B超定位微创经皮肾穿刺取石术治疗上尿路结石的疗效

[目的]探讨B超定位下微创经皮肾穿刺取石术(MPCNL)治疗上尿路结石的疗效。[方法]回顾性分析总结2003年6月至2004年6月B超定位下MPCNL治疗上尿路结石病例31例的临床资料。31例中铸型肾结石18例，输尿管上段结石13例。[结果]28例患者一期穿刺取石成功，3例穿刺造瘘后二期取石成功。31例均取得良好效果，且无远期并发症。[结论]MPCNL治疗上尿路结石可取得良好效果，较开放手术有明显优越性。而B超在术中定位可提高肾穿刺准确度，减少C臂X线机使用时间，值得推广应用。     

老年女性患者经鼻烟壶桡动脉与经典桡动脉行冠状动脉诊疗的对比性研究

目的探讨老年女性患者经鼻烟壶处桡动脉行冠状动脉造影和PCI的可行性和安全性。方法选择行冠状动脉造影和(或)PCI的老年女性患者100例,根据穿刺部位不同随机分为鼻烟壶组50例(穿刺鼻烟壶部位)及经典组50例(穿刺常规桡动脉)。观察2组穿刺时间、穿刺成功率、手术时间、手术成功率、置入支架、穿刺部位出血、血肿、动脉瘤及桡动脉闭塞率等情况。结果 2组血管内径、穿刺时间、穿刺成功、手术成功、手术时间、置入支架、术后血肿、动脉瘤和动静脉瘘发生率比较,差异无统计学意义(P>0.05)。鼻烟壶组桡动脉痉挛、闭塞和总并发症发生率较经典组明显降低(2%vs 8%,2%vs 10%,6%vs 20%,P<0.05)。结论老年女性患者经鼻烟壶桡动脉途径的桡动脉痉挛发生率及闭塞率更低,安全性好,可以作为常规桡动脉的替代途径应用于冠状动脉诊疗。     

激素与骨髓血注射治疗孤立性骨囊肿

目的:探讨激素囊内注射和自体骨髓血移植治疗孤立性骨囊肿的效果。方法:对确诊的64个病理性骨折愈合后孤立性骨囊肿患儿,采用经皮穿刺抽吸囊液后注射激素或自体骨髓血,回顾性分析其影像学资料和随诊结果。结果:激素组和自体骨髓血组治愈率分别为43.2%和77.8%(P<0.05);发病年龄在10岁以下者治愈率分别为25.0%、75.0%(P<0.05);10岁以上者治愈率分别为57.1%、80.0%(P>0.05)。结论:骨髓血移植治疗孤立性骨囊肿的疗效优于激素,是一种微创、安全有效的方法。     

经皮穿刺椎体成形术治疗症状性椎体血管瘤

[目的]探讨经皮穿刺椎体成形术(percutaneousvertebroplasty,PVP)治疗症状性椎体血管瘤的临床效果。[方法]采用经皮穿刺椎体成形术(PVP)治疗椎体症状性血管瘤12例,共17个椎体。[结果]12例17个病变椎体PVP均获成功,无严重并发症发生。疼痛完全缓解10例,部分缓解2例,术后随访12～24个月。未出现新的椎体压缩性骨折,血管瘤无复发。[结论]PVP可以缓解症状性椎体血管瘤引起的疼痛,增加椎体的稳定性,是治疗椎体症状性血管瘤的理想方法。     

DOES THE MANAGEMENT OF BLADDER PERFORATION DURING TRANSURETHRAL RESECTION OF SUPERFICIAL BLADDER TUMORS PREDISPOSE TO EXTRAVESICAL TUMOR RECURRENCE?

PURPOSE: We evaluated the impact of a bladder perforation during transurethral resection of superficial bladder tumor on extravesical tumor recurrence and patient prognosis. We also defined potential risk factors for extravesical recurrence prospectively giving emphasis to the management of the perforation. MATERIALS AND METHODS: The medical records of 3,410 patients were reviewed. Parameters recorded included patient age and sex, tumor stage, grade, number, size and location at the time of perforation, the type of bladder perforation (extraperitoneal vs intraperitoneal) and the way the perforation was managed (open surgical repair vs conservative treatment). Logistic regression analysis was used to identify risk factors for extravesical recurrence. Cox regression analysis was used to compare cancer specific survival. RESULTS: A total of 34 cases of bladder perforation were recorded, 4 patients were treated with open surgery and 30 treated conservatively. The 4 patients who underwent open surgery presented with extravesical recurrence after a mean followup of 7.5 months. The remaining 30 patients had no evidence of extravesical recurrence after a mean followup of 60 months (p <0.001). Of the patients with extravesical relapse 3 died of disease. The surgical management of bladder perforation was the best predictor of extravesical recurrence (p <0.001, r = 1.13), followed by an intraperitoneal localization of the perforation (p =0.0003, r = 0.67) and tumor size (p =0.01, r = 0.42). CONCLUSIONS: Surgical repair of a bladder perforation during transurethral resection of bladder tumor increases the risk of extravesical tumor cell recurrence and negatively affects patient prognosis.     

Sedation practices for Australian and New Zealand paediatric oncology patients

OBJECTIVES: Paediatric oncology patients often require repeated bone marrow aspirates and lumbar punctures. These procedures commonly require sedation and analgesia. The Australian and New Zealand College of Anaesthetists and the American Academy of Pediatrics have published guidelines that provide recommendations on monitoring and staffing requirements during sedation of paediatric patients. A survey was conducted of the oncology units in Australia and New Zealand in order to compare current practices with published guidelines. METHODS: Telephone interviews were conducted with nursing or medical staff members. RESULTS: Fourteen oncology units collectively perform approximately 130 procedures each week, of which 74% are performed under general anaesthesia. Of the remainder, most are performed using conscious sedation. Most units adhere to published recommendations regarding equipment and staffing during procedures performed under sedation. Only a minority of units follow guidelines regarding documentation; fasting requirements; observation and documentation of vital signs during and after the procedure; and obtaining informed consent for procedures performed using sedation. CONCLUSION: Sedation practices among paediatric oncology units in Australia and New Zealand vary. None of the units fully adhere to published guidelines on childhood sedation. Paediatric oncology units should be familiar with the content of these guidelines and make an informed decision as to their usefulness, both in directing best clinical practice, and in supporting current practice in the event of medico-legal challenge.     

二戳孔无钛夹腹腔镜阑尾切除术

目的 :探讨二戳孔无钛夹腹腔镜阑尾切除术的方法 ,适应证和应用价值。方法 :各种急慢性阑尾炎 6 1例 ,无条件采用二戳孔无钛夹腹腔镜阑尾切除术 ,将阑尾提至腹腔外 ,在体外分离系膜 ,切除阑尾 ,将盲肠放回腹腔 ,用抗生素溶液冲洗切口。结果 :行腹腔镜阑尾切除术 6 0例 ,其中完成二戳孔无钛夹腹腔镜阑尾切除术 5 3例 ,占 86 89% ,术中转为常规腹腔镜阑尾切除术 7例。 1例阑尾周围脓肿行脓肿引流术。所有病例无中转开腹 ,术后无并发症发生 ,均顺利出院。结论 :二戳孔无钛夹腹腔镜阑尾切除术 ,患者创伤更小 ,康复快 ,更符合美观要求。无需应用钛夹 ,降低了手术费用。该方法安全可靠 ,值得推广。     

穴位透刺与复正贴膏并用治疗周围性面瘫80例

该科从2008年以来，利用穴位透刺法与复正贴膏并用治疗周围性面瘫，取得了令人满意的疗效，现报道如下。     

微创血肿引流术治疗老年人重型脑出血的效果评价

目的　探讨老年人重型脑出血的有效治疗方法。方法　采用微创引流清除血肿的方法治疗了 35例患者 ,同时选择与之相匹配的、同期住院的、只行内科治疗的老年人重型脑出血患者 4 0例作对照。结果　微创治疗组的总有效率 (77.14 % )及BarthelIndexes(BI) (6 2 .2 1± 2 6 .5 8分 )均明显高于内科治疗组 (P <0 .0 5 ) ,并且其脑疝发生率(2 2 .86 % )及消化道出血发生率 (2 2 .86 % )明显低于内科治疗组 (P <0 .0 5 )。结论　微创引流清除血肿术是一种抢救老年人重型脑出血的有效治疗方法