经脐单孔腹腔镜下高位结扎术治疗精索静脉曲张

目的探讨经脐单孔腹腔镜下高位结扎术治疗单侧精索静脉曲张（VC）的临床效果。方法采用经脐单孔腹腔镜下高位结扎术治疗精索静脉曲张21例。结果所有患者手术均获成功,平均手术时间为（30±7）min,术后平均住院时间为3 d,精液质量明显改善。结论经脐单孔腹腔镜下精索静脉曲张高位结扎术是一种新型可选的治疗精索静脉曲张的手术方式,疗效可靠,具有良好的美容和微创治疗效果     

探讨经脐单孔腹腔镜精索静脉高位结扎术的可行性

目的：探讨经脐单孔腹腔镜精索静脉高位结扎术的可行性。方法选取精索静脉曲张患者100例作为研究对象,根据手术方法不同分为2组,观察组50例采用经脐单孔三通道腹腔镜精索静脉高位结扎术,对照组50例精索静脉曲张患者采用传统三孔法腹腔镜下精索内静脉高位结扎术,观察2组患者手术时间、住院时间、术后精子数量、精子活率、精子浓度的差异性。结果2组患者均成功完成手术,无中转开放手术。观察组患者的手术时间和住院时间均短于对照组,差异有统计学意义（P＜0.05）,术后均无需联合应用镇痛药,术后第1天下床活动、进食等;观察组患者术后精子数量、精子活率、精子浓度均显著高于对照组术后,差异有统计学意义（P＜0.05）。结论经脐单孔腹腔镜精索静脉高位结扎术不需专用单孔多通道操作平台,手术操作简化,安全有效,术后腹壁不留瘢痕,值得临床推广。     

腹腔镜经脐单孔三通道精索静脉高位结扎术60例

目的总结经脐单孔三通道腹腔镜手术治疗原发性精索静脉曲张手术经验。方法对60例经脐单孔三通道腹腔镜下精索静脉高位结扎术治疗患者的病例资料进行回顾分析。结果 60例手术中,成功率100%,无一例复发,仅5例存在近期并发症,且无远期并发症发生,术后随访6～12个月恢复良好。结论经脐单孔三通道腹腔镜下精索静脉高位结扎术是一种成功率高、无明显并发症的较理想的手术方式,值得临床推广应用。     

脐入路单孔腹腔镜精索内静脉高位结扎手术配合

目的总结经脐单孔腹腔镜行精索内静脉高位结扎术护理配合经验。方法本组24例均采用单孔三通道穿刺器及单孔腹腔镜专用手术器械,行精索内静脉高位结扎术,术前、术中给予精心护理。结果 24例患者手术均取得成功,无中转开放手术,术中、术后均无明显并发症发生。结论经脐单孔腹腔镜精索内静脉高位结扎术创伤更小,康复时间更短,可同时解决双侧精索静脉曲张,而充分的术前准备、流畅的术中配合是确保手术成功的关键。     

两种腹腔镜精索静脉高位结扎术的临床效果比较

目的:为了比较腹腔镜精索静脉高位结扎手术和经脐单孔法无气腹腹腔镜精索静脉高位结扎术两者治疗精索静脉曲张的临床效果差异。方法:将精索静脉曲张患者86例随机分成两组,实验组43例,行腹腔镜精索静脉高位结扎手术;对照组43例,行经脐单孔法无气腹腹腔镜精索静脉高位结扎术,比较两组的手术时间、术后住院天数、术后复发率、并发症发生率、术后1年精液质量改善及术后1年内受孕率等情况。结果:两者患者单侧、双侧手术时间及住院时间的差异均具有统计学意义(均P<0.05);实验组术后无并发症,对照组术后并发症发生率为11.63%,两组间比较具有统计学差异(P<0.05)。术后实验组无复发病例,而对照组复发率为4.65%,术后复发率比较两组间具有统计学差异(P<0.05)。实验组术后1年的精液质量改善情况及1年内受孕率明显高于对照组(P<0.05)。结论:经脐单孔法无气腹式腹腔镜精索静脉高位结扎术手术可取得满意的临床疗效。     

经脐三通道腹腔镜技术治疗精索静脉曲张15例临床分析

目的：介绍改良经脐三通道腹腔镜手术治疗原发性精索静脉曲张临床经验。方法：对原发性精索静脉曲张15例采用改良经脐部三通道腹腔镜行精索静脉高位结扎术。结果：精索静脉曲张15例手术全部成功,手术时间单侧10例13～28分钟,双侧5例25～38分钟,平均22分钟。出血量2～5mL,平均3mL,住院时间2～5天,平均3天。术后随访3～12个月,平均8.7个月。术后11例中单侧8例,双侧3例精子质量检查明显提高。结论：经脐三通道腹腔镜技术,安全可行,具有良好的美容和微创治疗效果,特别适合基层医院普遍开展治疗精索静脉曲张。     

腹腔镜下精索血管集束状结扎术临床疗效分析

目的:比较腹腔镜下高选择性精索内静脉结扎术与腹腔镜下精索血管集束状结扎术(Palomo术式)治疗精索静脉曲张的临床疗效。方法:总结研究2009年8月～2011年10月采用腹腔镜下治疗Ⅱ度以上精索静脉曲张的临床资料,其中行腹腔镜保留精索动脉及淋巴组织的高选择性精索内静脉高位结扎术(A组)35例,腹腔镜精索血管高位集束状结扎术(B组)37例。回顾性分析两组患者术后复发率、鞘膜积液发生率及精液质量、睾丸体积等指标,比较其临床疗效。结果:72例手术均获成功,术后随访2年,两组均各失访1例,两组手术方式时间分别为A组(41.1±9.2)min、B组(21.3±3.8)min,两组术后精液质量均较术前有明显提高(P<0.05),但组间比较差异无统计学意义(P>0.05);术后睾丸鞘膜积液差异无统计学意义(P>0.05);术后患侧睾丸血供均无减少,未出现睾丸体积减小等并发症;但是两组复发率差异具有统计学意义(P<0.05)。结论:腹腔镜下高选择性精索内静脉高位结扎术与Palomo术均是治疗精索静脉曲张行之有效的手术方法,但是Palomo术较之前者具有操作更简便、手术时间更短、复发率更少等优点,更具有临床推广价值。     

30例经脐单孔腹腔镜术治疗精索静脉曲张分析

目的：总结分析经脐单孔腹腔镜高位结扎术治疗精索静脉曲张的经验及疗效。方法：回顾性分析2011年3月-2013年3月我院采取经脐单孔腹腔镜技术高位结扎治疗30例精索静脉曲张患者的资料。结果：30例手术均获得成功,平均手术时间30min,术后平均住院时间4d。术后随访6-12个月均恢复良好,未见远期并发症发生。结论：经脐单孔腹腔镜高位结扎治疗精索静脉曲张疗效确切,患者痛苦小、创伤小、恢复快、美容效果好,值得临床应用。     

显微镜与腹腔镜手术治疗精索静脉曲张的疗效分析

目的比较显微镜下精索静脉结扎术和腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的临床效果。方法将88例原发性精索静脉曲张患者随机分为两组:显微镜下精索静脉结扎组(A组)45例,腹腔镜下精索静脉高位结扎组(B组)43例;术后随访6个月,对比分析两组患者的治疗效果。结果两组患者手术均顺利完成。两组手术时间差异无统计学意义(P>0.05);A组患者精液质量改善率、睾丸鞘膜积液发生率和术后复发率明显优于B组,差异有统计学意义(P<0.05)。结论显微镜下精索静脉结扎术治疗精索静脉曲张疗效好,并发症少,值得推广。     

经导管硬化疗法与高位结扎术治疗精索静脉曲张的疗效及安全性比较

目的比较经导管泡沫硬化剂逆行注射疗法与腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的疗效。方法对101例原发性左侧精索静脉曲张患者行经导管泡沫硬化剂逆行注射治疗（硬化剂组）,同期另105例行腹腔镜下精索静脉高位结扎术（高位结扎组）。比较两组患者的住院时间、治疗费用、术后并发症发生率、手术前后精液指标（精子密度、前向运动及正常形态精子比例）以及术后复发率。结果所有患者均顺利完成手术;术后随访12个月,患者症状均明显改善,无深静脉血栓、肺栓塞等严重并发症发生。硬化剂组患者泡沫硬化剂使用量为4~7（5.05±1.05）ml,术中造影精索静脉反流均消失;住院时间（3.55±0.69）d、住院费用（6634.72±680.24）元、术后鞘膜积液发生率12.9%、阴囊坠胀发生率14.9%分别低于高位结扎组的（5.56±0.89）d、（8640.36±853.88）元、41.0%和25.7%（均P＜0.05）。两组患者术后6、12个月精子密度、前向运动比例和正常形态精子比例均较入院时明显改善（均P＜0.05）,组间比较差异均无统计学意义（均P＞0.05）;组间精索静脉曲张复发率比较,差异均无统计学意义（均P＞0.05）。结论与腹腔镜下精索静脉高位结扎术相比,经导管泡沫硬化剂逆行注射疗法疗效相当,但患者创伤小、恢复快、费用低。     

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.