机器人辅助下的腹腔镜手术

目的：探讨机器人辅助手术系统在腹腔镜外科手术中的应用。方法：应用美国摩星有限公司生产的AESOP3000型 HERMES机器人系统行腹腔镜胆囊切除术39例，肝囊肿开窗手术2例，和肾囊肿开窗手术2例。结果：本组机器人辅助腹腔镜手术43例均顺利完成，无术中中转手术，患者无疾病本身手术风险外的附加危险。结论：AESOP3000型 HERMES机器人系统具有智能化、人性化的特点，通过人机合一的配合，提供稳定、高清晰图像，减轻术者疲劳，使手术更安全，具有广阔的应用前景。     

机器人伊索在微创外科手术418例中的应用

目的 探讨机器人辅助手术系统在微创外科手术中的应用.方法 应用美国Computer Motion公司生产的AESOP3000型机器人行腹腔镜胆囊切除术354例,腹腔镜胆囊切除联合肝囊肿开窗引流17例,腹腔镜阑尾切除36例,Miles手术3例,乙状结肠及直肠癌根治术8例.结果 本组418例患者手术,除5例中途转为人工扶镜外,其余全程均为机器人持镜,无术中中转手术,患者无手术风险外的附加危险.中途改为人工扶持腹腔镜5例,均为腹腔镜胆囊切除的患者,其主要原因是:解剖困难、腹腔镜不断起雾、早期操作不熟练等.结论 AESOP3000型机器人系统具有智能化、人性化的特点,通过人机合一的配合,可提供稳定、高清晰图像,减轻术者疲劳,使手术更安全,且节省人力资源.     

达芬奇机器人辅助低位直肠前切除术的卫生经济学评价

目的:本研究旨在调查福建省达芬奇机器人辅助手术开展情况,对达芬奇机器人辅助低位直肠前切除术与腹腔镜辅助低位直肠前切除术进行对比作卫生经济学方面的评价,为临床医师和患者及其家属选择达芬奇机器人辅助手术提供参考。方法:本研究根据福建省某医院筛选出的达芬奇机器人辅助低位直肠前切除术与腹腔镜辅助低位直肠前切除术病例,运用数据分析法系统比较分析达芬奇机器人组和腹腔镜组患者的基本情况、医疗安全、短期疗效、住院时间、住院费用等方面的指标差异。运用卫生经济学评价方法对纳入研究的患者住院费用的绝对值和相对值进行对比分析。结果:达芬奇机器人组手术时长比腹腔镜组平均长89. 61 min,总费用平均高出30334. 13元,差异有统计学意义(P <0. 05);术中出血量、术后住院时间、手术并发症等手术安全性指标差异均无统计学意义(P> 0. 05);手术并发症发生率、严重并发症发生率、术后排气时间、术后进入ICU比例等短期疗效指标差异均无统计学意义(P> 0. 05)。结论:(1)达芬奇机器人辅助手术时间长于腹腔镜辅助手术;(2)达芬奇机器人辅助手术术中出血量和腹腔镜组相当;(3)达芬奇机器人辅助和腹腔镜辅助手术同样安全有效;(4)达芬奇机器人辅助和腹腔镜辅助手术的住院时间差异无统计学意义;(5)达芬奇机器人辅助手术的住院费用高于腹腔镜辅助手术的住院费用;(6)达芬奇机器人和腹腔镜辅助手术的费用构成基本相同;(7)达芬奇机器人对术者方面有很大优势。?     

利用DaVinci系统的计算机辅助腹腔镜结肠切除术:一项初步体会

目的:遥控机器人外科手术是一项正在发展的、具有良好前景的技术,它能大大改善腹腔镜操作的灵活性。自2002年12月起,在Da V inci机器人操作系统的辅助下已实施腹腔镜和胸腔镜手术100例以上。本研究旨在评估机器人在腹腔镜结肠手术中的应用价值。在此介绍最初的机器人辅助结肠切除术。方法:2例患者因乙状结肠憩室炎接受遥控机器人辅助的乙状结肠切除术。其中1例并发乙状结肠-膀胱瘘。其余3例患者因结肠癌行结肠切除术,其中乙状结肠切除术2例,右半结肠切除术1例。所有手术均使用4个trocar孔技术。结肠粘连组织解剖、结肠分离、瘘管处理、肠系…     

比较机器人外科手术系统与腹腔镜肝切除治疗肝细胞癌的初步结果

目的 通过与腹腔镜肝切除治疗肝细胞癌的结果进行比较,初步总结机器人外科手术系统辅助肝切除手术的技术特点、安全性及初步疗效.方法 2010年1～10月,应用机器人外科手术系统辅助肝切除手术(机器人组)治疗3例肝细胞癌患者,均伴不同程度肝硬化,肿瘤均为单发,分别位于Ⅲ段(2例)、Ⅵ段(1例),并与同期完成的腹腔镜肝切除治疗的15例肿瘤大小、位置相似的肝细胞癌患者(腹腔镜组)进行比较.结果 机器人组的中位肿瘤直径为3 mm(2.0～3.5 cm),腹腔镜组为4 cm(1.7～9.0 cm).机器人组的中位手术时间为120 min(90～180 min).腹腔镜组为150 min(100～220 min).机器人组的中位术中出血量为100 mL,腹腔镜组为75 mL,两组各有1例患者术中输血.腹腔镜组有1例患者中转开腹手术.机器人组术后中位住院时间为5 d(4～6 d),腹腔镜组为6 d(4～8 d).机器人组无手术并发症发生,腹腔镜组有1例因术后双侧胸腔积液而需引流.随访至今腹腔镜组有1例发生肝内复发.结论 初步结果显示,对周边型(如Ⅱ、Ⅲ、Ⅵ段)肝细胞癌患者,机器人外科手术系统辅助肝切除手术的治疗效果与腹腔镜肝切除相似.     

腹腔镜手术495例临床报告

我科自 1992年 5月至 2 0 0 2年 3月开展各类腹腔镜手术4 95例 ,现报告如下。1　临床资料1.1　一般资料 :4 95例中男 2 0 7例 ,女 2 88例 ,年龄 18～ 77岁。除 1例小肝癌系腹腔镜胆囊切除术中意外发现外 ,其余4 95例术前均明确诊断。有腹部手术史 18例。腹腔镜手术种类 :腹腔镜胆囊切除术 (L C) 4 6 7例 ;腹腔镜胆总管切开取石+L C8例 ;L C+阑尾切除 4例 ;腹腔镜肝囊肿开窗引流 +L C4例 ;L C+腹腔镜辅助脾切除 2例 ;腹腔镜胆囊造瘘 2例 ;腹腔镜辅助脾切除 +术中肝癌射频治疗、腹腔镜假性胰腺囊肿切除 +L C、腹腔镜脾切除 +门奇静脉断流…     

腹腔镜手术治疗伴有2型糖尿病肝囊肿5例体会

目的:探讨腹腔镜在伴有2型糖尿病肝囊肿治疗中的应用价值。方法:回顾分析2010年1月2012年12月腹腔镜治疗伴有2型糖尿病肝囊肿5例临床资料,均行腹腔镜开窗引流术,观察手术时间、术中出血量和并发症发生情况。结论:腹腔镜在合并2型糖尿病肝囊肿的治疗中具有操作方便可靠、创伤性小、瘢痕小、痛苦轻、并发症少、恢复快的优点。     

妇科腹腔镜手术的护理体会

妇科腹腔镜手术是近年来临床上应用较广泛的手术方法之一 ,与传统手术方法比较 ,它具有不暴露腹腔 ,损伤小 ,切口小且美观 ,腹腔粘连少 ,术后恢复快等优点。 2 0 0 0年 11月～ 2 0 0 1年 5月 ,我科共完成腹腔镜手术 10 3例 ,取得了较好的临床效果 ,现将护理体会报告如下。1　临床资料本组施行腹腔镜手术病人 10 3例 ,年龄 18～ 5 1岁 ,其中包括腹腔镜辅助下阴式子宫切除术 7例 ,宫外孕手术 3 0例(行输卵管开窗术 18例 ,输卵管切除术 12例 ) ,卵巢畸胎瘤剥离术 14例 ,卵巢巧克力囊肿切除术 17例 ,其他手术 3 5例。 10 3例手术中只有 1例腹腔…     

腹腔镜肝囊肿开窗引流术50例临床分析

目的:探讨腹腔镜肝囊肿开窗引流术的临床应用价值.方法:对我院收治的50例腹腔镜肝囊肿开窗引流术患者进行回顾性分析.结果:手术均获成功,无一例中转开腹,术后住院时间3～6 d,无并发症发生,术后复发2例.结论:严格掌握手术指征,掌握手术要点,腹腔镜肝囊肿开窗引流术是一种安全、有效的术式,具有创伤小、疼痛小、恢复快的优点.     

达芬奇机器人辅助肾切除四例

目的 总结应用达芬奇机器人腹腔镜行肾脏切除的初步经验,探讨该技术在肾脏切除术方面的可行性及安全性.方法 沈阳军区总医院2011年应用达芬奇机器人技术行肾脏切除术4例;其中肾癌2例,肿瘤直径分别为4 cm及5 cm（T1N0MO）;肾盂肿瘤2例（T1NOMO）.收集围手术期资料进行分析.结果 4例患者均在达芬奇机器人辅助腹腔镜下成功施行,平均手术时间为（120.8±30.1）min,机器人外科手术系统定位的平均时间为（15.3±3.8） min,术中失血量平均为（68±29） ml.所有患者均按期出院,术后均无继发性出血等并发症发生.结论 应用达芬奇机器人腹腔镜行肾脏切除术的创伤小、安全可靠,且疗效确切.随着手术者操作熟练程度的提高,机器人腹腔镜在泌尿外科的优势将更加明显.     

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.