人工破膜对诊断羊水过少的价值

目的 :探讨人工破膜在诊断羊水过少中的意义。方法 :观察组是根据人工破膜时所流出的羊水量判断羊水多少 ;对照组则用同期产前超声检查所见判断羊水多少。以产时所见羊水量作为最终诊断。结果 :人工破膜和超声诊断羊水过少的符合率分别是 79 73 %和 82 76 % ;两者无显著差异 (P >0 0 5 ) ;人工破膜漏诊率 2 84% ,超声是 6 15 % ,两者无显著差异 (P >0 0 5 )。结论 :人工破膜是诊断本病的一种有价值的方法 ,结合超声检查可作为诊断本病的依据     

先天性主动脉窦瘤破裂的外科治疗

目的 :总结先天性主动脉窦瘤破裂的外科治疗经验。方法 :在低温体外循环下行主动脉窦瘤切除修补 ,同时矫正合并畸形。结果 :全组无手术死亡 ,无残余分流 ,均痊愈。结论 :首选超声心动图检查 ,且其确诊率高。一经确诊 ,尽早手术治疗 ,同时矫正合并畸形。     

Changes in serum ammonia concentration in cirrhotic patients with Helicobacter pylori infection

Objective To study whether liver cirrhosis associated with Helicobacter pylori (H. pylori) infection will induce increased serum ammonia and whether the peripher al serum ammonia reflects the level of portal vein serum ammonia. Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H. pylori infection and non-cirrhotic patients (splenic rupture) with and without H. pylori infection, and the serum ammonia was measured.Results The mean levels of serum ammonia in the group of cirrhotic patients with H. pylori infection were 167.82±8.97 μmol/L (portal vein) and 142.2±13.35 μmol/L (cubital vein). They were increased significantly as compared with cirrhotic patients without H. pylori infection (47.68±12.03 μmol/L portal vein and 37.23±7.04 μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H. pylori infection ( P <0.01). There was no significant difference between the serum ammonia level of the cubital vein and portal vein (P>0.05).Conclusions H. pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method. Eradication of H. pylori in cirrhotic patients may prevent hepatic encephalopathy (HE).     

41例卵巢黄体破裂临床分析

[背景 ]卵巢黄体破裂是妇科急腹症之一 ,误诊率较高 .[病例报告 ]对 41例经手术及病理检查确定诊断的卵巢黄体破裂进行了临床分析 ,发病年龄为 2 0～ 41岁 ,平均 2 9岁 ;多在月经周期后半期发病 ,占 6 5 % ;发生于左侧卵巢 2 1例 ,右侧卵巢 2 0例 ;腹腔内出血为 15 0～ 2 5 0 0mL ,其中少于 5 0 0mL者2 5例 ,占 6 1% ;休克 7例 ,占 17% .黄体破裂出血量的多少与破口大小无关 .[讨论 ]本病因有腹痛、月经周期延长、不同程度的腹腔内出血及不规则阴道流血 ,易误诊为异位妊娠     

洛噻克三联疗法根除幽门螺杆菌1周与2周疗效对比研究

目的　研究洛噻克三联疗法治疗幽门螺杆菌 (Hp)相关性十二指肠溃疡疗效及安全性 ,比较 1周疗法与2周疗法Hp根除率和溃疡愈合率。方法　 46例经胃镜证实Hp阳性的十二指肠溃疡患者 ,随机分成 1周疗法组(A组 )和 2周疗法组 (B组 ) ,A、B两组用药均为洛噻克 2 0mg ,每日 2次 ;阿莫西林 1 0g ,每日 2次 ;甲硝唑 0 4g ,每日 2次。A组抗生素 (阿莫西林和甲硝唑 )只用 1周 ,B组用 2周 ,洛噻克均用 2周。停药 4周之后复查胃镜观察溃疡愈合和Hp根除率。结果　溃疡愈合率A组B组分别为 85 7% (18 2 1)和 92 0 % (2 3 2 5 ) ;Hp根除率为 71 4%(15 2 1)和 84% (2 1 2 5 )。A、B两组之间比较 ,各项结果均无明显差异 (P >0 0 5 )。结论　洛噻克三联疗法对根除Hp及治疗十二指肠溃疡的疗效及安全性 1周与 2周比较无显著性差异     

奥曲肽及垂体后叶素治疗食管胃底静脉曲张破裂出血的效果观察

①目的 比较奥曲肽和垂体后叶素治疗肝硬化食管胃底静脉曲张破裂出血的临床效果。②方法 将９２例（１０５次）食管胃底静脉曲张破裂出血病人随机分为奥曲肽组（５０例５８次）和垂体后叶素组（４２例４７次）,分别给予奥曲肽和垂体后叶素治疗,每隔０．５ｈ冲洗胃腔吸取胃液１次,比较两组止血率。③结果 奥曲肽组和垂体后叶素组８ｈ内止血率分别为６０．３％,１７．０％,差异有极显著性（Ｘ＾２＝２０．１５,Ｐ〈０．０１）     

有否静脉溶栓的急性心肌梗死63例尸解病理分析

探讨溶栓治疗的并发症。方法急性心肌梗死住院死亡并行尸体解剖６３例,２６例曾给予溶栓治疗,３７例行常规治疗。结果两组性别、年龄、ＣＨＤ的危险因素,梗死次数,心肌酶学、梗死部位及血管狭窄程度均无明显差异。结论ＡＭＩ早期溶栓治疗心脏破 发生率较非溶栓组明显升高。     

Study of congenital duodenal obstruction

A study of 23 neonates with congenital duodenal obstruction is reported. Their mean gestational age was 38 weeks and mean weight was 2.2 kg. Main clinical features observed were vomiting (100%), which was bilious in 74%, and epigastric fullness with visible peristalsis (74%). Plain X-ray abdomen confirmed the diagnosis in 78%. Associated congenital malformations were seen in 39% of cases. Eleven babies had an intrinsic defect, 11 had extrinsic defect and one baby had combination of intrinsic and extrinsic defect. Malrotations along with band was seen in 39% of cases. Reported mortality was 39%.     

‘Hybrid’ Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch - Preliminary Experience

Background: Hybrid, combined or mixed bariatric surgery is the combination of a degree of ‘malabsorption’ (as achieved by the intestinal bypass) with a ‘rrestriction’ (as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel and decreasing the intake of food. Methods: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use of staplers and continuous running sutures reduces surgical risks and operative time. Results: One patient, converted from a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multisystemic organ failure, a mortality rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas. Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching 1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. Conclusion: This operation appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications.     

内窥镜十二指肠乳头切开术的应用解剖

目的：为临床经内窥镜十二指肠乳头括约肌切开术（Ｅｎｄｏｓｃｏｐｉｃｓｐｈｉｎｃｔｅｒｏｔｏｍｙ,ＥＳＴ）提供形态学的依据。方法：３０例正常成人腹部标本,解剖观测胆总管、胰管、肝胰壶腹和乳头区长度、宽度,胆总管与胰管的夹角,肝胰壶腹区的血管分布。结果：肝胰壶腹及十二指肠乳头区的营养动脉平均为２．１支,均来源于胰十二指肠上动脉、胰十二指肠下动脉,其中肝胰壶腹区及十二指肠乳头区９～１２点钟处营养动脉的出现率为４６．１％（２９支）。测量胆总管、胰管、壶腹末端的长度分别为３２．１±８．９ｍｍ、９．９±３．９ｍｍ、１２．８±２．９ｍｍ;宽度分别为７．２±２．２ｍｍ、３．１±０．６ｍｍ、７．１±１．４ｍｍ。胆总管和胰管间的夹角７０％为２０°至４５°,平均３５．４°。结论：本实验的结果为临床在ＥＳＴ中选择切开部位和切开的深度等提供了理论依据,对防止术后并发症具有重要的临床意义。