加速康复外科理念在腹腔镜胆囊切除术中的应用

[目的]探讨加速康复外科（FTS）理念在腹腔镜胆囊切除术中的应用效果。[方法]选取106例腹腔镜胆囊切除手术患者,随机分为快速康复组（FTS组）53例和常规治疗组（对照组）53例。比较两组术后的首次排气时间、进食时间、术后下床时间及恶心呕吐和手术并发症的发生率、住院时间、住院费用等指标。[结果]与对照组比较,FTS组术后首次排气时间缩短,术后进食和下床活动时间均提前,住院时间缩短,住院费用降低（P＜0．01或 P＜0．05）。两组术后恶心、呕吐发生率及手术并发症的发生率差异无统计学意义（P＞0．05）。[结论]加速康复外科可广泛应用于腹腔镜胆囊切除。     

腹腔镜胆囊切除术561例临床探讨

目的进一步探讨腹腔镜胆囊切除术并发症的原因和预防措施。方法回顾分析自2003—08—2008—12我科561例胆囊疾病的病人行腹腔镜胆囊切除术的资料。结果561例中558例成功施行腹腔镜胆囊切除术,腹腔镜手术成功率99．47％,中转开腹3例;并发症4例（0．71％）中,胆管横断伤2例（0．36％）,胆漏2例（0．36％）。手术时间（51．36±20．46）min;病人术后住院时间1～10d,平均（4．15±1．36）d。结论腹腔镜胆囊手术具有戳口小、创伤少、并发症少、术后痛苦少、恢复快等微创优点;但一旦发生并发症,如果处理不当后果相当严重,重视预防和提高手术技能能降低腹腔镜胆囊切除术中并发症的发生率。     

腹腔镜胆囊切除术的治疗体会

目的探讨腹腔镜胆囊切除术的手术原则及并发症的预防。方法收集2006年1月～2008年12月完成的180例腹腔镜胆囊切除术的临床资料,分析腹腔镜胆囊切除术的术前、术中应注意事项及术后并发症的预防。结果180例腹腔镜胆囊切除术中176例手术均获得成功,中转开腹胆囊切除术3例,发生率1．7％;术后腹腔内出血而进腹手术止血1例,发生率0．6％;术中置管引流6例,发生率3．3％。结论腹腔镜胆囊切除术充分体现微创外科的优点,但应重视术中操作技巧及围手术期的管理,及时发现各种情况并及时处理,是腹腔镜胆囊切除术成功的关键。     

肝外胆管损伤治疗体会（附20例报告）

胆管损伤是肝胆外科手术的严重并发症,国外报道总发生率0．221％,国内文献报道其发生率一般为0．15％～0．5％,也可高达1％～2％^[1],其中90％发生在腹腔镜胆囊切除术和／或开腹胆囊切除术中^[2]。因此,如不能及时发现和正确处置,其后果非常严重,甚至危及到患者的生命。1982年1月-2008年1月我院共诊治医源性胆管损伤20例,现报告如下。     

护理干预在腹腔镜胆囊切除术围手术期中的应用杉值分析

目的探讨护理干预在腹腔镜胆囊切除术围手术期中的应用价值。方法将80例腹腔镜胆囊切除术患者随机分为观察组和对照组各40例,观察组采用护理干预,对照组采用传统护理模式,比较二者的护理效果。结果两组患者人院时SAS评分差异无显著性（P〉0．05）,但是术前lh观察组患者SAS评分显著下降,与对照组比较,差异存在显著性（P〈0．05）。观察组患者术后并发症发生率和满意度分别为17．50％和11（29．01±2．56）分,均优于对照组的35．00％和（23．47±2．52）分（P〈0．05）。结论护理干预可减轻腹腔镜胆囊切除术患者围手术期的焦虑,降低术后并发症,提高患者满意度,值得临床推广应用。     

妇科腹腔镜手术并发症的相关因素分析及处理

目的探讨妇科腹腔镜手术的并发症和相关因素。方法回顾分析1167例妇科腹腔镜手术病例并发症的相关因素及处理结果。结果腹腔镜手术并发症发生率o．94％（11／1167）。附件手术并发症的发生率为o．28％（2／726），肌瘤剔除术为0．98％（2／205），子宫切除术为2．97％（7／236）。穿刺与气腹并发症的发生率为0．34％（4／1167），术中并发症为0．34％（4／1167），术后并发症为0．26％（3／1167）。子宫切除术的并发症发生率高于其他种类手术（P〈0．05）。结论妇科腹腔镜并发症的发生主要与手术的难易程度以及医生操作经验有关，了解其并发症的发生原因，加强预防措施，可以降低并发症的发生。     

腹腔镜胆囊切除术和小切口胆囊切除术治疗急性胆囊炎的临床疗效差异

目的：探讨腹腔镜胆囊切除术和小切口胆囊切除术在急性胆囊炎治疗上的临床疗效。方法：选择来该院接受治疗的80例急性胆囊炎患者为研究对象,采用随机分配法,分为两组,观察组患者接受腹腔镜胆囊切除术,对照组患者接受小切口胆囊切除术。结果：观察组患者的术中出血量以及住院时间均明显低于对照组,差异具有显著性,有统计学意义（P ＜0．05）。观察组患者的并发症发生率为5．0％,对照组患者的并发症发生率为22．5％,两组数据存在显著差异,具有统计学意义（P ＜0．05）。结论：腹腔镜胆囊切除术治疗急性胆囊炎疾病,可以有效降低患者的并发症发病率,促进患者身体健康恢复,具有临床应用意义。     

300例腹腔镜胆囊切除术临床体会

目的：探讨腹腔镜胆囊切除术的临床效果。方法：选择我院收治的行腹腔镜胆囊切除术的患者300例为研究组,再选择同期行传统胆囊切除手术的患者300例为对照组。系统性回顾2组患者的临床资料,重点对手术时间、术中出血量、住院时间、并发症发生率等方面进行组间对比。结果：研究组与对照组手术平均时间为48．3±10．7分钟和82．8±15．4分钟;术中出血量分别为72．3±9．0ml和168．5±21．4ml;住院时间分别为3．7±0．6天和7．4±1．8天;并发症发生率分别为4％（12/300）和11．3％（34/300）。2组患者在手术时间、术中出血量、住院时间、并发症发生率等方面均存在显著差异（均P＜0．05）。结论：腹腔镜胆囊切除术临床效果明显优于传统胆囊切除术,值得临床推广应用。     

腹腔镜胆囊切除治疗急性胆囊炎60例临床分析

目的：探讨腹腔镜胆囊切除治疗急性胆囊炎的临床疗效及安全性。方法：选取我院收治的急性胆囊炎患者110例,随机分成观察组60例和对照组50例,对照组采取传统的开腹胆囊切除手术治疗,观察组在气管插管下全麻后,给予腹腔镜胆囊切除术。比较2组患者的术中情况（手术时间、术中出血量）、术后恢复（术后排气时间、下床活动时间、住院时间）以及并发症的发生情况。结果：2组患者的手术时间、术中出血量、术后排气时间、下床活动时间、住院时间均少于对照组（ P＜0．05）,差异有统计学意义;观察组的并发症发生率为8．3％,低于对照组的22．0％,差异有统计学意义（ P＜0．05）。结论：腹腔镜胆囊切除治疗急性胆囊炎较传统开腹手术更有优势,其手术时间短、术中出血量少,术后恢复快,并发症少,安全性良好,临床效果满意。     

腹腔镜胆囊切除术并发症及其防治

目的探讨腹腔镜胆囊切除术的操作技巧、并发症及其防治。方法对我院施行腹腔镜胆囊切除术共772例的临床资料进行回顾性分析。结果772例全部治愈。并发症5例，占0．6％，胆总管损伤1例，术后大出血1例，腹腔遗留结石1例，戳孔感染2例。术中即刻中转开腹12例。LC成功率99％。结论病人的局部条件、手术者的操作技能及经验是决定腹腔镜胆囊切除术并发症的主要原因之一。     

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…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.     

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.