12例十二指肠憩室手术治疗体会

十二指肠憩室是消化道的常见病,但产生症状和需要手术治疗并不多,我院从1990年1月至1997年12月间．共手术治疗12例。报告如下：临床资料男8例,女4例。年龄45～60岁。其中单纯十二指肠憩室手术4例,并胆囊结石行胆囊切除加十二指肠憩室手术5例．合并胃溃疡行胃大部切除术加十二指肠憩室手术2例,合并胃底平滑肌肉瘤行近端胃大部切除加十二指肠惠室手术1例。术前均经十二指肠钡餐检查确诊。手术方法：单纯憩室切除4例,十二指肠想室内翻术6例,胃肠改道术2例。术后无近期并发症。术后经6个月至2年随访．症状消失1l例．减轻1例。讨论十二指…     

十二指肠乳头旁憩室并缩窄性乳头炎28例手术体会

[摘要] 目的 总结十二指肠乳头旁憩室并缩窄性乳头炎的手术治疗经验。方法 回顾性分析28例十二指肠乳头旁憩室并缩窄性乳头炎患者手术切除的疗效。结果 21例行憩室切除同时行Oddi括约肌切开成形者,1例出现胆瘘,3例出现一过性胃排空障碍,5例行憩室切除、胆总管-十二指肠端侧吻合及胰管-空肠Roux-en-y吻合者,无手术并发症,远期随访疗效好;2例行毕2式胃大切、胆总管-十二指肠端侧吻合者,手术恢复顺利,1例术后3年出现恶性贫血,1例术后1年有胆汁反流性胃炎。结论 十二指肠乳头旁憩室合并缩窄性乳头炎时,应切除憩室,同时行Oddi括约肌切开成形或胆胰管转流,疗效可靠。     

十二指肠憩室的诊断和治疗

目的 探讨十二指肠憩室的临床诊治问题。方法 回顾性分析34例憩室的诊断和治疗，总结十二指肠憩室的诊治经验。结果 22例为低张十二指肠钡餐造影和(或)十二指肠镜检查证实．12例为术中发现。10例保守治疗，24例手术治疗．单纯憩室切除7例．内翻缝合4例．奥狄括约肌切开成形3例，胃大部分切除憩室旷置7例(毕Ⅱ式吻合3例、胃空肠Roux-en-Y吻合4例)．胆肠Rouren—Y吻合3例，33例患者痊愈出院，1例乳突旁憩室行憩室切除术后并发急性坏死胰腺炎死亡。结论 低张十二指肠钡餐造影和(或)十二指肠镜是确诊本病的可靠方法，当憩室有并发症时应手术治疗。     

胃十二指肠溃疡急性穿孔76例的诊治体会

目的研究胃十二指肠溃疡穿孔的诊治。方法对76例胃十二指肠溃疡穿孔患者手术治疗。结果 67例行单纯缝合修补,8例行胃大部切除、胃空肠吻合术,随诊50例,复查胃镜溃疡愈合45例,未愈5例。结论 X线检查及腹腔穿刺是重要诊治手段,早期确诊及时手术,手术治疗以单纯缝合为主,术后正规药物治疗,效果满意。     

十二指肠憩室并发症及其术式选择

目的探讨十二指肠憩室的各种临床并发症及其手术治疗的术式选择。方法回顾性分析接受手术治疗的33例十二指肠憩室患者的临床资料,手术采用憩室切除术,憩室内翻缝合术,BillrothⅡ式胃切除+胃空肠吻合术和胃切除+胆肠吻合术。结果27例(81.8%)憩室位于十二指肠降部,老年患者23例(69.7%)。患者主要并发症为憩室炎症、出血、胆石症、慢性胃炎和胰腺炎,19例手术患者随访2~6年,17例(89.5%)近、远期临床效果良好。结论十二指肠憩室的并发症主要是炎症、出血、胆胰疾病,临床根据憩室部位和并发症合理选择手术方式,可以取得理想疗效。     

外伤性十二指肠破裂的诊治分析

目的：探讨外伤性十二指肠破裂的诊断和治疗方法.方法：回顾分析外伤性十二指肠破裂患者13例临床资料。结果：入院后3h内确诊6例,24～72h内确诊4例,72h后确诊3例。3例行十二指肠裂口修补,2例行十二指肠造瘘,2例行十二指肠空肠Roux-en-Y吻合,1例行十二指肠憩室化手术,1例行改良十二指肠憩室化手术,1例行十二指肠两断端关闭、胃空肠吻合,1例行十二指肠远端关闭、近端与空肠端侧吻合,2例行胰十二指肠切除术。术后6例（46.2%）出现切口感染、十二指肠瘘、消化道出血、胰瘘或腹腔感染等并发症,2例（15.4%）患者死亡,分别死于多器官系统衰竭和感染中毒性休克。结论：早期诊断与正确的术式选择是成功救治外伤性十二指肠破裂的关键。     

十二指肠憩室的外科治疗

目的探讨十二指肠憩室外科治疗的适应证和术式选择。方法对本医院1990年7月-2005年10月间收治的40例患者的临床资料进行回顾性分析。结果本组患者30-60岁居多,平均58.5岁。合并有较重的憩室炎、憩室出血、憩室穿孔、十二指肠梗阻、胆管炎或胰腺炎等症状。30例采用憩室旷置、胃大部切除、Billroth II氏吻合术,1例行憩室内翻缝合术,胃-空肠、十二指肠-空肠及胆总管-空肠Roux-en-Y吻合术各2例,憩室切除术3例中同时行Oddi氏括约肌切开成形术1例,另2例出现严重并发症死亡。33例获得随访,时间3-14年,临床疗效良好率达86.84%(33/38)。结论本病的外科治疗必须在有适应证的前提下由有胆胰十二指肠手术经验的医师施行。憩室旷置、胃大部切除、Billroth II氏吻合术应作为基本术式,疗效满意。     

胃十二指肠溃疡穿孔36例治疗体会

目的 探讨胃十二指肠溃疡急性穿孔的诊断和治疗方法.方法 对2007年4月-2009年8月收治的36例胃十二指肠溃疡急性穿孔患者的临床资料作回顾性分析.结果 4例行保守治疗,32例行手术治疗,其中修补手术30例,胃大部切除2例,均治愈.结论 胃十二指肠溃疡穿孔修补术和胃大部切除术是治疗胃十二指肠溃疡穿孔的常用术式,效果可...     

胃十二指肠溃疡穿孔76例治疗分析体会

目的 探讨胃十二指肠溃疡穿孔手术治疗及保守治疗的疗效.方法 2008年7月～2010年7月,共收治了76例胃十二指肠溃疡穿孔患者,通过治疗方法和效果比较,对76例患者进行了详细的资料分析总结.结果 单纯胃十二指肠溃疡修补51例.胃肠减压、抗炎、抗溃疡保守治疗10例,其中3例中转手术治疗（单纯缝合修补）,行胃大部分切除15例.结论 单纯缝合修补手术治疗是治疗胃十二指肠溃疡穿孔的主要治疗方法,保守治疗、胃大部分切除要根据病人情况选择适应人群.     

手术治疗胃十二指肠溃疡穿孔26例临床分析

目的 讨论胃十二指肠溃疡穿孔的手术方式及疗效.方法 总结本院26例胃十二指肠溃疡穿孔手术治疗的资料及随访结果.结果 单纯缝合修补22例,病灶局部切除缝合1例,胃大部切除3例.随访21例,复查胃镜溃疡愈合19例,未愈2例.结论 胃十二指肠穿孔的手术治疗以单纯缝合为主,术后正规药物治疗效果满意.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.