腹腔镜辅助根治性右半结肠切除术的临床应用

目的 探讨腹腔镜辅助根治性右半结肠切除术的手术路径和安全性及可行性.方法 2004年2月-2007年10月对26例结肠癌患者行腹腔镜辅助根治性右半结肠切除术,按照清扫血管根部淋巴结、处理系膜血管、游离右半结肠系膜和肠管、体外切除病变肠管并吻合的手术路径进行手术,并对患者临床资料和随访情况进行分析.结果 25例手术在腹腔镜下顺利完成,中转开腹1例.平均手术时间(1 58±32)min,平均出血量(97±39)mL.辅助切口平均长(5.7±1.8)cm,术后第1天VAS评分(5.8±1.4),排气排便平均时间(46.5±4.8)h.清除淋巴结的平均数(14.6±8.4)枚,术后平均住院时间(8.5±3.3)d.辅助切口感染率4%(1/25),无术后并发症.术后25例患者中3例失访,余随访2～46个月,2例结肠癌患者肝转移死亡.随访患者腹壁穿刺孔及辅助小切口均无肿瘤种植和肠梗阻发生.结论 腹腔镜辅助根治性右半结肠切除术是安全可行的,具有微创手术的优越性,手术近期疗效满意.     

全结肠系膜切除概念下腹腔镜右半结肠癌根治术25例临床分析

目的 探讨全结肠系膜切除（CME）概念下的腹腔镜中间入路右半结肠癌根治术的可行性.方法 回顾性分析25例行CME概念下腹腔镜中间入路右半结肠癌根治术患者的临床资料.结果 手术均取得成功,无中转开腹.手术时间147～251 min,平均（186±35）min;术中出血量50～120ml,平均（77±24）ml;淋巴结清扫13～30枚,平均（20±5）枚;术后住院时间10～15 d,平均（12.0±2.2）d.术后3例患者出现并发症,无手术后死亡.随访4～22个月,未发现肿瘤复发或转移.结论 CME概念下的腹腔镜中间入路右半结肠癌根治术具有创伤小、术中出血少、术后疼痛轻及康复快等优点,安全可行的,值得临床推广使用.     

腹腔镜下内侧入路行右半结肠切除术治疗右半结肠癌的疗效观察

目的 探讨腹腔镜下内侧入路行右半结肠切除术治疗右半结肠癌的临床疗效.方法 对46例右半结肠癌患者均采用腹腔镜下内侧入路行右半结肠切除术.所有肠系膜分离、肠系膜血管的处理和淋巴结清扫均在腹腔镜下完成,肠段的切除和吻合通过腹部小切口完成.结果 平均手术时间(166±21.8)min,术中平均出血量(75.65±23.85)mL,平均辅助切口长度(5.8±0.9)cm,平均淋巴结清扫数目(16.7±3.5)个.术后平均肠道排气时间(67.4±11.3)h,平均住院时间(10.7±1.8)d.无中转开腹.无术中和术后并发症发生.46例患者术后随访12～36个月,平均22.6个月,无癌肿复发及死亡病例.结论 腹腔镜下内侧入路行右半结肠切除术治疗右半结肠癌近期疗效较好.     

腹腔镜技术在大肠癌手术中的应用

目的探讨腹腔镜大肠癌手术的安全性、根治性和存在的问题。方法回顾性分析2001年12月~2005年12月106例腹腔镜大肠癌手术。其中,腹腔镜Miles术25例、Dixon术17例、乙状结肠癌根治术10例,手助腹腔镜右半结肠切除术52例、左半结肠切除术2例。结果腹腔镜手术成功率83.1%(88/106),中转开腹率16.9%(18/106)。术中和术后并发症的发生率均为2.8%(3/106),无手术死亡病例。直肠癌(或肛管癌)平均清扫13.5枚淋巴结,结肠癌平均清扫23.4枚淋巴结。平均随访18.6个月,无腹壁穿刺孔或切口肿瘤复发。结论只要正确掌握适应证,严格遵循肿瘤根治原则,腹腔镜大肠癌手术是安全、有效的。     

肠系膜上静脉外科干解剖在右半结肠切除术中的应用

根治性右半结肠癌切除术的淋巴结清扫范围仍存在争议。近年来,一些作者报道,广泛的淋巴结清扫直至主淋巴结（第三站）,可以改善右半结肠癌患者的预后。右半结肠癌的D3根治术已被Et本外科医师接受为标准的右半结肠癌术式。但是由于第三站淋巴结清扫必须解剖及清扫肠系膜上静脉外科干,还涉及到胰腺、十二指肠等重要的脏器,导致手术者往往放弃对第三站淋巴结的清扫。本研究对18例右半结肠癌患者采用改良的右半结肠癌D3根治术,术中清晰解剖肠系膜上静脉外科干,整块移除肿瘤组织和淋巴结,取得良好的结果,现报道如下。     

腹腔镜下完整结肠系膜切除术与传统结肠癌根治术治疗右半结肠癌的对比研究

目的探讨腹腔镜下完整结肠系膜切除术(CME)和传统开腹结肠癌根治术治疗右半结肠癌的疗效及安全性。方法回顾性分析本院接受腹腔镜下完整结肠系膜切除(CME组)的右半结肠癌患者32例与同期接受传统结肠癌根治术(对照组)的右半结肠癌患者30例的临床资料。观察记录两组手术相关情况(手术时间、术中出血量、术后排气时间、进食时间、住院时间等);比较两组患者淋巴结清扫数量及术后并发症情况。结果 CME组淋巴结清扫数量为(24.8±5.8)枚,多于对照组的(21.7±4.6)枚,两组比较,差异有统计学意义(P0.05)。CME组术后肛门排气时间、术后进食时间、术后并发症以及术后住院时间均少于对照组,差异有统计学意义(P0.05)。两组手术时间、术中出血量对比,差异无统计学意义(P0.05)。结论 CME组术后恢复更快于对照组,CME组能切除更大范围的结肠系膜组织,清扫更多的淋巴结,根治肿瘤更彻底,但并不增加手术时间和风险,腹腔镜下CME手术安全可行,疗效确切。     

腹腔镜结直肠肿瘤根治术23例临床分析

目的观察腹腔镜结直肠肿瘤根治术治疗结直肠肿瘤的临床效果。方法将23例结直肠肿瘤患者根据肿瘤部位的不同行相应的腹腔镜结直肠肿瘤根治术。结果本组23例患者全部顺利完成腹腔镜结直肠肿瘤切除术,无中转开腹手术;手术时间130~245(164±36)min;术中失血量50~300(120±40)mL;结肠清扫淋巴结数目为11~24(16±3)枚;直肠清扫淋巴结数目为4~15(9±2)枚;术后肠功能恢复时间32~60(40±12)h。术后患者发生切口感染2例,所有患者未出现术后出血、吻合口漏等并发症,总体并发症发生率为8.70%(2/23)。所有患者顺利出院,围术期无患者死亡。术后22例患者获得随访,随访时间6~28个月,因腹腔广泛转移衰竭而死亡2例,其余20例未出现复发及远处转移。结论腹腔镜行结直肠肿瘤切除术安全可行,疗效理想,值得推广应用。     

腹腔镜下结直肠癌根治术的临床分析（附45例报告）

目的 探讨腹腔镜结直肠癌根治术的临床效果.方法 回顾性分析我院自2004年10月至2008年10月45例腹腔镜结直肠癌根治术患者的临床和病理资料.结果 全组均在腹腔镜下完成,行腹腔镜下Dixon术15例,Miles术3例,乙状结肠癌根治术14例,降结肠癌根治术4例,右半结肠切除9例,同时行腹腔镜胆囊切除术4例,再加回肠憩室切除1例.45例结直肠癌患者淋巴结清扫均达第3站.手术时间330～150 min.手术出血量从10～200 mL,术后排气时间36～120 h,平均59 h(2.46 d).术后两切缘均未见癌,淋巴结清扫数4～30枚,平均15.28枚,其中3例第3站淋巴结阳性.术后至出院平均天数8.25 d.术后至今均获随访,最长已4年.42例术后至今无复发,肝转移复发2例,1例已死亡.无局部、腹盆腔淋巴结转移复发和切口种植等.结论 腹腔镜结直肠癌根治术具有微创、安全、切口小、视野清、恢复快等特点,优势显著.     

腹腔镜辅助胃癌根治术45例分析

目的 探讨腹腔镜辅助胃癌根治术在胃癌治疗中的临床应用.方法 回顾性分析45例接受腹腔镜辅助胃癌根治术的胃癌患者的临床资料.结果 除1例中转开腹手术外,其余44例均在腹腔镜下完成胃切除和D2式淋巴结清扫,其中腹腔镜远端胃切除术41例,全胃切除术3例.手术时间为(190.5±60.5) min,术中失血(124.5±106.5) mL,术后排气时间(2.9±1.0)d,术后住院天数为(11.3±5.6)d,3例(6.67％)患者出现胃瘫,经非手术治疗后痊愈.手术平均清扫淋巴结(22.34±12.6)枚.术后随访3～12个月,均无肿瘤复发和远处转移.结论 腹腔镜胃癌根治术是治疗胃癌安全、可行、微创、有效的手术方法.     

以肠系膜上动脉为导向的腹腔镜下完整结肠系膜切除治疗右半结肠癌的可行性及近期效果

目的探讨以肠系膜上动脉（SMA）为导向的腹腔镜下完整结肠系膜切除（CME）治疗右半结肠癌的可行性及近期效果。方法2018年5月至2021年2月树兰（杭州）医院肛肠外科同一手术组对32例右半结肠癌患者实施尾侧入路、以SMA为导向的腹腔镜下右半结肠癌CME术，观察并分析患者的术中情况、术后病理检查结果、术后恢复情况及随访结果。结果32例右半结肠癌患者均顺利完成手术，手术时间195.0（172.5，210.0）min；术中出血量50.0（31.3，60.0）ml；淋巴结清扫数目25（17，42）枚，其中单独送检SMA周围淋巴结3（2，4）枚，有1例患者出现淋巴结转移（2/4枚）；术后病理分期Ⅰ期（T2N0M0）4例，Ⅱ期15例，Ⅲ期13例，与术前临床分期符合率78.1%。术后乳糜漏、胃瘫等并发症总发生率为18.8%。术后30d内无再入院患者。术后28例患者获得2~36个月的随访，期间有2例出现肝脏转移，目前仍在治疗中；2例患者出现多发远处转移而死亡；其余24例患者（包括1例SMA周围淋巴结转移患者）均健康生存。结论以SMA为导向的腹腔镜下CME治疗右半结肠癌安全可行，近期效果良好。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.