腹腔镜治疗小儿腹股沟斜疝的器械改进与应用研究

目的：探讨自行改进的手术器械应用于腹腔镜小儿腹股沟斜疝内环口关闭术的应用价值。方法：回顾分析60例11个月～12岁的小儿腹股沟斜疝患儿应用自行改进的手术器械实施经腹腔镜腹股沟斜疝内环口关闭术的临床资料。结果：60例手术时间5～8min,治愈59例,复发1例,平均住院3～5d。结论：应用该技术治疗小儿腹股沟斜疝,具有创伤小、手术时间短、副损伤小、恢复快、住院时间短、手术疤痕小等优越性。     

膀胱三角区注射肉毒素A治疗膀胱过度活动症不会引起膀胱输尿管返流

膀胱过度活动症是一种以尿急症状为特征的症候群,常伴尿频和夜尿症状,可伴或不伴急迫性尿失禁.抗胆碱能药物抑制逼尿肌收缩是主要的治疗手段,但疗效不理想,且不良反应较大.膀胱镜下于膀胱内逼尿肌散在注射肉毒素A是一种新的治疗方法,但目前认为注射区域不应该包括三角区,以避免术后膀胱输尿管返流.     

硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响

目的探讨硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响。方法择期行子宫下段剖宫产术患者60例,年龄24～30岁,体重59～73 kg,随机分为2组,每组30例,A组蛛网膜下腔注射规定剂量的0.75%布比卡因后硬膜外腔注射生理盐水5 ml;B组蛛网膜下腔注射0.75%布比卡因。按序贯法进行试验,设定布比卡因的起始剂量为9 mg,剂量梯度为1.5 mg,若上一例有效,则下一例递减一个剂量梯度,若无效则下一例递增一个剂量梯度,蛛网膜下腔阻滞有效的标准为注射布比卡因后20 min内阻滞上平面达T5。采用概率单位法计算ED50。结果A组布比卡因的ED50（5.8 mg）低于B组（8.1 mg）,两组比值为0.72,95%置信区间为0.27～0.98,区间范围不包括1,差异有统计学意义（P〈0.05）。结论硬膜外腔注射生理盐水可增强剖宫产术患者腰麻的效果。     

大鼠脂肪干细胞复合胶原-壳聚糖-硫酸软骨素三维支架构建组织工程软骨

Objective To evaluate the character of the collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells. Methods A dipose tissue were harvested from 6 weeks old Wistar rats and the stromal cells were harvested by type Ⅰ collagenase and then cultured in vitro. Type Ⅰ collagen was fully mixed with chitosan, freeze-dried and cross-linked with chondroitin sulfate, then freeze-dried again and sterilized by ethylene oxide. The pore diameter, water content, porosity of the scaffold were tested. The adipose tissue-derived stromal cells were digested, seeded into the plates, scaffold, and cen-trifuged into pellet, and then induced into cartilage. MTT detection for cell proliferation was done. After 3 weeks, the cell morphology, and cell proliferation and adhesion were observed, and chondrngenic differenti-ation was also analyzed. Results The pore diameter, water content, porosity tested for the scaffold showed an appropriate form. Cell proliferation showed faster in the scaffold and pellet culture system after 5 day, there was still cell proliferation in the scaffold system after 14 days but no obvious changes in the pellet cul-ture system; ceils on the scaffold proliferated densely showed by histological staining, but there was a scaf-fold structure residues in the inner layer. The finding of type Ⅱ immunohistochemistry stain showed that cells express strong positive for type Ⅱ collagen in the scaffold and pellet culture system whereas it was weakly positive in the plate culture system; the specific mRNA for cartilage, type Ⅱ collagen, aggrecan and SOX-9 were expressed in all three systems showed by RT-PCR, but type X collagen was expressed continu-ously in the plate culture system and expressed after 21 days in the pellet culture system, whereas it was not detected in the collagen-chitosan-chondroitin sulfate scaffold system. Conclusion The parameters of the collagen-chitosan-chondroitin sulfate scaffold were suitable in our study. The results suggested that it can promote the adipose tissue-derived stromal cells proliferation and chondrogenic differentiation better than the plate and pellet culture systems and maintain the phenotype of chondrocytes well; it is the optimal choice for cartilage tissue engineering in the future.     

蜡泪样骨病1例

蜡泪样骨病（melorheostosis）为一罕见的骨质硬化性疾病，多侵犯一侧肢体，增生的骨质自上而下沿骨干一侧向下流注，酷似蜡烛表面的烛泪，故名为蜡泪样骨病或蜡油样骨病，又称肢骨纹状肥大症。据国内文献报道自2003年以来共发现该病10余例。本科于2006年收治该病人1例。报道如下。     

小干扰RNA干扰大鼠神经元Nogo受体mRNA表达的实验研究

目的观察大鼠Nogo受体(NgR)特异性小干扰RNA(small interfering RNA,siRNA)在原代神经元干扰其mRNA表达的效果。方法体外培养大鼠原代皮层和海马细胞,应用阳离子脂质体转染试剂转染4对化学合成的大鼠NgR特异性siRNA,72h后提取细胞总RNA,实时荧光定量RT-PCR检测NgR mRNA表达情况。结果4对siRNA均能够下调靶基因NgR的mRNA表达水平,siNgR199、siNgR562、siNgR772和siNgR964等干扰后,NgR mRNA的表达分别为对照siRNA干扰组的6.5%、62.4%、15.2%和6.86%,与对照siRNA干扰组比较有统计学意义(P<0.05)。结论化学合成的NgR特异性siRNA能够有效的干扰大鼠原代皮层和海马细胞内NgR基因mRNA的表达水平。     

胃肠道浆肌层吻合的动物实验

目的探讨胃肠道浆肌层吻合的可行性。方法将中国家兔分成浆肌层吻合组、2层吻合组、1层吻合组和黏膜外吻合组,每组10只。每只家兔行1处吻合胃十二指肠侧侧吻合、2处回肠和2处结肠的端端吻合。术后第3、7天,测定吻合口爆破压(ABP)和羟脯氨酸(HP)含量。结果术后第7天,浆肌层吻合组各吻合口ABP均高于其他3组(P<0.05,P<0.01);HP含量高于2层吻合组(P<0.05)。结论胃肠道浆肌层吻合是一种安全、可靠及简便的方法。     

带十二指肠全胰及肾联合移植一例

我院于 2 0 0 0年 6月 1 8日完成 1例同种异体胰、肾联合移植 ,现报告如下。一、临床资料患者为男性 ,35岁 ,胰岛素依赖型糖尿病病史 2 5年 ,3年前出现肾功能不全、尿毒症 ,胸腔积液 ,心包积液 ,高血压等 ,对症治疗无效而行血液透析 ,2～ 3次 /周。术前主要相关检查 :血红蛋白83ｇ/Ｌ,糖化血红蛋白 8.2 6 % ,血糖 (治疗后 ) 6 .0 1ｍｍｏｌ/Ｌ ,果糖胺 2 .72ｍｍｏｌ/Ｌ ,胰岛素 9.56ｍＩＵ/Ｌ ,Ｃ 肽 1 .1 5ｎｇ/Ｌ,尿素氮1 3 .0 9ｍｍｏｌ/Ｌ ,肌酐 576 .1 μｍｏｌ/Ｌ。心电图示窦性心动过速 ,ＳＴ Ｔ改变。超声心动图提示左室扩大、高血…     

大鼠脂肪干细胞复合胶原-壳聚糖-硫酸软骨素三维支架构建组织工程软骨

Objective To evaluate the character of the collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells. Methods A dipose tissue were harvested from 6 weeks old Wistar rats and the stromal cells were harvested by type Ⅰ collagenase and then cultured in vitro. Type Ⅰ collagen was fully mixed with chitosan, freeze-dried and cross-linked with chondroitin sulfate, then freeze-dried again and sterilized by ethylene oxide. The pore diameter, water content, porosity of the scaffold were tested. The adipose tissue-derived stromal cells were digested, seeded into the plates, scaffold, and cen-trifuged into pellet, and then induced into cartilage. MTT detection for cell proliferation was done. After 3 weeks, the cell morphology, and cell proliferation and adhesion were observed, and chondrngenic differenti-ation was also analyzed. Results The pore diameter, water content, porosity tested for the scaffold showed an appropriate form. Cell proliferation showed faster in the scaffold and pellet culture system after 5 day, there was still cell proliferation in the scaffold system after 14 days but no obvious changes in the pellet cul-ture system; ceils on the scaffold proliferated densely showed by histological staining, but there was a scaf-fold structure residues in the inner layer. The finding of type Ⅱ immunohistochemistry stain showed that cells express strong positive for type Ⅱ collagen in the scaffold and pellet culture system whereas it was weakly positive in the plate culture system; the specific mRNA for cartilage, type Ⅱ collagen, aggrecan and SOX-9 were expressed in all three systems showed by RT-PCR, but type X collagen was expressed continu-ously in the plate culture system and expressed after 21 days in the pellet culture system, whereas it was not detected in the collagen-chitosan-chondroitin sulfate scaffold system. Conclusion The parameters of the collagen-chitosan-chondroitin sulfate scaffold were suitable in our study. The results suggested that it can promote the adipose tissue-derived stromal cells proliferation and chondrogenic differentiation better than the plate and pellet culture systems and maintain the phenotype of chondrocytes well; it is the optimal choice for cartilage tissue engineering in the future.     

上尿路尿路上皮癌预后多因素分析及术后再发膀胱癌危险因素分析

目的:探讨影响上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)患者的预后因素及术后再发膀胱癌危险因素。方法:回顾性分析304例UTUC资料。随访并分析吸烟、含有马兜铃酸的中药、既往患有膀胱癌、年龄、性别、肿瘤数目、肿瘤位置、肿瘤分期、肿瘤分级、手术方式等对UTUC预后的影响,应用Cox比例风险回归分析各因素与术后生存率的关系,生存率分析采用Kaplan-Meier方法。应用Logistic回归分析上述因素与术后再发膀胱癌的关系。结果:T_1患者5年生存率为80.0%(60/75),T_2为64.6%(62/96),T_3为43.8%(35/80),T_4为18.9%(10/53),T_1~T_2与T_3~T_4之间比较差异有统计学意义。影响UTUC患者长期生存率的因素为吸烟、既往服用含有马兜铃酸的中药、既往患有膀胱癌、年龄、肿瘤分期、肿瘤分级。与术后再发膀胱癌显著相关的因素是肿瘤分期、分级、肿瘤数目、输尿管镜检、是否术后膀胱灌注药物、低位肿瘤。结论:吸烟、既往服用含有马兜铃酸的中药、既往患有膀胱癌、年龄、肿瘤大小、淋巴结转移、肿瘤分期、肿瘤分级是影响UTUC患者长期存活的危险因素。肿瘤分期、肿瘤分级、肿瘤数目、输尿管镜检、低位肿瘤是术后再发膀胱癌的高风险因素,术后定期膀胱灌注为保护性因素。