后肾

objective to raise the level of regarding congnition,prevention,diagnosis and therapy on multiple organ dysfunction syndrome.methods report the process and correlative therapy on one case who occured with mods involving 6 organs after hemorrhagic shock lead to heartbeat and respiration stopping suddenly and resuscitated resulting in left nephrostome titanium nip falled off accidentally from left kidney lymphatic fastening.at the same time,the author reviewed correlative literature and introduce the investigative progress about mods.results one case who happened with mods following hemorrhagic shock,heartbeat and respiration stopped suddenly was diagnozed and resuscitaed.6 organ dysfuncted including brain,heart,lung,liver,kidney and the digestive system.after being given therapy integrated chinese and western medicines,allopathy and nutritional treatment,all circadian parameters of the case came back in gear and discharged at last.conclusion the mechanism about mods is very complicated.because of serious infection,hurt and oxygen-lack,excessive inflammatery reaction activates multifarious cell factors and inflammatery mediums,which improve the happen-rate of mods.wiping off pathogeny,providing life-sustain treatment and recognising sirs and mods in time and adopting corresponding therapy,such as treatment integrated chinese and western medicines,can improve the hit-rate of cure on mods.

作者：王静恩，蔡金芳，王志华，谢晓洪多器官功能障碍综合征；中西医结合；治疗；休克，出血性目的提高对多器官功能障碍综合征（multiple organ dysfunction syndrome，mods）的认识、预防、诊断、治疗水平。方法报告成功抢救1例经腹腔镜左肾淋巴管结扎手术后左肾静脉钛夹意外脱落失血性休克，导致心跳呼吸骤停复苏后再手术并发mods累及6个脏器功能衰竭过程及有关治疗，并复习相关文献，介绍目前关于mods的研究进展。结果确诊1例因失血性休克心跳呼吸骤停复苏后并发mods，累及脑、心、肺、肝、肾、血液、胃肠等6个脏器。经积极采取中西医结合对症、支持救治，各生理指标全部恢复正常，康复出院。结论 mods的发生机制非常复杂，在严重感染、创伤、缺氧等打击下，失控的过度炎症反应激活多种细胞因子和炎症介质的释放，使mods发生率升高。尽早去除病因，尽早给予各种生命支持治疗，尽早对可能发生全身炎症反应综合征、mods识别并给予干预治疗，包括中西医结合治疗能改善mods的救治成功率。

Methods Three hundred and fifty patients for laparoscopic surgery were admitted to our department from August 2001 to February 2002. They included 45 cases of adrenal glands surgery, 55 simple nephrectomy, 25 radical nephrectomy, 11 nephroureterectomy, 3 partial nephrectomy, 110 renal cyst decortication, 4 polycystic kidney decortication, 12 ureterolithotomy, 16 pyeloplasty, 3 retrocaval ureteroplasty, 58 varicocele-varix ligation and 8 pelvic lymph node dissection.

从2001年8月～2004年2月，350例患者施行了腹腔镜下泌尿外科手术，其中肾上腺手术45例，单纯肾切除55例，根治性肾切除25例，肾输尿管全切11例，肾部分切除3例，肾囊肿去顶术110例，多囊肾去顶减压术4例，输尿管切开取石术12例，UPJ成型术16例，腔静脉后输尿管成型术3例，精索静脉高位结扎术58例，盆腔淋巴结切除术8例。

Results:Main imaging features of APK were as follows:On abdominal plain films showed the lobalate renal enlargement in 46 cases,calcification of polycystic wall in 14 cases,renal calcium milk in 5 cases,60 cases were showed separation,deform and longthend of renal pelvis on intravenous urography and retrograde urography,5 cases were showed renal enlargement on retroperitoneal pneumography,on CT scans in 25 cases showed mulltiply cysts with thin wall,unecho liquid shadows were showed on B-mode ultrasound.

结果：成人多囊肾的主要影像学征象：腹部平片(46例)显示肾影呈分叶状增大；囊壁钙化(14例)；多囊肾合并肾钙乳(5例)；肾盂造影(60例)，表现为肾盂、肾盏相互分离、变形、拉长；腹膜后充气造影(5例)：表现为肾影增大肾影与邻近器官之间的关系，其界限清晰可辨；CT扫描(25例)：表现为肾内多数大小不等的薄壁圆形低密度区；B型超声(47例)表现为肾内多个类圆形无回声的液性暗区。

The way to manage the hilus renalis and renal sinus from the inferior pole of kidney in retroperitoneal laparoscopic operation is safe and reliable. At the same time, it increases the stereoscopy of operation.

经肾下极途径在后腹腔镜中处理肾动静脉血管及肾窦，增加了后腹腔镜中处理肾血管及肾窦的手术立体感，安全可靠。

Nevertheless, According to Kaplan-Meier analysis, the 1-year graft survival rate was signicantly worse in the C4dgroup(62.9%) than in the C4dgroup (83.3%; log-rank P=0.038).(5) The distribution of deficiency syndrome as follows: spleen-kidney Qi deficiency (53.2%), hepatic and renal Yin deficiency (28.6%), spleen-kidney Yang Deficiency (18.2%). The distribution of sthenia syndrome as follows: syndrome of blood stasis(58.4%), damp-heat syndrome(20.8%), pathogenic damp(11.7%).

应用Kaplan-Meier法观察移植肾穿刺后的生存曲线，log-rank比较两组的移植肾生存率，P=0.040，两组穿刺后生存率差异具有统计学意义。6、观察77例慢性移植物肾病中虚证分布情况：脾肾气虚占53.2%，其次是肝肾阴虚占28.6%，脾肾阳虚占18.2%，而没有观察到阴阳两虚患者；实证分布情况：血瘀证占58.4%，其次是湿热证占20.8%，湿浊证占11.7%和水气证占7.8%，没有观察到风动证。

objective to evaluate dsa and percutaneous transluminal renal arterioplasty for the treatment of renovascular hypertension.methods 82 suspected patients with renovascular hypertension were given dsa examination.28 patients were treated by means of ptra while another 5 cases with unilateral kidney atrophy treated surgically.results 49 patients were normal,33 patients were abnormal,28 patients were treated by means of ptra.blood pressure had got to normal in 10 patients while in 13 patients bp dropped noticeably after ptra.the overall benefit rate was 82.1%.conclusion dsa and ptra are clinically effective for the treatment of renovascular hypertension.ptra is technically successful.

目的 评价经皮腔内肾动脉成形术治疗肾血管性高血压的价值。方法 82例全部行dsa检查，肾血管狭窄者行ptra术或外科手术，观察其治疗效果。结果 82例患者行肾动脉造影后血管正常者49例，异常者33例，其中单侧肾萎缩5例行外科手术（肾动脉搭桥1例），肾动脉狭窄28例行经皮腔内肾动脉成形术（血管内支架5例），术后10例血压降至正常或基本正常，13例血压得到改善，5例无效，总有效率达82.1%。结论 dsa检查和ptra术在诊断和治疗肾血管性高血压方面有明显的临床价值。高血压，肾血管性；数字减影血管造影术；经皮腔内肾动脉成形术

Results The main imaging of adult polycystic kidney disease signs: abdominal plain film (45 cases) showed renal shadow was lobulated increase; cystic wall calcification (14 cases); polycystic kidney disease and renal milk of calcium (8 cases); pelvis angiography (61 cases), the performance of the renal pelvis, renal calices separated, distorted, elongated; retroperitoneal inflatable angiography (6 cases): Performance increases of renal kidney shadow Shadow and the relationship between the neighboring organs, its boundaries clear and identified; CT scan (30 cases): the performance of the majority of the size of the renal low-density areas, ranging from thin-walled circular; B-mode ultrasonography (47 cases) showed a circular echo-free renal multiple classes of liquid dark area .

结果 成人多囊肾的主要影像学征象：腹部平片(45 例)显示肾影呈分叶状增大；囊壁钙化(14例)；多囊肾合并肾钙乳(8例)；肾盂造影(61例)，表现为肾盂、肾盏相互分离、变形、拉长；腹膜后充气造影(6例)：表现为肾影增大肾影与邻近器官之间的关系，其界限清晰可辨；CT扫描(30例)：表现为肾内多数大小不等的薄壁圆形低密度区；B型超声(47例)表现为肾内多个类圆形无回声的液性暗区。结论影像学检查有助于提高多囊肾的诊断的准确性。

The diffusive XGPN shows cystic-solid multi-occupying with the whole kidney involved and kidney renal pelvis and calices enlarged. The lesions were extensive with unclear border which made the perirenal space dim renal fasciae thicken and with the abscess formation of psoas and abdominal wall. The localized XGPN shows mass in the renal parenchyma with low density clear border after enhancement and rim enhancement.

弥漫型累及全肾，肾影增大，肾盂肾盏扩大积液，肾实质幕粥发囊实性占位，病变分界不清，向肾外扩展，肾周间隙模糊，肾筋膜增厚并累及腰大肌，腹壁脓肿形成；局灶型表现为肾实质内局限性占位，病灶区呈略低密度灶，增强后边界清晰，病灶内见环形强化，而略低密度灶者强化较明显，但仍低于肾实质。

Mmol/L and 385±24. 6 mmol/L. At 3, 7 and 14 days after transplantation, the grafts were removed for a morphological observation under histological studies. In 7d, the macro pathology in control group's renal allograft was packed by gastrocolic omentum thickly, open the package and dissect the kidney, the color was paleness and interstitial edema.

对移植后第3、7、14d移植肾的形态学观察：对照组在移植后7d打开大鼠腹腔，可见移植肾被受体的大网膜包裹，网膜明显增厚，剖开移植肾脏，外观色泽苍白间质水肿明显，呈&大白肾&样改变，对照组动物一般在移植后12d左右死亡，死亡时移植肾组织包裹更加严重，肾脏部分发生液化。

The ureteroscopic holmium: YAG laser lithotripsy can he the first choice for the post-renal acute renal failure associated with upper urinary tract stones, due to its safety and efficiency. At the same time, retrograde intubation under cystoscope and percutaneous nephrostomy will be helpful.

上尿路梗阻是肾后性急性肾功能衰竭的主要原因，如能明确是结石引起的肾后性肾功能衰竭，应首选输尿管镜下钬激光碎石并置管引流；如不能明确，膀胱镜下逆行插管和经皮肾穿刺造瘘引流也是可行的急诊有效方法。

I'm strongly against the death penalty — it's an eye for an eye.

我不赞成死刑——这是以牙还牙的报复行为。

And to get you the support you need, we're enlisting all elements of our national power: our diplomacy and development, our economic might and our moral suasion, so that you and the rest of our military do not bear the burden of our security alone.

并给你们所须的支援，我们正徵召国家所有各种的力量：我们的外交及发展，我们的经济力量与道德劝说，所以你们与其他军人不须要孤独地负起国家安全的责任。