腹腔镜技术在医源性输尿管或膀胱损伤治疗中的应用(54例报告)

目的探讨腹腔镜技术在治疗医源性膀胱或输尿管损伤中的价值。方法采用回顾性分析2007年7月～2012年6月,收治54例医源性膀胱或输尿管损伤腹腔镜手术治疗效果,其中妇科手术损伤45例,泌尿外科损伤7例,普通外科损伤2例,手术包括膀胱修补、输尿管修补、输尿管端端吻合、输尿管膀胱再植及膀胱阴道瘘修补术等方法,所有患者随访1～24个月。结果所有患者均治愈,手术成功率100%,1例输尿管吻合术后7d出现盆腔积液,经阴道后穹窿引流痊愈。结论腹腔镜手术在治疗医源性膀胱或输尿管损伤较传统开放手术更具有显著优势,可最大限度的减少患者的创伤和痛苦。     

医源性输尿管损伤的诊治

目的:探讨医源性输尿管损伤的诊治。方法:本组50例中,术中发现40例,输尿管修补术15例,输尿管断端吻合术13例,输尿管膀胱吻合术12例。其余10例术后根据病史、肾分泌造影(IVU)、逆行造影等检查后,再进行相应手术。结果:本组50例均获痊愈,所有患者肾功能恢复正常。结论:细致规范手术操作,及早发现处理,是预防和治疗医源性输尿管损伤的有效方法。     

医源性输尿管损伤的诊断与治疗(附15例报告)

目的探讨医源性输尿管损伤的原因,处理和预防。方法本组15例,输尿管逆行插管（双J管）采取保守治疗1例,输尿管端端吻合术5例,输尿管膀胱吻合术8例,1例先行肾造瘘,3个月后被迫行肾脏切除。结果除1例肾切除患者外,余14例患者,肾功能恢复正常者7例,肾积水减轻者7例。结论细致规范的手术操作以及对手术中可能发生意外的预见是预防医源性输尿管损伤的关键。术中或术后一旦发现有输尿管损伤,应及时进行修复。     

医源性输尿管损伤

目的 探讨医源性输尿管损伤的诊治.方法 本组20例中,术中发现10例,其中输尿管修补术5例,输尿管断端吻合术3例,输尿管膀胱吻合术2例.其余10例术后根据病史和肾分泌造影(IVU)、逆行造影等检查后,再进行相应手术.结果 本组20例均获痊愈,所有患者肾功能恢复正常.结论 熟练手术操作,及早发现处理,是预防和治疗医源性输尿管损伤的有效方法.     

输尿管损伤的诊断与治疗

目的：探讨输尿管损伤诊断与治疗的有关问题。方法：该组共收治30例输尿管损伤患者，保守治疗2例，采用经膀胱镜置入双丁管内引流。手术治疗28例，其中肾盂输尿管吻合术8例，输尿管端端吻合术17例，输尿管膀胱移植术3例，所有手术患者均放置6，8号双丁管内支架引流。结果：30例患者1个月后拔出双丁管，同时行静脉尿路造影示肾功能良好，输尿管正常。结论：输尿管损伤原因较多，早期往往不易发现。一旦诊断为输尿管损伤，应尽早手术治疗，输尿管损伤修复成败的关健决定于修复后输尿管内支架及腹膜后引流是否可靠。     

医源性输尿管损伤36例的临床分析

目的:分析医源性输尿管损伤的原因,以及总结该病症的治疗和预防措施.方法:以1992至2009年间本院收治的36例医源性输尿管损伤患者为例,对36例患者的发病原因、治疗方法及治疗效果进行分析.其中输尿管修补术10例,输尿管端端吻合术16例,输尿管膀胱吻合术8例,其余2例患者根据术前检查情况进行相应手术.结果:30例患者均在术后痊愈,输尿管通常无狭窄,没有出现肾积水现象,肾功能恢复正常.结论:在术前,要认真分析患者发病的原因,在手术中要认真规范手术操作,可以有效治疗和预防医源性输尿管损伤.     

浅谈35例医源性输尿管损伤的诊治体会

目的:分析医源性输尿管损伤的原因,总结医源性输尿管损伤的防治措施。方法:回顾性分析35例医源性输尿管损伤患者的临床资料。结果:35例患者中妇产科、普外科、泌尿外科手术致伤者分别为17例、8例和10例。损伤方式为结扎、撕裂、离断。行松解缝扎线6例,仅留置双J管引流8倒,输尿管吻合术15例,输尿管膀胱移植术5例,肾切除术1例。术后随访35例患者肾功能均正常,无肾盂积水。结论:细致规范手术操作,及早发现处理,是预防和治疗医源性输尿管损伤的有效方法。     

延迟诊断的医源性输尿管损伤8例治疗体会

目的 探讨手术中早期未能发现的医源性输尿管损伤的处理方案。方法 回顾性分析手术中未能及时发现的医源性输尿管损伤8例的处理方法。2例经腹膜外行输尿管膀胱抗逆流吻合术；l例行输尿管膀胱肌瓣吻合术；l例再手术仅留双“J”管，由于炎症水肿严重未能仔细缝合输尿管漏口；l例经膀胱镜插入双“J”管；l例顺行介入球囊扩张后再植入双“J”管；l例经膀胱前列腺摘除术后50h仅拆除前列腺窝口过多缝合的l号肠线；l例肾脏切除。结果 7例恢复了泌尿道连续性的病例均痊愈，肾功能大部分得以恢复。l例漏诊15个月，肾脏无功能行肾切除。结论 对于不同的病情方法有别，如果能够早期正规抗逆流输尿管膀胱吻合最好；以恢复泌尿道连续性和尽量保护肾功能为基本治疗原则。     

医源性输尿管损伤一期修复20例体会

目的总结医源性输尿管损伤后首次修复的体会。方法回顾性分析和总结本院泌尿外科收治20例医源性输尿管损伤一期修复的病例资料。结果术中及时发现修复8例,修复方式:单纯留置双J管2例,行输尿管端一端吻合2例,输尿管黏膜剥脱复位并内置双J管3例,阑尾代输尿管l例;术后72h内发现并修复ll例,修复方式:输尿管膀胱再植术5例(其中2例为双侧),膀胱管状瓣输尿管成形术4例,输尿管端一端吻合术2例;以上l9例均一次修复成功,成功率为95%(19/20);超过72h后发现1例,行输尿管腹壁造瘘,6个月后行输尿管膀胱再植术后成功。结论输尿管损伤后处理较为复杂,不同部位、不同形式的损伤其治疗方法不同;在损伤72h内可行一期修复,成功率高。超过72h,应行输尿管腹壁造瘘,待二期手术。     

输尿管镜手术致输尿管长段撕脱的诊治

目的探讨输尿管镜手术致输尿管长段撕脱的诊断治疗及其预防。方法回顾性分析5例输尿管镜手术致输尿管长段撕脱患者的临床资料,包括损伤的诱因、长度及治疗方法,其中3例行回肠代输尿管术,1例行肾切除术,1例行患侧肾造瘘术、输尿管肾盂吻合术及输尿管膀胱再植术。结果 3例行回肠代输尿管患者术后肾功能正常,仅1例有轻度积水;1例行肾切除术恢复良好;1例行患侧肾造瘘术、输尿管肾盂吻合术及输尿管膀胱再植术,术后3月出现输尿管长段狭窄,拟行回肠代输尿管术。结论输尿管镜手术致输尿管长段撕脱是输尿管镜手术中最严重的并发症,及时行回肠代输尿管术,既可保护肾功能,又可保持肾输尿管膀胱的连续性,是一种很好的解决方法。     

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.