直视微创胆道手术367例临床研究

目的 探索直视微创胆道手术方法和技巧。以减小胆道手术创伤和加速术后康复。方法 应用普通手术器械和深部手术拉钩，完成微创直视胆道手术。结果 完成单纯胆囊切除术320例，胆囊切除同时胆总管切开探查取石T型管引流术39例，胆总管再次手术8例，微创切口：2.5cm9例，3cm335例，4cm11例，扩大为小切口4cm以上12例，367例患者无死亡，无感染，无胆道损伤和术后出血，治愈率100%，结论 此术式适应症广，手术时间短，出血少，恢复快，合并症发生率低，痛苦微小，成本低，安全可靠。     

直视微创无痛胆道手术的研究（附322例报告）

目的：减小胆道手术创伤和术后疼痛，探索手术方法和技巧。方法：应用冷光源拉钩暴露系列器械、分离钩、钛夹、胆道镜、术中胆道造影器械，长效局麻合剂术野浸润和固定手术步骤、技巧。完成胆囊切除术322例，术中胆道造影85例。胆总管切开胆道镜探查取石“T”管引流术24例，胆总管十二指肠侧侧吻合术10例。结果：微小切口（2．5－4cm）311例，小切口（4－4．5cm）11例，322例手术无死亡，无胆道损伤和术后出血，平均手术时间短，术后无痛或微痛，费用低。结论：此术式达到经腹腔镜胆囊切除术（LC）微创效果，术后无痛或微痛，设备投资和医疗费用低，无需全麻和气腹，适应症广，安全可靠，作者称为直视微创无痛胆道手术。     

直视微创无痛小切口胆囊切除术310例报告

目的 探讨直视下微创无病小切口胆囊切除术的可行性．方法 采用直视微创胆道手术系列器械在微小切口下完成胆囊切除310例，术后使用止痛输注泵止痛。结果 直视下微小切口胆囊切除术成功298例（96．1％），延长切口12例，其中9例延长切口4～6cm．切口长度约2．5-3．5cm，手术时间短，术后无痛或微痛，平均住院时间5天。发生手术并发症3例。无死亡病例。结论 此术式是在传统胆囊切除术的基础上采用微创器械完成。具有切口小，术后无痛或微痛，设备投资和医疗费用低，无需全麻和气腹，适应证广的特点。是一安全有效的术式，值得临床开展应用。特别是基层医院，称为“直视微创无痛胆囊切除术”。     

直视微创胆道手术220例临床报告

目的 在直视下，微创化胆道手术。方法 利用冷光源系列器械，完成胆道手术220例，合并胆总管探查25例。结果 胆总管探查患者切口长约3～3．5cm，胆囊切除切口长约2．50cm左右，平均住院时间为3天，术后微痛。结论 与腹腔镜胆囊切除术比较，不需全麻、气腹、插胃管和尿管，直视下操作，简便安全，特别适于基层医院推广应用。社会、经济效益很好。     

直视微创无痛小切口胆囊切除术310例报告

目的探讨直视下微创无痛小切口胆囊切除术的可行性。方法采用直视微创胆道手术系列器械在微小切口下完成胆囊切除310例,术后使用止痛输注泵止痛。结果直视下微小切口胆囊切除术成功298例(96.1%),延长切口12例,其中9例延长切口4￣6cm。切口长度约2.5￣3.5cm,手术时间短,术后无痛或微痛,平均住院时间5天。发生手术并发症3例,无死亡病例。结论此术式是在传统胆囊切除术的基础上采用微创器械完成。具有切口小,术后无痛或微痛,设备投资和医疗费用低,无需全麻和气腹,适应证广的特点。是一安全有效的术式,值得临床开展应用,特别是基层医院,称为“直视微创无痛胆囊切除术”。     

小切口胆囊切除术120例临床应用

目的探讨小切口胆囊切除术的临床应用技术。方法选择右上腹肋缘下4～5cm长斜形切口开腹直视下行胆囊切除术。结果小切口开腹胆囊切除术120例中113例（94.2%）成功,手术困难延长切口操作7例,并发漏胆2例,2周自愈,胆总管残余结石1例,术后经T管瘘道胆道镜取出,无胆管损伤和术后出血。结论正确选择适应证,小切口胆囊切除术安全实用。     

小切口胆囊切除术并发症的防治

我院外科自 1997年 3月以来 ,至今已开展小切口胆囊切除术 (MC) 4 84例 ,占同期胆道手术的 80 % ,其中并发症 :术中发现胆总管损伤 1例 ,术后腹腔内出血1例 ,术后胆道出血 1例 ,切口下积液 3例 ,胆道残余结石 2例。现报告如下。1　临床资料1 1　一般资料 :本组 4 84例 ,男 91例 ,女 393例。年龄19～ 78岁 ,平均 4 3岁。其中胆囊结石 4 17例 ,胆囊结石伴胆总管结石 4 8例 ,胆囊息肉 19例。1 2　手术方法 :单纯胆囊切除 4 2 1例 ,胆囊切除加胆总管切开探查、取石、引流 6 3例。切口长度 2 5～6cm ,其中 2 5～ 3cm 96例 ,3 1～ 6cm 388例。…     

直视微创胆道手术技巧的探讨

目的探讨直视微创胆道手术的操作技巧,提高手术质量。方法应用MEBS系列器材和相应的手术步骤,直视下采用刮吸、推剥和缝吊等操作技巧解剖胆囊三角区域并行肝外胆道手术。结果直视微创操作完成胆囊摘除98例,胆总管切开“T”管引流10例,胆总管一十二指肠吻合7例。相关手术技巧的应用使术中解剖更为清楚,出血量减少,手术时间缩短。术后迷走胆瘘1例,经缝扎瘘口后痊愈出院。无术后出血、黄疸和切口感染等并发症,无死亡病例。结论MEBS具有LC相同的微创效果,相应的操作技巧应用使手术更为安全简捷。     

直视下微小切口胆囊切除术治疗胆囊良性疾病80例

目的 :论证直视下微小切口胆囊切除术的可行性及优越性。方法 :对应用直视微创胆道手术系列器械完成的 80例胆囊切除进行回顾性分析。结果 :直视下微小切口胆囊切除手术成功 76例 ( 95 % ) ,4例 ( 5 % )延长切口。手术切口 2 .5～ 3.5 cm,手术平均时间35 min,术后 1 2 h恢复肠鸣音、进流食 67例 ( 88.1 6% )。术后平均住院时间 5 d。发生手术并发症 2例 ( 2 .5 % ) ,无 1例死亡。结论 :在熟练传统胆囊切除术的前提下 ,直视下微小切口胆囊切除术治疗胆囊良性疾病安全可行。且具有经济实用、损伤小、痛苦轻、伤口美观、平均住院日短、术后恢复快、病床周转率快等优点。值得在临床开展应用、尤其是基层医院。     

直视微创胆囊切除术及其拓展应用112例体会

目的探讨直视下微创胆囊切除术的方法、技巧、适应证及其拓展应用。方法应用冷光源拉钩、MEBS微创系列器械、钛夹完成112例手术。结果110例（98％）成功。术后胆管狭窄（胆管炎症及结石）1例，经胆道镜胆管扩张后好转，迷走胆瘘1例。微小单孔状切口（2～3cm），手术时间短，全组无胆道损伤、术后出血、黄疸、切口感染及死亡病例。随访3～18个月。结论此术式达到直视微创效果，设备投资及医疗费用低，无须全麻及人工气腹，直视下的微创操作相对安全，手术操作较容易掌握，设备投资小，医疗费用低，具有良好的社会效益和推广价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.