术中电生理监测下听神经瘤切除显微手术配合

一、一般资料：本组15例，其中男性9例，女性6例；年龄19～63岁，平均年龄44．6岁。病程8个月～12年，平均4～5年。发病部位左侧6例，右侧9例；肿瘤直径〈3cm者8例，3cm～5cm 3例，5cm～7cm 4例；术前7例轻度面瘫，所有患者术后面瘫症状无加重。     

超声刀在腹腔镜手术中的应用及保养

超声刀是现代新型的手术工具,用于腔镜手术,大地推动了手术操作的发展。我院自2005年6月～2010年12月应用强生公司生产的Et hiccon Endo-Surgery32型超声止血刀,在腹腔镜外科手术中取得了满意的效果。行各类手术共597例,并取得满意疗效,积累了一定的手术配合技巧和经验,现报告如下。     

P物质和降钙素基因相关肽及炎症因子在非糜烂性食管炎发生中的作用研究

ObjectiveTo explore the mechanism of substance P (SP), calcitonin gene-related peptide (CGRP) and inflammatory cytokines in the development of non erosive reflux disease. MethodsA total of 25 NERD patients and 10 normal controls were enrolled. All the subjects underwent GERDQ score, 24 h pH monitoring, high resolution esophageal manometry monitoring and endoscopic removal of the local mucosa at 3 cm of the esophageal dentate line as specimens. The expression of SP, CGRP and inflammatory cytokines (IL-1β, IL-6, IFN-γ, TNF-α) was detected by HE staining and RT-PCR. Results24 h esophageal pH monitoring showed that the number of weak acid reflux (4＜pH＜7), acid reflux (pH≤4), acid reflux (%) in proximal esophagus and DeMeester score in NERD group were significantly higher than in control group the t values were -2.365, -2.145, -2.782 and -2.776, and the P values were 0.025, 0.021, 0.021 and 0.017, respectively (P＜0.05). H&E staining showed that there were obvious neutrophil infiltration and pre-inflammatory reaction in esophageal mucosa of NERD group, and the score of inflammation injury was significantly higher than that of control group,the P value were 0.003 (P＜0.01). The relative expression of SP and CGRP in NERD group was significantly higher than that in control group, the P values were 0.0046,0.002, respectively (P＜0.01). In NERD group, the relative expressions of IL-1β, IL-6, IFN-γ and TNF-α in esophageal mucosa were significantly increased,P values were 0.0034, 0.0043, 0.004 and 0.0028, respectively (P＜0.01). Pearson correlation analysis showed that the acid reflux score (DeMeester) in NERD group was positively correlated with the expression of SP, CGRP and inflammatory factors (IL-1β, IL-6, IFN-γ, TNF-α) respectively. The P values 0.003, 0.000, 0.002, 0.005, 0.004 and 0.000, respectively (P＜0.01), the correlation coefficients were r=0.678, 0.686, 0.90, 0.482, 0.374 and 0.415, respectively. ConclusionThe expression of SP, CGRP and inflammatory cytokines in NERD patients increased significantly, which may be closely related to the increase of esophageal acid sensitivity caused by acid reflux and the occurrence of inflammation.     

脐静脉分次注入缩宫素减少产后出血量的临床观察

目的探讨脐静脉注入缩宫素对第三产程及产后出血量的影响。方法2007年7月～2009年4月选择在我院进行阴道分娩的孕产妇80例,随机平分为两组。实验组：胎儿娩出后,立即断脐,并从脐静脉注入缩宫素10u（用5％GS或0．9％NS20ml稀释）,6分钟后肌肉注射缩宫素10u。对照组：胎儿娩出后单纯肌肉注射催宫素20u。两组各计算第三产程时间、出血量、产后2小时的出血量。结果实验组比对照组第三产程、出血量、产后2小时出血量均明显减少,两组之间的差异有统计学意义（p〈0．05）。结论脐静脉注入缩宫素,能增强子宫肌的收缩力度,从而缩短第三产程,减少产后出血量;缩宫素的分次应用使子宫肌层维持较高的药物浓度,维持子宫肌的高张力状态,子宫肌持续收缩,加快子宫腔内胎盘剥离面的血窦闭合,达到减少出血的目的。     

遗传性牙龈纤维瘤病一家系

遗传性牙龈纤维瘤病一家系王秀荣，杜秀云先证者（Ｖ１）女，７岁。因下颌第一切牙萌出时牙龈增生而就诊。检查：下颌第一切牙已萌出，间隙大，牙龈增生，舌侧龈明显，其余恒牙未萌出，牙龈未增生。家系调查见图１。先证者之母（Ⅳ２），３３岁。替牙期牙龈开始增生至２０...     

腹腔镜下食管裂孔疝修补术的手术配合

目前，一般认为，食管裂孔疝修补后，需要加做胃底折叠抗反流术，这有助于预防疝复发和防治胃食管反流性疾病。当前应用腹腔镜修补食管裂孔疝在欧美发达国家已被广泛运用，手术技术日益成熟，国内报道亦逐渐增多，由于腹腔镜手术的特殊性，手术配合存在一定的特殊性，从2005年6月至2008年11月，我院为64例患者施行该手术，现将手术配合经验介绍如下。