腹腔镜联合手术21例报告

目的：探讨腹腔镜联合手术的优势及其适应证。方法：自1992年5月至2002年2月开展腹腔镜手术488例中21例联合手术，其中腹腔镜胆总管切开取石与胆囊切除7例；腹腔镜肝囊肿开窗引流与胆囊切除术4例；腹腔镜胆囊切除与阑尾切除4例；腹腔镜胆囊切除与腹腔镜辅助脾切除2例；腹腔镜假性胰腺囊肿切除与胆囊切除1例；腹腔镜胆总管切开取石与胆囊切除与右肾囊肿开窗引流1例；腹腔镜右卵巢囊肿切除与胆囊切除1例；腹腔镜胆囊切除与边缘型小肝癌切除1例。结果：21例均顺利完成联合手术，无并发症。结论：腹腔镜联合手术拓宽了腹腔镜手术领域。     

重组腺相关病毒介导抑癌基因联合诱导人肝癌细胞系凋亡与生长抑制研究

目的 观察腺相关病毒介导的抑癌基因p53,p16和p21联合治疗肝癌的可能性和效果。方法 用携带人野生型p53,p16和p21的腺相关病毒分别或联合转导人肝癌细胞系HLE，HepG2,QGY-7701,QGY-7703,BEL-7402,SMMC-7721，通过体外及裸鼠体内实验研究转基因的表达及对癌的促凋亡和生长抑制作用。结果 腺相关病毒介导的p53,p16及p21对人肝细胞肝癌细胞系均有明显的促凋亡作用，体外凋亡率约30％左右，体内生长抑制率30％－44％；联合感染肝癌细胞效果更明显，体外凋亡率达56％，体内癌生长抑制率65％。结论 腺相关病毒介导的外源抑癌基因p53，p16和p21不仅对多种肝癌细胞系均有诱导凋亡和抑制生长作用，联合应用治疗肝癌更具有明显的相互协同作用。进一步提高病毒滴度和纯度是腺相关病毒作为载体进行基因治疗的目标。     

肝肾联合移植的临床体会（附10例分析）

目的总结肝肾联合移植的治疗体会。方法收集接受肝肾联合移植的10例患者的临床资料,对其手术时间、供肝和供肾热缺血时间、术中出血量、术后并发症,受者和移植物功能等情况进行总结分析。结果 10例患者的原发病分别为乙型病毒性肝炎（乙肝）后肝硬化5例,其中合并药物性肾衰竭1例、移植肾失功1例、肝肾综合征3例;原发性肝细胞癌合并肾衰竭2例;酒精性肝硬化合并尿毒症1例;先天性多囊肝和多囊肾（polycystic liver and kidney disease,PCLKD）1例;肝移植术后缺血性胆管狭窄并肾衰竭1例。肝移植采用改良背驮术式,肾移植采用常规移植方法,将移植肾置于左髂窝或右髂窝。手术均获成功,肝移植手术时间（444±175）min,肾移植手术时间（184±36）min;移植肝和移植肾热缺血时间为8min以内;术中出血量（3367±1726）ml。术前严重感染的5例,术后1周内死于多器官功能衰竭。存活的5例患者中,其中1例患者术后反复肺部感染,给予呼吸机辅助支持治疗、积极抗感染后治愈,其余4例患者无明显并发症。5例患者均存活,生存12~32个月,受者和移植物功能良好。结论肝肾联合移植是治疗终末期肝、肾功能同时受损的有效的不可替代的治疗手段。选择合适病例,把握适当的手术时机,术中控制手术时间、热缺血时间和出血量,术后积极处理并发症是获得良好疗效的关键。     

中药,西药及中西药联合治疗对慢性前列腺炎疗效的比较

目的评价中西药联合应用及单独应用治疗慢性前列腺炎的疗效。方法将90例诊断为慢性前列腺炎患者随机分为3组:中药治疗组(A组)30例,西药治疗组(B组)(头孢哌酮+吲哚美辛+奥美拉唑)30例,中西药联合治疗组(C组)30例。于治疗后1个月、2个月、3个月门诊复查,通过慢性前列腺炎临床症状指数(NIH-CPSI)评分了解症状改善情况以及查前列腺液了解白细胞数量情况。结果在症状改善方面,中药组与西药组差异无统计学意义(P=0.185),中药组与中西药联合组差异有统计学意义(P0.001),西药组与中西药联合组差异有统计学意义(P=0.019)。在前列腺液白细胞数量等级上,3组差异无明显统计学意义。结论中药与西药联合治疗慢性前列腺炎上,症状的改善优于单独应用中药或西药;但在前列腺液白细胞数量等级的改善效果与单独应用中药或西药并无明显差异。     

胃肠道间质瘤71例预后影响因素分析

目的探讨胃肠道间质瘤的诊断和治疗方式及影响术后复发的因素。方法对我院2001年1月～2007年6月收治并获随访的71例胃肠道间质瘤的临床资料进行回顾性分析。分别采用单因素和多因素两种方式对影响复发的因素进行分析。结果单因素分析显示,肿瘤大小、有无浸润、坏死和手术方式均对术后复发有影响(P<0.05);多因素分析显示,肿瘤大小、有无浸润和手术方式对术后复发有影响(P<0.05)。结论适当扩大切除范围,术后服用依马替尼可降低胃肠道间质瘤的术后复发率,改善病人预后。     

贲门癌近端胃切除术后残胃排空障碍的诊断和治疗

目的探讨贲门癌术后胃瘫的临床诊治方法。方法对我院2001年1月～2006年12月收治的贲门癌术后胃瘫18例的临床资料进行回顾性分析。结果本组经胃肠减压,营养支持,维持水、电解质代谢平衡及促进胃肠动力药物等治疗后均得以缓解。结论贲门癌术后胃瘫的诊断主要依据临床表现;胃镜检查有其重要价值;排除机械性梗阻后应积极采取非手术治疗,不应盲目再次手术。     

术后早期炎性肠梗阻综合治疗疗效分析

目的探讨综合治疗在术后早期炎性肠梗阻疗效。方法回顾分析43例术后早期炎性肠梗阻患者的临床资料。结果 39例早期炎性肠梗阻经胃肠减压、生长抑素、糖皮质激素和肠外营养等综合措施治愈,平均治愈时间12.1±8.4d;4例经手术治疗治愈。结论非手术综合治疗是术后早期炎性肠梗阻的有效治疗方法。     

The effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study

Background

Labor epidural analgesia is associated with maternal hyperthermia. This pilot study compared the effects on maternal temperature during labor of different timing of initiation of the epidural component of combined spinal–epidural analgesia.

Methods

After induction of analgesia with intrathecal bupivacaine 2 mg and fentanyl 20 μg, healthy term nulliparas in spontaneous labor were randomized to receive immediate epidural analgesia (n = 26) or delayed epidural analgesia after the return of pain (n = 28), by patient-controlled epidural analgesia with 0.125% bupivacaine and fentanyl 1 μg/mL. Maternal tympanic temperature, visual analog scale pain score and dermatome block level were measured hourly during labor.

Results

The duration of labor for most parturients (83.3%) was <5 h. Mean maternal temperature gradually increased over time but did not significantly differ from either from baseline or between the two groups. There was no significant difference in the incidence of maternal fever (?38°C) between the two groups. At 2 h post spinal analgesia the visual analog scale score was higher (P = 0.03) and the dermatome block level was lower (P = 0.005) in the delayed epidural analgesia group compared to the immediate epidural analgesia group.

Conclusions

Delaying the epidural component of combined spinal–epidural analgesia did not significantly affect maternal temperature in the study population of whom 83.3% had a labor of <5 h. However, this study was underpowered to detect a difference in the incidence of fever and a larger prospective study is required.     

腰麻、腰硬联合麻醉、硬膜外麻醉在瘢痕子宫剖宫产手术中的麻醉效果比较

目的 探讨瘢痕子宫产妇剖宫产的麻醉方法.方法 比较腰麻、腰硬联合麻醉、硬膜外麻醉3种麻醉在瘢痕子宫产妇剖宫产手术中的麻醉效果.结果 腰麻、腰硬联合麻醉较硬膜外麻醉起效快、镇痛肌松好,牵拉反应也轻.结论 腰麻、腰硬联合麻醉在瘢痕子宫产妇剖宫产手术中麻醉效果良好.     

肝肾联合移植的单中心经验总结

目的 分析单中心肝肾联合移植(SLKT)的治疗效果.方法 1999-2010年间共实施SLKT 21例,患者的原发疾病分别为多囊病11例,病毒性肝炎后肝硬化合并肝肾综合征5例,慢性肾炎肾功能衰竭合并肝硬化2例,肾移植术后移植肾功能丧失合并肝硬化2例,肝炎后肝硬化合并糖尿病肾病1例.统计患者的资料,与同期同中心"中国肝移植注册网站"收录的肝炎后肝硬化行肝移植的133例(LT组)和"中国肾移植科学登记系统"收录的尸体肾移植609例(KT组)进行对比,分析各组受者术前状态和预后的差异.结果 SLKT组术前终末期肝病模型(MELD)评分为21.3±5.5,血肌酐为(516.0±329.9)mmol/L;LT组术前MELD评分为20.6±9.9,血肌酐为(111.4±138.1)mmol/L,与SLKT组相比较,血肌酐的差异有统计学意义(P＜0.01).SLKT组中,3例分别于术后2周、半年和5年因感染而死亡,1例因多器官功能衰竭而死亡,1例于术后5年自行停药,因排斥反应而死亡.SLKT组术后1年内移植肾急性排斥反应的发生率为零,KT组为6 %(P＞0.05).术后SLKT组移植肾功能延迟恢复的发生率为9.5 %,KT组为17.3 %(P＞0.05).SLKT组术后1、3和5年的受者存活率分别为87.7 %、67.8 %和67.8 %,LT组分别为84.2 %、73.5 %和69.4 %(P＞0.05).结论 SLKT是终末期肝、肾疾病的有效、安全的治疗方法.

Abstract：

Objective To analyze the curative effect of simultaneous liver and kidney transplantation (SLKT) for patients with end-stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome.Methods All SLKTs (n=21) performed at our center from January 1999 to December 2010 were reviewed and SLKT outcomes were compared with those of kidney transplantation (KT) (n=609) and liver transplantation (LT) (n=133) performed during the same period.Results There were 3 deaths due to infection 2 weeks, 6 months and 5 years respectively after operation. One patient died due to multiple organ dysfunction syndrome 2 weeks after operation. One patient was dead 5 years after operation because of rejection. MELD level between SLKT and LT had no significant difference, but serum creatinine in SLKT group was significantly higher than in LT group (516.0±329.9 vs 111.4±138.1 mmol/L, P<0.01). The 1-year acute kidney rejection rate and rate of delayed graft function (DGF) of the kidney had no significant difference between SLKT group (0 vs 9.5 %) and KT group (6 % vs 17.3 %). There was no significant difference in one-, 3- and 5-year patient survival rate between SLKT group (87.7 %, 67.8 % and 67.8 %) and LT group (84.2 %, 73.5 % and 69.4 %).Conclusion SLKT is a safe and effective treatment for end-stage liver and kidney diseases.