连续性空肠间置完成远端胃大部切除术时消化道重建的研究

目的 探讨在远端胃大部切除术时采用连续性空肠间置完成消化道重建的临床体会。方法在胃大部切除后，以手工或管状消化道吻合器辅助行残胃与空肠、十二指肠与空肠的端侧吻合，再行空肠侧侧吻合，将胃空肠吻合的输入袢空肠和十二指肠空肠吻合口的输出袢空肠分别结扎阻断，形成完整的连续性间置空肠代胃。统计术后并发症发生率和死亡率，术后3个月观察病人的Visick分级指数，血浆白蛋白水平，每餐进食量和体重。结果 10例远端胃癌病人，术后病人均顺利恢复，未发生吻合口瘘或梗阻等术后并发症。术后3个月观察，Visick分级指数Ⅰ级8例，Ⅱ级2例；所有病人平均每餐进食量在术前水平的85％左右，血浆白蛋白水平有8例恢复正常，有7例病人体重在术前正常体重的80％以上。结论 连续性空肠间置能够安全简便地完成远端胃大部切除术时消化道重建，降低手术难度，并使食物通过十二指肠，恢复消化道生理通道并避免反流性胃炎发生，提高生活质量。     

胃次全切除后残胃-十二指肠-连续性空肠间置术的临床研究

目的探讨胃次全切除后残胃、十二指肠、连续性空肠间置术的临床疗效。方法将远端胃癌患者54例,分为两组,A组(26例)胃次全切除后应用手工缝合或管状消化道吻合器行残胃与空肠、十二指肠与空肠的端侧吻合,再行空肠侧侧吻合,将胃空肠吻合口的近端空肠和十二指肠空肠吻合口的远端空肠分别结扎阻断,以形成连续的间置空肠;B组(28例)胃次全切除后行BillrothⅡ式消化道重建;统计两组患者消化道重建的时间,术后3个月和6个月的体重、预后营养指数(PNI)、Visick分级指数。结果两组患者术后均顺利恢复,未发生吻合口漏或梗阻等术后并发症;A、B组平均消化道重建时间分别为53min±9min和57min±6min(t=-2.145,P=0.037);术后6个月时A组体重和PNI均恢复到手术前水平,而B组虽有所恢复,但与术前相比差异仍有统计学意义。术后6个月Visick分级指数A组明显优于B组(u=2.1,P<0.05)。结论残胃、十二指肠、连续空肠间置术能够使食物通过十二指肠,恢复生理通道,并降低胃次全切除术时消化道重建的难度,避免胆汁反流,改善生活质量。     

远端胃大部分切除术后消化道重建术式的对比研究

目的 对比远端胃大部分切除术后行连续性空肠间置术与BillrothⅠ式及Roux-en-Y 式吻合术的临床效果。方法 回顾性分析2012 年1 月至2013 年6 月接受手术的远端胃癌患者95 例,按不同消化道重建方式分为3 组。A 组30 例患者行连续性空肠间置术,B 组32 例行BillrothⅠ式吻合术,C 组33 例行Roux-en-Y 式吻合术。比较3 组患者术前预后营养指数（PNI）、手术时间、术后6个月及1 年并发症发生率、进食量、血浆白蛋白水平、体重及Visick 分级指数。结果 3 组患者术前PNI均无统计学差异（均P＞0.05）。A 组患者手术时间与B 组无明显差异,且均明显少于C 组的手术时间（均P＜0.05）。术后6 个月及术后1 年3 组患者的进食量、体重及营养状况的恢复均无统计学差异（均P＞0.05）。A 组患者术后腹胀情况明显少于C 组（P＜0.05）,胆汁反流性胃炎明显少于B 组（P＜0.05）。结论 胃大部分切除术后连续性空肠间置,安全有效,与传统的BillrothⅠ式及Roux-en-Y 式吻合术比较,可缩短手术时间,更快的恢复患者的消化功能,维持消化道正常通路,防止胆汁反流,将有可能成为消化道重建的主要方式之一。     

两种方法对胃癌术后消化道的疗效分析

目的探讨胃癌全胃切除术后消化道的重建方式。方法全胃切除术后分别采用袢式空肠代胃术及郝氏法顺行性间置空肠代胃术两种消化道重建术,对其手术时间、术后并发症、术后1年饮食情况、消化道症状及营养指标进行比较。结果与袢式空肠代胃术相比,郝式法顺行性间置空肠代胃术后手术时间相当,手术并发症少,术后进食量、体重、血浆蛋白、红细胞计数比较,差异有统计学意义（P〈0．05）。结论郝式法顺行性间置空肠代胃术优于袢式空肠代胃术。     

全胃切除术后消化道重建的方法及其评价

48例全胃切除术的病人,分别采用了食管十二指肠吻合、食管空肠 Braun's 吻合、食管空肠 Roux-Y 吻合、食管ρ袢空肠 Roux-Y 吻合及间置ρ袢空肠插入代胃5种不同方式重建消化道。本文对这些术式的功能作用、不良反应及效果进行了观察研究,认为不同的术式具有其各自的特点,其中ρ袢空肠 Roux-Y 式吻合与间置ρ袢空肠代胃术式操作方便,并发症少,消化功能好,似更值得推崇。     

胃癌全胃切除术几种消化道重建方式的比较

目的探讨胃癌患者全胃切除术后较理想的消化道重建方式。方法对115例胃癌行全胃切除术患者的临床资料进行回顾性分析。结果行食管-十二指肠端端吻合术15例（13．04％）。行食管-空肠端侧吻合、空肠-空肠侧侧吻合术40例（34．79％）。行P型空肠袢代胃术、空肠-空肠行Roux-en-Y吻合术式45例（39．13％）。行间置P型空肠袢代胃术15例（13．04％）。P型空肠袢代胃术和间置P型空肠袢代胃术式出现返流性食管炎及恶心、呕吐、腹胀者明显少于十二指肠-食管端端吻合术式及食管-空肠端侧吻合、空肠-空肠侧侧吻合术式。食管-空肠端侧吻合、空肠-空肠侧侧吻合术式有1例术后出现肠漏。采用P型空肠袢代胃术、空肠-空肠行Roux-en-Y吻合术式联合脾切除有1例术后出现脾窝感染。结论P型空肠袢代胃术手术操作简便，符合生理要求，术后并发症少，是全胃切除术后一种较为合理的消化道重建方式。     

全胃切除术后消化道重建对生活质量影响的对比研究

目的：分析胃癌全胃切除术后3种常见消化道重建对患者生活质量的影响及术式的合理选择。方法：将169例全胃切除术患者按消化道重建的方式不同,分为袢式空肠代胃＋Braun吻合（Braun组,45例）、Roux-en-y空肠代胃（RY组,75例）和P型Roux-en-y空肠代胃（RYP组,49例）。对3种术式术后手术并发症、体重、进食后的症状、单餐进食量、血清学指标及Visick指数分级进行比较作为评价依据。结果：3种术式术后死亡率及并发症发生率各组之间无显著性差异（P〉0.05）。术后6个月RYP组较其他两组能显著提高体重、单餐进食量,部分血清学指标也明显改善,术后Visick指数分级较高,有显著性差异,术后12月间RYP组和RY组生活质量均优于Braun组,差异有显著意义,但RYP组与RY组差异无显著性意义。结论：RYP和RY是全胃切除术后消化道重建的较理想术式,能显著改善患者术后的生活质量。     

近端胃切除消化道重建新方法-环状襻式单通道空肠间置术的初步报告

目的设计一种近端胃切除消化道重建新方法，可有效的减少消化道返流的发生。方法距屈氏韧带25～30cm的空肠段与食管端侧吻合，距此吻合口15～20cm，输出袢作空肠与残胃端侧吻合，距空肠残胃吻合口远段10～15cm，作输入、输出袢空肠侧侧吻合，在距食管空肠吻合口5cm输入袢和残胃空肠吻合口下方分别行空肠闭合，命名为环状襻式单通道空肠间置吻合术。结果14例近端胃癌患者接受该种手术，手术过程安全，吻合时间短（平均25min）。术后恢复良好，进食规律，无1例返流主诉。术后2个月分别进行了影像学和生理学方面监测，效果满意。结论环状襻式单通道空肠间置吻合术是一种理想的、有效阻止返流的近端胃切除吻合术式。     

不同手术方式对贲门癌患者远期生活质量及营养状况的影响

目的探讨责门癌患者行根治性近端胃大部切除食管残胃端侧吻合、根治性全胃切除Roux-en-Y吻合及根治性全胃切除空肠间置法吻合术后3年的生活质量及营养状况。方法回顾性分析医院胃肠外科收治的108例贲门癌患者的临床资料,其中行根治性近端胃大部切除食管残胃端侧吻合术30例（近端胃大部组）,行根治性全胃切除食道空肠Roux-en-Y吻合49例（Roux-en-Y组）,行根治性全胃切除空肠间置法吻合29例（空肠间置组）。术后3年进行胃癌患者生活质量问卷（QLQ-ST022）调查,同时检测患者体重、血红蛋白（Hb）、血白蛋白（ALB）,前白蛋白（PAB）、转铁蛋白（TF）。并对三组患者资料进行比较。结果胃癌患者生活质量问卷评分吞咽困难、胃部疼痛、饮食受限、焦虑、口干、味觉、身体外观等项目三组间差异无统计学意义（P〉0.05）,近端胃大部组术后呃逆评分（46.07±12.94）高于Roux-er-Y组（26.59±10.31）及空肠间置组（29±8.34）,有显著性差异（f=22.339,P〈0.05）。三组患者在术后3年体重、血红蛋白、白蛋白、前白蛋白、及转铁蛋白各项营养指标差异无统计学意义（P〉0.05）。结论近端胃大部切除术后患者存在较为严重的呃逆及返流,影响生活质量。保留远端残胃及空肠间置并不能显著改善患者的营养状况。根治性全胃切除Roux-en-Y吻合操作相对简便,术后长期生活质量及营养状况较好,是目前贲门癌患者较为合适的手术方式。     

连续间置空肠折叠代胃术在全胃切除术后消化道重建中的临床观察

目的探讨连续间置空肠折叠代胃术在全胃切除术后消化道重建中的作用。方法选取到本院进行消化道重建的胃全切患者72例,观察组36例进行连续间置空肠折叠代胃术,对照组36例进行食管空肠Roux—en—Y吻合术治疗。结果观察组对比对照组在每日进餐次数、每目的进食量、体重变化情况、血红蛋白和白蛋白等观察指标上具有明显优势。结论连续间置空肠折叠代胃术效果良好,值得临床推广使用。     

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.