探析电视胸腔镜食管癌切除术中及术后并发症观察

目的:分析患者接受电视胸腔镜食管癌切除术治疗过程中及术后出现的相关并发症。方法:选择2012年5月-2014年7月在院接受电视胸腔镜食管癌切除术治疗的88例患者临床资料进行回顾性分析。结果:术中并发症发生率为5.68%,术后并发症发生率为44.32%。结论:吻合口瘘、肺部并发症、乳糜胸为食管癌切除术后较为常见的并发症,也是导致患者死亡的主要原因。     

结直肠癌术后吻合口瘘危险因素分析

目的:探讨可能引起结直癌术后吻合口瘘的原因。方法:回顾性调查分析1999年1月至2009年1月所有在石河子大学医学院第一附属医院接受手术治疗并行肠吻合的结直癌患者病历资料826例。结果:826例手术患者中发生吻合口瘘70例,发生率为8.5%。吻合口瘘的发生与病人的性别、年龄、体型等有关,与手术者、术中是否使用生物蛋白胶无关。结论:结直肠癌术后吻合口瘘发生与多个危险因素有关。     

2例剖胸术后并发乳糜胸的护理体会

乳糜胸是剖胸术后的常见并发症，是由于剖胸手术过程中损伤胸导管的主干或其主要分支所致。从2001年8月至2005年2月，我科剖胸术后病人发生了2例乳糜胸，经过积极的治疗及护理，病人痊愈出院。现将护理体会介绍如下。     

覆膜支架封堵治疗食管胃吻合口- 胸腔瘘的临床疗效

目的:探讨采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘的临床价值及其安全性。方法:6例经碘水造影检查证实的食管胃吻合口-胸腔瘘患者,植入覆膜支架后,持续性胸腔引流,抗感染治疗。结果:6例患者共植入7枚支架,支架展开良好,1枚移位。有效率6/7(86%)。置入覆膜支架后,既封堵了瘘口又解决了进食问题,控制了感染。结论:采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘具有较高的临床价值及安全性。     

新型可降解支架治疗食管吻合口瘘的疗效分析

目的:评价新型生物可降解支架治疗颈部食管吻合口瘘的效果,为治疗食管吻合口瘘提供理论依据。方法:将成年健康新西兰大白兔采用切开吻合置管造瘘法建立颈部食管吻合口瘘的动物模型,1周后,食管造影确定食管瘘口完成。完全随机分组,空白对照组(A组,n=5),对照组(B组,n=5)和实验组(C组,n=5)。实验组使用生物可降解支架封闭瘘口,而对照组应用同规格不可降解支架封堵食管瘘口。植入后每周行食管造影,观察支架及瘘口情况,植入后8周为实验终点。结果:本研究成功建立了兔颈部食管吻合口瘘的动物模型,至实验终点,普通支架组,支架覆盖瘘口,未发生支架移位及穿孔等现象。新型可分解支架组,3例支架分别在支架植入后5-8周分解,发生移位。实验组与对照组闭合率无统计学意义(4/5比3/5,P0.05)。结论:新型生物可降解支架支架是治疗食管吻合口瘘的一种有效方法。     

泡沫敷料对结肠造瘘患者造瘘口周渗出液炎性物质的影响

目的:探讨泡沫敷料对结肠造瘘患者造瘘口周渗出液炎性物质的影响。方法:选取我院普外科收治的结肠造瘘术患者104例,采用随机数字表方法将所有患者平均分为两组,各52例,对照组常规清洁造瘘口,造瘘口及周围皮肤涂抹氧化锌软膏后安装肛门袋;治疗组在对照组治疗的基础上,平铺一层多爱肤有边辅料,安装肛门袋,两组患者均每日更换肛门袋一次,连续治疗2周。采用酶联免疫吸附法(ELISA)检测两组患者治疗前后造瘘口周渗出液炎性物质水平;记录两组患者治疗过程中和治疗后皮肤损伤及造瘘口并发症发生情况。结果:1治疗后,两组患者造瘘口渗出液炎性物质水平较治疗前明显降低,且治疗组下降程度高于对照组(P0.05);2治疗后,治疗组造瘘口皮肤完好率明显高于对照组,差异有统计学意义(P0.05);3对照组造瘘口并发症的发生率明显高于治疗组,差异有统计学意义(P0.05)。结论:泡沫敷料能够降低结肠造瘘患者造瘘口周炎性物质的分泌,减少造瘘口周围皮肤的损伤,降低造瘘口并发症的发生,对结肠造瘘口的护理具有重要临床意义。     

生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破的疗效观察

目的:观察生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破,对孕妇、胎儿及新生儿的影响,明确该技术治疗胎膜早破的疗效。方法:我院产科共收治妊娠<30周胎膜早破患者48例,采用生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破,观察治疗后孕妇羊水指数,胎儿双顶径,新生儿出生时体重,及孕妇的副反应。结果:在本次封堵治疗过程中均一次封堵成功,没有不良反应发生,所有孕妇术后阴道流水情况均明显改善,其中有2例孕妇术后1周阴道流水停止。所有孕妇术后羊水漏出量均明显减少,B超检查显示羊水指数均在(6±2)cm,胎儿每周双顶径增长均达到(0.15±0.02)cm,延长孕周最短(5±2)w,10例早产,38例继续妊娠至37 w。新生儿出生时体重为(2000±260)g,无1例发生NRDS。同期没有进行宫颈内封堵仅行药物保胎治疗的10例孕妇,胎龄延长最长达到10 d,最短者24 h内出现早产分娩,早产儿平均体重1400 g,均发生NRDS,有2例放弃治疗,4例在NICU行治疗,最终因各种并发症死亡。48例行封堵治疗孕妇未发生过敏反应,无阴道出血及产后出血和感染等。结论:应用生物蛋白胶结合宫颈环扎术治疗胎膜早破,手术操作简单,可延长了孕周,提高了新生儿成活率,无不良反应,具有广泛的应用前景。     

单体位左胸左颈两切口管型吻合器治疗食管上段癌的疗效

目的:探讨单体位左胸左颈两切口的手术方式在外科治疗食管上段癌中的应用效果。方法:选择2008年1月至2012年4月间我院收治的食管上段癌患者49例,根据手术方法分为研究组(n=19)和对照组(n=30),研究组行单体位左胸左颈两切口管型吻合器治疗,对照组行传统颈、胸、腹三切口方法治疗。观察两组手术时间、术中出血量、清扫淋巴结数、术后引流量和术后并发症等。结果:研究组手术时间显著短于对照组,术中出血量和术后引流量显著低于对照组(P0.05)。两组清扫淋巴结数比较无统计学差异(P0.05)。两组患者均全部治愈出院,研究组肺不张、反流性食管炎、吻合口瘘、吻合口狭窄等发生率显著低于对照组(P0.05)。结论:单体位左胸左颈两切口管型吻合器治疗食管上段癌安全,可靠,省时易行,是一种较好的手术方式,值得推广。     

食管癌术后并发症及其处理

食管癌是我国一种常见的消化道恶性肿瘤,居世界癌症死因第7位,中国癌症死因第4位。其中以中段鳞状细胞癌多见,临床表现以晚期进行性吞咽困难为主,确诊主要以胃镜病理活检为金标准,其治疗方法主要有手术、放疗、化疗及分子靶向治疗等。但目前治疗上仍然以手术为主,术前术后放化疗为辅。然而,随着手术在食管癌治疗中适应症的不断扩大、根治性手术淋巴结的扩大清扫及拥有基础疾病高龄患者的增多,术后并发症的发生率不可避免的随之增加。本文将重点阐述吻合口瘘、吻合口狭窄、呼吸及心血管并发症、乳糜胸、胃排空障碍、膈疝、喉返神经损伤及单纯脓胸、严重腹泻、呕血等食管癌术后常见、严重并发症的病因、临床表现与诊断、治疗及其预防。通过对食管癌术后并发症的充分认识及有效预防,从而对食管癌手术成功率及患者术后生存质量的提高、肿瘤预后的改善起到了重要作用。     

覆膜支架封堵治疗食管胃吻合口-胸腔瘘的临床疗效

目的：探讨采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘的,临床价值及其安全性。方法：6例经碘水造影检查证实的食管胃吻合口-胸腔瘘患者,植入覆膜支架后,持续性胸腔引流,抗感染治疗。结果：6例患者共植入7枚支架,支架展开良好,1枚移位。有效率6／7（86％）。置入覆膜支架后,既封堵了瘘口又解决了进食问题,控制了感染。结论：采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘具有较高的临床价值及安全性。     

Impact of middle and lower jugular neck dissection on supraclavicular lymph node metastasis from endometrial carcinoma

ABSTRACT: Supraclavicular lymph node metastasis from endometrial carcinoma is considerably rarer than metastasis from uterine cervical cancer. To date, there have been no reported cases regarding systematic neck dissection as a salvage treatment. In this report, we describe the neck dissection procedure carried out on a 74-year-old woman with supraclavicular lymph node metastasis. Our objective was to histologically determine the origin of the metastasis while simultaneously providing appropriate treatment. The patient's past medical history included two prior cases of cancer: rectal cancer 7?years earlier and endometrial adenocarcinoma 4?years earlier. We determined that middle and lower jugular neck dissection was appropriate in treating this case based on the results of our preoperative FDG-PET and tumor markers. This surgery provided histological evidence that metastasis occurred from endometrial carcinoma. Middle and lower jugular neck dissection was expected to improve the patient's prognosis without impacting the patient's active daily life. We have continued to monitor the patient closely over an extended period.     

Surgical techniques for long-term studies of thoracic duct circulation in the rat.

Two techniques for cannulation of the thoracic duct in the rat, thoracic duct shunt and thoracic duct side fistula, are described. They give access, for repetitive sampling, to a normal thoracic duct circulation and are suited for study of the circulation under physiologic conditions. The thoracic duct shunt creates, with tubing, a shunt between the caudad and cephalad ends to the cisterna chyli. The exteriorized midportion of the shunt allows observation of the lymph. In the thoracic duct side fistula, the short arm of a T tube is placed within the cisterna and sampling is done via the long arm of the tube. Ten shunts functioned for 8-26 days and 10 side fistulas functioned for 8-30 days. Average lymph flow was 0.044 ml/min (shunts) and 0.042 ml/min (side fistulas). Average thoracic duct lymphocyte output was 1,729,000 cells/min (shunts) and 2,310,000 cells/min (side fistulas). Average blood lymphocyte count was 11,700 cells/mm3 (shunts) and 12,600 cells/mm3 (side fistulas). All parameters remained stable during the period of study. Advantages of those techniques over the Bollman end fistula are presented.     

先天性耳前瘘管二次手术68 例治疗体会

目的:探讨先天性耳前瘘管术后复发原因,以及二次手术临床治疗的效果。方法:回顾性分析我院自2006年1月至2010年12月的共诊断收治的68例复发先天性耳前瘘管病例,观察其二次手术效果。结果:68例先天性耳前瘘管复发患者中,66例Ⅰ期愈合,治愈率97.06%。结论:再次手术是治疗先天性耳前瘘管术后复发的有效途径,完全切除残余的瘘管及上皮组织是防止再复发的关键。     

钬激光在胆总管下段嵌顿结石术中的应用

目的探讨钬激光在胆总管下段嵌顿性结石手术中的应用价值。方法通过腹腔镜下胆道镜工作通道,应用钬激光,功率为0．6—0．8J／10Hz,直径为200um光导纤维,在直视下接触结石,将嵌顿结石击碎后注水冲出,或用取石篮套出。结果11例均取石碎石成功,手术时间75—205min,平均95．5min,出血80—130ml,平均89．4ml。平均住院8．2d。术后无胆道出血,胆漏。术后2W照影无结石残留,胆总管下段通畅无胆道狭窄。术后肝功能2W恢复正常6例,5例1月均恢复正常。随访3—6月未见结石复发。结论钬激光治疗胆总管下段嵌顿结石,具有创伤小、恢复快、碎石确切、操作容易、安全有效等优点,为治疗复杂性胆总管结石开辟了一条新的治疗途径。     

18 例维吾尔族膀胱阴道瘘临床分析

目的:探讨维吾尔族膀胱阴道瘘的病因、诊断及治疗措施。方法:对2006年6月～2011年6月新疆自治区人民医院泌尿外科经美兰试验和膀胱镜检查确诊的18例维吾尔族膀胱阴道瘘患者的病历资料进行回顾性的临床分析。17例患者行瘘修补术,其中12例(70.59%)经腹修补,5例(29.41%)经阴道修补。1例患者行双侧输尿管经皮造瘘术。结果:18例患者中,16例1次修补成功,1例2次修补后成功。术后随访1至12个月无复发。结论:阴道分娩难产在维吾尔族膀胱阴道瘘患者中最为多见,根据患者全身情况、瘘道大小及位置选择合适的手术路径,术前充分准备,术后严格管理,大大提高手术成功率。     

富血小板纤维蛋白膜片修复上颌窦瘘的临床研究

目的:观察自体富血小板纤维蛋白(Platelet-rich fibrin,PRF)膜片修补口腔上颌窦瘘的临床疗效。方法:选取解放军第425医院疗养区眼耳鼻喉科2010年4月到2013年4月间24例上颌窦瘘患者,采用随机分组,其中A组12例患者各采静脉血20 mL制备PRF膜片修补上颌窦瘘,另外B组12例患者采用组织瓣法修补上颌窦瘘,比较两组患者的伤口一期愈合成功率以及6-12月后随访预后并进行统计学分析。结果:PRF膜片修补组手术均获得成功,而组织瓣修补组中采用带蒂颚粘膜瓣有1例失败,两组间一期愈合成功率无显著差异(P=0.755),随访发现颊侧黏骨膜瓣修补的患者术后口腔前庭沟均有不同程度变浅,而其它修补方法术后前庭沟无明显异常。结论:自体PRF膜片制备简单,用其修补上颌窦瘘效果确切,手术简单,并发症少,可应用于临床实践。     

Neck dissections: radical to conservative

BACKGROUND: Neck dissection is an important surgical procedure for the management of metastatic nodal disease in the neck. The gold standard of neck nodal management has been the radical neck dissection. Any modification in the neck dissection is always compared with this standard. Over the last few decades, in order to alleviate the morbidity of radical neck dissection, several modifications and conservative procedures have been advocated. These procedures retain certain lymphatic or non-lymphatic structures and have been shown not to compromise oncological safety. METHODS: A literature search of the Medline was carried out for all articles on neck dissections. The articles were systematically reviewed to analyze and trace the evolution of neck dissection. These were then categorized to address the nomenclature, management of node positive and node negative neck including those who had received chemoradiation. RESULTS: The present article discusses the neck nodal nomenclature, the radical neck dissection, its modifications and migration to more conservative procedures and possible advances in the near future. CONCLUSION: Radical neck dissection is now replaced with modified radical neck dissections in most situations. Attempts are being made to replace modified radical neck dissections with selective neck dissections for early node positivity. Sentinel node biopsy is being studied to address the issue of node negative neck. More conservative surgeries are likely to replace the 'radical' surgeries of bygone era. This process is facilitated by earlier detection of the disease and better understanding of cancer biology.     

Venous Drainage of the Femoral Neck in Legg Perthes Disease and in Hip Dysplasia

Three clinical cases of canine avascular femoral head necrosis and 4 cases of hip dysplasia were examined using intraosseus femoral neck venography. The contrast medium passed initio the diaphyseal bone marrow in all cases. Three growing dogs and 7 growing pigs were examined with the same method, before and after experimental ligation of the femoral veins. Before the venous tamponade, no contrast medium was visible in the femoral neck. The venography performed immediately after ligation showed contrast flow into the femoral neck similar to that seen in the clinical cases of Legg Perthes disease or hip dysplasia. However, a collateral circulation developed within 7 weeks. No more contrast-flow into the diaphysis was observed after that time. Although osteomedullography shows that both in Perthes disease and in hip dysplasia venous drainage has failed, venous tamponade may not induce the onset of the disease.     

Increased venous pressure causes increased thoracic duct pressure in awake sheep.

The lymph from most organs drains through the thoracic duct and into veins in the neck. We hypothesized that increases in neck vein pressure (Pnv) are reflected through the thoracic duct to the lung lymphatic-thoracic duct junction. To test this, we cannulated the lung lymphatics in the direction of flow in four sheep. We advanced each cannula until it entered the thoracic duct. Thus the pressure at the tip of the lymphatic cannula (Px) was the pressure at the outflow of the lung lymphatics. We also placed a balloon into the superior vena cava. One to two days later, we measured Px in the awake sheep as we inflated the balloon and increased Pnv in steps to 25-45 cmH2O. We found no significant differences in Px and Pnv. Furthermore, Px closely followed Pnv after each step increase in Pnv. These results support our hypothesis that increases in Pnv cause increases in the outflow pressure to lung lymphatics.     

改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用

目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。