腹腔镜胆道探查在有上腹部手术史患者中的应用

目的探讨上腹部手术后腹腔镜胆道探查手术的安全性及可行性。方法有上腹部手术史行腹腔镜胆道探查的16例患者(甲组),其中男性7例,女性9例;年龄52～84岁,平均年龄65.4岁。3例合并肝内胆管结石,胆管结石直径大于1.5cm患者10例,结石>2枚者7例。胆总管结石合并胆囊结石患者5例。同期无上腹部手术史行腹腔镜胆道探查243例(乙组),其中男性115例,女性128例;年龄30～81岁,平均年龄56.8岁。甲、乙两组手术方式包括腹腔镜胆囊切除、胆总管探查(LCBDE)、胆总管一期缝合术;LCBDE取石T管引流术(LCTD)。结果甲组手术时间为55～235 min,平均手术时间128.1 min;术中出血量20～300 mL,平均出血量130.6 mL;2例中转开腹。乙组手术时间45～190 min,平均手术时间105.2 min;术中出血量15～120 mL,平均出血量45.2 mL;1例中转开腹。两组术中均无胆道损伤、胃肠道损伤、大出血、气体栓塞等严重并发症发生。结论有上腹部手术史的胆道结石患者行腹腔镜胆道探查,由操作熟练的腹腔镜医师进行手术是安全可行的。     

下肢动脉缺血性患者假性高压的鉴别及临床意义

Objective To evaluate the diagnosis of and management for pseudo-high blood pressure in patients with lower limb ischemia. Methods From March 2006 to March 2007, 182 cases with lower limb ischemia were admitted, and they were divided into three groups. In group 1 pseudo-high blood pressure did not exist, in group 2, patients had pseudo-high blood pressure with ABI<1.3, in group 3, patients had pseudo-high blood pressure and with ABI≥1.3. ABI and TBI were compared with color Doppler, angiography, MRA and CTA. Results In all those 182 patients, there were 102(56.0%)cases having no pseudo-high blood pressure, and 27.5% with concomitant diabetes. Seventy-two cases(39.6%) had pseudo-high blood pressure (ABI<1.3) with 44.4% having diabetes. Eight cases (4.4%) (ABI≥ 1.3) manifested pseudo-high blood pressure with the ratio concomitant diabetes being 75%. Conclusions In diabetic patients with lower limb's ischemia there is increased ratio of pseudo-high blood pressure.     

乙型肝炎病毒基因型与肝细胞肝癌关系的研究

目的 探讨HBsAg阳性肝细胞肝癌(HCC)患者乙型肝炎病毒(HBV)DNA基因型与其患HCC之间的关系.方法 运用PCR条带分析与基因测序相结合的方法对我院500例HBsAg阳性患者(其中HCC患者150例)的HBV DNA进行分型,并对分型结果进行分析.结果 HBV DNA B型和C型基因型是HBsAg阳性HCC患者和非HCC患者的共同优势基因型.但HCC患者中C型基因型所占比例为65.33%(98/150),明显高于非HCC患者的25.14%(88/350),而B型则相反,分别为28.67%(43/150)与68.86%(241/350),x2=75.45,P<0.05.HCC患者中,HBV的B型与C型基因型分布在不同性别及不同年龄段之间的差异无统计学意义(P>0.05).结论 HBV DNA C型基因型在HCC患者中多见,可能与HCC的发生有关.     

重视动脉硬化闭塞症全身治疗与手术及腔内治疗的紧密结合

<正>动脉硬化闭塞症(ASO)是目前中老年发病率极高的全身性疾病,也是血管外科常见的疾病。尽管中国缺乏大样本的流行病学的调查资料,但是据各大医院收治的动脉硬化闭塞症数量证实,此病近年呈明显的增长趋势,必须引起我们的高度重视。     

超声诊断胎儿腹部囊性病变

<正>胎儿腹部异常囊性病变较常见,但病变种类较多,有时不易鉴别。产前超声检查早期检出胎儿腹部异常囊性病变,可使临床医师尽早决定分娩方式及时间,减少围产期死亡率。回顾性总结我院2009年1月至2012年1月期间由我院超声诊断的腹部囊性病变71例,旨在进一步探讨超声在胎     

硅橡胶长期堵塞兔输卵管对其分泌活动的影响

本文通过输卵管结扎获得输卵管分泌液并测定其氨基酸及葡萄糖,同时观察上皮细胞内希夫过碘酸染色(PAS)阳性物质反应。正常假孕兔输卵管液及血清中有18种相同的氨基酸,浓度各有不同,两者均是甘氨酸最高,丙氨酸次之,但输卵管液甘氨酸、丙氨酸及丝氨酸浓度明显高于血清(P<0.01),血清中赖氨酸、精氨酸及鸟氨酸则明显高于输卵管液(P<0.01);输卵管液葡萄糖浓度为5.06±0.88 mg/dL,低于血清葡萄糖量(168.82±20.45 mg/dL);上皮细胞PAS阳性物质反应较强。硅橡胶堵塞输卵管假孕兔输卵管液中部分氨基酸浓度上升或下降,丝氨酸增加显著(P<0.05);葡萄糖浓度略有降低;上皮细胞PAS阳性物质反应明显减弱。结果表明兔输卵管经硅橡胶堵塞后分泌活动发生轻度变化。     

喉全切除经鼻食管上段置管发声器

我们在做食管充气试验（esophageal insufflation test）时观察到在食管入口下方存在最佳发音位置，自制了经鼻食管上段置管发音器，简称食管音发声器，获得了发音功能，现报告如下。     

临床肝移植的体会（附5例报告）

目的 总结开展临床肝移植的经验.方法 从2003年12月～2005年4月间对2例肝炎后终末期肝硬化,3例原发性肝癌患者施行原位肝移植.结果 全组成功4例,围手术期死亡1例,直接死亡原因是肝肾综合征、急性肾功衰,最长存活已超过32个月.结论 基层医院开展肝移植,初期专业队伍建设非常重要,应精心组织,分工明确,各科通力合作,协调运作是肝移植成功开展的保障.同时应严格掌握适应证,选择条件较好的受体;围手术期的严密监测与正确处理是肝移植成功的关键.     

动脉支架放置术前白细胞计数与锁骨下动脉支架远期通畅率的观察

Objective To study relationship between preprocedural white blood cell count(WBC) and long-term patency of stent implanted in the subelavian artery.Methods Data of 113 cases with stents implanted in the atherosclerotic SUbclavian arteries in Anzhen Hospital,Beijing during January 2005 to January 2008 were analyzed.Student t-test was used to compare the difierence in WBC count between those with patency and those with stenosis after the procedure and chi-square test was used to compare the difference in stent pateney between those with higher and lower WBC counts.Results There Was significant difference in WBC counts between 102 cases with patency and 11 cases with stenosis of the stents after implantation(t=-5.051.P<0.001).Percentage of patency ofthe stents in 36 cases witll higher WBC count(>7.195×109/L)was significantly higher than that in 77 cases with lower WBC count(≤7.195× 109/L)before the procedure(P=0.001).Among 113 cases with stents implanted,109 cases(96.5%) could keep their stents patent one year after implantation,and 60 cases(89.6%)could keep stents patent three yeats after implantation.Conclusions In addition to those traditional factors associated with long-term patency of stents after their implantation,inereased WBC count alSO associated with stenosis or occlusion of the stents after the procedure.     

连袜背带裤治疗新生儿先天性膝关节脱位

新生儿先天性膝关节脱位是一种少见疾病，国内就本病早期诊治的报告不多见。为探讨本病在新生儿期的早期诊治，膝关节固定方法改进的可能性，对我院 1987年4月～ 1997年1月诊治的15例进行总结。现报告如下。 1资料与方法本组 15例，本院妇产科分娩 5例(臂位 3例，头位 2例)，产后半小时急会诊确诊;院外就诊10例，分娩情况不详。男 5例，女 10例，年龄产后半小时～ 3d。右侧 10例，左侧 5例。无阳性家庭史。临床诊断依据 15例患肢呈屈髋，膝反曲 30°～ 70°畸形，小腿贴近胸腹壁，不能主动屈膝，被动屈膝 0°～ 15°受限，抽屉实验(＋ )。例…