无张力腹股沟疝修补手术35例临床分析

目的探讨无张力腹股沟疝手术的优点。方法选择我院2006年4月～2008年10月住院的腹股沟疝病例65例，行无张力腹股沟疝修补手术35例为实验组和传统开刀腹股沟疝修补手术30例为对照组，比较手术时间、术中出血量、术后镇痛药的应用、术后下地时间、术后疼痛、术后复发情况、术后切口感染、术后住院天数等。结果无张力腹股沟疝手术和传统开刀腹股沟疝修补手术相比，手术时间分别为（10±10）min、（30±15）min（P〈0．05）；术中出血量分别为5mL、50mL（P〈0．01）；术后镇痛药的应用分别为0、75．2％（P〈0．01）；术后进食时间分别为8h、48h（P〈0．01）；术后复发分别为0、6．7％（P〈0．01）；术后切口感染率分别为0、8．2％（P〈0．01）；术后住院天数分别为4、8d（P〈0．01）。结论无张力腹股沟疝手术和传统开刀腹股沟疝修补手术相比，无张力腹股沟疝手术具有较明显优势，为当今疝修补手术首选。     

传统疝修补与疝环充填式无张力疝修补术治疗腹股沟嵌顿疝比较

目的 探讨疝环充填式无张力疝修补术治疗腹股沟嵌顿疝的临床价值。方 法比较2000年6月～2005年4月我院102例腹股沟嵌顿疝行疝环充填式无张力疝修补术与1992年12月～2000年6月我院124例腹股沟嵌顿疝传统疝修补术的临床资料。结果疝环充填式无张力疝修补术组手术时间（1.18±9．387）min显著短于传统组（79．73±11．840）min（t=-12．845，P=0．000），切口疼痛22例显著少于传统组53例（χ^2=11．315，P=0．001），下床活动时间（17．12±4．340）h显著短于传统组（75．02±7．331）h（t=-73．653，P=0．000），切口感染6例显著少于传统组26例（χ^2=11．613，P=O．003），术后肺部感染、尿潴留、阴囊血肿、下肢深静脉血栓等并发症共5例显著少于传统组30例（χ^2=21．167，P=0．000），住院（7．0±1．395）d显著短于传统组（7．98±1．876）d，（t=4．048，P=0．000），术后复发0例显著少于传统组6例（χ^2=119．320，P=O．000），差异有统计学意义。结论 疝环充填式无张力疝修补术具有手术时间短、创伤小、无张力、疼痛轻、住院时问短、复发率低、康复时间短等优点，也是治疗腹股沟嵌顿疝的理想术式。     

小体积前列腺增生的治疗

目的比较和评价TURP加经尿道膀胱颈切开（TUIBN）与TURP加经尿道膀胱颈电切术（TURBN）治疗小体积前列腺增生的疗效。方法总结经尿道手术治疗小体积前列腺增生27例的临床资料，12例行TURP加经尿道膀胱颈切开。15例行TURP加经尿道膀胱颈电切术，比较研究两组病例术前、术后国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、残余尿量（PVR），以评估疗效。结果TURP＋TUIBN组：术前、术后IPSS评分分别为：（24．3±3．8）分、（7．2±3．6）分；Qmax：（8．5±3．6）mL／s、（17．4±4．2）mL／s；PVK：（102．0±20．0）mL、（19．0±4．0）mL。TURP＋T1瓜BN组：术前、术后IPSS评分分别为：（23．6±5．7）分、（6．9±3．0）分；Qmax：（8．2±3．1）mL／s、（23．1±3．1）mL／s；PvR：（96．0±37．0）mL、（9．0±5．0）mL。术前IPSS、Qmax、PVt（两组间差异无显著性（P〉0．05），术后两组间IPSS评分差异无显著性（P〉0．05），而Qmax、PvR两组间差异有显著性（P〈0．01）。结论TURP＋TURBN治疗小体积前列腺增生的临床疗效比TURP＋TUIBN更理想。     

完全腹膜外腹腔镜疝修补术与经腹腔腹膜前腹腔镜疝修补术的临床比较

目的探讨完全腹膜外腹腔镜疝修补术（TEP）的临床效果以及和经腹腔腹膜前腹腔镜疝修补术（TAPe）相比较的优缺点。方法回顾性分析367例TEP和43例TAPP手术患者的临床资料。结果367例TEP手术,中转TAPP手术3例,平均手术时间为45．47±18．29min,术后住院时间4．52±1．20d,共46例出现腹股沟血清肿,经穿刺抽液后治愈;43例TAPP手术,平均手术时间为63．50±27．28min,术后有4例使用了口服镇痛剂,2例出现阴囊积液,未予处理自然吸收,术后住院时间5．28±1．62d。随访1-30个月均未见复发。结论较TAPP手术相比,TEP手术具有手术时间短、手术费用低、手术安全性高等优点,但TEP因操作空间有限,其技术要求较TAPp高。     

Maquet改良术治疗髌骨不稳定的临床研究

目的探讨应用膝关节髌骨支持带调整和胫骨结节内移抬高（改良Maquet术）三联手术治疗髌骨不稳定的临床疗效。方法对2007年以来26例髌骨不稳定患者行外侧支持带松解、内侧支持带紧缩、胫骨结节内移抬高三联手术,术后随访平均16个月（6-28个月）,分析疗效。结果术前Q角（17．2±3．8）°,术后（8．9±2．6）°（P〈0．01）,Lysholm膝关节评分（Lysholmkneescorescale,LKSS）术前（46．5±7．6）分,术后（91．3±4．2）分（P〈0．01）,髌股关节关系改善,髌骨轨迹良好。结论本手术方法具有并发症少,功能恢复好,矫形可靠,疗效确切的优点。     

胆脂瘤型中耳炎不同手术方法效果的分析

目的：对比分析同术者用不同手术方法治疗胆脂瘤型中耳炎的疗效。方法：47例（耳）为A组手术时间在2003年1月-2006年4月，男28例，女19例，年龄（13～83）岁，术后观察随访12个月～25个月，平均17．24个月。另38例为B组，手术时间在1995年4月-1999年12月，男21例，女17例，年龄（9～60）岁，术后观察随访6个月～9年，平均17．12个月，二组的年龄，术前气导（AC）和气骨导差（ABG）相似，统计分析差别无显著意义。治疗方法：A组包含上鼓室外壁重建（鼓室盾板修复），鼓索神经弹压听骨，防粘连可用吸收网片置入等多项综合技术。B组大多采用上鼓室，乳突外壁凿开和插柱法。二组都用最后一次随访听力为统计数据，统计分析用t检验。结果：术后AC，ABG和ABG术前后差值（dB），A组是27．05±12．53，12．89±8．08，22．34±11．92；B组是42．76±14．22，22．27±10．95，8．83±8．72，t检验P均〈0．01，差别都有显著意义，随访期A组有5耳发现鼓膜穿孔（10．6％），3耳接受再次手术，术中发现1耳有胆脂瘤上皮残留（2．1％）；再次术后听力恢复均满意，1耳随访1年以上，而B组有9耳因胆脂瘤复发被再次手术（22．5％）。结论：耳道骨回复作盾板等综合技术对提高胆脂瘤手术听力和减少复发有明显效果。     

子宫良性疾病腹式与阴式子宫切除手术的临床分析

目的探讨子宫良性疾病经腹子宫切除术（TAH）与经阴道子宫切除术（VH）的临床效果。方法回顺性分析30例TAH手术患者（TAH组）和32例VH手术患者（VH组）的临床资料,对比分析两组的手术时间、术中出血量、术巾术后并发症和术后肛门排气时间和术后住院时间。结果手术时间：TAH组（92．00±13．5）min,VH组（70．00±11．5）min;术中出血量：TAH组（215．00±57．6）mL,VH组（140．00±43．5）mL;术后肛门排气时间：TAH组（31．2±5．8）h,VH组（11．6±7．4）h;术后住院时间：TAH组（7．6±2．8）d,VH组（5．5±1．5）d。2组以上4类指标差异有统计学意义（P〈0．01）。结论与腹式子宫切除术相比较,阴式子宫切除术符合微创手术原则,具有手术时间短、患者损伤小、术后恢复快、术后住院时间短的优点。     

胰岛素泵入与注射治疗围手术期糖尿病护理对比分析

目的评估胰岛素泵持续皮下胰岛素输注（CSⅡ）与多次皮下注射胰岛素（MSⅡ）两种方法在糖尿病患者围手术期应用时的临床疗效、患者生活质量及护理强度。方法胰岛素治疗的围手术期糖尿病患者105例，随机分为CSⅡ组（54例）和MSⅡ组（51例），观察两组血糖控制、低血糖发生率、注射区皮肤瘙瘁及皮下结节出现频数、术后并发症、切口愈合情况以及患者生活质量、护理工作强度。结果与MSⅡ组相比，CSⅡ组2hPBG降低更为明显[早餐：（7．4±2．2）VS（9．7±2．0），中餐：（6．9±1．8）vs（8．5±1．7），晚餐：（7．0±1．4）vs（8．8±1．7），P＜0．05]；术后切口甲级愈合率高（94．4％vs84．4％，P＜0．05）；低血糖发生率低（13．0％vs29．4％，P＜0．05）；患者生活质量明显改善；护理工作强度明显减轻（11．8±5．4）vs（14．64-4．7），P＜0．01。结论CSⅡ较MSⅡ在围手术期糖尿病患者能有效控制血糖，提高患者生活质量。降低护理人员工作强度，使患者安全度过围手术期。     

腹腔镜在食管裂孔疝治疗中的应用

目的：探讨腹腔镜在食管裂孔疝治疗中应用的可行性。方法：腹腔镜下食管裂孔疝修补术4例。结果：4例均在腹腔镜下完成手术，手术时间40～182min，平均（60±26．3）min。术中出血10～30ml，平均（15．3±10．5）ml。术后住院3．6d，平均5d。术后随访1年，无疝复发。结论：腹腔镜食管裂孔疝修补同时行胃底折叠术是食管裂孔疝治疗的首选手术方法，这一术式具有并发症发生率低、创伤小、住院时间短及恢复快等优点，恰当的病例选择、术前检查是这一术式安全有效的重要保证。     

单极电凝腹腔镜次全宫切除术326例临床分析

目的探讨腹腔镜下单极电凝行次全宫切除术与传统的开腹行次全宫切除的疗效及手术技巧。方法回顾性分析我院2002年1月至2006年12月单极电凝行腹腔镜次全宫切除术（LSH）326例与同期传统开腹次全宫切除术410例的临床资料进行比较分析。结果两组手术时间分别为（86±31．18）min，（107±34．68）min，术中出血分别为（Tz．24±4．21）ml，（89．06±56．86）ml。胃肠功能恢复时间分别为（23±5．26）h，（32±6．34）h。两组病例在手术时间、术中出血、胃肠功能恢复及术后3天体温比较差异有显著性（P〈0．05）。结论比较两种手术方式及术后情况，LSH组对病人损伤小，影响少，恢复快，使用腹腔镜器械简单，手术操作技巧容易掌握等优点，只是选择合适的病例尤为关键。     

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.     

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.     

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.