完全腹腔镜保留贲门胃癌根治术的临床应用

为了探讨完全腹腔镜保留贲门胃癌根治术的可行性和治疗效果。回顾性收集2020年11月至2021年12月在浙江省人民医院行完全腹腔镜保留贲门胃癌根治术10例患者的临床资料。男7例, 女3例;年龄(66.1±12.9)岁(38～86岁)。10例患者均成功实施腹腔镜保留贲门胃癌根治术, 无中转开腹, 消化道重建时间(24.8±3.3)min(20～30 min), 术中出血量(35±24)ml(20～100 ml)。术后排气时间(2.5±0.9)d(2～3 d), 术后进食流质饮食时间(2.25±0.87)d(2～3 d), 术后住院时间(9.5±2.1)d(6～13 d)。术后未发生出血、吻合口瘘或吻合口狭窄等严重手术相关并发症。术后病理显示, 切除标本近远端切缘均阴性。患者术后随访2～15个月, 随访期间无死亡或肿瘤复发转移病例。术后无反流症状。与全胃切除和近端胃切除相比, 保留贲门功能胃癌根治术理论上能降低反流性食管炎发生率。采用手工缝合法进行消化道重建, 可以减少2～3个吻合器枪钉的应用, 降低了手术材料费。与胃次全切除术相比, 腹腔镜保留贲门胃癌根治术淋巴结清扫更彻底, 胃残留组织很...     

改良空肠间置术在近端胃癌根治术中应用的临床研究

目的探讨改良空肠间置术在近端胃癌根治术中的治疗效果。方法选择15例近端胃癌患者作为观察组,行近端胃癌根治时采用改良空肠间置术重建消化道;选择同期15例胃近端癌行近侧胃大部切除术,残胃-食管吻合患者作为对照组。观察比较2组患者的术中出血量、手术时间、术后并发症及患者生活质量等情况。结果 2组病例均无围手术期死亡病例,无吻合口漏、中度以上贫血及倾倒综合征病例发生。2组术中出血情况无明显差异,观察组手术时间略长于对照组（P〈0.05）;术后并发症发生情况比较,2组胃排空情况及返流性食管炎发生率有显著差异（P均〈0.05）;患者术后6个月的体质量及营养指标变化情况比较,观察组患者术后生活质量显著优于对照组患者（P〈0.05）。结论在近端胃癌根治术中应用改良空肠间置术,可以显著减少术后并发症的发生,改善患者术后的生活质量,值得临床推广。     

近端胃大部分切除术后改良间置空肠吻合的临床应用研究

目的 探讨近端胃癌行近端胃大部切除后理想的消化道重建方式.方法 对60例近端胃癌患者行根治性近端胃大部分切除后采用两种常用的消化道重建术式：食管与胃直接吻合31例（直接吻合组）,食管与胃之间空肠间置吻合29例（间置吻合组）.对两种重建术的手术时间、术中出血量、术后并发症、术后1年吻合口狭窄发生率、反流性食管炎发生率及营养状况进行比较.结果 与直接吻合组比较,间置吻合组手术时间显著延长（P＜0.01）,但术中出血量、术后并发症发生率两组的差异无统计学意义（均P＞0.05）;术后1年间置吻合组反流性食管炎发生率较直接吻合组明显降低（P＜0.01）,而吻合口狭窄发生率及营养状况两组间的差异无统计学意义（均P＞0.05）.结论 食管残胃间空肠间置吻合是近端胃大部分切除后较为合适的消化道重建术式.     

食管-胃粘膜吻合术

目的 :探讨一种新的食管胃吻合方法 ,以减少食管癌、贲门癌术后吻合口瘘、吻合口狭窄及胃食管返流等并发症的发生。方法 :将 2 18名食管癌、贲门癌患者按入院顺序随即分为两组。实验组 12 6例 ,行食管 -胃粘膜吻合术 ;对照组 92例 ,行常规食管胃端 端吻合术。观察术后吻合口瘘、吻合口狭窄及胃食管返流等并发症的发生率。结果 :实验组术后吻合口瘘、吻合口狭窄及胃食管返流发生率分别为 0、 1.6%和 4.8% ,而对照组为 3 .3 %、7.6%和 3 7.0 % (P <0 .0 5 )。结论 :食管 -胃粘膜吻合术能有效地预防吻合口瘘、吻合口狭窄和胃食管返流等并发症的发生     

近端胃癌根治术临床特点分析

目的:分析近端胃癌根治术临床特点。方法:选取年7月-2011年7月行近端胃根治术的患者57例,临床根据患者病情情况分别采用全胃切除(8例)保留迷走神经切除(31例)、保留贲门切除(12例)、联合脾脏切除(6例),对不同术式的手术整体情况和不良反应发生情况分别予以统计分析。结果:在淋巴结扫描上,不同术式结果不具明显差异(P0.05);在手术出血量、手术时间、肛门排气时间和肛门排便时间、住院时间上比较,保留贲门术式和保留迷走神经术式整体效果相对更佳,联合脾脏切除术效果相对最差。不良反应发生情况上,保留迷走神经核保留贲门发生率相对更少,脾脏联合切除术发生率相对最高,比较差异均比较明显(P0.05)。结论:近端胃根治术因患者具体病情的不同临床手术特点存在差异性,应在确保手术效果的前提下,尽量行近端胃切除,以利于手术预后效果的改善。     

应用空肠间置治疗近端胃癌40例观察

近端胃癌是指食管胃结合部癌、胃底癌或胃体上段癌,如果手术切除范围不够,达不到根治的目的;手术切除胃组织过多易出现吻合困难,临床上常不得已行全胃切除术.全胃切除后,丧失了胃的贮存、混合食物及分泌消化液的功能,影响了食物摄取、消化、吸收功能,造成术后营养状况下降.     

经腹入路近端胃切除胃食管及空肠侧侧吻合的抗返流应用研究

目的:探讨经腹入路近端胃切除术后胃食管吻合的抗返流效果。方法:采用近端胃食管吻合+幽门成形(Heinecke氏法)+距屈氏韧带约20～25cm近端空肠与输出袢远端空肠行侧侧(Braun’s)全层间断缝合吻合。结果:对37例实验组患者实行该术式操作,均获得满意恢复,抗返流效果明显优于传统术式,有效减少术后返流性食管炎及吻合口瘘等并发症,提高了患者术后生活质量,效果满意。结论:近端胃切除术后,行近端胃食管吻合+幽门成形+距屈氏韧带约20～25cm近端空肠与输出袢远端空肠行侧侧(Braun’s)全层间断缝合吻合抗返流方法安全可行。     

近端胃切除后的贲门重建--介绍食管~胃胃套叠吻合术

目的为了预防近端胃切除后返流性食管炎的发生,改善病人的生活质量,探讨食管胃吻合重建食管胃连接部的最佳术式.方法在近端胃切除后,采用食管残胃对端或端侧粘膜对粘膜的同层对接吻合后,再行食管~胃胃套叠缝合,使食管胃吻合口隐藏在套入段的中下部,即是用折叠的胃壁作为贲门与食管下段的部分,如此在解剖学和组织学上似对贲门(食管胃连接部)的重建,在生理上起到贲门机制的活瓣作用.结果用本法施术395例,其中贲门癌和胃底癌335例,贲门下和胃底部巨大良性溃疡12例,贲门平滑肌瘤6例,贲门胃底息肉样腺瘤5例,贲门部平滑肌肉瘤3例,门脉高压症合并食道下段及胃底静脉曲张出血再次手术者16例,重度贲门失驰症18例.本组无手术死亡,抗返流效果良好,也未发生吻合口漏,术后发生吻合口狭窄3例.全部病例随访1-20年未出现胃液返流和返流性食管炎.结论在选择好适应证的情况下,采用近端胃切除后食管~胃胃型套叠吻合,似对贲门的重建,起到贲门机制的活瓣作用,可预防胃液返流和返流性食管炎的发生,并可减少或避免吻合口漏、溃疡和吻合口瘢痕狭窄的发生,因此是理想的术式.     

近端胃癌切除术后消化道重建方式的临床分析

目的分析近端胃癌切除术后消化道重建方式的临床效果。方法选择我院近端胃癌患者50例,根据胃癌切除术后消化道重建方式的不同,将患者分为两组:对照组与实验组,各25例;其中对照组患者行根治性全胃切除术后采用食管空肠直接吻合术治疗,实验组患者行根治性近端胃癌根治术后采用食管远端胃空肠间置术的消化道重建治疗,对两组患者进行6个月的随访,对两组胃癌患者的手术指标和并发症情况、营养学指标以及食管反流现象进行比较。结果实验组患者手术时间略长于对照组患者,差异有统计学意义(P0.05);对照组患者住院时间、术后肛门排气时间与实验组患者住院时间、术后肛门排气时间基本相同,差异无统计学意义(P0.05)。两组患者术后并发症发生率基本相同,差异无统计学意义(P0.05)。实验组患者饮食量和体重增加指标优于对照组患者,实验组患者生活质量明显优于对照组患者,两组比较差异有统计学意义(P0.05)。结论近端胃癌根治术后消化道重建方式中,食管远端胃空肠间置术具有显著效果,能够对患者的临床症状、营养情况和生活质量等进行改善,且并发症发生率相似,值得临床推广与应用。     

食管胃颈部侧侧T吻合在胸腹腔镜联合下食管癌根治术中的应用

目的 探讨食管胃颈部侧侧T型吻合在胸腹腔镜联合下食管癌根治术中的临床效果。 方法 选取行胸腹腔镜联合食管癌根治术治疗的病人66例,根据病人颈部吻合方式不同分为观察组(30例)和对照组(36例),观察组采用T型全机械侧侧吻合治疗,对照组采用颈部管状吻合。比较2组病人术中颈部吻合时间、出血量及术后1个月吻合口瘘、术后6个月吻合口狭窄及食管胃反流情况。 结果 围手术期内2组病人无死亡。观察组病人吻合时间和6个月吻合口狭窄发生率均明显低于对照组(P < 0.01);2组病人术中出血量、术后1个月吻合口瘘发生率、术后6个月胃食管反流发生率差异均无统计学意义(P>0.05)。 结论 在胸腹腔镜联合下食管癌根治术中,应用胃食管颈部侧侧T型吻合可有效缩短手术操作时间,减少吻合口狭窄的发生率,值得临床推广。     

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.