胰体尾部肿瘤的手术切除

摘要：目的 探讨胰体尾部肿瘤的外科治疗方法。方法 近18年来，采用手术治疗胰体尾部肿瘤45例，其中恶性肿瘤33例，良性肿瘤12例；行远端胰腺切除17例，联合脏器切除24例，肿瘤局部切除4例。结果 病理类型：胰体尾癌33例，胰岛细胞瘤8例，囊腺瘤2例，上皮样纤维瘤1例，囊性畸胎瘤1例。切除肿瘤最大径：胰体尾癌平均为（8.0±2.6）cm；胰岛细胞瘤平均为（6.5±2.4）cm。无手术死亡病例。术后并发症：胰瘘2例，膈下脓肿2例，胰腺假性囊肿1例，上消化道出血 1例，切口感染或愈合不良3例，均经非手术疗法治愈。结论 远端胰腺切除术是治疗胰体尾部肿瘤的有效方法；术前需常规做好联合脏器切除的准备；胰腺残端的处理选用主胰管结扎加褥式缝合法可有效避免胰瘘的发生。     

烧伤重症监护病房细菌学调查及其药物敏感性分析

目的调查笔者单位烧伤重症监护病房(ICU)6年来细菌感染及其药物敏感性动态变化。方法对1998—2003年笔者单位烧伤ICU209例患者的细菌培养及药物敏感试验结果进行回顾性分析。结果209例患者标本检出感染菌株845株,其中革兰阴性(G-)菌486株占57.51%,革兰阳性(G )菌339株占40.12%。G-菌中铜绿假单胞菌占66.26%,位居第一;G 菌中粪肠球菌占34.51%、金黄色葡萄球菌占31.27%,耐甲氧西林金黄色葡萄球菌(MRSA)在金黄色葡萄球菌中的分离率为72.64%。药物敏感试验结果显示各检出菌具有多重耐药性。结论笔者单位烧伤ICU细菌感染以G-菌为主,G 菌次之;这些细菌对临床常用抗生素具有多重耐药性。临床应重视细菌的药物敏感性,合理使用抗生素。     

肝尾状叶原发性肝细胞肝癌的外科治疗

目的 探讨尾状叶原发性肝癌手术切除的方式及其影响。方法 自1995年至2003年,对39例尾状叶原发性肝癌进行了手术切除,其中单独尾状叶切除19例,联合切除20例。并对两组病例中可能影响术后肝功能的指标进行了比较。结果 39例患者均被成功切除肿瘤,1例于术后30d因肾功能衰竭死亡,3例并发胸腔积液,4例并发腹水,1例并发胆漏,其余病例均顺利恢复。术后30例获得随访,1年、3年、5年生存率分别为53％、50％、39％。结论 尾状叶切除是治疗原发于尾状叶肝癌的有效手段,若肿瘤原发于肝尾状叶而又无其他肝叶侵犯时,单独尾状叶切除该是外科治疗的最佳选择。     

同位素稀释-亲水作用色谱串联质谱快速测定尿液中8-羟基脱氧鸟苷和可替宁的研究

  目的  建立尿液中8-羟基脱氧鸟苷和可替宁的同位素稀释-亲水作用色谱串联质谱的快速测定方法。  方法  离心后的尿样上清液加入15N₅-8-羟基脱氧鸟苷、D₃-可替宁两种内标,以3 mmol/L甲酸铵水溶液稀释5倍,经0.22 μm水系滤器过滤后,引入液相色谱-串联质谱法（ultra-performance liquid chromatography-tandem mass spectrometry,UPLC-MS/MS）分析。以ACQUITY UPLC? BEH HILIC色谱柱（50 mm×3.0 mm, 1.7 μm）分离,3 mmol/L甲酸铵水溶液与乙腈为流动相(10∶90) 等度洗脱,柱温40 ℃,流速0.3 mL/min;质谱以电喷雾电离源（electrospray ionization, ESI）+扫描多反应监测模式检测,内标法定量。  结果  8-羟基脱氧鸟苷和可替宁在各自线性范围内线性良好,方法检出限分别为0.064 μg/L和0.035 μg/L;定量限分别为0.21 μg/L和0.12 μg/L;加标回收率分别为92.6%～102.0%和102.0%～106.0%。采用所建立的方法测定实际尿样,并通过40例样本统计分析发现,主、被动吸烟者的烟草烟气暴露量、烟草特有亚硝胺摄入量存在差异（P<0.05）,NNAL和可替宁含量在主动吸烟者尿样中含量更高;主、被动吸烟者的烟草烟气暴露与烟草特有亚硝胺暴露呈正相关（其相关系数r分别为0.487和0.786,P<0.05）。  结论  本研究成功建立同时测定尿液中8-羟基脱氧鸟苷和可替宁含量的同位素稀释-亲水作用色谱串联质谱法,该方法前处理简单、快速,通过同位素内标校正,定量灵敏准确,能够满足批量分析的需求。     

头针联合空气压力波治疗脑卒中后肩手综合征的疗效观察

目的将传统针刺疗法中的头皮针结合空气压力波治疗仪联合现代康复运动疗法与单纯采用现代康复运动疗法治疗脑卒中后肩手综合征的疗效进行对比研究。方法入选90例脑卒中并发肩手综合征患者,用随机数字法分为对照组与治疗组,每组45例;对照组:常规用药+康复训练;治疗组:在对照组的治疗基础上加用头皮针和空气压力波治疗仪的联合治疗,30 d为1个疗程,1个疗程后将两组的观察结果进行统计和对照分析;观察指标:(1)手功能试验(Carroll评分法);(2)疼痛分级指数(pain rating index,PRI评分);(3)手掌围度(使用软尺测量)。结果对照组45例脑卒中并发肩手综合征患者中,疗程结束后总有效28例,无效17例;治疗组45例脑卒中并发肩手综合征患者中,疗程结束后总有效39例,无效6例。两组疗效比较,治疗组中有效患者明显高于对照组,差异有统计学意义(P<0.01)。治疗组脑卒中并发肩手综合征患者手功能试验Carroll评分(57.71±34.34比较46.56±24.08)与疼痛分级指数PRI评分(8.09±3.56vs.17.31±6.08)显著高于对照组脑卒中并发肩手综合征患者,差异有统计学意义(P<0.05)。治疗组脑卒中并发肩手综合征患者手掌围度有效改善率91.1%明显高于对照组脑卒中并发肩手综合征患者57.8%,差异有统计学意义(P<0.01)。结论头针联合空气压力波结合康复训练是一种治疗脑卒中后肩手综合征行之有效的方法,尤其是在缓解肢体肿胀程度上较常规康复疗法显著。     

氯沙坦对脑缺血再灌注损伤大鼠血脑屏障通透性和MMP-9表达的影响

目的：观察血管紧张素Ⅱ受体阻断药氯沙坦对大鼠局灶性脑缺血再灌注损伤后血脑屏障通透性和基质金属蛋白酶-9（MMP-9）表达的影响。方法：采用血管内栓线阻断法制备大鼠局灶性脑缺血再灌注损伤模型, 于脑缺血2h、再灌注24h后测定脑组织含水量、伊文斯蓝（EB）含量, 免疫组织化学方法测定MMP 9表达。结果：脑缺血2h、再灌注24h, 大鼠脑组织含水量及EB含量增加, MMP-9呈现高表达。 而氯沙坦组脑组织含水量、 EB含量及MMP-9表达明显低于脑缺血再灌注组（P＜0.05）。 结论：氯沙坦通过降低脑缺血再灌注大鼠基质金属蛋白酶 9的活性及血脑屏障通透性, 从而发挥其脑缺血再灌注损伤的保护作用。     

Associations of blood pressure and arterial compliance with occupational noise exposure in female workers of textile mill

Background There are few studies on the arterial compliance of noise exposure. The purpose of this study was to understand the relationship between hearing loss, blood pressure and arterial compliance of female workers who exposed to occupational noise in a textile mill.Methods The noise levels in the workplace were measured with a HS6288 sound level meter. Cumulated noise exposure (CNE) was calculated according to the noise intensity and the exposure period. Hearing ability and arterial compliance were measured in 618 noise exposed workers. The database was set up with EpiData and the statistical analysis was performed with SAS software 9.1.3. Results The noise levels were 80.1dB(A) to 113.5dB(A), of which the levels at 92.5% of the noise monitoring sites were over the national standard. The incidence of high frequency hearing loss (HFHL) was 24.43% and language frequency hearing impairment (LFHI) was 0.81%. The incidence of hypertension was 7.93%. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the high frequency hearing loss group were significantly higher than those in the normal hearing group (P&lt;0.05), while C(1) (large artery compliance) and C(2) (small artery compliance) were significantly lower (P&lt;0.05). The high frequency hearing threshold (HFHT) of the hypertension group was significantly higher than in the normal blood pressure group (P&lt;0.05), while C(1) and C(2) were significantly lower (P&lt;0.05). C(1) and C(2) had a negative correlation with HFHT, SBP, DBP, mean of arterial pressure (MAP), pulse pressure (PP) and pulse rate (PR) (P&lt;0.05). The multiple regression analyses showed that blood pressure and PR were the main influencing factors on C(1) and C(2). LFHT was an influence on C(2) and HFHT on C(1).Conclusions Textile mill noise pollution is very serious and has an obvious influence on worker’s auditory function. The female workers with low artery compliance or with high blood pressure might be suffering from hearing loss; those with noise induced hearing loss might be suffering from hypertension if she is constantly exposed to loud industrial noise.     

Congenital choledochal cysts in adults: twenty-five-year experience

Background Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults. Methods The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed. Results Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P= 0.000; odds ratio, 7.800; 95 % confidence interval, 2.450 to 24.836). Conclusions ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type I or type IV cysts. For type V cyst (Caroli’s disease) with recurrent cholangitis, liver transplantation should be considered.     

医学发展的未来:从基因组学到整合医学

综观20世纪生命科学发展,从宏观向微观、由表型到机制的探求是其重要特征。以还原论为基础的经典结构生物学、分子生物学与细胞生物学的研究极大地增进了人们对生命本质的理解。人类基因组计划（HGP）完成后,生命科学研究进入到“功能基因组学”研究时代,转录组学、蛋白质组学、代谢组学开始迅速发展,生命科学的研究方法不再局限于以还原论为指导的微观拆分,     

异体阔筋膜细胞外基质作为肾修补材料的生物相容性研究

目的 研究异体阔筋膜细胞外基质（ECM）的生物相容性,探讨开发一种新的肾损伤修补材料。方法将犬的阔筋膜用脱细胞液及DNA酶、RNA酶等处理,制成异体阔筋膜ECM。制备阔筋膜ECM浸提液,对昆明种小白鼠行急性全身毒性试验;用四甲基偶氮唑盐（MTT）比色法对小鼠成纤维细胞进行细胞毒性检测。将犬左肾制成肾损伤模型,用异体阔筋膜ECM进行修补,分别于术后不同时段于修补局部取材行光镜及扫描电镜检查。结果阔筋膜ECM浸提液注射后4h,小鼠无异常反应,第1～3天体重均呈增长趋势,未发现死亡和中毒反应,与阴性对照生理盐水组无明显差别。MTT法显示细胞相对增殖率（RGR）为112％（第2天）、96％（第4天）及97％（第7天）,毒性评定相应为0、1、1级,材料无明显细胞毒性。术后各时段ECM材料修补局部均无明显的炎性细胞浸润,与周围组织无明显粘连。结论 异体阔筋膜ECM具有良好的生物相容性,有望成为理想的肾损伤修复材料。