目的：采用常压间歇性低氧(intermittent hypoxia,IH)大鼠的动物模型，观察间歇性常压低氧预处理的促血管生成作用。方法:成年雄性Wistar大鼠25只，体重210～215 g，随机分为2大组:对照组(C组，n=5)和间歇性低氧预处理组(IH组，n=20)。IH组动物进行间歇性低氧预处理(4 h/d，间歇缺氧1 d者为IH1组，7 d者为IH2组，14 d者为IH3组，28 d者为IH4组)，按计划完成实验后测定心肌血管内皮生长因子(VEGF) 蛋白表达及毛细血管密度。结果：间歇性低氧预处理大鼠心肌VEGF蛋白表达增加，心肌毛细血管密度增高。结论：间歇性低氧预处理能促进大鼠心肌内的血管生成，其机制可能与心肌VEGF表达增高有关。
目的：讨论剖宫产瘢痕妊娠的早期正确诊断方法和适当的治疗措施。方法：回顾性分析我院35例剖宫产瘢痕妊娠病例的临床表现、超声影像和治疗方法。结果：33例病例经血βhCG测定、B超或彩超确诊，2例行清宫术或诊刮术时发生大出血，后经彩超修正诊断。31例接受药物、清宫等保守性治疗，4例接受介入治疗，所有病例均好转或痊愈。结论：广大临床医师对剖宫产瘢痕妊娠认识的提高，以及超声检查技术的发展，使早期明确诊断和成功保守治疗该病成为可能。
目的 探讨白试验在肝切除手术中检测漏胆的价值。方法 笔者所在医院2008年1月至2013年1月期间在肝切除手术中采用白试验联合干纱布擦拭法检测漏胆56例。即在肝切除手术操作末期，用干纱布擦拭法确认无漏胆后，经胆囊管或左右肝管插管注入5%无菌脂肪乳剂10～30mL，同时用手阻断远端胆总管。观察肝切除手术创面的白色液体渗出情况，对渗出白色液体处予以间断缝合。重复操作，至断面无白色液体渗出为止。结果 56例患者经术中检测，发现漏胆17例（漏胆检出率为30.4%），每例发现漏胆1～6处（平均2.9处），术中均予以确切缝合以关闭漏胆处，且重复试验操作，证实均再无漏胆。术后发生漏胆2例（3.6%），经相应治疗后痊愈出院。全部患者出院后均随访3～6个月（平均3.8个月），无膈下积液或膈下感染病例发生。结论 术中白试验能够发现漏胆的精确部位，不会污染肝切除手术创面，并能够无限次地重复试验，值得临床推广。
ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
Objective To discuss the pathogeny， treatment and prophylactic measures of postcholecystectomy syndrome (PCS). Methods The clinical data of 150 patients with laparoscopic PCS in our department from October 2000 to March 2009 were analyzed. Results Etiological factors were found in 131 patients: one hundred and twelve cases were due to the reasons of biliary system, including bile duct residual stones after cystic resection， the injury bile duct stenosis， a long residual cystic canal， nipple benign stricture, bile duct tumor etc; Nineteen examples were due to other reasons, including gallbladder stone merger reflux gastritis, gastroduodenal ulcer， diverticulum beside duodenal nipple, and so on, which resulted in the symptoms un-release after cystic resection. Nineteen cases were not found organic lesion. In ones whose etiological factors were definite, 117 cases were treated with different surgeries according to different etiological factors; another 33 cases were treated with conservative treatment. Total 145 cases were followed up, and 139 cases in them were cured or relieved at different degrees. Conclusion Careful preoperative examination, normalized operation avoiding damaging bile duct and leaving behind bile duct stones can effectively prevent laparoscopic PCS.
ObjectiveTo study the protective effects of ischemia preconditioning (IPC) on cryopreservation injury of rat liver.MethodsThe model of isolated nonrecirculated perfusion rat liver was established. The grafts were treated with IPC in different time (ischemia preconditioning time in IPC1 group was 5 min; the time in IPC2 group was 10 min; while the time in IPC3 group was 15 min). The cryopreservation injury of the grafts in each group was determined and compared. ResultsThe levels of aspartate transaminase (AST) and alanine transaminase (ALT) in the effluent solutions in IPC1 group were (40.1±6.3) U/L and （17.1±0.5） U/L respectively, and IPC2 group (53.6±3.7) U/L, （19.7±0.5） U/L, which were much lower than those of nonpreconditioning (NPC) group 〔(64.5±8.2) U/L, （23.8±3.9） U/L〕 (P＜0.05). Those in IPC1 group was much lower than those in IPC2 group and IPC3 group 〔(63.8±7.2) U/L,（22.8±2.5） U/L〕 (P＜0.05). The level of lactic acid dehydrogenase (LDH) in NPC group (104.3±20.6) U/L, IPC1 group (84.1±19.7) U/L, IPC2 group (90.5±21.1) U/L, and IPC3 group (103.1±18.5) U/L were of no significant difference (Pgt;0.05). The contents of bile product and the hepatocellular contents of ATP in IPC1 group were (53.5±10.2) μl and (6.15±0.65) μmol/g respectively, and IPC2 group (41.5±8.1) μl, (4.77±0.21) μmol/g, which were much higher than those NPC group 〔(22.8±9.7) μl, (2.62±0.34) μmol/g〕 (P＜0.05). Those in IPC1 group were much higher than those in IPC2 group and IPC3 group 〔(27.5±2.8) μl, (2.61±0.29) μmol/g〕 (P＜0.05). The contents of malondialdehyde (MDA) in liver tissue in IPC1 group was (4.36±0.26) nmol/gand IPC2 group (5.51±0.13)
目的总结胆总管探查术中对其下端狭窄和医源性穿通伤的处理经验。方法对我院1994～2001年行胆总管探查术发现下端狭窄和发生医源性穿通伤病例15例进行回顾性分析。结果11例处理恰当，疗效好； 4例处理错误，发生穿通伤而行胆总管十二指肠吻合，疗效差。结论术中发现胆总管下端狭窄应行术中造影或胆道镜检查以明确原因，切不可盲目用探条探查。若发生胆总管下端穿通伤应行穿孔修补、T管引流，有结石嵌顿者同时行Oddi’s括约肌切开取石。