腹腔镜辅助胃癌D2根治术治疗老年进展期远端胃癌患者的临床价值及近期预后

目的 探讨腹腔镜辅助胃癌D2根治术治疗老年进展期远端胃癌患者的疗效及近期预后.方法 回顾性分析2014年1月至2017年3月中国科技大学附属第一医院收治的限期行胃癌D2根治术治疗的64例老年进展期远端胃癌患者的临床资料,根据治疗方案不同分为观察组(28例)和对照组(36例).观察组应用腹腔镜辅助胃癌D2根治术治疗,对照组应用常规开腹胃癌D2根治术治疗.比较两组患者的手术时间、术中出血量、术后胃肠排气时间、术后住院时间、淋巴结清扫数等临床指标;比较两组患者切口感染、肺部感染、吻合口瘘、吻合口出血及术后胃瘫等术后并发症的差异.随访3～36个月,比较两组患者术后生存时间及术后肿瘤复发率的差异.结果 观察组的手术时间、术中出血量、术后胃肠排气时间、术后住院时间等临床指标均低于对照组,差异有统计学意义(P<0.05),两组患者淋巴结清扫数差异无统计学意义(P>0.05),两组患者的术后并发症发生率差异无统计学意义(P>0.05).随访3～36个月,术后平均生存时间及术后肿瘤复发率差异无统计学意义(P>0.05).结论 腹腔镜辅助胃癌D2根治术治疗老年进展期远端胃癌患者具有手术时间短、术中出血量少、术后恢复快等优点,近期预后与开腹手术相似.     

腹腔镜辅助下胃癌根治术(附57例报道)

目的:观察近期临床疗效,探讨腹腔镜下胃癌根治术的可行性?方法:2008年5月~2009年5月,行腹腔镜下胃癌根治性切除术57例,其中根治性远端胃癌根治术37例,根治性近端胃癌根治术10例,根治性全胃切除术10例?结果:57例均在腹腔镜辅助下完成手术,d1淋巴结清扫6例,d2淋巴结清扫51例?平均手术时间273 min(155~450 min)?镜下术中出血量平均为35 ml(l0~60 ml)?术中无脏器损伤?清扫淋巴结平均数为16枚(4~23枚)?本组无手术死亡?术后胃肠功能恢复时间的平均数3天(2~5天)?术后无出血?吻合口漏及肺部感染等并发症?结论:用腹腔镜进行胃癌根治术是安全的,也是可行的?     

腹腔镜下胃癌D2根治术治疗进展期胃癌的临床效果

目的观察腹腔镜下胃癌D2根治术治疗进展期胃癌的临床效果。方法采用随机数表法将2016年1月至2018年11月在鹤壁市人民医院就诊的68例进展期胃癌患者分为对照组和观察组,各34例。对照组接受开腹手术,观察组接受腹腔镜手术。记录围手术期相关指标,统计淋巴结清扫数目,使用健康状况调查量表(SF-36)评估术前和术后3个月患者的生活质量,统计术后并发症发生率。结果观察组术中出血量少于对照组,首次排气时间、首次进食时间、胃管留置时间和住院时间均短于对照组,差异有统计学意义(均P<0.001)。两组淋巴结清扫数目比较,差异无统计学意义(均P>0.05)。术后3个月,两组SF-36评分均较术前升高,且观察组SF-36评分高于对照组,差异有统计学意义(均P<0.05)。观察组术后并发症发生率(8.82%)低于对照组(29.41%),差异有统计学意义(P<0.05)。结论腹腔镜下胃癌D2根治术治疗进展期胃癌,手术创伤小,术后恢复快,在临床选择手术方案时可优先考虑腹腔镜手术。     

腹腔镜辅助与开腹远端胃癌根治术治疗进展期胃癌的疗效比较

目的比较腹腔镜辅助远端胃癌根治术与开腹远端胃癌根治术治疗进展期胃癌的疗效比较。方法收集76例由同一组医师连续实施远端胃癌根治术的进展期胃癌患者的临床资料。其中行腹腔镜辅助远端胃癌根治术46例(腹腔镜组),行开腹远端胃癌根治术30例(开腹组)。对2组患者的手术时间、术中出血量、术后通气时间、术后住院时间、住院费用、清扫淋巴结数目、术后并发症(伤口感染、粘连性肠梗阻、胃瘫、吻合口漏等)的发生情况及近期疗效(1、3年的生存率和无瘤生存率)进行比较。结果腹腔镜组的手术时间、住院费用、清扫淋巴结数目、术中出血量及术后并发症例数与开腹组比较差异均无统计学意义(均P>0.05)。腹腔镜组术后通气时间及术后住院时间均明显短于开腹组(均P<0.05)。2组患者术中均未发生损伤大血管或周围脏器等严重并发症,腹腔镜组无转开腹病例。2组患者均随访10~52(26.8±9.8)个月,1、3年生存率和无瘤生存率比较差异均无统计学意义(均P>0.05)。结论对于进展期胃癌患者,腹腔镜辅助远端胃癌根治术是一种可行而短期疗效好的手术方式,远期疗效仍需长期随访。     

保留脾脏的胃癌根治术中拖出式脾门淋巴结清扫与原位脾门淋巴结清扫的疗效分析

目的:探讨保留脾脏的胃癌D2根治术中拖出式脾门淋巴结清扫与原位淋巴结清扫的疗效。方法:选取82例行腹腔镜D2全胃根治术的进展期近端胃癌患者,根据淋巴结清扫方式不同分为观察组和对照组,每组各41例。观察组患者术中行拖出式脾门淋巴结清扫;对照组患者术中行原位脾门淋巴结清扫。比较两组患者手术相关指标、术后恢复相关指标、术后并发症情况及术后1年总生存率。结果:观察组患者手术时间短于对照组;术中出血量低于对照组;清扫脾门淋巴结数量多于对照组,差异均有统计学意义(P<0.05);两组患者清扫脾门淋巴结总数、术后排气时间、流质饮食时间、拔除引流时间、住院时间、术后并发症发生及1年总生存率均无统计学差异(P>0.05)。结论:腹腔镜D2全胃根治术中,与原位脾门淋巴结清扫方式相比,拖出式脾门淋巴结清扫术手术时间更短,术中出血更少,且提高了脾门淋巴结清扫率。     

三角吻合技术在全腹腔镜胃癌根治术中的应用

目的 探讨分析三角吻合技术应用于全腹腔镜胃癌根治术的临床治疗效果和安全性.方法 选取确诊远端胃癌并接受腹腔镜下胃癌根治术治疗患者,共60例,随机分为两组.30例患者以三角吻合技术行全腹腔镜远端胃癌根治术,为观察组;余30例患者以常规临床开放远端胃癌根治术行手术治疗,为对照组.观察记录两组患者手术时间、术中出血量、肛门排气时间、淋巴结清扫个数及术后并发症发生率并比较分析.结果 观察组患者手术时间、术中出血量、肛门排气时间较对照组显著减少,淋巴结清扫个数较对照组明显增加,差异具有统计学意义(P<0.05);观察组患者术后并发症发生率较对照组明显降低,差异具有统计学意义(P<0.05).结论 三角吻合技术应用于全腹腔镜胃癌根治术在临床上疗效相较于常规开放远端胃癌根治术显著提高,且其具有更高的安全性,值得推广运用.     

腹腔镜辅助胃癌根治术治疗进展期胃癌临床指标评价及随访观察

目的探讨腹腔镜辅助胃癌根治术与开腹胃癌根治术治疗进展期胃癌患者的临床疗效,并随访观察并发症发生情况。方法选取我科2015年1月~2016年12月收治的142例进展期胃癌患者为本次研究对象,根据患者意愿采取不同手术方式进行治疗,再根据不同手术方式将其分为对照组和观察组,对照组70例行开腹胃癌根治术,观察组72例行腹腔镜辅助胃癌根治术,观察两组患者的临床指标并随访并发症发生情况。结果两组患者的术中临床指标除吻合方式及清扫淋巴结数目外,差异均有统计学意义(P0.05);术后临床指标除CRP术前1 d无差异外,其余指标差异均有统计学意义(P0.05);两组患者并发症发生率比较,差异无统计学意义(P0.05);对照组患者1例出现吻合口复发,1例出现肝转移;观察组患者1例出现后腹膜转移。两组患者均无死亡病例及远期肠梗阻发生。结论腹腔镜辅助胃癌根治术治疗进展期胃癌患者具有安全及微创优势,疗效较开腹胃癌根治术更好。     

腹腔镜D2淋巴结清扫胃癌根治术术后并发症及危险因素的分析

目的 分析腹腔镜D2淋巴结清扫胃癌根治术术后并发症及危险因素.方法 选取2018年10月至2019年12月于本院行腹腔镜D2淋巴结清扫胃癌根治术治疗的胃癌患者109例为研究对象,根据患者术后并发症发生情况分为并发症发生组(n=21)与未发生组(n=88),统计两组临床资料,包括年龄、性别、有无腹部手术史等,分析可能导致行腹腔镜D2淋巴结清扫胃癌根治术患者术后发生并发症的危险因素.结果 入选109例行腹腔镜D2淋巴结清扫胃癌根治术患者中,21例术后发生并发症,占19.27％,其中吻合口瘘4例,肠梗阻2例,腹腔出血7例,腹腔感染1例,术后胃排空障碍3例,淋巴瘘2例,肠坏死1例,切口感染1例.两组年龄、性别、有无既往腹部手术史比较差异无统计学意义;两组肿瘤TNM分期、淋巴结数目、BMI、吻合方式比较差异有统计学意义(P<0.05).经多项非条件Logistic回归分析检验结果显示,肿瘤TNM分期Ⅲ期、淋巴结数目≥40枚、BMI≥24 kg/m2、BillrothⅡ式吻合可能是导致腹腔镜D2淋巴结清扫胃癌根治术患者术后发生并发症的危险因素(OR>1,P<0.05).结论 肿瘤TNM分期Ⅲ期、淋巴结数目≥40枚、BMI≥24 kg/m2、BillrothⅡ式吻合可能是导致腹腔镜D2淋巴结清扫胃癌根治术患者术后发生并发症的危险因素,临床于手术过程中需积极做好应对措施,以降低并发症发生率.     

3D腹腔镜技术在腹腔镜辅助根治性全胃切除术中的应用价值

目的探讨3D腹腔镜技术在腹腔镜辅助全胃切除术及D2淋巴结清扫中的应用价值。方法选取2015年2月至2016年3月郑州大学附属肿瘤医院收治的符合入组标准的行腹腔镜辅助根治性全胃切除术的73例患者,根据患者使用腹腔镜的不同将其分为3D腹腔镜组(3D组,35例)和2D腹腔镜组(2D组,38例)。比较两组患者腹腔镜下食管空肠吻合时间、脾门清扫时间、总手术时间、出血量、淋巴结清扫数、排气时间、进食时间、术后短期并发症(吻合口瘘、吻合口出血、乳糜漏及胰漏)和术后住院时间。结果 3D组腹腔镜下食管空肠吻合时间、脾门清扫时间、总手术时间和出血量均明显优于2D组(P<0.05);两组淋巴结清扫数、排气时间、进食时间、术后短期并发症(吻合口瘘、吻合口出血、乳糜漏及胰漏)和术后住院时间比较,差异无统计学意义(P>0.05)。3D组出现吻合口瘘1例,2D组出现吻合口瘘2例,胰瘘2例,乳糜漏1例,均经保守治疗后恢复出院。结论 3D腹腔镜技术在腹腔镜辅助根治性全胃切除术中是安全可行的,且能缩短腹腔镜下食管空肠吻合时间、脾门清扫时间及总手术时间,减少术中出血量。     

腹腔镜胃癌根治术治疗进展期胃癌的疗效分析

目的探讨腹腔镜胃癌根治术治疗进展期胃癌的疗效,旨在为腹腔镜辅助胃癌根治术的临床推广及应用提供有利的参考依据。方法选择2016年1月~2017年1月我院行腹腔镜胃癌根治术患者40例作为观察组,另外选择同期行开腹手术患者40例作为对照组,对比两组的手术效果。结果观察组患者的手术时间为(140.5±18.2)min,明显短于对照组,观察组的术中出血量为(132.4±22.6)m L,明显少于对照组,观察组的术后下床活动时间为(2.3±0.7)d,明显短于对照组,两组比较差异有统计学意义(P0.05)。观察组患者无一例出现肺部感染、腹腔感染、肠梗阻,对照组患者出现肺部感染2例、腹腔感染1例、吻合口出血2例、吻合口瘘4例、肠梗阻3例,两组并发症发生率分别为5.0%、30.00%,观察组患者的并发症发生率明显低于对照组,两组比较差异有统计学意义(P0.05)。结论腹腔镜胃癌根治术治疗进展期胃癌手术效果确切,较开腹手术具有较多优点,如术中出血少、术后并发症少及术后恢复快等,值得临床广泛推广和应用。     

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.