代谢综合征与胃癌患者术后短期疗效的关系研究

Objective To investigate the incidence of metabolic syndrome (MS) in patients with gastric cancer, and to explore the relationship between MS and the tumor site and the influence of MS on surgical procedure and short-term outcomes of patients with gastric cancer. Methods The clinical data of 639 patients with gastric cancer who were admitted to the Affiliated Hospital of Qingdao University from January 2006 to June 2008 were retrospectively analyzed. Patients with MS were in the MS group ( n= 64) and those without MS were in the control group ( n = 575 ). The surgical and postoperative complications were reviewed and the tumor site, intraoperative conditions and short-term outcomes between the two groups were analyzed. All data were analyzed using the chi-square test or t test. Results The incidence of MS in patients with gastric cancer was 10.0% (64/639).The incidence of MS in female patients was 14.4% (27/188), which was significantly higher than 8.2% (37/451)of male patients ( χ2= 6.265, P < 0.05). The operation time of the MS group was ( 185 ± 133 ) minutes, which was significantly longer than ( 168 ± 50) minutes of the control group ( t = 2. 126, P < 0. 05 ). The number of lymph nodes dissected in the MS group was 18 ± 11, which was significantly lower than 21 ± 11 of the control group ( t = 2. 125, P < 0.05 ). The postoperative period of fever of the MS group was (3.0 ± 1.4) days, which was significantly longer than (2.5 ± 1.4) days of the control group (t = 2. 433, P < 0.05 ). The incidence of postoperative complications of the MS group was 31.3% (20/64), which was significantly higher than 14.3% (82/575) of the control group ( χ2 = 12.291, P < 0.05 ). The length of hospital stay of the MS group was ( 19 ± 11 ) days,which was significantly longer than ( 16±11 ) days of the control group ( t = 2. 141, P< 0.05 ). The mortalities of MS group and control group were 0 and 0. 5% (3/575), respectively, with no significant difference ( χ2 = 0.000,P >0.05). Condusions A low prevalence of MS is found in patients with gastric cancer. However, patients with gastric cancer complicated with MS may present with prolonged surgical procedure, reduced amount of lymph nodes dissected and increased incidence of postoperative complications, hospital stay and costs. Perioperative management of patients with gastric cancer complicated with MS should be paid more attention.     

绿茶多酚改善环孢素A抑制血管舒张的作用

Objective To observe the alleviation effect of green tea polyphenols (GTP) on cyclosporine A (CsA)-induced inhibition of vasodilation, and to study the underlying mechanism. Methods Thirty SD rats were randomly divided into three groups: CsA group, control group and CsA + GTP group. Five weeks after the treatment, the body weight, kidney function (BUN, Cr) of the rats were measured. Then thoracic aorta rings were mounted on a bath system, and the Ach-induced vasodilation, the effect of L-NAME and indomethacin pretreatment on the vasodilation and the denuded vasodilation were evaluated. The contents of nitric oxide (NO) in the vascular tissues were measured. Results Five weeks later, the body weight of the rats in CsA group (253.2 ±8.1) g was lighter than that in control group (292.1 ±9.5) g (P < 0.05);the body weight in CsA + GTP group (287.9 ± 9.7) g was heavier than that in CsA group ( P < 0.05);The levels of BUN and Cr in CsA group were higher than in control group (P <0.05);The levels of BUN and Cr in CsA + GTP group were lower than in CsA group (P <0.05). The maximal response for Achinduced vasodilation in CsA group was (42.5 ±4.3)% , significantly lower than (81.2 ±7. 6)% in control group and (70.1 ± 6.5) % in CsA + GTP group (both/P < 0.05). After pretreatment with L-NAME, the vasodilation in CsA group and CsA + GTP group was (40.3 ±3.7)% and (45.8 ±4.2)% respectively, lower than in control group (79. 4 ± 6. 8)% ;After pretreatment with indomethacin, the vasodilation in control group and CsA + GTP group was higher than in CsA group (both P < 0.05). The vasodilation in the denuded groups was inhibited, but there was no significant difference between groups (P>0.05). In CsA group, the content of NO in vascular tissues was lower than that in control group and CsA + GTP group (both P < 0.05). Conclusion CsA might decrease the NO content in vascular tissues and induce abnormal endothelium-dependent vasodilation which is mediated by NO. The administration of GTP could increase the NO content and alleviate the CsA-induced inhibition of the endothelium-dependent vasodilation.     

绿茶多酚改善环孢素A抑制血管舒张的作用

Objective To observe the alleviation effect of green tea polyphenols (GTP) on cyclosporine A (CsA)-induced inhibition of vasodilation, and to study the underlying mechanism. Methods Thirty SD rats were randomly divided into three groups: CsA group, control group and CsA + GTP group. Five weeks after the treatment, the body weight, kidney function (BUN, Cr) of the rats were measured. Then thoracic aorta rings were mounted on a bath system, and the Ach-induced vasodilation, the effect of L-NAME and indomethacin pretreatment on the vasodilation and the denuded vasodilation were evaluated. The contents of nitric oxide (NO) in the vascular tissues were measured. Results Five weeks later, the body weight of the rats in CsA group (253.2 ±8.1) g was lighter than that in control group (292.1 ±9.5) g (P < 0.05);the body weight in CsA + GTP group (287.9 ± 9.7) g was heavier than that in CsA group ( P < 0.05);The levels of BUN and Cr in CsA group were higher than in control group (P <0.05);The levels of BUN and Cr in CsA + GTP group were lower than in CsA group (P <0.05). The maximal response for Achinduced vasodilation in CsA group was (42.5 ±4.3)% , significantly lower than (81.2 ±7. 6)% in control group and (70.1 ± 6.5) % in CsA + GTP group (both/P < 0.05). After pretreatment with L-NAME, the vasodilation in CsA group and CsA + GTP group was (40.3 ±3.7)% and (45.8 ±4.2)% respectively, lower than in control group (79. 4 ± 6. 8)% ;After pretreatment with indomethacin, the vasodilation in control group and CsA + GTP group was higher than in CsA group (both P < 0.05). The vasodilation in the denuded groups was inhibited, but there was no significant difference between groups (P>0.05). In CsA group, the content of NO in vascular tissues was lower than that in control group and CsA + GTP group (both P < 0.05). Conclusion CsA might decrease the NO content in vascular tissues and induce abnormal endothelium-dependent vasodilation which is mediated by NO. The administration of GTP could increase the NO content and alleviate the CsA-induced inhibition of the endothelium-dependent vasodilation.     

胃十二指肠吻合口异常肌电活动对胃排空的影响

Objective To explore the impact of abnormal myoelectricity at gastroduodenal anastomosis on gastric emptying in rats.Methods Rats were randomly divided into experimental group (n =16) and control group (n =16).Pylorectomy and end-to-end gastroduodenal anastomosis were performed in the experimental group and electrodes were implanted in the serosal surface adjacent to the anastomosis.Slow waves were recorded by the implanted electrode in vivo.Gastric emptying was examined by scintigraphy.Results At the first week after surgery,antral slow-wave frequency was significantly lower in the experimental group (0.8± 1.4 vs.3.3 ± 1.2,P＜0.01 ),as was the duodenal slow-wave frequency (2.1±0.6 vs.11.1±0.7,P＜0.01).There was no consecutive slow-waves transduction across the pylorus or the anastomosis.Within 12-16 weeks after operation,antral slow-wave frequency in the experimental group and the control group were (8.7±0.6) cpm and (4.0±0.4) cpm,respectively(P＜0.01 ),and duodenal slow-wave frequency were ( 11.1 ±0.8) cpm and (10.8±0.7) cpm,respectively (P＞0.05).Retrograde and antegrade myoelectricity transduction through the anastomosis were detected.The mean semi-emptying time in the proximal stomach was 14.7 min in the experimental group and 13.6 min in the control group (P＞0.05).Radionuclide retention rate was 25.4% in the experimental group and 39.4% in the control group (P＞0.05).The mean semi-emptying time in the distal stomach was 25.3 min in the experimental group and 10.5 min in the control group (P＜0.01).Radionuclide retention rate was 46.4% in the experimental group and 18.7% in the control group(P＜0.01 ).Conclusion The abnormal myoelectricities in the region of gastroduodenal stoma may delay liquid gastric emptying in pylorectomy rats.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

膝关节后交叉韧带断裂治疗临床分析

目的 对35例膝关节后交叉韧带断裂治疗进行临床分析,重点探讨了有关交叉韧带断裂的治疗问题。方法 经明确诊断后,分析采用胫骨附着处撕脱骨折复位固定手术治疗26例、早期髌韧带中1／3移植重建3例、单纯长腿石膏固定6例。结果 本组病例全部进行随访,随访时间13个月－5年,胫骨附着处撕脱骨折复位固定及髋韧带中1／3移植重建29例为优良、单纯长腿石膏固定6例为差。结论 后交叉韧带断裂后应该及时给予手术修复;膝后外侧手术入路,操作简单,暴露充分;少于3个月的陈旧性病例仍适应手术治疗。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

胫骨干骨折的手术治疗对策

目的：明确不同固定器械在胫骨干不同骨折类型固定中的特点，以指导临床应用。方法：68例胫骨干骨折，行加压钢板螺钉、交锁髓内钉、单侧外固定架固定后，作临床疗效分析。结果：加压钢板固定组42例，感染5例，骨不连1例，平均愈合时间3．8个月；交锁髓内钉固定组13例，无感染及骨不连，平均愈合时间5．4个月；单侧外固定架组13例，骨不连1例，踝关节背伸受限3例，平均愈合时间4．5个月。结论：胫骨骨折交锁髓内钉固定并发症少，功能恢复好，适用范围广，但要注意及时进行动力加压。加压钢板及外固定架固定应选择各自的最佳适应证，以达到理想的疗效。