食管癌患者不同手术入路术后并发症的比较

目的 比较不同手术入路治疗食管癌患者的术后并发症.方法 150例患者按手术入路不同,分为3组:三切口根治术组55例、左胸一切口根治术组50例、胸腹联合根治术组45例,观察3种手术入路术后并发症、转移度、平均住院天数.三切口根治术组、一切口根治术组、左胸腹联合根治术组术后并发症发生率分别为23.6%(13/55)、24.0%(12/50)、20.0%(9/45),3组患者术后并发症发生率之间差异无统计学意义(x2=1.82,P>0.05);3组转移度比较无显著性差异(P>0.05);三切口根治术组、一切口根治术组、左胸腹联合根治术组住院天数分别为(27.56±10.11)d、(26.33±11.54)d、(25.75±9.89)d,3组平均住院天数差异无统计学意义(F =1.856,P>0.05).结论 食管癌患者三种手术入路术后并发症无显著性差异,根据病变的具体情况选择个体化的手术入路.     

胸中下段食管癌二野淋巴结清扫手术方式的探讨

目的比较经左胸单切口、右胸胸腹二切口行中下段食管癌根治手术二野淋巴结清扫的优劣,探讨食管癌淋巴结清扫的最佳手术路径。方法回顾性分析185例手术切除中下段食管癌患者的临床资料。根据手术入路不同分为左胸入路组（A组）80例和右胸入路组（B组）105例,比较两组的胸／腹淋巴结清扫数、各区域淋巴结转移度、手术时间、术中出血量、术后并发症发生率、围术期病死率、生存率及术后恢复时间。结果经左胸单切口、右胸胸腹二切口行食管癌根治术在上纵隔淋巴结转移度分别是7．69％和11．97％。两组比较差异有统计学意义（P〈0．05）,围术期病死率、手术时间、出血量、术后恢复时间、生存率,两组比较差异无统计学意义（P〉0．05）。结论食管癌根治术经右胸胸腹二切口入路对上纵隔淋巴结清扫、腹腔淋巴结清扫均有优势。     

胸中段食管癌不同手术路径临床对比观察

目的：对比左胸两切口及右胸三切口两种不同手术路径在胸中段食管癌中的应用效果。方法将我院2009年3月—2012年3月收治的胸中段食管癌患者114例随机分为右胸入路组和左胸入路组各57例,分别选择右胸三切口和左胸两切口的路径行食管癌根治术。比较2组手术情况、术后并发症、3年复发率及生存率。结果左胸入路组手术时间、术中出血量、术后住院时间少于右胸入路组,右胸入路组淋巴结清扫数量多于左胸入路组,差异有统计学意义（P﹤0.05）;2组并发症发生率及围术期病死率比较无显著差异（P﹥0.05）;右胸入路组3年复发率低于左胸入路组、生存率高于左胸入路组,差异有统计学意义（P﹤0.05）。结论右胸三切口路径虽然相对创伤较大,并发症发生率增多,但以其良好的淋巴结清扫效果,可显著提高胸中段食管癌患者的无瘤生存时间。     

中下段食管癌左胸单切口术治疗疗效分析

目的探讨左胸单切口术治疗中下段食管癌的临床疗效。方法回顾分析于该院手术治疗的中下段食管癌35例病例资料,根据手术入路方式不同将其分为左胸单切口组19例、胸腹双切口组16例。比较两组患者手术时间、住院天数、引流时间及并发症等。结果左胸单切口组患者平均手术时间、住院天数均较胸腹二切口组缩短（P〈0.05）,左胸单切口组术后并发症发生率明显低于对照组（P〈0.05）。结论中下段食管癌患者行左胸单切口术较胸腹双切口手术创伤相对较小,手术时间及患者住院天数均明显缩短,同时术后并发症也显著减少。     

不同手术方式治疗中上段食管癌临床效果及并发症比较

目的：比较经左胸食管癌根治术与经颈胸腹三切口食管癌根治术两种不同术式治疗中上段食管癌的临床效果及并发症。方法选取中上段食管癌患者70例,随机分为左胸切口组与三切口组,各35例,分别行左胸食管癌根治术与经颈胸腹三切口食管癌根治术,观察效果及并发症。结果根治性切除率,三切口组为94．29％,高于左胸切口组的74．29％（ P ＜0．05）;三切口组术中出血量、术后切口引流量、术后引流时间少于（短于）左胸切口组（ P ＜0．01）;术后并发症发生率,三切口组为25．71％,低于左胸切口组的65．71％（ P ＜0．05）,三切口组并发症中肺部感染、胃食管反流发生率低于左胸切口组（ P ＜0．05）。结论中上段食管癌采用经颈胸腹三切口食管癌根治术治疗效果优于经左胸食管癌根治术,术后并发症发生率低。     

经左胸左颈部切口食管癌根治术50例分析

目的探讨经左胸左颈部切口食管癌根治术的临床效果。方法选取于2016年1月至2018年9月在我院救治的食管癌患者86例,按照手术方式分为研究组(经左胸左颈部切口食管癌根治术,n=50)和对照组(传统胸腹颈三切口食管癌根治术,n=36),对比分析两组手术时间、术后胸腔置管时间、术后住院时间及术后并发症发生情况。结果研究组手术时间、术后胸腔置管时间、术后住院时间均显著短于对照组,差异均具有统计学意义(P0.05)。研究并发症发生率12%显著低于对照组30.55%,差异有统计学意义(χ2=4.544,P=0.033)。结论经左胸左颈部切口食管癌根治术是安全可行的,值得在临床推广应用。     

不同术式治疗下段食管癌的疗效观察

目的：探讨经胸及经左胸腹联合行下段食管癌根治术的临床疗效.方法：回顾性分析经胸入路（34例）和经左胸腹联合入路（40例）行下段食管癌根治术患者的临床资料,术中行胸、腹淋巴结清扫,术后行病理组织学检查了解淋巴结转移情况.术后观察2周,比较2组忠者的淋巴结肿瘤转移度、手术时间、术中出血量、围手术期死亡率、并发症发生率、手术住院时间.结果：经胸与经左胸腹联合行下端食管癌根治术比较,手术时间短[（2.6 4±0.8）h vs（4.7 4±1.1）h,P〈0.05]、出血量少[（418.5 4±112.5）mLvs（693.5.4±124.8）mL,P〈0.05]、围术期并发症发生率低[5.9%（2/34）vs 22.5%（9/40）,P〈0.05]、手术住院时间缩短[（15.5±4.7）dvs（24.8 4±6.5）d,P〈0.05];2组手术切除淋巴结肿瘤转移度差异无统计学意义（P〉0.05）.结论：经胸行下段食管癌根治术,手术损伤小、恢复快,但远期存活率仍需观察.     

胸腹腔镜联合胸段食管癌根治术在胸段食管癌治疗中的临床疗效评价

目的研究胸腹腔镜联合食管胸段癌根治术在胸段食管癌治疗中的临床疗效。方法回顾性分析2014年1月至2015年10月我院胸段食管癌患者65例,根据随机数字表法,分为2组,胸腹腔镜联合组和小切口组。胸腹腔镜联合组行颈胸腹腔镜联合手术;小切口组行小切口胸段食管癌根治术。就两组患者手术耗时、手术切口、术中出血、淋巴结清扫数目、术后引流总量、卧床时间和术后并发症发生情况进行比较。结果胸腹腔镜联合组术后并发症发生情况低于小切口组,c2检验显示P0.05。胸腹腔镜联合组患者手术耗时、淋巴结清扫数目跟小切口组相似,t检验显示P0.05。胸腹腔镜联合组患者手术切口、术中出血、术后引流总量、卧床时间均少于小切口组,t检验显示P0.05。结论小颈胸腹腔镜联合手术和小切口胸段食管癌根治术一样可有效清扫淋巴结,但其应用效果更确切,可减轻创伤和出血,减少术后引流量,缩短卧床时间,减少并发症的发生,对患者术后康复有益,值得推广。     

食管癌外科手术治疗136例临床分析

目的探讨食管癌患者行不同外科手术治疗的近远期疗效。方法选取该院2008年5月—2011年5月间收治的食管癌患者,分别采用左胸单切口,右胸与上腹部正中双切口,右胸、腹部与颈部三切口手术等3种不同术式展开治疗,对3种手术方法的治疗效果进行对比。结果双切口手术组手术时间相比单切口组与三切口组明显延长,双切口组与三切口组术中出血量显著低于单切口组,3组患者术后恢复时间差异无统计学意义。单切口、双切口、三切口手术组患者淋巴结清扫数量依次升高。3组患者并发症发生率对比差异无统计学意义,单切口组与双切口组3年生存率显著低于三切口组。结论左胸单切口、右胸与上腹部正中双切口、右胸、腹部与颈部三切口食管癌根治术在食管癌患者治疗中均具有一定优势与不足,经综合评价三切口手术食管癌根治术在食管癌患者中的应用价值最高,可有效延长患者生存期,缓解患者痛苦,值得在临床中推广。     

经上腹左胸两切口治疗贲门癌24例临床分析

目的：探讨经上腹左胸两切口加腹腔、胸腔两野淋巴结清扫术治疗贲门癌的临床经验。方法：采用胸、腹两切口加两野淋巴结清扫术治疗贲门癌患者24例,与同期经左胸行贲门癌根治性切除术28例进行比较。结果：两切口组清除转移淋巴结数高于左胸组;3年生存率显著高于左胸组（P〈0.05）;术后并发症低于左胸组。结论：经上腹左胸两切口行贲门癌根治术,有利于胸、腹两野淋巴结清扫,提高手术的彻底性,有利于提高患者生存率。     

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.