Repairing the Upper Esophageal Defects using Isolated Jejunum with Cervico-mesenteric Vessels Anastomosis

FromMay1984toJune1994,thetransplantationofjejunumhasbeenmadetorepairallkindsofesopha-gus-stomachdefectsin21patients.In14ofthem,iso-latedjejunumwithcervico-mesentericvesselsanastomo-qiswastransplantdtorepairupperesophagealdefects.Clintkaldata.Therewere14cases(11malesand3females)rangedfrom42to68yearsold.8caseswithinferiorpharynxandcervicalesophaguscancer;1casewithlarynxcancerandmetastasizedtoesophagus;2caseswithpostoperativerecurrenceofesophaguscancerincervicalanastomosis;1casewithfocalstomachw…     

自发性食管破裂15例临床分析

我院自1978年5月至2001年2月共收治自发性食管破裂患者15例,取得一些经验,现报告如下:1　临床资料本组15例均为男性,年龄26～73岁。发作诱因:12例为饮酒、饱食后呕吐,2例为饱食后搬重物,1例为餐后咳嗽。发病至手术时间24h内者6例,48h内4例,72h3例,5天1例,20天1例。临床表现:剧烈呕吐后突感胸痛、呼吸困难9例,上腹痛3例,咳嗽、胸闷3例。伴有发热14例,颈及上胸部皮下气肿7例,有休克表现4例。15例均经碘油造影或口服亚甲蓝胸穿证实。除1例破入左胸外,余14例均破入右胸。食管裂口均位于奇静脉水平下方,裂口长度4～11cm。15例中,1例73岁疑胆囊炎…     

电视胸腔镜治疗首次发作自发性气胸31例临床分析

目的：探讨胸腔镜治疗首次自发性气胸的术式、适应证及其疗效。方法：2000年7月～2001年12月胸腔镜手术治疗首次自发性气胸31例，28例为原发性气胸(PSP)，3例为继发性气胸(SSP)。镜下探查4例无病灶，5例仅有胸膜粘连，22例有肺大疱。手术方式为松解胸膜粘连 切除或闭合大疱 胸膜固定术。结果：术后并发皮下气肿2例，并发症率6．5％。全组患者中位随访时间24个月，无病例复发气胸。结论：电视胸腔镜手术治疗首次自发性气胸并发症少、复发率低，是首次自发性气胸患者的首选治疗方法。     

肋骨内固定术治疗创伤性连枷胸

目的 比较肋骨内固定术和外固定胸廓治疗创伤性连枷胸的临床疗效.方法 回顾性分析2006年1月至2009年6月收治的86例以创伤性连枷胸为主的多发伤病例的临床资料,分为内固定组和外固定组.内固定组45例,采用镍钛记忆合金环抱式接骨器内固定肋骨骨折;外固定组41例,采用外固定胸廓非手术保守治疗.比较2组的临床疗效.结果 内固定组患者胸壁畸形均消失,而外固定组中有19例患者遗留胸壁畸形.内固定组患者平均住院时间、平均住ICU时间和平均机械通气时间均短于外固定组[(15.1±1.8)d与(22.9±2.8)d,t=-15.724;(5.7±1.5)d与(14.4±2.9)d,t=-17.711;(3.9±1.5)d与(11.6 ±2.3)d,t=-17.256;P均＜0.01],内固定组患者呼吸系统并发症[包括肺部炎症或(和)肺不张或(和)呼吸功能衰竭]的发生率低于外固定组(35.6%与70.7%,x2=10.641,P＜0.01).出院3个月后,内固定组患者肺功能指标包括肺总量、用力肺活量、1秒钟用力呼气容积、呼气峰流量、75%肺活量最大呼气流量均高于外固定组[(89.5±3.1)%与(79.1±5.1)%,t=11.705;(80.2±2.8)%与(69.8±3.8)%,t=14.241;(74.8±4.4)%与(71.9±3.6)%,t=3.201;(82.8±4.4)%与(79.8±4.9)%,t=2.885;(68.2±2.2)%与(61.9±2.9)%,t=11.286;P均＜0.01].结论 肋骨内固定手术治疗创伤性连枷胸,可以迅速纠正畸形,稳定胸廓,消除反常呼吸,治疗过程顺利,缩短重症监护及住院时间,减少并发症,还可以减轻连枷胸对患者远期肺功能的影响.采用镍钛记忆合金环抱式接骨器内固定肋骨,手术简单、方便,疗效确切.

Abstract：

Objective To compare the effects of rib internal fixation and thoracic external fixation in treatment of traumatic flail chest. Methods Eighty six cases of traumatic flail chest with multiple injuries,admitted to hospital from January 2006 to June 2009 ,were recruited into the study and divided into rib internal fixation and thoracic external fixation groups randomly. The clinical data were analyzed retrospectively. Rib internal fixations with Ti-Ni shape memory alloy embracing connector were performed in internal-fixation group(n = 45) and thoracic external fixations were performed in external-fixation group(n = 41). The outcomes were compared between the two groups. Results No patient in internal-fixation group developed chest wall deformity,while 19 patients in external-fixation group had chest wall deformity left. The mean times of hospital stay([ 15. 1 ± 1.8]d vs [22. 9 ±2. 8]d,t = - 15. 724,P ＜0. 01) ,ICU stay([5.7 ± 1.5]d vs [ 14. 4 ±2. 9]d,t =- 17.711, P ＜ 0. 01), and mechanical ventilation([ 3.9 ± 1.5 ] d vs [ 1 1.6 ± 2. 3 ] d, t = - 17. 256, P ＜ 0. 01),in internal-fixation group were significantly shorter than those in external-fixation group. The occurrence rate of respiratory complications (including pulmonary inflammation and (or) atelectasis and (or) respiratory failure)in internal-fixation group was significantly lower than those in external-fixation group(35.6% vs. 70. 7% ,x2 =10.641,P ＜ 0.01). Followed-up data of three months after discharge showed that the pulmonary function parameters, such as total lung capacity([ 89. 5 ± 3. 1 ] % vs. [ 79. 1 ± 5. 1 ] %, t = 11. 705, P ＜ 0. 01), forced vital capacity([ 80. 2 ± 2. 8 ] % vs. [ 69. 8 ± 3. 8 ] % ,t = 14. 241 ,P ＜0. 01) ,forced expiratory volume in the 1st second ([74.8 ±4.4]% vs. [71.9 ±3.6]% ,t =3.201,P ＜0.01),peak expiratory flow ([82.8 ±4.4]%vs. [79. 8 ±4. 9]% ,t =2. 885,P ＜0. 01) and forced expiratory flows at 75% of the vital capacity( [68.2 ±2. 2] % vs. [61.9 ± 2. 9 ]%, t = 11. 286; P ＜ 0. 01) were significantly higher in internal-fixation group than those in external-fixation group. Conclusion Rib internal fixation for traumatic flail chest can quickly correct chest wall deformity, stabilize thoracis and eliminate paradoxical chest wall movement. Patients accepted this treatment have a shorter therapy process during the intensive care unit and hospital stay, less pulmonary complications. They also show less long-term restrictive pulmonary functions impairment, when compared to the patients in the thoracic external fixation group. Rib internal fixation with Ti-Ni shape memory alloy embracing connector is a simple and effective therapy.     

正交设计法优化桦褐孔菌总三萜超声提取工艺

目的:在单因素试验的基础上,通过正交试验优化桦褐孔菌总三萜的超声提取工艺。方法:采用单因素试验和正交试验法考察提取溶剂、超声温度、时间及料液比对桦褐孔菌总三萜得率的影响,优化出最佳提取工艺条件。结果:各因素的影响依次为超声提取时间>提取温度>料液比,提取的最佳工艺条件为采用异丙醇做提取溶剂,料液比为1∶10,在50℃下,超声提取30 min。在此最佳条件下,总三萜得率为5.06%。结论:优化得到的桦褐孔菌总三萜超声提取工艺稳定,可行。     

响应面优化酶协同超声提取四角菱角壳多酚工艺

目的:优化四角菱角壳中多酚的酶协同超声提取工艺。方法:采用酶协同超声提取法,在单因素试验基础上,以多酚提取量为应变量,以纤维素酶浓度、超声提取时间、提取温度为自变量,采用响应面设计方法优化四角菱角壳中多酚的提取工艺。结果:最佳提取工艺为用pH 4.5的1.86%纤维素酶溶液30 m L·g-1预处理30 min后,在53℃下超声提取26 min,在此条件下多酚提取量为161.3 mg·g-1,与模型预测值(158.14 mg·g-1)相符,相对标准偏差2.00%。与乙醇超声提取和回流提取相比,酶协同超声提取多酚提取量显著提高。结论:响应面法优化四角菱角壳多酚的酶协同超声提取工艺方法简单、提取效率高、可预测性良好,值得推广使用。     

三区域淋巴结清扫术治疗胸段食管癌临床研究

目的：探讨颈、胸、腹三区域淋巴结清扫术在胸段食管癌中的临床应用及判断病理分期。方法：对308例胸段食管癌患者在切除癌肿的同时,施行了颈、胸、腹三区域淋巴清扫术。结果：305例患者获根治性切除,术后并发症28例（9．06％）,淋巴结受累194例（62．99％）,术后死亡3例（0．97％）。颈部、纵隔、和腹部淋巴结转移率分别为38．21％、53．20％、12．72％。结论：胸段食管癌易发生广泛及跳跃性淋巴结转移,扩大淋巴结清扫范围有利于提高手术根治率和临床病理分期的准确性。     

响应面法优化仙鹤草总黄酮的超声提取工艺

目的:优化仙鹤草总黄酮的最佳超声提取工艺。方法:以总黄酮得率为指标,采用响应面设计方法对影响总黄酮得率的乙醇体积分数、超声温度及料液比进行优化。结果:各因素对总黄酮提取率的影响大小依次为料液比-超声温度-乙醇体积分数。最佳工艺条件为72%乙醇,料液比1∶25,60℃下超声提取20 min。在此最佳条件下,总黄酮得率为9.02 mg.g-1,试验结果与模型预测值相符。结论:利用超声提取仙鹤草总黄酮工艺稳定可靠。     

人食管癌间充质干细胞对食管癌细胞株Eca-109侵袭性的影响

目的探讨人食管癌间充质干细胞(hEC-MSCs)对食管癌细胞株Eca-109侵袭性的影响。方法在体外将间质干细胞与食管癌细胞株ECA-109非接触共培养,使用RT-PCR和Western blotting的方法检测间质干细胞对ECA-109细胞株中基质金属蛋白酶-9(MMP-9)和抑癌基因E-cadherin表达的影响。结果间质干细胞可明显上调ECA-109细胞株中的MMP-9表达,显著下调ECA-109细胞株中E-cadherin的表达。结论食管癌间充质干细胞可能参与调节食管癌细胞的侵袭与转移。