后腹腔镜下肾部分切除术后发生尿瘘的危险因素分析

目的 分析和探讨后腹腔镜下肾部分切除术后发生尿瘘的危险因素。方法统计和分析2004-10-2013-06 行腹 腔镜下经后腹膜路径肾部分切除术后发生尿瘘的128 例肾肿瘤患者的临床资料,尿瘘严格定义为手术2d 后仍从后腹膜引流管持续引流出尿液。结果术后有14 例（10.9%）患者发生尿瘘。发生尿瘘的患者中10 例（71.4%）未行CTA 检查,术中平均出血量（232.3±86.7）ml,平均肾动脉阻断时间（28.2±7.5）min,平均住院时间（13.1±2.1）d,9 例（64.3%）术中发现集合系统破损。单因素分析提示年龄（P =0.1102）、糖尿病（P =0.0445）、肿瘤内生型生长（P =0.0835）、术前是否行CTA 检查（P=0.0137）、集合系统损伤（P=0.0935）、肾动脉阻断时间（P =0.1225）及术中出血量（P=0.0045）是发生尿瘘的危险因素;多因素分析提示糖尿病（P =0.0381）、术前是否行CTA 检查（P =0.0433）及术中出血量（P =0.0155）是术后发生尿瘘的独立危险因素。结论糖尿病、术中出血 量及术前是否行肾脏CTA 检查是后腹腔镜下肾部分切除术后发生尿瘘的独立危险因素。减少术中出血有利于术者获得清晰的操作视野,有效缝合破损的集合系统,从而防止尿瘘的发生。     

肝癌术后肺部并发症危险因素分析

目的探讨肝癌术后发生肺部并发症的相关因素分析,以期为减少或避免术后肺部并发症的发生提供思路。方法选取行肝癌根治术的肝癌患者105例,其中22例（观察组）术后发生肺部并发症,83例（对照组）术后未发生肺部并发症。比较两组患者的一般资料（性别、年龄、吸烟指数、高血压病史、呼吸系统病史、糖尿病史、术前2周呼吸道感染史、肺部听诊情况）、术前检查结果（肿瘤位置、肿瘤大小、侵犯门静脉、侵犯肝静脉、门静脉癌栓、门静脉宽度、胆红素水平、白蛋白水平、凝血酶原时间、腹水、Child评分、Child分级、ALT、AST、GPT、AFP、血红蛋白水平、血小板、血氧饱和度、ASA分级）以及手术信息（手术切口、手术方式、手术时间、麻醉时间、术中输血量）。对上述比较差异有统计学意义的相关因素,采用非条件二元多因素Logistic回归分析其与肝癌术后肺部并发症的相关性。结果单因素分析显示：低蛋白血症、手术时间、麻醉时间及术中输血量是肝癌术后发生肺部并发症（胸腔积液、肺炎）的危险因素（P＜0.05或0.01）。多因素Logistic回归分析结果显示术前白蛋白水平是发生术后肺部并发症的独立危险因素（P＜0.05）。结论术前白蛋白水平是肝癌术后肺部并发症的独立危险因素。     

改良经脐单孔三通道腹腔镜精索静脉高位结扎术的临床应用

目的 探讨改良经脐单孔三通道腹腔镜精索静脉高位结扎术的可行性。方法 2011 年3 月至2013 年3 月对25例精索静脉曲张患者采用改良经脐单孔三通道腹腔镜精索静脉高位结扎术（A 组）,30 例精索静脉曲张患者采用传统三孔法腹腔镜下精索内静脉高位结扎术（B 组）,比较并分析两种术式的手术时间、术后住院时间、术后近期并发症、精液常规变化、术后美容效果等。结果 单侧及双侧手术时间A 组分别为（35.0±8.6）min 及（45.0±11.5）min, B组分别为（18.0±6.5）min 及（25.0±8.2）min,A 组长于B 组,差异有统计学意义（P＜0.05）。术后住院时间A 组为（2.1±0.3）d,B 组为（2.5±0.5）d,差异无统计学意义（P ＞0.05）。两组术后近期并发症发生率及精液改善率均无统计学差异（均P ＞0.05）。A 组手术美容效果优于B 组。结论 改良经脐单孔三通道腹腔镜精索静脉高位结扎术不需专用单孔多通道操作平台,手术操作简化,安全有效,术后腹壁不留瘢痕,值得临床推广。     

亚临床甲状腺功能减退症与贫血的相关性研究

目的 探讨亚临床甲状腺功能减退症（简称亚临床甲减）与贫血之间的关系及其临床意义。方法 以2011 年1月至2013 年6 月健康体检发现的193 例亚临床甲减患者为研究对象（简称亚临床甲减组）,选取同期进行健康体检的772 例甲状腺功能正常者作为对照（简称甲功正常组）,比较两组受试者甲状腺功能、血常规、肝肾功能、血糖及血脂等各项指标的差异,以及两组间贫血患病率的差异,并分析贫血患病的危险因素。结果 与甲功正常组比较,亚临床甲减组患者的血红蛋白和红细胞均明显降低（均P＜0.05）;球蛋白则高于甲功正常组（P＜0.05）;其余各项指标间比较均无统计学差异（均P ＞0.05）。与甲功正常组比较,亚临床甲减组的贫血患病率增高（6.2% vs 2.7%,P＜0.05）。Pearson 相关分析发现,在亚临床甲减和甲功正常组中,FT3、FT4水平与血红蛋白和红细胞水平呈明显正相关（r=0.364、0.328、0.288、0.243,均P＜0.01）。logistic 回归分析显示亚临床甲减（OR=2.440,95%CI=1.100~5.411,P＜0.05）和低FT4（OR=0.793,95%CI=0.633~0.993,P＜0.05）是贫血患病的独立危险因素。结论 亚临床甲减可引起患者外周血红细胞和血红蛋白的降低,亚临床甲减患者贫血的患病率明显增高;亚临床甲减和低FT4 是贫血患病的独立危险因素。     

II、III期直肠癌术前与术后放化疗疗效比较的Meta分析

目的通过Meta分析比较术前与术后放化疗对II、III期直肠癌的疗效。方法检索2014年12月前发表的有关II、III期直肠癌术前与术后放化疗疗效比较的文献,纳入本研究的文献为随机对照试验（RCT）,提取其短期及长期临床疗效指标进行分析。结果共包括1642例直肠癌患者的5项RCT纳入本研究。术前放化疗组患者较术后放化疗组5年局部复发率低（OR＝0.60,95%CI:0.41~0.88,P=0.008）,两组5年远处转移率（OR=0.87,95%CI:0.67~1.11,P=0.26）、5年无病生存率（HR=0.84,95%CI:0.70~1.00,P=0.05）及总生存率（HR=0.90,95%CI:0.75~1.08,P=0.27）比较均无统计学差异,术前放化疗组毒性反应发生率较术后放化疗组低（OR=0.64,95%CI:0.50~0.82,P＜0.01）。结论采用术前放化疗的患者较术后放化疗的患者对直肠癌复发及毒性反应发生风险小,但远处转移及远期预后无明显差别。     

下肢静脉曲张腔内激光治疗与传统剥脱手术治疗的远期疗效对比研究

目的 比较静脉腔内激光治疗（EVLT）和传统剥脱手术治疗下肢静脉曲张（VVLE）的远期疗效。方法 选取VVLE患者120例,随机分为EVLT 组与对照组,每组各60例。EVLT组采用EVLT治疗,对照组采用传统剥脱手术治疗。分别对两组患者手术并发症、术后1、2、3 年复发率以及术后生活质量进行对比评价。结果 术后3 个月EVLT 组患者生活质量调查表（CIVIQ）评分显著高于对照组（P＜0.05）,术后6 个月两组患者CIVIQ 评分比较则无统计学差异（P＞0.05）。EVLT 组患者术后皮下瘀血、感觉麻木、硬结、皮下脂肪液化感染的发生率均显著低于对照组（均P＜0.01）,皮肤灼伤的发生率则高于对照组（P＜0.05）,两组患者静脉炎的发生率无统计学差异（P＞0.05）;两组患者术后1、2、3年复发率比较均无统计学差异（均P＞0.05）。结论 应用EVLT治疗VVLE 手术并发症少,患者术后恢复较快,远期疗效理想,值得临床推广应用。     

腹腔镜下经肠系膜途径与结肠旁 途径左侧输尿管上段切开取石术 的疗效比较

目的 寻找疗效更佳的腹腔镜下左侧输尿管上段切开取石术的手术途径。方法 收集43例经肠系膜途径（A组）和 46 例结肠旁途径（B 组）患者的手术时间、术中出血量、术后肠道功能恢复时间、住院时间、术后并发症、下床活动时间等临床资料,比较两组的差异。结果 A 组在手术时间、术中出血量、术后肠道功能恢复时间、住院天数明显优于B 组,差异有统计学意义（均P＜0.05）;术后并发症、下床活动时间,两组差异无统计学意义（均P＞0.05）。结论 腹腔镜下经肠系膜途径左侧输尿管上段切开取石术是一种更安全、有效、微创的手术方法,值得在临床上推广应用。     

远端胃大部分切除术后消化道重建术式的对比研究

目的 对比远端胃大部分切除术后行连续性空肠间置术与BillrothⅠ式及Roux-en-Y 式吻合术的临床效果。方法 回顾性分析2012 年1 月至2013 年6 月接受手术的远端胃癌患者95 例,按不同消化道重建方式分为3 组。A 组30 例患者行连续性空肠间置术,B 组32 例行BillrothⅠ式吻合术,C 组33 例行Roux-en-Y 式吻合术。比较3 组患者术前预后营养指数（PNI）、手术时间、术后6个月及1 年并发症发生率、进食量、血浆白蛋白水平、体重及Visick 分级指数。结果 3 组患者术前PNI均无统计学差异（均P＞0.05）。A 组患者手术时间与B 组无明显差异,且均明显少于C 组的手术时间（均P＜0.05）。术后6 个月及术后1 年3 组患者的进食量、体重及营养状况的恢复均无统计学差异（均P＞0.05）。A 组患者术后腹胀情况明显少于C 组（P＜0.05）,胆汁反流性胃炎明显少于B 组（P＜0.05）。结论 胃大部分切除术后连续性空肠间置,安全有效,与传统的BillrothⅠ式及Roux-en-Y 式吻合术比较,可缩短手术时间,更快的恢复患者的消化功能,维持消化道正常通路,防止胆汁反流,将有可能成为消化道重建的主要方式之一。     

完全腹腔镜胰十二指肠切除术6例临床疗效分析

目的 评估完全腹腔镜胰十二指肠切除术（laparoscopic pancreaticoduodenectomy,LPD）的可行性、安全性。方 法 采用LPD 治疗胰头或十二指肠肿瘤患者6 例,回顾性分析手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后住院天数、手术并发症发生率及术后短期疗效。结果 6 例手术均在完全腹腔镜下完成,无中转开腹病例。手术时间（380.5±38.1）min;出血量（241.7±189.3）ml;清扫淋巴结（15.3±2.8）枚;平均肛门排气时间（3.5±1.0）d;术后住院（14.0±5.7）d。手术并发症发生率为33.3％（2/6）,其中轻度胰漏1例,肺炎1例;本组患者术后随访3~12个月,无肿瘤复发及转移。结论 LPD 安全、可行,能达到胰头或十二指肠肿瘤根治性切除的目的。     

糖尿病患者血浆同型半胱氨酸与围术期心血管事件的相关性分析

目的探讨糖尿病患者血浆同型半胱氨酸（homocysteine,Hcy）水平与围术期心血管事件（PCE）的相关性。方法2011年10月至2012年10月,合并糖尿病的择期非心脏手术患者300例,根据Hcy水平分为N组（Hcy＜15.4滋mol/L,217例）和H组（Hcy≥15.4滋mol/L,83例）。记录患者一般临床资料及心血管危险因素,通过动态心电图（DCG）持续监测术后48h的PCE发生情况。结果59例发生PCE,发生率为19.7%;其中,N组PCE的发生率为15.7%,H组PCE的发生率为30.1%,两组差异有统计学意义（t=7.937,P=0.005）;两组患者hs- CRP、LDL、TG浓度和ECG异常比较差异有统计学意义（P＜0.05）。结论糖尿病患者Hcy水平与PCE的发生率及心血管危险因素的控制密切相关。     

Qualitative Analysis of Bifurcating Solutions in the Lengyel-Epstein Model

One of the most fundamental problems in theoretical biology is to explain the mechanisms by which patterns and forms are created in the＇living world. In his seminal paper ＂The Chemical Basis of Morphogenesis＂, Turing showed that a system of coupled reaction-diffusion equations can be used to describe patterns and forms in biological systems. However, the first experimental evidence to the Turing patterns was observed by De Kepper and her associates（1990） on the CIMA reaction in an open unstirred reactor, almost 40 years after Turing＇s prediction. Lengyel and Epstein characterized this famous experiment using a system of reaction-diffusion equations. The Lengyel-Epstein model is in the form as follows     

A REPRESENTATION FORMULA RELATED TO SCHR(O)DINGER OPERATORS

Schr(o)dinger operator is a central subject in the mathematical study of quantum mechanics.Consider the Schrodinger operator H = -△ V on R, where △ = d2/dx2 and the potential function V is real valued. In Fourier analysis, it is well-known that a square integrable function admits an expansion with exponentials as eigenfunctions of -△. A natural conjecture is that an L2 function admits a similar expansion in terms of "eigenfunctions" of H, a perturbation of the Laplacian (see [7], Ch. Ⅺ and the notes), under certain condition on V.     

On a class of self-similar processes with stationary increments in higher order Wiener chaoses

We study a class of self-similar processes with stationary increments belonging to higher order Wiener chaoses which are similar to Hermite processes. We obtain an almost sure wavelet-like expansion of these processes. This allows us to compute the pointwise and local Hölder regularity of sample paths and to analyse their behaviour at infinity. We also provide some results on the Hausdorff dimension of the range and graphs of multidimensional anisotropic self-similar processes with stationary increments defined by multiple Wiener–Itô integrals.     

(0,1 ;0)-INTERPOLATION ON INFINITE INTERVAL (-∞, +∞)

In this paper, we study the explicit representation and convergence of (0, 1; 0)-interpolation on infinite interval, which means to determine a polynomial of degree ≤ 3n - 2 when the function values are prescribed at two set of points namely the zeros of Hn(x) and H′n(x) and the first derivatives at the zeros of H′n(x).     

On a class of Riemann surfaces

It is considered the class of Riemann surfaces with dimT1 = 0, where T1 is a subclass of exact harmonic forms which is one of the factors in the orthogonal decomposition of the spaceΩH of harmonic forms of the surface, namely The surfaces in the class OHD and the class of planar surfaces satisfy dimT1 = 0. A.Pfluger posed the question whether there might exist other surfaces outside those two classes. Here it is shown that in the case of finite genus g, we should look for a surface S with dimT1 = 0 among the surfaces of the form Sg\K , where Sg is a closed surface of genus g and K a compact set of positive harmonic measure with perfect components and very irregular boundary.     

CONTENTS OF VOLUME 30

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Instructions for contributions

正Applied Mathematics-A Journal of Chinese Universities,Series B(Appl.Math.J.Chinese Univ.,Ser.B)is a comprehensive applied mathematics journal jointly sponsored by Zhejiang University,China Society for Industrial and Applied Mathematics,and Springer-Verlag.It is a quarterly journal with     

Journal of Mathematical Research with Applications Guide for Authors

正Journal overview:Journal of Mathematical Research with Applications(JMRA),formerly Journal of Mathematical Research and Exposition(JMRE)created in 1981,one of the transactions of China Society for Industrial and Applied Mathematics,is a home for original research papers of the highest quality in all areas of mathematics with applications.The target audience comprises:pure and applied mathematicians,graduate students in broad fields of sciences and technology,scientists and engineers interested in mathematics.     

Staircase transportation problems with superadditive rewards and cumulative capacities

A cumulative-capacitated transportation problem is studied. The supply nodes and demand nodes are each chains. Shipments from a supply node to a demand node are possible only if the pair lies in a sublattice, or equivalently, in a staircase disjoint union of rectangles, of the product of the two chains. There are (lattice) superadditive upper bounds on the cumulative flows in all leading subrectangles of each rectangle. It is shown that there is a greatest cumulative flow formed by the natural generalization of the South-West Corner Rule that respects cumulative-flow capacities; it has maximum reward when the rewards are (lattice) superadditive; it is integer if the supplies, demands and capacities are integer; and it can be calculated myopically in linear time. The result is specialized to earlier work of Hoeffding (1940), Fréchet (1951), Lorentz (1953), Hoffman (1963) and Barnes and Hoffman (1985). Applications are given to extreme constrained bivariate distributions, optimal distribution with limited one-way product substitution and, generalizing results of Derman and Klein (1958), optimal sales with age-dependent rewards and capacities.To our friend, Philip Wolfe, with admiration and affection, on the occasion of his 65th birthday.Research was supported respectively by the IBM T.J. Watson and IBM Almaden Research Centers and is a minor revision of the IBM Research Report [6].