上尿路结石腔内手术中迷走心血管反射的防治

目的探讨上尿路结石腔内手术中迷走心血管反射的防治;方法总结我院2002年12月至2008年12月行上尿路结石腔内手术中发生迷走心血管反射及诊治的经验。结果本组1023例上尿路结石腔内手术,术中发生迷走心血管反射38例,发生率为3．7％。其中2例死亡,1例成为植物人,其余均经积极抢救治愈。结论上尿路结石腔内手术中迷走心血管反射时有发生,严重时可导致病人死亡,应引起高度重视,主要的防治措施为术中给予足够剂量的阿托品。     

老年人结直肠癌的外科治疗

目的 探讨高龄结直肠癌患者的外科治疗方法。方法 回顾性分析8年间109例60岁以上结直肠癌患者行外科治疗的临床资料。结果 高龄结直肠癌患者入院前误诊率高(38．5％)，并存病多(89．0％)，肿瘤切除率为89．6％，围手术期病死率为8．2％。结论 手术切除是高龄结直肠癌患者最佳治疗方法，早期诊断，早期治疗，合理处理并存病，选择适当的麻醉和手术方式，有效的预防和治疗并发症是提高疗效的关键。     

中南大学湘雅医院血液透析患者血管通路现状

目的：了解血液透析患者的血管通路现状。方法：回顾性分析中南大学湘雅医院血液透析中心2015年4 月1日至2016年4月1日新导入及维持性血液透析患者的基本资料、血管通路选择和并发症。结果：维持性血液透析 患者258例,采用自体动静脉内瘘(artetiovenous fistula,AVF)的患者占87.60%、带涤纶套带隧道导管占12.40%。新导入 患者61例,首次透析采用无隧道无涤纶套导管的患者占80.33%,AVF占8.19%,带涤纶套带隧道导管占9.84%,动静脉 穿刺占1.64%。AVF选择吻合血管依次为腕桡动脉-头静脉(76.55%)、肱动脉-头静脉(11.06%)、前臂中段桡动脉-头静脉 (7.08%)、肱动脉-肘正中静脉和肱动脉-贵要静脉(5.31%)。AVF发生并发症占总AVF透析人数的 34.07%,其中动脉瘤占 24.34%。结论：维持性血液透析患者绝大多数采用 AVF,而新导入透析患者中使用无隧道无涤纶套导管者比例较大。     

重度肩锁关节脱位的手术治疗

目的：对15例重度肩锁关节脱位的手术7治疗进行治疗,方法：15例全部为Allman分型中的Ⅲ型损伤,其中有11例切除纤维软骨盘,7例修复锁韧带,3例加用一枚松质骨螺钉固定于锁骨与喙空间,肩锁韧带全部修复,用两枚克氏针交叉固定于肩锁关节。结果：经10个月－6年的随访。疗效评价按Karlsson分类A级为12例,B级3例,病人均重返原工作岗位,有10例喙锁间隙软组织钙化,但对病人肩关节活动并无影响,结论：对重度肩锁关工锐位的病人应尽早手术治疗。克氏针交叉内固定是一种简单而有效的方法,纤维软骨盘是否切除和喙锁韧带是否修复对预后无明显影响。     

背阔肌解剖分区及其肌电研究

目的 明确背阔肌的解剖分区及各区在肩关节运动中的肌电表现。方法 对10具成人尸体背岂进行血管、神经解剖并按主要血管、神经的分支、分布将背阔肌分区、。利用体表电极记录13例（25侧）健康成人背阔肌不同区在肩关节运动中的肌电表现，并将记录结果进行统计学处理、分析。结果 背阔肌的主要血管、神经来自胸痛血管、神经及其内、外侧分支，部分来自肋间血管、神经，胸背血管、神经分支及肋间血管、神经分支间有广泛的吻合，胸背血管、神经内、外侧支及其延长线将背阔肌分成三个区域。三区在肩关节6种运动中的肌电表现不同。结论 背阔肌内不同区域肌纤维在肩关节运动中的作用不同。     

护理研究成果在临床应用中阻碍因素的调查分析

目的 探寻护理研究成果应用中的阻碍因素,以促进护理成果的转化.方法 对从事临床护理工作的486名护士进行问卷调查,并对阻碍护理研究成果应用的因素进行统计分析.结果 没有权力更新护理常规或技术操作规程、护理研究可信度不高、对护理研究缺乏认识、没有知识丰富的同事共同讨论新观点、没有时间去阅读护理文献及试用成果分别占92.6%、83.5%、70.0%、60.7%、51.0%及53.5%,是重要的阻碍因素.结论 管理部门应重视护理成果的转化,及时更新护理常规及技术操作规程,组建成果应用合作团队等,以加速成果的转化.     

股骨髁部骨折四种内固定方法的疗效比较

目的对股骨髁部骨折四种内固定方法的疗效进行比较分析,指导临床合理选择和应用。方法自2000年8月~2005年8月,对291例股骨髁部骨折分别应用“L”型髁钢板(LSCP)、动力髁螺钉(DCS)、逆行交锁髓内钉(GSCN)及微创内固定系统(LISS)的疗效进行回顾性比较分析,包括股骨髁上骨折143例和股骨髁间骨折75例。获随访218例,平均随访时间38·6个月(3~58个月)。按AO/OTA分类,A型(关节外骨折)143例,其中A2型80例,A3型63例;C型(完全关节内骨折)75例,其中C2型37例,C3型38例。结果四种内固定方法的骨愈合率及HSS功能评定结果分布有统计学差异(P<0·05)。LISS组的骨愈合率及HSS功能评定优秀结果分布最高,而LSCP组骨愈合率及HSS功能评定优秀结果分布最低。最终所有骨不连患者经翻修后全部获得骨性愈合。结论微创内固定系统在治疗A3、C2及C3型股骨髁部骨折中,较其他内固定方法具有骨愈合率高和功能恢复满意等特点,值得临床推广应用。     

胃肠道癌腹膜转移的核心病理机制

胃肠道癌腹膜转移是目前临床治疗的最大难题,解决该难题的根本之道在于临床医生准确把握胃肠道癌腹膜转移的核心细胞病理学机制,基本掌握分子病理学机制,并融会贯通地运用到每一例患者诊治的临床决策过程中,做到"防""治"并举,积极预防、主动治疗。与临床治疗决策密切相关的胃肠道癌腹膜转移的核心细胞病理学机制有4点：（1）腹腔游离癌...     

Laparoscopic-Assisted Resection for Advanced Colorectal Cancer in Solid Organ Transplant Recipients

ABSTRACT

Aim: To evaluate the feasibility, short- and long-term outcomes, and safety of laparoscopic resection for advanced colorectal cancer (CRC) in solid organ transplant recipients. Methods: Between September 2001 and April 2016, five patients who underwent laparoscopic-assisted resection for CRC after solid organ transplantation were included in this study. Their clinical data were retrospectively analyzed with regard to patient demographics, immunosuppressive therapy, tumor characteristics, surgical outcomes, and follow-up data. Results: Four kidney and one heart transplant recipients were included. Laparoscopic-assisted low anterior resection was performed in four patients with rectal or rectosigmoid junction cancer, and sigmoidectomy was done in one with sigmoid colon cancer. One kidney transplant patient received a protective loop transverse colostomy. All resections achieved complete tumor removal with tumor-free margins and total mesorectal excision, with an average number of 14 lymph nodes harvested. Most tumors were in stage III (n = 3), one was in stage II, and one in stage IV. The mean duration of surgery, intraoperative blood loss, and postoperative hospital stay were 144 min, 105 mL, and 8.8 days, respectively. No major complications occurred and graft function stayed well. During a mean follow-up period of 62 months, two patients developed metastasis and died eventually. Conclusion: Laparoscopic resection for advanced CRC in organ transplant recipients is technically feasible and therapeutically safe, and seems to have the advantages of few postoperative complications, short recovery time, and acceptable oncological outcomes.     

Role of glycogen synthase kinase 3β in protective effect of propofol against hepatic ischemia–reperfusion injury

Background

It was previously reported that propofol, an intravenously administered hypnotic and anesthetic agent, protects organs from ischemia–reperfusion (I/R) injury. However, the underlying mechanisms are largely unknown. Glycogen synthase kinase 3β (GSK-3β) is known to play an important role in the oxidative stress–induced apoptosis. In this study, we investigated the role of GSK-3β and mitochondrial permeability transition pore (MPTP) in the protective effects of propofol against hepatic I/R injury.

Materials and methods

The left and median hepatic artery and the portal vein branches were blocked by no-damage artery clips to create the model of partial ischemia (70%), and liver lobes were subjected to warm ischemia for 30, 60, 90 min, respectively. Reperfusion of 120 min was then initiated by the removal of clamp. The MPTP opening was assessed by measuring mitochondrial large amplitude swelling and mitochondrial membrane potential.

Results

Pretreatment with propofol in conditions of hepatic I/R inhibits the apoptosis of hepatocytes as evidenced by decreased terminal deoxynucleotidyl transferase dUTP nick end labeling–positive cells. Importantly, propofol suppressed the mitochondrial GSK-3β by promoting or preserving its phosphorylation at Ser9, thus restraining the opening of MPTP and preventing the mitochondrial swell and mitochondrial membrane potential collapse.

Conclusions

Propofol protects liver from I/R injury by sustaining the mitochondrial function, which is possibly involved with the modulation of MPTP and GSK-3β.