尿透明质酸酶和核基质蛋白22联合检测在膀胱肿瘤诊断中的价值

目的探讨尿液中透明质酸酶(HAase)和核基质蛋白22(NMP-22)联合检测在膀胱肿瘤诊断中的价值。方法采用ELISA方法分别检测40例健康人(对照组)、60例膀胱肿瘤(肿瘤组)患者手术前后尿HAase、NMP-22含量,并计算两指标术前单独检测及联合检测的灵敏度、特异性和准确度。结果肿瘤组手术前后尿HAase含量分别为(77.5±21.8)、(51.5±14.7)mg/ml,对照组为(23.3±6.3)mg/ml,术前含量高于术后(P<0.05)以及对照组(P<0.01)。肿瘤组手术前后NMP-22含量分别为(26.4±6.6)、(17.6±4.4)ng/ml,对照组为(8.1±2.1)ng/ml,术前含量高于术后(P<0.05)以及对照组(P<0.01)。术前尿HAase检测的灵敏度、特导性及准确度分别为89.1%、86.4%及86.1%,术前尿NPM-22检测的灵敏度、特异性及准确度分别为74.3%、85.2%及78.6%,而HAase与NMP-22联合检测的灵敏度、特异性及准确度分别为95.1%、80.9%及90.3%。结论尿HAase与NMP-22联合检测诊断膀胱肿瘤的灵敏度、特异性和准确度均较高...     

腹腔镜剔除卵巢畸胎瘤可行性分析

目的 探讨应用腹腔镜进行卵巢成熟畸胎瘤剔除的可行性.方法 回顾性分析47例卵巢畸胎瘤行腹腔镜下肿瘤剔除术,同期27例采用传统的开腹手术行肿瘤剔除术,对两组病人的术中囊肿破裂率、手术时间、术中出血、手术前后血红蛋白、术后病率及住院时间进行比较分析.结果 两组术中囊肿破裂率相近(12.8% vs 11.1%,P>0.05);两组手术时间相近[(83±22)min vs (80±16)min,P>0.05].腹腔镜组手术前后血红蛋白无明显改变[(114.4±3.5)g/L vs (113.1±2.9)g/L,P>0.05];开腹组手术后血红蛋白下降[(113.8±2.7)g/L vs (110.9±1.1)g/L,P<0.05].腹腔镜组术中出血少[(53±25)ml vs(75±16)ml,P<0.001];肛门排气时间早,两组肛门排气时间分别为(19.0±2.1)h和(27.0±1.8)h(P<0.001);术后病率低,两组术后病率分别为2.1%(1/47)和22.2%(6/27)(P<0.05);术后住院时间短,两组术后住院时间分别为(4.4±0.7)d和(7.0±0.2)d(P<0.001).结论 全部病人随访1-4年,两组均无复发.应用腹腔镜剔除卵巢成熟性畸胎瘤是可行且优于传统开腹手术.     

TSGF检测在恶性肿瘤中的临床意义

目的探讨肿瘤特异性生长因子(TSGF)在肿瘤诊断及复发转移中的临床应用价值.方法用肿瘤相关物质联合检测试剂盒,对190例恶性肿瘤、60例非肿瘤、50例复发肿瘤者进行TSGF水平检测.结果 190例恶性肿瘤患者血清TSGF含量为(81.28±8.53)U/ml,50例肿瘤复发组为(91.21±5.09)U/ml其值均显著高于非肿瘤组(58.37±7.21)U/ml和健康对照组(52.31±5.13)U/ml,P<0.001,肿瘤复发组显著高于恶性肿瘤组,P＜0.05.结论恶性肿瘤患者血清TSGF含量明显增高,其总阳性率为88%,敏感性为92%,特异性为96%.TSGF对恶性肿瘤的早期诊断、复发转移的监测具有重要价值.     

血清NT-proBNP在青紫型先天性心脏病患儿中的临床意义

目的 研究青紫型先天性心脏病患儿血清氨基末端脑利钠肽前体(N-terminal proBNP,NT-proBNP)水平,探讨其临床意义.方法 采集先天性心脏病患儿的血清,按照小儿心衰改良Ross标准分为无心衰的非青紫型组48例,青紫型无心衰组23例,青紫型轻度心衰组10例;对照组为同期门诊体检的正常儿童25例;酶联免疫法(ELISA)检测血清NT-proBNP;测经皮血氧饱和度(SaO2)、红细胞计数(RBC)、红细胞压积(HCT)、血红蛋白(Hb);采用单因素方差分析、LSD法及Pearson相关分析进行统计处理.结果 (1)与正常对照组(34.35±4.98)fmol/ml及非青紫型组(38.54±4 50)fmol/ml比较,青紫型无心衰组患儿血清NT-proBNP(55.87±7.96)fmol/ml分别增高62.6%,45.0%,差异有统计学意义(P<0.01);与青紫型无心衰组(55.87±7.96)fmol/ml比较,青紫型轻度心衰组血清NT-proBNP(91.83±17.01)fmol/ml增高64.6%,差异有统计学意义( P<0.01).(2) 不同类型非青紫型先心患儿、青紫型先心患儿间NT-proBNP、SaO2、RBC计数、HCT、Hb比较, 均无明显差异(P<0.05).(3)青紫型无心衰组患儿血清NT-proBNP与SaO2呈明显负相关(r=-0.63, P<0.01);而与RBC、HCT及Hb浓度无相关性(P<0.05).结论 青紫型先心病患儿血清NT-proBNP水平升高可能与心脏缺氧严重程度相关;其可以用于是否合并心衰的早期诊断及预测.     

乳腺癌患者血清VEGF-C水平变化及临床意义

目的探讨乳腺病患者血清血管内皮生长因子-C(Vascular Endothelial Growth Factor-C,VEGF-C)水平变化及其临床意义。方法采用酶联免疫吸附试验(双抗夹心ELISA法)检测54例乳腺癌患者、30例乳腺良性疾病患者血清VEGF-C水平及30例健康者血清VEGF-C水平,并作对比分析。结果乳腺癌患者血清VEGF-C水平(6056.72±123.95pg/ml)明显高于乳腺良性肿瘤患者血清VEGF-C水平(5031.34±209.10pg/ml)及正常对照组血清VEGF-C水平(5029.58±210.86pg/ml),差异有显著意义(P<0.01);晚期乳腺癌(Ⅲ、Ⅳ期)患者血清VEGF-C水平(5863.70±175.92pg/ml)较早期乳腺癌(Ⅰ、Ⅱ期)患者血清VEGF-C水平(5267.72±170.3pg/ml)增高,两组比较差异有显著性(P<0.01);有淋巴结转移的乳腺癌患者血清VEGF-C水平(6369.27±162.49pg/ml)显著高于无淋巴结转移的乳腺癌者(5784.90±147.14pg/ml)(P<0.05);手术前后患者血清VEGF-C水平有明显差异(P<0.05);而不同肿瘤组织学类型的乳腺癌患者血清VEGF-C水平差异无显著性(P>0.05)。结论乳腺癌患者血清VEGF-C水平变化,有可能作为乳腺癌病情进展的动态监测及预后判断的新指标之一。     

糖类抗原CA—50对肿瘤诊断的价值

应用~(125)Ⅰ标记CA-50单克隆抗体的放射免疫抑制试验,检测37例恶性肿瘤患者、9例良性肿瘤、27例非肿瘤患者及30例正常人血清CA-50含量。其中正常人血清CA-50含量为6.03±1.15u/ml,原发性肝癌组为19.3±12.8u/ml,胰癌组为18.5±10.0u/ml,其他消化道癌肿为14.05±12.07u/ml,与正常对照组相比均明显升高(P<0.001)。良性肿癌组为5.32±2.12u/ml,接近正常对照组。另外,本组有4例原发性肝癌栓塞后,随着肿瘤缩小,其血清CA-50由高值转为阴性。综上所述,血清CA-50可作为恶性上皮类肿瘤诊断、鉴别诊断、疗效观察及判断预后的一项指标。     

恶性肿瘤120例血清VEGF Cox-2含量的分析

目的研究恶性肿瘤患者血清VEGF与Cox-2含量的变化,探讨VEGF与Cox-2含量与肿瘤的发生、发展、预后的相互关系。方法所有标本均采用深圳晶美生物公司提供的VEGF ELISA试剂盒及美国Assay Design公司提供的Cox-2ELISA试剂盒进行检测。结果24例正常对照组血清VEGF含量平均为(96.67±25.74)pg/ml,血清Cox-2含量平均为(5.60±2.13)ng/ml;120例恶性肿瘤组血清VEGF含量平均为(224.93±96.16)pg/ml,血清Cox-2含量平均为(24.89±6.97)ng/ml,2组比较均具有显著性差异(P<0.001)。结论恶性肿瘤患者血清VEGF及Cox-2含量明显高于对照组,且二者具有相关性。     

血清总唾液酸测定在鉴别肿瘤良恶性质中的应用

本文对40例恶性肿瘤患者和46例良性疾病患者血清总唾液酸(SA)含量进行测定,结果发现恶性肿瘤组血清总SA含量为710.25±71.82μg/ml,良性疾病组血清总SA含量为426.34±96.12μg/ml,二者有显著性差异(P<0.001).恶性肿瘤患者血清SA阳性率达90.00%,而良性疾病组阳性率为4.35%,两组之间有显著性差异(P<0.005).提示血清总SA测定可作为鉴别肿瘤良恶性质的重要指标.     

血清YKL-40在卵巢癌患者诊断和预后中的应用

目的探讨血清中YKL-40在卵巢癌诊断和预后评价中的价值。方法用酶免疫吸附法测定39例卵巢癌患者、37例卵巢良性肿瘤患者及40例正常妇女血清中的YKL-40水平,分析YKL-40在3组间、卵巢癌患者不同临床分期和手术治疗前后的变化。结果卵巢癌患者血清YKL-40水平[(149.4±116.9)ng/ml)]显著高于卵巢良性肿瘤组[(37.3±16.7)ng/ml)]和对照组[(35.4±18.6)ng/ml)](P<0.01),而卵巢良性肿瘤组和对照组之间差异无显著性(P>0.05)。Ⅰ/Ⅱ期与Ⅲ/Ⅳ期卵巢癌患者血清中YKL-40水平相比较,差异有显著性(P<0.01)。卵巢癌患者术后第3天和第7天血清YKL-40水平显著低于术前水平(P<0.01);未能手术切除的卵巢癌患者血清YKL-40水平和超出正常对照组上限值的比率高于手术切除的患者,差异均有显著性(P<0.01)。结论血清YKL-40水平检测在卵巢癌的诊断、临床分期、疗效及预后评价方面均有较大的临床价值。     

胃肠道恶性肿瘤血清胆碱酯酶活性变化的研究

目的探讨胆碱酯酶(CHE)与胃肠道恶性肿瘤发生、发展的相关性。方法采用速率法检测,对观察组77例经内镜、活检及手术、病理证实的胃肠道恶性肿瘤患者血清胆碱酯酶的含量,并与手术后及对照组77例对照比较,对结果进行分析。结果77例胃肠道恶性肿瘤术前血清CHE含量为(3723±1464)IU/L,术后7d为(5686±1392)IU/L。t值为5.50,P<0.01。对照组(8967±1675)IU/L,观察组术前与对照组比较,t值为20.69,P<0.01;观察组术后与对照组比较,t值为13.22,P<0.01。结论胃肠道恶性肿瘤患者术前CHE活性明显低于手术后的CHE活性,更低于对照组。血清CHE活性降低与胃肠道恶性肿瘤的发生、转移密切相关,可作为诊断胃肠道恶性肿瘤的标志物,对其筛查和诊断具有重要的临床意义。     

血清表皮生长因子受体水平在垂体腺瘤增殖诊断中的作用

目的　探讨血清表皮生长因子受体 (EGF R)水平与垂体腺瘤患者瘤前病变和肿瘤增殖的关系。方法　采用酶联免疫分析技术对 137例垂体疾病患者的术前血清EGF R胞外区表达水平进行检测。患者中 5例为垂体Rathke囊肿 ,13例垂体增生 ,119例垂体腺瘤患者 ,其中微腺瘤 17例、大腺瘤 6 4例、巨大腺瘤 38例 ,2 8例正常献血者为对照组。结果　血清EGF R水平在垂体增生患者中为194fmol/L± 38fmol/L ,在垂体微腺瘤、垂体大腺瘤、垂体巨大腺瘤患者中分别为 2 19fmol/L± 37fmol/L、32 2fmol/L± 6 6fmol/L、4 2 8fmol/L± 6 2fmol/L ,均明显高于垂体Rathke囊肿患者 (15 2fmol/L± 17fmol/L ,P <0 0 0 0 1)和对照组 (15 9fmol/L± 4 1fmol/L ,P <0 0 5 )。血清EGF R水平与垂体腺瘤大小呈正相关 (r=0 998) ,并在垂体腺瘤患者各组间存在明显差异 (P <0 0 0 0 1)。结论　检测垂体腺瘤患者术前血清EGF R水平可反映肿瘤的增殖状况 ,可能有助于垂体腺瘤和垂体Rathke囊肿的鉴别诊断。建议血清EGF R可作为反映垂体腺瘤增殖的一种分子参考标志     

慢性肾功能衰竭大鼠下丘脑组织和血浆食欲素A及神经肽Y水平的变化及其意义

目的　探讨大鼠慢性肾功能衰竭 (CRF)动物模型的下丘脑组织和血浆食欲素A及神经肽Y(NPY)水平的变化及其意义。方法　将 41只 2 0 0～ 2 50 g雄性Wister大鼠分为 :正常组、假手术组和CRF组。术后 4、 8、 1 2周分批断头处死大鼠 ,取血浆和下丘脑组织标本。用放射免疫法测定血浆和下丘脑组织食欲素A和NPY。用生化自动分析仪测定血清肌酐。结果　CRF大鼠术后4、 8和 1 2周血肌酐水平均高于假手术组。其术后 1 2周的血浆食欲素A水平高于假手术组 (2 64pg/ml± 62pg/mlvs 1 83pg/ml± 56pg/ml,P =0 0 39)。CRF大鼠术后 1 2周的下丘脑食欲素A水平明显低于假手术组 (1 0 5fmol/mg± 2 7fmol/mg湿重vs 1 7 4fmol/mg± 3 9fmol/mg湿重 ,P =0 0 2 3)。CRF大鼠术后 8周 (7 1 pmol/ml± 1 7pmol/mlvs 5 0 pmol/ml± 0 5pmol/ml,P =0 0 1 )和1 2周 (7 9pmol/ml± 1 1pmol/mlvs 4 8pmol/ml± 1 1 pmol/ml,P =0 0 0 0 8)的血浆神经肽Y水平高于假手术组 ,其术后 1 2周的下丘脑神经肽Y水平明显低于假手术组 (70fmol/mg± 2 3fmol/mgvs1 1 3fmol/mg± 31fmol/mg湿重 ,P =0 0 33)。 结论　 (1 )CRF大鼠血浆食欲素A和NPY水平有逐渐增高趋势 ,肾功能减退可能导致食欲素A和NPY排泄障碍。 (2 )CRF时下丘脑组织食欲素     

早期胃癌次全切除术中完全与部分网膜切除的疗效比较

目的：探讨早期胃癌次全切除术中完全与部分网膜切除的疗效比较。方法：收集本院52例开放性远端胃次全切除术的早期胃癌患者,分别行网膜部分切除（n=30）及网膜全切除术（n=22）,比较两组手术时间、术后出血、术前及术后血清白蛋白水平、术后住院时间等手术情况。结果：两组术中出血、术前白蛋白无统计学差异。网膜部分切除组手术时间显著低于网膜全切组,术后血清白蛋白水平显著高于网膜全切组。两组合并症无统计学差异。术后随访两组患者1年,未出现1例患者死亡。结论：早期胃癌患者行开放性远端胃次全切除术中采取网膜部分切除可使手术时间缩短,住院时间短,术后血清白蛋白水平更接近于术前,临床效果优于网膜全切术。     

ELEVATED SOLUBLE EPIDERMAL GROWTH FACTOR RECEPTOR LEVEL IN PITUITARY ADENOMA AND CARCINOMA

Objective To investigate effect of the soluble epidermal growth factor receptor (sEGFR/sErbB1) level in the peripheral blood in development, invasiveness, apoplexy of each type of pituitary tumor.Methods The sEGFR level was determined in peripheral serum from 190 patients with pituitary diseases by enzyme linked immunosobent assay. The sEGFR levels were measured in 10 pituitary Rathke's pouch, 18 pituitary hyperplasia, 161pituitary adenomas including 30 microadenomas, 83 large adenomas, 48 giant adenomas, 1 pituitary carcinoma, and 28 healthy controls.Results In the patients with pituitary hyperplasia, microadenoma, large adenoma, giant adenoma, and pituitary carcinoma, the sEGFR level was 188.92 32.62, 209.83 19.01,333.20 69.33, 405.85 37.38, and 617.45 fmol/mL independently. They were all significantly higher than patients with pituitary Rathke's pouch (156.78 18.24 fmol/mL, P ＜ 0.001)and healthy control group (159.11 40.50 fmol/mL, P ＜ 0.05). The sEGFR level in pituitary carcinoma was higher than pituitary adenoma. In patients with pituitary adenoma, the sEGFR level was positive correlated to the size of pituitary adenomas (r = 0.998), the significant difference was observed for the sEGFR level in each group of the patients with pituitary adenomas (P ＜ 0.001). Furthermore, in patients with pituitary ACTH-secrefing microadenomas, the serum sEGFR levels in invasiveness (295.00 77.80 fmol/mL) was higher than that in non-invasiveness (210.60 16.4 fmol/mL, P ＜ 0.05). In patients with pituitary ACTH-secreting, PRL-secreting, GH-secreting, and non-functioning large adenomas, the serum sEGFR levels in invasiveness (407.86 28.50, 399.25 30.10, 386.00 13.08, and 369.25 36.70 fmol/mL) was higher than that in non-invasiveness (335.25 63.49, 300.64 47.57, 297.00 61.93, and 269.30 25.68 fmol/mL) respectively (P ＜ 0.05). In patients with invasive pituitary PRL-secreting, GH-secreting, and non-functioning giant adenomas, the serum sEGFR levels not significantly different in between invasiveness (417.50 35.94, 409.50 69.14, and 417.50 44.13 fmol/mL) and noninvasiveness (386.00 49.64, 417.50 44.03, and 409.51 35.17 fmol/mL) (P ＞ 0.05). In patients with pituitary large adenomas, the sEGFR levels in pituitary apoplexy (377.48 39.18 fmol/mL) was higher than that in non-pituitary apoplexy(343.18 68.17 fmol/mL, P ＞ 0.05).Conclusions The increased level of peripheral serum sEGFR is concomitant with development, proliferous size of the adenomas in patients with pituitary adenomas. In addition, the elevated levels of serum sEGFR occur in pituitary apoplexy as clinical active tumors, and the non-invasive ACTH secreting adenomas. The sEGFR levels could be differentiated helpfully between pituitary adenomas and non-pituitary adenomas. These data suggest that serum sEGFR could be as a referable marker of the size and activation of proliferation in pituitary adenoma.     

七氟烷或丙泊酚麻醉对老年肺癌患者术后认知功能的影响

目的:比较七氟烷和丙泊酚对老年肺癌患者术后早期认知功能的影响。方法:80例65岁以上的老年肺癌患者择期行肺癌根治术,随机分为七氟烷组(S组,40例)和丙泊酚组(P组,40例),分别于术前1 d、术后6 h、1 d、3 d、7 d对患者进行简易智能精神状态评分(MMSE),并于麻醉前10 min、术毕10 min及术后1 d取血测定血清S100β蛋白。结果:两组患者年龄、体质量、手术时间和麻醉时间无显著性差异(P>0.05),术前MMSE评分及术前S100β蛋白亦无显著差异(P>0.05)。S组患者术后6 h、1d、3 d的MMSE评分均高于P组(P<0.05),术后7 d两组的MMSE评分无显著性差异(P>0.05)。与术前10 min相比,两组患者术毕10 min的S100β蛋白水平均明显升高(P<0.05),但两组间无明显差异(P>0.05),S组术后1 d的S100β蛋白水平低于P组(P<0.05)。结论:七氟烷与丙泊酚均可影响老年患者全身麻醉术后早期认知功能。但七氟烷与丙泊酚相比,术后认知功能障碍的发生率较低,恢复更快。     

Hypomagnesemia after major abdominal operations in cancer patients: clinical implications

BACKGROUND: Serum magnesium levels are rarely measured in routine chemistry panels. The extent and impact of postoperative serum magnesium changes remain unclear. METHODS: One hundred seventy-one cancer patients who had undergone celiotomy procedures during a 38-month period were evaluated retrospectively for postoperative electrolyte alterations, with special emphasis on serum magnesium. Clinicopathologic predictors and early postoperative outcome correlations were examined. RESULTS: There were 151 major procedures and 20 minor operations. All postoperative electrolyte and hematocrit values were significantly different from preoperative values, except for serum phosphate. Preoperative total serum magnesium (normal range: 1.7-2.5 mg/dL {0.7-1.03 mmol/L}), obtained prior to any bowel cleansing, differed from postoperative levels (means +/- standard deviation: 2.0 +/- 0.46 vs. 1.53 +/- 0.33 mg/dL; p < 0.0001). A lowered postoperative serum magnesium was observed in those patients who had either undergone an operation with curative intent (p = 0.0035), a major resection (vs. no resection, p = 0.0259), or preoperative bowel cleansing with sodium phosphate (p = 0.024). Other laboratory serum parameters that correlated with the postoperative magnesium level included postoperative levels of phosphate (p = 0.009), potassium (p = 0.01), and total calcium (p = 0.012), as well as preoperative calcium (p = 0.017). The complication rate was 20%, with five postoperative deaths (2.9%). Postoperative morbidity was predicted by preoperative potassium (p = 0.004) and albumin levels (p = 0.016); deaths were predicted by postoperative infections (p = 0.0007) and correlated to postoperative hypokalemia (p = 0.03). CONCLUSIONS: Major abdominal cancer operations lead to significant electrolyte alterations. The severity of these changes correlates with the resection extent, especially in procedures with curative intent. In addition, bowel cleansing with sodium phosphate may participate in lowering serum magnesium as well as other electrolytes. In light of our postoperative magnesium replacement policy, no untoward events could be linked to postoperative hypomagnesemia in this series. To evaluate the impact of postoperative hypomagnesemia or magnesium replacement on postoperative outcomes requires a prospective randomized trial.     

脑膜瘤术后近期预后影响因素分析

目的 探讨影响脑膜瘤患者术后近期预后的相关因素.方法 回顾性研究哈尔滨医科大学附属第一医院自1999年1月至2006年12月收治的953例良性脑膜瘤患者,用出院时患者的生活质量评分(KPS)来评价预后,对患者的年龄,肿瘤部位,肿瘤大小,术前伴有高血压、糖尿病、心脏病及脑梗死,肿瘤切除级别,术中出血量及合并失血性休克、脑膨出等11个因素行单因素x2检验和多因素Logistic回归模型分析,探讨影响脑膜瘤术后患者近期预后的相关因素.结果 患者年龄、肿瘤部位及大小、术前伴有脑梗死、肿瘤切除级别、术中出血量及合并失血性休克预后差异有统计学意义(P＜0.05);且肿瘤大小、术前伴有脑梗死、切除级别、术中合并失血性休克是影响预后的独立危险因素.而术前伴有高血压、心脏病、糖尿病及术中合并脑膨出与预后无关(P＞0.05).结论 患者的年龄、肿瘤的部位和术前合并症都可能影响患者的预后,但肿瘤大小、术前伴有脑梗死、切除级别、术中合并失血性休克是影响预后的独立危险因素.

Abstract：

Objective To study the related factors of early post-operative prognosis of meningiomas. Methods The clinical data of 953 patients with meningiomas were recorded and statistically analyzed withx2 test of single factor and logistic regression model of multivariate factors. Patient age; tumor size; tumor location; pre-operative complication of patients such as hypertension, diabetes, heart disease and cerebral infarction; the extent of tumor resection; hemorrhagic shock; blood loss or hemorrhagic shock and brain swelling intra-operatively were taken as variables. The prognosis was evaluated by postoperative Karnofsky performance scale. Results The prognosis was significantly correlated with the patient age, tumor size, tumor location, preoperative cerebral infarction, the extent of tumor resection, blood loss and hemorrhagic shock intra-operatively ( P ＜ 0. 05 ) . Such factors as tumor size, preoperative cerebral infarction, the extent of tumor resection (Simpson's scale) and intra-operative hemorrhagic shock were independent risk factors of prognosis for meningiomas. Other factors, such as hypertension, diabetes and heart disease, were unrelated with the prognosis of meningiomas ( P ＞ 0. 05 ). Conclusion Patient age,tumor location and pre-operative complications of patients maybe affect the early postoperative prognosis of meningiomas. But such factors as tumor size, preoperative cerebral infarction, the extent of tumor resection and intra-operative hemorrhagic shock are independent risk factors for the post-operative prognosis of meningiomas.     

胃癌胃全切除手术和胃部分切除手术后患者的临床预后情况比较差异探讨

目的：探讨胃癌胃全切除手术和胃部分切除手术后患者的临床预后差异。方法方便选取2014年11月—2015年11月在该院住院治疗的132例胃癌患者,根据手术治疗术式的不同将分为部分切除组(76例)和全切除组(56例),部分切除组患者采取胃部分切除术治疗,全切除组患者采取胃全切除术治疗,并比较两组患者通气时间、术后下床时间、住院时间、术后胃肠道免疫情况以及术后并发症发生率。结果部分切除组患者通气时间、术后下床时间、住院时间、术后CD4+/CD8+和血清白蛋白等分别为(3.0±0.6)d、(1.3±0.4)d、(6.0±1.1)d、(1.5±0.3)、(3.1±0.2)g/L,全切除组患者分别为(3.9±1.2)d、(2.6±1.3)d、(7.9±2.5)d、(1.0±0.1)、(3.8±0.4)g/L,组间比较差异有统计学意义(P﹤0.05)；部分切除组患者术后并发症发生率为3.9%,全切除组患者术后并发症发生率为14.3%,两组比较差异具有统计学意义(P﹤0.05)。结论与胃癌患者实施胃全切除术相比,胃部分切除术有助于减轻患者手术损伤,保证患者肠道免疫功能,减少术后并发症的发生,该方法值得推广应用。     

不同硬膜外给药方式对全子宫切除患者术后镇痛效果的比较

目的　比较不同硬膜外给药方式对子宫切除手术患者术后镇痛效果的影响。方法　对75例择期子宫全切手术的患者 ,随机单盲分为 3组 ,每组 2 5例 ;Ⅰ组为空白对照组 ,切皮前 10min于硬膜外中加用生理盐水 10ml。Ⅱ组切皮前 10min于硬膜外中加用 2 %利多卡因 10ml(其中每ml含芬太尼 2 5 μg) ,后于硬膜外中持续泵入罗哌卡因和芬太尼混合液 (罗哌卡因 0 12 5 % ,芬太尼 2 μg/ml)至手术结束 (速度 9ml/h)。Ⅲ组切皮前 10min于硬膜外中加用 2 %利多卡因 10ml(其中每ml含芬太尼 2 5 μg ,氟哌啶 0 15mg) ,后于硬膜外中持续泵入罗哌卡因和芬太尼的混合液 (罗哌卡因 0 12 5 % ,芬太尼 2 μg/ml) ,至手术结束 (速度 9ml/h)。所有患者均于气管插管全麻下手术。 3组患者均于手术结束后自控硬膜外镇痛 (PCEA) ,微电脑泵为BaxterAP Ⅱ。自控镇痛液为罗哌卡因和芬太尼的混合液 (罗哌卡因浓度 0 12 5 % ,芬太尼 2 μg/ml) ,预充 5ml,背景剂量 3ml/h ,单次自控镇痛 (PCA)剂量 2ml/次 ,锁定时间 10min ,限量 16ml/h ,术后镇痛维持 4 8h。结果　第 1个 2 4h自控镇痛的视觉模拟(VAS)评分静息时Ⅰ组为 2 2分± 1 5分 ,Ⅱ组为 1 4分± 0 78分 ,Ⅲ组为 1 1分± 1 1分 ;Ⅰ组与Ⅱ组比较P <0 0 5 ,I组与Ⅲ组比较P <0 0 1     

鞍结节脑膜瘤的显微手术治疗

目的 探讨显微手术治疗鞍结节脑膜瘤的方法和疗效.方法 对1991年10月至2009年8月收治的56例鞍结节脑膜瘤进行回顾性分析.其中男20例,女36例,年龄32～65岁,平均46岁.采用经额下、翼点、眶颧、眶上锁孔入路切除肿瘤.结果 56例患者中Ⅰ级切除3例;Ⅱ级切除48例;ⅢA级切除3例;ⅣB级切除2例.Ⅰ级和Ⅱ级切除共51例,占91.1%,术后恢复良好者53例,优良率为94.6%;中度残废2例;重度残废1例.结论 大部分鞍结节脑膜瘤可以通过显微外科手术安全、有效、彻底切除;依据肿瘤大小、生长方式,采用不同的手术入路;显微手术可以明显提高肿瘤全切除率,减少手术并发症,降低死亡率.