肝切除术联合术中胆道镜治疗17例肝内胆管结石的疗效分析

目的：探讨肝切除术联合术中胆道镜治疗肝内胆管结石的临床疗效。方法回顾性分析该院肝胆外科2005～2014年行肝切除术联合术中胆道镜治疗肝内胆管结石17例患者的临床资料,根据肝内胆管结石的分布,其中左外叶6例,左半肝5例,右肝第Ⅵ段3例,第Ⅶ段1例,第Ⅷ段1例,左外叶合并右后叶下段1例。17例患者均采用传统肝叶或肝段切除术（单钳法联合第一肝门阻断技术）,其中左外叶切除6例,左半肝切除5例,右肝第Ⅵ段切除3例,第Ⅶ段切除1例,第Ⅷ段切除1例,左外叶联合右后叶下段切除1例,同时行胆总管切开取石、T管引流附加手术10例,所有患者术中均常规行胆道镜检查。结果17例患者均治愈,无严重并发症,无远期结石复发。结论肝切除术联合术中胆道镜是治疗肝内胆管结石积极、有效、彻底的方法。     

儿童肝母细胞瘤长期生存并发肝脏多发性占位

1病历摘要 患儿男性,14岁,因“肝母细胞瘤治疗后12年,发现肝脏占位性病变1周”于2011—08—10入院。 12年前患儿因腹胀、面色苍白1个月于1999—08—30来我院就诊,腹部MRI提示肝脏左叶内侧段及右叶前段占位性病变,肿块大小11．2×6．8×1．8cm,行超左半肝切除术。术中所见：左肝Ⅳ段及第Ⅷ段巨大肿物,直径15cm,第Ⅱ、Ⅲ段见数个直径2cm肿物,切除左半肝、右肝静脉及部分第Ⅷ段。     

肝切除术治疗肝海绵状血管瘤22例分析

目的：探讨提高肝脏海绵状血管溜的手术切除水平。方法：回顾性分析手术切除的长径＞10cm肝海绵状血管瘤22例的手术资料，其中行右三叶切除1例，右半肝切除5例，Ⅵ段、Ⅶ段部分切除3例，Ⅴ、Ⅵ段及Ⅶ段部分切除1例，Ⅳ部分及Ⅴ段切除3例，近左半肝切除4例，Ⅱ、Ⅲ段切除5例。对巨大肝血管溜采用全肝血流阻断或项置第一肝门阻断带及患侧肝动脉结扎法，注意第三肝门的处理。结果：全组3例术后出现右侧胸腔积液。术后12—21天均痊愈出院，随访6个月—5年，共18例，患者情况良好。结论：肝海绵状血管溜行现代肝切除术是一种安全彻底的方法，疗效好，术后并发症少。     

肝部分切除术19例报告

报告１９例肝部分切除术，其中左半肝切除４例，肝左外叶切除７例，中肝４￣５段切除２例，右半肝切除１例，右肝５￣６段切除２例，右肝６￣７段切除３例，重点讨论了肝部分切主的手术指证及手术方法等问题。     

肝部分切除术19例报告

报告１９例肝部分切除术，其中左半肝切除４例，肝左外叶切除７例，中肝４～５段切除２例，右半肝切除１例，右肝５～６段切除２例，右肝６～７段切除３例．重点讨论了肝部分切除术的手术指证及手术方法等问题。     

完全腹腔镜与开腹肝切除治疗肝肿瘤临床疗效比较

目的 观察完全腹腔镜肝切除与开腹肝切除治疗肝肿瘤的临床疗效.方法 回顾性分析2010年1月至2014年1月期间海南省人民医院肝胆外科62例行肝切除术的肝肿瘤患者的临床资料.结果 完全腹腔镜下肝切除术组30例,手术均获成功,包括肝血管瘤4例,肝炎性假瘤2例、局灶性增生1例,原发性肝癌23例;手术方式:肝左外叶切除(Ⅱ+Ⅲ段) 14例、左半肝切除(Ⅳa,Ⅳb段) 2例,Ⅴ~Ⅶ段部分肝切除14例.开腹肝切除术组32例,其中肝血管瘤6例,肝炎性假瘤1例、肝腺瘤1例,原发性肝癌24例;手术方式:左外叶切除(Ⅱ+Ⅲ段) 16例、左半肝切除(Ⅳa,Ⅳb段) 3例,Ⅴ~Ⅶ段部分肝切除13例.两种术式在肿瘤大小、部位、平均手术时间、术中出血量、术后引流量,术后并发症发生率等指标比较差异均无统计学意义(P>0.05),但腹腔镜组术后胃肠道恢复时间,术后住院时间等指标优于开腹手术组,差异均有统计学意义(P<0.05).结论 肝脏Ⅱ、Ⅲ、Ⅳb、V~Ⅶ的肿瘤行完全腹腔镜肝切除术是安全有效的,其具有术后恢复快、进食早、痛苦少、住院时间短等优点,近期疗效好.     

肝段叶切除联合手术治疗肝内胆管结石

目的探讨肝段叶切除联合手术治疗肝内胆管结石。方法对72位肝内胆管结石患者进行肝段叶切除方法治疗肝内胆管结石。左外叶或左半肝叶切除36例,右肝段切除7例,右半肝切除15例。其中24例行高位胆管切开整形及胆管空肠Roux-en-Y吻合32例;行肝断面扩张胆管、肝门胆管分别与空肠作双口吻合4例,T管引流20例和U管引流2例,手术后道镜取石12例。结果肝段叶切除＋胆管空肠RouxenY吻合24例（33.3%）,肝段叶切除＋胆道探查14例（19.4%）,肝段叶切除＋胆肠吻合口切开探查7例（9.7%）,肝段叶切除＋胆道探查＋右肝表面切开取石术5例（6.9%）,术后胆道常规留置T管。其中肝段叶切除手术包括左外叶36例,左半肝21例,右前肝7例,右后叶2例,不规则左或右肝切除术5例。病人均治愈,无死亡。术后发生并发症例（13.9%）,其中切口感染8例,切口裂开3例,均治愈。术后均经T管行胆道造影及胆道镜检,发现结石15例,残石率20.8%。72例肝段叶切除术中同时行胆管空肠吻合24例,肝断面扩张胆管、肝门胆管与空肠双口吻合6例,T管和U管引流分别为20例和14例。本组无手术死亡。72例随访1～10年,无复发病症,无再手术者。结论肝段叶切除联合手术治疗肝内胆管结石具有疗效好,残石率低,并发症较少的优势,是目前治疗肝内胆管结石理想而有效的手术方式。     

肝切除治疗肝胆管结石的临床体会

目的 评价肝切除术在肝胆管结石治疗中的作用。方法 报告1989年3月-2003年9月采用肝切除术治疗179例肝胆管结石患者的手术方式、术后并发症和随访情况。结果 肝切除以左肝叶(段)切除为主148例(82．7％)，右肝叶(段)切除18例(10．1％)，多段切除4例(2．2％)，肝方叶切除作为附加术式9例(5．0％)；手术并发症35例(19．6％)，包括暂时性胆瘘、肝断面及膈下感染、胆道出血等；死亡3例(1．7％)。156例(87．2％)获3月-17年的随访，优良率91．7％。结论 肝叶段切除手术是治疗肝胆管结石的有效方法。     

肝叶切除治疗肝内胆管结石23例临床分析

目的 总结肝叶切除治疗肝内胆管结石的临床疗效。方法 对1990）年2月~1998年12月我院收治的23例肝内胆管结石行肝叶切除的临床资料进行回顾性分析。结果 本组行左肝外叶切除15例、左半肝切除2例、右肝前叶切除3例、右后叶切除1例、左肝外叶和右肝前叶联合切除2例。术后肝衰死亡1例、随访21例、失访1例,除胆管癌的1例术后2年复发死亡外,其余20例随访8个月至9年无结石复发。结论 肝叶切除术是治疗肝内胆管结石较理想的有效手术方式。     

小儿肝肿瘤的综合诊治

目的探讨小儿肝肿瘤的综合诊治方法。方法选择我院1999年～2009年收治的26例小儿肝肿瘤病例。按其病变范围施行右三叶切除2例,右半肝切除2例,左半肝切除4例,左外叶切除8例,不规则性局部肝切除10例。恶性肝母细胞瘤患儿术后化疗。结果1例肝母细胞瘤患儿术后因凝血功能障碍出血死亡,其余25例患儿术后均存活,其中肝良性肿瘤20例。患儿术后随访1～10年,生长发育良好。结论早期诊断、早期手术切除病变,能延长患儿的生命。     

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.