小儿直肠肛门损伤的诊治分析

目的：探讨小儿直肠肛门损伤的早期诊断及治疗方法。方法：21例患儿，单纯性直肠损伤12例，复杂性直肠损伤9例，受伤原因车祸最多，共12例。结果：15例行单纯修补，5例行结肠造瘘，1例仅行异物取出术。术后治愈20例，治愈率95.2％。结论：小儿直肠肛门损伤多为外伤所致。对医源性损伤提出预防方法，可减少发病，主张早期诊断，及时治疗。     

结、直肠疾病医疗差错:美国民事法庭诉案20年复习

本文对美国所有民事法庭1971～1991年结肠和直肠疾病诊断或治疗失当造成的医疗诉案98例进行复习,以客观地分析其原因.可分为5类:(1)未及时诊断(43%);(2) 医源性结肠损伤(24%);(3) 医源性医疗并发症(15%);(4)括约肌损伤致排便失禁(10%);(5)未经病人同     

直肠肛门损伤诊治分析（附52例报告）

目的探讨直肠肛门外伤的诊治经验。方法回顾性分析52例直肠肛门外伤患者的临床资料,26例行单纯直肠肛管损伤清创、修补或局部引流,25例行肛管直肠损伤清创修补加乙状结肠双腔造口术,1例医源性腹膜反折上直肠损伤患者行经腹单纯损伤修补缝合。结果本组无围手术期死亡,无肛门失禁。出现并发症5例：1例尿道狭窄,1例创面严重感染伴肛管狭窄,3例单纯创面感染。结论早期明确诊断,及时、个体化的手术治疗,合理的围手术期抗感染及综合治疗是治疗肛门直肠外伤的关键。     

低切高挂半缝合半开放引流术治疗高位肛瘘

目的 :探讨治疗高位肛瘘的手术方式。方法 :5 0例高位肛瘘分为 2组 ,试验组直肠环以上瘘管挂线 ;直肠环以下瘘管切除 ,肛门外切口间断全层缝合 ,肛门内切口开放引流。对照组直肠环以上瘘管挂线 ;直肠环以下瘘管切开。结果 :(1)治愈率 :试验组 10 0 % (2 5 / 2 5 ) ,对照组 96 % (2 4 / 2 5 )。 (2 )伤口愈合时间 :试验组 (9.0 4± 1.93) d,对照组 (2 4 .6± 4 .2 2 )d (P <0 .0 1)。 (3)肛管弹性 :试验组术前优 18例、良 6例、差 1例 ;术后优 16例、良 7例、差 2例。对照组术前优 2 0例、良 3例、差 2例 ;术后优 11例、良 9例、差 5例。 (4)肛门平滑度 :试验组术后正常 2 4例 ,对照组术后正常 3例。(5 )伤口水肿 :试验组 2 3例 (92 % ) ,对照组无。 (6 )伤口疼痛 :试验组重度 2 1例、中度 3例、轻度 1例。对照组重度 2例、中度 2 0例、轻度 3例。 (7)伤口感染 :试验组 2例、对照组 1例。结论 :瘘管切除半缝合半开放引流术在保持肛门的功能、外形及缩短治疗时间上优于瘘管切开全开放引流术     

直肠损伤16例报告

我院1990年～1998年共收治直肠损伤16例。现报如下。 临床资料 1.一般资料 本组16例,男14例,女2例;年龄10～72岁,平均35岁。其中,戳伤3例(异物从会阴部刺入,致直肠损伤);钝性腹部损伤致直肠损伤6例;骨盆骨折致直肠损伤4例;自发性直肠破裂1例;医源性直肠损伤2例(宫颈癌、膀胱癌术中损伤直肠各1例)。损伤部位为:盆底腹膜返折近侧段直肠损伤10例;盆底腹膜外损伤6例(2例医源性损伤均为该类型损伤)。除1例20小时以后作出诊断以外,其余均在8小时之内诊断为直肠损伤。16例直肠损伤中并发小肠损伤及后尿道损伤     

肛管直肠损伤的诊治

目的 探讨肛管直肠损伤的诊断和治疗.方法 对钦州市第二人民医院1985年1月至2005年10月间收治的肛管直肠损伤32例进行回顾性分析.结果 32例均行手术治疗.病死率为3.1%(1/32),并发症发生率为15.6%(5/32).结论 及时、正确的早期诊断和处理是提高肛管直肠损伤疗效的关键.     

直肠肛管损伤的诊治原则

直肠位于盆腔内的骶前凹 ,有骨盆保护 ,故损伤机会较少。骨盆骨折并发直肠损伤 ;瞬间暴力挤压腹部可致直肠破裂 ,这种闭合性直肠损伤易被忽视。会阴部、臀部开放性损伤易伤及直肠、肛管。医源性的乙状结肠镜检查、纤维结肠镜检查时活检及电切息肉等均可造成直肠损伤。直肠肛管损伤占腹部外伤的 0 .5 %～ 5 .5 % ,而直肠肛管损伤的合并伤约为 5 6 .2 %～ 79.6 % ,常见的为骨盆骨折、尿道损伤及大出血等。延误诊断和处理不当的早期并发症可继发全身脓毒败血症而导致死亡。其晚期并发症为难以治愈的瘘管、肛门狭窄、大便失禁等。腹膜返折以上的…     

医源性胆道损伤129例分析

医源性胆道损伤近年有明显增加之势 ,其处理困难且后果严重 ,本文对医源性胆道损伤的原因及防治进行讨论。1　临床资料　　我院从 1970年 1月 - 2 0 0 1年 12月收治医源性胆道损伤12 9例 ,占同期胆道手术的 3.0 2 % (12 9 4 2 6 8) ,其中本院 5 9例 ,外院转来 70例。男 4 7例 (36 .4 3% ) ,女 82例 (6 3.5 7% ) ,男∶女=1∶1.74 ,年龄最小 2 1岁 ,最大 72岁 ,平均 4 4 .9岁。　　其病因为 :首次行胆道手术 115例 (89.15 % ) ,胃切除手术5例 (3.88% ) ,其它手术 9例 (6 .98% )。胆道手术中有胆囊切除术 98例 (85 .2 2 % ) ,胆囊切除并胆总管…     

医源性结直肠损伤的诊治分析

探讨医源性结直肠损伤科学、合理的处理方案。回顾性分析2004年1月—2012年12月收治的19例医源性结直肠损伤的病例资料。19例患者均行手术治疗,一期手术切除或修补17例(89.47%),其中2例(11.76%)发生切口感染,2例(11.76%)发生肠瘘,均为Ⅱ级损伤引起;二期乙状结肠造瘘及造瘘还纳术2例(10.53%)。所有患者均痊愈出院。重视医源性结直肠损伤的处理,严格掌握其适应证,对早期发现、污染轻的医源性结直肠损伤可行I期手术;发现较晚或污染较重的则考虑行结肠造瘘及II期造瘘还纳术。     

儿童盆底失弛缓综合征的诊断与治疗

目的探讨儿童盆底失弛缓综合征的诊断与治疗。方法对2001年11月至2004年11月间29例便秘患儿经结肠造影和直肠肛门测压诊断为盆底失弛缓综合征的临床资料进行回顾性分析。结果本组男13例,女16例,年龄(6．7±4．0)岁。所有病例经过结肠造影和直肠肛门抑制反射(RAIR)检查均排除先天性巨结肠症。29例患儿排便弛缓反射均为上升相(正常为下降相),RAIR正常(注气5～10 m1)21例,RAIR减弱(注气15～30 ml)8例；20例直肠初始感觉和最大耐受量均正常。明确诊断后采用排便诱导训练法,配合饮食调节、乳果糖或福松等缓泻剂软化大便等治疗1-2个月,痊愈4例,好转5例,有效率31．0%；开塞露依赖20例。有4例病史在1年以上、长期依赖开塞露的学龄期患儿做了肛门内括约肌和直肠平滑肌部分切除术(Lynn术),术后随访5—24个月,平均每1-2日自行排便1次,疗效满意；其中2例术后复查直肠肛门测压、肛管静息压及括约肌功能长度均较术前下降,排便弛缓反射仍为上升相。结论儿童盆底失弛缓综合征的诊断主要依据便秘病史、结合直肠肛门测压和结肠造影；排便诱导训练法等治疗不满意者可选择Lynn术。     

Perforation and rupture of the oesophagus: treatment and prognosis

AIM OF THE STUDY: To analyze treatment and prognosis of perforations and ruptures of the oesophagus. MATERIAL AND METHODS: This retrospective study included 40 patients (26 men and 14 women; mean age = 59 +/- 17 years) with a perforation or a rupture of the oesophagus. Seven perforations were cervical: iatrogenic (n = 6) or following ingestion of a foreign body (n = 1). Thirty-three perforations were thoracic: iatrogenic (n = 15), spontaneous rupture (n = 14), following ingestion of foreign body (n = 3) or traumatic (n = 1). All patients with cervical perforations were operated on (suture or drainage). One patient with thoracic perforation died before surgery, 2 underwent non-operative treatment and 30 were operated on. Twenty-eight underwent an oesophageal procedure: suture (n = 13), oesophagectomy (n = 11) or double exclusion (n = 4). Two uderwent surgery without oesophageal procedure (one pleural decortication, and one ablation of a pleural foreign body). RESULTS: The overall mortality rate was 17% (7/40), 21% (3/14) after spontaneous ruptures and 19% (4/21) after iatrogenic perforations (no death for other aetiologies). The mortality rate was 14% (1/7) for cervical lesions and 18% (6/33) for thoracic ones. It was 8% (1/13) after intrathoracic suture, 18% (2/11) after oesophagectomy and 50% (2/4) after double exclusion. CONCLUSION: Iatrogenic perforation and spontaneous rupture had the same poor prognosis. Non-surgical treatment is rarely indicated. oesophagectomy is a good option in case of non suturable oesophagus or delayed operation.     

急性下肢深静脉血栓形成的 诊治

目的：探讨急性下肢深静脉血栓形成（DVT）的诊治。方法：回顾性分析96例DVT患者的临床资料。结果：彩色血管多普勒超声检查的正确率为97.8%, 空气容积描记MVO/SVC值结合曲线诊断正确率为97.2%, ECT为100%。手术+药物治疗组MVO/SVC值及大小腿周经术后1周与非手术组比较，差异有显著性意义（P<0.01）。治愈62例（64.6%），好转25例（26.0%），无效3例（3.1%），自动出院6例（6.3%）。结论：彩色血管多普勒超声是DVT首选的无创诊断方法,空气容积描记对DVT的诊断和疗效评价是一种客观有效的无创性检测方法，尽早手术取栓加溶栓抗凝综合治疗效果满意。     

Iatrogenic Ureteric Injuries: Incidence,Aetiological Factors and the Effect of Early Management on Subsequent Outcome

Objective: To investigate the changing pattern in incidence, aetiological factors and the effect of early diagnosis and surgical treatment on the outcome of iatrogenic ureteric injuries in our Urology Unit over a 5 year period. Patients/Methods: All patients with ureteric injuries caused as a result of any surgical procedures (iatrogenic ureteric injuries) were studied during a 5 year period (1998–2002). Data collected and analysed included yearly incidence of injury, aetiological factors, modalities of treatment and the outcome of management of the injuries. During the study period, our general surgical colleagues had a policy of requesting “J” stent insertion prior to major abdominopelvic surgical procedures. During the same period, in nearly all difficult cases of ureteroscopy (URS) + lithoclast lithotripsy±Dormia basket, a ureteric catheter or “J” stent was prophylactically inserted by urological surgeons. Results: There were 82 iatrogenic ureteric injuries in 75 patients over the 5 year period. The total number of iatrogenic ureteric injuries declined from 26 (31.7%) in 1998 to 10 (11.8%) in 2002. Urological, obstetrics and gynaecological and general surgical procedures were involved in 69(84.1%), 7(8.7%), and 4(4.9%) of the injuries respectively. The commonest types of injuries encountered were; injury to ureteric mucosa post URS or lithoclast calculi disintegration 34 (41.5%), complete ureteric perforation 15 (18.3%) and false passage 15 (18.3%). The most severe complications encountered were complete ureteric avulsions 3 (3.75%) and loss of ureteral segment 2 (2.4%). The commonest treatment options used were “J” stent insertion or ureteric catheter placement (48, 59.4%), percutaneous nephrostomy (17, 20.7%), laparotomy and removal of suture on tied ureters (5, 6.1%). Two (2.4%) nephrectomies were performed because of poor renal function in one patient and severe damage to a functioning renal unit during a difficult retroperitoneal surgery in another patient. Recognition and treatment of ureteric injuries at the time of surgery was associated with less morbidity compared to those in whom the diagnosis was delayed. The overall successful resolution of ureteric injuries in this series was 77/82 (93.9%). There was no mortality attributable to these ureteric injuries. Conclusion: In our Unit, the incidence of significant iatrogenic ureteric injuries has shown a decline over a 5-year period. We attribute this trend to the prophylactic use of “J” stents or ureteric catheter placement and good surgical technique during major abdomino-pelvic surgeries in our hospital. Endourological procedures are the commonest causes of ureteric injuries. Prompt diagnosis and institution of appropriate corrective surgical procedures often result in a very satisfactory outcome in about 94% of cases.     

External and iatrogenic trauma of the urinary bladder: a survey in Poland

OBJECTIVE: To assess incidence of urinary bladder injuries (frequently associated with pelvic trauma and often iatrogenic) in Poland. MATERIALS AND METHODS: The records and details of urinary bladder injuries treated between 1995 and 1999 were analysed for 61 urological departments in Poland. RESULTS: During the 5-year period 512 patients had urinary bladder injuries; in 210 (41%) the injury was caused by a road traffic accident, in eight (2%) by compression (crushing injury) within the limits of the pelvic bones, in 40 (8%) by a fall from a height, in three by a gunshot wound and in the remaining 251 (49%) the injury was iatrogenic. Among the 261 bladder injuries that were not iatrogenic, 41 (16%) were associated with pelvic bone trauma. In 36 patients there was simultaneous injury of the urinary bladder and posterior urethra, constituting 14% of such injuries and 7% of all trauma cases. The iatrogenic injuries were in 98 patients (39%) in urological departments, in 130 (52%) women in gynaecological departments and in 23 (9%) on surgical wards. The injury was open in 102 patients (20%) and closed in 372 (73%); there was bladder contusion in 38 patients (7%). The injuries were intraperitoneal in 225 patients (44%) and extraperitoneal in 287 (56%). For diagnosis, abdominal ultrasonography was used in 455 (89%) patients, intravenous pyelography in 266 (52%), cystography in 388 (76%) and computed tomography in 15 (3%). The delay between trauma and diagnosis was 0.5-124 h. Surgical treatment of the injury comprised a monolayer suture of the bladder wall in 51 patients (10%), a two-layered suture in 461 (90%), perivesical drainage in 468 (91%) and inspection of the peritoneal cavity in 232 (45%). The mean (range) interval between diagnosis and treatment was 14 (7-70) days. Seven patients died after the treatment failed. CONCLUSIONS: Almost half the patients had iatrogenic injuries, of which over half occurred in gynaecological and maternity wards. Thus it is important teach the basic range of urological operations to trainee doctors. The commonest diagnostic method was not ascending cystography but ultrasonography; we recommend ascending cystography be used with at least two views after filling the urinary bladder with approximately 300 mL of contrast medium, with an additional film after emptying the contrast medium. In patients with pelvic bone trauma it is reasonable to use spiral computed tomography with virtual analysis before surgery. A two-layered suture of the bladder wall with perivesical drainage should be used.     

胆总管近端分流远端支撑引流治疗胆胰肠结合部医源性损伤11例分析

目的：探讨医源性胆胰肠结合部损伤的诊断与治疗方法。方法回顾性分析自1992年6月至2013年6月共收治的11例胆胰肠结合部损伤患者诊断与治疗过程,全部为医源性损伤,9例为经腹胆总管切开取石时发生,术中即时发现;2例为ERCP十二指肠乳头切开取石时发生,术后延迟发现。急症手术,均行近端胆总管空肠Roux-e-y吻合、远端支撑引流术。腹膜后放置多套自制双套管。术后双套管温盐水冲洗、生长抑素、静脉高营养及抗感染治疗。结果11例医源性胆胰肠结合部损伤的患者中8例（72．7％）5～7 d体温下降,引流液清淅并逐渐减少,引流液淀粉酶﹤50 U/L,2周内逐渐拔除引流管;有3例（27．3％）早期出现胰漏,引流液淀粉酶﹥140 U/L,患者均1周内胃肠功能恢复,逐渐实施肠内营养,支撑引流管内引流液逐渐减少。结论胆胰肠结合部损伤是胆总管切开取石术时的严重并发症,一旦发生应及时正确处理,可避免严重不良后果的发生。     

医源性胆管损伤的外科处理

探讨医源性胆管损伤的外科处理。方法回顾性分析近9年的30例医源性胆管损伤病人的外科处理。结果30例医源性胆管损伤的病人,2例死亡。1例保守治愈。随访24例(3月至5年)。结论大多数医源性胆管损伤需再手术并且疗效不太理想,早期(48小时以内)或4周以后修复损伤的胆管可能会减少胆管狭窄．提高疗效。梗阻性医源性胆管损伤再手术时机值得进一步探讨。     

Scanning electron microscopy of alveolar surface topography in induced acute respiratory insufficiency

Scanning electron microscopy has been used to assess alveolar surface topography in a canine model of induced acute respiratory insufficiency (ARI). Mongrel dogs were infused with saline solution intermittently, continuously, or continuously with intermittent furosemide treatment. Ultrastructural and pathophysiological correlates of ARI were seen only in dogs that had fluid loading continuously at 100 ml. per kilogram of body weight per hour for 4 to 6 hours and that were not treated with furosemide. In acute pulmonary edema produced by continuous fluid overloading, the alveolar cell-air interface was altered. Irregular surface elevations, extravasated erythrocytes, and an apparent reduction in the diameter of the pores of Kohn were observed only in alveoli from dogs that died terminally after 4 to 6 hours of continuous fluid overloading. The morphological changes at the alveolar gas-exchange surface correlated with data indicating that respiratory function was being compromised by pulmonary edema. These observations and their relation to the genesis of ARI induced in the dog by continuous fluid overloading may provide a model for better understanding iatrogenic clinical respiratory failure.     

肾出血急诊肾动脉造影特点及栓塞策略

目的探讨肾出血急诊肾动脉造影特点及栓塞策略。方法回顾性分析63例接受急诊肾动脉造影的肾出血患者,其中医源性操作致出血43例(医源性组)、非医源性操作出血20例(非医源性组),比较2组肾动脉造影表现、所用栓塞材料和止血效果。结果 45例造影可见阳性表现,18例造影阴性。医源性组造影阳性率[79.07%(34/43)]高于非医源性组[55.00%(11/20),P=0.049];2组造影阳性表现差异有统计学意义(P=0.001),医源性组以假性动脉瘤最常见,所用栓塞材料差异无统计学意义(P=0.090)。45例造影阳性病例中,41例经一次栓塞治疗后出血停止,一次栓塞成功率91.11%(41/45),2例经二次栓塞后出血停止,栓塞总成功率95.56%(43/45)。结论医源性操作所致肾动脉出血是急诊肾动脉造影的主因,造影阳性率高,其中假性动脉瘤最常见。选择性肾动脉栓塞治疗肾出血疗效较好。