经腹腔与经腹膜后腹腔镜治疗上尿路尿路上皮癌疗效对比的meta分析

目的 比较经腹腹腔镜肾输尿管切除术(TLNU)和经腹膜后腹腔镜肾输尿管切除术(RLNU治疗上尿路尿路上皮癌患者的手术时间、术中出血量、术后胃肠功能恢复时间、术后住院时间和术后复发及转移情况。方法 在中国知网(CNKI)、万方医学网、维普百科、Pub Med、Embase、Cochrane library等数据库选取符合要求的TLNU和RLNU的比较研究。对文献进行筛选并评估,采用Rev Man 5.3软件进行数据分析。结果共检索文献14篇,样本总量为1 036例,其中TLNU组476例,RLNU组560例。2组患者术后住院时间、术后复发及转移情况比较,差异均无统计学意义(P>0.05);手术时间、术中出血量、术后胃肠功能恢复时间比较,差异均有统计学意义(P<0.05)。结论 对上尿路尿路上皮癌患者采用TLNU治疗拥有更短的手术时间和更少的术中出血量,采用RLNU治疗拥有更短的术后胃肠功能恢复时间,二者术后住院时间、术后复发及转移情况无明显差异,两种术式具有各自的特征,临床医师可根据患者病情选择适合的手术入路方式。     

胆囊切除术后胆漏8例临床分析

<正>胆漏是胆囊切除术常见的严重并发症之一,发生率为0.51%～2.4%,病死率为4%,是肝胆外科医生处理起来最棘手的问题之一。本院自1990年1月-2009年1月在987例开腹胆囊切除术中发生胆漏8例(0.81%)。现就胆漏的相关问题进行分析总结。1临床资料1.1一般资料本组987例开腹胆囊切除术中有8例发生胆漏,女5例,男3例;年龄31～79岁,中位年龄53.1岁。胆囊管     

急性闭合性肠系膜损伤20例诊治体会

1999年6月-2012年12月,我院共收治急性闭合性肠系膜损伤患者20例,诊治体会报告如下。1临床资料1．1一般资料本组20例,男16例,女4例,年龄17～72岁,平均38．6岁。损伤原因：交通事故伤9例,坠落伤4例,挤压伤3例,踢打伤2例,刀刺伤2例。损伤部位：小肠系膜损伤17例,结肠系膜损伤3例。损伤程度：重度撕裂伤7例,失血量〉20％;中度撕裂伤12例,表现为肠管局部缺血;轻度撕裂伤1例,表现为系膜挫伤和较小的系膜血肿。受伤至手术时间：伤后24h内手术12例,24～48h手术6例,48h以上手术2例。合并肝被膜下血肿6例,脾被膜下血肿4例,腹膜后血肿4例,腰椎骨折6例,骨盆骨折4例,四肢骨折8例,肾挫伤4例,颅脑损伤合并Cushing溃疡1例。主要临床表现：腹痛,频繁性呕吐,     

陕西省地震重灾区地方病防治恢复重建工作需求调查

Objective To evaluate the effect of endemic disease prevention in Shaanxi province caused by earthquake and supply a scientific basis for making decision regarding restoration and reconstruction after the earthquake.Methods Forty different drinking water samples were collected respectively from Mianxian county and Chencang district the earthquakes'most severely hit areas in Shaanxi province with drinking-water-borne fluorosis.The contents of fluorine and arsenic in the water was detected by Fluoride ion-selective electrode and hydride generation atomic fluorescence spectrometry,respectively.Two hundreds iodized salt and urine samples were collected from affected household women aged 18-45 in severely hit Ningqiang and Lveyang countie with iodine deficiency disorders.The contents of iodine in the salt was detected by semi-quantitative and of urinary iodine of household women was determined by AsⅢ-Ce4+ catalytic spectrophotometry.Two hundred children aged 7-12 were detected by clinical and X-ray examination from Ningqiang and Lveyang counties of Kashin-Beck disease prevailing areas.Hair and food samples from 20 children were collected.The contents of selenium were determined by 2,3-Diamino naphthalene fluorescence spectrophotometry and of T-2 toxin in the food was detected by ELISA.Results No incidents of serious hydrologieM or geological damage were found.Fluoride content in one of eighty water samples was beyond 1.5 mg/L,accounting for 1.25%;five samples were between 1.0 mg/L and 1.5 mg/L,accounting for 6.25%:the arsenic content of all samples were below 0.01 mg/L;all the salt samples from the home of household aged 18-45 were iodine salt,the median of urine iodine of household wonlen Was 303.03μg/L (21.40-1133.54 μg/L) and 325.21 μg/L(27.61 - 1191.46 μg,/L) in Ningqiang and Lveyang counties, respectively.No clinical and X-ray patients were found in the children aged 7 - 12, the average content of selenium in hair was (0.2638 ± 0.0875)mg/kg; the content of T-2 toxin in the forty food samples was below 100 μg/kg. Conclusions The prevention of the endemic disease in the four counties has been moderately affected by the earthquake, but the situation of endemic disease is stable and there is no evidence of the endemic disease.     

健胃左金丸治疗胃炎150例

采用清泄肝胃之火,平降肝胃之气法自拟健胃左金丸(黄连、生大黄、吴萸、半夏、佛手、柴胡)治疗肝胄郁火型胃炎150例,总有效率96％。提示本方有杀灭或抑制幽门螺杆菌的作用。     

纳络酮在重度酒精中毒院前急救中的应用

目的评价纳络酮对重度酒精中毒患者在院前急救中的疗效及安全性。方法对院前急救中重度酒精中毒患者60例,在现场常规治疗的基础上,给予静脉滴注盐酸纳洛酮2mg。观察起效时间、血氧饱和度(SpO2)、清醒时间等临床效果及有无不良反应。选择既往50例仅予常规治疗的急性重度酒精中毒患者作为对照组,进行比较分析。结果应用纳洛酮后,SpO2恢复至95%以上时间为(6.1±1.4)min,清醒时间为(16.5±4.3)min,对照组SpO2恢复至95%以上时间为(8.4±1.5)min,清醒时间为(25.4±3.1)min。两组比较具有统计学差异(P<0.05)。结论纳洛酮在院前急救中治疗急性重度酒精中毒的疗效明显,且无明显的不良反应。     

肾上腺皮质癌2例报道并文献复习

目的:探讨肾上腺皮质癌临床诊疗过程中的特征,以期提高对该病的认识。方法:回顾性分析我院两例肾上腺皮质癌患者的临床资料,并检索中国知网、万方、Pubmed等数据库,对相关文献进行系统性分析,归纳其临床特点。结果:本组患者1例行肾上腺肿物开放手术,术后一个月行放疗,行骨扫描,提示多发骨转移,给予抗骨转移治疗,术后5个月复查,提示肾周多发转移,以密妥坦口服抗肿瘤治疗,术后2年患者死亡;1例行腹腔镜肾上腺肿物切除术,术后病理提示伴肝转移,术后三个月复查:肝区占位,考虑肝转移,以密妥坦口服抗肿瘤治疗,随访5个月,疾病未进一步进展。结论:肾上腺皮质癌是一种罕见的泌尿系肿瘤,有些无特异临床表现。肾上腺皮质癌的诊断应该结合临床表现,肾上腺内分泌检查,如雄激素和皮质醇等,再同时结合影像学资料,金标准依靠病理学。治疗应以手术切除为首选,对于难以切除的肾上腺皮质癌可行辅助化疗、放疗、免疫治疗、靶向治疗等治疗。     

健胃左金丸治疗胃炎150例

笔者于1999年元月开始运用自制胃痛定散为主结合中药汤剂辨证施治治疗胃痛(胃脘痛)，获得较好疗效，现报告如下。     

多发伤患者血清促炎介质水平与创伤预后的相关性

目的 探讨在多发伤患者发病过程中TNF-α、IL-8、C反应蛋白(CRP)、铜蓝蛋白(CER)的变化及其与创伤预后的相关性.方法 选择100例多发伤患者,根据ISS,将其分为轻伤组(ISS＜16分),重伤组(16分≤ISS＜25分),严重伤组(ISS≥25分).在入院后各时段测定其血清TNF-α、IL-8、CRP、CER的水平,比较各组的差异及其对预后的影响.结果 血清TNF-α、IL-8、CRP、CER在伤后早期即升高,4～7 d后达高峰.各组促炎介质水平若下降后再升高,则预示创伤感染或其他并发症将发生.结论 ISS的增高与致炎因子血清水平增高呈明显的正相关,通过测定TNF-α、IL-8、CRP、CER水平有助于对创伤并发症和预后的判断.     

李永成运用“开心气，泻肝气”法治疗胃痞病肝郁气滞证经验

胃痞病是一种常见的脾胃病,常反复发作,影响患者生活质量。李永成教授认为,胃痞病病位在脾、胃,与脾、胃、心、肝等多个脏腑密切相关,病机关键在于心气郁、肝气结、脾胃升降功能失常,进而引发胃痞病。李永成教授应用“开心气,泻肝气”法治疗胃痞病肝郁气滞证,开心气之郁,散肝气之结,以平调脾胃,疗效显著。