十二指肠憩室溃疡并下腔静脉瘘致反复消化道大出血、脓毒血症1例报道

十二指肠下腔静脉瘘是一种十分罕见的病变,患者多病情危重,短时间内诊断困难,死亡率极高。而十二指肠憩室多数并无明显症状,仅少数患者可出现梗阻、穿孔、出血等并发症。现就我院救治的十二指肠憩室溃疡并下腔静脉瘘致反复消化道大出血、脓毒血症1例进行报道。     

Fistule pyéloveineuse révélée par des accidents thromboemboliques après hystérectomie d’hémostase

We report the case of a 51-year old woman presenting pyelovenous fistula revealed by recurrent and serious thromboembolic events after ureteral ligation during emergency peripartum hysterectomy. Imaging reported a complete left ureteral obstruction, a fistula between the upper calix and the left renal vein and a renal function preserved. Uretero-vesical reimplantation was performed. The patient was well doing after 12 months. The authors wonder if pyelovenous fistula is responsible for prothrombotic state and maintaining renal function.     

Clean intermittent catheterization rates after initial and subsequent treatments with onabotulinumtoxinA for non-neurogenic overactive bladder in real-world clinical settings

Objective: Previous randomized controlled trials have reported a 6.1–6.9% incidence of clean intermittent catheterization (CIC) following treatment with onabotulinumtoxinA in non-neurogenic overactive bladder (OAB) patients who were inadequately managed by ≥1 anticholinergic. A multi-center retrospective chart review assessed the real-world rate of voiding dysfunction requiring catheterization.

Methods: Patients received onabotulinumtoxinA 100?U (approved dose) administered by experienced injectors between January 2013 and June 2015. Patients using CIC or an indwelling catheter for ≥24?hours for voiding dysfunction prior to onabotulinumtoxinA injections were excluded. The primary outcome was post-treatment CIC (lasting >24?hours; per individual physician’s clinical judgment considering patient’s voiding symptoms, post-void residual [PVR] urine volumes and patient bother). Potential baseline predictors of CIC (history of pelvic prolapse, cystocele, diabetes, PVR urine volume and age) were assessed using multivariable logistic regression.

Results: Overall, 299 patients received their first treatment with onabotulinumtoxinA 100?U. Mean age was 66.4 years; 98.3% were female. The incidence of CIC was 2.7% in the total study population after the first treatment with onabotulinumtoxinA. The de novo CIC rate in treatments 2 and 3 combined was similarly low (3.2%). None of the evaluated baseline characteristics were significant predictors of CIC initiation due to the low CIC incidence.

Conclusions: This real-world study of non-neurogenic OAB patients treated with onabotulinumtoxinA suggests that the CIC rate is lower than the rates reported in previous studies. There were no significant correlations between baseline predictors and CIC initiation, although statistical significance may not have been reached because of the low incidence of CIC.     

胃癌根治术后吻合口及十二指肠残端瘘的疗效

目的 探讨胃癌根治术后吻合口及十二指肠残端瘘的治疗效果。方法 回顾性分析铜陵市人民医院胃肠外科2010年1月至2017年9月接受胃癌根治术后发生吻合口及十二指肠残端瘘的13例患者临床资料,观察采用保守治疗或手术治疗后瘘的愈合情况及治愈天数。结果 13例患者中,8例患者接受禁食、胃肠减压、生长抑素、营养支持及穿刺引流后治愈,治愈的天数为术后32~78 d,平均（51.75±14.96）d;5例患者经再次手术治疗后治愈,于胃癌术后23~45 d,平均（37.00±8.37）d。结论 胃癌根治术后出现吻合口及十二指肠残端瘘后,首选保守治疗,必要时手术治疗可治愈。     

八正散加减对痔瘘术后湿热下注型尿潴留患者排尿时间及自行排尿能力恢复的影响

目的:观察八正散加减对痔瘘术后湿热下注型尿潴留患者排尿时间及自行排尿能力恢复的影响,并探讨其作用机制。方法:选取106例痔瘘术后尿潴留患者,随机分成对照组和研究组,每组53例。两组均予听流水声诱导、心理疏导和膀胱区按摩等基础治疗,对照组予溴新斯的明口服,研究组予八正散加减。检测尿动力学,评价膀胱功能和中医主要症状评分,记录排尿情况,比较治疗效果。结果:与治疗前比较,治疗后两组尿动力学参数最大尿流量(Q-max),最大尿率时逼尿肌压(Pdet-Q-max)升高(P0.01),最大尿意膀胱容量(VMCC),残余尿量(PVR)降低(P0.01),逼尿肌受损、膀胱低顺应性和膀胱感觉缺失发生率降低(P0.05),排尿无力、小腹坠胀和倦怠乏力症状评分降低(P0.01);与对照组治疗后比较,研究组Q-max,Pdet-Q-max升高(P0.01),VMCC,PVR降低(P0.01),逼尿肌受损、膀胱低顺应性和膀胱感觉缺失发生率降低(P0.05),自行排尿、完全通畅排尿、排便、进食时间缩短(P0.01),排尿无力、小腹坠胀和倦怠乏力症状评分降低(P0.01),总有效率升高(P0.05)。结论:八正散加减可促进膀胱尿液排出,减少残余尿量,缩短自行排尿时间,提高自主排尿能力的恢复,有效治疗痔瘘术后湿热下注型尿潴留。     

先天性口角瘘1例报告

先天性口角瘘是一种出生时即存在的口腔发育畸形，临床上较罕见，该文报告1例典型病例，结合相关文献．对其临床特点、诊断和治疗进行分析。     

鳃裂囊肿及瘘43例治疗效果分析

目的：探讨鳃裂囊肿及瘘管术后复发原因及预防措施。方法：对43例鳃裂囊肿及瘘病例行手术，术前于囊管内注入美蓝液，以便术中分离追踪蓝染管支，近内口处行荷包缝合术或电凝、微波等处理。结果：43例中41例治愈，随访1年以上未见复发，2例复发，再次手术治愈，复发率4.7％。结论：对鳃裂囊肿及瘘患者，术前、术中、术后处理好每个环节，是防止复发的关键。     

刘沈林教授治疗喉癌术后咽瘘并发症经验

全国名中医刘沈林教授基于“肺气通于喉”“肺属金为子,脾属土为母”等中医藏象学理论,总结喉癌术后出现咽瘘并发症的病因病机为局部器官缺失,肺气受损,金破不鸣。病程演变特点为子病及母,肺病及脾,正虚无力驱邪外出,癌毒内留。主张应从整体观念出发,重视脏腑之间的相互关系,虚则补其母,遵循标本兼顾的原则,确立了清肺解毒、祛邪消肿,培土生金、脾胃兼养,随证加减、内外同治的治法治则,以促进气血化生,修复肌肉组织,消散局部炎症,加速咽瘘愈合。      

食管黏膜延长预防食管吻合口瘘的临床研究

目的 研究食管黏膜延长能否预防食管吻合口瘘。方法 回顾性分析2018年1月至2019年12月在本院胸外科接受手术治疗的205例食管癌患者的临床资料。其中接受食管黏膜延长手术的食管癌患者65例为观察组,接受常规手术的140例为对照组。比较两组患者的基本临床资料、手术时间、术中出血量及术后食管吻合口瘘发生率。结果 两组患者的基本临床资料比较,差异无统计学意义(P0.05)。观察组手术时间明显短于对照组,差异有统计学意义(P0.05),两组术中出血量比较,差异无统计学意义(P0.05);观察组患者术后吻合口瘘的发生率为3.08%,明显低于对照组的12.86%,差异有统计学意义(P0.05)。结论 食管黏膜延长可以有效预防食管癌术后吻合口瘘的发生,不失为一种食管胃吻合的新方法。     

脊髓硬脊膜动静脉瘘6例临床分析

目的:探讨脊髓硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特征、影像学特点及治疗,以期提高对SDAVF的早期识别和诊断.方法:对上海市普陀区人民医院神经外科收治住院的6例SDAVF患者临床表现、影像学资料及治疗进行回顾性分析.结果:6例患者中5例为男性,1例为女性,确诊年龄22～74岁,病程2～24个月.累及双下肢肌力5例,累及双下肢或四肢感觉6例,累及大便和(或)小便功能4例,其中2例需留置导尿管.5例患者术前行脊髓磁共振(magnetic reso-nance,MR)检查,脊髓MR可见脊髓长T1、长T2信号,脊髓表面迂曲血管流空影,增强后可见部分强化.6例患者均行脊髓数字血管造影(digital subtraction angiography,DSA)检查,显示5例瘘口在胸段,1例行3次脊髓血管造影均未见瘘口,手术时发现瘘口.5例患者于手术下行瘘口切除,术后均恢复良好.结论:SDAVF有其临床特征和影像学特点,磁共振检查可作为初筛标准,脊髓血管造影为其诊断金标准.手术为其有效治疗方法,早期诊断、早期治疗有助于改善患者预后.