肠外营养支持临床应用七年回顾

目的分析7年来肠外营养支持在我院临床应用的疗效.方法据不完全统计,从1992年中旬到1999年11月,对2768例病人进行了以肠外营养为主的营养支持.凡严重感染、创伤可能引起之营养不良,不能进食,胃肠道无功能或胃肠道需要休息,以及各种原因引起或即将引起营养不良者均为肠外营养适应症.2768例病人分布于我院普外科,SICU、烧伤、胸外、骨科、干疗科,神经内科,肾内,血液等17个科室,其中外科系统占71.8%,内科仅占28.2%.结果和结论1.肠外营养是治疗危重病人的重要手段,它使重症胰腺炎,肠瘘,严重感染,严重创伤等病人获得了治愈机会.2.危重病人处于严重应激和代谢紊乱,治疗中应遵循代谢支持原则,减少糖量,增加氮量.3.治疗中应注意保护胃肠粘膜屏障,少量早期进食和口服谷氨酰胺是保护胃肠粘膜屏障简单有效的方法.4.对于严重创伤病人,尽管提供了足够而合理的营养底物,但病人的分解代谢并不因此而减轻,给予代谢调理剂(如生长激素)是有益的.5.肿瘤病人的营养支持应配合化疗或用于围手术期,肝功能差的病人则应提高支链氨基酸含量,肾衰病人应降低氮量,主要提供必需氨基酸.6.一旦肠道能利用就要尽可能利用,肠内营养能保护肠屏障功能,还能改善内脏血液循环障碍,加速重症病人的康复.7.肠外营养的并发症时有发生,要特别注意.

房室结改良术终点、快径传导功能与复发率三者关系的回顾性研究(摘要)

Antiepileptic drugs are the preferred treatment approach for epileptic patients. However, informal treatment is important for intractable epilepsy. In this study, 500 epileptic patients were recruited from the General Hospital of Beijing Military Area Command of Chinese PLA during the period of October 2009 to January 2012. These involved patients that had been medical y treated for at least 1 year. Information on the initial treatment and changes to treatment regimens for each patient was col ected through questionnaires. The survey results showed that 52.3% of the epileptic patients searched for treatment after the first seizure, and the mean numbers of seizures was 12.8;59.8%of the epileptic patients were diagnosed at the first visit, and the mean onset time was 17 months after the first seizure. After diagnosis, patients were treated for an average of 20 days, and the median time was 1 day. Formal anti-epileptic drugs were selected as the first treatment regimen by 67.8%of patients, and 77.5%of these drugs were monotherapies. The mean and median numbers of seizure were respectively 36.9 and 3.0 times before the first regimen was changed. The regimen was changed within the first 6 months by 46.6% of patients, and after the first and second years of treatment, the proportions increased to 54.0%and 71.8%, respectively. In total, 78.5%of the regi-mens were changed to informal treatments. The informal treatment of epilepsy in China is common, being initiated by either patients or physicians. Enhancing epileptic treatment services in hospital, improving physicians’ professional quality, and strengthening health propaganda may promote the normalization of drug treatment of epilepsy in China.

Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids（ 20 cases） , mainly pain or urine frequency ； progressively increasing fibroid size (7 cases)； coexistent adnexal pathology（ 26 cases） and infertility（ 21 cases） . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7％ ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3～ 8 cm (mean 4.8 cm). In 19 cases (25.6％ ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids <4cm. The difference was statistically significant (P< 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4％ . The average postoperative follow-up period was 22 months (1～ 62 months). All the patients with symptoms showed remission of their complaints at 2-month follow-up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.

PURPOSE. To investigate the sensitivity, specificity, and spatial distribution of the product of p28 gene (p28(GANK) protein) in human hepatocellular carcinoma (HCC) and nonhepatocellular carcinomas in relation to immunostaining with Cytokeratin 18 (CK18), alpha-fetoprotein (AFP), and Hepatocyte paraffin 1 (HepPar1). METHOD. In this retrospective study, formalin-fixed paraffin-embedded tissues from 24 HCCs, five intrahepatic cholangiocarcinomas (ICC), five combined hepatocellular cholangiocarcinomas (C-HCC-CC) and mine metastatic hepatic carcinomas (MHC) were immunostained for p28(GANK) as well as CK18, AFP and HepPar1. Only cases with more intensified staining in carcinoma contrast to the adjacent liver tissues were accepted as positive. RESULT. In HCC, p28(GANK) was expressed restrictively in hepatocytes of both para-lesion and carcinoma liver tissues, while absent in the bile duct epithelial cells, Kupffer cells, and other interstitial cells. The positive staining of p28(GANK) was noted in 16 (66.7%) specimens of HCC and three (60.0%) specimens of C-HCC-CC, and no specific lesion staining was found in all tested specimens of ICC and MHC. Sensitivity and specificity for hepatocyte-originated carcinoma were, respectively, 65.5% and 100% for p28(GANK), 79.3% and 85.2% for CK18, 20.7% and 100% for AFP, 79.3% and 92.0% for HepPar1. CONCLUSION. The hepatocytic staining for p28(GANK) is clearly useful in differentiating hepatocyte-originated carcinoma from non-HCC. p28(GANK) may be used as an ancillary marker for the diagnosis of HCC.

小肠闭锁的临床与病理形态研究

为研究小肠闭锁患儿术后功能性肠梗阻与病理形态的关系,我们将五年来经手术治疗的32例中,21例送检标本作了较细致的显微镜检查.并选择11例日龄1～17天,非肠源性疾病死亡患儿作对照组.观察到十二指肠及回肠闭锁患儿肠管发育不全,闭锁远、近端肠壁全层增厚,粘膜及肌层比例失调,肌间神经丛存在,神经节细胞明显减少.作者认为这些是手术后肠梗阻的结构基础,随其全身情况好转,消化道继续发育功能可逐渐恢复正常.

儿童及青少年卵巢肿瘤(附108例临床病理分析)

沂蒙山区1966～1984年间收治卵巢肿瘤1,715例,其中儿童及青少年(＜1～17岁)卵巢肿瘤108例,发病率为6.4%.按WHO卵巢肿瘤组织学分类,结合范郎娣提出的标准,复查了全部病理切片,并整理有关临床资料,报道如下.

Objective:A retrospective study was conducted to investigate the rules of lymph node metastases in distal gastric cancer and its clinical significance.Methods: This study was performed on 129 patients who had distal gastric cancer with lymphadenectomy for radical cure, whose specimens were obtained during surgery.Results:Among 129 patients with distal gastric cancer, lymph node metastases were found in 80 patients (62.02%) with a total collection of 3,295 lymph nodes and an average of 25.54 lymph nodes per patient.Conclusion:According to the clinical and pathological factors and combining it with the characteristics of lymph node metastasis by groups and stations in different areas and then properly choosing and extending the extent of lymph node resection, the objective of radical cure for distal gastric cancer could be achieved individually when it is performed radical lymphadenectomy.