改良式经阴道子宫切除术75例临床分析

目的探讨改良式阴式全宫切除术的临床应用。方法2005年1月～11月全宫切除术103例，其中经阴道75例．经腹部28例。结果阴式全宫切除术的比例达75．8％（75／103）；阴式组的手术时间（50±19）win短于腹式组（92±16）min（P〈0．01），出血量（190±26）ml少于腹式组的（276±31）ml（P〈0．01），且术后肛门排气时间和住院时间，明显短于腹式组（P〈0．01）。结论阴式切除术较腹式有手术时间短，出血量少，体力恢复快，住院时间短及无腹部疤痕等优点，应该扩大适应证应用，提高应用比例。     

非那雄胺和立止血联合用于经尿道前列腺电切术的临床观察

目的评价术前服用非那雄胺和术中使用立止血对经尿道前列腺切除术（TURP）术的影响。方法采用随机对照试验,将拟行TURP术的BPH患者随机分为A组术前非那雄胺组（5mg/d×2w）、B组术中立止血组（1ku iv＋1ku im）、C组术前非那雄胺联合术中立止血组及D组对照组,每组30例。记录各组TURP前列腺切除重量、术中失血量,电切操作时间,以及术后连续膀胱冲洗时间,并进行统计学分析。结果A、B、C、D组前列腺组织平均手术切除量分别为（19．4±7．9）g、（20．3±8．）6g、（19．3±6．7）g、（21．2±5．4）g,统计学分析四组之间无显著差异（P〉0．05）。术中平均出血量分别为（170．5±86．4）mL、（163．4±73．4）mL、（137．0±68．2）mL、（245．1±168．9）mL,术后连续膀胱冲洗时间平均为（49．4±10．5）h、（51．9±14．6）h、（41.4±9．5）h、（52．7±16．9）h,经统计学分析,A组、B组在术中平均出血量上没有差异（P〉0．05）,都与D组有显著性差异（P〈0．05）,而在术后连续膀胱冲洗时间上,A组与B组存在差异（P〈0．05）,但B组与D组没有差异（P〉0．05）;对于这两个方面,C组与另三组均有显著性差异（P〈0．05）。电切操作时间分别为（67．2±19．5）min、（66．8±25．8）min、（65．5±20．9）min、（83．5±20.3）min,A、B、C组间无明显差异,但都与D组有统计学意义。结论术前服用非那雄胺联合术中使用立止血可减少TURP术中术后出血,缩短手术时间和术后冲洗时间。     

妇科联合普外科腹腔镜手术的临床应用价值

目的：探讨妇科联合外科腹腔镜于术机微创外科中的应用价值。方法：选择因妇科疾病合并外科疾病而需行腹腔镜联合于术的患者72例为观察组，选择同期因单一妇科疾病行腹腔镜手术的患者72例为对照组。结果：两组患者均获得成功，无一例中转开腹，无相关并发症发生。观察组平均手术时间106±17．43min，对照组的甲均手术时间72±14．38min，观察组平均出出量78±34．72ml，对照组的平均出血量54±28．42ml，两组比较，差异有显著性（P〈0．01）；观察组术后平均住院时间4．07±1．31d，对照组术后平均住院时间3．82±1．45d，观察组术后病率15．14％，对照组术后病率14．65％，两组比较，差异无显著性（P〉0．05）。结论：妇科联合普外科腹腔镜手术在同一麻醉下完成两种以上手术，创伤小，住院时间短，病人痛苦少，充分体现微创外科的优越性，值得推广。     

子宫良性疾病腹式与阴式子宫切除手术的临床分析

目的探讨子宫良性疾病经腹子宫切除术（TAH）与经阴道子宫切除术（VH）的临床效果。方法回顺性分析30例TAH手术患者（TAH组）和32例VH手术患者（VH组）的临床资料,对比分析两组的手术时间、术中出血量、术巾术后并发症和术后肛门排气时间和术后住院时间。结果手术时间：TAH组（92．00±13．5）min,VH组（70．00±11．5）min;术中出血量：TAH组（215．00±57．6）mL,VH组（140．00±43．5）mL;术后肛门排气时间：TAH组（31．2±5．8）h,VH组（11．6±7．4）h;术后住院时间：TAH组（7．6±2．8）d,VH组（5．5±1．5）d。2组以上4类指标差异有统计学意义（P〈0．01）。结论与腹式子宫切除术相比较,阴式子宫切除术符合微创手术原则,具有手术时间短、患者损伤小、术后恢复快、术后住院时间短的优点。     

无张力腹股沟疝修补手术35例临床分析

目的探讨无张力腹股沟疝手术的优点。方法选择我院2006年4月～2008年10月住院的腹股沟疝病例65例，行无张力腹股沟疝修补手术35例为实验组和传统开刀腹股沟疝修补手术30例为对照组，比较手术时间、术中出血量、术后镇痛药的应用、术后下地时间、术后疼痛、术后复发情况、术后切口感染、术后住院天数等。结果无张力腹股沟疝手术和传统开刀腹股沟疝修补手术相比，手术时间分别为（10±10）min、（30±15）min（P〈0．05）；术中出血量分别为5mL、50mL（P〈0．01）；术后镇痛药的应用分别为0、75．2％（P〈0．01）；术后进食时间分别为8h、48h（P〈0．01）；术后复发分别为0、6．7％（P〈0．01）；术后切口感染率分别为0、8．2％（P〈0．01）；术后住院天数分别为4、8d（P〈0．01）。结论无张力腹股沟疝手术和传统开刀腹股沟疝修补手术相比，无张力腹股沟疝手术具有较明显优势，为当今疝修补手术首选。     

微创与常规全髋关节置换术临床疗效的比较

目的探讨微创与常规全髋关节置换术（total hip arthroplosty,THA）临床疗效。方法全髋关节置换术20例,按治疗方法不同分为髋关节前外侧小切口THA（微创组）10例和常规后外侧THA（常规组）10例;观察两组病例的手术时间、出血量、切口长度、并发症、术后疼痛程度、术后功能评价等。结果微创组优3例,良4例,中2例,差1例;常规组优2例,良3例,中3例,差2例。两组优良率比较差异有统计学意义（χ2=3．984,P〈0．05）;微创组术中出血量、引流量、输血量、切口长度[（315．5±223．1）ml、（259．5±170．1）ml、（88．5±13．2）ml、（9．9±0．4）cm]与常规组[（520．5±219．7）ml、（517．9±212．7）ml、（359．1±31．5）ml、（15．8±2．1）cm]有显著性差异（均P〈0．05）;微创组手术时间、术后3个月Harris评分与常规组无显著性差异（均P〉0．05）。结论微创全髋关节置换术,具有创伤小、出血少、安全、并发症少等优点。     

不阻断入肝血流左半肝切除治疗左肝内胆管结石(附20例报告)

目的分析不阻断入肝血流行左半肝外切除术治疗左肝内胆管结石的临床疗效。方法回顾分析2003年12月～2008年07月20例左半肝肝内胆管结石,肝切除时不阻断入肝血流的临床资料,并与同期28例相同部位结石肝切除时阻断入肝血流的术中失血量、肝切除时间,术后肝功能AST、ALT变化和术后并发症进行比较。结果两组肝切除时间分别为（19±4）min和（20±5）min（P〉0．05）;出血量分别为（243．2±89．5）ml和（248．7土94．6）ml（P〉0．05）;术后第7d肝功能AST变化分别为（68±15）UI;（144±26）,ALT分别为（70±14）;（142±28）（P〈0．01）,术后并发症分别为9例和10例（P〉0．05）。结论不阻断入肝血流行左半肝切除术是治疗左肝内胆管结石的一种安全、有效方法,且能明显减少对肝功能的损害。     

Maquet改良术治疗髌骨不稳定的临床研究

目的探讨应用膝关节髌骨支持带调整和胫骨结节内移抬高（改良Maquet术）三联手术治疗髌骨不稳定的临床疗效。方法对2007年以来26例髌骨不稳定患者行外侧支持带松解、内侧支持带紧缩、胫骨结节内移抬高三联手术,术后随访平均16个月（6-28个月）,分析疗效。结果术前Q角（17．2±3．8）°,术后（8．9±2．6）°（P〈0．01）,Lysholm膝关节评分（Lysholmkneescorescale,LKSS）术前（46．5±7．6）分,术后（91．3±4．2）分（P〈0．01）,髌股关节关系改善,髌骨轨迹良好。结论本手术方法具有并发症少,功能恢复好,矫形可靠,疗效确切的优点。     

GnRH激动剂作为子宫肌瘤腹腔镜切除术前治疗的疗效观察

目的分析用促性腺激素释放激素激动剂（GnRH—a）预处理后，腹腔镜行子宫切除术的手术效果、适应证及并发症。方法回顾性分析直径大于5cm肌瘤的腹腔镜肌瘤切除术，其中30例术前给予曲普瑞林醋酸盐（研究组），38例未用药（对照组），比较两组的手术时间、术中出血量及手术并发症等。结果（1）研究组和对照组术前两组肌瘤直径比较，差异无显著意义（P〉0．05），切除术后两组肌瘤直径比较，研究组肌瘤直径明显缩小，肌瘤体积平均缩小率52％，两组比较差异有显著意义（P〈0．01）；（2）研究组中有28例进行了缝合，手术时间为（44±17）min，出血量为（50±20）mL；对照组中有35例进行了缝合，手术时间为（102±30）min，出血量为（120±105）mL，两者比较，研究组手术时间及出血量均明显减少，差异有显著意义（P〈0．01，P〈0．05）；（3）研究组、对照组术后2个月后随访，两组术前有症状者术后均改善。结论对于较大体积的子宫肌瘤行腹腔镜肌瘤切除术术前应用GnRH—a 3个月，可明显缩小肌瘤体积，缩短手术时间，减少术中出血量，拓宽了腹腔镜子宫机肌瘤切除术的适应证。     

经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效观察

目的探讨经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效。方法2006年12月至2008年2月,采用经皮球囊扩张椎体后凸成形术在C臂引导下治疗16例骨质疏松性椎体压缩骨折。患者共25个伤椎,其中男性6例11个椎体,女性10例14个椎体。观察患者术后疼痛缓解及压缩椎体高度恢复情况。结果所有手术顺利完成。2例2个椎体前缘有少许未引起临床症状的骨水泥渗漏。16例患者术后疼痛均得到有效控制,次日即可佩戴要为下床活动,随访6～24个月,平均16个月。VAs评分由术前的平均8．5±0．3分,下降为术后2．3±0．2分;椎体前缘高度由术前的1．96±0．71增加到术后的2．22±0．70（P〈0．01）;椎体椎体中部高度由术前的1．91±0．68cm增加到术后的2．26±0．32cm（P〈0．01）。脊柱后凸Cobb角由术前平均24．2°±10．4°,矫正至21．3°±10．2°（P〈0．01）。结论经皮球囊扩张椎体后凸成形术可有效恢复骨质疏松性椎体压缩骨折椎体的高度,缓解疼痛,方法简单,安全高效,临床疗效满意。     

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.