翻转内皮小梁网滤过手术治疗闭角型青光眼

目的:探讨翻转内皮小梁网滤过手术治疗闭角型青光眼的临床应用价值。方法:观察组40例(46眼)闭角型青光眼患者,行翻转内皮小梁网滤过手术;对照组36例(42眼)闭角型青光眼患者,行常规小梁切除术。术后观察浅前房发生率、眼压及滤过泡情况。结果:随访3~18个月,观察组1眼发生浅前房,占2.17％,对照组7眼发生浅前房,占21.47％;观察组43眼有功能性滤过泡,占93.43％,对照组34眼有功能性滤过泡,占80.95％;最后一次随访平均眼压,观察组14.12±2.32mmHg,对照组16.02±3.21mmHg,两组相比,差异有显著性意义。结论:翻转内皮小梁网滤过手术是治疗闭角型青光眼的一种安全、有效的方法。     

复合式小梁切除术治疗原发性闭角型青光眼效果观察

目的探讨复合式小梁切除术治疗原发性闭角型青光眼的效果。方法随机将84例(99眼)闭角型青光眼患者分为2组,对照组40例(47眼)采用传统小梁切除术,观察组44例(52眼)采用复合式小梁切除术治疗,比较2组患者术后眼压控制和功能性滤过泡的维持等临床指标。结果 2组患者术后均获随访6个月,2组术后1周眼压控制良好率比较,差异无统计学意义(P0.05)。观察组内浅前房出现率低于对照组,差异有统计学意义(P0.05)。术后6个月观察组眼压控制良好率优于对照组,功能性滤过泡维持率高于对照组,差异均有统计学意义(P0.05)。结论复合式小梁切除术治疗原发性闭角型青光眼,眼压控制效果好,并发症低。     

改良小梁切除术治疗闭角型青光眼临床疗效观察

目的观察应用联合丝裂霉素C等改良小梁切除术方法治疗闭角型青光眼的临床疗效。方法将60例闭角型青光眼患者随机分为对照组和观察组两组,对照组30例(34眼)实施单纯小梁切除术治疗,观察组30例(36眼)实施改良小梁切除术治疗,比较两组术后眼压、滤过泡和前房深度等情况。结果两组术后眼压均恢复良好,组间差异无统计学意义(P0.05)。观察组术后浅前房发生率较对照组低,随访6个月,观察组功能性滤过泡较对照组增多。组间相比差异均有统计学意义(P0.05)。结论应用改良小梁切除术治疗闭角型青光眼有效率高,且术后并发症的少,效果肯定。     

两种显微手术方式处理原发性闭角型青光眼的对比研究

目的 探讨两种显微手术方式对处理原发性闭角型青光眼的初步临床疗效。方法 采用非随机对照临床研究方法。拟定手术适应证。对临床收治的45例50眼原发性闭角型青光眼进行单纯抗青光眼手术（trabeculectomy，Trab），或青光眼-白内障联合手术（phacotrabeculectomy＋IOL，Phaco Trab＋IOL）。比较不同适应证下两种手术方式初步的临床疗效。结果 术后与术前相比：两组眼压均明显降低（P值均〈0．001）；PhacoTrab＋IOL组视力提高占77．3％（P=0．026）、前房深度加深（P〈0．001）、房角加宽或重新开放、C值提高（P〈0．001）；Trab组视力提高仅占39．3％（P=0．026）、前房深度和房角改变均不明显（P〉0．05），但C值亦有改善（P〈0．001）；两组均未见严重术中术后并发症。结论 两种显微手术方式适合不同的病人情况。PhacoTrab＋IOL组有更好的房角开放、C值改善以及视力提高等优势，提示超声乳化白内障吸除术能有效地从发病机制上处理原发性闭角型青光眼。     

手术治疗高眼压状态下原发性急性闭角型青光眼临床观察

目的探讨手术治疗高眼压状态下原发性急性闭角型青光眼的安全性和疗效。方法收集整理手术治疗高眼压状态下原发性急性闭角型青光眼30例患者的临床资料,通过对治疗效果的分析,研究其临床治疗效果。结果本组30例患者当中,经过手术治疗之后,患者的情况均得到了明显的改善,患者的视力取得很好的恢复,眼压控制效果也非常明显,具有很好的治疗效果,且在治疗过程中和治疗后3个月内均没有发生严重并发症。结论手术治疗高眼压状态下原发性急性闭角型青光眼,可以有效缓解患者症状,患者视力恢复和眼压控制理想,值得在临床推广使用。     

青光眼滤过手术失败后显微手术治疗的体会

目的报道30例(31眼)青光眼滤过手术失败后再次显微小梁切除手术的治疗体会。方法回顾性分析2003年1月至2005年12月30例(31眼)青光眼滤过手术失败的因素、再次小梁切除手术的方法技巧及其临床效果。结果滤过泡瘢痕化是初次手术失败的最主要原因。患者术前眼压(30．39±16．95)mm Hg,经个体化的再次手术治疗,滤过泡形成良好,眼压显著降低。术后第1天眼压(11．87±12．73)mm Hg,第7天眼压(8．33±4．96)mm Hg。结论根据患者术眼具体情况而设计的个体化再次小梁显著切除手术,效果显著,可安全、有效地降低眼压。     

小视野青光眼晚期显微手术治疗体会

目的评价小视野青光眼晚期显微小梁切除术的安全性和临床效果。方法自2005年5月起对小视野青光眼晚期实施复合小梁切除术24例（26眼），术前尽量控制眼压，于球周麻醉下进行显微手术，术中注意微创操作、避免眼压骤降，术后行视神经保护治疗，并进行疗效观察。结果24例（26眼）均顺利完成手术，术后眼压得到稳定控制，视力及视野得到有效保持，无严重并发症发生。结论复合小梁显微切除术是一种安全、有效的手术方法。为了挽救小视野青光眼的残余视功能，应尽早手术为宜。     

三联手术治疗高龄闭角型青光眼合并白内障的临床效果

目的 探讨超声乳化术并植入超薄人工晶状体+小梁切除术治疗高龄闭角型青光眼伴白内障的临床效果。方法 回顾性分析2020年6月至2023年1月在本院接受手术治疗的闭角型青光眼伴白内障70例高龄患者的临床资料,依据手术方式不同,分为对照组（35例,使用超声乳化术并植入超薄人工晶状体治疗）与观察组（35例,使用超声乳化术并植入超薄人工晶状体+小梁切除术治疗）。术后3个月,比较2组患者眼压、前房深度、视野缺损状况、视网膜神经纤维层厚度、角膜内皮细胞数量及并发症发生状况。结果 术前,两组眼压、前房深度相比,差异无统计学意义（P>0.05）;术后1周、1个月及3个月,观察组眼压均明显低于对照组,差异有统计学意义（P<0.05）,术后3个月,前房深度明显高于对照组,差异有统计学意义（P<0.05）;术前及术后,两组视野缺损状况、视网膜神经纤维层厚度、角膜内皮细胞数量相比,差异无统计学意义（P>0.05）;观察组并发症发生率明显低于对照组,差异有统计学意义（P<0.05）。结论 超声乳化术并植入超薄人工晶状体+小梁切除术在干预高龄闭角型青光眼伴白内障中能有效降低眼压,提升中...     

原发性闭角型青光眼合并白内障超声乳化术治疗的临床观察

目的研究白内障超声乳化联合后房人工晶状体植入术在原发性闭角型青光眼合并白内障的『临床效果。方法对2008年3月至2012年2月在本院治疗的早期原发性闭角型青光眼合并白内障患者42例（48只眼）,施行白内障超声乳化联合后房人工晶状体植入术,术后随访3-12个月。结果术后所有患者术后视力均有明显提高,眼压得到控制,前房均有不同程度的加深,术前关闭的房角有不同程度的开放。结论白内障超声乳化联合后房人工晶状体植入术对于原发性闭角型青光眼合并白内障患者具有提高视力,控制眼压的效果。     

慢性闭角型青光眼急性发作合并前房出血1例

患者男,60岁。因右眼红痛6d于2010年2月18日入院。患者入院前6d出现右眼红、痛、畏光、流泪,伴同侧头痛,3d前在当地医院求治,拟诊为＂急性青光眼＂并静滴20%甘露醇,症状无好转,遂转笔者所在医院求治,2010年2月22日行抗青光眼手术治疗,术中、术后出血明显。患者既往有高血压史。入院体格检查：血压120/95mmHg,全身检查未见异常。     

晶状体不全脱位致急性闭角型青光眼的显微手术处理方式探讨

目的探讨晶状体不全脱位致急性闭角型青光眼的临床诊治经验。方法回顾性分析我院确诊为晶状体不全脱位致急性闭角型青光眼的患者资料。本组病例共20例（21眼），临床表现均为急性闭角型青光眼；所有病例皆已根据患者晶状体移位程度及视力情况给予相应手术治疗。结果患者出院后平均随访（16．95±15．69）个月。1例患者经保守治疗后出院。余患者术后最佳矫正视力3眼0．01～0．10，7眼0．10—0．30，4眼0．30～0．50，7眼〉0．50，眼压均控制在正常范围。经保守治疗的患者眼压控制在正常范围，无晶状体移位加重的情况出现；手术后患者无一例严重并发症，无再次手术者，眼压控制及视力恢复良好。结论晶状体不全脱位致急性闭角型青光眼的临床特点与原发性急性闭角型青光眼类似，易误诊。细致的眼科检查将有助于提高正确诊断率。正确诊断是有效治疗的基础。     

改良显微小梁切除术治疗葡萄膜炎继发性青光眼

目的 探讨小梁切除术中采用虹膜节段切除联合应用丝裂霉素C(MMC)及粘弹剂治疗葡萄膜炎继发性青光眼的临床疗效.方法 术中根据患者的年龄、炎症和结膜Tenon囊情况选用不同浓度的MMC(0.25～0.33 mg/ml),应用粘弹剂分离虹膜前后粘连和瞳孔区机化膜并剪除机化膜,节段切除虹膜,可控缝线缝合巩膜瓣.观察手术前后视力、眼压、炎症和术后并发症情况.结果 葡萄膜炎继发性青光眼共38例42眼,平均随访时间(12.01±3.56)月.术后末次复查与术前比较,视力提高14眼,不变28眼;前房炎症消失35眼,减轻7眼;平均眼压(15.20±4.64)mmHg与术前(38.37±12.93)mmHg比较差异有统计学意义(t=8.255,P=0.000).手术总成功率92.9%,无严重并发症发生.结论 小梁切除术术中联合应用MMC、粘弹剂、虹膜前后粘连分离、虹膜节段切除及可控缝线技术能够提高较严重葡萄膜炎继发性青光眼的手术成功率,减少手术并发症及术后炎症反应,减少葡萄膜炎复发.     

59例30岁以下原发性肺癌的临床及病理

目的 探讨30岁以下青少年原发性肺癌的特殊临床和病理特点.方法 外科治疗年龄8～29岁,平均23岁的原发肺癌病人59例.术前有症状者49例,其中18例术前被误诊.根治性手术46例,姑息性手术3例,剖胸探查术7例,胸腔镜下活检术3例.术后病理腺癌18例,类癌13例,黏液表皮样癌9例,鳞癌5例,小细胞癌4例,腺鳞癌3例,其他4例.TNM分期:Ⅰ a期8例,Ⅰ b期3例,Ⅱ a期9例,Ⅱ b期12例,Ⅲa期15例,Ⅲ b期8例,Ⅳ期4例.结果 术后并发肺不张3例,发生率5.08%,剖胸探查组术后并发呼吸衰竭死亡1例.全组5年生存率为27.0%,其中根治组为35.0%.单因素分析显示不同p-TNM分期和手术方式与其生存率高度相关(P<0.05),性别、病理类型和术后化疗均不是预后的影响因素(P>0.05),Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期+Ⅳ期5年生存率分别为75.0%、33.3%、14.3%和0.0%.叶切、全切和探查术5年生存率分别为43.0%、18.2%和0.0%.多因素分析显示仅TNM(P=0.000)是影响青少年原发性肺癌术后的独立影响因素.结论 青少年肺癌应引起重视,提高确诊率,避免当作肺部良性疾病而耽误手术时机.青少年肺癌根治性手术治疗5年生存率为35%,与普通肺癌人群相当,应积极采取以手术为主的综合治疗.

Abstract：

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients.Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic carcinoma between 1969 and 2008.There were59 patients (36 male and 23 female).Mean age was 23 years ( range 8-29 ) .The ratio of men to women patients was 1.7∶1.Forty-nine cases ( 83.0% ) were symptomatic at presentation and 18 cases(30.5% )were misdiagnosed as other diseases.Surgical procedures included radical resection in 46 cases,palliative resection in 3 cases,thoracotomy only for unresectable disease in 7 cases and VATS biopsy in 3 cases.The histological types were 18 adenocarcinomas,13 carcinoids,9 mucoepidermoid carcinoma,5 squamous cell carcimomas,4 small cell lung cancer,3 adenosquamous carcinoma and 4 others.On TNM staging,8 cases in stage Ⅰa,3 cases in stage Ⅰb,9 cases in stage Ⅱ a,12 cases in stage Ⅱb,15 cases in stage Ⅲa,8 cases in stage Ⅲb,4 cases in stageⅣ.Results There were no operative death in radical group.Post-operative atelectasis in 3 cases.One case died from postoperative respiratory failure in explosive group,the postoperative five year survival rate was 27.0%.radical resection group 5-year survival was 35%.Univariate analysis identified TNM stage and surgical procedures as predictors of survival( P <0.05).factors that had no significant effect on overall survival included gender,histologic sbutype and postoperative chemotherapy (P > 0.05).The 5 year survival in stage Ⅰ,Ⅱ,Ⅲa,Ⅲb + Ⅳ were 75.0%,33.3%,14.3% and 0,respectively.The 5 year survival in lobectomy,pneumonectomy and exporsive were 43.0%,18.2% and O,respectively.On multivariate analysis,TNM stage of disease was the only independent predictor of survival ( P =0.000) .Conclusion We should pay attention to adolescent lung cancer and improve the diagnosis rate avoiding of delaying surgical treatment.The five year survival rate of radical resection for adolescent lung cancer was good.They should be treated with aggressive multimodality therapy and surgical resection is the first-line treatment for them.     

59例30岁以下原发性肺癌的临床及病理

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients.Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic carcinoma between 1969 and 2008.There were59 patients (36 male and 23 female).Mean age was 23 years ( range 8-29 ) .The ratio of men to women patients was 1.7∶1.Forty-nine cases ( 83.0% ) were symptomatic at presentation and 18 cases(30.5% )were misdiagnosed as other diseases.Surgical procedures included radical resection in 46 cases,palliative resection in 3 cases,thoracotomy only for unresectable disease in 7 cases and VATS biopsy in 3 cases.The histological types were 18 adenocarcinomas,13 carcinoids,9 mucoepidermoid carcinoma,5 squamous cell carcimomas,4 small cell lung cancer,3 adenosquamous carcinoma and 4 others.On TNM staging,8 cases in stage Ⅰa,3 cases in stage Ⅰb,9 cases in stage Ⅱ a,12 cases in stage Ⅱb,15 cases in stage Ⅲa,8 cases in stage Ⅲb,4 cases in stageⅣ.Results There were no operative death in radical group.Post-operative atelectasis in 3 cases.One case died from postoperative respiratory failure in explosive group,the postoperative five year survival rate was 27.0%.radical resection group 5-year survival was 35%.Univariate analysis identified TNM stage and surgical procedures as predictors of survival( P <0.05).factors that had no significant effect on overall survival included gender,histologic sbutype and postoperative chemotherapy (P > 0.05).The 5 year survival in stage Ⅰ,Ⅱ,Ⅲa,Ⅲb + Ⅳ were 75.0%,33.3%,14.3% and 0,respectively.The 5 year survival in lobectomy,pneumonectomy and exporsive were 43.0%,18.2% and O,respectively.On multivariate analysis,TNM stage of disease was the only independent predictor of survival ( P =0.000) .Conclusion We should pay attention to adolescent lung cancer and improve the diagnosis rate avoiding of delaying surgical treatment.The five year survival rate of radical resection for adolescent lung cancer was good.They should be treated with aggressive multimodality therapy and surgical resection is the first-line treatment for them.     

超声乳化白内障吸除联合人工晶体植入术治疗闭角型青光眼的临床疗效观察

目的观察超声乳化白内障吸除联合折叠式人工晶体植入术治疗急性闭角型青光眼合并白内障患者的临床疗效。方法收集2002年7月至2005年9月于中山眼科中心青光眼病区收治的急性闭角型青光眼合并白内障31例(31眼),患者均接受超声乳化白内障吸除联合折叠式人工晶体植入术,术后随访3个月。结果术后最佳矫正视力,较术前显著提高(P<0·05);患者术后3个月眼压平均为(15·3±3·2)mmHg,较术前用药前后眼压相比均显著下降(P<0·05);超声生物显微镜检查发现术后前房深度较术前均显著增加,平均为(3·01±0·47)mm(P<0·05);术后患者房角均较术前增宽,房角粘连关闭象限不同程度开放。结论超声乳化白内障吸除联合折叠式人工晶体植入术可有效降低眼压、提高视力,为急性闭角型青光眼同时合并白内障患者安全有效的治疗途径。     

Long-term results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years

The results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years are presented. Eighty-three arthroplasties were performed on 55 patients with an average age of 24.9 years (range, 17–29 years) and an average follow-up period of 240 months (20 years; range, 62–360 months). There were 2 nonfatal pulmonary emboli, 2 cases of deep sepsis, and 3 fractured femoral implants. Twenty-eight acetabular components migrated (34%), 25 have been revised (30%), and the average annual acetabular wear rate was 0.12 mm. Sixteen femoral implants subsided (19%), and fracture of the tip of the cement mantle occurred in 8 hips (10%). Nineteen femoral components (23%) were revised; femoral osteolysis was seen in 15 hips (18%) and changes in the calcar in 33 (38%). Acetabular component survivorship was 92% (95% confidence interval, 85–98%) at 10 years, 70% (60–81%) at 20 years, and 68% (57–79%) at 25 years, with the figures for the femoral implant being 93% (87–98%), 76% (66–86%), and 73% (62–85%), respectively.     

A study of preoperative fasting in infants aged less than three months

The effects of preoperative fasting on plasma glucose and gastric emptying was studied in 62 infants aged less than three months after a feed of either breast milk or an infant milk formula. Prior to induction of anaesthesia no infant was hypoglycaemic, defined as plasma glucose less than 2.2 mmol/l. Five per cent of infants had a significant volume of residual gastric contents. The mean intraoperative plasma glucose levels rose significantly and this was not influenced by the use of intravenous Hartmann's solution or low dose opioids. Infants in this age group tolerate three- to four-hour preoperative fasts well as no infant became hypoglycaemic intraoperatively. They demonstrate a hyperglycaemic response to the stress of anaesthesia and surgery, and may not need routine intraoperative glucose supplements although plasma glucose should still be monitored.     

单纯性非穿透性小梁显微手术治疗青光眼的临床效果

目的评价单纯性非穿透性小梁显微手术在治疗原发性开角型青光眼中的近期临床疗效。方法对16例20眼原发性开角型青光眼患者进行不加植入物的非穿透性小梁手术治疗,术后观察眼压、眼内反应、滤过泡形态,并对手术区域进行超声生物显微镜检查。随访时间平均(4.2士2.4)个月。结果术前平均眼压(3.78士1.11)kPa,术后3个月平均眼压(2.08±0.51)kPa,差异有显著性(P＜0.01)。无需额外药物治疗而术后眼压≤2.80kPa者占65％,需加用局部药物占35％。所有患者术前与术后视力差异经x2检验无统计学意义;无1例出现前房变浅、炎症、脉络膜脱离等并发症。超声生物显微镜检查显示眼压控制良好者在巩膜瓣下形成一透明液性间腔,在结膜下有功能性滤过泡形成。结论不加植入物的非穿透性小梁显微手术在近期能有效降低眼内压,是一种对开角型青光眼很有应用前景的抗青光眼手术。     

Total hip arthroplasties in patients younger than 45 years. A nine- to ten-year follow-up study

Eighty-one cemented total hip arthroplasties in patients younger than 45 years were reviewed with an average 9.2-year follow-up interval. The results were compared with the same group previously reported at an average follow-up time of 4.5 years. Clinically satisfactory results were 58% compared with 78% at 4.5 years. The revision rate almost tripled to 33%. Impending failure was present in 56% of those hips not yet revised. In the first study, technique was a primary determinant of success. In this report there was no influence of technique on the incidence of revision. Age did not influence revision rates either, with 35% in patients younger than 30 years and 32% in patients aged 30-45 years. Patients younger than 30 years had fewer satisfactory clinical results and a higher rate of impending failure. As in the first study, the best results were obtained in patients with inflammatory collagen disease aged from 30 to 45 years.