食管癌23例报告

目的探讨管状胃加幽门成形术在治疗食管癌中的应用价值。方法对本院2006年10月-2008年10月开展的管状胃加幽门成形术治疗食管癌23例患者的临床资料进行回顾性分析,重点分析该术式在防止并发症方面的临床效果。结果本组患者均治愈出院,无手术死亡。术后发生颈部吻合口瘘1例,吻合口狭窄1例。无心慌、心累、胸闷、气喘、咳嗽、咳痰及恶心、反酸、呃气等并发症发生。结论管状胃加幽门成形术治疗食管癌操作简单、安全,是一项预防术后吻合口瘘、胸胃综合征、返流性食管炎等并发症的有效措施,提高了患者的生活质量。     

管状胃食管颈部分层吻合法在食管癌手术中的应用

目的 探讨食管癌病人用管状胃与食管在颈部分层吻合重建上消化道的应用价值. 方法 对我院2009-07～2012-02的184例食管癌病人的根治术中采用管状胃在颈部与食管黏膜对黏膜、肌层对肌层的分层吻合法,其中黏膜层采用4-0可吸收缝线连续缝合,肌层采用0号丝线间断缝合重建上消化道.中、下段食管癌病人采用经左胸、左颈两切口改良食管癌根治术,上段食管癌病人采用右胸、腹、左颈三切口食管癌根治术.对184例患者的资料进行回顾性分析,术后随访,重点探讨该术式在防止并发症方面的优势. 结果 本组184例病人中,颈部吻合口瘘4例,吻合口狭窄3例,吻合口出血1例,无胸胃综合征及胸胃漏发生,返流性食管炎症状明显改善,提高了病人的生活质量. 结论 分层吻合法能有效减少吻合口瘘和狭窄的发生;管状胃可以满足颈部吻合时所需胃的长度并可有效预防或减少胸胃综合征、返流性食管炎、胸胃漏等并发症的发生,术后对病人肺功能影响小,远期生活质量高.     

管状胃在胸中上段食管癌手术中的临床应用

目的:探讨胸中上段食管癌患者术中用管状胃重建上消化道的临床意义.方法:对35例胸中上段食管癌患者用管状胃重建上消化道的资料进行回顾性分析,并重点探讨该术式在防止并发症方面的优势.结果:本组35例患者中,吻合口瘘2例和吻合口狭窄1例,均经保守治疗治愈;无胸胃综合征、反流性食管炎及胃漏等并发症的发生.术后近期恢复良好,远期生活质量高.结论:用管状胃重建上消化道治疗胸中上段食管癌可有效预防或减少胸胃综合征、反流性食管炎、胸胃漏、吻合口瘘和吻合口狭窄等并发症的发生.     

管状胃重建在食管癌手术中的应用

目的:探讨管状胃在食管癌切除术中的应用效果。方法:将80例接受食管癌切除术的患者按不同术式分为2组,管状胃组40例行管状胃食管吻合术,全胃组40例采用传统全胃代食管吻合术。观察2组患者手术后肺部并发症、吻合口瘘、胸胃综合征、反流性食管炎发生率等临床指标。结果:2组均无手术死亡。管状胃组术后肺部并发症、反流性食管炎、胸胃综合征和无吻合口瘘的发生率分别为17.5%、32.5%12.5%和0,全胃组分别为40.0%、65.0%.32.5和2.5%。管状胃组的胸胃综合征、肺部并发症和反流性食管炎的发生率均低于全胃组(P<0.05～P<0.01);2组吻合口瘘发生率差异无统计学意义(P>0.05)。结论:食管切除术后管状胃制作简单、安全,有效改善了胃食管反流,降低了胃排空不良的发生率,改善了患者术后生活质量。     

管状胃在食管重建中的临床应用体会

目的:探讨采用管状胃食管癌根治手术的手术时间和术后并发症与传统手术方式的差异。方法:对比2005年1月-2007年12月传统食管癌根治手术68例和2008年1月-2011年12月同类手术采用管状胃替代85例,比较2组手术时间,术后吻合口瘘、胃残端瘘、胃排空障碍、反流性食管炎、胸胃综合征、肺部感染、吻合口狭窄等发生情况。结果:管状胃病例术后未发生食管-胃吻合口瘘、胸胃瘘、胸腔胃综合征等并发症,均恢复出院,无死亡病例;术后发生房早2例,房颤1例,肺部感染5例,胃排空障碍2例,术后随访有症状的反流性食管炎6例,吻合口狭窄3例。治疗效果及并发症发生情况均优于传统手术组。结论:利用直线型切割缝合器制成管状胃行食管癌切除术可以缩短手术时间,减少术后并发症,提高患者的术后生活质量。     

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.