三孔无钛夹法腹腔镜胆囊切除术152例临床经验

目的探讨三孔法腹腔镜胆囊切除术中运用丝线结扎胆囊管及胆囊动脉的可行性。方法分析2005年8月至2007年6月行三孔无钛夹法腹腔镜胆囊切除术152例的临床资料。结果平均手术时间50min,平均术后住院时间4．5d。无手术并发症。结论三孔无钛夹法腹腔镜胆囊切除术安全、可靠、创伤小,无体内金属异物残留。     

Comparison of Norepinephrine Release in Hypertensive Rats: I Hypothalamic and Brainstem Tissues

Stimulation induced ³H-norepinephrine release was measured in hypothalamus and brainstem of spontaneously hypertensive (SHR) and normotensive (WKY) rats. Age dependent changes in ³H-norepinephrine release were shown to occur in the anterior and posterior hypothalamus and the A₂ region of the nucleus tractus solitarius (NTS). In an attempt to determine whether these changes in ³H-trasmitter release were causal or merely secondary to the increase in blood pressure, similar release studies were carried out in DOCA-salt and one kidney-one clip hypertensive animals with similar levels of systolic blood pressure. The changes in stimulus-induced ³H-norepinephrine release seen in the SHR were not observed in the other two models of hypertension, suggesting that one: they were not secondary to an increase in systolic blood pressure; and two that the changes observed in the SHR may possibly play a role in the development and/or maintenance of the hypertension.     

Changes in Plasma Ace Activity During the Development and Reversal of One-Kidney,One Clip Hypertension in Rats

We conducted a randomized, double-blind, cross-over comparison of six weeks' treatment with 5 mg clopamide or with 25 mg hydrochlorothiazide in 17 hypertensive patients (average age 62 years). No significant differences were found between the two treatments in blood pressure control, plasma biochemical values, body weight or response to a comprehensive “quality of life” questionnaire. Despite the apparently identical performance of both drugs, significantly (x²=4.76;P<0.05) more patients expressed a preference for clopamide (12) than for hydrochlorothiazide (3). Two had no preference. Current quality of life assessments are relatively insensitive and patient preference remains a valid discriminator between otherwise comparable medications.     

布巾钳复位治疗单纯颧弓M型骨折的临床观察

目的：探讨布巾钳复位单纯颧弓M型骨折的临床疗效。方法：对15例患者应用布巾钳复位后,利用钢丝和铝板进行外固定,术后影像学随访。结果：15例患者均治愈,无张口受限,面部无瘢痕及神经损伤等症状。结论：该方法创伤小,并能有效恢复颧弓外形及开口功能,获得良好临床疗效。     

内镜下钛夹治疗上消化道非静脉曲张出血60例的护理配合

摘要：目的通过对60例上消化道非静脉曲张出血患者采用金属钛夹在内镜下直接止血,总结护理配合技巧和要点。方法用金属钛夹推送器安装钛夹,对准出血部位释放金属钛夹达到止血目的。结果60例非静脉曲张上消化道出血,根据Forrest分级标准,Ⅰa6例,Ⅰb38例,Ⅱa9例,Ⅱb7例。共用金属钛夹125枚,所有病例内镜下首次止血成功率100％,术后无不良反应及并发症。结论掌握内镜性能,正确使用金属钛夹推送器,可确保内镜下金属钛夹治疗消化道出血的成功。     

Hem-o-10k在腹腔镜肛门成形术中的应用

目的探讨Hem-o—lok在腹腔镜肛门成形术处理直肠尿道瘘中的价值。方法2012年1月～2013年12月采用腹腔镜治疗15例中高位肛门闭锁,在距球部、膜部或膀胱颈部尿道0．5cm处应用Hem—o—lok夹闭瘘管处理直肠尿道瘘。结果均在腹腔镜辅助下完成肛门成形＋尿道瘘修补术,腹腔镜手术（包括会阴手术）操作时间90～150min（平均120rain）。出血量10～20ml（平均15m1）,无需要输血者,无术中并发症发生。术后7d拔除尿管,无排尿困难。15例随访2～12个月（平均5个月）,术后排尿功能基本正常,无尿道瘘复发,无尿道狭窄发生,肛门外观正常,2例患儿轻度直肠黏膜脱垂。结论腹腔镜辅助下Hem-o-lok夹闭处理直肠尿道瘘,更加精准、方便,降低手术难度,可取得满意的治疗效果。     

Management of a large mucosal defect after duodenal endoscopic resection

Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.     

可视化经皮穿刺乳腺病灶定位标记夹的临床应用

可视化经皮乳腺病灶定位标记夹（简称乳腺Marker）是一类可置入乳腺肿瘤及区域转移病灶的标记物,目前可分如下两类：纯金属Marker和聚合物涂覆的Marker,主要用于乳腺可疑小肿瘤或不可触及乳腺癌的定位、新辅助化疗病灶的评估及腋窝可疑转移淋巴结的标记。目前,国内外对于新辅助化疗时乳腺Marker的放置时机和数目仍存在争议。乳腺Marker相关安全问题包括可能造成影像学局部伪像、Marker移位和丢失等。乳腺Marker是帮助提升乳腺精准外科水平的有效工具,可用于活检标记,术前精准定位、随访追踪和新辅助疗效评估,具有不错的安全性,但仍存在术前术中再定位的问题。     

钛夹联合内镜下黏膜切除术治疗重度胃黏膜脱垂症的临床观察

目的：观察钛夹联合内镜下黏膜切除术对重度胃黏膜脱垂症的治疗效果及安全性。方法：对53例经胃镜确诊的重度胃黏膜脱垂症患者采用钛夹联合内镜下黏膜切除术治疗,并分别于术后4周、8周行临床症状随访和胃镜复查。结果：53例患者治疗成功率100％,4周有效率98．1％,8周有效率100％,无出血、穿孔等并发症发生。结论：钛夹联合内镜下黏膜切除术治疗重度胃黏膜脱垂症疗效确切,安全性高,是目前比较先进的微创治疗方法之一。