胸腔镜辅助左胸小切口胃、食管超胸膜顶吻合治疗食管癌

目的:探讨胸腔镜辅助左胸小切口术式在中下段食管癌手术中的应用价值。方法:选择36例中下段食管癌患者,随机分为观察组和对照组。对照组采用左侧剖胸、右侧胸腹两切口等常规手术方式治疗,观察组采用胸腔镜辅助左胸小切口手术治疗,比较两组患者的手术治疗效果。结果:全部病例均顺利完成手术康复出院,观察组手术时间较对照组延长;观察组术中出血量、术后留置胸管引流时间、术后疼痛程度、术后并发症、住院时间、生存率均显著优于对照组(P<0.05)。结论:胸腔镜辅助左胸小切口术式治疗中下段食管癌创伤小、并发症少、患者恢复快、治疗效果好,有较好临床应用价值。     

高龄食管癌患者100例的外科治疗

目的：分析高龄食管癌的临床手术治疗方式与效果.方法：收集本院胸外科100例食管癌手术患者,病变位于上段30例,食管中段46例,食管下段24例 手术分左胸切口组48例,右胸切口组52例.结果：近期并发症发生率左胸切口组术后为10.4%,右胸切口组为36.5%,差异有显著性（P=0.030）,两组均无术中死亡及住院死亡 左胸切口组术后1年和3年生存率分别为84.2%和57.1%,右胸切口组分别为77.3%和50.0%.两组1年和3年生存率率比较无统计学差异（P＞0.05）.结论：手术采用右胸切口与左胸切口具有各自的优点与适用范围,需根据病变的具体情况而定 无论左胸切口还是右胸切口,采用颈部吻合都是较好的选择.     

剖右胸三切口治疗胸中上段食管癌56例体会

目的 探讨剖右胸三切口手术治疗胸中、上段食管癌的优缺点。方法 采用剖左颈、右胸、上腹正中三切口治疗胸中、上段食管癌58例，观察其效果，并与剖左胸作比较。结果 根治性切除54例，姑息性切除1例，探查1例，切除率98％（55／56），术后并发症8例，发生率14％（8／56），无围手术期死亡，术后1，3，5年生存率分别为87%(49/56),71%(40/56),32%(18/56)。结论 剖右胸三切口手术治疗胸中、上段食管癌手术切除率高，解剖有优势，淋巴结清扫易于进行，术后恢复快，远期疗效好，生活质量高。     

术前放疗并小切口治疗胸段食管癌的疗效观察

目的:观察术前放疗并小切口治疗胸段食管癌的疗效.方法:260例胸段食管癌患者随机分为观察组和对照组,各130例.观察组术前给予60Co照射,2~3周后进行胸腔镜下小切口食管癌根治术;对照组仅行常规切口食管癌根治术.比较两组手术时间、术中出血量、住院时间、术后并发症发生率.结果:观察组患者手术时间、术中出血量、住院时间、术后并发症发生率均明显低于对照组患者,该结果差异显著(P<0.05),具有统计学意义.结论:胸段食管癌患者采用术前放疗并小切口胸段食管癌根治术治疗具有较好的临床治疗效果,该技术可显著减少术后并发症的发生率,改善患者的生活质量.     

左进胸、左颈两切口食管癌切除术683例分析

目的:探讨食管癌的手术方式及常见并发症的防治.方法:采用左进胸、左颈两切口行食管癌切除、胃食管左颈部吻合术治疗食管癌683例.结果:术后痊愈出院678例,围手术期死亡5例,术后发生颈部吻合口瘘16例(占2.34%),吻合口狭窄9例(占1.32%),肺部并发症12例(占1.75%),心血管系统并发症27例(占3.95%),乳糜胸7例(占1.02%),喉返神经损伤6例(占0.87%),胸腔出血2例(占0.29%).结论:左进胸、左颈两切口食管癌切除术具有切除彻底、减小创伤、并发症少、病死率低等优点,是比较理想的手术方式.     

左胸径路手术治疗胸中、上段食管癌

目的评估左胸径路手术治疗胸中、上段食管癌的临床价值。方法左胸径路组与右胸径路组进行对比。结果左胸径路切除胸中、上段食管癌92例,手术时间3.00~6.40h,平均4.34h;术中出血200~1300m l,平均578m l;术后并发肺部感染20例(21.74%),伤口感染13例(14.13%),吻合口瘘5例(5.43%),乳糜瘘2例(2.17%),死亡3例(3.26%)。结论左胸径路对食管、胃的显露、游离较右胸径路满意;唯独奇静脉的出血处理没有右胸径路方便;左胸二切口较右胸三切口手术创伤小、出血少、手术时间缩短、术后并发症少,可作为一种常规的手术切口选择。     

70岁以上高龄食管癌贲门癌的手术治疗

目的　总结 70岁以上高龄食管癌贲门癌的手术治疗经验。方法　手术治疗 2 6例 70岁以上高龄食管癌贲门癌病人 ,年龄 70～ 78岁 ;食管癌 16例 ,贲门癌 10例 ,术前伴发其他系统疾病 15例 ,其中 4例合并两种以上疾病。16例食管癌病人分别行经左胸切除、弓下吻合 9例 ,经左胸切除、颈部吻合 3例 ,经右胸、颈腹部三切口切除 1例 ,经左颈、腹部食管剥脱术切除 1例 ,探查 2例 ;10例贲门癌病人行经左胸切除 2例 ,经腹切除 6例 (其中 1例术中改行胸腹联合切口 ) ,探查 2例。结果　全组手术切除率 84.6%,术后并发症发生率 46.2 %,其中呼吸系统并发症发生率占 5 0 %,手术死亡率 7.7%。结论　高龄食管癌贲门癌的病人 ,虽然常伴有其他疾病 ,有较高的术后并发症发生率 ,但只要合理选择手术方式 ,注重围手术期管理 ,仍应积极进行手术治疗。     

老年食管癌外科治疗317例

目的探讨老年食管癌手术适应证及围术期治疗。方法对收治的317例老年食管癌行手术切除304例,探查13例,切除率95.9%,颈部吻合66例,其中颈段食管癌行食管内翻拔脱、食管胃颈部吻合5例,颈胸腹三切口颈部吻合35例,左胸左颈两切口颈部吻合26例;经左胸食管胃胸腔内吻合235例;结肠代食管行食管结肠胸顶机械吻合3例。结果术后并发症62例(19.6%)。呼吸衰竭死亡8例,病死率2.5%。术后随访267例,1、3和5年生存率分别为89.8、60.3和33.6%。结论老年人食管癌术后并发症及手术死亡率明显高于60岁以下者,对高龄病人手术应持慎重而积极的态度;外科治疗仍是首选的治疗方法;加强围术期治疗、选择合理的手术方式是降低手术死亡率的重要措施。     

电视胸腔镜辅助左胸小切口食管下段癌根治术

目的 探讨用电视胸腔镜辅助左胸小切口行食管下段癌根治术的可行性和近期疗效.方法 10例食管下段癌患者施行了电视胸腔镜辅助左胸小切口食管癌切除,食管胃左胸内吻合手术.经3个戳卡孔,及胸部1个8～10 cm小切口在电视胸腔镜辅助下游离胸段食管,打开膈肌游离胃,切除食管,用管型吻合器行食管胃左胸内吻合,并用缝合切割器制作管状胃.结果 全组患者无中转手术,术后1例患者出现乳糜胸,保守治疗后痊愈.余患者无其他并发症发生,术后8～15 d出院.随访1～44个月,患者全部生存,肿瘤无复发.结论 电视胸腔镜辅助左胸小切口行食管下段癌根治术具可行性,近期疗效满意.     

中下段食管癌左胸单切口术治疗疗效分析

目的探讨左胸单切口术治疗中下段食管癌的临床疗效。方法回顾分析于该院手术治疗的中下段食管癌35例病例资料,根据手术入路方式不同将其分为左胸单切口组19例、胸腹双切口组16例。比较两组患者手术时间、住院天数、引流时间及并发症等。结果左胸单切口组患者平均手术时间、住院天数均较胸腹二切口组缩短（P〈0.05）,左胸单切口组术后并发症发生率明显低于对照组（P〈0.05）。结论中下段食管癌患者行左胸单切口术较胸腹双切口手术创伤相对较小,手术时间及患者住院天数均明显缩短,同时术后并发症也显著减少。     

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.