分米波与透明质酸钠预防屈肌腱粘连的比较研究

目的 比较分米波与透明质酸钠防治肌腱粘连和促进肌腱愈合的作用. 方法取6月龄雄性白色来亨鸡96只,体重(2.24±0.07)kg.于左足第Ⅲ、Ⅳ趾制备肌腱损伤模型,随机分为3组(n=32):分米波照射组(A组),模犁制备后第1～21天行分米波照射,频率915 MHz,功率8 W,辐射距离10 cm,每日1次,每次10 min;透明质酸钠组(B组),模型制备后即刻予1.2%透明质酸钠0.5 mL均匀涂于肌腱缝合处;对照组(C组)未作处理.术后观察动物一般情况;术后14、28 d,行大体、透射电镜及组织学观察:于7、10、14、18、21、28 d取材,行生物力学测试. 结果 各组动物术后切口愈合良好,无感染及死亡.大体和组织学观察示A、B组腱周有较疏松粘连,C组腱周广泛粘连;透射电镜观察示A、B组胶原纤维较C组排列规则.生物力学测试示术后各时间点最大拉伸断裂强度、最大延伸率、拉断肌腱粘连带功耗A、B组均优于C组(P＜0.05).术后14、18 d最大拉伸断裂强度、术后18、21 d最大延伸率以及术后18、21、28 d拉断肌腱粘连带功耗,A组均优于B组(P＜0.05),余时间点两组间比较差异均无统计学意义(P＞0.05). 结论 分米波和透明质酸钠均能有效促进肌腱愈合,预防肌腱粘连,且分米波操作简便、作用持久.     

氦－氖激光对损伤肌腱粘连及愈合影响的实验研究

用白来亨鸡５０只，随机选１０只作为正常对照，４０只手术。将鸡双腿第２、３趾屈趾深肌胜切断１／２，术后不固定。随机选择一侧为治疗组，另一侧为对照组。治疗组屈趾肌腱损伤处，术后２４小时开始，每天用氦－氖激光治疗仪纤维光针照射２０分钟，疗程最长为３周，对照组不做治疗。实验结果发现，治疗组趾活动度较对照组好（Ｐ＜０．０１）；肌腱粘连较轻（Ｐ＜０．０５）；组织学检查证明激光照射具有消炎、消肿、促进肌腱愈合的作用。     

THE ROLE OF PERITONEAL IMMUNITY AND THE TUMOUR-BEARING STATE ON THE DEVELOPMENT OF WOUND AND PERITONEAL METASTASES AFTER LAPAROSCOPY

Background : The effect of the tumour-bearing state and alterations in peritoneal immune function on the incidence of port-site and peritoneal metastases was investigated after laparoscopy with and without CO₂ pneumoperitoneum. Methods : A suspension of viable adenocarcinoma cells was introduced into the left upper quadrant of the peritoneal cavity of syngeneic tumour-bearing rats at laparotomy, laparoscopy with CO₂, and gasless laparoscopy. Control rats did not have pre-existing tumours. A group of non-tumour-bearing rats were also injected intraperitoneally with endotoxin 4 h before intraperitoneal tumour cell injection. Six days later the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour. Peritoneal macrophages were obtained from tumour-bearing rats subjected to different laparoscopic procedures and the activation state measured following exposure to lipopolysaccharide in vitro. Results : In the control rats, tumour implantation in the surgical wounds and peritoneum was significantly greater in the rats that had undergone laparoscopy with CO₂. The presence of a pre-existing tumour was associated with increased tumour spread in all treatment groups and at most sites. Injection of endotoxin also resulted in increased tumour spread. Peritoneal macrophages from control and tumour-bearing rats who underwent laparoscopy with CO₂ produced significantly less TNF-αin vitro, compared to gasless laparoscopy or laparotomy. Conclusions : Carbon dioxide insufflation enhances tumour spread and implantation. The underlying immune or metabolic status of the host, as influenced by the tumour-bearing state or modification of the peritoneal environment, also has a marked independent effect on tumour spread and implantation. The immune and metabolic status of the peritoneum including the extent of macrophage activation is implicated in this effect.     

INTERLEUKIN-6 GENE EXPRESSION IN PERIPHERAL BLOOD MONONUCLEAR CELLS FROM PATIENTS UNDERGOING HEMODIALYSIS OR CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

To compare the interleukin-6 (IL-6) gene expression in the peripheral blood mononuclear cells (PBMCs) and plasma IL-6 levels in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with those in patients undergoing hemodialysis.

Eleven hemodialysis patients, 10 CAPD patients, 15 non-dialyzed patients with end-stage kidney disease (ESKD), and 7 healthy controls were included in this study. PBMCs were collected by differential centrifugation. Plasma IL-6 concentration was measured by enzyme immunoassay.

Plasma IL-6 levels were significantly increased in the hemodialysis and CAPD patients as compared with non-dialyzed ESKD patients and normal subjects (p < 0.01). Following hemodialysis, plasma IL-6 levels exceeded those before hemodialysis. No significant difference was found in plasma IL-6 levels in CAPD patients and in hemodialysis patients when blood was drawn before hemodialysis. Low but steady-state levels of IL-6 mRNA expression were observed in the non-dialyzed ESKD patients. The expression of IL-6 mRNA in PBMCs was significantly increased in the patients undergoing hemodialysis or CAPD as compared with the non-dialyzed ESKD patients. The PBMC IL-6 mRNA was significantly lower in CAPD patients than in hemodialysis patients (p < 0.01). A significant correlation was found between the plasma concentration of IL-6 and the expression of IL-6 mRNA in PBMCs from patients undergoing hemodialysis or CAPD (p < 0.01).

The hemodialysis or CAPD procedure contributed to the increase in PBMC IL-6 mRNA expression and plasma IL-6 concentration. CAPD treatment stimulated the production of IL-6 to a lesser extent than hemodialysis treatment.     

PRIMARY PERITONEAL CARCINOMA: A TREATABLE SUBSET OF PATIENTS WITH ADENOCARCINOMA OF UNKNOWN PRIMARY

The syndrome of adenocarcinoma of unknown primary (ACUP) is a frequent problem in both medical and surgical practice. The prognosis is poor, the median lifespan being 4 months. In general, multiple invasive procedures aimed at determining the primary tumour are not warranted due to the low frequency of detecting a tumour for which adequate treatment exists. In this paper we wish to highlight a subset of female patients presenting with malignant ascites and no evidence of a pelvic mass, who on laparotomy were found to have primary peritoneal papillary serous adenocarcinoma. These tumours must be regarded as a potentially treatable subset of patients with ACUP in view of their frequent response to chemotherapy and relatively good prognosis.     

EARLY MANAGEMENT OF ABDOMINAL TRAUMA THE ROLE OF DIAGNOSTIC PERITONEAL LAVAGE

This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intraabdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity. A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra-abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non-therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis. In this series, there was no mortality or morbidity attached to the use of DPL or from non-therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed late.     

COMPARATIVE EXPERIENCE OF A SIMPLE TECHNIQUE FOR LAPAROSCOPIC CHRONIC AMBULATORY PERITONEAL DIALYSIS CATHETER PLACEMENT

Background : Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long-term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy. Methods : A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2-year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared. Results : Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P= 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P= 0.00002). There were three minor peri-operative complications in the laparoscopic group and seven peri-operative complications in the laparotomy group, three required reoperation and one resulted in the patient'death. There were no significant differences in the incidence of exit-site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months). Conclusions : This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of peri-operative complications. Medium-term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.     

苯妥英在兔骨折愈合中的作用

为了观察苯妥英在骨折愈合中的作用，选用健康家兔７２只，手术造成双侧桡骨骨折模型。随机分为三组：全身用药组，局部用药组及对照组。分别于骨折后第９，１６及３０ｄ处死动物，采用Ｘ线摄片、骨痂重量测定及组织学检查等方法观察苯妥英局部应用和全身应用在促进骨折愈合中的作用。结果表明：苯妥英局部应用和全身应用均有促进骨折愈合的作用。     

胆道阻塞时兔肝抗氧化酶系的变化

本实验采用新西兰大耳白兔制作胆道阻塞模型。研究了胆道阻塞以后肝脏抗氧化酶系的变化。结果表明,胆总管结扎二周后肝组织谷胱甘肽过氧化物酶(GPX)只有对照组的30%。超氧化物歧化酶(SOD)下降了50%;谷胱甘肽(GSH)含量也降了50%;而丙二醛(MDA)增加近2倍;红细胞SOD含量明显低于对照组;血清中MDA含量为对照组的4倍。结果提示,胆道阻塞时肝脏抗氧化能力受损,本文对其机理和意义进行了讨论。     

重症急性胰腺炎腹水内磷脂酶A2对腹膜通透性的影响

目的 应用SD大鼠重症胰腺炎模型探讨磷脂酶A_2是否与腹膜通透性升高有关.方法40只大鼠分为4组,分别于制模后3、6.12h和自然死亡时取材,测定腹水体积和腹水内粒细胞弹力蛋白酶(PMNE)及PLA_2的活性,观测前两者分别与磷脂酶A_2活性的关系,同时观察胰腺组织的病理学改变.结果 随病情加重,磷脂酶A_2的活性与腹水体积呈显著升高趋势,两者之间的相关系数是0.94,并且任何两组间的腹水体积皆有显著差异.PMNE的活性,在3～12h内呈显著下降,而死亡组的活性反而升高.3～12h内,PMNE活性与磷脂酶A_2活性的相关系数是-0.87.结论 腹水内PLA_2是导致重症急性胰腺炎腹膜通透性升高的关键因素,且呈剂量依赖性.     

微波辐射家兔阴囊对精子运动能力的影响

本实验用2,450MHz微波照射家兔阴囊,待睾内温度升至43(±0.1～0.2)℃时,维持0.5小时。每周人工阴道采精,以动态观察精子爬高力、精子cAMP含量及精子密度的变化。微波照射后,精子爬高力逐渐下降,至第31天降至最低水平(从照射前33.5±19.8降至12.1±17.0mm,P<0.05);精子cAMP含量明显下降(从照射前6.69±3.80降至3.61±3.28pmol/10~8精子,P<0.05);精子计数亦逐渐下降,约于照射后第4周降至最低水平(从照射前301×10~6降至63×10~6精子/ml,P<0.01)。本实验表明,微波照射后,尽管精子密度始终未降至零,但此时的精子运动机能已受损,从而会影响精子的受精能力。本文还探讨了微波照射后精子运动机能下降的可能机制。     

兔同种异体半月板移植后膝胫股关节面生物力学重建的研究

目的探讨兔同种异体半月板移植后膝关节内侧间隙受力面积、压强的变化及其生物力学重建情况。方法 6～7月龄清洁级日本大耳白兔28只,雌雄不限,体重3.0～3.5kg;随机取7只兔右膝关节内侧半月板,制备同种异体半月板。余21只兔随机分为3组,每组7只。A组为空白对照组,单纯打开膝关节后缝合;B组为右膝内侧半月板切除组;C组为右膝内侧半月板切除后行同种异体半月板移植组。术后观察各组实验动物一般情况,于12周处死实验动物取右膝关节行生物力学测试,并取A、C组半月板行组织学及免疫组织化学染色观察。结果术后实验动物均存活至实验完成。术后12周大体观察见C组移植半月板愈合较好,前后角及体部附着良好。术后12周膝关节屈膝0、30、60、90°时,B组膝关节内侧间隙受力面积及压强与A、C组比较,差异均有统计学意义(P<0.05),A、C组间比较差异均无统计学意义(P>0.05);屈膝120°时,任意两组间受力面积及压强比较,差异均有统计学意义(P<0.05)。组织学观察显示C组软骨细胞及胶原纤维数量恢复正常;免疫组织化学染色示C组移植半月板内胶原纤维含有大量Ⅰ型胶原和Ⅱ型胶原。术后12周A、C组Ⅰ型胶原含量分别为0.6125±0.0598和0.5872±0.0639,差异无统计学意义(t=0.765,P=0.465);Ⅱ型胶原含量分别为0.7724±0.0815和0.8143±0.0517,差异无统计学意义(t=—0.136,P=0.894)。结论兔同种异体半月板移植可增加膝关节受力面积,减小压强,有利于保护关节软骨,并可重建生物力学平衡。     

腹腔内应用透明质酸钠预防术后粘连的实验研究

为证明透明质酸钠对术后暖腔粘连的预防作用,将38只大鼠随机分为A、B、C三组,于腹腔内损伤部位分别应用0.9％生理盐水,6％右旋糖酐-40和透明质酸钠(术康林-1)。术后14天处死动物。结果显示,三组粘连分级差异有显著统计学意义(P<0.01)。显微镜下见透明质酸钠治疗组炎症反应轻微。纤维增生不显著。实验证明,透明质酸钠可减少术后腹腔粘连的程度,其作用优于右旋糖酐。     

腹腔镜胆囊切除术中结石漏入腹腔的原因及对策

目的：探讨腹腔镜胆囊切除术（LC）结石漏入腹腔发生的原因,预防措施及处理方法。方法：回顾分析了1991年9月－1999年12月7200例LC术中结石漏入腹腔患者发生的原因,探讨其临床预防措施及处理成功的经验。结果：LC术中结石入腹腔363例,其中LC术中胆囊分破所致219例,钳夹胆囊侧胆囊管钛铗脱落所致43例,自腹壁戳孔取出时撕破34例,分离钳扩开戳孔时刺破67例,结石漏入腹腔发生率约为5％,LC术中结石入腹腔后多全部取出,。腹腔残留结石患者确切数目不甚清楚,随访1－8年无腹腔脓肿,窦道形成等并发症出现,结论：LC术中胆囊分破,钳夹胆囊侧胆囊管的钛铗碰落,自腹壁翟孔取出时用力撕破或胆囊取出时因戳孔过小扩开时刺破是LC术中结石漏入腹腔的主要原因,LC术中一旦结石脱入腹腔采取必要的方法全部取出是减少或避免腹腔残石发生的主要措施。LC术中结石脱入腹腔未能全部取出,可严密观察随访,不必为此中转开腹。     

微波辐射家兔阴囊后对精子透明质酸酶活力的影响

本文对用微波辐射阴囊后的新西兰种雄兔排出精子内透明质酸酶活力进行了测定,并与辐射前排出精子内透明质酸酶活力进行了比较。结果发现:辐射后第一次排出的精子(约辐射后2周左右),其所含透明质酸酶的活力比辐射前明显降低(P<0.01),以后各次采集到的精子的酶活力基本与辐射前一致。此结果提示:微波辐射动物阴囊能使贮存在附睾内精子透明质酸酶活力受到抑制。     

高渗盐水对低氧条件下失血性休克家兔肾功能及超微结构的影响

本实验观察分析了高渗盐水对低氧条件下失血性休克家兔肾功能及超微结构的影响。实验结果表明，高渗盐液输入后能明显增加尿量，降低ＢＵＮ和Ｃｒ水平，降低钠排泄分数（ＦＥＮａ）和肾衰指数（ＲＦＩ），从而明显改善低氧条件下失血性休克时的肾功能；此外，高渗盐液输入后还能明显降低低氧失血性休克后肾组织损伤的程度，提示高渗盐液能保护休克肾，与单纯高渗盐水相比较，高盐高胶液加６５４－２后其保护休克肾的作用更加明显，因此是更理想的低氧休克复苏液。实验同时表明高渗盐液输入不引起血清钾浓度增高等并发症，说明高渗盐液的应用是安全的。以上结果为高渗盐液的临床应用提供了实验依据。     

IS LAPAROSCOPY ASSOCIATED WITH A LOWER RATE OF POSTOPERATIVE ADHESIONS THAN LAPAROTOMY? A COMPARATIVE STUDY IN THE RABBIT

This trial set out to test the hypothesis that there is no difference in the incidence of intra-abdominal adhesions after a stereotyped intraperitoneal injury created via laparoscopy or laparotomy. Twenty New Zealand White rabbits had a 2 × 2 cm area of peritoneum stripped off their caecum and adjacent parietal peritoneum, either by laparotomy or laparoscopy. Outcome was assessed by the incidence of adhesions to the test site and the wound. There was no difference in the rate of adhesions at the test site in the two groups. The rate of adhesions to the wound was different in the two groups (70% laparotomy, 0% laparoscopy; P = 0.003). In a rabbit model, comparing laparoscopy and laparotomy in a strictly controlled operative environment, a stereotyped intraperitoneal injury results in similar rates of postoperative adhesions. Laparoscopy is, however. associated with a much lower incidence of wound adhesion. The potential for postoperative adhesions is real after laparoscopic surgery.     

兔肝癌组织缺血再灌注后的损伤及凋亡

目的研究肝癌缺血再灌注后的损伤及凋亡。方法超声引导穿刺新西兰兔肝脏左中叶注射VX2肿瘤组织混悬液,建立肝脏肿瘤模型,阻断肿瘤所在的肝左中叶的肝动脉分支60min后去除血管阻断恢复血流,分别再灌注0min、1h、1d、3d和1w。取肿瘤组织、癌周组织和肝脏组织,除测定肿瘤组织和肝脏组织超氧化物歧化酶(SOD)、丙二醛(MDA)的含量外,还对肿瘤组织、癌周组织及肝脏组织进行了HE染色。结果缺血再灌注后肿瘤组织和正常肝组织中的SOD浓度均迅速下降并分别于再灌注1h和0min达最低水平(64.59±4.97,12.38±0.31),其后逐渐恢复(112.83±5.84,25.78±0.56)但至再灌注7d仍低于再灌注前(200.32±26.43,42.00±1.07)。但癌组织中的SOD含量下降更为显著。从缺血再灌注开始至7d肿瘤组织的MDA含量下降(21.59±0.59),而肝脏组织缺血再灌注后0min至7d(29.04±1.43),MDA含量明显升高,均高于缺血再灌注前水平(18.26±0.43)。HE染色显示,肝癌组织缺血再灌注后凋亡细胞明显增多,其中以1d最为显著(23.08%),而癌周和肝组织改变不甚明显(与同时点的癌组织相比P<0.01)。结论缺血再灌注可增强对肝癌组织的损伤并促进细胞凋亡而癌周和正常肝脏组织的改变不明显。