腹腔镜、胆道镜和十二指肠镜微创技术联合应用治疗肝内外胆管结石

目的探讨运用多种微创外科技术在腹腔镜胆总管探查术中的联合应用价值. 方法在腹腔镜超声和术中胆道造影指导下,联合应用腹腔镜,十二指肠镜,胆道镜,对120例肝内外胆管结石病人进行微创外科治疗. 结果 120例手术均获成功,无中转开腹或严重并发症发生.术后住院时间明显缩短,而手术时间并无延长.部分残留结石病人经术后胆道镜取净结石,随访2年未见远期并发症. 结论多种微创外科技术联合应用治疗胆石症安全可靠,切实可行,可望成为肝内外胆管结石微创化治疗的有效新途径.

手辅式腹腔镜在结肠手术中的应用

目的 探讨手辅式腹腔镜在结肠手术中的应用及疗效.方法于患者腹壁切一5～6 cm 小切口,另置2个troear(套管).采用HandPort手辅式装置和超声刀,充分利用这个"小口",运用开放手术和腹腔镜手术的技术,施行了10例结肠手术.结果 10例手术时间平均92 min,手术失血量为50～100 ml,中转开放手术率为0.病人术后过程平稳,恢复快.结论 运用手辅式腹腔镜技术能集中开放手术和腹腔镜手术的优势完成复杂的传统手术,使手术达到微创的目的 .

广州地区临床分离多重耐药肠杆菌科细菌的耐药基因检测

Objective To detect resistant gene in clinical application Enterobacteriaceae strains and exploreits characteristics. Methods Biomerieux's VITEK-2 system was used to identify Enterobacteriaceae and its drug susceptibility. The double disk synergy test for detecting metallo-β-Lactamase of Enterobacteriaceae. The Metallo-β-Lactamases gene, qacE△l-sull gene,qnr genes and class 1,2,3 integrons carried on Enterobacteriaceae strains were detected by polymerase chain reaction (PCR)method. Results The positive rate of integron 1 of 109 from 115 strains was 94.8%. Class 2,3 integrons were not found. 107 of 115 strainswere qacE△l-sull gene positive. The positive rate of qnrA, qnrB, qnrS were 53. 9% ,12. 2% and 5.2% respectively. Nine strains were MBL-positive using EDTA double disk synergy test. This 9 strains was only susceptible to amikacin and polymyxin B. The IMP-4 and IMP-1 metallo-β-Lactamases were positive, meanwhile qnrA, qnrS, qacE △l-sull and intll were positive. Conclusion Especially ,producesd metal β-lactamase enterobacteriaceae bacteria appear to be highly multiple drug resistance and carry a variety of drug resistance gene. Integrons were important molecular mechanism in the development of multidrug resistance.%目的 检测临床分离的低产碳青霉烯酶肠杆菌科细菌的耐药基因,探讨其存在特点.方法 肠杆菌科细菌的鉴定和药敏采用法国生物梅里埃公司的VITEK-2系统进行药物的最低抑菌浓度(MIC)检测;EDTA双纸片增效法检测金属β-内酰胺酶(MBL);采用聚合酶链反应(PCR)方法检测碳青霉烯酶基因,qacE△1-sul1消毒剂耐药基因,qnr喹诺酮类耐药基因及Ⅰ,Ⅱ,Ⅲ类整合酶基因等相关耐药基因.结果 115株肠杆菌科细菌94.8%(109/115)I类整合酶基因阳性,未检出携带Ⅰ,Ⅲ类整合酶基因的细菌;93.0%(107/115)消毒剂基因(qacEΔ1-sul1)阳性;qnrA基因阳性率53.9%(62/115),qnrS基因阳性率12.2%(14/115),qnrB基因阳性率5.2%(6/115),有9株菌EDTA增效试验阳性,检出金属β-内酰胺酶基因型,且同时携带qnrA,qnrS,intI1和qacEΔ1-sul1基因,金属β-内酰胺酶基因型别确定为IMP-4(blaIMP-4)和IMP-1(blaIMP-1)型.结论 多重耐药肠杆菌科细菌的多重耐药与整合子相关,且携带多种耐药基因,尤其产金属β-内酰胺酶的细菌多种抗菌药物呈现高度的多重耐药.

微创手术中的"脑减压性损害"

众所周知,在正常情况下颅内压是恒定的,当某些特定的致病原因如高血压,脑血管畸形,颅脑创伤等引起脑出血形成颅内血肿时,可使颅内环境失去平衡,从而改变颅内压力的恒定状态.