Percutaneous endoscopic lumbar discectomy (PELD)

Percutaneous endoscopic lumbar discectomy (PELD) is a new technique for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. The technique was introduced in Germany by the authors in April 1987. The method is indicated in patients with non-equestrated lumbar disc herniation with an intact lorsal longitudinal ligament. In local anesthesia, a working cannula (OD 5 mm) is placed at the dorsal lateral border of the disc. The disc space is opened with anulus trephines and the nucleus pulposus is removed with rigid and flexible forceps as well as with automated shaver systems under intermittent endoscopic control (discoscopy). The procedure is performed in local anesthesia. The results of the first thirty patients with a follow-up time between 6 months and 17 months could be graded as excellent in 13 cases, as good in 9 cases, as fair in 6 cases, and as bad in 2 cases. The relief of symptoms as judged by the patients was between 70–100 percent in the majority of the cases. Three patients had to be reoperated at the same level and site, because of either persistent or recurrent sciatica. The performance in local anesthesia, the atraumatic extraspinal approach, the reduced time of hospitalization and post-operative morbidity as well as the reduced time of work incapability are the main advantages of this new method.     

标准通道经皮肾镜取石术治疗孤立肾肾结石的长期安全性和有效性

目的: 探讨超声引导下标准通道经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗孤立肾肾结石患者的长期有效性和安全性。方法: 回顾性分析2008年9月至2014年6月于北京大学人民医院行PCNL治疗的22例孤立肾肾结石患者临床资料以及5年以上随访资料,记录围手术期相关指标、术后无石率(stone free rate,SFR)及并发症发生率,采用超声检查评估远期结石复发率,通过血肌酐及估计肾小球滤过率(estimated glomerular filtration rate, eGFR)评估肾功能情况。结果: 本组22例患者中,平均年龄为(50.3±11.8)岁,10例解剖性孤立肾,12例功能性孤立肾,中位结石直径为1.65(1.1~3.9) cm,全部为多发结石,包括7例鹿角形结石。术前的中位血肌酐为104.5(60.0~460.0) μmol/L,平均eGFR为(60.3±29.4) mL/min。平均手术时间为(88.2±42.0) min,各有11例单通道和双通道PCNL。术后第一天的中位血肌酐为102.0(63.0~364.0) μmol/L,平均eGFR为(58.0±25.1) mL/min,与术前相比差异均无统计学意义。术后平均住院时间为(8.7±5.2) d。本组有5例(22.7%)患者出现短期并发症,其中4例患者同时出现术后感染和大量出血,保守治疗后好转,1例患者出现胸膜损伤,行胸腔闭式引流后好转; 2例(9.1%)患者出现长期并发症,术后3个月发生输尿管狭窄,行球囊扩张术后好转;其余15例(68.2%)患者均未见并发症。中位随访时间为6.2(4.7~11.1)年,最近一次随访的中位血肌酐为104.0 (72.4~377.0) μmol/L,平均eGFR为(60.1±23.7) mL/min,与术前相比差异均无统计学意义,6例(27.3%)患者出现肾功能减退。术后初始和最终SFR分别为72.7%和100%; 6.2年的随访时间内9例(40.9%)患者结石复发,复发后共进行13次取石手术,最近一次随访的SFR为63.6%。结论: 本研究目前是国内外已有报道中关于孤立肾肾结石患者PCNL术后随访时间最长的研究,超声引导下标准通道PCNL治疗孤立肾肾结石是安全有效的,可以达到理想的SFR。长期随访结果表明仍有较高的结石复发率,但术后患者远期肾功能稳定,部分患者出现轻度肾功能减退。     

经皮腰椎间盘切除术治疗复发性腰椎间盘突出症

目的：总结经皮腰椎间盘切除术治疗传统后路术后复发性腰椎间盘突出症的经验。方法：分析１９９５年１月至１９９８年１２月采用经皮腰间盘切除术治疗１９例复发性腰椎间盘突出症的临床资料。结果：穿刺成功率１００％,术后随访１０～３２月,平,平均２１月,优１１例、良５例,可２例,差１例,优良率８４．２％。结论：在具有再次开放手术适应症的复发性腰椎间盘突出症中,初次手术行单节段半椎板、全椎板切除和开窗术者中一侧单     

The treatment of spondylotic cervical myelopathy by ventral discectomy. Long term results on 121 patients

The pathophysiology of spondylotic cervical myeolopathy is still a matter of discussion. This paper presents a series of 126 patients operated on using a ventral approach. In 47% of the patients only a spondylotic narrowing of the spinal canal was present and in 35% an additional disc herniation was found. In 13% of the cases however a soft disc without spondylotic spures was found and in 5% a dislocation of vertebral bodies. We found a marked male preponderance of 77%, mean age was 51.6 years, ranging from 25–50 years. Most patients were operated on at the levels of C4/5 and C5/6. Observation time covered a period of 3–10 years. The outcome was rated relatively to the preoperative degree of disablement using a questionnaire for the patients and their family doctors. We found a marked difference in the answers, especially in rating deterioration, which was stated by patients in 34%, by physicians only in 12%. Another finding was the time-related out-come. We found best results with 75% improvement and 5% deterioration between 3–6 months postoperatively, with increasing time the results decreased to 33% improvement, 33% identical statys and in 33% a deterioration related to the preoperative status must be noted.     

部分手术类项目标准成本分析

对6个手术类医疗服务项目进行了标准成本测算,分析了其成本构成,并与全国的实际成本平均水平进行了比较。建议政府以标准成本作为调整医疗服务价格的依据,同时,建议医院在加强手术室成本管理时应着重加强医用材料的管理。     

2616例肠癌死亡率分析及预防对策探讨

通过对成都市七区两县监测点中２６１６例肠癌死亡率的统计学分析,总死亡率为７．００／１０万,标化死亡率为６．６７／１０万（其中,大肠癌死亡１６７４例,占肠癌死亡例数构成比６４％,其总死亡率４．８８／１０万,标化死亡率４．２７／１０万）,均呈逐年上升趋势。男性死亡率７．６７／１０万,标化死亡率７．２９／１０万,女性死亡率６．２９／１０万,标化死亡率６．００／１０万,男性明显高于女性（Ｐ＜０．０１）;城区死亡率９．３０／１０万,郊（区）县死亡率４．９４／１０万,二者有显著性差异,城区高于郊（区）县（Ｐ＜０．０１）;在２６１６例肠癌死亡例数中,工人、农民、干部、离退休人员占８２．６５％,且以４５岁以上的男性居多。     

Smoking behaviour and compensation: a review of the literature

Rationale: Compensation or compensatory smoking, accurately defined, deals with the question of whether switching to cigarette brands with different smoke yields is associated with a change in smoke uptake proportional to the change in machine-derived yields. The issue of compensation is important because it bears on whether switching to ”lighter” brands means lower overall smoke intake or not. Objectives: The present review investigated whether and to what extend low yield cigarettes are smoked more intensively. In addition, published data on whether nicotine, ”tar”, or any other smoke constituent or property influence compensational smoking are summarized. Methods: The studies on compensation were classified as follows: (1) studies on smoking behaviour in relation to cigarette yields (with and without brand switching); (2) studies on compensation for nicotine (switching between cigarettes which differ ”only” in their nicotine yield, nicotine supplementation, manipulation of renal nicotine excretion, administration of nicotine agonists or antagonists); (3) studies on compensation for other factors (influence of tar, taste, irritation, draw resistance). In order to quantify the degree of compensation, an index is defined and applied to selected brand switching studies. This compensation index determines, in relative units, the degree to which a smoker responds to a change in smoke yields with a change in smoke uptake measured by suitable biomarkers. The role of vent blocking is also briefly discussed. Results: Most of the studies which compare the smoking behaviour when smoking cigarettes with different smoke yields supply evidence for ”partial” compensation, suggesting that cigarettes with lower yields are smoked more intensively than those with higher yields. These studies also show that a change in the daily number of cigarettes is not a common mechanism of compensation. Effective vent blocking during smoking is a rare event and can therefore also be regarded as an uncommon mechanism of compensation. Evaluation of a suitable subset of brand-switching studies revealed an average compensation of 50–60% of the nicotine yield. Compensation tended to be more complete when changing to cigarettes with higher yields than when changing to cigarettes with lower yields. In general, brand-switching studies do not supply information on the underlying causal factors responsible for compensatory smoking. Results of the nicotine supplementation studies are not conclusive: some report evidence of nicotine titration, others do not. A general problem with this type of investigation is that continuous nicotine application does not mimic the spike-wise application with cigarette smoking, and may lead to nicotine tolerance. There is limited evidence that cigarettes were smoked more intensively when the urinary clearance of nicotine was increased. A small number of studies provide some evidence that smoking intensity increased after smokers were administered a nicotine antagonist. Several reports indicate that tar, taste and sensory properties of the smoke as well as the draw resistance of the cigarette may play a role in compensatory smoking. Low-yield cigarettes usually have reduced pressure drops which smoke researchers have suggested leads to increased puff volume. This effect seems to be independent of the smoke yield of the cigarette. There is also some evidence that some smokers maintain a consistent pattern of smoking which works independent of any changes in nicotine or tar yields, taste or design features of the cigarette (”functional autonomy”). Conclusions: The available data suggest that smokers partially compensate for a different smoke yield. While the factors and their interaction responsible for compensational smoking are not fully understood, there are data suggesting that a subgroup of smokers may partially compensate for nicotine. Even in this subgroup of smokers, however, the relative importance of the pharmacological versus the sensory effects of nicotine in smoke remains to be determined. Received: 4 January 1999 / Final version: 22 March 1999     

急性脑肿胀去大骨瓣减压术后迟发性血肿

目的探讨外伤后急性脑肿胀去大骨瓣减压术后迟发性血肿的发病机制及临床表现，以提高该类病人的手术疗效。方法回顾性分析28例急性脑肿胀去大骨瓣减压术后迟发性颅内血肿病人的临床表现。结果外伤后急性脑肿胀去大骨瓣术后迟发性血肿的发生率为19．56％，术区继发硬膜外血肿10．87％。死亡率为32．12％。结论急性脑肿胀去大骨瓣术后迟发性血肿的发生率较高，多见于脑肿胀缓解病例，对术中出现的急性脑膨出和术后病情恶化应考虑到迟发性血肿的可能，早期的诊断是提高疗效的关键。     

MRI-Findings After Uncomplicated Anterior Cervical Discectomy

Summary ? Background. The anterior approach for cervical discectomy with methacrylate-implant involves manipulations on vertebral bodies and ligaments. Foreign materials like methacrylate and fibrin sponge are inserted. On postoperative MRI it may be difficult to differentiate pathological from “normal” findings caused by routine manipulations.  Method. In this study 14 patients free of symptoms after anterior discectomy with methacrylate-implant were examined clinically and a MRI was performed on the 7th day after surgery and again after a 6 month follow-up. All patients had an uneventful recovery and no signs of inflammation after surgery.  Findings. Independent of the underlying pathology (e.g. soft or hard disc) 73% of the patients had a signal reduction within the vertebral bodies adjacent to the operated disc on T1-weighted spin-echo images on the 7th postoperative day. Signal intensities were normal after 6 months in all patients. Remarkable metal artifacts were present in one patient only. The methacrylate-implant could be identified as a hypo-intense structure on all sequences at any time without artifacts. In 80% of the cases a hyperintensity was found on T2-weighted images between the methacrylate-implant and the dura on the 7^th postoperative day. A protrusion of the posterior ligament was present at the level of the operated disc on day 7 after surgery, which had resolved completely 6 months later. This may mimic residual disc tissue or osteophytes early after surgery.  Interpretation. It is very important to know this “normal” postoperative appearance of the cervical spine in order to avoid misinterpretations.     

评价家用水质处理器标准化试验装置的研制

目的 研制评价家用水质处理器卫生安全性与功能性的标准化试验装置。方法 设计并研制由纯水制造系统、配水系统与家用水质处理器的通水系统组成试验装置。结果 该装置配制的通水试验用水均匀、稳定，可满足设计要求，整套试验装置设计合理、操作简便、可连续运行。结论 本实验装置可为家用水质处理器卫生安全性与功能性评价方法的标准化提供依据。