36例腹腔镜胆囊切除术患者并发症情况分析

目的:探讨腹腔镜胆囊切除术(LC)并发症原因及其治疗方法。方法:回顾性调查分析做胆囊切除术并有并发症的36例患者,应用一般统计学方法进行描述。结果:并发症患者中胆总管部分或完全损伤11例,胆管或胆囊颈漏9例。胆总管残余结石5例,腹腔内出血和穿刺孔感染各4例。结论:胆管损伤、胆漏和胆总管残余结石是LC的主要并发症。绝大部分并发症是能够预防和治愈的。     

腹腔镜胆囊切除术并发症的防治

目的：探讨腹腔镜胆囊切除术（LC）并发症的防治。方法：回顾性分析4000例腹腔镜胆囊切除术临床资料。结果：术后发生出血15例，胆漏5例，胆总管残余结石2例，胆管损伤1例，肠漏1例，均经手术及保守治疗治愈，无死亡病例。结论：术中以充分暴露、钝性分离为主，准确识别胆囊管、胆总管和肝管的关系，是减少术后并发症的关键。     

ERCP在治疗腹腔镜胆囊切除术后胆管并发症中的应用

目的探讨ERCP在治疗腹腔镜胆囊切除术后胆管并发症中的应用价值。方法回顾性分析近6年（2002年1月-2008年4月）间腹腔镜胆囊切除术后胆总管残余结石行乳头括约肌切开及气囊扩张术取石34例,LC术后胆漏行鼻胆管引流（ENBD）13例,胆管狭窄行胆管球囊扩张,放置胆管内支架4例。结果34例胆总管残余结石患者经乳头括约肌切开及气囊扩张术取石,其中有2例经2次操作取净结石。13例胆漏患者经鼻胆管引流6-11d后,胆漏均闭合,无严重并发症发生。4例胆管狭窄患者经胆管球囊扩张、放置胆管内支架治愈。结论ERCP在治疗腹腔镜胆囊切除术后胆管并发症中具有重要应用价值,是腹腔镜胆囊切除术后胆总管残余结石、胆漏及胆管狭窄的有效介入方法。     

腹腔镜胆囊切除术并发症12例的临床分析

目的探讨腹腔镜胆囊切除术（LC）并发症的预防和体会。方法总结1168例并发症种类,处理方法和预防措施。结果1168例LC中转开腹64例,发生并发症12例（1．03％）,其中胆管损伤3例（0．25％）,胆漏3例（0．25％）,胆总管残余结石4例（0．34％）,腹腔脓肿1例（0．08％）,死亡1例（0．08％）。结论胆总管残余结石、胆管损伤、胆漏是LC的主要并发症,绝大部分是能够预防和治愈的。     

腹腔镜胆囊切除并发症的防治

通过探讨腹腔镜胆囊切除术的并发症原因及预防处理原则,得出结论:胆总管残余结石、胆管损伤、胆漏是LC的主要并发症,绝大部分是能够预防和治愈的.     

胆囊管结石腹腔镜治疗策略

目的：探讨胆囊管结石腹腔镜治疗措施。方法：回顾我院腹腔镜（LC）胆囊管结石治87例临床资料。结果：85例顺利完成腹腔镜胆囊管结石切除术,2例中转开腹,未发生胆管损伤、出血、胆漏、胆总管结石等术后并发症发生。结论：只要严格仔细把握手术指征,及时中转开腹,防止胆囊管结石的遗漏,慎重处理胆囊管结石可避免胆囊管结石掉入胆总管[1]。谨慎解剖Calot三角可防止胆管损伤,可降低腹腔切口感染率,促使患者提前康复,因此,LC术是安全可行的。     

腹腔镜胆囊切除术常见并发症及原因预防

目的：分析腹腔镜胆囊切除术常见并发症及其原因预防。方法：回顾性分析10例腹腔镜胆囊切除术后并发症的临床资料。结果：2例发生胆漏，3例合并有腹腔出血，1例十二指肠损伤，2例有胆管结石，1例结石遗漏腹腔，1例损伤胆总管但是没有造成重大后果。结论：从严掌握LC手术适应证、提高腹腔镜操作技术LC严重并发症的防治具有重要意义。     

腹腔镜胆囊切除术200例体会及并发症分析

目的探讨腹腔镜胆囊切除术的手术疗效及并发症。方法我院2007年5月至2011年4月收治的400例胆囊结石患者随机分为腹腔镜组与4、切口组各200例,分别行小切口胆囊切除术（MC）、LC治疗。结果与Mc组比较,腹腔镜组手术时间延长．术中出血量减少、并发症降低,住院时间缩短（P〈0．05）。结论LC胆囊切除术疗效确切,胆管损伤、胆漏和胆总管残余结石是LC的主要并发症,关健在于预防,发现并发症及时处理。     

腹腔镜对哈萨克族肥胖病人胆囊手术的治疗体会

目的：探讨我区哈萨克族肥胖病人腹腔镜胆囊切除术（LC）的安全性及可行性,探讨防范风险的应对措施。方法：回顾性分析我院2009年2月～2012年12月对42例肥胖胆囊疾病病人行腹镜胆囊切除术的临床资料。结果：65例成功行LC手术,中转开腹3例,无严重手术并发症及死亡病例。结论：胆管损伤、胆漏和胆总管残余结石是LC的主要并发症,精细的操作、适时中转开腹、CT增强扫描,能有效地预防LC并发症,保证手术的安全性。只要重视围手术期的处理,对肥胖病人也可以安全地施行腹腔镜胆囊切除术。     

腹腔镜胆囊切除技巧与严重并发症的预防

目的探讨如何合理运用手术技巧避免腹腔镜胆囊切除术(LC)并发症。方法回顾性分析我院15例合并严重并发症的手术过程及并发症处理方法。结果本组患者发生严重并发症15例,其中胆管损伤5例,胆漏4例,腹腔出血3例,胆总管残余结石2例,腹腔脓肿、切口感染不愈各1例。结论熟悉胆囊血管和胆管的解剖变异,合理的手术技巧、规范的操作、及时果断的中转开腹可以最大限度地减少LC并发症的发生。     

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.