麻醉对人体吞噬功能的影响及其机制初探

本实验观察了三种不同麻醉时手术病人全血吞噬功能的变化,结果发现静脉麻醉(硫喷妥钠诱导,普鲁卡因静脉复合维持麻醉)和静-吸复合麻醉(硫喷妥钠诱导、氟烷吸入维持麻醉)能使全血化学发光峰值显著下降,表明有吞噬功能明显抑制,布比卡因硬膜外麻醉时人体吞噬功能无明显变化。同时发现,两种全麻手术时血浆免疫调理蛋白FN、C_3水平的降低可能是麻醉引起吞噬功能抑制的重要原因之一。     

掌腱膜滑车形态结构及功能解剖学研究

目的　通过解剖学研究了解掌腱膜滑车 (palmaraponeurosis,PA)、A1 滑车和指屈肌腱的生物力学关系。方法　解剖 1 8只新鲜尸体手标本并从腕部桡、尺动脉灌注中华墨汁 ,观察并测量掌腱膜滑车与A1 滑车的宽度及形态学、组织学的变化。结果　掌腱膜滑车平均宽 1 0～ 1 2mm ,A1 滑车平均宽 5.5～7.0mm ,两者差异有显著性意义 (t=1 2 .0 2 ,P <0 .0 1 )。掌腱膜滑车的结构疏松 ,与指屈肌腱之间的间隙大 ,滑车作用不明显。PA滑车富含血管 ,与指屈肌腱滑液囊近端有血管联系。结论　PA滑车的作用小 ,PA滑车血管与鞘内肌腱血管有联系 ,是鞘内近端肌腱的营养途径之一。     

射频消融治疗继发性脾肿大、脾功能亢进可行性和安全性的实验研究

目的 评价射频消融(RFA)脾脏治疗继发性脾肿大和脾功能亢进的可行性和安全性。方法 14只健康杂种狗随机分为Ⅰ组(脾静脉结扎,n=4)和Ⅱ组(脾静脉结扎 RFA,n=10),通过结扎脾静脉主干和脾静脉属支引起淤血性脾肿大,3周末Ⅱ组剖腹行射频热能毁损脾脏。观察动物脾脏经RFA后的并发症,定期行CT扫描以及切取脾脏观察热毁损后脾脏病灶的影像学和组织病理学变化。结果 全组动物无死亡和并发症。CT显示脾静脉结扎后脾脏明显肿大并可持续2个月以上,RFA后脾脏病灶呈节段性毁损,包括高密度的坏死区和低密度的梗死区——后者称为“旁观者效应”;梗死区在RFA后4—6周内消失,残脾缩小;坏死区改变不明显。射频热能引起脾脏局部组织凝固性坏死和广泛的血栓性梗死形成。梗死区逐渐吸收、纤维化,血管闭塞、纤维素沉积和脾窦消失引起活性脾脏组织结构致密。结论 RFA治疗实验性脾肿大和脾亢是可行和安全的,将来可在开腹或腹腔镜下严格隔离脾脏周围器官后在临床安全实施。     

脾切除和自体脾组织移植对肺吞噬功能的影响

本实验采用放射性Ⅰ标记的脂类乳剂测定肝、脾、肺的放射性活度和吞噬指数，并结合病理组织学检查动点观察脾切除和脾移植对肺吞噬功能的影响，结果发现，脾切除组动物肝的吞噬功能受到抑制，啼的吞噬功能代偿性增强，自体移植脾组织能部分恢复肺的吞噬功能。     

五种静脉麻醉药对人体中性白细胞吞噬功能的影响

取健康人外周肝素抗凝血，用细胞分离液分离出中性白细胞（ＰＭＮ）以１×１０＾６／ｍｌ浓度与氟哌利多、咪唑安定、芬太尼、乙咪酯、羟丁酸钠麻醉药物四种不同剂量的稀释液，对照组为生理盐水混匀分别置于２４孔培养板内孵育。孵育后１０分钟、３０分钟、２小时、２４小时又分别加等量６￣９亿／ｍｌ白色葡萄球菌液再孵育４５分钟后涂片镜检。计算各种药物、浓度、各时间的ＰＭＮ吞噬率。结果表明，五种麻醉药随剂量增大ＰＭＮ吞噬     

不同分流手术对枯否细胞吞噬功能的影响

目的 研究不同类型的门体分流手术对肝脏枯否细胞吞噬功能的影响。     

肝硬化巨脾切除对免疫功能的影响

目的：探讨肝硬化巨脾切除对免疫功能的影响。方法：对２６例肝硬化巨脾患者切脾主前、术手两周、术手半年、一年分别抽取周围静脉血测定ＩｇＧ,ＩｇＡ,ＩｇＭ,Ｃ３,Ｃ４,ＴＮＦ,ｓＩＬ－２Ｒ,ＣＤ３＾＋,ＣＤ４＾＋,ＣＤ８＾＋,ＣＤ４＾＋／ＣＤ８＾＋,用Ｆ检验作出显著性测定。结果：ＩｇＧ,ＩｇＡ,ＩｇＭ,Ｃ３,Ｃ４,ＴＮＦ,ｓＩＬ－２Ｒ,ＣＤ８＾＋切脾差异均无意义（Ｐ〉０．０５）,ＣＤ３＾＋,ＣＤ４＾＋,     

微波定量消融脾组织治疗脾大脾亢对患者免疫功能的影响

目的 探讨脾大、脾亢微渡部分消融脾脏组织对机体免疫功能的影响.方法 对脾大、脾亢患者在腹腔镜下或超声引导下经皮行脾组织微波定量消融治疗,治疗前、后分别检测患者外周血T淋巴细胞亚群、B淋巴细胞及NK细胞.结果 治疗后1个月外周血T淋巴细胞亚群CD3、CD4+细胞水平明显升高.B细胞水平每个检测时间点均较治疗前明显升高.脾脏微波消融体积≤20%组CD3,CD4+细胞水平治疗后1个月较治疗前升高.治疗后3个月时较1个月有所下降;CD8+细胞水平治疗后1个月、3个月均高于治疗前;CD4+/CD8+比值治疗后呈下降趋势;B淋巴细胞水平呈上升趋势:NK细胞治疗后较治疗前降低.脾脏微波消融体积20%-40%组CD3、CD4+、CD4+/CD8+比值、B细胞、NK细胞水平治疗后1个月、3个月均高于治疗前水平,呈上升趋势;CD8+细胞水平治疗后1个月、3个月低于治疗前水平,并一直呈下降趋势.其中治疗后3个月,该组CD4+T淋巴细胞水平明显高于消融体积≤20%组.结论 微波定量消融脾脏治疗脾大、脾亢的疗法是一种微创的相当于部分手术切除脾脏的治疗方法,不仅维持了脾脏免疫功能还可提高机体免疫水平;微波消融脾脏体积大小与治疗后机体免疫功能的恢复和维持有关.     

全腹腔镜巨脾和非巨脾切除的对比研究

目的：探讨全腹腔镜巨脾切除术的安全性、可行性和手术技巧。方法：2007年3月1日—2009年5月31日实施腹腔镜脾切除术（LS）65例,以脾脏长径是否〉20cm分为巨脾组（n=24）和非巨脾组（n=41）。对2组术中出血量、中转开腹率、手术全程时间和术后并发症发生率进行对比。结果：2组均未发生严重手术并发症。与非巨脾组相比,巨脾组术中出血量、中转开腹率差异均无统计学意义,但手术全程时间长（P〈0.05）,并发症发生率高（P〈0.05）。结论：全腹腔镜巨脾切除术是安全、可行的。与非巨脾切除相比,手术时间长、术后并发症发生率高与原发病有关。     

Sex steroids in relation to cardiac structure and function in men

The prevalence of testosterone substitution as well as of androgen deprivation therapy in men is increasing. This review aims to summarise available knowledge of the effects of sex steroids on cardiac structure and function in men. MEDLINE was searched through PubMed. Original studies, systematic reviews and meta‐analyses, and relevant citations were screened. A short‐term hormonal intervention study in healthy young men with respect to echocardiographic parameters of structure and function was performed. Preclinical research provides sufficient evidence for the heart as a substrate for sex hormones. In animals, administration of oestradiol appears to have beneficial effects on cardiac structure and function, whereas administration of testosterone to noncastrated animals adversely affects cardiac function. However, the effects of sex steroids on cardiac function and structure appear more heterogeneous in human observational studies while comparative, prospective studies in humans are lacking. It is concluded that although effects of testosterone substitution as well as of androgen deprivation on cardiac structure and function can be expected based on pre‐clinical research, there exists an important knowledge gap of the effects of hormonal intervention in men. As such, there is a need to address this question in future prospective intervention trials.     

Redefining the role of splenectomy in patients with idiopathic splenomegaly

BACKGROUND: Despite extensive work-up to establish the cause of splenomegaly, splenectomy may be required for diagnosis in certain situations. The aim of this study was to find out the role of diagnostic splenectomy in the current era. METHODS: Between January 1989 and June 2004, 211 patients underwent splenectomy for indications other than trauma. In 41 (19%) patients, splenectomy was carried out for diagnostic purposes. Retrospective analysis of these patients was done for the purpose of the study. RESULTS: All patients who underwent diagnostic splenectomy had a complete haemogram, biochemical tests for liver and renal function, bone marrow biopsy and abdominal ultrasonography before splenectomy. There were 28 (68%) men and 13 (32%) women with median age of 37 years (range, 6-62 years). The median duration of symptoms was 12 months (range, 1-180 months). Common presentations were fever (n = 27; 66%), malaise (n = 26; 63%), pallor (n = 33; 80%) and gross splenomegaly (n = 27; 66%). Thirty-two (78%) patients had hypersplenism. Splenic lesions were shown in 14 (34%) patients on ultrasonogram and in 16 (39%) patients on contrast-enhanced computed tomography scan of the abdomen. Open splenectomy was carried out in all patients. Seventeen (41%) patients had postoperative complications. Among these, three (7%) patients had postoperative bleeding. One patient died because of acute respiratory distress syndrome. Final histopathology of the spleen showed lymphoma in 15 (37%), tuberculosis in five (12%) and other lesions in five (12%) patients. Sixteen (39%) patients had only congestive splenomegaly. CONCLUSION: A high proportion of patients presenting with idiopathic splenomegaly will have underlying haematological malignancies even in tropical countries. The clinical presentation, laboratory profile and imaging findings were not helpful in differentiating between patients with haematological malignancies and non-malignant conditions. Splenectomy still has an important role in establishing the pathology in patients presenting with idiopathic splenomegaly.     

巨脾型晚期血吸虫病临床路径探讨

参考国外最新临床指南,结合笔者多年的实践经验,制定巨脾型晚期血吸虫病的临床路径。路径包括诊断、药物治疗、内镜治疗、介入治疗、手术适应证、手术方式、围手术期处理、总体住院时间以及出院后治疗、护理、随访等,从而为晚期血吸虫病的外科治疗建立一套标准化流程、路线。     

手助腹腔镜技术在巨脾切除中的应用

目的:探讨手助腹腔镜技术在巨脾切除术中的应用。方法:用手助腹腔镜技术实施1例巨脾切除术。结果:顺利完成手助腹腔镜巨脾切除,手术时间3h,术中失血30ml,切除脾脏约40cm×15cm×10cm大小,未中转开腹,无术中术后并发症发生,住院7d,治愈出院。结论:手助腹腔镜脾切除术对于巨脾是可行的、安全的,而且保留了微侵袭外科恢复快的优点,为组织学检查提供足够大的标本。     

腹腔镜巨脾切除的适应证与外科疗效分析

目的探讨腹腔镜巨脾切除的适应证与手术疗效。方法对23例腹腔镜巨脾切除病例与53例腹腔镜普通大小脾脏切除及35例开腹巨脾切除病例的手术疗效进行比较。结果本组腹腔镜巨脾切除23例,其中3例同时行腹腔镜巨脾切除伴责门周围血管离断术,9例同时行胆囊切除术,无手术死亡,其中2例中转开腹。巨脾组和普通组相比,手术时间长[（142±29）min vs（92±18）min]和术中出血量多[（540±90）ml vs（210±80）ml]（P均〈0．05）．术后住院时间、腹腔引流置管时间、术后并发症和中转开腹率方面没有差异。巨脾组与开腹组相比,术后腹腔镜引流置管时间[（4．7±0．5）d vs（7．7±0．9）d]和术后住院时间[（5．7＋0．5）d vs（8．4±0．9）d]短,术后并发症少（4.3％vs11.4％）（P均〈0．05）,但术中出血和手术时间差异没有统计学意义。结论腹腔镜巨脾切除术安全可行．近期疗效良好。     

腹腔镜巨脾切除术治疗小儿遗传性球形红细胞增多症(附7例报告)

目的探讨腹腔镜巨脾切除术在小儿遗传性球形红细胞增多症治疗中的可行性及效果评价.方法实施腹腔镜巨脾切除术7例,年龄1～14岁,平均8.8岁;体重10～57 kg,平均33.8kg.其中3例合并胆石症,2例同时行胆囊切除术和1例行胆囊切开取石术.结果手术均获成功,1例脾静脉出血小切口辅助完成.手术时间50～150 min,平均90 min;术中出血量30～500 ml,平均117 ml;住院时间4～10 d,平均5.5 d;术后3 d红细胞计数较术前显著增高(t=2.652,P＜0.05).7例随访2个月～1年,平均7.8月.术前症状完全消失,无明显并发症发生.结论腹腔镜巨脾切除术是治疗小儿遗传性球形红细胞增多症的一种安全有效的方法.