神经源性尿失禁膀胱扩大术后早期并发症

目的：了解神经源性尿失禁回肠膀胱扩大术后早期并发症的发生特点及处理办法。方法：对我科治疗的149例神经源性尿失禁患者住院期间出现的早期术后并发症的特点、治疗方法、治疗结果进行总结分析。结果：主要的早期并发症有腹壁造瘘口尿瘘及术后痿口愈合延迟6例(发生率为4．03％)，泌尿系感染21例(发生率为14．09％)，急性尿潴留19例(发生率为12．75％)，粘连性肠梗阻2例(发生率为1．34％)，经相应的处理后均完全恢复。结论：回肠去黏膜浆肌层补片膀胱扩大术存在一定的手术并发症，经相应治疗后可恢复，此种手术是治疗神经源性尿失禁较为安全有效的治疗方法。     

经尿道前列腺电汽化术后并发症及防治对策(附920例报告)

目的:探讨经尿道前列腺电汽化术(TVP)术后并发症及其防治对策。方法:对920例良性前列腺增生(BPH)患者行TVP,分析术后并发症。结果:术后并发症包括:大出血30例(3.3%),经尿道电切综合征(TURS)6例(0.7%),下尿路感染16例(1.7%),急性附睾炎11例(1.2%),急性尿潴留34例(3.7%),尿失禁35例(3.8%),尿道狭窄26例(2.8%),复发22例(2.4%)。随机选取TVP术前性功能正常的44例患者(51~65岁),术后逆行射精占54.5%(24/44),勃起功能障碍占9.1%(4/44)。结论:TVP是治疗BPH的理想术式,但应注意其并发症。     

颅内动脉瘤破裂急性期的电解可脱式弹簧圈栓塞治疗技巧与并发症

目的总结颅内动脉瘤破裂急性期的电解可脱式弹簧圈(GDC)栓塞治疗操作技巧、并发症及其防治经验。方法1998年10月至2002年10月我科用GDC栓塞治疗破裂急性期颅内动脉瘤41例,动脉瘤大小3.6～25mm;位于Willis环前循环39例,后循环2例。结果术后造影100%栓塞33例,90%～99%栓塞5例,90%以下栓塞3例。产生与栓塞技术相关的并发症6例,与蛛网膜下腔出血相关的并发症5例。平均住院时间12 d;术后随访12～48个月,无再出血,恢复良好36例,中度致残,生活能自理4例,死亡1例。结论GDC栓塞治疗急性期的破裂颅内动脉瘤安全有效。正确处理术中并发症,提高栓塞技术有助于减少术后并发症,提高治愈率。     

体外循环心脏直视手术后再次开胸止血11例分析

对11例患体外循环心内直视手术后再次剖胸止血，2次手术相隔时间为4．5±0．7h，术中发现活动性出血2例，渗血9例；再次手术死亡4例，并就其术后出血原因，再次开胸适应时机，以及开胸前后处理进行了分析。     

减少前列腺癌根治术并发症56例临床报告

目的　探讨改进前列腺癌根治术的手术技巧,减少手术并发症的发生。方法　对 56例前列腺癌患者进行耻骨后前列腺癌根治术。结果　平均手术时间 3小时 40分,术中平均失血量约 460ml,平均输血量 600ml。并发直肠前壁损伤 6例,尿失禁 24例,尿道狭窄 5例。结论　随着手术方法的改进,并发症不断减少,前列腺癌根治术已成为治疗前列腺癌的标准方法和将得到更广泛的开展。     

Analysis of the Effectiveness of In-Office and Transtelephonic Follow-Up in Terms of Pacemaker System Complications

A study was undertaken to determine the most effective method of pacemaker follow-up in terms of the total number of complications detected and yield per follow-up in single and dual chamber pacing systems. The analysis involved 9,786 patient records from 635 patients. The records were reviewed with respect to method of follow-up, number of chambers paced, and complications detected. Complications included: oversensing, undersensing, noncapture, pocket and diaphragmatic stimulation, pacemaker mediated tachycardia, crosstalk, pulse generator malfunction, lead malfunction, infection/erosion, premature end of service, exit block, and other miscellaneous problems. Eight thousand two hundred eighty-eight of the 9,786 follow-ups were performed in the office while 1,498 were transtelephonic. Single chamber pacing systems were implanted in 329 patients and 306 were dual chamber systems. A total of 599 complications were detected. Analysis yielded a per patient complication rate of 5.1 % (single chamber) and 8.4% (dual chamber) for in-office follow-up. This compared to a transtelephonic follow-up per patient complication rate of only 0.3% (single chamber) and 1.0% (dual chamber). In-office pacemaker follow-up is significantly more effective (P < 0.001) than transtelephonic follow-up in detecting both single and dual chamber pacemaker system complications.     

壳多糖预防椎板切除后硬膜周围纤维化与粘连的作用

观察壳多糖在预防椎板切除术后硬膜周围纤维化与粘连的作用效果及其机制。方法：用４８只ＳＤ大鼠制作硬膜外周围宫模型，在损伤的硬膜表面涂布透明质酸钠，自体游离脂肪，壳多糖，生理盐水分别４，８，１２周观察瘢痕形成的情况并测定胶原纤维含量。结果；生理盐水组大鼠瘢痕自第４周就已开始形成，于第８周达高峰，１２周时开始软化，收缩。     

Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging

Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF–s) – simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome. Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization. Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4–46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6–24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed. Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.     

黄蜀葵总黄酮对脑卒中后抑郁模型大鼠行为学及血浆ACTH、CORT浓度的影响

目的探讨黄蜀葵总黄酮(TFA)对脑卒中后抑郁(PSD)大鼠模型行为学及血浆促肾上腺皮质激素(ACTH)和皮质醇(CORT)浓度的影响。方法采用线栓法制备局灶性脑缺血大鼠模型,在此基础上综合孤养、应激处理复合制备PSD大鼠模型。观察TFA对PSD大鼠开野行为和糖水消耗试验等行为学指标变化,采用放射免疫方法检测大鼠血浆ACTH和CORT的水平。结果TFA可增加PSD大鼠的水平与垂直运动得分,增加糖水消耗量,降低血浆ACTH和CORT的水平。结论TFA具有抗PSD作用,其机制可能与其调节PSD大鼠血浆ACTH和CORT的水平有关。     

腹腔镜手术对早期卵巢癌患者疗效及应激反应的影响

目的探讨腹腔镜手术对早期卵巢癌患者疗效及应激反应的影响。方法依据手术方式将140例卵巢癌患者分为观察组和对照组,每组70例,对照组患者接受开腹肿瘤细胞减灭术治疗,观察组患者接受腹腔镜肿瘤细胞减灭术治疗。比较两组患者的手术相关指标、手术前后应激反应指标[皮质醇、促肾上腺皮质激素(ACTH)及肾上腺素]水平、并发症发生情况、随访20个月的短期疗效及肿瘤复发情况。结果观察组患者手术时间、肠道恢复时间、手术切口长度和住院时间均明显短于对照组患者,术中出血量明显低于对照组患者,差异均有统计学意义(P﹤0.01)。术后,两组患者皮质醇、ACTH及肾上腺素水平均高于本组术前,且观察组患者皮质醇、ACTH及肾上腺素水平均低于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者并发症发生率、生存率和复发率比较,差异均无统计学意义(P﹥0.05)。结论腹腔镜肿瘤细胞减灭术治疗早期卵巢癌患者短期疗效较好,且手术创伤小,对患者应激刺激较小,有助于患者的术后恢复。