内镜下组织粘合剂注射术后并发症的护理

对60例胃底静脉曲张出血患者在内镜下行胃曲张静脉组织粘合剂注射治疗,19例患者术后发生并发症,其中发热7例、胸骨后疼痛6例、再出血4例、术中出血1例、胃溃疡1例,对症处理后症状消失。提出熟练掌握栓塞技术,迅速准确地进行静脉注射、避免过量注射;对现存及潜在并发症应予以充分的临床评估,做好预防性护理、饮食指导、健康教育及术后随访,可减轻和预防并发症发生,提高止血效果。     

胃镜下曲张静脉套扎治疗门静脉高压并食管胃底曲张静脉破裂出血效果观察

目的探讨胃镜下曲张静脉套扎治疗门静脉高压并食管曲张静脉破裂出血的效果。方法随机将108例门静脉高压并食管曲张静脉破裂出血患者分为2组。对照组采用保守疗法,观察组采用胃镜下曲张静脉套扎治疗。对比分析2组的治疗效果。结果观察组治疗总有效率为94.4%(51/54),明显高于对照组的77.8%(42/54),差异有统计学意义(P0.01)。随访12个月,观察组患者再出血发生率为9.3%(5/54),明显低于对照组的42.6%(23/54),差异有统计学意义(P0.01)。结论胃镜下曲张静脉套扎治疗食管曲张静脉破裂出血,止血效果显著,可有效降低再出血率。     

食管胃底静脉曲张破裂出血内镜治疗后再手术74例的临床分析

目的探讨贲门周围血管离断术治疗食管胃底静脉曲张破裂出血的最佳手术时机及术中策略。方法回顾性分析2006年1月至2015年1月天津市第三中心医院收治的180例因门静脉高压出血行选择性贲门周围血管离断术的临床资料。依据手术时机,选取术前有内镜治疗史病人74例,分析病人临床资料,进一步区分内镜治疗次数、治疗方法,分析其与术后并发症关系,采用Clavien-Dindo外科手术并发症分级分析术后并发症。结果本组病例急诊手术率高达47.30%,肝功能Child-Pugh C级病人占17.57%,所有Child-Pugh C级病人均为急诊手术,术后总体并发症发生率为43.24%,无围手术期死亡。进一步分析,术前经历≥3次内镜治疗较3次治疗病人具有更高的并发症发生率(3次28.57%,≥3次62.50%,P0.05);术前经历以组织胶为核心的单独或联合治疗病人手术更加困难,与术前单纯内镜下曲张静脉套扎术治疗相比,其手术并发症发生率更高(单纯内镜下曲张静脉套扎术组为32.61%,以组织胶为核心组为60.71%,P0.05),其中Ⅲ、Ⅳ级严重并发症增加显著。结论虽然药物及内镜治疗是食管胃底静脉曲张破裂出血的一线方案,但以选择性贲门周围血管离断术为代表的手术治疗仍占据重要地位。临床上,应尽早识别内镜治疗风险高、效果不佳或不适宜内镜治疗的病人,及时手术,术中精确操作,合理选择术式,以进一步提高疗效。     

门静脉高压症食管胃底静脉曲张出血急诊断流术后再出血23例分析

门静脉高压症食管胃底静脉曲张出血 (EGVB)是上消化道大出血的主要原因之一 ,直接威胁着病人的生命。我院自 1990年 8月至 2 0 0 2年 8月期间急诊施行贲门周围血管离断术治疗EGVB169例 ,术后 6周内发生再出血 2 3例 ,现报告如下。临床资料1.一般资料 :2 3例中 ,男 18例 ,女 5例     

用吻合器治疗食管胃底静脉曲张出血103例报道

198 1～ 2 0 0 0年我们应用国产ＧＦ 1型管状胃肠吻合器行食管下段横断术治疗食管胃底静脉曲张出血 10 3例 ,取得了良好的止血效果。1.临床资料 :本组病例男性 79例 ,女性 2 4例 ,年龄 18～ 72岁 ,均系首次手术。首发出血 77例 ,二次出血 19例 ,无出血 7例。急诊手术 82例 ,择期手术 2 1例。肝功能ＣｈｉｌｄＡ级 47例 ,ＣｈｉｌｄＢ级39例 ,ＣｈｉｌｄＣ级 17例。手术方法 :常规切除脾脏。离断食管下段及上半胃周围所有血管。在离贲门 10ｃｍ左右之胃前壁作切口 ,检视胃底 ,如有出血的静脉血管则予缝扎。管状胃肠吻合器选择外径 2 6ｍｍ ,…     

上消化道出血史对肝移植治疗肝硬化门静脉高压的疗效分析

目的探讨上消化道出血史对肝移植治疗肝硬化门静脉高压(PHT)疗效的影响。 方法回顾性分析2005年1月至2017年9月中国人民解放军联勤保障部队第九○○医院肝胆外科因肝硬化PHT行肝移植的受者临床资料,根据肝移植术前是否出现上消化道出血将其分为出血组和非出血组。观察指标为受者性别、年龄、术中出血量和输血量、住院时间、住院费用和肝移植前后肝功能指标。采用Wilcoxn符号秩和检验比较出血组与非出血组年龄、术中出血量和输血量等指标,采用成组t检验比较两组术前ALT、AST、总胆红素(TBil)、白蛋白(ALB)和凝血酶原时间(PT),采用两因素重复测量资料方差分析比较两组术后1周内各时间点肝功能指标,采用卡方检验比较两组性别和原发病情况。P<0.05为差异有统计学意义。 结果最终纳入80例因肝硬化PHT接受肝移植治疗的受者,其中男性61例,女性19例,年龄7～71岁。原发病：乙型病毒性肝炎后肝硬化71例,胆汁性肝硬化5例,肝豆状核肝硬化2例,酒精性肝硬化2例。所有受者均采用原位下腔静脉逆灌注肝移植术。出血组(39例)与非出血组(41例)受者性别、年龄、原发病情况、术前肝功能指标、术中出血量和输血量、住院费用及住院天数差异均无统计学意义(P均>0.05)。出血组与非出血组术后各时间点ALT、AST、TBil、ALB和PT差异均无统计学意义(P均>0.05)。两组术后第3、5和7天血清ALT水平均低于术后第1天,两组术后第5和7天血清ALT水平均低于术后第3天,非出血组术后第7天血清ALT水平低于术后第5天(P均<0.05)。 结论肝移植前是否存在上消化道出血史对肝移植治疗肝硬化PHT受者移植术后早期肝功能无影响。     

食管胃底静脉曲张破裂出血内镜治疗失败后再手术

目的 比较内镜治疗后贲门周围血管离断术与未经内镜治疗患者贲门周围血管离断术治疗食管胃底曲张静脉破裂出血的疗效.方法 2005年6月至2010年6月期间共完成贲门周围血管离断术230例,其中肝炎后肝硬化202例,酒精性肝硬化28例.A组16例,为内镜治疗(套扎、栓塞)后再行贲门周围血管离断术;B组214例,直接行贲门周围血管离断术.结果 A组平均手术时间为(198±59)min,平均出血(750±120)ml,术后平均住院(11±2)d;B组平均手术时间为(120±26)min,平均出血(250±43)ml,术后平均住院(7±1)d.两组的平均手术时间、术中出血量、术后住院时间之间相比差异有统计学意义(均P＜0.05).230例患者中获得随访212例,随访率为92.2％,术后平均随访2.5年(1～6年),死亡率为4.2％,再出血率为5.7％.结论 内镜治疗后食管胃底周围组织纤维化、质硬,明显增加手术难度,手术时间、术中失血量较单纯贲门周围血管离断术明显增加,故对于适合行手术治疗的门静脉高压症患者应首选贲门周围血管离断术.     

施他林联合可利新治疗食管胃底静脉曲张破裂大出血的临床研究

目的研究施他林联合可利新在处理食管胃底静脉曲张破裂引发重度上消化道出血时的疗效。方法74例肝硬化合并重度上消化道出血患者随机分为3组:施他林联合可利新组26例;单用施他林组24例;单用可利新组24例。结果三组病例总止血率分别为96.2%、72.7%和70.8%(P<0.05);平均出血时间分别为(8.66±4.92)h、(13.47±9.02)h和(13.58±8.35)h(P<0.05);输血量分别为(869.23±403.75)ml、(1172.72±513.79)ml和(1250.00±599.27)ml(P<0.05);总病死率分别为3.8%、27.3%和29.2%(P<0.05)。结论施他林联合可利新治疗肝硬化并发重度上消化道出血在近期止血率和总止血成功率方面明显优于单用施他林或可利新,具有止血迅速、疗效肯定、安全可靠等优点。     

门静脉高压症外科治疗进展与展望

门静脉高压症的治疗已从单一学科经验式诊疗模式转变为目前的多学科综合治疗协作组（MDT）诊疗模式。其外科治疗将与药物、消化内镜治疗、经颈静脉肝内门体分流术（TIPS）以及肝移植治疗共同实现优势互补、相辅相成。在MDT诊疗模式下,重新审视与定位门静脉高压症外科治疗的地位非常必要。外科医师应直视门静脉高压症所面临的问题,注重发展新方法、新技术、新理念,努力推动门静脉高压症外科治疗的规范化、个体化、精准化与微创化。应努力规范外科手术适应证,甄别最适合行外科手术的病人,掌握手术方式及手术时机,最大程度优化诊疗方案,使病人临床获益最大化。我国学者应在正确认识与推动门静脉高压外科治疗的发展的基础上,鼓励开展基于循证医学的临床多中心随机对照试验,以制订符合我国国情的门静脉高压症的外科治疗指南与共识,提高我国在该领域的国际话语权。     

手术、内镜下治疗食管胃底静脉曲张出血的近期和远期疗效观察

目的：比较内镜下食管静脉套扎术（EVL）联合硬化剂注射（EVS）和食管胃底静脉断流术对食管胃底静脉曲经破裂出血的近期和无期疗效，探讨EVL结合EVS和两种方法单独应用的适应证。方法：12例肝硬化门脉高压症患行食管胃底静脉断流术，术后胃镜观察曲张静脉消失程度及合并出血的情况，其中6例术后做了EVL或EVS；32例行EVL结合EVS；9例单纯行EVS；5例单纯行EVL。所有病例术后随访3年，观察曲张静脉消失和复发程度以及出血情况。结果：食和胃底静脉断流术为急诊止血的可靠方法，但术后仍存在程度不同的曲张静脉，术后3年内再出血发生率高达66.7%（8/12），术后择期行EVL或EVS，曲张静脉可完全消退。EVL结合EVS曲张静脉完全消退达93.75%(30/32)，总疗程2-3周。内镜下治疗后3年内观察曲张静脉复发率仅为10.53%(4/38)，再出血发生率为6.52%(3/46)。结论：EVL结合EVS对食管胃底静脉曲张破裂出血的近期和远期疗效明显优于手术组。食管胃底静脉断流术后施行EVL和/或EVS可以同时达到降低门脉高压和消除曲张静脉目的。EVL结合EVS明显优于两单独应用的疗效，同时避免了单纯用EVS容易引起出血的可能性，并且缩短了单纯用EVL的疗程，克服了后期套扎的难度。     

Effectiveness of Radiation Therapy After Surgery for Hilar Cholangiocarcinoma

Purpose Some studies suggest that giving radiation therapy after surgery for hilar cholangiocarcinoma improves the survival rate; however, many of these studies did not specify numbers of subjects or provide an impartial analysis. Thus, we evaluated the effectiveness of radiation therapy as adjuvant treatment after surgery and attempted to establish appropriate adaptation standards.Methods We reviewed the records of 69 patients who underwent surgery for hilar cholangiocarcinoma between June 1980 and April 1998. Thirty-nine patients were treated with surgery followed by radiation therapy and 30 were treated with surgery alone.Results The clinicopathologic features that might have influenced prognosis were similar in the patients who received radiation therapy and those who did not. Radiation as adjuvant therapy did not have a beneficial effect on overall survival (P = 0.554, log-rank test); however, it tended to improve survival in the group of patients who underwent curative resection for with p-stage III or IVa disease (P = 0.042, log-rank test).Conclusions Radiation therapy after surgery did not show any clinical benefits for patients with hilar cholangiocarcinoma. However, it may be effective as adjuvant therapy after curative resection in a small subgroup of patients with p-stage III or IVa disease.     

自制漱口液联合吹氧治疗化疗后口腔黏膜炎

目的 探讨自制漱口液联合吹氧治疗血液痛患者化疗后口腔黏膜炎的效果.方法 将106例化疗后口腔黏膜炎患者分成两组,观察组56例应用自制漱口液漱口联合吹氧疗法进行口腔护理,对照组50例应用我院常规漱口液即甲硝唑加锡类散进行口腔护理.结果 观察组总有效率显著优于对照组,且患者更易接受(均P＜0.05).结论 自制漱口液和吹氧疗法联合应用于化疗后口腔黏膜炎,可以达到消炎、抑茵、镇痛的作用,可以促进口腔黏膜炎的愈合.     

不同口腔护理方法预防呼吸机相关性肺炎及口腔感染的效果观察

目的探讨自制漱口液联合吹氧治疗血液病患者化疗后口腔黏膜炎的效果。方法将106例化疗后口腔黏膜炎患者分成两组,观察组56例应用自制漱口液漱口联合吹氧疗法进行口腔护理,对照组50例应用我院常规漱口液即甲硝唑加锡类散进行口腔护理。结果观察组总有效率显著优于对照组,且患者更易接受（均P〈0.05）。结论自制漱口液和吹氧疗法联合应用于化疗后口腔黏膜炎,可以达到消炎、抑菌、镇痛的作用,可以促进口腔黏膜炎的愈合。     

腰腿痛病人药熨疗法效果观察

将122例腰腿病病人随机分为观察组(62例)和对照组(60例),观察组采用中药药熨疗法止痛,对照组采用针灸理疗法止痛,结果观察组止痛效果显著优于对照组(P＜0.05).提示药熨疗法可减轻或缓解病人腰腿痛.     

急攻疗法配合复方泛影葡胺造影治疗粘连性肠梗阻

为探讨粘连性肠梗阻的有效治疗方法,采用急攻疗法配合复方泛影葡胺治疗粘连性肠梗阻115例。结果显示,110例临床缓解,5例24h后症状加重而手术。结果表明,急攻疗法配合复方泛影葡胺治疗粘连性肠梗阻不但方法简便,而且可及时动态观察病情,随时提供手术指征,安全有效。     

Photopneumatic Technology Used in Combination with Profusion Therapy for the Treatment of Acne

Background: Topical and oral medications, such as retinoids, benzoyl peroxide, antibiotics, and isotretinoin, have been the standard of care for the treatment of mild-to-moderate acne for the last several decades. More recently, a number of pubHshed studies on optical treatments, such as ultraviolet light, visible (blue) light, and intense pulsed Hght systems, have also shown clinical improvement in the appearance of acne. Specifically, photopneumatic technology, which utilizes gentle pneumatic energy (vacuum) to draw the target tissue into the treatment tip and then deHver broadband pulsed Hght to the dermal targets, has demonstrated marked improvement in the appearance of acne lesions and side effects associated with acne. Objective: To demonstrate the safety and efficacy of using a combination treatment of the photopneumatic system and profusion therapy using three currently marketed topical agents for the treatment of mild-to-moderate acne on the face and/or body, including neck, chest, or back. Methods: A prospective, multicenter, dinical trial of 41 individuals with mild-to-moderate acne was performed. Patients received up to four treatments at 1- to 2-week intervals with the photopneumatic system and profusion therapy with three separate topical agents. Study investigators and subjects evaluated dinical efficacy at 1-month and 3-month follow-up visits. Results: At three months, a 69-percent reduction was noted in inflamed acne lesions and a 41-percent reduction in noninflamed acne lesions was noted by physician assessment. Additionally, at this same time point, subjects reported moderate-to-marked (26-75%) improvement in acne lesions. Eighty-one percent of subjects (22/27) were either satisfied or very satisfied with treatment outcome. There were no adverse events caused by malfunction of the device, and no serious adverse events or deaths. Conclusion: The results, as well as the reported patient satisfaction and safety, suggest that the treatment of acne with the photopneumatic system in combination with profusion using currently available topical acne agents demonstrated significant treatment results.Acne vulgaris is a common skin disease that affects more than 85 percent of adolescents and often continues into adulthood.1 Laser and Hght-based devices traditionally target the sebaceous glands, which are part of the pilosebaceous unit, the site of acne and commensal organisms, such as Propionibacterium acnes. P. acnes live on the fatty acids in the sebaceous glands and proHferate when the infundibulum of the pilosebaceous unit becomes blocked with sebum and sheds cells, immune reactions and inflammation occur, and, as a result, acne vulgaris develops.2 Ultraviolet Hght and visible (blue) Hght kill the bacterium and/or sebaceous cells through activated mechanisms of endogenous porphyrins and in turn cause a reduction in acne lesions.3,4Intense pulsed light (IPL) systems have also been used for the treatment of acne on all skin types in the medical specialties of dermatology and plastic surgery. One of the more recent pulsed Hght combination treatments that has been cleared by the United States Food and Drug Administration (FDA) for the treatment of comedonal and pustular acne, in addition to inflammatory acne (including acne vulgaris), utilizes photopneumatic technology (Isolaz®, Solta Medical Inc., Hayward, California), which consists of a gentle pneumatic energy (vacuum) to draw the target tissue into the treatment tip and then deHvers broadband pulsed Hght (400–1200nm) to the dermal targets. The vacuum technique causes elevation of the sebaceous gland and other dermal structures toward the epidermal surface, where the pore is opened and the sebaceous contents are mechanically removed. The sebaceous gland is then treated with broadband light, followed by the release of the treatment area. This mechanism has been supported by histological evidence that this therapy mechanically removes comedo contents from the infundibulum, and ultrastructural evidence has shown that the P. acnes bacteria and the pilosebaceous unit are thermally injured after treatment.4,5 The profusion tip used in combination with this photopneumatic system is subsequently used on the treatment areas to assist in deHvery and profusion of therapeutic topicals to the cleansed sebaceous gland while the skin is again gently stretched via vacuum technology.5The objective of this prospective, multi-center study was to evaluate the safety and efficacy of using the photopneumatic device followed by profusion using three different commercially available topical agents for the treatment of mild-to-moderate acne.     

电化学治疗中晚期肺癌的临床效果

应用电化学治疗不适宜手术切除的中晚期肺癌或经放、化疗无效的５９３例病人，包括年老体弱或有高血压、冠心病、糖尿病、肝肾功能不全者１５１例，经放化疗无效或未完成者１３８例，曾仅接受中医治疗但肿瘤继续增大者８３例，消化道癌术后肺内转移５２例，开胸探查手术１６９例。治疗方法为应用直流电治癌仪，将特制铂金电极针插入肿瘤内，针间距离以２ｃｍ为宜，电压调至８Ｖ左右，电流为６０～８０ｍＡ，按肿瘤直径每１ｃｍ给１００库仑（Ｃ）。结果１年内近期疗效显示获ＣＲ１５５例（２６１％），ＰＲ２６８例（４５１％），ＮＣ８９例（１５０％），ＰＤ８１例（１３０％）；ＣＲ和ＰＲ评为有效，占７１３％。远期随访结果示生存１年以上者共５０８例（８５６％），生存２年者４４０例（７４１％），生存３年者３３４例（５６３％），生存４年者２３２例（３９１％），生存５年者１６９例（２８４％）。结论：电化学治疗适应证为不能手术的中晚期肺癌或开胸后肿瘤不能切除者，放化疗无效者。尤其是对＞８ｃｍ的巨块肺癌，更宜采用电化学和放化疗相结合的综合方法。本疗法具有简便、安全、有效、创伤小、恢复快的优点。     

Comparison of Adhesive Properties of Five Different Prosthetic Materials Used in Hernioplasty

This experimental study was designed to assess and to compare intra-abdominal adhesions following the use of five commercially available prosthetic mesh grafts in the repair if abdominal wall defects. Sixty Wistar albino rats were randomly divided into six groups (n = 10). A 2 × 1 cm defect at abdominal wall was created and defects were closed either primarily or with one of the following prosthetic mesh grafts: monofilament polypropylene, polytetrafluoroethylene, sodium hyaluronate/carboxymethylcellulose-coated polypropylene, polypropylene/polyglactin 910 composite, or resorbable hydrophilic collagen-coated multifiber polyester. The severity of adhesions was graded, tensile strengths of adhesions were measured, and histopathological grades of inflammation and fibrosis were evaluated. Polypropylene mesh resulted in more adhesion formation in comparison to primary repair and other grafts used in this study, except polypropylene/polyglactin 910 composite mesh. In addition, the highest tensile strength of omental adhesions was detected in the polypropylene group (χ² = 26.249; p =. 0001). Polyester composite mesh caused the least adhesion formation among the groups. Sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polyester composite meshes revealed the highest fibrosis scores (χ² = 50.776; p =. 0001). The highest inflammatory activity was detected in the polytetrafluoroethylene mesh group (χ² = 16.564; p =. 005). Thus, sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polytetrafluoroethylene meshes following polyester composite mesh were the minimal adhesion-forming grafts in this study. Disadvantages of the polytetrafluoroethylene mesh were lower fibrotic activity and higher inflammatory reaction to the graft.