目的 探討腹腔鏡下輸卵管妊娠開窗取胚術后縫合與否對輸卵管再通、宮內妊娠率的近期影響。方法 回顧分析2008年4月－2010年4月112例有保留生育功能意愿且具備隨訪條件的輸卵管妊娠患者行腹腔鏡手術的臨床資料。根據手術方法將患者分為兩組：A組54例，行患側輸卵管開窗取胚術，術后縫合輸卵管；B組58例，行患側輸卵管開窗取胚術，術后不予縫合輸卵管。兩組術畢均予甲氨喋呤20 mg注射于病變輸卵管處系膜，并行通液了解患側輸卵管通暢情況（對側輸卵管均通暢）。3個月后比較兩組患側輸卵管的再通情況，并隨訪其近期（12個月內）宮內妊娠率、重復性異位妊娠率情況。 結果 A組54例患者術中患側輸卵管通暢48例，通而不暢6例；術后3個月B型超聲監測下通液43例通暢，10例通而不暢，1例不通，通暢率79.63%。B組58例患者術中患側輸卵管通暢54例，4例通而不暢；術后3個月B型超聲監測下通液37例通暢，13例通而不暢，8例不通，通暢率63.79%。近期（12個月內）宮內妊娠率、重復性異位妊娠率情況：A組54例，實訪42例，宮內妊娠29例，占69.05%；重復性異位妊娠6例，占14.29%。B組58例，實訪44例，宮內妊娠18例，占40.91%，重復性異位妊娠12例，占27.27%。A組術后患側輸卵管通暢率、宮內妊娠率高于B組，而重復性異位妊娠率明顯降低，兩組差異有統計學意義（P＜0.05）。 結論 腹腔鏡下輸卵管妊娠開窗取胚術后行輸卵管縫合，可以減少對患側輸卵管損傷并恢復其正常的解剖結構，從而有效地保留患者生育功能。術后患側輸卵管通暢率、宮內妊娠率明顯高于術后不縫合者，而重復性異位妊娠率明顯降低。
Objective To summarize and analyze the experience of Canadian hospital report, including report contents, indicators system and result application, so as to provide basis for improving Chinese hospital information report and enhancing healthcare regulation. Methods Official networks and databases in Canada were searched, and relative policies, documents, research reports and information reports were included. Results Canadian Hospital Report Project carried out by Canadian Institute for Health Information was effective for gathering and comparing hospitals’ information, and regulating healthcare service. Ontario Hospital Report Project, as a local policy based on national hospital report project, was a good example of local government to improve healthcare service regulation. Conclusion Canadian Hospital Report and Ontario Hospital Report enlighten us that, carrying out the comparison of hospitals in the same type, ensuring the comparability of data, setting comprehensive and scientific report contents and indicators, and emphasizing the self-evaluation function and self-improvement function of the hospital performance evaluation.
Objective To investigate the cl inical effect of minimally invasive internal fixation percutaneous plate osteosynthesis (MIPPO) assisted by arthroscopy on tibial plateau fractures. Methods From September 2005 to December 2007, 29 patients with tibial plateau fracture underwent arthroscopy-assisted MIPPO, including 18 males and 11 females aged18-59 years old (average 34.7 years old). There were 8 cases of type II, 10 of type III, 5 of type IV, 3 of type V, and 3 of type VI according to Schatzker classification system. The fracture was combined with meniscus injury in 13 cases, anterior cruciate l igament injury in 4 cases, and medial collateral l igament injury in 3 cases. The time from injury to operation was 2-10 days. Firstly, the combined injury was treated under arthroscopy. Then, reduction of tibial plateau fractures was performed, bone grafting was conducted in the area of bone defect, and internal fixation using strut plates was performed after establ ishing subcutaneous tunnel via minimally invasion. Early rehabil itation activities were carried out for each patient 1 day after operation. Results No early compl ications such as poor heal ing of incisions, infections, and osteofascial compartment syndrome occurred. Over the follow-up period of 12-39 months (average 24 months), there was no failure of internal fixation, traumatic knee osteoarthritis, and inversion and eversion of the knee. The fractures healed within 3-4.5 months (average 3.5 months). The cl inical effect was excellent in 23 cases, good in 4 cases, and fair in 2 cases according to Lysholm knee rating system, and the excellent and good rate was 93.1%. Conclusion Arthroscopy-assisted MIPPO is a safe and effective way of managing tibial plateau fractures due to its features of minimal invasion, earl ier recovery, fewer compl ications, and simultaneous treatment of associated intra-articular injuries.
Objective To study the surgical treatment of tracheal and main bronchial tumors. Methods We retrospectively analyzed the clinical data of 30 patients with tracheal and main bronchial tumors treated in Shengjing Hospital of China Medical University from January 2000 to December 2015. There were 12 males and 18 females with the age ranging from 22 to 80 years. Results Ten patients were treated with enucleation, 12 patients tracheal tumor resection and end-to-end anastomosis, 1 patient window resection, 1 patient wedge resection, 5 patients tumor resection and tracheal reconstruction by using pulmonary tissue flap with alloy stent and 1 patient left pneumonectomy. One patient died of sudden massive hemoptysis 26 d after operation. Intraoperative complications were found in 2 patients. Others had a good recovery after operation. Patients were followed up for 11 months to 14 years. Eight patients were followed up less than 5 years postoperatively, one patient died of sudden massive hemoptysis 14 months after operation, while others survived; 21 patients were followed up more than 5 years and 5 patients were lost to follow-up. Conclusion Surgical resection is recommended for tracheal and main bronchial tumors. Patients with small benign tumor may choose local tracheal resection; tracheal segmental resection and end-to-end anastomosis is the most common surgical treatment. Patients with more than half of the whole length of tracheal defects or in the risk of anastomotic ischemic necrosis may be suggested to receive tracheal reconstruction.
【摘要】 目的 探討骨形成蛋白-2（bone morphogenetic protein-2，BMP-2）對室管膜前下區（anterior subventricular zone，SVZa）神經干細胞DLX5表達的影響。 方法 體外培養SVZa神經干細胞，用BMP-2及其拮抗劑Noggin誘導SVZa神經干細胞，分別用免疫熒光染色和逆轉錄-聚合酶鏈反應（RT-PCR）檢測DLX5表達變化。 結果 BMP-2組SVZa神經干細胞DLX5蛋白表達和DLX5mRNA表達水平明顯高于對照組（Plt;0.05），且該效應能被其拮抗劑Noggin特異性地抑制。 結論 BMP-2是DLX5上游調節基因，可促進SVZa神經干細胞DLX5的表達。【Abstract】 Objective To investigate the effect of bone morphogenetic protein-2 (BMP-2)on expression of DLX5 of neural stem cells in anterior subventricular zone (SVZa). Methods The neural stem cells of SVZa were separated and cultured in vitro, which were induced by BMP-2 and Noggin.Immunofluorescence staining and RT-PCR were employed to assay the expression of DLX5. Results The percentages of expression of DLX5 protein and DLX5 mRNA in BMP-2 group were much higher than those in the control group (Plt;0.05). And this induction could be specifically blocked by Noggin. Conclusion BMP-2 is an upstream gene of DLX5; BMP-2 can promote the expression of DLX5 of the neural stem cells of SVZa.
Abstract： Objective To evaluate clinical outcomes of tricuspid annuloplasty using a C-type ring made of autologous pericardium for the treatment of functional tricuspid regurgitation （TR）.?Methods?Eleven patients underwent tricuspid annuloplasty in Guizhou Provincial People’s Hospital between March 2009 and January 2011， including 5 male patients and 6 female patients with their age of 32-57 （43.80±12.20） years. There were 3 patients with mild TR， 7 patients with moderate TR， and 1 patient with severe TR. Concomitant procedures included mitral valve replacement and/or aortic valve replacement and/or left atrial thrombectomy. The C-type ring was created using a strip of pericardium after 0.8% glutaraldehyde fixation for 15 minutes. Interrupted horizontal mattress suture was used to secure the C-type ring to the tricuspid annulus. Hear function and echocardiography were examined during follow-up. Results There was no in-hospital death， and the hospital stay was 15-28 （21.10±3.80） days. All the patients were followed up for 8-28 （18.50±7.00）months. There was no death or reoperation because of TR or tricuspid stenosis during follow-up. Ten patients had TR during follow-up， including 9 patients with mild TR and 1 patient with mild to moderate TR， but there was no patient with severe TR. The degree of TR during follow-up was significantly reduced than preoperative degree （Z?=-2.81，P＜0.05）. Preoperative and postoperative right ventricular dimension （19.95±5.11 mm vs. 21.57±12.81 mm，P=0.705） and right atrial dimension（37.55±6.79 mm vs. 35.55±5.22 mm，P=0.317）were not statistically different. Conclusion Tricuspid annuloplasty using a C-type ring made of autologous pericardium has satisfactory clinical outcomes for patients with functional TR.
【Abstract】 Objective To improve the knowledge of pulmonary embolism with normal D-dimer levels. Methods Nine consecutive patients of established pulmonary embolism with a normal D-dimer concentration admitted from January 2004 to December 2009 were analyzed retrospectively. Results Pulmonary embolism was confirmed in the 9 patients with a normal D-dimer concentration. Pulmonary embolismwas confirmed in only one patientwith an unlikely probability of pulmonary embolism. Wells score was 3 and the localization of the emboli was segmental emboli. In other 8 patients with a likely clinical probability of pulmonary embolism, the complaints of those patients existed between 1 hour and 2 months.Wells score was between 4. 5 and 7. 5, with a median of 6. 0. D-dimer concentration was between 0. 1 and 0. 5 mg/L, with a median of 0. 3 mg/L. The localization of the emboli was sub-segmental emboli in 3 cases,segmental emboli in 4 cases, and central emboli in 2 cases. Conclusions Our findings indicate that it is essential to examine the patient and assess the clinical probability at the first, then the D-dimer concentration should be taken into account. In patients with a likely clinical probability, a normal D-dimer test result can not exclude pulmonary embolism, and additional imaging testing is necessary.
Objective To study the curative effect of operative and interventional treatment in 78 cases of BuddChiari syndrome (BCS). Methods Among these patients, percutaneous transinferior vena cava angioplasty (PTA) was performed in 18 cases, PTA and stent in 10 cases, splenopneumopexy plus pedicled omento-pneumopexy of the left lower lobe in 20 cases, combined transcardiac membranotomy and transfemoral venous ballon dilatation and stent in 15 cases, right atrium-inferior vena cava shunt in 10 cases, and radical operation plus stent in 5 cases. Results After the treatment, the descent of inferior vena cava (IVC) pressure from 2.50～3.95 kPa to 1.41～2.33 kPa, the descent of portal venous pressure from 3.63～5.00 kPa to 2.16～3.23 kPa were observed. Conclusion The authors consider that PTA is the first choice for localized lesions, the following method is the operation combined with interventional treatment.
Objective To observe the action and correlation of p16 and estrogen receptor (ER) in papillary thyroid cancer (PTC).Methods Using immunohistochemical method, the p16 and ER in 50 cases of PTC were detected. Results The expression of p16 and ER was associated with the cellular differentiation, the lymphatic metastasis and prognosis in PTC. Conclusion It is helpful to detect the p16 protein and ER for analyzing the cellular differentiation degree and prognosis in PTC.
Objective To review recent studies in molecular biology of gastric cancer. Methods Relevant references were reviewed. Results The development and progression of gastric cancer were correlated with oncogenes, growth factors, cyclins, tumor suppressor genes, cell adhesion molecules and unstability of genes.Conclusion Gastric cancer is related to much mutation of genes.