单孔与标准腹腔镜下无功能肾切除术的临床疗效对比

目的 比较经脐单孔多通道腹腔镜与标准经腹腹腔镜下行无功能肾切除术的治疗效果。 方法 2009年9月至2013年8月,本单位同一手术组完成无功能肾切除微创手术72例,其中50例行标准经腹腹腔镜手术,22例行经脐单孔多通道腹腔镜手术,回顾性分析50例标准经腹腹腔镜无功能肾切除术(A组)和22例经脐单孔多通道腹腔镜无功能肾切除术术(B组)的临床资料。两组的配比因素为患者年龄、性别、体质指数、无功能肾位置。 结果 72例手术均获成功,无中转开放手术。A、B两组的术后疼痛评分分别为(4.3±1.0)、(3.7±0.8)(p=0.015)、术后肠通气恢复时间分别为(58.1±16.1h)、(49.2±14.0h)(p=0.032),术后留置引流管时间分别为(3.9±1.5天)、(2.8±1.1天)(p=0.003),术后住院天数分别为(7.3±3.1天)、(6.3±3.4天)(p=0.048),手术切口满意度评分分别为(7.4±0.9)、(8.0±0.6)(p＝0.001),均有统计学差异(P＜0.05)。A、B两组的手术时间分别为(200.2±59.7min)、(185.8±55.4min)(p=0.299),术中出血量分别为(173.2±112.9ml)、(134.1±82.2ml)(p=0.168),均无统计学意义(P＞0.05)。 结论 与标准经腹腹腔镜下无功能肾切除相比,经脐单孔多通道腹腔镜手术的患者术后疼痛轻,肠道功能恢复快,引流管拔除时间早,术后住院天数短,切口满意度高,因此,经脐单孔多通道腹腔镜下无功能肾切除术是一种安全、有效、可靠的微创治疗方法。但无功能肾切除术后,患者的远期治疗效果仍需进一步长期随访予以证实。     

腹腔镜下肾切除37例分析

目的:探讨腹腔镜手术治疗肾脏疾病的方法、疗效与处理要点。方法:应用后腹腔镜下行肾切除术治疗肾脏疾病37例。结果:平均时间(135±10)min,出血量(140±10)ml,术后平均失血量、下床活动时间及术后住院天数均显著优于开放手术,无需要输血和严重并发症病例发生。平均随访6个月,病例均达到治疗目的。结论:腹腔镜下肾切除手术创伤小、安全有效,恢复快、住院时间短、生活质量高。     

后腹腔镜下早期肾癌行肾部分切除术21例报告

目的：探讨后腹腔镜对早期肾癌行肾部分切除术的方法和疗效。方法：2003年7月至2007年6月采用后腹腔镜技术使用超声刀、电凝钩对21例早期肾癌患者行保留肾单位手术，肿瘤平均直径（2.8±0.8） cm (1.5~4.5 cm)。其中肾透明细胞癌17例，肾颗粒细胞癌3例，嗜酸性细胞癌1例。结果：21 例均完成后腹腔镜保留肾单位手术，平均手术时间（105±15）min，平均出血量（120±22） ml，4例患者术中平均输血400 ml。1例发生尿漏，引流量200～300 ml，术后15 d负压吸引小于20 ml后拔出。术后住院时间平均（9±2） d (7～17 d)。随访时间3~48个月，平均（20±4）个月，肿瘤无复发。结论：腹腔镜肾部分切除术是可行的，也是安全的。     

后腹腔镜保留肾脏手术治疗肾肿瘤的临床分析

目的 探究后腹腔镜保留肾脏手术法治疗肾脏肿瘤的临床疗效.方法 随机选取在郑州大学第一附属医院进行治疗的肾肿瘤患者35例,分成观察组和对照组,观察组患者应用后腹腔镜技术进行肿瘤切除手术,对照组患者应用传统的开放性肾部分切除术进行治疗,观察比较2组患者的手术出血量、手术时间以及住院天数、肠道恢复时间、并发症等指标.结果 观察组患者的术中出血量、手术时间、住院天数以及肠道恢复时间明显少于对照组,差异有统计学意义（P＜0.05）.结论 肾肿瘤患者应用后腹腔镜下的保留肾脏手术方式具有操作简便、手术出血少、患者恢复快等优点,能够有效缩短患者的住院时间,提高患者的生活质量.     

腹腔镜和开放根治性肾切除术治疗T2期肾癌的临床疗效比较

目的 比较腹腔镜和开放行根治性肾切除术治疗T2期肾癌的临床效果。方法 对同期138例肾癌患者分别行腹腔镜或开放根治性肾切除术,腹腔镜手术组63例,开放手术组75例。比较两组术中出血量、手术时间、术后进食时间及住院时间等指标。结果 腹腔镜肾根治性切除术手术时间为90~385min,平均（213±61.6）min;开放手术时间为55~320 min,平均（173±52.3）min,二者差异有统计学意义（P=0.000）。腹腔镜手术组术中失血量为30~1 600 ml,平均（220±291.8）ml;开放手术组术中失血量为50~1400 ml,平均（319±244.1）ml,差异有统计学意义（P=0.032）。经腹腹腔镜组术后1～4d进食,平均（2.4±0.82）d;经后腹膜腹腔镜组为术后2～5 d进食,平均（3.1±1.02）d,差异有统计学意义（P=0.000)。经腹腹腔镜组术后住院4～15 d,平均（7.3±2.50）d;经后腹膜腹腔镜组术后住院6～15 d,平均（9.3±2.25）d,差异有统计学意义（P=0.000)。结论 腹腔镜根治性肾切除术有出血少、术后进食早和术后住院时间短等优点,术后并发症发生率和开放手术相近,腹腔镜根治性肾切除术治疗T2期肾癌安全可行。     

腹腔镜肾部分切除术手术方法的探讨

目的 探讨腹腔镜下肾部分切除手术的技术特点及与传统开放肾部分切除术的优劣。方法回顾性总结过去5年内完成的26例腹腔镜下肾部分切除术病例,其中包括11例腹腔镜及15例开放手术。将两组病例进行对比,分析两种术式在手术时间,出血量,热缺血时间,术后恢复进食时间,术后住院时间等方面的差异。结果 11例腹腔镜肾部分切除手术均顺利完成,无中转开放病例。开放组与腹腔镜组对比,平均手术时间为（92±36）min比（138±97）min,术中平均出血量为（150±68）ml比（176±88）ml,热缺血时间为（25±18）min比（12±5）min,术后恢复进流食时间为（31±7）h比（16±6）h,术后住院时间为（12．0±4．5）d比（7．0±2．4）d。结论 腹腔镜下肾部分切除手术时应阻断肾门血管,以剪刀锐性切除肿瘤,切实全层缝合切缘,以达到理想手术效果。此术式是一种安全、可行的手术方法。     

完全后腹腔镜下肾输尿管根治术与开放手术的比较

目的：比较完全后腹腔镜下肾输尿管根治术与开放手术治疗上尿路移行细胞癌的临床疗效。方法：44例上尿路移行细胞癌患者行肾输尿管根治术,其中15例为腹腔镜手术组,采取完全后腹腔镜下手术,29例为开放手术组,采取开放肾输尿管根治性手术。比较2组患者的手术时间、术中出血量、术后止痛药应用时间和剂量、胃肠道功能恢复时间、下床活动时间、术后住院时间和并发症,并随访6~42月,比较2组膀胱肿瘤发生及远处转移、存活时间等。结果：2组手术均获成功。腹腔镜手术组与开放手术组比较,出血量明显减少（116.1±29.4） ml vs. （278.6±84.3） ml,P=0.000;止痛药（杜冷丁注射液）应用时间短（0.7±0.5） d vs. （2.3±0.9） d,P=0.000;剂量少（33.3±24.4） mg vs. （155.2±62.8） mg,P=0.000;下床活动早（2.1±0.5） d vs. （4.2±1.0） d,P=0.000;术后住院时间短（8.7±1.6） d vs. （13.1±3.2） d,P=0.000。腹腔镜手术组手术时间较短（212.1±19.5） min vs. （251.7±24.2） min,P=0.000,肠道功能恢复较快（1.9±0.8） d vs. （2.9±0.8） d,P=0.00１,但与开放手术组比较差异无统计学意义（P >0.05）。随访6~42月,2组病人均存活,术后并发症、肿瘤复发及转移差异无统计学意义（P >0.05）。结论：完全后腹腔镜下肾输尿管根治术具有微创并与开放手术相同的肿瘤学效果,将成为上尿路移行细胞癌的理想手术方法。     

后腹腔镜肾部分切除术个体化方案治疗微小肾癌的疗效分析

目的探讨后腹腔镜肾部分切除术（RLPN）个体化方案治疗微小肾癌的疗效。方法回顾性分析11例实施RLPN个体化方案治疗的微小肾癌患者,其中4例内生性微小肾癌患者采用腔内超声术中精确探查定位,肾动脉阻断下实施肾部分切除的方案（A组）;7例外突性生长的微小肾癌患者采用术中游离肾动脉,套橡皮条备用,试行不阻断肾动脉零缺血的状态下实施肾部分切除的方案（B组）。从术中出血量、手术时间、术中热缺血时间以及术后随访结果等方面分析疗效。结果A组患者均手术顺利,术中出血量35~250（85.2±44.5）ml,手术时间110~235（174.6±38.6）min,术中热缺血时间25~40（28.3±6.2）min。B组患者中有6例未阻断肾动脉,1例出血明显;在切除肿瘤过程中,再阻断肾动脉15min,完成肾部分切除,出血量160~380（220.3±40.1）ml,手术时间85~215（142.7±32.5）min。对11例患者术后随访6~48个月,均无复发、转移。结论RLPN个体化方案治疗微小肾癌安全、有效。     

后腹腔镜下肾切除术52例手术体会

目的：探讨不同病因导致的肾脏病变行后腹腔镜患肾切除的手术方法。方法：对52例不同病因导致的肾脏病变患者行后腹腔镜下肾切除术。结果：52例后腹腔镜肾切除手术均顺利完成,手术时间70～180 m in ,平均120 min。术中出血量50～150 ml平均100 ml ,所有病人术中及术后均未输血。随访2～24个月,均无迟发性出血,肿瘤复发及种植转移等并发症。结论：后腹腔镜下肾切除术具有创伤小,出血少,恢复快,并发症少的优点。     

解剖性后腹腔镜根治性肾切除术快速寻找并处理肾蒂体会

目的:探讨解剖性后腹腔镜根治性肾切除术快速寻找并处理肾蒂技巧。方法:后腹腔镜根治性肾切除43例,根据肾蒂寻找和处理方式不同,分为2组。对照组21例采用传统后腹腔镜根治性肾切除术,于肾脏背侧肾门隆起处寻找肾蒂;观察组22例行解剖性后腹腔镜根治性肾切除术,沿下腔静脉表面（右侧）或腹主动脉表面（左侧）寻找肾蒂。比较2组肾蒂寻找并处理时间、术中出血量、手术时间、术中及术后并发症发生率、淋巴结清扫数量、引流管拔出时间及术后住院时间。结果:43例手术均获成功,无中转开放手术。观察组肾蒂寻找并处理时间明显短于对照组（P<0.01）,淋巴结清扫数量多于对照组（P<0.05）;2组术中及术后均无严重并发症发生,2组术中出血量、手术时间、术后引流管拔出时间和术后住院时间差异均无统计学意义（P>0.05）。结论:解剖性后腹腔镜根治性肾切除术采用下腔静脉或腹主动脉表面法寻找并处理肾蒂,解剖层面清晰,操作视野好,可快速寻找并处理肾蒂血管,并提高淋巴结清扫数量,有助于手术规范化、标准化及技术快速推广。     

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.