脾切除贲门周围血管离断术后门静脉血栓形成的相关因素分析

目的总结脾切除贲门周围血管离断术后门静脉血栓形成的相关因素。方法门静脉高压伴上消化道出血患者128例,均采用脾切除贲门周围血管离断术治疗,观察其术后门静脉血栓形成情况,并对术后门静脉血栓形成的相关因素进行分析。结果脾切除贲门周围血管离断术后门静脉血栓形成与患者合并糖尿病、门静脉压力、肝功能分级有关（P均〈0.05）。结论合并糖尿病、门静脉压力、肝功能分级是门静脉高压合并上消化道出血患者脾切除贲门周围血管离断术后门静脉血栓形成的相关因素。     

贲门周围血管离断术治疗门静脉高压症100例分析

贲门周围血管离断术(包括脾切除)是常用于治疗肝硬化、门静脉高压症的手术之一。1999—01／2002—12我们采用周围血管离断术治疗门静脉高压症100例，现报告如下。     

我国门静脉高压症外科治疗的现况和展望

门静脉高压症外科曾引领现代外科的发展。然而,在过去的10~20年里,筛查和控制食管胃曲张静脉破裂出血的药物、曲张静脉套扎和经颈静脉肝内门体分流术等非手术疗法获得广泛应用。手术治疗只适用于内镜疗法无效、肝功能Child-Pugh A级的患者。目前公认可取的3种手术是远端脾肾分流术、广泛的贲门周围离断术加脾切除术和二阶段经胸腹联合断流术。由于在中国供肝短缺,因此肝移植难以普及。腹腔镜脾切除以及腹腔镜脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者乃是重大挑战。认为外科治疗门静脉高压症应与非手术疗法合作,从而对肝硬化和非肝硬化门静脉高压症患者采取个体化治疗方案。     

脾切除贲门周围血管离断术治疗470例门静脉高压症疗效分析

目的总结脾切除贲门周围血管离断术治疗不合并肝癌及胆管癌的门静脉高压症患者的疗效。方法对不合并肝癌及胆管癌的门静脉高压症患者行脾切除贲门周围血管离断术并随访470例,其中肝炎后肝硬化436例,占92．8％。结果出血患者424例,手术止血率为993％（421／424）,围手术期病死率为1．4％（6／424）,主要死亡原因是上消化道出血、肝肾功能衰竭;急症及择期手术424例,预防手术46例,预防手术嗣手术期无死亡。平均随访时间4年,出血患者术后复发出血率为3．2％（15／470）,预防手术后无出血,肝性脑病发生率为1．9％（9／470）。结论脾切除贲门周围血管离断术防治门静脉高压症引起的上消化道出血效果好。合理选择手术适应证及手术时机、完全彻底断流、术后早期抗凝及近端脾静脉结扎预防术后肝外门静脉系统血栓形成是提高手术疗效的必要措施。     

晚期血吸虫病脾切除加周围血管离断术后再出血的手术治疗

目的 目的 观察晚期血吸虫病门静脉高压脾切除术加周围血管离断术后再出血的手术治疗效果。方法 方法 2002年10 月-2011年10月, 采用左侧经胸食管切开曲张静脉缝扎加贲门周围血管再离断术 （部分患者加做胃底大弯侧部分切除术）, 治疗晚期血吸虫病门静脉高压症脾切除加断流术后再出血的患者。随访1～9年, 观察疗效。结果 结果 共手术治疗43例, 其 中择期手术27例, 急诊手术16例, 平均随访时间为6.8年, 止血率为100%。术后死亡1例, 死亡原因为从事重体力劳动后 再出血。2例解黑色柏油样大便, 均经保守治疗后消失。其余病例均恢复良好。结论 结论 左侧经胸食管切开曲张静脉缝扎 加贲门周围血管再离断术治疗晚期血吸虫病门静脉高压症脾切除加断流术后再出血, 效果满意。     

脾切除贲门周围血管离断术治疗晚期血吸虫病并门静脉海绵样变

目的 目的 探讨晚期血吸虫病门静脉高压症合并门静脉海绵样变的外科治疗方式。 方法 方法 对湖南省血吸虫病防治 所附属湘岳医院18例晚期血吸虫病合并门静脉海绵样变患者的临床资料进行回顾性分析。结果 结果 16例患者行脾切除贲 门周围血管离断术; 2例患者先行内镜食管曲张静脉套扎术, 后因再次食管静脉曲张破裂出血, 分别于术后32、 40个月行脾 切除贲门周围血管离断术。术后随访6～72个月, 未再发现食管胃底静脉曲张。结论 结论 脾切除贲门周围血管离断术适用 于晚期血吸虫病门静脉高压合并门静脉海绵样变的治疗。     

肝硬化门静脉高压症脾切除手术技巧

目的探讨肝硬化门静脉高压症脾切除术的技术难点及手术技巧。方法回顾性分析2010年4月—2011年12月我科480例因肝硬化门静脉高压症行脾切断流术患者的临床资料。结果 450例行脾切除加贲门周围血管离断术,30例为单纯脾切除。开腹后到断脾胃韧带至脾切除完成平均耗时20min、出血50ml、输血量400m(l125例未输血)。术后并发症为腹腔感染(18例)、胸腔积液(5例)、肺部感染(1例)、胰瘘(1例)及腹腔内出血(1例)。结论门静脉高压症合并脾大(最大3.75kg,平均1.6kg)使得脾周间隙狭小,脾蒂宽,脾胃韧带及脾结肠韧带内侧支血管丰富,血管壁薄,术中极易出血。脾切除术前先结扎脾动脉,后分离脾上下极,最后分离结扎脾蒂,是预防脾切除术中大出血的关键。     

脾切除贲门周围血管联合手术对肝硬化门静脉高压症患者凝血功能的影响

目的分析脾切除贲门周围血管联合手术后,肝硬化门静脉高压症患者血小板数量、平均体积和血流动力学的改变,探讨其对凝血功能的影响。方法选取中国人民解放军第四军医大学第二附属医院2008年1月至2012年12月经脾切除贲门周围血管联合手术治疗的肝硬化门静脉高压症患者83例进行回顾性分析。计量资料组间比较采用配对t检验。结果手术后门静脉压力较术前下降,血流量变小,门静脉内径显著变窄;术后肝动脉内径变宽,肝动脉血流量增加。术后30 d ALT、白蛋白(Alb)、总蛋白(TP)、纤维蛋白原(FIB)、凝血酶时间(TT)以及血小板平均体积(MPV)值较术前7 d无明显变化(P0.05),而TBil、部分活化凝血酶(APTT)和凝血酶原时间(PT)3项指标有所下降(P0.05);血小板(PLT)及凝血酶原时间活动度(PTA)上升(P0.05),术后30 d与术前7 d相比较,患者PLT数量显著增加(P0.05),但MPV无显著改变(P0.05)。结论脾切除贲门周围血管联合手术能够明显改善肝硬化门静脉高压症患者肝脏功能储备及凝血功能。     

脾切除贲门周围血管离断术治疗肝硬化门静脉高压症232例围手术期及术中护理体会

本文对232例肝硬化门静脉高压症(PHT)实施贲门周围血管离断术(EED)加脾切除术治疗病例手术前、术中及术后临床护理资料进行总结分析,旨在探讨EED加脾切除术治疗肝硬化P价门静脉高压症的围手术期护理关键环     

脾切除贲门周围血管联合术对肝硬化门静脉高压症患者凝血功能的影响

目的：分析脾切除贲门周围血管联合手术后,肝硬化门静脉高压症患者血小板数量、平均体积和血流动力学的改变,探讨其对凝血功能的影响。方法选取中国人民解放军第四军医大学第二附属医院2008年1月至2012年12月经脾切除贲门周围血管联合手术治疗的肝硬化门静脉高压症患者83例进行回顾性分析。计量资料组间比较采用配对t检验。结果手术后门静脉压力较术前下降,血流量变小,门静脉内径显著变窄;术后肝动脉内径变宽,肝动脉血流量增加。术后30 d ALT、白蛋白（Alb）、总蛋白（TP）、纤维蛋白原（FIB）、凝血酶时间（TT）以及血小板平均体积（MPV）值较术前7 d无明显变化（P＞0.05）,而TBil、部分活化凝血酶（APTT）和凝血酶原时间（PT）3项指标有所下降（P＜0．05）;血小板（PLT）及凝血酶原时间活动度（PTA）上升（P＜0．05）,术后30 d与术前7 d相比较,患者PLT数量显著增加（P＜0．05）,但MPV无显著改变（P＞0．05）。结论脾切除贲门周围血管联合手术能够明显改善肝硬化门静脉高压症患者肝脏功能储备及凝血功能。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.