目的：探讨鼻内窥镜辅助利用口腔黏膜瓣复合鼻腔黏膜瓣修补鼻中隔穿孔的可行性。材料和方法:从2001～2006，采用鼻内窥镜辅助带蒂口腔前庭沟黏膜瓣复合鼻腔黏膜瓣修补巨大鼻中隔穿孔16例，其中10例使用带蒂口腔前庭沟黏膜瓣复合鼻中隔黏骨膜瓣，6例使用带蒂口腔前庭沟黏膜瓣复合带蒂下鼻甲黏骨膜瓣，术后随访5月～3年。结果：3例患者在鼻腔的后份边缘在内窥镜下可见明显穿孔，半年后复查，4例患者中隔残余穿孔，出院时11例患者感觉口腔黏膜瓣进入的鼻腔侧鼻阻明显增加，半年后这种感觉明显改善，所有患者术后头昏、头痛、鼻腔干燥的症状完全消失。结论：鼻内窥镜辅助利用口腔黏膜瓣复合鼻腔黏膜瓣修补鼻中隔穿孔的方法具有较大的临床应用价值。
目的:分析X线对小儿穿孔性阑尾炎的诊断价值。方法:对经临床手术证实为穿孔性阑尾炎50例的腹部X线平片资料（含12例B超、7例CT资料）作回顾性分析。结果:X线表现为右侧胁腹脂线短缩及腹脂线髂段模糊41例，横结肠充气征43例，小肠积气（小肠环内径≤3 cm）12例、胀气（小肠环内径gt;3 cm）38例，小肠积液50例，小肠壁增厚32例，回盲部密度增高并小气泡影12例，右侧腹腔少量游离气体1例。结论:X线检查对穿孔性阑尾炎有一定诊断价值，结合超声检查和/或CT检查可提高诊断准确率。
Objective To evaluate the role of CT in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma. MethodsTwenty preoperative CT scans and clinical data were obtained in 20 patients who subsequently had bowel ruptures verified surgically. CT findings were analyzed retrospectively in these patients. Retrospective interpretation was made by consensus of at least two radiologists. ResultsTwenty cases of CT scan showed intraperitoneal fluid (18 cases), pneumoperitoneum (18 cases), extravasations of gastrointestinal tract contents (2 cases), bowel wall findings (14 cases) and mesenteric injury (15 cases). Conclusion CT is fast, sensitive and noninvasive in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma.
目的探讨胃癌穿孔的手术时机及术式选择。方法对我院1985年1月至2000年12月间急诊收治的64例胃癌穿孔患者的资料进行回顾性分析。结果保守治疗后行择期手术5例； 59例行急诊手术，其中行根治性切除术22例，姑息性切除术10例，穿孔修补后3周内二期行根治性手术6例，行单纯穿孔修补术14例，穿孔修补+短路手术7例。本组手术后30天内死亡6例，死亡率为9.4%，58例中获随访52例，随访5年，失访6例，其中根治性手术、姑息性切除、单纯穿孔修补和穿孔修补+短路手术者平均生存期分别为31个月、18个月、5个月和7个月。结论合理的手术时机及术式选择是延长患者生命和提高患者生存质量的关键所在。
Objective To explore the role of renin-angiotensin system( RAS) in acute lung injury( ALI) /acute respiratory dysfunction syndrome( ARDS) by using amouse cecal ligation and puncture ( CLP)model.Methods The ALI/ARDS animal models were assessed bymeasuring blood gas, wet/dry lung weight ratio( W/D) , and lung tissue histology 18 hours after CLP operation. After the ALI/ARDS models was successfully established, immunohistochemistry, western blotting and radioimmunity were used to investigate the changes of several key enzymes of RAS, such as ACE, ACE2 and Ang Ⅱ. In addition, two groups of animals received a separate intraperitoneal injection of angiotensin-converting enzyme ( ACE) inhibitor captopril or recombinant mouse ACE2 ( rmACE2) after CLP, then the changes of RAS in ALI/ARDS modelswere observed. Results The extensive lung injuries can be observed in the lung tissues from CLP-treated animals 18 hours after operation. The CLP-induced ALI/ARDS led to an increase in the wet/dry weight ratio of the lung tissues, and a decrease in the PaO2 /FiO2 [ ( 194. 3 ±23. 9) mm Hg vs ( 346. 7 ±20. 5) mm Hg,P lt;0. 01] . Immunohistochemistry and western blotting tests of the lung tissues from CLP-treated animals showed a decrease in the ACE2 protein level. However, in both the CLP and sham mice there were no significant differences between the two groups. CLP markedly increased Ang Ⅱ level in lungs and plasma of mice, and RAS drugs significantly impacted the Ang Ⅱ levels of mice. Compared with the CLP group,captopril or rmACE2 led to a decrease of the Ang Ⅱ level in mice [ Lung: ( 1. 58 ±0. 16) fmol /mg,( 1. 65 ±0. 21) fmol /mg vs ( 2. 38 ±0. 41) fmol /mg; Plasma: ( 178. 04 ±17. 87) fmol /mL, ( 153. 74 ±10. 24) fmol /mL vs ( 213. 38 ± 25. 44) fmol /mL] . Conclusions RAS activation is one of the characteristics of CLP-induced ALI/ARDS in mice models. ACE and ACE2 in RAS have a different role in the regulation of AngⅡ synthesis, while ACE has a positive effect in generating AngⅡ, and ACE2 shows a negative effect.
Abstract: Ventricular septal rupture is a rare complication of acute myocardial infarction, but it can easily lead to such complications as acute heart failure and cardiac shock with sinister prognosis. Surgical treatment is a fundamental measure to improve the prognosis, and the selection of operation time is a key factor. The basic guiding principles of operation timing are as follows. Those patients who have acute heart failure and/or cardiac shock soon after the onset of ventricular septal rupture, and can not be controlled by nonsurgery therapy and are also unable to tolerate surgery, will die soon. For them, surgery treatment cannot be implemented because they have missed the optimal operation time. For those whose perforation was so small that they can be stably controlled by nonsurgery therapy, surgery treatment can be postponed for 1 to 4 weeks. However, emergency operation should be performed in time once the condition of the patients becomes unstable. For others, no matter in what state they are, surgical treatment should be implemented immediately.