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老年人急性胆囊炎急诊腹腔镜胆囊切除术时机探讨 总被引：1，自引：0，他引：1
目的：探讨老年人急性胆囊炎急诊腹腔镜胆囊切除术（LC）的可行性及时机。方法：回顾分析86例65岁以上老年人急性胆囊炎急诊LC的临床资料。结果：成功完成LC83例,中转开腹3例,中转开腹率3.49%;无肝外胆管损伤等严重手术并发症发生。发病48h内行LC42例,全部完成LC,无手术并发症;发病48-72h行LC24例,中转开腹1例,术后并发毛细胆管漏1例;发病72h以上行LC20例,中转开腹2例,术后并发毛细胆管漏2例,一过性黄疸2例,全身皮下气肿2例,并发症发生率为30%。全组患者均痊愈出院。结论：老年人急性胆囊炎经合理围手术期处理可安全完成LC,发病48h内行LC成功率高。LC较开腹手术更易治疗伴发病。 相似文献
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本文收集了近五提内以急性胆囊炎或合并胆石症住院,既往或近期又有胃切除手术史者35例。作者认为胃术后发生老性胆囊炎音大多数为男性,其中老年胃术后易发生胆道病,并且提出胃术后胆囊炎病理改变均是破坏性变化(蜂窝织炎性改变)。亦认为其发生与下列因素有关:(1)迷走神经肝支损伤;(2)内源性的 CCK(胆囊收缩素)明显减少;(3)胆囊动脉损伤;(4)近端空肠袢过短或过长影响胆汁排出;(5)胃术后胆囊排空障碍,易形成胆泥;(6)胃酸分泌降低,胃液杀菌作用减弱,易发生逆行感染。主张此类病人应以早期手术为主要治疗原则,并提出预防办法。 相似文献
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吕涛 《赤峰学院学报(自然科学版)》2015,(13)
目的：比较经桡动脉和经股动脉介入治疗冠心病的临床疗效和优势.方法：收集2009年10月至2012年3月于我院接受冠心病介入手术治疗的78例患者,其中48例患者接受经桡动脉介入手术（为经桡动脉组）,30例患者接受经股动脉介入手术（为经股动脉组）,比较两种术式患者的平均穿刺时间、术中动脉痉挛发生率、手术成功率及术后并发症.结果：经桡动脉组患者平均穿刺时间较经股动脉组时间长（P＜0.05）,且术中动脉痉挛发生率较经股动脉组高（P＜0.01）,两组手术成功率无显著性差异（P＞0.05）,但经桡动脉组的术后并发症远低于经股动脉组（P＜0.01）.结论：经桡动脉介入手术治疗冠心病创伤小、并发症少、住院时间短,是一种安全可行的介入术式,值得临床推广和应用. 相似文献
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徐忠 《河北北方学院学报(医学版)》2005,22(6):47-49
目的:探讨急性胰腺炎的治疗方法及手术方式、手术时机.方法:总结收治的急性胰腺炎132例,其中16例符合重症急性胰腺炎诊断标准.治疗采用单纯内科保守治疗124例,手术8例.手术方法有胰腺坏死病灶清创、切除,胰腺周围引流术,胰腺被膜切开减压加胰腺周围引流术,脓肿或囊肿引流术,单纯胆囊切除术;胆囊切除术加胆总管探查引流术,胆囊切除术、胆总管探查引流术加胰腺周围引流术等.结果:治愈好转率97.1%(129/132),其中重症急性胰腺炎治愈好转率81.3%(13/16);死亡或病情恶化自动出院3例,死亡率18.7%(3/16).结论:急性胰腺炎的治疗应全面而有系统,并在病程的各个阶段采取不同的治疗措施.应注意早期联合使用能穿透血胰屏障的抗生素.TPN虽不能改善重症急性胰腺炎本身的病理进程,但可帮助患者缩短恢复期.及时的手术可排出有害的酶性液体、清除胰腺周围坏死和感染组织,减少并发症的发生.对合并胆囊结石或胆总管结石者,应根据胰腺炎不同的病理类型选择适当的手术时机. 相似文献
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腹腔镜胆囊切除术(Laparoscopic Cholecystecto-my,LC)已成为治疗胆囊良性病变的金标准[1]。其具有创伤小、患者痛苦小、住院时间短、脏器功能恢复快等优点,但如何对腹腔镜胆囊切除术中复杂胆囊情况进行处理,以尽可能减少手术创伤和术后并发症是行LC时所必须面临的问题,现将我院经验总结如下。1资料及方法1.1一般资料本组64例,男23例,女41例。年龄32~76岁,中位数49.5岁。平诊手术27例(42.2%),其中慢性结石性胆囊炎12例,胆囊隆起性病变5例,萎缩性胆囊炎10例;急诊手术37例(57.8%),均为胆囊结石并急性化脓性或坏疽性胆囊炎。1.2手术处理1.2.1出血:⑴胆囊动脉脆性大、易断裂:分离胆囊动脉时拉断3例,胆囊动脉上的钛夹脱落1例。处理:分离胆囊动脉时不过分强调血管骨骼化,分离时尽量贴近胆囊,断裂后及时补夹钛夹;⑵胆囊动脉变异:双胆囊动脉3例,解剖变异4例。处理:因胆囊动脉走行变异,胆囊动脉远段走行在胆囊壁上,应靠近胆囊壁处结扎;⑶胆囊床出血:急性炎症毛细血管扩张,肝硬化时胆囊床有小血管出入肝实质,多有明显渗血,部分渗血在胆囊取出后自止,部分渗血用电灼止血;肝硬化渗血明... 相似文献
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王伟 《河北北方学院学报(医学版)》1998,(3)
肝外胆道的损伤或狭窄是胆道手术中或手术后最严重的并发症,其发生率为千分之二,其中90％继发于胆囊切除术,5％发生于胆道探查术,3％是胃大部切除术的并发症,其余2％可能继发于十二指肠、胰腺等手术。现就一例胆道严重损伤吸取的经验教训总结如下: 病历:患者女性29岁、主因右下腹持续性疼,伴有恶心呕吐两天,在当地医院按急性阑尾炎收住院。并于当晚在连续硬膜外麻醉下行阑尾切除术。取右下腹探查切口,术中见阑尾正常,右下腹可见少量淡黄色渗液,胆囊明显肿大,张力高颈部嵌顿结石一枚。术中诊断胆囊结石、急性化脓性胆囊炎,即向上延长切 相似文献
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腹腔镜胆囊切除术(LC)日趋普及,手术适应症逐渐扩大。我院自1997年开展LC以来,对21例胆囊结石嵌顿完成了LC,报告如下: 1 临床资料 一般资料:本组21例,女19例,男2例,年龄28-63岁,结石嵌顿并发胆囊炎3例,慢性胆囊炎18例(其中胆囊积脓型4例)。术后住院24-48小时,无胆汁瘘及腹腔内感染发生,无手术后死亡病例。 手术方法:常规四孔法进入腹腔,胆囊因结石嵌顿积液肿大,内压增高,为了便于无创 相似文献
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李春海 《河北北方学院学报(医学版)》2005,22(4):43-44
目的:利用人脐带血干细胞移植治疗兔急性心肌缺血,探索防治缺血性心脏病的新方法.方法:新西兰白兔40只,雌雄不拘.随机等分为实验组和对照组.两组均结扎冠状动脉左前降支中1/2,复制心肌梗死模型.缺血60min后将0.3ml的108/ml人脐带血干细胞注射到实验组兔的缺血区心肌组织,对照组兔缺血区心肌组织中注射等体积的人静脉血.3周后观察心功能、心肌梗死面积和心肌生化指标.结果:实验组的LVSP和左心室最大变化速率均明显高于对照组(P＜0.01),而LVEDP显著低于对照组(P＜0.01).实验组的心肌梗死面积明显小于对照组(P＜0.01),血清CK和MDA的含量也显著低于对照组(P＜0.01),SOD含量则明显高于对照组(P＜0.05).结论:人脐带血干细胞移植能够明显改善兔急性心肌缺血的心功能,减轻氧自由基对心肌的损伤,缩小心肌梗死面积. 相似文献
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目的：探讨腹腔镜胆囊切除术与开放胆囊切除术治疗胆囊结石的临床疗效。方法：选择2010年1月至2013年7月收治的胆囊结石患者共90例作为研究对象,按照治疗方式将其分为腹腔镜胆囊切除术（LC）组和开腹胆囊切除术（OC）组,比较两组患者疗效。结果：LC组手术时间、术中出血量、抗生素使用时间、胃肠功能恢复时间以及住院时间等围手术期指标均明显优于OC组（P〈0．05）;LC组并发症发生率为0．1％,OC组并发症的发生率3％,LC组并发症的发生率明显低于OC组（P〈0．05）。结论：腹腔镜胆囊切除术治疗胆囊结石术中出血少,术后恢复快,住院时间短,是一种安全可靠的治疗方式。 相似文献
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AMI患者PCI术对血浆BNP水平变化的初步临床观察 总被引：1，自引：0，他引：1
目的:观察PCI术对AMI患者血浆中BNP的水平变化,初步探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对20例AMI患者PCI治疗前后和20例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在AMI患者PCI术与对照组比较有显著性差异(P＜0.05),PCI治疗后呈明显下降趋势.结论:AMI患者PCI治疗血浆BNP水平变化说明PCI术能对改善AMI患者的预后有重要意义. 相似文献
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Xi-ping ZHANG Guang-hua FENG Jie ZHANG Yang CAI Hua TIAN Xiao-feng ZHANG Yi-feng ZHOU Zhi-wei WANG Ke-yi WANG 《Journal of Zhejiang University. Science. B》2009,10(3)
Objective: To investigate the therapeutic effects and mechanisms of Salvia miltiorrhizae (Danshen) in the treatment of severe acute panereatitis (SAP)- or obstructive jaundice (OJ)-induced heart injury. Methods: A total of 288 rats were used for SAP-(n=108) and O J-associated (n=180) experiments. The rats were randomly divided into sham-operated, model control, and Salvia miltiorrhizae-treated groups. According to the difference of time points after operation, SAP rats in each group were subdivided into 3, 6 and 12 h subgroups (n=12), whereas OJ rats were subdivided into 7, 14, 21, and 28 d subgroups (n=15). At the corre-sponding time points after operation, the mortality rates of the rats, the contents of endotoxin and phospholipase A2 (PLA2) in blood, and pathological changes of the hearts were investigated. Results: The numbers of dead SAP and OJ rats in the treated groups declined as compared with those in the model control group, but not significantly (P>0.05). The contents ofendotoxin (at 6 and 12 h in SAP rats and on 7, 14, 21, and 28 d in OJ rats, respectively) and PLA2 (at 6 and 12 h in SAP rats and on 28 d in OJ rats, respectively) in the treated group were significantly lower than those in the model control group (P<0.01 and P<0.001, respec-tively). Besides, myocardial pathological injuries were mitigated in SAP and OJ rats. Conclusion: In this study, we found that Salvia miltiorrhizae improved myocardial pathological changes, reduced the content of PLA2 in blood, and decreased the mortality rates of SAP and OJ rats, exerting protective effects on the hearts of the rats. 相似文献
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Xi-ping Zhang Guang-hua Feng Jie Zhang Yang Cai Hua Tian Xiao-feng Zhang Yi-feng Zhou Zhi-wei Wang Ke-yi Wang 《Journal of Zhejiang University. Science. B》2009,10(3):193-202
Objective To investigate the therapeutic effects and mechanisms of Salvia miltiorrhizae (Danshen) in the treatment of severe acute pancreatitis (SAP)- or obstructive jaundice (OJ)-induced heart injury.
Methods A total of 288 rats were used for SAP- (n=108) and OJ-associated (n=180) experiments. The rats were randomly divided into sham-operated, model control, and Salvia miltiorrhizae-treated groups. According to the difference of time points after operation, SAP rats in each group were subdivided into 3,
6 and 12 h subgroups (n=12), whereas OJ rats were subdivided into 7, 14, 21, and 28 d subgroups (n=15). At the corresponding time points after operation, the mortality rates of the rats, the contents of endotoxin and phospholipase
A2 (PLA2) in blood, and pathological changes of the hearts were investigated.
Results The numbers of dead SAP and OJ rats in the treated groups declined as compared with those in the model control group, but
not significantly (P>0.05). The contents of endotoxin (at 6 and 12 h in SAP rats and on 7, 14, 21, and 28 d in OJ rats, respectively) and PLA2 (at 6 and 12 h in SAP rats and on 28 d in OJ rats, respectively) in the treated group were significantly lower than those
in the model control group (P<0.01 and P<0.001, respectively). Besides, myocardial pathological injuries were mitigated in SAP and OJ rats.
Conclusion In this study, we found that Salvia miltiorrhizae improved myocardial pathological changes, reduced the content of PLA2 in blood, and decreased the mortality rates of SAP and OJ rats, exerting protective effects on the hearts of the rats.
Projected supported by the Technological Foundation Project of Traditional Chinese Medicine Science of Zhejiang Province (Nos.
2003C130 and 2004C142), the Grave Foundation Project for Technological and Development of Hangzhou City (No. 2003123B19),
and the Intensive Foundation Project for Technology of Hangzhou City (No. 2004Z006), China 相似文献
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灯盏花素治疗冠心病的疗效观察 总被引：5，自引：0，他引：5
目的：探讨灯盏花素治疗冠心病的疗效机理．方法：用灯盏花素治疗冠心病伴高粘滞血症患者４０例，与用复方丹参注射液治疗的同样患者４０例进行对比，两组疗程均１５天．对血清脂质过氧化物（ＬＰＤ）含量、超氧化物歧化酶活性（ＳＯＤ）、血脂、血液流变学指标进行检测．结果：患者症状、心电图、血脂、血流变、ＬＰＯ、ＳＯＤ，治疗组较对照组改善明显．（ｐ＜０．０５）．结论：灯盏花素降低冠心病者血液的高粘滞状态，提高抗氧化能力，有效改善其症状． 相似文献
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Xiao-cao Shen Cai-xiao Gu Yi-qing Qiu Chuan-jun Du Yan-biao Fu Jian-jun Wu 《Journal of Zhejiang University. Science. B》2009,10(1):1-6
Objective: Adrenocortical carcinoma (ACC) is a rare but highly malignant tumor, and its diagnosis is mostly delayed and prognosis is poor. We report estrogen receptor (ER) expression in this tumor and our clinical experiences with 17 ACC cases. Methods: The data of the 17 patients (9 females and 8 males, age range from 16 to 69 years, mean age of 42.6 years) with ACC were reviewed, and symptoms, diagnostic procedures, treatment, and results of follow-up were evaluated. Immunohistochemistry was used to detect ER expression in tumor samples from the 17 patients. Results: At the time of diagnosis, 4 tumors were classified as Stage Ⅰ, 4 as Stage Ⅱ, 3 as Stage Ⅲ, and 6 as Stage Ⅳ. Eight patients demonstrated positive nuclear immunostaining of ER. The prognosis of patients with ER positive was significantly better (P<0.05) than that of patients with ER negative, with 1- and 5-year survival rates at 86% and 60% for ER-positive patients, and 38% and 0% for ER-negative patients, respectively. Conclusion: ER-positivity may be one of the factors associated with a worse prognosis of ACC. 相似文献
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Objective: To investigate the effects and complications of primary and secondary placements of motility coupling post (MCP) in the unwrapped porous polyethylene orbital implant (PPOI) following enucleation. Methods: We investigated 198 patients who received PPOI implantation following the standard enucleation procedure in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, from 2002 to 2004. These patients were subgrouped into PPOI-only patients (112 cases, received PPOI following enucleation), primary MCP patients (46 cases, received primary placement of MCP during PPOI operation), and secondary MCP patients (40 cases, received secondary placement of MCP 6 months after the initial surgery). Effects and complications among these three groups were compared. Results: The PPOI-only patients took shorter treatment course when compared with other two MCP groups (P<0.001), without significant difference noted between the two MCP groups. However, the two MCP groups had better prosthetic motility than PPOI-only group (P<0.001), without significant difference between the two MCP groups. In the early stage, 2 eyes in the PPOI-only group and 1 eye in the primary MCP group had PPOI infection. In PPOI-only group, 3 (2.68%) eyes had PPOI exposure, which occurred after fitting the prostheses; 4 eyes (8.70%) in primary MCP group and 1 eye (2.50%) in secondary MCP had PPOI exposure, which occurred before fitting the prostheses. After prosthesis was fit successfully, the excessive discharge and granuloma were 33.9% and 1.79% in PPOI group-only, 53.3% and 8.9% in primary MCP group, and 52.5% and 7.5% in secondary MCP group, respectively. Conclusion: Both primary and secondary placements of MCP into the PPOI following enucleation can help patients to obtain desirable prosthetic motility, but maybe associated with more complications. The primary placement of MCP with skilled operation in selected patients is more recommendable than secondary placement. 相似文献
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目的：进一步了解血小板活化因子（PAF）与狼疮性肾炎（LN）病理类型的关系。方法：对35例不同病理类型的LN患者与31例正常对照患者的血浆和尿液PAF水平进行比较。结果：LN患者血浆及尿液PAF水平均比对照组显著增高（P〈0.05），且随病理损伤程度的加重其水平亦增高；血浆和尿液PAF水平与病变程度之间均存在密切相关（P〈0.01）；血浆PAF水平与尿液PAF水平之间亦存在密切相关（P〈0.01）。结论：PAF水平可作为判断LN免疫病理损伤程度的重要指标。 相似文献
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Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder(PLG), 260 patients with polypoid
gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and
group B (without cholecystolithiasis). The clinical pathological characteristics were analyzed. The intestinal epithelium
metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium
metaplasia and atypical hyperplasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included
16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis
hyperplasia, which occurred in 26 and 21 patients in group A and group B, i. e. 44.0% and 10.3% respectively. The difference
between group A and group B was statistically significant (P<0.01). Conclusion: Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder
to develop tumour.
Project (No. 2002ZXO19) supported by the Zhejiang Province Health Bureau, China 相似文献
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目的以衰老的自由基学说为依据,研究蚁皇浆口服液的抗衰老作用.方法52周龄小白鼠30只随机分为老龄实验组和老龄对照组,4周龄15只作为成年对照组,灌胃四周后分别取血测定SOD、CAT、Tch、TG和MDA等各项生化指标.结果老龄实验组SOD、CAT活性均明显升高(P＜0.01),MDA、Tch和TG含量明显降低(P＜0.01或P＜0.05).结论蚁皇浆口服液具有较强的抗氧化和抗衰老作用,是一种很有经济价值药食两用的保健品. 相似文献