会阴部坏死性筋膜炎5例临床分析

为探讨会阴部坏死性筋膜炎的临床特点、诊断与治疗方法，提高诊疗水平，回顾性分析了5例会阴部坏死性筋膜炎的病历资料。结果显示，5例患者均治愈。随访6个月至6年，均无复发。结果表明，起病急，病变发展快，感染易发展到会阴部、下腹部及腰部等部位是会阴部坏死性筋膜炎的特点。诊断本病的必备条件是皮下组织及筋膜广泛性感染性坏死，早期肌肉不受累。早期诊断、尽早切开、充分引流、联合使用抗生素、支持治疗是治疗的关键。     

脂肪抽吸术后出现“类坏死性筋膜炎”征候的表现及治疗

2003年10月至2006年7月，我们共处理5例比较特殊的脂肪抽吸术后出现感染并发症的患者，感觉与普通的感染并发症不同，还兼有一些坏死性筋膜的特征，但又不是典型的筋膜坏死征象，故暂称为“类坏死性类筋膜炎”征候，现与广大同道共同探讨。     

坏死性筋膜炎的诊断与治疗

目的 探讨坏死性筋膜炎的诊断治疗。方法 回顾性分析７例坏死性盘膜炎患者的临床资料。结果 男５例,女２例。平均年龄４５．７（８～６９）岁。７例经及时广泛切开清创引流术,有效抗菌素及支持治疗,均获痊愈。结论 提高对本病的认识,早期诊断,及时手术,加强围手术期的综合治疗是提高坏死性筋膜炎治愈率的关键。     

急性坏死性筋膜炎治疗体会

急性坏死性筋膜炎俗称“食肉病”，是一种少见的坏死性软组织感染，1999年5月-2003年8月期间，收治3例急性坏死性筋膜炎，体会如下。     

重症肛周坏死性筋膜炎5例治疗体会

目的总结坏死性筋膜炎的诊断与治疗体会,并对其作进一步探讨和研究。方法对近6个月诊疗的5例肛周坏死性筋膜炎的治疗进行回顾分析,总结其诊治体会。结果 3例治愈,1例转院,1例自动放弃治疗回家后死亡。结论坏死性筋膜炎的初期诊断至关重要,并注重综合治疗,以提高治愈率,减少病死率。     

肢体坏死性筋膜炎的诊断与治疗

[目的]探讨肢体坏死性筋膜炎的临床诊断与治疗。[方法]对10例肢体坏死性筋膜炎患者的临床资料进行回顾性分析，对其诊断和治疗方法进行探讨。[结果]该病均继发于肢体微小创伤之后，局部溃疡创面沿肢体纵轴慢性、顽固性蔓延，全身症状较轻，不同于其它部位的坏死性筋膜炎表现。10例病人均治愈。[结论]肢体坏死性筋膜炎的诊断主要依据其特有的临床表现，在治疗上细菌学检查结粟仅作为参考，全身支持、局部清创、药物辅助是治疗的要点。     

综合疗法治疗会阴部急性坏死性筋膜炎临床疗效观察（附14例报告）

目的探讨采用综合疗法治疗会阴部急性坏死性筋膜炎的临床疗效。方法回顾性分析本院1998年1月至2008年9月采用综合疗法治疗的14例急性坏死性筋膜炎患者临床资料。结果 12例治愈,治愈率85.7%,2例死亡。结论采取综合的治疗方法,对会阴部急性坏死性筋膜炎的治疗有一定疗效。     

肛源性急性坏死性筋膜炎5例治疗体会

目的 总结肛源性坏死性筋膜炎的诊断与治疗体会,并对其作进一步探讨和研究.方法 对近8月诊治的5例肛源性急性坏死性筋膜炎的治疗进行回顾分析,总结其诊治体会.结果 5例均治愈出院.结论 坏死性筋膜炎的手术扩创彻底、术后充分引流至关重要,并注重初期诊断及综合治疗,以提高治愈率.     

带血管蒂的岛状筋膜皮瓣与前臂肌腱筋膜瓣联合修复手掌重度瘢痕挛缩

带血管蒂的岛状筋膜皮瓣与前臂肌腱筋膜瓣联合修复手掌重度瘢痕挛缩张东臣，苏天福，谭天双，昝慧敏１９８９年以来，我们采用带血管蒂的岛状筋膜皮瓣与前臂肌腱筋膜瓣联合修复手掌重度瘢痕挛缩５例，疗效满意。资料与方法本组５例，男２例、女３例，年龄６～１４岁。瘢痕...     

Fournier坏疽五例报告

目的 探讨Ｆｏｕｒｎｉｅｒ坏疽的诊断和处理方法。方法 报告５例Ｆｏｕｒｎｉｅｒ坏疽的临床特点并进行文献复习。结果 ５例经清创引流,抗炎及对症治疗第,３例康复,随访１年无复发;死亡２例;结论Ｆｏｕｒｎｉｅｒ坏疽是一种累及阴囊、阴茎的感染性坏死性筋膜炎。及时正确的诊断,处理可减少其死亡率和并发症;超声显像,ＣＴ等技术有利于此病的早期发现;治疗原则为早期清创,引流,全身应用大剂量广谱抗生素等。     

原发性脾脏肿瘤(附16例分析)

目的：探讨原发性脾脏肿瘤的诊断与治疗。方法：回顾分析仁济医院１９９０年７月至１９９８年７月间原发性脾脏肿瘤１６例,其中良性８例,恶性８例,全部行脾脏切除,３例附加胰腺体尾切除。结果：全组无手术死亡,脾良性肿瘤预后良好,随访５例恶性淋巴瘤病例,３例分别于术后７个月,９个月和１８个月死亡,死于肿瘤复发,１例生存８年健在,１例术后５个月仍在术中,结论：原发性脾脏肿瘤早期诊断很 重要,治疗选择及预后与病理     

A combined treatment with 8 MHz radiofrequency hyperthermia, HPC-adriamycin, immunotherapy, radiation, systemic chemotherapy and irradiation for invasive bladder carcinoma

Hyperthermia was induced for the treatment of invasive bladder carcinoma in order to study its usefulness. The subjects were 12 cases of invasive bladder cancer; including 5 cases of T2, 3 cases of T3, 2 cases of T4, and 2 cases of recurrence after total cystectomy. As previous treatment, 4 patients received radiotherapy and the other received TUR, systemic chemotherapy, and intravesical injection of anticancer drugs. For hyperthermia treatment, a Thermotron RF-8 was used for heating a deep seated tumor. Each case received hyperthermia 2 to 10 times. Combined therapy included injection of HPC-adriamycin into the urinary bladder in 5 cases, immunotherapy in 3 cases, M-VAC therapy in one case, radiotherapy in one case, radiotherapy and intra-arterial injection in one case, and Peplomycin and OK-432 local injection in one case. The treatment results showed a 75% effectiveness; with CR in 4 cases, PR in 5 cases, MR in 2 cases and PD in one case. Three patients died and 9 survived. Of four patients who had received radiotherapy as a previous treatment 3 cases obtained CR and one case MR. Therefore, it was considered that a favorable treatment effect with hyperthermia could be obtained after radiotherapy.     

保留肾单位的肾癌手术(附66例报告)

目的 探讨保留肾单位的肾癌手术治疗方法 和疗效.方法 66例行保留肾单位的肾癌切除手术,肿瘤直径2.0～6.5 cm,平均4.1cm;肿瘤位于肾上极19例,肾中部17例,肾下极30例.TNM分期:T1a NOMO42例,T1b NOMO23例,T3NOMO1例.透明细胞癌59例,颗粒细胞癌6例,乳头状肾细胞癌1例.结果...     

Fractures ouvertes de jambe — La série du C.H.U. Hautepierre

Nineteen cases were studied retrospectively between 1982 and 1993. All had been stabilised immediately by external fixators. Free or pedicle flap and early bone graft was carried out as required. Bone stability was obtained by Hoffmann or Orthofix fixators which allowed later manoeuvres for skin covers. The stabilisation by the fibula was attempted by intertibio-fibula grafting (ITF). Skin cover was obtained in 13 cases by pedicle flaps, in 4 by a free flap and 2 cases healed by secondary intention. The local flaps were 5 medial gastrocnemius or soleus flaps, 4 fasciocutaneous flaps, 3 medial gastrocnemius muscular cutaneous flaps and one cross-leg flap. These flaps were done on average at the 17th day (between 4th and 45th day). Four free flaps were done: 2 pure cutaneous flaps and 2 osteo-cutaneous flaps. A second flap was required in 3 cases because of infection or loss of soft tissue. A medial gastrocnemius flap and 2 free fibula flaps were done at the 105th and 210th day. Bony union was obtained primarily in 6 cases. Thirteen bone grafts were necessary of which 7 were done electively before three months (4 decortication grafts, 3 ITF). Additional bone graft was needed in 4 cases. Six non-unions were seen, 2 sterile which were treated by one decortication/graft and one ITF and 4 infected (21%) which were treated successfully by 2 ITF grafts and 2 free fibula flaps. Overall consolidation occurred by 9.9. months with good alignment in 15 cases. The complications were 2 varus and one 15° external rotation malunions and one shortening of 2 cm. Ankle movements were normal in 5 cases, reduced by 25% in 5 cases and by half in one case. There was one fixed equinus of 15° and one arhtrodesis. Five patients were able to run. The average number of general anaesthetics required was 5.7 and the average length of hospitalisation 120 days. In conclusion, the authors emphasise the beneficial role of early skin cover in the outcome of these fractures which is otherwise characterised by secondary contamination. They were extremely satisfied with the results of composite free grafts in cases of loss of substance of bone and soft tissue. At present, they tend towards locked nailing for these fractures preferably without reaming whenever possible. Skin cover can than be planned during the first 5 days after injury.     

拖出式低位吻合术在特殊情况下的应用价值

为探讨拖出式低位吻合术在特殊情况下的应用价值，回顾性分析1995～2004年32例拖出式低位吻合术的临床资料，中位随访期61个月（3～108个月）。其中严重直肠损伤6例，直肠癌Dixon术后严重肠吻合口漏2例，直肠血管瘤1例，幼年性大肠息肉病2例．经多次手术未治愈的巨结肠病5例，Hartmann手术后造口回纳术5例，家族性大肠腺瘤性息肉病3例，大肠广泛炎性息肉伴大出血1例，直肠子宫内膜异位症伴梗阻切除造口术后造口回纳1例，直肠癌伴陈旧性会阴Ⅲ度裂伤1例，直肠巨大绒毛状腺瘤5例。结果显示，拖出式低位吻合术术后并发症少，术后6个月肛门功能恢复满意（Ⅰ级29例．Ⅱ级3例）。结果表明，拖出式低位吻合术在特殊情况下应用是一种有效、安全的术式。     

腹腔镜在结直肠癌根治术中的应用

目的 探讨腹腔镜结直肠癌根治术的临床应用价值.方法 回顾分析31例腹腔镜下结直肠癌根治术的临床病例资料.结果 除1例中转开腹外,其余30例均在腹腔镜下完成手术;其中右半结肠切除术8例、左半结肠切除术4例、乙状结肠切除术5例、直肠癌行直肠前切除术8例、Miles术6例.手术时间150～300 min(平均200 min)...     

clinical studies on primary renal pelvic tumors

The 15 cases of the primary renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. The most frequent symptom was macrohematuria, which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.     

Local injection of bleomycin A5 in lymphangioma in children. Analysis of 100 cases

From Jan. 1985 to Dec. 1988, 100 newborn and small infants suffering from lymphangioma were treated with bleomycin A5 injecting into lymphangioma. The cases were divided into three types: (1) Bleomycin A5 local injection into the lymphangioma were practiced on 70 cases; (2) Surgical partial resection of lymphangioma plus local injection on 26 cases; (3) A previous excision but recurred postoperatively were 4 cases. The dosage of bleomycin A5 was 10 mg per time. The therapeutic course was not more than 5 times. The efficacy of bleomycin A5 were satisfactory in all cases except only one case with a large lymphangioma of previous palliative excision but recurred. There was not a recurrent patient at following-up from 3 months to 4 years.     

脊柱肿瘤切除术后稳定性重建

目的：探索脊柱肿瘤切除术后稳定性重建的方法与效果。方法：本组对28例脊柱肿瘤实施了椎体切除。扇形半脊椎切除，附件切除和全脊椎发除四种术式，同时采用了椎体间植骨，人工椎体及前，后路内固定重建技术。结果：全组病人局部疼痛及放射痛缓解。13例截瘫患者中11例肌力均有不同程度改善。11例原发良性肿瘤中2例术后4和10年复发，1例伴恶变，均再次治疗，11例原发恶性肿瘤中2例术后9和12个月死亡，1例植骨块脱出，再次手术。另1例局部肿瘤复发截瘫加重，再次手术但神经功能无恢复。内固定并发症有；钉尾螺母松动脱落1例，椎弓根螺钉位置不良4例计9枚。结论：应用椎体间植骨，人工椎体并辅以前。后路内固定可有效重建脊柱稳定性，促进患者术后早期康复。     

微创经皮肾取石术治疗孤立肾铸型结石的疗效观察

目的：探讨微创经皮肾取石术（MPCNL）治疗孤立肾铸型结石的安全性及有效性。方法：回顾性分析2007年4月-2008年12月应用MPCNL治疗34例孤立肾铸型结石患者的临床资料：34例患者结石平均表面积（2314±179）mm^2,肾积脓5例。4例先行穿刺造瘘术,5～7天后行二期经皮肾镜取石术,其余患者均行一期取石术。其中单通道取石18例,双通道取石15例,三通道取石1例。结果：3例一期取石时残余小结石,结合ESWL清除小残石,结石总清除率为91．2％（31／34）。1例出现感染性休克,1例术后大出血行介入栓塞治疗,无死亡患者。术后随访4～18个月,19例肾功能不全患者中,11例肾功能恢复正常,6例肾功能有不同程度改善,2例发展为尿毒症期行血液透析,其中1例为术后大出血行介入栓塞的患者。结论：微创多通道MPCNL治疗孤立肾铸型结石安全可行,效果确切,具有创伤小、恢复快、可反复操作等优点,可作为孤立肾铸型结石的首选治疗方法。