目的 探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与反流性食管炎(Reflux esophagitis,RE)二者之间的关系。方法 选取 2010年1—12月在我院消化内科门诊就诊,经内镜检查确诊为反流性食管炎的 364 例患者作为研究对象。364 例患者的食管炎程度按洛杉矶标准进行分级,记为相应的 A(156 例)、B(196 例)、C(7 例)、D(5 例) 4 组。内镜下常规取胃窦黏膜组织 2～3 块送病理检查,标本分别行 HE 染色明确胃炎类型、炎症活动度及快速尿素酶实验、改良 Giemsa 染色明确 H.pylori 感染情况等。结果 反流性食管炎患者中以男性多见,平均发病年龄早于女性平均发病年龄[(52.4± 11.6)岁 vs(56.6±12.4)岁,P=0.002];门诊反流性食管炎患者的总体 H.pylori 感染率为 90.9%,以轻度 H.pylori 感染为主,四组的 H.pylori 感染率及感染程度的比较差别无统计学意义(P值分别为 0.419,0.332);反流性食管炎患者以慢性浅表性胃炎、中度活动性炎症为主,四组比较差别无统计学意义(P值分别为 0.146,0.496);H.pylori 阳性、阴性患者的食管炎程度比较差别无统计学意义(P>0.05);不同程度 H.pylori 感 染情况下,患者的食管炎程度比较差别无统计学意义。结论 四组反流性食管炎患者的 H.pylori 感染率及感染程度的比较无差别,H.pylori 阳性患者与阴性患者的食管炎程度比较无差别,不同程度 H.pylori 感染情况下,患者的食管炎程度比较无明显差别。提示 H.pylori 感染与反流性食管炎程度无关。

Objective To explore the relationship between helicobacter pylori infection and reflux esophagitis. Methods 364 patients with reflux esophagitis were enrolled in our hospital from Jan to Dec in 2010.The severity grade of reflux esophagitis was according to Los Angles standard. All the patients received biopsies from gastric antrum,then received pathologic examinations. Results Reflux esophagitis in men was more common, with an average age of onset earlier than the female(52.4±11.6 years vs 56.6±12.4 years,P=0.002);Reflux esophagitis in patients with H.pylori infection rate was 90.9% overall,mainly with mild infection,four groups of H.pylori infection rate and extent of infection was no significant difference (P values were 0.419,0.702);reflux esophagitis in patients with chronic superficial gastritis(CSG),moderate active inflammation based was more common,there was no statistically significant difference in four group(P values were 0.146,0.496). There was no significant difference between H.pylori positive patients and H.pylori negative patients in esophageal mucosal damage(P> 0.05). There was no significant difference in reflux esophagitis with varying degrees of H.pylori infection on the degree of esophagitis. Conclusion Four groups of H.pylori infection rate and extent of infection was no significant difference; there was also no significant difference between H.pylori positive patients and H.pylori negative patients in esophageal mucosal damage. There was no significant difference in RE with varying degrees of H.pylori infection on the degree of esophagitis. Our research showed H.pylori infection had no relationship with degree of RE.

目的 探讨原发性脾脏肿瘤的诊断与治疗。方法 选取2006年1月—2014年12月期间收治的58例原发脾脏肿瘤患者进行临床观察。结果 脾脏良性肿瘤45例,其中脾血管瘤21例,脾囊肿11例,脾淋巴管瘤8例,脾脏窦岸细胞血管瘤3例,脾错构瘤1例,脾脏硬化性血管瘤样结节性转化1例;脾脏恶性肿瘤13例,其中脾脏B细胞淋巴瘤11例,脾脏霍奇金淋巴瘤及脾脏血管肉瘤各1例。B超和CT是主要的检查方法。全组行脾切除术51例,其中开腹脾切除术23例,腹腔镜脾切除术28例;部分脾切除术5例;脾切除+胰腺体尾部切除术2例。所有病例无手术并发症。术后随访9个月~9年,平均随访时间(43.8±21.3)个月,41例脾脏良性肿瘤患者预后良好,无复发和转移;11例脾脏恶性肿瘤患者的1、3、5年生存率分别为81.8%、63.6%和27.2%。结论 原发性脾脏肿瘤的诊断主要依靠临床表现和影像学检查。手术切除不仅是脾脏肿瘤一种有效的治疗手段,也是重要的确诊方法。脾脏局限性良性肿瘤可选择部分脾切除术以保留脾脏功能。早期手术及术后联合放化疗可改善脾脏恶性肿瘤的预后。

Objective To investigate the diagnosis and treatment of primary splenic tumor. Methods The clinical data of 58 patients with primary splenic tumor from January 2006 to December 2014 were retrospectively analyzed. Results 45 cases were benign splenic tumor, including 21 hemangioma, 11 splenic cyst, 8 lymphangioma, 3 littoral cell angioma, 1 hamartoma and 1 sclerosing angiomatoid nodular transformation of spleen. 13 cases were malignant splenic tumor, including 12 lymphoma and 1 angiosarcoma. Ultrasound and CT were the main diagnostic methods. 51 cases underwent splenectomy, including 23 open splenectomy and 28 laparoscopic splenectomy. 5 cases underwent partial splenectomy and 2 splenectomy combined distal pancreatectomy. There had no postoperative complications. The follow-up period was 9 months to 9 years. 41 cases with benign splenic tumor had no recurrence or metastasis. The 1-, 3-, 5-years survival rate were 81.8%, 63.6% and 27.2% respectively of 11 patients with malignant splenic tumor. Conclusion The diagnostic of primary splenic tumor mostly rely on clinical features and imagic examination. Surgical resection is not only an effective treatment, but also a confirmed diagnosis method for primary splenic tumor. Partial splenectomy is a reasonable procedure for local benign splenic tumor. Early surgery, combined adjuvant chemotherapy and radiotherapy are important for improving the prognosis of malignant splenic tumor.

目的 探讨开展药学服务干预对中老年COPD患者用药时间以及剂量的准确性的影响。方法 选取100名中医科门诊中老年COPD患者,随机分为干预组与对照组,干预组开展参与中医药治疗方案的确立、用药的衡量以及对患者进行用药指导、疾病健康宣教、定期随访等药学服务。对照组不作相关的药学服务干预。结果 干预组服药时间依从性(97.89±1.11)%,剂量准确率(99.95±0.05)%,干预组患者用药依从性比对照组有提高;平均疗程(11.12±2.1)天,比对照组缩短,差异有统计学意义(P<0.05)。结论 药师通过药学服务提高了中老年COPD患者的用药依从性及准确性,从而缩短疗程,值得推广。

Objective To investigate the time of drug use and dose accuracy in middle aged and elderly patients with COPD to develop pharmaceutical care intervention. Methods 100 middle aged and elderly patients with COPD were selected from the department of traditional Chinese medicine, randomly divided into intervention group and control group, the intervention group was developed pharmaceutical care including taking part in setting of therapeutic schedule, pharmaceutical measurement and guide of drug use in patients, health education, regular visit etc. The control group did not have pharmaceutical care intervention. Results The time of taking medicine compliance was (97.89±1.11)% and dose accuracy was(99.95±0.05)% in the intervention group. The intervention group had significantly improved compared with the control group. The course of treatment was(11.12±2.1)days. The average course of treatment was shorter than the control group. The difference was statistically significant (P<0.05). Conclusion Medication compliance of middle aged and elderly patients with COPD is higher by pharmaceutical care from the pharmacists. The course of treatment is shortened. It is worth using widely.

目的 比较胆总管切开探查术后留置T管和胆总管切开探查并一期缝合术后胆管内支架引流这两种模式治疗胆管疾病的手术疗效。方法 对2012年—2014年期间收治的90例需择期行胆总管探查的患者进行前瞻性随机对照研究。按照实验方式分为T管组40例和单管内支架组50例。对比分析两组胆总管置管缝合手术时间、住院时间、治疗总费用、生活质量指数值以及并发症发生率,包括引流失败率(T管滑脱、内支架管滑脱、移位)、胆漏、胆道感染、胰腺炎和残石率。结果 开腹胆总管探查术术后内支架引流患者的出院前生存质量评价高于T管引流患者,住院时间少于T管引流患者,置管及胆管缝合时间长于T管引流患者(均为P＜0.05);术后两组患者间的治疗总费用和非计划脱管、胆漏、胆道感染、胰腺炎、残石率和不能拔/脱管等术后并发症发生率的差异无统计学意义(P＞0.05)。结论 内镜下胆道支架内引流术(Endoscopic retrograde biliary drainage,ERBD)移植于胆总管切开探查并一期缝合术具有可行性、安全性及治疗效果确切,显著缩短患者住院时间、加快患者康复提高患者出院前的生存质量,并放宽胆总管一期缝合指征。

Objective To compare the clinic research between biliary stent insertion drainage and T-tube drainage after choledochotomy. Methods The clinical data of 90 cases from 2012 to 2014 were analyzed in a prospectively randomized trial, and they were divided into two groups by T-tube drainage and biliary stent insertion drainage. Cathetering and suture time, length of stay, hospital costs, life quality and incidence of complications were compared, respectively. Results After open common bile duct exploration (OCBDE), the life quality of stent group was significantly higher than that of T-tube group, the length of stay in stent group was shorter, and cathetering and suture time of bile duct in stent group was longer than that of T-tube group (P＜0.05); There were no significant differences between the two groups in the hospital costs and incidences of postoperative complications including bile leakage, early stent dislodgement, biliary infection, pancreatitis and residual stone (P＞0.05). Conclusion Endoscopic retrograde biliary drainage (ERBD) with primary closure after choledochotomy is a safe, effective and feasible procedure for the management of choledocholithiasis, it can significantly reduce the postoperative hospital stay and improve the life quality of patients and expand the indications for primary closure of CBD incision.

目的 观察不同疗程吗替麦考酚酯(MMF)治疗激素依赖或激素抵抗成人微小病变肾病(MCD)的疗效和复发率。方法 2011年2月—2013年8月我院收治的25例激素依赖或抵抗成人MCD,随机分为短疗程组12例和长疗程组13例。短疗程组给予MMF联合口服泼尼松治疗6个月,观察12月,长疗程组治疗18个月,前6个月治疗同短疗程组,此后单用小剂量MMF维持,观察两组的疗效及复发率。结果 长疗程组有1例因严重感染在第2月退出研究,其余24例均完成18月的随诊;两组在治疗第6月时尿蛋白定量降低、血浆白蛋白升高,均与治疗前有差异(均P<0.05);与第6月比较,疗程结束时短疗程组尿24小时蛋白定量升高(P<0.05),长疗程组尿24小时定量无明显改变(P>0.05);治疗第6月两组均有9例完全缓解(75%),两组无差异(χ²=0.372,P>0.05);治疗第18月时与第6月比较,短疗程组6例复发(54.54%),长疗程组有2例复发(18.18%),两组复发率比较无差异(χ²=0.076,P>0.05)。结论 MMF能有效诱导缓解成人MCD,小剂量维持治疗可以有效降低复发率。

Objective To observe the efficacy and recurrence rates of mycophenolate mofetil (MMF) on hormone-dependent or steroid-resistant adult minimal change disease (MCD). Methods We retrospectively reviewed the records of adult patients at Shunde district hospital of traditonal Chinese medicine of Foshan for minimal change from February 2011 to August 2013. All patients who were hormone-dependent or steroid-resistant were collected. Twenty-five patients were randomly divided into short or long course group. The patient at short course group was given MMF combined with oral prednisone for 6 months, and the long course group was given for 18 months. Patient demographics, efficacy of medicines and recurrence rates were observed. Results Except one case of the long course group quitting at the second month because of severe infection, the other cases all finished the 18 months of follow up. At the 6 month after therapy with MMF, in both group, the 24h urine protein had lowered significantly (P<0.05) and the serum albumin level had risen remarkably (P<0.05). At the end of the follow up, compared with the 6 month after therapy, the 24 h urine protein of the short course group had increased (P<0.05), while those of the long course group had no obvious difference (P>0.05). At the 6 month after therapy, there were 9 cases achieved complete remission.There was no significant difference between the two groups (χ²=0.372, P>0.05). At the end of the follow up, compared with the 6 month after therapy, there were 6 cases experienced relapse (54.54%) in the short course group and 2 cases of those in the long course group (18.18%), but with no significant difference between them (χ²=0.076, P>0.05). Conclusion MMF can induce the remission of adult MCD efficiently, and its low dose maintenance treatment can decrease recurrence rates.

目的 探讨纤维支气管镜吸痰联合镜下注药治疗慢性阻塞性肺疾病(COPD)的应用价值。方法 选择50例确诊慢性阻塞性肺疾病患者,随机分为A、B两组(每组25例),两组患者均予常规治疗,B组在常规治疗的基础上加予每周二次经纤维支气管镜吸痰和镜下注药治疗。通过观察比较2组治疗前后的症状、肺通气功能、动脉血气分析的变化及不良反应来评价疗效。结果 治疗两周后,B组患者的症状、肺通气功能、血气分析以及氧合指数较A组有明显改善,无明显不良反应。结论 纤维支气管镜吸痰联合镜下注药治疗慢性阻塞性肺疾病安全、有效,值得临床推广。

Objective To investigatethe utility of applying bronchoscopy combined with endoscopic injection in patients with chronic obstructive pulmonary disease. Methods 50 patients diagnosed with chronic obstructive pulmonary disease, were randomly divided into A, B groups (n=25,respectively). All the patients received internal routine treatment. Patients in group B received bronchoscopy and endoscopic injection therapy twice a week additionally. The efficacy was evaluated by comparing improvement of symptoms, pulmonary ventilation function and arterial blood gas analysis before and after treatment. The assessment of adverse reactions was also included. Results After two weeks of treatment, the patients in group B had been improved more significantly than the patients in group A, no significant adverse reactions were found. Conclusion It's safe and effective using bronchoscopy combined with endoscopic injection therapy for chronic obstructive pulmonary disease.

目的 了解广东省某区级三甲综合医院住院老年人慢性非传染性疾病(慢非病)疾病谱及性别差异随年度推移的变化。方法 回顾性分析南方医科大学附属南海医院2006—2014年老年人出院资料。结果 住院老年人疾病谱中名列前位的疾病除了肺炎、急性胃肠道疾病,余为慢非病。慢非病比例逐年下降(65.8%~57.8%, P<0.01),疾病谱明显变化:脑血管疾病由第一位占21.3%降至17.0%居第二,恶性肿瘤从10.4%升至18.8%居第一。性别有差异:男性慢阻肺和恶性肿瘤的构成比多于女性;慢非病比非慢非病、男性比女性慢非病的人均住院总费用高(P<0.05)。结论 总结9年来南海区三甲综合医院住院诊治的慢非病居高及攀升病种、性别差异,制定措施优化医疗资源配置、减轻社会经济负担。

Objective To analyze the alteration of disease distribution and gender-differences of chronic non-communicable diseases (NCD) in hospitalized elderly from a large Comprehensive Hospital of Guangdong province. Methods Retrospective observational study including profile of discharged elderly in Nanhai hospital attached to Southern medical university from the year 2006 to 2014. Results In the top rank of diseases in hospitalized elderly, all were NCDs other than pneumonia and acute gastrointestinal diseases. The proportion of NCD accounted for all hospitalized elderly was reduced year by year, changed from 65.8% to 57.8%, P<0.01. Disease distribution of NCD altered obviously, showing that cerebrovascular disease (CVD) decreased from the first 21.3% to the second 17.0%, malignancy increased from 10.4% to 18.8% ranking as the first. Gender-differences did exist. Greater constituent ratio of chronic obstructive pulmonary disease (COPD) and malignancy were found in men than women yearly. NCD showed higher hospitalized expenses than non-NCD per capita, that of men were higher than women (P<0.05). Conclusion Summarizing the top and increasing rank of NCD and gender-differences in hospitalized elderly in a large comprehensive hospital, Nanhai district, Foshan city of 9 years, policy and program could be guided to optimize the distribution of medical resources and try to reduce the output of social economic burden.

目的 提高对精索静脉曲张合并同侧腹股沟隐匿性斜疝的认识。方法 2009年1月—2013年9月,3例左侧精索静脉曲张合并同侧腹股沟隐匿性斜疝患者经我科诊治,合并的隐匿性腹股沟斜疝术前均未能发现,其中2例患者在行经腹股沟精索静脉高位结扎时发现合并的隐匿性疝,同时行疝修补手术;另1例术后第2天发现再次行疝修补术,疝修补手术采用Bassini术式。结果 术后6个月电话随访,3例患者腹股沟疝无复发、无睾丸萎缩、鞘膜积液并发症。结论 精索静脉曲张合并腹股沟隐匿性疝少见,但临床工作中还是会遇到,需要提高对该疾病的认识,治疗方式存在一定争议。

Objective To improve the realization of the varicocele combined with ipsilateral concealed indirect hernia. Methods Three cases of the varicocele combined with ipsilateral concealed indirect hernia were treated in our department from January 2009 to September 2013. Combined ipsilateral concealed indirect hernia were not diagnosed before operation, 2 were found during the operation of spermatic vein ligation through the groin and received Bassini's hernia repair simultaneous, another found 2 days after operation and then received Bassini's hernia repair. Results No recurrence of hernia, testicular atrophy and hydrocele observed in the follow-up by phone 6 after months. Conclusion Varicocele combined with ipsilateral concealed indirect hernia is rare, we need to improve the understanding of this disease and the therapy is controversial.

目的 探讨血清胃蛋白酶原在胃癌筛查中的价值。方法 用ELISA方法对1102名患者血清PG水平进行检测,并行内镜病理组织学检查,采用ROC曲线确定PG筛查胃癌的最佳界定值。结果 与对照组、萎缩性胃炎组、胃良性溃疡组相比,早期胃癌组、进展期胃癌组PGI、PGR下降(P＜0.05),进展期胃癌组PGI、PGR较早期胃癌组下降(P＜0.05)。与对照组相比,早期胃癌组、进展期胃癌组、胃良性溃疡组PGII升高(P＜0.05)。PGI及PGR在ROC曲线下面积为0.920和0.831,对胃癌的诊断价值较高。PGI≤71.50 μg/L或PGR≤4.50作为筛查标准时,对胃癌高危人群筛查的灵敏度为83.33%,特异度为82.25%。结论 血清PGI、PGR在不同胃部病变中的表达水平不一致,对胃癌的早期筛查和早期诊断具有重要价值。PGI≤71.50 μg/L或PGR≤4.50是东莞地区筛查胃癌较合适的界定值。

Objective To investigate the value of serum pepsinogen PG detection for screening of gastric cancer. Methods PG was detected by ELISA of 1102 people, gastrointestinal endoscopy and biopsy pathology were also carried on. Using ROC curve to establish the PG screening standard, and verified its' value at high risk population of gastric cancer. Results Compared with control group, atrophic gastritis group and benign gastric ulcer group, serum PGI and PGR in early gastric cancer group and advanced gastric cancer group decreased significantly(P＜0.05). Serum PGI and PGR in advanced gastric cancer group were lower than early gastric cancer group(P＜0.05). Serum PGII in early gastric cancer group, advanced gastric cancer group and benign gastric ulcer group were higher than control group(P＜0.05). The area under ROC curve of PGI and PGII was 0.920 and 0.831 respectively, both of them showed high value for the diagnosis of gastric cancer. Took PGI≤71.50μg/L or PGR≤4.50 as the diagnosis criteria, the sensitivity was 83.33% and specificity was 82.25% at high risk population of gastric cancer. Conclusion Serum PGI and PGR were inconsistent in different gastric disease, which showed high sensitivity and specificity in the screening of gastric cancer,and have important value in early screening and early diagnosis of gastric cancer. PGI≤71.50μg/L or PGR≤4.50 were established as the appropriate standard for PG screening.

目的 观察HB13对SD大鼠的一般生殖毒性。方法 SD大鼠,雌雄各100只,分为低、中、高剂量组(20、40和80 mg/(kg·d))和对照组(0.5%羧甲基纤维素钠溶液),每组25只。雄鼠于交配前28 d给药,雌鼠于交配前14天给药,给药至妊娠第7天。雄鼠交配后处死,孕鼠于妊娠第14天颈椎脱臼处死,观察HB13对雌雄鼠一般情况、生育力和胚胎发育的影响。结果 与对照组相比,HB13高、中剂量组雄鼠给药期体重减轻,睾丸系数及附睾系数增大,异常精子率升高;高剂量组还使雄鼠生育力降低。给予高、中剂量HB13的雌鼠妊娠后体重较对照组减轻,着床后丢失率增高,吸收胎数增加,活胎数减少,连胎子宫重降低;高剂量组HB13还使雌鼠生育率及着床数降低,着床前丢失率升高。结论 HB13低剂量对雌、雄性大鼠无一般生殖毒性;中剂量对孕鼠早期胚胎发育有明显干扰作用;高剂量对雌、雄大鼠生育力有显著降低作用并且对早期胚胎发育有明显干扰作用。

Objective To study the general reproductive toxicity of HB13 in SD rats. Methods SD rats, 100 females and 100 males, were divided into low, medium and high dose groups 20, 40 and 80 mg/(kg·d) and the control group (0.5% CMC-Na), The rats were given HB13 for 28 days in male rats and 14 days in female rats respectively before mating, and then mated. The HB13 treatment continued until the 7th day of pregnancy. When the female rats were confirmed pregnant, the male rats were executed and the female rats were executed on the 14th day of pregnancy. Then we can observe the effect of HB13 on fertility and embryonic development in rats. Results Compared with the control group, the body weight of medium, high dose group reduced significantly, the coefficient of testicular and epididymis, abnormal sperm rate increased significantly. High dose group of HB13 also made the fertilityof male rats decline; The body weight, live births uterus weight (including the fetus) of pregnant rats in high and medium group decreased significantly. At the same time, the rate of lost oosperm and absorbed embryo increased. The high dose group of HB13 can also reduce the fertility of female rats. Conclusion The low dose group of HB13 didn't have general reproductive toxicity in rats, the medium dose group impaired early embryonic development, but the high dose group can significantly reduce the fertility of both male and female rats, and can impair the development of embryonic.