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81.
下肢动脉硬化闭塞症的外科治疗 总被引:2,自引:0,他引:2
目的:探讨外科治疗下肢动脉硬化闭塞症的临床经验。方法:从1995年7月~2002年7月共对292例(313条肢体)动脉硬化闭塞症病人进行外科治疗,其中20条患肢施行解剖外血管重建术,38条患肢施行了腔内外科治疗或合并开放性血管重建手术,255条患肢施行了开放性手术重建下肢血供。结果:手术成功者患肢的踝肱指数与术前比较显著增加(P<0.01),症状得到明显改善。平均随访时间3.1年(0.5~7年),解剖外重建组移植血管一期通畅率为56%,腔内外科组通畅率为78%,开放性手术组通畅率为72%。结论:病人的全身情况、动脉病变的范围和程度是选择下肢动脉硬化闭塞症外科治疗方法的主要依据,为取得较好的长期通畅率和临床效果需要重视围手术期处理和术后随访。 相似文献
82.
普外科住院患者营养状况评价 总被引:21,自引:0,他引:21
目的 调查本院 2 0 0 2~ 2 0 0 3年间普外科住院患者的营养状况。方法 采用多项营养评价指标测定 4 0 12例非急诊住院患者营养状况 ,分析年龄、疾病等因素与营养状况之间关系。结果 各项指标进行营养评价得出本院普外科非急诊患者营养不良的发生率分别是 :BMI 2 1 3% ,TSF5 0 6 % ,MAC 2 0 5 % ,AMC 2 1 2 % ,SGA 38 0 % ,MNA 2 0 8% ,ALB 2 4 2 % ,PA 35 4 % ,TLC 5 5 8%。 >6 0岁组老年患者、消化道疾病患者及恶性肿瘤患者营养不良发生率分别高于≤ 6 0岁患者、消化道外疾病患者及良性疾病患者 ,差异有显著性 (P <0 0 5 )。结论 本院普外科住院患者的营养不良发生率为 2 0 5 %~ 5 5 8% ,不同的营养评价指标得出的营养不良发生率不同。 相似文献
83.
We describe what we believe to be the first reported case of intragastric erosion and migration to the jejenum of a laparoscopically
inserted gastric band, 3 months after the original bariatric surgery was performed. This had caused ulceration and necrosis
of the small bowel as the tension in the port tubing had caused the bowel to become concertinaed over it and resulted in a
cheese-wire effect through the jejunal convolutions. As bariatric surgery becomes more common, patients with complications
of their procedure may present to the general surgeon as an emergency. We recommend early intervention in patients with gastric
erosion. 相似文献
84.
Fady K. Balaa T. Clark Gamblin Allan Tsung J. Wallis Marsh David A. Geller 《Journal of gastrointestinal surgery》2008,12(2):338-343
Background Application of linear stapling devices for extrahepatic vascular control in liver surgery has been well-established. However,
the technique for use of stapling devices in hepatic parenchymal transection is not well defined.
Purpose To describe the safety and efficacy of our technique for use of vascular stapling devices in hepatic parenchymal transection
during open right hepatic lobectomy is the purpose of this study.
Methodology We reviewed our experience with 101 consecutive open right hepatic lobectomies performed by a single surgeon between January
2003 and July 2006, in which vascular staplers were utilized for the parenchymal transection phase.
Results Of the 101 patients who underwent resection, 53 (52%) were female. The mean age was 58 years. Malignant disease was the indication
for resection in the majority of patients (88%). Of those with cancer, 78% (69 of 89) had metastatic colorectal cancer, 6%
(5 of 89) had metastatic neuroendocrine tumor, 4% (4 of 89) had hepatocellular carcinoma, 4% (4 of 89) had cholangiocarcinoma,
and the remaining 8% were other metastatic cancers. Twelve patients (12%) underwent resection for hepatic adenoma or symptomatic
benign disease (FNH or hemangioma). Forty-eight patients (48%) underwent a major ancillary procedure at the time of hepatic
resection. Thirty-nine patients (39%) had a nonanatomic wedge resection of a left lobe lesion, 27 patients (27%) had one or
more lesions treated with radiofrequency ablation (RFA), and 6 patients (6%) were treated with a synchronous bowel resection.
The median total operative time was 336 min (range 155–620 min). A Pringle maneuver for temporary vascular inflow occlusion
was utilized in all cases, with a median time of 9 min (range 4–17 min). Ten patients (10%) required blood transfusion during
surgery or in the postoperative period. The maximum transfusion was 2 U of packed red blood cells (PRBC) in seven patients
and 1 U of PRBC in three patients. The mean nadir postoperative hematocrit was 28.2. All patients with malignant disease had
tumor-free margins at the completion of the procedure. The average hospital length of stay was 6.0 days. One patient (1%)
developed a clinically significant bile leak requiring a postoperative endoscopic retrograde cholangiography (ERCP). No patient
required reoperation. The 30 and 60-day postoperative survival was 100%.
Conclusion These findings indicate that application of vascular stapling devices for parenchymal transection in major hepatic resection
is a safe technique, with low transfusion requirements and minimal postoperative bile leak. The technique allows for rapid
transection of the entire right hepatic lobe in under 10 min. Short video clips of the technique will be demonstrated.
Presented at the 2007 American Hepato–Pancreato–Biliary Association, Las Vegas, Nevada, April 19–22, 2007 (oral presentation/video
presentation). 相似文献
85.
B. S. Sharma Sumit Sinha V. S. Mehta A. Suri Aditya Gupta A. K. Mahapatra 《Child's nervous system》2007,23(3):327-333
Object Intracranial aneurysms are rare in children and have different epidemiological, clinical, and morphological characteristics
and outcome from those in adults.
Materials and methods We analyzed demographic, clinical, radiologic features, treatment, and outcome in 55 patients <18 years of age, treated from
Jan 1995 through December 2005.
Results Intracranial aneurysms in children below 18 years constituted 4% of all intracranial aneurysms. Internal Carotid artery (ICA)
bifurcation was the commonest location. About half of the aneurysms were complex. Three-fourth of the patients required surgical
treatment. Two patients died, constituting 5% mortality. Two patients (5%) had poor outcome, whereas the majority (90%) had
a favorable outcome.
Conclusions Pediatric aneurysms have male predominance, higher incidence of clinical features of mass effect or seizures, high incidence
of large, traumatic/mycotic aneurysms, associated illnesses and ICH/IVH and hydrocephalus, better Hunt and Hess grades at
presentation, ICA bifurcation as the commonest site, and better outcome than their adult counterparts. 相似文献
86.
目的研究创伤性复发性腓骨肌腱脱位的手术方法. 方法回顾分析1986年1月~2003年12月手术治疗的21例创伤性复发性腓骨肌腱脱位的病例,所有病例均应用Watson Jones手术. 结果 15例得到随访,随访时间1~15年,平均4.9年.1例因外伤再次脱位,其余14例未再出现脱位,均恢复正常运动或训练,比赛. 结论 Watson Jones手术治疗复发性脱位操作简单,损伤小,效果满意. 相似文献
87.
胃癌术后膳食纤维和早期肠内营养与消化道并发症的关系 总被引:12,自引:1,他引:11
目的探讨胃癌术后膳食纤维和早期肠内营养(EN)与消化道相关并发症的关系。方法采用随机对照的方法,把56例胃癌术后患者随机分成能全素组和能全素加膳食纤维组,经鼻肠管进行早期肠内营养(EN),观察两组EN常见消化道并发症的发生情况。结果两组患者在临床资料方面具有可比性(P>0.05)。两组患者的术后腹胀、腹泻的发生率相似,均P>0.05,差异无统计学意义。1例能全素加膳食纤维组患者因吻合口水肿、输入袢不完全性梗阻而发生恶心、呕吐,其余患者均未发生恶心和呕吐。结论胃癌术后的早期膳食纤维EN并不增加EN消化道并发症的发生率。 相似文献
88.
V. Lenin Babu K. Baskaran 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2005,15(2):148-150
We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK 相似文献
89.
目的:探讨成人结肠冗长症的诊断与围手术期处理经验,提高对该病的诊治水平。方法:回顾性分析42例成人结肠冗长症的临床资料,并作了随访观察。结果:32例患者(75.7%)有顽固性便秘,18例患者(42.9%)存在反复不完全肠梗阻,16例患者(38.1%)便秘与腹泻交替出现,以便秘为主。39例经X线钡剂灌肠透视确诊。急诊手术3例,择期手术39例。41例(97.6%)病理检查于镜下可见典型改变。42例均行不同长度的肠段切除,4例加行乙状结肠固定术。术后随访率为83.3%(35/42),28例症状消失,4例仍有症状,保守治疗有效果,3例再次手术,术后症状消失。结论:典型的病史和X线钡剂灌肠可确诊成人结肠冗长症,外科手术是治疗本病的最终有效措施。 相似文献
90.
结直肠癌肝转移的外科治疗 总被引:1,自引:1,他引:0
目的探讨结直肠癌肝转移的外科手术适应证和疗效,以及临床病理因素对其预后的影响。方法回顾性分析1991年1月至2000年12月间施行肝切除术的61例结直肠癌肝转移患者的临床资料。结果结直肠癌肝转移切除术后1、3、5年生存率分别为72.1%、58.1%和26.0%,术后出现并发症8例,20例肝转移灶有假包膜形成。结直肠癌Dukes分期、病理类型、转移灶数目、假包膜形成对术后生存率有影响(P<0.05)。术后综合治疗者3年生存率明显优于无综合治疗者(P<0.05)。肝转移灶大小及其切除时间并不影响患者预后(P>0.05)。结论临床病理分期早、肿瘤分化程度高、转移灶数目不超过3个、肿瘤假包膜形成及术后综合治疗预示结直肠癌肝转移切除患者有较好的预后。 相似文献