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1.
腹腔镜疝囊双重高位结扎术治疗小儿腹股沟斜疝   总被引:1,自引:0,他引:1  
目的:探讨腹腔镜治疗小儿腹股沟斜疝的临床应用价值和降低复发率的技术改进。方法:回顾性分析腹腔镜下疝囊双重高位结扎术治疗小儿腹股沟斜疝236例的临床资料。结果:236例手术均获成功,手术时间单测为8~20min,平均14min,双侧为18~35min,平均28min,术后住院1~2d,无并发症,随访3~36个月,无一例复发。结论:操作者学习曲线期疝术后复发率较高,通过技术改进可以降低复发率;腹腔镜治疗小儿腹股沟斜疝安全可行,具有创伤小、并发症少、康复快、复发率低的优点。  相似文献   

2.
腹腔镜下疝囊高位结扎治疗小儿腹股沟斜疝21例体会   总被引:2,自引:0,他引:2  
目的:探讨腹腔镜下疝囊高位结扎治疗小儿腹股沟斜疝。方法:在腹腔镜下用特制带线钩针带线环绕内环口,在内环口处高位结扎疝囊。结果:21例均顺利完成手术,手术时间8~20min,术后住院1~2d,无手术并发症,近期效果良好。结论:腹腔镜下疝囊高位结扎治疗小儿腹股沟斜疝损伤小、并发症少、安全有效、操作简单、恢复快、美容效果好。  相似文献   

3.
目的探讨小儿腹腔镜疝囊高位结扎术后复发独立影响因素。方法选取2015年10月至2017年10月于我院治疗的204例采用腹腔镜疝囊高位结扎术患儿,随访2年以上,调查复发情况,分析小儿腹腔镜疝囊高位结扎术后复发的独立影响因素。结果 204例腹股沟疝患儿术后复发18例,发生率8. 82%;多因素logistic回归分析显示,内环口直径 2 cm、年龄 6岁、可吸收缝线是小儿腹腔镜疝囊高位结扎术后复发的独立影响因素。结论小儿腹腔镜疝囊高位结扎术治疗腹股沟疝后存在一定的复发率,且与结扎线类别、内环口直径、年龄等因素有关,可开展围术期及院外针对性护理措施,以预防术后复发。  相似文献   

4.
微型腹腔镜小儿腹股沟斜疝疝囊高位结扎术32例分析   总被引:3,自引:0,他引:3  
目的:探讨微型腹腔镜下小儿腹股沟斜疝疝囊高位结扎术的临床应用价值。方法:使用微型腹腔镜配合自行改进的针形器械缝扎内环口周边腹膜行疝囊高位结扎32例,总结临床资料并结合文献进行分析。结果:32例小儿腹股沟斜疝均经微型腹腔镜下完成手术,手术时间短,术后恢复快,切口美观,无复发。结论:微型腹腔镜治疗小儿腹股沟斜疝创伤小,手术操作简单,疗效确实,值得临床推广。  相似文献   

5.
凌丽娟  陈凌武  肖惠坚  汪青蓉 《现代护理》2006,12(23):2217-2218
腹腔镜治疗小儿腹股沟斜疝与开腹手术一样,主要操作步骤是疝囊高位结扎,由于腹腔镜可以同时探查双侧腹股沟,因此较开腹疝囊高位结扎更彻底,但腹腔镜下小儿腹股沟斜疝术后复发率仍有0.5%~2.7%[1-2]。为进一步降低小儿腹腔镜下疝囊高位结扎术后复发率,我院从2003年1月起,建立并开展了腹腔镜下小儿腹股沟斜疝内环缝合并疝囊高位结扎术,该术式在国内外尚未见报道,现对比腹腔镜小儿腹股沟斜疝疝囊高位结扎术报道如下。1临床资料从2003年1月~2004年12月,我院完成了61例共85个小儿腹股沟斜疝,其中21例共31个斜疝行内环缝合并疝囊高位结扎术,另40例…  相似文献   

6.
目的 探讨腹腔镜下疝囊高位结扎日间手术在治疗小儿腹股沟疝中的可行性和注意事项.方法 对洛阳市第六人民医院2008年2月至2011年2月收治的228例小儿腹股沟疝患者采用腹腔镜下疝囊高位结扎日间手术治疗.结果 228例患者均顺利完成手术,所有病例24 h内出院,随访1年,复发1例,无其他并发症发生.结论 应用腔镜下疝囊高位结扎日间手术治疗小儿腹股沟疝疗效确切,安全可行,值得推广.  相似文献   

7.
目的 评价微型腹腔镜下缝扎关闭疝囊、修补内环的手术方法 对小儿腹股沟斜疝的临床治疗价值.方法 对经该手术治疗的198 例小儿腹股沟斜疝病历资料进行回顾分析.结果 手术均顺利,无副损伤.单侧疝平均手术时间15 min(较单纯的高位结扎多3 ~5 min).除2 例出现阴囊小气肿(24 h 后消失)外,术中和术后未发现其他并发症.平均住院时间2.5 d,术后随访2 周~12 个月,无复发,切口瘢痕线状不明显.结论 疝囊的超高位结扎加内环区域腹壁的加强构成了两道阻碍屏障,使近1%的腹腔镜手术术后复发率进一步降低.手术操作简单、创伤小、损伤少、恢复快、并发症少、疗效确实可靠.特别适合年长儿和婴幼儿巨大型腹股沟斜疝的治疗,值得临床推广应用.  相似文献   

8.
腹腔镜治疗小儿腹股沟斜疝与开腹手术一样,主要操作步骤是疝囊高位结扎,由于腹腔镜可以同时探查双侧腹股沟,因此较开腹疝囊高位结扎更彻底,但腹腔镜下小儿腹股沟斜疝术后复发率仍有0.5%~2.7%[1-2].为进一步降低小儿腹腔镜下疝囊高位结扎术后复发率,我院从2003年1月起,建立并开展了腹腔镜下小儿腹股沟斜疝内环缝合并疝囊高位结扎术,该术式在国内外尚未见报道,现对比腹腔镜小儿腹股沟斜疝疝囊高位结扎术报道如下.……  相似文献   

9.
目的:探讨腹腔镜下疝囊高位结扎术治疗小儿腹股沟疝的术后复发情况与相关危险因素。方法:选取2013年1月至2016年7月河南科技大学第一附属医院收治的246例腹股沟疝患儿,分析术后复发情况与相关危险因素。结果:术后9例患者复发,发生率为3.66%,再次行手术后均治愈。单因素分析结果显示:术后复发与年龄、合并肥胖症、内环口大小、结扎线及术者经验相关(P0.05),而与性别、合并呼吸系统疾病、合并隐匿疝、疝囊部位、病程及术前有无嵌顿无相关性(P0.05)。多因素分析结果显示:年龄≥6岁、内环口≥3 cm、可吸收缝线及术者经验缺乏是术后复发的独立危险因素(P0.05)。结论:腹腔镜下疝囊高位结扎治疗小儿腹股沟疝术后仍存在一定的复发率,尤其是具备年龄≥6岁、内环口≥3 cm、使用可吸收缝线及术者经验缺乏等独立危险因素的患儿。  相似文献   

10.
小儿腹股沟斜疝是小儿普外科常见病之一,传统治疗方法为开放性疝囊高位结扎术,其复发率及并发症相对较多。随着医学技术的飞速发展,腹腔镜下治疗小儿腹股沟斜疝已经逐渐取代传统治疗方法,其具有切口小、损伤少、复发率低、恢复快等诸多优点。故本研究回顾性分析了42例行腹腔镜下内环口缝扎术的复发性斜疝患儿资料,现总结报道如下。1资料与方法1.1一般资料本组病例为2010年1月至2014年3月  相似文献   

11.
Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.  相似文献   

12.
Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.  相似文献   

13.
This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.  相似文献   

14.
Ranganath C  Heller AS  Wilding EL 《NeuroImage》2007,35(4):1663-1673
Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.  相似文献   

15.
ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.  相似文献   

16.
目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4%(55/72)]明显高于成功组[31.7%(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3%(42/72)]高于成功组[38.1% (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9% (28/72)]高于成功组[23.8%(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大<6 cm、胎头位于坐骨棘上及宫口开大8~10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1%(44/72)]高于成功组[38.9%(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2%(52/72)]明显高于成功组[34.1 %(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.  相似文献   

17.
18.
The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.  相似文献   

19.
20.
目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高<20%视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P<0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P<0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P<0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.  相似文献   

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