侧脑室—腹腔分流治疗脑积水62例报告

目的　探讨脑积水的治疗方法和疗效。方法　62例均行侧脑室-腹腔分流术。脑室端从枕角穿入10cm接引流泵,再从皮下隧道引至上腹或左下腹放入腹腔。结果　1～4周后复查,症状完全消失56例,部分改善5例,无变化1例。57例复查CT示:52例脑室恢复正常,4例脑室较前缩小,1例无变化。堵管9例。低颅内压2例,硬膜下血肿2例,经保守治疗痊愈。49例随访1～8年,41例能正常工作学习,5例生活自理,1例植物生存,2例死亡。结论　明确诊断,掌握手术适应症及手术技巧是成功的关键。     

进展期结直肠癌术前经直肠5-Fu化疗的疗效观察

目的　探讨术前经直肠 5 -Fu化疗对进展期结直肠癌术后生存率的影响。方法　统计进展期结直肠癌术前经直肠 5 -Fu化疗病例 112例及对照组 14 4例 ,观察化疗反应情况并比较两组术后并发症、局部复发率、5年生存率。结果　两组术后并发症、局部复发率无显著性差异 (P >0 .0 5 ) ,但化疗组中B期病人及直肠癌病人 5年生存率均显著高于对照组 (P <0 .0 5 )。结论　进展期结直肠癌术前经直肠 5 -Fu化疗是一种有效、安全、方便的治疗措施 ,具有一定的提高生存率的作用 ,可作为术前常规应用。     

Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy?

Although the application of a topical local anaesthetic before fibreoptic nasendoscopy is routine practice in many otolaryngological outpatients, the actual benefit to the patient of this procedure remains in doubt. Eighty-two patients were recruited in this double-blind randomized control trial which compared the patients’ experiences of fibreoptic nasendoscopy with nasal preparations of Xylocaine^® (lidocaine), normal saline, and no spray to the nose and throat. A visual analogue scoring system was used to determine scores for the overall unpleasantness of procedure, receiving a spray, and taste of the spray, and pain. This study has shown significantly worse overall experience (P = 0.001) and pain (P = 0.048) scores for Xylocaine^® spray versus no spray. It is concluded that the routine use of topical local anaesthetics within the nose before routine fibreoptic nasendoscopy is not only of no value, but actually makes the experience worse for the patient.     

局部植入BMP对去势大鼠股骨近端生物力学强度及髓腔面积变化的影响

目的探讨去势大鼠股骨近段植入牛骨形成蛋白(bone morphorgeneic protein,BMP)后其骨生物力学强度及髓腔面积的变化。方法随机选取6月龄wistar雌性大鼠22只,摘除卵巢制作绝经后骨质疏松模型成功后,同一只动物双侧肢体对照,试验侧股骨颈植入牛骨形成蛋白及纤维蛋白(FS)复合物,对照侧植入纤维蛋白,术后4周、8周处死取材,测量股骨近端生物力学强度及髓腔面积和截面面积。结果4周后,试验侧与对照侧股骨近端骨生物力学强度和髓腔面积无明显差异;8周后,试验侧股骨近端生物力学强度较对照侧增高;髓腔面积较对照侧有较明显的减小(P<0.05)。结论股骨近端局部植入BMP可提高去势大鼠股骨近端局部的生物力学强度和减小近端髓腔面积和截面积,其可能减少骨质疏松性髋部骨折置换后假体的松动,成为骨质疏松性骨折假体置换中新的辅助治疗方法。     

鼻内镜下鼻腔成形术治疗结构性鼻炎

目的:探讨鼻内镜下治疗结构性鼻炎的手术方法和疗效。方法:对84例结构性鼻炎患者行鼻内镜下鼻腔成形术。包括:①三段法下鼻甲功能性部分切除;②中鼻甲成形;③窦口鼻道复合体功能性切除;④鼻中隔黏膜下矫正。手术结合患者主诉症状、鼻内镜检查和鼻窦CT分析,将上述各个单一手术进行组合,制定个性化方案进行手术。结果:术后随访8~12个月,平均10个月。痊愈59例(70.24%),有效21例(25.00%),无效4例(4.76%),总有效率95.24%。结论:结构性鼻炎是由于鼻腔存在多种结构异常而引起功能异常的一类疾病。鼻内镜下鼻腔成形术是对双侧鼻腔进行统一的功能性矫正,恢复鼻腔对称性整体结构的手术,应进行统一规范。     

Levels of biological markers of nitric oxide in serum of patients with squamous cell carcinoma of the oral cavity

The aim of the study was a determination of the levels of nitric oxide（NO）and its biological markers such as malonyldialdehyde（MDA）and nitrotyrosine in the serum of patients with squamous cell carcinoma（SCC）of the oral cavity and identification of the relationships between NO and those markers.These studies were performed on patients with SCC of the oral cavity before and after treatment.Griess reaction was used for the estimation of the total concentration of NO in serum.The nitrotyrosine level in serum was assessed with an enzyme-linked immunosorbent assay（ELISA）kit,and MDA level using a spectrophotometric assay.Higher concentrations of NO in blood serum were determined in patients with stage IV of the disease before treatment in comparison to the control group and patients with stages II and III of the disease.Moreover,higher concentrations of MDA and nitrotyrosine were determined in the serum of patients in all stages of the disease in comparison to healthy people.After treatment,lower concentrations of NO in the serum of patients with stage IV of the disease were observed in comparison to the amounts obtained prior to treatment.In addition,lower levels of nitrotyrosine in the serum of patients with all stages of the disease were recorded,whereas higher concentrations of MDA were determined in these patients in comparison to results obtained before treatment.The compounds formed with the contribution of NO,such as MDA and nitrotyrosine,may lead to cancer progression in patients with SCC of the oral cavity,and contribute to formation of resistance to therapy in these patients as well.Moreover,the lack of a relationship between concentrations of NO and MDA,and between NO and nitrotyrosine in serum suggests that the process of lipid peroxidation and nitration in patients with SCC does not just depend on NO.     

鼻腔扩容术的临床疗效观察

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图（PSG）描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表（Epworth sleepiness score,ESS）、鼻塞主观视觉模拟量表（visual analogue scale,VAS）评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术（鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放）。结果鼻腔扩容术后患者鼻腔总阻力显著降低[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L,P〈0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P〈0.01],白天嗜睡ESS评分显著降低（12.7±1.2 vs 8.6±2.9,P〈0.01）,打鼾程度减轻（62.2±25.6 vs 45.6±18.6,P〈0.01）。轻度OSAHS患者呼吸暂停低通气指数（apnea and hypopnea index,AHI）较术前显著下降（P〈0.05）,觉醒指数较术前显著下降（P〈0.01）,最低动脉血氧饱和度（lowest SaO2,LSaO2）较术前显著升高（P〈0.01）。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变（P〉0.05）。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化（P〉0.05）。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。     

腹腔化疗前后腹水中端粒酶活性的变化及意义

目的 了解监测腹液中端粒酶活性(TA)用于诊断腹腔转移癌、评价腹腔化疗疗效及预后的临床价值.方法 应用端粒末端重复序列扩增-杂交-酶联免疫技术检测腹液中TA,分析腹腔转移癌患者腹腔化疗前后腹液中TA结果的变化与预后的关系.结果 腹腔转移癌腹液中TA的阳性结果(56/68)显著性高于良性腹水患者(2/33)(P<0.01),其阳性率也显著高于CEA、细胞学检测结果(P<0.01);化疗有效者的阳性结果(10/37)明显低于化疗无效者(28/31) (P<0.01),且化疗后TA阳性者6～18个月的生存人数显著性低于指标阴性者(P<0.01或P<0.05).结论 检测腹腔化疗前后腹液中TA对协助诊断腹腔转移癌、评价腹腔化疗疗效及判断预后都有较高的应用价值.     

活化素A在未足月胎膜早破合并羊膜腔感染中的表达及临床意义

目的：探讨活化素A在未足月胎膜早破合并羊膜腔感染中的表达水平及其临床意义。方法将我院妇产科2014年4月至2015年3月收治的30例未足月胎膜早破合并羊膜腔感染(IAI)患者作为观察组,另选同期30例未足月胎膜早破患者为对照组,在征得两组患者知情同意下对其活化素A表达水平进行测定及比较,以分析活化素A在未足月胎膜早破合并羊膜腔感染诊断中的应用价值。结果观察组患者的血清活化素A表达水平和羊水中活化素A表达水平分别为(245.35±12.85) pg/mL、(396.21±5.33) pg/mL,均明显高于对照组的(132.44±11.46) pg/mL、(277.65±5.21) pg/mL,组间比较差异均有统计学意义(P<0.05);观察组中轻度未足月胎膜早破合并羊膜腔感染者血清、羊水中活化素A表达水平分别为(120.85±11.84) pg/mL、(360.72±5.50) pg/mL,均低于中、重度未足月胎膜早破合并羊膜腔感染者的(370.44±12.92) pg/mL、(500.24±5.75) pg/mL,差异均有统计学意义(P<0.05)。结论活化素A表达水平与未足月胎膜早破合并羊膜腔感染息息相关,膜腔感染程度越高,则其表达水平越高,可作为临床判定是否发生羊膜腔感染以及感染程度的重要参照指标。     

一点红用于经口气管插管患者口腔护理的效果观察

目的评估采用一点红对经口气管插管（oral endotracheal tube,OETT）患者进行口腔护理的应用效果。方法将60例OETT患者按气管插管的时间先后编号随机分成试验组和对照组各30例,试验组采用一点红进行口腔护理,对照组采用复方硼砂液进行口腔护理。观察两组在插管后7d内口腔溃疡发生率、发生时间。结果两组患者口腔护理后口腔溃疡发生率差异有统计学意义（P〈0．005）,试验组口腔溃疡发生率低于对照组;两组患者发生口腔溃疡的时间差异有统计学意义（P〈0．01）,试验组口腔溃疡发生时间明显比对照组晚。结论采用一点红口腔护理明显优于复方硼砂液,对防止和控制OETF患者口腔感染有积极意义。