胰外瘘防治的探讨

目的　胰外瘘 ( PF)系胰腺炎症、外伤及手术后严重并发症 ,兹探讨其防治。方法　总结治疗组 13例。因重症胰腺炎 ( SAP)坏死清除引流 4例 ;外伤单纯引流 3例 ,胰十二指肠切除 ( PD) 1例 ;十二指肠降段癌及胰头炎性肿块各 1例均行PD;假性囊肿左半胰切除 1例 ;十二指肠首段癌首段及部分降段切除 1例 ;原因不明 1例。 PF发生于术后 1～ 5 d,胰液量 10 0～ 10 0 0 m l,淀粉酶多数 >10 0 0 IU。影像学有关检查。 11例非手术治疗 ;2例手术 ,分别为瘘管空肠 Y吻合及瘘管胃吻合、脾及胰尾切除和胰空肠 Y吻合。预防组 12例 ,术前影像学检查。壶腹 (周 )癌 PD9例 (保幽 5、空肠造瘘 4 ) ,均行胰管空肠吻合并安支撑 ;胰尾癌左半胰切除 1例 ;慢性胰腺炎左半胰切除近端空肠 Y吻合 1例 ;胰管结石伴胆囊炎胆囊切除、胆总管引流、胰管切开取石 T管引流经胃窦部引出 1例。结果　非手术治疗 10例 5 d～ 9个月 PF愈合 ,1例死于原发病 SAP;2例手术治愈。预防组未发生 PF。结论　大多数 PF可非手术治愈。手术指征按 PF时间长短、引流量、有无壶腹及主胰管梗阻或狭窄等综合地掌握 ;术式按病情针对性地选择。 PF预防是多方面的 :SAP严格手术指征和时机 ;胰伤按伤情轻重、有无邻近脏器损伤、特别是有无主胰管受伤而采用适当术式     

防范Whipple术后胰瘘的临床体会

目的 探讨预防胰十二指肠切除术后胰瘘的经验。方法 回顾性总结胰十二指肠切除术42例的临床资料，实施胰空肠端端套入吻合术28例，捆绑式胰肠吻合术14例，全组病人均放置胰管支撑引流，外引流18例，内支架管引流24例，结果 全组无胰瘘发生，术后并发伤口感染2例，胃排空障碍1例，肺部感染1例，胃肠出血1例，腹腔脓肿1例，胆瘘1例，并发症发生率为16.7%，内支撑引流的病人术后恢复明显快于完全外引流的病人。结论 胰管内支撑引流，精细的胰肠吻合和有效的围手术期治疗是预防Whipple术后胰瘘的关键。     

COMPARISON OF THE USE OF DOMPERIDONE, DROPERIDOL AND METOCLOPRAMIDE IN THE PREVENTION OF NAUSEA AND VOMITING FOLLOWING GYNAECOLOGICAL SURGERY IN DAY CASES

The efficacy of domperidone 20 mg, droperidol 2.5 mg, metoclopramide10 mg or placebo (saline) administered i.v. before inductionof anaesthesia, was studied in 199 women undergoing gynaecologicalsurgery as day cases. Following a standardized general anaesthetictechnique, droperidol or metoclopramide significantly reducedthe incidence of nausea and vomiting; domperidone decreasedthe incidence of postoperative nausea alone. The occurrenceof extrapyramidal reactions was similar in all groups. Patientstreated with antiemetics were no more sedated than those givenplacebo. Those receiving droperidol complained of significantlyless postoperative pain than those who had received domperidoneor metoclopramide.     

胰十二指肠切除后胰瘘的因素分析及预防

本组１２４例胰十二指肠切除术病人，术后发生胰瘘２４例。对可能影响胰瘘发生的１０个因素进行分析，结果发现，年龄≥６０岁者，术前血清白蛋白＜３５ｇ／Ｌ，血清总胆红素≥１２０μｍｏｌ／Ｌ是胰瘘发生的危险因素，缺乏综合措施及术者经验不足是胰瘘发生的主要因素。有目的地控制这些因素将有助于预防胰十二指肠切除术后胰瘘的发生。     

低切高挂半缝合半开放引流术治疗高位肛瘘

目的 :探讨治疗高位肛瘘的手术方式。方法 :5 0例高位肛瘘分为 2组 ,试验组直肠环以上瘘管挂线 ;直肠环以下瘘管切除 ,肛门外切口间断全层缝合 ,肛门内切口开放引流。对照组直肠环以上瘘管挂线 ;直肠环以下瘘管切开。结果 :(1)治愈率 :试验组 10 0 % (2 5 / 2 5 ) ,对照组 96 % (2 4 / 2 5 )。 (2 )伤口愈合时间 :试验组 (9.0 4± 1.93) d,对照组 (2 4 .6± 4 .2 2 )d (P <0 .0 1)。 (3)肛管弹性 :试验组术前优 18例、良 6例、差 1例 ;术后优 16例、良 7例、差 2例。对照组术前优 2 0例、良 3例、差 2例 ;术后优 11例、良 9例、差 5例。 (4)肛门平滑度 :试验组术后正常 2 4例 ,对照组术后正常 3例。(5 )伤口水肿 :试验组 2 3例 (92 % ) ,对照组无。 (6 )伤口疼痛 :试验组重度 2 1例、中度 3例、轻度 1例。对照组重度 2例、中度 2 0例、轻度 3例。 (7)伤口感染 :试验组 2例、对照组 1例。结论 :瘘管切除半缝合半开放引流术在保持肛门的功能、外形及缩短治疗时间上优于瘘管切开全开放引流术     

COMPARISON OF THE USE OF DOMPERIDONE, DROPERIDOL AND METOCLOPRAMIDE IN THE PREVENTION OF NAUSEA AND VOMITING FOLLOWING MAJOR GYNAECOLOGICAL SURGERY

Domperidone 20 mg, droperidol 2.5 mg, metoclopramide 10 mg andplacebo (saline) were given i.v. 10 min before the end of anaesthesia,to 200 women undergoing major gynaecological surgery, and theincidence of postoperative nausea and vomiting following a standardanaesthetic technique was assessed. Droperidol was significantlymore effective than domperidone, metoclopramide or placebo inreducing emetic sequelae. There were no significant differencesbetween the groups in the incidence of extrapyramidal effectsand postoperative sedation. Patients given droperidol requiredless postoperative analgesia than those given domperidone ormetoclopramide. It was concluded that, of the drugs studied,droperidol alone was effective in protecting against nauseaand vomiting after major gynaecological surgery.     

生物粘合剂预防胆道损伤修复重建术后吻合口再狭窄

传统丝线缝合技术修复重建胆道易形成吻合口瘢痕性狭窄，导致梗阻性黄疸和胆汁性肝硬化。为了克服丝线缝合组织加重瘢痕形成的缺点，应用生物粘合剂（ＦＧ）替代缝线结合内支撑导管建立各种胆肠吻合口瘢痕动物实验模型，定期对吻合口瘢痕组织进行生化胶原测定，从瘢痕形成的角度观察胆肠吻合口愈合过程，明确ＦＧ可促进伤口愈合、减少瘢痕形成和加速瘢痕成熟软化；内支撑保留６个月，瘢痕成熟，从而为预防胆道狭窄提供了有效措施。     

外科应激分数在小儿术后应激性溃疡预防中的应用

用外科应激分数计算法，对７８例非上消化道手术患儿进行分析，结果显示，外科应激分数越大，术后应激性溃疡发生率越高。流行病学筛选试验发现外科应激分数９分时，是区分术后应激性溃疡发生的高发病人标准。研究结果揭示，对术后应激性溃疡预防，最好的办法是降低外科应激分数以及对其高发病人的正确处理。     

肌成纤维细胞在创面愈合及瘢痕形成中的作用

正常创面愈合过程中的创面收缩或过度愈合引起的病理性瘢痕以及各种纤维化疾病中，肌成纤维细胞的作用越来越受到学者们的广泛关注。围绕肌成纤维细胞的结构特征、来源、作用、转归以及调节机制等问题已有大量文献报道，本文在参考有关文献的基础上，将有关问题作一综述。 1　肌成纤维细胞简介　 Gabbiani和Majino等(1971)将离体的肉芽肿包膜条加上平滑肌刺激物时，可引起其收缩，并发现在形态及生物学上具有成纤维细胞(Fibroblast, Fb)和平滑肌细胞双重特性的特殊细胞，故有了肌成纤维细胞(Myofibroblast, MFb)一词的出现。     

THE PREVENTION OF MUSCLE PAINS ASSOCIATED WITH THE USE OF SUXAMETHONIUM

The incidence and severity of muscle pain was assessed in 150males who underwent bronchoscopy using thiopentone and suxamethoniumiodide or chloride for anaesthesia. In 50 patients tubocurarine3–5 mg, diplacin 10–15 mg or kvalidil 10–15mg was injected intravenously after the induction dose of thiopentone.In a further group of 50 patients neostigmine 0.5–0.75mg was injected intramuscularly 20–30 minutes after bronchoscopy.The remaining 50 patients were not given either of these treatmentsand formed a control group. Six patients developed pain whennon-depolarizing relaxants had been used compared with 29 inthe neostigmine group and 40 in the control group.     

THE USE OF MAMMOGRAPHY IN DIAGNOSIS AND SCREENING

Up to nine per cent of women are destined to have breast cancer. Of these 25% are likely to be occult lesions only detectable on mammography.¹ Early detection is important. Ten year survivals of over 65% can be expected in patients without axillary node Involvement, compared to 25% with nodes.² Apart from biopsy, mammography is the most sensitive method of cancer detection and is therefore of considerable help to the surgeon in evaluation of breast disease     

THE IMPORTANCE OF ACTIVITY AND PRETREATMENT IN THE PREVENTION OF SEXUAMETHONIUM MYALGIAS

We have studied the effectiveness of pretreatment with atracurium0.05 mg kg^–1 and placebo before administration of suxamethonium,in the prevention of postoperative myalgia in inpatients havingsurgery in which rapid postoperative mobilization was possible(vaginal hysterectomy). On the second day after operation, thepatients pretreated with atracurium had significantly fewerpostoperative myalgias than those receiving placebo (P <0.025). All patients were significantly more active on the secondday compared with the first day after operation (P < 0.025).Possible causal relationships are discussed.