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1.
目的:探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。方法:2006年12月至2009年3月,对58例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,间段缝合输尿管切口。结果:58例手术均获成功,无中转开放手术,结石清除率100%。术后创腔引流液量少,3~5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1~27个月,B超复查显示肾积水明显好转或消失,无结石复发。结论:后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小/疗效好、术后恢复快等特点,明显优于开放手术及其它手术,值得推广应用。  相似文献   

2.
目的:探讨后腹腔镜下肾盂输尿管切开取石术的方法。方法:回顾分析后腹腔镜肾盂输尿管切开取石术21例患者的临床资料,其中肾盂结石3例,输尿管上段结石16例,输尿管中段结石2例;右侧13例,左侧8例;均在全身麻醉下手术,术中留置双J管并缝合切口。结果:20例取石成功,1例肾盂结石中转开放。手术时间55~190 min,平均85 min;术中失血20~55 mL,平均37 mL;术后次日可下床活动,1~2 d肛门排气,2~3 d拔除腹膜后引流管,5~7 d拔导尿管,无尿漏发生,术后住院时间6~7 d,3~4周后经膀胱镜拔除双J管。随访3~18个月,B超显示肾积水明显好转或消失。结论:后腹腔镜肾盂输尿管切开取石术是治疗肾盂及输尿管中上段结石安全有效的微创手术方式,术后恢复快。  相似文献   

3.
腹腔镜输尿管切开取石术17例体会   总被引:1,自引:1,他引:0  
目的探讨腹腔镜输尿管切开取石术的效果。方法腹腔镜输尿管切开取石术17例,平均40岁,结石直径12~30mm,根据X线定位,采用经腹膜后腔和腹腔途径,显露输尿管,用自制刀及电凝钩切开输尿管取出结石。置入双J管,缝合切口。结果17例手术均获成功。随访3~9个月无并发症发生。结论腹腔镜输尿管切开取石术疗效好,患者术后恢复快。  相似文献   

4.
目的探讨腹腔镜下输尿管切开取石术的临床意义和初步经验.方法从2002年6月~2003年6月作者共完成腹腔镜下输尿管切开取石术18例23侧,其中单侧13例,即左侧9例,右侧4例;双侧5例;上段结石15侧(例),中段结石8侧(例).结果手术均取得成功,手术时间为55~156min,平均84min,失血20~50ML,术后住院时间为3~5d(带导尿管出院),无尿漏,随访2月至1年,输尿管无狭窄.结论腹腔镜输尿管切开取石术创伤轻、痛苦少、恢复快,是治疗输尿管结石有效、可行的微创技术,可望替代开放输尿管切开取石术.  相似文献   

5.
目的探讨腹腔镜下输尿管切开取石术处理体外冲击波碎石术(ESWL)失败后输尿管结石的临床意义和初步经验。方法从2003年6月~2005年6月作者对ESWL治疗失败后的25例输尿管结石患者行经腹腔途径腹腔镜下输尿管切开取石术。其中男12例,女13例,平均48.1岁;输尿管上段结石15例,中段结石10例;左侧10例,右侧15例;结石大小平均为1.3cm×1.5cm,均伴有不同程度肾积水。结果手术均取得成功,手术45~110min,平均70min,失血20~60mL,术后住院3~5d,无尿漏,随访6 ̄16个月,输尿管无狭窄,肾积水改善。结论腹腔镜输尿管切开取石术是治疗ESWL失败后的输尿管结石有效、适宜的微创技术,创伤轻,痛苦少,恢复快,可替代开放输尿管切开取石术。  相似文献   

6.
目的探讨腹腔镜技术在治疗巨大肾积水中的临床价值。方法该组29例,其中肾盂结石5例,先天性肾盂输尿管交界处狭窄4例,输尿管上段结石11例,输尿管中段结石3例,输尿管上段狭窄2例,中下段狭窄3例,输尿管中段结石并肾盂癌1例。均行后腹腔镜手术,肾切除术18例,肾输尿管全切术1例,离断性肾盂成形术3例,输尿管上段狭窄段切除再吻合1例,肾盂切开取石术1例,输尿管切开取石术4例,输尿管上段切开取石加肾折叠术1例。结果29例手术均成功,手术时间30~245min,术中出血20~600mL。行肾切除者术后2~4d拔除切口引流管,保留肾者术后4~8d无漏尿后拔除引流管,1个月后取出双J管。住院时间7~12d,平均9.2d。随访6~41个月,无严重并发症,保留肾者肾积水均明显减轻,患肾功能均好转。结论后腹腔镜技术治疗巨大肾积水安全,微创,恢复快,可根据不同病情选择手术方式,一般可取代开放手术。  相似文献   

7.
目的 探讨后腹腔镜输尿管上段切开取石术的技术要点和临床疗效.方法 回顾性分析采用后腹腔镜治疗输尿管上段结石49例患者的临床资料.结果 1例输尿管结石因结石返回肾盏内改开放手术,其余48例后腹腔镜下取石成功.1例术后1个月拔管后出现漏尿,改开放手术修补痊愈.手术时间30~145min,平均95min;术中出血5~20 mL.结论 后腹腔镜输尿管切开取石术是一种安全有效的微创技术,可作为开放手术或其他微创方法的替代或补充.  相似文献   

8.
目的 探讨后腹腔镜榆尿管切开取石术的适应证选择及手术技巧.方法 回顾性分析10例后腹腔镜输尿管切开取石术的临床资料.男7例,女3例;输尿管上段结石9例,中段结石1例.结果 10例患者取石均成功,手术时间90~120n血,平均95min,术中出血量30~50mL,平均45mL.术后有9例漏尿1~3d,全部患者术后3~5d拔除后腹膜腔引流管,术后住院3~5 d.随访4~19个月,所有患者肾输尿管积水明显好转,无结石复发和输尿管切开缝合处狭窄.结论 后腹腔镜输尿管切开取石术作为ESWL或URL治疗输尿管结石失败的补救措施,可部分取代传统的开放性手术.  相似文献   

9.
目的探讨后腹腔镜输尿管切开取石术的技术要点及临床价值。方法应用后腹腔镜行输尿管切开取石16例。结果16例患者15例成功取石,手术成功率93.75%,1例患者因放置双J管过程中输尿管撕裂中转开放行修补手术,共取石21枚。手术时间为70.00~150.00min,平均(110.55±21.50)min。出血量10.00~60.00 ml,平均(30.45±5.55)ml,术后住院时间3~9 d,平均(6.37±1.22)d,随访3~9个月,肾功能均有不同程度改善,无输尿管狭窄发生。结论后腹腔镜输尿管切开取石术是治疗输尿管中、上段结石,替代开放手术的安全有效的微创治疗方法。  相似文献   

10.
经后腹腔镜治疗输尿管上段复杂性结石   总被引:2,自引:1,他引:1  
目的 探讨经后腹腔镜输尿管切开取石术治疗上段复杂性结石的适应证及临床应用价值.方法 回顾性分析32例经后腹腔镜输尿管上段切开取石术患者的临床资料.本组体检发现21例,腰部胀痛就诊11例.经B超、静脉及逆行造影证实为单侧输尿管上段结石,结石直径1.2~2.6 cm.距肾门位置4~10cm,停留时间1~24个月,18例行体外冲击波碎石术(ESWL),17例行经输尿管镜碎石术(URL)不成功,其中11例合并远段输尿管扭曲.术中留置双J管并缝合输尿管切口.结果 32例结石均一次性完整取出,无中转开放手术及结石残留,同期处理输尿管扭曲.手术时间平均130 min.术中出血量平均30 mL.术后3例漏尿4~6d.术后2、3个月均予随访,21例随访6~24个月,肾输尿管积水均明显好转,无输尿管狭窄及扭曲.结论 经后腹腔镜输尿管上段切开取石术具有安全、有效、微创的优势,不仅可作为ESWL、URL治疗失败的补救措施,亦可作为有合并病变的复杂性输尿管结石的一线治疗方案.  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.
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   

15.
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   

16.
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   

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18.
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   

19.
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   

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