腔镜交通静脉结扎治疗原发性下肢慢性静脉功能不全的中长期疗效观察

目的 探讨腔镜交通静脉结扎对治疗CEAP分级CA ～ C6级的下肢慢性静脉功能不全的中长期疗效.方法 回顾性分析82例慢性静脉功能不全患者的临床资料,根据治疗方式的不同分为A、B2组:A组为交通静脉结扎组(SEPS组),B组为非交通静脉结扎组(非SEPS组).所有患者根据临床症状体征及彩超或顺行性静脉造影确诊,术后CEAP临床分级、CEAP临床症状评分、累积溃疡愈合率及累计溃疡复发率评估两组不同手术方式的疗效.结果 术前2组患肢的CEAP临床分级、CEAP临床症状评分差异无统计学意义(P＞0.05).术后2年,A、B组患肢肿胀、脂肪硬化症及静脉性溃疡等症状CEAP临床分级差异有统计学意义(P＜0.05).术后3、5年,A组肿胀、愈合性溃疡、活动性溃疡患肢少于B组(P＜0.05).A组与B组术后总临床症状评分差异有统计学意义,A组肿胀、色素沉着、溃疡等症状缓解明显优于B组(P＜0.05).Kaplan-Meier分析,2组的溃疡的中位愈合时间分别为2.3、3.7个月;Log-rank检验对组间累积溃疡愈合率远期差异敏感(x2=4.063,P=0.044);而Breslow检验对组间累积溃疡愈合率近期差异敏感(x2=5.471,P=0.019).术后A组患肢累积溃疡愈合率显著高于B组(P＜0.05),而B组累积溃疡复发率显著高于A组(P＜0.05).结论 浅静脉切除联合交通静脉结扎显著增强临床疗效,促进溃疡愈合,中长期溃疡复发率明显降低,疗效优于单纯浅静脉手术.     

内镜筋膜下交通静脉结扎治疗慢性下肢静脉性溃疡的临床体会

目的:探讨内镜筋膜下交通静脉结扎术(subfascial endoscopic perforator surgery,SEPS)治疗慢性下肢静脉性溃疡的临床效果。方法:回顾分析78例,86条下肢慢性静脉性溃疡患者行内镜深筋膜下交通静脉离断+大隐静脉高位结扎并抽剥术的临床资料。结果:患者术后均恢复良好,浅静脉曲张消失,溃疡愈合,未发生明显并发症,随访1~3年,无皮肤溃疡及浅静脉曲张复发。结论:大隐静脉高位结扎剥脱术+SEPS治疗下肢静脉性溃疡有效,患者创伤小、康复快,效果好。     

SEPS联合大隐静脉结扎剥脱术治疗中度下肢慢性静脉功能不全

目的评估腔镜筋膜下静脉交通支离断术(subfascial endoscopic perforator surgery,SEPS)联合大隐静脉高位结扎剥脱术治疗中度慢性下肢静脉功能不全(chronic venous insufficiency,CVI)的疗效。方法对34例患者共48条中度CVI患肢实施SEPS联合大隐静脉高位结扎剥脱手术(联合手术组),以同期单纯实施大隐静脉高位结扎剥脱手术的34例患者共49条中度CVI患肢(单纯手术组)作为对照,观察比较两组术后3月和12月的疗效。结果术后3月联合组和单纯组患肢症状改善和皮肤营养不良改善情况相似,组间比较无统计学差异(95.83%vs.93.88%,χ2=0.19,P>0.05;83.33%vs.79.59%,χ2=0.23,P>0.05),近期均无静脉曲张复发和溃疡形成。术后12月联合手术组和单纯手术组患肢症状改善者分别占97.92%和89.80%,组间比较差异无统计学意义(χ2=2.76,P>0.05);但皮肤营养不良改善者分别占87.50%和67.35%,组间差异有统计学意义(χ2=5.62,P<0.05);下肢静脉复发率分别为0%和10.20%,组间差异有统计学意义(P=0.03,P<0.05);下肢溃疡形成,两组分别为0%和4.08%,组间比较无统计学差异(P=0.26,P>0.05)。结论 SEPS联合大隐静脉高位结扎剥脱手术治疗中度CVI患者,较单纯大隐静脉高位结扎剥脱手术的远期效果更佳,能显著改善患者皮肤营养状况,预防静脉曲张的复发,更适合中度CVI患者。     

下肢静脉性溃疡的综合性手术治疗

目的探讨下肢静脉性溃疡综合性手术治疗的价值。方法总结38例(43条肢体)下肢静脉曲张合并静脉性溃疡患者手术治疗的临床资料。全部患者术前都行顺行性深静脉造影。所有患肢均行浅静脉手术和溃疡周围曲张浅静脉缝扎术,其中8条患肢加行深静脉瓣膜修补术,17条患肢加行腔镜深筋膜下交通静脉结扎术即SEPS,9条患肢加行深静脉瓣膜修补术和SEPS。结果术后所有患者的症状消失,溃疡愈合,小腿皮肤的湿疹或色素沉着明显减轻。术后6个月随访,有6条患肢出现溃疡复发,加行SEPS治疗后溃疡愈合。术后1～2年随访,均无静脉性溃疡复发。结论下肢静脉性溃疡是深、浅静脉和交通静脉功能不全共同作用的结果。在治疗下肢静脉性溃疡时,应同时纠正每个静脉系统的功能不全,尤其是交通静脉功能不全。     

股浅静脉瓣膜环形缩窄术治疗原发性下肢深静脉瓣膜功能不全疗效评价

目的　评价股浅静脉瓣膜环形缩窄术治疗原发性下肢深静脉瓣膜功能不全的疗效和应用价值。方法　 97例 (97侧肢体 )经静脉顺行造影证实为原发性下肢深静脉瓣膜功能不全的患者分为A、B两组 ,A组 79例 ,B组 18例。A组行大隐静脉高位结扎剥脱术加交通支结扎术同时行股浅静脉瓣膜环形缩窄术 ,B组仅行大隐静脉高位结扎剥脱术加交通支结扎术。以CEAP临床分类与临床记分和顺行性下肢静脉造影评价疗效。结果　A、B两组术后临床记分均明显下降 (A组P <0 0 1;B组P <0 0 5 )。A组中C5～C6者手术效果较C2 ～C4者好 ;两组C2 ～C4者比较 ,A组手术效果优于B组。术后A组中 6 7侧患肢行顺行性下肢静脉造影 ,瓣膜功能恢复有效率为 83 5 8% (5 6 /6 7) ,显效率为 4 1 79% (2 8/6 7) ;B组 12侧患肢股浅静脉瓣膜功能恢复有效率为 33 33% ,两组有效率比较 ,有显著性差异 (P <0 0 5 )。结论　大隐静脉高位结扎加交通支结扎加股浅静脉瓣膜环形缩窄术 ,较大隐静脉高位结扎加交通支结扎术更有助于临床症状缓解和瓣膜形态功能的恢复。术前明确诊断为原发性下肢深静脉瓣膜功能不全患者 ,宜行股浅静脉瓣膜环形缩窄手术。     

内镜筋膜下交通静脉离断术治疗重度下肢静脉曲张:前瞻性随机对照研究并中期随访

目的评价内镜筋膜下交通静脉离断术(subfascial endoscopic perforator surgery,SEPS)治疗重度下肢静脉曲张的临床效果。方法前瞻性单中心随机对照试验。2012年6月～2014年11月,将60例重度下肢静脉曲张(CEAP分类C5或C6)随机分为A组和B组,每组30例。A组采取传统的大隐静脉高位结扎并剥脱术,B组行SEPS+传统大隐静脉高位结扎并剥脱术。术后随访4年,随访内容包括术后并发症、溃疡复发及静脉临床严重度评分(Venous Clinical Severity Score,VCSS)。结果 2组术后下肢浅静脉曲张消失,活动性溃疡全部愈合。A组术后皮下血肿1例,皮肤淤血2例,随访率90. 0%(27/30),术后4年下肢溃疡复发率25. 9%(7/27),VCSS评分由术前的(13. 2±2. 7)下降至(6. 1±1. 4)(t=12. 687,P=0. 000)。B组术后胫前麻木2例,皮肤淤血1例,随访率93. 3%(28/30),术后4年下肢溃疡复发率21. 4%(6/28),VCSS评分由术前(13. 6±2. 7)下降至(6. 2±1. 4)(t=13. 041,P=0. 000)。2组术后并发症发生率、术后4年溃疡复发率和VCSS评分差异无统计学意义(P 0. 05)。结论大隐静脉高位结扎并剥脱术附加SEPS治疗重度下肢静脉曲张疗效满意,但并不优于单独行大隐静脉高位结扎并剥脱术。     

下肢慢性静脉性溃疡的治疗和护理

目的 探讨治疗下肢慢性静脉溃疡有效、简单的方法.方法 采用筋膜下交通静脉结扎术(SEPS)结扎交通支静脉和静脉旋切技术(TriVex)清除表浅曲张静脉,配合局部使用新型的保湿敷料处理创面治疗下肢静脉性溃疡.结果 36例共42条患肢经手术治疗患肢酸胀感消失,曲张的浅静脉消失,全部静脉性溃疡创面在7～32天内愈合.随访4～16个月,无溃疡复发.结论 运用SEPS和TriVex技术配合创面局部使用新型的保湿敷料治疗下肢慢性静脉性溃疡,并发症少,创面愈合快.     

内镜交通支离断术联合中医综合方法治疗下肢静脉性溃疡

目的:探讨内镜交通支离断术联合中医综合治疗下肢慢性静脉性溃疡的疗效;方法:对40例共51条静脉性溃疡患肢在内镜下行交通支静脉离断术加大隐静脉高位结扎术,术后联合中医综合治疗。结果:患肢浅静脉曲张基本消失,临床症状缓解,溃疡在术后1个月内愈合或好转,总有效率96.1%,术后CEAP临床评分较术前明显好转(P0.05),随访1年无复发。结论:内镜下交通支静脉离断术联合中医综合治疗下肢静脉性溃疡术后并发症少,复发率低。     

腔镜深筋膜下交通支结扎+溃疡周围环缝术治疗慢性下肢静脉性溃疡23例

目的 探讨腔镜深筋膜下交通支结扎（SEPS）＋溃疡周围环缝术联合治疗慢性下肢静脉性溃疡的临床疗效。方法 2004年3月至2006年9月对23例慢性下肢静脉性溃疡患者实施SEPS＋溃疡周围环缝术（联合治疗组）。另有SEPS组（19例）和溃疡周围环缝组（30例）作对照。所有病例均行常规大隐静脉高位结扎＋剥脱术。结果 联合治疗组溃疡于术后12～60d愈合,平均25．7d;SEPS组于术后18～90d愈合,平均35．1d;溃疡周围环缝组于术后21～90d愈合,平均47．3d,各组间差异均有统计学意义（P〈0．05）。3组间复发率比较,差异无统计学意义（P〉0．05）。结论 SEPS＋溃疡周围环缝术能够有效地治疗慢性下肢静脉性溃疡,2个术式联合应用其溃疡愈合时间较单独应用缩短。     

经内镜结扎交通静脉治疗慢性下肢静脉性溃疡

目的 探讨内镜深筋膜下交通静脉结扎术（SEPS）治疗慢性下肢静脉性溃疡的疗效。方法 SPES治疗11例（11条）慢性下肢静脉性溃疡病人,（CEAP）分型：V型7例,Ⅵ型4例。手术方法用腹腔镜行SEPS、股浅静脉第一瓣膜缩窄术和浅静脉高位结扎术加抽剥术。结果 术后肢体症状和浅静脉曲张消失。11例溃疡均在4－6周内愈合。结论 SEPS是治疗慢性下肢静脉性溃疡的有效方法,损伤小,并发症少,溃疡愈合快,且能改善下肢外观。具有腹腔镜设备的医院都能开展该手术。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.