中西医结合治疗急性胆源性胰腺炎的临床研究

[目的]评价急性胆源性胰腺炎中西医结合治疗的有效性和安全性。[方法]2004年1月—2005年12月共收治急性胆源性胰腺炎136例,24～72h内行逆行胰胆管造影(ERCP)、内镜下乳头括约肌切开(EST)后用网篮取石或气囊取石及内镜下鼻胆管引流(ENBD),术后应用加减清胰汤;合并胆囊结石者,待胰腺炎恢复后,施行腹腔胆囊切除术(LC)。[结果]54例胆管结石行EST取出,所有病人均行ENBD,胰腺炎顺利治愈131例,治愈率为96.3%;合并胆囊结石113例,病情稳定后行LC。未发生与之有关的严重并发症。[结论]内镜联合中药治疗急性胆源性胰腺炎的安全性、有效性,使微创的优点在该病整个疗程中得以体现,为其治疗提供了较为理想的方法。     

急性胆源性胰腺炎的早期内镜介入治疗

[目的]探讨急性胆源性胰腺炎早期内镜治疗的方法及疗效。[方法]对急性胆源性胰腺炎64例,入院24～72h先行逆行胰胆管造影(ERCP)。对明确有胆总管结石、狭窄等病例行乳头括约肌切开术(EST)及内镜鼻胆引流术(ENBD)和内镜逆行胆管引流术(ERBD)等治疗,合并胆囊结石者,待胰腺炎恢复后,施行腹腔镜胆囊切除术(LC)。[结果]64例中,20例胆总管结石行EST取出,行ENBD7例,胰腺炎顺利治愈62例,治愈率96.9%;合并胆囊结石42例,恢复期行LC,均顺利切除胆囊治愈,非手术治愈14例占21.9%。[结论]EST ENBD能有效治疗急性胆源性胰腺炎,合并胆囊结石者联合应用LC,是目前理想的治疗方法。     

内镜联合腹腔镜治疗急性胆源性胰腺炎

目的评价胆源性胰腺炎内镜、腹腔镜治疗的临床效果。方法2000年10月至2005年6月共收治急性胆源性胰腺炎26例，其中急诊内镜治疗16例，24h内行逆行胰胆管造影术（ERCP）、内镜下乳头括约肌切开（EST）后用网篮取石术及内镜下鼻胆管引流术（ENBD）；保守治疗10例。腹腔镜胆囊切除术（LC）治疗24例，腹腔镜胆总管探查（LCBDE）1例。结果内镜组治疗的成功率为100％，未发生与内镜操作有关的严重并发症，LC后随访3个月到半年无胰腺炎复发。结论早期通过ERCP和ENBD治疗胆源性胰腺炎是安全、有效的。联用腹腔镜是治疗急性胆源性胰腺炎的理想方法。     

十二指肠镜腹腔镜联合治疗急性胆源性胰腺炎

目的 探讨应用十二指肠镜及腹腔镜治疗急性胆源性胰腺炎(ABP)的有效性.方法 回顾性分析2001年2月至2006年2月ABP病例微创治疗疗效.ABP病人按照胆道病变情况施行单纯腹腔胆囊切除术(LC);或者行内镜下乳头括约肌切开取石(EST),同时置入鼻胆管引流(ENBD);胆总管结石合并胆囊结石者,行EST、ENBD、LC联合治疗.结果 全组94例中,ABP合并胆囊结石59例行LC;胆总管结石14例行ERCP + ENBD治疗,其中3例联合EST;胆囊结石合并胆总管结石21例,行ERCP + EST或ERCP+ENBD+EST,联合LC治疗.本组病例全部治愈,住院期间无复发者.结论 十二指肠镜及腹腔镜联合应用可以有效治疗ABP.ABP微创治疗是目前理想的治疗方法.     

微创治疗急性胆源性胰腺炎

目的：评价胆源性胰腺炎虎镜、腹腔镜治疗的临床效果。方法：统计2003年1月-2007年1月共收治急性胆源性胰腺炎患者376例，371例成功于24h内行逆行胰胆管造影术（ERCP）、内镜下乳头括约肌切开（EST）后用网篮取石术及内镜下鼻胆管引流术（ENBD）OLC治疗201例，腹腔镜胆总管探查（LCBDE）6例。结果：内镜组治疗的成功率为98．67％，与内镜操作有关的并发症3．19％，LC及LCBDE后随访3个月到半年无胰腺炎复发。结论：早期通过ERCP和ENBD治疗胆源性胰腺炎是安全、有效的。联用腹腔镜是治疗急性胆源性胰腺炎的理想方法。     

内镜下EST联合鼻胆管引流术治疗急性胆源性胰腺炎

目的探讨内镜下EST联合鼻胆管引流术对急性胆源性胰腺炎的治疗作用。方法回顾分析34例进行早期内镜下乳头括约肌切开术（EST）和鼻胆管引流术（ENBD）治疗的急性胆源性胰腺炎患者和42例保守治疗的急性胆源性胰腺炎患者。结果早期内镜治疗组患者腹痛缓解时间、血淀粉酶恢复正常时间、住院时间均明显低于对照组,未发生与内镜操作有关的严重并发症。结论急性胆源性胰腺炎患者早期行内镜下EST联合鼻胆管引流术治疗是有效的、安全的。     

十二指肠镜、腹腔镜联合治疗胆结石68例效果分析

目的探讨十二指肠镜联合腹腔镜治疗胆囊结石并肝外胆管结石的临床效果。方法对68例胆囊结石合并肝外胆管结石患者的临床资料进行回顾分析。68例患者均先行内镜下十二指肠乳头切开（EST）取石、鼻胆引流（ENBD）,然后行腹腔镜胆囊切除术（LC）。结果EST取石成功64例（94.1%）,术后并发症5例（7.4%）,LC手术全部成功。结论EST和LC联合治疗胆囊结石合并肝外胆管结石是一种安全有效的微创手术方法。     

早期ENBD和EST治疗急性胆源性胰腺炎135例分析

目的探讨早期鼻胆管引流（endoscopic nasobiliary drainage,ENBD）和括约肌切开术（endoscopic sphincterotomy,EST）治疗急性胆源性胰腺炎的临床疗效。方法我们选择135例急性胆源性胰腺炎患者,早期行括约肌切开术和鼻胆管引流,并观察手术疗效和并发症情况。结果129例患者得到治愈,4例患者因胰腺脓肿接受开腹手术,2例患者死于多器官功能衰竭。结论早期ENBD和EST治疗急性胆源性胰腺炎安全有效,并发症少,是急性胆源性胰腺炎理想的手术方法。     

ERCP技术治疗急性胆源性胰腺炎43例分析

目的:研究ERCP术对急性胆源性胰腺炎的治疗效果.方法:选取2003年1月～2009年10月43例急性胆源性胰腺炎(ABP)患者,早期施行经内镜鼻胆管引流术(ENBD),经内镜十二指肠乳头切开术(EST),及取石为主的综合治疗.结果:本组病例治疗效果良好.绪论:对于急性胆源性胰腺炎患者早期行ERCP术是一种非常有效的治疗手段.     

急性胆源性胰腺炎内镜治疗护理

目的探讨急性胆源性胰腺炎内镜治疗护理的临床意义.方法对50例急性胆源性胰腺炎(ABP)患者进行了内镜逆行胰胆管造影(ERCP)检查,并进行了经内镜下乳头括约肌切开术(EST)及鼻胆管引流术(ENBD)等内镜治疗.结果全组50例患者46例治愈,其中水肿型胰腺炎40例治愈,1例转外科手术治疗.9例重症胰腺炎治愈6例,3例内镜治疗后症状无缓解或症状加重而转外科手术治疗,1例术后因多器官功能衰竭而死亡.全组行单纯性ENBD 10例,EST加ENBD 40例.38例患者在进行EST后即时取出结石,2例行EST后结石自行排出,6例行EST或ENBD后择期进行内镜治疗.内镜治疗后1周,患者体温、WBC、血、尿淀粉酶降至正常,腹膜炎症状消退,2周后黄疸消失,临床症状均明显缓解.结论内镜治疗急性胆源性胰腺炎可迅速解除梗阻,恢复胆流,具有临床疗效高、可重复性、并发症少、费用低及创伤小等优点,对明确诊断的急性胆源性胰腺炎应尽早行ERCP及内镜治疗.     

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.