垂直半喉切除术后喉狭窄原因分析

目的 探讨早期声门型喉癌行垂直半喉切除术后喉狭窄的原因.方法 总结1995～2003年手术治疗早期声门型喉癌34例.结果 垂直半喉切除术术后9例患者术后2个月～1年后出现不同程度呼吸困难.狭窄原因:气道塌陷、肉芽形成、疤痕粘连.结论 传统的垂直半喉切除术术后狭窄率高,应该被喉垂直部分切除术取代.     

老年患者喉部分切除术后误咽的原因分析

目的明确喉部分切除术式对老年喉癌患者术后误咽发生及其程度的影响。方法回顾性分析2005~2009年老年患者各种喉部分切除术后误咽的发生情况,并采用自制术后误咽程度评分表对术后5~10天患者进行误咽程度评估。结果术后误咽程度评分结果(x±s):喉垂直部分切除术组为4.32±0.60,喉声门上水平部分切除术组为17.81±0.64,SCPL-CHEP术组为14.00±0.74,SCPL-CHP术组为18.50±0.81。喉声门上水平部分切除和SCPL-CHP术组术后误咽程度明显。术后8周评价误咽发生率:喉垂直部分切除术组为0/56,喉声门上水平部分切除术组为3/32,SCPL-CHEP术组为1/30,SCPL-CHP术组(26例)为7/26,SCPL-CHP术尤为明显。结论喉垂直部分切除术和SCPL-CHEP术是老年喉癌的较安全理想术式。对于高龄(>75岁)喉癌患者手术方式的选择应谨慎,特别是喉声门上水平部分切除和SCPL-CHP这两种术式。     

喉癌喉部分切除术后喉狭窄的处理

（1）目的 探讨喉癌喉部分切除术后喉狭窄患的治疗效果，提高喉癌喉部分切除术后的拔管率。改善生存质量。（2）方法 17例喉癌喉部分切除术后喉狭窄患，应用喉重建成形术及环状软骨-舌骨-会厌固定吻合术“T”形硅胶管支撑扩张术。支撑喉镜下CO2激光切除瘢痕术，镍钛记忆合金支架置入术。（3）结果 17例患均恢复正常呼吸，在术后5d-5个月均拔除气管套管。（4）结论 喉癌喉部分切除术后喉狭窄患，选择适当的外科治疗方法。可提高拔管率，恢复喉功能。     

水平垂直部分喉切除术疗效分析

探讨29例T3期声门上型和跨声门型喉癌,行水平垂直部分喉切除术治疗声门上型和跨声门型喉癌的疗效.结果:3年生存率为72.4%,5年生存率为48.3%,术后3个月拔管率为96%.在正确掌握手术适应证和喉重建技巧,水平垂直半喉切除术3～5年生存率不低于全喉切除术,并且保留了吞咽和发音功能.     

鼻内窥镜在检查治疗咽瘘中的应用

<正> 咽瘘是全喉切除术后的并发症之一。咽瘘的治疗主要有两种方法,一种是保守治疗,一种是保守治疗无效采用手术修补。我科于1999年12月-2001年5月间采用鼻内窥镜检查治疗同期喉癌、喉咽癌术后遗留咽瘘患者两例,取得良好效果,现报告如下:     

聚丙烯龙骨在喉裂开双侧声带切除术中的应用

目的探讨自制聚丙烯龙骨置入在声门型喉癌双声带切除术后喉功能重建术中的应用价值。方法选择11例单纯双侧声门型喉癌的病例,年龄45～70岁;10例男性,1例女性,其中9例男性患者术前均有病理诊断,余2例为术中冰冻确诊为喉癌;颈腹部彩超、CT等检查均未发现淋巴结异常肿大;所有患者喉裂开双侧声带切除术后均置入龙骨,分别对：有无呛咳、呼吸功能、发音功能、气管套管拔除率、并发症进行分析。结果 11例患者喉裂开双侧声带切除龙骨置入术后1月均取出置入之龙骨;1年后其中1例患者由于肉芽组织增生致呼吸困难,曾先后3次于支撑喉镜下行肉芽组织清除术,余10例患者均发音良好,无呛咳、无呼吸困难,均拔管,均未见肿瘤复发。结论聚丙烯龙骨置入在声门型喉癌双声带切除术后喉功能重建术中,既避免了喉腔粘连,又不造成喉腔黏膜的损伤,并发症少。     

喉癌42例部分喉切除疗效分析

目的 :观察部分喉切除的疗效及喉功能情况。方法 :总结各种喉部分切除术并获得随访资料 42例 ,所有病例均经病理学证实为喉癌 ,其中声门上癌 4例 ,声门癌 38例 ,共 6种术式 ,即声带切除术 3例、垂直部分切除术 34例 ,额侧切除术 2例 ,声门上水平部分切除术 2例 ,水平垂直部分切除术 1例 ,同期颈廓清术 3例。结果 :全部病例恢复发音功能 ,7～ 14天克服误咽 ,拔掉鼻饲管 ,全部病例 9天～ 3个月拔除气管套管 ,3年、5年生存率为 88.0 9% (37/ 42 )、85 .71% (30 / 35 )。结论 :喉部分切除术是保存喉功能的根治性手术 ,严格掌握适应证 ,正确选择术式 ,熟练的手术技巧及完善的修复技术是提高生存质量及疗效的根本。     

钬激光在喉气管狭窄治疗中的应用

目的:探讨钬激光在喉气管狭窄治疗方面的应用。方法:应用钬激光治疗喉气管狭窄15例,包括有气管肉芽组织增生,双侧声带外展麻痹,喉癌部分喉切除术后喉狭窄,气管癌术后气管狭窄。其中气管肉芽组织增生及气管癌术后气管狭窄病例选用经纤维喉镜钬激光治疗,双侧声带外展麻痹病例选用悬吊喉镜下钬激光治疗,喉癌术后喉狭窄病例中有选择悬吊喉镜下钬激光治疗者,另有患者因为暴露困难选择动态喉镜下钬激光治疗。结果:全部患者术后随访2个月~3年,疗效良好,无复发。结论:钬激光治疗喉气管狭窄方法简单,易于操作,患者花费少。     

喉部分切除术及喉功能重建术的临床观察

目的:观察喉部分切除术的远期疗效及喉功能重建术后的恢复情况。方法:总结1999年5月~2005年12月间各种喉部分切除术及喉功能重建术20例,病理诊断均为鳞状上皮癌,其中男15例,女5例。年龄最大78岁,最小51岁,以51~70岁组最多。声门上型喉癌11例,声门型喉癌9例。共4种术式,即声门上喉水平部分切除术6例,水平垂直(3/4)喉部分切除术5例,声带切除术2例,喉垂直部分切除术7例。20例适应证患者均施行了区域性颈清术(ⅡⅢⅣ区)及喉功能重建术。结果:全部病例均恢复发音功能。15~35d全部克服误咽,拔掉鼻饲管,18例于术后20d~2个月拔除套管,2例未能拔管,总拔管率90%。随访1~5年,2例死亡,18例存活。结论:喉部分切除术是保存喉功能的根治性手术。严格掌握手术适应证,正确选择术式,熟练的手术技巧及完善的修复技术是提高生存质量及疗效的根本。     

喉癌全喉切除术后咽瘘的原因分析

目的 :探讨喉癌患者行全喉切除术后发生咽瘘的原因 ,以预防或降低咽瘘的发生率 ,提高喉癌术后切口的愈合率。方法 :回顾分析 14 1例喉癌患者行全喉切除术后发生咽瘘的原因。结果 :14 1例患者咽瘘发生率为 2 7.6 6 % ,与手术时间 ,拔除胃管时间 ,术前有无合并感染 ,以及抗生素的应用有关。结论 :喉癌术后发生咽瘘的原因有多重性 ,避免相关因素 ,能有效降低咽瘘的发生率 ,提高患者术后生存质量     

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.