青少年特发性脊柱侧弯非手术治疗的现状

青少年特发性脊柱侧弯是常见的无明显发病原因的脊柱畸形，不及时治疗会引起侧后凸角度加重及心肺功能障碍等多种并发症，使得生活质量下降，甚至威胁生命。目前对于青少年特发性脊柱侧弯的治疗手段分为非手术治疗和手术治疗，主张早发现、早诊断、早治疗，有效阻止侧弯进展。本文对现有非手术治疗中主要的运动疗法和支具治疗方法进行综述，为青少年特发性脊柱侧弯非手术治疗方法提供参考。     

病理性瘢痕的非手术治疗新进展

病理性瘢痕是创伤后真皮成纤维细胞过度增殖而形成的良性病变，常见致病因素包括外伤、手术、烧伤、痤疮及皮肤感染等，目前其发病机制以成纤维细胞过度增殖、胶原过度沉积且排列紊乱为主。病理性瘢痕的治疗主要分为手术和非手术治疗，其中非手术治疗以其操作简单，创伤较小等优势被长期广泛应用于临床。除了压迫疗法、硅酮凝胶外用、药物和放射治疗等方法外，干细胞与自体脂肪移植、A型肉毒毒素注射、细胞因子治疗、激光及射频等新型疗法目前也已被广泛应用于瘢痕的非手术治疗和研究中。本文拟就目前瘢痕非手术治疗的国内外进展进行综述，并探讨新型治疗方法的优势及应用前景。     

腰椎间盘突出症非手术治疗综述

腰椎间盘突出症因种种原因，许多患者不愿接受手术治疗，而采用非手术疗法。近5年来的非手术治疗腰椎间盘突出症的文献资料表明，卧床休息、牵引治疗、手法治疗、针灸治疗、物理因子治疗、药物治疗、运动疗法、封闭治疗、介入治疗、心理治疗等疗法单独或综合应用于腰椎间盘突出症治疗，均有一定疗效。现将近年来非手术治疗该病方法的研究综述如下。     

内痔的非手术疗法

内痔的非手术疗法第三军医大学新桥医院普外科（６３００３７）单治堂内痔的非手术疗法较多，包括枯痔、注射、扩肛、冷冻、胶圈套扎、红外线凝固和应用电子、激光仪器的疗法。多数患者以非手术治疗为主，只有较重者才考虑手术治疗。非手术治疗是促进痔组织纤维化，固定松...     

综合治疗腰椎间盘突出症1912例回顾性分析

腰椎盘突出症是临床常见病多发病,此病复杂,治疗棘手,病情反复发作,患者痛苦是困扰患者的主要症状之一.腰椎间盘突出致病机制复杂,单一法的非手术治疗效果往往不令人满意.作者近一年来吸取多种单一法的非手术治疗效果的优点,采用硬膜外腔注射、骶管冲击疗法、侧隐窝注射疗法、椎旁注射疗法、按摩手法复位、牵引、中药内服外用的方法综合治疗腰椎间盘突出症,对1912例患者进行回顾性分析.     

内痔的非手术疗法

内痔的非手术疗法单治堂内痔的非手术疗法较多。目前国外仍以手术治疗为主，国内多数采用非手术治疗，只有较重者才考虑手术治疗。现就内痔非手术治疗的有关问题谈些体会，以供参考。一、枯痔钉疗法国内曾广泛应用枯痔，后发现因含砒较多，患者有中毒反应，改为无砒枯钉。...     

骶管注射疗法有关问题的认识

腰椎间盘突出症是引起慢性腰腿痛麻的常见病，骶管注射疗法因其疗效显著、治疗安全、操作简单等优点，已成为非手术治疗腰椎间盘突出症的基本疗法之一。我科1994年以来，应用骶管注射疗法治疗腰椎间盘突出症1600余例，取得良好疗效，现对该疗法治疗中的有关问题总结如下。     

应当重视急性胰腺炎的非手术治疗

外科医生，特别是年轻的外科医生，在临床工作中容易进入一个误区——重视手术操作技术，轻视非手术治疗方法。若用这一观点来处理急性胰腺炎更是一个严重偏差，必须强调：应当重视急性胰腺炎的非手术治疗。１　非手术治疗在急性胰腺炎治疗中的地位（１）　非手术治疗贯穿急性胰腺炎治疗的全程。急性胰腺炎的治疗无论在哪一级医院；无论在哪一个科室；无论病因如何；无论其病理类型；无论其治疗过程中需否手术，非手术治疗都是必需的、首选的、不可缺少的治疗方法。只有单用非手术治疗治愈的急性胰腺炎，没有单用手术疗法治愈的急性胰腺炎。…     

腰椎管狭窄症的非手术治疗——89例临床疗效观察

目的探讨非手术治疗89例腰椎管狭窄症患者的临床疗效。方法收集腰椎管狭窄症住院患者62例,门诊患者27例,采用药物、理疗、腰椎牵引、腰部推拿手法等治疗,评价治疗效果。结果非手术治疗腰椎管狭窄症优良率为69.66%,有效率达96.63%。联合药物、理疗、牵引和推拿等多种疗法综合治疗腰椎管狭窄症最佳。结论通过推拿手法、腰椎牵引、理疗配合药物和功能锻炼等治疗腰椎管狭窄症取得较为满意的临床疗效,故非手术治疗也应作为腰椎管狭窄症的治疗方法之一;在非手术治疗中,采用药物、理疗、牵引及推拿手法等综合治疗,效果最佳。     

重症胰腺炎非手术治愈的启示

非手术治疗重症胰腺炎１５例，治愈１３例，好转１例，有效率９３．３％，１例死于ＡＲＤＳ和ＡＲＦ。本组非手术治疗治愈重症胰腺炎的启示：非手术疗法主要为全身支持，增强患者机体抗损伤能力；临床治疗结果提示，非手术疗法是可行的；善得定临床早期应用，其抑制胰外分泌功能作用强，疗效显著。     

THE SAFETY AND DURATION OF NON-OPERATIVE TREATMENT FOR ADHESIVE SMALL BOWEL OBSTRUCTION

Small bowel obstruction (SBO) due to adhesions is often initially treated non-operatively but the safety and duration of non-operative treatment is controversial. The aims of this study were to assess the safety of non-operative treatment and determine the optimal duration of non-operative treatment in adhesive SBO. A retrospective analysis of patients admitted with a diagnosis of adhesive SBO following an initial period of non-operative treatment was performed. Patients whose condition resolved with non-operative treatment were compared with patients who required surgical intervention after an initial period of non-operative treatment. There were 123 admissions having an initial period of non-operative treatment. The SBO resolved in 85, the remaining 38 required surgical intervention. Complete resolution occurred within 48 h in 75 (88%) cases, the remaining 10 had resolved by 72 h. Thirty-one of 38 patients required surgical intervention for SBO more than 48 h duration after admission. The difference between cases resolving within 48 h and those requiring surgery after 48 h was significant (x²= 113, P < 0.001). Three (2.4%) patients, initially treated non-operatively, had small bowel strangulation. All three were operated on within 24 h of admission when changes in clinical findings suggested small bowel strangulation may be present. There were no deaths in the group having an initial period of non-operative treatment. In the absence of any signs of strangulation, patients with an adhesive SBO can be managed safely with non-operative treatment. Most cases of adhesive SBO that will resolve, do so within 48 h of admission. In the absence of any clinical or radiological evidence of resolution within 48 h, non-operative treatment should be abandoned in favour of surgical intervention.     

The Stiff Elbow

Elbow motion is essential for upper extremity function to position the hand in space. Unfortunately, the elbow joint is prone to stiffness following a multitude of traumatic and atraumatic etiologies. Elbow stiffness can be diagnosed with a complete history and physical exam, supplemented with appropriate imaging studies. The stiff elbow is challenging to treat, and thus, its prevention is of paramount importance. When this approach fails, non-operative followed by operative treatment modalities should be pursued. Upon initial presentation in those who have minimal contractures of 6-month duration or less, static and dynamic splinting, serial casting, continuous passive motion, occupational/physical therapy, and manipulation are non-operative treatment modalities that may be attempted. A stiff elbow that is refractory to non-operative management can be treated surgically, either arthroscopically or open, to eliminate soft tissue or bony blocks to motion. In the future, efforts to prevent and treat elbow stiffness may target the basic science mechanisms involved. Our purpose was to review the etiologies, classification, evaluation, prevention, operative, and non-operative treatment of the stiff elbow.     

保脾术治疗外伤性脾破裂的体会

目的 探讨外伤性脾破裂手术保脾治疗方法的选择及其治疗效果.方法 对2000年10月至2007年10月对19例外伤性脾破裂采用手术保睥治疗的临床资料进行回顾性分析.19例中脾损伤Ⅲ级11例,Ⅳ级7例,Ⅴ级1例,其中6例伴有不同程度休克.结果 19例均痊愈出院.其中2例为非手术保脾治疗期间因活动性出血而中转行脾切除后脾组织...     

Evaluation and treatment of internal impingement of the shoulder in overhead athletes

One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulderpain resulting from internal impingement. "Internal impingement" is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial,involving physiologic shoulder remodeling,posterior capsular contracture,and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up,decline in performance,or posterior shoulder pain. On physical examination,patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic "Bennett lesion" on radiographs,as well as articular-sided partial rotator cuff tears and concomitant SLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology,but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed,therefore intense non-operative treatment should remain the focus of treatment.     

Management of complicated acute appendicitis in children:Still an existing controversy

Complicated acute appendicitis(CAA) is a serious condition and carries significant morbidity in children. A strict diagnosis is challenging, as there are many lesions that mimic CAA. The management of CAA is still controversial.There are two options for treatment: Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon. Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events. In many cases, non-operative management with or without drainage and interval appendectomy is advised. The reasons for this approach include new medications and policies for the use of antibiotic therapy. Furthermore, advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries. However, questions have been raised about the risk of recurrence,prolonged use of antibiotics, lengthened hospital stay and delay in returning to daily activities. Moreover, the need for interval appendectomy is currently under debate because of the low risk of recurrence. Due to the paucity of high-quality studies, more randomized controlled trials to determine the precise management strategy are needed. This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.     

Non-operative treatment of anastomotic leaks: Current and investigational therapies

The treatment of anastomotic leaks remains primarily operative; however, recent advances in technology are changing the scope of non-operative interventions for managing this difficult complication. The authors sought to provide an evidence-based review of the non-operative treatment options for anastomotic leaks using both current guidelines and investigational modalities on the horizon. A search of MEDLINE, PubMed, and the Cochrane Database of relevant scientific papers and reviews was performed. Abstracts were reviewed to determine their scientific merit and relevance to non-operative treatment of anastomotic leaks. Recommendations and treatment algorithms were based on consensus conclusions of the data. A total of 87 articles were reviewed and analyzed for this article. Reoperation is the first-line therapy for many anastomotic leaks, but non-operative techniques are appropriate and effective for a subset of this population. Image-guided percutaneous drainage has changed the treatment paradigm for many patients with anastomotic leaks. Endoscopic drainage and stenting are in their infancy, and controlled trials are needed to prove their efficacy; however, the future of non-operative treatment appears promising.     

桡骨远端关节内骨折手术与非手术治疗的Meta分析

目的 通过Meta分析比较桡骨远端关节内骨折手术与非手术治疗的疗效.方法 通过检索1988年1月至2008年6月关于桡骨远端骨折于术与非手术治疗对照研究的文献(共5篇),采用循证医学Meta分析对患者腕关节功能,骨折复位后X线位置、患者满意度及并发症进行综合分析.结果 Meta分析发现:与非手术治疗相比,手术治疗能明显改善腕关节功能(OR=0.23,95%CI 0.11-0.48,P<0.05)、可以良好复位(OR=0.20,95%CI 0.10-0.39,P<0.05)、减少并发症的发生(OR=0.29,95%CI0.17-0.49,P<0.05),但患者满意度方面低于非于术治疗(OR=0.32,95%CI 0.14-0.75,P=0.009).结论桡骨远端关节内骨折应采用手术治疗,同时应该关注患者的要求及期望值.     

急性颈脊髓中央损伤综合征的治疗

目的探讨急性颈脊髓中央损伤综合征的治疗效果。方法对我院1990年1月至2004年1月收治的32例急性颈脊髓中央损伤综合征患者进行回顾性分析,其中非手术治疗14例,手术治疗18例,在治疗前后进行JOA评分。结果平均随访21个月,非手术治疗组脊髓功能恢复差。而手术治疗病例脊髓功能恢复较好。结论急性颈脊髓中央损伤综合征手术治疗效果明显优于非手术治疗,急性颈脊髓中央损伤一旦确诊,应当积极早期手术治疗。     

Pancreatic pseudocysts in chronic pancreatitis. Surgical or interventional drainage?

Pseudocyst formation is a well-known complication of acute and chronic pancreatitis. Many pseudocysts are asymptomatic and may resolve without intervention. For a symptomatic pseudocyst drainage is indicated. Although surgical cystoenterostomy has been the treatment of choice for many years, recently invasive but non-operative treatment methods have challenged surgical drainage as the standard therapy for pancreatic pseudocysts. Both the method as well as the timing of intervention has become a matter of debate. Percutaneous catheter drainage and endoscopic drainage have proven beneficial in the treatment of pseudocysts, although long-term outcome remains to be awaited. Resolution rates after surgical and non-surgical methods are comparable, but clinical and technical aspects may mandate either method. Each patient requires an individual, multidisciplinary approach, thereby obtaining optimal treatment-outcome.