超低位直肠癌切除术后吻合口漏和直肠阴道瘘的防治

目的 探讨超低位直肠癌术后吻合口漏和直肠阴道瘘的防治.方法 回顾性分析2009年1月至2011年1月本院28例双吻合技术超低位直肠癌切除术患者的临床资料.结果 28例超低位直肠癌术后发生吻合口漏3例,直肠阴道瘘1例,经治疗后均痊愈.结论 超低位直肠癌术后吻合口漏发生率较高,应采取多方面的预防措施,吻合口漏和直肠阴道瘘若局部或全身感染较重宜尽早行近端结肠造瘘术.     

低位直肠癌全直肠系膜切除术后直肠阴道瘘的诊断和治疗

目的：分析低位直肠癌全直肠系膜切除（TME）术后发生直肠阴遭瘘的原因,并探讨直肠阴道瘘的治疗方法。方法：回顾性总结2000年1月-2006年6月共187例女性患者低位直肠癌患者行全直腑系膜切除术后（腹腔镜手术切除23例）后,19例发生直肠阴道瘘的时间、部位、瘘口的直径与肿瘤的分期、大小和位置等关系。结果：直肠阴道瘘的发生率为10．62％（19／187例）,其中低位单纯型瘘36．84％（7／19例）。中位单纯型瘘52．6：3％（10／19例）。复杂瘘10．52％（2／19例）。因吻合口瘘局部感染致阴道瘘52．63％（10119例）。因电刀或超声刀妁伤直肠瘘21．05％（4／19例）。4饲患者行肠内、外营养治疗30天内治愈,15例行回肠造瘘术,13例在3个月内瘘口自愈。1倒行经阴道瘘口修补术治愈。结论：直肠阴道瘘（RVF）常见为手术损伤和局部感染等原因有关。痿发生和脑造瘘转流肠内容物是治疗的关键,复杂瘘应行手术修复。     

女性直肠癌患者术后并发直肠阴道瘘的危险因素分析

目的分析女性直肠癌患者术后并发直肠阴道瘘的危险因素。方法对589例直肠癌患者的临床资料进行回顾性研究,对术后并发直肠阴道瘘的危险因素进行Logic回归分析。结果 589例直肠癌患者术后发生直肠阴道瘘54例,发生率为9.2%。经Logic回归分析发现,直肠阴道瘘的发生主要与使用双吻合器、肿瘤位于直肠前侧壁、联合盆腔脏器切除、肿瘤距肛门距离<10 cm、术前放射治疗、患者绝经等因素有关(P<0.01、0.05)。结论术中使用双吻合方式、肿瘤位置、联合其他脏器切除、肿瘤距肛门距离(<10 cm)、术前放射治疗和患者绝经是女性直肠癌术后发生直肠阴道瘘的危险因素。     

直肠阴道瘘的手术治疗

目的总结直肠阴道瘘的手术治疗经验。方法1995年3月—2008年9月,收治各种原因所导致的直肠阴道瘘32例,根据导致直肠阴道瘘的原因与时间以及瘘管的部位与范围,分别采用直接缝合术、瘘管切除＋直接缝合术和瘘管切除＋局部阴道黏膜瓣转移修复术治疗。结果1例因放射性损伤所致的直肠阴道瘘,采用瘘管切除＋局部阴道黏膜瓣转移修复术治疗,因瘘管周围受放射性损伤的组织未被完全切除,于术后14 d伤口开裂,遂转肛肠外科行直肠切除、结肠肛门吻合术。本组其余患者伤口均一期愈合,未发生任何并发症;术后6个月常规随访结果显示,修复处阴道黏膜光滑,感觉和运动正常,无复发。结论根据导致直肠阴道瘘的原因与时间、瘘口的大小选择相应的手术治疗方法有助于提高手术成功率。     

女性低位直肠癌前切除术后并迟发性吻合口-阴道瘘的临床分析

目的探讨女性低位直肠癌前切除术后迟发性吻合口-阴道瘘的原因。方法回顾性分析13例女性低位直肠癌经腹前切除吻合术治疗后并迟发性吻合口-阴道瘘的临床资料。结果术后11～14d发生吻合口-阴道瘘9例，术后0．5～4个月发生吻合口-阴道瘘4例。结论低位直肠前壁大而晚的癌肿累及直肠-阴道膈、高频电刀对阴道后壁组织的延迟性热力损伤、术中拉钩挫伤阴道后壁组织以及吻合口可能嵌入部分阴道后壁组织等可能为女性低位直肠癌患者术后迟发性吻合口-阴道瘘发生的主要因素。     

中药保留灌肠治疗放射性肠炎临床疗效观察

目的:探讨保留灌肠治疗放射性肠炎的临床疗效。方法:使用生理盐水100ml,甲硝唑、硫氨磺胺嘧啶、氟哌酸、地塞米松、云南白药、锡类散混合液保留灌肠,七天一个疗程,临床观察1~2个疗程。结果:30例放射性肠炎患者,痊愈的20例,显效7例,好转3例。结论:使用中药保留灌肠在治疗放射性肠炎方面能提高疗效,减少病程的时间,保留灌肠刺激性小,患者比较容易接受,是放射性肠炎有效的治疗方法,值得临床推广应用。     

直肠癌术后并发直肠阴道瘘围术期全程优质护理评价

目的:研究直肠癌术后并发直肠阴道瘘围术期全程优质护理的临床效果。方法:选取我院于2011年7月-2012年11月收治的80例直肠癌术后并发直肠阴道瘘患者,将其随机分为观察组和对照组,观察组40例患者在围手术期实施全程优质护理,对照组40例患者在围术期进行常规护理,对比两组患者的临床效果。结果:观察组40例,显效16例,有效20例,无效4例,治疗有效率为90.00%;对照组40例,显效10例,有效15例,无效15例,治疗有效率为62.50%,观察组与对照组比较,差异具有显著性(P<0.05)。结论:对于围手术期的直肠癌术后并发直肠阴道瘘患者实施全程优质护理,可提高治疗有效率,值得临床推广。     

直肠癌术后直肠阴道瘘的治疗策略

目的 探讨直肠癌术后发生直肠阴道瘘(RVF)的治疗策略.方法 回顾性分析1995年1月至2008年1月收治的9例直肠癌根治术后RVF的肿瘤临床情况和手术方式、RVF的临床表现和诊治经过.结果 行横结肠造口和回肠造口后直肠阴道瘘均顺利愈合.结论 直肠癌根治术后发生直肠阴道瘘应首选近侧肠道去功能性造口,局麻下回肠造口值得推荐.     

阴道直肠瘘围手术期的护理体会

目的总结直肠阴道瘘修补、直肠阴道瘘修补+肛门成形术修补术后的护理体会。方法对采用直肠阴道瘘修补、直肠阴道瘘修补+肛门成形术治疗阴道直肠瘘及阴道直肠瘘并肛门闭锁的患者进行临床观察和护理。结果患者术后无发生感染、瘘复发等并发症。结论通过术前后严密观察和护理可有效控制并发症的发生,促进患者早日康复。     

舍兰与甲硝唑联合灌肠治疗放射性肠炎48例疗效分析

目的:探讨舍兰与甲硝唑联合灌肠治疗放射性肠炎的经验。方法对子宫颈癌经放射治疗后出现放射性肠炎的患者给予舍兰与甲硝唑联合灌肠治疗,观察其临床效果。结果治疗组48例中,显效38例(79%),有效6例(13%),无效4例(8%),总有效率92%;对照组48例中,显效10例(21%),有效22例(46%),无效16例(33%),总有效率67%,2组显效率及有效率有显著性差异(P均<0.05),治疗组疗效明显优于对照组。结论采用舍兰与甲硝唑联合灌肠治疗放射性肠炎疗效显著,而且方便、安全可靠、无毒副作用,具有广泛的实用性。     

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.