肝移植的研究进展

世界范围内,肝疾病是危害人类健康的主要疾病之一,虽然有多种方法可以治疗各种肝病,但外科手术仍是治疗各种肝病的主要手段之一,肝脏外科从始至今,不断发展,尤其近30年来有着突飞猛进地发展,而在其所有的重大进展中,肝移植的出现对肝脏外科产生的影响最为广泛和深远。仅就肝移植方面的现状及研究进展简要综述。     

高血压脑出血术后疗效与手术适应证的关系

目的回顾性分析我院在2002-05～2007-05间，采用手术治疗的108例高血压脑出血病人的临床经验。以评估诸多因素对疗效的影响。方法对患者的年龄、血压、意识水平、瞳孔大小、出血部位、出血量、中线移位、肢体活动、出血破入脑室情况以及出血至手术时间等因素分析，以确定对预后有价值的变量因素。结果在单因素分析的基础上，通过多变量Logistic回归方法分析表明：意识水平、瞳孔大小、出血部位、出血量及出血破入脑室情况等因素，对预后最有价值。本组病例存活76例，死亡32例，死亡率29．6％。结论掌握手术适应证，选择适当的手术方式是提高高血压脑出血治疗效果和降低死亡率的关键。     

经皮穿刺颈椎间盘切除术治疗早期颈椎病的临床分析

目的 :探讨经皮穿刺颈椎间盘切除术 (PCD)治疗由颈椎间盘突出引起的早期颈椎病的适应证以及对颈椎稳定性的影响。方法 :把 16 8例PCD病例对比研究 ,根据X光片 (包括动力侧位片 )、CT或MRI抽选为Ιa、Ⅱa两组 (可重复 )及其对照组Ιb、Ⅱb。Ιa组 6 0例 :伴有颈椎骨质增生的颈椎病病例。相同例数单纯颈椎间盘膨出或突出病例为Ιa组的对照组Ιb ;Ⅱa组 5 6例 :相邻颈椎椎体成角 >110及位移 >2mm的颈椎病病例。相同例数测量阴性的颈椎病为B组的对照组Ⅱb。术后随访 6个月～ 7年临床分析。结果 :术后优良率 :Ιa组只有 5 6 .7% ,而Ιb组 93.3%。两组之间差别有显著性 (P <0 .0 5 )。Ⅱa组 83.9% ,术后颈椎失稳程度无加重 ,Ⅱb组 87.5 % ,两组之间差别无显著性 (P >0 .5 )。结论 :只要掌握好手术指征 ,PCD对于早期颈椎病是一种具有临床价值的治疗方法 ,且不影响颈椎的稳定性 ,颈椎失稳对PCD的疗效无影响。     

Indication for surgery of spinal metastases within the cervical region

A 40-year-old female patient developed a nearly complete tetraparesis within two weeks. Neurological examination showed nearly complete tetraparesis, complete sensory impairment from the level of C4 and hyperreflexia of tendon jerks. Radiological examination showed a space occupying lesion with an extraspinal extension. Operative decompression was carried out and the patient recovered completely within 3 months.     

Indications and contra-indications for perforation keratoplasty

Thirty years' experience with perforating keratoplasty has shown us new indications for this technique, but certainly also new contra-indications.At first the prognosis of perforating keratoplasty improved because of better surgical techniques, so that the number of indications increased.Recently a better prognosis for heavily vascularized eyes has become possible thanks to HLA-matched donor material.     

The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity

INTRODUCTION: There is little outcome data on functional results after non-operative treatment of greater tuberosity fractures, and no clear evidence in minimally displaced (1-5 mm) fractures of the greater tuberosity showing that the results of non-operative treatments are good enough. This study assesses the relationship between degree of displacement in non-operatively treated patients and shoulder function. MATERIALS AND METHODS: We evaluated the radiographs and function in 135 patients after non-operative treatment of minimally displaced (1-5 mm) fractures of the greater tuberosity at a mean time of 3.7 years (2-20 years) after injury. Shoulder function was assessed using the Vienna Shoulder Score (VSS), the Constant Score (CS) and the UCLA-Score. RESULTS: 97% of the evaluated patients had good or excellent results. Patients with a displacement of more than 3 mm had slightly worse results compared to those with less displacement, but this was not statistically significant. Female patients had significantly better results than male patients, and patients in the eighth and ninth decade had significantly worse results compared to younger patients. CONCLUSION: We recommend non-operative treatment in all patients with minimally displaced fractures of the greater tuberosity, as most obtain very good results. The best results followed treatment with Gilchrist bandages or Mitella slings for 3 weeks, followed by intensive rehabilitation.     

Acute Total Hip Replacement for Displaced Acetabular Fractures in Older Patients

Abstract Background: Primary total hip arthroplasty (THA) has been suggested for old patients with acetabular fractures, because it permits immediate full weight bearing and precludes secondary surgery for posttraumatic osteoarthritis. Patients and Methods: The authors retrospectively analyze the outcome after 35 primary THAs performed between 1982 and 2001 focusing on complications, functional impairment and pain. Results: 19 patients were available for a follow-up after a median of 6 years. Seven patients had died and nine were lost to follow-up. Among those available for follow-up, four were severely handicapped or required regular analgesic medication. By contrast, four were able to work regular hours or to engage in sports activities. Eight patients had undergone various revision procedures. Conclusion: Primary THA is an option for the treatment of acetabular fractures in aged or chronically ill patients as well as for individuals with concomitant osteoarthritis at the time of fracture. However, complications are not infrequent and a solid buttress achieved, e. g., by a roof reinforcement ring (hemispherical plate) is considered crucial for a successful outcome.     

Liver transplantation for hepatocellular cancer: should the current indication criteria be changed?

Liver transplantation (LTx) is the best treatment for hepatocellular carcinoma (HCC), but should be offered only to selected patients. The usual procedure is to transplant only for small and unilobular tumors. The aim of this paper is to verify whether the actual indication criteria are still justified. The details of 121 patients with HCC who were submitted to LTx from 1985 to 2000 were analyzed. Age, gender, liver disease, Child class, alpha-fetoprotein (AFP) level, presence of tumor capsule, vascular invasion, size and number of nodules, histological grade, and pTNM were considered. The 5- and 10-year actuarial survival rates were 61.7% and 53.1%. Freedom from recurrence was 85.9% and 85.9%, respectively. At univariate analysis, size, presence of capsule, AFP levels, vascular invasion, grade, pTNM, transarterial chemoembolization (TACE), Child class, and age were all significantly related to survival and/or cancer recurrence. Presence of capsule, AFP levels, and viral cirrhosis were independent variables in Cox's analysis for survival, whereas histological grade, AFP levels, and vascular invasion were significant independent variables for recurrence. In conclusion, a strict selection should be made to optimize graft allocation while size and multifocality should probably no longer be considered a contraindication for LTx. Histological grade, AFP levels, and vascular invasion, as indicator of tumor behavior, more likely reflect the risk of recurrence.     

手卫生研究进展

综述了医务人员手卫生的重要意义以及手卫生的历史发展。阐述近年来医务人员洗手现状，以及手卫生依从性、洗手指征、手卫生的改进和发展等方面，国内外手卫生的研究现状和进展。     

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。