原发性甲亢CT测定甲状腺重量与称量重量的比较分析

原发性甲亢术前准确预测甲状腺重量是原发性甲亢个体化手术的关键因素之一[1-2].目前甲状腺测重方法有临床触诊法、放射性核素平面显像、B超、CT等方法,无论误差大小,均未与手术实体样本的称量重量作比较分析,临床应用有待进一步研究.2004-2005年我们通过71例原发性甲亢手术患者术前CT测定甲状腺重量,与术中、术后手术样本称量重量进行比较分析,并应用于原发性甲亢的个体化手术,取得了较好的效果.     

原发性甲亢手术中甲状腺重量测定方法的探讨

目的　探讨原发性甲亢手术中甲状腺重量的测定方法 ,为术中甲状腺残存量的控制提供指导性依据。方法　应用双侧甲状腺次全切除术治疗 70例原发性甲亢病人 ,术中用标尺测定甲状腺两侧腺叶上、下极间的平均长度 ,即甲状腺长度。通过“模拟称量法”测定甲状腺残存量 ;术后用药物天枰称量甲状腺切除量 ;甲状腺重量即等于残存量加切除量。结果　 70例原发性甲亢手术样本 ,甲状腺长度 (x)范围为 3 .6～ 8.4cm ,甲状腺重量 (y)范围为 15 .5～ 12 0 .7g ,相关分析表明 ,两者相关性良好 (γ =0 .87777,P <0 .0 0 0 1)。术中测定甲状腺长度便可预测甲状腺重量 ,从而决定原发性甲亢手术残存量。结论　原发性甲亢手术中甲状腺长度是一个简单易行且较准确的方法 ,可使甲状腺次全切除术中残存量的保留更加规范化 ,达到原发性甲亢个体化手术切除的目的。     

38例甲状腺次全切除术临床分析

甲状腺次全切除术是临床上较常用的手术方式。为减少术中术后并发症的发生 ,作者采用保留甲状腺下动脉主干的方法 ,取得了良好的效果。1　临床资料1 1　一般资料　　本组 38例中 ,男性 8例 ,女性 30例 ;原发性甲亢 2 8例 ,继发性甲亢 10例 ,平均年龄 37(2 4～ 5 0 )岁。发病至手术时间 6个月至 5年。1 2　临床表现　　甲亢病例均有明显的甲亢表现 ,甲状腺Ⅲ度肿大 2例 ,Ⅰ～Ⅱ度肿大 36例 ,术前合并甲亢性心脏病者 1例 ,糖尿病者 2例。1 3　手术方法　　全部病例均行双侧甲状腺次全切除术。每侧切除甲状腺80 %～ 90 % ,残留腺体重量约 6～ 1…     

甲状腺固定解除在腔镜下甲状腺功能亢进手术中的应用研究

目的探讨腔镜下手术治疗甲状腺功能亢进（甲亢）的实用性和安全性。方法回顾性分析2008年1月至2011年12月收治的115例甲亢患者资料,术前准备方法相同及采用甲状腺固定解除手术方式的45例患者入组,分为开放手术组（28例）和腔镜手术组（17例）,对两组患者年龄、手术时间、术中出血量、术后引流量、术后并发症、住院天数、住院费用等数据进行统计学分析。结果开放组平均年龄（34.6±10.1）岁,腔镜组（27.1±5.7）岁,两组年龄差异有统计学意义（P〈0.05）。两组术中出血量、住院天数、住院费用、服碘前甲状腺容积、术后低钙血症、喉返或喉上神经损伤等数据差异无统计学意义。开放组手术时间平均（1.68±0.69）h,术后引流量平均（95.0±68.3）ml;腔镜组手术时间平均（2.87±0.67）h,术后引流量平均（179.7±70.8）ml,两组数据差异均有统计学意义（P〈0.05）。腔镜组无一例中转为开放手术,随访至今无甲状腺功能低下或甲亢复发者。结论腔镜下采用甲状腺固定解除手术方式治疗甲亢是安全、可行的。     

个体化肺结节三维重建模拟手术在胸腔镜肺段切除中的应用

目的探讨个体化肺结节三维重建模拟手术在胸腔镜肺段切除中的应用价值。方法 2018年12月～2019年12月接受手术治疗的肺结节病人60例,随机分为三维重建模拟手术组和非三维重建模拟手术组,每组各30例。比较两组围手术期相关指标的差异。结果两组均顺利完成胸腔镜下肺段切除术;三维重建模拟手术组术前与术中吻合率分别为:结节部位100%,靶段血管96.67%,靶段支气管96.42%;三维重建模拟手术组的手术时间、术中出血量、引流管留置时间、术后总引流量以及术后住院时间均低于非三维重建模拟手术组,差异有统计学意义(P0.05),两组术中清扫淋巴结个数与术后并发症发生率比较,差异无统计学意义(P0.05)。结论肺结节基于三维重建个体化胸腔镜解剖性肺段切除术安全有效,较常规手术更具临床应用价值。     

甲状腺良性结节腔镜手术与传统手术对比分析

目的探讨甲状腺良性结节腔镜下手术与传统手术的治疗效果。方法将80例甲状腺良性结节患者随机分为腔镜手术组与传统手术组,各40例。观察比较2组手术出血量、手术时间、术后并发症、住院时间等指标。结果 2组患者手术时间比较,差异无统计学意义(P0.05),腔镜手术组患者手术出血量(45.5±5.6)m L、住院时间(4.6±1.5)d、术后并发症发生率2.50%,均明显低于传统手术组,2组差异具有统计学意义(P0.05)。结论与传统手术相比,甲状腺腔镜手术出血量更少,术后恢复更快,美容效果良好。     

改良Miccoli技术对老年原发性甲亢合并甲状腺癌患者的临床疗效分析

探究改良Miccoli技术对老年原发性甲亢合并甲状腺癌患者的临床疗效。收集我院就诊的144例原发性甲亢合并甲状腺癌老年患者临床资料,依据治疗方式不同,分为采用改良Miccoli技术治疗的观察组(72例患者)和采用传统甲状腺手术治疗的对照组(72例患者),对两组手术相关指标、治疗前后甲状腺激素水平及治疗后并发症发生率进行比较。观察组除手术时间长于对照组外,术中出血量、手术切口长度、引流量及住院时间均优于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者总三碘甲腺原氨酸(TT3)、总甲状腺素(TT4)含量无统计学差异(P>0.05);治疗后两组患者激素水平均明显降低,差异具有统计学意义(P<0.05),对照组降低更显著(P<0.05)。对照组术后发生10例并发症(3例喉返神经损伤、2例甲状腺功能损伤、2例皮下积液及3例切口感染),并发症发生率为13.89%;观察组术后发生3例并发症(1例喉返神经损伤、1例甲状腺功能损伤、1例切口感染),并发症发生率为4.17%。两组并发症发生率比较差异有统计学意义(P<0.05)。对老年原发性甲亢合并甲状腺癌患者而言,改良Miccoli技术具有切口小、恢复快、并发症少、安全性高等优势。     

102例良性原发性纵隔肿瘤的治疗分析

目的比较常规开胸手术与胸腔镜手术对良性原发性纵隔肿瘤的治疗效果。 方法收集2001年1月—2019年12月接受手术治疗良性原发性纵隔肿瘤患者的临床资料，将患者分为常规开胸手术组和胸腔镜手术组进行回顾性分析。 结果共纳入102例患者资料，常规开胸手术组40例，胸腔镜手术组62例。与常规开胸手术组比较，胸腔镜手术组切口较小，术中出血量和术后胸腔引流量较少，手术时间、留置胸腔引流管时间和术后住院时间较短，术后并发症的发生率较低，两组间差异均有统计学意义(P<0.05)。 结论胸腔镜手术对良性原发性纵隔肿瘤的治疗效果明显优于常规开胸手术，对患者术后快速康复更为有利。     

甲状腺功能亢进症术后复发的再手术治疗:附34例报告

目的 探讨甲状腺功能亢进症(甲亢)术后复发的原因，再手术治疗的适应证及手术方法。方法 回顾性分析34例甲亢术后复发再手术治疗的l临床资料。结果 再次手术术式包括双侧甲状腺次全切除29例，单侧腺叶切除5例。全部治愈。并发症发生率5．9％，与笔者收治的同期甲亢初次手术比较无统计学差异。全组经随访l～l0年，无甲亢再复发或甲状腺功能低下者。结论 腺体残留过多是甲亢术后复发的主要原因，有选择地再手术是甲亢术后复发较好的治疗方法。术中仔细解剖可避免损伤喉返神径和甲状旁腺，以及预防大出血的发生。     

超声刀在小切口甲状腺手术中的应用研究

探讨超声刀在小切口甲状腺手术中的应用价值。以2014年3月—2015年6月在我院接受甲状腺手术的患者为观察对象。根据其手术方式分为传统手术组(30例)和超声刀组(50例)。比较两组患者切口长度、术中出血量、术后引流量、麻醉时间、手术时间、住院时间、住院费用及术后并发症发生率的差异。与传统手术组比较,超声刀组切口长度、麻醉时间、手术时间、术后住院时间更短,术中出血量、术后引流量少(P0.05);但两组住院费用差异无统计学意义(P0.05)。超声刀组甲状腺功能降低、喉返神经损伤和喉上神经损伤发生率明显低于传统手术组(P0.05),两组甲状旁腺损伤发生率差异无统计学意义(P0.05)。超声刀应用于小切口甲状腺手术可取得较好效果,具有临床应用价值。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.