食管胃吻合附加胃底折叠术的抗胃食管反流机制研究

目的 探讨高龄食管癌和贲门癌切除食管胃吻合附加改良胃底折叠术抗胃底食管反流的机制.方法 选取我院2013年4月-2014年4月收治的高龄食管癌(45例)、贲门癌患者(45例),均进行吻合口静息压检测和pH检测,对比2组患者的静息压情况.结果 在贲门癌患者中期吻合口上静息压显著高于吻合口下,对比差异具有统计学意义(P＜0.05).结论 对于高龄食管癌、贲门癌患者采用食管切除联合改良胃底折叠手术治疗后,使用全天候pH检测和吻合口静息检测能够为后期使用的黏膜保护剂等提供指导.     

贲门癌近端胃切除后残胃间置对胃酸和食管胃压力的影响

目的了解贲门癌行近端胃切除后残胃间置对胃功能的影响,以探讨减少贲门癌术后并发症、改善患者生活质量的更佳术式.方法对21例贲门癌患者行近端胃次全切除、残胃间置消化道重建术.术后行24h食管胃pH监测及压力测定,并与传统术式及术前监测结果进行比较.所有病例常规行纤维内镜及上消化道造影检查.结果(1)残胃间置组术后酸反流6项指标明显优于传统组(P＜0.01),24h食管pH＜4的总百分时间、立位pH＜4的百分时间、反流次数、反流持续超过5min的次数与术前相似(P＞0.05),但上述指标传统组术后较术前明显增加(P＜0.01).(2)两组术后食管残胃吻合口高压带长度及静息压力较术前食管下括约肌长度和静息压力明显下降(P＜0.01),但残胃间置组食管残胃吻合口静息压力和残胃静息压力较传统组明显下降(P＜0.05).(3)残胃间置组仅2例发生中度反流性食管炎,而传统组有12例发生中重度反流性食管炎(P＜0.01).结论贲门癌切除后行残胃间置重建消化道,能进一步降低酸反流及残胃静息压力,促进残胃排空,改善术后症状,提高生活质量,是一种较为理想的手术方法.     

食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗

目的 探讨食管癌贲门癌切除食管胃机械吻合术后重建食管与胃食管反流之间的关系。方法 对50例食管癌术后患者进行了食管胃的压力测定，其中25例尚行了24h食管pH监测和内镜及病理检查，以及35例贲门癌术后患者进行食管胃压力测定，其中20例行24h食管pH监测，15例行内镜和病理学检查。结果 测压结果显示：吻合口与吻合口下方的静息压相似，两者比较差异无显著性（P〉0．05），而吻合口上方静息压增高，食管癌组平均为4．28mmHg，贲门癌组平均为3．46mmHg，经比较食管癌组和贲门癌组吻合口上方和吻合口下方差异有显著性（P〈0．05）。值得注意的是食管癌组压力值（4．28mmHg）和贲门癌组压力值（3．46mmHg）远低于正常括约肌的静息压（10～45mmHg），因此其抗反流作用的程度是有限的。食管癌组和贲门癌组食管24hpH监测表明食管的酸暴露时间延长，食管酸暴露时间平均百分比分别为11．76％和13．88％，为正常人的9倍和11倍，反流次数增加，最长反流时间达32min和38min，说明手术后的胃食管反流是客观存在的。内镜和病理检查，80．0％的食管癌和86．7％的贲门癌有异常现象及食管炎征象，进一步证实术后患者有不同程度的反流性食管炎。结论 食管癌贲门癌切除食管胃吻合术后存在胃食管反流；反流的发生不因机械吻合或手工吻合而异；反流的发生与术后时间的长短无关；24h食管pH监测是最敏感的观察方法；半卧位睡眠是预防反流的有效方法；反流的治疗主要应用促动力药和黏膜保护剂。     

贲门癌、食管癌切除术后食管-胃肌瓣胃腔内瓣膜式吻合术的测压观察

目的 研究预防食管-胃吻合术后反流性食管炎的吻合方式.方法 2000年3月-2009年8月,对食管下段癌5例,贲门癌25例,Barrett食管行癌肿切除1例,食管-胃肌瓣胃腔内瓣膜式吻合术,并对其中20例患者术后14~547d(平均44.9d)在吻合口上方5cm、吻合口、吻合口下方的胃腔内行压力测定.结果 吻合口与吻合口下方的静息压相似,差异无统计学意义(P＞0.05),而吻合口上方静息压增高,平均为1.886kPa,与吻合口上方和吻合口下方比较差异有统计学意义(P＜0.001).结论 食管-胃肌瓣胃腔内瓣膜式吻合术是预防反流性食管炎严重吻合口并发症的有效手术方法.     

食管、贲门癌切除机械吻合术后反流性食管炎的临床研究

目的 探讨食管癌和贲门癌术后食管胃机械吻合术后重建食管与胃食管反流之间的关系.方法 对214例食管癌和贲门癌切除术后患者采用多指标检测方法,其中食管造影检查106例、电子胃镜检查108例并取病理检查43例.结果 食管造影检查反流为70%,弓上吻合反流低于弓下吻合(P＜0.05);胃镜检查86%有异常表现,其发生与术后时间长短无关(P＞0.05),反流性食管炎评分弓上吻合明显低于弓下吻合(P＜0.05).结论 食管贲门癌切除食管胃机械吻合术后,广泛存在胃食管反流,反流的发生与术后时间的长短无关,食管胃吻合口位置越高胃食管反流和反流性食管炎程度越轻.     

食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗研究

目的分析讨论食管癌与贲门癌切除机械吻合术后胃食管反流的临床病理诊断及治疗情况。方法本组选择2013年10月至2016年10月我院收治的72例食管癌贲门癌切除机械吻合术后患者作为观察对象,回顾性的对全部患者的基本临床资料进行研究分析。结果本研究中72例食管癌贲门癌切除机械吻合术后患者的24h食管压力测定结果同正常人的比较结果显示具有病理性胃食管酸反流。全部患者经内镜检查显示,有50例患者存在吻合口上方食管黏膜异常,但经临床治疗后均恢复健康。结论食管癌贲门癌切除机械吻合术后常常发生胃食管反流症状,反流的出现和术后时间长短没有紧密联系,而预防反流的方法主要是半卧位睡眠,且临床中治疗胃食管反流主要是采用黏膜保护剂与促动力药。     

贲门癌、食管癌切除术后食管一胃肌瓣胃腔内瓣膜式吻合术的测压观察

目的研究预防食管-胃吻合术后反流性食管炎的吻合方式。方法2000年3月-2009年8月,对食管下段癌5例,贲门癌25例,Barrett食管行癌肿切除1例,食管一胃肌瓣胃腔内瓣膜式吻合术,并对其中20例患者术后14～547d（平均44．9d）在吻合口上方5cm、吻合口、吻合口下方的胃腔内行压力测定。结果吻合口与吻合口下方的静息压相似,差异无统计学意义（P〉0．05）,而吻合目上方静息压增高,平均为1．886kPa,与吻合口上方和吻合口下方比较差异有统计学意义（P〈0．001）。结论食管一胃肌瓣胃腔内瓣膜式吻合术是预防反流性食管炎严重吻合口并发症的有效手术方法。     

食管贲门癌切除胃底重建术中保留迷走神经的价值分析

目的:分析食管贲门癌切除胃底重建术中保留迷走神经的价值.方法:采用随机数字表法将行食管、贲门癌切除主动脉弓下食管胃吻合术95例患者分为2组,对照组术中切断迷走神经并不行胃底重建术,观察组术中保留迷走神经加胃底重建手术,比较2组患者术后症状改善、上消化道压力和反流性食管炎情况.结果:观察组临床症状发生率明显低于对照组,P＜0.01;观察组术后食管体部静息压高于正常组和对照组,P＜0.05;对照组、观察组与正常组胃静息压比较,P>0.05;对照组反流性食管炎发生率53.19%明显高于观察组16.67%,P＜0.01.结论:在早期无周围外侵的食管、贲门癌切除胃底重建术中保留迷走神经能够保持胃正常泌酸、运动和排空功能,在提高手术疗效和改善预后方面意义重大.     

食管癌患者食管胃壁内吻合与机械吻合术比较研究

目的 比较研究食管胃壁内吻合术与机械吻合术在手术治疗中的应用.方法 在135例食管癌患者手术中,70例采用食管胃壁内吻合术,65例采取机械吻合术.然后将两组患者术后吻合口瘘、吻合口狭窄及食管反流发生率进行对比分析.结果 食管癌患者行食管胃壁内吻合术70例中均未发生吻合口瘘和吻合口狭窄,发生反流性食管炎2例(2.9%);行机械吻合术65例患者中发生吻合口瘘1例(1.5%),发生吻合口狭窄6例(9.2%),反流性食管炎12例(18.5%),食管胃壁内吻合术并发症发生率低于机械吻合术(P<0.05).结论 食管癌患者手术中食管胃壁内吻合术在预防术后吻合口瘘,吻合口狭窄和反流性食管炎方面优于机械吻合术.     

食管胃壁内吻合与传统吻合的对比及评价

目的:探讨食管贲门癌切除后采取不同方法重建消化道术后并发症发生情况及术后患者生存质量。方法:256例食管贲门癌患者中,随机抽取153例采取食管胃壁内吻合,103例采取传统食管胃全层端侧或端端吻合。然后将术后吻合口瘘,吻合口狭窄及反流性食管发生率进行对比分析。结果:食管胃壁内吻合吻合口瘘发生率为0%,吻合口狭窄发生率为0%,返流性食管炎发生率为2.61%;传统食管胃全层(端侧或端端)缝合吻合口瘘发生率为4.85%,吻合狭窄发生率为5.83%,反流性食管炎发生率14.56%。结论:食管胃壁内吻合术吻合较传统食管胃全层吻合术可靠,并发症少,更大程度的恢复了贲门功能,明显提高了患者的术后生活质量,是食管贲门癌切除术后消化道重建的理想术式。     

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.