两种腹腔镜肾上腺切除术式治疗原发性醛固酮增多症效果评价

目的：比较腹腔镜肾上腺全切术与部分切除术治疗原发性醛固酮增多症的效果。方法：对152例原发性醛固酮增多症分别采用肾上腺全切术（A组82例）和肾上腺部分切除术（B组70例）进行治疗,测量并比较两组患者手术时间、手术失血量、住院时间以及术后一月内血压恢复者比例。结果：两组患者性别、年龄、高血压和低血钾在组间情况无统计差异,具备可比性（P〉0．05）。A组患者手术时间、术后一月内血压恢复比例高于B组（P〈0．05）,而失血量和住院时间无组间差异（P〉0．05）。结论：在腹腔镜肾上腺切除手术中,肾上腺全切取得了较好的效果,具有较高的临床应用价值。     

小儿腹腔镜肾上腺切除术对IL-6、内皮素和C反应蛋白水平的影响

目的:探讨小儿开腹肾上腺切除术与腹腔镜肾上腺切除术两种方法对患儿血IL-6、C反应蛋白水平和内皮素水平的影响,从而比较两种术式对患儿手术应激的影响程度。方法:选择开腹肾上腺切除术患儿25例,腹腔镜肾上腺切除术患儿17例,分别于术前和术后抽取静脉血检测血IL-6、C反应蛋白和内皮素的水平并进行比较。同时比较两组手术时间、术中出血量及术后住院时间。结果:开放手术组患儿术后血IL-6、C反应蛋白和内皮素的水平明显高于腹腔镜手术组,而术前两组间无统计学差异。腹腔镜组患儿手术时间术中出血量及住院时间均小于后者。结论:腹腔镜肾上腺切除术与开腹肾上腺切除术相比,手术刺激小,恢复快。     

腹腔镜辅助下阴式子宫切除术与阴式子宫全切除术治疗子宫良性病变的临床比较

目的:探究阴式子宫全切除术与腹腔镜辅助下阴式子宫切除术治疗子宫良性病变的临床效果。方法:选择2011年10月~2013年9月我院收治的子宫良性病变的患者120例,其中行腹腔镜辅助下阴式子宫切除术80例(研究组)和行阴式子全宫切除术40例(对照组),观察并分析两组的临床指标及手术并发症。结果:研究组住院费用明显高于对照组(P0.05),手术时间、术中出血量及住院时间均低于对照组(P0.05);研究组无邻近脏器损伤,对照组输尿管损伤2例(5.00%),研究组患者出现手术损伤率明显低于对照组,差异存在统计学差异(x2=3.968,P=0.046);对两组患者术后随访1年,两组患者均无出现再手术情况;两组患者术后阴道残端均愈合较好,未出现阴道残端漏,患者无大小便困难及其他不适。结论:腹腔镜辅助下阴式子宫切除术治疗子宫良性病变疗效优于阴式子宫全切术,其手术时间、术中出血量及住院时间均较低,创伤小,更有利于患者恢复健康,在临床上值得应用推广。     

阴式全子宫切除术和腹腔镜下全子宫切除术的临床对比分析

目的:比较阴式全子宫切除术与腹腔镜下全子宫切除术的临床治疗效果。方法:回顾性分析2014年6月-2015年6月我院收治的137例子宫良性病变患者的临床病历资料,按照手术方式将其分为阴式组(行阴式全子宫切除术)和腹腔镜组(行腹腔镜下全子宫切除术),比较两组患者的术中、术后临床指标及术后并发症情况。结果:阴式组手术时间及术中出血量均少于腹腔镜组,差异有统计学意义(P0.05)。阴式组肛门排气时间、下床活动时间以及住院时间均短于腹腔镜组,住院总费用低于腹腔镜组,差异有统计学意义(P0.05)。两组患者并发症发生情况差异无统计学意义(P0.05)。结论:阴式全子宫切除术较腹腔镜下全子宫切除术而言,具有手术创伤小、术后恢复快的特点,值得临床推广。     

胸顶胸膜部分切除翻转与机械摩擦行胸膜固定应用于胸腔镜肺大疱切除治疗自发性气胸中的对比研究

目的:探讨胸顶胸膜部分切除翻转应用于胸腔镜肺大疱切除治疗自发性气胸中的可行性、安全性以及临床疗效。方法:回顾性分析我院自2014年1月1日至2015年9月30日行胸腔镜肺大泡切除治疗自发性气胸同时行胸顶胸膜部分切除翻转或机械摩擦进行胸膜固定的患者103例,其中行胸顶胸膜部分切除翻转者46例(A组),行机械摩擦者57例(B组),比较两组患者的手术时间、术中出血量、术后引流量、术后引流时间、住院时间、术后并发症(切口感染/不愈、出血二次手术、神经损伤、漏气7天)发生率、术后1年内术侧气胸的复发率。结果:两组术中出血量、术后引流量、术后引流时间、住院时间、术后并发症(切口感染/不愈、出血二次手术、神经损伤、漏气7天)发生率比较差异无统计学意义(p0.05),A组手术时间比B组长(p0.05),但术后1年内术侧气胸的复发率较B组低(p0.05)。结论:胸顶胸膜部分切除翻转应用于VATS肺大疱切除治疗自发性气胸安全可行,可有效降低自发性气胸术后复发率。     

腹腔镜子宫切除术对宫颈癌患者近期疗效及远期复发率的影响

目的:探讨腹腔镜根治性子宫切除术对宫颈癌患者近期疗效及远期复发率和生存率的影响。方法:选取2013年5月-2015年5月在我院接受手术切除治疗的宫颈癌患者71例为研究对象,根据手术方法不同将所选患者分为两组。腹腔镜组37例患者采用腹腔镜根治性子宫切除术,开腹手术组34例患者采用改良式根治性肿瘤切除术。观察并比较两组患者的手术时间、术中出血量、肿瘤切除长度、淋巴结清扫数、盆腔引流量、术后拔管时间等近期疗效,以及远期复发率及生存率。结果:与开腹手术组比较,腹腔镜组患者手术时间长、术中出血量少,差异具有统计学意义(P0.05);两组患者的肿瘤切除长度及淋巴结清除数比较,差异无统计学意义(P0.05);与开腹手术组比较,腹腔镜组患者的盆腔引流量较少,术后排气时间较早,差异具有统计学意义(P0.05);但两组患者术后拔管时间及住院时间比较,差异无统计学意义(P0.05);两组患者术后五年的复发率及生存率比较,差异无统计学意义(P0.05)。结论:腹腔镜根治性子宫切除术治疗宫颈癌的近期疗效显著,且不会影响患者的远期复发率及生存率。     

腹腔镜与开腹直肠癌全直肠系膜切除治疗直肠癌临床疗效

目的:探讨腹腔镜与开腹直肠癌全直肠系膜切除治疗直肠癌的临床疗效。方法:选择我院2012年12月~2013年12月行腹腔镜直肠癌根治术(A组)和开腹直肠癌全直肠系膜切除术(B组)的患者,各40例,比较两组患者手术时间、肠道排气时间、住院时间、术后下床时间、术后并发症和标本病理情况。结果:1相比B组,A组手术时间较长,术中出血量少,肠道排气时间短,住院时间短,术后下床活动时间短,术后并发症发生率低,差异有统计学意义(P0.05)。2A、B两组淋巴结清扫数、切除标本长度、肿瘤距远切断、标本切缘情况比较差异无显著性(P均0.05)。结论:腹腔镜手术相比开腹直肠癌系膜切除治疗直肠癌具有手术时间短、创伤小、术后恢复快,并发症少的优点,值得在临床上推广应用。     

腹腔镜阑尾切除术与开腹阑尾切除术治疗急性阑尾炎的疗效比较

目的:比较腹腔镜阑尾切除术和开腹阑尾切除术治疗急性阑尾炎的临床疗效。方法:选取2012年3月-2014年3月我院收治的急性阑尾炎患者127例,按照随机数字表法分为两组,观察组63例行腹腔镜阑尾切除手术,对照组64例行开腹阑尾切除手术,比较两组的手术效果及术后并发症情况。结果:两组的手术时间差异无统计学意义(P0.05),观察组术中出血量、肛门排气时间及住院时间均低于对照组,差异有统计学意义(P0.05)。两组治疗后VAS评分较治疗前有不同程度的降低,且观察组低于对照组,差异有统计学意义(P0.05)。观察组切口感染、肠梗阻以及腹腔脓肿发生率均低于对照组,差异有统计学意义(P0.05),而两组腹腔内出血、阑尾残端瘘的发生率比较,差异无统计学意义(P0.05)。结论:腹腔镜阑尾切除术治疗急性阑尾炎具有手术效果好、预后快及术后并发症少等特点,值得临床推广使用。     

Ⅰ期肠切除吻合术治疗急性梗阻性结肠癌的临床效果分析

目的:探讨Ⅰ期肠切除吻合术处理急性梗阻性结肠癌的临床效果,为普外科手术提供参考。方法:对我院2011年4月-2013年11月实施Ⅰ期肠切除吻合术的59例急性梗阻性结肠癌患者的临床资料进行分析,并与择期接受结肠癌根治术的42例患者对比。观察两组患者的平均术中出血量、手术时间、切口长度、切除肿瘤大小、清扫淋巴结数、术后肛门排气、并发症发生率、住院时间及肿瘤复发率等。结果:与根治切除术组比较,Ⅰ期肠切除吻合术组患者的平均手术时间及术中出血量无显著性差异(P0.05),但肿瘤切除率及淋巴结清扫情况优于根治切除术组,且手术切口小,组间比较差异具有统计学意义(P0.05)。Ⅰ期肠切除吻合术组患者术后肛门排气时间和下床活动时间早于根治切除术组患者(P0.05);Ⅰ期肠切除吻合术组患者术后并发症的发生率、肿瘤复发转移率均明显低于根治切除术组患者,差异具有统计学意义(P0.05);两组患者术后两年的生存率无显著差异(P0.05)。结论:Ⅰ期肠切除吻合术用于急诊处理急性梗阻性结肠癌具有良好的手术效果,并发症的发生率低,有利于改善患者术后的生存质量。     

腹腔镜胆囊切除术与小切口胆囊切除术治疗胆结石的临床效果及对应激反应的影响

目的:探讨腹腔镜胆囊切除术与小切口胆囊切除术治疗胆结石的临床效果及对应激反应的影响。方法:选取2016年1月至2016年12月于我院行胆囊切除术治疗的胆结石患者80例作为研究对象,根据治疗方案不同将研究对象分为腹腔镜组和小切口组,腹腔镜组采用腹腔镜胆囊切除术,小切口组采用小切口胆囊切除术,比较两组患者手术时间、术中出血量、肛门排气时间、住院时间以及术后并发症的发生情况,检测并比较两组患者术前、术后1d、3d的白细胞(WBC)计数、中性粒细胞(NE)百分数、空腹血糖(Glu)、血清皮质醇(Cor)含量、C-反应蛋白(CRP)含量。结果:腹腔镜组的手术时间、术中出血量、肛门排气时间、住院时间均明显短于小切口组(P0.05),并发症发生率显著低于小切口组(P0.05)。术前,两组的WBC、NE、Glu、Cor、CRP水平比较差异均无统计学意义(P0.05);腹腔镜组术后1 d的WBC、NE、Glu、Cor、CRP水平均显著高于术前(P0.05),术后3 d的Glu、Cor、CRP恢复至术前水平(P0.05),WBC、NE也有所降低但仍高于术前(P0.05);小切口组术后1 d的WBC、NE、Glu、Cor、CRP水平均显著高于术前(P0.05),且高于同期腹腔镜组(P0.05),术后3 d的WBC、NE、Glu、Cor、CRP水平有所降低但仍高于术前(P0.05),且高于同期腹腔镜组(P0.05)。结论:腹腔镜胆囊切除术引起的应激反应更轻,并有利于胆结石患者术后快速恢复,并减少并发症的发生。     

甲状腺全切除术与半切除术治疗甲状腺癌的临床效果分析

目的:比较甲状腺全切除术与半切除术治疗甲状腺癌的临床效果。方法:选取我院收治的90例甲状腺癌患者,对所有患者行甲状腺全切除术或近全切除术,同时应用I131以及甲状腺激素抑制治疗作为辅助治疗,并对所有患者进行随访。结果:两组患者的术中出血量、喉返神经显露率比较差异无统计学意义(P0.05),观察组的手术切口以及手术时间均明显长于对照组(P0.01),甲状旁腺显露率高于对照组(P0.01)。两组患者暂时性、永久性喉返神经损伤,暂时性、永久性甲状旁腺功能低下发生率比较差异无统计学意义(P0.05)。复发率为13.33%(6/45),观察组无复发,两组患者术后复发率比较差异具有统计学意义(P0.05)。结论:甲状腺全切除术治疗甲状腺癌的效果优于半切除术,且能够有效降低术后复发率。     

Distribution and morphology of ghrelin immunostained cells in the adrenal gland of the African ostrich

Ghrelin is the endogenous ligand for the growth hormone secretagogue receptor. We investigated the distribution and morphological characteristics of ghrelin-immunopositive (ghrelin-ip) cells in the African ostrich adrenal gland. We found that the adrenal gland of the African ostrich consisted of three parts: capsule, inter-renal tissue and chromaffin cells. The inter-renal tissue and chromaffin cells interdigitated irregularly. The inter-renal tissue consisted of a peripheral zone and a central inner zone. The peripheral zone could be divided into an outer subcapsular zone and an inner zone. The subcapsular zone cells were arranged as a bow, while the inner area cells formed cords that were perpendicular to the capsule. The central inner zone exhibited irregular clumps and the cells were morphologically similar to chromaffin cells. Ghrelin-ip cells were located throughout the adrenal gland except the capsule. The majority of ghrelin-ip cells were found among the chromaffin cells. The number of ghrelin-ip cells in the inter-renal tissue decreased gradually from the central inner zone, to the inner zone to the subcapsular zone. The ghrelin-ip cells were oval or irregular in shape and exhibited cytoplasmic staining. Our findings suggest that ghrelin may play a role in regulating adrenal hormone secretion in the African ostrich.     

腹膜后腹腔镜技术在泌尿外科的应用

目的:对比腹膜后腹腔镜手术起步阶段和相对成熟阶段的临床资料,总结手术经验,提高应用水平。方法:对2005年1月至2008年12月起步阶段腹膜后腹腔镜手术65例患者,及2016年1月至2016年12月相对成熟阶段腹膜后腹腔镜手术148例患者进行回顾性分析。结果:起步阶段:中转开放手术5例,术后发热及切口延迟愈合7例;相对成熟阶段:中转开放手术4例,术后发热及切口延迟愈合6例,无大血管破裂、腹腔内脏器损伤、死亡等并发症。在肾囊肿去顶减压手术及肾上腺手术中,成熟阶段患者的各项指标包括手术时间、出血量、中转开放手术比例、术后拔除引流管时间及住院时间均显著优于起步阶段,差异有统计学意义(P0.05)。结论:腹膜后腹腔镜技术适于治疗上尿路及肾上腺疾病,具有患者创伤小、安全、术后康复快等优点,早期起步阶段适合选择简单术式,随着手术技术的熟练可逐步开展复杂的手术。     

白暨豚肾上腺的研究

白鱀豚肾上腺重与体重的平均比值为0.25克/公斤,皮质体积与髓质体积的比值为6.59。白鱀豚肾上腺的组织结构与其它海豚相似,它有比较发达的球状带。讨论了白鱀豚肾上腺形态变化在年龄生长、授乳等生理过程和在自然环境、豢养环境生态适应上的意义。并报道了一例罕见的白鱀豚肾上腺先天性表皮样囊肿。       

Inhibition of the rat adrenal ornithine decarboxylase activity by immobilization stress and/or dexamethasone

The effects of immobilization stress and/or dexamethasone (DEX) on the adrenal ornithine decarboxylase (ODC) activities of sham-operated and adrenal-medulloectomized (enucleated) male Sprague-Dawley rats were investigated. On day 11 after surgery, rats were injected with saline or DEX (1 mg/kg), 3 h before the time of sacrifice (0600 h or 1800 h). Four groups, from sham-operated and enucleated rats (ENU) treated with saline or DEX were subjected to immobilization stress for 1 h prior to sacrifice. Groups of rats from stress-sham-DEX, non stress-sham-DEX, stress-sham, non stress-sham, stress-ENU-DEX, non stress-ENU-DEX, stress-ENU, and non stress-ENU were sacrificed at 0600 h or 1800 h on day 11 after surgery. Adrenal glands were excised and later analyzed for ODC activities. Results indicated that DEX and/or immobilization stress inhibited ODC activities (p < 0.05) in normal and regenerating adrenal glands at 1800 h and ODC activity varies diurnally, the activity being greater at 1800 h than at 0600 hours (p < 0.001).     

促肾上腺皮质激素引起大鼠肾上腺c-fos原癌基因表达的免疫组化研究

采用冰冻切片及免疫组化法观察了注射促肾上腺皮质激素(ACTH,75U/kg)、胰岛素及正常对照大鼠中肾上腺各部分c-fos原癌基因表达产物Fos蛋白的出现和分布特点。结果表明注射ACTH后90min,大鼠肾上腺皮质网状带出现Fos蛋白染色阳性细胞,阳性染色物集中于细胞核,肾上腺皮质束状带仅见少数Fos蛋白染色阳性细胞,肾上腺髓质则未见Fos蛋白染色阳性细胞。与注射ACTH相反,注射胰岛素引起肾上腺髓质出现Fos蛋白染色阳性细胞。注射生理盐水对照组动物肾上腺皮质和髓质均未见Fos蛋白染色阳性细胞。上述结果表明,注射ACTH或胰岛素可以引起大鼠肾上腺不同部位c-fos原癌基因表达。     

Purification and reconstitution of the 32Pi-ATP exchange activity of bovine chromaffin granule membrane

Ghosts derived from bovine chromaffin granules have a ³²P_i-ATP exchange activity which is associated with the H⁺ pump of that membrane. This activity was low when compared to bacteria, chloroplasts or submitochondrial particles, but had similar properties (K_m for ATP and P_i, ATP/Mg²⁺ ratio, pH profile, inhibition by dicyclohexylcarbodiimide and tributyltin) to the ATPase from above membranes. The ³²P_i-ATP exchange activity was solubilized by cholate/octylglucoside mixtures. The soluble extract was lipid depleted by ammonium sulfate fractionation and partially purified by sucrose gradient centrifugation. The purified preparation was reconstituted with phospholipids by freeze-thawing. The reconstituted vesicles had a ³²P_i-ATP exchange sensitive to dicyclohexylcarbodiimide and trybutyltin and an ATPase with a sensitivity to the inhibitors which varied with the reconstitution conditions. The α- and β-subunits of F₁-ATPase were major components of the preparation.     

Adrenal responsiveness and social status in intact and ovariectomized Macaca fascicularis

Plasma cortisol (F) response to intravenous adrenocorticotropin (ACTH) infusion (following dexamethasone suppression) was examined in adult female Macaca fascicularis that had been living for 22 months in social groups consisting of four to six females and one male. A portion of these females were ovariectomized (n = 21), while the rest were reproductively intact (n = 23). The social behavior of all animals was monitored with a focal sampling procedure, and dominance ranks were determined on the basis of fight outcomes. Further, intact females were swabbed vaginally to determine onset of menstruation and were sampled for plasma progesterone (P) every three days during the luteal phase of their cycles. Among the results was that the plasma F response to ACTH infusion was greater in subordinate animals than in dominants (P < .02). Subordinates and dominants did not, however, differ in plasma F measured at baseline. It was found further that plasma F concentrations were greater in ovariectomized than in intact females at baseline and following ACTH injection (P < .01). Finally, there was an appreciable elevation in plasma F across all animals during the 15- and 30-minute post-ACTH injection measurements (P < .01). Subsequent analyses of data from intact females showed interrelationships among dominance rank, reproductive function (indicated by luteal phase plasma P concentrations), adrenal size, and adrenal response to ACTH infusion. These data indicated that subordinate females were at a reproductive disadvantage compared to dominants, a result that may have been mediated, in part, by the increased adrenal size and enhanced adrenal responsiveness of subordinate females.