年龄因素对患者硬膜外注射左旋布比卡因药效学和药代动力学的影响

目的 探讨年龄因素对患者硬膜外注射左旋布比卡因药效学和药代动力学的影响.方法 择期拟行下肢手术患者45例,年龄30～72岁,体重52～83 ks,ASA Ⅰ或Ⅱ级,按不同年龄分为3组:Ⅰ组(≤45岁)、Ⅱ组(46～64岁)和Ⅲ组(>64岁),每组15例,均采用腰段硬膜外麻醉,左旋布比卡因(7.5 mg/ml)用量1.8 mg/kg(含肾上腺素5 μg/ml).经L1,2硬膜外穿刺成功后,注射试验量0.5%左旋布比卡因3 ml,3 min后注射剩余量0.75%左旋布比卡因.硬膜外注药后记录感觉和运动阻滞效果及不良反应的发生情况;每组随机选择9例,于注药后即刻、注药后10、20、30、45、60、90、120、180、240、360、480、840、和1 440 min时采用高效液相色谱法测定血浆左旋布比卡因浓度,绘制血浆左旋布比卡因浓度-时间曲线,计算3组药代动力学参数.结果 与Ⅰ组比较,Ⅲ组最高感觉阻滞平面高,感觉和运动阻滞维持时间长,(P<0.05);各组麻醉效果优良率均达100%;各组左旋布比卡因的血浆药物浓度-时间曲线均符合二房室开放模型;硬膜外注药后1 440 min时Ⅱ组和Ⅲ组左旋布比卡因血药浓度高于Ⅰ组(P<0.05);Ⅱ组和Ⅲ组左旋布比卡因消除半衰期明显长于Ⅰ组,Ⅲ组明显长于Ⅱ组(P<0.05).结论 不同年龄患者硬膜外注射0.75%左旋布比卡因1.8 mg/kg安全有效;随年龄增加,感觉阻滞平面升高、感觉和运动阻滞恢复时间延长,药物代谢明显减慢.     

微波消融对比射频消融治疗结直肠癌肝转移瘤的荟萃分析

目的通过荟萃分析探究结肠癌肝转移瘤(CRLM)局部消融的最佳治疗方法。方法系统检索PubMed、Web of Science、Embase、CNKI以及Cochrane Library数据库, 检索时间为建库至2022年8月22日。通过纳入和排除标准筛选出比较微波消融(WMA)和射频消融(RFA)治疗CRLM的文献。并使用Review Manager 5.3软件对围手术期结局和生存数据进行统计汇总及分析。结果共纳入5篇回顾性研究, 总样本量648例, 其中WMA组316例(48.8%), RFA组332例(51.2%)。荟萃分析结果显示, WMA组的局部复发率低于RFA组, 两组间差异有统计学意义(P<0.05)。WMA组患者的1、2年疾病无进展生存期优于RFA组, 两组间差异有统计学意义(1年:P=0.04, HR=1.77, 95%CI:1.04～3.02;2年:P=0.02, HR=1.60, 95%CI:1.09～2.35)。结论对于CRLM的治疗, WMA在局部控制率和1、2年疾病无进展生存期方面优于RFA。     

乌司他丁对原位肝移植术患者围术期肾功能的影响

目的乌司他丁对原位肝移植术患者围术期肾功能的影响。方法 40例择期行原位肝移植术患者,随机分为2组,乌司他丁组(U组,n=20):切皮后将乌司他丁30万IU加入100 ml生理盐水,持续静脉输注1 h,之后每4小时重复一次直至术后48 h。对照组(C组,n=20):以等容量生理盐水代替。测定麻醉前、术毕、术后24、48 h血清尿素氮(BUN)、肌酐(Cr)的水平及尿N-乙酰β-D氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)、α1-微球蛋白(α1-MG)、γ-谷氨酰转肽酶(γ-GTP)的水平。结果麻醉前组间血清BUN、Cr及尿γ-GTP、RBP、α1-MG、NAG水平差异均无统计学意义(P>0．05)。与麻醉前比较,C组血清BUN和Cr在术后24、48 h升高(P<0．05或0．01),尿γ-GTP、α1-MG、RBP和 NAG在各时点升高(P<0．01);U组血清BUN、Cr和尿γ-GTP、NAG在各时点差异无统计学意义(P> 0．05),尿α1-MG在各时点升高(P<0．01),尿RBP在术后24、48 h升高(P<0．05或0．01)。与C组比较,U组血清BUN、Cr和尿α1-MG在术后24、48 h降低,尿γ-GTP、RBP和NAG在各时点降低(P<0．05 或0．01)。结论乌司他丁对原位肝移植术患者围术期肾功能有一定的保护作用。     

肺癌手术中淋巴结清扫的现状与进展

淋巴结转移是肺癌主要而常见的转移途径,也是术后癌残留而导致复发和转移的主要因素,肺癌手术中纵隔、肺门淋巴结清扫至关重要。但目前淋巴结的清扫方式尚不统一,有系统淋巴结清扫术（CMLND）、根治性淋巴结清扫术、淋巴结采样、系统淋巴结采样以及前哨淋巴结技术导航切除,并且随着微创外科的发展,胸腔镜下淋巴结清扫也日趋成熟。而寻求一个更规范、更完善的淋巴结清扫方式甚有必要。现就目前肺癌手术中纵隔、肺门淋巴结清扫的临床意义、清扫方式、清扫范围以及胸腔镜下淋巴结清扫的现状以及展望进行综述。     

计算机快速成型辅助个体化三踝骨折的手术治疗

Objective To compare the operation with computer-aided rapid prototyping technique and the conventional procedure for treatment of trimalleolar fractures.Methods Twenty-four patients with trimalleolar fracture who had been admitted to our hospital from March 2007 to March 2008 were divided into 2 even groups randomly.Group A underwent 3-dimensional reconstruction, computer simulation and rapid pro-totyping and demonstration of individual fracture model before operation.Group B received only conventional procedures.The therapeutic effects were evaluated by Cedell criteria and compared statistically between the 2 groups.Comparision between the 2 groups was made in the exposure time, reduction and fixation time curative effect.Results Fallow-up from 8 to 15 months revealed that the operation time for Group A (45.43 ± 9.38 minutes) was significantly shorter than for Group B (58.61 ± 12.32 minutes) (t = - 2.948, P < 0.05).The exposure time between the 2 groups had no statiscal difference (t = - 1.06, P =0.102).The excellent rate of curative effect in Group A was 83.3% and 66.7% in Group B.Conclusion Computer aided rapid prototyping can shorten the operation time and improve operational efficiency for trimalleolar fractures.     

计算机快速成型辅助个体化三踝骨折的手术治疗

目的 通过与常规手术比较,探讨计算机快速成型辅助个体化治疗三踝骨折的效果.方法 2007年3月至2008年3月收治二踝骨折患者24例,随机分为两组,计算机快速成型辅助设计手术组(A组)12例,常规手术组(B组)12例.A绀手术前采取CT三维重建、计算机模拟、快速成型与个体化标本预手术.比较两组的切开暴露时间、复位与固定时间及手术疗效优秀率.结果 所有患者术后随访8～15个月.两组切开暴露时间差异无统计学意义(t=-1.06,P=0.102);A组手术复位与固定时间为(45.43±9.38)min,低于B组(58.61±12.32)min,差异有统计学意义(t=-2.948,P<0.05);A组于术疗效优秀率为83.3%,B组手术疗效优秀率为66.7%.结论 计算机快速成型辅助个体化技术可提高三踝骨折手术效率与精确度.     

儿童肝脏间叶性错构瘤的CT表现与临床病理研究

目的 探讨儿童肝脏间叶性错构瘤(HMH)的CT影像特点,提高术前诊断正确率.方法 搜集经病理证实的HMH9例,其中男4例,女5例,年龄为3d至9岁5个月(中位年龄为7个月).术前均进行CT平扫及增强扫描.结果 本组9例均为单发肿瘤,位于右叶6例,位于左叶2例,累及两个肝叶1例.瘤体长径约7.0～22.5 cm,平均约13.5 cm.CT表现取决于肿瘤囊实性成分比例和分布,表现为1例为囊性型肿瘤,5例为实性为主的囊实混合型肿瘤,3例为实性型肿瘤,增强后肿瘤实性部分及分隔强化,囊性部分无强化,1例病灶见点状钙化,所有病例均可见肿瘤推压相邻血管,使之变形、移位.结论 儿童HMH的CT表现多样,但有一定特征性,可反映大体病理变化,了解其CT影像特点,结合临床特征,有助于早期诊断.     

131I-17-AAG对荷H460人非小细胞肺癌裸鼠的抗癌效应

目的 观察131I标记17-丙烯胺基-17-去甲氧基格尔德霉素(17-KAG)对荷H460人非小细胞肺癌裸鼠移植瘤的抑癌效应.方法 过氧化氢法制备131I-17AAG.建立荷H460人非小细胞肺癌BALB/c裸鼠模型,28只荷瘤裸鼠按随机数字表法分为7组(n=4),瘤内和尾静脉注药各3组,剂量依次为5.5 MBq×2(间隔8 d)、11.0 MSq和5.5 MBq及空白对照组.另设Na131I瘤内给药对照组.8组分别于注药后2,6,24 h及2,3,7,10,16 d各取2只鼠行γ显像.观察肿瘤生长情况,16 d后处死全部小鼠,计算抑瘤率,并做光学显微镜、电镜及免疫组织化学检测.计量数据以x±s表示,采用SPSS 13.0软件进行统计分析.结果 SPECT显像证实131I-17-AAG靶向定位好,能较长时间聚集在瘤体内;各治疗组存在不同程度抑瘤效应,以瘤内间隔给药(5.5 MBq×2)组疗效最好,抑瘤率高达(86.77±4.57)%,尾静脉给药5.5 MBq×2组和11.0 MBq组间差异无统计学意义(q=1.67,P>0.05),余各组间抑瘤率差异均有统计学意义(q=3.16～24.34,P均<0.05);形态学显示抑瘤效应越好,瘤组织破坏越明显;免疫组织化学显示瘤内及尾静脉注药组热休克蛋白90(HSP90)a阳性率[分别为(26.01±3.71)%、(61.57±5.98)%]均较空白对照组[(84.13±5.71)%]下降(t值分别为20.91和6.68,P均<0.05).结论 131I-17-AAG能有效抑制裸鼠非小细胞肺癌的生长,以瘤内注药及间隔给药抑癌效应最佳.     

The effect of Chinese herbal medicine“heche assisted pregnancy recipe”on endometrial estrogen and progesterone receptor,proliferating cell nuclear antigen and vascular endothelial growth factor in the patients with infertility

<正> Objectives.To investigate the effect of Chinese herbal medicine"heche assisted preg-nancy recipe (HCAPR)"on estrogen receptor(ER),progesterone receptor (PR),pro-lifierating cell nuclear antigen(PCNA) and vascular endothelial growth factor (VEGF)in endometrium of infertile women.Methods.The S-P immunohistochemical assay was used to observe expression ofER,PR ,PCNA and VEGF in late proliferative phase before and after the HCAPR treat-ment.Results.After the treatment,the expression of ER,PR,PCNA and VEGF in nucleiof glandular epithelium and stromal cells was significantly stronger (all P<0.001) re-spectively than that before treatment,especially the expression of PCNA and VEGF.Conclusions..These results suggest that traditional Chinese medicine HCAPR oftonifying kidney and regulating menstruation increased the synthesis of ER,PR,PCNAand VEGF,which may promote normal growth and development of the endometrium ,improve the micro-environment of the endometrium,and enhance uterine receptivity.The evidence may provide theoretical basis for therapy infertility with Chinese herbalmedicine.     

Treatment of femoral neck fracture with muscle-bone flap of both tensor fasciae latae and sartorius

Objective： To evaluate the effect of muscular pedicle bone grafts with sartorius or tensor fasciae latae and sartorius in fresh transcervical or subcapital fractures of the femoral neck. Methods: Thirty cases of fresh transcervical and subcapital fractures of the femoral neck were treated by the tail breakable screws and sartorius pedicle bone grafts(single muscular pedicle, SMP group). The other 23 cases were treated by cannulated pressure screws and bone grafts with the muscular pedicles of both sartorius and tensor fasciae latae (double muscular pedicles, DMP group). Results: Fifty-two cases were followed up for 3 to 5 years (mean, 4 years). In SMP group, ten cases showed poor therapeutic results. Excellent therapeutic effects were achieved in all cases of DMP group. Conclusions : The transcervical or subcapital fractures of the femoral neck can be treated by double muscular pedicles bone graft. The bone graft with double muscular pedicles is more effective than single sartorius muscular pedicles for fresh transcervical and subcapitul fractures of the femoral neck during short and medium terms.