檢測結直腸癌患者血清巨噬細胞集落刺激因子(M-CSF)的含量并探討其臨床意義。方法:采用酶聯免疫吸附分析法(ELISA)對62例經病理證實的術前結直腸癌患者、40例結直腸良性病患者和40例健康體檢者血清M-CSF水平進行檢測。結果:結直腸癌患者血清M-CSF水平明顯高于結直腸良性病患者和健康體檢者(Plt;0.01);結直腸癌患者血清M-CSF水平與腫瘤分期、淋巴結轉移及遠處轉移有關(Plt;0.05),與性別、年齡、分化程度不相關(Pgt;0.05)。結論:M-CS與結直腸癌的腫瘤分期、淋巴結轉移及遠處轉移有關,可能是一個判斷結直腸癌預后的生物學指標。
目的 觀察帕瑞昔布鈉與舒芬太尼用于無痛胃鏡麻醉的安全性和有效性及對患者滿意度的影響,為提高臨床無痛胃鏡麻醉的安全性和舒適性提供依據。 方法 采取前瞻性隨機雙盲對照方法,納入2011年8月-12月擬行無痛胃鏡檢查的患者120例,隨機分為3組。患者于胃鏡檢查開始前口服利多卡因膠漿,靜脈注射舒芬太尼、帕瑞昔布鈉或生理鹽水10 mL。檢查時靜脈注射異丙酚。記錄患者檢查過程中生命體征、異丙酚使用量、誘導時間、檢查時間、蘇醒時間、醫師以及患者滿意度、舒適度等數據。 結果 舒芬太尼組檢查中各時間點平均動脈壓明顯低于帕瑞昔布組(P=0.029),血管活性藥物用量明顯高于帕瑞昔布組(P=0.036)。醫師以及患者滿意度舒芬太尼組和帕瑞昔布組相當,且均高于對照組(P<0.05)。除嗆咳外,帕瑞昔布組其他不良反應的發生率明顯低于舒芬太尼組(P<0.05)。 結論 實施無痛胃鏡檢查前15 min靜脈注射帕瑞昔布鈉0.6 mg/kg或舒芬太尼0.10 μg/kg均可以獲得滿意的麻醉效果,麻醉醫師和患者及家屬的滿意度明顯增高,且帕瑞昔布對呼吸和循環的影響更小,安全性更高。
Transesophageal echocardiogram (TEE) can promote the quality of cardiac surgery and reduce peri-operative complications, and thus has been gradually accepted by cardiac surgeons. Through an esophageal probe, TEE can clearly visualize the internal structure of the heart without interrupting surgical procedure. As a newly developed technology which breaks the limitations tied to the traditional two-dimensional TEE, the realtime threedimensional transesophageal echocardiogram (RT3D-TEE) has the advantages of showing threedimensional structure of the heart and providing full range of anatomical information of the heart. Furthermore, it can precisely analyze the anatomical structure of the abnormal heart valves and provide assessment of the change of heart volume. Relying on its unique imaging property, it can largely facilitate preoperative decision-making and provide realtime intraoperative guidance as well as accurate postoperative evaluation. It has now been successfully applied in various types of cardiac surgical procedures including valve repair surgery, congenital heart defect intervention, cardiac mass removal as well as heart function evaluation. In this article, we will review the applications of RT3D-TEE in cardiac surgery, and try to form a basis for its further clinical application.
Objective To analyze and compare the effectiveness of the closed reduction with elastic intramedullary nail ing and open reduction with Kirschner wire fixations in the treatment of O’Brien type III radial neck fractures in children. Methods Between November 2007 and November 2010, 31 children with O’Brien type III radial neck fractures were treated by the closed reduction with elastic intramedullary nailing fixation (closed reduction group, n=18) and by the open reduction with Kirschner wire fixation (open reduction group, n=13). There was no significant difference in age, gender, disease duration, and fracture classification between 2 groups (P gt; 0.05). Results The incisions of 2 groups healed primarily. Allthe patients were followed up 1-2 years (mean, 1.5 years). Limitation of the elbow extension occurred in 2 cases of the closed reduction group, l imitations of the elbow extension, flexion, and forearm pronation in 6 cases of the open reduction group. There was no significant difference in elbow flexion, extension, pronation, and supination between affected side and normal side in the closed reduction group (P gt; 0.05). Except in supination (P gt; 0.05), there were significant differences in flexion, extension, and pronation between affected side and normal side in the open reduction group (P lt; 0.05). According to Metaizeau’s grading criterion, excellent results were achieved in 16 cases and good in 2 cases in the closed reduction group; excellent results were achieved in 4 cases, good in 4 cases, fair in 3 cases, and poor in 2 case in the open reduction group; and there was significant difference between 2 groups (Z=3.435, P=0.001). The X-ray films showed anatomical reduction in 2 groups before removal of internal fixation; redisplacement occurred in 4 cases after removal of internal fixation in the open reduction group, no redisplacement occurred in the closed reduction group. There was no avascular necrosis of radial head and epi physes during follow-up. Conclusion Comparison with the open reduction with Kirschner wire fixation, the closed reduction with elastic intramedullary nailing fixation is a rel iable and good treatment for O’Brien type III radial neck fractures in children, because it has the advantages of minimal invasion, easy operation, stable fixation, early mobilization, and less complication.
Objective To investigate the impact of laparoscopic versus. open hepatic resection for liver cancer on clinical rehabilitation and humoral immune function in patients organism. Methods Forty-four patients of laparoscopic and open left-lateral sectionectomy from January 2010 to June 2012 were selected, including 22 patients of laparoscopy group and 22 patients of conventional laparotomy group. The levels of IgG, IgA, IgM, C3, C4, C reactive protein (CRP), IL-2, IL-6, and TNF-α in peripheral blood of patients on the last day before operation, first day and 5th day after operation were determinated by using ELISA assay. At the same time, the operative time, intraoperative bleeding, hospitalization time, and complications after operation between two groups were compared. Results The postoperative analgesic using time, first time eating, and hospitalization time in laparoscopic group were (1.9±0.8) days, (2.2±0.5) days, and (6.3±1.3) days, respectively, they were shorter than that in conventional laparotomy group (P<0.05). The operative time, intraoperative bleeding, complication rate, and mortality in two groups were not significant differences(P>0.05) . Compared with before operation, the levels of C3, C4, IgA, IgG, IgM, and IL-2 on the first day after oper-ation in two groups were obviusly reduced, the levels of CRP, IL-6, and TNF-α on the first day after operation in two groups were significantly increased. The levels of C3, C4, lgA, IgG, lgM, and IL-2 on the first day after operation in conventional laparotomy group were significantly decreased than that in laparoscopic group (P<0.05). On the 5th day after operation, the levels of C3, C4, lgA, IgG, lgM, and IL-2 of laparoscopy group increased, the levels of CRP, IL-6,and TNF-α were reduced,that were no difference compared with before operation. Compared with before operation,the levels of C3, C4, lgA, IgG, lgM, and IL-2 of conventional laparotomy group were still at a low level state, and the levels of CRP, IL-6, and TNF-α were still at a high level state on the 5th day after operation. Conclusions Laparoscopic resection of liver cancer after operation, the patients’ recovery are quickly, and the impact on humoral immune function of laparoscopic radical resection for liver cancer patients is significantly less than that conventional laparotomy.