颅底骨折并发大出血的临床救治20例临床分析

目的探讨颅底骨折并发大出血的临床救治.方法回顾分析我院近三年来,收治20例颅底骨折并发大出血的临床救治结果.结果男16例,女4例;单纯前颅底骨折并大出血7例,前颅底骨折致海绵窦瘘迟发大出血1例,前、中颅底骨折并大出血12例.继发脑脊液漏6例,治愈8例,死亡8例.结论颅底骨折并发大出血病情凶险、致残率、死亡率高,应积极救治.     

标准大骨瓣减压术治疗大面积脑梗死临床体会

目的 探讨标准大骨瓣减压术治疗大面积脑梗死两种不同方法的疗效以及影响其疗效的因素。方法 对大面积脑梗死患者随机分组部分行标准大骨瓣减压颞肌黏覆术，另一部分行标准大骨瓣减压硬膜扩大减张缝合术，术后分析其疗效，并分析GCS评分和梗死面积同患者疗效的关系。结果 35例中是否行颞肌黏覆术对其疗效无明显差别，GCS评分低，梗死面积大的患者疗效差。结论 标准大骨瓣减压术是治疗大面积脑梗死的有效方法，硬膜扩大减张缝合术优于颞肌黏覆术，判断大面积脑梗死术后疗效基本因素为患者术前GCS评分和梗死范围。     

支气管动脉介入治疗严重并发症的防治（附679例报告）

目的：探讨支气管动脉介入治疗术中严重并发症的防治措施。方法：支气管动脉介入治疗679例．其中肺癌596例，大咯血83例，肺癌采用动脉灌注化疗或加明腔海绵栓塞术，大咯血采用明胶海绵动脉栓塞术。术前采用支气管动脉内推注盐酸利多卡因行脊髓功能诱发试验，判断支气管肋间动脉干有无合并根动脉。结果：并发症发生率为1．9％。其中脊髓前动脉损伤致瘫6例，3例治愈，2例好转，1例无效；咯血4例。3例治愈，1例窒息死亡；局部软组织缺血3例，全部治愈。结论：熟悉支气管动脉的正常解剖和变异，掌握正确的治疗方法，术前行利多卡因脊髓功能诱发试验，判断支气管肋间动脉干有无合并根动脉，能有效避免脊髓动脉损伤致瘫痪等严重并发症的发生。     

Early gastric cancer located just above Dieulafoy's ulcer, with massive bleeding

In 2003, a 69-year-old man visited our emergency department because of hematemesis and anemia. Emergency gastroscopy revealed massive bleeding from Dieulafoy's ulcer in the upper body of the stomach. The arterial bleeding was successfully controlled by endoscopic clipping. Blood transfusion and a proton-pump inhibitor were administered and his condition recovered smoothly. Two weeks after the treatment, type IIa early gastric cancer was detected at the previous bleeding point by follow-up endoscopy. He underwent distal gastrectomy with systematic lymph node dissection (D2), and he had no sign of recurrence until 2005. Histopathological examination revealed an early gastric cancer with submucosal invasion located just above the Dieulafoy's disease. The characteristic finding of Dieulafoy's disease was an enlarged and tortuous artery arising from the subserosa, penetrating the muscle layer, and spreading in the submucosa. Abnormal Dieulafoy's artery coexisting with gastric cancer has been reported in only 17 cases until now. Our clinical and pathological findings led us to the following speculation on the pathogenesis in our patient. Repeated regeneration of the mucosal membrane would have been caused by circulatory disturbance in Dieulafoy's vessels. This regeneration and mucosal dysplasia may have been a factor in promoting the gastric cancer. In the previously reported cases of the coexistence of abnormal Dieulafoy's artery and gastric cancer, the initial gastroscopic examination rarely diagnosed the gastric cancer. Thus, follow-up gastroscopy is essential, so as not to miss such coexisting diseases.     

改良微创颅内血肿清除术治疗大量脑出血26例疗效观察

目的：探讨微创颅内血肿清除术应用于治疗高血压大量脑出血的可行性。方法：选择26例微创手术治疗的，和24例小骨窗手术治疗的高血压脑出血病例，从格拉斯哥评分、再出血机率、血肿残留量、颅内感染率、死亡率5个方面进行对比。结果：微创治疗组和小骨窗手术组比较：（1）3天后（X^2=1．872，P=0．171），（2）5天后血肿残留量（t=0．8418，P=0．4051），（3）再出血率（X^2=0．43，P=0．509），（4）颅内感染率（X^2=1．083，P=0.298），（5）死亡率（X^2=0．437，P=0．509），均元统计学意义。结论：改良微创颅内血肿清除术可以应用于大量脑出血的治疗。     

生长抑素联合云南白药治疗急性上消化道大出血

目的:观察生长抑素联合云南白药治疗急性上消化道大出血的临床疗效。方法:选择临床确诊的急性上消化道大出血患者156例,在常规药物治疗的基础上,持续静滴生长抑素(SS)或其类似物奥曲肽(Oct),同时间断口服或胃管内注入云南白药粉,按疗效判定标准判断治疗效果。结果:156例患者中,显效77例(49.36%),平均止血时间为(20±4)h;有效65例(41.67%),平均止血时间为(38±10)h;无效14例(8.97%),总有效率为91.03%,14例无效患者中,9例转急诊手术或内镜治疗,4例死于失血性休克,1例死于大量呕血后窒息。结论:生长抑素联合云南白药治疗急性上消化道大出血,疗效好,安全可靠。     

Remission induced by interferon alfa in a patient with massive osteolysis and extension of lymph-hemangiomatosis: a severe case of Gorham-Stout syndrome

The treatment of massive osteolysis with lymphangioma and/or hemangioma (Gorham-Stout syndrome) has been controversial. The authors report on a patient with multiple massive osteolyses and extensive lymph-hemangiomatosis whose lesions were reduced by interferon alfa therapy.A 2-year-old girl had complained of left chylothorax. Thoracoscopy showed an increase in small lymphatic vessels in the chest wall. The chylothorax was improved by coagulation of the lymphatic vessels. Later, multiple massive osteolyses appeared in the left 11th and 12th ribs, the TH10-L3 vertebrae, and the right femur. There were also hemangiomas in the liver and spleen, a tumor lesion in the left lower chest wall, and hemangiomatous change on the skin surface of the left back. The left lung had only a minimal air content. After OK-432 was injected into the femur and chest wall lesions, the femur lesion disappeared. Then, as right chylothorax appeared, OK-432 was injected into the right pulmonary cavity. The chylothorax disappeared, but pericardial effusion appeared. After steroid pulse therapy, pericardial effusion disappeared. During these treatments, the 7th to 10th ribs disappeared from the x-ray and scoliosis developed. One month later, a cloudy fluid collection in the right lung was found on computed tomography. Interferon alfa and steroid pulse therapy were started. Interferon alfa (1,500,000 units) was subcutaneously administered daily for 2 months and was gradually reduced and maintained at 1,500,000 unit/wk. Steroids were also reduced and maintained at 5 mg/d of predonine. Later, the progress of osteolysis and the extension of lymph-hemangiomatosis stopped. Ten months later, hemangioma in the back disappeared, and the 7th to 10th ribs, which had disappeared, reappeared. The interferon alfa therapy was stopped 14 months after it was administered. The patient's condition has been stable for 10 months since then. At this time, computed tomography shows regression of the hemangiomatous lesion in the back.The authors clinically diagnosed the patient as having Gorham-Stout syndrome with extension of lymph-hemangiomatosis. Interferon alfa with or without steroid therapy should be a choice for patients with extension lesions.     

Massive pulmonary haemorrhage: a cause of sudden unexpected deaths in severely growth retarded infants

ABSTRACT. To determine aetiological factors a seven year review of massive pulmonary haemorrhage (MPH) was performed at the Mercy Maternity Hospital, Melbourne and compared with 26,208 consecutive live births. Statistically significant correlations were found between MPH and prematurity, birth asphyxia, hyaline membrane disease, breech delivery, multiple births, fetal growth retardation, Caesarean delivery, and the presence of a patent ductus arteriosus. MPH was associated with a mortality of 92.6%.
Three severely growth retarded infants with unexpected MPH are presented. These cases indicate that severe intrauterine hypoxia is a major factor predisposing to MPH. Clinicians should be alert for the possibility of MPH in severely growth retarded infants and with vigilance and anticipation a more favourable outcome may be possible.     

胸部手术后胸腔大出血的再手术治疗

目的 讨论胸部术后大出血的诊断与处理、剖胸止血指征、以及出血原因及预防措施。方法与结果 我院自１９８９年～１９９８年进行了各类普胸手术３７３５例，术后胸腔大出血再次剖胸止血治疗１５例，１４例治愈，１例死亡。结论 认为对胸部手术后大出血病人，经观察与保守治疗无效，则尽早手术。而通过出血原因的分析，提出预防措施。同时认为，只要手术中认真操作，遵守操作规程，大多数术后胸腔出血是可以避免的。