选择性半肝血流阻断在肝癌半肝切除术中的应用研究

目的探讨选择性半肝血流阻断在肝癌半肝切除术中的临床价值及安全性。方法将54例行半肝切除术的肝癌患者分为两组：HVC组30例，行选择性半肝血流阻断（HVC法），Pringle组24例，行第一肝门阻断（Pringle法），比较两种方法对术中失血量、手术时间、术后肝功能及并发症发生率等指标的影响。结果两组患者均顺利完成手术。两组失血量、手术时间相比，差异无显著性（P〉0．05）。两组肝功能指标、并发症发生率相比，差异有统计学意义（P〈0．05）。结论肝癌半肝切除术中采用选择性半肝血流阻断能安全有效地控制术中出血．减少术后并发症．有利于术后肝功能的恢复。     

食管横断法门奇静脉断流术联合肝脾切除术治疗原发性肝癌并脾功能亢进的临床研究

目的探讨原发性肝癌合并肝硬化门静脉高压并脾功能亢进患者手术方式及病例选择对手术效果及安全性的影响。方法对2005-05～2011—11我院收治的60例肝癌合并肝硬化门静脉高压并脾功能亢进行手术治疗患者的临床资料进行回顾性分析。观察组30例应用食管横断法门奇静脉断流术联合肝脾切除术,对照组30例单纯行肝癌切除术。比较两组肝功能分级、肝硬化程度、术前与术后血常规及肝功能变化、术后并发症等指标,判断手术安全性及病例选择对手术效果的影响。结果60例患者随访5个月～5年,平均（12．3±2）个月,观察组治愈20例,总有效率为96．7％,复发率为16．7％;对照组治愈15例,总有效率为80％,复发率为30．0％,两组差异无统计学意义（P〉0．05）。对照组术前术后血小板、白细胞变化无明显差异。观察组术后血小板、白细胞较术前明显升高（P〈0．01）。观察组和对照组术后5年无瘤生存分别为10例（33．3％）和5例（16．7％）,差异有统计学意义（P〈0．05）。结论原发性肝癌合并肝硬化门静脉高压并脾功能亢进患者同期行食管横断法门奇静脉断流术联合肝脾切除术是可行的。     

诊断性脾切除术对不明原因发热伴脾肿大的临床意义

目的探讨不明原因发热伴脾肿大行诊断性脾切除术的临床意义及可能的危险因素。方法回顾分析了我院20年来因不明原因发热、脾肿大行剖腹探查加诊断性脾切除术的54例患者的临床资料及病理检查结果,并对可能的危险因素进行分析。结果54例患者手术后经病理确诊39例,病理诊断率为72．2％（39／54）,其中恶性淋巴瘤32例（59．3％,32／54）。25．9％的（14／54）患者出现手术并发症,并发症发生依次主要为：术后感染、出血、心功能衰竭、肝功能衰竭及膈下积液。9例（16．7％）患者围手术期死亡,死亡原因主要为：严重感染、术后出血、本身疾病恶化、心功能衰竭、肝功能衰竭及猝死。在相关危险因素中,有、无浆膜腔积液组死亡率分别为46．2％和7．5％（P=0．011）;脾脏重量≤500g,500—1500g及≥1500g组围手术期死亡率分别为0％、11．8％、50．0％（后2组比较,P=0．01）;有无黄疸、血三系减少、转氨酶升高及乳酸脱氢酶升高及病程长短与围手术期死亡率无明显相关（P〉0．1）。浆膜腔积液和巨脾是相对独立的影响死亡的因素（P值分别为0．011和0．01;／bY分别为20．4和18．6）。结论不明原因发热伴肝脾肿大患者,在高度怀疑恶性血液病但又不能明确诊断时,剖腹探查及诊断性脾切除术是有意义的方法。合并浆膜腔积液及巨脾者围手术期死亡率增高。     

肝癌切除联合全脾切除治疗原发性肝癌合并脾功能亢进的疗效分析

目的：探讨临床治疗原发性肝癌合并脾功能亢进的有效方案。方法：回顾分析163例原发性肝癌合并脾功能亢进患者的临床资料,根据治疗方案将上述患者分为观察组（n=83）与对照组（n=80）,观察组接受肝癌切除术联合全脾切除术治疗,对照组仅接受肝癌切除术治疗。结果：（1）两组患者术中出血量、输血量比较差异无统计学意义（P〉0．05）。（2）术前,两组患者红细胞（RBC）、白细胞（WBC）、血小板（PLT）比较差异无统计学意义（P〉0．05）;术后2个月,观察组WBC、PLT显著高于对照组（P〈0．05）,两组患者RBC比较差异无统计学意义（P〉0．05）。（3）术前,两组患者CD4、CD8、CD4／CD8比较差异无统计学意义（P〉0．05）;术后2个月,观察组C现、CD4／CD8显著高于对照组（P〈0．05）,CD。显著低于对照组（P〈O．05）。（4）两组患者并发症发生率、病死率比较差异无统计学意义（P〉0．05）。结论：肝癌切除术联合全脾切除术是治疗原发性肝癌合并脾功能亢进的有效方案,该方案值得临床应用与推广。     

转移性肝癌切除术后肝功能代偿不全的危险因素分析

目的探讨转移性肝癌术后肝功能代偿不全的危险因素及其防治措施。方法回顾性分析2003年8月至2008年8月行手术切除的43例转移性肝癌患者的临床资料。结果术后肝功能轻度代偿不全（ChildB级）20例（46．0％），重度代偿不全（ChildC级）4例（9．3％）。术后1个月内死亡2例（4．6％）。单变量分析显示：癌灶大小（P〈0．05）、切肝方式（P〈0．01）和失血总量（P〈0．01）与术后肝功能代偿不全有密切关系。结论癌灶多发、癌灶大、联合肝段切除术、失血过多是术后肝功能代偿不全主要的危险因素。术中严格控制出血、在保证完全切除肝肿瘤的同时尽可能保留功能正常的肝组织，是提高手术安全性和减少术后并发症的关键。     

肝硬化合并肝癌手术后肝功衰竭的预防

肝癌合并肝硬化的病人，肝切除后易发生肝功衰竭。发生率各家报道不一，一般认为与肝硬化的严重程度有关。本组63例51例情况良好（生存组）。12例肝功衰竭并死亡（衰竭组）。本前两组肝功能无明显不同。从病理切片看，肝功能衰竭组肝内中、重度炎症反应为11例（83％）。左或右半肝切除较肝部分切除或肝段切除发生率高。在肝功衰竭组围手术期失血为4332ml，生存组仅1945ml，有显著差异（P＜0．001）。肝衰组术后其它并发症11例（92％），生存组为11例（22％），有明显差异（P＜0．01）。因此，对合并肝硬化的肝癌病人术前注意如下几点。①在肝切除前应做肝脏的病理检查。②围手术期失血应少于2000ml。③术后加强护理，预防可能导致的并发症。     

腹腔镜脾切除178例临床分析

目的总结12年来行腹腔镜脾切除术（laparoscopic splenectomy,LS）的临床经验,探讨肝硬化、门静脉高压症、继发性脾功能亢进和巨脾患者行LS的安全性和有效性。方法回顾性统计分析178例（主要是肝硬化、继发性脾功能亢进和血液病患者）LS的临床结果,比较巨脾组（62例）和非巨脾组（116例）的平均手术时间、术中失血量、术中输血量、中转开腹手术率、并发症发生率和术后住院时间。结果178例LS中转行开腹脾切除术4例（2.2％）,出现并发症21例（11．8％）;巨脾组和非巨脾组平均手术时间分别为3．0h和2.4h,并发症发生率分别为21.0％和6.9％,术后住院时间分别为（8.0±2,2d）和（6.6±1.7d）,两组的差异均有统计学意义（均P〈0．05）;两组术中失血量、术中输血量和中转开腹手术率的差异均无统计学意义（均P〉0．05）.结论LS安全、有效,适用于有脾切除指征的各种脾疾病,肝硬化、门静脉高压症、继发性脾功能亢进和巨脾不是LS的禁忌证。     

肝细胞癌合并肝硬化脾功能亢进患者行肝脾联合切除术的临床意义

目的：探讨肝癌合并肝硬化脾功能亢进患者行肝癌联合脾脏切除术与单纯肝癌切除术的临床疗效。方法：55例肝癌合并肝硬化脾功能亢进患者中，25例行肝癌联合脾切除，30例行单纯肝癌切除，对两种术式术后并发症、肝功能及血常规进行比较和分析。结果：单纯肝癌切除组与肝癌联合脾脏切除组术后感染、消化道出血、腹水、黄疸的发生率分别为10％和0％、6．67％和4％、20％和16％、20％和20％。两种术式的患者术后肝功能差异无统计学意义，而肝癌联合脾脏切除组能明显改善术后血常规。结论：应严格掌握肝癌联合脾脏切除的手术指征，同时应加强围手术期管理。肝癌联合脾切除术治疗肝癌合并肝硬化脾功能亢进是安全可行的。     

肝癌患者围手术期血清胆碱酯酶水平评估手术预后的意义

目的研究肝癌患者围手术期血清胆碱酯酶（ChE）水平的变化及其与预后的关系。方法采用酶速率法，测定113例肝癌患者行肝癌切除术术前和术后1、7、12d的血清ChE。结果术前及术后各时期血清ChE水平随血清白蛋白水平和肝功能Child—Pugn分级的降低而下降（P〈0．05）。肝硬化组患者的血清ChE水平显著低于同时期无肝硬化患者的水平（P〈0．05）。术后轻度肝功能损害70例，中度肝功能损害28例，重度肝功能损害11例，出现肝功能衰竭4例，血清ChE水平随术后肝功能损害程度加重而下降（P〈0．05），但后两者间的差异无统计学意义（P〉0.05）。结论血清ChE水平号熳性肝病严重程度一致，对估计肝脏的储备功能、判断手术耐受性及预后具有一定的临床价值，其进行性下降与肝功能损害明显相关，但不能很好地预测肝癌切除术后肝功能衰竭的发生。     

选择性出入肝血流阻断技术在右半肝切除术中的应用

目的比较两种肝脏血流阻断方法在因肝脏恶性肿瘤行右半肝切除术中的作用,评价右半肝出入肝血流阻断技术在右半肝切除中的应用价值。方法将49例肝癌行右半肝切除的患者分为右半肝入肝血流阻断组（n=22）和右半肝出入肝血流阻断组（n=27）。比较两组患者术中出血量、输血患者比例、术后并发症以及术后肝功能的恢复等指标。结果两组患者术后输血比例差异无统计学意义（P〉0．05）,右半肝入肝血流阻断组有1例患者术后死于肝脏功能衰竭。右半肝出入肝血流阻断组术后并发症数量明显减少、无患者死亡,术中出血量明显低于右半肝入肝血流阻断组（P〈0．05）,且术后第7天的肝脏功能恢复明显优于右半肝入肝血流阻断组（P〈0．05）。结论右半肝出入肝血流阻断技术可以提高因肝脏肿瘤而行右半肝切除的成功率和患者对手术耐受性,为右半肝切除手术提供了一个安全、合理的手术方式。     

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.