胃胆宁汤治疗胆汁反流性胃炎54例

目的:观察自拟胃胆宁汤治疗胆汁反流性胃炎的临床疗效。方法:选符合标准的该病患者82例,随机分为两组,治疗组54例予自拟胃胆宁汤,对照组28例用吗丁啉片及雷尼替丁,两组治疗4周为1疗程。结果:治疗组痊愈20例,显效13例,有效16例,无效5例,总有效率为90.74%(95%CI=83.01%～98.48%);对照组痊愈5例,显效6例,有效9例,无效8例,总有效率为71.43%(95%CI=54.70%～88.16%);两组综合疗效比较,有显著性差异(u=2.3027,P=0.0215)。结论:自拟胃胆宁汤治疗胆汁反流性胃炎疗效优于吗丁啉及雷尼替丁,其收益为OR=0.25(95%CI=0.07～0.87),NNT=5(95%CI=2.78～37.88)。     

Ross术后中远期主动脉瓣反流的危险因素分析

Objective To analyze the risk factors of the postoperative mid- and long-term aortic valvular regurgitation after ROSS procedure(pulmanary valve homograft transplantation). Methods Between March 1998 and July 2007,47 patients[25male, 22 female, mean age (13.31±5.79) years, ronge 1-34 years] with aortic valvular disease underwent the Ross procedure at our insti tution. There were 6 patients suffering fron rheumatic heart disease and 41 patients suffering from congenital heart disease. The aver age aortic blood flow velocity was (4.67±3.47) m/s, the average pressure gradient across aortic valve (88.26±58.06)mm Hg, LVEDD (45.53 ±10.78) mm, EF 0.69±0.08. All the patients were followed up in out-patient departement by ultrasonic cardio gram. Multiple logistic regression analysis was performed to find out the risk factors of the postive aortic valvular regurgitation. Results There was no poetoperative death in hospital. The mean follow-up periods was (36.15±22.1) months, rasnge from 12 to 110 months and none long-dated death. Compared with the data recorded in hospital, the diamenters of the aortic sinus and aortic annu lus enlarged significantly, respectively from (26.16±5.10) mm to (32.37±6.84) tam and from (19.41 ～3.98) mm to (23.45± 5.86) mm. The average flow velocity d the homograft (new aortic valve) was(1.39±0.48) m/s, graclient pressure (8.17+6.16) mm Hg. Mild aortic regurgitstion was present in 5 patients (10.6%), moderate aortic tegmgitafion in 2 pmieats (4.3%) and aevere aortic regurgitation in 1 petient (2.1%). The rate of free from regurgitation was 82.9%. Multiple logistic analyses identified the per esence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years as the risk factors for posterative aortic regurg itation. Conclusion The Ross procedure is a safe and effective procedure with good clinical results in mid-and long-term follow-up. However, the presence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years preoperatively were identified as the risk factors for postoperative aortic regurgitation.     

全膀胱切除、去带乙状结肠原位新膀胱围手术期并发症的处理

目的探讨根治性全膀胱切除、去带乙状结肠原位新膀胱围手术期并发症的防治。方法回顾性分析根治性全膀胱切除、原位新膀胱术并发症的防治及处理。结果围手术期并发症包括消化道、泌尿生殖道、心血管、呼吸系统、内分泌系统等诸多方面。结论围手术期的治疗及护理对于全膀胱切除、去带乙状结肠新膀胱术的顺利恢复至关重要。通过预防和治疗并发症,可以减少围手术期死亡率,提高生存质量。     

一层吻合法在直肠癌超低位直肠前切术中的应用

低位直肠癌保肛术已成为患者迫切需要。我院自2000年以来实施直肠癌超低位直肠前切除手术40例，癌肿均位于腹膜返折以下，距肛缘4.5～6cm之间，全部采用全层一层吻合法，术后均取得了满意的效果。现总结如下：     

冠状动脉重建后无复流现象的临床研究进展

急性心肌梗死(AMI)早期最显而易见的病理解剖学现象为冠状动脉(冠脉)的完全闭塞，所以既往大多数人们的研究兴趣以及治疗策略集中于心外膜下的闭塞冠脉，并且已有多种成熟应用于临床的闭塞冠脉重建措施。然而，近期人们发现冠脉一旦闭塞，其相关微小动脉和毛细血管即发生相应严重损害。以致重建后的冠脉远端缺血区微循环血流可能仍然受阻，称之为“无复流”(norenow，NR)现象，并已成为临床广泛关注的热点，本文对冠脉重建后NR的临床研究进展作一综述。     

原发性胆汁性肝硬化与HLA研究进展

原发性胆汁性肝硬化 (PBC)是一种慢性进行性胆汁淤滞性肝疾病 ,病因未明 ,以 30～ 6 0岁女性多见。其肝组织病变特征为以淋巴细胞为主的大量炎性细胞浸润 ,肝内小叶间胆管的慢性非化脓性破坏性胆管炎 ,最终发展为肝硬化甚至肝功能不全。近年来认为 ,PBC为典型的自身免疫性疾病(AID) [1 4 ] 。现简述PBC与HLA关系的研究进展。1　HLA在免疫应答中的作用主要组织相容性复合体 (MHC)在将抗原肽提呈给T细胞受体 (TCR)的免疫应答中起重要作用。TCR识别由抗原提呈细胞提呈的抗原肽 MHC复合体 ,使T细胞活化而产生免疫反应。MHC相当…