腹股沟无张力疝修补个体化治疗体会

目的探讨腹股沟疝分型及相应手术方式，提高腹股沟疝治疗水平。方法总结2000年2月至2007年9月502例腹股沟疝个体化无张力修补术。结果随访3个月至7年，无张力个体化腹股沟疝修补者3例复发。结论根据患者疝类型及年龄和完善手术方法等具体情况施行个体化无张力疝修补，可最大限度减少腹股沟疝复发。     

曲马多联合米索前列醇应用于无痛人流分析

目的:探讨曲马多联合米索前列醇应用于无痛人流的镇痛效果.方法:回顾性分析我院近年来收治的248例早孕且要求进行无痛人流术的患者的临床资料,将患者随机分为2组,比较2组的镇痛效果差异.结果:对照组139例患者,有效镇痛115例,无效24例,镇痛的有效率为82.73%,治疗组109例患者,有效镇痛106例,无效3例,镇痛的有效率为97.25%,两组患者的镇痛效果经X2检验,P<0.05,具有统计学差异,由此可见,曲马多联合米索前列醇应用于无痛人流的镇痛效果明显强于单独使用米索前列醇的镇痛效果.结论:曲马多联合米索前列醇应用于无痛人流术,既发挥了盐酸曲马多的镇痛作于又发挥了米索前列醇促进子宫收缩的作用,减轻手术者的痛苦及手术并发症的发生,值得临床推广使用.     

Clinical features and outcomes of anti-neutrophil cytoplasmic autoantibody-associated vasculitis in Chinese childhood-onset patients

Data on anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are limited in children. This study is to determine the clinical features and outcomes of childhood-onset AAV. A retrospective study was performed on patients who were diagnosed with AAV before 18 years old in Xiangya Hospital. Their medical records were analyzed by retrospective review. Sixteen patients were diagnosed with AAV before 18 years old in the past 9 years, with an average age of 13.3?±?3.3 years and 13 of them were female. There were 15 patients with microscopic polyangiitis (MPA) and 1 with Wegener’s granulomatosis. The interval between onset of disease and diagnosis of AAV was 2 (1.5–3) months. Most patients (15/16, 93.8%) had multi-organ involvement, and all patients had renal involvement with 7 (43.8%) patients requiring dialysis at presentation. Eleven patients underwent a renal biopsy, of which mixed class and sclerotic class were the most two common histological types. All patients received immunosuppressive therapy for induction therapy including intravenous administrations of methylprednisolone (MP) pulse therapy for 8 patients. 8 patients (50%) achieved remission after induction therapy. After a median follow-up of 46.3?±?36.1 months, nine (56.3%) patients progressed to end-stage renal disease (ESRD) and 5 (31.3%) patients died. Childhood-onset AAV showed similar clinical and pathological features compared to those of adults, except that it usually occurs in girls. The most commonly involved organ was the kidney, and it had a high risk of progression to ESRD. Early diagnosis and initiation of appropriate immunomodulatory therapy would be important to improve outcomes.

     

彭筱平教授治疗失眠经验

失眠是现代人常见的一种疾病,虽不致命但严重影响人们的生活质量,现代医学中多用药物治疗失眠,辅助心理治疗、物理治疗等,药物治疗病情容易反复,停药后容易出现反弹或加重等情况,物理及心理治疗适用人群极为有限,难以从根本解决失眠的问题,故而从中医中药上寻求帮助。彭筱平教授熟读《黄帝内经》《伤寒论》等经典著作,从阴阳角度提出了治疗失眠应重视阴不足的病机,根据心、肝、肾、脾胃的脏腑生理病理特性分析了以上几脏易于出现阴不足病机而至失眠,从营卫角度分析了营阴与失眠密切相关,在治疗过程中除了清热养滋阴血安神等治法外,提出了个人用药特色——白芍,白芍用药可以入营阴,有滋阴养血柔肝和营的功效,运用上述滋阴养血和营之法治疗失眠,临床上收效甚佳。     

袁尚锋从肾虚血瘀证论治成人股骨头缺血性坏死经验总结

〔摘 要〕　袁尚锋主任医师是全国第六批老中医药专家师承指导老师、湖湘张氏正骨株洲流派传承代表,其在治疗成人 股骨头缺血性坏死方面有较深的造诣。笔者梳理了袁尚锋主任医师对成人股骨头缺血性坏死的病因病机、治则治法等方面 的理解及认识,并通过分析典型病案总结了其从肾虚血瘀证论治成人股骨头缺血性坏死的临床经验。     

经胸入路腔镜下甲状腺肿块切除术

目的 探讨腔镜下甲状腺切除术的方法优缺点。方法 连续为18例甲状腺肿块患者施行经胸入路的腔镜下甲状腺肿块切除术。结果 全部均成功地施行腔镜下甲状腺肿块切除术，平均手术时间128分钟。平均术后住院时间5天（4—7天）。无喉返神经或甲旁腺损伤及其它并发症。结论 经胸入路腔镜下甲状腺切除术具有更好的美容效果。