电针心包经经穴及非经穴对家兔缺血心肌电活动的影响

在４４只麻醉兔上观察了电针＂内关＂、＂中冲－劳宫－大陵＂与。心包经上非穴点对缺血心肌电活动的影响。结果电针上述心包经穴位与非穴位点均可明显地：（１）促进缺血后心电图ＳＴ段及动脉平均压的恢复；（２）抑制ＭＡＰＡ的衰减；（３）加快ＭＡＰＤ５＊及ＭＡＰＤ９０的恢复过程。表明电针心包经经穴及非经穴点都能维持缺血心肌电活动的相对稳定，改善泵血功能，促进血压的恢复。说明心包经经穴与非经穴均与心脏密切相关。     

Reinforcing Gastric Staple-Lines with Bovine Pericardial Strips May Decrease the Likelihood of Gastric Leak after Laparoscopic Roux-en-Y Gastric Bypass

Background: Staple-line leakage is a potentially devastating complication of Roux-en-Y gastric bypass (RYGBP). Bovine pericardial strips (BPS) have been used to reinforce staple-lines in pulmonary resections and have been shown to decrease air-leaks.This study examined the use of BPS to decrease gastric staple-line leaks. Methods: 250 consecutive patients undergoing laparoscopic RYGBP had BPS used for the gastric pouch. Ease of use, operative complications, and visual bleeding were recorded. In addition, the postoperative leak rate was compared to 100 consecutive patients operated on prior to the study when BPS was not used. Results: Patient characteristics were the same for both groups and comparable with most published data. With the use of BPS, there were no operative complications and no meaningful increase in operating time. BPS reinforced staple-lines had no visual bleeding. In the 100 cases without BPS, there were 2 staple-line leaks (2%) both of which required emergency exploration. One additional patient was subsequently found to have a gastrogastric fistula. In the 250 patients who had BPS-reinforced staple-lines, there were no acute leaks.Three patients were subsequently found to have gastrogastric fistula. None required emergency surgery. Conclusion: In this non-randomized trial, BPS were found to be easy and safe to use. In addition, staple-line hemorrhage was essentially non-existent. Although the reduction in gastric staple-line leak rate may also be attributed to learning curve, there were no acute leaks in 250 patients with BPS, which is below the published norms.     

以压迫阻滞针效定位的方法测试人体体表心包经的循行路线

以心功能和心电图为指标,以机械压迫阻滞针效为手段,比较压迫心包经穴位、经线上非穴位点和该穴点两侧对照点对针刺内关穴针效的影响,检测心包经在体表的循行轨迹。结果,压迫经上穴点针后各项指标变化微小,针效显著降低;压迫两侧对照点则对针效无明显影响。两者比较,差异非常显著。证明上肢屈侧确有一条与心包经一致的机能路线,并与心脏机能活动调节密切相关。     

The Use of Bovine Pericardial Strips on Linear Stapler to Reduce Extraluminal Bleeding during Laparoscopic Gastric Bypass: Prospective Randomized Clinical Trial

Background: A prospective comparison was conducted of extraluminal bleeding following gastric transection with or without staple-line reinforcement by dehydrated bovine pericardium (Peri-Strips Dry^? - PSD) during laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: From January 2001 to September 2003, 98 consecutive morbidly obese patients underwent LRYGBP. Patients were randomly allocated to 2 groups according to the use (Group A, n= 50) or not (Group B, n= 48) of Peri-Strips Dry^?. In both groups, mortality, intra- and postoperative early and late complications, operating-time, number of hemostatic clips used, blood transfusion and any specific event directly related to the prosthetic material were prospectively evaluated. Data were expressed as mean ± SD except as otherwise indicated. Statistical analysis was done by means of Student t-test and Fisher exact test. P-value cut off for statistical significance was set at 0.05. Results: Intra- and postoperative mortality were absent. Intra-operative methylene blue test was positive in 6/48 (12.5%) of Group B patients (P<0.001). Overall laparotomic conversion was 3/98 patients (3.1%). One/48 Group B patient was converted because of unsatisfactory exposure and one for linear stapler misfire. One/50 Group A patients was converted for short gastric vessels bleeding during dissection. No patients were re-operated or transfused because of extraluminal bleeding. Mean number of clips used was significantly lower in Group A patients (5 vs 23, P<0.001). The operating-time was significantly less in Group A patients (120±60 vs 220±100 minutes, P<0.01). Conclusions: Gastric staple-lines reinforced with Peri-Strips Dry^? result in a significant reduction in the number of Endo-clips used and prevent bleeding. A dry operating field was obtained, and operating-time was significantly reduced. No adverse events could be related to the use PSD.     

Intraluminal Migration of Bovine Pericardial Strips Used to Reinforce the Gastric Staple-Line in Laparoscopic Bariatric Surgery

A 41-year-old morbidly obese woman (BMI 40.8) underwent elective laparoscopic biliopancreatic diversion with duodenal switch. The operation involved: sleeve gastrectomy, division of duodenum, creation of a duodenoenterostomy, and creation of a distal ileoenteric anastomosis. With laparoscopic stapling, bleeding is often a problem along the sleeve gastrectomy staple-line. To reduce this risk, we used bovine pericardial strips to reinforce the staple-line throughout its length. 4 weeks postoperatively, the patient was found to have fragments of pericardium in her vomitus, indicating intraluminal migration of the reinforcing strips. Her subsequent course has been uneventful. This represents the first report of such migration. Indications, benefits, complications and risks of using bovine pericardium to reinforce gastric staple-lines in laparoscopic bariatric surgery are discussed.     

心与心包俞募配穴法对冠心病患者心电图的影响

本文取心与心包两组不同的俞募配穴法，即心俞配巨阙，厥阴俞配膻中，分别对冠心病患者进行了心电图的观察。结果表明，两组配穴法均能改善冠心病患者的心肌缺血状态，但以心包组为著，而心组次之。本实验为针刺治疗冠心病提供了客观依据。