无植片Molteno管插入的疗效

目的：确定采用改良手术方法植入Molteno阀以排除对供体巩膜植片的需求的远期效果。方法：对35例接受首次Molteno阀植入治疗难治性青光眼的连续患者的病例记录进行回顾性病例分析，主要指标包括术后眼压控制的生存表分析以及术中、术后并发症的发生频率。结果：无明确与导管放置改良方法相关的并发症。中期眼内压控制与其他组相似。结论：这种插入Molteno阀的简化方法在保持植入物控制眼内压作用的同时排除了对供体巩膜植片的需求。     

Hypertrophic pulmonary osteoarthropathy complicating Celestin tube insertion.

A case is reported in which hypertrophic pulmonary osteoarthropathy (HPOA) developed following the insertion of a Celestin tube for a benign oesophageal stricture. The HPOA resolved completely following removal of the tube. It is believed that the Celestin tube was the major factor causing the HPOA, a complication of Celestin tube insertion not previously reported.     

Acute post-streptococcal glomerulonephritis following ear piercing.

A case of post-streptococcal glomerulonephritis following ear-piercing is reported. It illustrates a rare but life-threatening complication of a cosmetic procedure carried out under unhygienic conditions.     

延长胃管插入长度的效果分析

目的:探讨洗胃时适当延长胃管插入长度的可行性。方法:将80例洗胃患者按入院先后分为试验组、对照组,观察对比不同胃管插入长度对洗胃时呕吐率、洗胃后呕吐率、胃管堵塞率的影响。结果:采用两种不同的胃管插入深度,患者洗胃时呕吐率、洗胃后呕吐率、胃管堵塞率等差异有统计学意义(P<0.5)。结论:延长胃管插入长度5～10 cm优于传统的胃管插入长度。     

Otolaryngologists' perceptions of the indications for tympanostomy tube insertion in children

BACKGROUND: Bilateral myringotomy with insertion of tympanostomy tubes is the most common operation that children in Canada undergo. Area variations in surgical rates for this procedure have raised questions about indications used to decide about surgery. The objective of this study was to describe the factors that influence otolaryngologists to recommend tympanostomy tube insertion in children with otitis media and their level of agreement about indications for surgery. METHODS: A survey was sent to all 227 otolaryngologists in Ontario in the fall of 1996. The influence of 17 clinical and social factors on recommendations to insert tympanostomy tubes were assessed. Case vignettes were used to determine the effect of multiple factors in decisions about the need for surgical management. RESULTS: Surveys were returned by 138 (68.3%) of the 202 eligible otolaryngologists. There was agreement (more than 90% of respondents) about 6 indications for surgery: persistent effusion, a lack of improvement after 3 months of antibiotic therapy, a history of persistent effusion for 3 or more months per episode of otitis media, more than 7 episodes of otitis media in 6 months, a bilateral conductive hearing loss of 20 dB or more and a persistently abnormal tympanic membrane. Some respondents were more likely to recommend tube insertion if there were parental concerns about hearing problems or the frequency or severity of episodes of otitis media. Otolaryngologists agreed about the role of tympanostomy tubes in 1 of 4 case vignettes but disagreed about whether adenoidectomy should also be performed in that instance. Most viewed tympanostomy tube insertion as beneficial, with few adverse effects. INTERPRETATION: There is a lack of consensus among practising otolaryngologists in Ontario as to which children with recurrent otitis media or persistent effusion should undergo bilateral myringotomy with tympanostomy tube insertion. These findings suggest the need to revisit clinical guidelines for this procedure.     

导光纤维喉镜引导咽鼓管插管治疗中耳疾病

目的：研究导光纤维间引导咽鼓管插管治疗中耳疾病的疗效。方法：使用Ｏｌｙｍｐｈｕｓ公司生产的Ｔ３型纤维喉主冷光源系统和上海医用诊疗仪器厂生产的输尿 管为７６例中耳疾病患者通气、吸引、注药治疗。结果：７６例、１２１耳中１０３耳咽鼓管通畅，１２耳症状改善，６耳效果不明显，有效率９５％。结论：用导光纤维喉地准咽鼓管咽口，插入准确，治疗成功率高。因输尿管导管前端光滑，不易损伤鼻咽及咽鼓口粘膜，咽口粘膜，咽口     

T管拔除后胆汁性腹膜炎17例分析

目的：探讨胆汁性腹膜炎的原因、预防和治疗。方法：回顾性分析1998-08-2000-08间17例T管的拔出时间。结果：17例中，6例保守治疗成功；11例二次手术并重新引流治愈。术中证实，6例系窦道形成不完全，2例为窦道撕裂，1例为窦道过长，2例为拔管失误。结论：对T管拔除后胆汁性腹膜炎应重点预防，一旦出现，应根据具体情况，积极治疗。     

宫腔镜下输卵管通液在输卵管因素引起不孕治疗中的应用

目的探讨宫腔镜及宫腹腔镜联合下输卵管插管通液术在治疗输卵管中段及近端阻塞引起的不孕症中的应用。方法2008年1月-2011年12月92例不孕症患者实施宫腔镜输卵管插管通液及宫腹腔镜联合输卵管插管通液,追踪术后1年内受孕情况。结果宫腔镜组14例患者输卵管通液通畅（通畅率35%）,宫腹腔镜组30例输卵管插管通畅（通畅率65.2%）,两者比较差异明显。术后1年观察宫腔镜组9例妊娠,宫内妊娠率19.5%;宫腹腔镜组14例宫内妊娠,宫内妊娠率30.4%。结论宫腔镜下输卵管插管通液是治疗输卵管阻塞尤其是近端梗阻行之有效的方法,宫腹腔镜联合可提高疗效。     

纤维宫腔镜输卵管插管诊治输卵管近端梗阻

目的探讨纤维官腔镜直视下输卵管插管注液诊断和治疗输卵管近端梗阻的临床效果。方法选择经输卵管通液检查或输卵管碘油造影诊断为输卵管性不孕的妇女150例，对其进行官腔镜直视下输卵管插管注液，比较插管注液前后输卵管的通畅情况。结果150例患者291条输卵管，经官腔镜下输卵管插管，确诊输卵管梗阻101条；46条插管注液后输卵管通畅。结论纤维官腔镜直视下输卵管插管注液，是诊断和治疗输卵管近端梗阻的一种安全、有效、简便的方法。     

难置性洗胃管置入中纤维胃镜的应用探讨

目的：探讨纤维胃镜在难置性洗胃管患者置入中的应用.方法：10例患者均采用经纤维胃镜指引下置入洗胃胃管.结果：所有经口置管或在喉镜直视下置管失败患者改用纤维胃镜指引下置管,均获成功.结论：纤维胃镜指引下对置入难置性洗胃管成功率高,对患者的心率、血压、血氧饱和度的干扰和影响小.     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的:探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法:对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者(128耳)行有针对性的治疗。结果:鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义(P<0.01)。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义(P<0.05)。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论:儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。     

Hemolytic anemia following insertion of Ionescu-Shiley mitral valve bioprosthesis.

Hemolytic anemia is a relatively common complication after the replacement of cardiac valves with mechanical prostheses; the prevalence rate varies from 38% to 85%, depending on the prosthesis implanted. However, cardiac valves fabricated from biologic material are associated with a reduced incidence of hemolytic anemia, and to the authors' knowledge this report is the first to document hemolytic anemia in a patient who had the mitral valve replaced with an Ionescu-Shiley valve. The anemia was not associated with evidence of hemodynamically important mitral regurgitation and was ultimately controlled by iron and folate supplements.     

儿童分泌性中耳炎的鼓室置管远期疗效分析

目的 观察分泌性中耳炎 (OME)患儿鼓膜置管术后的远期疗效及其相关影响因素,并探讨可能潜在的病变因素在通气管排出后OME复发中的作用.方法 回顾性分析41例(64耳)OME住院患儿接受鼓膜置管且随访12～18个月的病历资料.结果 ①64耳中,52耳听力改善(81.3%),12耳复发,未见有严重的并发症;②病程短者置管疗效明显优于病程长者;③单纯OME组与伴发鼻窦炎OME组鼓室置管有效率比较有显著性差异.结论 鼓室置管术安全、有效,远期效果良好.鼓膜置管的同时,针对病因解除邻近病灶的影响,才有可能取得更好的远期效果.     

新生儿两种置胃管方法的对比

目的为新生儿安置胃管选择最佳途径提供依据。方法对2004年10月-2006年7月,在我院新生儿科住院的48例需放置胃管的新生儿进行随机分组,分为常规经鼻置管组和经口置管组,对2组一次性成功率、置管需要的时间、置管时的不良反应进行比较。结果经口放置胃管的一次成功率高,对患儿的不良反应少,置管所需要的时间少。2组比较,P<0.05,有统计学差异。结论新生儿适合经口置胃管。     

床边判断重症患者盲插鼻肠管尖端通过幽门方法的研究

目的：研究重症患者盲插螺旋形鼻肠管判断导管尖端通过幽门的方法。方法回顾性分析某院重症医学科2011年5月至2012年12月176例盲插螺旋形鼻肠管重症患者,在置管过程中,通过床边综合判断方法(注气听诊法联合胃液或小肠液 pH 测试法)初步确定导管尖端通过幽门在肠道,最后经 X 线证实,验证该方法的准确性。结果对于176例盲插螺旋形鼻肠管患者,床边综合判断方法鼻肠管位置通过幽门成功率89.20%(157例),失败率10.80%(19例);其中成功的157例中有117例(74.54%)通过肠内肠液监测 pH 值碱性;40例(25.48%)患者肠内未抽出肠液。结论通过床边综合判断方法判断导管尖端通过幽门的准确率高,操作简便易行,避免了反复 X 线照射等对于患者射线吸收及经济负担等不利影响,对临床判断盲插鼻肠管效果具有重要意义。