普胸手术经听诊三角微创切口与传统后外侧切口的对比研究

目的 探讨经听诊三角入路切口在普胸外科手术中的临床应用价值.方法 需行普胸手术患者62例,随机分成经听诊三角微创切口(ATT)组、后外侧切口(PLT)组各32组,比较两组患者的手术情况.结果 两组均无手术死亡病例,术中、术后无严重并发症.ATT组开胸切口长度为(8.5±1.9)cm,开胸时间(7.3±2.5)min,关...     

剖胸术微创开胸法临床应用76例报告

资料与方法 2004年1月开始对传统剖胸切口进行改进,采用以腋下竖直小切口为主的微创开胸法共完成各类剖胸手术76例,男46例,女20例,年龄5—72岁。其中食管癌38例（中、上段34例,下段4例）,贲门癌9例,肺癌13例,自发性气胸10例,纵隔肿瘤2例,动脉导管未闭1例,胸外伤3例。全组均行腋下竖直小切口完成手术,仅食管中,上段癌34例辅以颈部切口完成食管胃吻合。     

经听诊三角的肌肉非损伤性开胸术

目的 推荐一种经听诊三角的肌肉非损伤性开胸术。方法 我院共行32例此类手术。切口是经肩胛骨下角作一弧形切口，不损伤背阔肌及前锯肌。结果 3例后纵隔肿瘤切除，22例肺叶切除，1例全肺切除，2例复发性气胸，1例肺活检，1例凝固性血胸纤维板剥脱，2例肋骨纤维结构不良切除。这种经听诊三角切口完全满足这些手术的需要，无需输血，无围手术期死亡，未出现严重并发症。结论 胸壁肌肉非损伤性开胸术操作简便、暴露充分，可供部分胸外科手术选用。     

普胸术后再次剖胸止血11例临床分析

目的:总结普胸术后胸腔内大出血再次剖胸止血的临床资料,以便更好地预防和处理普胸术后胸腔内大出血。方法:对我院近5年普胸外科术后胸腔大出血并行再次剖胸止血的病例资料进行分析,寻找出血原因并总结治疗经验。结果:共11例普胸术后再次剖胸止血,痊愈10例,死亡1例,出血部位有切口肋间血管出血3例,壁层与纵隔胸膜广泛渗血1例,右下肺动脉干结扎线脱落1例,肋骨断端出血1例,支气管动脉出血1例,下肺韧带出血1例,食管床出血1例,纵隔手术创面出血1例,未能找到明确出血点1例。结论:关胸前仔细检查,严密止血是预防术后胸腔大出血的重要措施。及时果断地再次剖胸止血是治疗术后胸腔大出血的关键。     

胸改术在巨大纵隔肿瘤手术止血上的应用

<正> 纵隔肿瘤切除为胸外科常见手术,而巨大纵隔肿瘤术中,常因粘连严重,出血甚多,止血困难。采用胸廊改形术(简称胸改术)压迫止血能取得满意效果。例1.男,58岁,因右侧纵隔巨大肿瘤,于1976年3月30日在全麻下剖胸探查,见肿瘤25×18×18cm~3,部分呈实质性,大部分呈囊性,与胸壁广泛坚实粘连,右肺被压迫不张。迫使手术行肿瘤并右肺切除术。术中失     

改良胸后外侧切口在胸外科的应用

目的探讨保留胸肌改良后外侧切口在胸外科手术中的临床应用。方法对112例胸部疾病的患者施行剖胸手术时,采用保留胸肌的改良胸后外侧切口,于第4、第5或第6肋间径路完成手术。结果采用此切口避免切除或切断肋骨;避免大片胸壁肌肉切断;明显减轻术后胸痛和肩关节活动障碍;减少出血和输血;大大缩短开关胸时间。结论保留胸肌改良后外侧切口行普胸外科手术可获得满意手术效果,可以在开胸手术中广泛应用。     

改进的剖胸切口在56例普胸外科手术中的应用

施行肺、食管等普胸外科手术最常采用后外侧剖胸切口,术野显露好。传统的后外侧切口常采用肋床切口或助间切口,两种切口各有优缺点。笔者通过进修学习,应用上海中山医院普胸外科设计的中断肋骨剖胸切口方法,于１９９６年９月～２０００年７月对５６例普胸外科病人施行手术,效果良好,报道如下。１临床资料 肺癌２例,均为男性,分别为左下肺及右上肺周围型肺癌,前者５５岁,后者６２岁。食管癌贲门癌５４例,男３２例,女２２例;年龄５３～６９岁;其中食管上段癌２例,食管中段癌２０例,食管下段癌１５例,贲门癌２５例。 食管上段…     

剖胸术后切口感染与营养状况相关性病例对照分析

对外科手术后患者营养状况的评价和营养支持的应用 ,已受到临床医生的广泛重视[1] 。本组以胸外科剖胸手术患者为研究对象 ,从术后营养状况的角度 ,采用病例对照分析方法 ,拟探讨其与切口感染的相关性。1　临床资料本组选择 1997年 1月— 2 0 0 2年 1月第三军医大学附属新桥医院心胸外科存档病历。选择病例符合以下条件 :①胸外科剖胸手术 ;②单纯切口感染 ;③术后 5d有确切的术后血清蛋白检查和累积氮平衡记录 ;④除外与切口感染相关性并发症。符合以上条件的 15例为感染观察组 ,其中男 11例 ,女4例 ,年龄 38～ 6 7岁 ;手术类型及构成比 :…     

微创腋下切口在胸外科的应用

目的总结腋下微创切口在胸外科手术中应用的体会。方法115例患者在全麻双腔插管下经微创腋下切口手术治疗。全组术中2例因致密粘连而延长切口，其他病例均顺利完成手术。包括肺癌根治术（含肺叶或全肺切除、淋巴清扫）食道癌根治术，纵膈肿瘤切除等。结果全组均康复出院，无严重并发症发生，达到了微创美容。减轻痛苦和提高生活质量的目的。结论微创腋下切口适合大部分胸科手术，但应达到与常规开胸手术同样治疗效果。     

持续负压吸引在胸部切口全层感染裂开清创缝合中的应用观察

<正>胸外科胸部剖胸手术切口感染全层裂开是胸外科常见术后并发症。从2006—2012年我科对剖胸手术及肋骨骨折内固定术后切口感染全层裂开的7例患者采用清创全层缝合加用负压吸引治疗,患者切口全部达到一期愈合,现报告如下。1资料与方法 1.1一般资料:本组7例患者为食管癌三切口前外侧剖胸术后切口感染全层裂开、食管癌标准后外侧切口感染全层裂开4例,胸腹联合刀刺伤剖胸术后切口感染全层裂开1例,胸部开放性损伤剖胸术后切口感染全层裂开1例,肋骨骨折内固     

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.