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31.
目的探讨防止毕-Ⅱ式胃大部切除术后十二指肠残端破裂发生的方法;方法对毕-Ⅱ式胃大部切除术中出现十二指肠残端水肿或血运差的病例,采取预防性十二指肠腔内置管引流减压的方法,收集临床资料、观察治疗效果;结果采取十二指肠腔内置管引流减压后,十二指肠残端破裂发生率明显下降;结论十二指肠腔内置管引流减压,可以预防十二指肠残端破裂的发生,并可拓宽溃疡穿孔病例采用胃大部切除术的适应证。 相似文献
32.
Background: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing.
Methods: After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a lift and cut technique. Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots.
Results: Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm3/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement.
Conclusions: It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.Poster presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995 相似文献
33.
Effect of continuous cisternal drainage on cerebral vasospasm 总被引:3,自引:0,他引:3
Summary The effect of continuous cisternal drainage on cerebral vasospasm was studied under strict criteria in 140 patients with ruptured intracranial aneurysms. The degree of subarachnoid haemorrhage (SAH) on the computed tomography scan was graded from I to IV. The patients were classified according to the total amount of cisternal drainage into three groups, regardless of the duration of the drainage and whether or not it was accompanied by irrigation; i.e., those with less than 500 mL (group 157 cases), those with 500–3000 mL (group 2 44 cases), and those with 3000–9500 mL (group 3 39 cases).While correlations could be found between both clinical and SAH grades with the severity of vasospasm, closer correlation could be found in the SAH grades. In analyzing the cases with subarachnoid haemorrhage grades III–IV (severe clots), the angiographic vasospasm was less severe in groups 2 and 3 than in group 1, and the incidences of permanent symptomatic vasospasm and low-density area on computed tomography were lower in groups 2 and 3 than in group 1. Regarding the surgical outcome in cases with SAH grades III–IV, the mortality rate was lower in groups 2 and 3 (22% and 19%) than in group 1 (33%). Further, the rate of good recovery was higher in groups 2 and 3 (61% and 57%) than in group 1 (28%). However, there were no differences between groups 2 and 3 in cerebral vasospasm or in surgical outcome. As a shortcoming of continuous cisternal drainage, the need for shunt operation was higher in groups 2 and 3 than in group 1. 相似文献
34.
The inhibitory effect of the thoracic duct lymph of a patient with lung cancer on the "one-way" mixed lymphocyte reaction without cytoxicity is unequivocally demonstrated. The effect seems to be dose related. A moderate inhibition of mixed lymphocyte reaction is still observed, even if the responding cells are preincubated in the thoracic duct lymph for 1 hr only prior to the addition of stimulating cells. The inhibitory effect of thoracic duct lymph on the mixed lymphocyte reaction is no longer evident when the material is added 1-4 days after the beginning of culture. These observations suggest that the mechanism of the inhibitory effect of thoracic duct lymph may be a simple attachment of inhibitory factors to the receptor sites on the responding lymphocytes, causing interference in cell to cell interaction. The inhibitory effect of thoracic duct lymph collected 1 week after the thoracic duct drainage on mixed lymphocyte reaction is significantly lower than that of thoracic duct lymph collected at the beginning of the procedure. This indicates that the blocking effect of thoracic duct lymph can be easily removed by this technique; which is technically feasible in man. The interrelationship of the tumor-specific blocking factor, thoracic duct drainage, and tumor growth pattern are discussed with respect to the potential usefulness of this procedure as adjuvant immunotherapy in the management of patients with neoplastic diseases. 相似文献
35.
腰穿置管稳压引流治疗蛛网膜下腔出血后脑积水 总被引:1,自引:0,他引:1
目的探讨蛛网膜下腔出血(SAH)后脑积水简便、安全、有效的治疗方法。方法所收治的283例SAH病人中有90例发生了急性脑积水,在内科治疗基础上,其中46例进行了腰穿置管稳压引流治疗结果与无脑积水者对照比较。结果上法治疗后32例(32/46,70%)意识水平均有所改善;所有受治病人12d内再出血和脑缺血的发生率与无脑积水的病人组无显著性差异〔5/46(11%),24/193(12%);16/46(35%)60/193(31%)。P>0.05〕。治疗组未发生脑室炎或脑膜炎。结论腰穿置管稳压引流是一种治疗SAH后脑积水简便、安全、有效的方法。 相似文献
36.
超声心动图对儿童完全性肺静脉异位引流诊断价值的探讨 总被引:2,自引:0,他引:2
目的 旨在评价超声心动图对完全性肺静脉异位引流 (TAPVD)的诊断价值。方法 对 1987年 9月至2 0 0 2年 11月收治的TAPVD患儿 70例进行分析。均有完整的临床及超声心动图资料 ,其中 35例施行了手术治疗。结果 70例TAPVD的解剖分型为 :心内型 5 2例、心上型 16例、心下型 2例 ,未发现混合型。 35例施行手术 ,32例与术前超声心动图的诊断一致 ;3例与超声心动图诊断不完全一致 ,其超声心动图诊断分别为 :三房心伴继发孔房缺、左房隔膜伴继发孔房缺、原发孔房缺伴卵圆孔未闭 ,而手术结果均显示为心内型TAPVD伴继发孔房缺。结论 超声心动图检查是诊断TAPVD重要且准确的方法 ,并能确定其分型 ,提供精确的解剖及血流动力学资料。在应用超声心动图诊断TAPVD时 ,应注意与三房心、左房隔膜等疾病进行鉴别。 相似文献
37.
慢性鼻窦炎手术方法的探讨 总被引:11,自引:0,他引:11
目的:探讨治疗慢性鼻窦炎的手术方法及中鼻甲前端部分切除术在治疗慢性鼻窦炎中的作用。方法:对87例(155侧)慢性鼻窦炎患者,根据其发病原因及病情不同分为3类,采用相应的手术方法进行治疗。结果:第l类43侧,治愈39侧,好转4侧;第2类8l侧,治愈69侧,好转l0侧,无效2侧;第3类3l侧,治愈17侧,好转9侧,无效5侧。总治愈率为80.6%,有效率为95.5%。结论:对慢性鼻窦炎的手术治疗应因病因、病情不同,采用不同的手术方法,中鼻甲前端部分切除术对治疗慢性鼻窦炎具有重要作用。 相似文献
38.
重组人表皮生长因子促进鼻内镜术后术腔上皮化 总被引:1,自引:0,他引:1
目的观察重组人表皮生长因子(rhEGF)对鼻内镜手术后术腔愈合的影响.方法对131例(235侧)施行鼻内镜手术分析的Ⅱ型2期、3期患者,随机分为两组,A组应用rhEGF,B组不用,随访4个月以上比较同期两组的治愈率.结果同期治愈率A组显著优于B组(P<0.05).结论 rhEGF能促进术腔早日上皮化. 相似文献
39.
Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial 总被引:1,自引:0,他引:1
Blood isotone contrast media is considered to be less toxic to vascular and pancreatic duct endothelium than high-osmolar
contrast media. In this study we assessed the impact of a low-osmolar contrast agent compared with a blood isotone product
on pancreatic damage induced by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde sphincterotomy
(EST). In a prospective trial 42 consecutive ERCP/EST patients were randomized to receive either iopromid, a low-osmolar non-ionic
contrast agent (770 mosmol/kg H2O), or iotrolan, a blood-isotone non-ionic product (320 mosmol/kg H2O). The endoscopies were performed by two experienced endoscopists. Forty patients were included in the study. Blood samples
were collected before and 40 min, 2, 4, 6 and 24 h after the endoscopic procedure. Samples were analysed for pancreatic serum
enzymes, acute-phase proteins and blood counts. A clinical pain score was investigated. Post-ERCP pancreatitis was diagnosed
in 2 patients in the iopromid group and in 5 patients in the iotrolan group. There was no significant difference between groups
in the time course of pancreatic serum enzymes, acute-phase proteins or in the pain score. Due to the small number of patients
in this study, only stronger differences caused by the two contrast media could have led to statistically significant results.
We did not observe statistically significant differences in comparing iotrolan and iopromid concerning ERCP/EST-induced pancreatic
damage.
Received: 26 February 1999; Revised: 14 May 1999; Accepted: 9 June 1999 相似文献
40.
上颌窦窦口大小与鼻内镜手术疗效 总被引:2,自引:0,他引:2
目的探讨鼻内镜手术中扩大上颌窦自然窦口大小对手术疗效的影响.方法对我院1995~2002年Ⅱ型鼻窦炎患者行ESS手术扩大上颌窦自然窦口,按大小分为两组.一组为0.5~1.0cm,另一组为>1.0cm.术后随访6~12月.结果窦口0.5~1.0cm治愈率为84.4%;窦口>1.0cm治愈率为71.3%.窦口0.5~1.0cm明显优于窦口>1.0cm,两组间治愈率差异有显著性意义(P<0.01).结论在FESS手术中上颌窦自然窦口不宜过分扩大. 相似文献