白塞病并发动脉瘤12例的外科治疗体会

目的总结白塞病并发动脉瘤的外科手术和腔内治疗经验。方法对1977年6月至2006年3月收治的12例白塞病患者并发21个动脉瘤进行回顾性分析。腹主动脉瘤3个,升主动脉瘤1个,髂动脉瘤4个,髂动脉吻合口假性动脉瘤1个,股总动脉瘤3个,股浅动脉瘤2个,腘动脉瘤2个,椎动脉瘤1个,锁骨下动脉瘤2个。颈动脉瘤1个和肠系膜上动脉瘤1个。21个动脉瘤中,行外科手术14个,包括动脉瘤切除、人工血管或自体大隐静脉移植术12个,动脉瘤切除、病变动脉结扎术2个;行支架型人工血管腔内修复术6个;1个升主动脉瘤因患者全身情况差,行保守治疗。结果围手术期死亡患者2例,其中1例行外科手术,1例行腔内修复术。术后吻合口假性动脉瘤1例（1个）,其他部位新动脉瘤形成7个,下肢血管移植物闭塞2例,但患肢无明显缺血坏死。6例患者随访3-293个月,随访中位时间28个月,1例死于肺癌。结论白塞病动脉瘤一旦发生,需积极处理。术前、术后积极免疫抑制治疗可降低外科手术和腔内修复术后并发症发生。因术后有吻合口和其他部位假性动脉瘤复发及血管移植物闭塞可能,需长期随访、及时处理。     

乳头溢液的外科治疗（附207例分析）

目的探讨乳头溢液的渗断和治疗方法，为合理的治疗提供科学依据。方法回顾分析手术治疗的207例乳头溢液病例资料。结果（1）在非哺乳期间发生乳头溢液多属病理性溢液；（2）通过美蓝法或平针头指示法行区段切除术，安全准确。结论（1）乳头溢液特别足血性溢液应手术治疗．对早期发现和早期治疗乳腺癌有鼋要的临床意义。（2）乳头溢液伴肿块者，不沧年龄大小、溢液性质均应手术治疗。     

回收式自体输血在儿童先天性髋关节脱位手术中的应用

[目的]探讨儿童先天性髋关节脱位的股骨和骨盆联合手术中洗涤式自体血液回收的应用方法与前景。[方法]2003年8月~2005年12月,17例先天性髋关节脱位股骨和骨盆联合手术中,使用Cell Saver 5血液回收系统行术中的血液回收。观察回输自体血液后的并发症发生情况,记录术中估计失血量、实际回收血量,以及回输血前后的Hb、Hct、P lt、PT、APTT、HR、BP、SPO2等的变化情况。[结果]17例患儿术中血液回收总量2 090 m l,平均每人(171±53)m l。其中4例出现一过性血红蛋白尿,其他无并发症。患者术前和术后24 h的Hb、Hct、HR比较差异有显著性意义(P<0.01);患者术前和术后24 h的P lt、PT、APTT、SPO2、BP比较差异无显著性意义(P>0.05)。[结论]儿童先天性髋关节脱位的股骨和骨盆联合手术中的血液回收是安全、有效的自体输血方式,明显节约异体血的用量,有效避免血液传播性疾病的发生。     

Primary carcinoma of gallbladder in Yazd, Iran: A 14-year study (1992–2006)

Aim: To investigate the clinico‐pathological profile and stage of disease at presentation of patients with carcinoma of the gallbladder diagnosed during 1992–2006 in Iran. Methods: During this study period 34 consecutive patients with gallbladder carcinoma were identified using a pathology‐based tumor database. The data extracted for each study patient included their gender, age at diagnosis, signs and symptoms, presence of gallstones and histopathological pattern of the gallbladder carcinoma and the UICC/AJCC TNM staging system was used for labeling the stages of the disease. Results: The median age of the 34 patients studied was 69.50 with most between 61 and 70 years of age. The age range of the men was between 53 and 80 years with a median age of 71.50 years and that of the women was between 33 and 79 years with a median age of 68.50 years. The most common symptom was pain in the right hypochondrium. More women had gallstones (15/34) than men (3/10). Adenocarcinoma was the most common histopathological type (91.18%) with the commonest subtype being papillary (47.06%). Eighteen patients had stage IB and stage IIA (52.94%) carcinomas whereas stages IIB and III were observed in six (17.6%) and seven cases (20.6%), respectively. Only three cases (8.82%) were seen in stage IV. The follow up of gall bladder carcinoma (GBC) patients in this study ranged from 6 to 60 months. However, there was a progressive reduction of patients attending follow‐up oncology clinic, particularly by those who had stages III and IV of the disease. Conclusion: Most patients (52.94%) presented with early disease (stage IB and IIA) which carries a good prognosis. Early detection of GBC and a national consensus for the evidence‐based management of GBC in Iran should be the major components of a strategy aimed at improving therapeutic outcome.     

损伤性肝外胆管狭窄45例临床分析

目的：分析损伤性肝外胆管狭窄发生的原因和损伤后狭窄的修复术式选择。方法：损伤性肝外胆管狭窄45例，诊断方法以B超，PTC、ERCP为主，全组分别行胆管空肠吻合术，胆管十二指肠吻合术，肝门胆管整形术等手术治疗。结果：随访36例，末次手术行胆管空肠吻合术33例，优良87.9%。结论：可见性损伤和隐性损伤所致的瘢痕收缩是胆道狭窄的主要原因，损伤性肝外胆管狭窄的治疗方法以胆管空肠Y形吻合术较为理想。     

老年重症急性胰腺炎手术治疗探讨

目的：讨论老年重症急性胰腺炎的手术治疗。方法：我院1984年1月－2000年10月共收治60岁以上手术证实的重症急性胰腺炎26例，本对其手术治疗的方法和时机以及相应的并发症和死亡率进行回顾性分析。结果：本组术后死亡6例，其中4例死于MOF，2例死于ARDS。在发病24小时内手术8例中无1例死亡，24－36小时内手术14例有2例死亡，36小时后手术4例均死亡。结论：老年重症胰腺炎患多伴有心、肺、肾等重要器官慢性疾病，脏器代偿功能差，较易出现MOF，因此如有手术指证或经短期非手术治疗效果不明显，应及时手术，并在术中和术后采用合理的治疗措施，有利于减少术后并发症，降低手术死亡率。     

The effect of prior back surgery on surgical outcome in patients operated on for lumbar spinal stenosis a matched-pair study

Summary It has been widely observed that the outcome after repeat lumbar surgery is rarely comparable to that of primary surgery. In particular, the results of repeat surgery for lumbar spinal stenosis (LSS) have not been favourable. We used a matched-pair format in an attempt to decrease the confounding factors so as to determine as exactly as possible the effect of prior back surgery on the LSS patients surgical outcome. The matching criteria were sex, age, myelographic findings, major symptom, and duration of symptoms. From one group of 251 patients without prior back surgery (SO patients) and another of fifty-three patients with one preceding back operation (RS patients), forty-one similar matched patients pairs (one SO and one RS-patient) were formed.There were 8 female and 33 male pairs. The mean age of the SO patients was 51.6 and of the RS patient 51.4 years, and the mean follow-up time was 4.6 and 4.4 years. The assessment of outcome was based on a subjective disability questionnaire. The SO patients fared significantly better than the RS patients (32.1 versus 41.3, P = 0.026). A short time interval between operations in the RS patients had a worsening effect on outcome, but this trend was not significant.We concluded that one preceding back operation had a worsening effect on the outcome of patients operated on for LSS. As a whole, the results of RS patients were unfavourable. The proper time for achieving good surgical results in LSS patients is the initial operation.     

应用抗凝剂的心脏瓣膜置换患者接受胆道手术的术前处理

目的总结瓣膜置换患者行胆道手术的术前用药方法。方法对38例瓣膜置换后在服用华法令过程中因胆道疾病需行择期手术治疗的患者随机分为2组,肝功能正常组(A组)23例、肝功能不正常组(B组)15例均于术前3d停服华法令,B组术前12h肌注VitK110mg。术前无应用华法令历史的患者115例做为对照组。结果38例患者停药2d后A组血浆凝血酶原时间与对照组差异无显著意义,B组于术前12h肌注VitK110mg后,血浆凝血酶原时间与对照组相比差异也无显著性意义。结论瓣膜置换患者在抗凝期间行胆道手术,只要准备充分,围手术期是安全的。     

年轻人腹主动脉瘤九例临床分析

目的探讨年轻人腹主动脉瘤(AAA)的临床特征、治疗和预后。方法回顾性分析244例AAA中9例(37%)年龄小于35岁的年轻患者的诊治经过。结果本组男7例,女2例,年龄21～35岁,临床表现腹部或腰背部痛、腹部搏动性肿物。瘤体直径(65±09)cm。4例行择期手术均成功,3例急诊手术1例成功,2例入院后未能手术治疗者均死亡。结论年轻人的AAA有病程短、瘤体较大且较多累及腹主动脉近端,症状重的特点,应尽早手术治疗。