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。     

Ivor-lewis与左胸后外侧手术切口治疗胸中下段食管癌的疗效分析

目的探讨运用Ivor-lewis法与左胸后外侧手术切口法治疗胸中下段食管癌的疗效差异。方法利用回顾性分析的方法对该院收治的125例胸中下段食管癌患者的临床资料进行分析,其中运用Ivor-lewis法的胸中下段食管癌患者65例,运用左胸后外侧手术切口法治疗胸中下段食管癌的患者60例。比较两组患者的治疗效果和并发症发生率等,由此具体探析运用何种方法治疗胸中下段食管癌的效果较好。结果该院运用Ivor-lewis法治疗的65例患者与运用左胸后外侧手术切口法治疗的60例患者相比,根治治疗效果、并发症发生情况差异均有统计学意义。结论运用Ivor-lewis法治疗胸下段食管癌具有明显优势,具有并发症发生率低、死亡率低、恢复快等特点。是我们目前较为推鉴的治疗胸中下段食管癌的手术方法。     

43例右开胸三切口治疗胸上、中段食管癌疗效观察

目的探讨右开胸三切口治疗胸上、中段食管癌的并发症及生存率,为临床提供参考。方法采用前瞻性研究的方法,分析肇庆市第一人民医院自2006年7月至2009年7月收治的86例上中段食管癌患者,按照配对设计将患者分为试验组和对照组,试验组采用左颈、右胸、腹正中三切口的手术方法,对照组采用左颈、左胸两切口的方法,比较两组的疗效。结果试验组和对照组手术时间、淋巴结清扫数、吻合口瘘和喉返神经损伤情况比较,差异有统计学意义(P<0.05);两组胸腔积液引流量、术中出血量、住院时间及乳糜胸比较,差异无统计学意义(P>0.05)。试验组和对照组存活率比较,3年存活率试验组高于对照组,差异有统计学意义(P<0.05)。结论对于有手术指征的胸上、中段食管癌患者,右开胸三切口有利于提高肿瘤的根治率,有效地提高患者的生存率,值得临床推广。     

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。     

探讨Ivor-lewis食管癌根治术治疗食管癌的效果观察

目的分析Ivor-lewis食管癌根治术治疗食管癌的临床效果。方法于2015年8月~2017年4月期间我院收治的食管癌患者50例,将其按照1:1随机数字法分为两组,每组25例。对照组接受胸腹三切口食管癌根治术治疗,研究组接受Ivor-lewis食管癌根治术治疗,观察并比较两组患者治疗效果、并发症、住院时间、术中出血量、手术时间等。结果两组患者并发症总发生率比较,研究组12%低于对照组的32%,差异有统计学意义(P0.05)。两组患者住院时间、经口进食时间、带鼻胃管时间、ICU时间、清扫淋巴结枚数、术中补液量和出血量、手术时间比较,研究组均低于对照组,差异有统计学意义(P0.05)。结论临床治疗食管癌可给予Ivor-lewis食管癌根治术,可缩短手术时间,降低出血量,促进术后恢复,且并发症低,进而改善疾病预后,促进恢复,此手术方式有效且安全,值得推广。     

不同方式中下段食管癌根治术特点及疗效的对比分析

目的比较不同方式食管癌手术的特点及对患者疗效的影响。方法回顾性分析近年来134例经左胸单切口术（Ⅰ组）、右胸＋上腹正中双切口术（Ⅱ组）及右胸、腹部和颈部三切口食管癌切除术（Ⅲ组）患者的临床资料。结果Ⅰ组手术时间及出血量均明显少于其他两组（P〈0.05）,Ⅲ组术后恢复时间最长（P〈0.05）,淋巴结清扫数目Ⅰ、Ⅱ、Ⅲ组依次递增明显（P〈0.05）,三组并发症发生率及术后生存率无统计学差异（P〉0.05）。结论食管癌根治术三种手术方式各具特点,临床工作中应根据患者及医院实际情况选择术式,以达到最佳治疗效果。     

不同手术治疗食道癌的临床疗效分析

目的:探究不同手术治疗食道癌的临床效果。方法:选择本院2011年1月至2014年1月所收治的133例食道癌患者,分别使用左胸单切口、右胸与上腹双切口以及右胸、上腹以及颈部三切口的手术方式对患者开展治疗工作,同时对三种手术方法治疗的临床效果进行对比分析。结果:经过对三组患者的对比分析,单切口手术方式所需要花费的手术时间最少,而三切口患者淋巴结的清扫数目最多,且三切口患者的存活率最高。该三组患者在术后住院时间上对比不明显,不具备统计学意义。结论:单切口、双切口以及三切口手术方式在临床治疗食道癌的应用中均有一定的可取性,但就总的临床疗效来看,右胸、腹部与颈部三切口手术治疗的方式疗效最为显著,能够有效提高患者的存活率,还能够在很大程度上缓解食道癌患者的痛苦,具有较高的临床推广价值。     

高龄食管癌患者100例的外科治疗

目的：分析高龄食管癌的临床手术治疗方式与效果.方法：收集本院胸外科100例食管癌手术患者,病变位于上段30例,食管中段46例,食管下段24例 手术分左胸切口组48例,右胸切口组52例.结果：近期并发症发生率左胸切口组术后为10.4%,右胸切口组为36.5%,差异有显著性（P=0.030）,两组均无术中死亡及住院死亡 左胸切口组术后1年和3年生存率分别为84.2%和57.1%,右胸切口组分别为77.3%和50.0%.两组1年和3年生存率率比较无统计学差异（P＞0.05）.结论：手术采用右胸切口与左胸切口具有各自的优点与适用范围,需根据病变的具体情况而定 无论左胸切口还是右胸切口,采用颈部吻合都是较好的选择.     

胸腹腔镜联合与开放三切口食管癌根治术治疗食管癌的疗效及对机体免疫功能的影响

目的探讨胸腹腔镜联合与开放三切口食管癌根治术治疗食管癌的近期疗效及对机体免疫功能的影响。方法随机选取2016年3月~2018年9月间在我院接受手术治疗的食管癌患者140例,按照随机照的原则分为微创组与开放组(每组70例),微创组采用胸腹腔镜联合食管癌根治术(经右胸、上腹部、左颈入路),开放组采用开放三切口食管癌根治术(经右胸、上腹部、右颈入路),观察患者围手术期相关指标及免疫功能。结果两组患者术后并发症发生率比较无统计学差异(P0.05),微创组患者的术中出血量、术后排气时间及住院时间均优于开放组,差异具有统计学意义(P0.05)。微创组对患者术后免疫功能影响小于开放组,差异具有统计学意义(P0.05)。结论胸腹腔镜联合食管癌根治术治疗食管癌具有创伤小、术后恢复快,对机体T细胞免疫功能影响小等优点,临床疗效确切。     

应用吻合器三联切口治疗胸上、中段食管癌

目的　探讨经右胸、腹正中、右颈食管胃机械吻合治疗胸上、中段食管癌的结果及术式的利弊。方法　采用经右胸、上腹正中、右颈三切口治疗 80例胸上、中段食管癌 ,在颈部行食管胃机械吻合。结果　术后发生吻合口瘘 2例 (2 5 % ) ,肺部感染 3例 (3 7% ) ,胃排空障碍 9例 (1 1 3% ) ,无手术死亡 ,无吻合口出血 ,术后随访 1 ,3年生存率分别为 4 1 %和 2 7%。结论　经右胸、腹正中、右颈三切口治疗胸上、中段食管癌切除彻底 ,淋巴结清扫彻底 ,颈部机械吻合安全可靠 ,缩短了手术时间 ,减少了术后并发症的发生 ,但创伤较大。     

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.