吻合器痔上黏膜环切术常见并发症及预防

目的 探讨吻合器痔上黏膜环切术治疗痔的并发症,以及如何防范、治疗这些并发症.方法 对我院共收治的痔患者1 194例,其中672例在腰麻或硬膜外麻醉下采用吻合器痔上黏膜环切术治疗.结论 手术全部成功,平均手术操作时间10.5 min.平均住院时间5.6天.术后出血7例(1.0%),肛缘水肿,228例(33.9%).肛周不适,便意频繁179例(26.6%).吻合口狭窄3例(0.4%).吻合口撕裂2例(0.3%),直肠阴道瘘0例.复发2例.结论同传统手术相比,吻合器痔上黏膜环切术具有痛苦小、恢复快、复发少的明显优势,是一种安全有效的治疗痔的手段.通过仔细的手术操作,绝大多数并发症可以避免.     

痔上直肠黏膜环切吻合术治疗重度环形痔84例分析

为探讨痔上直肠黏膜环切吻合术(PPH)治疗重度痔病的疗效,分析使用特制的管状吻合器Ⅲ、Ⅳ期内痔行手术治疗84例临床资料.结果 ,术后住院时问3～7d,95%患者对治疗效果满意,随访3～12个月,无复发、肛瘘和大便失禁.表明吻合器痔上直肠黏膜环切术具有安全、有效、术后痛苦少、住院时间短和恢复快等优点.吻合口的高度是影响疗效的重要因素.     

吻合器痔上黏膜环切术出血并发症的防治

目的:总结吻合器痔上黏膜环切术(PPH)出血并发症的防治措施经验,提高临床疗效。方法:收治吻合器痔上黏膜环切术患者80例,男36例,女44例,年龄21～75岁,平42.3岁,病程4～22年,平均8.3年。其中内痔18例,混合痔62例,均采用吻合器痔上黏膜环切术进行治疗。结果:80例患者经过吻合器痔上黏膜环切术,手术时间10～35分钟,平均23.3分钟。术后出现急便感或肛门部异物感24例(30.0%),术后肛门部疼痛44例(55.0%),术中吻合后即刻出血33例(41.25%),未发生术后早期出血,发生迟发性出血3例(3.75%)。术后残留皮赘8例(10.0%),需局部修剪。术后轻度吻合口狭窄1例(1.25%)。经过4～22个月的随访,无复发病例发生。结论:吻合器痔上黏膜环切术具有疗效好、恢复快、疼痛少的优点,缝扎止血可以预防术中明显的渗血或搏动性出血,局部压迫止血、肛门镜下缝扎止血对于迟发性出血有较好的临床疗效。     

吻合器痔上黏膜环切术治疗急性嵌顿痔效果

目的了解外剥内扎术与吻合器痔上黏膜环切术治疗急性嵌顿痔的临床效果。方法急性嵌顿痔病人84例,随机分为两组,各42例。对照组应用外剥内扎术治疗,观察组采用吻合器痔上黏膜环切术治疗,比较两组围手术期指标和并发症发生情况。结果观察组手术时间、住院时间和切口愈合时间显著短于对照组,差异有显著性(t=8.695~14.570,P<0.05)。观察组术后出血、肛门坠痛评分低于对照组,差异有显著性(t=5.042、5.919,P<0.05);肛管狭窄、肛缘水肿、肛门瘙痒和复发率与对照组比较,差异无显著性(P>0.05)。结论吻合器痔上黏膜环切术治疗急性嵌顿痔效果好于外剥内扎术。     

吻合器痔上黏膜环切术治疗重度痔病的止血效果观察

目的观察吻合器痔上黏膜环切术治疗重度痔病的止血效果,为临床治疗提供依据。方法选择黑龙江省大庆市肇源县肇源镇医院2012年4月～2013年3月收治的重度痔病患者91例作为观察对象,按照手术方式分为观察组46例、对照组45例,对照组采用外剥内扎术治疗,观察组采用吻合器痔上黏膜环切术治疗,比较两种手术方案的止血效果。结果2组患者均手术成功,观察组的手术时间、住院时间分别为（19．7±34）min、（2．6±0.9）d均明显短于对照组（28．3±4．8）min、（43±1.1）d,且观察组术中出血量为（11.5±3．0）mL、明显少于对照组的（18．0±4.5）mL,组问差异均有统计学意义（均P〈0.05）;观察组术后出血发生率为22％,明显低于对照组的17．8％,组问差有统计学意义（P〈0.05）。结论吻合器痔上黏膜环切术治疗重度痔病的术中、术后出血均明显减少,且手术成功率高,是值得首选的手术方案。     

吻合器痔上黏膜环切术与外剥内扎术治疗重度痔的临床比较研究

目的:分析研究吻合器痔上黏膜环切术(PPH)治疗重度痔的临床疗效。方法:将吻合器痔上黏膜环切术与传统外剥内扎术两种术式方法及临床疗效进行比较分析。结果:通过临床分析研究吻合器痔上黏膜环切术组再术中术后疼痛、出血情况及术后并发症等方面明显优于外剥内扎术组。结论:PPH是临床治疗重度痔疮有效治疗方法。     

吻合器痔上黏膜环切术治疗重度痔的临床观察

目的探讨吻合器痔上黏膜环切术治疗脱垂性痔的临床疗效。方法利用特制的环形吻合器对22例重度痔行痔上黏膜环切术。结果手术时间平均22.5分钟,术后住院时间平均3.8天,没有发生严重的手术并发症,手术效果满意。结论吻合器痔上黏膜环切术治疗脱垂性痔具有简单、安全、有效、术后痛苦少、恢复快,并发症少等优点。     

应用国产吻合器痔上黏膜环切术治疗痔的临床疗效

目的：探讨用国产吻合器痔上黏膜环切术治疗痔的临床效果。方法：将88例重度痔患者分为国产吻合器组(46例)和进口吻合器组(42例),分别为其使用国产吻合器和进口吻合器进行痔上黏膜环切治疗,并比较两组患者的临床疗效。结果：国产吻合器组患者和进口吻合器组患者的手术时间及术中出血量相比较,差异不显著(P>0.05),无统计学意义。两组患者发生肛门疼痛、大便带血、尿潴留和痔脱出复发等术后并发症的几率相比较,差异不显著(P>0.05),无统计学意义。国产吻合器组患者的手术费用明显低于进口吻合器组患者,差异显著（P<0.05）,有统计学意义。结论：用国产吻合器痔上黏膜环切术治疗痔的临床疗效确切,费用低廉,此法值得在临床上推广应用。     

经肛门吻合器痔上黏膜环切术治疗Ⅲ、Ⅳ度痔临床疗效观察

目的：分析经肛门吻合器痔上黏膜环切术治疗Ⅲ、Ⅳ度痔的临床疗效。方法选取在2013年12月-2014年12月期间,该院收治的Ⅲ、Ⅳ度痔患者中随机抽取100例患者作为研究对象,将这100例患者随机分成对照组和实验组,每组50例,对照组的患者采用传统的手术进行治疗,实验组的患者采用经肛门吻合器痔上黏膜环切术进行治疗。对比两组患者的治疗效果。结果实验组的患者在治疗的总有效率上明显优于对照组的患者,两组对比差异有统计学意义(P<0.05)。实验组的患者在手术时间、住院时间、恢复时间、出血率等并发症的发生情况上与对照组相比明显要少,差异有统计学意义(P<0.05)。结论经肛门吻合器痔上黏膜环切术治疗Ⅲ、Ⅳ度痔疗效好,并发症少,值得在临床治疗中推广使用。     

吻合器痔上黏膜环切术常见并发症与对策

目的 探讨吻合器痔上黏膜环切术(PPH)对中重度痔病治疗术后并发症的成因及对策.方法 总结PPH治疗150例中量度痔病的临床资料.结果 本组手术时间35 min,平均住院时间4.5 d;术后脱出肛门外的痔块回缩有效率为100%,114例(76%)吻合切除术中再检查需要缝合止血,术后出血5例(3.3%),肛门疼痛需要止痛剂88例(58.7%),尿潴留123例(82%),吻合口狭窄3例(2%).结论 PP术式是安全有效的,减少并发症的关键为荷包缝合及术者的经验.     

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.