夫精宫腔内人工授精临床妊娠率影响因素的分析

目的 探讨影响夫精宫腔内人工授精(IUI)临床妊娠率的各种因素.方法 回顾性分析402例患者进行的726个IUI周期.对女性患者年龄、输卵管条件、子宫内膜厚度、卵泡直径,处理前、后精子密度,精子活力(a级 b级)和活动精子总数(PTMS)与临床妊娠率的关系进行分析.结果 IUI共获89个临床妊娠周期,每周期临床妊娠率12.26%,每例临床妊娠率为22.14%.女方年龄>40岁、子宫内膜厚度＜9mm且输卵管通畅而盆腔造影剂弥散差者,临床妊娠率降低.处理前精子密度＜10×106/ml,PTMS＜10×106;处理后精子密度＜30×106/ml,精子活力<30%,活动精子总数＜5×106的患者临床妊娠率明显降低.治疗周期数对临床妊娠率无影响.结论 IUI中女性的年龄、子宫内膜厚度、输卵管情况和处理前后精子各项参数,尤其是PTMS是影响IUI临床妊娠率的直接因素.     

肌萎缩侧索硬化自评量表介绍

目的 介绍一套新的肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)自评量表.方法 综合目前各种常用ALS功能量表及自评量表,结合实际工作经验及数字疼痛分级法,制定了ALS自评量表.结果 ALS自评量表共分3大项18小项.采用10分制,正常为10分,极差为0分,总分180分.自评量表包括:①延髓功能:语言、吞咽、口水、伸舌:②肢体功能:左上肢运动、左手运动、右上肢运动、右手运动、左下肢运动、右下肢运动、躯干运动、抬头、行走、爬楼;③其他:呼吸、肌张力、疼痛、肌肉不适感.结论 ALS自评量表专门用于ALS患者,能够客观、灵敏评定患者功能,简便实用、费时短.     

丙泊酚-雷米芬太尼靶控输注在心脏手术中的应用

目的 观察丙泊酚-雷米芬太尼靶控输注(TCI)在心脏瓣膜置换术和冠状动脉旁路移植术中使用的安全性、有效性以及对术后恢复的影响.方法 择期心脏手术患者150例,以丙泊酚TCI、雷米芬太尼3～5μg/kg诱导,丙泊酚-雷米芬太尼2～8 ng/ml TCI维持,维持脑电双频指数(BIS)于50±10.观察术中血流动力学指标和术后恢复情况.结果 所有患者术中血流动力学平稳,术后恢复良好,无术中知晓.结论 雷米芬太尼[效应部位浓度(Ce)2～8 ng/ml]复合丙泊酚[血浆浓度(Cp)1～2μg/ml]用于心脏手术的麻醉安全有效,血流动力学平稳,有利于术后早期气管拔管.     

较大乳腺癌新辅助化疗后保乳手术24例报告

目的探讨较大乳腺癌新辅助化疗后保乳手术的可行性。方法2003年6月～2006年9月我院对24例肿瘤直径〉3cm的乳腺癌行空心针穿刺活检,以紫杉醇和（或）表阿霉素为主的联合新辅助化疗2～4个周期,化疗后7～10d行保乳手术。结果24例接受2～4个周期的新辅助化疗,临床完全缓解率（CR）12.5%（3/24）,部分缓解率（PR）87.5%（21/24）,病理完全缓解率（pCR）8.3%（2/24）。14例成功完成保留乳房手术,保留乳房率58.3%（14/24）,7例不符合保留乳房规范直接行改良根治术,3例术中冰冻切缘阳性改行改良根治术。24例随访5～44个月,中位时间24个月,无局部复发和远处转移。结论对于较大的乳腺癌,采用新辅助化疗缩小降期后,使相当部分患者获得保乳机会。     

Migration of endoclip into duodenum. A rare complication after laparoscopic cholecystectomy

The long-term effect of spilled clips within the abdominal cavity after laparoscopic cholecystectomy is unknown. However, most surgeons agree that the migration of clips has limited clinical consequences. A few cases have been reported of clips that have migrated into the common bile duct, causing stone formation and/or obstructions. We present a case of gallstone pancreatitis treated with laparoscopic cholecystectomy that was complicated by bile leakage from the cystic duct stump 1 day after the procedure. Although the leaking stump sealed itself spontaneously after the placement of a biliary stent, a clip had migrated directly to the superior wall of the first portion of the duodenum. Herein the details of the patient's history are presented. We also discuss the possible mechanisms of clip migration and describe some preventive measures.     

The Impact of Roux Limb Length on Weight Loss After Gastric Bypass

Background Extending the length of the Roux limb (RL) in gastric bypass (GBP) may improve weight loss in super obese patients (body mass index [BMI] > 50 kg/m²), but no consensus exists about the optimal length of the RL. We sought to determine the impact of RL length on weight loss in super obese patients 1 year after GBP. Materials and Methods One-year weight loss outcomes were analyzed in all super obese patients who underwent consecutive and primary laparoscopic or open GBP between January 2003 and June 2006. Patients were divided into two groups according to RL length (100 vs. 150 cm). The RL length was at the discretion of the attending surgeon. Baseline and follow-up data were collected prospectively. Multiple linear regression was used to adjust for potential confounders in the weight loss outcomes. Results Twelve-month follow-up data were available in 137 (85%) of 161 patients with a BMI ≥ 50 who underwent GBP during the study period. An RL of 100 or 150 cm was used in 102 (74.5%) and 35 patients (25.5%), respectively. In multivariate analysis, patients with the 150-cm RL lost more weight (68.5 vs. 55.3 kg, p < 0.01), had a greater change in BMI (25 vs. 21 kg/m², p = 0.01), and had greater excess weight loss (64 vs. 53%, p < 0.01). Conclusion A 150-cm RL provides better weight loss outcomes in super obese patients at 1-year follow-up.     

The effect of Darifenacin on overactive bladders in female and male rabbits

Our current study utilized a model of bladder instability to compare the effectiveness of darifenacin, a selective m₃ muscarinic antagonist, at inhibiting overactive bladder (OAB) dysfunction in both male and female rabbits. Twenty-four male and female NZ white rabbits were used for this experiment. Each rabbit was anesthetized and the carotid artery was cannulated for blood pressure (BP) monitoring and the left femoral artery was cannulated for acetylcholine (Ach) administration. The bladder dome was catheterized for monitoring bladder pressure and for cystometry. A ligature was placed around the urethra just distal to the bladder to induce OAB. After OAB developed, the response to four IV doses of darifenacin (0.003; 0.01; 0.03; 0.09 mg/kg) evaluated for their effects. Darifenacin: (1) was an equally potent inhibitor of the contractile response of both sexes to intra-arterial Ach, (2) had no effects on BP, (3) was a potent inhibitor of the frequency of OAB, but had a significantly less potent effect on the amplitude, and (4) Darifenacin showed a greater potency in the female rabbits than in the males. These studies provide support for the use of darifenacin in the treatment of OAB.     

多学科协作诊治模式下运行结直肠癌综合治疗的临床对照研究

目的探讨四川大学华西医院结直肠外科多学科协作（MDT）诊治模式的运行效果。方法回顾性分析从2006年12月至2007年5月，在四川大学华西医院结直肠外科住院治疗的大肠癌患者的病历资料，比较MDT组与非MDT组的疗效。结果MDT组围手术期住院时间及外科住院时间少于非MDT组（P〈0．05），但住院总时间上2组间差异无统计学意义（P〉0．05）。在手术治疗结果上，MDT组肿瘤手术切除率高于非MDT组（P〈0．05）。从术后早期并发症的发生情况分析，MDT组术后早期肠梗阻发生率低于非MDT组（P〈0．05），但吻合口漏和吻合口出血发生率2组间差异无统计学意义（P〉0．05）。经过5～10个月的随访，MDT组的患者术后肿瘤复发率低于非MDT组（P〈0．05），而术后吻合口狭窄和肠梗阻的发生率，2组间差异无统计学意义（P〉0．05）。结论结直肠肿瘤MDT模式针对大肠癌采用综合治疗方案，不仅有利于治疗方案的合理时间分配，而且提高了治疗效果。但对于MDT模式的影响因素尚缺乏系统性研究，同时还需将MDT模式中手术治疗的多模式环节进一步完善，以推出更为细化的围手术期MDT模式。     

胫骨下端恶性骨肿瘤切除后大段异体骨重建

目的应用大段异体骨移植及踝关节融合的保肢方法治疗胫骨下端恶性肿瘤和侵袭性肿瘤，并从预后、术后并发症及功能等几个方面加以评价。方法自1998年1月至2005年12月应用大段异体骨移植及踝关节融合的保肢方法治疗胫骨下端肿瘤患者11例；包括骨肉瘤8例，骨巨细胞瘤2例，软骨肉瘤1例。对骨肉瘤患者行新辅助化疗，按照Enneking分期，手术行边缘切除或广泛切除，应用大段深低温冷冻保存同种异体骨重建，钢板螺钉或带锁髓内钉固定。结果术后随访18-78个月，平均47个月。其中8例骨肉瘤患者随访28-78个月，平均50个月。11例均获得良好的骨愈合，开始出现骨愈合时间为术后3-18个月，平均8个月。无异体骨反应继发感染，无内固定失败。异体骨骨折1例，复发2例，肺转移3例，保肢率为81．8％。术后功能评定采用骨骼肌肉系统肿瘤手术治疗后重建功能评估系统（MSTS系统），评分为16～27分，平均24-3分。结论胫骨下端虽然软组织覆盖较薄，血运相对较差，但保肢术后肿瘤复发率不高，异体骨感染、不愈合、骨折率较低。固定方式以髓内固定为佳。大段异体骨移植及踝关节融合的保肢方法术后功能良好，给患者带来较大的心理安慰，是一种较好的保肢方式。     

不同大小机械牵张力对成骨细胞OPG/RANKL表达的影响

目的：研究不同大小机械牵张力对成骨细胞OPG／RANKL表达的影响。方法：通过自制多通道细胞牵张应力加载系统对小鼠成骨样细胞MC3T3-E1同时施加0％、6％、12％和18％的机械牵张力，作用24h后，用RT-PCR方法检测细胞受力后OPGmRNA／RANKL mRNA表达的变化，用免疫印迹法（Western Blotting）检测其蛋白表达的变化。结果：细胞受力后，其OPG mRNA及蛋白表达随牵张力值的增大明显增加，而RANKL mRNA及蛋白表达随牵张力值的增大明显减少。结论：不同大小机械牵张力可以影响成骨细胞的OPG／RANKL表达，进而影响正畸骨改建。