经内镜综合治疗胃石16例

目的探讨内镜下多种方法综合治疗胃石。方法利用套扎器、活检钳,结合口服碳酸氢钠、芝麻油治疗16例胃结石患者。结果16例患者中13例经1次碎石排尽,3例巨大结石经第2次碎石消失。2周后复查胃镜,胃石均消失,无出血、肠梗阻等并发症。结论经内镜综合治疗胃石,一次成功率81％,二次成功率100％;器械简单,操作方便、成本低,患者痛苦少,值得推广。     

胶囊内镜对慢性腹痛的诊断分析

目的分析胶囊内镜在慢性腹痛中的诊断价值。方法 2008年9月-2009年7月慢性腹痛25例、无消化道症状体检20例进行胶囊内镜检查,对诊断结果进行相关统计学分析。结果胶囊内镜均顺利完成检查,全部胶囊在检查结束后排出体外。检查过程中患者无任何不适。慢性腹痛患者中,小肠溃疡3例（12%）,小肠息肉3例（12%）,十二指肠扭转1例（4%）,空肠静脉瘤1例（4%）,空肠蛔虫病1例（4%）,回肠黏膜糜烂1例（4%）。无消化道症状的体检者中,小肠息肉2例（10%）,回肠黏膜糜烂1例（5%）。小肠疾病在慢性腹痛患者中检出率40%,明显高于无消化道症状的体检者（15%）,两者比较有统计学意义（P〈0.01）。两组的胃排空时间分别为（40.99±31.38）min和（37.90±24.89）min,到达回盲部时间分别为（220.89±91.64）min和（225.68±80.59）min,两组比较无统计学意义（P〉0.05）。结论胶囊内镜在慢性腹痛的诊断中有良好价值,临床安全性好。     

胃食管反流病误诊为呼吸道疾病1例诊治分析

胃食管反流病（gastro—esophageal reflux disease,GERD）是一种胃十二指肠内容物反流人食管,引起反酸、烧心、反食等症状,并可有非心源性胸痛、支气管哮喘及慢性咽喉炎等食管外表现。反流的常见典型症状有反酸和烧心。其他相关症状包括1种或多种,如上腹痛、胸痛、暖气、     

腹部开放伤后海水浸泡对实验犬肠屏障功能的影响

目的 探讨腹部开放伤后海水浸泡对实验犬肠屏障功能的影响.方法 实验动物致伤后随机分为对照组(n=10)和海水浸泡组(n=10).对照组致伤后直接观察,海水浸泡组于致伤后立即放入人工配制的海水中,于致伤前(0 h)及出水后4、8、12、24 h取血测定血浆内毒素、谷氨酰胺、D-乳酸、双胺氧化酶(DAO)含量.实验后取门静脉血、肠系膜淋巴结进行细菌培养,并取小肠组织进行病理检查.致伤后给予乳果糖/甘露醇(L/M)肠内注入,收集24 h尿测定L/M含量.结果 海水浸泡组血清D-乳酸、DAO活性呈进行性上升趋势,8 h后与对照组比较差异有统计学意义(P＜0.05);谷氨酰胺呈进行性下降,12 h后与对照组比较差异有统计学意义(P＜0.01);内毒素升高,12 h后与对照组比较差异有统计学意义(P＜0.05);24 h后尿L/M与对照组比较差异有统计学意义(P＜0.05);门静脉和肠系膜淋巴结细菌培养,海水浸泡组出现大量菌落,与对照组比较差异有统计学意义(P＜0.01).病理结果显示,海水浸泡组与对照组比较肠黏膜损伤明显,黏膜厚度和绒毛高度均显著减小.结论 海水浸泡可导致实验犬的肠道屏障功能受损.     

早期肠内营养对晚期胰腺癌患者营养状况的影响

目的 探讨早期肠内营养对晚期胰腺癌患者营养状况和并发症的影响。方法 选择2012年1月-2013年12月海军总医院肿瘤科和消化内科收治的晚期胰腺癌患者68例,将其按照入院后24～72 h是否接受鼻空肠管置管行肠内营养支持分为肠内营养组（33例）和对照组（35例）。肠内营养组患者给予肠内营养粉支持,对照组患者给予普通流质饮食。两组患者在给予营养支持的同时,均给予同类肠道益生菌及镇痛等对症治疗。于治疗第1天和第30天时观察两组营养指标,包括体质指数（BMI）、肱三头肌皮褶厚度、上臂围|生化指标,包括空腹血糖、血清总蛋白、清蛋白、胆固醇、三酰甘油|肝功能指标,包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（TBiL）|以及两组肠道并发症和感染发生率。结果 治疗前,两组BMI、肱三头肌皮褶厚度、上臂围比较,差异均无统计学意义（P＞0.05）|治疗后,肠内营养组BMI、肱三头肌皮褶厚度、上臂围均高于对照组（P＜0.05）。治疗前,两组血糖、总蛋白、清蛋白、胆固醇、三酰甘油比较,差异均无统计学意义（P＞0.05）|治疗后,肠内营养组空腹血糖、总蛋白、清蛋白、胆固醇均高于对照组（P＜0.05）。治疗前,两组ALT、AST、TBiL比较,差异均无统计学意义（P＞0.05）|治疗后,肠内营养组ALT、AST、TBiL均低于对照组（P＜0.05）。两组腹胀发生率比较,差异无统计学意义（P＞0.05）|肠内营养组腹泻、便秘、感染发生率均低于对照组（P＜0.05）。结论 早期肠内营养支持治疗可有效改善晚期胰腺癌患者的营养状况,降低肝功能受损、腹泻、便秘和感染的发生率。     

还原型谷胱甘肽联合甘草酸二铵对腹部开放伤后海水浸泡犬肝功能损伤的治疗作用

Objective To investigate effect of reduced glutathione and diammonium glycyrrhizinate on the treatment of hepatic damage in experimental dogs following open abdominal injuries coupled with seawater immersion. Methods Twenty-four dogs with open abdominal injuries were randomly divided into 3 groups: the control group (given with simple observation after 1.5 h seawater immersion); the routine treatment group (given routine care and fluid transfusion after 1.5 h seawater immersion) ; the hepatic treatment group (given routine are, fluid transfusion and hepatic treatment as well, after 1.5 h seawater immersion). Each group consisted of 8 dogs. Blood samples were taken at different time points to measure total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothromin time (PT), endotoxin, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and pathological examination was also made at the same time. Results For the control group, contents of TB, ALT, AST and LDH increased significantly and survival time was less than 24 hours. Contents of TB, ALT, AST and LDH of the routine treatment group also increased significantly, but survival time of all the experimental animals was mere than 24 hours. Reduced glutathione and diammonium glycyrrhizinate could reduce the extent of lesion quite significantly 12～24 hours following open abdominal injuries. Conclusions Reduced glutathione and diammonium glycyrrhizinate seemed to have good effects on the treatment and prevention against hepatic damage induced by trauma coupled with seawater immersion. It could be used as a primary means for the treatment of such kind of hepatic damage.     

幼猪头颅低剂量螺旋CT扫描参数优化研究

Objective To optimize the scanning parameters for CT with lower radiation dose on the infant pigs' brain which mimic the baby's head of human being. Methods Five pigs underwent CT scan using regular X-ray dose I. E. , 400 mAs, and other dose including 300,250, 200,150 and 100 mAs respectively, and the other parameters were the same. Each pig was scanned 12 times repeatedly with each of the six X-ray doses, which obtained 960 image. Anatomic details and the confidence level in reaching a diagnosis were evaluated by three radiologists respectively in a double-blinded manner using a 4-point scoring system. The CTDI of every group were compared. All Results were analyzed by Chi-square test and analysis of variance. Results The CTDI of 400,300,250,200,150,100 mAs was (55.5±0.1),(41.9±0.0), (34.7±0.0), (27.8±0.0), (20.9±0.0), (12.2±0.0) mGy respectively, there was a significant difference(F = 214872.0,P < 0.05)among the six groups. There was no significant difference in the quality of images obtained from the conventional 400 mAs scanning and low dose group of 300,250,200, 150 mAs scanning images, the total score was (3.7±0.5), (3.7±0.5), (3.6±0.3), (3.6±0.5), (3.6±0.5) respectively,which was more than 3 points, while the 100 mAs group showed low quality (2.1±0.5) which was less than 3 points. In the 100 mAs group, there were 215 in 960 images >3 points, 745 images < 3 points, and regular doses of 400 mAs group (934 image > 3 points). Image quality difference was statistically significant (χ2=3289.9,P <0.05). Conclusion The low-dose scanning (120 kV, 150 mAs, 20.8 mGy)would be practical in diagnosing in normal infant pigs' brain.     

混合型过敏性紫癜1例及诊断分析

报道1例以紫癜、急性胰腺炎、十二指肠降部溃疡和心脏受损为主要临床表现的成年女性病例.复习1990年美国风湿病学会制订的过敏性紫瘢新的诊断标准及在该病例的应用.临床怀疑腹型或混合型过敏性紫癜的患者,对实验室和影像学检查结果要综合分析,多次复查,有助于诊断和疗效的判断.     

经内镜胆管支架或鼻胆管置放结合γ刀治疗晚期胰腺癌的临床观察

目的 探讨经十二指肠镜胆管支架或鼻胆管置放与γ刀结合治疗晚期胰腺癌的疗效.方法 有35例晚期胰腺癌病人接受治疗,其中26例被放置塑料支架,6例放置鼻胆管,均行γ刀治疗10～12次/疗程,总剂量为40～50 Gy.结果 插管成功率91.4%,并发症3例,并发症发生率9.4%,2例急性胰腺炎,1例急性胆管炎.血清胆红素由310 μmol/L下降到术后1周的126 μmol/L.治疗后3个月、6个月存活率分别达96%及80%.结论 经内镜胆管支架置放或鼻胆管置放结合γ刀治疗晚期胰腺癌是安全、有效的方法.     

供体血管内皮细胞对小鼠-大鼠移植心脏存活时间的影响

目的:探讨供体血管内皮细胞对小鼠-大鼠移植心脏存活时间的影响.方法:分离小鼠血管内皮细胞并于移植前14天经大鼠阴茎背静脉注入2×106细胞/只或联合注射环磷酰胺20mg/Kg·D.异位小鼠-大鼠心脏移植后观察供心存活时间.结果:成功分离小鼠血管内皮细胞,注射小鼠血管内皮细胞14天后,移植心脏平均存活时间10±1.414min,组化染色显示供心有IgM、C3沉积,血浆IgM、IgG、C3、C4较未注射血管内皮细胞组明显增高;联合使用环磷酰胺能延长供心成活时间19.44±2.6034min(t=2.880,P＜0.01).结论:外周静脉注射供体血管内皮细胞不能诱导延迟性异种移植排斥反应(DXR)的免疫耐受,却促使发生HAR.联合环磷酰胺可延长供心存活时间.