颅脑损伤术后颅骨缺损患者超早期行颞肌下颅骨成形术的临床疗效

目的 评价颅脑损伤术后颅骨缺损患者超早期行颞肌下颅骨成形术的临床疗效.方法 2007年1月-2011年9月在我院行颅骨成形术且术前存在神经功能障碍患者105例,根据修补术与减压术之间的间隔时间分为超早期组59例和晚期组46例.两组修补术与减压术之间的间隔时间,超早期组平均(35.1±5.3)d;晚期组平均(102.3±18.2)d.回顾性分析两组修补术后1个月的神经功能障碍改善情况,以此评价超早期颅骨成形术的临床疗效. 结果 术后1个月超早期组神经功能障碍改善的平均有效率为81.4％(48/59),高于晚期组的63.0％( 29/46),差异显著(P＜0.05).术后一个月超早期组遗留的神经功能障碍包括单侧肢体(含单纯上肢或下肢)运动障碍25例,语言功能障碍14例,神经官能症5例,颅骨缺损综合征33例;晚期组则包括单侧肢体运动障碍5例,语言功能障碍7例,神经官能症2例,颅骨缺损综合征27例. 结论 超早期颅骨成形术有助于改善颅脑损伤术后颅骨缺损患者的神经功能障碍.     

颅骨缺损修补术后并发症及其处理

目的探讨钛网颅骨缺损修补术后并发症的相关因素及处理方法。方法对本院2006年6月至2012年6月．89例钛网颅骨缺损修补术后并发症的情况进行回顾性分析。结果89例患者共11例发生各类并发症。结论在进行颅骨缺损修补术的时候,应当严格以患者的症状表现,合理的选择手术时机以及手术方式,避免并发症的出现,提高康复率。     

早期颅骨修补术治疗颅脑外伤术后颅骨缺损临床分析

目的探讨颅脑外伤术后颅骨缺损早期颅骨修补术的效果。方法随机将84例颅脑外伤术后颅骨缺损患者分为2组,各42例。对照组行晚期颅骨修补术,观察组行早期颅骨修补术。比较2患者的治疗效果。结果对照组KPS评分为(71.5±11.3)分,观察组为(84.6±12.3)分,2组比较,差异有统计学意义(P0.05)。对照组与观察组治疗优良率分别为69.0%和83.3%,差异有统计学意义(P0.05)。对照组并发症发生率为16.7%,观察组为4.8%,2组比较,差异有统计学意义(P0.05)。结论颅脑外伤后行早期颅骨修补术效果显著,可减少并发症发生率。     

数字成型钛网早期修补对颅骨缺损术后康复及美学效果的影响

目的 分析数字成型钛网早期修补对颅骨缺损术后康复及美学效果的影响.方法 2017年1月～2019年1月我院收治的颅骨缺损病人81例,按照数字成型钛网修补时间分为早期组(颅骨修补术时间<3个月)42例、晚期组(颅骨修补术时间≥3个月)39例,对比两组病人术前、术后和随访3个月的总有效率、手术时间、术中出血量、皮瓣游离时间...     

早期颅骨修补术对颅脑创伤术后颅骨缺损的临床效果研究

目的 探讨早期颅骨修补治疗颅脑创伤术后颅骨缺损的临床效果。方法 选取2019年1月至2022年12月于本院行颅骨修补术的86例颅脑创伤术后颅骨缺损患者进行回顾性研究。按照行颅骨修补术的时期分为早期组（术后1～3个月）和常规组（术后4～6个月）,每组各43例。应用美国国立卫生研究院卒中量表（NIHSS）、简明精神状态量表（MMSE）、改良Rankin量表（mRS）和格拉斯哥预后评分（GOS）分别评价两组患者各时间点的神经功能、认知功能、日常生活活动能力及预后情况,并比较两组患者术后脑后流动力学指标及并发症发生情况。结果 两组患者行颅骨修补术后6个月时的NIHSS评分、mRS评分均显著降低,而MMSE评分、GOS评分和MCA血流速度均显著升高（P<0.05）;且早期组患者的各项指标改善均优于常规组（P<0.05）。早期组患者的术后并发症发生率为4.65%(2/43,例)显著低于常规组的18.60%(8/43,例),比较存在差异（P<0.05）。结论 颅脑创伤术后出现颅脑缺损患者行早期颅骨修补术可有效改善神经、认知功能和MCA血流速度,减少并发症的发生,并提高远期生活质量。     

早期颅骨修补术治疗成人颅脑外伤术后颅骨缺损的效果观察

目的 探讨早期颅骨修补术治疗成人颅脑外伤术后颅骨缺损的效果.方法 回顾性分析长葛市华健医院神经外科2017-02-2020-02间收治的58例成人颅脑外伤术后颅骨缺损患者的临床资料.将术后≤3个月行颅骨修补术的患者作为早期组,术后＞3个月行颅骨修补术的患者作为常规组,各29例.术后随访6个月,记录随访期间的并发症情况,...     

用钛网修补颅骨缺损的少见并发症及经验总结

目的 总结用三维数字成型钛网修补颅骨缺损的少见并发症及相关经验教训。方法 回顾分析2008年6月至2012年6月,本院67例应用钛网三维适型颅骨修补术,总结术前、术中、术后的处理方法和经验教训。结果 共发生各类少见并发症9例,其中面瘫1例,张口困难1例,失血性休克1例,脑梗塞1例,头皮缝合困难1例,眉毛上扬困难1例,颞部不整1例,皮瓣中心坏死1例,面部畸形1例。结论 使用三维数字成型钛网,术前定制钛网、术中选切口、分离头皮、放置固定钛网、术后处理均需掌握一定经验技巧,除有效减少或控制常见并发症外,还要考虑到可能的少见并发症。     

同期脑室腹腔分流术联合颅骨修补术治疗颅骨缺损合并脑积水效果分析

目的研究颅骨修补术同期联合脑室-腹腔分流术对颅骨缺损合并脑积水患者神经功能的影响。方法选取76例颅骨缺损合并脑积水患者,随机分为2组,各38例。对照组采取脑室-腹腔分流术后择期行颅骨修补术,观察组采取颅骨修补术同期联合脑室-腹腔分流术。比较2组治疗效果、治疗前后神经功能缺损(NIHSS)评分及并发症。结果观察组总有效率高于对照组,术后1个月、3个月的NIHSS评分低于对照组,差异均有统计学意义(P0.05)。2组并发症发生率差异无统计学意义(P0.05)。结论颅骨修补术同期联合脑室-腹腔分流术应用于颅骨缺损合并脑积水患者,疗效显著,可明显改善神经功能。     

颅骨缺损修补的研究与进展

颅骨缺损后由于大脑缺少了完整的颅骨保护，会产生一系列症状，如头痛、头晕、恶心、肢体肌力减退、畏寒、怕震动等。同时心理上会产生不安全感，影响病人的情绪。外观上的畸形也会让病人难以参加正常的工作和社会交往，临床上称为颅骨缺损综合征。因此，应当在适当的时机给予修补，这在神经外科界已达成共识。目前颅骨修补的材料和方法有很多，各有优势及不足，国内外学者的观点也不尽相同，综述如下。     

心脏手术后早期昏迷的病因探讨

目的探讨心脏手术后早期昏迷的病因和预防措施。方法回顾性分析武汉亚洲心脏病医院2002年1月1日至2004年5月31日4358例心血管手术后早期昏迷的22例患者,研究原发疾病、外科术式、体外循环参数、水电解质平衡和血液生化等因素与昏迷发生发展的关系。结果不同手术方式术后脑损害发生率显著不同(P<0.001);术后Glasgow评分与术中平均动脉压正相关,与手术时间负相关(P<0.01);体外循环中最低血红蛋白与深昏迷时间和脑损害的总病程负相关(P<0.05);手术时间、术后Glasgow评分、血肌酐、白细胞和中性粒细胞计数对患者的预后有显著性影响(P<0.05)。结论体外循环中的动脉压下降、血液稀释和失血性贫血、涉及主动脉的手术方式和手术时间延长是心脏术后发生昏迷的高危因素。因此,提高手术技巧、缩短手术时间、减少失血、减少主动脉损伤、维持有效的脑灌注压是减少术后昏迷、改善预后的关键。     

Regional flap: A reliable coverage for post-radiation ulcer

Ulcer in radiation-damaged tissue is a dilemma with limited treatment strategies. The study aimed to evaluate the safety and efficacy of regional flaps for patients with post-radiation ulcers through a 10-year experience. A retrospective study of consecutive patients with post-radiation ulcers at a single institute from 2012 to 2022 was conducted. Reconstruction included complete excision of irradiated tissue and coverage with well-vascularised tissue, including local flaps, regional flaps and free flaps. Study outcomes included complications, reoperation rates, overall flap success and recurrence rates. Thirteen patients (six males and seven females; mean age, 56.85 ± 13.87 years) with a mean 10-month history of post-radiation ulcers were enrolled. Ulcers are predominantly located in the chest (n = 3, 23.1%), head (n = 2, 15.4%) and neck (n = 2, 15.4%), with a mean size of 33.1 cm² (range from 1 cm² to 120 cm²). Eleven patients underwent reconstruction with 15 regional flaps and three local flaps, one patient received a free anterolateral thigh fasciocutaneous flap and one patient underwent amputation. Among these 15 regional flaps, one (6.7%) had wound dehiscence and four (26.7%) had localised necrosis requiring reoperation. In addition, one patient with a non-healing sinus tract underwent reoperation. The overall success rate of the regional flap was 100% and no recurrence was observed with a mean follow-up of 23.3 months. Regional flaps seem a safe and effective reconstructive method for post-radiation ulcers.     

泌尿腔内手术患者术后尿脓毒症休克发生的相关因素及临床特征分析

目的 探讨泌尿腔内手术患者术后尿脓毒症休克发生的相关因素及临床特征分析.方法 选取泌屎腔内手术后并发尿脓毒症患者73例,其中15例并发尿脓毒症休克.记录患者年龄、性别、ASA分级、是否有泌尿系统感染史、术前尿白细胞(WBC)、尿细菌培养结果、是否预防性使用抗生素、术中肾盂是否积脓、手术方式、手术时间、术毕时血WBC和C反应蛋白浓度及术后早期是否出现感染征象.记录尿脓毒症休克患者血压、多器官功能障碍综合征评分和预后情况.尿脓毒症休克患者最低SP与休克诊断时间、休克纠正时间、ICU停留时间和最高多器官功能障碍综合征评分间进行Person相关分析.结果 女性和术后早期出现感染征象与尿脓毒症休克发生相关(P＜0.05).血压突然下降是尿脓毒症休克的首发症状,最低收缩压[(71±10) mm Hg]与休克诊断时间[术后(90±44)min]呈正相关,与ICU停留时间[(3.8±1.3) d]和最高多器官功能障碍综合征评分[(6.1±3.1)分]呈负相关(P＜0.05),但与休克纠正时间无关(P＞0.05).所有尿脓毒症休克患者出院时器官功能都恢复至术前水平.结论 女性和术后早期出现感染征象的尿脓毒症患者术后易发生尿脓毒症体克;及时诊断和治疗尿脓毒症休克,预后良好.     

Incidence and management of biliary leakage after hepaticojejunostomy

This study analyzes the change in the management of biliary leakage after hepaticojejunostomy. Between 1993 and 2003 all patients (n = 1033) were studied with a hepaticojejunostomy as part of a pancreatoduodenectomy (n = 486), proximal bile duct resection (without liver resection) (n = 35), and biliodigestive bypass for malignant (n = 302) and benign (n = 210) disease. Biliary leakage was defined as the presence of bile-stained fluid (>50 mL) in the abdominal drain more than 24 hours after surgery, proven radiologically or at relaparotomy. The studied patients were divided into two equal periods to analyze the change in management. Overall, 24 of 1033 patients (2.3%) had biliary leakage. In multivariate analysis, a body mass index greater than 35 kg/m² (P = .012), endoscopic biliary drainage (P = .044), and an anastomosis on the segmental bile ducts (P < .001) were independent predictors of leakage. Management in the first half of the study period (1993-1998) versus the second half (1999–2003) was maintenance of operatively placed drains (18% vs. 15%, respectively, P = 1.000), percutaneous transhepatic biliary drainage (18% vs. 69%, respectively, P = .012), surgical drainage (55% vs. 8%, respectively, P = .023), and re-hepaticojejunostomy (9% vs. 8%, respectively, P = 1.000). There was no mortality in the patients with biliary leakage. Leakage after a hepaticojejunostomy is a relatively rare complication without mortality and can safely be managed with percutaneous transhepatic biliary drainage. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).     

Short‐ and long‐term outcome of laparostomy following intra‐abdominal sepsis

Aim This study reports the short‐ and long‐term outcomes of laparostomy for intra‐abdominal sepsis. Method Twenty‐nine sequential patients with intra‐abdominal sepsis treated with a laparostomy over 6 years were included. Results The median age of the patients was 51 years, postoperative intensive care unit stay was 8 days, postoperative length of hospital stay was 87 days and follow up was 2 years. The expected mortality of 25% was insignificantly different from the observed mortality of 33% (P = 0.35). Seven per cent of patients required percutaneous drainage of intra‐abdominal collections. An enterocutaneous fistula developed in 31% of all patients and in 15% of those treated with vacuum dressings. Component‐separation fascial reconstruction was successful and uncomplicated in 83% of recipients compared with 25% of mesh repairs. Conclusion Laparostomy does not significantly reduce mortality from the expected rate and commits the patient to a prolonged recovery with a high risk of enterocutaneous fistulation. Component‐separation fascial reconstruction has a better outcome than mesh repair.