目的 探讨精囊神经鞘瘤临床诊治特点.方法 分析1例精囊囊实性神经鞘瘤患者的临床诊疗经过,通过检索国内外相关文献进行总结分析.结果 患者经CT、MRI检查发现左侧精囊肿瘤,通过腹腔镜左侧精囊肿瘤切除术切除病灶,术后病理结果证实为神经鞘瘤,患者术后恢复良好,随访13月肿瘤无复发.结论 精囊神经鞘瘤临床罕见,首选腹腔镜手术治疗,能否保守治疗尚需大样本病例资料随访研究.

目的 探讨超声引导下经会阴自由手认知融合前列腺穿刺活检学习曲线及初步体会.方法 收集我院2019年5月至2021年5月直肠超声引导下经会阴自由手认知融合前列腺穿刺活检患者临床资料60例,按入院时间顺序分为3组,每组20例,记录每例患者的穿刺病理结果,同时比较并分析各组手术时间、穿刺术后并发症、穿刺失败率、可疑部位穿刺阳性率、术后平均住院日等指标之间有无差异.结果 60例患者均穿刺顺利,穿刺阳性率38.3％,术后血尿6例,其中轻微尿道出血4例,严重肉眼血尿2例,尿潴留2例.其中第1组与第2组比较其手术时间、穿刺失败率、可疑部位穿刺阳性率差异有统计学意义(P＜0.05),在出现并发症例数、平均住院日差异无统计学意义(P＜0.05).其余两组之间各项指标差异均无统计学意义.结论 经会阴自由手认知融合前列腺穿刺活检安全性高、易操作性好,在经历约20例穿刺学习曲线后,手术时间明显缩短,术者的穿刺精准性明显提高.

目的 探讨腹腔镜袖状胃手术(LSG)治疗重度肥胖症的短期疗效.方法 选择2018年1月至2019年1月在安徽医科大学第二附属医院接受LSG治疗的42例重度肥胖症患者,回顾性分析患者的临床及随访资料,记录术后并发症情况,比较患者术前和术后第1、3、6、12个月的体质量、体质指数(BMI)、额外体质量下降百分比、甘油三酯(TG)、血清总胆固醇、血清低密度脂蛋白、血清高密度脂蛋白、血清尿酸及肝脏CT值的情况,并通过Epworth嗜睡量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)对患者术前与术后第12个月的嗜睡、焦虑、抑郁状态进行评价.结果 42例患者均顺利完成腹腔镜袖状胃手术,术后2例切口脂肪液化,4例术后呕吐,3例残胃水肿行短期全肠外营养,未发生Clavien-Dindo III类及以上并发症.患者术前与术后第1、3、6、12个月的体质量、BMI差异有统计学意义(P<0.05),患者术后各时间点EWL(％)的差异有统计学意义(P<0.05).术后第1、3、6、12个月的体质量和BMI均低于术前,术后第3、6、12个月的EWL％均低于术后第1个月,术后第3、6、12个月的TG低于术前,术后第6、12个月患者肝脏CT值高于术前,差异有统计学意义(P<0.05).术后第12个月的Epworth、SAS和SDS评分均低于术前,差异有统计学意义(P<0.05).结论 LSG手术可以有效治疗重度肥胖症及其诱发的多种合并症,并发症低,疗效确切,值得推广普及.

Objective:To explore the efficacy of loop diuretics on reducing volume load in anuric patients with end-stage renal disease(ESRD), who is receiving maintenance hemodialysis(MHD).Methods:From September 2016 to August 2018, Ninety-two ESRD patients, receiving MHD, with a urine volume of 50-100 mL were randomly divided into 3 groups, the control group A (25 patients, without diuretics), the study group B(34 patients, with furosemide tablets 60 mg/d) and the study group C(33 patients, with furosemide tablets 120 mg/d). The baseline data such as age, primary disease, pre-study daily urine volume, blood pressure, cardiothoracic ratio, plasma brain natriuretic peptide(BNP), and blood uric acid value were not significantly different among the three groups ( P>0.05). Also, there was no significant difference in the interval and dialysis time ( P>0.05). Besides diuretics, all patients in the three groups received the same integrated treatment schedule including treating renal anemia and bone diseases, anti-hypertension, controlling diet, water and salt intake. The observation duration was 3 months, and the endpoint events were death and urine output continued to be greater than 500 mL/d×14 days. The mean urine volume, mean dialysis ultrafiltration volume, blood pressure control, cardiothoracic ratio, BNP, serum uric acid and other indicators were compared among the three groups by the end of the study. Results:The prevalence of refractory hypertension in anuric patients was 54.4%, higher than that in urinary patients , which was 27.5%( P<0.001). The furosemide had good antihypertensive efficacy on anuric patients in the first 4 weeks, and had good diuretic efficacy in the first 12 weeks( P<0.05). But the antihypertensive effect was poor after 4 weeks, and the diuretic effect was poor after 12 weeks( P>0.05). Sixty mg furosemide only exerts antihypertensive effect in patients with anuric within 1 week, and diuretic effect was significant within 8 weeks( P<0.05), and less effective later( P>0.05). The usage of furosemide had statistically significance in reducing BNP in anuric patients( P<0.05), which was an independent result of the increase in urine output. One hundred and twenty mg/d furosemide can reduce the cardiothoracic ratio( P<0.05), but 60 mg/d furosemide was ineffective( P>0.05). After the treatment, uric acid was not significantly changed with 60 mg/d furosemide (K=0.080, P>0.05), but serum uric acid was increased with 120 mg/d furosemide(K=2.739, P<0.05). Conclusions:The usage of furosemide has a significant effect on increasing urine volume and blood pressure in anuric patients with ESRD in a short period of time, and large doses of furosemide can maintain long-term effects and reduce ultrafiltration needed by the patients, thus reducing cardiothoracic ratio, BNP, etc. It is suggested that loop diuretics should not be completely abandoned on anutic patients with ESRD, moreover, the usage of large doses of that is an effective and economical therapy for anutic patients with ESRD to reduce the volume load and cardiovascular complications.

目的 分析单中心上尿路结石患者的血生化代谢水平,探索上尿路结石形成的代谢危险因素.方法 回顾性分析2017年2月—2018年2月安徽医科大学第四附属医院随机抽取的单中心上尿路结石组和非结石组患者的临床资料,比较两组患者的血生化代谢指标水平.结果 按照纳入和排除标准,结石组患者144例,年龄21～85岁,平均(52.67±13.42)岁.非结石组76例,年龄15～86岁,平均(56.89±18.02)岁.结石组甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、血肌酐、血尿酸水平高于非结石组(P<0.05),高密度脂蛋白胆固醇(HDL-C)、肾小球滤过率(GFR)水平低于非结石组(P<0.05).多因素Logistic分析显示低HDL-C(O^R=3.747,95％CI:1.865,7.529)、血肌酐(O^R=1.028,95％CI:1.013,1.044)或降低的GFR(O^R=0.962,95％CI:0.944,0.980)是上尿路结石的代谢危险因素(P<0.05).结论 低HDL-C、血肌酐是上尿路结石形成共同的代谢危险因素,降低的GFR是上尿路结石的危险因素.

目的 探讨快速康复理念在胸腔镜肺癌根治术患者围手术期的应用效果.方法 选取安徽医科大学附属六安医院2018年1月至2019年1月收治的行支气管插管全身麻醉的肺癌手术患者54例,按照随机数字表法分成对照组(27例)与观察组(27例).对照组实施常规麻醉复苏康复技术,观察组在常规麻醉复苏康复技术基础上,应用快速康复理念系列康复技术,进行干预.比较两组患者术中阿片类麻醉药剂量、术后康复效果、术后48 h的镇痛效果、术后感染相关并发症、住院时间及住院费用的差异.结果 观察组患者术中舒芬太尼、瑞芬太尼用量均低于对照组,术后麻醉复苏指标(麻醉清醒时间、气管拔管时间、低体温的发生率)均优于对照组,康复指标(首次下床活动时间、首次自主咳嗽时间、胸腔闭式引流管留置时间)均优于对照组,差异均有统计学意义(P<0.05).术后疼痛评分(NRS)比较,不同时间点NRS比较,差异均有统计学意义(P<0.05),不同康复技术和时间对NRS评分无交互作用(P>0.05).术后C-反应蛋白(CRP)水平比较,术后不同时间CRP比较,差异均有统计学意义(P<0.05),不同康复技术和时间对术后CRP有交互作用(P<0.05).观察组患者术后肺部感染率(7.41％)、肺损伤并发症总发生率(18.52％)低于对照组肺,住院时间、住院费用均低于对照组,差异均有统计学意义(P<0.05).结论 在胸腔镜肺癌根治术围手术期应用快速康复理念,可以减少患者并发症的发生,值得临床推广.

目的 分析后腹腔镜输尿管切开取石术(RLUL)与微通道经皮肾镜碎石术(mPCNL)治疗输尿管上段嵌顿性结石的临床疗效.方法 将103例输尿管上段嵌顿性结石患者按手术治疗方法分为RLUL治疗组50例和mPCNL治疗组53例,比较2组手术时间、术中术后出血量、结石清除率、术后住院时间及并发症发生率.结果 两组手术时间、术中出血量及术后住院时间比较差异无统计学意义(均P＞0.05).mPCNL术后出血量(98.13±18.22)mL,RLUL术后出血量(33.95±10.10)mL,两组比较,差异有统计学意义(P＜0.05).RLUL术后并发症发生率为2.0％,mPCNL为15.1％,RLUL组结石清除率100％,mPC-NL组为88.7％,两组比较均差异有统计学意义(均P＜0.05).RLUL组有2例结石上移至肾盂,打开肾盂取出结石.其余101例手术均按计划顺利完成.结论 RLUL与mPCNL均是治疗输尿管上段嵌顿性结石安全有效的微创治疗方法,RLUL组具有结石清除率高,术后并发症和出血少的特点,值得临床推荐,但防止结石上移是技术要点.

目的 探讨双镜联合技术治疗胃间质瘤的安全性和有效性.方法 回顾性分析2014年1月至2016年6月安徽医科大学第一附属医院治疗的胃间质瘤患者136例临床资料,其中采用双镜联合治疗患者44例、单纯胃镜治疗患者42例、单纯腹腔镜治疗患者50例.比较3种治疗方式的手术时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间,以及术后并发症发生率和肿瘤复发情况.结果 所有患者均手术顺利,无术后死亡病例,所有患者术后随访均未见复发.双镜联合组操作时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间均短于或少于单纯腹腔镜组(P<0.05),单纯胃镜组肿瘤直径、操作时间、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间均短于或少于单纯腹腔镜组(P<0.05).绪论对于直径较小的胃间质瘤,单纯胃镜切除是最佳方案.双镜联合技术更适合治疗直径在10 cm以内较大的胃间质瘤,其操作安全可行,且具有定位准确,创伤小、术后恢复快的特点,近期疗效令人满意,但其远期疗效仍需进一步随访.

患者,男,34岁,因尿量逐渐减少2d急诊入院.患者入院前2d,因上呼吸道感染在当地医院给予头孢曲松钠静脉用药,入院前1d输液期间即出现双侧腰区绞痛,伴有恶性、呕吐等胃肠道症状,随后出现血尿,尿色淡红无血凝块,尿量逐渐减少至无尿,当地医院B超提示双侧肾盂分离均17 mm,泌尿系CT提示双肾轻度积水,双侧输尿管全段未见明显结石梗阻及扩张,于2017年6月9日凌晨急诊转入我院.既往否认各急慢性疾病史及手术史.

Objective To investigate the clinical features, diagnosis, treatment and prognosis of adult testicular teratoma. Methods Clinical data of three patients with adult testicular teratoma were retrospectively analyzed from the June, 2014 to June, 2016.The mean age was 24 years old, ranging 22 to 28 years old. Color Doppler echocardiography examination showed round or oval regular tumors in the scrotum with the diameter from 1.6 to 10 cm, mean 5.6 cm, but abdomen and pelvic cavity CT analysis demonstrated no abnormal changes. Testosterone levels and semen indicators of three patients were normal. Levels of serum AFP and beta hCG in two patients were normal, whereas that of the other one elevated. One patient received tumor resection with retained testicular, and the others underwent radical orchiectomy. Results Operations for three patients were completed successfully. The mean operation time was 62 minutes, ranging from 45 to 80 minutes. One case was pathologically diagnosed as dermoid cyst, one case as maturity teratoma, and other one as teratoma with somatic cell malignancy. Two cases received postoperative chemotherapy. After 12 to 36 months postoperative follow-up, all 3 cases survived, and their postoperative testosterone levels, AFP level, β-hCG level, semen indicators were all normal, 2 cases had no tumor recurrence and metastasis, but one case had high level of AFP, β-hCG, and retroperitoneal tumor occurred in 6 months after surgery. Conclusion Adult testicular teratoma and testicular dermoid cyst are rare in clinic. Postpubertal-type testicular teratoma with malignant behavior should receive testes radical resection as early as possible, prepubertal-typle may underwent tumor resection with retained testicular. Type of tumor tissues and pathological staging determine the prognosis of adult testicular teratoma.

Objective To observe the expression of nucleotides-binding domain receptor family containing CARD domain-5 (NLRC5) and β-catenin in gastric cancer,analyzc the relationship bctween NLRC5 and clinicopathological features and prognosis of gastric cancer,and preliminary explore the relationship between NLRC5 and Wnt/β-catenin signaling pathway.Methods A total of 93 patients with gastric cancer who underwent radical gastrectomy were enrolled.All patients were diagnosed by immunohistochemical staining to investigate the expression of NLRC5 and β-catenin in gastric carcinoma,and to analyze the relationship between the expression of NLRC5 and the clinicopathological features of gastric cancer.Gastric cancer cell lines MKN-45 and MGC-803 were transfected by pFPFP-C2-NLRC5 recombinant plasmid,qRT-PCR and Western blot were used to verify the transfection efficiency of NLRC5.The effect of NLRC5 expression on the biological behavior was observed by MTT cell proliferation and cell scratches test (P ＜0.05,P ＜0.01),and the changes of related protein in Wnt/β-catenin signaling pathway were detected by Western blot in gastric cancer cells.Results The expression of NLRC5 in 93 cases of gastric cancer was positive in 67 cases (72.04％) and negative in 26 cases (27.96％).The expression of NLCR5 was closely related to the TNM staging,lymph node metastasis and recurrence of gastric cancer.Kaplan-merier survival analysis was performed in gastric cancer patients with different expression of NLCR5.The results showed that patients with NLCR5-negative expression were better than those with positive expression (P ＜ 0.05).The expression of β-catenin was positive in 63 cases (67.74％) and negative in 30 cases (32.26％).Cox multivariate regression analysis showed that the positive expression of NLRC5 and β-catenin,low TNM staging and lymph node metastasis were independent prognostic factors of gastric cancer.MTT and scratches showed that overexpression of NLRC5 could significantly promote the proliferation and migration of gastric cancer cells.Western blot showed that overexpression of NLRC5 could significantly increase the key protein β-catenin and the key downstream of Wnt/β-catenin signaling pathway target protein C-myc,matrix metalloproteinase-7 expression levels.Conclusion NLRC5 is widely expressed in gastric cancer tissues,and its expression is closely related to TNM staging and lymph node metastasis of gastric cancer.Kaplan-merier survival analysis shows that NLRC5 overexpression is a risk factor for prognosis of gastric cancer.Cox multivariate regression analysis shows that NLRC5 overexpression is an independent risk factor for the prognosis of gastric cancer patients.NLRC5 and β-catenin are positively correlated,and the expression of NLRC5 affects the biological behavior of gastric cancer cells and the expression of key proteins in Wnt/β-catenin signaling pathway,suggesting that NLRC5 may affect the invasion andmetastasis of gastric cancer by regulating Wnt/β-catenin signaling pathway.

目的:分析重组链激酶在早期脑梗塞治疗中的应用效果.方法:根据纳入/排除标准共选取83例病例作为研究对象并随机分组;对照组给予口服阿司匹林肠溶片、尼莫地平片以及经静脉输注丹参注射液等常规处理,研究组给予常规处理+重组链激酶治疗;比较两组患者治疗前、治疗后血浆比黏度、血小板粘附率等血液流变学指标变化情况及临床疗效.结果:研究组治疗后血浆比黏度值、血小板粘附率及血小板最大聚集率值依次为(1.81±0.13)、(50±4)％,(55±4)％,均较对照组明显下降,差异均有统计学意义(P＜0.05);两组治疗总有效率依次为95.2％,75.6％,差异有统计学意义(P＜0.05).结论:重组链激酶用于临床早期脑梗塞的治疗可取得较满意的临床效果,可进一步提高早期脑梗塞患者的预后,具有较高的临床推广价值.

Objective To investigate the safety and efficacy of laparoscopic D3 radical correction with pelvic autonomic nerve preservation for rectal cancer.Methods The clinical deta of 211 patients with rectal cancer underwent D3 radical correction with pelvic autonomic nerve preservation in our hospital from 2010 to 2014 were retrospectively analyzed,they were divided into two groups (laparoscopic group,n =131 ; open group,n =80),the statistical results of the two groups were compared.Results All the operated patients was successful,211 cases were successfully completed surgery.The laparoscopic group mean operative time was (3.33 ± 0.72) h,ambulation began within 1-4 days postoperatively,the average time for passage of flatus was (3.48 ±0.82) d,the median number of total lymph nodes removed was 14.94 ± 3.41.The postoperative complications were observed in 16 of 131 cases (12.2％) including incision infection in 9 cases,Pulmonary infection in 2 cases,anastomotic fistula in 1 cases,anastomotic bleeding in 4 cases,no anastomotic fistula occurred.No significant difference in the number of total lymph nodes removed (P ＞ 0.05) and the postoperative complications (P ＞ 0.05) was observed between the two groups.Bowel flatus passed and hospital stay (P ＜ 0.05) earlier (P ＜ 0.01) in laparoscopic than that in open group.Operative time shorter (P ＜ 0.01) in open than that in laparoscopic group.no significant difference in urinary dysfunction and sexual dysfunction after operation was observed between the two groups.Conclusion Laparoscopic D3 radical correction with pelvic autonomic nerve preservation for rectal cancer is feasible and safe,quick postoperative recovery,has the obvious advantage of minimally invasive,and the life quality of patients is higher.

目的：探讨腹腔镜操作训练在腹部外科实习教学中的效果。方法将实习研究生40人分为腹腔镜操作训练组及传统方法教学组。训练组的实习教学包括理论学习、录像教学、模拟训练和实验动物操作等；传统教学方法的实习教学内容包括临床查房、临床手术示教和手术患者管理等。完成腹部外科实习教学后，以考试和问卷方式进行腹腔镜操作技能的教学效果评价。结果腹腔镜操作训练组的考试成绩和教学效果明显好于传统方法教学组，学生的出科考试成绩分别为（95．8±8．9）分和（80．4±10．6）分（t＝2．84，P＜0．05），教学效果调查表的综合得分分别为（94．0±6．7）分和（78．0±11．2）分（t＝3．21，P＜0．05）。结论腹腔镜操作训练能提高腹腔镜外科实习教学效果。

Objective To explore the technique and effect of applying new type stapler(OrVil) for laparoscopic cardiac carcinoma resection.Methods From Nov.2010 to Feb.2013,21 patients(15 men and 6 women,mean age 67 ± 3.52 years,ranging from 52 to 82 years) underwent laparoscopic resection with OrVil in our hospital.Among the patients,the tumor was located at cardiac region with carcinoma invasive the lower esophagus.The mean length of the tumor to incisor was 38cm(ranging from 36cm to 40cm).Results All surgeries were successful with no death or serious complications.The mean operation time for 21 patients was 280min(240min ~ 535min).The mean blood loss during operation was 250ml(200ml ~ 350ml).All the patients received liquid diet 3 to 5 days after the operation.The mean hospital stay was 10 days.Except for 1 case of thoracic infection after treatment who was well-healed,the others had no complications during the hospitalization and follow-up period.Conclusion The application of new type stapler(Orvil) for laparoscopic cardiac carcinoma resection is safe and feasible with microinvasion.Thus,it can be applied clinically.

Objective:To observe the population pharmacokinetic model of sustained-release 5-fluorouracil for implantation in colorectal cancer patients in order to offer the individual therapy.Method:Totally 120 human plasma samples from 20 colorectal cancer patients were collected using complete pharmacokinetic sampling method.First-order compartment model as the base,the population pharmacokinetic model was established by NONMEM.The fixed effects,such as height,weight,sex,hepatorenal function and drug combination etc on the pharmacokinetic parameters of 5-fluorouracil were observed.Result:The population pharmacokinetic parameters of sustained-release 5-fluorouracil for implantation in colorectal cancer patients were as follows:Kr was 0.005 44±0.002 89 h~(-1),Ka was 0.748±0.602 h~(-1),V/F was 1.06±0.343 L·kg~(-1),Ke was 0.005 7±0.541 h~(-1) and CL/F was 262±0.194 L·kg~(-1).The 90%confidence interval covered the measured values using the simulated blood concentration in 1 000 patients,suggesting the reliability of the results.Conclusion:The population pharmacokinetic model of sustained-release 5-fluorouracil for implantation is successfully found,which can estimate individual pharmacokinetic parameters,forecast human plasma and meet the requirements of individual drug therapy in colorectal cancer patients.

Objiective To establish an HPLC method for the determination of sustained-release 5-fluorouracil in human plasma.Methods The plasma samples were extracted with ethyl acetate.The solvent was evaporated to dryness under vacuum.Residue dissolved with 50% methanol before injection.The analysis involved a C18 column as stationary phase and methanol∶ water(5∶ 95) as mobile phase.The flow rate was 1.0 ml·min-1,UV detection wavelength was at 263 nm.5-bromouracil was used as the internal standard.The lower limit of quantitation,stability,relative recovery and technical indicators were detected.Results The plasma background didn't interfere with the determination of drugs.The regression equation of calibration curve is Y=0.748 3X+0.023 6,r=0.999 7.RSD of intra-and inter-day were from 2.1% to 6.9% and from 3.5% to 7.2%(n=5),respectively.The relative recovery was between 98.7% and 104.5%.The minimal detectable plasma drug concentration was 0.025 mg·L-1.Conclusion The method is economic,simple,rapid,sensitive and accurate,which is suitable for pharmacokinetical study and conventional monitoring of sustained-release 5-fluorouracil.

大电导Ca2+激活的K+通道(BKCa通道)广泛地表达于各种细胞中,并参与体内多种生理活动。其在前列腺正常上皮细胞内高表达,而慢性前列腺炎上皮细胞中的表达尚不清楚。研究BKCa通道在前列腺疾病发病机制中的作用,将为疾病的诊断和治疗提供了新的思路。

<正>近年来随着高频电刀的广泛应用及肥胖人数的增多,切口脂肪液化及感染已成为影响切口愈合的常见原因之一。本研究通过对结直肠癌体重超重133例患者行手术切口皮下放置引流管,可有效预防切口脂肪液化及感染,现报道如下。

目的分析高脂血症性胰腺炎(HLAP)的临床特点及预后。方法回顾性分析收治的98例急性胰腺炎的临床资料,按入院时血清三酰甘油(TG)水平分为高TG组和正常TG组。结果高TG组患者以男性居多,男女比例3∶1,发病年龄平均(36.5±12.6)岁,合并脂肪肝者占81.25%,BMI(28.17±4.19)kg/m2。相比正常TG组,高TG组男性所占比例高、发病年龄较低;全身炎症反应综合征(SIRS)发生率、入院时APACHEⅡ评分、肺、心血管和肾脏功能不全、假性囊肿的发生率高于正常TG组;住院时间长[(38.67±10.46)dvs(17.48±7.52)d](P<0.05),非手术治疗痊愈率高。结论高脂血症引起的急性胰腺炎并不少见,病情更严重。应重视对HLAP早期诊断,并尽早对高脂血症病因进行干预,以缓解病情,预防胰腺炎的复发。