腹腔镜肝切除术的体会

目的:研究腹腔镜肝切除的手术操作技术。方法:分析行腹腔镜肝切除术4例患者的临床资料。结果:4例均顺利完成手术,无中转开腹。平均手术时间159min(120～280min),术中平均出血量280ml。除1例术后发生小量胆漏外,余者均未出现与手术相关的并发症。术后平均住院11d(7～25d)。结论:合理选择手术适应证、医护的良好配合是完成手术的重要条件。     

钛缆结合钛网板与锁骨钩钢板治疗完全性肩锁关节脱位临床疗效观察

[目的]观察钛缆结合钛网板与锁骨钩钢板治疗完全性肩锁关节脱位临床疗效。[方法]RockwoodⅢ型肩锁关节脱位48例,均为新鲜脱位。男36例,女12例,年龄19~56岁,平均35.4岁,采用钛缆结合钛网板治疗22例,采用锁骨钩钢板治疗26例,所有患者均作喙锁韧带修补。[结果]所有患者均获随访,随访时间12~35个月,平均16.6个月。按照Karlsson标准对术后肩关节功能进行评定。钩钢板组优18例,良5例,差3例,治疗优良率88.46%;钛缆结合钛网板组优17例,良4例,差1例,治疗优良率95.45%,与钩钢板组无显著差异。[结论]钛缆结合钛网板治疗完全性肩锁关节脱位的效果与锁骨钩钢板相当,且具有术后肩痛发生率低、利于早期功能锻炼的优点,此外钛缆生物相容性佳,可在体内长期存留而不必取出。     

内毒素耐受和拟胆碱药物对巨噬细胞分泌肿瘤坏死因子-α的影响

目的:探讨内毒素耐受和拟胆碱药物卡巴胆碱对巨噬细胞肿瘤坏死因子-α(TNF-α)分泌的调节作用.方法:①分离小鼠腹腔巨噬细胞,将其与内毒素(LPS)作用不同时间(0、2、4、8 h);②小鼠腹腔巨噬细胞分为3组:空白对照组(RPMI1640常规培养),LPS耐受组(LPS预刺激20 h,再用LPS刺激4 h)和LPS不...     

癌胚抗原阳性CT26结肠癌细胞株的构建及鉴定

目的构建适于普通小鼠的癌胚抗原（CEA）阳性结肠癌细胞株。方法以重组CEACAM5cDNA-Lentivims慢病毒转染小鼠结肠癌CT26细胞．抗生素筛选2周．以有限稀释法获得癌胚抗原阳性细胞CT26CEA,体外培养至第7代和第14代进行鉴定。用RT．PCR法和Western blot法分别检测CEACAM5mRNA及蛋白表达．用荧光显微镜和免疫细胞化学法观察CEACAM5表达位置：并以第14代CT26CEA细胞建立BALB／c鼠皮下种植瘤模型．用活体荧光成像法和免疫组织化学染色观察瘤体CEACAM5表达情况。结果在第7代和第14代CT26CEA细胞内可以检测到CEACAM5mRNA及CEACAM5蛋白表达．荧光显微镜和免疫细胞化学法观察到其表达主要在细胞质,活体荧光成像法和免疫组织化学染色观察到小鼠瘤体有丰富CEACAM5表达。结论成功构建小鼠结肠癌CT26CEA细胞株,能够在体外培养及小鼠体内稳定表达癌胚抗原．为研究正常免疫环境下癌胚抗原对结肠癌进展的影响及作用机制提供了适用工具．     

活性氧、线粒体通透性转化孔介导肌细胞凋亡在失神经骨骼肌萎缩中的相关性

目的 观察活性氧(ROS)、线粒体通透性转化孔(MPTP)在失神经骨骼肌萎缩后的表达变化且与肌细胞凋亡的相关性,探讨ROS、MPTP参与失神经骨骼肌萎缩的具体分子机制.方法 将30只Vistar大鼠随机分为对照组、失神经2d组、失神经7d组、失神经14d组、失神经28d组,每组6只.制作坐骨神经切断后失神经支配的腓肠肌Vistar大鼠模型.应用流式细胞术(FCM)检测失神经支配后腓肠肌细胞ROS的含量,激光共聚焦显微镜检测MPTP的开放,脱氧核糖核苷酸转移酶介导的缺口末端标记(TUNEL)法检测肌细胞凋亡.结果 大鼠失神经支配后,肌细胞中的ROS、MPTP及凋亡率与正常对照组比较,表达随失神经支配时间的延长(<28d)而持续增加,且各组的表达均显著高于对照组(P<0.05),ROS的表达与MPTP的开放呈正相关(r=0.884,P<0.01),与肌细胞的凋亡率呈正相关(r=0.893,P<0.01),MPTP的开放与肌细胞凋亡率呈正相关(r=0.927,P<0.01)与肌细胞萎缩指标肌湿重比呈负相关(r=-0.907,P<0.01).结论 ROS、MPTP为调控失神经支配后骨骼肌萎缩的重要分子,其具体机制是通过线粒体介导的凋亡通路促进骨骼肌萎缩.

Abstract：

Objective To study the expression of reactive oxygen species (ROS) and mitochondrial permeability transition pore (MPTP) in denervated skeletal muscle atrophy and its correlation with cell apoptosis, and explore specific molecular mechanism in denervated skeletal muscle atrophy. MethodsThirty Vista rats were randomly divided into five group: control group, 2-days group, 7-days group, 14-days group, 28-days group. Standard model of denervated gastrocnemius muscle was established. The content of ROS and the opening of MPTP in the gastrocnemius were detected by flow cytometry (FCM) and fluorescence microscope respectively. The apoptotic cells in atrophic muscle were examined by TdT-mediated dUTP nick end labeling (TUNEL). Results As compared with the control group, the content of ROS, the opening of MPTP and the apoptosis of gastrocnemius were increased continuously (<28 days) in 2-days group, 7-days group, 14-days group, 28-days group (P<0.05). The content of ROS had a positive correlation with the opening of MPTP (r=0.884,P<0.01) and the apoptosis rate (r=0.893,P<0.01), and the opening of MPTP had a positive correlation with the apoptosis rate (r=0.927,P<0.01), but a negtive correlation with the ratio of muscle wet weight (r=-0.907,P<0.01). Conclusion ROS and MPTP are important elements in regulating skeletal muscle atrophy after denervation by the mitochondrial apoptosis pathway.     

手术治疗Pilon骨折36例

2007年1月～2010年6月,我科采用不同的手术方式治疗Pilon骨折36例,效果满意. 1 材料与方法 1.1 病例资料 本组36例,男27例,女9例, 年龄21～56岁.左侧22例,右侧14例.开放性骨折13例,闭合性骨折23例.骨折按Rüedi分型：Ⅰ型7例,Ⅱ型21例,Ⅲ型8例.     

肝移植术后不放置腹腔引流管的安全性评价

目的评价肝移植术后不放置腹腔引流管的安全性。方法原位肝移植术后不放置腹腔引流管患者32例,观察其术后引流管相关并发症（胆瘘、腹腔出血、腹腔感染、腹腔积液、切口感染）的发生情况。结果 32例患者术后无发生胆瘘、腹腔出血、腹腔感染、切口感染等并发症,9例出现腹水较多,经行腹腔穿刺抽液后病情好转。结论肝移植术后不置腹腔引流管是安全可靠的。     

双牵开摆动椎间盘镜技术治疗多节段腰椎间盘突出症

目的 评价双牵开摆动椎间盘镜技术治疗多节段腰椎间盘突出症的临床效果.方法 2006年12月至2009年11月,应用双牵开摆动椎间盘镜技术治疗多节段腰椎间盘突出症85例,椎间盘突出合并腰椎管狭窄53例,椎间盘突出伴腰椎失稳15例.两处开窗105例,三处开窗33例,四处开窗13例,五处开窗2例;15例伴腰椎失稳者行"全合"膨胀式融合器椎间融合+椎弓根钉内固定术.根据Macnab评分标准评价疗效.结果 术后随访3～36个月,平均16个月.两处开窗减压手术时间平均45min,三处开窗61 min,四处开窗83 min,五处开窗110 min;"全合"膨胀式融合器椎间融合+椎弓根钉内固定者另平均增加92min.术中出血量平均150ml;术中发生硬膜囊撕裂1例,马尾轻度损伤1例;术后发生切口浅表感染1例,下肢静脉血栓形成1例,"全合"膨胀式椎间融合器翻修1例.患者术后1～3 d下床活动,平均住院10d.疗效:优117例,良32例,可4例.132例患者术后3周内恢复原工作或生活.结论 双牵开摆动椎间盘镜技术应用时不必过度倾斜工作通道即可满足对临近椎间隙的手术操作要求,操作难度相对降低、显露理想、神经双牵开应力分散,更有利于保护神经,减压彻底,效果优良.

Abstract：

Objective To evaluate the effect of double tractors swing microendoscopic discectomy technique in multi-segmental lumbar disc herniation. Methods From December 2006 to November 2009,153 patients with multi-segmental lumbar disc herniation were treated with double tractors swing microendoscopic discectomy. They included 85 cases of multi-segmental disc herniation, 53 cases of degenerative canal stenosis and 15 cases of lumbar instability. Among them, 2, 3, 4 and 5 fenestrations were performed in 105,33, 13 and 2 cases respectively and interbody fusion was done with "quanhe" inflation cage and screws in 15 cases. The results were evaluated with Macnab scale. Results All the 153 patients were followed from 3to 36 months, with an average of 16 months. The mean operative time was 45, 61, 83 and 110 min for 2,3,4 and 5 fenestrations respectively, with a mean blood loss of 150 ml. And it took extra 92 min to finish interbody fusion. Complications included dural sac tears in 1 case,canda equina slight lesion in 1, superficial incision infection in 1, the formation of deep venous thrombosis in 1, and revision for"quanhe"inflation cage in 1. The mean hospital stay was 10 days. Excellent results were obtained in 117 cases, good in 32 and fair in 4. One hundred and thirty-two patients returned to their work or normal activities in 3 weeks. One hundred and forty-nine cases were satisfied with the therapeutic effect. Conclusion This technique not only can reach adjacent intervertebral space easily but also disperse pressure on the nerve root effectively. This technique can provide thorough decompression and good results.     

The role of nitric oxide in the mechanical repression of RANKL in bone stromal cells

Both mechanical loading and nitric oxide (NO) have positive influences on bone mass. NO production is induced by mechanical strain via upregulation of eNOS mRNA and protein, the predominant NOS in adult bone. At the same time, strain causes decreased expression of RANKL, a factor critical for osteoclastogenesis. In this study, we harvested primary stromal cells from wild-type (WT) and eNOS(-/-) mice to test whether induction of NO by mechanical strain was necessary for transducing mechanical inhibition of RANKL. We found that strain inhibition of RANKL expression was prevented by NOS inhibitors (L-NAME and L-NMMA) in WT stromal cells. Surprisingly, stromal cells from eNOS(-/-) mice showed significant mechanical repression of RANKL expression (p<0.05). Mechanical strain still increased NO production in the absence of eNOS, and was abolished by SMTC, a specific nNOS inhibitor. nNOS mRNA and protein expression were increased by strain in eNOS(-/-) but not in WT cells, revealing that nNOS was mechanically sensitive. When NO synthesis was blocked with either SMTC or siRNA targeting nNOS in eNOS(-/-) cells however, strain still was able to suppress RANKL expression by 34%. This indicated that strain suppression of RANKL can also occur through non-NO dependent pathways. While our results confirm the importance of NO in the mechanical control of skeletal remodeling, they also suggest alternative signaling pathways by which mechanical force can produce anti-catabolic effects on the skeleton.     

侧卧位微创经皮肾镜碎石术治疗肾结石的临床应用价值

目的:探讨侧卧位在微创经皮肾镜手术中的临床应用价值.方法:回顾性分析2007年1～12月采用侧卧位微创经皮肾镜手术治疗肾结石患者56例的临床资料:单侧结石48例,双侧结石8例.肾单发结石38例,肾鹿角形结石18例.结石最大经2.4～6.7 cm.结果:平均手术时间85 min,平均住院12天.45例次单发肾结石手术中,38例次行单通道一期手术;7例次因术中发现肾积脓,留置造瘘管后改二期手术;19例次肾鹿角形结石均采用双通道取石,其中一期手术取石8例次,二期手术取石11例次.术前血红蛋白112±28 g/L,一期手术后1～3天检查血红蛋白为102.5±31.5 g/L.术后需用ESWL辅助治疗17例.总结石排净率为92.3%.结论:侧卧位是泌尿外科医生最熟悉的手术体位,也是进行微创经皮肾镜手术的理想手术体位,特别是B超定位穿刺技术的广泛应用,更应该推广使用侧卧位进行微创经皮肾镜手术.