Hem-o-lok在后腹腔镜解剖性根治性肾切除术中的应用

目的 评价后腹腔镜解剖性根治性肾切除术中单独应用Hem-o-lok处理肾动静脉的安全性及可靠性.方法 2005年1月～2007年6月行后腹腔镜根治性肾切除术168例,常规制备后腹腔操作空间.按顺序分别进入4个相对无血管解剖层面进行分离.单独应用Hem-o-lok处理肾动静脉.结果 168例手术均成功.无中转开放手术,无Hem-o-lok滑脱,移位.全部手术均成功完成.手术时间(138±46)min,出血量(90±30)mL.无严重手术并发症发生,无输血.恢复饮食和下床活动时间分别为1.3d和1.2d.术后平均住院日5.B d.随访6～18个月,平均8个月,均无瘤生存.结论 后腹腔镜解剖性根治性肾切除术中单独使用Hem-o-lok处理肾动静脉安全、可靠.     

老年大肠肿瘤患者的内镜下黏膜切除治疗

目的 探讨内镜下黏膜切除术（EMR）对老年大肠扁平及广基肿瘤治疗的有效性及安全性。方法 60例老年患者，年龄平均71岁，通过结肠镜检查，非抬举征（non-lifting sign）阳性入选为EMR适应证。46例病变〈2cm行一次性切除；14例病变〉2cm行分次切除（EPMR），创面用夹子缝合，回收后做连续病理切片，证明肿瘤全部切除。结果 60例病变病理学检查结果：腺瘤55例，早期大肠癌5例均为黏膜层癌（m1-m3）。腺瘤55例中，管状腺瘤33例、腺管绒毛腺瘤14、绒毛腺瘤8例。结论 EMR作为内镜下治疗老年人大肠肿瘤是一个令人满意的治疗手段，特别适合高龄、不愿或不宜行外科手术的患者。     

鼻内窥镜下泪囊鼻腔吻合术的护理

目的总结鼻内窥镜下泪囊鼻腔吻合术的护理经验。方法对83例慢性泪囊炎患者进行鼻内窥镜下泪囊鼻腔吻合术,于术前、术后全面护理。结果患者全部治愈出院,无并发症发生。结论鼻内窥镜下泪囊鼻腔吻合术治疗慢性泪囊炎具有创伤小、出血少、病灶清除彻底、愈合快的优点,配合系统的护理方法,可提高治疗效果。     

小鼠“两肾一夹”高血压模型的改良及病理改变

目的:建立并改进小鼠两肾一夹(2K1C))高血压模型,并研究其特征性病理改变。方法:C57BL/6小鼠(24～26 g)随机分为手术组(用U型银夹钳夹右侧肾动脉)和假手术(Sham)组(不钳夹右侧肾动脉);术后第3d用尾套加压法测量小鼠BP,第28d处死小鼠。苏木精-伊红染色观察小鼠心脏和肾脏的病理改变。结果:术后第27 d,手术组小鼠BP均升至150mmHg以上;且心脏肥大,夹侧肾脏明显萎缩,对侧肾脏代偿性肥大。结论:经背部开口,钳夹右侧肾动脉及选用适当体质量(24～26g)小鼠,可成功建立稳定的小鼠2K1C高血压模型,该模型能表现特征性病理改变。     

Hem-o-lok在后腹腔镜肾切除肾蒂处理中的应用

目的：探讨带锁塑料夹（Hem-O-lok）在后腹腔镜肾切除手术应用的可行性。方法：应用后腹腔镜技术行肾切除30例,均用Hem-O-lok结扎肾蒂血管,其中肾癌13例,肾盂、输尿管癌17例。结果：26例手术获成功。1例中转开放手术完成,无肾血管出血。手术时间90～180min,平均130min;出血50-400ml,平均100ml;术后住院7～10d,平均8d。随访1～24个月,无肿瘤复发及术区、切口种植转移。结论：后腹腔镜肾切除术中应用Hem-O-lok结扎肾蒂血管安全可行、疗效可靠。     

内镜下四种方法治疗消化性溃疡出血的疗效

目的 探讨4种内镜下治疗方法对上消化道溃疡出血的疗效.方法 将349例内镜下有活动出血的溃疡患者分为4组:肾上腺素注射组、金属钛夹组、氩离子凝同组及联合治疗组.肾上腺素注射组157例接受内镜下肾上腺素注射止血;金属钛夹组46例接受金属钛夹止血;氩离子凝固组51例接受氩离子凝固止血;联合治疗组95例接受肾上腺素注射联合氩离子凝固止血治疗.对比各组间止血效果.结果 4种方法的即时止血率均为100%,有效止血率在肾上腺素注射组为87.9%,在金属钛夹、氩离子凝同及联合治疗组分别为89.1%、86.3%、91.6%,各组间差异均无统计学意义(P>0.05).肾上腺素注射组中,Forrest Ⅰ a患者的有效止血率为55.0%,明显低于其余3组患者(P<0.01).结论 4种内镜下治疗均能有效、安全止血.药物注射对Forrest Ⅰ a患者的止血效果差.     

Antihypertensive effect of total flavone extracts from Puerariae Radix

Aim of the study

To evaluate the antihypertensive effect of total flavone extracts from Puerariae Radix (FEPR). To explore the hemodynamic profiles and pertinent mechanism of the extracts.

Materials and methods

Acute and chronic antihypertensive effects of FEPR were examined in spontaneous hypertensive rats (SHRs) and reno-hypertensive rats (two kidneys one clip model, 2K1C). Anesthetized dogs were used to evaluate the hemodynamic effects of FEPR. The determination of angiotensin converting enzyme (ACE) activity in vitro and plasma renin activity (PRA) and endothelin (ET) in vivo were used to study the pilot mechanism of FEPR. Moreover, the toxicity study of FEPR was evaluated.

Results

FEPR (100, 200 and 400 mg/kg, i.v.) notably reduced the blood pressure of SHRs in a short time period. A two-week administration of FEPR (45, 90 and 180 mg/kg, p.o.) decreased the blood pressure of both 2K1C rats and SHRs. The results of hemodynamic study in anesthetized dogs showed that, left ventricular end systolic pressure and left ventricular dP/dt_max had shown no significant difference between FEPR-treated dogs and those from the control group, while the cerebral blood flow increased significantly in FEPR-treated groups. FEPR significantly inhibited the ACE activities in vitro dose dependently, and inhibited the PRA in vivo, while the content of ET showed no difference in the FEPR treated group comparing with the control group.

Conclusions

FEPR shows significantly blood pressure lowering and cerebral vascular resistance (CVR) decreasing effect, which can partly be explained by the involvement of the Renin-Angiotensin-System (RAS).     

内镜下治疗消化性溃疡出血的疗效观察

目的观察不同内镜下止血治疗方法的疗效。方法选择消化性溃疡出血患者158例,其中十二指肠溃疡95例,胃溃疡38例,复合性溃疡17例,吻合口溃疡8例,随机分成药物（肾上腺素）注射法组（A组）49例,APC止血法组（B组）58例,金属钛夹止血法组（C组）51例进行内镜下止血治疗,对比观察各组间止血效果。结果A组、B组、C组3组即时止血率均为100.0%,A组有效止血率为89.8%,B组为91.4%,C组为92.2%,3组间比较差异均无统计学意义（P〉0.05）。结论以上3种内镜下止血方法治疗消化性溃疡出血疗效确切、安全性好、副作用少,临床医师可根据自己最熟悉的治疗技术来选取内镜下治疗方法。     

The effect of temporary aneurysm clip on the common carotid artery of atherosclerotic rabbits

BACKGROUND: We compared the effect of temporary aneurysm clips on atherosclerotic and nonatherosclerotic CCA of rabbits by morphometric and ultrastructural methods. METHODS: The rabbits (N = 12) were divided into 2 groups: the first group was fed a 2% cholesterol diet, and the second group, a normal diet for 4 weeks. Atherosclerotic lesions developed after 4 weeks. Temporary aneurysm clips were placed on the left CCA of both groups; the right CCA of both groups served as control. Thus, a total of 4 groups were used: atherosclerotic (A), atherosclerotic/clip (AC), nonatherosclerotic (NA), and nonatherosclerotic/clip (NAC). Temporary aneurysm clips were applied for 1, 5, and 10 minutes in the AC and NAC groups. No temporary clip was placed on the right CCA (A and NA groups). The affected parts of the CCA via clips were examined under light microscope and SEM. RESULTS: Comparison of atherosclerotic and nonatherosclerotic CCA of rabbits under light microscope indicated that the wall of atherosclerotic CCA was thicker than that of nonatherosclerotic CCA. The difference between the thickness of atherosclerotic and nonatherosclerotic CCAs was significant. SEM analyses showed that in nonatherosclerotic CCAs, the effect of temporary aneurysm clips was seen after 10 minutes, but in atherosclerotic CCAs, the effect was seen within the 1st minute of clipping and continued in the 5th and 10th minutes. CONCLUSION: The duration of temporary clipping should be decreased for the neurovascular surgery of atherosclerotic patients.     

Placement of radiopaque clips for tumor localization in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

BACKGROUND: The objective of this study was to determine whether patients with breast cancer who received breast-conservation therapy after neoadjuvant chemotherapy had improved outcomes if radiopaque clips were placed to mark the primary tumor. METHODS: The authors retrospectively reviewed the records of 410 patients with nonmetastatic breast cancer who received doxorubicin-based neoadjuvant chemotherapy and breast-conservation therapy from January 1990 to September 2005. Thirty-seven of those patients were omitted because of the inability to verify radiopaque clip placement in the primary tumor. RESULTS: Of the 373 patients who were analyzed, 145 patients had radiopaque clips placed to mark the primary tumor before or during neoadjuvant chemotherapy, and 228 patients did not. The distribution of clinical T classification, nuclear grade, estrogen receptor status, final margin status, and extent of residual primary disease was similar between the 2 groups. After a median follow-up of 49 months (range, 20-177 months), 21 patients developed a local recurrence in the treated breast. The 5-year rate of local control was 98.6% in patients who had radiopaque clips placed versus 91.7% in patients who did not have tumor marker clips placed (P=.02; log-rank test). On multivariate analysis, the omission of tumor bed clips was associated with a hazard ratio of 3.69 for increased local recurrence compared with patients who did have radiopaque clip placement (P=.083; 95% confidence interval, 0.84-16.16). CONCLUSIONS: The placement of radiopaque clips in patients who were receiving neoadjuvant chemotherapy and breast-conservation therapy was associated with better local control independent of stage and other clinicopathologic findings. The authors concluded that the placement of tumor-marker clips should be an integral part of the multidisciplinary approach in appropriate patients.