胸腔镜与开胸手术治疗胸腺瘤合并重症肌无力的临床疗效对比研究

目的比较胸腔镜与开胸手术治疗胸腺瘤合并重症肌无力的效果。方法将我院收治的60例胸腺瘤合并重症肌无力患者随机分为实验组与对照组各30例。对照组采用常规开胸手术治疗,实验组采用胸腔镜手术治疗,比较两组患者的围术期指标及术后并发症发生情况。结果实验组手术时间与术后住院时间明显短于对照组,术中出血量与术后引流量明显少于对照组(P<0.05)。实验组重症肌无力治疗总有效率为93.33%,明显高于对照组的73.33%(P <0.05)。实验组术后并发症发生率为3.33%,明显低于对照组的20.00%(P <0.05)。结论胸腔镜手术治疗胸腺瘤合并重症肌无力患者具有创伤小、恢复快、疗效好及并发症发生率低等优势,值得推广。     

甘露醇联合吡拉西坦治疗脑出血致脑水肿的疗效及其安全性分析

目的分析甘露醇联合吡拉西坦治疗脑出血致脑水肿患者的疗效及其安全性。方法选择2019年9月-2020年5月在沈阳市第五人民医院接受治疗的脑出血致脑水肿患者118例,按随机数字表法分为观察组和对照组各59例,两组入院后均实施常规治疗,在此基础上对照组予以甘露醇治疗、观察组给予甘露醇联合吡拉西坦治疗,比较两组的疗效、药物安全性,以及治疗前和治疗20d后神经功能和神经肽Y水平。结果观察组总有效率为98.31%,高于对照组的86.44%,差异有统计学意义(P<0.05)。治疗后两组美国国立卫生研究院卒中量表评分及神经肽Y水平均较治疗前下降,且观察组较对照组更低,差异有统计学意义(P<0.05)。观察组不良反应总发生率为8.47%,高于对照组的5.08%,但差异无统计学意义(P>0.05)。结论甘露醇联合吡拉西坦治疗脑出血致脑水肿的疗效较单独应用甘露醇更好,而且能够改善患者神经功能,安全性较高,值得推广。     

低位直肠癌保肛术后低位前切综合征发生的危险因素分析

目的探讨低位直肠癌患者行保肛术后出现低位前切综合征(LARS)的危险因素。方法收集2015年1月-2019年12月在本溪市中心医院行保肛手术治疗的低位直肠癌患者421例,对患者的临床资料进行回顾性分析,并依据患者术后是否发生LARS分为LARS组106例和非LARS组315例、分析LARS发生的危险因素。结果单因素Logistic回归分析显示,年龄,术前放宁、术后恢复时间、坐骨棘间径是LARS发生的危险因素(P<0.05)。多因素Logistic回归分析显示,术前放疗.术后恢复时间、坐骨棘间径是LARS发生的危险因素(P<0.05)。结论对于低位直肠癌行保肛手术治疗患者,术前放疗.术后恢复时间.坐骨棘间径与术后LARS的发生密切相关,对存在上述危险因素的低位直肠癌患者,术前应采取针对性预防措施,或采取其他术式治疗。     

Portomesenteric vein thrombosis following sleeve gastrectomy: Case report focusing on the role of pathogenetic factors

IntroductionSleeve gastrectomy has currently become the most commonly performed bariatric. procedure worldwide according to the last IFSO survey, overtaking gastric bypass with. a share of more than 50% of all primary bariatric-metabolic surgery. Gastric leak, intraluminal bleeding, bleeding from the staple-line and strictures are the most common complications. Portomesenteric vein thrombosis (PMVT)after sleeve gastrectomy is. another complication that has been increasingly reported in case-series in recent.years, although it remains uncommon. In this case report is described an extended portomesenteric vein thrombosis after. sleeve gastrectomy interesting splenic vein too with a favorable course and an. uneventful follow-up. We try to search in this case for pathogenetic factors involved in. this complication.Case reportA 42-year old man, with a body mass index (BMI) of 45 kg/m2, with a medical history of Obstructive Sleep Apnea Sindrome (OSAS) underwent laparoscopic sleeve gastrectomy. Early postoperative course was uneventful. Six days after discharge he complained abdominal pain and was admitted at the Emergency Department. A CT scan with intravenous contrast showed an occlusion of the portal vein, of the intrahepatic major branches and an extension to the superior mesenteric vein and the splenic vein. The patient received heparin and oral anticoagulation together with intravenous hydration and proton pump inhibitors. Considering the favourable course the patient was discharged after six days with long-term oral anticoagulation therapy. Anticoagulation with acenocumarol was continued for six months after a CT scan showed resolution of the PMVT without cavernoma. He had no recurrence of symptoms.DiscussionPorto-mesenteric thrombosis after sleeve gastrectomy is a rare complication but it has been increasingly reported over the last 10 years along with the extensive use of sleeve gastrectomy. Because PMVT is closely associated with sleeve gastrectomy in comparison with other bariatric procedures, we need to investigate what pathogenetic factors are involved in sleeve gastrectomy. Thrombophylic state, prolonged duration of surgery, high levels of pneumoperitoneum, thermal injury of the gastroepiploic vessels during greater curvature dissection, high intragastric pressure, inadequate antithrombotic prophylaxis and delayed mobilization of the patient after surgery have been reported as pathogenetic factors of portmesenteric vein thrombosis. Most of the cases presented in the literature such as our clinical case resolve with medical therapy, although portal vein thrombus extends into the superior mesenteric vein and the splenic vein.ConclusionPortomesenteric venous thrombosis is a rare but serious complication of bariatric surgery, especially associated with sleeve gastrectomy. Diagnosis is based on CT examination with intravenous contrast, and initial therapy is anticoagulation. Etiologic factors reported in the literature include a long duration of surgery, a high degree of pneumoperitoneum, high intragastric pressure after sleeve gastrectomy and thermal injury to the short gastric vessels and gastroepiploic arcade. Limited operative time, controlled values of pneumoperitoneum, careful dissection with energy device of gastric greater curvature, appropriate prophylaxis with low molecular weight heparin may be useful tools to prevent and limit this complication. Nonetheless we have to search which factors may condition the evolution of an extended PMVT as that described in this case towards resolution or to a further worsening clinical state. Early diagnosis? Correct treatment? Undiscovered patientrelated factors?     

高压氧治疗的并发症分析

为分析高压氧治疗的并发症发生原因和处理对策,对125例颅脑外伤、2例颅脑伤、2例脑梗塞、1例一氧化碳中毒及1例麻醉意外患者行高压氧治疗,对治疗中出现的并发症进行分析。结果：129例高压氧治疗的病人中7例出现头痛、头昏等不适反应,其中1例死亡。结果表明：重型颅脑损伤病人行高压氧治疗应慎重,如有不适,应及时中止高压治疗并采取相应措施。     

止消通脉宁对糖尿病微血管合并症患者心功能影响的临床研究

为了探讨中药复方止消通脉宁对有微血管合并症的亚临床期糖尿病心脏病患者心功能的影响 ,我们选择了 63例 2型有微血管合并症的糖尿病患者 ,分为对照组 (2 0例 )和治疗组 (4 3例 ) ,分别使用常规疗法和加用止消通脉宁的治疗方法 ,疗程 4周 ,着重观察心功能、眼底和 2 4h尿白蛋白定量的改变。结果 :止消通脉宁可以明显改善心功能、减少尿白蛋白定量 ,而常规治疗对照组则无明显作用。表明止消通脉宁干预治疗可以改善有微血管合并症的亚临床期糖尿病心脏病患者心功能的异常 ,从而预防和治疗糖尿病心脏病。     

脂肪栓塞综合征治疗体会(附12例报告)

脂肪栓塞综合征（Fat Embolisim Syndrome,简称FES）是骨折早期最严重的并发症之一,临床上常常误诊误治。我院1988年至1998年共收治12例,经积极治疗,11例救治成功,1例抢救无效死亡。本文对FES的发病机制、诊断、治疗、预防等进行了进一步的讨论。     

老年人慢性肺源性心脏病并发低盐综合征临床分析

目的探讨发生慢性肺心病并发低盐综合征的诱因及其防治.方法采用临床回顾方法分析住院肺心病并发低盐综合征患者的临床特点、诊断和防治方法.结果和结论低盐综合征是老年人慢性肺心病常见并发症之一,正确的防治措施可改善本并发症的预后.     

Surgical site infection following surgery for spinal deformity: About 102 patients

IntroductionComplex spinal surgery is known to be at risk of complications. Surgical site infection is a serious complication in spine surgery and its frequency is significantly increased in adult spinal deformity correction. The aim of this study is to identify patients’ characteristics and risk factors of surgical site infection (SSI) following an osteotomy.MethodsThis is a single-center retrospective study of patients who underwent an osteotomy between January 2015 and December 2017. Surgical site infection diagnosis was based upon patient's clinical evidence of infection, biologic parameters, microbiological criteria and/or image findings.ResultsIn total, 102 patients were eligible and 70 were women (68.6%). Mean age was 65 years old (27–83 years) and mean body mass index (BMI) was 26.14 kg.m⁻² (18.4–44.1). Eleven patients were in the SSI group and 91 in the No-SSI group. The mean Schwab grade was 1.5 (1–4) in the SSI group vs. 1.4 (1–5) in the No-SSI group (P = 0.435). The mean operative time was on 201.9 minutes (67–377). Mean length of stay was 20.6 days (10–73) in the SSI group vs. 15 days (5–44) in the No-SSI group (P = 0.041). Favorable outcome was found in 10 patients (90.9%) in the SSI group.ConclusionCorrection surgery for adult spinal deformity with osteotomies carries a high risk of complications specially SSI. Identification of risk factors, prevention and medical management of SSI should be well assessed.