目的探讨自制双套管持续负压吸引对低位直肠癌经腹前切除术后吻合口漏的防治效果。 方法2006年1月至2012年12月期间笔者所在医院施行了106例低位直肠癌经腹前切除术，均采用自制双套管持续负压吸引，回顾性分析其预防和治疗吻合口漏的效果。 结果本组106例患者术后发生吻合口漏6例（5.66%），给予双套管持续滴注冲洗结合持续低负压吸引，同时给予全身抗感染、禁食、肠外营养或后期肠内营养处理。12～16 d（平均14 d）后患者的大便成型、冲洗液清亮，遂拔除引流管。其中1例为直肠阴道瘘，经保守治疗失败后行横结肠双腔造瘘术，于术后6周恢复，3个月后行造瘘口关闭术。 结论低位直肠癌保肛手术应用自制双套管持续负压吸引技术后，吻合口漏的发生率较低；其还能有效控制盆腔感染，从而促进漏口愈合。
ObjectiveTo summarize the current status and the management and prophylaxis of complications in laparoscopic gastrectomy. MethodsThe literatures on laparoscopic gastrectomy in domestic and abroad were reviewed and analyzed combined with our experiences. ResultsThe complications of laparoscopic gastrectomy primary attributed to surgery itself and pneumoperitoneum. Limited field under laparoscopy, loss of threedimensional space and finger touch, new instrument and technology and working conditions increased the difficulty of operation and the possibility of surgical complications. Clear anatomical layer under laparoscopy, accurate dissection of lymph nodes, and digestive tract reconstruction were the basis to reduce the complications in laparoscopic gastrectomy. ConclusionCorrect surgical procedures may reduce the occurrence of complications in laparoscopic gastrectomy.
【Abstract】ObjectiveTo explore the effects of p38 mitogenactivated protein kinase (MAPK) on apoptosis of small intestinal epithelial cells after transplantation in rats. MethodsSmall intestinal transplantation was performed in SD and Wistar rats. The recipients were divided into three groups: isograft group (Wistar→Wistar group), allograft group (SD→Wistar group) and allograft+cyclosporine A group (SD→Wistar+CsA group). The grafts were harvested on day 1, 3, 5 and 7 after operation. All graft samples were subjected to histological examination. The apoptosis of graft epithelial cells was detected by TUNEL method. p38 MAPK was measured by Westernblotting method and serum TNFα was determined by ELISA. ResultsMild, moderate and severe rejection reaction occurred in the SD→Wistar group, it was showed that the number of apoptotic cells increased with the severity of the rejection reaction by TUNEL. In SD→Wistar group, the numbers of apoptotic cells were significantly higher than those of the other two groups （P＜0.01）. The severity of rejection reaction in SD→Wistar+CsA group was less than that of SD→Wistar group and the number of apoptotic cells increased with the severity of the rejection reaction (P＜0.01). The level of serum TNFα varied with the apoptotic degree of small intestinal epithelial cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）. The expression of p38 MAPK increased with the number of the apoptotic cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）, but there was no evident change in Wistar→Wistar group （Pgt;0.05）. The expression of p38 MAPK and the level of serum TNFα were positively correlated with apoptosis in small intestinal rejection after transplantation （r=0.875， P＜0.01； r=0.837， P＜0.01）. p38 MAPK and TNFα were also positively correlated （r=0.826，P＜0.01）. ConclusionApoptosis plays an important role in small intestinal rejection. p38 MAPK is involved in apoptosis and is an important regulator in signal pathway of cell apoptosis.
【摘要】 目的 用老年大鼠建立一种与人类发病年龄相符的稳定可重复的急性心肌梗死动物模型。 方法 Wistar大鼠经戊巴比妥钠麻醉后，气管切开插管，连通呼吸机，开胸后结扎左冠状动脉前降支。分不同时间点测血流动力学后取出心脏行病理组织学观察。 结果 成功建立老年大鼠心肌梗死模型并进行病理组织学验证。 结论 建立老年大鼠心梗模型是可靠的，有助于指导临床实践。【Abstract】 Objective To develop a steady and repeatable acute myocardial infarction model in old rats in accordance to human age. Methods Wistar rats were anaesthetized with sodium phenobarbital. After tracheotomy intubation, respiration machine was linked. Left anterior thoracotomy was performed to ligate the left anterior descending coronary artery. After hemodynamic parameters were obtained at various time points, hearts of the rats were taken for pathologic and histological examinations. Results The model of acute myocardial infarction in old rats was established successfully and proved by pathologic and histological staining. Conclusion It is reliable to establish the myocardial infarction model in old rats, which is helpful in guiding clinical practices.
ObjectiveTo systematically review the effectiveness and safety of taxanes combined with cisplatin and fluorouracil (TFP) versus cisplatin and fluorouracil (FP) for locally advanced head and neck squamous cell carcinoma. MethodsDatabases such as The Cochrane Library (Issue 1, 2013), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched to collect randomized controlled trials (RCTs) about taxanes combined with cisplatin and fluorouracil in the treatment of locally advanced head and neck squamous cell carcinoma from the date of their establishment to April 1st, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 7 RCTs involving 2 088 patients were included. The TFP group included 1 051 cases, while the FP group included 1 037 cases. The results of meta-analyses showed that, there were significant differences between the two groups in the 1-year, 2-year, and 3-year overall survival rates (RR=1.12, 95%CI 1.02 to 1.23, P=0.02; RR=1.20, 95%CI 1.11 to 1.29, P < 0.000 01; RR=1.18, 95%CI 1.07 to 1.31, P=0.000 7), the 1-year, 2-year, and 3 year of progressions free survival (RR=1.18, 95%CI 1.08 to 1.28, P=0.000 2; RR=1.20, 95%CI 1.06 to 1.36, P=0.003; RR=1.48, 95%CI 1.25 to 1.74, P < 0.000 01), the complete remission rate (RR=1.67, 95%CI 1.26 to 2.23, P=0.000 4), and the overall response to chemotherapy (RR=1.18, 95%CI 1.11 to 1.27, P < 0.000 01). As for the side effect, the FP group was superior to the TFP group in the neutropenia (RR=1.42, 95%CI 1.24 to 1.63, P < 0.000 01), alopecia (RR=16.09, 95%CI 4.59 to 56.38, P < 0.000 1), and febrile neutropenia (RR=2.21, 95%CI 1.29 to 3.80, P < 0.004). ConclusionThe fluorouracil with cisplatin and fluorouracil for advanced head and neck squamous cell carcinoma might have better effects, but with higher side effects.
Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.
目的探讨超声引导经皮穿刺置管引流术在重症急性胰腺炎(SAP)治疗中的应用价值。方法对我院2001年 1 月至2009年12 月期间收治的35例腹腔渗液较多及合并胰腺周围积液、假性胰腺囊肿及脓肿的SAP患者采用了超声引导经皮穿刺置管引流术，观察其疗效。结果35例患者，置管引流45例次，置管成功率为100%。4例(11.4%)中转开腹手术，31例(88.6%)置管能有效引流。2例(5.7%)穿刺后并发少量出血。结论选择性应用超声引导经皮穿刺置管引流术对于腹腔积液较多及合并局部并发症的SAP患者，是一种有效的治疗手段。