Lingual lymph nodes: Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.     

敷料更换的不同次数对穿刺引流术后穿刺口感染的影响

目的 研究敷料更换的不同次数对穿刺引流术后穿刺口感染的影响.方法 随机将该院2013年6月—2014年7月收治的100位进行穿刺引流术的患者分为两组,50例为A组,50例为B组. 为A组患者1周更换1次敷料,B组患者1周更换2次敷料. 对两组患者穿刺口感染的情况进行分析比较. 结果 A组患者穿刺口感染的几率显著低于B组(P<0.05),A组患者的病原菌定植率显著低于B组(P<0.05),两组患者导管相关性血流感染率差异无统计学意义(P>0.05). 结论 穿刺引流术后的患者1周更换1次敷料比较合理,既能降低患者术后穿刺口感染的几率,又能降低医护人员的工作量,但要注意在敷料发生松动或者潮湿时也要及时进行更换.     

改良切开引流术治疗直肠壁内脓肿

目的:探讨改良切开引流术治疗直肠壁内脓肿的临床效果。方法:将32例直肠壁内脓肿患者随机分为改良切开引流术(治疗组)和传统切开引流术(对照组)治疗,每组16例,对比观察两组治愈率、创面愈合时间、肛门功能状况、术后复发以及术后并发症情况。结果:治疗组与对照组比较,治疗组治愈率高100%,(P<0·05);创面愈合时间短(17·3±2·5)d,P<0·01;但肛门功能、术后复发及术后并发症两组差异无统计学意义(P>0·05)。结论:改良切开引流术在治疗直肠壁内脓肿方面明显优于传统手术。     

自发性气胸的临床特点与治疗对策

目的通过对多种自发性气胸的临床表现采用不同的治疗方法,达到治愈。方法根据不同临床表现及气胸压缩程度采取人工抽气、闭式引流术、胸膜粘连术等检测效果。结论96例病人中治愈90例,说明采用适用的方法可有效地治疗自发性气胸。     

IMPROVED BALLOON‐TIPPED TRANS‐ANAL ILEUS TUBE

Background: For management of bowel obstruction due to colorectal cancer, endoscopic trans‐anal decompression technique has been first reported by Lelcuk et al. in 1986 using balloon dilatation technique. Since then, various types of trans‐anal decompression tubes have been clinically used for patients suffering from left side obstructing colorectal cancer as an emergent decompressing device. At present, two types of trans‐anal ileus tube (trans‐anal decompression tube) have been available for clinical use, but they have two main problems that are late colon perforations caused by the tip of the tube and tube obstruction by stool. Methods: Analysis on three late colon perforations experienced with the use of conventional devices drew possible improvements to make a trans‐anal ileus tube less harmful. To overcome the pitfalls inherent to conventional tubes, the author has developed an improved trans‐anal ileus tube with a balloon installed at the very end of the tube (‘balloon‐tipped type’) made of silicone, measuring 1200 or 1700 mm in total length and 22 Fr in outer diameter. It has been used for 12 cases with obstructing colorectal cancer etc. and its outcomes were compared with those obtained by the use of conventional trans‐anal ileus tube. Results: No late perforations have been encountered, but tube obstruction did occur in one of 12 cases. Conclusion: The new trans‐anal ileus tube with a balloon installed at the tip of ileus tube is considered to be safer and especially effective in preventing late colon perforation and tube obstruction.     

B超引导下穿刺置管引流术治疗肝脓肿 92例临床分析

目的探讨肝脓肿在超声引导下穿刺置管引流术对肝脓肿治疗的疗效.方法回顾性分析1998年3月～2004年3月,92例肝脓肿病人的临床资料.结果本组92例病人共进行102次穿刺置管引流术,总治愈率为96.63%,平均疗程19天(8～30天).术后无腹腔内出血、气胸、脓胸及严重腹腔感染等并发症.治疗效果满意.结论B超引导下肝脓肿穿刺置管引流术具有简便、安全、住院时间短、费用少,并发症低的优点,可用于治疗大多数肝脓肿.     

ENDOSCOPIC NASOBILIARY DRAINAGE: CURRENT INDICATIONS AND EVALUATION OF THE PRODUCTS

Endoscopic nasobiliary drainage (ENBD) is a well established mode of biliary decompression. Although ENBD is certainly an uncomfortable procedure with the potential risk of spontaneous dislocation or removal of the drainage catheter by disoriented patients, it has several advantages over endoscopic biliary drainage (EBD) using an indwelling stent. The current indications for ENBD are: (i) temporary drainage to treat obstructive jaundice and cholangitis caused by malignant or benign biliary stricture; (ii) urgent drainage to treat suppurative cholangitis primarily caused by common bile duct stones; (iii) temporary drainage after stone removal in patients with suspected incomplete clearance and/or with cholangitis; and (iv) biliary leaks that occur primarily after surgery, as well as other indications. Different types of nasobiliary catheters are currently available that have been designed with various diameters, shapes, and materials. However, the current catheters are not considered by most endoscopists to be sufficient. Further improvements are needed to achieve better drainage and better maneuverability.     

经皮激光椎间盘减压术治疗椎间盘源性腰痛

目的探讨经皮激光椎间盘减压术（percutaneous laser disc decompression，PLDD）治疗椎间盘源性腰痛的疗效。方法2002年6月～2004年12月我院对36例椎间盘源性腰痛，采用英国DIOMED公司半导体激光仪，激光功率15W，每个激光脉冲持续1s，间隔1s，照射能量800～1200J。VAS评分评价治疗效果。结果手术时间15～60min，平均30min。32例出现“疼痛复制效应”。36例随访6～36个月，平均11个月，32例有效（术后VAS评分改善≥3分18例，≥分14例），4例无效，有效率88．9％（32／36）。结论PLDD治疗椎间盘源性腰痛安全、有效、微创。     

后路治疗胸腰椎爆裂骨折

目的：探讨后路环椎管减压，椎弓根钉系统复位固定并植骨治疗胸腰椎爆裂骨折的疗效。方法：1996－2001年，环椎环椎管减压，结合具有钉杆角的椎弓根钉系统复位固定，并横突及小关节突间植骨或椎间植骨治疗128例病人，从伤椎椎体前后缘高度恢复，Cobb角矫正度及神经功能恢复情况评价疗效。结果：128例病人脊髓神经损害无加重，神经功能有不同程度恢复；伤椎高度恢复理想，Cobb角明显减少，植骨融合成功108例（占84．4％），术后部分病例出现伤椎复位度丢失现象。结论：后路环椎管减压内固定治疗胸腰椎骨折效果好，应重视植骨融合以获得良好稳定性。     

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients beause of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux. Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple arterial loop and neurovascular contract. Probably, many immediate failures and early relapses are the consequence of the inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate selection can be explained by the difficult preoperative diagnosis of NVC in the past. Indeed, angiography and computed tomography showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with the following: (1) percutaenous techniques are indicated for patients without demonstrated NVC (including patients with TN in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and (2) MVD is incated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor this operation desiring no sensory deficit. Received: 23 June 2001 / Accepted in revised form: 24 August 2001