两种修补术治疗成人腹股沟疝的对比分析

目的观察前入路腹膜前疝修补术和疝环充填式无张力修补术治疗成人腹股沟疝的疗效。方法选取2010年1月-2012年6月在我院治疗的腹股沟疝170例患者,随机分为两组,对照组80例,用"美外"mesh-plug补片行疝环充填式无张力修补术。观察组90例,用善释D10补片行前入路腹膜前疝修补术,比较两组的术后疼痛、手术时间、术后恢复、住院费用和复发率等情况。结果两组的术后慢性疼痛、手术时间、自主下床时间比较差异无统计学意义(P>0.05);对照组住院时间(5.4±1.2)d长于观察组(3.5±1.1)d,对照组住院费用(5862.2±125.3)元低于观察组(6380.0±163.2)元,差异具有统计学意义(P<0.05)。对照组有1例复发,复发率为1.25%,观察组无复发;对照组并发症发生率2.5%明显高于观察组1.11%,差异具有统计学意义(P<0.05)。疝环>3cm和手术方式是腹股沟疝气复发的危险因素,差异具有统计学意义(P<0.05)。结论前入路腹膜前疝修补术相对而言疗效显著,住院时间短,复发率低,值得临床推广应用。     

改良Kugel补片修补腹股沟复发疝应用体会

目的:探讨改良Kugel补片腹膜前修补腹股沟复发疝的治疗效果。方法:回顾性分析2009年9月至2012年6月郑州大学第一附属医院应用改良Kugel补片开放式腹膜前置入治疗58例腹股沟复发疝的临床资料,观察手术时间、疼痛、术后恢复情况及复发率。结果:手术时间40~110 min,平均63 min。术后疼痛较轻,未见切口感染,平均住院时间(5.4±0.8)d。术后随访6个月~3 a,未见复发。结论:选择改良Kugel补片腹膜前修补腹股沟复发疝创伤小,并发症少,术后复发率低,可有效地治疗腹股沟复发疝,值得临床推广和应用。     

疝环充填式与腹膜前双层补片疝装置治疗腹股沟疝的临床疗效对比分析

目的探讨两种无张力疝修补术的优缺点。方法对548例各类型腹股沟疝行无张力修补,其中疝环充填式(Rutkow手术)102例(A组),选用强生公司提供的腹膜前双层补片疝装置行腹膜前双层补片术(bilayer patch device)446例(B组)。结果 A组术后4例复发,B组术后无复发;A组手术时间、尿潴留和阴囊水肿发生率均显著少于B组(P<0.01);A、B两组术后自主能力恢复时间、术后24 h疼痛程度比较差异无统计学意义(P>0.05)。结论对腹股沟疝及疝环较大的,尤其是复发疝者,应尽量选用腹膜前双层补片疝装置进行手术,疝环较小的腹股沟疝可选用疝环充填式修补手术。     

腹膜前间隙平片式与疝环充填式修补术用于腹股沟斜疝的对比研究

目的：比较腹膜前间隙补片疝修补术和疝环填充式无张力疝修补术两种术式,总结腹股沟斜疝修补术的改进方法与优点.方法：选取我院2009年10月-2012年10月行腹股沟斜疝无张力修补术患者72例,随机分为2组,每组36例,分别行腹膜前间隙补片疝修补术和疝环填充式无张力疝修补术,比较两组的疗效.结果：腹膜前间隙补片疝修补术组在手术时间、局部异物感、伤口疼痛感等方面优于疝环填充式无张力疝修补术组.结论：腹膜前间隙补片疝修补术能更好地缩短手术时间,减少术后不适.     

善释补片腹膜前间隙修补术与疝环充填式无张力疝修补术的临床疗效分析

目的:比较善释补片腹膜前间隙疝修补术与疝环充填式无张力疝修补术治疗腹股沟疝的临床疗效.方法:120例腹股沟疝患者随机分成A、B两组,每组各60例.A组采用善释补片腹膜前间隙无张力修补术,B组疝环充填式无张力修补术,比较分析两组的手术时间、术后下床时间、术后疼痛、术后住院时间、术后并发症及复发率.结果:两组均痊愈出院,无复发.A组手术时间、术后8h疼痛显著高于B组(P＜0.01),B组术后局部不适感显著高于A组(P＜0.01),A、B两组术后下床活动、术后住院时间,切口感染,阴囊血肿、复发率比较无显著差异.结论:善释补片腹膜前间隙修补术与疝环充填式无张力疝修补术在治疗腹股沟疝均有术后恢复快、复发率低的优点,但在手术时间,术后局部异物感发生率方面各有优缺点,根据患者具体情况选择不同的修补方法可提高手术效果.     

经腹腹膜前腹腔镜疝修补术治疗腹股沟复发疝的效果分析

目的探讨经腹腹膜前腹腔镜疝修补术治疗腹股沟复发疝的临床效果。方法选取2013年在解放军第一五四中心医院采用开腹腹膜前疝修补术治疗的56例腹股沟复发疝患者作为开腹组,同时选取2014年采用经腹腹膜前腹腔镜疝修补术治疗的76例腹股沟复发疝患者作为微创组,比较两组患者手术时间、术中出血量、术后下床活动时间、平均住院时间以及术后复发率。结果微创组手术时间、术中出血量、术后下床活动时间以及平均住院时间均显著优于开腹组(P<0.05);两组术后复发率比较,差异无统计学意义(P>0.05)。结论经腹膜前腹腔镜疝修补术治疗腹股沟疝气,具有较好的临床效果,值得推广应用。     

腹膜前入路无张力疝修补术治疗老年腹股沟斜疝的临床应用

目的:探讨腹膜前入路无张力疝修补术治疗老年腹股沟斜疝的疗效。方法:将64例老年腹股沟斜疝患者随机分为对照组(32例)和观察组(32例),对照组采用传统疝修补术治疗,观察组采用腹膜前入路无张力疝修补术治疗,比较两组的疗效差异。结果:观察组的手术时间、开始下床活动时间、住院时间及复发率均明显优于对照组(P<0.05),两组术后并发症差异无统计学意义(P>0.05)。结论:腹膜前入路无张力疝修补术治疗老年腹股沟斜疝手术时间短、恢复快、术后复发率低,可作为推荐术式。     

“善愈”网片腹膜前修补术治疗腹股沟复发疝126例体会

目的:探讨"善愈"聚丙烯网片在复发性腹股沟疝手术中的临床应用。方法:应用"善愈"补片无张力腹膜前修补治疗腹股沟复发疝126例,对其结果进行临床观察与随访。结果:126例患者平均手术时间30～40min,术后8h下床,8～10d伤口痊愈后出院。平均随访20月,随访期间,无复发病例,患者局部无明显异物感,术中阴囊积液1例,穿刺抽液后治愈,无其它并发症。结论:"善愈"聚丙烯网片治疗复发性腹股沟疝兼有治疗疝和预防疝的作用,具有操作简便、手术时间短、修补范围大、复发率低的优点,是治疗复发性腹股沟疝的良好术式。     

腹膜前间隙修补手术治疗嵌顿性股疝23例体会

目的探讨腹膜前间隙补片修补耻骨肌孔在嵌顿性股疝手术治疗中的应用。方法回顾分析23例应用腹膜前间隙内衬补片修补耻骨肌孔手术治疗嵌顿性股疝,探讨手术方法,观察术后的恢复与术后并发症的情况。结果全组病例术后的恢复优于传统的疝修补,术后无局部的异物感、无术后感染等症状。结论腹膜前间隙补片修补耻骨肌孔是对腹股沟区的全面修补,对股疝治疗符合腹股沟区的解剖与生理,是一种合理而理想的手术方式,临床效果确切,术后并发症少。     

局麻下腹膜前间隙疝无张力修补术与李金斯坦疝无张力修补术治疗腹股沟疝效果比较

目的比较局麻下腹膜前间隙疝无张力修补术与李金斯坦疝无张力修补术治疗腹股沟疝的效果。方法选取腹股沟疝患者60例,其中30例患者采用Kugel补片行腹膜前间隙疝无张力修补术,为K组;另30例患者采用自固定补片行李金斯坦疝无张力修补术,为L组。两组患者术中均采用局部神经阻滞麻醉。观察并比较两组患者手术时间、术后疼痛评分、术后住院时间、术后1周腹股沟区异物感、有无复发。结果两组患者手术时间、术后疼痛评分、术后住院时间比较均无统计学差异（均P＞0.05）;术后1周,K组患者腹股沟区异物感发生率低于L组（P＜0.05）。两组患者术后随访期间（3~12个月）均无复发。结论局麻下腹膜前间隙疝无张力修补和李金斯坦疝无张力修补术均能较好地修补腹股沟疝,临床上可根据患者的具体情况选择个体化的修补方案。     

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.