保胆胆囊息肉摘除术的临床应用

目的总结保胆胆囊息肉摘除治疗胆囊息肉的方法和经验,探讨保胆胆囊息肉摘除术的疗效及临床应用价值。方法回顾性分析32例胆囊息肉样病变患者行保胆胆囊息肉摘除术治疗胆囊息肉的临床资料。结果胆囊息肉和结石均一次性取净,术后无并发症;27例获得定期随访者B超检查示病人胆囊功能得到完好保留,无息肉或结石复发。结论内镜保胆胆囊息肉摘除法和小切口直视保胆胆囊息肉摘除法创伤小、效果好、并发症少,而且保留了胆囊功能,对胆囊良性息肉且胆囊功能良好者是一种合理的微创治疗方法     

腹腔镜内镜微创保胆治疗胆囊息肉的临床效果观察

目的探讨腹腔镜内镜微创保胆治疗胆囊息肉的临床效果。方法选择2007年6月—2011年4月在我院行腹腔镜内镜微创保胆治疗的胆囊息肉患者43例,回顾性分析其临床及手术资料。结果 43例中2例因术中冷冻病理结果为腺瘤性息肉,改为腹腔镜胆囊切除术;余均经胆道镜一次性切除息肉61枚,息肉直径6～13 mm,其中单发息肉26例,多发息肉15例,术后病理回报胆固醇性息肉32例,炎性息肉9例,术后无胆瘘及伤口感染,住院4～8d,术后定期超声检查。术后随访40例(93%),随访时间1～3年,均恢复良好,且无息肉复发。失访3例。结论腹腔镜内镜微创保胆治疗胆囊息肉技术安全可靠,创伤小,保留了胆囊,值得推广。     

胆囊息肉样病变临床分析

目的：探讨胆囊息肉样病变的临床特点、病理特征及手术指征。方法：对108例胆囊息肉样病变病人资料进行回顾性分析。结果：102例行开腹胆囊切除术,手术者均行病理检查,其中胆固醇性息肉75例（69．4％）;炎性息肉14例（13．0％）;腺瘤性息肉12例（11．1％）;早期胆囊癌3例（2．8％）;腺肌病4例（3．7％）。结论：息肉直径〉10mm、单个、年龄〉50岁、反复发作右上腹疼痛,影响日常生活者,合并胆囊结石,病变逐渐增大者,胆囊无功能或功能不良者,病人精神负担重者应手术治疗。     

腹腔镜联合胆道镜行保胆取息肉86例治疗体会

目的探讨腹腔镜联合胆道镜行保胆取息肉术治疗胆囊息肉的手术方法及临床疗效。方法回顾分析86例胆囊息肉患者行腹腔镜联合胆道镜保胆取息肉术治疗的临床资料。结果 86例患者中,成功行微创保胆取息肉术80例,成功率93.2%,4例患者由于腹腔粘连,慢性炎症较重中转行开腹胆囊切除术,2例患者由于术中快速病检提示胆囊癌中转行胆囊癌根治切除术。术后住院时间1～5 d,平均4 d。全部病例术后复查彩超显示无息肉残留,切口愈合良好。随访76例,随访率95%,术后随访2个月～2年,2例病人胆囊息肉复发(2.5%);2例胆囊收缩功能不良(2.5%);1例胆漏(1.2%)。结论应用腹腔镜联合胆道镜保胆取息肉术治疗胆囊息肉创伤小、恢复快,是可行的、安全的,并且有效的保留了胆囊功能,复发率低。     

微创内镜保胆取息肉术治疗胆囊息肉64例临床分析

目的：：探讨微创内镜保胆取息肉术与腹腔镜胆囊切除术治疗胆囊息肉的疗效。方法：128例胆囊息肉患者随机分为观察组和对照组,每组64例,观察组行微创内镜保胆取息肉术治疗,对照组行腹腔镜胆囊切除术治疗。对比分析两组患者术中出血量、手术时间、术后第1次排气时间、术后不良反应和并发症等。结果：观察组患者术中出血量、手术时间、第1次排气时间、不良反应发生率、并发症发生率均明显低(短)于对照组,组间比较差异具有统计学意义(P＜0.05)。结论：微创内镜保胆取息肉术治疗胆囊息肉具有操作简单、手术时间短、创伤小、出血少、术后排气早及恢复快、并发症少等优点。     

胆囊息肉样病变67例临床分析

目的:分析胆囊息肉样病变的诊断及治疗。方法:回顾性分析67例胆囊息肉样病变临床资料。结果:67例均经B超检查确定诊断,63例行胆囊切除术,4例因息肉<0.5 cm,无任何临床自觉症状,患者不愿手术治疗,门诊定期随访;手术者均行病理检查,胆固醇息肉38例,乳头状腺瘤14例,腺肌瘤5例,炎性息肉3例,息肉癌变3例。结论:胆囊息肉样病变临床诊断以B超为首选,息肉直径在10 mm以上,单发或广基息肉,合并结石或慢性胆囊炎,临床当根据不同情况确定是否要手术治疗。     

腹腔镜胆囊切除术治疗1001例胆囊息肉样病变疗效观察

目的：探讨胆囊息肉样病变的诊断及手术指征。方法：回顾性分析1001例经腹腔镜胆囊切除术的胆囊息肉样病变病例的临床资料。结果：肿瘤性息肉222例,占21．3％,非肿瘤性胆囊息肉样病变779例,占78．7％。其中胆固醇息肉754例。4例为恶性息肉,单发,直径≥0．8cm,均为B超检查确诊。术后证实为早期腺癌。结论：B超是诊断胆囊隆起性病变的良好方法,胆囊息肉样病变实施腹腔镜胆囊切除术是安全可靠的。     

胆囊保留性手术与胆囊癌的预防

目的探讨胆囊保留性手术在胆囊癌预防中的作用。方法对1999～2009年该院开展的胆囊保留性手术进行随访,调查胆囊癌的发生情况。结果共调查病人2166例,1825例获得随访,失访341例,随访率84.2%;1825例中胆囊结石1061例,胆囊息肉752例,胆囊结石合并息肉12例;男781例,女1044例;平均年龄52.6岁;平均随访4.3年,未发现胆囊癌病人。结论胆囊保留性手术能够预防胆囊癌的发生,同时保留了胆囊功能,具有预防性胆囊切除术不可比拟的优势,在胆囊癌的二级预防中将发挥重要作用。     

术前超声在腹腔镜胆囊切除术中的应用价值

目的：探讨术前超声在腹腔镜胆囊切除术中的应用价值。方法对109例胆囊结石或胆囊息肉腹腔镜胆囊切除术患者进行术前常规腹部超声检查,记录胆囊大小、壁厚度、胆囊内结石或息肉的情况,胆囊颈管有无结石嵌顿,胆囊周围有无粘连,胆囊窝有无积液等。结果本组病例109例,超声诊断与手术符合率约99.08%,其中超声提示胆囊周围粘连者3例,经手术证实,2例患者术中发现胆囊周围粘连严重、解剖结构难以分辨而中转开腹手术。结论术前超声可以明确诊断急慢性胆囊炎、胆囊结石及胆囊息肉样病变,预测腹腔镜手术的难易程度,对腹腔镜胆囊切除术具有重要的临床指导价值。     

胆管镜微创治疗胆囊息肉18例报告

目的总结内镜治疗胆囊息肉的方法和经验，探讨良性胆囊息肉保留胆囊的可行性。方法回顾分析2003年1月-2006年8月我院18例胆囊息肉样病变患者行内镜微创治疗胆囊息肉。结果共摘除息肉24枚，4例患者术前有临床不适症状，术后症状消失，18例中无并发症，术后病理1例增生活跃，单发息肉切除率100％。结论内镜治疗胆囊息肉样病变保留了胆囊功能，有利于提高患者术后生活质量，减少术后并发症。     

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.