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1.
保存植物神经的直肠癌根治术对排尿和性功能的影响   总被引:11,自引:0,他引:11  
目的 探讨中下段直肠癌患者行保存植物神经的肿瘤根治术对排尿和性机能的影响。方法 根据不同病情实施不同保存植物性神经的直肠癌根治术188例:Dukes A期98例,完全保存神经;B期78例,保存一侧或两侧神经;C期12例,只保存S3、4神经。结果 术后自行排尿时间平均为:A期8.5d,B期9.0d,C期16.8d。保存勃起和射精机能者:Dukes A期分别是96.9%和100%;B期是47.4%和50%;C期均为0。术后肿瘤局部复发者占12.8%(24/188),其中Dukes A、B、C期分别为4.1%、20.5%和33.3%。5年生存率Dukes A、B、C期分别是77.6%、52.6%、33.3%。结论 保存植物神经的直肠癌根治术,在不增加局部复发率和减少5年生存率的同时,可明显提高患者的生存质量。  相似文献   

2.
直肠癌的临床特征及手术方式的探讨   总被引:2,自引:0,他引:2  
总结直肠癌的临床特征及探讨中下段直肠癌手术方式的选择。回顾分析1991年1月~1996年12月外科治疗直肠癌210例,随访不同手术方式的治疗效果。统计学处理采用率和X2检验。直肠癌发病年龄中位数45岁,Astler-Coler分期B、C分别为58.4%、28.9%。中、下段直肠癌分别占40%、49.5%。保肛手术和Miles术疗效无显著性差异(P>0.05)。我国的直肠癌中青年患者较多,多位于直肠中下段,早期就诊病例较少。中下段直肠癌保肛手术疗效肯定,选择保肛手术时重要的是重视肿瘤的生物学特征。  相似文献   

3.
局部切除治疗低位直肠癌32例报告   总被引:6,自引:0,他引:6  
目的探讨低位直肠癌局部切除的适应证。方法结合文献分析了中国医学科学院肿瘤医院1975年1月至1997年8月局部切除治疗低位直肠癌病人32例。结果26例做了术后放疗,3例做了术前放疗。5年生存率为(844±83)%(寿命表法)。总局部复发率为188%,高分化腺癌复发率125%(3/24),中分化腺癌375%(3/8)。T1期复发率179%(5/28),T2期复发率25%(1/4)。结论低位直肠癌局部切除适应证为:肿瘤局限于粘膜下层,病理为高分化腺癌,肿瘤直径≤4cm。  相似文献   

4.
124例Ⅱ期非精原细胞瘤治疗分析   总被引:2,自引:1,他引:1  
目的:比较Ⅱ期非精原细胞瘤不同治疗方法的疗效。方法:将124例Ⅱ期非精原细胞瘤患者按治疗方法不同分三组,其中单纯手术组(A组)45例,手术+术后放疗组(B组)40例,手术+术后化疗组(C组)39例。比较三组局部复发率,远处转移率,3、5年生存率。结果:A组局部复发率为37.8%,远处转移率为42.2%,3、5年生存率分别为57.8%、40.0%;B组局部复发率、远处转移率,3、5年生存率分别与A组  相似文献   

5.
报道1986年1月~1994年12月间收治直肠癌患者783例,其中,中下段直肠癌552例(占70.5%)。该552例中施行各类保肛术201例(占36.4%),其中经腹骶切除5例,经耻骨切除5例,Dixon式67例,拉下式吻合44例,拖出式吻合68例及局部切除12例。术后3年生存率达90.9%。文中就保肛手术的根治性、术后排便功能的恢复、并发症的产生和处理以及综合治疗的必要性等问题进行了分析讨论。认为保肛术是治疗中下段直肠癌的一种合理术式,其主要适用于Duke’sA和B1期病例。采取综合治疗则是预防癌肿复发和提高生存率的重要措施。  相似文献   

6.
Budd-Chiari综合征的病因、诊断、分型和处理   总被引:6,自引:1,他引:6  
自1986年1月至1993年4月我们采用IVC切开直视根治术证实BCS67例,凡有原因不明的淤血性肝肿大、腹水与躯干浅表静脉上行性曲张者.首应考虑本病.BUS、CT、IVCG可确诊,有定位定性价值.经手术证实BUS对IVC单纯性病变正确诊断率为97.0%,复合病变确诊率为83.6%,病变定位准确率100%;IVCG定位准确率95.3%,定性符合率74.5%.本组病例曾作CT10例和ECT3例,对病变定位定性诊断尚缺乏经验。术中发现IVC膜性梗阻37例(55.2%),IVC狭窄15例(22.4%),单纯栓塞9例(13.4%,包括癌栓1例),缺损或闭塞3例(4.8%),外压3例(4.8%),其中复合病变23例(34.3%).本组均为IVC病变,未发现单纯HV病变.作者将本病分为5型和5种根治原则:Ⅰ型为膜性梗阻(MOVC,55.2%),需行膜切除;Ⅱ型为肝段IVC狭窄(SVC,22.4%),应行腔静脉扩大成形术;Ⅲ型为IVC血栓型(TVC,13.4%),应摘除血栓或癌栓;Ⅳ型为IVC缺损型(CVC,4.8%),应行血管移植;Ⅴ型为外压型(EPVC,4.8%),应解除外压因素(索带或肿瘤切除等);各型可有复合型(  相似文献   

7.
低位直肠癌保肛手术临床分析   总被引:1,自引:0,他引:1  
目的:分析探讨低位直肠癌保肛手术适应证、术式选择和疗效,方法:根据肛门指诊、直肠腔内超声、CT,1993年8月至1994年12月在161例直肠癌中选择94例实施保肛手术。手术术式分别为低位、超低位结肠-直肠吻合手术。Park’s手术、Bacon手术、比较分析术工选择原则。手术合并症、排例功能、5年生存率、局部复发率。结果:低位直肠癌保肛率为58.39%,其中低位吻合9例,超低位吻合48例,Park’s手术25例,Bacon手术13例;手术死亡2例(2.1%),吻合口瘘3例(3.19%,吻合口狭窄13.8%。术后排便功能优良率;低位吻合为100%,超低位吻合为97.71%,Park’s88%,Bacon手术53.33%。5年生存率和局部复发率,低位吻合为82%、0%;超低位吻合78.9%,41.6%;Park’s  相似文献   

8.
上皮钙粘附素和树突细胞在膀胱癌中的表达及临床意义   总被引:6,自引:0,他引:6  
目的:探讨膀胱癌中树突细胞(DC)和上皮钙粘附素(E-cd)的表达及其与生物学行为的关系。方法:采用免疫组织化学LSAB法检测E-cd和DC。结果:69例膀胱癌中35例E-cd正常表达(50.7%),22例DC正常表达(31.9%),E-cd正常表达率在Ⅰ,Ⅱ,和Ⅲ级肿瘤中分别为72.2%,65.2%和25.0%,在Tis ̄1期和T2 ̄4期肿瘤中分别为78.8%和25.0%。DC正常表达率在Ⅰ、Ⅱ  相似文献   

9.
为探讨乳腺癌P62^C-myc蛋白表达与雌激素和孕激素受体的关系及其临床意义,采用LSAB免疫组化法对107例乳腺癌标本进行P62^C-myc蛋白检测。结果:P62^Cmyc蛋白表达阳性率为63.55%(68/107),在生存时间≤5年、〉5年〈10年及≥10年者,其P^62Cmyc蛋白表达阳性率分别为94.00%(47/50),65.00%(13/20)和 21.62%(8/37),表明P62C  相似文献   

10.
结直肠癌患者术前区域动脉灌注化疗对癌细胞增殖的影响   总被引:4,自引:0,他引:4  
目的 探讨术前区域动脉灌注化疗对人结直肠癌细胞增殖的影响。方法 选择术前临闲是证实的结直肠癌患者20例,于术前选择肿瘤供应动脉行区域灌注化疗。10d后行根治手术,免疫组织化学法测定并比较癌组织增殖细胞核抗原(PCNA)及细胞周期蛋白D1(cyclinD1)的表达水平,同时选择同期未行动脉灌注化疗的结直肠癌患者直接接受根治手术,作为对照组。结果 化疗组及对照组PCNA标记指数(LI)分别为16.4%&;#177;15.2%及38.1%&;#177;17.8%(P=0.02);cyclinD1LI分虽为8.7%&;#177;8.0%及27.4%&;#177;16.5%(P=0.0002)。细胞增殖指标PCNA及cyclinD1的表达在化疗组显著低于对照组,结论 术前选择性区域动脉灌注化疗对结直肠癌细胞可能有较明显的抑制作用,从而发挥抑制肿瘤生长的治疗作用。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

14.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

15.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

16.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

17.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

18.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

19.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

20.
A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.  相似文献   

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