胰头及壶腹周围癌广泛淋巴结清扫的可行性及意义

目的: 探讨胰头及壶腹周围癌广泛淋巴结清扫可行性和意义,并提出行广泛淋巴结清扫的指征。方法: 对2000年10月~2003年10月的16例胰头及壶腹周围癌进行广泛淋巴结清扫术资料进行分析。结果: 16例中有6例出现淋巴结转移,转移率为37.5%。胰头癌与壶腹周围癌、肿块大小和胰头肿瘤部位间发生淋巴结转移均无明显不同(P=0.588~P=0.511)。行广泛淋巴结清扫术病例中无手术死亡,手术并发症也是胰十二指肠切除常见并发症。结论: 胰头及壶腹周围癌肿瘤大于3 cm以上,无论是位于胰头还是壶腹部癌均应在胰十二指肠切除同时行胰头周围广泛淋巴结清扫,手术是安全的。     

胰头癌和壶腹周围癌的手术治疗

我院最近21年间,手术治疗胰头癌和壶腹周围癌共351例(胰头癌211例,壶腹周围癌140例)。手术包括胰～十二指肠切除72例(20.5%),内引流术183例(52.2%),剖腹探查活检96例(27.3%)。在72例胰～十二指肠切除手术中有1例手术死亡,手术死亡率为1.3%,用我们改良的胰～十二指肠切除术式,术后并发症和死亡率明显下降。壶腹周围癌的切除率(40%)比胰头癌(7%)高,且切除后平均生存时间也比胰头癌长;故对壶腹周围癌应首选胰～十二指肠切除术,对不能切除的胰头 应作内引流术。     

壶腹周围癌影像学诊断及选择

目的 :探讨壶腹周围癌影像学诊断及检查方法的选择。方法 :总结 2 6 1例经手术、病理证实壶腹周围癌患者的影像学检查。结果 :十二指肠镜检及逆行胰胆管造影对壶腹周围癌诊断符合率最高 (96 .1 % ) ,B超 (88.6 % ) ,CT(88.2 % ) ,胃肠气钡双重造影 (5 8.5 % )。结论 :B超和 ERCP联合检查可提高十二指肠乳头、胆总管下端癌的检出率 ;CT对胰头癌价值最大 ,对疑有壶腹周围癌的患者应早做 B超检查 ,超声和 CT还有助于显示肿瘤腔外侵犯的范围以及腹腔转移 ,血管受累等情况     

术中放射性125I粒子植入在胰腺壶腹癌中的应用

目的:研究放射性125I粒子植入治疗在不可切除的胰腺壶腹癌中的应用.方法:2007年6月至2009年6月对10例经病理证实且不可切除的胰腺壶腹癌患者施行125I粒子肿瘤植入术,所有患者术前CT与MRI均显示胰腺壶腹癌,术后经病理组织学检查证实.结果:10例肿瘤患者中6例疼痛明显减轻,3例肿瘤缩小,1例肿瘤增大;5例Ⅰ期患者生存期均在20个月以上;1例发生小肠梗阻.结论:放射性125I粒子能控制原发性胰腺壶腹癌的局部生长,镇痛效果显著,并发症较少,有望提高早期患者的生存期.     

胆肠置管桥式内引流治疗恶性梗阻性黄疸

我院自1994～1996年间应用胆肠置管桥式内引流术治疗7例恶性肝外梗阻性黄疸,近期效果满意,现报告如下:一、临床资料　男性3例,女性4例。年龄42～71岁,平均595岁。术前血清总胆红质1427～3056ｕｍｏｌ/Ｌ。诊断:胆管癌3例,胰腺癌3例,壶腹周围癌1例。手术后5～14天,黄疸明显消退,血清总胆红质较术前下降95～136ｕｍｏｌ/Ｌ。除1例并发肠瘘和消化道出血仅生存1月外,其余存活3个月～9个月,中位生存期为4个月。二、手术方法　常规剖腹探查,确定癌肿已无法切除,且病变的部位、范围和病人的情况适合本术式者,可在肿瘤上段进行解剖,找出并切开扩张的…     

胆胰结合部切除治疗壶腹周围癌的临床分析

目的:总结胆胰结合部切除治疗壶腹周围癌的临床疗效。方法:7例壶腹周围癌行十二指肠降部切除、胆总管及部分胰头组织及区域淋巴结清扫,术后定期随访,进行临床评估;结果:7例手术均顺利完成,术后无肠、胰、胆瘘及继发出血等严重并发症,痊愈出院。术后随访1个月至30月不等,其中1例术后一年颅内转移衰竭死亡,其余6例至今健在。结论:胆胰结合部切除术治疗壶腹癌具有损伤小,根治率高,疗效确切,值得临床推广。     

胰头癌和壶腹周围癌398例临床分析

目的:提高胰头癌、壶腹周围癌诊治水平。方法:回顾性分析2003—2010年组124例胰十二指肠切除和1981—2002年组163例胰十二指肠切除的临床诊断与病理诊断符合率、切除率、手术死亡率和生存率。结果:2003—2010年组和1981—2002年组临床诊断与病理诊断胰头、壶腹周围肿瘤符合率分别为90.3%和86.5%;胰十二指肠切除率分别为79.8%和68.2%;手术死亡率分别为0和5.4%;生存率:平均生存期胰头癌分别为16.1个月和11.7个月;壶腹癌分别为18.3个月和12.7个月,胆管下段癌分别为23.1个月和21.8个月;十二指肠癌分别为44.5个月和29.1个月。结论:2003—2010年组胰头癌、壶腹周围癌诊治水平明显高于1981—2002年组;胰十二指肠切除是外科的主要疗法,胰管对空肠粘膜吻合可防止胰瘘的发生,治愈瘘的关键是通畅引流。     

原发性胰腺淋巴瘤的诊断和治疗(附9例报告)

目的:提高原发性胰腺淋巴瘤的诊治水平.方法:回顾性分析1980年1月至2005年2月间经病理确诊的9例原发性胰腺淋巴瘤病例资料.结果:本组9例患者临床症状以上腹部不适、体质量减轻、腹部包块为主.术前血浆CA19-9均正常,影像学检查均误诊为胰腺癌,肿瘤位于胰头3例,胰体尾6例.2例行Whipple手术,1例行胰体尾切除术,1例行胆肠吻合术,5例行剖腹探查、组织活检术,9例均证实为胰腺非霍奇金淋巴瘤.术后均行化疗,4例加行放疗,1例行γ刀放疗.除1例失访外,其余8例分别存活72、58、49、36、22、13、12和4个月.结论:原发性胰腺淋巴瘤因无特异的临床症状及影像学表现,易与胰腺癌混淆;对于血浆CA19-9正常的胰腺肿瘤患者应积极手术探查,明确诊断,避免延误有效的临床治疗.     

血清糖类抗原19-9、癌胚抗原在壶腹周围癌中的诊断和预后价值

目的 :观察壶腹周围癌病人术前血清 CA 19- 9和 CEA水平 ,探讨 CA19- 9和 CEA诊断壶腹周围癌的敏感性 ,预后价值。方法 :回顾性分析 130例经手术证实的壶腹周围癌病例 ,术前 1周内测量血清 CA19- 9和 CEA水平 ,比较病人血清 CA19- 9、CEA诊断敏感性 ,术后随访为 2～ 6 3个月 ,在全部病例及切除病例中分别评价血清 CA19-9、CEA阳性和阴性的预后。结果 :壶腹周围癌 5 9例切除 ,71例未能切除。CA19- 9检测壶腹周围癌阳性率为 81.5 4 % ,而 CEA阳性率为 2 9.2 3% ,两者比较差异有显著性 (P<0 .0 5 )。全部病例中 CA19- 9阳性者中位生存期 11个月明显短于 CA19- 9阴性者 32个月 (P<0 .0 5 )。同样 ,CEA阳性者中位生存期 6个月明显短于 CEA阴性者 17个月 (P<0 .0 5 )。结论 :CA19- 9比 CEA能提供更重要的诊断和预后价值 ,血清 CA19- 9在检测壶腹周围癌 ,评价切除性和预测预后方面可作为重要的辅助检查     

原发性胸膜肿瘤22例临床分析

目的探讨原发性胸膜肿瘤的临床特点及诊治方法.方法回顾性分析22例原发性胸膜肿瘤的临床资料.结果本组孤立性纤维性胸膜肿瘤9例,均手术切除,术后长期存活.弥漫性恶性胸膜间皮瘤13例,行胸膜剥脱术加辅助化疗6例,平均存活16个月以上;剖胸探查活检术后行全身化疗5例及未手术单纯支持治疗2例,均于6个月内死亡.结论原发性胸膜肿瘤病变弥漫性者均为恶性,临床表现以胸痛、胸腔积液为主,手术加化疗效果优于单纯化疗;局限性者多为良性,常无症状;治疗首选手术切除,但术后易复发,局限性者二次切除后仍可长期存活.     

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.