中西医结合治疗胃切除术后胃瘫16例临床分析

目的探讨胃大部切除术后胃瘫的发生原因、诊断及治疗。方法对1998年2月-2009年2月胃大部切除术后出现的16例胃瘫患者的临床资料进行回顾性分析总结。结果本组胃瘫一般发生于术后6—10d,16例均经非手术治愈,9d恢复4例,12d恢复5例,15d恢复3例,20d恢复3例。结论胃瘫的发生是由多种因素诱发,上消化道造影及胃镜检查是诊断胃瘫的可靠方法,采用非手术疗法包括心理治疗、营养支持、适当应用胃动力药物及激素等西医治疗,同时结合中医针灸治疗,可取得到良好疗效,进一步缩短治疗时间,应严格把握手术指征。     

瑞芬太尼用于甲状腺切除手术麻醉28例

目的 观察瑞芬太尼用于甲状腺切除术麻醉时患者的苏醒时间及并发症的发生情况.方法 选择2010年6月至2011年1月择期甲状腺切除术的患者56例,随机均分为两组,研究组28例的麻醉维持采用瑞芬太尼,对照组28例采用芬太尼,观察两组麻醉苏醒时间及不良反应.结果 研究组意识恢复时间为(7.1-4-2.3)min,自主呼吸恢复时间为(5.1 4-2.0)min,清醒时间为(8.2±3.5)min.拔管时间为(9.3±4.3).均明显短于对照组(P<0.05);研究组低血压的发生率为25.0%,心动过缓的发生率为28.6%,与对照组比较差异无统计学意义(P>0.05).结论 瑞芬太尼用于甲状腺切除术麻醉,能明显缩短患者的苏醒时间,且不增加并发症,可在临床推广使用.     

含盐酸罗哌卡因膨胀液在腔镜下甲状腺切除手术中的应用

目的：探讨含盐酸罗哌卡因的膨胀液对腔镜下甲状腺手术患者术后镇痛、镇静、血流动力学和不良反应等影响,阐明其临床应用的有效性和安全性。方法：择期行经胸乳路腔镜下甲状腺手术患者40例,根据使用膨胀液不同随机分为生理盐水组和含盐酸罗哌卡因膨胀液组（罗哌卡因组）,每组20例。记录2组患者术前麻醉访视时（T₀）、注射膨胀液前（T₁）、手术结束时（T₂）和气管导管拔除时（T₃）的平均动脉压（MAP）和心率（HR）,以及术中出血量、手术时间、术后引流量、住院天数和术后 24 h内恶心呕吐、呼吸抑制和局麻药毒性反应及术后切口感染、喉返神经损伤等不良反应。观察拔除气管导管后即刻（T₃）、0.5 h （T₄）、2 h （T₅）、6 h （T₆）、12 h （T₇）和24 h （T₈）各时间点患者的疼痛视觉模拟评分法（VAS）评分及T₃和T₄时间点的Ramsay镇静评分。结果：2组患者T₀和T₁时间点MAP和HR比较差异无统计学意义（ P > 0.05 ）;与生理盐水组比较,罗哌卡因组患者MAP和HR在T₂和T₃时间点均明显降低（P < 0.05 ）。2组患者手术时间、术中出血量、术后引流量和住院天数比较差异均有统计学意义（ P< 0.05 ）。与生理盐水组比较,罗哌卡因组患者术后 24 h追加镇痛药和恶心呕吐发生例数明显减少（ P< 0.05 ）。与生理盐水组比较,罗哌卡因组患者在T₃、T₄、T₅、T₆、T₇和T₈各时间点的VAS评分和T₃、T₄时间点的Ramsay镇静评分均明显降低（P < 0.05）。结论：含盐酸罗哌卡因的膨胀液可有效降低腔镜甲状腺手术期间的应激反应,并可提供良好的术后镇痛,减少手术引起的创伤。     

Propylthiouracil-associated liver failure presenting as probable autoimmune hepatitis in a child with Graves' disease

This case describes a young girl with Graves' disease, who presented with fulminant hepatic failure 9 months into propylthiouracil (PTU) therapy. Her clinical presentation was consistent with 'probable autoimmune hepatitis,' as defined by the International Autoimmune Hepatitis Group scoring system. Despite discontinuation of PTU and high-dose steroid therapy, she required liver transplantation. Subsequent pathology could not definitively rule out autoimmune hepatitis. PTU is an important cause of drug-related liver failure in children, and clinicians should be mindful that it is frequently used in patients who already have an underlying risk of autoimmune liver disease.     

毕路Ⅱ式胃大部切除术对2型糖尿病的影响

目的：对毕路Ⅱ式胃大部切除术对2型糖尿病的影响及其作用机制的综述,探讨该术式是否可以成为治疗2型糖尿病的有效治疗方式。方法：复习文献,回顾分析毕路Ⅱ式胃大部切除术对继发性糖代谢和内分泌变化的影响。结果：毕路Ⅱ式胃大部切除术后,2型糖尿病患者的糖代谢改善率明显提高。结论：毕路Ⅱ式胃大部切除术对控制2型糖尿病有积极的影响。     

Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy—results of a prospective outcome study

Background Substantial modifications in surgical treatment of thyroid disease have changed the postoperative management of thyroidectomized patients. The reduction of postoperative pain permit a short-stay surgery. Materials and methods We have analyzed the patients treated in our Unit from July 2006 to December 2006, with minimally invasive cervicotomy and mini-invasive video-assisted thyroidectomy. We have registered the postoperative pain applying an evaluation protocol numeric scale. The results were analyzed by t test. Results One hundred thirteen patients were divided in two groups: group A, minimally invasive cervicotomy (15 male and 46 female patients); group B, mini-invasive video-assisted thyroidectomy (9 male and 43 female patients). Upon returning to the ward, the pain scale group A vs B was 2.77 ± 1.16 vs 2.5 ± 0.762 (p = 0.22) .At 24 h after surgery, the pain scale in group A was 1.82 ± 1.258 vs 1.031 ± 0.8608 (p < 0.005). Conclusions Both methods are safe, but mini-invasive video-assisted thyroidectomy gives not only a better cosmetic result but a reduction of postoperative pain especially at 24 h.     

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目的客观评价腔镜辅助下甲状腺切除术治疗甲状腺疾病的有效性及安全性。方法计算机检索MEDLINE、EMBASE、PubMed、CBM及Cochrane图书馆2006年第2期;手工检索有关中文杂志。纳入腔镜辅助下甲状腺切除术与传统手术治疗甲状腺疾病的随机对照试验,并对其方法学质量进行评价。用Revman4.2.8软件进行统计分析。结果共纳入4个随机对照试验,包括164例病人。Meta分析结果显示,腔镜辅助甲状腺切除术与传统甲状腺切除术相比,有较好的美容效果[WMD1.05,95%CI(0.47,1.62)];术后疼痛较轻[WMD-8.20,95%CI(-11.60,-4.80)];并发症发生率二者差异无统计学意义[RR1.90,95%CI(0.65,5.54)];腔镜辅助手术耗时较长[WMD18.96,95%CI(17.23,20.69)]。结论腔镜辅助手术具有美容、微创的优势,但适应证范围较窄,手术时间较长。治疗甲状腺癌尚有待进一步开展随机对照研究以评价疗效。     

十二指肠溃疡病三种手术方法疗效的估价

本文就我院20年来对胃大部切除术、选择性胃迷走神经切断加半胃切除术及高度选择性迷走神经切断术治疗十二指肠溃疡病743例作有选择地临床对比研究,认为三种手术的优良率均在80％以上,其中选择性胃迷走神经切断加半胃切除组最优,而高选迷切是一个安全的,副作用少的手术方式,如能改进技术操作,严格掌握适应症,注意易漏神经,疗效可望提高。胃大部切除的效果也较肯定,不应随意放弃。     

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目的前瞻性随机对照观察结肠次全切除联合改良Duhamel术与结肠次全切除术治疗重度功能性便秘(severe functional constipation,SFC)的疗效及并发症。方法分析南京军区南京总医院2004年6月至2006年7月间31例经过严格非手术治疗后效果欠佳的SFC临床资料,随机分为结肠切除组(n=10)和联合切除组(n=21),经过对结肠镜、结肠传输试验和排粪造影等检查结果的分析,分别行结肠次全切除和结肠次全切除联合改良Duhamel术治疗。均随访1年以上,对比两组术后近期疗效。结果两组术前临床资料差异无显著性意义,均手术成功。联合切除组随访1年后胃肠生活质量指标评分[(107.6±8.2)对(92.1±9.6)分]、便秘症状指标改善度[(73.6±8.2)%对(60.3±8.5)%]和便秘复发率(9.5%对60.0%)等方面明显好于结肠切除组。两组术后肛门排气时间、术后平均住院日、术后早期并发症和大便失禁等方面差异无显著性意义。结论结肠次全切除联合改良Duhamel术治疗SFC较结肠次全切除术对于胃肠生活质量改善更明显,是较为合理、疗效较好的手术方案。     

Angiotensin-converting enzyme inhibition attenuates renal platelet-derived growth factor gene expression and cell proliferation in subtotal nephrectomy

Cell proliferation, matrix accumulation and cell infiltration are characteristic features of progressive glomerulosclerosis and tubulointerstitial fibrosis. Platelet‐derived growth factor (PDGF), a cytokine which has proliferative, prosclerotic and chemokine properties, has been shown to be upregulated in the rat remnant kidney model. Inhibition of the renin–angiotensin system by angiotensin‐converting enzyme (ACE) inhibitors has a beneficial effect on renal function and morphology, but the effect of ACE inhibition on PDGF gene expression and PDGF‐mediated cellular proliferation in subtotal nephrectomy has not been studied in detail. Twelve rats were subtotally nephrectomized (STNx) and received either the ACE inhibitor perindopril or a placebo for 12 weeks. Five sham‐operated rats served as controls. Subtotal nephrectomy was associated with hypertension, proteinuria, elevated plasma creatinine and increased kidney weight. After 12 weeks, PDGF B‐chain mRNA was significantly upregulated in the glomeruli and tubulointerstitium of subtotally nephrectomized rats. ACE inhibition attenuated PDGF mRNA expression in association with a reduction in tubular and glomerular proliferation, as assessed by staining for proliferating cell nuclear antigen. In the context of the known in vitro and in vivo effects of PDGF, it is postulated that the renoprotective action of ACE inhibitors may be partially related to PDGF‐mediated antiproliferative mechanisms.