重症急性胰腺炎的手术与非手术治疗

为提高重症急性胰腺炎（ＳＡＰ）的疗效，作者总结了９３例ＳＡＰ患者的治疗经验。９３例中，治愈７３例（７８．５％）、死亡２０例（２１．５％）。手术治疗组５３例，死亡１５例（２８．３％）；非手术治疗组４０例，死亡５例（１２．５％）。１９９２年以前早期手术为主，死亡率２３％；１９９２年以后非手术或延期手术为主，死亡率１９．５％。作者认为本病的死亡原因与病情、胰腺坏死范围、有无继发感染及器官衰竭的处理方法有关。早期手术未能改善初期休克、胰腺广泛坏死、器官衰竭等并发症的预后，而非手术方法可以治愈大多数ＳＡＰ病例。胰腺组织坏死继发严重感染者应行手术治疗。手术方法以坏死组织清除和充分引流为主。     

大剂量去甲长春花碱联合顺铂治疗非小细胞肺癌近期临床疗效观察

目的：观察大剂量去甲长春花碱（ＮＶＢ）联合顺铂（ＤＤＰ）治疗非小细胞肺癌（ＮＳＣＬＣ）近期临床疗效及毒副作用，方法：治疗ＮＳＣＬＣ３８例均有病理学或细胞学明确诊断，采用ＮＶＢ３０ｍｇ／ｍ＾２，第１．８天，ＤＤＰ９０ｍｇ／ｍ＾２化疗，２个周期评价疗效，结果部分缓解（ＰＲ）１７例，稳定（Ｓ）１６例，进展（Ｐ）５例，总有效率（ＲＲ）为４４．７％，毒副反应，骨髓抑制Ｉ型ＩＶ度占７６．３％，局部静脉炎发生率     

壁细胞迷切术加修补术治疗十二脂肠溃疡穿孔远期疗效观察

作者采用壁细胞迷切加穿孔修补术（ＰＣＶ＋Ｓ）治疗４０例十二指肠溃疡穿孔患者。同期采用壁细胞迷切术（ＰＶＣ）治疗４０例慢性十二指肠溃疡。术后１－５年的随访结果表明：急诊ＰＣＶ＋Ｓ和择期ＰＣＶ同样具有显著降酸和促进溃疡愈合作用，远期疗效属ＶｉｓｉｃｋＩ和Ⅱ级者为８７．５％，溃疡复发３例，仅１例需再手术。因此ＰＣＶ＋３是值得推荐的手术。     

经尿道前列腺电汽化与经尿道前列腺电切对BPH的疗效比较

对２４０例有症状的前列腺增生症（ＢＰＨ）患者分别行经尿道前列腺电汽化术（ＴＶＰ）和经尿道前列腺电切术（ＴＵＲＰ）。结果显示：１２０例ＴＶＰ手术者，前列腺症状评分（ＩＰＳＳ）从术前的２０．９下降至术后３个月的５．１（Ｐ＜０．００１），最大尿流率由１０．６ｍｌ／ｓ上升至１９．２ｍｌ／ｓ（Ｐ＜０．０１）。ＴＵＲＰ组１２０例，ＩＰＳＳ从术前的２１．２下降至术后３个月的５．２（Ｐ＜０．００１），最大尿流率由１０．２ｍｌ／ｓ上升至１９．４ｍｌ／ｓ（Ｐ＜０．０１），两组比较无显著差异性（Ｐ＞０．０５）。平均留置导尿管时间：ＴＶＰ组２６．５小时，ＴＵＲＰ组５０．７小时，有显著性差异（Ｐ＜０．０１）。术后阳萎发生率：ＴＶＰ组２．４％，ＴＵＲＰ组１４．５％（Ｐ＜０．０５）。ＴＶＰ组术中无大出血及经尿道前列腺电切综合征（ＴＵＲＳ）发生，需输血者仅１例。ＴＵＲＰ组３例发生ＴＵＲＳ，输血１４例。比较结果：ＴＶＰ能达到与ＴＵＲＰ完全相同的治疗效果，且并发症少，价格相对较低，近期效果满意。     

腹腔镜胆囊切除术二氧化碳气腹对血流动力学的影响

通过对１０例腹腔镜胆囊切除术患者施以ｓｗａｎ—Ｇａｎｚ导管监测，探讨二氧化碳化气腹对血流动力学影响。于二氧化碳气腹前、充气后５分、２０分和放气后５分钟，分别测录血流动力学指标。结果：ＭＡＯ、ＣＶＰ、ＰＡＰ与ＰＣＷＰ于充气后５分钟，分别增加２８％、１７２％、８３％与１２１％；于充气后２ｏ分钟，分别增加３２％、２０９％、１４７％与１７３％，与充气前相比，变化非常显著（Ｐ＜０．０１）。与充气前相比，ＨＲ与ＰＶＲ于充气后５分和２０分钟均显著增加（Ｐ＜０．０１），ＳＶＲ、Ｃｌ、ＳＩ、ＬＶＳＷＩ与ＲＶＳＷＩ的变化无统计学意义（Ｐ＞０．０５）。提示我们应注意腹腔镜胆囊切除术中血流动力学的变化。     

深颈丛阻滞终止围术期PSVT发作的疗效观察

围术期阵发性室上性心动过速（ＰＳＶＴ）发作患者２３例，其中有６例于术后４．５～１２ｈ再次发作ＰＳＶＴ，共２９例次。２９例次均经心电图证实，心率１６２～２１７次／分。２３病例中男８例，女１５例，年龄１６～８１岁。其中有１２例有一定程度的心脏器质性损害，...     

静脉注射不同剂量异丙酚对血流动力学及通气功能的影响

应用阻抗法和分气流监测法观察静脉注射不同剂量异丙酚（Ｐｒｏｐｏｆｏｌ，ＰＲＯ）后患者血流动力学（ＭＡＰ、ＮＲ、ＳＬＣＩ、ＩＦＩ、ＶＥＴ、ＥＶＩ、ＳＶＲＩ、ＩＣ、ＰＦＩ、ＬＳＷＩ）与通气功能（ＶＴ、ＲＲ、ＶＥ、ＦＥＶ１％、ＥＴＣＯ２、ＳＰＯ２、 Ｉ－ＥｔＯ２）的变化。 ４０例（ＡＳＡⅠ～ Ⅱ）随机分成四组，ＰＲＯ剂量分别为 １．０ｍｇ／ｋｇ、１．５ｍｇ／ｋｇ、２．０ｍｇ／ｋｇ、２．５ｍｇ／ｋｇ。结果：（１）１～４组呼吸暂停发生率为０％、２０％、３０％、８０％，苏醒时间分别为３ ０±１．５、７．４±２．３、９．１±３．６、９．６±４．２分钟：（２）静脉注射不同剂量ＰＲＯ启ＳＡＰ、ＤＡＰ、ＭＡＰ、ＳＩ下降，ＨＲ、ＣＩ、ＳＶＲＩ无明显变化，心肌收缩性（ＩＣ、ＰＦＩ、ＥＶＩ）明显减弱，ＳＶＲＩ减少；（３）ＰＲＯ对呼吸有抑制作用，以ＶＴ和ＶＥ影响最大，与剂量呈正相关；对面罩吸氧患者ＳｐＯ２、ＲＲ、ＥＴＣＯ２无明显改变，Ｉ－ＥｔＯ２减少；舌后坠者托起下颌对ＶＴ、ＶＥ的恢复颇为有效。     

肺动脉瓣下室间隔缺损的外科治疗

我院自１９７４年５月～１９９８年４月共施行室间隔缺损（ＶＳＤ）修补手术１０７０例,其中肺动脉瓣下室间隔缺损（ＳＰＶＳＤ）１９３例,占１８％（不包括法洛四联症的ＳＰＶＳＤ）。由于ＳＰＶＳＤ部位特殊,且常合并主动脉瓣脱垂及主动脉瓣关闭不全（ＡＩ）,因此,此型ＶＳＤ与常见的膜部室间隔缺损（ＭＶＳＤ）的外科治疗有所不同。现对本组病例的临床特点和手术治疗加以分析和讨论。１　临床资料与方法本组１９３例中,男１１２例,女８１例。年龄２～３５岁,平均９．４±５．５岁。体重１０～５９ｋｇ,平均２５．２±１２．１ｋ…     

修补术加PGV与修补术加奥美拉唑方案治疗十二指肠溃疡穿孔的疗效对比

目的研究十二指肠溃疡穿孔的两种不同疗法——穿孔修补术加近侧胃迷走神经切断术（ＰＧＶ）与穿孔修补术加奥美拉唑方案的临床疗效。方法将１９９４年１月－１９９６年１２月相继入院的４８例十二指肠溃疡穿孔患者随机分为Ａ、Ｂ两组。Ａ组（２１例）在穿孔修补术的基础上，加行ＰＧＶ。Ｂ组（２７例）仅作穿孔修补术，术后辅予奥美拉唑方案（即口服奥美拉唑加羟氨苄青霉素加灭滴灵）。术后定期随访。随访结果按Ｖｉｓｉｃｋ标准分级。结果Ａ组术后半年和２年疗效优良者（ＶｉｓｉｃｋⅠ加Ⅱ级）分别为１８例（８５．７％）和１７例（８１．０％），溃疡复发者（ＶｉｓｉｃｋⅣ级）分别为１例（４．８％半年）和２例（９．５％２年）。Ｂ组术后半年和２年疗效优良者分别为１９例（６６．７％）和１０例（３７．０％），溃疡复发者分别为５例（１８．５％）和１２例（４４．５％）。Ａ组疗效优于Ｂ组（Ｐ＜０．０１）。Ｈｐ检测，Ａ组术后半年和两年的Ｈｐ阳性率分别为８１．０％和８５．７％（Ｐ＞０．０５）；Ｂ组分别为１８．５％和５１．９％（Ｐ＜０．０１）。结论十二指肠溃疡穿孔在施行修补术后，应同时加行ＰＧＶ，以提高对溃疡病的根治效果     

PSVT不同复律方法的对比分析

本文对８４例１３３例次阵发性室上性心动过速（ＰＳＶＴ），随机分成异搏定等六组治疗，结果：ＰＳＶＴ转复例次率心律平１００％，心房调搏９３．３％，异搏定９０．５％，ＡＴＰ６９．２％，刺激迷走神经６６．７％，西地兰４０％。副反应便次率最低为心律平（０），其次为异搏定（９．５％），最高为ＡＴＰ（６９．２％），笔者认为心律平转复率最高，副作用最低，为ＰＳＶＴ复律的首选药物。     

Therapeutic time window for musicokinetic therapy in a persistent vegetative state after severe brain damage

Objective: To determine the therapeutic time window in which musicokinetic therapy (MKT) could be of potential benefit for a persistent vegetative state (PVS), this study analysed the relationship between the timing of MKT and changes in PVS score following MKT. Methods: Twenty-six patients who fulfilled the definition of PVS were treated consecutively by MKT employing a trampoline with live music performance for 3 months. The PVS score ranges from 0-30 and the condition which meets the definition of PVS is never scored greater than 20. Results: As compared to patients with brain damage caused by trauma (n = 12) or subarachnoid haemorrhage (SAH; n = 9), those caused by other cerebrovascular accidents (n = 3) or anoxic encephalopathy (n = 2) appeared to demonstrate a much smaller improvement in their PVS score. When the patients caused by trauma or SAH were analysed in isolation, the effects of MKT were clearly better in those patients in whom the MKT was initiated within 6 months after brain damage. Among nine patients caused by trauma or SAH who had been in a PVS for more than 12 months, however, six (66.7%) demonstrated improvement of their PVS score by 5 or more and four (33.3%) reached a post-MKT score of greater than 20. Conclusions: These findings suggest that, contrary to the commonly held belief, the therapeutic time window for MKT is far greater than 6 months, insofar as patients with brain damage caused by trauma or SAH are concerned. Although the benefits of MKT were not proven directly, this inference is consistent with the hypothesis that MKT can induce an improvement in the clinical condition of PVS patients.     

儿童肝移植术后门静脉狭窄的诊断与治疗

目的分析儿童肝移植术后门静脉狭窄(PVS)的可能危险因素,并探讨不同治疗方式的临床疗效。 方法回顾性分析2013年6月至2017年12月首都医科大学附属北京友谊医院肝移植中心396例儿童肝移植受者临床资料(年龄≤14周岁)。随访至2018年6月,有26例发生PVS(6.6%)。对于超声怀疑PVS的儿童受者,本中心多选用门静脉血管造影确诊。术后采用超声监测门静脉直径及流速,观察血管通畅情况。采用随访观察并口服药物抗凝治疗、球囊扩张、门静脉支架置入或Meso-Rex分流术治疗PVS。监测肝功能变化,评估有无门静脉相关的移植物损伤,并观察有无门静脉高压相关的症状或体征。 结果26例儿童受者术后发生PVS中位时间为9.5个月(1.3～50.0个月),其中3个月以内发生者占26.9%(7/26),3个月以后占73.1%(19/26)。行介入球囊扩张和支架置入或Meso-Rex分流术共47例次,均未因PVS死亡。2例儿童受者动态随访,期间口服抗凝药物;23例行门静脉球囊扩张术,1例因门静脉冗长行1次门静脉球囊扩张＋支架置入术,10例经1次门静脉球囊扩张术后无效后行二次球囊扩张,7例经二次门静脉球囊扩张术后无效行门静脉支架置入术,2例经门静脉支架置入术后再次狭窄,行Meso-Rex手术。1例口服药物抗凝治疗的儿童受者,随访期间超声提示门静脉流速偏快,其余随访至今未见PVS复发。 结论超声是监测儿童肝移植术后门静脉情况、早期发现PVS的有效办法。发生PVS时,轻症儿童受者可动态随访,期间口服抗凝药物;中重度儿童受者首选门静脉球囊扩张、门静脉支架置入术。Meso-Rex分流术是对门脉支架置入术后PVS复发或发生门静脉闭塞的一种可选择的手术方式。     

儿童肝移植术后门静脉狭窄的血管腔内介入治疗

目的探讨经皮肝血管成形术在儿童肝移植术后门静脉狭窄(PVS)治疗中的应用价值。方法回顾性分析儿童肝移植术后PVS 8例患儿资料,均经门静脉造影证实,并行经皮血管成形术和(或)经皮血管内支架成形术治疗。分析8例患儿血管腔内介入治疗的效果。结果对8例患儿共进行12例次血管内腔内介入治疗,技术成功率66.67%(8/12),首次治疗临床成功率62.50%(5/8)。3例分别于首次球囊扩张后再次行球囊扩张,2例术后PVS无复发,1例患儿再次球囊扩张治疗后,行血管腔内支架成形术,支架植入后未狭窄。8例患儿均未出现治疗相关并发症。结论儿童肝移植术后PVS的血管腔内介入治疗是一种安全、有效的治疗方法。     

Short- and long-term effectiveness, morbidity, and mortality of peritoneovenous shunt inserted to treat massive refractory ascites of nephrogenic origin analysis of 14 cases

The experience with 14 patients with end-stage renal disease (ESRD), 13 of them maintained on chronic hemodialysis (x 20.4 months +/- 2.9 SEM) and one following successful renal transplantation, underwent placement of a peritoneovenous shunt (PVS) for refractory ascites that had been present before insertion from two to 15 months (x 5.3 +/- 0.8 SEM). A "specific" cause for the ascites could not be identified in any of the 14 patients. The ascites was an exudate in every patient (protein content greater than 3.5 gm/dl). Twelve patients (86%) obtained significant relief of the discomfort and all effects of the ascites, and objective clinical improvement persisted for at least six months. Nine patients (75%) survived one year and six (50%) survived three or more years. Three patients (21%) had recurrence of ascites because of shunt malfunction; however, two of them were successfully treated with placement of a second shunt. Eight (57%) patients have died since the onset of their ascites (x 14.1 months +/- 3.5 SEM); one death was attributable to PVS placement, while the other seven deaths were due to complications of their ESRD. Insertion of a PVS is an effective therapeutic alternative to palliate the discomfort and ill effects of massive nephrogenic ascites that is often refractory to hemodialysis with ultrafiltration.     

Porcine xenografts in Parkinson's disease and Huntington's disease patients: preliminary results

The observation that fetal neurons are able to survive and function when transplanted into the adult brain fostered the development of cellular therapy as a promising approach to achieve neuronal replacement for treatment of diseases of the adult central nervous system. This approach has been demonstrated to be efficacious in patients with Parkinson's disease after transplantation of human fetal neurons. The use of human fetal tissue is limited by ethical, infectious, regulatory, and practical concerns. Other mammalian fetal neural tissue could serve as an alternative cell source. Pigs are a reasonable source of fetal neuronal tissue because of their brain size, large litters, and the extensive experience in rearing them in captivity under controlled conditions. In Phase I studies porcine fetal neural cells grafted unilaterally into Parkinson's disease (PD) and Huntington's disease (HD) patients are being evaluated for safety and efficacy. Clinical improvement of 19% has been observed in the Unified Parkinson's Disease Rating Scale "off" state scores in 10 PD patients assessed 12 months after unilateral striatal transplantation of 12 million fetal porcine ventral mesencephalic (VM) cells. Several patients have improved more than 30%. In a single autopsied PD patient some porcine fetal VM cells were observed to survive 7 months after transplantation. Twelve HD patients have shown a favorable safety profile and no change in total functional capacity score 1 year after unilateral striatal placement of up to 24 million fetal porcine striatal cells. Xenotransplantation of fetal porcine neurons is a promising approach to delivery of healthy neurons to the CNS. The major challenges to the successful use of xenogeneic fetal neuronal cells in neurodegenerative diseases appear to be minimizing immune-mediated rejection, management of the risk of xenotic (cross-species) infections, and the accurate assessment of clinical outcome of diseases that are slowly progressive.     

Sham surgery does not ameliorate MPTP-induced behavioral deficits in monkeys

Parkinsonism has been reported to improve following transplantation of fetal mesencephalic tissue into the striatum of MPTP-exposed monkeys and humans and in patients with idiopathic Parkinson's disease. While there is good evidence for the survival of grafted tyrosine hydroxy-lase (TH)-positive cells in animal studies, it is not known whether they produce neuronal effects that account for behavioral improvement after transplantation or whether spontaneous or graft-induced changes in the host striatum are at least partly responsible. Are neuronal synaptic connections and dopamine release necessary, or would “toenails and talcum powder” do the job equally well? We have addressed these questions by studying several types of implantation surgeries, including sham surgery, the implantation of cerebellar tissue, and the implantation of mesencephalic TH-positive fetal tissue of various gestational ages into the striatum. Adult male African green monkeys received systemic MPTP administration (cumulative doses of 2.0–2.5 mg/kg) prior to these stereotaxic surgical manipulations. Subjects were matched for quantitative behavioral deficits prior to surgery. Subjects were examined and assessments made by “blinded” observers who scored individual spontaneous and elicited behaviors. Observers were trained and tested repeatedly for inter-rater reliability. A “parkinsonian summary score” derived and determined using a principal component factor analysis of a large sample of data from MPTP-treated and normal monkeys of the same species was used to assess behavior. Postmortem brain tissue was prepared for biochemical analysis of dopamine concentrations and TH immunohistochemical studies. The most dramatic improvement was seen in monkeys with “early” (<4 cm fetal crown rump length) surviving substantia nigra grafts in the caudate nucleus. Some behavioral improvements were seen in MPTP-treated sham-operated monkeys, cerebellar-grafted monkeys, and “later” (>14 cm fetal crown rump length) substantia nigra-grafted monkeys. These changes in monkeys which did not have surviving dopamine-producing grafts probably represent the recovery capacity of MPTP-treated host brain during this time interval since un-operated subjects showed similar changes. More variable effects were seen with substantia nigra grafts in the putamen. The most consistent correlate of behavioral improvement in all experimental groups was elevation in dopamine concentrations near the grafts compared with a distant striatal location which is believed to represent the depletion without the effects of the grafts. While these data do not establish the precise mechanism of action, they point to a hierarchy of factors which provide increasingly larger restorative effects, including sprouting of host neurons and increased dopamine production by grafted fetal dopamine neurons. Sham surgery appears to be significantly less effective than early fetal mesencephalic tissue which survives and releases dopamine.     

胆道闭锁患儿肝移植术后门静脉狭窄的血管腔内治疗

目的探讨血管腔内治疗在胆道闭锁患儿肝移植术后门静脉狭窄(PVS)治疗中的应用价值。方法收集因原发病为胆道闭锁接受肝移植、术后后发生PVS的患儿14例,均经门静脉造影证实,并接受经皮血管成形术和(或)经皮血管内支架成形术治疗。分析14例患儿血管腔内介入治疗的效果。结果 14例患儿共进行23次血管内腔内介入治疗,技术成功率82.61%(19/23)。10例患儿经1~2次球囊扩张治疗后治愈,4例患儿球囊扩张治疗后,行血管腔内支架成形术,支架植入后未发生狭窄。14例患儿均未出现治疗相关并发症。结论胆道闭锁患儿肝移植术后PVS的血管腔内介入治疗安全、有效。     

Diagnosis and treatment of pediatric patients with late-onset portal vein stenosis after living donor liver transplantation

Portal vein stenosis (PVS) after living donor liver transplantation (LDLT) is a serious complication that can lead to graft failure. Few studies of the diagnosis and treatment of late-onset (≥3 months after liver transplantation) PVS have been reported. One hundred thirty-three pediatric (median age 7.6 years, range 1.3–26.8 years) LDLT recipients were studied. The patients were followed by Doppler ultrasound (every 3 months) and multidetector helical computed tomography (once a year). Twelve patients were diagnosed with late-onset PVS 0.5–6.9 years after LDLT. All cases were successfully treated with balloon dilatation. Five cases required multiple treatments. Early diagnosis of late-onset PVS and interventional radiology therapy treatment may prevent graft loss.     

大鼠胎脑组织冻存与同种异体移植

目的 探讨冻存大鼠胎脑细胞体外培养的活性及其移植后的存活情况。方法 对经冷冻保存1－24周的WK大鼠胎脑细胞进行体外培养,观察其存活情况,并将保存24h后培养14d的胎脑细胞行脑内定位移植。结果 冻存1－24周的胎脑组织其活细胞率在90％以上,复苏后培养14d的胎离细胞活性最强;胎脑细胞移植后可在受者体内存活至少30d以上。结论 冷冻保存后培养的胎脑细胞级够存活,并可用于移植。     

胎脑组织移植对额叶皮层损伤大鼠辨别学习,记忆之影响

为观察胎脑组织移植对双侧额叶皮层损伤大鼠学习、记忆功能的影响，对大鼠模型行胎脑组织移植。学习，记忆再现测验在Ｙ型迷宫中进行。大鼠学习和记忆成绩以测验时达至于是０次电击均为正确反应时所需的电击次数表示。结果表明，胎脑组织移植能显著减少达到上述标准所需的电击次数，且移植３个月较移植１０天的动物达到上次标准所需的训练次数减少更明显。