中华医学会外科学分会乳腺外科学组成员名单

正组长:刘荫华副组长:任国胜,姜军,吴炅,范志民秘书:余之刚(兼)委员(依姓氏汉语拼音为序):曹中伟,陈德滇,段学宁,傅佩芬,黄建,蒋宏传,金锋,康骅,凌瑞,刘克,刘锦平,刘运江,刘真真,罗永辉,马榕,毛大华,欧江华,屈翔,宋爱琳,宋尔卫,唐利立,田兴松,王殊,王水,王翔,王川,王建东,吴克瑾,余之刚,张瑾,张建国,张景华,赵毅,赵作伟,朱玮,邹强     

“实用手术学系列”教学片出版

最新人卫版卫生部视听教材:手术前准备和术后处理,手术无菌技术,外科输血,介入放射技术,外科放射性核素检查,胆道疾病超声诊断,肝脏疾病超声诊断,全身麻醉,椎管内麻醉,局部麻醉,乳腺癌根治术,乳腺良性肿瘤切除术,乳房脓肿切开引流术,胃肠道吻合术,腹部的切口与缝合,胃癌根治术,肠吻合基本缝合法及小肠吻合术,小肠部分切除术,直肠癌手术,胆囊切除术,胆总管探查引流术,肝血管药物泵植入术,胰岛素瘤切除术,胰腺及壶腹部周围癌根治术,十二指肠乳头部肿瘤局部切除术,胰十二指肠切除术,胰腺移植,急性周围动脉栓塞手术,胸部切口及引流,食管恶性肿瘤…     

SUBJECT INDEX VOLUME 6, 2003

Abdominalinjuries,171Accidents,traffic,35 5Adenoviridae,75Adenoviruses,human ,199Aged ,139Alkaloids,37Aneurysm ,2 13Anteriorcruciateligament ,332Apoptosis,135Arteriovenousfistula ,2 13Arthroplasty ,hip ,replacement,2 6 5Biomechanics,332Bloodcoagulationfactors ,14Bloodgasanalysis,15 2Bonedensity ,16 0Bonelengthening ,32 ,91Bonemorphogeneticproteins ,86Bonescrews ,2 88Bonetransplantation ,86 ,91,2 75Brainedema ,2 3,118Braininjuries ,14 ,2 3,99,10 4 ,139,15 2 ,179,2 70 ,30 2 ,32 6 ,346 ,2 …     

中药为炭母草致急性肾衰竭1例报告

病例 患者男性,63岁,因乏力,消瘦3月,无尿20h入院.患者3个月前出现乏力,消瘦,体重减轻约2.5kg,无多饮,多食,多尿,在当地医院诊断"糖尿病",给于"优降糖,达美康,胰岛素"治疗,血糖控制情况不详.入院前3d,因听信当地流传偏方谓中药火炭母草可治疗糖尿病,遂自行采集后取30g左右煎汤,服用2d后出现20h未排小便,伴腹胀,下腹部间断隐痛不适,遂急诊入住我科.入院体查:Bp,18/10 kPa,T37.8 ℃,R22次/min,P88次/min,神清,皮肤,巩膜无黄染,全身浅表淋巴结无肿大,心肺（-）,腹稍隆,下腹部轻压痛,肝脾肋下未及,双肾区无叩击痛,移动性浊音（-）,双下肢无凹陷性浮肿.     

高渗性非酮症糖尿病昏迷一例

1 病例介绍 患者,男性,61岁,汉族,已婚,农民.有糖尿病史6年,未控制饮食,未正规应用降糖药物,未监测血糖.主因意识不清4小时入院.被家人发现意识不清,呼之无应答,伴尿失禁.查体:体温不升,P105次/分,R46次/分,BP50/?mmHg消瘦,脱水貌,浅昏迷,呼吸急促,双侧瞳孔3 mm,对光反射迟钝,无颈部抵抗,双肺未闻及干湿性啰音,心界不大,心率105次/分,律齐,未闻及杂音.     

后路椎间融合器及钉棒系统内固定治疗腰椎间盘突出症后并发大面积脑梗死1例

正posterior lumbar interbody fusion cage and pedicle-rod instrument代艳1,3,纪舒妤2,黄先盈3,李崇3,谢天裕3,林成森3,李波香3,叶雨1DAI Yan,JI Shu-yu,HUANG Xian-ying,LI Chong,XIE Tian-yu,LIN Cheng-sen,LI Bo-xiang,YE Yu     

新生儿肝破裂分析与防范

1992年我院诊治2例新生儿肝破裂,男女婴各1例,1例经早期发现,及时手术,抢救存活;1例因出血过多,术后7小时死亡,现报告如下。病例简介例1 男婴,第1胎第1产,出生15小时,因面色苍白,四肢厥冷,心率130次/分,心音低,两肺有水泡音,腹胀,腹腔穿刺有鲜红色不凝固血液,即在全麻下行剖腹探查术,术中见腹腔内大量暗红色积血,肝右叶较多凝血块,清除后见肝右叶脏面包膜下呈星状裂伤,有活动性出血,术中吸出腹腔血约300ml,用止血纤维填塞压迫止血,术后给予抗感染,止血敏,能量合剂治疗,同时给予吸氧、保暖,7小时后出现面色苍白,呼吸浅不规则,全身厥冷,心音低,肺部有湿罗音,心脏骤停,经抢救无效死亡。例2 女婴,第2胎第1产,娩出体检时发现有上腹包块,10小时后突然发现面色苍白,腹部包块消失,腹穿有不凝固血液,考虑为肝破裂,立即在全麻下行剖腹探查术,术中见右肝叶,肝包膜下广泛血凝块,肝右叶脏面见一长约2cm裂口,有活动性出血,行肝修补术,腹腔引流管引流,术中呼吸,血压平     

退变性脊柱侧凸的诊断与治疗

主持人:孙天胜,王以朋. 参加者:张光铂,孙天胜,王以朋,刘忠军,李中实,孙常太,伍骥,王炳强,洪毅,马远征,孙宁,刘波,沈惠良,卢庆霞.张志成.蒋欣,孙英飞.     

颅内异物存留误诊1例报告

患者,男,16岁,因左额部一痿管,反复流脓半月余入院,追述病史24天前被不明飞行物击中额面部,当时意识清楚、自动体位,曾到某医院检查,CT示额骨凹陷性骨折,清创缝合,创口继发感染,形成瘘管,流脓不止。查体:T37℃,P76次/min,R24次/min,Bp16/10kPa神智清楚,自动体位,言语流利,眼球活动自如,双眼视力均为5.2,光反射灵敏,无触压痛,曲光     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7–, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20–, MUC2–). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Oddi括约肌肌电活动实验模型的建立

目的建立研究Oddi括约肌肌电活动的动物模型和实验方法。方法将双极金属钩状电极通过浆膜层置入Oddi括约肌，记录不同条件干预下家兔的Oddi括约肌肌电活动信号，调整电生理实验参数并经放大、滤波及计算机处理后，对其大小、波形、幅度进行分析。结果不同条件干预下的家兔Oddi括约肌的肌电活动在波形、频率、幅度等方面均有明显的不同，具有明显的规律性。重复实验可得到相似的结果。结论使用双极金属钩状电极配以合理的电生理实验参数调整可以稳定地采集到在体的家兔Oddi括约肌肌电活动信号。这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。     

复合小剂量阿曲库铵对顺苯磺酸阿曲库铵起效时间的影响

目的观察顺苯磺酸阿曲库铵同时复合阿曲库铵用于全凭静脉诱导的起效时间。方法择期全麻手术患者80例,随机均分为A、B、C、D四组。A组单用3ED95(0.15 mg/kg)顺苯磺酸阿曲库铵作为对照组;另三组分别用3ED95顺苯磺酸阿曲库铵复合阿曲库铵0.05 mg/kg(B组)、0.10 mg/kg(C组)或0.15 mg/kg(D组)。采用TOF-Watch SX肌松监测。静注咪唑安定0.05mg/kg、芬太尼5μg/kg、依托咪酯0.3 mg/kg及相应剂量肌松药,记录起效时间,进行气管插管条件评级。结果B、C、D组肌松起效时间依次加快,均明显短于A组(P<0.01),但B、C、D组之间差异无统计学意义。结论复合小剂量阿曲库铵能缩短3ED95顺苯磺酸阿曲库铵的起效时间。     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

鼻尖、鼻翼缺损修复方法的探讨

１９５７年以来共收治鼻尖、鼻翼缺损１１９例，据情分别采用以下四种方法修复：①全层皮片移植２７例；②游离耳廓复合组织片移植３６例；③鼻唇沟皮瓣移转１２例；④上臂内侧皮管移植４４例，效果较为满意。我们在文章中就选用的原则、手术方法及注意事项等进行了探讨