腹腔镜下行消化性溃疡穿孔缝合修补术治疗45例临床分析

目的探讨腹腔镜下行消化性溃疡穿孔缝合修补术的临床疗效,为临床治疗提供参考依据。方法随机将我科91例消化性溃疡急性穿孔患者分为两组,对照组46例行传统开腹穿孔修补手术,治疗组45例行腹腔镜下穿孔缝合修补术,观察两组手术疗效、并发症和远期疗效。结果治疗组手术时间、进食时间、住院时间明显优于对照组(P<0.05);组间术后并发症发生率和胃溃疡复发率比较,差异无统计学意义(P>0.05)。结论腹腔镜下消化性溃疡穿孔缝合修补术治疗消化性溃疡穿孔疗效确切,具有操作简单、腹壁损伤轻、脏器干扰少、术后并发症低和胃溃疡复发率低等优点,值得临床继续研究和推广。     

腹腔镜与开腹行消化性溃疡穿孔修补手术的疗效对比

目的了解消化性溃疡穿孔患者用腹腔镜、开腹方式手术修补的疗效差异及临床推广价值。方法纳入本院2015年-2016年期间收治确认消化性溃疡穿孔需采取外科修补术治疗患者相关临床数据为一般资料来源,从中选取80例并根据患者入院时间先后将其以每组40例分为腹腔镜组(腹腔镜消化性溃疡穿孔修补术治疗)与开腹组(传统开腹消化性溃疡穿孔修补术治疗)。比较两种手术方式的各项临床指标。结果所有患者均顺利完成手术治疗,比较不同手术方案各指标,包括:手术时间、术中出血量、术后排气时间以及住院时间等,提示腹腔镜组患者各指标数据均明显优于开腹组,组间差异经统计学软件处理后显示有意义(P0.05);术后对患者进行平均1周时间的随访,腹腔镜组手术相关并发症发生情况明显低于开腹组,组间差异经统计学软件处理后显示有意义(P0.05)。结论用腹腔镜辅助外科手术手段治疗消化性溃疡穿孔患者对于病情有着突出的改善作用,另一方面与常规外科开腹修补术相比具有微创、康复时间短以及操作简单等突出优点,值得临床推广。     

腹腔镜与开腹儿童消化性溃疡穿孔修补术疗效比较

目的:探讨腹腔镜技术在小儿消化性溃疡穿孔(d<10 mm)中的治疗价值.方法:回顾性分析2000年6月～2008年7月期间42例经腹腔镜及开腹手术治疗的消化性溃疡穿孔患儿的治疗过程.结果:两组患儿手术时间,穿孔大小比较无明显差异(P>0.05).腹腔镜组手术治疗的患儿术中出血量、术后肠蠕动恢复时间,住院时间及并发症均优于开腹手术组.结论:腹腔镜修补小儿消化性溃疡穿孔安全、可靠;与传统开腹术式相比腹腔镜创伤小,恢复快,住院时间短,外形美观.     

腹腔镜与传统开腹手术治疗消化性溃疡穿孔修补的临床分析

目的:比较腹腔镜与传统开腹穿孔修补术对消化性溃疡穿孔的治疗效果。方法 :选取接受单纯穿孔修补手术的消化性溃疡穿孔患者共110例,根据手术方式的不同,将患者分为传统开腹组和腹腔镜组。比较两组患者术中情况、术后情况以及手术前后感染相关指标(包括白细胞计数、C反应蛋白和术后体温恢复时间等。结果:腹腔镜组的术中出血量明显少于传统开腹组(P<0.05)。传统组患者术后排气时间及住院时间均明显长于腹腔镜组(P<0.05)。两组患者的术后并发症发生情况,差异存在显著统计学意义(P<0.05)。术后48h,腹腔镜组术后48hWBC和CRP均明显低于传统组(P<0.05)。腹腔镜组患者术后体温恢复时间明显短于传统组(P<0.05)。结论:腹腔镜下消化性溃疡穿孔修补术,与传统开腹手术相比,具有术中出血少、机体损伤少、术后并发症少、感染及术后恢复快等优点,同时并不延长手术时间,可以作为消化性溃疡穿孔的首选手术方式。     

腹腔镜手术与开腹手术治疗82例消化道溃疡急性穿孔的效果对比研究

目的对比分析腹腔镜手术与开腹手术治疗消化性溃疡急性穿孔的疗效。方法 2011年2月-2012年10月间收治82例消化道溃疡急性穿孔患者,其中40例在腹腔镜下行穿孔修补术,42例行传统开腹下修补作为对比。结果两组在术后排气时间、镇痛药使用率、住院时间、术后并发症等方面,差异有统计学意义(P<0.05),但两组在手术时间、住院费用方面无统计学差异(P>0.05)。结论较传统开腹修补术,腹腔镜下修补术具有创伤小、疼痛轻、并发症少、康复快、住院时间短、疗效好等优点,是治疗消化道溃疡急性穿孔的一种理想手术方法。     

腹腔镜消化性溃疡穿孔修补术18例报告

目的：探讨腹腔镜手术在胃十二指肠溃疡穿孔修补术中的应用价值。方法：2004年7月-2007年8月我院为18例消化性溃疡穿孔患者进行腹腔镜穿孔修补术。结果：17例成功完成腹腔镜手术，1例中转开腹。手术时间40～105min，平均50min，术后住院时间5～10d，平均7．5d，术后患者恢复快，并发症少，无一例死亡。结论：腹腔镜胃十二指肠溃疡穿孔修补术具有痛苦小、恢复快、并发症少、住院时间短等优点，疗效确切，操作简单易行，值得在临床工作中推广应用。     

腹腔镜治疗消化性溃疡急性穿孔的临床研究

目的探讨腹腔镜下消化性溃疡急性穿孔修补术的临床疗效。方法选取98例消化性溃疡急性穿孔患者,随机分为治疗组、对照组各49例,治疗组选择腹腔镜下修补术,对照组采用传统开腹术,对比俩组的术中、术后情况和临床疗效。结果治疗组术中出血量、术后排气时间、术后切口感染、切口疝并发症发生例数、住院时间均显著优于对照组,且P均〈0.05。结论应用腹腔镜下修补术治疗消化性溃疡急性穿孔具有创伤小、术后恢复快、住院时间短、并发症少等优势,值得临床推广和应用。     

胃十二指肠溃疡穿孔患者行腹腔镜修补术的近期疗效观察

目的探讨胃十二指肠溃疡穿孔患者行腹腔镜修补术的近期疗效。方法将我院住院治疗的100例胃十二指肠溃疡穿孔患者的病例资料进行收集整理,其中选择腹腔镜穿孔修补术的58例设立为腹腔镜组,传统开腹胃十二指肠溃疡修补术42例设立为开腹组,比较两组的手术时间、出血量、术后下床活动时间、术后镇痛率及并发症、住院时间等观察指标的差异。结果与开腹组比较,腹腔镜的手术时间、术中出血量少于开腹组,术后下床活动时间、住院时间均短于开腹组,术后腹腔镜组采取术后镇痛比率低于开腹组,腹腔镜术后无一例并发症发生,其并发症发生率明显低于开腹组,差异均有显著性（P〈0．05）。结论腹腔镜胃十二指肠溃疡修补术疗效优于开腹手术,具有手术时间短、术中出血量少、患者胃肠功能恢复快、术后镇痛率低及住院时间短、术后并发症少等优点,值得推广和应用。     

腹腔镜技术在急腹症中的临床应用

目的探讨腹腔镜技术在急腹症中的临床应用。方法回顾性分析2016年1月~2017年1月我院收治的60例急腹症患者的临床资料。40例行腹腔镜手术(腹腔镜组),20例行开腹手术(开腹组),对两组的手术各项观察指标进行比较分析。结果腹腔镜组中,急性阑尾炎20例、急性胆囊炎13例、粘连性肠梗阻5例、消化性溃疡穿孔修补术2例。开腹组中,急性阑尾炎10例、急性胆囊炎2例、粘连性肠梗阻2例、消化性溃疡穿孔6例。腹腔镜组患者的手术时间、术后下床活动时间及患者住院时间明显短于开腹组,术中出血量明显少于开腹组,术后并发症发生率显著低于开腹组,差异具有显著性(P0.05)。结论腹腔镜技术用于急腹症中具有重要作用,可显著提高疾病诊断的准确率,且具有手术时间短、术中出血少、术后恢复快、并发症少、住院时间短等优点,值得广泛推广和应用。     

腹腔镜下消化性溃疡急性穿孔修补术17例临床分析

目的 探讨腹腔镜下胃十二指肠溃疡穿孔修补术的可行性及操作要点.方法 十二指肠溃疡15例,胃窦部溃疡2例,采用腹腔镜探查证实为急性穿孔并作溃疡穿孔修补术.结果 腹腔镜下手术均获成功,无中转开腹,平均手术时间57.9 min,平均住院时间5.7 d,无手术并发症.结论 腹腔镜下消化性溃疡穿孔修补术创伤小,并发症少,具有集诊断与治疗于一体的优点,是切实可行的治疗消化性溃疡穿孔的手术方法.     

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.