肥胖病人急性阑尾炎腹腔镜手术与开腹手术临床效果比较分析

目的分析对肥胖急性阑尾炎病人实施腹腔镜阑尾切除与开腹阑尾切除的临床治疗效果。方法回顾性分析我院2007年1月至2011年12月期间腹腔镜阑尾切除与开腹阑尾切除相关资料。结果实施腹腔镜阑尾切除手术病人的总体并发症发生率与致死率均较低,住院时间较短,住院费用较少,两种方法相比差异显著,具有统计学意义。结论对于肥胖病人实施腹腔镜阑尾切除手术比实施开腹阑尾切除手术更为安全可靠,疗效更好,不论阑尾炎是否穿孔,腹腔镜阑尾切除手术应作为首选方法。     

眼科手术等候期患者家属对健康教育需求的调查

目的:了解眼科手术等候期患者家属对健康教育的需求。方法:采用自行设计的调查问卷对100名在患者手术过程中等候的家属进行调查。调查内容包括手术等候中希望获得的相关信息及其需求程度,需要的健康教育方式及每种健康教育的需求程度。结果:1).眼科手术等候中,家属强烈需要的信息有手术效果(76%)、术后饮食指导(60.4%)、手术费用(57.3%)、患者目前病情(54.2%)、术后头位指导(51%)。2).最需要的健康教育方式是与医生护士交谈(66%)。结论:对手术等候期的患者家属应根据需求实施科学有效的健康教育,用恰当的方式及时提供家属想要了解的信息,使他们具有良好的应对能力和心理承受能力,在照顾患者的过程中为患者提供有效的支持系统。     

垂体偶发瘤的研究进展

垂体偶发瘤(Pituitary Incidentalomas)是指因进行尸检或进行与垂体病变无关的头部影像学检查过程中偶然发现的垂体病变,其特点是不具有与垂体疾病相关的临床表现。其尸检发现率约10.7%,影像学检查发现率低于尸检,不同文献报道差异较大。垂体偶发瘤如不进行治疗,10%的偶发微腺瘤和24%的偶发大腺瘤会出现瘤体增大,瘤体增大是明确的手术指征。因此,患者应定期进行头部MRI扫描以明确瘤体有无增大。本文对垂体偶发瘤的相关文献进行回顾分析。     

中药单提成分在青光眼术后抗瘢痕化中的应用

青光眼滤过手术术后滤过道瘢痕化是导致青光眼手术失败的主要原因,临床应用的青光眼滤过手术抗滤过道瘢痕化药物有较大副作用。近年来,国内外学者对抗瘢痕形成的药物,尤其是中药单提取成分进行了大量的研究,并取得了一定的研究进展。现将青光眼滤过手术抗滤过道瘢痕化中药成分的研究及潜在应用价值进行综述及展望。     

中下段胆管癌的预后影响因素分析*

目的:探讨中下段胆管癌的预后影响因素。方法:对79例中下段胆管癌患者的临床资料进行回顾性分析,采用Kaplan-Meier分析对确定的单因素进行生存率的描述,用Cox回归进行多因素分析,采用log-rank法对单因素进行生存分析评价。结果:79例患者1、3、5年生存率分别为70.2%,36.2%,19.1%,中位生存时间为19.8个月。行根治性手术患者1年、3年、5年生存率分别为87.9%、45.5%和24.2%,分别显著高于姑息性手术患者1年、3年、5年生存率(28.9%、14.3%和7.1%);行根治性手术患者的中位生存时间为34.5个月,较姑息性手术患者显著延长(8个月),根治术与姑息性手术1、3、5年生存率及中位生存时间比较四项均P<0.01,差异具有统计学意义。单因素分析显示肿瘤病理分化,慢性病史,淋巴结转移为影响中下段胆管癌预后的因素。多因素分析显示慢性病史、手术切缘、肿瘤病理分化程度是影响中下段胆管癌预后的独立危险因素。结论:慢性病史、手术切缘、肿瘤病理分化程度为中、下段胆管癌行切除术后预后的独立危险因素,根治性手术可提高中、下段胆管癌患者的生存率和延长其生存时间。     

体外循环心脏手术围术期脑损伤监测进展

脑损伤是体外循环心脏手术的严重并发症之一,目前患病人数在全球范围内呈逐年增高的趋势,并且临床上应用的脑保护措施效果并不确切,因此有效的神经系统监测关系到外科手术的成败和病人的预后。本文从术中脑组织氧供需平衡、栓子的监测、生化标志物和术后神经功能监测四个方面综述目前脑损伤监测的新进展。     

Radio tagging American mink (<Emphasis Type="Italic">Mustela vison</Emphasis>)—experience with collar and intraperitoneal-implanted transmitters

American minks (Mustela vison) are difficult to radio tag because of their similar head and neck circumference as well as their semi-aquatic and frequently subterranean behaviour patterns. During a radio-telemetry study of American mink, we compared collar transmitters and intraperitoneal-implanted transmitters with reference to animal welfare and practicability in the field. Between October 2003 and March 2004, we fitted eight minks with collar transmitters. Six showed serious neck injuries caused by carrying the radio collars. From April 2004 to June 2005, radio transmitters were surgically implanted in the peritoneal cavity of 14 minks by veterinarians. After surgery, the observation of mink in a quarantine cage for 72 h appeared adequate to ensure that they do not attack the sutures. During quarantine, minks were calm and took the offered food (fresh carp). The replacement of five failed implanted transmitters after 2–10 months revealed that the transmitters were floating freely in the peritoneal cavity, and no local reactions were observed. Except for one male, intraperitoneal implants do not appear to affect short-term survival or reproductive potential of minks. For long-term telemetry studies, we recommend implanted transmitters instead of external radio collars to radio tag American minks.     

广东杨东山十二度水省级自然保护区啮齿类、翼手类物种多样性初步研究

对广东杨东山十二度水省级自然保护区的啮齿类、翼手类物种多样性进行了初步调查,采集动物标本61号,为9种,观察或采访记录到3种,该保护区共有两个目的哺乳动物12种,其中我国特有种1种——贵州菊头蝠(为2000年发现的广东省翼手类新记录)。鼠类中进入国家保护的有益的或者有重要经济、有科学研究价值的陆生野生动物名录的动物有5种,约占该保护区啮齿类种类的70％。初步调查显示,该保护区翼手类、啮齿类动物种类较为丰富,是食物链中的重要环节,在该保护区自然生态系统中占有极重要的地位,深入开展对它们的研究十分必要。     

Changes of Body Weight and Plasma Ghrelin Levels after Gastric Banding and Gastric Bypass

Objective: Ghrelin is an enteric peptide with strong orexigenic and adipogenic effects. Plasma ghrelin levels are decreased in obese subjects but increase after weight loss; this increase is not observed after Roux‐en‐Y gastric bypass (RYGB). Prospective and comparative data after adjustable silicone gastric banding (ASGB) have not been reported previously. Research Methods and Procedures: Overnight fasting plasma ghrelin concentration was measured in morbidly obese subjects at baseline and 3, 6, 12, and 24 months after ASGB (n = 8) or RYGB (n = 5) and in nonoperated controls (n = 7). Results: After RYGB, body weight (BW) decreased by 29.5 ± 5.5 kg (mean ± SE, p < 0.001), whereas plasma ghrelin failed to increase significantly (+167 ± 119 pg/mL, not significant). In contrast, after ASGB, BW decreased less (by 22.8 ± 5.9 kg; p < 0.001), and plasma ghrelin significantly increased by 377 ± 201 pg/mL (p = 0.025). Neither BW nor plasma ghrelin changed in nonoperated controls. Plasma leptin decreased in both operated groups (similarly p < 0.05) but not in nonoperated controls. Plasma growth hormone and insulin‐like growth factor 1 were not correlated with changes in plasma ghrelin concentrations. Discussion: Plasma ghrelin levels failed to increase during substantial weight loss after RYGB, but did increase in response to lesser weight loss after ASGB. These findings suggest that the plasma ghrelin response after weight loss is impaired after exclusion of major parts of the stomach and the duodenum (RYGB), and the smaller long‐term weight loss after ASGB compared with RYGB may be due, at least in part, to an absent increase in plasma ghrelin after RYGB.