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中国中西医结合外科杂志

中国中西医结合外科杂志

CSTPCD

Chinese Journal of Surgery of Integrated Traditional and Western Medicine
本刊是由中国科协主管、中国中西医结合学会主办的中西医结合外科方面的国家级综合性学术期刊。旨在报道急腹症、肿瘤、周围血管、骨科、泌尿外科、肛肠科和疡科等七个专业范畴在中西医结合临床、科研、预防、教学等方面的经验和成果，探讨中西医结合的思路和方法，介绍国内外有关本专业的进展，促进我国医学科学现代化。
  • 发文量：5755
  • 被引量：1988
  • H指数：1
  • 开始收录时间：1994,1(1)
  • CNKI综合因子：0.721
  • 维普期刊影响因子： 2.14
  • 万方期刊影响因子：1.69
  • 创刊时间：1994
  • 国内刊号/CN：12-1249/R
    国际刊号/ISSN：1007-6948
  • 发行周期：双月刊
    邮发代号：6-31
  • 主管单位：中国科协
    主办单位：中国中西医结合学会 天津市中西医结合急腹症研究所
中国中西医结合外科杂志-联系信息
  • 主编：吴咸中
  • 电话：022-27420471
  • 邮箱：zxyjhwk@126.com;zxyjhwk@hotmail.com
  • 地址：天津市南开区三纬路122号
  • 邮编：300100
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中国中西医结合外科杂志 >2023年第6期

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  • 摘要：目的:探讨地奥司明联合麝香痔疮膏治疗肛肠病的效果,分析其对疼痛和生活质量影响.方法:选取112例肛肠病患者,依据中心随机双盲平行对照法将其分为联合组与对照组各56例,对照组用地奥司明治疗,联合组地奥司明与麝香肛肠病膏联用,对两组疗效、疼痛状况及生活状况进行观察.结果:联合组、对照组治疗总有效率分别为94.6%、71.4%(P＜0.05);联合组治疗前与治疗后VAS评分分别为(6.4±1.4)分和(2.1±0.5)分,对照组治疗前与治疗后VAS评分分别为(6.3±1.5)分和(3.5±0.7)分,两组VAS评分较治疗前均下降,组间差异有统计学意义(P＜0.05).联合组、对照组生活质量ADL评分分别为(89.4±7.3)分、(72.6±5.9)分(P＜0.05);两组不良反应发生率差异无统计学意义(P＞0.05).结论:地奥司明与麝香痔疮膏联合治疗肛肠病效果显著,可减轻患者疼痛,提高其生活质量.%Objective To investigate the effects of Musk Hemorrhoids Ointment on pain release and life quality in patients with anorectal disease. Methods One huandred and twelve patients with anorectal disease were selected and divided into a combination group of Diosmin and Musk cream and a control group of Diosmin only according to the center, randomized, double blind, parallel controlled method. Fifty six patients were in each group. The curative effect, pain status and living conditions were analysized. Results The total efficien?cy in the combination group and the control group were 94.6%, 71.4% (P＜0.05), respectively. The VAS scores before and after treatment in the com?bined group were (6.4 ± 1.4) and (2.1 ± 0.5), respective?ly, while the ones before and after treatment in the control group were (6.3 ± 1.5) and (3.5 ± 0.7), repctively. The VAS scores before treatment in both groups were decreased, and differnce was statistically significant (P＜0.05) The life quality by the analysis of ADL scores were 89.4 ± 7.3 and 72.6 ± 5.9, respectively (P＜0.05). The inci?dence of adverse reactions was no significant difference between the two groups (P＞0.05). Conclusion The combination of Diosmin and musk cream for the treatment of anorectal disease showed very significant effects on reducing pain and improving the quality of life.
  • 摘要：目的:探讨膝骨性关节炎患者行腓骨上段截骨术前后膝关节活动范围与疼痛变化之间的关系.方法:选择34例(40膝)膝骨性关节炎伴膝内翻患者行腓骨上段截骨术.比较手术前与术后1周、术后3个月膝关节活动范围变化,采用视觉模拟评分(VAS)评估手术前后膝关节静息痛和活动痛.结果:所有膝关节伸直功能均得到改善,膝关节活动范围由术前(102.4°±12.4°)变为术后1周(112.8°±11.8°)、术后3个月(113.5°±12.1°),屈曲角度手术前后无明显改变,伸直角度变化明显.手术前后膝关节活动范围比较差异有统计学意义(P＜0.01).膝关节静息痛VAS评分由(3.52±1.14)分变为术后1周(1.36±1.14)分、术后3个月(1.33±1.19)分;活动痛VAS评分由(8.73±1.16)分变为术后1周(3.91±1.15)分、术后3个月(3.67±1.17)分.手术前后比较差异有统计学意义(P＜0.01).结论:腓骨上段截骨术后膝关节后外侧得到了部分松解,膝关节伸直功能得到一定改善,下肢力线趋于正常使关节疼痛缓解.
  • 摘要：1临床资料患者,女性,76岁,主因＂发现脐周肿物半年＂就诊。偶伴腹胀,无其他不适。查体发现脐部不规则肿物,表面无溃疡和渗出,大小约2.0 cm×2.0 cm,边界清楚,质硬,活动性差,轻压痛（图1）。超声引导下行脐旁肿物穿刺活检术,细胞学结果（图2）显示纤维结缔组织中及汗腺管组织旁可见小灶异型细胞,似有腺样排列及瘤巨细胞,细胞不典型增生较显著,不除外癌性浸润。
  • 摘要：孤立性小腿深静脉血栓形成是一种发病率较高的静脉血栓栓塞性疾病,起病隐匿,患者自觉症状较轻,临床体征大多数不明显,往往容易漏诊、误诊.随着超声技术的发展,越来越多的孤立性小腿深静脉血栓形成被诊断出来.孤立性小腿深静脉血栓形成是否应进行抗凝治疗目前尚没有达成共识.本文结合孤立性小腿深静脉血栓形成的累及血管、危险因素、诊断及治疗对其研究进展进行综述.
  • 摘要：肝纤维化是各种慢性肝病发展的必经阶段.肝纤维化尚属可逆的过程,早期诊断与及时有效治疗可延缓或避免发展成为不可逆的肝硬化阶段.影像学检查可以比较准确的无创性评估肝纤维化程度,随着新技术的发展与应用,弹性技术在肝纤维化评估中得到广泛应用.本文就弹性技术在超声和磁共振方面的应用进展进行综述.
  • 摘要：目的：探讨Delta样配体4（DLL4）和基质金属蛋白酶2(MMP-2)、白细胞分化抗原34(CD34)在结直肠癌组织中的表达及其之间的相关性。方法：应用免疫组化方法检测90例临床确诊为结直肠癌组织中DLL4及MMP-2、CD34的表达情况并分析其与结直肠癌临床病理特征的相关性。结果：通过免疫组化可以发现，DLL4（均值为4.91）和MMP-2（均值为5.34）、CD34（均值为5.40）在癌组织中的表达水平较癌旁组织、正常组织中的表达均明显增高；DLL4和MMP-2、CD34在癌旁组织中的表达水平较正常组织中也明显增高。DLL4表达水平与病理分期T、N分期相关，呈正相关（相关系数分别为0.226、0.262），但与MMP-2、CD34的表达水平并无相关性。结论：在结直肠癌组织中，DLL4的表达水平明显增高，与肿瘤侵润程度、淋巴结转移情况相关。%Objective To investigate the expression level of DLL4, MMP-2 and CD34 in colorectal cancer tissues and its correction with clinicopathologic feature. Methods Immunohistochemical methods were used to detect the expression level of DLL4, MMP-2 and CD34 in 90 cases of clinically diagnosed colorectal cancer tissues and investigate their correlation with clinicopathologic feature. Results The expression level of DLL4 (average 4.91 ), MMP-2(average 5.34 ) and CD34(average 5.40 ) in tumor tissues were significantly higher than in adjacent tissues and normal tissues. Expression level of DLL4, MMP-2 and CD34 in adjacent tissues was sig⁃nificantly higher than those in normal tissues. The expression level of DLL4 was positively corrected with patho⁃logical stage of T and N.(correlation index 0.226, 0.262), but it was not related with the expression level of MMP-2 and CD34. Conclusion In colorectal cancer tissues, the expression level of DLL4 was significantly increased and correlated with extent of tumor invasion and lymph node metastasis.
  • 摘要：目的：：分析胰十二指肠切除术后胃瘫综合征发生的危险因素。方法：回顾性分析497例胰十二指肠切除术患者的临床资料，以手术后是否发生胃瘫综合征为因变量，对临床资料进行统计学检验，有统计意义的变量再引入二分类非条件逐步Logistic回归模型进行多因素分析，确定独立的危险因素。结果：单因素分析结果显示，ASA评分(P=0.039)、年龄(P=0.014)、术后应用生长抑素(P=0.003)、胰管支撑管长度(P=0.027)、胰管直径(P=0.007)均是胰十二指肠切除术术后胃瘫发生的危险因素；多因素非条件Logistic回归分析结果显示，年龄(P=0.001)、术后应用生长抑素(P=0.026)是胰十二指肠切除术术后胃瘫综合征发生的独立危险因素。结论：患者年龄较大、术后应用生长抑素易发生胰十二指肠切除术术后胃瘫综合征，提高手术精细度、适当增加胰管支撑管的长度，可能减少胰十二指肠切除术术后胃瘫综合征的发生率。%Objective To investigate the risk factors of postoperative gastroparesis syndrome in patients un⁃dergoing pancreaticoduodenectomy. Methods A retrospective review was performed on the medical records of 497 patients undergoing pancreaticoduodenectomy. With or without gastroparesis syndrome after operation as the dependent variable, all cases were carried out on the clinical data of statistical tests, and those with statistically significant variables were studied to introduce two classifications on unconditioned stepwise Logistic regression model for multiple factors analysis, to identify independent risk factors. Results Single factor analysis results showed that ASA score, age, postoperative application of somatostatin, pancreatic duct supporting tube length, and the diameter of the pancreatic duct, all were the risk factors for pancreaticoduodenectomy postsurgical gastro⁃paresis syndrome. Multi-factor unconditioned Logistic regression analysis results showed that age, and postopera⁃tive application of somatostatin were the independent risk factors for pancreaticoduodenectomy postsurgical gas⁃troparesis syndrome. Conclusion Postoperative somatostatin makes older patients more prone to gastroparesis syndrome after pancreaticoduodenectomy . To improve the operation precision, increasing the length of the pan⁃creatic duct supporting tube, the incidence of postsurgical gastroparesis syndrome after pancreaticoduodenectomy may be reduced.
  • 摘要：Objective To compare the efficacy and complications of the two therapeutics to the circular in⁃carcerated hemorrhoids, by external excision and internal ligation and sclerotherapy, and by Milligan-Morgan op⁃eration and sclerosing agent injection. Methods Retrospective analysis on the clinical data of 156 circular in⁃carcerated hemorrhoids patients was done, 78 cases received external excision and internal ligation and sclero⁃therapy as group A, and 78 cases received Milligan-Morgan operation and sclerosing agent injection as group B. The changes of symptom scores, wound healing time and incidence of complications of both groups before and af⁃ter treatment were observed and compared. Results One month after treatment, the symptom scores of the ob⁃servation group and control group were (0.07 ± 0.32) and (0.06 ± 0.34) (P>0.05). The wound healing time of the observation group was significantly shorter than that of the control group (15.61 ± 2.01 vs 18.58 ± 2.81, P<0.05). The differences of the incidence of complications, including hemafecia in 1 week, perianal epicanthus, co⁃pracrasia and anorectal stenosis, between the two groups were not statistically significant (P>0.05). In the obser⁃vation group, the incidence rates of anal pain, dysuresia and edema of anal margin were 7.69%, 3.85% and 3.85% (P<0.05). Conclusion The combined treatment of external excision and internal ligation and sclero⁃therapy was effective for circular incarcerated hemorrhoids. It can effectively shorten the wound healing time and reduce the incidence of anal pain and dysuresia..%目的：对比外切与外剥内扎硬注术治疗环状嵌顿痔的疗效和并发症。方法：回顾性分析156例环状嵌顿痔患者的临床资料，78例接受外切内扎硬注术为A组，78例接受外剥内扎硬注术为B组，对比两组治疗前后的症状评分变化情况，对比两组术口愈合时间和并发症发生情况。结果：手术治疗后1个月，A组症状评分（0.07±0.32）分，B组（0.06±0.34）分（P＞0.05）；A组术口愈合时间（15.61±2.01）d，B组（18.58±2.81）d（P＜0.05）；两组术后1周便血、肛缘赘皮、肛门失禁、肛管狭窄发生率的对比，差异没有统计学意义（P＞0.05）。A组术后1周肛门疼痛发生率7.69%，排尿困难发生率3.85%，肛缘水肿发生率3.85%，均显著低于B组（P＜0.05）。结论：外切内扎硬注术治疗环状嵌顿痔具有良好的临床疗效，可有效缩短术口愈合时间，减少肛门疼痛、排尿困难等术后并发症的发生率。
  • 摘要：目的：探讨全结肠系膜切除术(CME）在腹腔镜辅助右半结肠切除术中的安全性及短期疗效。方法：回顾性分析20例右半结肠癌患者行腹腔镜右半CME术的临床资料，并与同期20例传统开腹右半结肠根治术患者的相关资料进行对比。结果：20例腹腔镜右半结肠CME术手术顺利，平均手术时间132.5 min，平均术中出血20 mL，淋巴结清扫数目平均19枚，III期患者平均清扫淋巴结数目20枚，术后排气时间平均2 d，与对照组对比均具有明显优势。结论：CME用于腹腔镜右半结肠切除术，可以获得完整的肿瘤标本，清扫更多的淋巴结，并未增加术中及术后并发症发生率。
  • 摘要：咳嗽是人体清除呼吸道内分泌物或异物的保护性呼吸反射动作,长时间顽固性咳嗽常会严重影响患者的生活质量。顽固性咳嗽常由呼吸道感染引起,表现为咳嗽持续时间长,且咳嗽不止,迁延难愈,临床上治疗方法颇多,但临床效果欠佳。我院崔公让应用局麻药物注射人迎穴治疗取得了良好的疗效,现将2015年2月—2015年11月治疗的30例,总结如下。
  • 摘要：1临床资料 患者男性,63岁,因上腹部胀痛3 d,加重伴恶心、呕吐13 h于2015年7月24日经急诊收入院。入院查体：腹部平坦,未见肠形及蠕动波。上腹部压痛,以脐上方压痛最明显,无明显反跳痛,无液波震颤,全腹未触及包块,腹部叩诊呈鼓音,移动性浊音阴性,肠鸣音1~2次/min。未闻及振水音及血管杂音。血常规：白细胞总数7.0×10~9/L、中性粒细胞百分比81.3%,
  • 摘要：1临床资料 患者女性,21岁。主因间断心前区疼痛2周、加重4 h入院。既往系统性红斑狼疮病史10余年;高血压病史10余年,血压最高200/130 mm Hg（1 mm Hg=0.133 k Pa）,平素服用科素亚、卡托普利血压控制在150/100 mm Hg;冠心病史近1年,未规律服用药物治疗。有蛋白尿、肾炎病史,有牛羊肉及海鲜过敏史。
  • 摘要：目的：探讨理气健脾中药外敷对胃癌术后胃肠功能恢复的作用。方法：将37例手术后的胃癌患者随机分为中药外敷组和对照组，分别予以中药脐周外敷和常规治疗，观察两组患者出院2周后的单项症状积分、胃肠激素、营养状况和不良反应等变化。结果：两组患者出院时的单项症状积分、营养状况均无明显差异（P＞0.05）；出院2周后，中药外敷组患者的腹胀、食后饱胀，恶心、暖气、乏力等症状明显好于对照组(P＜0.05)；两组患者出院时的血浆胃动素水平和血浆血管活性肠肽水平无明显差异[(258.69±20.05) pg/mL vs （261.25±16.18） pg/mL，P＞0.05；（27.41±4.63） pg/mL vs （27.61±5.23） pg/mL，P＞0.05],但出院后二周,中药外敷组患者的血浆胃动素水平明显高于对照组[(351.73±34.75) pg/mL vs（302.64±20.17）pg/mL，P＜0.05],而血浆血管活性肠肽水平则较对照组明显降低[（33.56±6.12）pg/mL vs（36.75±5.43）pg/mL，P＜0.05]；并且，两组患者的血浆白蛋白水平、血浆前白蛋白水平和不良反应等无明显差异(P＞0.05)。结论：健脾理气中药外敷可有效促进胃癌术后患者胃肠功能的恢复。%Objective To study the effect of plastering therapy of Chinese herbal preparation that invigo⁃rates spleen and regulates Qi (ISRQ) for promoting gastrointestinal function after gastric carcinoma operation. Methods Thirty-senven patients after gastric carcinoma operation were divided randomly into the ISRQ group (n=19) which were administrated with ISRQ plastering therapy at skin around umbilicus, and the control group (n=18) having conventional treatment. Single symptom score, gastrointestinal hormones, nutritional status and the adverse reactions were observed. Results There was no significant difference in single symptom score and nu⁃tritional status between two groups at discharge(P>0.05). Abdominal distension, nausea and belching were de⁃creased in the ISRQ groups within two weeks of discharge compared to those in the control groups(P<0.05. The levels of plasma motilin (MOT) and vasoactine intrestinal peptide (VIP) had no significant differences be⁃tween the ISRQ groups and the control groups at discharge [(258.69±20.05)pg/mL vs(261.25±16.18)pg/mL, P>0.05;(27.41±4.63)pg/mL vs(27.61±5.23)pg/mL,P>0.05]. But two weeks after discharge, the level of plasma MOT in the ISRQ group was higher than that in the control groups [(351.73±34.75)pg/mL vs(302.64± 20.17) pg/mL, P<0.05]. The level of plasma VIP in the ISRQ groups was significantly lower than that in the control groups [(33.56±6.12)pg/mL vs(36.75±5.43)pg/mL,P<0.05]. There were no significant differences in the level of plasma albumin, plasma pre-albumin, and the adverse reaction between the two groups. Conclusion The plastering therapy of ISRQ powder can effectively promote gastrointestinal function rehabilita⁃tion in those patients with postoperative gastric cancer.
  • 摘要：Objective To study the effect of traditional Chinese medicine for thrombocytopenia patients af⁃ter the treatment of myelodysplastic Syndrome(MDS) demethylation. Methods Thirty-nine patients diagnosed with thrombocytopenia after the treatment of MDS demethylation were randomly divided into two groups. The con⁃trol group was treated with conventional methods (dicynone, single donor platelets infusion); While the traditional Chinese medicine group was treated basing on conventional methods, traditional Chinese medicine with curative effect of invigorating the kidney and reinforcing spleen and hemostasis. The purpose of the research is to detect the expression and changes of the platelet count, platelet reducing duration, serum level of IL-11, bone marrow mononuclear cells IL-11 receptor alpha gene. Results Compared with control group, after treatment of tradi⁃tional Chinese medicine for 15 days, the platelet count significantly increased to(101.3±16.2)×109/L, the plate⁃let reducing duration decreased to (12.2 ± 2.0) d,the volume of platelet transfusion decreased to 17 u. The ex⁃pression level of serum IL-11 and bone marrow mononuclear cells (IL-11 receptor alpha) gene showed no obvi⁃ous difference between the two groups. Conclusion Posttreatment of MDS demethylation combined with tradi⁃tional Chinese medicine which has invigorating the kidney, reinforcing spleen and hemostasis effect can reduce bleeding symptoms, accelerate the platelet recovery and reduce platelet transfusion.%目的：：观察骨髓增生异常综合征(MDS)去甲基化治疗后血小板减少的中药疗效。方法：将39例MDS去甲基化治疗后血小板减少患者随机分成两组，对照组采用常规方法(止血敏、输注单采血小板)治疗，中药组在对照组基础上加服补肾健脾止血中药治疗，检测血小板计数、血小板减少持续时间、血清IL-11水平、骨髓单个核细胞IL-11受体α基因的表达与变化。结果：与对照组比较，中药组治疗后15 d血小板计数明显升高达（101.3±16.2）×109/L，血小板减少持续时间缩短为（12.2±2.0）d、血小板输注量减少至17 U；2组血清中IL-11水平及骨髓单个核细胞IL-11受体α基因的表达两组之间无明显差异。结论： MDS去甲基化治疗后配合补肾健脾止血中药，可以减轻出血症状、加快血小板恢复，减少血小板输注。
  • 摘要：目的：总结钩针辅助法经脐双孔腹腔镜阑尾切除术的应用经验。方法：对38急性阑尾炎、12例慢性阑尾炎急性发作和2例慢性阑尾炎患者行腹腔镜下阑尾切除术。在腹腔镜监视下，钩针自右下腹穿刺进入腹腔，于阑尾系膜无血管区刺穿悬吊固定阑尾，调整钩针将阑尾固定于适当位置便于手术操作，超声刀切断阑尾系膜至阑尾根部，圈套线或Hemolok夹结扎处理阑尾根部，阑尾残端黏膜用电钩喷洒式烧灼。结果：48例经脐双孔腹腔镜阑尾切除成功；4例改为三孔法，其中1例阑尾残端坏疽严重，无法镜下修补，中转开腹，未发生严重并发症。全组无术后出血、腹腔脓肿、肠瘘、粘连性肠梗阻等并发症。结论：钩针辅助法经脐双孔腹腔镜下阑尾切除手术时间短、术后恢复快、并发症少，是手术安全可行的。
  • 摘要：目的：观察宁泌泰胶囊治疗妊娠期慢性尿路感染的疗效和安全性。方法：对60例诊断为淋证下焦湿热型慢性尿路感染的妊娠期患者给予宁泌泰胶囊治疗，7d为1疗程，观察临床疗效、中医症状评分变化和不良反应情况。结果：临床总有效率90%，与治疗前比较，尿频、尿急等症状评分均显著降低（P＜0.01）；服药期间未发生不良反应。结论：宁泌泰胶囊可显著提高妊娠期慢性尿路感染的疗效，明显改善尿路症状，且安全性好。
  • 摘要：对胫骨平台骨折的临床手术方法较多,为了解不同手术方法治疗胫骨平台骨折患者的临床治疗效果,本次研究回顾性分析了2014年2月—2015年2月期间我院收治的78例胫骨平台骨折患者的临床手术资料,将采取了胫骨近端解剖钢板内固定治疗方法的患者与采取了锁定钢板内固定治疗方法的患者进行了对比,比较了两种手术方式的疗效,取得了满意结果,现报告如下。
  • 摘要：由中国中西医结合学会骨伤科分会主办,辽宁省中西医结合学会骨伤科分会、辽宁中医药大学附属医院承办,沈阳医学院附属中心医院协办的中国中西医结合学会骨伤科分会第23届全国中西医结合骨伤科学术年会将于2016年9月16~18日在辽宁省沈阳市召开。本次会议将邀请多位国内著名的骨伤科专家就骨伤疾病中西医结合特色诊治的最新国内、外进展进行专家论坛、专题讲座和疑难、典型病例讨论。
  • 摘要：1临床资料 例1,患者女性,70岁。有糖尿病及消化性溃疡史。2010年7月15日因黑便1个月,加重伴发热3 d入院,体温38.9℃,血压108/66 mm Hg（1 mm Hg=0.133 k Pa）,心率102次/min。血常规WBC 37.6×109/L,N 96.6%,HB 74 g/L;生化CRP 286.1 mg/L,总蛋白46.2 g/L,白蛋白21.3 g/L。
  • 摘要：目的：评价目前常用的血浆标志物及CT血管造影（CTA）检查对于肠系膜血管缺血性疾病(AMI)诊断的价值。方法：按照《流行病学观察行研究的meta分析》中的要求进行设计。使用随机效应模型对指标进行合并。如果研究提供的数据不足以重建四格表则被排除。结果：24篇文献被纳入最终的研究。合并后，D-乳酸的敏感性为74%（95%CI=61.0%~84.7%），特异性为74%（95%CI=69%~79%）；D二聚体敏感性为96%（95%CI=89%~99%），特异性为40%（95%CI=33%~47%）；肠型脂肪酸结合蛋白的敏感性为77%（95%CI=66%~86%），特异性为77%（95%CI=72%~82%）；谷胱甘肽巯基转移酶的敏感性为68%（95%CI=55%~80%），特异性为85%（95%CI=76%~92%）；CT诊断AMI的敏感性为93%（95%CI=90%~96%），特异性为96%（95%CI=94%~97%）。结论：血浆标志物可能有助于排除非AMI，但其可靠性仍需进一步验证。CTA在诊断AMI上具有很高的准确性。%Objective To evaluate the value of plasma biomarkers and computed tomography angiography (CTA) in the diagnosis of acute mesenteric ischemia(AMI). Methods The design of this meta-analysis fol⁃lowed the recommendations from the Meta-analysis of Observational Studies in Epidemiology. Summary esti⁃mates of diagnostic accuracy were computed by using a random-effect model. The studies without enough data to reconstruct cross-table were excluded. Results Twenty-four studies were included in the meta-analysis. The pooled sensitivity and specificity for D-lactate was 74%(95% confidence interval [CI] = 61%~84%) and 74%(95%CI = 69%~79%)respectively. The pooled sensitivity and specificity for D-dimer was 96%(95%CI=89%~99%)and 40%(95%CI=33%~47%)respectively. The pooled sensitivity and specificity for intestinal fatty acid binding protein (i-FABP) was 77%(95%CI=66%~86%)and 77%(95%CI=72%~82%)respectively. The pooled sensitivity and specificity for Glutathione S-transferase (GST) was 68%(95%CI=55%~80%)and 85%(95%CI=76%~92%)respectively. The pooled sensitivity and specificity for CTA was 93%(95%CI=90%~96%)and 96%(95%CI=94%~97%)respectively. Conclusion The plasma biomarkers may be helpful for excluding AMI , but their reliability need further confirmation. The CTA had high accuracy in the diagnosis of AMI.
  • 摘要：Objective To explore the effects of amifostine on improving neurotoxicity induced by oxaliplat⁃in. Methods Ninty-six cases of patients with gastrointestinal cancers were randomly divided into observation group and control group, 48 patients in each group. The patients in the observation group were treated with oxali⁃platin combined with amifostine, but those in the control group were only treated with oxaliplatin. After 6 cycles of the treatment, the neurotoxicity of patients in two groups was evaluated. Results After 2, 4, 6 cycles of che⁃motherapy, the occurrence rates of grade 1~2 of peripheral neurotoxicity in the observed group was significant⁃ly lower than that of the control group[(10.41%)VS(50.00%),(14.58%)VS(58.33%),(6.26%)VS(68.75%), P<0.05]. The occurrence rates of grade 3~4 peripheral neurotoxicity in the observation group was also signifi⁃cantly lower than that of the control group[(4.17%)VS(29.17%),(6.25%)VS(25.00%), P<0.05]. The efficien⁃cy (Cr+PR) and the clinical benefit rate (Cr+PR+SD) in the observation group were higher than those in the con⁃trol group, [(79.17)%VS(83.33%);(87.50%)VS(91.67%)], but the difference was not statistically significant (P>0.05). Conclusion Amifostine can improve the neurotoxicity induced by oxaliplatin and have protective effect on peripheral nerve, while it will not reduce the clinical curative effect of oxaliplatin medicine.%目的：探讨氨磷汀改善奥沙利铂药物神经毒性的疗效。方法：选择96例胃肠道肿瘤患者，随机分为2组各48例，观察组给予奥沙利铂联合氨磷汀治疗，对照组仅给予奥沙利铂治疗，6个疗程后对两组神经毒性进行评估。结果：经2、4、6个周期的化疗，观察组1~2级神经毒性发生率分别为10.41%、14.58%、6.26%，明显低于对照组（50.00%、58.33%、68.75%）,P均<0.05。经4、6个周期的化疗观察组3~4级神经毒性发生率明显低于对照组（4.17%VS 29.17%,6.25%VS 25.00%, P均<0.05）；观察组有效率（CR+PR）为79.17%，临床受益率（CR+PR+SD）为87.50%，对照组分别为83.33%、91.67%，（79.17%VS 83.33%；87.50%VS 91.67%,χ2=0.274，0.447；P均>0.05）。结论：氨磷汀能预防奥沙利铂药物神经毒性，对周围神经产生保护作用，同时不会降低奥沙利铂类药物疗效。
  • 摘要：Objective To study the effects of Dezocine on pain in patients following laparoscopic cholecystectomy and during postoperative recovery pe⁃ riod. Methods All 120 patients with laparoscopic cholecystectomy were randomly divided into observation group and control group,60 cases in each group. Both groups of patients were given general anesthesia. About 30 minutes before the end of the operation, 0.1 mg/kg of intravenous dezocine injection were given to the obser⁃vation group while the same dose of saline was given to the control group. The recovery time and extubation time and VAS score were compared between two groups. Results As compared with the control group,the recovery time and extubation time were not significantly different(P>0.05). In the observation group VAS scores in anes⁃thesia recovery after 0.5 h, 1 h, 2 h and 4 h were respectively 2.91+0.52, 2.53+0.30, 1.91+0.29 and 1.54+0.37, which were lower than those in the control group [(4.61+0.61), (3.69+0.49), (3.02+0.41) and (2.81+0.38)], with statistically significant differences (P<0.05). In the observation group after wake up immediately and emer⁃gence of 10min, 20min, 30min, the restlessness scores were respectively 1.91+0.52, 1.62+0.49, 0.91+0.45 and 0.37+0.16, which were lower than those in the control group [(2.46+0.56), (2.15+0.44), (1.96+0.52) and (1.01+0.39)], with statistically significant differences(P<0.05). In the control group, 8 cases had adverse reactions with the incidence rate being 13.33%. In the observation group there were 2 cases with adverse reactions with the incidence rate being 3.33%. The adverse reaction rate of the observation group was lower than that in the control group(P<0.05). Conclusion Preventive intravenous injection of Dezocine will not affect the anesthe⁃sial effect of peritoneoscopic gallbladder excision surgery but can effectively relieve postoperative pain,and im⁃prove the recovery of patients with agitation and adverse reactions.%目的：探究地佐辛对腹腔镜胆囊切除术复苏期及术后疼痛的影响。方法：腹腔镜胆囊切除术患者120例，按随机数字表法分为观察组和对照组各60例。均给予常规麻醉，手术结束前30 min，观察组以0.1 mg/kg的剂量静脉注射地佐辛，对照组注射同等剂量的生理盐水。比较两组麻醉苏醒时间和拔管时间，麻醉苏醒后VAS评分，苏醒后躁动程度评分和不良反应。结果：与对照组相比，观察组苏醒时间与拔管时间没有明显差异（P＞0.05）；观察组在麻醉苏醒后的0.5 h、1 h、2 h、4 h时的VAS评分分别为（2.91±0.52）、（2.53±0.30）、（1.91±0.29）、（1.54±0.37）分，均低于对照组的（4.61±0.61）、（3.69±0.49）、（3.02±0.41）、（2.81±0.38）分，差异有统计学意义（P＜0.05）。观察组在苏醒即刻及苏醒后10 min、20 min、30 min时的躁动程度评分分别为（1.91±0.52）、（1.62±0.49）、（0.91±0.45）、（0.37±0.16）分，均低于对照组的（2.46±0.56）、（2.15±0.44）、（1.96±0.52）、（1.01±0.39）分，差异有统计学意义（P＜0.05）。对照组8例出现不良反应，发生率为13.33%；其中3例恶心，2例呕吐，2例头晕，1例寒战。观察组2例出现不良反应，发生率为3.33%；其中1例恶心，1例呕吐。观察组不良反应率比对照组有所降低（P＜0.05）。结论：预防性静脉注射地佐辛，不会影响腹腔镜胆囊切除术麻醉效果，可有效缓解术后疼痛，改善复苏期躁动与不良反应的发生率。
  • 摘要：目的：观察新型免疫抑制剂Fingolimod (FTY720)对雨蛙素致小鼠慢性胰腺纤维化的治疗作用。方法：健康雄性C57BL/6小鼠30只，随机分为对照组、模型组和FTY720治疗组。模型组和治疗组腹腔注射雨蛙素，50μg·kg-1·次-1，1周3次，连续6周；治疗组于第5周开始注射FTY720，1 mg·kg-1·d-1，持续2周；对照组腹腔注射等量的生理盐水。于第7周第1天留取胰腺组织，行HE染色和苦味酸-天狼星红染色，分别于光镜和偏振光显微镜下观察病理改变和评分，并用免疫组织化学染色法观察α平滑肌肌动蛋白（α-SMA）、CD3、FOXP3表达情况。结果：模型组病理评分中，腺泡萎缩为2.52±0.36，炎细胞浸润为3.42±0.31，纤维化程度为3.25±0.42，显著高于对照组的病理评分。模型组α-SMA表达为25.33±5.64，CD3表达为68.83±8.38， FOXP3表达为34.83±6.85，均显著高于对照组（分别为0.33±0.52，1.83±0.75，1.33±0.82）。治疗组病理评分中，腺泡萎缩为1.69±0.27，炎细胞浸润为2.34±0.33，纤维化程度为2.19±0.35，均较模型组明显减少。治疗组胰腺组织中α-SMA表达为12.33±2.58， CD3为25.00±4.93，FOXP3为17.33±4.41，也明显低于模型组。结论：FTY720能明显减少雨蛙素所致的T淋巴细胞浸润和调节性T细胞数量，在一定程度上减轻胰腺间质胶原的表达，从而抑制胰腺纤维化程度。%Objective To observe the inhibitory effect of Fingolimod (FTY720) in cerulein induced pancre⁃atic fibrosis. Methods Thirty male C57BL/6 mice were divided into control group, model group and FTY720 treated group(10 animals per group). The model mice and FTY720 treated mice were received repeated intraperi⁃toneal injection of cerulein for six weeks .The FTY720 group mice received intraperitoneal injection of FTY720 (1 mg/kg/d) after the fourth week. The control group mice received saline injections. Seven weeks after the first intraperitoneal injection of cerulein the pancreas was removed for pathological assessment of acinar atrophy, in⁃flammatory infiltration and fibrosis. The second part was stained with picric-sirius red and observed by polarized light microscopy. The third part of pancreatic specimen was used to examine α-smooth muscle actin (α-SMA) , CD3 and FOXP3 expression by immunohistochemical method. Results Compared with control group, the pathological score in model group mice( acinar atrophy 2.52 ± 0.36 vs 0,inflammatory infiltration 3.42 ± 0.31 vs 0,fibrosis 3.25±0.42 vs 0 ) was higher and much more expression of collagen in model mice. The expression ofα-SMA(25.33 ± 5.64 vs 0.33 ± 0.52)、CD3(68.83 ± 8.38 vs 1.83 ± 0.75) and FOXP3(34.83 ± 6.85 vs 1.33 ± 0.82) were all increased in model mice. Compared with model group, the pathological score in FTY720 group(acinar atrophy 1.69 ± 0.27 vs 2.52 ± 0.36,inflammatory infil⁃tration 2.34 ± 0.33 vs 3.42 ± 0.31,fibrosis 2.19 ± 0.35 vs 3.25 ± 0.42) was lower and the expression of collagen was decreased. The expression of α-SMA(12.33 ± 2.58 vs 25.33±5.64)、CD3(25±4.93 vs 68.83±8.38) and FOXP3(17.33 ± 4.41 vs 34.83 ± 6.85)were all de⁃ creased markedly in FTY720 group mice. Conclusion FTY720 could reduce the T lymphocytes infiltration and regulatory T cell quantity, thus alleviate the accumulation of collagen in pancrease. FTY720 inhibit pancre⁃atic fibrosis may be related to these.
  • 摘要：目的：观察中西医结合治疗老年急性梗阻性化脓性胆管炎的疗效。方法：分析204例老年急性梗阻性化脓性胆管炎患者的临床资料，按治疗方法不同分对照组98例，采用常规胃肠减压、解痉止痛、抗感染、抗休克治疗；治疗组106例，在常规治疗的基础上根据辨证施治加用中药汤剂治疗，观察比较两组疗效。结果：治疗组显效65例，有效32例，无效9例，总有效率91.5%，对照组显效41例，有效45例，无效12例，总有效率87.7%；治疗组出现严重并发症22例，对照组55例；治疗组平均住院天数为（12.5±3.2）d，对照组为（17.4±3.5）d。结论：中西医结合方法治疗老年重症梗阻性化脓性胆管炎疗效显著，可快速缓解患者症状，缩短患者住院时间，减少并发症，降低死亡率。
  • 摘要：目的：探讨针刺联合药物治疗慢性前列腺炎的疗效。方法：以91例慢性前列腺炎患者为研究对象，其中46例采用传统针刺联合药物治疗，为治疗组；45例单纯应用药物治疗，为对照组，比较两组的治疗效果。结果：经3个疗程共6周治疗，两组的症状都有好转，治疗组总有效95.35%，显著高于对照组（76.74%，P＜0.05）；2个月后随访，治疗组复发率显著低于对照组，患者满意度明显高于对照组。结论：采用针刺联合药物治疗慢性前列腺炎，疗效明显优于单纯药物治疗。
  • 摘要：本刊采用三横线表,如遇有合计和统计学处理内容（如t值、P值等）,则在此行上面加一条分界横线;表内数据要求同一指标有效位数一致,一般按标准差的1/3确定有效位数。表格中注释用的角码符号采用单个角码的形式,按a、b、c、d、e、f…顺序选用,在表注中依先纵后横的顺序依次标出。
  • 摘要：目前,经腹腔镜胆囊切除术（laparoscpoic cholecystectomy,LC）已成为治疗结石性胆囊炎的金标准。萎缩性胆囊炎作为胆囊炎的一种特殊类型,由于胆囊长期炎症刺激,胆囊和周围组织粘连及胆囊自身的萎缩,致使胆囊囊壁纤维化,胆囊三角解剖不清,手术操作难度高,被认为是LC的相对禁忌证[1]。
  • 摘要：目的：观察中药芪贞扶正固本汤联合化疗治疗术后非小细胞肺癌的疗效。方法：选取80例非小细胞肺癌手术后患者，随机分为两组，对照组给予常规化疗及对症辅助治疗，治疗组在对照组基础上加服芪贞扶正固本汤并随症加减，连续用药2个周期，观察治疗前后临床症状变化、KPS评分、免疫功能改变，随访3年，记录肿瘤复发率。结果：治疗组临床症状改善率70%以上，对照组50%，治疗组咳嗽、咳痰、气短、精神乏力等症状的改善情况明显好于对照组；KPS评分治疗组65.3±11.2，对照组(42.3±12.5)（P＜0.05）；免疫功能包括NK、CD3、CD8、CD4/CD8分子水平，治疗组均好于对照组（P＜0.05）；2年和3年复发率治疗组分别为40.0%、52.5%，对照组分别为62.5%、82.5%（P＜0.05）。结论：中药芪贞扶正固本汤联合化疗，能显著改善非小细胞肺癌患者的术后生存质量，降低肿瘤复发率，延长无瘤生存期。%Objective To study the clinical effects of Chinese medicine combined with chemotherapies on treating non-small cell lung cancer after operation Methods Choosed 80 cases of clinically diagnosed pa⁃tients with non-small cell lung cancer after operation were randomly divided into two groups. The patients in control group received conventional chemotherapy after operation and supportive treatment, while the patients in treatment group received the same treatment in the control group and also Qizhenguben soup. We compared the difference on the symptoms, KPS scores, immune function of the patientst between the two groups before and af⁃ter continuously administrating two cycles. Follow-up of 3 years, record the tumor recurrence rates. Results After the treatments, the treatment group were better than the control group in the clinical symptoms, KPS scores and the immune function. Comparing the recurrence rate of 2 years and 3 years, the treatment group was significantly lower than the control group (P<0.05). Conclusion Qizhenfuzheng soup combined with the chemotherapes could significantly improve the quality of life the patients after surgery, reduce the rate of tumor recurrence and prolong the disease-free survival period of patients.
  • 摘要：目的：观察针刺对全身麻醉下开腹手术后患者胃肠功能恢复的影响，客观科学地评价针刺疗效。方法：将40例全身麻醉下行妇科开腹手术病人随机分为针刺组和对照组，每组各20例。对照组术后常规处理，针刺组在常规处理基础上联合针刺双侧足三里、上巨虚、下巨虚、合谷、太冲，以平补平泻法行针20 s，留针30 min，每日治疗1次。借以观察针刺组与对照组在术后肠鸣音恢复时间及肛门排气方面的影响。结果：针刺组肠鸣音恢复时间（24.4±3.5）h明显短于对照组（31.2±3.9）h，（P＜0.05）；针刺组肛门排气时间（28.8±2.9）h明显短于对照组（36.8±3.3）h，（P＜0.05）。结论：针刺治疗对妇科开腹手术后胃肠道功能的恢复有良好的效果。%Objective To observe the effect of acupuncture on the recovery of gastrointestinal function in patients undergoing abdominal surgery under the general anesthesia. Methods Forty patients with general an⁃esthesia were divided into acupuncture group and control group randomly. Each group was 20 cases. The control group received routine postoperative treatment, and the acupuncture group was given routine treatment and acu⁃puncture at zusanli (ST36), shangjuxu (ST37), xiajuxu (ST39), hegu (LI4), taichong (LR3). The recovery time of bowel sound and anal exhaust time of the patients in acupuncture group and control group was observed. Results The recovery time of bowel sound is (24.4±3.5) h and the anal exhaust time is (28.8±2.9) h for the patients in acupuncture group. These index were earlier than it of the patients in control group whose anal ex⁃haust time is (31.2 ± 3.9) h and anal exhaust time is (36.8 ± 3.3) h (P<0.05). Conclusion The effect of acu⁃puncture on the recovery of gastrointestinal function after open surgery under general anesthesia is significantly.

    中国中西医结合外科杂志的期刊信息

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