恶性腹水双途径联合化疗的临床疗效评价

目的：评价双途径联合化疗治疗恶性腹水的临床疗效及不良反应。方法：根据瘤细胞类型选择药物，静脉与腹腔联合用药。结果：本方法治疗食管癌、胃癌、原发性肝癌、大肠癌、卵巢癌所致恶性腹水的总有效率依次为‘76．9％、85.l％、27.3％、75.l％和88．9％，腹水平均控制时间分别为46．3、5l.2、60．6、53．7和48．9天，平均生存期分别为13．4、10．8、5.2、ll.6和12.7个月。不良反应发生率，中、高度发热为35．5％，恶心呕吐为100％，轻、中度腹痛为77．7％；白细胞普遍下降，肝肾功能损害不显著。结论：双途径联合化疗是目前治疗恶性腹水有效、可行的一种方法。     

论僵蚕的不良反应

僵蚕的不良反应有过敏反应、腹胀不良反应，有出血倾向者和肝昏迷患者应慎用。古代文献中有僵蚕的“恶”、“忌”等论述，应根据病情选择适宜剂量。     

Incarceration of umbilical hernias in children: a rare but important complication

Umbilical hernia (UH) is a common condition in infants and young children, especially in those of Afro-Caribbean origin. Spontaneous closure occurs in a majority of cases before the age of 4 years unless the neck of the sac is greater than 2 cm in diameter. Complications are rare, and conservative management is therefore advised during this time. We present three cases of incarcerated UH in boys under 4 years old, all of whom presented with small-bowel obstruction. Interestingly, in two of them undigested vegetable matter in the small bowel appeared to have precipitated the obstruction. A survey of the literature suggests that the incidence of this complication is approximately 1:1,500 UHs. We conclude that the present policy of expectant management is safe for the vast majority of children, but parents and general practitioners should be aware of the small risk and early symptoms of incarceration. Accepted: 30 September 1997     

彩超诊断剖宫产术后腹壁疤痕子宫内膜异位症

目的探讨剖宫产术后腹壁疤痕子宫内膜异位症(简称腹壁内异症)的彩色多普勒超声表现。方法对8例经手术和病理证实的腹壁内异症的彩色多普勒超声结果进行回顾性分析。结果8例肿物均位于皮下脂肪层,直径为1.6～3.7cm;形态不规则,边缘不光滑,常呈毛刺状侵及腹直肌前筋膜;内部呈不均匀的低回声,可见一个或数个小的液性暗区;彩色多普勒显示肿物内部均可见点状和/或条状血流信号,为低速高阻的动脉血流。结论与临床资料相结合,彩色多普勒超声是诊断腹壁内异症的一种有价值的方法。     

Long-term survival following emergency abdominal aortic aneurysm repair

Survival following emergency surgery for ruptured abdominal aortic aneurysm remains poor and is in stark contrast to that for elective repair. We have carried out a 5-year retrospective observational study to determine the long-term (5-year) survival of patients following emergency surgery for ruptured abdominal aortic aneurysm at a district general hospital in East Anglia. A total of 99 patients presented to the operating theatre for emergency repair of ruptured abdominal aortic aneurysm in this 5-year study period. In-hospital mortality was 70% and was unchanged over the 5 years. Overall long-term survival in those patients discharged from hospital was good. The ICU cost per long-term survivor was calculated to be pound sterling 36750.     

临床超声技术在腹部淋巴结病变检查治疗中的应用

目的　研究分析腹部淋巴结主要病变的超声声像图特征及超声引导活检的临床应用价值。方法　对腹部淋巴结病变进行超声检查和超声引导活检。结果　超声检查可准确显示腹部淋巴结病变的数目、大小、形态、部位及其内部结构 ,能提示与周围组织的关系 ,从而作出诊断与鉴别诊断 ;超声引导能成功进行穿刺活检。结论　超声检查和超声引导活检是诊断腹部淋巴结病变的一种简便、快捷 ,准确、实用的检查手段 ,对明确临床诊断 ,指导临床治疗和观察病变进展与临床疗效 ,均具有良好的应用价值。     

腹部手术影响小肠平滑肌细胞收缩的细胞内信号转导机制研究

目的:探讨腹部手术操作对小肠平滑肌细胞收缩功能的影响及细胞内信号转导途径。方法:采用Wistar大鼠制作腹部手术动物模型,酶解法获取小肠游离环行平滑肌细胞,检测平滑肌细胞在乙酰胆碱作用下的收缩反应和胞浆游离钙离子浓度([Ca2 ]i)的变化,然后将细胞分别与一氧化氮合酶抑制剂L-NNA、钙活化的K 通道阻滞剂A-pamin、蛋白激酶A抑制剂H89和蛋白激酶G抑制剂KT5823等一同孵育,重复以上实验过程。测定小肠环行平滑肌细胞培养24 h后培养基中一氧化氮(NO)的含量。结果:培养24 h后,实验组小肠环行平滑肌细胞产生的NO量明显高于对照组(P<0.05),L-NNA可明显降低实验组NO的产量,而对照组NO产量没有明显影响;L-NNA和KT5823可明显提高实验组小肠环行平滑肌细胞的收缩能力及乙酰胆碱刺激的[Ca2 ]i升高的水平(P<0.05),而Apamin和H89没有明显的影响。结论:腹部手术操作导致小肠肌层大量生成NO,激活鸟苷酸环化酶产生cGMP,通过PKG途径降低细胞内[Ca2 ]i的水平,抑制小肠平滑肌细胞的收缩能力。     

腹腔镜妇科手术200例临床分析

目的探讨腹腔镜在妇科手术中的应用价值。方法回顾我院200名患者接受腹腔镜手术治疗,例如子宫肌瘤、子宫腺肌病、异位妊娠、盆腔粘连、卵巢囊肿、继发不孕的情况。结果194例患者手术均顺利完成,占97%;中转开腹4例,占2%;并发症2例,占1%。结论腹腔镜手术是一种更具人性化的手术方式,它具有创伤小、痛苦少、恢复快的优点。但必须提高医生的内镜手术技能和技巧,严格掌握手术适应证和禁忌证,减少并发症的发生。     

Saline irrigation and wound infection in abdominal gynecologic surgery.

OBJECTIVE: To evaluate whether saline wound irrigation decreases the incidence of wound infection following abdominal gynecologic surgery. METHOD: In this prospective randomized study, 104 patients underwent wound irrigation before wound closure following abdominal gynecologic surgery and 102 patients did not. RESULTS: There were no significant differences between the 2 groups in patient characteristics or in factors influencing the incidence of wound infection after abdominal gynecologic surgery. The incidence of wound infection was 10.6% among women who underwent wound irrigation and 9.8% among those who did not, and the difference was not statistically significant. CONCLUSION: Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery.