浸润性早期大肠癌局部淋巴结转移的治疗研究

目的 研究经内镜下电灼或外科扩肛局部切除后,有局部淋巴结转换的浸润性早期大肠癌是否追加外科根治性手术的问题。方法 对１０３例早期在肠癌及局部切除后的病理标本连续切片进行研究分析。结果 １０３例行局部切除的早期胡吕,经病理证实;３７例为粘膜内６６例为浸润性早期癌,其中５５例补充了外科根治性手术发现１４例（２５．５％）局部淋巴结转移或淋巴管变侵癌栓形成,其中６例肉型（２５．６％）,８全息肉型（７１．４     

直肠来源胃肠道间质瘤的治疗策略分析

胃肠道间质瘤（GIST）是间叶组织来源肿瘤，可发生于全消化道，最常见于胃（60% ～ 70%）， 其次是小肠（20% ～ 30%），只有5%GIST 起源于直肠。手术治疗一直是可切除直肠GIST 的首选治疗方式， 传统采用低位前切除和腹会阴联合切除等术式、切除范围广，对患者生活质量造成一定影响。随着研究的深入， GIST 罕见发生淋巴结转移，使得直肠GIST 存在经肛门、经骶尾和经阴道入路进行局部切除的可能。该类术 式创伤更小，对解剖结构和脏器功能不造成破坏。近年来，随着分子靶向药物不断研发上市，术前缩小肿瘤体 积，使越来越多的直肠GIST 可以实现局部R0 切除。但由于直肠GIST 发病率低，关于直肠GIST 的治疗策 略有待进一步研究与探讨。     

征文通知

由中华医学会外科分会肛肠外科学组主办、上海第二医科大学附属瑞金医院外科承办的第五届全国大肠肛门疾病外科学术会议暨第五届中日大肠肛门疾病学术交流会将于２０００年５月２日～５日在上海召开。征文内容：１．结直肠肿瘤分子生物学研究;２．结直肠肿瘤的综合治疗;３．腹腔镜结直肠手术;４．结肠肿瘤术后局部复发问题的探讨;５．功能性便秘;６．肠道营养在结直肠疾病中的应用;７．其他大肠肛门疾病基础与临床研究。征文要求：按中华医学杂志投稿要求撰写论文,包括论文（５０００字以内）及论文摘要（１０００字以内,包括中、英…     

直肠类癌14例临床分析

目的：对直肠类癌的临床诊治进行分析和总结。方法：对14例经肠镜和超声内镜及病理诊断证实的直肠类癌患者的临床诊治资料进行回顾性分析和总结。结果14例患者中12例（85．7％）直肠类癌位于距肛门8cm以内的直肠。内镜治疗6例,随访3年均无复发及转移;手术治疗8例,其中局部切除5例,局部扩大切除2例,根治性切除1例。结论：内镜和超声内镜对直肠类癌的诊断和治疗有重要作用,肿瘤直径〈1．0cm、浸润深度没有超出粘膜下层,可行内镜下局部切除。若肿瘤〉1．5cm和浸及肌层,有淋巴结转移,应行手术治疗。     

结肠肛管套式拖出吻合术治疗低位直肠癌的临床分析—附33例报告

目的 评价结肠肛管套式吻合术治疗低位直肠癌临床安全性及效果。方法 回顾性分析我院1993-2002年以来33例低位直肠癌应用结肠管套式拖出吻合术治疗情况，即肿瘤切除后使直肠远端外翻，近端结肠经外翻的直肠拖出，于肛门外行结肠一期吻合，并立即送回盆腔的外科技术。结果 随访5～10年，随访率100％。肛门功能正常及良好者28例，占85％（28／33）；较差者5例，占15％（5／33）。本组l例放疗后完全失去大便控制能力，改为Miles术。本组吻合口瘘1例，占3％，局部复发率15％；5年生存率60％（20／33），10年生存率39％（13，33）。结论 保留肛门括约肌的结肠肛管套式拖出吻合术治疗低位直肠癌应选择合适的病例，可获得较高的生存率及生活质量。     

腔镜切割缝合器在中低位直肠腺瘤治疗中的应用

目的:探讨在中低位直肠腺瘤手术治疗中,使用腔镜切割缝合器（Endo-GIA）行经肛门直肠局部切除术和传统经肛门直肠局部切除术（TAE）的效果。方法:收集66例TAE和50例应用Endo-GIA经肛门直肠局部切除术的临床资料,就患者一般资料、手术疗效和病理检查结果进行分析。结果:两组手术患者的性别、年龄、肿瘤大小、术后住院时间和并发症发生率差异无统计学意义（p＞0.05）。切除肿瘤距肛缘距离Endo-GIA组[（5.30±1.46）cm]高于TAE组[（3.62±1.31）cm]（P＜0.01）;手术时间GIA组[（30.10±9.61）min]较TAE组[（47.50±13.05）min]缩短（P＜0.01）;中位出血量GIA组5 mL,较TAE组20 mL明显减少（P＜0.01）。结论:与传统经肛门局部切除术相比,应用腹腔镜切割缝合器经肛门局部切除中低位直肠腺瘤出血量少,切除范围广,操作省时简便。     

改良IPAA治疗家庭性腺瘤息肉病12例

家庭性腺瘤息肉病（FAP）是一种常染色体显性遗传病,如时不进行外科手术治疗,最终将不可避免地发生癌变。早期诊断、早期切除可能发生癌变的大肠粘膜是目前治疗该病的唯一方法。我科自1985～1998年FAP12例,施行全结肠、部分直肠切除,回肠末段倒置、贮袋、直肠肌鞘、回肠肛管吻合术（改良I-PAA）,既全部切除了已发生病变或可能发生病变的结、直肠粘膜,又保留了肛门括约肠的功能,疗效满意,现报告如下。     

家族性腺瘤样息肉病22例手术分析

本文报道２２例家族性腺瘤样息肉病，５例行全大肠切除、回肠造口术；１２例行全结肠切除、直肠粘膜剥脱、回肠肛管吻合术；５例行全结肠切除、回直肠吻合术。平均表明，全结肠切除、直肠粘膜剥脱、回肠肛管吻合术是治疗ＦＡＰ的主要术式，并可获得较满意疗效。     

局部切除早期低位直肠癌12例报告

本科于１９８７年至１９９４年共局部全层切除治疗低位直肠癌１２例，取得了良好效果，现报告如下。１、临床资料本组男５例，女７例，年龄２８～６８岁，腺癌１０例，乳头状癌１例，胶状癌１例。中度恶性１例，低度恶性１１例．低度恶性占大多数，为９１．７％．本组有１０例为早期癌，病变局限于粘膜层及粘膜下层。作局部全层切除。２例为中、晚期直肠癌，因全身情况差，且伴有其它脏器严重疾患，不宜作直肠切除术。１２例肿块均距肛门６ｃｍ以下，瘤体直径分别为１．５～３ｃｍ。本组局部切除１２例无手术死亡。９例随访至今已超过４年。…     

直肠粘膜下药物注射治疗慢性前列腺炎（附30例疗效观察）

直肠粘膜下药物注射治疗慢性前列腺炎（附３０例疗效观察）西钢职工医院外科张世光我们采用直肠粘膜下药物注射治疗３０例慢性前列腺炎患者，取得了满意效果，总结如下。资料与方法本组３０例病人均系我院泌尿科外科门诊的病人，年龄：２０～４７岁，病程：半年～３．５年...     

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.