高龄大肠癌的外科治疗

目的 探讨高龄大肠癌的围手术期处理及外科治疗方法。方法 回顾经手术治疗的高龄大肠癌７６例,对其临床特点、术前准备、手术治疗及术后处理等进行总结分析。结果 高龄大肠癌病人病程长、就诊晚,术前并存病及合并症多（８５．５％）,术后并发症发生率高（４２％）,根治性切除率为７２．４％。结论 对高龄大肠癌应重视围手术期处理。高龄并非手术禁忌,有条件者应行根治性手术。     

CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS OLDER THAN 70 YEARS

Objective To present 3 - 15 years follow-up of patients older than 70 years who underwent cementless total hip arthroplasty. Methods One hundred and two consecutive primary total hip arthroplasties utilizing a circumferential proximal porous coated femoral component and smooth surfaced threaded acetabular were performed in 92 patients. The patients were followed up clinically and radiographically every two years from their third year after surgery. Ten patients （ 10 hips） died and 14 patients （ 15 hips） were lost to follow up in three years after surgery. Sixty-seven patients （ 77 hips） were included in this study. Results The pre-operative Harris hip scores and pain scores were 45 and 15 points. They increased to 89 and 42 points by the third year. These scores decreased to 81 and 42 points in the ninth year and 77 and 37 points in the fifteenth year, respectively. More than 75% of the hips demonstrated good or excellent clinical results in the fifth year and 60% of the hips were rated good to excellent in the seventh to eleventh year. In the fifteenth year, only 50% of the hips had good or excellent results. All femoral components showed stable fixation by bone in-growth. Eight acetabular components were revised, with 5 due to mechanical loosening and 3 for recurrent instability. Thigh pain was documented in 4 hips. Conclusion The smooth-surfaced threaded acetabular component has a high rate of failure. Circumferential proximal porous coated femoral components provided excellent radiographic results and acceptable clinical outcome with definite bone ingrowth. Patients older than 70 may be suitable candidates for cementless total hip arthroplasty.     

40岁以上房间隔缺损患者行心脏不停跳手术治疗的体会

目的探讨体外循环下心脏不停跳手术治疗40岁以上继发孔型房间隔缺损的手术效果及围手术期经验。方法13例40岁以上继发孔型房间隔缺损患者,年龄41~67岁,平均(45.9±5.6)岁。合并三尖瓣关闭不全8例,其中中度以上关闭不全6例;合并二尖瓣关闭不全2例;房颤3例。肺动脉平均压力为(36.5±17.1)mm Hg。在体外循环心脏不停跳下行房间隔缺损修补术,房间隔缺损修补采用直接连续缝合和心包片修补,术中在心脏跳动下探查二尖瓣和三尖瓣,决定是否对瓣膜进行处理。本组中7例行三尖瓣De vage成形,2例行二尖瓣成形术,为交界区修补。在心脏跳动下动态观察各瓣膜手术成形效果。结果13例患者术后全部生存,心功能均有明显改善。结论心脏不停跳手术治疗中老年房间隔缺损是一种安全和合理的手术方式,对合并二尖瓣、三尖瓣关闭不全病变的探查和手术成形治疗有一定的优越性;中老年房间隔缺损患者术后应加强心功能的支持。     

高龄肝胆管结石病人的外科手术治疗

目的:探讨70岁以上高龄肝胆管结石病人的临床特点和提高外科手术治疗的疗效.方法:对1993年1月至2002年12月间收治的98例高龄肝胆管结石病人进行回顾性分析.结果:全组98例,治愈92例,治愈率为93.9%;死亡6例,死亡率为6.1%.急症手术29例,择期手术69例,手术并发症发生率为35.7%.并存疾病37例,占总病例数的37.8%.结论:急症手术以肝、胆总管切开取石、T管引流为主要术式,择期手术可附加胆肠吻合或肝部分切除.只要手术时机和术式选择得当,同时做好并存疾病的处理,高龄肝胆管结石手术治疗同样可取得满意疗效.     

107例老年妇科肿瘤临床分析

总结了我院17年来107例老年妇科肿瘤的治疗情况,其中14例因合并严重心血管疾病,行非手术疗法,其余93例均进行了手术治疗。分析了手术的适应症、并发症,并对老年人急诊手术应采取的措施、麻醉、水电解质平衡、并发症的处理和术中术后管理等进行了讨论。     

47例青年食管癌的外科治疗分析

总结1980年～1991年40岁以下青年食管癌的外科治疗47例。其中男性30例,女性17例,男:女为1.76:1。按国际TNM分期,Ⅲ、Ⅳ期病人占68.09％,手术切除率76.60％,与其它两年龄组比较,无统计学差异。本组5年生存率为14.89％。作者认为,青年病人组织修复能力较强,心肺等合并症少,手术死亡率低。现代病理和细胞光度学分析结果表明,食管肿瘤的恶性程度,青年人与老年人无差异。影响远期疗效的主要因素,仍取决于局部病变和淋巴结转移情况,对青年食管癌病人,应适当扩大手术指征。     

80岁以上股骨粗隆间骨折病人的人工关节置换

目的探讨80岁以上股骨粗隆间骨折病人采用人工关节置换的手术方法及疗效.方法随机选择80岁以上股骨粗隆间骨折病人21例,骨折按Evans分类,Ⅲ型6例,Ⅳ型14例,Ⅴ型1例,行人工关节置换手术,术后进行早期功能锻炼.结果术后17例获得随访,随访时间6～34个月,平均20个月.人工关节置换优良率为89.4%,随访期间未发现置换关节松动和感染.结论 80岁以上股骨粗隆间骨折病人行人工关节置换治疗,操作可行,疗效满意.     

2岁以下婴幼儿动脉导管未闭的诊断和治疗——附30例分析

本文报道经手术证实的2岁以下动脉导管未闭30例。年龄最小9d。最早出现症状在生后15h。婴幼儿动脉导管未闭常因杂音不典型而使诊断困难,本组占13％。新生儿可应用超声心动图探测动脉导管的开放与否和计算左房/主动脉根部直径(LA/AO),若>1.2有诊断意义。择期手术可在1岁后进行。如存在不能控制的肺部感染、心力衰竭或呼吸窘迫,即使早产儿或新生儿也应手术。手术以进胸双重结扎加贯穿缝扎为妥。本组无并发症或死亡。随访0.5～5年,无导管再通。     

难复性寰枢椎脱位的临床治疗观察

目的探讨难复性寰枢椎脱位经颈前路松解、后路融合的临床疗效。方法2007年8月—2008年10月,我院对12例难复性寰枢椎脱位的病人进行外科手术治疗。所有病人术前常规行颅骨牵引,其中9例病人行经颈前路松解、后路寰枢椎融合术。3例病人行经颈前路松解、后路枕颈融合术。术后采用日本骨科学会(JOA)神经功能评分分析临床治疗效果。结果12例病人术后随访6～18个月,平均12个月。病人手术前后JOA评分比较差异有显著性(t=15.53,P<0.01)。寰枢椎及枕颈部植骨在半年左右均达骨性融合,未出现内固定物断裂、脱落。结论经颈前路松解、后路融合治疗难复性寰枢椎脱位均达到满意的临床效果,是一种合理可行的手术方法。     

DIAGNOSIS AND SURGICAL TREATMENT OF BRONCHOGENIC CYSTS

Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years, The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40.9%). There were symptoms (chest pain and recurrent bronehiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal eornpression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a rousd shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative complieations, late complica-tions, or recurrence developed in our patients.     

45岁以下子宫内膜癌

４５岁以下子宫内膜场常被忽略，但在临床病例中并非少见。本文对收治的３９例４５岁以下子宫内膜癌患者进行临床和病理分析。发病率为１４．１３％．临床特征包括；平均年龄３７．８２岁，月经紊乱、不孕．病理特点：分化好，有时难于与子宫内膜腺瘤样增生和不典型增生区别．本文强调分段诊断性刮宫是早期诊断４５岁以下子宫内膜癌的有效方法，特别是对主诉月经不调或不孕合并子宫增大的肥胖妇女。     

儿童主动脉缩窄的外科治疗

本文报告儿童主动脉缩窄３例，占该院同期先天性心血管病手术的０．６％。合并畸形有动脉导管未闭２例，室间隔缺损１例。手术在全麻低温下进行，缩窄段主动脉切除、端端吻合术２例，牛心包加涤纶布主动脉成形术１例。术后过程顺利，随访８～１２年效果满意。作者对本病的诊断、手术指征、手术方法和术后处理作了简要的讨论。     

211例妇科盆腔肿块患者血清CA125测定的临床意义

211例妇科盆腔肿块患者血清 CA125测定,以 CA125>65kU/L 为阳性标准,58例恶性肿块和153例良性肿块的 CA125阳性率分别为77.6%和20.4%.若以 CA125>188kU/L 为阳性标准,则阳性率分别为65.5%和6.5%。良、恶性肿块阳性率相差悬殊,故可考虑以 CA125>188kU/L 作为鉴别盆腔良、恶性肿块的参考标准。     

SURGICAL TREATMENT OF BLUNT CARDIAC TRAUMA IN CHILDREN： REPORT OF 2 CASES AND REVIEW OF LITERATURES

Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiac trauma and reviewing the relevant literaturesMethods A 6-year-old girl was diagnosed muscular ventricular septal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect repair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture of posterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury. Results Heart function of the first patient was in New York Heart Association (NYHA) class Ⅰ, echocardiography showed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second patient is in NYHA class Ⅱ, echocardiography showed mild mitral regurgitation. Conclusion Blunt traumatic heart disease occurs either because of heart compression between sternum and the spine and/or because of myocardial contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is advocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up is necessary.     

冠心病合并主动脉瓣病变的外科治疗

目的探讨冠心病合并主动脉瓣病变的外科治疗原则。方法2002年3月～2003年2月,采用冠状动脉搭桥加主动脉瓣置换术,治疗冠心病合并主动脉瓣病变患者4例。结果全部患者均痊愈出院,无手术并发症;随访7～9个月,无远期死亡病例。结论冠心病合并主动脉瓣病变的患者,同时行冠状动脉搭桥加主动脉瓣置换手术是安全的。     

老年性膝关节疼痛的治疗

目的：探讨老年性膝关节疼痛的治疗方法。方法：对377例568膝老年性膝关节疼痛患者，临床分期为软组织损害型；关节内轻中度病损型；关节内重度病损型。分别进行手法治疗，关节镜治疗及人工关节置换治疗。结果：平均随访38个月，优良率达85.7％。结论：对于老年性膝关节疼痛进行分期，然后选择适当的疗法，治疗效果较佳。     

131 碘、抗甲状腺药物及手术治疗Graves甲亢的比较

目的 :对13 1碘 (13 1I)、抗甲状腺药物 (ATD)和外科手术治疗Graves甲亢 (甲亢 )进行比较 ,评价三种方法的优劣。方法 :将甲亢分为13 1I、ATD和手术治疗三组 ,治疗后进行随访 ,统计三种方法的治愈率、复发率、甲低发生率、突眼发生和改善情况等 ,并对13 1I和ATD进行统计学处理和比较。结果 :13 1I疗效明显优于ATD(P<0 .0 0 1) ,13 1I和ATD的有效率分别为 96 .5 %和 81.6 % ,治愈率分别为 83.0 %和 4 8.4 % ;发生突眼方面两者无差别 (P >0 ,0 5 ) ,但突眼改善方面ATD优于13 1I(P <0 .0 5 ) ;甲低发生率13 1I高于ATD(P =0 .0 0 1) ,13 1I、ATD和手术治疗的永久性甲低发生率分别为 2 1.3%、2 .8%和 15 .1% ;甲亢治愈后复发方面13 1I明显低于ATD治疗 (P <0 .0 0 5 ) ,13 1I、ATD和手术治疗后复发率分别为 5 .8%、33.1%和 5 4 .0 % ,在甲心病、血象、肝功能受损等其它方面13 1I低于ATD(P <0 .0 0 1)。结论 :13 1I治疗甲亢优于ATD ,尽管有甲低发生、突眼改善差等不足 ,其在疗效、复发、出现其它系统损伤等方面优于ATD ,手术治疗有较高的复发率和某些近期或远期并发症 ,因此应首选13 1I治疗。     

低肺功能肺癌手术治疗探讨

目的探讨低肺功能肺癌患者外科手术治疗后并发症、术后呼吸机的应用及术前肺功能检查的价值。方法64例低肺功能肺癌患者依据肺最大通气量(maximum ventilatory volume,MVV)和第1 s用力呼气量(forced expiratory volume in 1 second,FEV1)分为两组,第1组为重度异常,即MVV≤50%,FEV1≤45%的23例;第2组为50%相似文献   

胎盘免疫调节因子对妇科恶性肿瘤病人免疫功能的影响

目的：观察胎盘免疫调节因子（ＰＩＦ）对病人细胞免疫功能及体液免疫功能的影响，方法：利用ＰＩＦ治疗妇科恶性肿瘤６３例，并设对照组６３例。治疗组病人第天肌注ＰＩＦ４ｍ，３０ｄ为一疗程，对照组不注射ＰＩＦ。两组病人治疗前及治疗３０ｄ后抽血检测Ｔ淋巴细胞亚群（ＣＤ３、ＣＤ４、ＣＤ８）、ＮＫ细胞活性、淋巴细胞转化率（ＬＴ）及免疫球蛋白（ＩｇＡ、ＩｇＧ、ＩｇＭ）。结果：经ＰＩＦ治疗后，治疗组病人ＣＤ３、ＣＤ４     

ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

Carotidbodytumor(CBT),namelytheparagan-glioma,isakindofrarechemodectomas.Becauseofitsspeciallesionlocationwithcomplexanatomicstructure,whereabundantwithbloodvessels,andtherequirementofsimultaneousresectionandreconstruc-tionofcarotidartery,thesurgicaldifficultyandcom-plicativeriskhavebeengreatlyincreased.Thehighpostoperativeincidencerateofcomplicationsuchashemiplegiaandcranialnerveimpairmentusuallymakesthemanagementmoredifficult.Inthisarticle,effectsandcomplicationsof46carotidbodytumorpatients…