目的 觀察鹽酸氨基葡萄糖治療膝骨關節炎（KOA）的臨床療效。 方法 2010年5月－2012年7月將130例經膝關節鏡清理術后的KOA患者隨機分成A、B兩組，每組65例。A組聯合口服鹽酸氨基葡萄糖膠囊750 mg，2次/d，6周為1個療程，治療3個療程；B組聯合口服尼美舒利膠囊0.1 g，2次/d，服用12周。采用Lequesne指數作為療效評定指標，觀察治療前后膝關節體征及癥狀變化，休息痛、運動痛、壓痛、腫脹、晨僵和行走能力的改善情況。 結果 B組患者在治療早期癥狀改善優于同期A組，且在第3個月有統計學意義（P＜0.05），隨著治療時間的延長，A組患者總有效率在1、3、6個月分別為70.8%、76.9%和92.3%，均呈逐漸上升趨勢，且第6個月療效較前2個時間點差異有統計學意義（P＜0.05）。分別停藥后繼續隨訪至1年，兩組患者總有效率均有所下降，但A組療效仍優于B組，且有統計學意義（P＜0.05）。A組出現不良反應2例，B組4例，均較輕微，無嚴重不良事件發生。 結論 鹽酸氨基葡萄糖在改善OA患者膝關節癥狀等方面效果肯定，且療效較穩定，安全性良好；但遠期療效仍需隨訪觀察。
Objective To investigate the impact of preoperative use of low-molecular-weight heparin （LMWH） on early outcomes of off-pump coronary artery bypass grafting （OPCAB） . Methods Clinical data of 809 patients undergoingisolated OPCAB from April 1st，2011 to September 30th，2012 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. All the patients were divided into LMWH group and control group according to preoperative use of LMWH or not. In LMWH group，there were 386 patients including 290 male and 96 female patients with their age of 49-81 years，who routinely received anticoagulation therapy with LMWH （LMWH sodium or LMWH calcium，4 000 U twice a day，subcutaneous injection） after discontinuation of anti-platelet therapy until the day before surgery. In the control group，there were 423 patients including 321 male and 102 female patients with their age of 46-78 years，who didn’t receive LMWH or any other anticoagulant after discontinuation of anti-platelet therapy. Postoperative mortality，incidence of perioperative myocardial infarction （MI），operation time，amount of blood loss and transfusion，and incidence of postoperative acute renal injury were compared between the 2 groups. Results Intraoperative blood loss （296±94 ml vs. 249±81 ml，P=0.03），postoperative thoracic drainage （526±159 ml vs. 410±125 ml，P=0.02），blood transfusion （2.6±1.1 U vs. 1.4±0.9 U，P=0.04） and operation time （172±34 min vs. 154±41 min，P=0.04） of LMWH group were significantly larger or longer than those of the control group. There was no statistical difference in postoperative mortality（1.0% vs. 1.2%，P=1.00）or incidence of perioperative MI（4.4% vs. 3.8%，P=0.55）between the 2 groups. Conclusion For OPCAB patientswith stable ischemic heart disease，preoperative management without use of LMWH can decrease operation time and amountof blood loss and transfusion without increasing postoperative mortality or incidence of perioperative MI.
ObjectiveTo evaluate the safety and feasibility of laparoscopic hepatectomy. Methods A total of 25 patients with hepatocellular carcinoma or liver hemangioma received laparoscopic hepatectomy, and perioperative results were analyzed. ResultsOnly one patient was converted to open hepatectomy because of massive hemorrhage. Blood loss of all patients during operation ranged from 100-1 200 ml with an average of 400 ml. The total blood volume of transfusion was 200-1 000 ml (mean 400 ml) in 14 patients. The operative time was 0.8-4.0 h (mean 2.3 h). All patients had no complications such as bile leakage and infection, and discharged from hospital in 5-10 d (mean 8 d) after operation. ConclusionLaparoscopic hepatectomy is safe and feasible to some liver diseases, but should be used with caution for the patients with tumor diameter over 9 cm and hepatic large vessels invaded by cancer.