术中胆道造影的临床意义

目的探讨术中胆道造影在胆道手术中的价值。方法回顾分析本院在2000至2006年间250例胆囊切除术以及胆总管探查术病人,术中经胆囊管或T管造影胆管结石的发生率。结果临床无胆总管探查指征110例,术中造影发现结石5例。胆囊切除术后有胆总管探查指征,经胆囊管插管造影60例,造影阳性,行胆道探查40例,无异常者1例。认为胆总管结石已取净,术中T管造影115例,造影阳性改变20例,再次探查有结石残留18例。结论术中常规胆道造影可发现隐匿性胆总管结石,并降低胆道阴性探查率,防止胆总管结石残留。     

超声刀在腹腔镜胆囊切除术中的应用体会

超声刀在腹腔镜下胆囊切除术中分离粘连、切割止血安全有效。我自2003年4～10月在北京人民医院普外三科进修期间,运用超声刀于腹腔镜下胆囊切除术,共计738例,现报道如下。     

瑞芬太尼复合丙泊酚在腹腔镜胆囊切除术中的应用

目的观察瑞芬太尼复合丙泊酚在腹腔镜胆囊切除术中的麻醉效果。方法比较2组患者不同时段的血流动力学情况和术后患者的苏醒情况。结果瑞芬太尼组的唤醒时间、自主呼吸恢复时间及拔管时间均明显优于芬太尼组。结论瑞芬太尼复合丙泊酚应用于腹腔镜胆囊切除术血流动力学平稳、术后苏醒更加迅速。     

经腹腔镜行胆囊切除术治疗109例急性胆囊炎的临床分析

目的探讨急性胆囊炎经腹腔镜行胆囊切除术的可行性及疗效分析。方法对收治的109例急性胆囊炎行腹腔镜胆囊切除术,术后使用抗生素2～4d。结果109例患者行胆囊切除术,手术顺利104例,占95.4%,5例中转开腹,术后无并发症,3～7d治愈后出院。结论急性胆囊炎经腹腔镜行胆囊切除术是可行的。     

基层医院腹腔镜胆囊切除术900例临床分析

目的总结基层医院开展腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的经验。方法对我院2005年1月至2011年1月实施900例病人临床资料进行回顾性分析。结果 879例完成LC术,9例中转手术。12例术后出现胆漏,经腹腔引流管引流治愈,无术后出血、胆道损伤等严重并发症,所有病例均痊愈出院。结论经过严格培训,掌握LC的适应证,术中精细操作,合理放置引流管,适时中转开腹,基层医院开展LC是安全可行的。     

腹腔镜胆囊切除术并发症22例临床分析

目的探讨腹腔镜胆囊切除术并发症的治疗和预防。方法回顾性分析22例LC并发症患者临床资料。结果 22例LC并发症患者中10例胆瘘,8例术后出血,2例胆道结石残留,2例胆管损伤,22例患者均无切口感染现象。结论医护人员应熟悉LC的操作方法,严格遵循LC绝对禁忌证的规定,行腹腔镜胆囊切除术手术前应进行严格的病例筛选,术前的病例筛选对于保障LC手术的安全,减少并发症的发生有着积极的意义。     

腹腔镜应用于胆囊切除术的临床研究

目的探讨腹腔镜在胆囊切除术的临床应用。方法分析2006年12月至2008年5月行腹腔镜胆囊切除手术的疗效及并发症。结果56例患者手术成功51例(91.2%),手术平均50min。中转开腹5例(8.8%),其中因胆囊动脉出血2例,胆囊化脓、Calot区呈冻结样改变2例,肌松药过敏1例。胆瘘2例,胆总管残留结石1例。结论腹腔镜在胆囊切除术中取得满意的临床效果。     

腹腔镜胆囊切除术并发症的防治

对腹腔镜胆囊切除术(LC)480例患者并发症的防治探讨。     

腹腔镜胆囊切除术治疗急性胆囊炎的应用体会

目的探讨腹腔镜胆囊切除术对急性胆囊炎的治疗价值。方法对2004～2008年493例急性胆囊炎患者行腹腔镜胆囊切除术。结果本组患者均顺利完成LC,平均住院时间4～5d。结论急性胆囊炎急诊行LC是安全可靠的,并且可取得良好效果。     

无钛法腹腔镜胆囊切除术在基层医院的应用

目的 探讨无钛二孔法腹腔镜胆囊切除术在基层医院的应用价值。方法 将120例行腹腔镜胆囊切除术的患者随机分入对照组与观察组,其中64例对照组患者行钛夹传统四孔法手术治疗,56例观察组患者接受无钛二孔法腹腔镜胆囊切除术。比较2组手术时间、术中出血量、住院时间、术后疼痛及术后并发症发生率。结果 观察组患者均手术成功,无中转开腹病例。观察组手术时间长于对照组(P<0.05);观察组术中出血量、术后疼痛均显著少于对照组,差别具有统计学意义(P<0.01);2组住院时间、术后并发症发生率无显著差别(P>0.05)。结论 无钛二孔法腹腔镜胆囊切除术与钛夹传统四孔法相比疗效相当,同时对机体损伤较小,减轻患者痛苦,只要经过严格培训手术医生均可掌握,适合在基层医院推广应用。     

腹腔镜手术治疗急性胆囊炎130例临床疗效观察

目的探讨急性胆囊炎患者施行腹腔镜手术的手术方式选择、安全性及可行性。方法回顾性分析2002年9月至2009年7月在我科行腹腔镜手术的130例急性胆囊炎患者的临床资料。结果112例行腹腔镜胆囊切除术,15例行腹腔镜胆囊大部切除术,3例中转开腹;所有患者均痊愈出院,均无手术死亡及严重并发症发生。结论急性胆囊炎患者采取急诊腹腔镜手术是安全可行的,值得临床推广应用。     

在胆囊切除术中预防胆囊损伤及大出血的临床观察

目的探讨胆囊切除术中发生大出血及胆囊损伤的原因。方法随机选用100例肝脏标本,解剖观察胆囊三角内血管及胆管的位置走行,结合胆囊切除术中大出血23例,胆管损伤11例的原因分析。结果胆囊切除术中大出血及胆囊损伤的原因,除了与术者的技术水平有关外,主要与术者对胆囊三角的正常解剖结构及变异认识不足有关。结论胆囊切除术中必须精细解剖胆囊三角,高度警惕有无变异,严格掌握手术适应证。     

壳聚糖对金属离子的吸附选择性

壳聚糖是一种天然高分子化合物,高分子链段中含有-NH2,-OH活性基团,与重金属离子形成配位化合物,可制成高分子吸附剂吸附重金属离子。以Cu^2＋、Zn^2＋和Pb^2＋为研究对象,通过等温吸附的分析,讨论壳聚糖吸附重金属离子的选择性。     

除草剂在植物体内的代谢与选择性及使用

简要论述了除草剂在植物体内的代谢反应及其调控。     

茴油臭氧化选择性的研究

研究了无水乙醇等溶剂对茴油臭氧化的影响以及茴油中三种主要双键物茴脑、α-蒎烯和草蒿脑臭氧化的选择性。研究结果表明 ,采用混合溶剂效果较好 ,混合溶剂的质量比为无水乙醇∶环己烷 =1∶ 3。臭氧对茴脑有很好的选择性     

Selectivity enhancement in heterogeneous catalysis induced by reaction modifiers

The application range of solid catalysts can be greatly extended by reaction or process modifiers, that is by simple addition of an inorganic or organic compound to the reaction mixture. The modifier, used in catalytic amounts, ideally interacts strongly with the active sites in a fashion which induces favorable changes in the outcome of the reaction. Evolution of the actual modified metal catalyst during reaction and the importance of in situ characterization in understanding these processes are illustrated using the examples of promotion by metal ions and nitrogen-containing bases. The major part of the review describes the advantages and limitations of employing N-base modifiers for tuning the performance of solid catalysts. Reactions discussed include chemo-, stereo-, enantio- and diastereoselective hydrogenations over metal catalysts, aerobic oxidation of alcohols with Pt and Pd, and epoxidation of allylic alcohols with titania–silica mixed oxides and alkyl hydroperoxides.     

The Protein Environment Drives Selectivity for Sulfide Oxidation by an Artificial Metalloenzyme

Magic Mn–salen metallozyme : The design of an original, artificial, inorganic, complex‐protein adduct, has led to a better understanding of the synergistic effects of both partners. The exclusive formation of sulfoxides by the hybrid biocatalyst, as opposed to sulfone in the case of the free inorganic complex, highlights the modulating role of the inorganic‐complex‐binding site in the protein.

     

三次风管摆动支撑体系的设计与应用

本文介绍了一种新的三次风管摆动支撑体系,从结构和原理以及相对于传统的滑动支撑体系的优点等几方面进行了阐述,并对其倾角、固定支座位置及支座载荷计算等设计问题进行了探讨。关键词:三次风管;摆动支撑;固定支座;摆动支座;二力杆     

The Molecular Origins of Selectivity in Methanol Decomposition on Pd Nanoparticles

We have combined multi-molecular beam methods and in-situ time-resolved IR reflection absorption spectroscopy (IRAS) to explore the kinetics of methanol decomposition on a supported Pd model catalyst. The well-shaped Pd nanoparticles are prepared under ultra-high vacuum conditions on a well-ordered alumina film and have previously been characterized with respect to size, density, and morphology.Two competing decomposition pathways are observed: Whereas dehydrogenation to CO represents the dominating reaction channel, C-O bond scission proceeds at much lower rates and leads to the formation of carbon and hydrocarbon species. Using CO as a probe molecule, we show via IRAS spectroscopy that these carbon and hydrocarbon species preferentially block defect sites on the Pd particles such as steps or edges, whereas the (111) facet sites are affected to a lesser extent.Employing quantitative IR\Sigma AS and steady-state isotope exchange experiments, the reaction rates for both channels are measured as a function of carbon coverage. It is found that with increasing carbon coverage, the rate of carbon formation drops rapidly, whereas the kinetics of dehydrogenation is hardly affected. These results demonstrate that the rate of C-O bond scission is drastically enhanced at the particle steps and edges, whereas for the dehydrogenation pathway this is not the case.     

Improvement of the Flotation Selectivity in a Mechanical Flotation Cell by Ultrasound

In this study, the effect of ultrasound on froth and pulp phases has been investigated in the flotation of two different ore samples, namely barite and chalcopyrite. In order to determine the overall flotation rate constants at various froth depths, incremental recoveries obtained from the flotation tests with and without ultrasound were fitted to a first-order rate equation. Thus, the recoveries of froth and pulp phases were calculated.

The use of ultrasound speeded up the bubble coalescence and therefore reduced the froth phase recovery in the ultrasonic flotation of both barite and chalcopyrite. In addition, the results indicate that there is a considerable effect of ultrasound on the pulp phase recovery in the chalcopyrite flotation whereas no significant differences in the separation performance were obtained from the ultrasonic flotation of barite with and without ultrasound. The results also indicate that a pronounced selectivity effect was obtained from the ultrasonic flotation of both barite and chalcopyrite. The use of ultrasound in the froth remarkably improves the quality of the chalcopyrite concentrate, especially at the shallow froths. Therefore, either effective pulp volume can be increased without sacrificing the separation selectivity or the pulp density can be decreased to obtain better product quality at shallow froths in the ultrasonic flotation of chalcopyrite.