保留左结肠动脉的腹腔镜直肠癌D3根治术对中晚期直肠癌患者的临床效果分析

目的探讨保留左结肠动脉的腹腔镜直肠癌D3根治术(Dixon)对中晚期直肠癌患者的临床效果分析。方法选取2015年12月至2018年1月60例中晚期直肠癌患者资料,根据术式不同分为保留组和未保留组,其中保留组(n=32)采用保留左结肠动脉的Dixon术,未保留组(n=28)采用高位结扎的Dixon术。采用SPSS 22.00软件对数据资料进行处理,围术期各项指标用(x±s)表示,采用独立t检验;术后并发症发生率、淋巴结清扫情况采用χ^2或Fisher检验,P<0.05表示差异有统计学意义。结果保留组肛门排气时间、边缘动脉弓压力显著少于未保留组(P<0.05),其余围术期指标比较均无统计学意义(P>0.05);两组清扫淋巴总数、转移淋巴结数及阳性淋巴结总数差异均无统计学意义(P>0.05),但保留组清扫第253组淋巴结数目显著大于未保留组(P<0.05);保留组吻合口漏发生率3.1%(1/32)显著少于未保留组10.7%(3/28),(P<0.05);两组患者术后1年肿瘤复发、转移发生率差异无统计学意义(P<0.05)。结论相比于高位结扎的Dixon术,保留左结肠动脉不增加术后肿瘤复发转移概率,并且可有效降低吻合口漏的发生率,具有良好的应用前景。     

The echocardiographic assessment of left ventricular performance during sevoflurane and halothane anesthesia

The cardiovascular effects of sevoflurane were studied and compared with those of halothane in 30 healthy patients. The patients were assigned to receive 1MAC sevoflurane (n = 10), 2MAC sevoflurane (n = 10) or 1MAC halothane (n = 10) in N₂O 2l·min^–1 and O₂ 4l·min^–1. The changes in left ventricular diastolic and systolic dimension (Dd and Ds), fractional shortening (FS), mean velocity of circumferential fiber shortening (mVcf), left ventricular diastolic and systolic volume (Vd and Vs), stroke volume (SV), ejection fraction (EF) and cardiac index (CI) were evaluated by echocardiography. Sevoflurane produced significant dose-dependent decreases in FS, mVcf, EF and SV, but no significant changes in Dd and Vd. Therefore, the decrease in SV was due mainly to the increase in left ventricular residual volume (Vs). One MAC halothane produced a more significant decrease in FS, mVcf, EF and SV, when compared to values obtained at 1MAC sevoflourane (P 0.01). CI was more significantly decreased with 1MAC halothane than with 1MAC and 2MAC sevoflurane (P 0.01). This was brought about by a slight decrease in HR with halothane and a slight increase in HR with sevoflurane, in addition to a smaller decrease in SV with sevoflurane than with halothane. This study suggests that sevoflurane may better preserve cardiac function as a pump in healthy patients, when compared to halothane.(Kasuda H, Akazawa S, Shimizu R.: The echocardiographic assessment of left ventricular performance during sevoflurane and halothane anesthesia. J Anesth 4: 295–302, 1990)     

阵发性心房纤颤患者P波离散度研究

目的 :探讨阵发性心房纤颤患者P波离散度的改变规律及临床价值。方法 :观察 41例非瓣膜性心脏病和2 1例瓣膜性心脏病阵发性心房纤颤患者最宽P波 (Pmax)和P波离散度及与左房大小关系 ,并与 30例正常人对比。结果 :阵发性心房纤颤的左房大小、Pmax、P波离散度、Pmax≥ 110ms、P波离散度≥ 40ms等均显著高于正常对照组(P <0 .0 1) ,非瓣膜性心脏病组年龄大于瓣膜性心脏病组 ,左房大小及Pmax均小于瓣膜性心脏病组 ,差异有非常显著性 (P <0 .0 1)。结论 :Pmax、P波离散度结合左房大小、年龄对预测阵发性心房纤颤的发生有重要意义。     

依那普利治疗高血压左室肥厚和左室舒张功能

目的：探讨依即普利对高血压左室肥厚与左室舒张功能的治疗作用。方法：对符合ＷＨＯ诊断标准的原发性高血压左室肥厚,服用依那普 治疗,用彩色普勒超声心电图测定治疗前后左室肥厚、左室收缩及舒张功能指标。结果：治疗后室间隔厚度、左室后壁厚度、左室心肌重量均明显减少,舒张早期流速峰值明显增大,房缩期最大流速下降,两比值下降,左室射血分数无变化。结论：依那普利可有效地抑制并逆转左室肥厚,改善左室舒张功能。     

高血压病患者血清PCⅢ、LN、HA的变化--苯那普利干预实验

目的 通过观察高血压病患者血清Ⅲ型前胶原（ＰＣⅢ）、层粘连蛋白（ＬＮ）、透明质酸 （ＨＡ）含量的变化,以及苯那普利对其影响;探讨上述参数作为心肌肥厚指标的临床价值。评价苯那普利对高血压性心肌纤维化的影响。方法 测定６４例高血压病患者在用苯那普利前后血清中ＰＣ蝮、ＬＮ、ＨＡ水平的变化,并将左室心肌重指数（ＬＶＭＩ）与上述各参数作相关分析。结果 高血压伴左室肥厚组较高血压不伴左室肥厚组及正常对照组的血清     

结肠腔内置管在梗阻性左半结肠癌中的应用

目的 探讨预防梗阻性左半结肠癌一期切除吻合术后吻合口漏发生的新方法,方法 将２１５例便阻性左半结肠癌术中结肠灌洗和一期切除吻合等处理的患者随机分为两组。双管引流组术中经肛门旋转结肠腔内双管引流,扩肛组术中不旋转肠腔内引流管,术后定时扩肛,对两组患者术后腹腔脓肿和吻合口漏发生率进行对比分析。结果 腹腔脓肿和吻合口漏发生率双管引流组分别为３．１％（４／１３０）和３．８％（５／１３０）,扩肛组分别为１０     

Observations of the relationship between left ventricular aneurysm and ST segment elevation in patients with a first acute anterior Q wave myocardial infarction

Seventy-eight consecutive survivors of a first acute anteriorQ wave myocardial infarction (AMI) underwent two-dimensionalechocardiography (2D echo), colour Doppler echo and radionuclideangiography (RNA) for the diagnosis of left ventricular (LV)anteroapical aneurysm, in order to study the relationship ofthis complication to precordial ST segment elevation in thesepatients. The ST elevation (mm) in lead V₂, the maximum ST elevationin V₁-V₆ and the sum of ST elevation in V₁ to V₆ were calculated.LV aneurysm was present in 19 patients by 2D echo, of whom 12had a paradoxical systolic flow pattern (red and outward towardsthe transducer) at the apex. There was no difference between the mean ST elevation in V₂or the maximum ST elevation in V₁-V₆ in patients with and withoutan aneurysm, although the sum of ST elevations in V₁ to V₆ washigher in the former group (P<0.01). ST elevation of patientswith and without paradoxical systolic flow also did not differsignificantly. Wall motion abnormality (akinesis and dyskinesis)by 2D echo in the anterior wall was seen in 74% of patientswith and 36% of patients without an aneurysm (P<0.005), andin the septal region in 63% and 47% of respective patients (P-NS).There was no difference between the magnitude of ST elevationin subgroups of patients with ejection fraction (EF) 30% to40%, but the mean EF of patients with (23 ± 2.1%) andwithout a LV aneurysm (34 ± 1.3%) differed (P<0.001). It is concluded that precordial ST segment elevation does notclearly and in the diagnosis of an anteroapical LV aneurysm.It is related to akinesis and dyskinesis in anterior and septalregions inherent in patients with AMI and does not indicateimpaired LV function.     

自发性高血压大鼠左心室肥厚与血压、心肌局部血管紧张素Ⅱ的关系

目的 研究自发性高血压大鼠(SHR)左心室肥厚与血压、心肌局部血管紧张素Ⅱ的关系。方法 取SHR(n=40)及正常对照组WKY(n=41),分为4周龄、8周龄、12周龄、24周龄及36周龄组．测收缩压、体重,左心室重量及用放免法测定心肌局部血管紧张素(AⅡ)含量,并进行两两线性相关分析。结果 通过对5个年龄段的SHR和WKY的收缩压、左心室重与体重比(LVM／BW)及心肌局部AⅡ含量的测定结果发现三者之间存在相关性,其中AⅡ与心肌肥厚有明显相关性。结论 血压与AⅡ在SHR大鼠的左心室肥厚中起着重要作用。     

上肺血管扩张对左心衰竭的诊断意义

目的：胸片显示上肺血管扩张对诊断左心衰竭的意义,文献报导较少,而临床多见此征象。研究该征象的病理基础及产生原因,可提高对左心衰的早期认识。方法：收集近几年确诊、资料较全的３５例各种疾病所致左心衰病例,观察胸片并测量上肺血管宽度,进行综合分析。结果：３５例（冠心病６例、高血压性心脏病１４例,肺源性心脏病合并左心衰４例;充血性心肌病及病毒性心肌炎１１例）均有上肺血管扩张表现。上肺血管宽４３～６７ｍｍ,平均５１ｍｍ。１２例左侧位上肺静脉均较上肺动脉宽１倍以上。部分胸片伴有肺淤血及肺间质水肿。结论：上肺血管扩张可作为左心衰的一项诊断依据。