超声刀在急性胆囊炎腔镜胆囊切除术中的应用研究

目的探讨超声刀腔镜胆囊切除术(LC)治疗急性胆囊炎的手术技巧及应用价值。方法回顾性分析2010年1月~2013年12月使用超声刀行急性胆囊炎LC患者48例与同期用高频单极电刀行急性胆囊炎LC者34例的临床资料进行比较。结果两组病例在手术时间,术中出血,住院时间等方面差异有显著性,超声刀组明显少于高频单极电刀组(P0.05),中转开腹数、术后腹腔引流量超声刀组也较少,患者均顺利出院。结论应用超声刀行急性胆囊炎LC安全可行,术中出血少,手术时间短,并发症低,值得临床推广,但应选择恰当的手术时机,具备娴熟的手术技巧。     

The effects of β-NGF controlled delivery system on growth of primary cultured chick embryo dorsal root ganglion axons

Objective To construct β-NGF controlled delivery system and evaluate the biological effects of β-NGF on the growth of chick embryo dorsal root ganglion (DRG) axons in vitro. Methods Delivery systems releasing β-NGF at 50/μL, 100/μg/L and 250 μg/L concentration were constructed. To determine the optimal dose response effects of NGF in the controlled delivery system, DRG were co-cultured with of β-NGF at above concentrations while using DRG basic culture as control. Axonal growth was observed. DRG were also cocultured with the components in the controlled delivery system to detect the effects on growth of DRG axons. The experiment was divided into 5 experimental groups and 1 control group: control group, DRG+ fibrin; Group A,DRG+ fibrin+ peptide + heparin + 100 μg/L β-NGF; Group B, DRG + fibrin + heparin + 100/μg/L β-NGF;Group C, DRG + fibrin + peptide + 100 μg/L β-NGF; Group D, DRG + fibrin + 100 μg/L β-NGF; Group E,DRG + fibrin + peptide + heparin. Results The growth of DRG axons in 50 μg/L, 100μg/L and 250/μg/Lconcentration of β-NGF controlled delivery system was 1.31 ( P > 0. 05), 3.78 ( P < 0. 01 ) and 3.05 ( P <0.01) folds of the control respectively. The growth of DRG axons in 100 μg/L group was significantly better comparing to that in 250 μg/L group. The growth of DRG axons in Groups A, B, C, D and E was 3.75, 1.15,1.12, 1.10 and 1.09 folds of the control group, respectively. The difference was only statistically significant between Group A and the control group ( P < 0. 01 ). Conclusion β-NGF released from the β-NGF controlled delivery system was bioactive. It could promote the growth of DRG axons.     

经胆囊管行胆总管探查取石的临床应用

具有胆总管探查指征的病人，行胆总管切开探查／取石T管引流是肝胆外科传统术式。该术式操作相对复杂，还有住院时间长，医疗费用高，手术并发症多等缺点。笔者近十年来有选择地对72例具胆总管探查指征的病人，胆囊切除后经胆囊管人路行纤维胆道镜胆总管探查，并一期缝扎胆囊管，保持胆总管完整性，取得了良好的效果，现报告如下。     

早期肠内谷氨酰胺补给对烫伤大鼠回肠p-ERK通路的影响

目的:观察早期肠内谷氨酰胺补给对烫伤大鼠回肠p-ERK1/2表达的影响.方法:选健康SD大鼠88只随机分为肠内营养组(EN组,n=40)、肠内营养加谷氨酰胺补给组(EN Gln组,n=40)和伤前对照组(n=8),制备总烧伤面积(TBSA)为30%的Ⅲ°烫伤动物模型,伤后早期分别给予肠内营养制剂能全力和能全力加Gln,于6,1 2,24,48和96 h观察肠黏膜细胞p-ERK的表达分布及血浆D-乳酸浓度变化.结果:烧伤后血浆D-乳酸水平升高,EN组在观察时间内血浆D-乳酸水平没有恢复正常(P＜0.05),EN Gln组血浆D-乳酸水平在伤后48 h恢复至伤前水平且明显低于EN组(4.7±0.9 mmol/L vs 6.9±1.2 mmol/L,P＜0.05).p-ERK1/2免疫组化染色显示烧伤后阳性细胞数量显著增加,EN Gln组回肠阳性细胞百分比在24,48,96 h明显高于EN组(绒毛:87.6%±9.6%,84.4%±10.3%,74.6%±9.7% vs 64.6%±7.3%,59.6%±7.1%,58.4%±7.4%,P＜0.05;隐窝:73.6%±11.2%,67.4%±8.6%,63.6%±7.9% vs 54.3%±6.3%,51.6%±5.9%,48.4%±5.3%,P＜0.05).Western blot显示EN组伤后6 hp-ERK1/2表达明显增加,12 h达高峰,然后逐渐下降,EN Gln在24 h达到高峰并逐渐下降.结论:相对于肠内营养,早期肠内给予Gln能促进肠上皮细胞p-ERK1/2的表达,改善黏膜局部的屏障功能.     

The effects of β-NGF controlled delivery system on growth of primary cultured chick embryo dorsal root ganglion axons

Objective To construct β-NGF controlled delivery system and evaluate the biological effects of β-NGF on the growth of chick embryo dorsal root ganglion (DRG) axons in vitro. Methods Delivery systems releasing β-NGF at 50/μL, 100/μg/L and 250 μg/L concentration were constructed. To determine the optimal dose response effects of NGF in the controlled delivery system, DRG were co-cultured with of β-NGF at above concentrations while using DRG basic culture as control. Axonal growth was observed. DRG were also cocultured with the components in the controlled delivery system to detect the effects on growth of DRG axons. The experiment was divided into 5 experimental groups and 1 control group: control group, DRG+ fibrin; Group A,DRG+ fibrin+ peptide + heparin + 100 μg/L β-NGF; Group B, DRG + fibrin + heparin + 100/μg/L β-NGF;Group C, DRG + fibrin + peptide + 100 μg/L β-NGF; Group D, DRG + fibrin + 100 μg/L β-NGF; Group E,DRG + fibrin + peptide + heparin. Results The growth of DRG axons in 50 μg/L, 100μg/L and 250/μg/Lconcentration of β-NGF controlled delivery system was 1.31 ( P > 0. 05), 3.78 ( P < 0. 01 ) and 3.05 ( P <0.01) folds of the control respectively. The growth of DRG axons in 100 μg/L group was significantly better comparing to that in 250 μg/L group. The growth of DRG axons in Groups A, B, C, D and E was 3.75, 1.15,1.12, 1.10 and 1.09 folds of the control group, respectively. The difference was only statistically significant between Group A and the control group ( P < 0. 01 ). Conclusion β-NGF released from the β-NGF controlled delivery system was bioactive. It could promote the growth of DRG axons.     

The effects of β-NGF controlled delivery system on growth of primary cultured chick embryo dorsal root ganglion axons

Objective To construct β-NGF controlled delivery system and evaluate the biological effects of β-NGF on the growth of chick embryo dorsal root ganglion (DRG) axons in vitro. Methods Delivery systems releasing β-NGF at 50/μL, 100/μg/L and 250 μg/L concentration were constructed. To determine the optimal dose response effects of NGF in the controlled delivery system, DRG were co-cultured with of β-NGF at above concentrations while using DRG basic culture as control. Axonal growth was observed. DRG were also cocultured with the components in the controlled delivery system to detect the effects on growth of DRG axons. The experiment was divided into 5 experimental groups and 1 control group: control group, DRG+ fibrin; Group A,DRG+ fibrin+ peptide + heparin + 100 μg/L β-NGF; Group B, DRG + fibrin + heparin + 100/μg/L β-NGF;Group C, DRG + fibrin + peptide + 100 μg/L β-NGF; Group D, DRG + fibrin + 100 μg/L β-NGF; Group E,DRG + fibrin + peptide + heparin. Results The growth of DRG axons in 50 μg/L, 100μg/L and 250/μg/Lconcentration of β-NGF controlled delivery system was 1.31 ( P > 0. 05), 3.78 ( P < 0. 01 ) and 3.05 ( P <0.01) folds of the control respectively. The growth of DRG axons in 100 μg/L group was significantly better comparing to that in 250 μg/L group. The growth of DRG axons in Groups A, B, C, D and E was 3.75, 1.15,1.12, 1.10 and 1.09 folds of the control group, respectively. The difference was only statistically significant between Group A and the control group ( P < 0. 01 ). Conclusion β-NGF released from the β-NGF controlled delivery system was bioactive. It could promote the growth of DRG axons.     

肠内营养添加谷氨酰胺对烧伤患者的免疫调理作用

目的 了解烧伤后早期肠内营养添加谷氨酰胺(Gln)对患者免疫调理状态的影响.方法 将24例烧伤患者随机分为2组,每组12例.标准营养(EN)组:给患者喂食标准肠内营养制剂能全力;免疫营养(EIN)组:喂食能全力+Gln.分别于伤后1、4、7、10 d清晨空腹抽血,检测血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TF)和免疫球蛋白IgG、IgA、IgM的浓度以及T淋巴细胞亚群CD3+、CD4+、CD8+和CD4+/CD8+的比值.结果 伤后各时相点2组患者TP、ALB、TF、CD3+、IgM组间比较,差异均无统计学意义(P＞0.05).伤后4、7、10 d,EIN组患者PAB浓度分别为(90±14)、(92±16)、(106±21)mg/L,显著高于EN组(60±15)、(64±13)、(72±17)mg/L(P＜0.05).伤后7、10 d,EIN组CD4+细胞百分比为(55±5)%、(56±5)%,明显高于EN组的(45±5)%、(49±5)%(P＜0.05);CD4+/CD8+比值为1.92±0.31和2.36±0.36,明显高于EN组的1.53±0.27和1.72±0.42(P＜0.05);IgA分别为(2.8±0.6)、(3.1±0.6)g/L,IgG为(12.1±1.3)、(14.2±1.3)g/L,显著高于EN组的IgA[(2.2±0.5)、(2.5±0.5)g/L,P＜0.05]和IgG[(9.8±1.2)、(10.4±1.3)g/L,P＜0.05].结论 添加Gln的肠内营养制剂可以促进免疫球蛋白IgA、IgG的合成并增加PAB浓度,改善患者营养状况,纠正免疫功能紊乱.     

肾上腺皮质癌腹痛误诊1例分析

对肾上腺皮质癌腹痛误诊1例分析如下。 1病历摘要 男，68岁。近2个月左下腹持续性隐痛、阵发性加重，右侧卧位时加重，疼痛影响睡眠，饭后有胃胀感，消瘦、体弱，以往有高血压．脑梗死、胃下垂病史，     

氨力农与氨酰心安联合治疗顽固性心衰16例

我们对我科1997～1999年收治的扩张型心肌病和缺血性心肌病心力衰竭,经强心、利尿扩血管等治疗效果不好的患者,应用氨力农与小剂量氨酰心安治疗,收到明显效果,报告如下。1 对象与方法1.1 对象 共观察心力衰竭患者16例,其中扩张型心肌病8例,缺血性心肌病8例,男性11例,女性5例,年龄43～72岁,经常规强心、利尿、扩血管等治疗1周,心功能仍在Ⅲ～Ⅳ级(NYHA分级)者,对照组为1996年6月～1997年5月收治的未用氨力农及氨酰心安治疗的心衰患者18例,入院时病情与治疗组相似,差异无显著性,有可比性。1.2 方法 治疗组在上述方案(强心、利尿扩血管治疗1周不见好转)中停用洋地黄制剂,改用氨力农150 mg加入生理盐水250 ml中静滴5～10 mg/kg/min,每日1次,氨酰心安6.25 mg,每     

藏医特色技术-白脉病疗法临床应用分析及推广应用思考

本文通过对现有文献的综合分析,认为藏医白脉病疗法是治疗藏医白脉病的重要治疗手段和藏医特色技术,在诸多疾病的治疗中疗效显著、优势明显,临床适用于中风、骨关节病、神经性疼痛等多种疾病的治疗;与中医学的推拿、按摩及针灸治疗也有异曲同工之妙,白脉病疗法还蕴含一些现代康复医学的理念,但是需要进一步规范其技术标准,方可推广应用。