理气类中药对大鼠离体胃平滑肌条的作用

目的：观察理气类中药对大鼠离体胃平滑肌条运动的影响。方法：将肌条放置在灌流肌槽中，用生理记录仪记录肌条的收缩活动。结果：陈皮、枳实对胃各部位平滑肌条均为抑制效应，香附、薤白、木香、柿蒂、乌药对胃底肌条为兴奋效应，但对其他部位肌条则表现为兴奋或抑制不同的效应，沉香仅降低胃窦环行肌收缩波平均振幅，对其他肌条无影响。结论：理气类中药对大鼠离体胃平滑肌条既有兴奋作用，也有抑制作用。     

26例前置胎盘分娩方式临床分析

[目的 ]探讨前置胎盘分娩方式的选择及分娩过程中减少出血的方法。 [方法 ]对 2 6例前置胎盘病例的发病率、诊断方法、胎盘分型、分娩方式、出血情况及剖宫产术子宫切口方式与出血的关系几个方面进行回顾性分析。[结果 ]2 6例中手术率为 96 .1 5 % ,阴道分娩率为 3.85 % ,1例阴道分娩出血量为 6 0 0mL ,剖宫产术平均出血量为 6 74 .5 5mL ;剖宫产术中切口方式选择推开胎盘与避开胎盘出血量比较 ,差异无显著性 (P >0 .0 5 ) ,切开胎盘与推开胎盘出血量比较及切开胎盘与避开胎盘的出血量比较 ,差异均有显著性 (P均 <0 .0 1 )。[结论 ]剖宫产术可成为前置胎盘终止妊娠的主要方法 ,同时原则上应避开胎盘选择切口     

Laparoscopic gastrojejunostomy and endoscopic biliary stent placement for palliation of incurable gastric outlet obstruction with cholestasis

Background: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined with endoscopic biliary stent placement seems to offer a minimally invasive palliation. Methods: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved preoperatively by stent placement via endoscopy (n= 6, 37.5%), percutaneous access (n= 5, 31%) or bilioenteric anastomosis (n= 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively. Results: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention; there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%) patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain oral intake during the remaining survival time. Conclusions: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional result while impairing the quality of life only to a minimal extent. Received: 7 May 1996/Accepted: 12 December 1996     

胃癌第一站淋巴结窦组织细胞增生生发中心增生对胃癌预后的影响

目的 :研究胃癌第一站淋巴结窦组织细胞增生 (SH)、生发中心增生 (GCH)对胃癌第一站淋巴结转移及预后的影响。方法 :将SH、GCH分别分为 - ,+ ,+ +三级 ,分析SH ,GCH对胃癌第一淋巴结转移的影响 ,比较其 5年生存率。结果 :①SH -患者淋巴结转移率明显比SH + ,SH + +高 (P <0 .0 0 5 ) ;5年生存率随SH分级数升高而升高 (P <0 .0 0 5 ) ;②GCH -患者淋巴结转移率明显比GCH + ,GCH+ +高 (P <0 .0 0 5 ) ;5年生存率随GCH分级数升高而升高 (P <0 .0 1)。结论 :SH ,GCH患者胃癌第一站淋巴结转移率较低 ;SH ,GCH分级数越高预后越好 ;SH ,GCH可作为预测胃癌预后的指标之一。     

早期鼻饲生大黄粉防治重型颅脑损伤后上消化道出血的临床研究

目的研究重型颅脑损伤后早期鼻饲生大黄粉对防治上消化道出血的作用.方法选择GCS3～8分重型颅脑损伤患者90例,随机选45例(实验组)伤后早期(24～48h)鼻饲生大黄粉,另45例(对照组)未予生大黄粉治疗.所有患者其他治疗措施均基本相同.结果39例患者出现上消化道出血.其中实验组14例,有13例上消化道出血治愈,治愈时间(7.6±2.5)d;对照组25例,有16例上消化道出血治愈,治愈时间(13.4±3.3)d.实验组上消化道出血率和上消化道出血治愈平均时间均显著低于对照组(P＜0.05),而上消化道出血治愈率显著高于对照组(P＜0.05).结论早期鼻饲生大黄粉能有效防治重型颅脑损伤后并发上消化道出血,值得临床推广应用.     

ELF方案治疗晚期胃癌21例近期疗效分析

用ＥＬＦ（ＣＦ／５－Ｆｕ及Ｖｐ－１６）方案治疗均经病理证实的晚期胃癌２１例，其中术后辅助性化疗４例，可评价１７例，结果ＣＲ３例，ＰＲ６例，总有效率５２．９％，同在存活最活最长３０个月，最短３个月，中位生存期９个月，化疗主要毒副作用为轻度骨髓抑制及胃肠道反应，对肝、肾、心功能无大影响。     

新式非脱垂子宫阴式全子宫切除术45例报告

目的探讨非脱垂子宫经阴道改良切除的可行性及方法。方法将103例子宫肌瘤、子宫腺肌瘤、功能性子宫出血等需行全子宫切除术的患者随机分为两组，常规经腹式全子宫切除术(腹式组)58例，经阴道全子宫切除术(阴式组)45例，比较两种手术方法的优劣。结果阴式组较腹式组手术时间短，术中出血少，术后痛苦少；48h内肛门排气阴式组40例(88．9％)，腹式组31例(53．4％)；平均住院天数阴式组5．1d，腹式组7．1d。结论新式非脱垂子宫的阴式全子宫切除术相对于经腹式全子宫切除术有一定的优势，但要严格选择其手术适应证。     

Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

不同病理类型胃息肉流式细胞DNA定量研究

应用流式细胞计对５７ 例正常胃粘膜、不同病理类型的胃息肉和胃癌组织作ＤＮＡ 定量分析。正常胃粘膜、炎性息肉、增生性息肉、腺瘤性息肉及胃癌中，ＤＮＡ 非整倍体检出率分别为０％ 、７．７％ 、９．１％ 、３６．４％ 、５８．３％ ；各型胃息肉和胃癌组织的增殖期细胞比率均显著地高于正常胃粘膜组（Ｐ＜ ０．０１）；增生性或炎症性息肉组增殖期细胞比率与胃癌组比较，差异有显著性（Ｐ＜ ０．０５）或非常显著性（Ｐ＜ ０．０１），而腺瘤性息肉组增殖期细胞比率与胃癌组近似（Ｐ＞ ０．０５）。结果表明胃息肉是一种细胞增殖活跃性病变，其中腺瘤性息肉的ＤＮＡ 生物学行为更接近于胃癌，可能容易癌变；应用流式细胞ＤＮＡ 定量分析技术，结合组织病理学诊断，能对胃息肉的预后作出更为确切的判断     

替勃龙改善绝经期功能性消化不良症状

目的 :探讨替勃龙能否改善绝经期功能性消化不良患者临床症状及其相关机制。方法 :14 3例绝经期功能性消化不良患者随机分成 3组 ,分别给予替勃龙、西沙必利及替勃龙 +西沙必利 ,治疗 4周 ,观察治疗前后各组患者上腹胀痛、餐后胀满、早饱、暖气等临床症状积分的变化。在随机分成的 3组中再随机各抽出 2 0例患者治疗前后测定胃 30min排空率及胃半排空时间 ,观察治疗前后胃动力的变化。结果 :3组药物治疗后 2周和 4周上腹胀痛、餐后胀满症状积分均明显下降。西沙必利治疗后 2周和 4周对早饱、暖气症状无明显缓解 ,替勃龙及替勃龙 +西沙必利则对所观察的所有症状均有明显缓解 ,替勃龙改善早饱和嗳气症状优于西沙必利 ,但与西沙必利合用无增强效应。 3种药物治疗后 ,胃 30min排空率均明显增加、胃半排空时间缩短 ,与治疗前比较有显著差异 (P <0 .0 5 ) ,但 3种治疗方案之间无显著性差异 (P >0 .0 5 )。结论 :替勃龙能通过增强胃动力 ,明显改善部分绝经期功能性消化不良患者的临床症状 ,疗效优于促动力药。