壮医药线点灸三种手法对脾虚证治疗作用的研究

目的：观察比较壮医药线点灸轻、中、重３种手法对脾虚证患者的临床疗效。方法：６０例脾虚证患者随机分为轻、中、重３组，每组２０例。其中轻法组采用壮医药线点灸轻手法治疗，中法组采用壮医药线点灸中手法治疗，重法组采用壮医药线点灸重手法治疗。结果：３种手法对脾虚证的主要临床症状及唾液负荷分泌水平均有改善作用（Ｐ＜００５），其中中、重法效果较轻法优（Ｐ＜００５）。３种手法治疗总有效率分别为８０％，９５％，９０％结论：壮医药线点灸轻、中、重３种手法对脾虚证确有疗效，且疗效与施术手法有关。     

悬吊法肝切除在第二肝门旁肝肿瘤切除术中的应用

目的:探讨肝脏悬吊法进行第二肝门旁肝肿瘤肝切除的可行性与安全性.方法:回顾性分析201 1年8月-2012年8月收治的7例第二肝门旁肝肿瘤病患者的临床资料.结果:7例术中顺利放置悬吊胶管并成功手术.行右半肝切除2例,右半肝+右肾周脂肪囊切除1例,右半肝切除+左肝内外叶2个血管瘤分别切除1例,右半肝+Ⅳ段部分切除术1例,左半肝+右肝Ⅷ段+右膈肌浆膜切除1例,右肝Ⅵ,Ⅶ段规则切除术1例.术中无断肝时误伤下腔静脉者,行右膈肌浆膜修补1例.中位手术时间375 min(295～460 min),中位出血量2 000 mL (750～8 000 mL),中位输血量1 000 mL(0～4 000 mL).术后胸腔积液2例,均经穿刺抽液恢复.无胆瘘,无腹腔感染.均痊愈出院,平均术后住院时间20 d.术后随访1～12个月,1例肝细胞癌有局部复发.结论:应用悬吊法进行第二肝门旁肝肿瘤肝切除是安全可行的.     

选择性半肝血流阻断在肝海绵状血管瘤切除中的应用

目的:探讨选择性半肝血流阻断在肝海绵状血管瘤切除中的应用效果。方法:回顾性分析2006年1月—2011年1月经手术切除的104例肝海绵状血管瘤患者的临床资料。其中26例行选择性半肝血流阻断(A组),78例行第一肝门阻断(Pringle法)(B组)。比较并分析两种方法对术中情况、术后肝功能恢复、并发症发生率等指标的影响。结果:104例手术均顺利完成。两组间术中失血量、输血量、阻断时间、血氧饱和度以及术后肠道恢复时间、并发症等指标的差异均无统计学意义(均P>0.05),但B组术中外周动脉血压及术中脉搏变化明显大于A组(均P<0.01)。术后肝功能指标如ALT,AST,ALB,TBIL等改变,B组优于A组,差异均有统计学意义(P<0.05或P<0.01)。结论:肝海绵状血管瘤切除术中采用选择性半肝血流阻断,能有效地减轻肝血流阻断对全身血流动力学的影响,减轻缺血再灌注损伤,有利于术后肝功能恢复。     

推拿手法加牵引治疗青少年特发性脊柱侧凸畸形

目的:探讨推拿手法加牵引矫正青少年特发性脊柱侧凸的疗效。方法:采用推拿手法加牵引治疗38例轻度青少年特发性脊柱侧凸畸形,本组男11例,女27例,年龄最小12岁,最大19岁,平均14.5岁。Cobb角11°～20°27例,21°～30°11例。结果:治愈15例,显效9例,好转8例,无效6例。结论:推拿手法加牵引治疗青少年特发性脊柱侧凸畸形有明显的治疗效果,具有不影响正常活动,无合并症等优点。     

Preliminary experience with the hanging maneuver for pancreaticoduodenectomy

Background

Malignant periampullary tumours often invade retroperitoneal peripancreatic tissues and a positive resection margin following pancreaticoduodenectomy (PD) is associated with a poor survival. The margin most frequently invaded is the retroperitoneal margin (RM). Among the different steps of PD one of the most difficult and less codified is the resection of the RM with high risk of bleeding. We have developed a surgical technique – “hanging maneuver” – which allows at the same time a standardization of this step, a complete resection of the RM, and an optimal control of bleeding.

Patients/Methods

We described the surgical technique, and we reported our preliminary experience. Surgical data, postoperative outcome and pathological results of patients submitted to PD for pancreatic carcinoma using “hanging maneuver” technique between January 2007 and December 2007 were reviewed.

Results

The hanging maneuver was performed in 20 patients without any intraoperative complication and massive bleeding. No patient required blood transfusion. After had inked the surgical margins, retroperitoneal peripancreatic tissue was invaded in 12 out of 17 patients with malignant diseases (70.5%). In only one case (6%), the retroperitoneal margin was involved by the tumour (R1 resection).

Conclusion

The “hanging maneuver” is a useful and safe technical variant and should be considered in the armamentarium of the pancreatic surgeons in order to achieve negative retroperitoneal margins.     

107家医院抗肿瘤药物治疗操作中的防护现状调查

采用便利抽样对107家医院进行访谈式调查,调查内容有各医院抗肿瘤药物使用的管理模式;化疗防护设备;护理人员防护用具;密闭式输液系统使用情况;存放废弃物所用的容器,并对调查结果进行统计分析,据此提出相应改进意见.     

Expected outcome loss to evaluate medical diagnosis and treatments

A model is developed to help evaluate the effect of a treatment on various defined outcomes when the diagnosis can be one of several classes. Loss factors are defined for a particular outcome using one treatment when there is a specific diagnosis (class). After defining appropriate multidimensional probability densities, Expected outcome loss is defined.Clinical examples are presented where the differential diagnosis is foreign body airway obstruction vs cardiac arrest.     

Mckenzie法治疗腰椎间盘突出症

目的：证实Mckenzie法是治疗腰椎间盘突出症的有效、经济和快捷的方法,方法：采用Mckenzie法评估40例腰椎间盘突出症患者,按Mckenzie分类,采用取伸展,侧滑和姿势保持等相应的手法治疗。结果40例患者治疗前后疼痛VAS评分、直腿抬高试验和腰椎后伸角度等相关指标经配对t检验,P＜0．001,治疗前后差异有显著性,结论：Mckenzie法是一安全、高效、经济的腰椎间盘突出症的治疗方法。     

何振辉教授疗伤手法的学术思想与技术特色

何振辉教授手法疗伤的学术观点和技术特色是:结合病理基础、力学原理、现代汉语法则,对古今手法进行研究,提出手法及手法名称规范化建议。对正骨手法概括为“纵压”和“横挤”;认为肱骨髁上骨折导致近期并发肘内翻的重要因素是折端向外成角畸形愈合,在施以手法整复及固定时,要注意纠正成角;在腰椎间盘突出症治疗,创大回环手法,取得良好的疗效。