Objective To establish dog model of testicular autotransplantation with a modified technique.Methods Testicular autotransplantations were performed on the right side of 30 male dogs, whose ages ranged from 1.5 to 2.0 years old and weights ranged from 14 to 17 kg. After the spermatic artery with a cuff of abdominal aorta and spermatic vein and with a cuff of inferior vena cava were detached, the testis was perfused and kept at icing temperature. An end-to-side anastomosis of the spermatic vessels to the external iliac vessels was conducted subsequently. The survival conditions of the auografts were assessed by digital subtraction arteriography (DSA). Histological examination and detection on the serum levels of follicle stimulating hormone (FSH), luteotrophic hormone (LH), and testosterone (T) were made at two weeks intervals. Results Of the 30 testicular autotransplantations performed, 27 cases were successful. The success rate was 90%. The time of heat ischemia, cold ischemia, anastomosis of spermatic vessels, and total operation was 4.5±0.9 minutes, 50.0±10.0 minutes, 35.5±5.5 minutes, and 3.5±0.5 hours respectively. DSA proved that the testis survived well. No morphological abnormality was found at different stages of the spermatogenic cells. The LH level was higherthan that before operation, being statistically different (Plt;0.05);however, the levels of FSH and T did not changed significantly (Pgt;0.05). Conclusion A stable and feasible model of testicular autotransplantation is established and it provides a reliable experimental platform for human testicular transplantation.
目的 建立重组人内皮抑素（恩度）联合顺铂一线治疗肿瘤进展的小鼠模型，继续应用内皮抑素联合紫杉醇二线治疗，研究内皮抑素协同紫杉醇抗肿瘤的作用及其机制。 方法 建立小鼠Lewis 肺癌移植瘤动物模型，内皮抑素联合顺铂治疗后观察肿瘤生长情况，遴选出肿瘤进展小鼠16只，随机留取1只，余15只小鼠随机分成紫杉醇组和联合用药组治疗，观察疗效。另取上述肿瘤进展小鼠1只，剥离肿瘤组织，重新接种，将成瘤小鼠随机分成生理盐水组，紫杉醇组及联合用药组治疗，观察疗效。治疗结束后24 h处死所有小鼠，采用免疫组织化学CD31单克隆抗体标记检测微血管密度（MVD），采用原位末端转移酶（TUNEL）检测细胞凋亡。 结果 只肿瘤进展小鼠中，联合用药组相比紫杉醇组生存时间无明显延长，但肿瘤体积增长较慢；而在重新接种成瘤的小鼠中，联合用药组较其余各组微血管密度明显减低（P＜0.05），凋亡指数明显增加（P＜0.05），肿瘤体积抑制明显。 结论 在内皮抑素联合顺铂治疗肿瘤进展的小鼠模型中，继续应用内皮抑素治疗与紫杉醇有较明显的协同抗肿瘤作用。
目的 采用腹腔镜、内镜联合技术处理胆囊结石合并肝外胆管结石，对同期及分期治疗的结果进行比较。方法 患者60例，其中同期处理36例，分期处理24例。术前诊断依据B超、ERCP或MRCP检查，术中诊断依据术中胆道镜检查和胆道造影，全部病例均诊断为慢性胆囊炎合并胆总管结石。同期手术者直接行腹腔镜胆囊切除术，胆道镜和（或）造影检查后行腹腔镜经胆囊管或胆总管胆道镜取石，闭合胆管开口或放置T管。分期手术者先行或者后行ERCP+经内镜乳头切开术/经内镜乳头气囊扩张术取石，再行常规的腹腔镜胆囊切除术。结果 60例患者腹腔镜胆囊切除术均成功，同期手术者手术时间40～90 min，平均68 min，术后发生1例漏胆； 分期手术者2次手术时间共60～120 min，平均80 min。同期手术者手术时间明显短于分期手术者（P＜0.01），而术后并发症发生情况二者间差异则无统计学意义（Pgt;0.05）。同期手术者住院费用较少（P＜0.01），同时在胆总管一期缝合或胆囊管一期结扎的情况下，住院时间相对较短（P＜0.01）。结论 腹腔镜胆囊切除术＋腹腔镜下胆道镜胆总管探查术或经胆囊管探查术同期治疗胆囊结石合并肝外胆管结石安全可靠，值得进一步研究、推广。
Objective To investigate the correlation between the initial arterial blood lactic acid and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score in trauma patients and its value in prognosis. Methods From August 1st 2015 to July 31st 2016, the clinical data of trauma patients treated in Department of Emergency were analyzed retrospectively. All patients were divided into survival group and death group by observing 28-day prognosis. We compared the relationship between the initial blood lactate level and APACHEⅡ score, and analyzed the relationship between the above indexes and the prognosis of the patients. Results A total of 743 patients were enrolled, with692 in survival group and 51 in death group.The APACHEⅡ score and initial blood lactate level in the survival group [(9.93±4.62) points, (2.02±1.44) mmol/L] were significantly lower than those in the death group [(22.84±7.26) points, (4.60±3.69) mmol/L] with significant differences (t=18.20, 9.77; P<0.01). The APACHEⅡ score and the mortality rate of patients with lactic acid level >4 mmol/L were significantly higher than those of patients with lactic acid of 2-4 mmol/L and <2 mmol/L; the differences were significant (P<0.05). The blood lactate and mortality in patients with APACHEⅡ score >20 were significantly higher than those in the patients with ≤10 and 11-20; the differences were significant (P<0.05). There was a significant positive correlation between initial blood lactate level and APACHEⅡ score (r=0.426, P<0.01). Conclusions The initial blood lactate level and APACHEⅡ score of trauma patients are correlated with the severity of injury and mortality. Both of the increase of initial blood lactic acid level and APACHEⅡ score suggest the risk of death in trauma patients.
ObjectiveTo evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection for ultra-low rectal cancer.MethodsThe medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated by Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively. According to the different methods during the operation, the patients were divided into a modified Bacon one-time operation group (modified Bacon group, n=26) and a Bacon secondary operation group (traditional Bacon group, n=33). The perioperative period data and follow-up results were observed and compared.ResultsA total of 59 ptients were collected, including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group. There were no significant differences in gender composition, age, etc. baseline data between the two groups (P>0.05). All surgery were successfully completed. There were no conversion to laparotomy, intraoperative or postoperative massive bleeding, severe infection and other serious complications and perioperative period death. The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group [0.0% (0/26) versus 18.2% (6/33), P=0.030]. There were no significant differences in the incidences of postoperative anastomotic bleeding, anastomotic stricture, rectal irritation, and external intestinal necrosis between the two groups (P>0.05). And the number of dissected lymph nodes, operation time, intraoperative blood loss, the first exhaust time, and postoperative hospital stay had no significant differences between the two groups (P>0.05). There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome (LARS) between the two groups at 3 and 6 months after operation (P>0.05). However, the total LARS score at 6 months after operation was lower than that at 3 months in the same group (P<0.001). By the end of the last follow-up (January 2021), there was no obvious difference in the anal shape between the two kinds of surgery. There was no recurrence or death during the follow-up period.ConclusionModified Bacon one-time operation for ultra-low rectal cancer is safe and feasible, which could achieve natural orififice specimen extraction surgery and ultra-low limit sphincter preservation, reduce occurrence of postoperative anastomotic leakage and external intestinal necrosis, times of operation, and shorten total length of stay and reduce total cost of hospitalization.
目的总结胰肾联合移植术后感染的特点，并对其预防及治疗进行讨论。方法对我院施行的2例胰肾联合移植术后感染的临床资料结合有关文献进行讨论。结果1例术后发生7次感染，其中2次为肺部感染，4次为泌尿系感染，1次为巨细胞病毒感染，移植之胰肾有功能存活3年余； 另1例发生呼吸系统及泌尿系统感染各1次，术后早期恢复尚可，3周发生急性肾排斥，7周死于混合菌感染败血症。结论胰肾联合移植围手术期感染根据其临床特点，正确的围手术期处理非常重要。
目的 探讨影响岩斜区脑膜瘤（PCM）预后的相关因素。 方法 回顾分析解放军452医院2005年9月－2009年6月及四川大学华西医院1999年9月－2009年2月110例患者的临床资料及随访结果，通过单因素生存分析及Cox比例风险模型分析探讨影响PCM预后的相关因素。 结果 单因素生存分析发现8种相关因素影响PCM患者的预后，但Cox多因素分析仅发现脑干T2像高信号（OR=5.54，P=0.012）、肿瘤侵入脑干（OR=5.10，P=0.034）、病理高级别（OR=4.03，P=0.011）这3种因素有统计学意义。 结论 脑干T2像高信号、肿瘤侵入脑干、病理高级别可影响岩斜区脑膜瘤患者的预后。