应用吻合器行中位直肠癌保肛根治术85例临床分析

目的：评价吻合器在中位直肠癌保肛根治术中的应用价值。方法：应用吻合器行直肠前切除保留肛门治疗85例中位直肠癌。结果：本组无手术死亡，无吻合口瘘、吻合口狭窄发生。术后随访6-102个月，局部复发4例，其中Dukes B期I例，Dukes C期3例，复发率为4.7％；10例(11.4％)术后有不同程度的排便功能不良现象发生。结论：吻合器的应用提高了中位直肠癌保肛手术成功率，降低了吻合口瘘、吻合口狭窄的发生率。     

不同门奇断流术式对门静脉高压症犬食管下段血管再生的影响

Objective To explore the effect on blood vessel regeneration of distal esophagus in ca-nines of portal hypertension with liver cirrhosis after different procedures with paraesophagastrie devascular-ization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CC14 combined with food restriction. Forty eight model canines were randomly divided into 4 groups: group A, traditional paraesophagastrie devascularization;group B, selective paraesophagastric devascularization;group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with sta-pler;group D,control group. Every group had 12 canines which were randomly divided into A1 ,B1 ,C1 ,D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2, B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemieal methods were used to detect VEGF,CD34 and FVⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expres-sion levels of VEGF and CD34 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation (P <0.05). All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla (P <0.05). The indices in group Cla were lower than those in group C1b (P < 0.05 ). The indices in groups A2 and B2 were higher than those in groups A1 and B1, re-spectively at the 6th month after the operation (P <0.05). They were higer in outer membrane in group C1a than in group C2a (P <0.05). The indices in group C2b were higher than those in group Clb (P<0.05). Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different pro-cedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastrie devascularization and selective paraesophagastrie devascularization, the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after parae-sophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization pins distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.     

一种新型生物人工肝系统对急性肝衰竭犬的治疗效果

我们在构建了 1种新型生物人工肝(BAL)系统并建立了 1种犬急性肝衰竭(ALF)新模型的基础上 ,应用新型BAL系统对ALF犬进行治疗 ,以评价新型BAL对ALF犬提供肝支持作用的有效性和安全性。一、材料和方法1.ALF犬模型的制作 :杂种犬 2 5条 ,体重 10～ 15kg ,雌雄不限。行门腔分流及胆总管结扎切断术 ,术前、术后 14d采血 ,全自动生化仪测定ALT、AKP、TBi,干式生化分析仪测定氨 (NH3 ) ,HPLC测定支链氨基酸 /芳香氨基酸比(BCAA/AAA) [1] 。2 .猪肝细胞分离和培养 :中国实验用小型猪 5头 ,体重 7～ 9kg ,雌雄不限。采用原位胶原酶…     

简易鼻塞式CPAP治疗新生儿呼吸衰竭50例

目的：探讨简易鼻塞式持续呼吸道正压给氧对新生儿呼吸衰竭的治疗效果。方法：对５０例新生儿呼吸衰竭应用简易鼻塞式持续呼吸道正压给氧,并与４０例对照组进行比较。结果：治疗组治愈率为５２％;死亡率为２１％;对照组治愈率为２０％,死亡率为６７５％。两组比较Ｐ＜００１有极显著差异。结论：简易鼻塞式持续呼吸道正压给氧是基层治疗新生儿呼吸衰竭的最有效的方法,值得推广。     

分化型甲状腺癌再次手术18例分析

有些甲状腺癌临床确诊不易,特别是滤泡状甲状腺癌即使术中作冰冻切片有时亦难以确诊,仍需五蜡切片报告作出诊断。因此,甲状腺肿瘤首次手术范围常受到限制,待病理报告为甲状腺癌后则常需再次手术,此外乳头状甲状腺癌术后易复发,对其处理亦需再次手术。本文总结了我院1992年1月～1997年12月因甲状腺癌再次手术18例,对残留癌的原因,再次手术的有关问题进行了讨论。至临床资料本组18例中,术后经石蜡切片证实为甲状腺癌后再手术13例,甲状腺癌术后复发5例。年龄18～58岁,平均40．3岁。男4例,女14例。再次手术距第一次手术的时间为5天…     

三升袋在注水小肠镜检查中应用的护理体会

目的：探讨和研究三升袋在注水小肠镜检查中的应用效果和护理配合。方法选取2016年1－6月在厦门大学附属东南医院消化内科门诊因小肠疾病需行小肠镜检查的患者,将志愿接受注水小肠镜检查的患者随机分为三升袋组和注射器组各4例,两组均为男性,比较两组患者完成注水经口单气囊小肠镜检查所需注水量和时间,以及对不同注水方法小肠镜检查的耐受程度。结果三升袋组用时（1．63±0．12）h,少于注射器组（1．96±0．08）h,差异有统计学意义（P＜0．05）;三升袋组用水量（800±35．36）mL,少于注射器组用水量（855±11．18）mL,差异有统计学意义（P＜0．05）;三升袋组患者耐受性好于注射器组,差异有统计学意义（ P＜0．05）。结论三升袋注水小肠镜检查法,节省操作时间,节约检查时所需的注水量,同时可以减轻患者腹痛程度,提高患者肠镜检查的依存性,值得在消化内镜临床护理工作中进一步推广。     

MDT联合CBL教学模式在肝癌临床教学中的应用

目的:分析肝癌临床教学中应用多学科诊疗(MDT)联合案例教学模式(CBL)的效果.方法:五年制临床医学实习学生86例,随机分为观察组和对照组各43例.观察组采用MDT联合CBL教学模式,对照组采用传统讲授式教学模式.比较两组考核成绩、学生对教学模式的认同度和满意度.结果:观察组基础理论成绩和病例分析成绩分别为42.53...     

结直肠癌中OPN和ADAM17的表达及其意义

目的探讨OPN、ADAM17在结直肠癌、正常肠黏膜组织中的表达情况及其临床意义.方法应用SP免疫组化方法检测60例结直肠癌(30例结直肠癌肝转移)、12例正常结直肠黏膜组织(对照组)中OPN、ADAM17的表达,分析其表达水平的差异性.结果(1)结直肠癌组织中OPN、ADAM17阳性表达率分别为71.6%、75%,与正常组比较,差异有统计学意义(P<0.05).(2)OPN、ADAM17在肝转移组、Dukes C+D期组中的阳性表达率均高于相应对照组,且差异有统计学意义(P<0.05).(3)OPN、ADAM17在结直肠癌的表达与患者的年龄、性别、部位及肿瘤大小无明显相关性(P>0.05).(4)OPN、ADAM17的表达呈正相关.结论 OPN、ADAM17的表达与结直肠癌侵袭转移的发生有密切关系,在结直肠癌的发生、发展过程中可能具有协同作用,对判断结直肠癌预后具有重要意义.     

HPLC法同时测定荆芥配方颗粒中4种成分的含量北大核心CSCD

目的：建立荆芥配方颗粒中咖啡酸、橙皮苷、迷迭香酸和胡薄荷酮的含量测定方法。方法：采用高效液相色谱法,Wondasil C18色谱柱（250 mm×4.6 mm,5μm）;流动相：乙腈-0.2%磷酸溶液,梯度洗脱;流速：1.0 m L/min;检测波长：咖啡酸为325 nm,橙皮苷为285 nm,迷迭香酸为330 nm,胡薄荷酮为252 nm;柱温：30℃。结果：咖啡酸、橙皮苷、迷迭香酸和胡薄荷酮的进样量分别在0.0324～0.324μg（r1=0.9998）、0.0917～0.917μg（r2=0.9996）、0.0403～0.403μg（r3=0.9997）、0.0406～0.406μg（r4=0.9997）范围内与峰面积呈良好的线性关系,平均加样回收率分别为98.08%、98.32%、97.25%、99.82%;结论：该方法同时测定了荆芥配方颗粒中咖啡酸、橙皮苷、迷迭香酸和胡薄荷酮的含量,方法可行,重现性好,可为荆芥配方颗粒的质量控制提供方法参考。     

止血绫修复内镜黏膜下剥离术后创面的应用研究*

目的探讨止血绫在内镜黏膜下剥离术(ESD)后预防创面出血及创面修复中的临床应用价值。方法采用活体兔对比研究手术切开兔胃后的出血量(ml),并以活体猪为研究对象行结肠ESD手术,实验组术后用止血绫进行覆盖,对照组创面则不予以处理,术后3天、1周、2周及4周分别进行内镜及病理学检查,比较两组的创面出血及组织愈合情况。结果兔胃出血量对比实验中,实验组出血量明显低于对照组,实验猪行结肠ESD术后创面均成功覆盖止血绫。行内镜检查及病理检查,实验组存在修复优势。实验组与对照组总共24处创面中,均未出现感染、穿孔等实验相关的不良事件。结论止血绫在临床ESD后创面修复中具有潜在的应用价值。