不明原因腹水患者腹腔镜探查的价值（附56例报告）

目的 总结腹腔镜探查对不明原因腹水患病因诊断的价值。方法：56例经多项影像学和实验室检查未能明确病因的患转行腹腔镜探查手术，其中腹壁活检29例，肝活检3例，脾活检1例，肠系膜及腹膜后淋巴结活检18例，肉眼观察但未取活检5例。结果：56例腹腔镜探查确诊51例，确诊率91.1%，1例中转开腹后确诊。结论：腹腔镜探查术创伤小、安全可靠，是不明原因腹水患的重要检查方法。     

624例巨大儿影响因素分析

目的应用描述性研究的方法,探讨巨大儿的危险因素,为避免巨大儿的发生和为临床提前干预提供可靠的理论依据。方法符合标准的624例产妇确立为分析和研究的对象,分为观察组（体重≥4 000 g）和对照组（体重〈4 000 g）。结果观察组产妇平均年龄、身高、体重、孕周明显高于对照组;经产妇、产妇空腹血糖大于6.16 mmol/L发生巨大儿的几率观察组明显高于对照组;观察组男性出生率明显高于对照组。同时对3种预测巨大儿的方法进行了评价,发现宫高、腹围预测巨大儿的灵敏度最高。结论孕妇的年龄、身高、体重、产次、孕周、空腹血糖、新生儿性别与巨大儿发生有关。     

腹腔镜胆囊切除术致胆管损伤5例分析

我院从１９９４～１９９８年腹腔镜胆囊切除术（ＬＣ）胆管损伤２例，占同期ＬＣ病例的０２５％。此期外院转入３例，合计５例。现分析如下。１临床资料男２例，女３例，手术诊断为胆囊结石并慢性胆囊炎。有４例在医院开展ＬＣ手术的前５０例内发生，最早是第６例，有１...     

41例前置胎盘临床分析

前置胎盘是妊娠晚期出血的主要原因，是危及母儿生命健康的产科急症之一，且并发症多，如产后大出血、植入性胎盘、产褥感染、新生儿死亡等。现将我院2001年1月～2004年6月发生的41例前置胎盘资料进行回顾性分析。     

合肥市3县中华按蚊对溴氰菊酯抗性现状的研究

目的探明合肥市中华按蚊对溴氰菊酯的抗性现状。方法选择合肥市肥东、肥西和长丰县,每县各选取1个自然村,于2011年7-8月采用牛诱和猪诱法捕获饱血中华按蚊,采用WHO推荐的成蚊接触筒法对按蚊进行敏感性测试。结果肥东、肥西和长丰县中华按蚊经0.05%溴氰菊酯测试后,击倒率分别为0、1.96%和4.72%;校正死亡率分别为4.90%、12.23%和20.05%。结论合肥市3县中华按蚊对溴氰菊酯已经产生明显抗性。     

腹腔镜脾切除与开腹脾切除治疗特发性血小板减少性紫癜的临床观察

目的比较腹腔镜脾切除术(laparoscopicsplenectomy,LS)和开腹脾切除术(opensplenectomy,OS)治疗特发性血小板减少性紫癜(idiopathicthrombocytopenicpurpura,ITP)的结果。方法36例进行LS,26例进行OS。率的比较采用χ2检验,均数比较采用Studentt检验。结果LS组和OS组手术时间分别为(135.3±60.5)min和(108.5±29.7)min(t=2.083,P=0.042),术中出血量分别为(110±127)ml和(185±128)ml(t=2.284,P=0.026),LS组术后疼痛显著较OS组轻微(χ2=18.158,P<0.01),术后恢复饮食快(t=2.251,P=0.028),而并发症发生率差别不显著(χ2=0.729,P>0.05)。对ITP治疗有效率LS组为92%,OS组为88%(χ2=0.177,P>0.05)。结论LS治疗ITP的疗效与OS相近,而且创伤小、恢复快、并发症发生率低。     

腹腔镜脾切除术治疗免疫性血小板减少性紫癜——单个教学医院经验

Background  High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy (LS) difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura (ITP) and to determine which clinical variables predict favorable hematological outcome.

Methods  LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables (including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count) were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.

Results  One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months (range 9–114 months), the overall initial response (i.e., at two months after LS) and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients (3.9%) developed pneumonia 3–35 months after LS. Univariate analysis showed a significant difference in mean age between responders (29.1 years) and nonresponders (38.8 years; P <0.05). Patients who responded to steroid therapy had better hematological outcome than those who did not respond (P <0.05). Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count (404×10⁹/L versus 213×10⁹/L, P <0.001). Multivariate Logistic regression analysis identified postoperative peak platelet count as the only independent predictor of favorable response to LS ( P <0.001).

Conclusions  LS is a safe and effective treatment for chronic ITP. Postoperative peak platelet count may serve as a major predictor of long-term response.

     

免疫性血小板减少性紫癜患者脾切除术前后外周血T细胞亚群的检测意义

目的探讨免疫性血小板减少性紫癜（ITP）患者脾切除术前后外周血T淋巴细胞亚群及CD56＋NKT细胞的变化及血液学疗效与各检测指标的关系。方法应用流式细胞技术,检测34例ITP患者腹腔镜脾切除术前后7d外周血T细胞亚群（CD3＋、CD3＋CD4＋和CD3＋CD8＋）及CD56＋NK细胞的百分数。根据不同的血液学疗效,将患者分为手术有效组（A组,22例）和无效组（B组,12例）。应用SPSS13.0forWindows软件对比分析两组术前后T细胞亚群、CD56＋NK细胞的百分数及CD4＋/CD8＋比值的差异及各组术前后各指标的变化。结果 A组和B组术前CD3＋CD4＋细胞百分数分别为（32.83±8.07）%和（26.23±6.17）%（P=0.045）,术前CD4＋/CD8＋比值分别为（1.30±0.51）和（0.84±0.42）（P=0.022）。余两组术前后各指标差异无统计学意义;B组术前后CD3＋细胞百分数分别为（65.51±4.54）%和（60.38±12.97）%（P=0.017）,CD3＋CD8＋细胞百分数分别为（37.27±12.47）%和（32.96±13.18）%（P=0.025）。余各组术前后各指标差异无统计学意义。结论脾切除疗效不同的ITP患者存在不同的细胞免疫发病机制。术前外周血CD3＋CD4＋细胞百分数及CD4＋/CD8＋比值有助于预测手术疗效。     

靶向Bcl-XL shRNA抑制人结肠癌Lovo细胞生长的研究

目的 探讨靶向Bcl-XL的shRNA对人结肠癌Lovo细胞的基因下调效应和细胞生长的抑制作用.方法 构建靶向Bcl-XL的shRNA载体质粒,然后转染人结肠癌Lovo细胞.用RT-PCR和Western Blot方法检测Bcl-XL的mRNA和蛋白的表达情况.MTT实验评价转染后各组细胞的增殖情况,并用流式细胞仪检测各组细胞的周期分布和凋亡情况.结果 靶向Bcl-XL的shRNA能够明显下调Bcl-XL mRNA和蛋白质表达(P<0.05),其抑制率分别是41.24%和45.26%.MTT实验显示转染特异性shRNA的BCL实验组细胞在转染后呈现随着时间延长而进行性生长抑制的现象.在转染后72 h,BCL组的细胞存活率为47.8%,与空白对照组相比有显著性降低,该组细胞还显示出明显的G0/G1阻滞和明显增高的凋亡率(P<0.05).结论 靶向Bcl-XL的特异性shRNA对结肠癌Lovo细胞具有下调Bcl-XL基因表达,促进细胞凋亡并且显著抑制细胞增殖的效应.