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find Author "周勇" 52 results
  • Prevention of Postoperative Acute Renal Failure in Patients with Malignant Obstructive Jaundice

    Objective To investigate the protection of renal function and the prevention of acute renal failure (ARF) in patients with malignant obstructive jaundice in perioperative period of radical resection. Methods A series of clinical interventions had been taken since 2004 in our treatment team, including control of endotoxemia, depression of biliary tract before operation, maintenance of adequate effective blood volume, nutritive support, administration of mannitol and low dose of furosemide, and avoidance of disseminated intravascular coagulation. The incidence of perioperative ARF in 206 patients with malignant obstructive jaundice who had been radically resected from 2000 to 2007 was retrospectively studied, and the RIFLE criteria was used for ARF classification. This study was progressed in two periods. The first one was from Jan. 2000 to Dec. 2003, and the second one was from Jan. 2004 to Dec. 2007. Results After 2003, the proportion of radical resection rose from 44.8% to 57.1% (P<0.05), and the rate of perioperative ARF dropped from 15.1% to 6.7%(P<0.05), among which the proportion in the RIFLE-R (Risk) stage had no significant change, while in the RIFLE-F (Failure) stage it dropped from 10.5% to 2.5% (P<0.05). Finally, perioperative mortality rate dropped from 16.3% to 5.8% (P<0.05). Therefore, the reduction of ARF was mainly attributed to the reduction in RIFLE-F stage. Conclusion By using the latest RIFLE criteria to classify ARF, it illustrates that our perioperative interventions have effectively decreased ARF, limited ARF in its early and reversible stage, and prevented advancing.

    Release date:2016-09-08 11:07 Export PDF Favorites Scan
  • 代谢性疾病外科手术方式的发展及演变

    Release date:2018-03-13 02:31 Export PDF Favorites Scan
  • Diagnosis and Treatment of Mirizzi Syndrome

    目的:探讨Mirizzi综合症的诊断治疗特点,以提高其诊断和治疗水平。方法:对35例经手术证实为Mirizzi综合症的临床资料进行回顾性分析。结果:35例Mirizzi综合症患者中仅4例(11.4%)术前确诊。Ⅰ型7例,Ⅱ型17例,Ⅲ型9例,Ⅳ型2例。5例行胆囊切除术,2例行胆囊大部分切除术;胆囊切除、胆囊瓣瘘口修补6例,12例行胆囊切除、胆总管探查、瘘口修补、T管引流术;胆囊切除、胆肠吻合术10例。术后恢复好,随访结果,无严重并发症.结论:Mirizzi综合症术前确诊困难,B超结合MRCP/ERCP检查可以提高Mirizzi综合症的术前确诊率,手术容易损伤胆管,手术方式应据病理损伤程度决定。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • All Hospitalized Patients Should be Screened for Nutritional Risk in Admission

    Release date:2016-09-08 10:45 Export PDF Favorites Scan
  • Effect of Short-Term Administration of Growth Hormone on Serum IGF-1 and Nutritional Status in Patients after Gastrointestinal Surgery

    Objective To investigate the effect of short-term administration of growth hormone (GH) on serum insulin-like growth factor-1 (IGF-1) level and nutritional status in patients after gastrointestinal operation, and evaluate whether postoperative application of GH rise the risk of tumor recurrence. Methods Forty-eight patients undergoing major gastrointestinal operation were randomly divided into two groups: GH group (n=24) and control group (n=24). The two groups received isocaloric isonitrogenous nutrition with daily injection of either GH 0.15 U/kg or placebo for a period of day 3-9 postoperatively. Serum albumin, fibronectin, and IGF-1 were measured before operation as a baseline, and day 3 and 10 after operation using standard laboratory techniques. Nitrogen balance was measured daily from day 3 to day 9 after operation. Postoperative complications and adverse reaction were observed. All cancer patients received regular abdominal B-type ultrasonography and chest X-ray examination during 2 years of follow-up. Results Compared with control group, GH treatment did not influence serum IGF-1 and serum albumin level (Pgt;0.05), but improved significantly the rise from day 3 to day 10 of serum fibronectin level 〔(22.8±5.8) mg/L vs.(9.6±3.6) mg/L, P<0.05〕 and the cumulative nitrogen balance 〔(11.37±16.82) g vs.(-9.11±17.52) g, P<0.01〕 postoperatively. There was no severe adverse effects and complications during GH treatment. The tumor-recurrence rates were not statistically different between two groups during follow-up. Conclusions Short-term administration of low-dose GH combined with early nutrition support can improve total nitrogen retention and protein metabolism, but not influence serum IGF-1 level after major abdominal surgery. Short-term administration of low-dose GH may not cause the tumor-recurrence.

    Release date:2016-08-28 03:48 Export PDF Favorites Scan
  • 腹部全厚皮肤移植覆盖乳腺癌根治术创面

    Release date:2016-09-01 11:37 Export PDF Favorites Scan
  • 硅胶内衬套治疗地震挤压伤截肢术后1例报告

    目的:观察硅胶内衬套应用于地震挤压伤截肢术后患者残端渗液不止的治疗效果。方法:采用个案分析。14岁女性少年,因地震挤压伤致左小腿中上段截肢,给予综合康复治疗,伤口愈合后安装假肢,残端出现水泡,原伤口少量浆液性液体渗出不止,给予加戴硅胶内衬套。结果:患者残端伤口渗液逐渐减少,水泡消失,正常熟练使用假肢,日常生活活动能力提高,正常上学。结论:硅胶内衬套是处理截肢术后残端渗液较好的方法。

    Release date:2016-09-08 09:54 Export PDF Favorites Scan
  • Effect of Ghrelin on Insulin Secretion and Expression of Glut-2 Protein in Isolated Pancreas of rat

    Objective To explore the effect of ghrelin on insulin secretion and expression of glucose transporter protein-2 (Glut-2) in isolated pancreas of rats. Methods Twenty five Wistar rats were randomly devided into normal control group (NC group), high concentration of glucose group (HCG group), high concentration of glucose with high concentration of ghrelin group (10-8mol/L, HCG+HCGh group), medium concentration of ghrelin group(10-9mol/L, HCG+MCGh group), and low concentration of ghrelin group (10-10mol/L, HCG+LCGh group) with 5 rats in each group. The rat isolated pancreas perfusion models were established firstly, then from the distal end of abdominal aortas, the models were perfused with low concentration of glucose (5.5mmol/L), high concentration of glucose (33.3mmol/L) or high concentration of glucose added with different concentrations of ghrelin. Levels of insulin outflowed from portal vein were tested by ELISA method, expression levels of Glut-2 protein were tested by immunohistochemical method,and ultrastructure changes of islet β cell were observed under the transmission electron microscope. Results There were no significant difference on levels of fasting blood glucose (FBG), fasting insulins (FINS), homeostasis model of assess-ment for insulin resistence index (HOMA-IR), and homeostasis model of assessment for pancreatic β cell function (HOMA-β),(P>0.05). There were no significant difference on insulin levels of effluent from portal vein of 5 groups (P>0.05) when isolated pancreas perfused with 5.5mmol/L glucose, while had 2 secretion peaks in 3min and 10-12min after 33.3 mmol/L glucose perfusion, where HCG+HCGh group at the top. The mean density value of Glut-2 protein in NC group was higher than that of other 4 groups (P<0.05). The results of transmission electron microscopy showed that apoptosis was lighter in NC group than that of other 4 groups, and apoptosis of HCG+HCGh group was lighter than that of HCG+MCGh group and HCG+LCGh group. Conclusions In isolated pancreas of rats, ghrelin promotes high concentration of glucose-stimulated insulin secretion, decreases expression of Glut-2 protein, and protects the islet β cell.

    Release date:2016-09-08 10:24 Export PDF Favorites Scan
  • 肝脏肺吸虫病1例报道

      患者,女,35岁,因反复右上腹痛伴发热15 d急诊入院。15 d 前患者无明显诱因感右上腹持续性胀痛,放射至背心,同时出现发热,最高体温(T)39 ℃,伴恶心、呕吐、腹胀等,抗生素治疗后症状有好转,其后上述症状反复发作,抗生素治疗有效,为进一步诊治来我院。入院时查体: T 38.3 ℃,R 87次/min, P 20次/min,BP 109/68 mm Hg(1 mm Hg=0.133 kPa); 急性病容,神志清楚,皮肤、巩膜无黄染; 心、肺(-); 腹软,右上腹压痛、叩痛,肌张力不高; 肝脏于肋下4 cm,质软,轻触痛,移浊(-)。急诊血常规: Hb 99.8 g/L, WBC 6.5×109/L; B超: 左、右肝低密度占位。入院诊断: 肝脓肿,肝肿瘤待排。入院后按肝脓肿治疗,用三联抗生素,T 36.7~39.5 ℃,右肝区叩痛。经上述抗感染治疗5 d后,T仍达39.2 ℃,复查血常规: Hb 100.2 g/L,WBC 6.3×109/L,N 0.496,淋巴细胞比例0.096,淋巴细胞数0.58×109/L; 嗜酸性细胞比例0.341,嗜酸性细胞数2.05×109 /L。TB 12 μmol/L,DB 4.2 μmol/L,AST 17 U/L,ALT 19 U/L,Alb 37.7 g/L,GLB 32.0 g/L; 血清CEA、CA15-3、AFP、CA19-9 均正常; 血培养24 h阴性。 心电图、胸片未见异常。CT检查: 左肝内叶、右肝前叶低密度占位但无明显液性暗区形成(图1); 复查B超: 肝右前叶及左外叶稍弱回声区7.2 cm×3.0 cm、4.3 cm×4.2 cm及 2.5 cm×2.0 cm大,边界不清,内见蜂窝状无回声。经全科讨论认为,肝低密度占位明确,以细菌性肝脓肿可能性大,经抗感染治疗后T仍高达39.2 ℃,有手术引流指征。于入院后第6天急诊行肝脓肿引流+活检。术中见左、右肝增大,色泽红; 左肝SⅡ、SⅢ各扪及包块约1.5 cm×2.0 cm×2.0 cm大,切开后有粉红色脓液; 右肝SⅤ~SⅥ各有包块6 cm×6 cm×6 cm大,质较硬,切开后有黄白色脓液20 ml及淡黄色颗粒样物,脓肿壁厚约0.5 cm,似干酪样。取含脓肿壁的肝组织送病检。术后诊断: 细菌性肝脓肿或肝结核继发细菌性肝脓肿。术后1 d症状缓解,T 37.4 ℃,肝区叩痛减轻,脓腔引流约10 ml/d。术后3 d,肠功能恢复,开始进流食,下床活动,T逐步降至正常,脓腔引流<5 ml/d。术后第5天拔出引流管后出院。血培养报告: 1周无细菌、真菌生长; 脓液涂片: 革兰染色无细菌,未见抗酸杆菌。术后病理报告: 肝组织内窦道样嗜酸性脓肿形成,可见夏科-雷登结晶,未见虫体及虫卵, 多为肺吸虫病。  讨论 肝脏肺吸虫病罕见,文献中仅有数例报道。本例为中青年女性,起病急,以发热、右上腹痛为主症,T高达39.5 ℃,无畏寒、寒战。抗生素治疗有效,但反复发作。WBC总数和中性粒细胞比例正常,淋巴细胞比例(0.096)明显降低,嗜酸性细胞绝对数及比例(0.341)明显增高。影像学检查示左、右肝多发性低密度区,但无明显液性暗区形成。术中探查: 肝明显增大,显暗红色,符合炎性表现,脓液有粉红色及黄白色,含淡黄色颗粒物,脓壁明显增厚(约0.5 cm),有干酪样物,引流后无明显脓液流出,临床症状缓解,T降至正常。本例临床表现与常见细菌性肝脓肿很相似,但本例感染症状明显,而WBC不高,中性粒细胞正常,淋巴细胞明显减少,嗜酸性细胞明显增高,这符合寄生虫感染表现。此病术前明确诊断困难,易诊断为细菌性肝脓肿,但若注意其特殊的血常规结果,结合影像学检查中的无典型表现,均可提示非细菌性肝脓肿的可能性。

    Release date:2016-09-08 11:05 Export PDF Favorites Scan
  • Multifactorial Analysis of 233 Pancreaticoduodenectomy Cases Related to Risk Factors of Postoperative Complications and Death

    【Abstract】 Objective To multifactorially analyze the risk factors related to the post-pancreaticoduodenectomy (PD) complications and death. Methods Two hundred and thirty-three PD cases were analyzed, average age 56, of those cases, 210 malignant with 72 pancreatic head and 138 periampullary involvement, 23 benign. Fifty-nine cases suffered coexisting vital organ disorders. Results Sixty-three cases (27.0%) experienced postoperative complications, among those 58 cases (24.9%) early complications, 28(12.0%) infection, 15(6.4%) organ systemic disorder, 14(6.0%) bleeding, 12(5.2%) pancreatic fistula, 15(6.4%) reoperations, 16 postoperative death during hospitalization. The independent risk factors related to the postoperative complications included coexisting vital organ disorders, operation methods, main pancreatic duct (MPD) diameter and surgeon’s experiences, those related to the death during hospitalization included preoperative serum creatinine, coexisting vital organ disorders, surgeon’s experiences; those related to the reoperation included preoperative CA19-9, surgeon’s experiences, tumor diameters, lymph nodes metastasis; and those related to the pancreatic fistula included operation methods, MPD diameters and surgeon’s experiences. Conclusion Coexisting vital organ disorders and surgeon’s experiences are the independent risk factors related to postoperative complications and death during hospitalization, operation methods, MPD diameter and surgeon’s experiences are the independent risk factors related to the pancreatic fistula. Thus, it is very important to choose the appropriate PD candidates, select the right operation method and to familiarize the operation.

    Release date:2016-09-08 11:43 Export PDF Favorites Scan
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