腹腔镜与开腹手术治疗急性结石性胆囊炎效果及安全性探讨

目的探讨腹腔镜与开腹手术治疗急性结石性胆囊炎的临床效果及安全性。方法将106例急性结石性胆囊炎患者结合病情及患者自愿原则分成观察组56例及对照组50例,观察组行腹腔镜胆囊切除术,对照组行开腹手术胆囊切除术,比较两组患者手术情况及并发症发生情况。结果观察组手术时间、术中出血量、术后排气时间及住院天数均明显少于对照组(P<0.05),并发症发生率明显少于对照组(P<0.05)。结论与开腹手术比较,腹腔镜手术治疗急性结石性胆囊炎手术效果好,安全性高,是一种值得优先选择的手术方案。     

老年急性结石性胆囊炎腹腔镜胆囊切除术手术时机的探讨

目的探讨急性结石性胆囊炎行腹腔镜胆囊切除术(LC)手术时机与疗效的关系。方法将我院收治的急性结石性胆囊炎老年患者分为早期手术组和延期手术组,观察两组手术治疗效果及患者康复情况。结果两组出血量及并发症发生率无差异(P>0.05)。早期组术中转开腹率、治疗费用及其他手术效果指标优于延期组(P<0.05)。早期组胃肠功能康复情况及预后指标均优于延期组(P<0.05)。结论急性结石性胆囊炎应尽早行LC术,以提高手术治疗效果,促进术后康复及降低治疗费用。     

324例急性结石胆囊炎行腹腔镜胆囊切除术临床分析

目的分析急性结石性胆囊炎行腹腔镜胆囊切除术(LC)的可行性、疗效和相关处理。方法对比分析本院2000年4月至2008年4月急性胆囊炎行腹腔镜胆囊切除术患者324例(急诊组)及慢性胆囊炎行腹腔镜胆囊切除术患者795例(择期组)的手术时间、术中出血量、术后住院时间、中转开腹手术率及相关并发症发生率,并对不同时间行急诊LC的患者上述指标进行比较。结果两组手术时间、术中失血量、中转开腹手术率及并发症发生率比较均有统计学意义(均P<0.01),术后住院时间比较差异无统计学意义(P>0.05);不同时间行LC的患者除术后住院时间无明显差异外(P>0.05),手术时间、术中失血量、中转开腹手术率及并发症发生率比较差异均有统计学意义(均P<0.01)。结论急性结石性胆囊炎采用LC手术治疗是可行的,关健是手术者的经验及手术的技巧。     

老年人急性非结石性胆囊炎的外科治疗分析

目的:探讨老年人急性非结石性胆囊炎临床特点和最佳手术时机。方法:通过设立严格的病例对照,对46例老年人急性非结石性胆囊炎不同手术时机的胆囊病变与术后结果进行比较。结果:发病48h以上手术的急性非结石性胆囊炎胆囊坏疽与穿孔率及术后并发症发生率与病死率较48h内手术者明显增高(P<0.001,P<0.001,P<0.05)。结论:老年人急性非结石性胆囊炎并存病多,胆囊病变重,术后并发症发生率高,宜在症状出现48h内手术治疗。     

78例急性结石性胆囊炎行腹腔镜胆囊切除术的临床疗效

目的探讨腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床疗效。方法回顾性分析2009年2月～2010年10月78例行腹腔镜胆囊切除术的急性结石性胆囊炎患者的临床资料,并与同期80例急性结石性胆囊炎行开腹胆囊切除术患者进行对照,统计并比较两组患者手术时间、平均住院时间、胃肠功能恢复时间以及并发症发生情况。结果腹腔镜组手术时间平均为(72.1±12.7)min,开腹手术组为(56.4±11.0)min,差异有统计学意义(P<0.05);腹腔镜组平均住院时间为(6.6±1.9)d,明显短于开腹手术组的(9.8±2.7)d,差异有统计学意义(P<0.05)。腹腔镜组排便、排气、肠鸣音、进食时间均短于开腹手术组(P均<0.05),并发症发生率低于对照组(P<0.05)。结论腹腔镜胆囊切除治疗急性结石性胆囊炎微创,并发症少,胃肠功能恢复快,住院时间短,但手术时间相对较长,对医生的技术要求较高。     

腹腔镜胆囊切除术与开腹胆囊切除术在急性结石性胆囊炎中的疗效对比

目的探讨腹腔镜胆囊切除术与开腹胆囊切除术在急性结石性胆囊炎中的疗效对比。方法选取2011年6月-2012年6月收治的急性胆囊炎患者98例,随机分为观察组和对照组各49例。对照组患者采取开腹胆囊切除术,观察组患者采用腹腔镜胆囊切除术,比较两组手术疗效。结果观察组手术时间、术后排气时间、手术出血量及并发症发生率均显著优于对照组,差异有统计学意义(P<0.05)。结论急性结石性胆囊炎患者行腹腔镜胆囊切除术,具有手术时间短,创伤小,术后恢复快、并发症少等特点,是安全可行的手术方式,值得在临床上应用和推广。     

急性结石性胆囊炎腹腔镜胆囊切除术手术时机的选择及中转开腹影响因素分析

目的探讨腹腔镜胆囊切除术治疗急性结石性胆囊炎的最佳手术时机及中转开腹的影响因素。方法选择2007年6月—2012年6月在我院行腹腔镜胆囊切除术的急性结石性胆囊炎患者230例。按从症状发作到接受腹腔镜胆囊切除术的时间间隔分为4组,Ⅰ组(74例)为症状发作48 h内手术的患者;Ⅱ组(69例)为症状发作后48～72 h内手术的患者;Ⅲ组(53例)为症状发作72 h后手术的患者;Ⅳ组(34例)为入院后先给予抗感染、对症及支持治疗,症状缓解2～4周后再择期手术的患者。比较4组患者术后并发症发生率、中转开腹率及手术时间,同时分析影响中转开腹的相关因素。结果 4组患者术后并发症发生率比较,差异无统计学意义(χ2=1.26,P>0.05);中转开腹率、手术时间比较,差异均有统计学意义(χ2=5.77,P<0.05;F=7.99,P<0.01)。单因素分析显示,体温、胆囊肿大、右上腹肌紧张、白细胞计数、胆囊壁厚度、胆囊颈部结石嵌顿、手术时机7个因素与中转开腹有关(P<0.05)。多因素Logistic回归分析结果显示,白细胞计数〔r=1.298,OR=3.698,95%CI(1.867,4.789)〕和手术时机〔r=1.062,OR=2.265,95%CI(1.688,3.821)〕进入回归方程。结论急性结石性胆囊炎症状发作后48 h内是腹腔镜胆囊切除术的最佳时机,白细胞计数和手术时机选择是影响中转开腹的两个独立危险因素。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎的效果分析

目的：研究腹腔镜胆囊切除术治疗急性结石性胆囊炎的效果。方法：选取2019年1月-2021年1月邳州市中医院收治的108例急性结石性胆囊炎患者作为研究对象,采用掷骰子法分为对照组和试验组,各54例。对照组采用开腹胆囊切除术治疗,试验组采用腹腔镜胆囊切除术治疗。比较两组肠鸣音恢复时间、排气恢复时间、住院时间、手术时间、术中出血量及术后并发症发生率。结果：试验组肠鸣音恢复时间、排气恢复时间、住院时间、手术时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);试验组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论：腹腔镜胆囊切除术治疗急性结石性胆囊炎的效果显著,安全性高,患者术后恢复效果好,值得推广应用。     

急性结石性胆囊炎60例手术治疗疗效分析

目的:探讨急性结石性胆囊炎手术治疗的临床效果。方法:将收治的60例急性结石性胆囊炎患者,随机分为对照组和观察组,每组各30例,对照组采用传统开腹胆囊切除术治疗,观察组采用小切口胆囊切除术治疗,比较两组治疗效果及不良反应发生情况。结果:观察组术中出血量、手术时间明显低于对照组,差异有统计学意义(P<0.05)。结论:两种胆囊切除术有其优缺点及适用范围,具体选择何种手术方式,需根据患者身体状况及局部病变程度施行,最终达到安全、顺利的完成手术。     

急性结石性胆囊炎临床治疗体会

目的:探讨分析急性结石性胆囊炎的治疗方案及手术时机的选择。方法:回顾性分析我院2010年10月-2012年10月收治的急性结石性胆囊炎患者48例,依据治疗方案的不同分为对照组和观察组,各24例。对照组首先给予药物保守治疗后行手术治疗;观察组入院后即行胆囊切除术。比较分析两组患者治疗效果以及症状缓解时间、住院时间。结果:经治疗,对照组和观察组总有效率比较,差异无统计学意义(P>0.05);症状缓解时间两组比较差异有统计学意义(P<0.05);住院时间两组比较差异有统计学意义(P<0.05)。结论:对急性结石性胆囊炎患者,临床上要准确把握手术时机,选用合理的治疗方式,提高临床治愈率,降低患者痛苦。     

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.     

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.     

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.