后腹腔镜手术与开放手术治疗肾上腺嗜铬细胞瘤疗效比较

目的：对比分析后腹腔镜手术与开放手术治疗肾上腺嗜铬细胞瘤的疗效,评价后腹腔镜手术治疗肾上腺嗜铬细胞瘤的临床价值。方法：选择本科收治的48例单侧肾上腺嗜铬细胞瘤患者,按患者意愿和手术者经验分别选择后腹腔镜手术（23例）和开放手术（25例）。比较2组肾上腺嗜铬细胞瘤患者临床资料,统计分析2种术式在手术时间、术中出血量、术中血压控制情况、术后住院时间及术后并发症发生率等方面的差异。结果：2组患者手术均获得成功。后腹腔镜组和开放手术组患者手术时间分别为（60±25） min和（100±40） min;出血量分别为（42±16） mL和（156±45） mL;术中血压分别为（160±10） mmHg和（165±55） mmHg;术后住院时间分别为（5.2±1.2） d和（7.4±1.6） d。后腹腔镜组手术时间、术中出血量、术中血压及术后住院时间与开放手术组比较,差异均有统计学意义（均P<0.01）。术后2组患者均无重大并发症发生。术后病理报告均为肾上腺嗜铬细胞瘤。术后随访时间6～48个月,2组患者临床症状消失,肿瘤局部无复发。结论：后腹腔镜肾上腺嗜铬细胞瘤切除术与开放手术比较出血少、创伤小、恢复快,明显优于开放手术,是治疗肾上腺嗜铬细胞瘤安全有效的方法。     

后腹腔镜与开放手术行肾上腺嗜铬细胞瘤切除术的疗效比较

目的:评价后腹腔镜与开放手术治疗肾上腺嗜铬细胞瘤的疗效及安全性。方法:分别采用后腹腔镜、开放手术治疗肾上腺嗜铬细胞瘤46例(A组)、30例(B组)。比较两组之间手术时间、术中出血量、术中血压剧烈波动例数、术后肠功能恢复时间和术后住院时间等。结果:A、B组手术时间分别为(101.14±35.37)min和(152.40±52.09)min(F=4.08,P<0.05);术中出血量分别为(62.05±21.17)ml和(316.14±58.91)ml(F=12.70,P<0.001);术中血压剧烈波动例数分别为6例和7例(χ2=2.06,P>0.05);术后肠功能恢复时间分别为(2.10±0.48)d和(3.49±1.07)d(F=6.52,P<0.05);术后住院时间分别为(4.17±1.25)d和(5.91±2.69)d(F=7.37,P<0.05)。结论:后腹腔镜肾上腺嗜铬细胞瘤切除术具有微创、手术时间短、术中出血量少和术后恢复快等优点。     

后腹腔镜手术治疗肾上腺嗜铬细胞瘤临床体会

目的:评价后腹腔镜手术治疗肾上腺嗜铬细胞瘤的手术方法和临床效果.方法:对85例肾上腺嗜铬细胞瘤患者采用腹腔镜经后腹腔途径手术治疗.结果:85例手术全部成功,无中转开放手术,手术平均时间(80.0士38.0) min,术中平均出血量(90.0士49.6) mL,均未输血,瘤体长径(4.3±1.5) cm,术后平均住院时间(5.7±1.8)d,病理检查报告均为嗜铬细胞瘤,随访(14.3士8.7)个月,肿瘤局部无复发及转移痛灶.结论:后腹腔镜肾上腺嗜铬细胞瘤切除术创伤小、出血少、术后恢复快,临床效果显著,是治疗肾上腺嗜铬细胞瘤可靠有效的方法之一.     

后腹腔镜嗜铬细胞瘤切除术与开放手术的初步探讨

目的:探讨后腹腔镜嗜铬细胞瘤切除术相对于开放肾上腺嗜铬细胞瘤切除术的手术安全性及其优势.方法:同期后腹腔镜肾上腺嗜铬细胞瘤切除术9例,开放手术11例,分别比较术中的血流动力学改变、出血及术后恢复随访的各项指标.结果:两组术中高血压发作、低血压发作、最高收缩压、最低收缩压、最快心率、最慢心率、手术时间、疗效等差异无显著性,而术中出血量、术后住院时间、术后恢复饮食时间及完全恢复正常活动时间,后腹腔镜组要明显优于开放手术组.结论:经后腹腔镜肾上腺嗜铬细胞瘤切除术同开放手术相比并不增加手术的危险性,手术的效果相当,并具有出血少、创伤小、恢复快等优点.     

后腹腔镜肾上腺嗜铬细胞瘤切除术与开放手术的疗效比较

目的：评价后腹腔镜手术治疗肾上腺嗜铬细胞瘤的疗效。方法：对我院15例行单侧后腹腔镜肾上腺嗜铬细胞瘤手术（后腹腔镜组）和18例行单侧开放性肾上腺嗜铬细胞瘤手术（开放手术组）的患者的临床资料进行比较。结果：后腹腔镜手术组15例均手术成功;肿瘤直径最大2．1～8．5cm,平均（4．2±1．8）em;手术时间55～180min,平均（85±35）min;出血量25-105ml,平均（45±25）ml;术中2例发生高血压,术后止痛剂应用1次;术后下床活动时间为2-4d,平均（2．5±1．5）d;术后住院时间为5～8d,平均（6．0±1．5）d。开放手术组18例均手术成功;肿瘤直径最大2．0～10．5cm,平均（4．5±2．5）cm;手术时间90-250min,平均（140±50）min;出血量95～650ml,平均（350±150）ml;输血6例。术中10例发生高血压,术后止痛剂应用4次;术后下床活动时间为5～7d,平均（5．5±1．5）d;术后住院时间为7～12d,平均（10．5±1．5）d。结论：对有较丰富腹腔镜手术经验的术者,后腹腔镜肾上腺嗜铬细胞瘤手术不仅手术时间短、出血量少、对患者的创伤小,而且术中对血压的控制较好,是治疗肾上腺嗜铬细胞瘤安全、有效的方法。     

肾上腺嗜铬细胞瘤腹腔镜与开腹手术麻醉结局的比较

[目的]回顾性评估肾上腺嗜铬细胞瘤腹腔镜与开腹手术麻醉的结局。[方法]同期肾上腺嗜铬细胞瘤手术患者60例,随机分为两组,每组30例,分别行开放手术(A组)和腹腔镜下手术(B组)。所有患者均采用静吸复合全麻,全程监测呼吸和循环状态,术中记录血压、心率,并测定血气值及血浆去甲肾上腺素(NE)浓度。统计手术、麻醉及复苏时间、出血量、术中输血例数、术后恢复情况等指标。[结果]手术、麻醉、复苏、下床、住院时间及出血量腹腔镜手术组均明显少于开腹手术组(P<0.01)。术中循环变化在分离暴露肿瘤时组内、组间变化均有明显差异(P<0.05),发生血压、心率剧烈波动者A组明显多于B组(P<0.01),各组循环波动时血浆NE的浓度亦全部明显升高(P<0.01)。腹腔镜组气腹后pH值低于开腹手术组,PaCO2高于开腹手术(P<0.05)。[结论]随着术前充分的准备、手术技巧的提高,围术期嗜络细胞瘤手术麻醉的结局及成本-效益比腹腔镜组优于开放手术组,显示术中循环相对稳定、出血少、手术麻醉时间短、恢复快、活动及出院时间早。     

护理干预对后腹腔镜下手术治疗肾上腺嗜铬细胞瘤的影响

目的观察实施围术期护理干预对腹腔镜手术治疗肾上腺嗜铬细胞瘤的影响。方法将22例肾上腺嗜铬细胞瘤患者根据随机数字表法随机分为干预组(n=11,实施围术期护理干预)与对照组(n=11,根据医嘱随机对症护理)。结果干预组患者的手术时间、术中平均出血量、术后下床活动时间、术后排气、恢复进食时间及术后住院时间均显著低于对照组,差异有统计学意义(P<0.05或P<0.01)。干预组无一例出现周围脏器损伤、腹膜破裂、皮下气肿,对照组无一例出现腹膜破裂、周围脏器损伤,干预组并发症发生率明显低于对照组,两组相比差异有统计学意义(P<0.05)。结论对后腹腔镜下手术治疗肾上腺嗜铬细胞瘤实施围术期护理干预措施,有利于缩短手术时间、减少术中出血量、减少住院时间,降低术后并发症的发生率,有利于疾病的恢复。     

后腹腔镜治疗肾上腺疾病探析

目的:探讨后腹腔镜在肾上腺疾病手术中的应用方法和效果.方法:同顾性分析本院2008年10月～2010年10月30例采用后腹腔镜手术治疗肾上腺疾病患者的临床资料,原发性醛固酮增多症12例(腺瘤10例、结节样增生2例),皮质醇症6例,嗜铬细胞瘤5例,无功能腺瘤3例,髓样脂肪瘤3例,肾上腺转移癌1例.结果:30例手术,28例次获得成功,2例因术中出血或粘连改行开放手术.手术时间为90～-140 min,平均(60±15)min;术中出血30～1 100 ml,平均(40±10)ml;住院时间为4-7 d,平均(4±3)d.结论:与开放手术相比,后腹腔镜手术不但创伤小、疼痛轻,而且康复快,可以作为有适应证患者的首选手术方法.     

后腹腔镜肾上腺嗜铬细胞瘤切除术疗效观察

目的 评价后腹腔镜肾上腺嗜铬细胞瘤切除术的安全性和可行性.方法 采用后腹腔镜手术治疗肾上腺嗜铬细胞瘤患者27例,其中左侧肾上腺嗜铬细胞瘤11例,右侧14例,双侧1例.结果27例后腹腔镜手术全部获得成功,术后病理检查证实为肾上腺嗜铬细胞瘤.手术时间150-191min,平均176min,术中出血90-135ml,平均102ml,术后住院时间5±2d,术中术后均未输血,术中、术后未发生重大并发症,肿瘤局部无复发.结论 后腹腔镜手术切除肾上腺嗜铬细胞瘤是安全可行的,能充分体现腹腔镜手术微创、出血少、恢复快等优点,肾上腺嗜铬细胞瘤是腹腔镜手术很好的适应证.     

后腹腔镜在肾上腺嗜铬细胞瘤手术中的应用研究

目的探讨后腹腔镜在肾上腺嗜铬细胞瘤切除术的适应证和技术方法。方法回顾性分析该院收治的6例肾上腺嗜铬细胞瘤患者的临床资料,患者均接受后腹腔镜下肿瘤切除术治疗。结果 6例后腹腔镜下肾上腺嗜铬细胞瘤手术均成功,术后恢复良好,平均手术时间112 min,平均出血量120 m L,术中平均补液量4 660 m L。2~4 d拔除引流管,术后平均住院时间10 d。无明显外科并发症,术后病理检查均证实为嗜铬细胞瘤。结论对肾上腺嗜铬细胞瘤的正确诊断、充分的术前准备和术者娴熟的操作技巧,可以明显降低手术并发症。     

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.