复杂型单孔腹腔镜胆囊切除术62例处理体会

目的探讨各种复杂类型胆囊结石的腹腔镜手术方法。方法本组62例复杂胆囊结石,腹腔镜胆囊切除术(LC)完成56例,6例中转开腹。结果 Mirizzi综合征I型3例全部中转;胆囊管汇入胆总管过低1例,胆囊管与胆总管共同一侧壁并行约2cm 1例,右肝管汇入胆囊管1例,均中转开腹;LC术成功56例,全部病例均临床治愈出院。结论熟悉胆囊管及胆囊三角区内引外胆管结构的特点,细致解剖胆囊三角区,辨清肝总管、胆总管位置,采取相应的措施,是复杂型LC手术成功的关键。     

MRCP在研究胆道系统解剖及变异中的临床应用进展

胆道系统疾病是临床常见病,外科以腹腔镜胆囊切除术为首选治疗方法。但是,腹腔镜胆囊切除术的胆管损伤发生率仍为0.2%～0.3%,约为开腹手术的2倍。胆道系统解剖变异是引起胆道系统疾病手术中胆管损伤这一严重并发症的重要因素之一,增加胆管损伤发生的风险,是临床愈发关注的问题。术前明确解剖变异的存在及变异类型对于临床制定治疗计划、制定手术方案、减少及避免并发症与二次手术的发生至关重要。磁共振胰胆管水成像技术（MRCP）自引入临床二十年以来,因其无创、无辐射、能够立体、多角度、直观全面地显示胆道系统组成,明确胆道系统的形态、位置、走行及分布而广泛应用。本文旨在综述胆道系统解剖、变异及变异类型以及MRCP技术对显示胆道系统解剖变异类型的临床应用、进展与临床意义。     

冠状动脉解剖变异的CTA影像特征分析

目的:分析冠状动脉解剖变异的CT血管造影(computed tomography angiography,CTA)影像特征。方法:回顾分析2010年6月到2014年4月间PACS存储的12326例心脏CTA图像资料,记录解剖变异冠状动脉的名称、开口起源位置、数目、行程状态及终止部位表现及其与毗邻结构的关系。结果:共有700例心脏有冠状动脉解剖变异,以冠状动脉开口起源异常最多见,共622例(622/12326,5.05%),其中左和右冠状动脉开口高位350例(350/12326,2.84%),左和右冠状动脉开口于对侧窦166例(166/12326,1.35%),冠状动脉双开口70例(70/12326,0.57%),左和右冠状动脉开口于窦间36例(36/12326,0.29%);其次为数目异常29例(29/12326,0.24%),包括左、右单支冠状动脉19例(19/12326,0.15%)和冠状动脉分支(LCx)缺如10例(10/12326,0.08%);冠状动脉终止异常(冠脉动脉-动脉圆锥和/或肺动脉瘘)29例(29/12326,0.24%)。VR是显示冠状动脉解剖变异最重要的后处理方法。结论:冠状动脉解剖变异CTA表现复杂多样,心脏CTA能够准确显示冠状动脉解剖变异种类及其毗邻关系。     

胆道系统探查中术中超声的应用及临床价值

目的:探讨胆管系统探查中术中超声(intraoperative ultrasound,IOUS)的应用及临床价值。方法:2007年3月至2014年8月应用术中超声对胆道系统进行探查的病例资料58例,对其术前影像学表现、手术过程、术中超声所见以及术中和术后诊断进行分析,研究术中超声对胆道探查的应用价值。结果:(1)58例应用术中超声病人中,肝内外胆管结石35例、肝门部胆管癌及胆总管癌11例,急性胆囊炎8例,胃癌1例,先天性胆总管囊肿1例,胆总管炎性狭窄1例,胰腺癌1例。术中超声确认取净结石或胆总管未见明显异常34例,定位肝内胆管残余结石6例,发现胆总管内尚有结石2例,术中超声确诊胆管癌2例;另发现胆总管先天性解剖异常2例;(2)在发现胆管结石方面,与术前MRCP无显著性差异(P=0.643);与术前CT、B超比较有显著差异(P0.05),诊断率分别为B超74.3%,MRCP 91.4%,CT 77.1%,IOUS 94.3%。结论:术中超声胆道系统的探查可以在广泛的疾病中得到应用,可以对术前影像学检查起到验证和补充的作用,且在术中引导各种介入操作中起到独特作用。     

超声引导下肝内胆管置管治疗肝内胆管结石并发梗阻的临床效果观察

目的:探究超声引导下肝内胆管置管治疗肝内胆管结石并发梗阻的临床效果和安全性。方法:选择2014年1月至2018年1月于我院接受治疗的98例肝内胆管结石并发梗阻患者为研究对象,将患者按照入院顺序统一编号后,根据随机数字表法进行分为实验组与对照组,每组各49例患者。对照组患者于常规X线引导下行肝内胆管置管治疗,实验组患者在超声引导下实施肝内胆管置管治疗,对比两组患者穿刺次数、手术时间、术后并发症的发生情况,并对两组患者随访3个月,比较其结石残余率及治疗效果。结果:(1)实验组患者穿刺次数及操作时间均显著少于对照组(P0.05);(2)实验组患者术后各类并发症发生率为4.08%,明显低于对照组(20.41%,P0.05);(3)对照组患者后3个月的结石残余率为14.29%(7/49),实验组为2.04%(1/49),显著低于对照组(P0.05);(4)术后3个月,实验组患者治疗总有效率为97.96%,明显高于对照组(81.63%,P0.05)。结论:与常规X线引导下行肝内胆管置管治疗相比,超声引导下肝内胆管置管在治疗肝内胆管结石并发梗阻中具有较更好的治疗效果和安全性。     

腹腔镜胆囊切除术后胆道损伤4例原因分析

目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy LC)胆管损伤后处理经验。方法:回顾性分析我院4例LC胆管损伤患者的临床资料,并根据胆管损伤的部位、程度及发现的时间采取不同的手术方式。结果:4例及时发现并处理治愈后出院。结论:LC手术是具有潜在风险的手术,慎重把握手术适应证,术中紧贴胆囊颈解剖,遵循"不轻易断管"[1]及"解剖Calot的前后三角",预防胆管的损伤。     

MRI检查在肝门部胆管癌诊断中的应用

目的:评价MR平扫、MRCP、DWI序列及MR动态增强扫描等不同MR检查方法对肝门部胆管癌的诊断价值。方法:回顾性分析经手术及病理证实的9例肝门部胆管癌在上述不同MRI检查方法中所显示的影像特征,提高对肝门部胆管癌的诊断认识。结论:肝门部胆管癌在MRI平扫上表现为边界不清的等、稍长T1信号稍高T2混杂信号团块,MRCP可明确显示肝门区肝管狭窄、截断征象,远侧肝管的显著扩张,DWI序列病灶表现为扩散受限稍高信号,MR动态增强扫描动脉期病变表现为不强化或轻度强化,程度不一的延迟强化较具特征性,同时增强MR对胆管壁和邻近肝实质的侵犯、血管侵犯以及肝门、腹膜后淋巴结转移有明显的诊断价值。合理选择上述多种MRI检查方法结合临床胆管癌相关抗原、CA19-9检测能对大多数肝门部胆管癌做出正确诊断,对疾病的诊断、分型、临床治疗路径选择具有重要价值。     

慢性乙型肝炎治疗中HBV YMDD变异的相关因素分析

目的 探讨拉米夫定治疗慢性乙型肝炎过程中HBV YMDD变异的相关因素。方法 对应用拉米夫定治疗的22例慢性乙型肝炎患者进行肝功能、乙肝病毒血清学标志物、HBV YMDD变异检测,同时进行肝组织病理学检查。结果 ALT异常率为55%,HBeAg血清转换率为13.6%,HBV YMDD变异发生率为31%,治疗前病毒量的高低不影响其治疗效果。5例患者肝穿组织中HBsAg和HBcAg依然阳性。结论 运用拉米夫定治疗慢性乙型肝炎6个月后可出现HBV YMDD变异,随着治疗时间延长,其变异发生率越高;HBeAg血清转换率不高;肝组织内仍处于炎症及纤维化状态。     

内镜下鼻胆管引流术与经皮肝穿刺胆道引流治疗急性梗阻性化脓性胆管炎疗效

目的:探讨内镜下鼻胆管引流术与经皮肝穿刺胆道引流治疗急性梗阻性化脓性胆管炎的疗效。方法:选择我院335例急性梗阻性化脓性胆管炎患者,按不同治疗方法分为A、B、C三组,A组125例患者使用传统胆管切开并T管引流术,B组100例患者使用内镜下鼻胆管引流术治疗,C组110例患者使用经皮肝穿刺胆道引流治疗。比较三组患者治疗有效率、脓性胆汁引流量、术后1周血清胆红素水平、住院时间及并发症发生率。结果:B、C组患者治疗有效率分别为91.0%(91/100)及90.9%(100/110),明显高于A组71.2%(89/125),B组与C组治疗有效率比较差异无统计学意义(P0.05);B、C组脓性胆汁引流量、术后1周血清胆红素水平及住院时间均优于A组,比较差异具有统计学意义(P0.05),B组与C组以上指标比较差异无统计学意义(P0.05);B、C组并发症发生率分别为11.0%(11/100)和8.2%(9/110),均明显低于A组的28.0%(35/125),比较差异具有统计学意义(P0.05)。结论:内镜下鼻胆管引流术与经皮肝穿刺胆道引流治疗急性梗阻性化脓性胆管炎疗效均明显优于传统开放手术,且术后并发症少,值得推广应用。     

老龄大鼠自发性肝胆管增生的病理学研究

目的为相关科研及新药安全评价工作积累大鼠肝胆管增生有价值的研究资料。方法大鼠共分为3组,第1组雌雄各30只动物(进口SD大鼠);第2组雌雄各60只(国产SD大鼠);第3组雌雄各60只(国产Wistar大鼠)。实验末期,对所有实验动物进行安乐死,进行系统解剖,对肝进行制片,进行组织病理学检查和免疫组织化学研究。结果各组大鼠均发生了不同程度的肝汇管区胆管增生,总发病率是32.33%。其中国产SD大鼠发病率明显高于进口SD大鼠(26.67%∶1.67%);国产Wistar大鼠的发生率明显高于国产SD大鼠(53.33%∶26.67%);雄性动物的发病率明显高于雌性动物(20%∶12.33%)。病理学观察显示多样化的胆管增生和纤维化改变,病变在I级和II级的大鼠发病率是84.5%,III级病变的发病率仅占15.5%。卵圆细胞的增生与胆管增生病变情况相一致,并呈现向胆管上皮方向分化。结论不同种系、不同性别的大鼠间肝胆管增生的发生率存在差异。本研究结果为动物和人类在增龄情况下肝胆管增生的研究提供了参考资料。     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

The effects of glutamine of the maintenance of embryogenic cultures of Cryptomeria japonica

Summary Embryogenic tissues of sugi (Cryptomeria japonica) were induced on a modified Campbell and Durzan (CD) medium containing 1 μM 2,4-dichlorophenoxyacetic acid (2,4-D) and 600 mg l⁻¹ glutamine, and subcultured in the medium of the same composition for over 1 yr. This resulted in a mixed culture of embryogenic and non-embryogenic cells. When embryogenic cells were isolated and cultured independently, their capacity to form embryogenic aggregates was lost. Thus, the non-embryogenic cells present within a mixed culture system were essential to the formation of embryogenic aggregates. When embryogenic tissues were isolated and cultured independently on a high glutamine-containing (2400 mg l⁻¹) medium, dry weights and endogenous levels of glutamine increased, and the tissue could generate a large number of embryogenic aggregates. Amino acid analysis of embryogenic and non-embryogenic cells from the maintenance culture indicated a higher level of glutamine was present in the latter. The high endogenous level of glutamine in the non-embryogenic portion of mixed cell masses may be the supplier of glutamine for maintaining the embryogenic property of the tissues.     

Specificity of action of piperidylcholine derivatives as substrates of cholinesterases of various origin

The review deals with study of enzymologic properties of a novel highly specific acetylcholinesterase substrate, N-(β-acetoxyethyl) piperidinium iodomethylate (“piperidylcholine”), and its 30 derivatives that were tested as effectors of cholinesterases of mammals and various species of Pacific squids. It was proven for the first time that responsible for specificity of action was structure of cyclic ammonium grouping of the alcohol part of molecule of the ester substrate. Analysis of specificity is performed based on enzymatic hydrolysis parameters—activity of catalytic center of cholinesterases and bimolecular constant of the reaction rate that are determined at optimal and low substrate concentrations. Among the specially synthesized group of thioester compounds there is revealed one more highly specific acetylcholinesterase substrate—N-(β-acetoxyethyl) piperidinium.     

真菌类遗传学分析的知识结构教学

本文以认知结构理论为指导,讨论了真菌类遗传分析与高等动植物遗传分析的内在联系,认为利用这种内在联系进行教学可收到好的效果并说明了作者的具体教学过程。 Abstract:In the paper, the relationship between genetic analysis of Fungi and genetic analysis of high animal and plant was discussed.A good results were obtained when we adopted this method in the teaching.     

医疗机构合理用药评价模型的构建研究

目的 针对医疗机构的合理用药水平进行评价研究。方法 根据医疗机构合理用药的具体要求,构建医疗机构合理用药评价指标体系,采用基于模糊群决策的方法和多指标评价分析法构建医疗机构合理用药评价模型。结果 构建了基于模糊群决策的医疗机构合理用药评价模型,并通过实例分析证明了评价模型的可行性。结论 建立的基于模糊群决策的医疗机构合理用药评价模型能够对医疗机构的合理用药水平进行科学评价,为提高医疗机构合理用药水平奠定基础。     

The mechanism of hatching of eggs of Haemonchus contortus

Fluid collected from hatching eggs of Haemonchus contortus contained a lipase which hydrolysed 2-naphthyl laurate (about 0·7 μmol naphthol freed /h/10⁶ eggs). The fluid also hydrolysed l-leucinamide (about 2·3 μmol leucine freed/h/10⁶ eggs). The fluid when added to normal or heated eggs caused ‘hatching’. ‘Hatching’ also occurred in exsheathing fluid from infective juveniles and in a preparation of pancreatic lipase containing leucine aminopeptidase. A purified mammalian leucine aminopeptidase in combination with several different lipases did not attack egg shells.The ‘spontaneous’ hatching of eggs of H. contortus was strongly inhibited by 1,10-phenanthroline, 10^?3M, and this inhibition was reversed by Zn²⁺. However, the inhibition of ‘hatching’ of eggs in externally applied hatching fluid, or the hydrolysis of leucinamide in hatching fluid was generally less marked.