超声乳化联合房角分离术治疗闭角型青光眼合并白内障临床分析

目的探讨超声乳化联合房角分离术治疗闭角型青光眼合并白内障的效果。方法对80例(86眼)闭角型青光眼合并白内障患者实施超声乳化联合房角分离术治疗,比较手术前后视力、眼压、前房容积(ACV)、中央前房深度(ACD)、前房角度(ACA)的变化。结果术后6个月患者的视力优于术前,眼压水平明显低于术前,ACV、ACD水平高于术前,各点的ACA宽于术前。差异均有统计学意义(P0.05)。结论对闭角型青光眼合并白内障患者实施超声乳化联合房角分离术治疗,能有效提高患者视力,降低眼压,改善患者视功能。     

超声乳化联合房角分离术对闭角型青光眼患者术后昼夜眼压及视功能的影响

目的观察超声乳化联合房角分离术对闭角型青光眼患者术后昼夜眼压及视功能的影响。方法随机将126例闭角型青光眼患者分为2组,每组63例。对照组给予超声乳化术,观察组在对照组基础上联合房角分离术。比较2组患者术前及术后6个月的昼夜眼压、视力及房角宽度的变化。结果术后6个月,观察组患者的峰值眼压、平均眼压、波动值低于对照组,视力水平及房角宽度高于对照组,差异均有统计学意义(P<0.05)。结论超声乳化联合房角分离术治疗闭角型青光眼,能较大程度恢复患者眼压及视力,且安全性较高。     

超声乳化人工晶体植入联合房角分离术治疗闭角型青光眼合并白内障

目的:观察超声乳化人工晶体植入联合房角分离术治疗团角型青光眼合并白内障的临床效果。方法:超声乳化人工晶体植入联合房角分离术治疗团角型青光眼合并白内障20例(22眼)。其中急性闭角型青光眼16例,慢性闭角型青光眼6例,所有手术由同一医师完成,均采用超声乳化人工晶体植入联合房角分离术,观察手术前后视力、眼压、前房深度及房角形态的变化。结果:术后随房3～24个月,视力均较术前明显提高(P<0.05),术后眼压较术前显著性降低。术后1个月前房角镜检查房角均较术前开放角度明显增加,虹膜平坦,周边膨隆消失。结论:采用超声乳化人工晶体植入术联合房角分离术可有效治疗合并白内障的闭角型青光眼。     

超乳联合房角镜下房角分离术治疗急性闭角型青光眼合并白内障的临床效果

目的 探讨超乳联合房角镜下房角分离术对急性闭角型青光眼（AACG）合并白内障患者的效果。方法 回顾性分析2020年2月至2023年2月于本院收治的AACG伴白内障患者98例（98眼）,根据不同治疗方法分为治疗组与对照组（n均=49例）。治疗组AACG伴白内障病例予超声乳化白内障吸除联合人工晶状体植入（Phaco+IOL）联合房角分离术;对照组AACG伴白内障病例给予复合式小梁切除术（CTO）。比较两组术前、术后1周、术后2周、术后4周的眼压、视力;记录两组AACG伴白内障病例术后3个月内并发症发生情况。结果 术前、术后1周、术后2周,两组AACG伴白内障病例的眼压差异无统计学意义（P>0.05）;术后4周,两组AACG伴白内障病例的眼压较术前显著下降,且治疗组下降更明显（P<0.05）;术前、术后1周、术后2周,两组AACG伴白内障病例的视力差异无统计学意义（P>0.05）;术后4周,两组AACG伴白内障病例的视力较术前显著提高,且治疗组提高更明显（P<0.05）;术后3个月内,治疗组（34.69%）AACG伴白内障病例的并发症发生率显著低于对照组（14.29%...     

超声乳化联合房角分离术治疗原发性闭角型青光眼合并白内障的临床效果分析

目的分析超声乳化联合房角分离术治疗原发性闭角型青光眼合并白内障的临床效果。方法对56例原发性闭角型青光眼合并白内障患者实施超声乳化人工晶状体植入联合房角分离术治疗,术后均获3~6个月的随访,观察手术前、后患者视力、眼压、前房深度变化、房角及术后并发症情况。结果术后2个月复查,最佳矫正视力水平高于术前,眼压明显低于术前,差异有统计学意义(P<0.05)。术后2个月前房深度均较术前明显加深;术后1个月前房角与术前比较,均明显增宽,差异有统计学意义(P<0.05)。术中及术后无严重并发症发生。结论超声乳化联合房角分离术治疗原发性闭角型青光眼合并白内障术后恢复效果可靠,并发症少,安全性高值得临床应用。     

白内障超乳联合玻璃体切割术治疗白内障合并玻璃体视网膜病变体会

目的探讨白内障超乳联合玻璃体切割术治疗白内障合并玻璃体视网膜病变的效果。方法回顾性分析2013-02—2014-11间116例(共137眼)白内障合并玻璃体视网膜病变患者实施白内障超乳联合玻璃体切割术治疗的临床治疗资料及随访情况。结果对患者随访4~24个月,137眼中112眼(81.75%)视力改善,其中66眼(48.18%)视力提高2行,30眼(24.59%)出现角膜水肿。48眼(39.34%)出现前房反应。33眼(27.05%)出现一过性高眼压。5例发生继发性青光眼。7例发生视网膜脱落,其中3例为复发性视网膜脱离。余患者术后2周恢复正常。结论白内障超乳联合玻璃体切割术治疗白内障合并玻璃体视网膜病变效果肯定,合理选择手术适应证,提高手术技巧可减少并发症。     

超声乳化联合房角粘连分离术治疗闭角型青光眼的临床观察

目的探讨超声乳化联合房角粘连分离术治疗闭角型青光眼(PACG)的疗效和安全性。方法随机将90例(90眼)PACG患者分为2组,各45例(45眼)。观察组采用超声乳化联合房角粘连分离术治疗,对照组仅行超声乳化手术,对比2组术后6个月眼压、视力、房角粘连程度及并发症。结果术后随访6个月,观察组视力、眼压、房角粘连度数分别为(0.69±0.72)、(10.80±1.59)mm Hg、(43.24±22.53)°,改善情况均优于对照组(P0.05);观察组并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论超声乳化联合房角粘连分离术是治疗PACG的安全有效方法。     

超声乳化吸除联合房角分离术治疗白内障合并急性原发性闭角型青光眼效果观察

目的探讨超声乳化吸除联合房角分离术治疗白内障合并急性原发性闭角型青光眼(APACG)的效果。方法对2013-09—2015-09间收治的42例(45眼)白内障合并APACG患者施行超声乳化吸除联合房角分离术。分析患者手术前后眼压、视力、房角变化、前房深度及术后并发症。结果患者术后1 d、1个月、3个月、6个月眼压均小于术前,差异具有统计学意义(P0.05);术后6个月眼视力明显优于术前,中央及周边前房深度大于术前,房角分级明显改善,差异均具有统计学意义(P0.05)。术后发生角膜水肿5例、瞳孔区絮状渗出3例、前房炎症2例,经对症处理后逐渐消失。结论超声乳化吸除联合房角分离术治疗白内障合并APACG,可明显降低眼压、提高视力、增加前房厚度、改善房角开放程度,安全、有效。     

视网膜脱离患者行玻璃体切割术后的疗效观察及护理对策

目的:探讨视网膜脱离手术后护理方法.方法:观察并总结对42例视网膜脱离病变的患者施行玻璃体切割手术治疗的术后护理.结果:体位心理及术后并发症的观察与护理可有效提高手术成功率.结论:规范的护理是保证视网膜脱离手术成功的关键之一.     

严重眼外伤一期缝合联合玻璃体切割术的疗效观察

目的观察严重眼外伤一期缝合联合玻璃体切割术的疗效。方法对46例严重眼球穿通伤患者实施一期缝合联合玻璃体切割术,治疗后进行指标统计,评价临床疗效。随访时间3个月～3年,观察视力变化、视网膜及眼球情况。结果 46只眼中有30只眼(65.3%)视力不同程度提高,眼内异物全部清除,视网膜复位率77.7%,眼球萎缩5只眼(10.8%)。结论严重眼外伤一期缝合联合玻璃体切割术临床疗效满意。     

前房穿刺术联合激光周边虹膜成形术治疗急性闭角型青光眼急性发作临床观察

目的评价前房穿刺术(ACP)联合激光周边虹膜成形术(LPI)治疗急性闭角型青光眼(AACG)急性发作的实用性和安全性。方法对48例53只眼确诊为急性闭角型青光眼首次急性发作患者非随机分为联合治疗组24例26只眼和药物组24例27只眼,观察治疗后眼压下降情况及眼压下降至21 mm Hg(1 mm Hg=0.133 kPa)所用时间和用药种数、房角开放情况及并发症。结果治疗后0.5、1、2、4、8、12 h眼压分别为:治疗组(10.4±3.8)mm Hg、(11.3±4.1)mm Hg、(11.9±3.6)mm Hg、(16.5±4.6)mm Hg、(17.2±3.3)mm Hg、(16.9±4.4)mm Hg。药物组(40.7±4.4)mm Hg、(36.3±4.8)mm Hg、(25.4±4.8)mm Hg、(18.7±6.6)mm Hg、(20.2±2.9)mm Hg、(17.3±4.1)mm Hg。治疗后0.5、1、2 h组间比较差异具有统计学意义(t=28.392,17.539,8.573。P<0.01)。眼压下降至21 mm Hg所用时间:治疗组30 min内全部降至21 mm Hg以下,药物组为1～12 h,平均6.73 h,组间比较差异具有统计学意义(t=4.635,P<0.05)。眼压下降至21 mm Hg用药种数:治疗组平均(1.15±0.50)种,药物组(3.87±0.33)种,组间比较差异具有统计学意义(t=3.781,P<0.05)。房角开放范围>180°治疗组为88.46%,药物组74.07%,组间比较差异具有统计学意义(x2=17.513,P<0.05)。主要并发症有前房内炎症反应和睫状体脉络膜脱离,无眼内感染和脉络膜上腔驱逐性出血等严重并发症。结论药物降低AACG急性发作时眼压所用时间长。ACP联合LPI治疗迅速安全,无严重并发症,可作为首选治疗措施。     

超声引导下左旋布比卡因复合硫酸镁股神经阻滞对前交叉韧带重建术后镇痛效果的影响

目的探讨左旋布比卡因复合硫酸镁用于超声引导下股神经阻滞对前交叉韧带重建术后镇痛效果的影响。方法选择择期行关节镜下前交叉韧带重建术患者107例,男66例,女41例,年龄25~60岁,ASAⅠ或Ⅱ级。将患者随机分为研究组(n=56)和对照组(n=51)。两组均在全麻诱导前实行超声引导患侧股神经阻滞,研究组给予0.25%左布比卡因和2%硫酸镁混合液20ml,对照组给予0.25%左布比卡因20ml。记录股神经感觉和运动阻滞情况,记录术后4、6、12、24和48h的静息和运动时VAS评分,记录术后48h内追加镇痛药情况、曲马多用量、术后48h满意度评分和术后48h内恶心呕吐等不良反应的发生情况。结果术后12h硫酸镁组静息和运动时VAS评分明显低于对照组(P0.05)。硫酸镁组需追加镇痛药5例(8.9%),明显少于对照组的10例(19.6%)(P0.05);硫酸镁组曲马多用量明显少于对照组(P0.05)。硫酸镁组股神经感觉和运动阻滞起效时间明显短于,感觉和运动阻滞持续时间明显长于,满意度评分明显高于对照组(P0.05)。两组恶心呕吐发生率差异无统计学意义。结论左旋布比卡因复合硫酸镁应用于超声引导股神经阻滞,可以缩短阻滞起效时间,延长阻滞持续时间,提高术后镇痛效果及患者的满意度,减少镇痛药物应用,并且不增加不良反应的发生。     

颈椎病前路择期手术早期并发症危险因素分析

目的: 分析与颈椎病前路择期手术后的早期并发症发生率有关的危险因素。方法: 研究本院 1997年~2003年的 250例颈椎病前路择期 [1]手术病人的出院病历, 确定术后早期并发症; 用logistic回归分析评价早期并发症的危险因素。结果: 在所有病人中 24%的病人有一种或多种并发症,其中 17. 6%为非感染性手术并发症, 4. 0%为感染性并发症, 6. 8%为其它医疗并发症, 1. 2%在住院期间接受无计划的二次手术, 1例病人院内死亡。危险因素包括: 女性、高龄、全费、手术持续时间过长和既往有颈椎手术史者。结论: 对于高龄、女性、全费、手术持续时间过长和有既往颈椎手术史的患者, 应该充分做好术前准备, 手术应尽量采用简单实用手术时间少的术式, 以降低术后早期并发症发生率。     

27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease: A meta-analysis

We performed a meta-analysis to evaluate the effect of 27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease. A systematic literature search up to June 2022 was performed and 1264 subjects with the vitreoretinal disease at the baseline of the studies; 562 of them were using the 27-gauge microincision vitrectomy surgery, and 722 were using 25-gauge microincision vitrectomy surgery. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of 27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease using the dichotomous, and contentious methods with a random or fixed-effect model. The 27-gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication (OR, 6.66; 95% CI, 0.46-0.95, P = .02), and wound suture number (OR, 0.38; 95% CI, 0.20-0.71, P = .002), and best corrected visual acuity (MD, −0.03; 95% CI, −0.05 to −0.001, P = .02) compared with 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. However, 27-gauge microincision vitrectomy surgery subjects had no significant difference in the wound closure time (MD, −8.45; 95% CI, −23.44 to 6.55, P = .27), operation time (MD, 0.85; 95% CI, −1.17 to 2.86, P = .41), intraocular pressure at postoperative day 1 (MD, 0.42; 95% CI, −1.45-2.28, P = .66), primary anatomical success rate (OR, 0.83; 95% CI, 0.42-1.63, P = .58), and central macular thickness (MD, 1.81; 95% CI, −21.76 to 25.37, P = .88) compared to 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The 27-gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication, wound suture number, and best corrected visual acuity, and no significant difference in the wound closure time, operation time, intraocular pressure at postoperative day 1, primary anatomical success rate, and central macular thickness compared to 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The analysis of outcomes should be with caution because of the low sample size of 12 out of 15 studies in the meta-analysis and a low number of studies in certain comparisons.     

颈椎前路手术并发食管瘘的治疗

目的 :探讨颈椎前路手术并发食管瘘的治疗措施及其效果。方法 :回顾性分析2006年9月~2016年7月颈椎前路手术并发食管瘘的8例患者资料,其中男6例,女2例;年龄31~71岁(52.32±13.05岁)。外伤性颈椎骨折4例(其中强直性脊柱炎2例),颈椎病2例,颈椎结核1例,颈椎畸形1例。术中发现食管瘘1例,当即给予修补;术后早发性(1个月内)食管瘘6例,其中2例经呋喃西林纱布条换药处理,2例行清创探查引流术并在术中给予修补,1例清创探查术后给予胸锁乳突肌瓣填塞,1例因脓毒血症死亡;迟发性(1个月后)食管瘘1例,行内固定取出清创探查,并肌瓣填塞。同时所有患者行伤口细菌培养,应用敏感抗生素,鼻饲饮食加强营养等治疗。结果:1例强直性脊柱炎合并颈椎骨折脱位患者,于术后第4天出现食管瘘,术后第7天因脓毒血症死亡;其余7例食管瘘口均愈合,愈合时间为2周~2.5个月;随访1~5年(2.86±1.36年),7例均无复发,且吞咽功能良好。结论:依据食管瘘发生的时间,结合其大小和污染程度采取不同的治疗方案,可取得较好的疗效。     

超声引导下低位前锯肌平面阻滞对上腹部手术患者术后镇痛及炎症反应的影响

目的 评价超声引导下低位前锯肌平面阻滞(SAPB)对上腹部手术患者术后镇痛及炎症反应的影响.方法 择期上腹部手术患者120例,男69例,女51例,年龄18～65岁,ASAⅠ或Ⅱ级.随机分为三组:对照组(C组,n=39),不行神经阻滞;常规SAPB组(SAPB组,n=40),全麻诱导前超声引导下双侧腋中线第5肋水平前锯肌...     

Surgical strategies in the removal of malignant tumors and benign lesions of the anterior skull base

The choice of surgical approaches to the tumors of the anterior skull base is determined by the location, dimensions of such lesions and their relations to the surrounding structures. Furthermore, the need for the reconstruction of the dura and skull base structures has an important influence on the decision about the surgical procedure. Transfacial approaches provide limited exposure, especially when tumors damage the floor of the anterior cranial fossa and involve the frontobasal dura and brain. Transcranial, craniofacial and subcranial approaches in particular may aid a surgeon in the removal of such lesions, and often these surgical procedures are the only beneficial methods. Our study comprised 15 patients. Transcranial approaches were used in ten cases. In five further cases, we adopted craniofacial or subcranial approaches. Total removal of these lesions was possible in 13 cases. Neither important complications nor death after surgery was observed except for two cases (craniofacial/subcranial approach) where the CSF leak and CNS infection were reported. We deem that the transcranial approach creates a good possibility for total removal of anterior skull base tumors, particularly of the benign lesions, and permits reconstruction of the skull base damaged by the tumor. However, in patients with large malignant tumors, the en bloc resection via the combined craniofacial/subcranial approach achieved better outcome.Parts of the materials of this research were presented at the 12th European Congress of Neurosurgery—EANS 2003, 7–12 September, Lisboa, Portugal     

腹腔镜直肠前切除术与开腹手术对患者术后疼痛影响的比较

目的:对比腹腔镜与开腹直肠前切除术对患者术后疼痛的影响。方法:将110例直肠癌根治术患者随机分为两组,腹腔镜组(n=56)行腹腔镜辅助下直肠前切除术,开腹组(n=54)行传统开腹直肠前切除术。对比分析两组患者术后不同时段疼痛程度、睡眠质量、术后止痛药的使用剂量及住院时间。结果:术后6 h、24 h及48 h,腹腔镜组疼痛评分显著低于开腹组(P<0.01);术后72 h,两组患者疼痛评分差异无统计学意义(P>0.05)。腹腔镜组住院时间、止痛药使用剂量明显少于开腹组(P<0.01),术后当天及术后第1天、第2天睡眠质量明显优于开腹组(P<0.01)。术后第3天,两组患者睡眠质量差异无统计学意义(P>0.05)。结论:腹腔镜辅助下直肠癌根治术可有效降低术后疼痛程度,提高患者的睡眠质量,减少住院时间,有效促进了患者的早期康复。     

Three-year outcome after anterior component separation repair of giant ventral hernias: A retrospective analysis of the original technique without mesh

IntroductionIn this study we presented our results with anterior component separation technique utilized in the repair of giant ventral hernias. Our primary endpoints were the rates of surgical site occurrences and recurrence at three years. Besides we investigated the impact of components separation repair on abdominal wall functions.MethodsWe retrospectively analyzed the prospectively-collected data of 40 patients that were operated on between April 2004 and February 2012 for their median ventral hernias sizing larger than 15 cm in width. Our inclusion criteria for component separation program excellently corresponded today's “giant ventral hernia” standards. The method used for components separation was identical to the original Ramirez technique, and did not comprise of any mesh reinforcement. The ICU stays, prolonged intubation, early and late complications, mortality and recurrences at three years were recorded. We used a curl-up test to demonstrate the amelioration of the abdominal wall functions postoperatively.ResultsThe older age and larger defect size were the significant risk factors necessitating prolonged intensive care. Surgical site occurrences were recorded in 18 patients (45.0%). A total of 7 recurrences (17.5%) were detected at three years. Patients showed a significant improvement in raising their trunks after repair (p < 0.001).ConclusionsOur findings demonstrated that components separation technique in the original form caused excessive wound complications including skin necrosis which in turn caused delayed discharge from the hospital. The 17.5% recurrence rate seemed higher than those of more recent papers. The already-established newer modifications should be integrated in the repair method. The components separation repair clearly improves abdominal wall functions.