外剥内扎联合皮桥整形缝合术治疗环状混合痔效果观察

目的观察外剥内扎联合皮桥整形缝合术治疗环状混合痔的效果。方法选取2018-01—2019-01间内乡县中医院收治的82例环状混合痔患者,按照治疗方案不同分为2组,各41例。对照组行外剥内扎术,观察组行外剥内扎联合皮桥整形缝合术。回顾性分析患者的临床资料。结果与对照组相比,观察组切口愈合时间短,术后24 h内出血量少,并发症发生率低,差异均有统计学意义(P<0.05)。结论外剥内扎联合皮桥整形缝合术治疗环状混合痔,术后出血量少,并发症少。     

TST 联合外剥内扎术治疗环状混合痔的临床观察

目的：观察选择性痔上黏膜切除吻合术（TST）联合外剥内扎术治疗环状混合痔的临床疗效。方法：回顾性分析2017 年 1 月—2017 年 12 月我们采用选择性痔上黏膜切除吻合术（TST）加外剥内扎术治疗治疗环状混合痔的 90 例的术中情况、疗效及并发症情况。结果：90 例手术均成功，住院时间 5~9 d，创面愈合时间 7~15 d。术后随访 6 个至 12 月，均无再次脱出，无便血，无肛门狭窄。结论：选择性痔上黏膜切除吻合术加外剥内扎术治疗环状混合痔疗效显著，患者满意度高， 值得推广应用。     

外剥内扎加横切缝合术治疗环状混合痔疗效观察

目的观察外剥内扎加横切缝合术治疗环状混合痔的疗效。方法将诊断明确的70例患者随机分为治疗组与对照组,各35例。治疗组采用外剥内扎加横切缝合术,对照组予以单纯外剥内扎术治疗,观察2组疗效及并发症。结果 2组总有效率相比差异无统计学意义,治愈率、术后肛门疼痛、水肿、坠胀、皮赘残留,治疗组明显优于对照组(P<0.01)。结论外剥内扎加横切缝合术是目前治疗环状混合痔的一种较好术式。     

外剥内扎加皮桥整形切缝术治疗环状混合痔的临床观察

目的:观察外剥内扎加皮桥整形切缝术治疗环状混合痔的临床疗效。方法:采用外剥内扎加皮桥整形切缝术治疗环状混合痔80例为治疗组,与常规外剥内扎术治疗环状混合痔60例为对照组进行对照观察。结果:两组治愈率比较,治疗组与对照组比较有显著性差异(P<0·01);两组术后并发症比较,治疗组与对照组比较有显著差异(P<0·01)。结论:外剥内扎加皮桥整形切缝术治疗环状混合痔疗效满意、术后并发症少。     

外切外剥内扎内注术治疗环状混合痔99例

环状混合痔是痔类疾病中最严重的一种 ,我们采用外切外剥内扎内注配合中药坐浴治疗环状混合痔 99例 ,疗效满意 ,现将方法及观察结果报告如下。1　一般资料本组男 6 2例 ,女 37例 ;年龄 2 9～ 71岁 ,平均4 0 6岁 ;病程 7～ 33年。环状混合痔中 ,环状外痔为主 6 1例 ,环状内痔为主 38例 ,伴粘膜下垂 12例。2　治疗方法2 1　术前准备　术前 1ｄ予甘露醇 2 5 0ｍｌ用 2 0 0 0ｍｌ水冲服 ,术前 30ｍｉｎ鲁米那钠 0 1ｇ肌注。2 2　手术方法　采用骶管麻醉或硬膜麻醉。取俯卧位垫高臀部 ,常规消毒 ,麻醉后消毒。提起较大母痔的外痔 ,剪开皮肤呈…     

外剥内扎皮桥减压术治疗环状混合痔30例

外剥内扎术治疗环状混合痔,存在术后肛门疼痛剧烈、水肿、残留皮赘和痔核的缺点,并可发生肛门狭窄和大便失禁等并发症。2010年1月—2011年12月,我们采用外剥内扎皮桥减压术治疗环状混合痔30例,取得了很好的疗效。1资料和方法1.1研究对象Ⅲ期以上内痔环状混合痔共60例,男36例,女24例;按就诊顺序分成两组,年龄18～65岁,平均年龄44岁,病程均在两年以上,排除伴有肛瘘、肛裂或肛乳头状瘤及手术禁忌症。     

注射并外剥内扎半缝合术治疗环状混合痔63例

我科1998-2002年用注射并外剥内扎半缝合术式治疗环状混合痔63例,取得较好疗效,报告如下.     

分段外剥内扎联合断桥整形缝合术治疗环状混合痔的临床观察

目的观察分段外剥内扎联合断桥整形缝合术治疗环状混合痔的临床疗效。方法将120例环状混合痔患者随机分为两组,治疗组采用分段外剥内扎联合断桥整形缝合术,对照组采用传统外拨内扎术。观察两组临床疗效、创面愈合时间,疼痛指数,术后并发症情况。随访半年患者肛门功能、满意度及复发情况。结果 1两组手术有效率均为100%,但治疗组治愈率为96.67%,观察组治愈率为83.33%,治疗组治愈率优于对照组,P0.05;2治疗组术后疼痛指数、创面愈合时间、并发症发生率,复发率、肛门不全失禁率、满意度优于对照组,P0.05。结论分段外剥内扎联合断桥整形缝合术治疗环状混合痔疗效可靠,治愈率高,并发症少,创面愈合时间短,复发率低,不影响肛门功能,兼顾了肛门美观,是一种较理想的手术方式,值得推广应用。     

PPH与外剥内扎术治疗环状混合痔疗效观察

目的：比较PPH与外剥内扎术治疗环状混合痔的临床疗效。方法将120例环状混合痔随机分为治疗组60例和对照组60例,治疗组采用PPH,对照组采用外剥内扎术。结果治疗组患者平均住院天数,术后并发症发生率,术后疼痛程度均优于对照组。结论PPH治疗环状混合痔疗效确切,术后恢复快,并发症少,术后疼痛轻,在环状混合痔手术方法的选择上可优先适用。     

外剥内扎结合切除缝合术治疗环状混合痔110例

近年来,我科采用外剥内扎结合切除缝合术治疗环状混合痔110例,取得满意疗效,现报告如下。     

TST吻合器经肛直肠部分切除术治疗直肠套叠的近期疗效观察

目的初步探讨TST吻合器经肛直肠部分切除术治疗直肠套叠的安全性及近期疗效。方法我院及武汉大学中南医院2014年1月至2014年8月共收治13例直肠套叠的患者均行TST吻合器经肛直肠部分切除术,记录分析缝扎止血情况、标本高度、手术时间、住院周期及术后并发症的发生情况。结果平均随访2个月,10例患者脱垂超过肛门扩张器长度的一半,平均手术时间35.2min,切除标本平均高度4.5cm,平均住院周期7d,本组患者吻合口均加固缝合,术中吻合不全出血1例缝扎止血,术后2例出血保守治疗愈合,2例术后2周内仍便急,无重大手术并发症。结论 TST吻合器经肛直肠部分切除术治疗直肠套叠安全,近期疗效可靠。     

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甲状腺切除手术是大多数医院都能开展并是医生熟悉的手术,但是手术并发症并未因此而显著减少。鉴于目前的有关医疗文件[如《中华人民共和国侵权责任法》和《中华人民共和国卫生部令(第32号)》等]的有关法律及规定,甲状腺手术的并发症可能成为医疗纠纷或诉讼案。因此,正确理解这些法律以规避风险、减少纠纷、杜绝医疗事故,尤为重要。     

老年人胰十二指肠切除术后并发症的临床分析

目的 探讨老年人胰十二指肠切除术(PD)后主要的并发症及防治方法.方法 回顾性分析我院采用PD术治疗的61例老年人胰胆管疾病患者的临床资料.结果 术后并发症发生率为29.51％( 18/61),死亡率为3.28％( 2/61).主要并发症为胰瘘2例(3.28％),上消化道出血3例(4.92％),腹腔内感染10例(16....     

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study

Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (S_pO₂ < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m⁻²); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94–1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.     

Prediction of severe postoperative complications in patients admitted to neuroanaesthesia

The purpose of this study was to identify factors which will predict the risk of severe postoperative complications in individual patients in a neurosurgical unit. Eleven risk factors were investigated in 363 neurosurgical patients, of whom 40 (11%) developed postoperative complications requiring mechanical ventilation for more than 24 h in an intensive care unit, 16 were found to be severely disabled or in a vegetative state at follow-up 1 month after admission, and 28 patients died. By applying stepwise, logistic regression analysis to the patient's data, we were able to select two significant risk variables, i.e. the Glasgow Coma Scale (GCS) 8 or less preoperatively and emergency anaesthesia. The presence of GCS 8 or less on the consciousness scale was associated with postoperative complications in approximately 40% of the cases. Emergency patients with severe neurological damage had the greatest risk of postoperative complications (93%). Fatal outcome for patients with postoperative complications was seen in 40% of the cases.     

马栗树籽提取物治疗混合痔术后并发症的观察

目的评价马栗树籽提取物治疗混合痔术后并发症的疗效。方法随机将96例混合痔患者分为两组,每组48例,术后治疗组用马栗树籽提取物治疗,对照组用痔宁片治疗。观察术后两组各种术后并发症改善情况。结果治疗组术后疼痛和便血的时间为（4.5±3.3）d和（4.0±1.5）d,水肿、湿疹、排尿困难、排便困难的患者占3.6%、1.2%、1.5%、10.3%;而对照组则分别为（7.5±5.3）d和（6.5±1.3）d及8.6%、7.8%、6.5%、11.3%;两组比较P〈0.05,差异具有统计学意义。结论马栗树籽提取物能减少混合痔术后并发症的发生。     

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目的观察布地奈德雾化混悬液联合氨溴索和地塞米松注射剂联合氨溴索两种雾化吸入方案对老年腹部外科病人术后肺部并发症的影响。方法对2009年11月至2010年6月南京军区南京总医院诊治199例择期老年手术病人的临床资料进行分析。将199例病人随机分为治疗组(99例)和对照组(100例),治疗组采用布地奈德雾化混悬液联合氨溴索、对照组采用地塞米松注射剂联合氨溴索雾化吸入。观察两组术后生命体征、皮质醇、促肾上腺皮质激素(ACTH)等变化及术后肺部并发症(PPCs)发生率和病死率的差异。结果与对照组相比,治疗组术后第3天脉氧、氧分压明显改善。两组术后第1天、第2天皮质醇的变化差异有统计学意义。治疗组术后3dACTH水平明显高于对照组(P<0.001)。但两组PPCs发生率、病死率差异无统计学意义。结论布地奈德混悬液联合氨溴索雾化吸入对机体下丘脑-脑垂体-肾上腺轴(HPA轴)的影响小,更为安全,同时可以改善老年病人术后肺部氧合功能。     

Evaluation of the risk of postoperative pulmonary complications

Ten of 40 patients who underwent major thoracic or abdominal operations developed postoperative pulmonary complications, consisting of six massive atelectasis, three pneumonias and one edema. They were mostly thoracotomy cases and cigarette smokers. Many of these complications would have been prevented, if reliable pulmonary function tests are available to predict preoperatively such occurrence. Flow-volume curve tracing and closing volume measurement were evaluated in this respect. Both flow at the point of functional residual capacity on flow-volume curve, and the closing capacity subtracted from functional residual capacity were found to be well correlated with the occurrence of postoperative complications and can be used to evaluate the risk of pulmonary complications developing in postoperative period.     

Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases

PURPOSE: We critically examined the intraoperative and postoperative complications associated with radical retropubic prostatectomy in the modern era. MATERIALS AND METHODS: Between April 18, 1994 and July 13, 2000, 1,000 men underwent radical retropubic prostatectomy performed by a single surgeon. The whole inpatient hospital medical record of 909 patients, the outpatient charts of 955 and a self-administered patient survey completed by 679 were reviewed by 2 data managers not involved in surgical management or followup care. In all 1,000 cases at least 1 of the 3 data sources was reviewed. RESULTS: Mean patient age was 60.3 years. In 73%, 99.8% and 95.7% of cases serum prostate specific antigen was 10 ng./ml. or less, disease was clinical stage T1 or T2 and Gleason score was 7 or less, respectively, while 19.9% of pathological specimens showed positive margins. There were 8 intraoperative complications (0.8%). All 5 rectal injuries and the single ureteral injury were detected during the initial surgical procedure and repaired without sequelae. Only 14 men (1.4%) had any other complications during hospitalization. Until postoperative day 30, 4 pulmonary emboli (0.4%) with or without deep vein thrombosis and 5 myocardial infarctions (0.5%) developed. There were no intraoperative or in-hospital postoperative deaths and only 1 postoperative death secondary to myocardial infarction during the initial 30 days. Reexploration was done for hemorrhage and a disrupted anastomosis in 3 and 2 cases, respectively. Mean hospitalization was 2.3 days, 9.7% of patients required allogenic blood transfusion and 15 (1.5%) were rehospitalized. CONCLUSIONS: Our series represents a rigorous assessment of the complications associated with radical retropubic prostatectomy. It shows that in the hands of an experienced urological surgeon, this procedure is associated with minimal intraoperative and postoperative morbidity. Of the patients 98% had no intraoperative or postoperative complications. Our series enables appropriate contemporary comparisons to be made with laparoscopic prostatectomy and radiation therapy. This outcomes analysis implies that radical retropubic prostatectomy cannot be assumed to have greater morbidity than radiation therapy and it sets a high standard for those advocating laparoscopic radical prostatectomy.     

脊髓型颈椎病前路手术并发症的临床分析

目的分析脊髓型颈椎病前路手术的并发症及其原因,寻找防治对策。方法对96例脊髓型颈椎病患者采用前路减压植骨融合术,其中前路减压自体髂骨植骨融合16例,前路减压TFC椎间融合24例,前路减压自体髂骨植骨融合、前路锁定钢板固定56例。观察并分析术后并发症的发生情况。结果96例均获得随访,时间36—84（66±14）个月。发生并发症40例（51例次）,发生率为41．7％。术后早期并发症包括：喉上神经损伤2例,硬膜破裂1例,植骨块移位1例,谵妄9例,C5神经麻痹6例,经过相应的对症处理均获得痊愈。远期并发症主要为邻近节段退变32例。4例出现新的神经症状和体征,其中2例再次行前路手术,术后症状有明显改善。结论颈椎前路手术伴有较高的并发症发生率,其原因是多方面的,均不同程度地影响着手术效果．尤其是邻近节段退变,临床应重视。