腹腔镜下精索静脉高位结扎术的临床疗效分析

目的：探讨腹腔镜下精索静脉高位结扎术的临床疗效。方法：2008年7月～2010年10月,本院选择132例Ⅱ度以上原发性精索静脉曲张患者,进行了腔镜下精索静脉高位结扎手术治疗,年龄（31±4.5）岁,双侧21例,左侧111例;Ⅲ度26例,Ⅱ度106例。其中98例患者婚后不育,病程1～9年,女方经检查未发现异常。52例患者有阴囊坠痛感。实验室检查101例精液异常。均行腹腔镜下精索静脉高位结扎术。结果：132例手术顺利成功,手术时间为（40±18.7）min,出血量为（8±2.3）ml,术中无周围脏器损伤,术后无切口感染,无肠梗阻等并发症,术后平均住院2.6（2～3）d,术后随访24个月,有7例复发,2例并发鞘膜积液,1例发生睾丸萎缩（体积〈3 cm3为萎缩）。术后3个月复查97例患者,精液质量有不同程度改善提高（a＋b精子百分比〉6%为质量提高）。结论：腹腔镜下精索静脉高位结扎手术安全可靠、效果满意,创伤轻微,腹部切口细小美观,恢复快、住院时间短。     

双侧椎动脉颈段完全栓塞早期对兔颈髓血流的影响

目的 :研究椎动脉颈段栓塞对颈髓血流量的影响。方法 :结扎兔双侧C6、C7处椎动脉 ,在术后 4、 8、2 4h观察行为学、细胞形态学 ,并采用激光多普勒血流测定仪测定颈髓血流。结果 :术后 4、 8、 2 4h组颈髓血流量明显下降 ,8、 2 4h组呈急性缺血性改变。结论 :椎动脉供血区血流量减少可导致颈髓相应区域急性缺血损伤。     

结扎子宫动脉上行支加宫腔纱布填塞治疗难治性产后出血

目的 探讨结扎子宫动脉上行支加宫腔纱布填塞治疗难治性产后出血的疗效。方法 对37例难治性产后出血患者结扎双侧子宫动脉上行支加宫腔纱布填塞处理。结果 37例患者均获得满意的止血效果，未发生再出血。结论 该止血方法简单迅速、易于掌握，效果确切，值得临床推广应用。     

子宫浆肌层“8”字缝合与子宫动脉上行支结扎治疗剖宫产术中出血临床观察

目的:探讨子宫浆肌层"8"字缝合与结扎子宫动脉上行支对治疗剖宫产术术中出血的临床价值。方法:回顾性分析2005年5月~2007年5月12例剖宫产术中出血患者施行子宫浆肌层"8"字缝合与子宫动脉上行支结扎术的方法及效果等。结果:12例剖宫产术中出血患者施行子宫浆肌层"8"字缝合,其中5例止血成功,7例因止血效果不满意行子宫动脉上行支结扎术。所有病例均保留子宫且术后无晚期产后出血等并发症。结论:子宫浆肌层"8"字缝合加子宫动脉上行支结扎治疗剖宫产术中出血,操作简单,止血迅速,适合基层医院剖宫产术中大出血的抢救。     

Novel characterization of a breakpoint in F8: an individualized approach to gene analysis when PCR and MLPA results contradict

Haemophilia A is an X‐linked bleeding disorder caused by heterogeneous mutations in the F8 gene. Two inversion hotspots in intron 22 and intron 1, as well as point mutations, small insertions and deletions in the F8 gene account for causal mutations leading to severe haemophilia A. Rarely, novel molecular mechanisms lead to a haemophilia A phenotype which cannot be completely characterized by routine molecular diagnostic methods. Here, we characterized the molecular abnormality in a boy with a severe haemophilia A phenotype. On investigation by PCR and DNA sequencing, exon 18 of F8 repeatedly failed to amplify. However, analysis by multiplex ligation‐dependent probe amplification demonstrated the presence of exon 18 sequence, suggesting a more complex rearrangement than a single exon deletion. The analysis of exon 18 and its flanking regions by inverse PCR revealed a complex mutation comprising insertions of extragenic sequences from Xq28 along with a partial duplication of exon 18. Based on the successful analysis and characterization of the familial breakpoint, we developed a PCR‐based diagnostic approach to detect this defect in family members in whom no diagnostic test could be offered until this time.     

Managing fistula‐in‐ano with ligation of the intersphincteric fistula tract procedure: the Western Hospital experience

Aim To review the preliminary results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas at our hospital. Method Between March and November 2010, patients with cryptoglandular anal fistulas were recruited prospectively from the colorectal clinic and treated using the LIFT procedure. A database was set up to collect information on demographics, past surgical treatments, fistula characteristics, MRI scan results, operative data and follow‐up findings. The primary end‐point measured was cure of the disease. The secondary end‐point was the degree of postoperative continence. Preoperative and postoperative incontinence rates were recorded using Wexner’s Incontinence Scale. Results Twenty‐five patients (eight women and 17 men; median age, 40 years) underwent the LIFT procedure. Ten patients had recurrent fistulas and previous fistula surgery. The median operating time was 39 min. No intraoperative complications were documented. The median follow‐up duration was 22 (3–43) weeks. Primary healing was observed in 17 (68.0%) patients and the median healing time was 6 weeks; one wound remained incompletely healed. Seven patients (28.0%) had disease recurrence presenting between 7 and 20 weeks postoperatively. No patients reported any incontinence postoperatively. Conclusion The LIFT procedure has favourable healing rates with little or no risk of incontinence. This operation is safe and easy to learn. The early results from this pilot study show promise and affirm some of the findings of other researchers. These results will suggest opportunities to conduct further controlled studies comparing the LIFT procedure with standard therapies.     

温馨提示卡应用于内镜下套扎术患者的效果观察

目的：探讨温馨提示卡在内镜下套扎术患者中的应用效果。方法将108例内镜下套扎术患者随机分为实验组和对照组,每组各54例。对照组进行常规护理,实验组在此基础上加用温馨提示卡,对2组患者的住院天数和疼痛程度进行比较。结果实施不同护理模式后,实验组患者住院天数明显少于对照组（P〈0.01）,疼痛程度显著低于对照组（P〈0.01）。结论将温馨提示卡运用于套扎术患者的护理过程中,能使患者感受到温暖,从而主动配合手术。     

自动痔疮套扎联合悬吊固定术治疗高危人群内痔临床疗效观察

目的探讨自动痔疮套扎联合悬吊固定术治疗高危人群内痔的临床疗效。方法 88例初次入院的合并多种疾病伴有内痔脱出或出血的患者随机分为治疗组(54例)与对照组(34例),治疗组采用自动套扎联合悬吊固定术治疗,对照组采用内痔结扎术。观察两组患者治疗后临床疗效及安全性。结果对照组34例患者治愈28例(82.35%),好转3例(8.82%),未愈3例(8.82%);治疗组54例治愈50例(92.59%),好转4例(7.41%),未愈0例;两组患者治疗后临床疗效比较差异有统计学意义(P0.05)。治疗组患者术中出血、手术时间、住院时间、住院费用与对照组比较差异有统计学意义(P0.05)。结论自动痔疮套扎联合悬吊固定术具有创伤小、痛苦少、住院时间短、复发率低等优点,对肛门结构及功能具有良好保护作用,各方面明显优于内痔结扎术,可有效地治疗高危人群的内痔,相对更安全可靠,值得推广应用。     

肝硬化食管静脉曲张破裂出血序贯治疗的临床应用价值

目的 评价曲张静脉套扎术(EVL)+不同硬化剂曲张静脉硬化术(EVS)序贯治疗肝硬化食管静脉曲张破裂出血的疗效及安全性.方法 回顾性总结314例肝硬化食管静脉曲张破裂出血内镜治疗患者的临床资料,包括单纯EVL治疗者112例(EVL组)、单纯鱼肝油酸钠硬化治疗者48例(EVS1组)、单纯聚桂醇硬化治疗者40例(EVS2组)、套扎+鱼肝油酸钠硬化序贯治疗者26例(EVLS1组)、套扎+聚桂醇硬化序贯治疗者88例(EVLS2组),统计各组曲张静脉治疗有效率、静脉曲张复发率、并发症发生率并进行对比分析.结果 EVL组、EVS1组、EVS2组、EVIS1组、EVLS2组曲张静脉治疗有效率比较差异均无统计学意义[85.7％ (96/112)、83.3％ (40/48)、92.5％ (37/40)、92.3％(24/26)、94.3％ (83/88),P＞0.05],但EVLS1组和EVLS2组曲张静脉完全消失率均明显高于其他3组[88.5％(23/26)和87.5％(77/88)比58.0％(65/112)、62.5％(30/48)、70.0％(28/40),P＜0.05],而EVLS1组与EVLS2组比较差异无统计学意义(P＞0.05).EVS1组再出血率最高(18.8％,9/48) (P ＜0.05),其次是EVL组(11.6％,13/112),均高于EVS2组、EVLS1组和EVLS2组[7.5％(3/40)、7.7％ (2/26)、6.8％ (6/88),P＜0.05],后3组再出血率相似(P＞0.05).治疗后随访6 ～18个月,EVL组静脉曲张复发26例(23.2％,26/112),EVS1组复发8例(16.7％,8/48),EVS2组复发6例(15.0％,6/40),EVLS1组复发4例(15.4％,4/26),EVLS2组复发9例(10.2％,9/88);EVL组复发率最高(P＜0.05),EVLS2组复发率最低(P＜0.05),EVS1组、EVS2组和EVLS1组复发率相似(P＞0.05).EVS1组总体并发症发生率(32.2％,49/152)明显高于其他4组(P＜0.05),而EVL组(14.5％,32/220)、EVLS2组(19.6％,22/112)、EVLS1组(22.7％,25/110)、EVLS2组(15.8％,34/229)4组间比较差异无统计学意义(P＞0.05).结论 EVL+鱼肝油酸钠EVS或+聚桂醇EVS序贯治疗肝硬化食管静脉曲张破裂出血是安全而有效的,尤以EVL+聚桂醇EVS序贯治疗效果显著,有可能成为治疗食管静脉曲张出血并防止再出血的最佳选择.     

脱氢枞胺钾盐对实验性胃溃疡的治疗作用

目的：研究脱氢枞胺钾盐对多种实验性动物胃溃疡的影响。方法：通过测定红细胞计数、弥漫性出血点、溃疡面积、胃液量、胃酸值、胃蛋白酶活性等指标的变化,观察脱氢枞胺钾盐对各种实验性溃疡的影响。结果：脱氢枞胺钾盐能明显降低溃疡指数。结论：脱氢枞胺钾盐对多种类型胃溃疡有抑制和治疗的作用。