尼卡地平、艾司洛尔用于经蝶垂体腺瘤切除术中控制性降压的观察

经蝶垂体腺瘤切除术创伤小,恢复快,因此目前多采用此术式行垂体腺瘤切除,但在显露和解剖蝶鞍区时,可导致交感神经兴奋,儿茶酚胺释放致血压升高,心动过速[1],增加心肌耗氧,诱发和加重心肌缺血,增加术中出血,影响术野,增加术者的操作难度和围手术期危险性。尼卡地平、艾司洛尔可用于缓解气管内插管引起的心血管反应[2,3],本研究旨在探讨单独应用尼卡地平及其复合艾司洛尔对经蝶垂体瘤     

内窥镜下直接经蝶入路切除垂体腺瘤

目的 探讨内窥镜控制下直接经蝶入路切除垂体腺瘤的方法。方法 22例垂体腺瘤患者,在内窥镜控制下,经单鼻孔进入,术中不切除鼻中隔,直接自蝶窦开口打开蝶突前壁,进一步经鞍底切除垂体腺瘤。结果 22例患者中,15例肿瘤全部切除,7例肿瘤次全切除。术后随访1－12个月,17例患者内分泌功能恢复正常。4例术后发生暂时性尿崩症。结论 内窥镜控制下直接经蝶切除垂体腺瘤入路与目前常规经蝶显微手术比较,入路途径较短,且安全简捷、损伤小,手术显露良好,术后反应小,值得进一步推广。     

神经内镜与显微镜下经鼻蝶垂体腺瘤切除术效果对比分析

目的:探讨神经内镜与显微镜下经鼻蝶垂体腺瘤切除术的手术效果。方法:回顾分析2009年12月至2012年12月收治的263例患者的临床资料,其中105例行神经内镜垂体腺瘤切除术(内镜组),158例行显微镜下经鼻蝶入路垂体腺瘤切除术(显微镜组),对比分析两组患者手术时间、出血量、手术切除率、术后并发症发生率、术后住院时间等指标。结果:内镜组手术时间较显微镜组长[(78.7±34.55)min vs.(66.8±31.32)min](P=0.014);两组术中出血量差异无统计学意义[(60.6±32.35)ml vs.(55.1±24.63)ml](P=0.943);两组手术全切率差异亦无统计学意义(93.3%vs.92.4%)(P=0.7760);内镜组术后并发症发生率低于显微镜组(5.71%vs.13.29%),差异有统计学意义(P=0.0470)。内镜组术后住院时间较显微镜组短[(6.12±1.94)d vs.(7.13±1.57)d],差异有统计学意义(P=0.0166)。结论:神经内镜手术在肿瘤全切方面与显微镜组相当,但术后并发症发生率及术后住院时间具有明显优势,代表了经鼻蝶垂体腺瘤手术的发展方向。     

鼻内镜下经鼻蝶入路垂体瘤切除术的护理体会

目的探讨鼻内镜下经鼻蝶入路垂体瘤切除术的护理配合方法。方法对41例接受鼻内镜下经鼻蝶入路垂体瘤切除术患者的临床护理资料进行回顾性分析。结果患者均顺利完成手术,发生并发症2例(4.9%),经对症治疗后治愈,患者均顺利出院。结论积极做好鼻内镜下经鼻蝶入路垂体瘤切除术围术期各项护理措施,可降低并发症发生率,提高手术治疗效果。     

经鼻蝶入路垂体瘤切除术的护理

目的探讨经鼻蝶入路垂体瘤切除术的护理措施。方法对41例垂体瘤患者行经鼻蝶入路垂体瘤切除术,术前做好心理护理,讲解手术的目的、意义及注意事项,完善术前准备。术后严密观察患者病情,及时发现和处理并发症。结果术后出现脑脊液鼻漏2例,暂时性尿崩症10例,经保守治疗均症状缓解,治愈出院。结论经鼻蝶入路垂体瘤切除手术创伤小,住院时间短,患者恢复快。做好术前护理及术后病情观察是保证手术成功的关键。     

内镜下经鼻蝶入路垂体腺瘤切除术的疗效分析

目的 探讨内镜下经鼻蝶入路垂体腺瘤(PA)切除术的安全性和效果。方法 回顾性分析武陟县人民医院外一科2019-02—2022-02行经鼻蝶入路PA切除术的82例患者的临床资料,分为内镜组和显微镜组,各41例。统计2组的有效全切率,记录围术期指标及并发症情况,检测手术前后体液的免疫球蛋白(IgA、IgM、IgG)水平,以及视野指数(VFI)、视野平均缺损值(MD)视功能指标。结果 2组总有效全切率、并发症总发生率差异均无统计学意义(P>0.05)。内镜组的手术时间、住院时间较显微镜组短,术中出血量、治疗费用较显微镜组低;术后第1天、第3天的IgA、IgG、IgM水平较显微镜组高;术后1个月时的VFI、MD较显微镜组高。以上差异均有统计学意义(P<0.05)。结论 内镜和显微镜下经鼻蝶入路PA切除术均是安全可靠的手术方式,但内镜下手术能优化围术期指标、减轻机体免疫功能损伤,促进视功能恢复。     

经蝶垂体瘤摘除术的护理

我院自1996．12～2000．12，对15例垂体瘤患施行了经蝶垂体瘤除术治疗，现将护理报告如下。     

经蝶切除垂体腺瘤术中各种严重出血及处理

经蝶手术中严重出血虽不多见，一旦出现如处理不当会造成严重后果，危及患者的生命。我们自1980年3月至2003年1月，经蝶手术1667例，其中38例发生严重出血，现报告如下。     

经蝶垂体腺瘤切除术后低钠血症的临床表现和处理

鞍区肿瘤特别是垂体腺瘤术后易并发尿崩症以及低钠血症，其早期诊断和有效治疗对预后至关重要。我科自1996年5月至2003年3月经蝶垂体腺瘤切除术后出现尿崩症和低钠血症17例，现报告如下。     

经蝶切除无功能垂体腺瘤对病人生活质量的影响

目的对无功能垂体腺瘤病人术前和术后生活质量进行评估,并探讨影响病人生活质量的危险因素。方法 2014年1月～2014年12月收治的无功能垂体腺瘤40例,采用SF-36问卷评估病人生活质量,结合术前资料及术后随访,采用t检验及Logistic回归分析探讨影响病人生活质量的危险因素。结果病人手术前后生活质量评分分别为(119±10)vs(99±11),肿瘤的侵袭性与术后生活质量下降无明显关系,肿瘤大小则与之呈负相关(r=-6.928,P0.05),病人术后垂体功能低下,垂体-性腺轴和垂体-肾上腺轴功能减退与生活质量关系密切,而垂体-甲状腺轴则无明显相关。结论经蝶切除无功能垂体腺瘤病人术后生活质量下降,肿瘤大小是其独立危险因素,术后垂体-性腺轴及垂体-肾上腺轴功能减退对病人生活质量的影响更为明显。     

Initial experiences with the Camey bladder

The construction of a new continent reservoir after cystectomy has been a major attempt of urological surgery during recent years. We have employed an ileal conduit which was anastomosed to the urethra according to Camey in 10 patients. Two patients died postoperatively because of complications. Eight left the hospital with a sufficiently working new bladder. Capacity, flow, bladder emptying and continence were satisfactory. The results are presented in detail. Most patients were incontinent to some degree during the night. This was handled by micturition, pads and condom urinals. All patients were content with the result. The longest follow up time is 2 years.     

Initial clinical experiences with RARE-MR urography

Potentials and limitations of a new, facultative non-tomographic Fast-Imaging sequence "RARE-MR-Urography" are presented. Its results in urological diseases are discussed on the basis of a pilot study of 35 patients. The images (4 s-32 s acquisition time) are extremely T2-weighted and display unbounded free water (urine). They reveal valuable information, not available with ultrasound or conventional radiology without application of contrast agents in the presence of urine retention. S/N problems reduce the accuracy of this method if the urinary tract contains only small amounts of urine.     

Retroperitoneal dismembered pyeloplasty: Initial experiences

AIM: To review the results of our first 40 cases of retroperitoneal dismembered pyeloplasty and to compare them with series of open and other minimally invasive treatments of pelviureteric junction (PUJ) obstruction. Also to compare our first 20 cases with the second 20 cases to see if there was an improvement in results with experience. METHODS: A retrospective review of the first 40 laparoscopic pyeloplasties performed by a single lead surgeon at two institutions was performed. The diagnosis of PUJ obstruction was confirmed with an intravenous urogram as well as a renogram prior to surgery. A retroperitoneal, dismembered pyeloplasty was routinely performed with three or four ports. All patients were followed up with an intravenous urogram, renogram and review of symptoms at 4 months and annual renogram after that. RESULTS: Average operation time was 236 min and this appeared to decrease with experience. Two cases had to be converted to open operations. The mean hospital stay was 3.4 days. Out of the 40 patients, 34 have had successful laparoscopic operations with total symptomatic relief as well as radiologically proven deobstruction. There were four major complications with 3 patients going on to have redo open pyeloplasty operations. There were seven minor complications. CONCLUSIONS: In our experience, retroperitoneal dismembered pyeloplasty is an effective and safe means of treating PUJ obstruction. Our results seem to be comparable with series of open pyeloplasty and other laparoscopic series and are better than some other minimally invasive techniques.     

Gil-Vernet transvesical antirefluxplasty. Initial clinical experiences

Our results in 18 cases with the Gil-Vernet technique of surgical correction of vesicoureteral reflux are presented. The ureteral orifices are advanced across the trigone by means of a single submucosal mattress suture in order to increase the intramural length of each distal ureter. The new procedure offers some advantages to the more widely applied techniques. It is rapid and simple to perform and the intrinsic and extrinsic musculature of the terminal ureters is preserved. This technique can be used indiscriminately in cases of primary unilateral or bilateral reflux, including grades II to IV.     

Initial experiences with the cementless PM endoprosthesis

A follow up of 40 cementless fixed endoprostheses type PM showed good results, similar to cement fixed prostheses. In cementless fixation seem to be more early complications and less late complications, so these results are encouraging what concerns cementless fixation.     

腹腔镜腹股沟疝修补术的初期应用体会

目的:探讨初期开展腹腔镜腹股沟疝修补术的注意事项,术中、术后常见并发症及其处理措施。方法:回顾分析2012年10月至2013年5月为21例患者行腹腔镜腹股沟疝修补术的临床资料,其中19例行全腹膜外疝修补术(totally extraperitoneal,TEP),2例行经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)。结果:1例TEP患者中转行TAPP。手术时间TEP平均(92±41.38)min,TAPP平均(122±26.38)min,术中腹壁下血管损伤1例,腹膜撕裂5例,均无血清肿、内脏损伤、尿潴留及输精管损伤,未见切口及深部创面感染,术后未使用止痛剂。患者均于术后第1天恢复正常饮食并下床活动。患者术后第1、3、6个月获得电话随访,无腹股沟区慢性疼痛及复发。结论:熟悉、掌握腹腔镜下腹膜前间隙及其重要结构、选择合适的手术方式是避免腹腔镜腹股沟疝修补术中、术后并发症发生的关键。     

后腹腔镜技术治疗肾盂旁囊肿的体会

目的:总结经腹膜后腹腔镜囊肿去顶术治疗肾盂旁囊肿的经验,讨论手术适应证和手术要点。方法:采用经腹膜后腹腔镜囊肿去顶术治疗肾盂旁囊肿7例。结果:7例手术均获成功。术后无并发症。手术时间30~120m in,平均65m in;术中出血30~80m l,平均55m l;术后住院5~8d,平均6.5d。结论:后腹腔镜手术治疗肾盂旁囊肿可望成为治疗肾盂旁囊肿的首选方法。     

Initial experiences with the Ilisarov method on the hand bones]

From 1 July 1991 to 1 July 1992, 23 patients were treated using an Ilisarov distraction apparatus. The apparatus was used for callus distraction in 13 patients, and for closed fracture treatment, for generating longitudinal pressure in the treatment of fractures, for corrective osteotomy and for soft tissue distraction in 10 patients. Callus distraction in the hand has advantages over conventional techniques. Furthermore, the Ilisarov technique has its merits in certain fractures of the hand.