侧脑室体外引流结合腰大池持续引流治疗脑室出血临床研究

目的评价早期腰大池引流结合侧脑室体外引流治疗脑室出血疗效。方法随机将48例脑室出血患者分成2组。治疗组28采用单侧或双侧侧脑室置管引流,同时或脑室外引流术后3 d内行腰大池引流。对照组20例单纯延长脑室外引流时间或停止脑室外引流后再行腰大池引流。结果治疗组积血完全清除、脑脊液循环通畅时间均低于对照组,脑积水发生率均低于对照组,GOS评定优于对照组。结论早期持续腰大池引流结合侧脑室体外引流可缩短脑室出血积血时间,降低患者的脑积水发生率。     

双侧脑室外引流结合腰大池引流治疗重症脑室出血63例

目的探讨双侧脑室出血外引流结合腰大池引流治疗重症脑室出血的疗效。方法对63例重症脑室出血患者先行双侧脑室外引流,24h后结合腰大池引流并用尿激酶灌注进行头腰侧交替引流血性脑脊液。结果术后10d复查CT,43例脑室系统积血基本消失,14例积血减少50%,6例积血减少30%,无梗阻性脑积水。术后死亡16例（占25.4%）。存活47例（占74.6%）,随访3个月,按ADL分级：Ⅰ级8例,Ⅱ级13例,Ⅲ级15例,Ⅳ级7例,Ⅴ级4例。结论采用双侧脑室引流结合腰大池引流治疗重症脑室出血,能明显减少引流时间,降低死亡率和致残率,提高患者生活质量。     

脑室外引流结合Ommaya囊及腰大池持续引流治疗脑室出血的研究

目的研究脑室外引流结合Ommaya囊及腰大池持续引流治疗脑室出血较传统手术方式的优点。方法 100例脑室出血病例随机分为改良组及传统组。改良组选择在出血相对较多的一侧常规行侧脑室额角穿刺外引流;而在出血相对较少的一侧额角置入Ommaya囊后行囊腔穿刺外引流。脑室外引流5～7天后,逐步改为仅Ommaya囊及腰大池持续引流。传统组则行双侧侧脑室普通外引流结合每天腰穿放血性脑脊液治疗。最后比较2组患者迟发性脑积水、颅内感染发生率及预后情况等。结果 2组迟发性脑积水、颅内感染发生率及预后（ADL分级）比较差异有统计学意义,P〈0.05,表明改良组疗效明显优于传统组。结论该项改良技术安全可靠、损伤小、恢复快,能大大降低病死率和伤残率,减少并发症和后遗症,改善预后,优于传统方法。     

双侧侧脑室引流联合腰池置管持续引流术治疗重度脑室出血39例

目的双侧侧脑室引流联合腰池置管持续引流术治疗重度脑室出血的疗效。方法对39例侧重度脑室出血患者采用双侧侧脑室引流加腰池置管持续引流术;同时交替行脑室内尿激酶灌注术进行治疗。结果本组39例,存活34例,死亡5例。结论双侧侧脑室引流加腰池置管持续引流术治疗重度脑室出血疗效显著,简单实用。     

颅内压监测下脑室外引流、腰大池引流治疗脑室岀血的疗效观察

目的 探讨颅内压监测下脑室外引流、腰大池引流治疗脑室岀血的疗效.方法 以本院就诊的重型脑室出血患者为研究对象.随机分成试验组和对照组.试验组给予颅内压监测下行脑室外引流;腰大池引流,对照组根据患者症状、体征和CT扫描结果 进行脑室外引流、腰大池引流.比较两组预后、并发症(颅内感染、脑积水、脑疝、再出血)、脑室引流时间、住院时间的差别.结果 ①试验组疗效显著优于对照组,差异有统计学意义(χ2＝9.621,P＜0.05);②试验组颅内感染、脑积水和脑疝发生率显著低于对照组,差异有统计学意义(P＜0.05);③试验组脑室引流时间和住院时间均显著低于对照组,差异有统计学意义(P＜0.05).结论 颅内压监测下脑室外引流、腰大池引流治疗脑室岀血疗效好,可减少并发症,降低住院时间.     

改良式腰大池置管引流联合脑室外引流治疗脑室出血60例体会

目的探讨改良式腰大池置管引流联合脑室外引流治疗脑室出血的临床疗效。方法对60例脑室出血患者行经颅穿刺脑室外引流术联合腰大池引流术的操作要点及疗效进行临床分析。结果脑室内血肿清除时间4～5天42例,6～7天12例,第三脑室积血消失时间平均6天。本组60例患者55例治疗成功,死亡5例,总有效率91.6%。结论采用改良式腰大池置管联合侧脑室引流救治脑室出血患者,在提高早期救治成功率、缩短脑室血肿清除时间、降低致残率及改善患者生存质量等方面有积极意义。     

原发性脑室出血并脑积水的治疗

目的探讨原发性脑室出血并脑积水的治疗方法。方法报告96例原发性脑室出血,38例采用单纯侧脑室外引流、早期注射尿激酶(1组),58例采用侧脑室外引流、早期注射尿激酶加腰大池置管持续引流术(2组)。结果两组死亡分别为10例(26.3%)、5例(8.6%);颅内感染分别为3例(7.9%)、1例(1.7%);脑积水分别为9例(23.7%)、2例(3.4%)。在死亡率、颅内感染率、交通性脑积水发生率,差异均有统计学意义(P分别为<0.01,<0.01,<0.01)。结论侧脑室外引流、早期注射尿激酶加腰大池置管持续引流术是治疗原发性脑室出血并阻塞性脑积水的有效方法。     

持续双侧脑室引流间断腰池引流治疗重症脑室出血

重症脑室出血起病急、进展快、死亡率高。本院从1991年10月至2000年9月,用双侧侧脑室持续引流,脑室内注入尿激酶,并且间断腰池引流灌洗治疗92例重症脑室出血,取得较好疗效。报道如下。1临床资料1.1一般资料:90例病人,其中男性54例,女性38例;年龄40～75岁,平均为63.5岁;高血压病史68例。1.2临床表现:起病时主要表现为剧烈头痛,恶心呕吐,迅速出现意识障碍。入院GCS评分:3分23例,4～6分53例,7～8分16例。呼吸不规则14例,双瞳孔缩小31例、大小不等11例,去脑强直8例。1.3CT表现:均为全脑室系统出血、脑室扩张。环池积血51例,原发性脑室出血21例…     

脑室外引流及腰穿脑脊液置换术治疗脑室出血34例临床分析

目的探讨脑室外引流及腰穿脑脊液置换术治疗脑室出血的临床疗效。方法对34例脑室出血患者采用脑室外引流及腰穿脑脊液置换术治疗脑出血。结果恢复良好生活基本自理16例,部分生活自理8例,完全卧床生活不能自理5例,死亡5例。结论本方法可以明显减少脑室内引流管放置时间,加快脑室内血液的引流,减轻脑血管痉挛的程度,减少迟发性交通性脑积水的发生,明显降低患者的病死率。     

全脑室铸型出血48例联合治疗体会

目的:研究全脑室系统铸型出血的治疗方法,评价其治疗效果.方法:对48例全脑室铸型出血患者采用双侧侧脑室外引流(其中一侧为ommaya)并用尿激酶冲洗治疗联合腰大池置管引流血性脑脊液.结果:38例存活,8例死亡,2例放弃治疗.6个月后随访结果:20例恢复良好,8例轻瘫,4例重瘫,6例植物生存状态.结论:这种综合疗法加快了血肿清除,提高了疏通脑脊液循环通路的效率,尤其适合于全脑室铸形出血的患者.     

Immediate percutaneous drainage compared with surgical drainage of renal abscess

Purpose To compare immediate percutaneous drainage of renal abscess via ultrasonographic guidance to surgical drainage. Procedures This was a retrospective cross-sectional study of 27 patients (mean age of 59.37 ± 12.25 years) with renal abscesses. Immediate percutaneous catheter drainage was performed in patients with pus-containing cavities greater than 3 cm who consented in the emergency section (n = 12). Other patients underwent surgical drainage (n = 11). Both groups were also treated with empirical antibiotic therapy. Four patients were treated exclusively with antibiotics and were excluded from the analysis. Findings Abscess size on computer tomography (CT) was similar between the percutaneous catheter drainage (PCD) patients and open surgical drainage patients (7.47 ± 1.75 cm vs. 8.67 ± 1.87 cm; P = 0.13). There was no significant difference in mean duration of hospitalization (PCD, 19.5 ± 10.5 days; surgical drainage, 14.55 ± 4.52 days. P = 0.15). Larger abscess size and higher C-reactive protein levels were important prognostic factors in both groups. Microbiological analysis revealed Escherichia coli and Klebsiella pneumoniae in most abscesses. Conclusions Patients treated with percutaneous drainage for renal abscess had outcomes comparable to those treated with surgical drainage.     

Clinical evaluation of closed suction drainage following hepatectomy

A prospective randomized study on 186 patients was conducted to determine the influence of closed suction drainage (n = 102) versus open drainage (n = 84) on the incidence of postoperative complications after elective hepatic resection. The patients were randomly allocated between the two groups. A total of 60 complications occurred in 31 of the 84 patients (36.9%) given open drainage, while 24 complications occurred in 15 of the 102 patients (14.7%) given closed suction drainage. The incidence of pleural effusion, postoperative ascites, and infected subphrenic collections was significantly lower in the closed suction drainage group than in the open drainage group, at 31%vs 16% (P < 0.05), 19%vs 3% (P < 0.01), and 17%vs 5% (P < 0.05) respectively. However, both groups showed similar rates of subphrenic hematoma and bile collection. These findings indicate that closed suction drainage significantly reduces the incidence of postoperative complications after elective hepatic resection.     

Preoperative biliary drainage for hilar cholangiocarcinoma

Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD) with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage (ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized.     

Commercial external ventricular drainage sets: Unsolved safety and handling problems

Summary Twelve commercially available sets for drainage of cerebrospinal fluid were tested for handling, design, features for fixation of the ventricular catheter, reliability of the anti-reflux valve, obstruction, efficiency of the air ventilation filter caps, accuracy of flow measurement and adjustment of flow, quality of material, adjustment, and cost.All systems showed considerable deficiencies in their reliability and handling. None of them can be recommended without certain restrictions and they should all be revised.     

Effects of portal versus systemic venous drainage in kidney-pancreas recipients

A randomized study of combined kidney-pancreas transplantation was performed on 30 insulin-dependent diabetic patients with end-stage renal disease to compare the consequences of pancreas transplantation with portal venous (PV) and systemic venous (SV) drainage. Fourteen patients (SV group) received systemically drained and sixteen (PV group) portally drained pancreas allografts. Enteric drainage was performed in both groups. The routine follow-up included documentation of the clinical course and detailed endocrine studies. At 1 year after transplantation, the patient survival rate was 92 % for the SV group and 96 % for the PV group; the graft survival rate was 78 % and 82 %, respectively. Endocrine studies indicated no difference in fasting and stimulated glucose or in glycosylated hemoglobin between the two groups. In addition, no hyperinsulinemia and lipidic abnormalities were evidenced in either group Long-term studies are required to conclude whether PV and SV drainage in pancreas transplantation are equivalent in terms of patient and graft survival as well as metabolic consequences. Received: 9 July 1999/Accepted: 8 October 1999     

Mounting device for external cerebrospinal fluid drainage: the Freiburg Stativ

Background  External drainage of cerebrospinal fluid (CSF) is one of the most common neurosurgical procedures. It is important to maintain a stable drainage rate, but with the commonly available mountings for CSF drainage this can be difficult to achieve. The drainage rate is dependent on the height-difference between the CSF space and the drip chamber of the device. Most mountings for open CSF drainage cannot be satisfactorily fixed at the bed of the patient; especially if the head of the bed is moved, there is a risk of over- or underdrainage. Materials and methods  We have therefore constructed a mounting for open CSF drainage which allows appropriate adjustment of the rate of CSF outflow, even if the patient’s head part of the bed is moved. Findings  The device was easily mountable or exchangeable at any hospital bed and served equally well for ventricular or for lumbar drainage. Conclusion  We think that this device can help to reduce serious complication of over- or underdrainage in external CSF drainage.     

Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma

Background/Purpose  Although percutaneous transhepatic biliary drainage has previously been recommended as a primary preoperative step, endoscopic nasobiliary drainage (ENBD) is prevalent as an alternative procedure. Few reports assess the efficacy and safety of ENBD in a substantial patient cohort. Methods  Of 116 patients with hilar cholangiocarcinoma who underwent surgery, 62 (43 men and 19 women, median age 69 years) underwent preoperative ENBD. After classification of lesions according to Bismuth–Corlette (B–C) criteria, we evaluated efficacy and safety with respect to B–C type. Results  Patients were classified as B–C types I (n = 5), II (n = 21), IIIa (n = 23), IIIb (n = 5), and IV (n = 8). Preoperative single ENBD was effective in 46/62 patients (74%) including 5/5 (100%) B–C type I, 20/21 (94%) type II, 16/23 (70%) type IIIa, 4/5 (80%) type IIIb, and 1/8 (13%) type IV. Sixteen cases (26%) required additional drainages with ENBD or endoscopic biliary stenting (EBS) in 8/16 (50%), and with PTBD in 8/16 (50%). Mild acute pancreatitis (n = 1, 2%), segmental cholangitis (n = 2, 3%), and acute cholangitis with catheter obstruction (n = 7, 11%) occurred with ENBD. Conclusions  Preoperative single ENBD in the future remnant lobe is effective treatment for B–C type I–III hilar cholangiocarcimona. Preoperative ENBD was rarely complicated with segmental cholangitis.     

Optional sump: novel use of triple lumen closed drainage system

Background: The debate over the use of drains in abdominal surgery is controversial. Selective drainage using a closed system is the method employed by most surgeons. There are, however, specific circumstances where different forms of drainage are required. Methods: One hundred and sixty‐seven patients undergoing a mix of complex upper gastrointestinal surgery and colorectal surgery received an Axiom sump drain at the time of surgery. All side air vents were spigoted and the main lumina connected to a urine bag, with the option to convert to irrigation/suction as required. Results: Two patients required conversion to irrigation/suction, because of ongoing egress of fluid. In both cases drainage ceased without surgical intervention. The remaining cases resolved with no complications related to the drain. Conclusion: The technique described allows the use of a large bore, soft, gravity‐driven drain in cases where wound drainage is necessary. The closure of the ventilation ports maintains the advantage of a closed drainage system, yet allows for the conversion to a true sump system as required. This obviates the need for further drainage procedures.