腹腔镜手术在肝胆外科的临床应用

目的探讨腹腔镜手术在肝胆外科中的应用价值。方法选取2009年2月-2013年8月来我院接受慢性萎缩性胆囊炎治疗的患者90例,随机平分为观察组和对照组,对照组采用常规开腹手术治疗法进行治疗,观察组患者采用腹腔镜胆囊切除术进行治疗,比较两组患者的手术时间、术中出血量、肛门排气时间、止痛药使用情况和并发症发生情况,并使用SPSS 13.0软件包对结果进行统计学分析。结果观察组患者的手术时间、术中出血量和肛门排气时间明显优于对照组患者,P〈0.05;观察组患者术后使用止痛药物和并发症的发生率也明显低于对照组患者,P〈0.05。结论腹腔镜手术可有效减少术中出血量、手术时间,且患者术后并发症较少,止痛药物使用率较低,有效的提高了肝胆外科手术的治疗效果和治疗安全性,具有推广应用价值。     

腹腔镜诊治普外科急腹症临床分析

目的 分析和研究腹腔镜诊治普外科急腹症的临床意义.方法 选取2012年9月-2014年1月该院普外科急腹症患者61例,随机分组.对照组患者采用开腹手术治疗;观察组患者采用腹腔镜诊断并行腹腔镜手术治疗,将两组患者治疗效果进行比较.结果 观察组并发症发生率为6.5％,对照组为26.7％,观察组手术指标明显优于对照组,观察站手术时间、术中出血量、肛门排气时间和住院时间分别为(37.65±14.21)min、(12.45±3.63)mL、(14.21±3.57)h和(3.12±0.81)d,而对照组分别为(75.32±15.35)min、(53.68±10.54)mL、(32.59±7.46)h和(7.33±1.72)d,差异有统计学意义(P＜0.05).结论 腹腔镜诊治普外科急腹症效果良好,值得推广.     

腹腔镜手术在基层医院妇科中的临床应用

目的探讨腹腔镜手术在基层医院妇科中的应用及临床疗效。方法将郑州市第九人民医院90例需要进行手术治疗的妇科患者随机分为两组,对照组患者采用常规开腹手术,治疗组患者采用腹腔镜手术进行治疗。观察两组的手术时间、术中平均出血量、术后镇痛药使用率、肛门首次排气时间、住院时间及手术并发症。结果两组手术时间、术后镇痛药使用率差异无统计学意义(P>0.05);治疗组平均出血量、肛门排气时间、住院时间明显短于对照组,差异有统计学意义(P<0.05);治疗组手术并发症均明显高于对照组,差异有统计学意义(P<0.05)。结论妇科腹腔镜手术创伤小、术后恢复快、住院时间短,在基层医院开展妇科腹腔镜手术是治疗妇科疾病可选择的较好方法。     

腹腔镜手术与传统开腹手术剔除子宫肌瘤的临床疗效比较

目的:探讨分析腹腔镜手术与传统开腹手术剔除子宫肌瘤的临床疗效。方法:随机选取就诊的197例充血性心力衰竭患者作为研究对象,随机分为观察组99例患者(腹腔镜下子宫肌瘤切除手术治疗),对照组98例患者(传统开腹子宫肌瘤切除手术治疗),回顾性分析两组患者的临床疗效。结果:观察组患者术后排气时间为(15.7±2.6)h,术后住院时间(5.2±3.1)d,术中出血量(70.8±20.4)ml,术后止痛药使用率为7.1%;对照组患者术后排气时间为(25.6±3.8)h,术后住院时间(8.7±4.3)d,术中出血量(100.6±22.7)ml,术后止痛药使用率为30.6%;两组临床疗效比较,差异具有统计学意义(P<0.05)。结论:腹腔镜下子宫肌瘤切除手术治疗子宫肌瘤住院时间段,并发症发生率低,建议临床逐步广泛应用。     

妇科急腹症两种手术方式的临床比较研究

目的：比较腹腔镜与传统的开腹手术治疗妇科急腹症的临床疗效。方法：将我院2010年1月至2011年1月收治的80例妇科急腹症患者随机分为对照组与观察组,每组40例。对照组采用传统的开腹手术进行治疗;观察组采用腹腔镜治疗。比较两组患者的手术时间、术中出血量、肛门排气时间、术后镇痛剂使用剂数、住院时间、手术成功率以及并发症发生情况,并进行统计分析。结果：观察组的手术时间、术中出血量、肛门排气时间、镇痛剂使用剂数、住院时间以及并发症发生率分别为（52.7±10.8）min、（32.8±7.2）mL、（16.2±1.7）min、（21±5）剂、（5.0±1.9）d和5.0%,均低于对照组的（66.4±11.4）min、（57.9±11.5）mL、（28.6±2.6）min、（32±7）剂、（8.1±2.2）d和17.5%。两组上述指标比较差异均具有统计学意义（P〈0.05）;两组手术成功率均为100%。结论：腹腔镜治疗妇科急腹症的临床疗效明显优于开腹手术,值得在临床中推广应用。     

腹腔镜胆囊切除术与开腹手术治疗胆结石的临床疗效观察

目的:比较腹腔镜胆囊切除术与开腹胆囊切除术治疗胆结石的临床效果。方法:选取本院接受胆囊切除的50例胆结石患者,随机分为观察组(腹腔镜胆囊切除术)和对照组(开腹胆囊切除术)各25例,对比两组手术效果。结果:观察组术中出血量[(41.58±10.78)mL]、手术时间[(51.59±5.12)min]、肛门排气时间[(11.21±4.32)h]和住院时间[(5.71±2.61)d]均低于对照组术中出血量[(68.54±16.47)mL]、手术时间[(76.18±10.48)min]、肛门排气时间[(24.62±8.37)h]和住院时间[(9.63±1.82)d](P0.05)。观察组并发症发生率12.00%显著低于对照组32.00%(P0.05)。结论:腹腔镜胆囊切除治疗胆结石具有创伤小、术后恢复快、并发症少优点,值得临床推广。     

腹腔镜手术治疗宫外孕的效果观察

目的探究宫腔镜手术治疗宫外孕的临床效果。方法选取我院2013年2月至2015年5月收治确诊为宫外孕患者36例,随机分为观察组和对照组各18例,对照组采取开腹手术治疗,观察组采取腹腔镜手术治疗,对比两组患者的手术时间、术中出血量、肛门排气时间及住院时间。结果观察组患者的手术时间、术中出血量、肛门排气时间、住院时间分别为(46.2±6.7)min、(68.7±11.2)mL、(11.1±1.5)h、(4.5±0.6)d;对照组分别为(69.5±8.2)min、(98.2±13.6)mL、(23.6±1.9)h、(8.6±1.2)d;经对比差异具有统计学意义(P0.05)。结论腹腔镜手术治疗宫外孕疗效显著,对患者的损伤小,术后恢复快,值得临床推广应用。     

腹腔镜手术与开腹手术治疗良性卵巢囊肿的临床观察

目的探讨腹腔镜手术与开腹手术治疗良性卵巢囊肿的临床疗效。方法本文选择我院2015年1月~2017年1月收治的60例良性卵巢囊肿患者作为观察对象,将其中行腹腔镜手术的患者38例设为腹腔镜组,22例行开腹手术设为对照组,观察两组的手术时间、术中出血量、肛门排气时间、住院时间及术后并发症情况。结果两组患者均顺利完成手术,腹腔镜组无一例中转开腹。观察组手术时间略长于对照组,但两组手术时间组间比较差异无统计学意义(P0.05)。观察组患者的术中出血量明显少于对照组,术后肛门恢复排气时间、住院时间明显短于对照组(P0.05)。观察组患者的术后并发症发生率7.89%,明显低于对照组的术后并发症发生率45.50%(P0.05)。结论腹腔镜手术较开腹手术治疗良性卵巢囊肿效果更好,具有出血少、并发症少、术后恢复快等优势,值得在临床中推广。     

探讨腹腔镜切除术在阑尾炎外科治疗中的应用效果

目的探讨腹腔镜切除术在阑尾炎外科治疗中的应用效果。方法选择2013年4月至2016年4月本院接收的需行手术治疗的阑尾炎患者100例,按照入院顺序将患者分为观察组(行腹腔镜切除术)和对照组(行开腹阑尾切除术),每组50例,通过对比两组患者的术中出血量、术后进食时间、疼痛持续时间、镇痛剂使用率、肛门排气时间、住院时间以及并发症发生率,以探讨腹腔镜切除术在阑尾炎外科治疗中的应用效果。结果相较于对照组,观察组患者术中出血量更少,术后进食时间、疼痛持续时间、肛门排气时间、住院时间更短,镇痛剂使用率、并发症发生率更低,组间存在的统计学差异具有显著性(P0.05)。结论相较于对阑尾炎患者行开腹阑尾切除术,对阑尾炎患者行腹腔镜切除术给患者造成的创伤更小,术中出血量更少,术后并发症发生率更低,更利于患者术后康复,腹腔镜切除术更适宜在阑尾炎治疗中应用。     

腹腔镜手术在急性小肠梗阻治疗中应用的疗效观察

目的：分析腹腔镜手术在急性小肠梗阻治疗中应用的疗效。方法将130例患者随机分为对照组和观察组（n=65）。对照组患者采用常规手术治疗，观察组患者采用腹腔镜手术治疗，比较2组患者治疗效果。结果观察组患者手术出血量(35.8±5.3)mL明显少于对照组(89.4±9.2)mL（P＜0.05）；手术时间（112.5±15.4）min、初次排气时间(1.5±0.5)d以及住院时间（8.3±1.5）d明显短于对照组手术时间（138.8±19.5）min、初次排气时间(2.6±1.3)d、住院时间（10.6±2.3）d（P＜0.05）；同时对照组患者手术中有6例患者发生并发症，占9.23%，而观察组患者仅有3例患者发生并发症，占4.62%，观察组术后并发症发生率明显低于对照组，差异有统计学意义（P＜0.05）。结论腹腔镜手术在急性小肠梗阻患者治疗中应用效果显著，可行性和安全性高。     

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.