腹腔镜与开放手术治疗结肠癌的远期疗效比较

目的分析腹腔镜与开放手术治疗结肠癌远期疗效存在的差异。方法随机选取2010年1月~2013年1月由同一手术组医师实施的150例结肠癌根治术患者的临床资料进行回顾性分析,根据手术方式的不同分为腹腔镜手术组(n=77)和开腹手术组(n=73),分析两组患者2年和5年生存率、局部复发和远处转移情况、术后随访期间(6个月~5年)的并发症。结果腹腔镜手术组2年生存率为79.22%,5年生存率为31.17%;开腹手术组2年生存率为79.45%,5年生存率为30.14%,两组比较差异无统计学意义(P0.05)。腹腔镜手术组术后转移复发率为20.78%,开腹手术组术后转移复发率为17.81%,两组比较差异无统计学意义(P0.05)。腹腔镜手术组随访期间并发症发生率为5.19%,与开腹手术组(17.81%)比较,差异有统计学意义(P0.05)。结论采用腹腔镜术式治疗结肠癌与开腹手术的远期疗效无显著差异,但腹腔镜手术术后远期并发症少,具有一定优势,值得进一步研究和推广。     

腹腔镜根治术与传统开腹手术治疗结肠癌的对比研究

目的单中心对比腹腔镜根治术与传统开腹手术治疗结肠癌近远期疗效。方法采用回顾性分析,2011年1月至2016年2月,医院采用腹腔镜根治术治疗结肠癌114例,纳入腹腔镜组,同期采用开腹手术根治治疗患者75例,纳入开腹组,对比分析。结果腹腔镜组与开腹组均未见切缘阳性,腹腔镜组术中出血量、下床活动时间、普食恢复时间、住院时间、并发症发生率低于开腹组,差异有统计学意义(P0.05)。腹腔镜组随访时间、局部复发、远处转移、CEA上升、生存率、局部复发/远处转移时间与开腹组差异无统计学意义(P0.05)。结论腹腔镜根治术治疗结肠癌有明显的微创优势,且不会增加复发转移死亡风险。     

腹腔镜下右半结肠癌D3根治术中期疗效评估

目的：分析采用腹腔镜下D3根治术治疗右半结肠癌的中期临床疗效。方法病例资料来源于我院2009年3月1日—2010年4月30日间60例右半结肠癌患者,进行腹腔镜下D3根治手术,探讨其中期治疗效果。结果术后随访8个月~48个月,期间1例出现戳创孔肿瘤种植,4例远处转移（其中1例骨转移,1例肝转移,2例肺转移）,2例（3.33%）局部复发。无病总生存率为81.67%,Ⅰ期达89.66%,Ⅱ期为88.89%,Ⅲ期为53.85%;4年总生存率为81.67%,其中Ⅰ期为93.10%,Ⅱ期为77.78%,Ⅲ期为53.85%。结论对右半结肠癌通过腹腔镜下D3根治术治疗安全性高、出血少,有利于改善患者的症状,中期疗效较好,值得临床推广及应用。     

不同分期结肠癌患者行腹腔镜手术的临床效果分析

目的:研究不同分期结肠癌患者行腹腔镜手术的临床疗效。方法:选取本院近年收治的结肠癌患者162例为研究对象,其中81例行开腹结肠癌根治术(常规组),另81例行腹腔镜手术(腹腔镜组),比较两组术后复发、远程转移及并发症情况。结果:两组在不同分期上的远处转移、局部复发及1年存活率上比较,差异均无统计学意义(P0.05);腹腔镜组术后总并发症率明显小于常规组,差异有统计学意义(P0.05);腹腔镜组Ⅲ期患者术后复发率、转移率及总并发症发生率均明显高于Ⅰ期、Ⅱ期患者,但差异均无统计学意义(P0.05)。结论:腹腔镜手术治疗结肠癌患者具有高效性和安全性,在手术时机选择上,结肠癌Ⅰ期、Ⅱ期是腹腔镜手术的最佳治疗时机,治疗时应当结合临床分期科学选择术式,进行针对性预后。     

腹腔镜结肠癌根治术与开腹结肠癌根治术的远期疗效比较

目的:探讨腹腔镜结肠癌根治术与开腹结肠癌根治术在远期疗效上的异同。方法:选取2010年~2012年间于我院手术治疗的结肠癌患者为研究对象,其中采用腹腔镜结肠癌根治术的患者78例为腹腔镜组,采用开腹结肠癌根治术的患者86例为开腹组。术后比较2组患者5年内生存率、结肠癌复发率、癌细胞转移率以及术后并发症等,评价腹腔镜结肠癌根治术与开腹结肠癌根治术在远期疗效上的异同。结果:2组患者的5年内生存率、复发率和癌细胞转移率无明显差异,P>0.05,腹腔镜组的并发症发生率低于开腹组,差异明显,有统计学意义,P<0.05。结论:腹腔镜和开腹2类结肠癌根治术的癌细胞复发、转移情况以及5年内生存率比较差异不大,但腹腔镜组手术损伤小,并发症少,具有一定优势。     

腹腔镜消化道恶性肿瘤手术的无瘤技术

目的 运用腹腔镜下消化道恶性肿瘤手术的无瘤技术与手术配合,探讨其在防止肿瘤细胞医源性扩散和局部种植的临床意义.方法 分析52例消化道恶性肿瘤患者严格遵循无瘤技术实施腹腔镜下肿瘤根治性手术的治疗效果.其中胃癌根治性远端胃切除4例,结肠癌根治术13例,直肠癌Dixon手术18例,直肠癌Miles手术17例.结果 随访3个月~2年,仅3例复发或转移,1例为Ⅱ期直肠癌患者,术后10个月吻合口复发,1例为Ⅲ期结肠癌患者术后9个月发现肝有转移病灶,1例Ⅱ期胃癌患者术后10个月发现肝有转移灶,均未发现穿刺鞘部位种植.结论 腹腔镜消化道恶性肿瘤手术中严格遵循无瘤技术,可有效地防止癌细胞的医源性扩散,对提高患者的长期生存率有重要的临床意义.     

开腹与腹腔镜手术治疗结肠癌的远期疗效对比分析

目的对比开腹与腹腔镜手术治疗结肠癌患者的远期疗效。方法将收治入院的180例按其手术方式分为开腹结肠癌根治术组(OP组)与腹腔镜结肠癌根治术组(LAP组)。对两组患者出院后的远期疗效进行对比,比较病死率、各期转移率及远期并发症等方面的差异。结果两组患者的远期疗效除粘连性肠梗阻并发症发生情况外,其他方面均相近,差异无统计学意义(P>0.05);LAP组粘连性肠梗阻并发率(I、II期为4.08%,III期7.32%)明显低于OP组(I、II期为23.40%,III期23.26%)患者,差异有统计学意义(P<0.05)。结论腹腔镜结肠癌手术与传统开腹结肠癌根治术的远期复发率和各期转移率等情况基本相近,而在远期并发症粘连性肠梗阻发生情况上腹腔镜结肠癌手术相对占优势。     

腹腔镜治疗高位结肠癌手术方案探讨

目的:通过对普通开腹治疗和腹腔镜治疗结肠癌的患者进行跟踪调查,判断和总结高位结肠癌的最佳治疗手段。方法:对38例高位结肠癌进行手术后跟踪随访调查,包括对患者术后的附件转移、肝肺转移、是否复发、吻合口以及是否死亡等状况进行调查记录。结果:术后患者随访2～38个月,随访6～12个月时发现5例附件转移(其中,3例为开腹手术治疗患者,2例为腹腔镜治疗患者),3例肝肺转移(为开腹手术治疗患者),1例局部复发(为开腹手术治疗患者),1例发生吻合口狭窄(为腹腔镜治疗患者),1例术后23个月死亡(为开腹手术治疗患者患者)。结论:腹腔镜治疗高位结肠癌相对于传统的开腹式手术具有观察视角清晰、手术简便、胃肠道功能恢复快、手术损伤小、术后可较早接受其他治疗、住院时间短和恢复速度快、免疫功能受损伤小、肿瘤所受挤压小等诸多优点,是高位结肠癌患者的首选治疗方案。     

腹腔镜与开放手术治疗结肠癌的远期疗效比较

目的对比腹腔镜手术与开放手术在结肠癌治疗中的远期疗效。方法选取该院2011年3月‐2012年3月收治的结肠癌患者45例为观察组,均行腹腔镜手术治疗,另选同期该症患者45例为对照组,行开放手术治疗,观察两组患者手术情况、远期治疗效果及远期并发症情况。结果观察组手术时间较对照组长,术中出血量及术后住院时间明显低于对照组(P0.05),观察组患者2年、5年生存率高于对照组,观察组远处转移及局部复发例数低于对照组,但无明显差异(P0.05),观察组远期并发症发生率为13.33%,对照组远期并发症发生率为24.44%,观察组远期并发症明显低于对照组,差异具有统计学意义(P0.05)。结论开放手术与腹腔镜手术在结肠癌治疗中运用,对患者远期生存及复发情况无较大差异,但腹腔镜手术远期并发症较少,且手术创口小,住院时间短,可有效减少患者痛苦,值得临床推广运用。     

腹腔镜手术与开腹手术在结直肠癌根治术中临床疗效的对比研究

目的 对比腹腔镜手术与开腹手术在结肠癌根治术中的临床疗效.方法 选择2006年7月-2012年6月由我组手术医生完成的结直肠癌根治术患者376例,根据手术方式将患者分为腹腔镜手术组196例和开腹手术组180例.对比两组患者手术情况及肿瘤情况,肠功能恢复时间及住院时间,并发症及死亡情况,随访情况等.结果 开腹手术组患者中转开腹率为9.7%(21/180).两组患者手术时间、术中出血量、术后镇痛药物使用率、切除淋巴结数目比较,差异均有统计学意义(P＜0.05);排气时间、排便时间、进食时间及住院时间比较,差异均有统计学意义(P＜0.05);切口感染发生率比较,差异有统计学意义(P＜0.05);两组中TNM Ⅱ期患者(χ2=0.682,P=0.641)、TNM Ⅲ期患者(χ2=0.541,P=0.713)累积生存率比较,差异均无统计学意义.结论 腹腔镜手术在结直肠癌根治术中安全有效,与传统开腹手术相比,可以减轻患者痛苦,降低患者术后切口感染发生率,缩短患者肠功能恢复时间,值得临床推广应用.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.