高血压性基底节区出血引流术后颅内感染的危险因素

目的 探讨高血压性基底节区出血引流术后发生颅内感染的危险因素。方法 回顾性分析2015年5月~2020年4月引流术治疗的481例高血压性基底节区出血的临床资料。结果 481例中,术后发生颅内感染28例,发生率为5.8%;治愈24例,治愈率85.7%。28例颅内感染中,培养出致病菌26例,其中革兰阳性菌16例（61.5%）,革兰阴性菌10例。多因素logistic回归分析显示年龄≥60岁、白蛋白水平<35 g/L、术前GCS评分≤8分、置管时间>3 d、鞘内注射>6次、引流管口漏是术后颅内感染的独立危险因素（P<0.05）。结论 高血压性脑出血引流术后颅内感染是受多种原因影响的,预防为主,防治结合,以降低术后颅内感染发生率及病死率。     

颅脑术后创腔张力性积液的诊治分析

目的 探讨颅脑术后创腔张力性积液的临床特点、治疗方法及预后。方法 回顾性分析2019年8月至2021年10月收治的10例颅脑术后创腔张力性积液的临床资料。结果 10例中,星形细胞瘤5例,胶质母细胞瘤2例,中枢神经细胞瘤1例,转移性肺癌1例,脑脓肿1例。3例行开颅积液清除术,7例行钻孔引流术。10例术后症状明显改善。出院时GOS评分5分6例,4分2例,3分2例。术后随访3个月,创腔完全消失3例,缩小失去张力7例。结论 创腔张力性积液是颅脑术后少见的并发症,以脑肿瘤术后多见;一旦发现创腔张力性积液,及时行钻孔引流术,可取得较好的预后。     

慢性硬膜下血肿术后早发性癫痫的影响因素

目的 探讨钻孔引流治疗慢性硬膜下血肿术后早发性癫痫的影响因素。方法 分析2011年1月—2020年1月在龙岩市第二医院和嘉兴市第一医院采用钻孔引流治疗的230例慢性硬膜下血肿患者的临床资料,分析性别、血肿量、血肿厚度、单双侧出血、术前MGS-GCS评分、电解质异常、术后24 h血肿清除率、术后是否颅内积气和是否使用预防性抗癫痫药物与术后早发性癫痫的相关性。结果 230例患者中术后13例发生早发性癫痫,术后早发性癫痫的发生率为5.7%。多因素Logistic回归分析显示术后24 h血肿清除率≥60%（95%CI：1.009~1.092）、未使用预防性抗癫痫药物（95%CI：0.033~0.575）和颅内积气（95%CI：2.113~26.744）与早发性癫痫相关（P＜0.05）。结论 钻孔引流治疗慢性硬膜下血肿术后早发性癫痫的发生与术后24 h血肿清除率和颅内积气相关,预防性使用抗癫痫药物能预防早发性癫痫。 [国际神经病学神经外科学杂志, 2022, 49(3): 21-25.]     

¿Es segura y eficaz la colecistostomía percutánea en la colecistitis aguda? Análisis de los efectos adversos asociados a la técnica

IntroductionThe main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure.Material and methodObservational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy.ResultsOf 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%).ConclusionWe consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.     

Percutaneous gallbladder drainage as a bridge to concomitant coronary artery bypass grafting and laparoscopic cholecystectomy

A 74-year-old woman with left main and three-vessel coronary artery disease was scheduled for off-pump coronary artery bypass grafting and developed acute severe cholecystitis preoperatively. Percutaneous gallbladder drainage was placed to achieve gallbladder decompression and infection control. Two weeks later, CABG and laparoscopic cholecystectomy were successfully performed at the same time.     

Abnormal lipid metabolism induced apoptosis of spermatogenic cells by increasing testicular HSP60 protein expression

Long-term consumption of high-fat and high-calorie foods not only causes obesity, but also may cause a decline in sperm quality in men. Rats with abnormal lipid metabolism (high-fat rats) were established by high-fat diet for 24 weeks. HE staining was used to observe the morphological changes of testis in rats, TUNEL and flow cytometer was used to detect the cell apoptosis in rat testis and in vitro. Immunohistochemistry and Western blotting were used to detect the expression of protein. After 24 weeks of high-fat food feeding, the body weight, serum lipids and number of apoptotic spermatogenic cells in the high-fat group rat were significantly higher than those in the control group. In vivo, the expression of HSP60 protein in testis of high-fat rats was positive related to apoptosis of spermatogenic cells, cleaved caspase 3/caspase 3 protein expression and Bax/Bcl2 protein expression in testis of high-fat rats. Proportion of apoptotic spermatogenic cells was increased by up-regulation of HSP60 protein expression in vitro. Long-term consumption of high-fat diets can cause high expression of HSP60 and spermatogenic cells apoptosis in rats, while HSP60 over-expression promotes spermatogenic cell apoptosis and MAPK signal pathway in vitro.     

经皮穿刺置管引流在重症急性胰腺炎治疗中应用时机的选择对患者预后影响

目的本研究旨在评估经皮穿刺置管引流(percutaneous catheter drainage,PCD)在重症急性胰腺炎(severe acute pancreatitis,SAP)治疗中应用时机的选择对患者结局和并发症方面的影响。方法回顾性分析2018年1月1日至2018年12月31日德阳市人民医院胰腺中心收治的75例接受PCD治疗的SAP患者的临床资料,研究患者的临床表现、PCD应用时期及其疗效。结果75例SAP患者中液体聚集期(ANC期)51例(68%),包裹坏死形成期(WON期)24例(32%),死亡0例(0%),治愈70例(93.3%),5例(6.7%)行进一步外科治疗。两期的平均PCD放置持续时间、并发症发病率(胰瘘、导管阻塞或脱落、出血)差异无统计学意义(P>0.05)。结论PCD在SAP不同阶段(ANC期和WON期)的应用不影响其安全性和疗效,延迟使用并不能取得较好的疗效。