胃肠道肿瘤病人围手术期细胞因子及蛋白质代谢的变化

目的 :探讨胃肠道肿瘤病人手术后肿瘤坏死因子 α (TNF α)、白介素 6 (IL 6 )、白介素 10 (IL 10 )的变化以及与蛋白质代谢的关系。　方法 :用酶联免疫法 (ELISA)检测 19例胃肠道肿瘤根治术病人术前和术后 1、3、5天血清TNF α、IL 6和IL 10水平 ,同时检测蛋白质分解代谢相关指标、2 4h尿中尿素和肌酐排泄量。　结果 :胃肠道肿瘤根治术后病人TNF α呈下降趋势 ,术后第 1天较术前明显下降 (P <0 .0 5 )。IL 6和IL 10术后升高 (P <0 .0 1) ,尤以术后第 1天升高明显。术后 2 4h尿中尿素和肌酐排泄量明显升高。　结论 :胃肠道肿瘤根治术后病人IL 6和IL 10的升高支持手术应激导致的细胞因子释放变化 ,但TNF α呈下降趋势 ,可能与胃肠道肿瘤病人术前TNF α的高表达有关。术后蛋白质分解代谢增加 ,可能与细胞因子IL 6和IL 10的升高有关。     

手术联合中药治疗激素性股骨头缺血性坏死的实验研究

目的 :初步探讨激素性股骨头缺血性坏死的发病机制 ,观察手术 +中药治疗本病的疗效。方法 :通过对新西兰大白兔联合应用马血清 +甲基强的松龙造模及手术处理 ,对正常组、模型组、手术组、手术 +中药组实验兔的血脂、血液流变学、血生化及股骨头标本切片观察 ,分析比较。结果 :手术 +中药治疗本病的疗效优于单纯保髋手术。结论 :手术 +活血化瘀补肾壮骨方法是股骨头缺血性坏死治疗的合理方法     

二尖瓣球囊扩张术并发心脏压塞1例的抢救与护理

目的:报告二尖瓣球囊扩张术(PBMV术)并发心脏压塞的抢救与护理.方法:主要从患者的术前准备、术中抢救与配合、术后护理介绍.结果:准备充分,抢救及时,护理得当,患者病情稳定后转心脏外科手术治疗.结论:二尖瓣球囊扩张风险大,心脏压塞是最危险、最常见的并发症之一,故加强术前准备,密切术中配合,及时抢救尤为重要.     

腹式全子宫切除术不同术式对排便功能影响的探讨

目的:探讨筋膜内和筋膜外全子宫切除术对女性排便功能的影响。方法:76例全子宫切除患者分为筋膜外全切除组(A组)56例,筋膜内全子宫切除组(B组)20例,对两组术后病人的排便次数,难易程度的变化进行分析。结果:76例全子宫切除病人42.1％出现不同程度排便困难,A组52.62%,B组为10%,两组具有显著性差异(P<0.05)。结论:全子宫切除术后可影响女性排便功能,筋膜内全子宫切除术对排便功能影响小,是一种较好手术方式。     

The popularization and application of cold storage red blood cells or whole blood at −80 °C of the Rh(D) negative patients in surgical operation

Summary The efficiency of cold storage red blood cells (CSRBC) or whole blood at −80 °C used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at −80 °C for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K⁺, Na⁺, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K⁺ and blood Na⁺ was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at −80 °C could be safely infused to the Rh(D) negative patients without side effects during the surgical operation. YU Zhongqing, male, born in 1957, Technician in Charge     

前颞下"锁孔"入路显微手术的临床应用

目的以"锁孔"微创的理念,改良常规颞下入路,以减少手术损伤.方法采用耳前方颧弓向上直切口4 cm,铣开2.0～2.5 cm左右直径骨窗,经颞下行海绵窦、脑干、岩斜区部位病灶的手术治疗13例.结果6例岩斜区脑膜瘤全切除4例,次全切1例,大部切除1例;脑干转移癌、颞底胶质瘤各1例均全切除,海绵窦脑膜瘤、脑桥胶质瘤各1例次全切除,脑桥病灶出血1例予AVM切除、血肿清除,海绵窦内血栓1例子全切除,大脑后动脉瘤1例予夹闭.1例术后出现脑脊液耳漏,经原入路修补后痊愈.2例岩斜区脑膜瘤切除术后遗有轻度偏瘫.结论颞下"锁孔"入路可满足岩斜区、脑桥腹、侧方及海绵窦区的手术要求,是一种行之有效的微创手术入路.     

Objective definition and measurement method of ground-glass opacity for planning limited resection in patients with clinical stage IA adenocarcinoma of the lung

Objective: The standard operation for patients with stage IA lung adenocarcinoma is considered to be a lobectomy. Recently, some researchers have reported that patients with tumors showing greater proportions of ground-glass opacity (GGO) at computed tomography (CT) could be candidates for limited resection, because of its less aggressive nature. However, the lack of a precise definition or standard measuring method of GGO prevents its general use as an index for planning limited resection. Therefore, we attempted to define GGO based on CT number and measured it more objectively. Methods: Between 1998 and 2001, 90 patients with clinical stage IA adenocarcinoma, who underwent standard or intentional limited resection and whose images of chest high-resolution CT were preserved in Digital Imaging and Communications in Medicine (DICOM) format, constituted the study population. The tumor shadow seen on the solid window (WL, −160 HU; WW, 2 HU) was regarded as the central solid area of the tumor seen on the lung window, and GGO was defined as the whole tumor area with the exception of the central solid area. Each area was measured using Scion Image (Scion Corp., Frederick, MD). We analyzed the relationship between the proportion of GGO and both of pathologic findings and recurrence. Results: Among the 90 tumors, 31 (34.4%) were calculated to have a GGO area greater than or equal to 50%. Of these, 27 (87%) tumors were bronchioloalveolar carcinoma. Lymphatic and vascular invasions, or nodal involvement were found only in patients with a smaller proportion of GGO (<50%) (P<0.05). During the follow-up period (median 36 months), recurrences occurred in eight patients who were diagnosed as having tumors showing smaller proportion of GGO (<50%). Conclusions: Tumors with a greater proportion of GGO measured by our method are thought to have a less invasive nature. Our objective measuring method of GGO could be useful for future multicenter trials to elucidate the value of limited resection for clinical stage IA adenocarcinoma based on the proportion of GGO.     

Rotational acetabular osteotomy for acetabular dysplasia of the hip with a giant acetabular bone cyst: a case report

In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.     

经关节突入路椎间融合椎弓根固定治疗峡部裂性腰椎滑脱

目的 评价经关节突入路手术治疗峡部裂性腰椎滑脱的应用价值。方法 2000年 9月 ~2003年 5月我院手术治疗峡部裂性腰椎滑脱患者 83例,随访患者 81例,年龄(55. 25±19. 21)岁,随访时间 (1. 68±0. 93)年。按照不同的手术入路方法分为两组,Ⅰ组经关节突入路,椎间融合椎弓根固定;Ⅱ组经椎板切除入路,椎间融合椎弓根固定。按各组术中的临床出血量、手术时间、术前和术后JOA评分等数据经SPSS11. 5统计软件处理数据。结果　术后采用Stauffer Coventry下腰椎术后疗效评定标准:临床优良率分别为 87%与 75%;术后神经功能改善率分别为 87. 81%与62. 88%。术后均无螺钉松动、断裂或者滑脱加重等并发症,有 3例假关节形成。结论　在峡部裂性腰椎滑脱的患者的手术治疗中,经关节突入路椎间融合椎弓根固定技术具有良好的临床效果。     

肝外胆管癌的诊治分析

目的：探讨肝外胆管癌的诊断和治疗的体会。方法：回顾性总结手术治疗的32例肝外胆管癌的临床资料、手术方式、手术并发症及生存率，并复习相关文献资料。结果：本组病例获根冶性切除14例，姑息切除2例，胆道引流术16例；手术并发症10例(31.3％)，手术死亡1例(3．1％)。其中22例获定期随访，存活一年以上的有12例(12／22)，至今存活8例。结论:早期诊断、正确的评估、合理的术式选择能提高疗效。降低手术并发症及死亡率。