胰十二指肠切除术后并发症的防治分析(附36例报告)

目的 分析胰十二指肠切除术后并发症发生原因及防治办法。方法 通过分析我院10年间36例接受胰十二指肠切除术的患者的临床资料,分析其术后主要并发症的原因和诊治经验。结果 36例中6例出现术后并发症,发生率16.7%,包括胰瘘3例、胆瘘1例、腹腔出血1例、消化道出血1例。死亡2例,死亡率5.6%。结论 提出防治胰瘘、胆瘘、腹腔出血、消化道出血及腹腔感染的具体措施。     

胰十二指肠切除术后并发症的防治分析（附36例报告）

目的 分析胰十二指肠切除术后并发症发生原闪及防治办法。方法 通过分析我院10年问36例接受胰十二指肠切除术的患者的临床资料，分析其术后主要并发症的原因和诊治经验。结果 36例中6例出现术后并发症，发生率16．7％，包括胰瘘3例、胆瘘1例、腹腔出血1例、消化道出血1例。死亡2例，死亡率5．6％。结论 提出防治胰瘘，胆瘘、腹腔出血、消化道出血及腹腔感染的具体措施。     

胰十二指肠切除术后胰瘘和胆瘘的防治

目的 探讨胰十二指肠切除术后胰瘘、胆瘘的预防和处理方法。方法 回顾性分析1998年5月至2007年1月我院行胰十二指肠切除术的57例患者的治疗效果。行标准胰十二指肠切除（PD）49例,行保留幽门的胰十二指肠切除术（PPPD）8例,重建方式以Child方式52例,以Whipple术式5例。结果病理类型胆总管下段癌13例,胰头癌21例,乏特氏壶腹部癌11例,十二指肠癌6例,胰岛细胞瘤2例,慢性胰腺炎4例。57例中5例出现并发症,发生率8.77％,其中胰瘘2例（3．5％）,胆瘘1例（1．75％）,腹腔出血1例,消化道出血1例。死亡2例,病死率3、5％,其中1例死于多器官功能衰竭,1例死于心功能衰竭。结论 胰十二指肠切除术后胰瘘和胆瘘的防治在于术中选择正确的胰肠、胆肠吻合方式。     

胰十二指肠切除术重建方式对胰瘘的防治体会

目的探讨胰十二指肠切除术后吻合口瘘的防治方法,提高胰十二指肠切除的安全性.方法回顾性分析1996～2003年胰十二指肠切除术35例,32例行Whipple手术,区域性胰十二指肠切除3例,使用Child方式重建,胰管空肠吻合20例,胰腺空肠套入式吻合10例,捆绑式胰十二指肠吻合5例.结果全组病人均痊愈出院,无围手术期死亡,术后发生胰瘘2例(2/35),胃排空障碍5例,胆瘘3例,消化道出血1例.结论采取适当的手术方式,重视围手术期管理,可以有效降低胰瘘等并发症的发生.     

29例胰腺癌行胰十二指肠切除术临床分析

目的:总结胰腺癌(pancreatic carcinoma,PC)的临床特点,以提高对PC的认识,探讨降低胰十二指肠切除术后并发症及死亡率的措施.方法:回顾性分析我院29例胰腺癌患者行胰十二指肠切除术的临床资料.结果:所有患者经术后病理证实,全部施行胰十二指肠根治术,术后10例出现并发症,其中,胆瘘5例,胰瘘2例,腹腔出血l例,肺部感染1例.腹腔感染1例,经积极治疗均治愈出院,平均住院时间43 d.结论:胰十二指肠切除术后应积极采取相应的措施,正确选择手术适应证及术式,防治并发症和降低病死率.     

胰十二指肠切除术98例临床分析

目的　探讨胰十二指肠切除术手术适应证选择、消化道重建方式及术后并发症的防治经验。方法　回顾总结 1988年～ 2 0 0 2年 98例胰十二指肠切除术的治疗经验。结果　经典式胰十二指肠切除术 79例 ,保留幽门胰十二指肠切除术 19例 ,其中联合脏器切除 5例。重建方式均为Child式 ,其中胃肠Roux -en -y吻合 71例 ,胰肠“套入式”吻合 40例。原发病为十二指肠恶性肿瘤 46例 ,胆总管下段占位性病变 11例 ,胰头恶性肿瘤 2 4例 ,壶腹部肿瘤 11例 ,胆囊癌 3例 ,其他肿瘤 3例。术后早期并发症率 3 2 .7%,手术死亡率 9.2 %,常见并发症为胆瘘和 /或胰瘘 ,主要死亡原因是出血、胰瘘和多脏器功能衰竭 (MOF)。结论　胰十二指肠切除术仍是一个高危险手术 ,应严格掌握其手术适应证 ,胰肠“套入式”吻合和胃肠Roux -en -y吻合可以有效降低和预防术后并发症     

胰十二指肠切除术后出血的临床分析

目的探讨胰十二指肠切除术后出血的原因及防治方法。方法回顾性分析2000年1月至2012年12月我院192例胰十二指肠切除术患者的临床资料。结果胰十二指肠切除术后出血共20例,发生率为10．4％。其中腹腔出血9例（早期4例,晚期5例）,消化道出血11例（早期4例,晚期7例）。20例患者中死亡6例,死亡率为30％。胰瘘和腹腔感染患者术后出血的发生率较无胰瘘和腹腔感染的患者高（P〈0．05）。结论胰十二指肠切除术后出血的发生率和死亡率仍较高。合理的术中及术后处理,术后预防和控制胰瘘、腹腔感染及应激性溃疡是减少术后出血的关键,应根据出血的部位、时间和严重程度采取相应的止血措施。     

胰十二指肠切除术97例临床报告

目的 探讨胰十二指肠切除术(pancreatoduodenectomy,PD)术后早期并发症及死亡率发生、预防及处理的问题,提高PD手术的治疗效果.方法 回顾性分析了该院2002年1月～2006年6月间97例采用标准PD手术和传统Child法消化道重建病人的术前状态、术中情况和术后并发症及死亡率.结果 术后发生并发症49例(50.5%),其中胰瘘13例(13.4%),胆瘘3例(3.1%),肺内感染19例(19.6%),腹腔感染18例(18.6%),切口感染11例(11.3%),上消化道出血38例(39.2%),肠梗阻(肠套叠)1例(1%).围手术期死亡6例(6.2%),其中1例为上消化道出血,2例为多脏器功能衰竭,1例为手术当日腹腔出血,1例为胰瘘继发腹腔感染,1例为肠系膜上动脉栓塞.结论 PD手术具有较高的死亡率和并发症发生率.术前减黄治疗不能降低围手术期并发症的发生.     

保留幽门的胰十二指肠切除术27例治疗体会

目的:探讨保留幽门的胰十二指肠切除术(PPPD)的疗效。方法:回顾性分析我院2003年1月-2009年12月实施的27例PPPD的临床资料。并与同期的34例胰十二指肠切除术(PD)相比较。结果:两组病例均未出现胆瘘、腹腔出血、消化道出血等并发症。PPPD组发生胰瘘2例,胃排空障碍3例。PD组发生胰瘘3例,胃排空障碍2例。差异无统计学意义。结论:PPPD病例术后恢复快,如无幽门附近侵犯转移者均可考虑行PPPD术式。     

胰十二指肠切除术后出血的观察和护理策略

目的 探讨胰十二指肠切除术后并发出血的观察和护理策略,进一步提高护理质量。方法 回顾性分析蚌埠医学院第一附属医院2008年6月—2012年6月病例资料完整的72例,均采用标准胰十二指肠切除术,Child法消化道重建,其中施行PD术后发生出血并发症的8例,男性7例,女性1例,年龄39~70岁,平均53.4岁,原发疾病为胰头癌3例,胆总管下段癌2例,十二指肠肿瘤2例(含十二指肠乳头癌1例),壶腹部癌1例,术后出血诊断采用国际胰腺外科研究协作组(international study group of pancreatic surgery,ISGPS)胰腺切除术后出血(postpancreatoduodenectomy hemorrhage,PPH)分级及定义标准,通过对该组患者实施有效的精细护理干预,早期密切观察,术后出血护理,并进行总结。结果 72例行胰十二指肠切除术者,共发生术后出血8例,发生率11.1%。术后出血8例中,其中腹腔出血7例(早期出血2例,晚期出血5例),消化道出血1例,7例出血治愈出院,1例大出血二次手术后再出血最终死亡,病死率为12.5%。结论 胰十二指肠切除术后出血是严重并发症,及时的发现、严密的观察和精心的护理在胰十二指肠切除术后出血并发症的防治过程中极其重要。     

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.