ANALYSIS OF BURIED BUMPER SYNDROME AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY DUE TO USE OF A BUTTON‐TYPE KIT

Background: Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Along with the widespread use of the button‐type kit, BBS is encountered frequently. Methods: In the present study, we examined causes and treatments for BBS among 1400 patients who had undergone PEG. Results: The causes of BBS after PEG were classified into two categories: early causes consisted of wound infection, inappropriate size of kit and severe lordosis, while late causes were inappropriate exchange of kit, rough management or weight gain. The treatments for BBS could be determined by the degree of wound infection, fistula and burial of the bumper. Conclusion: We prepared a flowchart for replacement, by which BBS can be managed safely and quickly without surgical or endoscopic intervention.     

Percutaneous nephrolithotomy of a staghorn stone in thoracic ectopic kidney

Congenital thoracic ectopic kidney is a very rare developmental anomaly and the rarest form of all ectopic kidneys. It is usually asymptomatic and discovered incidentally on routine chest radiography. Herein we reported the first case of staghorn stone in a thoracic kidney managed successfully by percutaneous nephrolithotomy.     

钬激光输尿管镜下碎石与经皮肾取石治疗嵌顿性输尿管上段结石的比较

目的比较钬激光输尿管硬镜碎石与经皮肾取石术治疗嵌顿性输尿管上段结石的疗效。方法106例单侧伴有肾积水的嵌顿性输尿管上段结石,48例采用URL治疗（URL组）,58例采用PCNL治疗（PCNL组）,统计分析2组的结石清除率及手术并发症。结果术后1 d结石清除率URL组25.0%（12/48）显著低于PCNL组98.3%（57/58）（χ^2=62.065,P=0.000）;术后3个月结石清除率URL组77.1%（37/48）显著低于PCNL组100%（58/58）（χ^2=14.831,P=0.000）;术后高热（T〉38.5℃）率URL组8.3%（4/48）与PCNL组6.9%（4/58）无统计学差异（χ^2=0.000,P=1.000）。结论对于嵌顿性输尿管上段结石,在有条件且技术成熟的医院PCNL可作为治疗的首选方法。     

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique. Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction of a heat exchanger offer significant benefits and that they are safe and reliable. Received: 23 August 1996 Received after revision: 14 January 1997 Accepted: 27 January 1997     

Percutaneous endoscopic gastrostomy–a user's perspective

Sixteen patients receiving percutaneous endoscopic gastrostomy (PEG) feeding following a period of nasogastric (NG) feeding were investigated to assess acceptance and identify problems by means of a questionnaire. PEG was considered to be superior to NG feeding in terms of tolerance and cosmetic acceptance by 81% and 88% of participants respectively ( P < 0.001). Pain was an infrequent problem. Interruptions to feeding were consideed to be more common with NG feeding by 50% of participants; 38% considered interruptions equally common with both PEG and NG, and 12% considered interruptions more common with PEG feeding ( P = NS). The time for care was equivalent for both methods. Seventy-five percent considered PEG to have made a valuable contribution to enteral feeding. Leakage was however considered to be more frequent in PEG feeding by 81% of participants (compared to 12% who considered leakage to be more common with NG feeding; P < 0.001) and leakage was more frequent at die junctions in the catheter rather than from the stoma. Thirty-one percent of patients with PEG had needed systemic antibiotics for stomal infections. All patients with both PEG and NG feeding needed professional help. Sixty-two percent needed professional help more frequently with PEG than with NG feeding (compared to 19% who considered that the NG tube needed professional help more frequently; P <0.05). We conclude that leakage and infections are major problems in PEG enteral feeding.     

经皮椎体成形术治疗脊柱疾病

目的评价经皮椎体成形术治疗脊柱疾病的临床应用价值.方法 56例多发骨髓瘤、溶骨性脊柱转移瘤、骨质疏松性椎体压缩性骨折患者应用经皮椎体成形术后,分24 h、3个月两阶段评估患者疼痛、术后X线片检查结果、椎体高度等指标.结果术后止痛效果良好,尤以骨质疏松性椎体压缩性骨折患者的止痛效果最好.无严重并发症. 结论经皮椎体成形术对骨质疏松性椎体压缩性骨折等脊柱疾病的止痛、稳固椎体等效果明显,可以谨慎开展.     

雷帕霉素洗脱支架预防冠状动脉再狭窄的研究进展

经皮冠状动脉介入治疗已成为治疗冠心病的重要手段之一，但术后再狭窄仍是介入心脏病学面临的难题。现论述雷帕霉素的一般药理特性和雷帕霉素洗脱支架预防再狭窄的基础研究、临床试验等方面的研究进展。并探讨了可能存在的问题。     

Treatment of iatrogenic biliary obstruction by balloon dilatation of a biliary jejunal fistula

Biliary obstruction and multiple hepatic abscesses occurred in a patient after ligation of a segmental branch of the right hepatic duct. The patient was successfully managed by transhepatic biliary drainage and balloon dilatation of an internal fistula that developed between the ligated duct and a Roux limb of jejunum. Internal biliary fistulas may be dilated using interventioanl radiologic techniques to permit nonobstructed bile flow. Implications for the nonsurgical treatment' of biliary strictures are discussed.     

超声引导下经皮经肝胆管穿刺置管引流在梗阻性黄疸病人中的应用

目的　评价超声引导下经皮经肝穿刺胆管置管引流 (UPTBD)对梗阻性黄疸病人的治疗价值。方法　对 1995年 1月至 2 0 0 2年 7月期间的 4 17例梗阻性黄疸病人进行 4 97次UPTBD治疗 ,并回顾总结他们的临床资料。结果　接受PTBD治疗共有 4 17例 (5 1例病人进行了两个胆管枝的PTBD) ,穿刺成功率达 93.2 % (4 36 / 4 6 8) ,32例首次穿刺失败的病人有 2 9例进行了第二次穿刺置管 ,全部成功。发生胆汁漏 /胆汁性腹膜炎 9例 ,胆道出血 8例 ,感染性休克 1例 ,无腹腔出血、后腹膜血肿、气胸等其他并发症。对 6 4例置管引流患者进行肝功能检测 ,与穿刺前相比 ,引流后 1周和 3周检测病人血清胆红素、转氨酶均显著下降。结论　UPTBD是一项姑息性治疗梗阻性黄疸的快捷、安全、有效的方法     

微创经皮肾镜取石术治疗上尿路结石

目的 探讨微创经皮肾镜取石术治疗上尿路结石的有效性和安全性.方法上尿路结石患者368例,平均年龄57岁.其中输尿管上段结石116例,结石大小(2.1±0.8)cm;肾结石252例,结石大小(4.6±1.4)cm,其中非鹿角形结石190例,结石大小(3.2±1.1)cm,鹿角形结石62例,结石大小(7.6±1.6)cm.均采用微创经皮肾穿刺,输尿管镜下气压弹道或联合钬激光碎石治疗,对结石清除率和并发症等进行统计分析.结果 368例患者中单通道取石356例(96.7%),双通道12例(3.3%).一期取石344例(93.5%),二期取石24例(6.5%).总结石取净率为88.6%(326/368).平均手术时间73 min.一期取净结石者住院时间4～8 d,平均6 d.术后发热14例(3.8%);输血5例(1.4%);2例肾结石术后出血严重者经输血及超选择性肾动脉栓塞后治愈.结论 微创经皮肾镜取石术损伤小、住院时间短、术中出血及并发症少、结石清除率高、可重复取石,是治疗上尿路结石有效的微创手段.