腹腔镜直肠癌手术与开腹直肠癌根治术治疗直肠癌的疗效及安全性分析

目的:分析腹腔镜直肠癌手术与开腹直肠癌根治术治疗直肠癌的临床疗效和安全性。方法:随机选取收治的直肠癌患者中抽取98例进行讨论,按照治疗方式分组,其中45例接受开腹直肠癌根治术治疗(对照组),另53例接受腹腔镜直肠癌手术治疗(研究组),观察比较治疗效果,如围术期治疗、疾病复发率、淋巴结清扫数量等。结果:研究组并发症总发生率(3.77%)低于对照组(35.56%),差异有统计学意义(P<0.05)。研究组术后转移率(1.89%)、复发率(3.77%),分别低于对照组(26.67%、31.11%),差异有统计学意义(P<0.05)。比较围术期治疗,研究组术中出血量、手术时间、肛门排气时间、术后进食时间、术中尿管拔出时间低于对照组,自由尿流率高于对照组,差异有统计学意义(P<0.05),淋巴结清扫数量比较,差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌手术治疗直肠癌,出血量少、并发症发生率低,远期疗效明显。     

结直肠癌腹腔镜手术与开腹手术的疗效对比分析

目的:对比结直肠癌腹腔镜手术和开腹手术的临床疗效。方法:120例结直肠癌手术的患者,根据手术方式的不同,分为腹腔镜组和开腹组各60例。腹腔镜组患者给予结直肠癌腹腔镜下根治性切除术治疗,开腹组患者给予开腹行结直肠癌根治性切除术,对比两组患者术中以及术后各项指标的情况。结果:腹腔镜组患者的手术时间显著长于开腹组(P<0.05);在手术出血量、肠鸣音恢复时间、术后住院天数以及术后开始下床活动时间上,腹腔镜组均显著少于开腹组(P<0.05);两组患者在淋巴结清扫数量上,差异没有统计学意义(P>0.05)。腹腔镜组术后并发症的发生率为12.50%(7/56),显著低于开腹组21.88%(14/64)(P<0.05);而两组患者的肿瘤复发率、1年生存率、3年生存率以及5年生存率的对比,其差异没有统计学意义(P>0.05)。结论:结直肠癌腹腔镜根治性切除术具有较好的临床疗效,且安全性高,术后并发症少,值得进一步推广应用。     

腹腔镜结直肠癌根治术与开腹结直肠癌根治术治疗不同分期结直肠癌效果对比

目的:对比分析腹腔镜结直肠癌根治术与开腹结直肠癌根治术治疗不同分期结直肠癌的效果。方法:选取126例结直肠癌患者随机分为观察组和对照组,观察组开展腹腔镜结直肠癌根治术,对照组开展开腹结直肠癌根治术,比较两组临床疗效、手术指标、术后恢复时间及术后并发症发生情况。结果:观察组临床总有效率较对照组显著提高(P<0.05),手术时间、切口长度显著缩短,术中出血量显著减少(P<0.05),两组淋巴结清扫数差异无统计学意义(P>0.05),观察组排气时间、肠鸣音恢复时间、排便时间、进食时间、下床活动时间、住院时间、术后并发症较对照组均显著降低(P<0.05)。结论:腹腔镜结直肠癌根治术对不同分期结直肠癌患者疗效显著,可缩短手术时间、减少出血量,减轻对患者的创伤,降低并发症发生率,促进患者术后的恢复,值得推广。     

腹腔镜直肠癌根治术与传统手术的比较

目的 比较分析腹腔镜直肠癌根治术与传统开腹手术在直肠癌治疗中的临床疗效.方法 对2007年3月～2009年10月27例腹腔镜和34例传统直肠癌根治术的临床资料进行回顾性分析.比较两组患者手术时间、术中出血量、切除淋巴结数目、肠道功能恢复时间、住院时间及术后并发症发生率.结果 腹腔镜组27例中无1例中转开腹手术.腹腔镜组手术时间短于传统开腹组,但差异无统计学意义(P>0.05).腹腔镜组术中出血量少于传统开腹组(P<0.05),术中输血例数腹腔镜组明显少于传统开腹组(P<0.05),术后肠道功能恢复时间明显早于开腹组(P<0.05),术后住院天数少于开腹组(P<0.05),手术时间腹腔镜组前期较开腹组长(P<0.05).两组肿瘤切除范围和淋巴结清扫、并发症比较差异均无统计学意义(P>0.05).两组切口均无肿瘤种植、近期死亡病例,局部复发各1例.结论 腹腔镜直肠癌根治性手术具有创伤小、术后恢复快、并发症少、住院时间短等优点,并且符合肿瘤根治原则,可达到与开腹手术同样的根治性治疗效果.     

腹腔镜与开腹直肠癌根治切除手术的术中及术后恢复情况对比观察

目的对比腹腔镜与开腹直肠癌根治切除术的术中及术后恢复情况的差异。方法选取我院收治的58例直肠癌患者作为研究对象,采用随机数字表法均分为研究组和对照组,各29例,研究组采用腹腔镜直肠癌根治术,对照组采用开腹直肠癌根治术,综合比较两组患者手术时间、术中失血量、住院时间、淋巴结清扫数量、并发症发生率和术后1年复发率、死亡率。结果研究组术中失血量、住院时间均少于对照组(P<0.05);两组患者手术时间和淋巴结清扫数量比较差异无统计学意义(P>0.05);研究组患者并发症发生率为6.90%,低于对照组的20.69%(P<0.05);随访1年,研究组复发率、死亡率均低于对照组(P<0.05)。结论腹腔镜直肠癌根治术治疗直肠癌效果确切,具有创伤小、恢复快、术后并发症少、复发率低等优点。     

腹腔镜与开腹手术治疗结直肠癌的疗效对比分析

目的比较腹腔镜和开腹手术治疗结直肠癌的临床疗效。方法选取2009年1月²010年9月我院收治的88例结直肠癌患者为研究对象,随机分为腹腔镜组和开腹手术组,每组44例,比较两组的临床疗效。结果腹腔镜组的术中出血量、吗啡药剂量和肠鸣音恢复时间均少于开腹手术组,手术时间长于开腹手术组,差异均有统计学意义(P<0.05);腹腔镜组的术后并发症及肿瘤复发率均低于开腹手术组,差异具有统计学意义(P<0.05);对比两组患者术后3年生存率,差异无统计学意义(P>0.05)。结论腹腔镜治疗结直肠癌具有创伤小、出血少、疼痛轻、恢复快等优势,值得在临床上推广。     

腹腔镜下不同入路行直肠癌根治术对患者术后肿瘤复发和转移发生率的影响

目的 探讨腹腔镜下不同入路行直肠癌根治术对患者术后肿瘤复发、转移发生率的影响.方法 选取2018年1月至2019年4月本院收治的91例直肠癌患者,根据手术方法的不同分为对照组(n=45)与观察组(n=46).两组均行腹腔镜直肠癌根治术治疗,对照组采用传统中间入路方式,观察组采用头侧中间入路方式.比较两组围术期指标、淋巴结清扫情况及术后肿瘤复发率、肿瘤转移率和并发症发生率.结果 观察组手术时间、住院时间、淋巴结清扫时间均短于对照组,术中出血量少于对照组,淋巴结清扫数目多于对照组,肿瘤转移率低于对照组,差异均有统计学意义(P<0.05);两组肿瘤复发率、并发症发生率比较差异无统计学意义.结论 对行腹腔镜直肠癌根治术患者采用头侧中间入路方式治疗效果显著,可明显缩短患者手术时间与住院时间,减少术中出血量,提升淋巴结清扫效率,降低肿瘤转移率,且肿瘤复发率、并发症发生率均较低,值得临床推广应用.     

腹腔镜与开腹手术治疗进展期直肠癌的疗效比较

目的 比较腹腔镜与开腹手术治疗进展期直肠癌的局部复发率与生存率.方法 回顾性分析68例腹腔镜手术与76例开腹手术治疗进展期直肠癌切除患者的临床资料,比较两组手术情况、术后情况、术后局部复发率及生存率.结果 腹腔镜组术中失血量、术后胃肠功能恢复时间、住院时间均少(短)于开腹组,差异有统计学意义(P<0.05),腹腔镜组生存率优于开腹组(P<0.05).两组年龄、性别、手术方式、肿瘤部位、病理分期、淋巴结清扫数、切除肠管近远端长度、局部复发率差异无统计学意义(P>0.05).结论 腹腔镜进展期直肠癌切除手术具有创伤小、恢复快的优点,且生存率优于开腹手术.     

腹腔镜辅助与开腹结直肠癌根治术临床疗效对比分析

目的:对比腹腔镜辅助与开腹结直肠癌根治术临床疗效.方法:纳入2011年5月~2013年5月期间我院纳入的120例结直肠癌患者,前瞻性非随机地将患者分为腹腔镜手术组68例和开腹组52例.并观察两组一般手术情况,并发症发生情况,以及术前1d、术后1d、3d的CRP、WBC水平,以及远期肿瘤复发、远处转移和生存情况.结果:腹腔镜组患者手术时间以及淋巴结清扫数目与开腹组差异不具有统计学意义,但是腹腔镜组术中出血量、切口长度、术后排气时间、住院时间等指标均优于开腹组,差异具有统计学意义.术后腹腔镜组胃瘫发生率和总的并发症发生率显著低于开腹组,差异具有统计学意义.腹腔镜组术后1d、3d的CRP、WBC水平均较开腹组低,差异具有统计学意义.腹腔镜组术后1年生存率、复发率指标优于于开腹组,差异具有统计学意义,腹腔镜组术后3年生存率、复发率和远处转移率等指标均优于开腹组,差异具有统计学意义.结论:本研究结果表明,腹腔镜手术用于根治结直肠癌相比开腹手术具有创伤小、切口小、出血少、并发症少,炎症控制更优以及患者术后恢复更快等特点,远期疗效也更优.     

腹腔镜与开腹手术对进展期胃癌D2根治术的临床比较

目的:对比分析腹腔镜与开腹手术在胃癌进展期根治术中的临床应用效果。方法:将2008年2月至2013年9月入院治疗的110例进展期胃癌患者,随机分为两组,各55例,研究组采用腹腔镜手术治疗,对照组采用开腹手术治疗,对比两组围手术期临床指标及随访中的生存率及复发率。结果:研究组手术时间、出血量、住院恢复时间、胃肠功能恢复时间均低于对照组,差异显著(P<0.05),但两组淋巴结清扫数量无显著性差异(P>0.05)。随访3年,两组生存率、复发率差异无显著性(P>0.05);研究组术后并发症发生率1.82%明显低于对照组的12.73%,差异有显著统计学意义(P<0.05)。结论:与开腹手术对比,腹腔镜手术治疗进展期胃癌D2根治术临床效果显著,具有手术住院时间短,术中出血量少,术后恢复快等优点,值得进一步研究。     

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.