腹腔镜胆囊切除术后放置引流管的效果评价

目的评价腹腔镜胆囊切除术（LC）后放置引流管的临床效果。方法将312例拟行LC治疗患者随机分为两组,非引流组（n=158）术后未行常规预防性腹腔引流;引流组（n=154）术后行常规预防性腹腔引流。观察两组术后一般情况及并发症等情况。结果非引流组患者术后排气时间和术后住院时间较引流组患者明显缩短（P〈0．05）;两组术后并发症发生率比较差异无统计学意义（P〉0．05）。结论应严格掌握放置腹腔引流管的指征,一般行LC治疗患者术后不放置腹腔引流管是合理可行的,更有利于患者的康复。     

腹腔镜下经胆囊管治疗胆总管结石疗效观察

目的:比较腹腔镜下经胆囊管与经胆总管切开T管引流两种方法治疗胆总管结石的疗效,方法:将2005年6月~2006年12月在我院住院的78例患者按胆道探查途径不同分为经胆囊管组(n=30)和胆总管切开组(n=48)。观察两组患者的术后肛门排气时间、腹腔引流时间、术后住院日、住院费用及手术并发症发生情况。结果:上述各观察指标胆总管切开组明显高于经胆囊管组(P<0.05)。结论:经胆囊管途径的疗效优于胆总管切开T管引流途径的腹腔镜胆道探查术。     

腹腔镜与十二指肠镜联合应用于胆囊结石合并胆管结石的疗效及结石残留和并发症的分析

目的：探究腹腔镜与十二指肠镜联合治疗胆囊结石合并胆管结石效果及对结石残留和并发症的影响。方法：回顾性分析2019年6月—2020年6月接受治疗的89例胆囊结石合并胆管结石患者的临床资料,根据患者使用手术类型进行分组,观察组患者实施腹腔镜与十二指肠镜联合治疗（n=46）;对照组患者实施传统开腹手术治疗（n=43）。比较两组患者手术情况（手术时间、术中出血量、住院时间、住院费用）、术后恢复情况（肠功能恢复时间、腹腔引流时间、术后镇痛情况）、术后并发症情况差异,比较两组患者手术半年后疗效差异。结果：观察组患者手术时间、术中出血量、住院时间、肠功能恢复时间、腹腔引流时间、术后镇痛率均低于对照组,观察组患者住院费用高于对照组（均P<0.05）;两组患者急性胰腺炎、手术切口感染、胆道出血、胆管结石残留发生率无显著性差异（均P>0.05）,观察组患者胆瘘发生率低于对照组（P<0.05）;手术半年后,两组患者反流性胆管炎、胆道狭窄、结石复发率无显著性差异（均P>0.05）。结论：腹腔镜与十二指肠镜联合治疗胆囊合并胆管结石效果较好,且有利于患者术后恢复,术后并发症少。     

肝移植术后不常规放置腹腔引流管安全性及可行性探讨

目的:探讨肝移植术后不放置腹腔引流管的安全性及可行性?方法:回顾2010年1月~2013年8月在南京医科大学第一附属医院肝移植中心行肝移植术的患者资料,根据术中是否放置腹腔引流管分成引流组(n = 63)和非引流组(n = 112)?分析比较患者术前因素?术中因素以及围手术期并发症和住院时间?结果:患者在术前因素及术中腔静脉阻断时间?门静脉阻断时间及术中出血?输血情况均未见显著差异?两组患者术后并发症分级(P = 0.78)以及腹腔引流管相关并发症(出血?胆漏?大量腹水?切口渗液等)均未见明显差异?而两组在ICU住院天数及术后住院天数有显著差异(P < 0.01)?结论:肝移植术后不放置腹腔引流管是安全的?     

快速康复外科在腹腔镜再次胆道探查术中的应用价值

目的 探讨快速康复外科(FTS)在腹腔镜再次胆道探查术中的应用价值.方法 将52例有胆道结石手术史需行腹腔镜再次胆道探查术的胆总管结石患者分为FTS组(28例)和对照组(24例).FTS组采用快速康复的围术期处理方法,对照组采用传统的围术期处理方法.记录两组患者术后下床时间、排气排便时间、恢复进食时间、住院时间及费用,对比血清前清蛋白(PA)、体重下降情况等营养指标,观察术后并发症发生情况和镇痛效果.结果 与对照组比较,FTS组术后排便时间、下床时间、排气时间、进食时间明显提前,住院时间明显缩短,住院费用大幅降低,差异均有统计学意义(P<0.05).两组术前、术后第3天PA水平无明显差异(P>0.05),FTS组术后第5天体重下降较对照组小(P<0.05).FTS组并发症发生率低于对照组(P<0.05).两组患者镇痛效果比较差异有统计学意义(P<0.05),FTS组患者恶心、呕吐的发生率明显低于对照组(P<0.05).结论 FTS联合腹腔镜再次胆道探查术可降低并发症发生率,缩短住院时间,减少住院费用,手术安全性较高,患者康复较快.     

腹腔镜联合胆道镜治疗肝外胆管结石的临床疗效

目的探讨腹腔镜联合胆道镜治疗肝外胆管结石的临床疗效。方法分析濮阳市妇幼保健院肝胆外科2015年10月—2017年10月收治的140例肝外胆管结石患者临床资料,其中腹腔镜手术组,即观察组(n=80)和开腹手术组,即对照组(n=60),比较两组手术及术后恢复情况、并发症发生率,随访2年结石复发率及胆道狭窄发生率。结果观察组无中转开腹情况,虽手术时间较对照组长,术中出血量、肛门首次排气时间、住院时间、腹腔引流管保留时间及T管保留时间均明显少于对照组(P<0.05);术后并发症发生率明显低于对照组(P<0.001);术后随访2年,观察组均未出现结石复发和胆管狭窄,对照组有4例(6.67%)结石复发,无胆管狭窄,两组结石复发率比较有统计学意义(χ2=5.490,P<0.05)。结论腹腔镜联合胆道镜治疗肝外胆管结石创伤小,术后并发症少,恢复快,能缩短住院时间,且不易复发。     

不预防性腹腔引流在结直肠癌手术中应用的可行性分析

目的研究探讨结直肠癌手术不预防性腹腔引流的可行性与安全性。方法选取结直肠癌患者110例,随机分为非引流组和引流组,引流组留置皮下多孔引流管,非引流组不留置引流管,比较两组患者的术后并发症情况及康复情况。结果非引流组患者的平均住院时间为(25.6±0.9)d,首次排气时间为(3.6±0.7)d,停止输液时间为(4.2±1.1)d,均明显低于引流组。结论在结直肠癌手术中,不预防性放置腹腔引流管不会增加患者术后并发症的感染风险,并且能够缩短患者的康复时间,提高康复效果,具有一定的可行性和安全性,但应根据患者的实际病情选择恰当的治疗方法。     

腹腔镜联合胆道镜治疗胆囊合并胆总管结石疗效

目的 探讨腹腔镜联合胆道镜治疗胆囊合并胆总管结石的疗效.方法 2001年2月-2010年1月我院对160例术前经CT或BUS、MRI确诊的胆囊合并胆总管结石患者分别行腹腔镜联合胆道镜取石术(观察组)或开腹手术(对照组),观察并比较两组手术时间、术中出血量、进食时间、腹腔流量、并发症发生率、术后止痛剂使用率、住院时间等.结果 与对照组相比观察组术中出血量、进食时间、腹腔流量、术后止痛剂使用率、住院时间等指标比较均有显著性差异(P<0.01),两组的手术时间比较有无显著性差异(P>0.05);两组的并发症发生率比较无显著性差异.结论 腹腔镜联合胆道镜是治疗胆总管结石安全有效的方法,值得临床的推广.     

不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究

目的：探讨对比经胆囊管腹腔镜胆道探查术与经胆总管切开T管引流手术治疗胆总管结石的临床效果。方法随机选取2013年7月-2014年6月该院收治的60例胆石症患者为研究对象,按照手术方法的不同将其分为观察组30例与对照组30例;给予观察组经胆囊管腹腔镜胆道探查术治疗,给予对照组经胆总管切开T管引流手术治疗。术后对比分析两组患者的手术时间、引流时间、术后排气时间、住院时间以及并发症发生情况等。结果观察组手术时间、引流时间、术后排气时间、住院时间均明显低于对照组;且两组比较差异有统计学意义(P<0.05)。观察组并发症总发生率为4.0%,对照组并发症总发生率为28.0%,同时观察组的胆漏、急性胰腺炎、急性胆汁腹膜炎、肝下积液感染、引流不畅等并发症的发生率显著小于对照组,两组比较差异有统计学意义(P<0.05)。结论使用胆囊管腹腔镜胆道探查术治疗胆总管结石症的效果优于胆总管切开T管引流手术,且该手术方法术后并发症发生率要低于胆总管切开T管引流手术,因此该方法值得临床推广应用。     

腹腔镜下经胆囊管治疗胆总管结石疗效观察

目的比较腹腔镜下经胆囊管与经胆总管切开T管引流两种方法治疗胆总管结石的疗效,方法将2005年6月～2006年12月在我院住院的78例患者按胆道探查途径不同分为经胆囊管组(n=30)和胆总管切开组(n=48).观察两组患者的术后肛门排气时间、腹腔引流时间、术后住院日、住院费用及手术并发症发生情况.结果上述各观察指标胆总管切开组明显高于经胆囊管组(P＜0.05).结论经胆囊管途径的疗效优于胆总管切开T管引流途径的腹腔镜胆道探查术.     

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.