用袖套式血管吻合法建立大鼠肝、肠联合移植模型

目的 建立肝、肠联合移植手术模型。方法 用Ｗｉｓｔａｒ大鼠行同种异体肝、肠联合移植。先行肝移植,再行小肠移植。肝脏为原位移植,供肠异位移植于左肾处（切除左肾）。门静脉、肝下下腔静脉和肠系膜上静脉采用袖套式吻合法分别与受者的门静脉、肝下下腔静脉和左肾静脉吻合,回肠末端在左下腹造瘘。结果 手术成功率为６２．５％,动物平均存活时间１１．２ｄ。组织学检查发现移植肝和小肠发生排斥反应。结论 用袖套式血管吻合     

应用岛状颊肌粘膜瓣修复腭裂初步报告

目的：介绍应用岛状颊肌粘膜瓣修复腭裂的临床实践。方法：应用裂缘葶粘骨膜瓣闭合硬腭裂隙的鼻腔侧、软腭后推、软腭鼻侧粘膜Z成形术延长、腭帆提肌吊带重建,再以蒂在后的血管神经蒂岛状颊肌粘膜瓣修复软腭后推后在腭部遗留的横行创面和硬腭裂隙的口腔侧创面。结果：1997年以来共治疗12例,术后岛状颊肌粘膜瓣完全成活,软腭延长显著,无腭瘘形成,无血肿、感染、肋腺导管和面神经损伤及开口功能障碍等并发症发生。结论：岛状颊肌粘膜瓣血运好,易成活;术后早期不需配戴牙垫,不影响恒磨牙的萌出,不干扰咬合,无埯断蒂,不破坏翼下颌皱襞形态和结构,供区易于缝合,感觉功能好。     

广泛肝内胆管结石合并左右肝叶萎缩尾状叶明显肥大行保留尾状叶次全肝切除术1例报道

目的探讨广泛肝内胆管结石合并左右肝叶萎缩而尾状叶明显肥大的患者行保留尾状叶次全肝切除术的可行性和安全性。方法回顾性分析四川大学华西医院2020年2月收治的1例肝内胆管结石患者的临床病理资料。结果患者左右肝叶结石伴左右肝叶明显萎缩而尾状叶明显肥大。患者术前一般情况良好,心、肺和肾功能正常,肝功能Child-Pugh A级,肝脏储备功能良好。患者体表面积为1.745 m2,标准肝体积为1 235 mL,CT图像三维重建评估肝尾状叶体积为735 mL,占标准肝体积59.5%,经评估患者能耐受手术。患者成功经历保留尾状叶次全肝切除术,术后肝功能恢复良好,术后第2天拔除胃管,术后第5天拔除腹腔引流管,术后第6天出院。术后病理诊断:肝内胆管扩张伴胆管结石,胆管周围大量炎细胞浸润,门管区纤维组织增生、小胆管增生、炎细胞浸润,病变符合肝内胆管结石改变。结论通过对本病例的分析结果看,对于广泛肝内胆管结石合并左右肝明显萎缩而尾状叶明显肥大的患者,保留尾状叶次全肝切除术是安全、可行的。     

Esophageal leiomyoma enucleated under the thoracoscopy; report of a case

We report a case of a 40-year-old male with a posterior mediastinal mass that was 8 cm in size and located behind the trachea. The thoracoscopic surgery was performed. The tumor was located from the level of left brachiocephalic vein to the carina. The mediastinal pleura over the tumor was longitudinally opened by cautery-scissors. The azygos vein lying over the tumor was divided by means of an endoscopic stapler. The muscular layer of the esophagus was also longitudinally opened. The tumor was enucleated. Then, the dissected proper muscle layer of the esophagus was suture-closed. The postoperative course was uneventful. On the first postoperative day Gastrografin was swallowed, showing the absence of leaks. The patient was discharged on the fourth postoperative day. The advantages of the thoracoscopic surgery are as follows: rapid, full recovery of the patient; decreased postoperative pain; short postoperative hospital stay. Esophageal leiomyoma in selected patient was suitable for thoracoscopic enucleation.     

Concentration of antibiotics (cefoperazone) in human brain, brain tumor tissue and cerebrospinal fluid

The transfer of cefoperazone (CPZ) into cerebrospinal fluid (CSF), brain or brain tumor tissue was studied in 13 cases with brain tumor, chronic subdural hematoma and benign intracranial hypertension in 1982. The peak values of CPZ in serum came up immediately after its rapid intravenous administration and then decreased exponentially. The concentration of CPZ in CSF started to increase with a long delay of about 60 min. The average peak level in CSF remained 21.6 micrograms/ml and corresponded to 10.3% of the peak level in serum. The best transfer of chloramphenicol into CSF has been reported, while that of CPZ would be one of the next. The CPZ levels in CSF showed a slower decay than in serum. The concentration of CPZ in brain reached the peak level in less than 30 min and the average peak level was 36.5 micrograms/g cerebral tissue. The brain to blood rate of the CPZ concentration was 11.1%. The CPZ levels in the brain showed a rapid decrease like the transition of antibiotic levels in serum. The antibiotic levels in brain tumors were divided into two groups. The one showed sharp peak about one tenth of the values in serum. The other was of a slowly increasing type.     

肾血管平滑肌脂肪瘤的诊治：附35例报告

报告肾血管平滑肌脂肪瘤３５例，其中３１例前行Ｂ超检查，２５例行ＣＴ检查，５例肾血管造影检查。手术治疗２５例，其中行全肾切除术１１例，肾部切除术６例，肿瘤剜除术８例，术后均经病理检查证实，行肾动脉栓塞术５例；定期观察５例，随访１－２例，无肿瘤恶变，无复发，结合文献对肾血管平滑肌脂肪瘤术前诊断及治疗方式进行讨论。     

Observation of healing process of operative wound in the first Polish upper limb transplant]

The goal of this paper was to present the healing process of the operative wound of the hand transplant. The recipient was a man, 32 years of age who lost his right dominant hand 14 years ago, as a result of an accident. The transplant was made at the level of the halves of a forearm. The total ischemia time was 10.5 hrs. The recipient was qualified by a tedious process of preparation, he was thoroughly informed about all of the risks involved. The wound was primarily closed with loose sutures, without a skin graft. The healing process was complicated by creation of a large hematoma, wound dispersal and candida infection. The granulation process was very slow. Only traditional dressings were applied. The secondary wound closure was performed with a skin graft, the healing was ended after 64 days. Within this period neither general infection nor rejection symptoms were observed.     

Superior mesenteric blood flow during digestion in man.

The superior mesenteric blood flow was studied with a dye-dilution technique after catheterization of the superior mesenteric artery and vein during the digestive phase after intake of a mixed meal (700 kcal). The material consisted of 5 patients. Within 5 minutes of the end of the meal the superior mesenteric blood flow, on the average, was increased by 60%. The largest increase was 113% and was noted one hour after the meal. The vascular resistance of the superior mesenteric vessles had by then fallen to a mean value of 55% below the prefeed value. The portal venous pressure was only slightly increased. The cardiac output was increased in 2 but slightly decreased in the remaining 3 patients. The pulse rate, blood pressure and haemoglobin concentration were largely unchanged. The ratio of the superior mesenteric blood flow to the cardiac output increased from 12 to 22% during the digestive period. The findings suggest the occurrence of a redistribution of blood after a meal with an increase in the superior mesenteric blood flow.     

Arthroscopic treatment of capsular shoulder stiffness

The shoulder capsular sitffness must be managed first by a physiotherapist and the arthroscopic release is indicated after failure. The clinical assessment is essential and reveals the loss of passive motion in specified direction. The x-rays and imaging are necessary for excluding the other etiologies of shoulder stiffness. The arthroscopic treatment is part of he treatment strategy which has to be explained to the patient. The arthroscopic treatment starts by measuring under anesthesia the loss of passive motion. The next step consists of the release of the rotator interval followed by resection of the anterior capsule. Finally, the posterior capsule is cut according to the location of the capsular retraction. The interest of the subacromial debridement is still of debate. The postoperative pain control and the rehabilitation are part of the treatment. The literature analysis demonstrates the efficiency of the arthroscopic treatment, even if the post-op care are often long. A delay of 6 months is currently necessary to obtain the final results. The main advantages of the arthroscopic treatment is to address specifically the retracted capsule and to perform a selective release which allow to start rehabilitation program early.     

5923例急性肠梗阻的病因学变迁及中西医结合诊治

目的：探讨急性肠梗阻的病因学变迁及诊治。方法：回顾性分析5923例急性肠梗阻病例的诊治经过。结果：粘连性肠梗阻始终占据病因第一位,肿瘤性肠梗阻比例明显增加,嵌顿疝比例增加。肠梗阻患者平均年龄增长,手术率、治疗有效率提高,中西医结合非手术成功率降低。结论：腹腔粘连是引起肠梗阻的首要原因;复杂性肠梗阻数量增加,肠梗阻诊断、治疗方法不断改进,提高了疗效,改善了预后。     

Innominate osteotomy (Salter) related to the correction of the acetabular abnormality and the prediction of the acetabular angle after operation (author's transl)]

The purpose of this paper is to know how to correct the maldirection of the acetabulum. The author devised a new system for the measurement of the degree of the forward rotation of the acetabulum. The acetabular improvement after the osteotomy is classified into two types, namely the primary and secondary improvement. The primary improvement is seen immediately after the osteotomy and the secondary improvement follows gradually. The effective factors for each of them were analyzed. The primary improvement is influenced mostly by the lateral inclination of the distal fragment. The secondary improvement was intimately correlated to the forward rotation of the acetabulum at the operation. The development of the acetabulum after operation can therefore be predicted from the post-operative X-ray film. In the case of the residual subluxation of the hip, there is about 10 degrees of acetabular elevation (frontalization), so the acetabulum should be rotated forward by more than 10 degrees in this operation.     

心房肽分泌异常与颈髓损伤后低钠血症

目的 :探讨心房肽 (AtrialNatriureticPeptide ,ANP)分泌异常与颈髓损伤 (CervicalSpinalCordInjury ,CSCI)后低钠血症的关系。方法 :用放免法研究了 15例CSCI并低钠血症患者血浆ANP ,与 2 3例CSCI不伴低钠血症患者及12例正常同龄组的ANP进行比较。并检测血钠和部分患者的尿钠及尿量。结果 :( 1)CSCI伴低钠血症者 ,其血浆ANP水平较不伴低钠血症者及正常对照组显著升高 (P <0 .0 1)。 ( 2 )CSCI急性期血浆ANP水平与CSCI程度密切相关 ,CSCI越重 ,ANP水平越高 ;ANP水平越高 ,血钠越低 ,二者呈负相关 (r =-0 .85 ,P <0 .0 1)。结论 :CSCI后低钠血症患者ANP分泌明显异常 ,ANP分泌增加可能是导致CSCI后低钠血症的一个重要因素。纠正缺氧可能降低ANP水平 ,从而纠正CSCI后顽固性低钠血症。     

从青岛市立医院10年胆石症构成分析看胶东地区胆石症发病的变迁

目的 探讨山东省胶东地区近10年来(1998-2008年)胆石病构成及其变化情况.方法 采用回顾性调查的方法,收集青岛市立医院1998-2008年10年期间住院并经手术证实的2899例胆石病病人的临床资料,经计算机整理后用SPSS 12.0软件包进行统计分析,并将统计结果与1991年的资料进行比较分析.结果 胆石病的男女性别构成比2008年组与1991年组无统计学差异;但2008年组不同部位胆石病的男女比例明显不同,单纯胆囊结石、肝内胆管结石病人在性别上有统计学差异(P值均＜0.05).单纯胆囊结石病发病的高峰年龄为40～69岁;胆囊合并胆总管结石以及单纯胆总管结石的发病高峰年龄均为70岁以上;肝内胆管结石的发病高峰年龄为40～59岁.结石部位之间比较,年龄分布差异有统计学意义(P值均＜0.01);2008年组年龄分布与1991年组统计资料相比明显后移.单纯胆囊结石所占比例最多,其次是单纯胆总管结石.与1991年组相比,2008年组胆囊结石的构成比例显著升高;胆总管结石的构成比例下降;胆囊结石的比例随年龄增长而增加.胆囊合并胆总管结石和肝内胆管结石的构成比例与1991年组比较无差异.结论 山东省胶东地区近10年来(1998-2008年)胆石病构成及其变化情况与1991年的统计资料比较,女性单纯胆囊结石及肝内胆管结石构成比例要高于男性;老年胆石病人明显增加;胆囊结石的构成比例明显增高.     

Ultrasonic diagnosis of subpleural parietal formations of the lung

The article generalizes experiences with ultrasonic scanning of the chest in patients with subpleural parietal formations of the lungs of inflammatory and tumorous etiology. The technique of the investigation and criteria of the assessment of the pathological focus are described. The normal echoscopic picture of the chest was determined. The ultrasonic images of the abscesses were compared with those of the peripheral lung carcinoma. The echoscopic pictures typical of each disease were revealed.     

乳房下皱襞上提法治疗巨乳缩小后乳房畸形

为矫正倒Ｔ形切口巨乳缩小术后常出现的乳头乳晕过高、乳房呈上小下大畸形，应用下胸皮瓣上推，使乳房下皱襞上提与深面肋骨膜、肋软骨膜或肋间筋膜固定的方法，共治疗４例７侧乳房，矫正良好。认为本方法是矫正Ｔ形切口巨乳缩小术后畸形的良好方法。     

Breast volume measurement in 125 Chinese young women

The author carried out measurement of breast volume and the body surface anatomy in 125 unmarried young women. Through the measurement and analysis, the author came to the following conclusions: 1. The characteristics of body build of Chinese young women are: a. The mean height: 159.00 cm-160.00 cm; The mean weight: 50.40 kg-60.00 kg; The standard weight: height minus 110. b. The mean chest circumference difference, 2.0 cm. c. The mean distance from nipple to the supra-sternal notch is 19.05 cm, that of between nipples 20.0 cm, forming a equilateral triangle. d. The average breast volume, 310-330 ml; The standard breast volume, 250-350 ml; if the body weight is over the standard, the breast volume increases by 20 ml every 1.0 kg in body weight. e. The standard breast forward projection: 3.0 cm-4.0 cm. 2. Variables of the breast volume are: a. The breast volume is positively correlated with weight, chest circumference, waist circumference and buttock circumference, but negatively with height. b. The breast volume is closely related to difference between the chest circumference across the nipple and that across the horizontal line just under the armpits. The correlative equation can be approximately represented as V = 250 + 50 x D + 20 x OW (D = difference OW = overweight). c. The nipple position is not dependent on the height, but varies with the breast volume, that is, the nipple position lowers 1.0 cm with every increase of 300 ml in the breast volume. 3. The breast volume calculating table is derived from the radius and forward projection of breasts.(ABSTRACT TRUNCATED AT 250 WORDS)     

犬胰和十二指肠的血供

通过动脉灌注，在４１例标本上研究犬胰和十二指肠的血供。犬胰的血供分为四组：胰械叶由胃十二指肠动脉、脾动脉主干及其尾侧干的胰支供应；胰角由胃十二指肠动脉和胃网膜右动脉的胰支供应；胰右叶头侧头由胰十二指肠头侧动脉的胰支供应；胰右叶属侧部由胰十二指肠头，尾侧动脉的胰动供应。十二指肠主要由十二指肠上动脉和胰十二指肠头，尾侧动脉的十二指肠支供应。本研究对犬的胰腺切除术及胰腺移植术提供了解剖学资料。     

椎板后移回植的椎管扩大术治疗椎管狭窄症

作者报告棘突劈开、椎板后移回植的椎管扩大术治疗椎管狭窄症１８２例，使椎管容积扩大３４．８％，横径扩大３．８ｍｍ，矢径扩大６．１ｍｍ。随访２年９个月，优良率８６．６％，椎板愈合率９６．９％。本文探讨少数椎板迟延愈合的原因和预防措施，如斜切椎板、缝合固定和腰背筋膜与棘上韧带悬吊缝合等。术后卧床１０～１２周，用石膏型保护。作者认为本法能有效的预防术后脊柱不稳，顽固性腰痛等并发症。     

腹腔镜巨大前列腺囊腺瘤切除一例报告并文献复习

目的提高对巨大前列腺囊腺瘤的认识。方法回顾性分析收治的1例巨大前列腺囊腺瘤并成功进行腹腔镜切除的临床资料,结合文献复习进行讨论。结果本例患者成功行腹腔镜完整切除,手术时间125min,出血量60ml,术中双侧精囊输精管完整保留,术后会阴部坠胀不适消失,复查精液常规精子数目及活动度正常。已随诊12个月,肿瘤无复发。结论巨大前列腺囊腺瘤罕见,最终确诊要依靠病理诊断,其最有效的治疗是手术完整切除,而腹腔镜途径可作为完整切除的微创手段。     

Descriptive anatomy and biodynamic study of the medial collateral ligament of the trapezio-metacarpal articulation of the thumb

The trapezoid articular surface is classically compared to a saddle. The movements of the thumb obey to two centers of rotation. The one is proximal and determined by the convexity of the saddle; the other is distal and determined by its convexity. The authors have realised 15 dissections and 20 cinematic studies; they bring precision to the collateral medial trapeziometacarpal ligament and show the fundamental role of its anchorage point on the medial metacarpal tubercle: the distal center of rotation and the anchorage point are practically superimposed. The movements from this center are realised in indifferent pronosupination. The proximal center of rotation and the anchorage point are distant. The movements from this center are necessarily accompanied by pronation or supination. Statement report of the mechanism of this double rotation.