两步翻出直肠法在低位直肠癌NOSES中的应用7例

目的介绍7例腹腔镜低位直肠癌根治经自然腔道取标本手术(NOSES)中,采用两步翻出直肠法取出直肠标本。方法回顾分析吉林大学第一医院2017年8月至2018年3月收治的采取两步翻出直肠法完成根治切除肿瘤的低位直肠癌患者7例,记录肿瘤大小(最大直径)、手术时间、术中出血量、清扫淋巴结数目、术后排气时间等近期疗效指标。具体翻出手术操作方法:当直肠的正常肠管部分被翻出体外时,立刻停止继续翻出操作,切开直肠顶端并用取物钳从该切口伸入被翻转的肠腔把系膜拉出体外;然后就可以很容易继续翻出剩余的带有肿瘤的直肠。结果本组7例患者均从肛门顺利拖出标本,切除后完成吻合,顺利完成了低位直肠癌的自然腔道取标本手术(NOSES),肿瘤直径3.1~5.2cm,手术时间为110~153min,出血量50~110ml,清扫淋巴结数目为13~25枚,术后肛门排气时间2~4d,术后进食流质时间3d,术后均无并发症发生。结论两步翻出直肠法在低位直肠癌NOSES中能降低直肠翻出难度,增加安全性,准确判定切缘,取得良好的近期疗效。     

基层医院开展腹腔镜下结直肠癌NOSES术式的临床体会

目的 探讨腹腔镜下结直肠癌根治性切除经自然腔道取标本术式的临床应用价值及个人体会。方法 对26例结直肠癌患者行腹腔镜下结直肠癌根治性切除,经完全腔镜下切除标本吻合,或经肛门切除吻合,或经肛门翻出切除吻合,经自然腔道取出标本治疗进行回顾分析。结果 26例手术均成功,平均手术时间180min,平均术中出血50m L,术后平均胃肠蠕动恢复时间为20.5h,平均住院时间为10d,无明显严重并发症。结论 腹腔镜下结直肠癌NOSES术式安全可行,无腹部辅助切口,美观、损伤小、恢复快,费用与传统腹腔镜手术无差异,深受病患及家属欢迎,值得推广应用。     

经直肠标本取出的3D腹腔镜直肠前切除术治疗高龄直肠癌近期疗效分析

目的 分析经直肠标本取出的3D腹腔镜直肠前切除术治疗高龄直肠癌的近期疗效和安全可行性。方法 回顾性分析同济大学附属东方医院自2016年1月至2019年7月接受3D腹腔镜直肠前切除术的高龄组患者的临床资料,比较结直肠癌经自然腔道取标本手术（natural orifice specimen extraction surgery, NOSES）组和小切口手术（小切口手术组）患者手术、术后并发症及术后恢复等情况。结果 2组在肿瘤距下切缘距离、淋巴结清扫数、淋巴结阳性率、回肠造口率及术后第1天疼痛评分差异无统计学意义;但NOSES组的手术时间、术中出血量、术后肛门排气、进食、住院时间、并发症及术后第3天疼痛评分均明显优于小切口组（P＜0.05）。结论 NOSES腹腔镜直肠前切除术治疗高龄直肠癌的近期疗效与小切口组无差异,但术后恢复较快,并发症发生率低,值得临床推广。     

保留左结肠动脉在腹腔镜直肠癌低位前切除术中的应用

目的 探讨在腹腔镜直肠癌低位前切除术中保留左结肠动脉(left colonic artery，LCA)的临床疗效及可行性。 方法 回顾性分析2014年9月—2018年2月于蚌埠医学院第二附属医院普外科行腹腔镜直肠癌低位前切除术的52例患者的临床资料。将52例患者根据手术方式分成2组，保留LCA组患者26例，肠系膜下动脉(inferior mesenteric artery，IMA)高位结扎组26例。比较和分析2组患者在回肠造口例数、游离脾区例数、手术时间、术中出血量、淋巴结清扫总数目、第3站淋巴结清扫数目、术后肛门排气时间、吻合口瘘发生率、肠梗阻发生率、排粪失禁发生率以及术后随访12个月肿瘤复发及转移情况等方面的差异。 结果 保留LCA组与IMA高位结扎组在回肠造口例数、游离脾区例数、手术时间、术中出血量、淋巴结清扫总数目、第3站淋巴结清扫数目、术后肠梗阻发生率、排粪失禁发生率以及术后随访12个月肿瘤复发及转移情况等方面差异均无统计学意义(均P＞0.05)。IMA高位结扎组术后肛门排气时间为(2.80±0.52) d，术后发生吻合口瘘6例，而保留LCA组术后肛门排气时间为(2.44±0.44) d，无吻合口瘘发生，组间差异均具有统计学意义(均P＜0.05)。 结论 保留LCA直肠癌低位前切除术临床疗效与肠系膜下动脉高位结扎相当，保留LCA可有效缩短患者术后肛门排气时间，降低吻合口瘘发生率。      

保留左结肠动脉腹腔镜全直肠系膜切除术对中低位直肠癌患者术后恢复及并发症的影响

目的 探讨保留左结肠动脉腹腔镜全直肠系膜切除术对中低位直肠癌患者术后恢复及并发症的影响.方法 选取2018年1月至2019年10月本院收治的97例直肠癌患者,根据手术方法的不同分为对照组(n=48)和观察组(n=49).对照组行不保留左结肠动脉腹腔镜全直肠系膜切除术,观察组行保留左结肠动脉腹腔镜全直肠系膜切除术.比较两组围术期指标、肠系膜根部下淋巴结清扫情况、并发症发生率及吻合口瘘发生率.结果 观察组手术时间、肛门排气时间、住院时间、肠系膜根部下淋巴结清扫时间均短于对照组,术中出血量少于对照组,淋巴结清扫数目多于对照组,吻合口瘘发生率低于对照组,差异均有统计学意义(P<0.05);观察组并发症发生率为6.12％,与对照组的14.58％比较差异无统计学意义.结论 中低位直肠癌患者采用保留左结肠动脉腹腔镜全直肠系膜切除术效果显著,可有效缩短患者手术时间,降低术中出血量,提高肠系膜根部下淋巴结清扫效率,并促进患者术后恢复,减少吻合口瘘的发生.     

经自然腔道取出标本的腹腔镜直肠癌根治术16例效果观察

目的探讨经自然腔道取出标本腹腔镜直肠癌根治术的可行性与疗效。方法回顾性分析16例经自然腔道取出标本腹腔镜直肠癌根治术患者的临床资料,对手术的可行性、安全性、根治性等进行评价。结果16例手术均获成功,无中转术式,无严重术中术后并发症,无手术相关死亡。手术平均时间为156（90-210）min,平均失血量147（50～350）ml,术后平均留置导尿时间10（7～15）d,平均住院日14（10-21）d。所有患者3个月后排便控便功能均良好。平均清扫淋巴结13（8-21）枚,11例低位直肠癌平均远切缘1.7（1-4）cm,无切缘阳性病例。结论经自然腔道取出标本腹腔镜直肠癌根治术安全可行,同时具有腹部创口最小化、降低直肠低位横断的难度等优点。     

保留左结肠动脉对中低位直肠癌患者微创手术效果的影响

目的探讨保留左结肠动脉对中低位直肠癌患者的微创手术效果。方法选取中低位直肠癌患者148例按照随机数表法分为观察组和对照组。观察组采用保留左结肠动脉腹腔镜全直肠系膜切除术,对照组采用不保留左结肠动脉腹腔镜全直肠系膜切除术。记录两组术中出血量、手术时间、预防性造口、肠系膜下动脉根部淋巴结清扫数目、首次肛门排气时间、吻合口出血、吻合口漏及肠系膜下动脉根部淋巴结转移数量。记录两组肿瘤复发或转移、术后肠梗阻及死亡情况。结果两组预防性造口、吻合口瘘差异均有统计学意义(均P<0.05);两组复发率、并发症发生率及死亡率差异均无统计学意义(均P>0.05)。结论保留左结肠动脉腹腔镜全直肠系膜切除术治疗中低位直肠癌能够改善预防性造口及术后吻合口瘘发生情况具有较好的安全性及临床疗效。     

老年患者无气腹腹腔镜结直肠癌根治术

目的 探讨腹壁悬吊式无气腹腹腔镜在老年结直肠癌根治手术的可行性.方法 回顾分析39例腹壁悬吊式无气腹腹腔镜行老年结直肠癌根治手术患者的临床资料,分别记录手术时间、术中出血量、清除淋巴结数、肠管切除长度,术后腹腔引流量,术后排气时间,住院时间.结果 本组病历均获成功,手术时间( 199.5±25.6 ) min; 术中出血量(330±48)ml;术后清出肠旁及肠系膜淋巴结( 18.2 ±4.6 )个;切除标本长度结肠癌为( 21.5 ±2.5 )cm,直肠癌为( 19.4 ±1.7 )cm;术后腹腔引流液(220±40);肛门排气时间( 4.0±1.2 )d;住院时间(13.5±4)天,除1例术后发生切口液化延迟愈合,其余未发生吻合口瘘等严重并发症,无手术死亡.结论 对于老年高龄高危结直肠癌患者,腹壁悬吊式无气腹腹腔镜较传统腹腔镜手术体现出更多优势,可达到结直肠癌根治性手术切除的要求,值得临床医师大力推广.     

腹腔镜与开腹结直肠癌根治术对患者胃肠功能的影响

目的比较腹腔镜与开腹结直肠癌根治术对患者胃肠功能的影响。方法将2014年1月～2017年1月我院接诊的62例结直肠癌根治术患者纳入本研究。按照随机数字表法将其均分为观察组和对照组各31例,对照组患者行开腹结直肠癌根治术,观察组患者行腹腔镜结直肠癌根治术,比较两组患者手术时间、术中出血量、标本切除长度、淋巴结清扫数、术后腹胀持续时间、术后肛门排气时间、术后住院时间、术后3年、5年无瘤生存情况。结果观察组患者手术时间显著长于对照组,术中出血量显著少于对照组,差异有统计学意义(P0.05);两组患者标本切除长度及淋巴结清扫数比较,差异无统计学意义(P0.05);观察组术后腹胀持续时间、术后肛门排气时间、术后住院时间均显著低于对照组,差异有统计学意义(P0.05);两组术后3年无瘤生存率及术后5年无瘤生存率比较,差异无统计学意义(P0.05)。结论腹腔镜结直肠癌根治术效果与开腹手术一致,但创伤更小,术后胃肠功能恢复更快,可作为优选术式。     

腹腔镜辅助与传统开腹结直肠癌根治术临床效果对比研究

目的通过回顾性研究对比腹腔镜辅助结直肠癌癌根治术与同期接受传统开腹手术患者的临床资料与效果,分析两者在结直肠癌根治术中的差异。方法选取2013年6月至2016年6月在胜利油田中心医院肛肠外科接受结直肠癌根治术的120例患者进行回顾性研究及分析。分为腹腔镜组与开腹组,每组各60例患者。对两组患者的手术及术后恢复和变化情况进行对比分析。结果腹腔镜组手术时间、术中出血量、术后肛门排气时间、住院时间与开腹组相比均有统计学意义(P0.05),而在清扫淋巴结数、吻合口瘘、手术时间方面差异无统计学意义(P0.05)。结论腹腔镜辅助结直肠癌根治手术安全性高,术后恢复快,可以在结直肠癌的手术治疗中不断推广使用。     

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.