脊髓损伤患者实施间歇导尿指征的研究

目的 探讨脊髓损伤患者拔出尿管、进行间歇导尿的指征.方法 2007年1月-2008年12月收治了脊髓损伤患者33例.按照简单随机的方法 将患者分为实验组和对照组.实验组18例,对照组15例.实验组患者拔出尿管、实施间歇导尿的指征为每日输液量＜500 ml、无压疮、膀胱容量测定＞150 ml.对照组患者拔除尿管、进行间歇导尿的指征为患者尿管测压＞28 cm H2O(1 cm H2O=0.098 kPa).比较2组患者留置尿管时间、留置尿管期间泌尿系统感染率,实施间歇导尿1个月后的膀胱容量、膀胱残余尿量、间歇导尿次数.结果 实验组留置尿管的时间要短于对照组,实验组留置尿管期间的感染率低于对照组;2组患者实施间歇导尿1个月后,实验组患者的膀胱残余尿要少于对照组,间歇导尿次数要少于对照组.结论 在患者每日输液量＜500 ml、无压疮、膀胱容量测定＞150 ml的指征下,拔出尿管、实施间歇导尿,缩短了留置尿管的时间,减少了泌尿系统感染,对患者膀胱功能的恢复有利.     

KTP激光治疗喉癌的远期疗效

目的: 探讨支撑喉镜下KTP激光治疗喉癌的远期疗效。方法: 对108例支撑喉镜下KTP激光手术治疗的喉癌患者,将其资料进行回顾性分析,其中声门型T1a87例,T1b17例,T22例,声门上型T12例。结果: 108例患者中失访7例,随访的101例患者中局部复发3例,转移4例。结论: 激光治疗早期喉癌疗效满意,喉功能保全好;局部复发的病例仍可采取挽救性治疗。     

剖宫产率与剖宫产指征的变化分析

目的总结6年来剖宫产率及剖宫产指征的变化,探讨降低剖宫产率的可行措施。方法回顾性分析6年来剖宫产的临床资料。结果(1)剖宫产率呈逐年上升:2003年为43.2%,相比1998年18.2%上升2.4倍(P<0.01);(2)剖宫产指征中以社会因素最明显(P<0.01),已跃居第2位;(3)胎儿宫内窘迫、妊娠合并症等并发症、臀位为指征的剖宫产增加。结论剖宫产指征已放宽,社会因素的剖宫产显著增加是造成剖宫产率上升的主要原因。降低剖宫产率的关键是严格掌握剖宫产指征,控制因社会因素而致的不必要剖宫产。     

外周静脉留置针不同拔管时机的随机对照研究

目的 比较依据临床指征拔除留置针和常规拔除留置针的效果。 方法 2019年3月—7月,采用多中心随机对照研究,选取12所三级甲等综合医院的3 669例患者作为研究对象,按照随机数字表法分为试验组和对照组,试验组依据临床指征拔除留置针,对照组常规拔除留置针,比较两组的外周静脉留置针留置时间、96 h内各导管相关并发症的发生率和整个留置期间各导管相关并发症（静脉炎、堵管、渗液、怀疑感染）发生的风险,其中静脉炎为主要结局指标,其他并发症为次要结局指标。 结果 共3 642例患者纳入研究,其中试验组1 803例,对照组1 839例。试验组外周静脉留置针留置时间为（85±52） h,对照组留置时间为（71±30） h,两组留置时间比较,差异具有统计学意义（P<0.001）;96 h内,主要结局指标静脉炎的发生率在两组之间的差异无统计学意义（P>0.05）,次要结局指标中除堵管有统计学意义（P=0.005）,其余指标的差异均无统计学意义（P>0.05）;整个留置期间,两组主要结局指标静脉炎发生风险的差异无统计学意义（P>0.05）,次要结局指标中除堵管外,其余指标的差异均无统计学意义（P>0.05）。 结论 依据临床指征更换外周静脉留置针,留置时间更长且不会增加静脉炎、渗液及怀疑感染的发生风险,但堵管的发生风险会增大,如根据临床指征拔管,需加强堵管的监测与评估。     

Cesarean births in Taiwan.

OBJECTIVE: To evaluate the use of cesarean delivery in Taiwan by comparing local clinical indications with those in international cohorts. METHODS: In-patient claims from the National Health Insurance (NHI) in Taiwan were analyzed. Indications for cesarean delivery were evaluated with primary diagnosis codes and procedure codes from the NHI dataset. To produce a stable numerator for cesarean section, 3 years (1998-2000) of claims for cesarean delivery were abstracted and annualized. RESULTS: Rates ranged between 27.3% and 28.7% for primary cesarean delivery and were below 5% for vaginal birth after a cesarean section (VBAC). Compared with rates in other countries, rates for overall and primary cesarean section as well as for VBAC were significantly higher in medical centers in Taiwan (P<0.001). However, the clinics contributed the most to the difference in both overall and primary cesarean rates. The most common indication for cesarean section was prior cesarean section (43.3%-45.5%), followed by malpresentation (19.6%-23.4%). The proportion of fetuses with malpresentation delivered by cesarean section in Taiwan was 7.9%, almost twice the upper limit expected for all pregnancies as indicated in international studies. CONCLUSION: It is important to use appropriately documented data and to compare them with international data when monitoring local obstetric practices. The disproportionately high cesarean delivery rates in Taiwan may hold major lessons for the many countries contemplating or having universal health insurance coverage with a similar mix of providers.     

显微解剖研究乙状窦后-内听道上入路中天幕切开的指征

目的　探讨天幕和周围结构的影像学表现与乙状窦后 内听道上入路中海绵窦后部暴露的相互关系 ,明确天幕切开的的指征。方法　取头颅标本行冠状位CT检查后 ,模拟乙状窦后 内听道上入路开颅 ,记录天幕切开前后天幕裂孔、上斜坡区结构的显露分值 ,统计分析冠状位CT上天幕与周围结构的夹角与该显露分值的相关性。结果　天幕 三叉神经夹角与该显露分值有高度相关性 (相关系数r=0 80 39)。该角度≥ 4 0°时海绵窦后部暴露良好 ,<30°时海绵窦后部显露不佳。结论　冠状位CT显示的天幕 三叉神经夹角≥ 4 0°时 ,一般无需切开天幕即可满意显露海绵窦后部 ;该夹角 <30°时 ,多需切开天幕     

Die Kniegelenksexarticulation bei arteriellen Durchblutungsstörungen der unteren Extremität

Zusammenfassung Bei 35 Patienten mit arteriellen Durchblutungsstörungen der unteren Extremitäten wurde primär oder nach erfolgloser Bypassoperation anstelle einer Oberschenkelamputation eine Exarticulation im Kniegelenk durchgeführt. Davon heilten 24 (67%) primär oder teils sekundär, 11 (31 %) zeigten keine Abheilung des Stumpfes. 4 Wundinfektionen und 7 Nekrosen des stumpfdeckenden Hautsubcutislappens waren die Ursache. Mögliche Einflüsse auf das Ergebnis der Stumpfheilung werden anhand unterschiedlicher Operationstechniken diskutiert. Da die Knieexarticulation der Oberschenkelamputation deutlich überlegen ist, wird aufgrund der hier aufgeführten Untersuchungsergebnisse diese Methode favorisiert.

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Knee disarticulation in arterial occlusive disease of the lower limb

Summary In 35 patients suffering from peripheral ischemic disease of the legs, disarticulation of the knee joint was performed instead of above-knee amputation. Operations were executed primarily or after failed bypass procedures for the salvation of the limb. 24 cases (67%) showed primary or delayed secondary stump healing. In 11 cases (31%), however, no stump healing was achieved due to either a wound infection (4 cases) or a necrosis of the anterior flap covering the weight bearing area of the stump (7 cases). Factors influencing the outcome of stump healing are discussed and different techniques of knee disarticulation are evaluated as to their benefits and disadvantages in ischemic limbs. As the method offers several advantages over above-knee amputation, a more frequent use of knee disarticulation in the surgical treatment of ischemic legs which cannot be preserved by other surgical measures and usually would be amputated at above-knee level is recommended.

     

Probleme und Prinzipien der Hormontherapie des fortgeschrittenen Prostatakarzinoms

Summary The availability of hormones with few side effects has enlarged the indication for their use: In the presence of metastases, primary endocrine treatment which includes orchiectomy as standard therapy is employed with palliative intent. Adjuvant endocrine treatment is given after radical prostatectomy when positive margins or lymph nodes were present. A salvage endocrine treatment is administered if the primary tumor persists after radiotherapy or recurred after prostatectomy. The term diagnostic hormone treatment is misleading and should not be used. A secondary hormone application is supported by the observation that allaged hormone resistant tumor progressed after testosterone injection.The problem of early versus delayed endocrine therapy is unsolved, however, it is conceivable that the latter therapy is confronted with a larger tumor burden. The principle of endocrine treatment is properly described as means suppressing the androgenic stimuli. There are 5 different routes of androgen deprivation, among which the antiandrogens and LH RH analogs have the highest priority. Phase III — studies are under way to clarify their efficacy.

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Abkürzungsverzeichnis DES Diäthylstilboestrol - SHBG Sexual Hormon Bindungsgloblin     

Laparoscopic splenectomy for splenic hamartoma

Advances in imaging techniques have made preoperative diagnosis of splenic tumors possible. A case of successful laparoscopic splenectomy for splenic hamartoma is described here and the indications of this technique are discussed. Received: 12 January 1996/Accepted: 22 March 1996     

经皮球囊二尖瓣成形术适应证合理选择

目的：介绍和探讨经皮球囊二尖瓣成形术适应证合理选择的１０ 年经验。　方法：采用改良ｉｎｏｕ 法对３５０例二尖瓣狭窄患者行ＰＢＭＶ。　结果：ＰＢＭＶ ３４４例,成功率为９８．３％ 。　结论：ＰＢＭＶ适宜于二尖瓣狭窄的治疗。其理想适应证取决于瓣膜条件,且无瓣下损伤。此类患者治疗效果常与外科手术相仿,若能合理选择适应证,ＰＢ－ＭＶ是安全和有效的。